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Neuro Flashcards

1
Q

Acute Mx of migraine

A

triptan (5HT agonist) + NSAID/paracetamol +/- metoclopramide*/prochlorperazine
*may cause acute dystonic reactions in young

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2
Q

who should have migraine prophylaxis?

what drugs?

A

> 2 attacks/month

1) topiramate or propanolol
* propanolol preferenced for women of child bearing age as ?teratogenic for topiramate
2) acupuncture or gabapentin

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3
Q

causes of restless leg syndrome

A 
Fe deficiency
uraemia
DM
pregnancy
idiopathic - positive FH in 50%
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4
Q

Mx of restless leg syndrome

A 
massage/stretching
dopamine agonist (ropinirole)
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5
Q

Reasons to start antiepileptics after 1st seizure

A

unacceptable consequences of second seizure
structural changes on brain imaging
unequivical epileptic activity on EEG
neurological deficit

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6
Q

1st line meds for:
generalised seizures
partial seizures

A 
sodium valproate (weight gain)
carbamazepine
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7
Q

pathological changes in Alzheimers disease

A

intraneuronal neurofibrillary Tau protein tangles
neuronal plaques
deposition of type A beta-amyloid protein in cortex

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8
Q

Mx of Alzheimers disease

A

mild-mod: acetylcholinesterase inhibitors - donepezil, galantamine, rivastigmine

mod-severe: NMDAr antagonist - memantine

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9
Q

symptoms of normal pressure hydrocephalus

A

urinary incontinence
gait disturbance
dementia and bradyphrenia (slow thoughts)

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10
Q

pathological cause of normal pressure hydrocephalus
secondary to what?
Mx

A

reduced CSF absorption at the arachnoid villi
secondary to head injury, SAH, meningitis
Mx: ventriculoperitoneal shunt

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11
Q

medical management of MND

A

riluzole - prevents glutamate r stimulation
mainly used in amyotrophic lateral sclerosis
increases life by 3months

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12
Q

Chorea - which part of the brain affected

A

basal ganglia, especially caudate nucleus

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13
Q

what is Uhthoff’s phenomenon?

A

worsening of neurological symptoms following rise in body temperature with demyelinating conditions

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14
Q

symptoms of MS

A

vision: Internuclear ophthalmoplegia, optic neuritis, optic atrophy
sensory: Lhermitte’s syndrome, paraesthesia
motor: spastic weakness (legs more commonly)
cerebellar: ataxia
urinary incontinence, sexual dysfunction

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15
Q

what is Lhermitte’s sign?

A

shooting pain down the spine on flexion of the neck

ass. with MS

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16
Q

Dx criteria for migraine

A 
atleast 5 attacks of:
- headache lasting 4-72hrs
- n&v or photo/phonophobia
- >2 of:
pulsating nature
unilateral
disrupts usual activity
mod-severe
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17
Q

features of CN III palsy

A

eye “down and out”
diplopia
ptosis
mydriasis (dilated pupil if “surgical”) - affected parasympathetic innervation

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18
Q

features of Horner’s syndrome

A

miosis (constricted pupil)
ptosis
anhydrosis

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19
Q

Features of neurofibromatosis type 1:

A 
cafe-au-lait spots (>6)
axillary/groin freckles
peripheral neurofibromas
Lisch nodules in the iris (pigmented spots)
scoliosis
phaeochromocytoma
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20
Q

features of neurofibromatosis type 2

A

bilateral acoustic neuromas

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21
Q

chromosomes affected in neurofibromatosis 1 and 2

A

NF1 - 17 - 17 characters in neurofibromatosis

NF2 - 22 - all the 2s

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22
Q

risk factors for cluster headaches

A

male

smoking

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23
Q

features of cluster headache

A

lacrimation, redness, nasal congestion
pain around 1 eye,
1 or 2 attacks/day
cluster for 4-12 weeks

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24
Q

Mx of cluster headache, acute and prophylaxis

A

100% oxygen, SC sumatriptan, nasal lidocaine

prophylaxis: verapamil, pred

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25
pathology of Parkinson's disease
progressive neurodegeneration of dopaminergic neurones in the substantia nigra
26
classical triad of Parkinson's disease
bradykinesia, resting tremor, rigidity | typically asymetrical
27
features of meniere's disease
vertigo, tinnitus, SN hearing loss, feeling of pressure/fullness in ear
28
Mx of meniere's
refer to ENT acute: prochlorperazine prevention: beta histine inform DVLA - cease driving until symptoms controlled
29
features of MND
fasciculation LMN signs in arms, UMN signs in legs sensation and cerebellum unaffected normal nerve conduction studies
30
ABCD2 score what is it for what are the criteria?
risk strafication after a TIA age >60 - 1 BP >140/90 - 1 clinical features: unilateral weakness - 2 speech disturbance only - 1 duration of symptoms: >60mins - 2 10-59mins - 1 Diabetes - 1
31
post TIA management
``` ABCD2 score 4-7: - 300mg aspirin - specialist review in <24hrs - secondary prevention measures (BP statin clopidogrel) ABCD2 score 0-3: - specialist review in 1 week ```
32
Mx of MS
acute relapse - IV methylpred beta-interferon (reduce relapse rate by 30%) baclofen and gabapentin for spasticity physio others: glatiramer acetate, natalizumab, fingolimod
33
classic triad of wernicke's encephalopathy | Cause
``` nystagmus ophthalmoplegia ataxia (also confusion, peripheral neuropathy) B1 (thiamine) deficiency - can recover ```
34
bitemporal hemianopia upper quadrants affected ?cause lower quadrants affected ?cause
upper quadrants= inferior chiasmal compression - pituitary tumour lower quadrants = superior chiasmal compression - craniopharyngioma
35
features of Lewy Body dementia
progressive cognitive decline parkinsonism visual hallucinations worsening with antipsychotics
36
pathology of Lambert-Eaton syndrome
paraneoplastic autoimmune reaction to pre-synaptic calcium channels associated with small cell lung cancer.
37
features of Lambert Eaton syndrome
limb girdle weakness (affects legs first) hyporeflexia autonomic dysfunction: impotence, dry mouth, difficulty micturating
38
secondary prevention meds in stroke Mx
clopidogrel statin if cholesterol >3.5 carotid doppler --> endarterectomy if >70% stenosed
39
causes of bilateral facial nerve palsy
``` sarcoidosis guillian barre polio lyme disease neurofibromatosis type 2 (bilateral acoustic neuromas) ```
40
which infection is most strongly associated with Guillian-Barre syndrome?
campylobacter jejuni
41
cause and features of lateral medullary syndrome (Wallenburg's syn)?
occulsion of post inf cerebellar artery cerebellar signs: ataxia and nystagmus contralateral limb sensory loss ipsilateral: dysphagia, facial numbness, CN palsy
42
pathology of Brown-Sequard syndrome? | features?
spinal cord hemisection ipsilateral spastic paresis ipsilateral loss of proprioception and vibration (dorsal column) contralateral loss of temperature and pain (spinothalamic)
43
what are the features of post-concussion syndrome
headache fatigue anxiety/depression dizziness
44
Side effects of triptans? | contraindications?
'triptan sensations' - tingling, heat, tightness (chest and throat), heaviness, pressure C/I in IHD or CVD
45
definition of cataplexy
sudden and transient loss of muscle tone due to strong emotion associated with narcolepsy
46
features of Bells palsy | Mx
LMN facial nerve palsy (forehead is affected) pts also get periauricular pain, dry eye, hyperacusis, altered taste oral pred 25mg BD if presented within 72hrs of onset.
47
which antibody is found in Guillian Barre syn
anti-ganglioside antibody (anti-GM1)
48
What is Miller Fisher syndrome? | which antibodies are present?
variant of Guillian Barre syn, ophthalmoplegia, ataxia, areflexia. Eyes are typically affected first - presents as a descending paralysis anti-GQ1b found in 90%
49
Symptoms of a parietal lobe lesion
``` sensory inattention Gerstmann's syndrome inferior homonymous quadrantinopia apraxia tactile agnosia (asteriognosis) [unable to identify object from touch alone] ```
50
Mx of BPPV
``` Epley manoeuvre (sucessful in 80%) teach pt exercises at home - Brandt-Daroff exercises ```
51
causes of neuroleptic malignant syndrome
NMS is due to a sudden decrease in dopamine activity adverse reaction to atypical antipsychotics after altering dose sudden stopping of dopaminergic medications anti-doperminergic meds eg metoclopramide lithium
52
Features of neuroleptic malignant syndrome
muscle rigidity, tachycardia, fever, autonomic instability, altered mental state elevated CK, may have leukocytosis
53
Mx of neuroleptic malignant syndrome
stop offending drug IV fluids dantrolene may be used bromocriptine (dopamine r agonist) may be used
54
Pathology and features of multifocal motor neuropathy (MMN)
Autoimmune demyelinating neuropathy affecting peripheral nerves associated with motor block raised anti-GM1 progressive asymmetric muscle weakness, no sensory signs, fasciculation, normal reflexes
55
features of Human T-lymphotrophic virus - 1 (HTLV-1)
seen in HIV patients tropical spastic paresis - progressive weakness, urinary retention. HTLV-1 positive
56
causes of a spastic paresis
UMN lesion brain - infarct, haemorrhage, meningioma, blastoma spine - trauma, tropical spastic paresis (HTLV-1), syringomyelia, transverse myelitis (eg HIV) demyelination eg MS OA cervical spine
57
features of Chronic inflammatory demyelinating polyneuropathy(CIDP)
progressive motor and sensory neuropathy with loss of reflexes. conduction studies show demyelination elevated CSF protein
58
pathology of multifocal motor neuropathy
autoimmune demyelinating motor neuropathy reflexes and sensation unchanged slowly progressive anti GM1 antibodies frequently raised.
59
contraindications to antieptileptics a) sodium valproate b) carbamazepine
sodium valproate: C/I in hepatic disease and pregnancy -> lamotrigine carbamazepine: C/I in heart defects (potentiates AV conduction problems) and pregnancy, previous bone marrow suppression
60
Common precipitating infections for Gillian Barre
Chlamydia, campylobacter, hep B, mycoplasma pneumoniae, CMV, EBV, HZV, HIV
61
Management of narcolepsy
Non pharmalogical - sleep diary, decrease alcohol | Methylphenidate (CNS stimulant)
62
Mx of cataplexy
Fluoxetine or clomipramine

MRCP (15 decks)

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