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Year 4 > Neuro > Flashcards

Neuro Flashcards

1
Q

Features of Cushing’s reflex?

A
  • Cushing’s triad
  • Bradycardia, widened pulse pressure, irregular breathing
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2
Q

When should anticoagulation be given after TIA in patient with AF, and what do you use?

A
  • Straight away
  • DOAC (e.g. apixaban)
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3
Q

When should anticoagulation be given after stroke in patient with AF, and what do you use?

A
  • After 2 weeks
  • DOAC (e.g. apixaban)
  • Give anti platelet in the meantime (e.g. aspirin)
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4
Q

Features of lateral medullary syndrome?

A
  • Ipsilateral facial pain and facial temperature loss
  • Contralateral trunk/limb pain and temperature loss
  • Ataxia, nystagmus
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5
Q

Lateral medullary syndrome is caused by an infarct in which vessel?

A

Posterior inferior cerebellar artery

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6
Q

Features of lateral pontine syndrome?

A

Similar to lateral medullary syndrome but with ipsilateral facial paralysis and deafnesss

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7
Q

Lateral pontine syndrome is caused by an infarct in which vessels?

A

Anterior inferior cerebella artery

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8
Q

Initial management of angina?

A
  • Aspirin and statin
  • GTN for acute attacks
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9
Q

Features of syringomyelia?

A
  • Cape like distribution of pain and temperature sensation loss
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10
Q

Investigation for syringomyelia?

A

MRI spine

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11
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine

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12
Q

What are the investigations for GBS syndrome and what would the finding be?

A
  • Lumbar puncture (raised protein, normal WCC)
  • Nerve conduction studies (decreased motor nerve conduction velocity)
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13
Q

What are features of Steven-Johnsons syndrome?

A
  • Presents 2 months after starting an anticonvulsant
  • Prodromal illness that resembles URTI followed by rapid onset painful rash on face, trunk and limbs
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14
Q

What is the management of Steven-Johnson syndrome?

A
  • Cease culprit drug and admit
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15
Q

Features of ankylosing spondylitis?

A
  • Younger patients (20-30)
  • Prolonged back pain and mornings stiffness
  • Stiffness improves on activity and worsens at rest
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16
Q

Signs of trochlear nerve palsy?

A

Defective downward gaze and vertical diplopia

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17
Q

What congenital malformation is associated with syringomyelia?

A

Arnold-Chiari malformation

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18
Q

Features of syringomyelia?

A
  • Cape-like distribution (neck, shoulders, arms) of loss of temperature sensation but preservative of light touch, vibration and proprioception
  • Spastic weakness
  • Neuropathic pain
  • Upping planters
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19
Q

What are features of Erbs palsy?

A
  • Damage to C5 and C6
  • Waiter’s tip
  • Winged scapula
  • May be caused by breech presentation
20
Q

What are features of Klumpke’s paralysis?

A
  • Damage to T1
  • Loss of intrinsic hand muscles
  • Due to traction
21
Q

What nerve is at risk in shoulder dislocation and humeral neck fracture?

A

Axillary

22
Q

What is first line treatment for MS spasticity?

A

Gabapentin or baclofen

23
Q

Which type of intracranial haemorrhage can present chronically?

A

Chronic subdural haematoma

24
Q

What should you check before prescribing folate and why?

A
  • B12 levels
  • Giving folate in B12 deficient patients can trigger subacute degeneration of the cord
25
Q

Signs of subacute degeneration of the cord?

A
  • When UMN and LMN signs always consider SADC
  • Causes damage to posterior and lateral columns of spinal cord
  • Damage to the posterior columns: loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg’s test)
  • Damage to lateral columns: spastic weakness and upgoing plantars (UMN signs)
  • Damage to peripheral nerves: absent ankle and knee jerks (LMN signs)
26
Q

What condition might give a clue towards SADC and why?

A
  • Macrocytic anaemia
  • May have been prescribed folate when B12 deficient
27
Q

What is the first line investigation for intracranial haemorrhage?

A

Non-contrast CT head

28
Q

What is a watershed stroke?

A

A stroke caused by sudden drop in BP (e.g. sepsis)

29
Q

What are the 3 aspects of the Bamford Criteria?

A

1) Unilateral hemiplegia or hemisensory loss
2) Homonymous hemianopia
3) Evidence of higher cortical dysfunction

30
Q

What are the features of a TACI?

A
  • All 3 Bamford Criteria present
  • Proximal infarct
  • 15% of ischaemic strokes
31
Q

What are the features of a PACI?

A
  • 2 of Bamford Criteria present
  • More distal infarct
  • 25% of ischaemic strokes
32
Q

What are the features of a lacunar stroke?

A
  • Pure motor or sensory loss
  • Perforating arteries of IC, basal ganglia or thalamus
  • Very strong link to chronic HTN
33
Q

What are features of a posterior stroke?

A
  • HiNTs postive
  • Infarct of vestibular arteries
  • 1 of: cerebellar symptoms, isolated homonymous hemianopia, LOC
34
Q

An infarct in the basilar artery is likely to result in what?

A

Locked in syndrome

35
Q

What tools may be used for initial assessment of stroke?

A
  • FAST by public
  • ROSIER by ED staff
  • ABCD2 for TIA
  • HiNTs for posterior stroke
  • Non-contrast CT head
  • NIHSS to assess thrombolysis
36
Q

What ROSIER score suggests stroke?

A

> 0

37
Q

What NIHSS score indicates need for thrombolysis?

A

> 5

38
Q

What are some absolute contraindications to thrombolysis in stroke? (Give 5)

A
  • Previous intracranial haemorrhage
  • Seizure at onset of stroke
  • Intracranial neoplasm
  • Suspected subarachnoid hemorrhage
  • Stroke or brain injury in preceding 3 months
  • Lumbar puncture in 7 days previous
  • GI hemorrhage in 3 weeks previous
  • Active bleeding
  • Pregnancy
  • Esophageal varices
  • Uncontrolled hypertension above 200/120
39
Q

What are somme relative contraindications to thrombolysis in stroke? (Give 3)

A
  • Concurrent anticoagulation with an INR above 1.7
  • Haemorrhagic diathesis
  • Active diabetic hemorrhagic retinopathy
  • Suspected intracardiac thrombus
  • Major surgery or trauma within past 2 weeks
40
Q

What its the thrombolysis window for stroke?

A

Within 4.5 hours

41
Q

What is the criteria for thrombectomy in stroke?

A
  • Within 6 hours
  • Proximal infarct
42
Q

What are some examples of CNS stroke mimics?

A
  • Migraine
  • Todd’s paresis
  • Mass effect of lesion
  • Exacerbation of neurological condition
  • Syncope
  • Encephalitis
43
Q

What are some examples of metabolic stroke mimics?

A
  • Hypoglycaemia (first to rule out; ruled out with ROSIER)
  • Electrolyte imbalance
  • Hepatic encephalopathy
  • Sepsis
44
Q

When should referral to specialist for TIA occur?

A
  • Within 24 hours if within 7 days or crescendo TIA
  • Within a week if more than 7 days
45
Q

What is a crescendo TIA

A

More than 1 TIA in a week

46
Q

What can be given for secondary prevention of stroke if clopidogrel is contraindicated?

A
  • DAPT
  • Aspirin and modified release dipyramidole
47
Q

What dementia subtype is associated with MND?

A

Frontotemporal

Year 4 (16 decks)

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