Neuro Flashcards
What is the name for not being able to extend the knee when the hip is flexed?
Kernig’s sign
What condition can Kernig’s sign be seen in?
Meningitis
What investigations should be ordered in a patient with suspected meningitis?
Blood culture, lumbar puncture, CRP, ESR, head CT, serum meningococcal and pWneumococcal PCR, throat swabs
What antibiotic should be given to patients with neisseria meningitidis?
IV cefotaxime
Give 7 signs of Parkinson’s disease.
Resting tremor, bradykinesia, resting tremor, increased tone/rigidity, stooped posture, decreased arm swing, decreased amplitude or accuracy of repetitive movement
How does dopamine normally stimulate movement?
It inhibits the inhibitory pathway of the striatum, allowing movement.
What is the first line treatment of Parkinson’s disease?
Levodopa
How does levodopa work?
Levodopa is a precursor molecule to dopamine. It therefore increases the amount of dopamine available to act upon receptors.
What drug is given with levodopa?
Carbidopa
Why is carbidopa given with levodopa?
It inhibits peripheral metabolism of levodopa
What are the two second line treatments for Parkinson’s disease?
Dopamine agonists - pramipexole, ropinirole
MAO/COMT inhibitors
How do MAO/COMT inhibitors work?
They reduce the metabolism of dopamine - more available
Give 2 conditions that are associated with Parkinson’s.
Depression, dementia
What symptoms are specific to a MCA stroke?
Contralateral motor weakness of upper limbs
Contralateral loss of sensation of the upper limbs
Hemianopia
Dysphasia
Aphasia
Face drop
What symptoms are specific to a ACA stroke?
Contralateral motor weakness of the lower limbs
Contralateral loss of sensation of the lower limbs
Which arteries does a total anterior circulation stroke involve?
Anterior and middle cerebral arteries
What is the difference between a partial and total anterior stroke?
A partial stroke has two of the following criteria, whereas a total has all 3:
- Homonymous hemianopia
- Unilateral hemiparesis or hemisensory loss
- Higher cognitive dysfunction e.g dysphasia
What type of stroke is AF a risk factor for?
Ischaemic stroke
Give 6 red flag symptoms associated with headache.
Altered consciousness Confusion New headache with a history of cancer Papilloedema Cluster headache Seizure
What drug is given to reduce ICP?
IV Mannitol
Give 4 lower motor neuron signs.
Decreased tone
Decreased reflexes
Muscle wasting
Fasciculations
Give 4 upper motor neuron signs
Brisk reflexes
Increased tone
Babinski’s sign
Minimal muscle atrophy - muscle weakness
How does normal pressure hydrocephalus present?
Dementia
Urinary incontinence
Unsteady gait
What are the pathological findings in normal pressure hydrocephalus?
CSF pressure is normal, but the ventricles are dilated
In a right superior homonymous quadrantanopia where would the lesion be?
Meyer’s loop - left temporal optic radiation
In a right inferior homonymous quadrantanopia, where would the lesion be?
Left parietal optic radiation
What is dysarthria?
A motor disorder where the muscles of speech are damaged, paralysed or weakened
Where in the brain is affected to cause chorea in Huntington’s?
Striatum of the basal ganglia (caudate nucleus)
What pattern of inheritance does Huntington’s show?
Autosomal dominant
What kind of mutation is seen in Huntington’s?
A trinucleotide repeat - CAG
What are the features of Huntington’s disease?
Chorea
Personality changes
Dystonia
Saccadic eye movements
After what age do Huntington’s symptoms typically start to develop?
35
Which neurones are affected in Huntington’s disease?
GABAnergic and cholinergic neurons
What is the first line medication for chorea in Huntington’s disease?
Tetrabenazine
What is the first line treatment of behavioural problems in Huntington’s?
SSRIs - citalopram or fluoxetine
What is the first line treatment of psychosis in Huntington’s?
Haloperidol
What kind of motor neuron symptoms does Huntington’s result in?
UMN
What type of hypersensitivity reaction is Guillain-Barre syndrome?
Type 4
Which infection classically causes Guillain-Barre syndrome?
Campylobacter jejuni
What is the characteristic feature of Guillain-Barre syndrome?
Progressive, symmetrical weakness of all limbs
What is the initial presenting feature of Guillain-Barre syndrome in many patients?
Back/leg pain
What are the first line investigations for Guillain-Barre syndrome?
Lumbar puncture
Nerve conduction studies
What will a lumbar puncture in a patient with Guillain-Barre syndrome show?
CSF with raised protein, and normal cell counts
What is the first line treatment for Guillain-Barre syndrome?
IV immunglobulins or plasma exchange
What features are typical of a temporal lobe seizure?
Lip-smacking, recurrent sense of deja vu, and postictal dyphasia.
What kind of features will a lesion below L1 cause?
Lower motor neuron symptoms
What are the symptoms of cerebellar disease?
Mnemonic DANISH
D - dysdiadochokinesia A - ataxia N - nystagmus I - intention tremor S - slurred, stachato speech H - hypotonia
What is the classic history of extra dural haemorrhage?
Brief loss of consciousness, followed by a lucid period ad then a quick deterioration
What is an extra dural haemorrhage commonly caused by?
Trauma to the head, which leads to a tear in the middle meningeal artery
What is the classic presentation of a subarachnoid haemorrhage?
Sudden onset of thunderclap headache
Occiptal headache
Signs of meningism
What is the most common cause of subarachnoid haemorrhage?
Berry aneurysm
What is the history of a subdural haemorrhage?
Typically more chronic:
- Headache
- Cognitive decline
- Fluctuating consciousness
What is the classic triad of symptoms in Parkinson’s disease?
Bradykinesia, rigidity, tremor
What is the acute management of cluster headache?
100% high flow oxygen
What is the prophylactic treatment of cluster headache?
Verapamil
What symptoms other than pain around the eye are seen in cluster headache?
Ipsilateral watering of the eye, red eye, nasal congestion and constricted pupil/drooping eyelid
What is the first line medication for patients with focal seizures?
Carbamezapine
What is the first line medication for patients with generalised seizures?
Sodium valproate
How long must patients be seizure free before they can drive?
12 months
What is the first line acute management to terminate a seizure?
Benzodiazepines
What are the first line investigations after a patient first has a seizure?
Electroencephelogram (EEG), MRI
What features are typical of a frontal lobe seizure?
Proximal spread of clonic jerking
Affected muscles remain weak after seizure (called post ictal Todd’s paralysis)
What features are typical of a temporal lobe seizure?
Pre-seizure aura/hallucinations
Lip smacking during seizure
Post-ictal confusion
What features are typical of an occipital lobe seizure?
Flashing and floaters
What features are typical of a parietal lobe seizure?
Non-specific sensory symptoms - paraethesia
Which limbs does an anterior cerebral artery stroke typically affect?
Lower limbs
Which limbs does a middle cerebral artery stroke commonly affect?
Upper limbs
What symptoms does a basilar artery stroke cause?
Locked in syndrome - complete paralysis of all muscles apart from the eyes
What is the initial management of a suspected TIA?
300mg aspirin daily
What is the first line long term anti-thrombotic therapy for patients who have had a confirmed TIA?
75mg clopidogrel daily
What are the symptoms of brown-sequard syndrome?
Ipsilateral weakness below the lesion
Ipsilateral loss of proprioception and vibration
Contralateral loss of pain and temperature
Where does the cauda equina begin?
L1/L2
What kind of symptoms does cauda equina syndrome cause?
Lower motor neuron symptoms
What kind of symptoms does a spinal cord compression present with?
UMN symptoms above the lesion
LMN symptoms below the lesion
How long after infection does Guillain-Barre syndrome typically develop?
2-3 weeks
Which infection classically causes Guillain-Barre syndrome?
Campylobacter jejuni
What is the first line investigation for suspected stroke?
CT head
Give an example of a benzodiazepine.
Clonazepam
What is the first line treatment for temporal arteritis?
Oral prednisolone
Give 3 symptoms of cauda equina.
Inability to open bowels/urinate
Reduced anal tone
Saddle anaethesia
What is the first line treatment of myasthenia gravis?
Acetylcholinesterase inhibitors
Name 2 acetylcholinesterase inhibitors.
Pyridostigmine
Neostigmine
How long after the onset of symptoms can IV alteplase be given for acute ischaemic stroke?
4.5 hours
Who does Wernicke’s encephalopathy typically affect?
Alcoholics
What symptoms are seen in Wernicke’s encephalopathy?
Ataxia, opthalmoplegia, confusion
What is the cause of spina bifida?
Multifactorial
What receptors are found in the sympathetic nervous system?
Adrenergic and nicotinic
What receptors are found in the somatic nervous system?
Acetylcholine
What mutation is found in patients with Huntington’s?
36 or more CAG repeats
What is the best prognostic treatment of motor neuron disease?
Riluzole
What happens in a tonic seizure?
The patient goes tense and stiff
What happens in a tonic-clonic seizure?
The patient goes tense and stiff, then has muscle tensing and relaxing
What is the first line treatment of tension headache?
Paracetamol
What are the CSF findings in bacterial meningitis?
High protein
Low glucose
High neutrophil polymorphs
What are the CSF findings in viral meningitis?
High or normal protein
Normal glucose
High lymphocytes
What are the CSF findings in fungal meningitis?
High protein
Low glucose
High lymphocytes
What is a complication of temporal arteritis?
Blindness (amaurosis fugax)
Why can temporal arteritis cause blindness?
Emboli occluding the retinal artery
What type of seizures is Jacksonian march associated with?
Frontal lobe seizure
What is Jacksonian march?
Where the seizures ‘march’ up and down the motor homonculus
What is the definition of multiple sclerosis?
An autoimmune demyelinating condition causing lesions disseminated in time and space
What is a common initial symptom of multiple sclerosis?
Optic neuritis
What is Uhthoff’s phenomenon?
When symptoms (of MS) are worse with heat
What virus is a risk factor for MS?
EBV
What type of symptoms does motor neuron disease present with?
Upper and lower motor neuron symptoms
What is the first line for bacterial meningitis in a primary setting?
IM benzylpenicillin
What is the first line for bacterial meningitis in a secondary setting?
IV benzylpenicillin or IV ceftriaxone
What is the treatment of viral meningitis?
Analgesia, antipyretic and hydration
What is the second line treatment of viral meningitis?
Aciclovir
What symptoms are seen in Horner’s syndrome?
Anhydrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)
Give a cause of Horner’s syndrome.
A pancoast tumour (rare tumour in the apex of the lung)
What sensory deficits are seen in Brown-sequard syndrome?
Ipsilateral loss of proprioception, vibration and motor function at the level of the lesion
Contralateral loss of pain and temperature sensation 2 levels below the lesion
Which vessel are extradural haematomas associated with?
Middle meningeal artery
What drug is given after subarachnoid haemorrhage to prevent vasospasm?
Nimodipine
What is the most common cause of Guillain-Barre syndrome?
Campylobacter jejuni
What symptoms can cluster headache cause other than pain?
Rhinorrhoea, ptosis, red eyes, lacrimation
What is the most appropriate first line investigation for MS?
MRI head
What is the classic history of an extradural haemorrhage?
Loss of consciousness, followed by a lucid period, then rapid onset of neurological defecits
What kind of brain bleeds are common in elderly patients who have fallen?
Subdural
Why are elderly patients more susceptible to subdural bleeds?
They have smaller brains and more fragile bridging veins
What is the first line acute treatment of migraine?
Sumatriptan
What is the first line cluster headache prophylaxis?
Verapamil
What type of dementia causes early memory loss?
Alzheimer’s
What type of dementia causes early personality changes?
Fronto-temporal
What type of personality changes are seen in fronto-temporal dementia?
Aggression, disinhibition, hypersexuality
What type of progression does vascular dementia cause?
Stepwise progression
What is the only life prolonging medication available for MND?
Riluzole
What is baclofen used for?
To treat cramps in MND
What other investigation should also be ordered in suspected MS?
Lumbar puncture
What type of weakness is associated with Charcot-Marie Tooth syndrome?
Champagne bottle weakness - wasting of the muscles in the lower legs
What is the first line treatment of generalised seizures in women of child bearing age?
Lamotrigine
What symptoms are likely seen in a brain tumour?
Headache Behavioural changes Nausea Speech problems Weakness
What is the pathophysiology of Alzheimer’s disease?
Buildup of extravascular beta amyloid plaques and neurofibrillary triangles in the brain
What is the cause of fronto-temporal dementia?
Atrophy of the frontal lobe
What is Phalen’s test used for?
Carpal tunnel syndrome
What is a positive Phalen’s test result?
The patient is only able to flex their wrist for a maximum of 1 minute
Which receptors are affected in myasthenia gravis?
Nicotinic acetylcholine receptors of the neuromuscular junction
Up to a 1/5 of myasthenia gravis patients also have what other condition?
Thymoma
What cells predominate in the CSF of someone with bacterial meningitis?
Neutrophils
What is the first line prophylaxis of migraine?
Topiramate
What other medications can be used for migraine prophylaxis?
Beta blockers
Tricyclic antidepressants - amitriptyline
What is the definition of stroke?
Sudden onset of neurological defecits, due to ischaemic or haemorrhagic compromise of blood supply to the brain
What tract carries sensation of pain and temperature?
Spinothalamic tract
What tract carries sensation of proprioception, vibration and fine touch?
Doral column lemniscus pathway
Where does the dorsal column lemniscus pathway decussate?
Medulla oblongata
What is the name for a loss of sensation in the genital area?
Saddle anaesthesia
Give 4 causes of cauda equina syndrome.
Trauma
Disc herniation
Tumours
Spine metastases
What is the first line management of cauda equina?
Lumbar decompression surgery
What is the first line investigation of cauda equina?
Emergency MRI spine
What distinguishes meningitis from meningococcal septicaemia?
Non-blanching petechial rash + signs of septic shock
What two signs will be positive on examination in meningitis?
Kernig’s sign
Brudzinski’s sign
What is Brudzinski’s sign?
When the neck is flexed in a patient with meningitis, the hips and knees will also flex
What are the two most common causative organisms o bacterial meningitis?
Neisseria meningitidis
Streptococcus pneumoniae
What is the gold standard investigation for meningitis?
Lumbar puncture
What is the treatment of meningitis in the community?
IM benzylpenicillin
What is the treatment of meningitis in hospital?
IV cefotaxime/ceftriaxone (3rd generation cephalosporins)
What are the risk factors for folate deficiency?
Alcohol
Crohn’s
Age
Diet
How long should a patient who has had a single TIA stop driving for?
1 month
How long should a patient who has had multiple TIAs stop driving for?
3 months - inform the DVLA
How long should a patient who has had a single seizure stop driving for?
6 months - inform the DVLA
What is the prophylactic treatment of cluster headache?
Verapamil
What is the immediate managment of cauda equina?
Immediate surgical decompression
What medications are recommended by NICE for migraine prophylaxis?
Topiramate
Propanalol
Amitriptyline
Acupuncture
What is the first line prophylaxis of migraines?
Beta blockers
When is topiramate used for prophylaxis of migraines?
When beta blockers are unsuitable e.g in asthma
What is the resting tremor seen in Parkinson’s often described as?
Pill rolling tremor
What is Charcot’s neurological triad?
Dysarthria, nystagmus, intension tremor
What condition is Charcot’s neurological triad seen in?
Multiple sclerosis
What is relapsing-remitting MS?
Flare ups are followed by a period of reduced symptoms - this baseline sees progressive disability with each remission.
What is progressive relapsing MS?
Progressive increase in disability with intermittent flares that resolve to the increasing baseline
What is the prophylactic treatment of meningitis?
Ciprofloxacin
What is the pathophysiology of Alzheimer’s disease?
Extra-neuronal beta amyloid plaques
Intra-neuronal neurofibrally triangles
Cortical atrophy
Give 4 risk factors for Alzheimer’s disease.
Family history
Caucasian
Increasing age
Down’s syndrome
What is the Oxford classification of stroke?
Assesses the following criteria:
- Unilateral hemiparesis
- Homonymous hemianopia
- Higher cognitive dysfunction
What is the first line treatment of trigeminal neuralgia?
Carbamezapine
What cells are targeted in MS?
Oligodendrocytes
What constitutes a complex partial seizure?
The patient is not aware of goings on during the seizure, and is confused afterwards
Which nerve opens the fist?
Radial nerve