Neuro Flashcards
1
Q
What is the name for not being able to extend the knee when the hip is flexed?
A
Kernig’s sign
2
Q
What condition can Kernig’s sign be seen in?
A
Meningitis
3
Q
What investigations should be ordered in a patient with suspected meningitis?
A
Blood culture, lumbar puncture, CRP, ESR, head CT, serum meningococcal and pWneumococcal PCR, throat swabs
4
Q
What antibiotic should be given to patients with neisseria meningitidis?
A
IV cefotaxime
5
Q
Give 7 signs of Parkinson’s disease.
A
Resting tremor, bradykinesia, resting tremor, increased tone/rigidity, stooped posture, decreased arm swing, decreased amplitude or accuracy of repetitive movement
6
Q
How does dopamine normally stimulate movement?
A
It inhibits the inhibitory pathway of the striatum, allowing movement.
7
Q
What is the first line treatment of Parkinson’s disease?
A
Levodopa
8
Q
How does levodopa work?
A
Levodopa is a precursor molecule to dopamine. It therefore increases the amount of dopamine available to act upon receptors.
9
Q
What drug is given with levodopa?
A
Carbidopa
10
Q
Why is carbidopa given with levodopa?
A
It inhibits peripheral metabolism of levodopa
11
Q
What are the two second line treatments for Parkinson’s disease?
A
Dopamine agonists - pramipexole, ropinirole
MAO/COMT inhibitors
12
Q
How do MAO/COMT inhibitors work?
A
They reduce the metabolism of dopamine - more available
13
Q
Give 2 conditions that are associated with Parkinson’s.
A
Depression, dementia
14
Q
What symptoms are specific to a MCA stroke?
A
Contralateral motor weakness of upper limbs
Contralateral loss of sensation of the upper limbs
Hemianopia
Dysphasia
Aphasia
Face drop
15
Q
What symptoms are specific to a ACA stroke?
A
Contralateral motor weakness of the lower limbs
Contralateral loss of sensation of the lower limbs
16
Q
Which arteries does a total anterior circulation stroke involve?
A
Anterior and middle cerebral arteries
17
Q
What is the difference between a partial and total anterior stroke?
A
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
18
Q
What type of stroke is AF a risk factor for?
A
Ischaemic stroke
19
Q
Give 6 red flag symptoms associated with headache.
A
Altered consciousness Confusion New headache with a history of cancer Papilloedema Cluster headache Seizure
20
Q
What drug is given to reduce ICP?
A
IV Mannitol
21
Q
Give 4 lower motor neuron signs.
A
Decreased tone
Decreased reflexes
Muscle wasting
Fasciculations
22
Q
Give 4 upper motor neuron signs
A
Brisk reflexes
Increased tone
Babinski’s sign
Minimal muscle atrophy - muscle weakness
23
Q
How does normal pressure hydrocephalus present?
A
Dementia
Urinary incontinence
Unsteady gait
24
Q
What are the pathological findings in normal pressure hydrocephalus?
A
CSF pressure is normal, but the ventricles are dilated
25
In a right superior homonymous quadrantanopia where would the lesion be?
Meyer's loop - left temporal optic radiation
26
In a right inferior homonymous quadrantanopia, where would the lesion be?
Left parietal optic radiation
27
What is dysarthria?
A motor disorder where the muscles of speech are damaged, paralysed or weakened
28
Where in the brain is affected to cause chorea in Huntington's?
Striatum of the basal ganglia (caudate nucleus)
29
What pattern of inheritance does Huntington's show?
Autosomal dominant
30
What kind of mutation is seen in Huntington's?
A trinucleotide repeat - CAG
31
What are the features of Huntington's disease?
Chorea
Personality changes
Dystonia
Saccadic eye movements
32
After what age do Huntington's symptoms typically start to develop?
35
33
Which neurones are affected in Huntington's disease?
GABAnergic and cholinergic neurons
34
What is the first line medication for chorea in Huntington's disease?
Tetrabenazine
35
What is the first line treatment of behavioural problems in Huntington's?
SSRIs - citalopram or fluoxetine
36
What is the first line treatment of psychosis in Huntington's?
Haloperidol
37
What kind of motor neuron symptoms does Huntington's result in?
UMN
38
What type of hypersensitivity reaction is Guillain-Barre syndrome?
Type 4
39
Which infection classically causes Guillain-Barre syndrome?
Campylobacter jejuni
40
What is the characteristic feature of Guillain-Barre syndrome?
Progressive, symmetrical weakness of all limbs
41
What is the initial presenting feature of Guillain-Barre syndrome in many patients?
Back/leg pain
42
What are the first line investigations for Guillain-Barre syndrome?
Lumbar puncture
| Nerve conduction studies
43
What will a lumbar puncture in a patient with Guillain-Barre syndrome show?
CSF with raised protein, and normal cell counts
44
What is the first line treatment for Guillain-Barre syndrome?
IV immunglobulins or plasma exchange
45
What features are typical of a temporal lobe seizure?
Lip-smacking, recurrent sense of deja vu, and postictal dyphasia.
46
What kind of features will a lesion below L1 cause?
Lower motor neuron symptoms
47
What are the symptoms of cerebellar disease?
Mnemonic DANISH
```
D - dysdiadochokinesia
A - ataxia
N - nystagmus
I - intention tremor
S - slurred, stachato speech
H - hypotonia
```
48
What is the classic history of extra dural haemorrhage?
Brief loss of consciousness, followed by a lucid period ad then a quick deterioration
49
What is an extra dural haemorrhage commonly caused by?
Trauma to the head, which leads to a tear in the middle meningeal artery
50
What is the classic presentation of a subarachnoid haemorrhage?
Sudden onset of thunderclap headache
Occiptal headache
Signs of meningism
51
What is the most common cause of subarachnoid haemorrhage?
Berry aneurysm
52
What is the history of a subdural haemorrhage?
Typically more chronic:
- Headache
- Cognitive decline
- Fluctuating consciousness
53
What is the classic triad of symptoms in Parkinson's disease?
Bradykinesia, rigidity, tremor
54
What is the acute management of cluster headache?
100% high flow oxygen
55
What is the prophylactic treatment of cluster headache?
Verapamil
56
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
57
What is the first line medication for patients with focal seizures?
Carbamezapine
58
What is the first line medication for patients with generalised seizures?
Sodium valproate
59
How long must patients be seizure free before they can drive?
12 months
60
What is the first line acute management to terminate a seizure?
Benzodiazepines
61
What are the first line investigations after a patient first has a seizure?
Electroencephelogram (EEG), MRI
62
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)
63
What features are typical of a temporal lobe seizure?
Pre-seizure aura/hallucinations
Lip smacking during seizure
Post-ictal confusion
64
What features are typical of an occipital lobe seizure?
Flashing and floaters
65
What features are typical of a parietal lobe seizure?
Non-specific sensory symptoms - paraethesia
66
Which limbs does an anterior cerebral artery stroke typically affect?
Lower limbs
67
Which limbs does a middle cerebral artery stroke commonly affect?
Upper limbs
68
What symptoms does a basilar artery stroke cause?
Locked in syndrome - complete paralysis of all muscles apart from the eyes
69
What is the initial management of a suspected TIA?
300mg aspirin daily
70
What is the first line long term anti-thrombotic therapy for patients who have had a confirmed TIA?
75mg clopidogrel daily
71
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
72
Where does the cauda equina begin?
L1/L2
73
What kind of symptoms does cauda equina syndrome cause?
Lower motor neuron symptoms
74
What kind of symptoms does a spinal cord compression present with?
UMN symptoms above the lesion
| LMN symptoms below the lesion
75
How long after infection does Guillain-Barre syndrome typically develop?
2-3 weeks
76
Which infection classically causes Guillain-Barre syndrome?
Campylobacter jejuni
77
What is the first line investigation for suspected stroke?
CT head
78
Give an example of a benzodiazepine.
Clonazepam
79
What is the first line treatment for temporal arteritis?
Oral prednisolone
80
Give 3 symptoms of cauda equina.
Inability to open bowels/urinate
Reduced anal tone
Saddle anaethesia
81
What is the first line treatment of myasthenia gravis?
Acetylcholinesterase inhibitors
82
Name 2 acetylcholinesterase inhibitors.
Pyridostigmine
| Neostigmine
83
How long after the onset of symptoms can IV alteplase be given for acute ischaemic stroke?
4.5 hours
84
Who does Wernicke's encephalopathy typically affect?
Alcoholics
85
What symptoms are seen in Wernicke's encephalopathy?
Ataxia, opthalmoplegia, confusion
86
What is the cause of spina bifida?
Multifactorial
87
What receptors are found in the sympathetic nervous system?
Adrenergic and nicotinic
88
What receptors are found in the somatic nervous system?
Acetylcholine
89
What mutation is found in patients with Huntington's?
36 or more CAG repeats
90
What is the best prognostic treatment of motor neuron disease?
Riluzole
91
What happens in a tonic seizure?
The patient goes tense and stiff
92
What happens in a tonic-clonic seizure?
The patient goes tense and stiff, then has muscle tensing and relaxing
93
What is the first line treatment of tension headache?
Paracetamol
94
What are the CSF findings in bacterial meningitis?
High protein
Low glucose
High neutrophil polymorphs
95
What are the CSF findings in viral meningitis?
High or normal protein
Normal glucose
High lymphocytes
96
What are the CSF findings in fungal meningitis?
High protein
Low glucose
High lymphocytes
97
What is a complication of temporal arteritis?
Blindness (amaurosis fugax)
98
Why can temporal arteritis cause blindness?
Emboli occluding the retinal artery
99
What type of seizures is Jacksonian march associated with?
Frontal lobe seizure
100
What is Jacksonian march?
Where the seizures 'march' up and down the motor homonculus
101
What is the definition of multiple sclerosis?
An autoimmune demyelinating condition causing lesions disseminated in time and space
102
What is a common initial symptom of multiple sclerosis?
Optic neuritis
103
What is Uhthoff's phenomenon?
When symptoms (of MS) are worse with heat
104
What virus is a risk factor for MS?
EBV
105
What type of symptoms does motor neuron disease present with?
Upper and lower motor neuron symptoms
106
What is the first line for bacterial meningitis in a primary setting?
IM benzylpenicillin
107
What is the first line for bacterial meningitis in a secondary setting?
IV benzylpenicillin or IV ceftriaxone
108
What is the treatment of viral meningitis?
Analgesia, antipyretic and hydration
109
What is the second line treatment of viral meningitis?
Aciclovir
110
What symptoms are seen in Horner's syndrome?
Anhydrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)
111
Give a cause of Horner's syndrome.
A pancoast tumour (rare tumour in the apex of the lung)
112
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
113
Which vessel are extradural haematomas associated with?
Middle meningeal artery
114
What drug is given after subarachnoid haemorrhage to prevent vasospasm?
Nimodipine
115
What is the most common cause of Guillain-Barre syndrome?
Campylobacter jejuni
116
What symptoms can cluster headache cause other than pain?
Rhinorrhoea, ptosis, red eyes, lacrimation
117
What is the most appropriate first line investigation for MS?
MRI head
118
What is the classic history of an extradural haemorrhage?
Loss of consciousness, followed by a lucid period, then rapid onset of neurological defecits
119
What kind of brain bleeds are common in elderly patients who have fallen?
Subdural
120
Why are elderly patients more susceptible to subdural bleeds?
They have smaller brains and more fragile bridging veins
121
What is the first line acute treatment of migraine?
Sumatriptan
122
What is the first line cluster headache prophylaxis?
Verapamil
123
What type of dementia causes early memory loss?
Alzheimer's
124
What type of dementia causes early personality changes?
Fronto-temporal
125
What type of personality changes are seen in fronto-temporal dementia?
Aggression, disinhibition, hypersexuality
126
What type of progression does vascular dementia cause?
Stepwise progression
127
What is the only life prolonging medication available for MND?
Riluzole
128
What is baclofen used for?
To treat cramps in MND
129
What other investigation should also be ordered in suspected MS?
Lumbar puncture
130
What type of weakness is associated with Charcot-Marie Tooth syndrome?
Champagne bottle weakness - wasting of the muscles in the lower legs
131
What is the first line treatment of generalised seizures in women of child bearing age?
Lamotrigine
132
What symptoms are likely seen in a brain tumour?
```
Headache
Behavioural changes
Nausea
Speech problems
Weakness
```
133
What is the pathophysiology of Alzheimer's disease?
Buildup of extravascular beta amyloid plaques and neurofibrillary triangles in the brain
134
What is the cause of fronto-temporal dementia?
Atrophy of the frontal lobe
135
What is Phalen's test used for?
Carpal tunnel syndrome
136
What is a positive Phalen's test result?
The patient is only able to flex their wrist for a maximum of 1 minute
137
Which receptors are affected in myasthenia gravis?
Nicotinic acetylcholine receptors of the neuromuscular junction
138
Up to a 1/5 of myasthenia gravis patients also have what other condition?
Thymoma
139
What cells predominate in the CSF of someone with bacterial meningitis?
Neutrophils
140
What is the first line prophylaxis of migraine?
Topiramate
141
What other medications can be used for migraine prophylaxis?
Beta blockers
| Tricyclic antidepressants - amitriptyline
142
What is the definition of stroke?
Sudden onset of neurological defecits, due to ischaemic or haemorrhagic compromise of blood supply to the brain
143
What tract carries sensation of pain and temperature?
Spinothalamic tract
144
What tract carries sensation of proprioception, vibration and fine touch?
Doral column lemniscus pathway
145
Where does the dorsal column lemniscus pathway decussate?
Medulla oblongata
146
What is the name for a loss of sensation in the genital area?
Saddle anaesthesia
147
Give 4 causes of cauda equina syndrome.
Trauma
Disc herniation
Tumours
Spine metastases
148
What is the first line management of cauda equina?
Lumbar decompression surgery
149
What is the first line investigation of cauda equina?
Emergency MRI spine
150
What distinguishes meningitis from meningococcal septicaemia?
Non-blanching petechial rash + signs of septic shock
151
What two signs will be positive on examination in meningitis?
Kernig's sign
| Brudzinski's sign
152
What is Brudzinski's sign?
When the neck is flexed in a patient with meningitis, the hips and knees will also flex
153
What are the two most common causative organisms o bacterial meningitis?
Neisseria meningitidis
| Streptococcus pneumoniae
154
What is the gold standard investigation for meningitis?
Lumbar puncture
155
What is the treatment of meningitis in the community?
IM benzylpenicillin
156
What is the treatment of meningitis in hospital?
IV cefotaxime/ceftriaxone (3rd generation cephalosporins)
157
What are the risk factors for folate deficiency?
Alcohol
Crohn's
Age
Diet
158
How long should a patient who has had a single TIA stop driving for?
1 month
159
How long should a patient who has had multiple TIAs stop driving for?
3 months - inform the DVLA
160
How long should a patient who has had a single seizure stop driving for?
6 months - inform the DVLA
161
What is the prophylactic treatment of cluster headache?
Verapamil
162
What is the immediate managment of cauda equina?
Immediate surgical decompression
163
What medications are recommended by NICE for migraine prophylaxis?
Topiramate
Propanalol
Amitriptyline
Acupuncture
164
What is the first line prophylaxis of migraines?
Beta blockers
165
When is topiramate used for prophylaxis of migraines?
When beta blockers are unsuitable e.g in asthma
166
What is the resting tremor seen in Parkinson's often described as?
Pill rolling tremor
167
What is Charcot's neurological triad?
Dysarthria, nystagmus, intension tremor
168
What condition is Charcot's neurological triad seen in?
Multiple sclerosis
169
What is relapsing-remitting MS?
Flare ups are followed by a period of reduced symptoms - this baseline sees progressive disability with each remission.
170
What is progressive relapsing MS?
Progressive increase in disability with intermittent flares that resolve to the increasing baseline
171
What is the prophylactic treatment of meningitis?
Ciprofloxacin
172
What is the pathophysiology of Alzheimer's disease?
Extra-neuronal beta amyloid plaques
Intra-neuronal neurofibrally triangles
Cortical atrophy
173
Give 4 risk factors for Alzheimer's disease.
Family history
Caucasian
Increasing age
Down's syndrome
174
What is the Oxford classification of stroke?
Assesses the following criteria:
- Unilateral hemiparesis
- Homonymous hemianopia
- Higher cognitive dysfunction
175
What is the first line treatment of trigeminal neuralgia?
Carbamezapine
176
What cells are targeted in MS?
Oligodendrocytes
177
What constitutes a complex partial seizure?
The patient is not aware of goings on during the seizure, and is confused afterwards
178
Which nerve opens the fist?
Radial nerve
