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Pathology and final year > NEURO > Flashcards

NEURO Flashcards

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1
Q

what scoring systems are used following a TIA

A

ABCD2
CHA2DS2VASc
HASBLED

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2
Q

what is the ABCD2 scoring system

A

risk of developing a stroke following a TIA

A- Age >60 =1
B- blood pressure >140/90=1
C- clinical unilateral leg weaknes =2, speech impairment =1
D- Duration >60=2, 10-59=1
D- DM=1

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3
Q

what is the CHADVASc score

A

risk of stroke in pts with AF

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4
Q

what is the HASBLED score

A

estimates the 1-year risk of a major bleeding event in patients with AF on anticoagulation

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5
Q

Management of TIA

A

300mg aspirin
inform DVLA and not to drive until specialist review

No aspirin if…
- >7 days since S/S
- Bleeding disorder / on an anticoagulant
- Takes regular low-dose aspirin
- Aspirin CI

long term Rx
1st line: clopidogrel + statin
2nd line: aspirin + dipyradimole + stain

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6
Q

which parts of the brain does the MCA supply

A

lateral frontal, lateral parietal and parts of temporal

frontal eye fields
motor cortex
sensory cortex
wernikes (inf division)
and brocas area (superior division)

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7
Q

main features of a MCA stroke

A

contralateral hemiparesis of face and upper limbs>lower limbs

contralateral sensory loss of face and upper limbs> lower limbs

ipsilateral gaze deviation

wernikes area- receptive aphasia - can talk but it makes no sense

brocas area- expressive dysphasia - cant talk

contralateral homonymous hemianopia (inferior div)

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8
Q

what parts of the brain does the ACA supply?

A

medial frontal lobe and medial parietal lobe

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9
Q

features of an ACA stroke

A

contralateral hepiaplegia lower extremities > upper extremities

contralateral sensory loss lower extre> upper extrem

paracentral lobule affected- urinary and faecal incontinence

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10
Q

features of ICA stroke

A

Amourosis fugax- vision loss

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11
Q

features of a PCA stroke

A

contralateral homonymous hemianopia

cant read, can write (alexia without agraphia)

anomia (cant name colours and objects)

midbrain: webers syndrome/ claude syndrome

Thalamus:
contralatoral sensory loss
contralateral pain
decreased arousal

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12
Q

where does the PCA

A

brainstem - esp midbrain
occipital lobe - primary visual cortex and association zone
thalamus

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13
Q

what is the watershed zone

A
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14
Q

what is webers synrome

A
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15
Q

What is claude syndrome

A
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16
Q

causes of a coma

A

metabolic:
- hypoglycaemia
- myxoedema coma
- drug OD, alcohol withdrawal
- hypercalcaemia

intracranial:
- SAH
- meningitis
- head injury
- encephalitis
- epilepsy, delerium tremens

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17
Q

things that can cause a lesion in the brain

A
  • infarct
  • haemorrhage
  • abscess
  • tumour
  • TB
  • WAW: cryptococcus, mucormycosis, toxo
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18
Q

causative organisms of meningitis

A

Neisseria meningitidis
Streptococcus pneumoniae
Listeria monocytogenes
Group B Streptococcus
Haemophilus influenzae
Mycobacterium tuberculosis
Viral

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19
Q

causes of headache

A

benign
tension headache
dehydration
medication overuse
febrile illness

severe
-migraine
- cluster
- meningitis
- tumour
- abscess
- intracranial bleed eg. SAH
- giant cell arteritis

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20
Q

differentials for dizziness

A

Is it Vertigo
Is it syncope
Is it hypotension
Is it hypoglycaemia
Is it epilepsy
Is it migraine

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21
Q

What is parkinsons

A

degeneration of the neurones in the substantra nigra

beta synuclein deposition

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22
Q

features of parkinsons

A

face:
- masked face
- monotonous speech
- reduction in spontaneous blinking

gait:
- difficulty initiating
walking,
- walking with small
slow shuffling steps
or rapid small steps
(festination)
- ‘Freezing’ occurs
on turning or
changing direction.

tremor:
- resting tremor
- pin rolling tremor

rigidity:
- cogwheel rigidity

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23
Q

side effects of L-DOPA

A

nausea or vomiting
postural hypotension
worsening of peptic ulcer symptoms
sweating
discoloration of urine/sweat
with long-term use:
–Motor fluctuations and dyskinesias.
–Neuropsychiatric problems. Confusion,
hallucinations, psychosis.

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24
Q

dorsal columns senses

A

(Visible panty line VPL)
vibration
proprioception
light touch

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25
spinothalamic tract senses
pain temperature crude touch
26
where do nerves cross in the dorsal column ?
brainstem passing to the thalamus
27
where do nerves in the spinothalamic tract cross?
in the spinal chord as soon as it enters
28
where are the most common tumours to metastasise to the brain
lung, breast, kidney, melanoma and colorectal cancers metastases
29
features of multisystem atrophy
parkinsonism autonomic disturbance erectile dysfunction: often an early feature postural hypotension atonic bladder cerebellar signs
30
features of normal pressure hydrocephalus
progressive dementia falls and difficulty walking urinary incontinence
31
parkinsonism differentials
parkinsons drug induced multisystem atrophy progressive supranuclear palsy lewy body dementia
32
gait disturbances causes: foot drop
neuropathy damage to the anterior tibialis
33
gait disturbances causes: ataxia
cerebellar pathology alcohol Korsikoffs syndrome
34
gait disturbances causes: parkinsonism
shuffling gait loss of arm movement
35
gait disturbances causes: gail apraxia
small vessel disease hydrocephalus
36
gait disturbances causes: spastic paraparesis (walking through mud)
chord lesion parasaggital lesion
37
gait disturbances causes: myopathic/ waddling
myopathic, dystrophic disorders
38
features of GBS
preceding GI or URT infection ascending muscel weakness back pain gradual loss in tendon reflexes
39
causes of loss of conciousness
neurological causes: - epilepsy - rasied ICP - SAH - sleeping disorders eg. narcolepsy neurally mediated - vasovagal syncope - carotid sinus syncope - situational syncope cardiac - arrhythmias - structural eg. AS, HOCM orthostatic: - postural hypotension - drugs metabolic/ endocrine - Addisons - hypoglycaemia - metabolic acid base disturbances
40
sudden onset of vertigo, hearing loss, tinnitus, and sensation of fullness in the affected ear
menieres disease
41
acute vertigo DDx
Benign proxysmal positional vertigo (BPPV)- Hx after head injury or infections acute vestibular neuritis- Hx develops over hrs, resolves in days, viral Menieres disease- Hx- hasting minutes to hrs, recurrent, tinitus and hearing loss
42
surgical sieve
Vascular Iatrogenic Trauma Autoimmune, inflammatory Metabolic Infection Neoplastic Congenital Degenerative Environment Functional (medically unexplained)
43
causes of cerebellar disease
V- ischaemic/ haemorrhagic stroke I- drugs: phenytoin, lithium T- head trauma A-autoimmune demyelination M- alcohol excess, thyrotoxicosis I- measles, HIV, prion N- metastases, primary brain tumors, neuroblastoma Nutritions- vit E def, vit B1 def (wernickes)
44
optic neuritis differentials
inflammatory/autoimmine: - SLE - autoimmune optic neuropathy - Bechets disease - post infectious - multiple sclerosis Compressive - tumours - Thyroid opthalmopathy infectious - syphilis - TB - lyme - HIV Toxic and nutritional: - vit B12 def - methanol intoxication - ethambutol - amiodarone - diabetic retinopathy
45
causes of a tremor
Parkinsonism Thyrotoxicosis medications: salbutamol, immunosuppressive drugs, lithium, steroids demyelination diseases Toxins: alcohol, cocaine
46
chorea differentials
Hereditary: - huntingtons - benign hereditary chorea - wilsons disease - mitochondrial disease Infection: - sydenhams chorea, rheumatic fever - HIV - vCJD vascular: - polycythemia - infarction Metabolic: - hypocalcaemia - hyperthyroidism - hyper and hypo gylcaemia Immunological: - SLE - APLS - chorea gravidarum Drug induced: - anti-parkinsons drugs - amphetamines
47
features of posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome
Ipsilateral: facial pain and temperature loss Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus
48
absolute contraindications for thrombolysis in stroke
- Previous intracranial haemorrhage - Seizure at onset of stroke - Intracranial neoplasm - Suspected subarachnoid haemorrhage - Stroke or traumatic brain injury in preceding 3 months - Lumbar puncture in preceding 7 days - Gastrointestinal haemorrhage in preceding 3 weeks - Active bleeding - Pregnancy - Oesophageal varices - Uncontrolled hypertension >200/120mmHg
49
investigations for suspected stroke
non contrast CT head- determine if ischaemic or haemorrhagic bloods: U&Es- hyponatraemia can cause neurological signs glucose: hypoglycaemia can mimic stroke FBC- polycythemia clotting- exclude coagulopathy
50
Management of acute stroke
CT- determine if ischaemic or haemorrhagic ischaemic: thrombolysis with alteplase within 4.5hrs consider mechanical thrombectomy start on aspirin and clopidogrel for 21 days after or aspirin + ticagrelor for 30 days
51
management of haemorrhagic stroke
supportive urgent neurosurgeon referral control of BP urgent reversal of any anticoagulation medication
52
reversal agent of warfarin
vitamin K
53
reversal agent of dabigatran
idarucizumab
54
management of myasthenia crisis
plasmaphoresis and IVIG
55
diplopia differentials
multiple sclerosis myesthenia gravis thyroid opthalmopathy
56
associations in myesthenia gravis
thymomas in 15% autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE thymic hyperplasia in 50-70%
57
causes of LMN facial nerve palsy
Bell's palsy Ramsay-Hunt syndrome (due to herpes zoster) acoustic neuroma parotid tumours HIV multiple sclerosis* diabetes mellitus
58
difference between UMN and LMN facial nerve palsy
UMN is forehead sparing
59
causes of peripheral neuropathy
Acute: GBS porphyria diptheria chronic Diabetes B12 deficiency drugs: isoniazid, HIV medications, alcohol hypothyroidism
60
features of central chord syndrome
man in a barrel legs are fine but arms have no power
61
features of a Total anterior circulation infarct (TACI)
Unilateral weakness (and/or sensory deficit) of the face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial disorder) must have all 3 to be a TACI
62
features of a partial anterior circulation infarct
1-2/3 of the following Unilateral weakness (and/or sensory deficit) of the face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial disorder)
63
Posterior circulation syndrome (POCS)
One of the following need to be present for a diagnosis of a POCS: Cranial nerve palsy and a contralateral motor/sensory deficit Bilateral motor/sensory deficit Conjugate eye movement disorder (e.g. horizontal gaze palsy) Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia) Isolated homonymous hemianopia
64
features of a lacunar stroke (LACS)
One of the following needs to be present for a diagnosis of a LACS: Pure sensory stroke Pure motor stroke Sensori-motor stroke Ataxic hemiparesis
65
What are you at risk of with a bleed in the ventricles
hydrocephalus
66
causes of bilateral peripheral neuropathy
diabetic neuropathy B12 deficiency
67
causes of cerebellar dysfunction
Parneoplastic Atrophy, autoimmune Stroke Trauma (rare) Raised ICP Infection Ethanol, drugs eg. phenytoin Sclerosis (MS)
68
features of a brainstem stroke
ipsilateral facial signs with LMN features (ie. forehead sparing)- stroke at the CN nucleus will give LMN conterlateral hemiparesis (UMN features)
69
causes of an UMN lesion
Stroke- haemorrhagic/infarct Trauma Infection- meningitis, TB Inflammation- sarcoid, lupus, amyloidosis, MS
70
Causes of LMN lesion
Cranial nerve Brainstem stroke bells palsy Anteriorhorn cells: Amyotrophic lateral sclerosis infection- polio, west nile NMJ: Myesthenia gravis, labert eaton Clostridium botulinum + tetani peripheral demyelination GBS, MFS myopathy polymyositis dermatomyositis metabolic- DM, cushings, hypothyroid
71
features of cauda equina syndrome
saddle parasthesia back pain bowel and bladder incontinence lower limb weakness
72
causes of causa equina synddrome
Mechanical: vertebral collapse and compression spondolytis Infection Potts disease (TB spine) osteomyelitis systemic metastasis
73
Imaging findings in MS
Periventricular white matter lesions not necessarily matching the clinical pitcture
74
triggers for myasthenia gravis crisis
emotions infection hypokalaemia exercise drugs- opioids, antibiotics, beta-blockers
75
features of 4th nerve palsy
vertical diplopia classically noticed when reading a book or going downstairs subjective tilting of objects (torsional diplopia) the patient may develop a head tilt, which they may or may not be aware of when looking straight ahead, the affected eye appears to deviate upwards and is rotated outwards
76
causes of peripheral neuropathy with predominant motor loss
Guillain-Barre syndrome porphyria lead poisoning hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth chronic inflammatory demyelinating polyneuropathy (CIDP) diphtheria
77
causes of peripheral neuropathy with predominant sensory loss
diabetes alcohol B12 deficiency chemotherapy amyloidosis
78
subtypes of peripheral neuropathy
axonal loss- sensory deficit demyelination- motor deficit
79
red flag symptoms of trigeminal neuralgia propting urgent neurology referral
Sensory changes Deafness or other ear problems History of skin or oral lesions that could spread perineurally Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally Optic neuritis A family history of multiple sclerosis Age of onset before 40 years
80
managament of trigeminal neuralgia
carbamazepine neuro referral if redflag signs
81
what are 2 characteristic signs of MS
Lhermitte's sign- neck flexion causes tingling down spine Uhthoff's sign- symptoms worsening (espesially visual sx) when body temperature raised
82
differentials for symmetrical parkinsonism signs
progressive supranuclear palsy multisystem atrophy Drug induced
83
features that would suggest progressive supranuclear palsy
symmetrical parkinsonism early presentation with falls vertical gaze palsy
84
features that would suggest mutisystem atrophy
symmetrical parkonsonism autonomic features early (eg. urinary incontenence) cerebellar signs poor response to levodopa
85
differentials for MS
neuromyelitis optics neurosarcoidosis
86
MG crisis triggers
infection drugs: b blockers, amninoglycosides (gentamycin, amikacin), tetracycline (doxy, lemy),statins stress/surgery/trauma
87
management of acute MG crisis
FVC and early ITU involvement if low IVIG +/- plasmaphoresis
88
chronic Rx of MG
pyridostigmine steroids immunosuppressives (azathioprine, MMF methotrexate)
89
examples of MND
amyotrophic lateral sclerosis bulbar palsy progressive muscular atrophy (purely LMN) primary lateral sclerosis (purely UMN)
90
MND mimics
spondylotic myeloradiculopathy multifocal motor neuropathy syringomyelia benign fasciculation syndrome

Pathology and final year (21 decks)

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