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Pathology and final year > NEURO > Flashcards

NEURO Flashcards

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
Q

spinothalamic tract senses

A

pain
temperature
crude touch

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26
Q

where do nerves cross in the dorsal column ?

A

brainstem passing to the thalamus

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27
Q

where do nerves in the spinothalamic tract cross?

A

in the spinal chord as soon as it enters

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28
Q

where are the most common tumours to metastasise to the brain

A

lung, breast, kidney, melanoma and colorectal cancers metastases

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29
Q

features of multisystem atrophy

A

parkinsonism
autonomic disturbance
erectile dysfunction: often an early feature
postural hypotension
atonic bladder
cerebellar signs

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30
Q

features of normal pressure hydrocephalus

A

progressive dementia
falls and difficulty walking
urinary incontinence

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31
Q

parkinsonism differentials

A

parkinsons
drug induced
multisystem atrophy
progressive supranuclear palsy
lewy body dementia

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32
Q

gait disturbances causes:

foot drop

A

neuropathy
damage to the anterior tibialis

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33
Q

gait disturbances causes:

ataxia

A

cerebellar pathology
alcohol
Korsikoffs syndrome

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34
Q

gait disturbances causes:

parkinsonism

A

shuffling gait
loss of arm movement

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35
Q

gait disturbances causes:

gail apraxia

A

small vessel disease
hydrocephalus

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36
Q

gait disturbances causes:

spastic paraparesis (walking through mud)

A

chord lesion
parasaggital lesion

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37
Q

gait disturbances causes:

myopathic/ waddling

A

myopathic, dystrophic disorders

38
Q

features of GBS

A

preceding GI or URT infection

ascending muscel weakness

back pain

gradual loss in tendon reflexes

39
Q

causes of loss of conciousness

A

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
Q

sudden onset of vertigo, hearing loss, tinnitus, and sensation of fullness in the affected ear

A

menieres disease

41
Q

acute vertigo DDx

A

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
Q

surgical sieve

A

Vascular
Iatrogenic
Trauma
Autoimmune, inflammatory
Metabolic
Infection
Neoplastic
Congenital
Degenerative
Environment
Functional (medically unexplained)

43
Q

causes of cerebellar disease

A

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
Q

optic neuritis differentials

A

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
Q

causes of a tremor

A

Parkinsonism
Thyrotoxicosis
medications: salbutamol, immunosuppressive drugs, lithium, steroids
demyelination diseases
Toxins: alcohol, cocaine

46
Q

chorea differentials

A

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
Q

features of posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

48
Q

absolute contraindications for thrombolysis in stroke

A
  • 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
Q

investigations for suspected stroke

A

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
Q

Management of acute stroke

A

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
Q

management of haemorrhagic stroke

A

supportive
urgent neurosurgeon referral
control of BP
urgent reversal of any anticoagulation medication

52
Q

reversal agent of warfarin

A

vitamin K

53
Q

reversal agent of dabigatran

A

idarucizumab

54
Q

management of myasthenia crisis

A

plasmaphoresis and IVIG

55
Q

diplopia differentials

A

multiple sclerosis
myesthenia gravis
thyroid opthalmopathy

56
Q

associations in myesthenia gravis

A

thymomas in 15%

autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE

thymic hyperplasia in 50-70%

57
Q

causes of LMN facial nerve palsy

A

Bell’s palsy
Ramsay-Hunt syndrome (due to herpes zoster)
acoustic neuroma
parotid tumours
HIV
multiple sclerosis*
diabetes mellitus

58
Q

difference between UMN and LMN facial nerve palsy

A

UMN is forehead sparing

59
Q

causes of peripheral neuropathy

A

Acute:
GBS
porphyria
diptheria

chronic
Diabetes
B12 deficiency
drugs: isoniazid, HIV medications, alcohol
hypothyroidism

60
Q

features of central chord syndrome

A

man in a barrel

legs are fine but arms have no power

61
Q

features of a Total anterior circulation infarct (TACI)

A

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
Q

features of a partial anterior circulation infarct

A

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
Q

Posterior circulation syndrome (POCS)

A

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
Q

features of a lacunar stroke (LACS)

A

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
Q

What are you at risk of with a bleed in the ventricles

A

hydrocephalus

66
Q

causes of bilateral peripheral neuropathy

A

diabetic neuropathy
B12 deficiency

67
Q

causes of cerebellar dysfunction

A

Parneoplastic
Atrophy, autoimmune
Stroke
Trauma (rare)
Raised ICP
Infection
Ethanol, drugs eg. phenytoin
Sclerosis (MS)

68
Q

features of a brainstem stroke

A

ipsilateral facial signs with LMN features (ie. forehead sparing)- stroke at the CN nucleus will give LMN

conterlateral hemiparesis (UMN features)

69
Q

causes of an UMN lesion

A

Stroke- haemorrhagic/infarct
Trauma
Infection- meningitis, TB
Inflammation- sarcoid, lupus, amyloidosis, MS

70
Q

Causes of LMN lesion

A

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
Q

features of cauda equina syndrome

A

saddle parasthesia
back pain
bowel and bladder incontinence
lower limb weakness

72
Q

causes of causa equina synddrome

A

Mechanical:
vertebral collapse and compression
spondolytis

Infection
Potts disease (TB spine)
osteomyelitis

systemic
metastasis

73
Q

Imaging findings in MS

A

Periventricular white matter lesions not necessarily matching the clinical pitcture

74
Q

triggers for myasthenia gravis crisis

A

emotions
infection
hypokalaemia
exercise
drugs- opioids, antibiotics, beta-blockers

75
Q

features of 4th nerve palsy

A

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
Q

causes of peripheral neuropathy with predominant motor loss

A

Guillain-Barre syndrome
porphyria
lead poisoning
hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth
chronic inflammatory demyelinating polyneuropathy (CIDP)
diphtheria

77
Q

causes of peripheral neuropathy with predominant sensory loss

A

diabetes
alcohol
B12 deficiency
chemotherapy
amyloidosis

78
Q

subtypes of peripheral neuropathy

A

axonal loss- sensory deficit
demyelination- motor deficit

79
Q

red flag symptoms of trigeminal neuralgia propting urgent neurology referral

A

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
Q

managament of trigeminal neuralgia

A

carbamazepine
neuro referral if redflag signs

81
Q

what are 2 characteristic signs of MS

A

Lhermitte’s sign- neck flexion causes tingling down spine

Uhthoff’s sign- symptoms worsening (espesially visual sx) when body temperature raised

82
Q

differentials for symmetrical parkinsonism signs

A

progressive supranuclear palsy

multisystem atrophy

Drug induced

83
Q

features that would suggest progressive supranuclear palsy

A

symmetrical parkinsonism
early presentation with falls
vertical gaze palsy

84
Q

features that would suggest mutisystem atrophy

A

symmetrical parkonsonism
autonomic features early (eg. urinary incontenence)
cerebellar signs
poor response to levodopa

85
Q

differentials for MS

A

neuromyelitis optics
neurosarcoidosis

86
Q

MG crisis triggers

A

infection
drugs: b blockers, amninoglycosides (gentamycin, amikacin), tetracycline (doxy, lemy),statins
stress/surgery/trauma

87
Q

management of acute MG crisis

A

FVC and early ITU involvement if low
IVIG +/- plasmaphoresis

88
Q

chronic Rx of MG

A

pyridostigmine
steroids
immunosuppressives (azathioprine, MMF methotrexate)

89
Q

examples of MND

A

amyotrophic lateral sclerosis
bulbar palsy
progressive muscular atrophy (purely LMN)
primary lateral sclerosis (purely UMN)

90
Q

MND mimics

A

spondylotic myeloradiculopathy
multifocal motor neuropathy
syringomyelia
benign fasciculation syndrome

Pathology and final year (21 decks)

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