Neuro Flashcards
What is neurosyphilis, and what are its characteristics?
Answers:
🧠 Neurosyphilis is the invasion of the Central Nervous System (CNS) by Treponema pallidum, causing an inflammatory reaction.
💥 It affects the meninges, surrounding vessels, and cerebral parenchyma.
🤒 Acute aseptic meningeal syphilis presents with symptoms of acute meningitis, including neck stiffness and nausea.
💔 Meningovascular syphilis may lead to subacute strokes and cranial neuropathies.
»»»🤔 Think of neurosyphilis when there is a combination of stroke, rash, and meningitis symptoms.«««
> Meningovascular syphilis: subacute stroke + cranial neuropathies
What diagnostic investigations are used for neurosyphilis?
🧪 The Venereal Disease Research Laboratory (VDRL) test is especially useful in evaluating neurologic involvement by examining cerebrospinal fluid.
✅ In neurosyphilis, VDRL is positive in approximately 80% of patients.
🚫 However, it’s important to note that a false-positive VDRL result can occur in conditions such as pregnancy, viral infections (EBV, hepatitis), autoimmune diseases like lupus, leprosy, and some medications (e.g., chlorpromazine).
How is neurosyphilis managed and treated?
💉 IV Penicillin is the primary treatment for neurosyphilis and should be administered for 10-14 days at a dose of 18-24 million units per day, divided into 3-4 doses.
🚫 In cases of penicillin allergy, alternative treatments include doxycycline (100 mg orally twice a day for 28 days) or ceftriaxone (2 g daily intravenously for 10-14 days).
What are the key characteristics of Tabes Dorsalis (syphilitic myelopathy)?
🧠 Mnemonic: “DORSALIS” summarizes key features:
🔍 Dorsal column degeneration.
🦴 Orthopedic pain, leading to Charcot joints.
🚫 Reflexes decreased or absent deep tendon reflexes.
🩸Shooting pain or Dysesthesias: loss of sensation, particularly in the lower extremities, with sharp, shooting pain in the legs.
👀 Argyll Robertson pupil: bilateral miosis (constricted pupils) where pupils accommodate but do not react to direct or indirect light.
🚶♂️Locomotor ataxia / Progressive sensory broad-based ataxia, often leading to gait disturbances.
🧪 Syphillis
What are the clinical symptoms associated with elevated intracranial pressure (ICP)?
🫁 Cushing triad: irregular breathing (Cheyne-Stokes, Low blood pressure (wide pulse pressure), bradycardia.
😴 Reduced level of consciousness.
🤕 Headache.
🤢 Vomiting.
👁️ Papilloedema (optic disc swelling).
👓 Diplopia (double vision).
What are the neurological symptoms associated with hypercapnia due to respiratory failure?
🫁 Shortness of breath.
🤕 Headaches.
😴 Persistent tiredness or sluggishness during the day.
🤷♂️ Disorientation.
🤪 Confusion or altered mental state.
🤯 Paranoia.
😞 Depression.
⚡ Seizures.
What are the clinical symptoms associated with epidural hematoma?
🧠 Initial loss of consciousness immediately following a head injury.
🤔 Temporary recovery of consciousness with a return to normal or near-normal neurological function (lucid interval).
🫁 Signs of raised Intracranial Pressure (ICP), including headache and Cushing triad (irregular breathing, wide pulse pressure, bradycardia).
🧯 Cerebral herniation: acutely worsening level of consciousness, pupillary changes, new focal neurological deficits (e.g., hemiparesis, decerebrate posturing), and cardiorespiratory compromise (bradycardia, apnea).
— 👁️ Uncal herniation: 3rd nerve (oculomotor) nerve palsy causing a fixed dilated pupil and the eye “out and down.”
Clinical Features of PICA (Posterior Inferior Cerebellar Artery) Infarction Leading to Lateral Medullary Syndrome
🚶♂️ Ataxic gait (broad-based gait) and nystagmus (involuntary eye movements).
👁️ Ipsilateral Horner syndrome, characterized by ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face.
😣 Ipsilateral loss of facial sensation to pain and temperature sensation.
💔 Contralateral loss of pain and temperature sensation of the body (on the opposite side).
🧤 Dissociated anesthesia: Loss of pain and temperature sensation with spared proprioception, light touch, and vibration sense (lesion below the pons).
🌀 Vertigo, difficulty with swallowing, dysarthria (speech difficulty), and hoarseness (IX, VIII and X impairment).
Main features of infarction in:
Anterior cerebral artery
Middle cerebral artery
Posterior communicating artery
PICA
👣 Anterior Cerebral Artery infarction often presents with LOWER LIMB impairment. Contralateral paresis, sensory loss legs > arms.
🚽 Urinary incontinence may occur.
🧠 Executive function impairment, affecting decision-making, planning and other higher cognitive functions can be observed. Also personality change (disinhibition, abulia).
Main features of infarction in:
Middle cerebral artery
😶 FACE ASYMMETRY is a common feature, often presenting as facial droop.
🖐️ Upper limbs may be affected, and there might be some involvement of the lower limbs.
🚗 Middle Cerebral Artery infarctions are often related to occlusion in the internal carotid artery.
Main features of infarction in:
Posterior communicating artery AND
PICA
Posterior Communicating Artery
🤕 Severe pain and headache can be prominent symptoms.
👁️ Ocular palsy may occur, affecting eye movement.
Posterior Inferior Cerebellar Artery (PICA)
👁️ Horner Syndrome is often observed in PICA infarctions, characterized by ptosis, miosis, and anhidrosis on the affected side of the face.
🚶♂️ PICA infarction may lead to gait and coordination problems, including ataxia (uncoordinated movements) and difficulty walking.
🙁 Facial weakness or paralysis may occur, affecting muscles on one side of the face.
🚫 Dysphagia (difficulty swallowing) can be a symptom.
🌪️ Vertigo and dizziness may be prominent, along with nausea and vomiting.
👁️ Nystagmus (involuntary eye movements) may also be observed.
🧠 Other possible features include limb weakness, sensory deficits, and Horner syndrome (ptosis, miosis, anhidrosis).
What are the key principles in the management of acute stroke?
⏱️ Early intervention is crucial within 3-4.5 hours of onset with tissue plasminogen activator (tPA) such as alteplase administered intravenously or tenecteplase.
🚫 Aspirin should be withheld for the first 24 hours in some cases.
💊 Aspirin (150-300 mg orally) can be initiated within 48 hours if tPA is not used.
🩺 Hypertension should be treated if the blood pressure is elevated (>200/120 mmHg).
☎️ Contact a local neurological center if surgery is required, such as intracerebral hemorrhage for surgical clot extraction or evidence of raised intracranial pressure for decompression.
💊 Clopidogrel 75 mg is used for dual therapy (in combination with aspirin) in transient ischemic attack (TIA) within 24 hours.
What is the management and the recommended investigations for a Transient Ischemic Attack (TIA)?
⏰ TIA typically presents with a sudden onset and short duration (less than 60 minutes).
⚖️ Complete clinical recovery occurs in less than 24 hours, usually within 2 hours, and consciousness is usually preserved.
What investigations are recommended for evaluating a Transient Ischemic Attack (TIA)?
🧠 The next step in evaluation is often a CT scan without contrast.
📊 An MRI is the preferred imaging modality (within 24 hours if available), especially in cases of suspected brain stem ischemia.
🚗 Duplex Doppler ultrasound of the carotid arteries is advisable if there is a carotid bruit or a history of amaurosis fugax (transient monocular blindness) or anterior circulation involvement. This should be done within 48-72 hours.
🫀 Additional investigations may include a 12-lead ECG/Holter and echocardiogram (ECHO), especially if there are signs of atrial fibrillation (AF), acute myocardial infarction (MI), endocarditis, or posterior circulation involvement.
What are the clinical features associated with myelopathy at the C5-C6 level?
🤷♂️ Lower Motor Neuron (LMN) signs are typically observed at the level of the lesion. These signs include flaccid weakness in the upper extremities and muscle wasting.
🚶♂️ Upper Motor Neuron (UMN) signs are present below the level of the lesion, resulting in a spastic gait with stiffness and the presence of Babinski’s sign.
🤖 Sensory symptoms such as numbness and tingling in the arms are less common.
🏥 Autonomic symptoms may include bowel and bladder incontinence, as well as erectile dysfunction.
Differential diagnosis of myelopathy at c5-6
Motor neuron disease gives UMN and LMN signs, but there is no the level of compression. UMN and LMN symptoms will be seen on upper limbs as well as low limbs (assymetric). No sensory symptoms. The age of onset is young adults.
Multiple sclerosis motor (UMN lesion signs) and sensory symptoms, diffuse. Mean age of onset 30s plus visual symptoms.
Subacute combined degeneration of spinal cord can cause spastic paresis, but in addition there are impaired vibration, proprioception, ataxia, paresthesia plus anaemia.
Diabetic peripheral neuropathy LMN lesion signs (muscle wasting), symmetrical low limbs more than upper limbs, gloves and stocking distribution. Sensory symptoms (pin and needles).
What are the common investigations used in the diagnosis of Guillain-Barre Syndrome?
💉 Lumbar puncture is a key investigation, revealing albuminocytologic dissociation.
⚡ Nerve conduction studies are often performed to assess nerve function.
What are the recommended treatments and management strategies for Guillain-Barre Syndrome?
💉 Jg Intravenous immunoglobulin (IVIG) or plasmapheresis (plasma exchange) are often used as treatments.
🫁 Monitoring of respiratory function is crucial.
🫂 Mechanical ventilation should be considered if there are signs of respiratory failure.
What are the clinical features commonly associated with Multiple Sclerosis (MS)?
Young age
Useless hand due to loss of position sense, incoordination.
Dysmetria – lack of accuracy in voluntary movements.
Intention tremor (cerebellar involvement).
UMN lesion (pronator drift due to difference in muscle tone).
Sensory impairment regional.
What investigations are commonly used in the diagnosis and evaluation of Multiple Sclerosis (MS)?
🧲 MRI with contrast is an important tool, revealing contrast-enhancing lesions in more than one part of the central nervous system (CNS).
💉 Lumbar puncture may show elevated levels of IgG.
👁️ Visual evoked potentials are often performed and may reveal delayed responses.
How is Multiple Sclerosis (MS) typically managed and treated?
💉 Acute relapses may be treated with intravenous methylprednisolone for 3 days.
⚗️ In some cases, plasma exchange may be considered if the patient is unresponsive to treatment.
💊 Disease-modifying treatments include interferon, glatiramer acetate, and natalizumab.
🩺 Other treatments may involve medications like baclofen, clonazepam, oxybutynin, and carbamazepine.
What are the key differences in the presentation of facial paralysis between cerebral infarction involving the corticobulbar tract and Bell’s palsy?
🔴 In cerebral infarction involving the corticobulbar tract, only the lower two-thirds of the face is affected (UMN-type lesion), and the forehead is not affected. The person can fully raise their eyebrow.
🟡 In Bell’s palsy, which affects the 7th cranial nerve (LMN-type lesion), the entire ipsilateral half of the face is affected. The individual cannot fully raise the eyebrow and may have difficulty closing the eye.
What are some of the common side effects associated with donepezil and other cholinesterase inhibitors?
🩸 Sweating
🤤 Excessive salivation
😢 Increased lacrimation (tear production)
💦 Frequent urination
💩 Diarrhea
🍽️ Anorexia (loss of appetite)
🤢 Nausea
🤮 Vomiting
🧩 Excitation of neuromuscular function
👁️ Miosis (constricted pupils)
💪 Muscle spasms
🫁 Bronchospasm
🫀 Bradycardia (slow heart rate)
What are the clinical features commonly associated with Lewy Bodies Dementia?
👁️ Visual hallucinations are a notable symptom.
🚶 Parkinsonism, characterized by movement problems similar to Parkinson’s disease, may be present.
🧠 Dementia is a key component, with deficits in executive function and memory loss being prominent.
💤 REM sleep disorder is often observed, leading to disturbances during rapid eye movement (REM) sleep.
What are the key steps in managing agitated delirium?
👥 Nonpharmacological measures should be the initial approach, including providing supportive care and reassurance.
🩺 Identify and treat any easily reversible causes of delirium, such as dehydration, pain, hypoxia, or urinary retention.
🗣️ Engage in calm verbal interaction with clear communication to help manage agitation.
🚫 Avoid the use of physical restraints whenever possible.
💊 If nonpharmacological measures are insufficient and the delirium is refractory, medications such as Haloperidol, Olanzapine, or Risperidone may be considered.
🍷 In cases of delirium due to alcohol withdrawal, benzodiazepines like Lorazepam may be appropriate
What are the clinical symptoms and effects associated with carbamazepine toxicity?
🧠 In the central nervous system (CNS), symptoms may include ataxia, nystagmus, diplopia, dizziness, vertigo, sedation, drowsiness, coma, and seizures.
❤️ Cardiovascular system effects can manifest as tachycardia, hypotension, and potentially life-threatening arrhythmias, such as heart block, widening of QRS complex, and ventricular fibrillation.
🌼 Anticholinergic effects may result in urinary retention, decreased bowel motility, dry mouth, and sinus tachycardia.
💉 Bone marrow toxicity can lead to conditions like agranulocytosis and pancytopenia.
What are the guidelines for driving after seizures in various scenarios?
🚗 For individuals under treatment whose epilepsy was previously well controlled and had no seizures during the 12 months leading up to the last seizure, they can drive if they remain seizure-free for at least 3 months.
🚗 In the case of a first seizure of any type, driving is permitted if there are no further seizures (with or without medications) for at least 6 months.
🚫 During planned withdrawal of antiseizure medication, individuals should not drive while the dose is being tapered and for 3 months after the last dose.
🚗 If seizures recur after withdrawal, driving can be resumed if the previously effective medication is restarted, and there have been no seizures for 4 weeks.
What are the clinical features commonly associated with Guillain-Barré Syndrome (GBS) and its possible preceding infections?
🩸 GBS is characterized by an autoimmune attack on the peripheral nerves, particularly the myelin sheath.
🦠 Preceding infections are common triggers for GBS and can include Campylobacter jejuni, upper respiratory tract infections (URTI), Epstein-Barr virus (EBV), and cytomegalovirus (CMV).
🦠 GBS can be distinguished from conditions affecting different areas of the nervous system: anterior horn cells (motor neuron disease), dorsum spinal columns (subacute combined degeneration of spinal cord), central canal of spinal cord (syringomyelia), and neuromuscular junction (conditions like botulism and myasthenia gravis).
