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Neuro Flashcards

1
Q

CVA stands for

A

Cerebrovascular accident - stroke

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2
Q

Types of CVA

A

Ischaemic, haemorrhagic

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3
Q

TIA management

A

Aspirin 300 mg daily
Specialist referral
Diffusion-weighted MRI scan

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4
Q

Stroke differentials

A

TIA, seizure, hypoglycaemia

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5
Q

Stroke management acute

A

immediate CT brain

Alteplase within 4.5 hrs if no haemorrhage

Thrombectomy cansidered within 24 hrs

Ischaemic stroke - keep high BP
Haemorrhagic - treat high BP

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6
Q

Stroke management long term

A

Assess for underlying cause e.g. Afib
Anticoagulation after finishing two weeks of aspirin, with Afib.

MDT rehab

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7
Q

Presentation intracranial haemorrhage

A

Sudden onset headache, seizure, vomiting, reduced LOC, focal neurological symptoms

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8
Q

GCS

A

Eyes, verbal, motor

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9
Q

Extradural haemorrhage blood vessel

A

MMA, often temporal bone fracture.

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10
Q

Subdural haemorrhage blood vessel

A

Bridging veins, elderly & alcoholic

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11
Q

Intracerebral Haemorrhage

A

Bleeding in the brain tissue, similar presentation to ischaemic stroke.
Aneurysm rupture, secondary to ischaemic stroke, tumours.

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12
Q

Subarachnoid haemorrhage bleed into

A

Subarachnoid space where CSF is - thunder clap headache

Usually cerebral aneurysm rupture

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13
Q

Intracerebral haemorrhage management

A

CT head
Bloods - include coagulation screen - correct any clotting abnormality
Correct severe hypertension but avoid hypotension

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14
Q

Presentation subarachnoid haemorrhage

A

Thunderclap headache - often when strenuous activity.
Neck stiffness, photophobia, vomiting, neurological symptoms

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15
Q

Subarachnoid haemorrhage investigations

A

CT head (less reliable after 6 hrs from symptoms starting)
Lumbar puncture if normal CT head - red cells in CSF
CT angiography - locate source of bleeding

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16
Q

Subarachnoid haemorrhage management

A

surgical intervention - endovascular coiling
Intubation & ventilation

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17
Q

MS pathology

A

Autoimmune demyelination of CNS

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18
Q

MS caused by

A

Low vit D, ebstein barr virus, smoking, obesity

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19
Q

optic neuritis

A

most common presentation of MS.
Unilateral reduced vision, developing over hours to days

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20
Q

Most common presentation MS

A

Optic neuritis

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21
Q

Ataxia can be (2)

A

Problem with coordinated movement
- Sensory - loss of proprioception
- Cerebellar

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22
Q

MS management

A

Disease modifying therapy - target immune system

Relapses - steroids

MDT

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23
Q

Motor neurone disease

A

Progressive disease affecting motor neurons. Eventually fatal. No effect on sensation.

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24
Q

Motor neurone disease presentation

A

Insidious progressive weakness of muscles throughout body. Often first noticed upper limbs. Dysarthria.

Diagnosis carefully after excluding other conditions - no effective treatments.

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25
Parkinsons pathology
reduction in dopamine in the basal ganglia
26
Parkinsons presentation
Resting tremor Rigidity Bradykinesia Shuffling gait Gradual onset symptoms - asymmetrical one side affected more
27
Dementia associated with parkinsons
Lewy body Also has visual hallucinations, delusions, REM sleep disorders, fluctuating consciousness
28
Parkinsons management
Levodopa + carbidopa, Dopamine agonists
29
Levodopa side effect
Dyskinesia - abnormal movements - chorea - athetosis - dystonia
30
Benign essential tremor
Fine tremor, mostly in hands but can also head, jaw and vocal. Worse when tired, stressed or caffeine.
31
Tremor differentials
Parkinson's MS Huntingtons chorea Hyperthyroid Fever Dopamine antagonists (antipsychotics)
32
Epilepsy types of seizure
Absence Generalised tonic-clonic Focal
33
Prior to seizure patient might experience
aura
34
Seizure history check
Tongue biting, aura, urinary incontinence, LOC, post-ictal period of confusion, tired, irritable.
35
Seizure differentials
Vasovagal syncope Pseudoseizures Cardiac syncope Hypoglycaemia Hemiplegic migraine TIA
36
Seizure investigations
EEG MRI brain - structural pathology ECG, serum electrolytes, blood glucose, blood cultures if suspect sepsis.
37
Anti-epileptic
Valproate, levetiracetam, ethosuximide Carbamazapine, phenytoin
38
Status epilepticus
Seizure more than 5 minutes Benzos first line
39
Opioid reversal
Naloxone
40
Bell's palsy presentation and treatment
Bell's palsy - LMN, unilateral face weakness Steroids Lubricating eye drops most patients fully recover over several weeks Rule out trauma, tumour, DM, GB, infection
41
Benign brain tumour
Meningioma
42
Presentation brain tumour
Progressive focal neurological symptoms
43
Intracranial hypertension causes
Brain tumours, intracranial haemorrhage, idiopathic, abscesses or infection
44
Headache concerns for intracranial hypertension
Constant headache, nocturnal, worse on waking, worse on coughing, vomiting, papilloedema on fundoscopy
45
Worst glioma
Glioblastoma
46
Pituitary tumour symptoms
Tend to be benign - bitemporal hemianopia Hormone deficiencies or excesses Acromegaly, hyperprolactinaemia, cushing's, thyrotoxicosis
47
Acoustic neuroma
Benign tumours of schwann cells that surround the auditory nerve Unilateral sensorineural hearing loss, tinnitus, dizzines, facial nerve palsy
48
Huntingtons inheritance
Autosomal dominant - huntingtin protein build up
49
Hungtinton's presentation
Chorea, dystonia, rigidity, eye movement disorders, dysarthria, dysphagia Cognitive, psychiatric or mood problems
50
Huntington's chorea is a progressive condition
Life expectance 10-20 yrs
51
Huntington's treatment and diagnosis
Diagnose via genetic testing, no treatments
52
Myasthenia gravis pathology
Autoimmune condition - acetylcholine receptor antibodies - neuromuscular junction
53
Myasthenia gravis presentation
Vary dramatically between patients Ptosis, diplopia Difficulty climbing stairs Weakness in facial movements Difficulty swallowing Slurred speech
54
Investigations myasthenia gravis
AChR antibodies Edrophonium test?
55
Treatment options myasthenia gravis
Pyridostigmine - cholinesterase inhibitor - prolongs the action of acetyl choline
56
Charcot marie tooth disease
Peripheral motor and sensory neurons - heriditary
57
GB Syndrome presentation
Ascending paralysis autoimmune Following EBV CMV campylobacter jejuni infection. Reduced reflexes
58
GB syndrome diagnosis
Nerve conduction study
59
GB syndrome management
Supportive care, VTE prophylaxis, Respiratory failure - intubation, ventilation, IV immunoglobulins
60
Cervical spondylosis
Degenerative changes in cervical spine
61
Eye afferent
optic nerve pathology
62
fasciculations upper or lower motor neuron
Lower
63
Spasticity upper or lower motor neuron
Upper
64
Chorea seen in
Huntingtons
65
Myoclonus seen in
MS, dementia, parkinson
66
Causes of delirium Chimps phoned
infection, drugs, dehydration Constipation Hypoxia Infection Metabolic disturbance Pain Sleeplessness Prescriptions Hypothermia/pyrexia Organ dysfunction (hepatic or renal impairment) Nutrition Environmental changes Drugs (over the counter, illicit, alcohol and smoking)
67
Hyperactive delirium symptoms
Clinical features of hyperactive delirium include: Agitation Delusions Hallucinations Wandering Aggression
68
Hypoactive delirium symptoms
Lethargy Slowness with everyday tasks Excessive sleeping Inattention
69
Delirium management - confusion screen
Blood tests: FBC (e.g. infection, anaemia, malignancy) U&Es (e.g. hyponatraemia, hypernatraemia) LFTs (e.g. liver failure with secondary encephalopathy) Coagulation/INR (e.g. intracranial bleeding) TFTs (e.g. hypothyroidism) Calcium (e.g. hypercalcaemia) B12 + folate/haematinics (e.g. B12/folate deficiency) Glucose (e.g. hypoglycaemia/hyperglycaemia) Blood cultures (e.g. sepsis) Urinalysis: UTI is a very common cause of delirium in the elderly. A positive urine dipstick without clinical signs is NOT satisfactory to diagnose urinary tract infection as a cause of delirium.2, 3 Look for other evidence supporting the diagnosis (WCC↑/supra-pubic tenderness/dysuria/offensive urine/positive urine culture). Imaging: CT head: if there is concern about intracranial pathology (bleeding, ischaemic stroke, abscess) Chest X-ray: may be performed if there is concern about lung pathology (e.g. pneumonia, pulmonary oedema)
70
Meds for delirium
Haloperidol Benzos can worsen - lorazepam if need
71
Postural hypotension management
Midrodrine, cease antihypertensive, IV fluids
72
Causes of afferent papillary defect
Optic nerve damage - MS, glaucoma, retinal detachment, trauma
73

Internal Medicine (6 decks)

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