neuro Flashcards
how to screen for diabetic nephropathy? what value is considered abnormal?
ACR may be measured on a spot sample if a first-pass sample is not provided (but should be repeated on a first-pass specimen if abnormal)
ACR > 2.5
A patient with AF + an acute stroke (not haemorrhagic) should have anticoagulation therapy started _______ (when?) ________
two weeks after the event
Painful third nerve palsy = lesion where?
posterior communicating artery aneurysm
associated effects of stroke in -
1. anterior cerebral artery
2. middle cerebral artery
3. posterior cerebral artery
- anterior cerebral artery: contralateral hemiparesis and sensory loss, lower > upper
- middle cerebral artery: contralateral hemiparesis ans sensory loss, upper > lower. Contralateral homonymous haemianopia, aphasia.
- posterior cerebral artery: contralateral homonymous hemianopia with macular sparing, visual agnosia
associated effects of stroke in -
1. Weber’s
2. Wallenberg
3. Lateral pontine syndrome
- Weber’s (branches of postrior cerebral artery): ipsilateral CN lll palsy, contralateral weakness of upper and lower exremities
- Wallenberg (PICA): ipsilateral paina and tempterature loss, contralateral loss of pain and temprature in limbs. Ataxia and nystagmus.
- Lateral pontine syndrome (Anterial inferior cerebellar artery): Ipsilateral facial paralysis and deafness (due to damage to facial nerve)
medication overuse headaches:
- simple analgesia
- opioid analgesia
- stop immediately
- withdraw gradually
Headache linked to Valsalva manoeuvres =
Other signs of raised ICP?
raised ICP
Papilloedema, Cushing’s triad (widened pulse pressure, bradycardia, irregular increased respirations)
Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive →
subacute combined degeneration of the spinal cord
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA,
they should be admitted immediately for imaging to exclude a haemorrhage
Progressive peripheral polyneuropathy with hyporeflexia suggests
Guillain-Barre syndrome
acute vs chronic subdural haematoma - difference in presentation?
chronic: dark –> hypodense
acute: bright –> hyperdense
which muscles does myasthenia gravis affect first?
proximal, extra-ocular
According to NICE guidelines patients over 65 get a CT head if they
have had some loss of consciousness or amnesia since a fall
visual field defects
explain how SDOSC presents
Damage to the posterior columns - loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg’s test).
Damage to lateral columns - spastic weakness and upgoing plantars (UMN signs).
Damage to peripheral nerves - absent ankle and knee jerks (LMN signs).
When there is a mix of UMN and LMN signs in a patient, always consider SCDC.
LP findings in GBS
raised protein, normal WBC
what exacerbates myasthenia gravis
bblockers
papilloedema, 6th nerve palsy, no other focal neuro signs =
Idiopathic intracranial hypertension
Lesions at ____ will cause finger abduction weakness
T1
Klumpke’s paralysis
________ is a common consequence of subarachnoid haemorrhage
SIADH
Ptosis + dilated pupil =
ptosis + constricted pupil =
- third nerve palsy
- Horner’s
A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with
Clostridium botulinum
Botulism does not usually present with fever, loss of sensation or loss of awareness
Pt started on steroids for exacerbation of COPD shows raised WCC - what do you do
nothing - Corticosteroids can induce neutrophilia
Low CSF headaches can occur due to spontaneous intracranial hypotension (not necessarily post-LP) and are classically worse on standing and improve when lying flat
Conduction dysphasia:
speech fluent, but repetition poor. Comprehension is relatively intact
MS Tx
- to reduce fatigue
- to reduce spasticity
- to reduce frequency of attacks
- to reduce fatigue: amantidine
- to reduce spasticity: baclofen
- to reduce frequency of attacks: nalaizumab
Autonomic dysreflexia can only occur if the spinal cord injury occurs above the ____ level
T6
spinal cord compression: which lesions cause which signs
. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion
____________ increase the risk of idiopathic intracranial hypertension
Tetracyclines
CMD only has ________ signs
LMN
Phenytoin is a cause of
aplastic anaemia
Raised ICP can cause
a third nerve palsy due to herniation
how does cavernous sinus thrombosis present?
Cavernous sinus thrombosis is another important complication in sinusitis but usually presents with unilateral facial oedema, photophobia, proptosis and palsies of the cranial nerves which pass through it (III, IV, V, VI).
what pathophysiological finding is CHARACTERISTIC of Alzheimer’s?
Amyloid plaques and tau proteins
Lady presents with Sx of stroke + fixed splitting of second heart sound - Dx?
ASD can cause paradoxical stroke where embolism travels from veins and bypasses pulmonary circulation
A 21-year-old man is involved in a road traffic accident. After a transient period of concussion he is found to have a GCS of 15 by the paramedics. On arrival at hospital he is monitored in a side room of the emergency department. When he is next observed he is noted to have a GCS of 3 and a blown right pupil. Which of the processes below best accounts for this deterioration?
- extradural bleed
- trans-tentorial herniation
How does SDotSC present? Which tracts are affected?
Subactute Combined Degeneration = Spinocerebellar, Corticospinal, Dorsal
Spinocerebellar: sensory ataxia, positive Romberg’s
Corticospinal: (UMN) so brisk knee reflexes, absent ankle reflexes, spasticity, weakness
Dorsal: symmetrical tingling/burning
When are phenytoin levels checked?
immediaely before next dose
A 28-year-old female presents with a two-day history of a gradual onset severe headache associated with nausea and three episodes of vomiting. She comes across as blunted and states she is having difficulty in finding the right words. She has no significant past medical history and her only medication is the combined oral contraceptive pill. The only thing of note in her family history is that her mother had an unprovoked DVT in her 30s. Given the likely diagnosis, what is the gold standard test to diagnose her condition?
MR Venogram is the gold standard test for diagnosing venous sinus thrombosis
A 65-year-old male with known nasopharyngeal carcinoma presents with double vision over a few weeks. On examination he is found to have left eye proptosis and it is down and out. He reports pain on attempting to move the eye. There is an absent corneal reflex. What is the most likely diagnosis?
Cavernous sinus syndrome
Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner’s syndrome.
___________ is a scale that measures disability or dependence in activities of daily living in stroke patients
The Barthel index
_____________is completely responsive to treatment with indomethacin
Paroxysmal hemicrania
Parkinsonism with associated autonomic disturbance (atonic bladder, postural hypotension) points towards
Multiple System Atrophy
autonomic disturbance
erectile dysfunction: often an early feature
postural hypotension
atonic bladder
cerebellar signs
what i Hoffman’s sign + what disease can it show?
Hoffmans sign is elicited by flicking the distal phalaynx of the middle finger to cause momentary flexion. A positive result is exaggerated flexion of the terminal phalanyx of the thumb.
Shows UMN stuff like degenerative cervical myelopathy and MS
Motion sickness Tx -
hyoscine > cyclizine > promethazine
