Neuro Flashcards
Give 5 medications that increase the risk of idiopathic intracranial HTN
- Corticosteriods
- Abx (tetracyclines e.g. lymecycline)
- COCP
- Lithium
- Vit A
What antibodies are seen in Lambert-Eaton myasthenic syndrome?
Voltage-gated calcium-channel antibodies
What drugs can worsen exacerbate myasthenia?
- Beta blockers
- Lithium
- Phenytoin
- Penicillamine
- Certain abx
What is the management of cerebral oedema?
- Slowing IV fluids
- IV mannitol
- IV hypertonic saline
What is always required to diagnose epilepsy?
An EEG
How can you differentiate Bells palsy and Ramsay Hunt?
- In Ramsay Hunt they would have ongoing ear pain + a vesicular rash in and around their ear
- In Bells ear pain comes on suddenly and then goes before weakness develops
- Ramsay Hunt is also associated with VZV
What is the stepwise Rx of idiopathic inter-cranial HTN?
- Lifestyle
- Acetazolamide
- Topiramate
- Repeated lumbar puncture
What condition do 50% of people with temporal arteritis have?
Polymyalgia rheumatica
What is the order and connections of ventricles in the brain?
Lateral ventricles -> foramina of Monro -> 3rd ventricle -> cerebral aqueduct -> 4th ventricle -> foramina of Luschken + Magendie -> subarachnoid space
Give 6 risk factors for SAH
- Smoking
- Alcohol
- Cocaine
- Ehlers Danlos
- Polycystic kidney disease
- Coarctation of the aorta
What is a simple febrile seizure?
- Tonic clonic
- <15 mins
- Occurs once during febrile illness
What is a complex febrile seizure?
- Partial/focal seizure
- > 15 mins
- Occurs multiple times during febrile illness
Do Parkinson’s tremors change with alcohol?
NO!
What CSF results are seen in bacterial meningitis?
- Cloudy CSF
- Low glucose
- Raised protein
- Raised neutrophils
What is the primary inhibitory neurotransmitter of the CNS? What is its effect?
- GABA
- It reduces neuronal excitability by inhibiting nerve transmission
What the primary excitatory neurotransmitter of the CNS?
Glutamate
Give some factors for differentiating between trigeminal neuralgia and temporal arteritis
- Pain in TA doesn’t radiate
- Pain in TA is present for days
- Pain in TN is present for months
- Pain in TN starts over CN V1/2 territories and later affects CN V3 territory
How long does it take the symptoms of optic neuritis to resolve?
Days/weeks
What is the first line medication for benign essential tremor?
Propanolol
What would patients with myelopathy complain of?
- Clumsy hands
- Difficulty walking:
- ‘Legs feel not my own’
- Legs feel heavy
- Can’t feel the ground under feet
What would patients with Radiculopathy complain of?
- Radiating limb pain
- Sharp shooting pain
- Pain often in pattern of a dermatome
What 1) myotome, 2) dermatome and 3) reflex are affected in a C6 radiculopathy?
1) Elbow flexion
2) Thumb
3) Biceps
What 1) myotome, 2) dermatome and 3) reflex are affected in a C7 radiculopathy?
1) Elbow extension
2) Middle finger
3) Triceps
What 1) myotome and 2) dermatome are affected in a L5 radiculopathy?
1) Dorsiflexion
2) Big toe, dorsum
What 1) myotome, 2) dermatome and 3) reflex are affected in a S1 radiculopathy?
1)Plantar flexion
2) Little toes, lat side of the foot, sole
3) Ankle jerk
What is bulbar palsy?
Impaired functioning of the lower CN (9-12)
What can cause bulbar palsy
- Brainstem tumours/strokes (main)
- ALS
- GBS
- Genetic diseases
How can bulbar palsy present?
- Difficulty chewing
- Dysphagia
- Slurred speech
- Drooling
How to test ulnar nerve function?
- Cross fingers or paper between thumb and first digit
- Ulnar function = finger ab/adduction and thumb adduction
How to test median nerve function?
- Keep thumb pointing to ceiling against resistance
- Median function = thumb abduction
How to test radial nerve function?
- Wrist and finger extension against resistance
What happens in radial nerve palsy?
Wrist drop
What bladder and bowel symptoms do you get with spinal cord lesions? Why?
- Constipation and urinary retention
- UMN involvement
- Increased sphincter tone preventing passage of urine and faeces
What bladder and bowel symptoms do you get in caudal equina? Why?
- Urinary and faecal incontinence
- Mainly LMN involvement
- Decreased sphincter tone resulting in incontinence
What spinal cord lesion can cause autonomic dysfunction? What are the symptoms?
- Lesion above T6
- HTN
- Bradycardia
- Urinary retention
- Constipation
- Flushing
- Sweating
What aspects of sensation are typically lost first with sensory loss?
- Fine touch, proprioception, vibration
- Pain and temp remain
What is the pattern of motor and sensory loss in Brown Squared Syndrome?
- Contralateral loss of pain and temp (fibres desucate in spinal cord)
- Ipsilateral loss of fine touch, vibration, proprioception (fibres desucate in brain
- Ipsilateral loss of motor
What is an important cause of reversible dementia?
Normal pressure hydrocephalus
What triad of features are typical of normal pressure hydrocephalus
- Urinary incontinence
- Dementia
- Gait abnormality
What is the management of normal pressure hydrocephalus?
Ventriculoperitoneal shunting
How does trigeminal neuralgia present?
- Sudden electric shock like pain
- Pain lasts seconds - mins
- Can be triggered by shaving, brushing teeth, wind