Neuro Flashcards

1
Q

Parietal Lobe Lesions - disorders

A

sensory inattention
apraxias
astereognosis (tactile agnosia)
inferior homonymous quadrantanopia
Gerstmann’s syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

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2
Q

Occipital Lobe Lesions

A

homonymous hemianopia (with macula sparing)
cortical blindness
visual agnosia

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3
Q

Temporal Lobe Lesion - disorders

A

Wernicke’s aphasia: this area ‘forms’ the speech before ‘sending it’ to Brocas area. Lesions result in word substituion, neologisms but speech remains fluent
superior homonymous quadrantanopia
auditory agnosia
prosopagnosia (difficulty recognising faces)

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4
Q

Frontal Lobe Lesions - disorders

A

expressive (Broca’s) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus. Speech is non-fluent, laboured, and halting
disinhibition
perseveration
anosmia
inability to generate a list

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5
Q

Cerebellum Lesions - Disorders

A

midline lesions: gait and truncal ataxia
hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus

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6
Q

Lesions at Medial thalamus and mammillary bodies of the hypothalamus

A

Wernicke and Korsakoff syndrome

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7
Q

Subthalamic nucleus of the basal ganglia - lesion - disorder

A

Hemiballism

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8
Q

Striatum (caudate nucleus) of the basal ganglia

A

Huntington Chorea

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9
Q

Substantia nigra of the basal ganglia - lesion - disorder

A

Parkinsons

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10
Q

Amygdala - lesion - disorder

A

Kluver-Bucy syndrome (hypersexuality, hyperorality, hyperphagia, visual agnosia

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11
Q

What does the facial nerve supply?

A

face: muscles of facial expression
ear: nerve to stapedius
taste: supplies anterior two-thirds of tongue
tear: parasympathetic fibres to lacrimal glands, also salivary glands

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12
Q

Causes of bilateral facial nerve palsy

A

sarcoidosis
Guillain-Barre syndrome
Lyme disease
bilateral acoustic neuromas (as in neurofibromatosis type 2)
as Bell’s palsy is relatively common it accounts for up to 25% of cases f bilateral palsy, but this represents only 1% of total Bell’s palsy cases

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13
Q

Causes of unilateral facial nerve palsy

A

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

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14
Q

Facial nerve palsy - upper vs lower motor neurone lesion

A

Forehead sparing in upper motor neurone not in lower

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15
Q

Most common psychiatric symptoms of Parkinson’s

A

psychiatric features: depression is the most common feature (affects about 40%); dementia, psychosis and sleep disturbances may also occur

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16
Q

What is Brown-Sequard syndrome

A

caused by lateral hemisection of the spinal cord

ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation

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17
Q

Features of HSV encephalitis

A

fever, headache, psychiatric symptoms, seizures, vomiting
focal features e.g. aphasia
peripheral lesions (e.g. cold sores) have no relation to the presence of HSV encephalitis

18
Q

Investigations for HSV encephalitis

A

CSF: lymphocytosis, elevated protein
PCR for HSV
CT: medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients
MRI is better
EEG pattern: lateralised periodic discharges at 2 Hz

19
Q

Treatment for HSV encephalitis

A

IV aciclovir

20
Q

General features of myotonic dystrophy

A

myotonic facies (long, ‘haggard’ appearance)
frontal balding
bilateral ptosis
cataracts
dysarthria

21
Q

Four D’s of myotonic dystrophy

A

Distal weakness initially
autosomal Dominant
Diabetes
Dysarthria

22
Q

What is syringiomelia?

A

Syringomyelia (‘syrinx’ for short) describes a collection of cerebrospinal fluid within the spinal cord.

23
Q

What causes syringomelia?

A

a Chiari malformation: strong association
trauma
tumours
idiopathic

24
Q

Features of syringomelia

A

a ‘cape-like’ (neck, shoulders and arms)
loss of sensation to temperature not light touch, proprioception, vibration
classic examples are of patients who accidentally burn their hands without realising
spastic weakness - LL mainly
neuropathic pain
upgoing plantars
autonomic features:
Horner’s syndrome due to compression of the sympathetic chain, but this is rare
bowel and bladder dysfunction
scoliosis - over years

25
Types of multiple system atrophy
MSA-P — mainly Parkinson features MSA-C — mainly cerebellar features
26
Features of multiple system atrophy
Parkinsonism Autonomic disturbance - erectile dysfunction, postural hypotension, atonic bladder Cerebellar signs
27
Classify focal seizures
Start in specific part of brain Level of awareness varies Motor, non motor or aura
28
Classify generalised seizures
Both sides of brain Immediately LoC Motor or non motor Types - tonic clonic, tonic, clonic, typical absence, atonic
29
Describe infantile spasms
Brief spasms in first months of life Flexion of head, trunk and limbs Progressive mental handicap EEG - hypsarrhythmia Secondary to serious neuro abnormality Vigabatrin or steroids Poor prognosis
30
Describe absence seizures
Age 4-8 Few seconds, no warning, quick recovery, many per day EEG - 3Hz generalised, symmetrical Valproate Good prognosis
31
Lennox-Gestault syndrome
Extension of infantile spasms sometimes Age 1-5yr Atypical absences, falls, jerks 90% moderate-severe handicap EEG - slow spike Ketogenic diet may help
32
Benign Rolandic epilepsy features
Most common in childhood and males Paraesthesia usually on waking up
33
Juvenile myoclonic epilepsy features
Typically teenager Infrequent generalised seizures often in morning - sleepy Daytime absences Sudden shock like myoclonic seizure Good response to valproate
34
Treatment for generalised tonic-clonic seizures
Males - valproate Females - lamotrigine or keppra
35
Treatment for focal seizures
Lamotrigine or keppra first Carbamazepine, oxcarbazepine, zonisamide
36
Absence seizures treatment
Ethosuximide Valproate for men Lamotrigine or keppra for women Not carbamazepine
37
Treatment for myoclonic seizures
Valproate for men Keppra for women
38
Tonic or atonic seizure treatment
Valproate for men Lamotrigine for women
39
Anti epileptic drugs and pregnancy issues
Valproate - neural tube defects Phenytoin - cleft palate - give Vit K in last month of pregnancy
40
First step of managing status epilepticus out of hospital
10-20mg diazepam PR
41
Status epilepticus treatment
Early - lorazepam Established - phenytoin infusion or posphenytoin infusion, phenobarbital infusion Refractory - propofol, midazolam, thiopental sodium