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MRCP 1 > Neuro > Flashcards

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
Q

Types of multiple system atrophy

A

MSA-P — mainly Parkinson features
MSA-C — mainly cerebellar features

26
Q

Features of multiple system atrophy

A

Parkinsonism
Autonomic disturbance - erectile dysfunction, postural hypotension, atonic bladder
Cerebellar signs

27
Q

Classify focal seizures

A

Start in specific part of brain
Level of awareness varies
Motor, non motor or aura

28
Q

Classify generalised seizures

A

Both sides of brain
Immediately LoC
Motor or non motor

Types - tonic clonic, tonic, clonic, typical absence, atonic

29
Q

Describe infantile spasms

A

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
Q

Describe absence seizures

A

Age 4-8
Few seconds, no warning, quick recovery, many per day
EEG - 3Hz generalised, symmetrical
Valproate
Good prognosis

31
Q

Lennox-Gestault syndrome

A

Extension of infantile spasms sometimes
Age 1-5yr
Atypical absences, falls, jerks
90% moderate-severe handicap
EEG - slow spike
Ketogenic diet may help

32
Q

Benign Rolandic epilepsy features

A

Most common in childhood and males
Paraesthesia usually on waking up

33
Q

Juvenile myoclonic epilepsy features

A

Typically teenager
Infrequent generalised seizures often in morning - sleepy
Daytime absences
Sudden shock like myoclonic seizure
Good response to valproate

34
Q

Treatment for generalised tonic-clonic seizures

A

Males - valproate
Females - lamotrigine or keppra

35
Q

Treatment for focal seizures

A

Lamotrigine or keppra first
Carbamazepine, oxcarbazepine, zonisamide

36
Q

Absence seizures treatment

A

Ethosuximide
Valproate for men
Lamotrigine or keppra for women
Not carbamazepine

37
Q

Treatment for myoclonic seizures

A

Valproate for men
Keppra for women

38
Q

Tonic or atonic seizure treatment

A

Valproate for men
Lamotrigine for women

39
Q

Anti epileptic drugs and pregnancy issues

A

Valproate - neural tube defects
Phenytoin - cleft palate - give Vit K in last month of pregnancy

40
Q

First step of managing status epilepticus out of hospital

A

10-20mg diazepam PR

41
Q

Status epilepticus treatment

A

Early - lorazepam
Established - phenytoin infusion or posphenytoin infusion, phenobarbital infusion
Refractory - propofol, midazolam, thiopental sodium

MRCP 1 (14 decks)

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