Neuro Flashcards

1
Q

Alzheimers on imaging

A

mesial temporal lobe atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

anterior cerebral artery stroke

A

contralateral hemiparesis & sensory loss

Lower extremeties > upper extrem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Total anterior circulation infarct (TACI)

A

(middle and anterior cerebral)

1 unilat hempiparesis +/- hemisensory loss of face arms and legs

2 homonopious hemaonpia

3 higher cognative dysfxn ie dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

anterior inferior cerebellar
lateral pontine

A

sudden onset vertigo & vom

ipsilateral facial paralysis and deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

aphasia where is brocas and what time

presenation

suppilied by

A

expressive ie speech made then sent here

inferior frontal gyrus

normal comprehension
speech non fluent
repetition impaired

Superior dividion of MCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

aphasia where is wernickes

suplied by

presentation

A

speech made here then sent to brocas
superior temporal gyrus

inferior MCA

not normal comprehension
speech no sense, word substitution and nedograms
but fluent
‘word salad’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

condustion aphasia where

and presentation

A

stroke in connection of arcuate fasiculus

speech fluent but poor
pt aware of errors
normal comprehension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

global aphasia
where
presentation

A

large lesion affecting all 3

servere expressive and receptive aphasia

may still be able to communicate with gestures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

true seizures may show compared to pseudoseizures

A

prolactin increase 10-20min after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

parksinons path

A

loss of dopaminergic neruons in substantia nigra = loss of excitatory signal

less dopamine (d2) = less GABA (inhibitory) = increased movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

parkinsons tx

A

Motor sx impacting QOL = levodopa-carbidopa

Motor sx not yet impacting = Dop agonist ie ropinirole
MAO-B inhib ie selegiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

essential tremor presentation n tx

A

no tremor at rest
worsens with movement

propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

cerebellar lesion tremor

A

no tremor at rest

worsens w movement gets worse w intention ie closer u get

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

huntingtons ix

A

genetic testing - CAG repeats in HTT allele

CT/MRI
atrophy (caudate striatal frontal)
dilated lateral ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

huntingtons tx

A

supportive and sx tx

counselling n support for pt and family

psychiatric - SSRIs, ECT, antipsychotics,CBT

Chorea - benzos

Bradykinesia/rigidity - Dopamine agonists, levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Spinal stenosis presentation

A

Bilateral

burning, lightening pain of thighs and bum

worse on upright - better when leaning forward or climbing stairs

(proximal pseudoclaudication that is positional!)

[peripheral cause would be distal legs too and not positional)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

syringomyelia path and ix, sx and tx

associated with

A

pockets of CSF cysts in spinal cord

ix - MRI

sx - back pain (neck shoulders arms)
loss of pain and temp which progresses to motor sx ie weakness and wasting esp hands and arms

(bc spinothalamic )

Tx - Surgery

associated w chiari malformation (cerebeller tonsils protrude from foramen magnum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

normal pressure hydrocephalus path presenation

ix

tx

A

normal ICP but hydrocephalus

Wet wobbly weird
(incontinence, ataxia, demetia)

ix
CT - hydrocephalus
LP - no raised ICP but improvement of Sx after

tx surgical shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

picks disease

A

FTD dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

lewy body pathway n presentation

A

Lewy bodies in substantia nigra

fluctuating changes in cognition - cycles get progressively shorter
w lucid period - can be v distressing for pt bc insight

acute delirium and hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

alzheimers tx

A

cholinesterase inhib

donezepil n rivastigmine

severe = memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CJ disease (mad cow)

A

prions accumulation

young rapid dementia myoclonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Reversible causes of dementia

A

b12 def
hypothyroid
electrolyte abnormality (CKD)
syphilis
Normal pressure hydrocephalus
anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anterior spinal artery occlusion

A

bilateral spastic paresis
loss of pain and temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
when does cushings reflex happen why what is it
happens in increased ICP to maintain peripheral perfusion opposite of hypovol shock vitals ie increase BP (HTN) decrease HR wide pulse pressure
26
Bitemporal hemanopia if upper quad worse then lower
pituatry tumor
27
bitemporal hemanopia lower quad worse than upper
craniopheningoma
28
pontine haemorrahe cause and presentation
life threatening emergency chronic HTN complication reduced GCS quadraplegia miosis absent horizontal eye movements
29
extradural haemorhage
middle meningeal artery
30
MCA stroke presentation
contralateral paralysis and sensory loss of face and upper limbs aphasia if infarct in dominant hemisphere
31
bells palsy
no foreheard sparing (bc LMN) loss of taste anterior 2/3 tongue
32
wilsons neuro sx
copper deposition in cerebellum = dysarthria and wide based gait in basal ganglia = tremor and rigidity (parkinsonism) also psych sx ie anxiety depression bipolar
33
wilsons diagnostic test
24hr urine collection
34
L5 root lesion
reduced ankle eversion and inversion and dorsiflexion sensory loss over big toe
35
pundendal nerve block what nerve fibres and palpate where
fibres S2,S3,S4 palpate ischial spine transvaginaly
36
GCS eyes
Eyes open spontaneously – 4 Eyes open to speech – 3 Eyes open to pain – 2 Eyes do not open – 1
37
GCS verbal
Orientated – 5 Confused – 4 Inappropriate words – 3 Inappropriate sounds – 2 No verbal response – 1
38
GCS motor
Obeys commands – 6 Localises pain – 5 Withdraws from pain – 4 Abnormal flexion – 3 Abnormal extension – 2 No response – 1
39
Charcot marie tooth disease (CMT)
hereditary peripheral neuropathy distal weakness, such as foot drop and pes cavus (high foot arch) distal atrophy loss of senstation maybe tingling and numbess
40
stroke no driving for how long
4 weeks
41
duchenne muscular dystrophy tx
steroids
42
brown sequard
hemisection of cord ipsilateral loss of vibration and proprioception and hemiplegia contralateral pain and temp
43
pinealoma
slowgrowing tumor of pineal gland may press on midbrain cerebral aqueduct = non communicating hydrocephlaus if compress edinger westphal nuclei = mydriasis (pupil dilation)
44
had two epsiodes of seizure both resolved but now having another seizure
IV phenytoin
45
LP spinal level and to which space
L3/L4 (cord ends at L1/L2) into subarachnoid space
46
spontanous intracranial hypotension
postural headache worse when standing/sitting - relieved by laying down Extrathecal leakage of CSF diagnosed CT myelogram Tx epidural blood patch common cause = LP
47
loss of vision right upper quad of both eyes
left inferior optic radiation
48
bacterial meningitis CSF
CSF pressure raised protein raised glucose low polymorphs
49
MMSE score
out of 30 <26 abnormal 20-26 mind dementia 10-20 moderate dementia
50
degenerative cervical myelopathy (DCM) what is it
progressive degen of spinal cord in cervical - associated w age related changes in spine and caused by wear and tear over time leads to compression and damage of spinal cord Age related changes - herniated discs between vertebae (bulge/herniate -= compress cord) - Osteophytes (abnormal bony outgrowths= same) - Ligament thickening (ligs in spine thicken = same) ix MRI tx decompressive surgery
51
Homonymous quadrantopia
PITS parietal = inferior Temporal = superior
52
webers syndrome
Stroke of Posterior cerebral artery ipsilateral oculomotor palsy (bc CN3 runs close to PCA in midbrain) contralateral hemiparesis
53
assessing stroke in acute setting
exclude hypoglycaemia then ROSIER score>0 = stroke likely
54
paroxsysmal hemicrania vs cluster headache
PH = Duration = shorter 2-30mins (not 15m-3h) freq= more -sometimes more than 10 (1-3times a day) Time = anytime even night (circadian same time evryday during night) tx = indomethacin (o2, triptans, verapamil)
55
Abx causing ICH
tetracycines
56
ICH Sx
Papilloedema (sx =transient vision loss) early morning headaches which improve in day (bc horizontal laying = increases pressuremore)
57
progressive supranuclear palsy
parkinsonism AND cant move eyes up and down and slurred speech
58
GBS diagnosis
LP- shows increased protein and normal white cel count after 1-2 weeks
59
amaurosis fugax path
ipsilateral stroke of retinal/ophthalmic artery
60
PICA (posterior inf cerebellar artery) lateral medullary syndrome
cerebellar signs (ataxia nystagmus dysphagia) contralateral sensory loss upper and lower limb ipsilateral facial sensory loss and horners syndrome
61
lhermittes sign
tingling in hands when neck flexed (MS)
62
Uhthoffs phenomenon
worsening of vision following rise in body temp (MS)
63
bladder dysfxn in MS pt n mx
urgency incontinence overflow get ultrasound KUB first 4 bladder emptying lots of residual = intermittent self cath no sig residual volume = anticholernergics may improve
64
oscillopsia in MS
visual fields appear to oscillate tx = gabapentin
65
chronic SDH on CT
hypodense (dark) crescent shaped, not limited by suture lines
66
juvenile myoclonic epilepsy (janz syndrome)
teenage yrs (12-16) MC in girls infrequent generalised seizures in the morning/after sleep deprivation daytime absences sudden shock like myoclonic seizures (may develop before seizures) tx sodium valp
67
locked in syndrome artery n pt
basillar artery 3 main presentations; - acute decreased GCS and advanced motor sx - insidious gradual deterioration in GCA n motor sx with sudden subsequent advanced decrease in both - herald hemiparesis w asx headache n vision changes prior to onset of permenant loss of motor symptoms
68
Branches of posterior cerebral artery which supply midbrain (Webers)
ipsilateral oculomotor CN3 palsy contralateral weakness of upper and lower extrem
69
myathenia crisis mx
IV ig and plasmapharesis
70
wernickes encephalopathy triad snd tx
confusion (encephalopathy) ataxia nystagmus/ophthalmoplegia (lateral rectus palsy) chronic alcoholics tx = Pabrinex (IV B1/C vit)
71
complication of wernickes encephalopathy
if left untreated by thiamine - may develop to korsakoffs ie triad + antero&retrograde amnesia Confabulation
72
What meds can excerbate MG
beta blockers
73
glioblastoma on imaging n prognosis
solid tumors w central necrosis n rim that enhances with contrast disrupts blood brain barrier therefore asx w vasogenic oedema MC primary brain tumor poor prog <1yr
74
Glioblastoma on histology and tx
pleomorphic tumor cells border necrotic areas TX - surgucal w post op chemo/radio dexameth for oedema
75
meningioma what is it
2nd MC primary brain tumor usually benign, extrinsic tumors of central nervous sytem arise from arachnoid cap cells of meninges and typically located next to dura cause sx of compression rather than invasion
76
meningioma location and histology, investigation
falx cerebri, superior sagittal sinus, convexity or skull base histology: spindle cells in concentric whorls and calcified psammoma bodies ix; CT = contrast enhancement & MRI tx; will involve either observation, radiotherapy or surgical resection
77
migraine tx
acute = triptan + (NSAID or paracetamol) Proph = topiramate or propanol avoid top in women childbearing age
78
temporal lobe seizures
with or without LOC Aura: - Rising epigastric sensation - deja vu - sometimes hallucinations; auditory/gustatory/olfactory seizures last 1 min; - automatisms ie lip smacking, grabbing, plucking
79
nerves affected during axillary discection
intercostobrachial nerves = impair sensation in axilla
80
smiths fracture
reverse colles ie fall on back of hand with wrist flexed = broken distal radius moved towards palmar side median nerve affected = thenar muscle loss of function = cant oppose thumb
81
supracondylar fracture
fall on outstretched hands in kids esp = humerus brake just above condyles = median nerve affected - loss of pronation
82
carotid endarterectomy in pt w TIA
considered if carotid artery stenosis> 70% on contralateral side to sx
83
early sign of brain mets
CN6 palsy (lateral rectus) = medially pointed eye + horizontal diplopia (excerbated by reading)
84
subacute degeneration of spinal cord cause and presentation
b12 def = impairment of dorsal columns, lateral corticospinal trats and spinocerebellar tracts dorsal = distal symmetrical sensory loss in legs more than arms (tingling/burning) + impaired propioception and vib LCST = hyperreflex, spaciity muscle weakness UMN signs in legs first brisk knee reflexes absent ankle jerks extensor plantars SCT = sensory ataxia - gait abnormal +ve rombergs
85
PCA stroke
contralateral homonymous hemanopia w macular sparing visual agnosia (cant recognise objects)
86
how long no drive after first unprovoked/isolated seizure if brain imaging and EEG normal
6 months
87
phenytoin side affects
peripheral neuropathy - glove and stocking distribution gingival hyperplasia lymphadenopathy
88
what should you always do before giving folate
replace b12 - otherwise precipitate subacute degen of spinal cord
89
klumpkes paralysis
damage to t1 traction injury = loss of intrinsic hand muscles (no thumb adduction and inger abduction) loss of sensation of medial epicondyle
90
temporal arteritis vision testing for what complications
anterior ischaemic neuropathy (most) temp vision loss (amaurosis fugax) diplopia permenant vision loss often sudden !!!
91
temporal arteritis what is anterior ischaemic neuropathy fundo
occlusion of posterior ciliary artery (branch of opthalmic artery) -> ischaemia of optic head fundoscopy -> swollen pale disc and blurred margins
92
frontal lobe siezure
(motor) head/leg movements posturing post ictal weakness jacksonion march
93
parietal lobe seizure
(sensory) paraesthesia
94
occipital lobe seizure
(visual) floaters/flashes
95
radial nerve injury (root) how and what
c5-T1 fracture of humeral shaft = wrist drop impaired wrist extension and impaired sensation over dorsal aspect of 1st and 2dnd metocarpal bones
96
fracture of olecranon
ulnar nerve injury claw hand hyperexten of metocarpalphalyngeal joints flexion at distal and proximal interphalangeal joints of 4th n 5th digits radial deviation of wrist sensory loss to palmar and dorsal medial 1.5 fingers
97
supracondylar fracture
ulnar nerve damage
98
axillary nerve damage present
flattened deltoid impaired shoulder abduction
99
causes of axillary nerve damage
frac of humeral neck or proximal humerus
100
how would you differentiate brain abcess from high grade tumor ie glioblastoma
abcess = restricted diffusion on diffusion weighted imaging
101
Homonymous quadrantopia superior lesion
Superior = temporal therefore lesion of inferior optic radiation in temp lobe (meyersloop)
102
Homonymous quadrantopia inferior lesion
inferior = parietal lesion of superior optic radiation in parietal lobe
103
migraine precip factors
CHOCOLATE Chocolate hangovers orgasms cheese/caffeime Oral pill lie ins alcohol travel exercise
104
where does HSV encephalitis affect
temporal lobe (medial) ie = aphasia also intferior frontal lobe seen on CT
105
HSV encephalitis tx ans what may you see on EEG
IV aciclovir lateralised periodic discharges at 2Hz
106
Jarisch-Herxheimer reaction and tx
Fever, rash, chills and headache occurs following antibiotic administration for syphilis (24hrs) supportive tx and antipyretic (use paracetamol)
107
symptomatic chronic subdural bleeds
burr hole evacuation
108
lumbar spinal stenosis ix and tx
MRI showing canal narrowing tx = laminectomy
109
neuroleptic malignant syndrome and serotonin syndrome both sx
drug reaction tachycardia, inc BP pyrexia sweating muscle rigidity both tx iv fluids and benzos
110
neuroleptic malignant syndrome over serotonin
caused by antipsychotics slower onset ie hours -days reduced reflexes, lead pipe rigidity normal pupils
111
neuroleptic malignant severe cases tx
dantrolene
112
serotonin syndrome over neuro mal
caused by ssri, moai, mdma, norval psychoactive stimulants faster onset (hours) increased reflexes, clonus, dilated pupils
113
mc of severe serotonin syndrome
cyproheptadine chlorpromazine
114
features of lithium tox
course tremor (fine tremor = in therapeutic range) hyperreflexia acute confusion polyuria seizure come
115
lithium tox tx
mild -mod = volume recuss w saline severe = haemodialysis
116
bacterial meningitis LP
opening pressure up turbid inc wbcs neutrophuls low glucose high protein
117
viral meningitis LP
normal pressure clear wbc lymphocytes normal glucose high protein
118
neoplastic spinal cord compression cause
lung breast prostate
119
neoplastic spinal cord compression features
back pain worse on lying down and coughing lower limb weakness sensory loss and numbless above l1 = UMW signs in legs below L1 = lmn signs in legs and perianal numbness
120
neoplastic spinal cord compression ix and tx
urgent MRI 24 hrs high dose oral dex urgent onco assessment for radiotherapy or assessment
121
CT head SAH
blood appears white (hyperdense) will be mixed with CSF this will be interhemispheric fissure, basal ganglia and ventricles
122
CT normal in SAH next ix
LP Xanthrochromia
123
what four bones meet at pterion
parietal temporal sphenoid frontal
124
extradural arterial or venous
arterial (middle meningeal)
125
subdural arterial or venous
venous
126
extradural CT pther fx
len shapes biconvex midline shift compression of ventricles
127
causes of seizure
space occupying lesion hypoglycaemia alcohol/withdrawal benzo withdrawal hepatic enceph infection ie menin n eceph trauma head injury
128
advice for seisures while waiting
avoid heavy machinerv shower instead od bath watch out alcohol/drugs/sleep deprivation when to call ambulance
129
median nerve muscles
LOAF lateral 2 lumbricals thenar mucles: opponens pollicus abductor pollicus flexor pollicis brevis
130
carpal tunnel ix
electromyography
131
why carbidopa
peripehal dopa-carboxylase inhib reduces periph breakdown = reduces SE and less levodopa needed
132