Neuro Flashcards
Alzheimers on imaging
mesial temporal lobe atrophy
anterior cerebral artery stroke
contralateral hemiparesis & sensory loss
Lower extremeties > upper extrem
Total anterior circulation infarct (TACI)
(middle and anterior cerebral)
1 unilat hempiparesis +/- hemisensory loss of face arms and legs
2 homonopious hemaonpia
3 higher cognative dysfxn ie dysphagia
anterior inferior cerebellar
lateral pontine
sudden onset vertigo & vom
ipsilateral facial paralysis and deafness
aphasia where is brocas and what time
presenation
suppilied by
expressive ie speech made then sent here
inferior frontal gyrus
normal comprehension
speech non fluent
repetition impaired
Superior dividion of MCA
aphasia where is wernickes
suplied by
presentation
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’
condustion aphasia where
and presentation
stroke in connection of arcuate fasiculus
speech fluent but poor
pt aware of errors
normal comprehension
global aphasia
where
presentation
large lesion affecting all 3
servere expressive and receptive aphasia
may still be able to communicate with gestures
true seizures may show compared to pseudoseizures
prolactin increase 10-20min after
parksinons path
loss of dopaminergic neruons in substantia nigra = loss of excitatory signal
less dopamine (d2) = less GABA (inhibitory) = increased movement
parkinsons tx
Motor sx impacting QOL = levodopa-carbidopa
Motor sx not yet impacting = Dop agonist ie ropinirole
MAO-B inhib ie selegiline
essential tremor presentation n tx
no tremor at rest
worsens with movement
propanolol
cerebellar lesion tremor
no tremor at rest
worsens w movement gets worse w intention ie closer u get
huntingtons ix
genetic testing - CAG repeats in HTT allele
CT/MRI
atrophy (caudate striatal frontal)
dilated lateral ventricles
huntingtons tx
supportive and sx tx
counselling n support for pt and family
psychiatric - SSRIs, ECT, antipsychotics,CBT
Chorea - benzos
Bradykinesia/rigidity - Dopamine agonists, levodopa
Spinal stenosis presentation
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)
syringomyelia path and ix, sx and tx
associated with
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
normal pressure hydrocephalus path presenation
ix
tx
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
picks disease
FTD dementia
lewy body pathway n presentation
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
alzheimers tx
cholinesterase inhib
donezepil n rivastigmine
severe = memantine
CJ disease (mad cow)
prions accumulation
young rapid dementia myoclonus
Reversible causes of dementia
b12 def
hypothyroid
electrolyte abnormality (CKD)
syphilis
Normal pressure hydrocephalus
anaemia
Anterior spinal artery occlusion
bilateral spastic paresis
loss of pain and temp
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
Bitemporal hemanopia if upper quad worse then lower
pituatry tumor
bitemporal hemanopia
lower quad worse than upper
craniopheningoma
pontine haemorrahe cause and presentation
life threatening emergency
chronic HTN complication
reduced GCS
quadraplegia
miosis
absent horizontal eye movements
extradural haemorhage
middle meningeal artery
MCA stroke presentation
contralateral paralysis and sensory loss of face and upper limbs
aphasia if infarct in dominant hemisphere
bells palsy
no foreheard sparing (bc LMN)
loss of taste anterior 2/3 tongue
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
wilsons diagnostic test
24hr urine collection
L5 root lesion
reduced ankle eversion and inversion and dorsiflexion
sensory loss over big toe
pundendal nerve block what nerve fibres and palpate where
fibres S2,S3,S4
palpate ischial spine transvaginaly
GCS
eyes
Eyes open spontaneously – 4
Eyes open to speech – 3
Eyes open to pain – 2
Eyes do not open – 1
GCS
verbal
Orientated – 5
Confused – 4
Inappropriate words – 3
Inappropriate sounds – 2
No verbal response – 1
GCS
motor
Obeys commands – 6
Localises pain – 5
Withdraws from pain – 4
Abnormal flexion – 3
Abnormal extension – 2
No response – 1
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
stroke no driving for how long
4 weeks
duchenne muscular dystrophy tx
steroids
brown sequard
hemisection of cord
ipsilateral loss of vibration and proprioception and hemiplegia
contralateral pain and temp
pinealoma
slowgrowing tumor of pineal gland
may press on midbrain cerebral aqueduct = non communicating hydrocephlaus
if compress edinger westphal nuclei = mydriasis (pupil dilation)
had two epsiodes of seizure both resolved but now having another seizure
IV phenytoin
LP spinal level and to which space
L3/L4 (cord ends at L1/L2)
into subarachnoid space
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
loss of vision right upper quad of both eyes
left inferior optic radiation
bacterial meningitis CSF
CSF pressure raised
protein raised
glucose low
polymorphs
MMSE score
out of 30
<26 abnormal
20-26 mind dementia
10-20 moderate dementia
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
Homonymous quadrantopia
PITS
parietal = inferior
Temporal = superior
webers syndrome
Stroke of Posterior cerebral artery
ipsilateral oculomotor palsy (bc CN3 runs close to PCA in midbrain)
contralateral hemiparesis
assessing stroke in acute setting
exclude hypoglycaemia
then ROSIER
score>0 = stroke likely
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)
Abx causing ICH
tetracycines
ICH Sx
Papilloedema (sx =transient vision loss)
early morning headaches which improve in day (bc horizontal laying = increases pressuremore)
progressive supranuclear palsy
parkinsonism AND
cant move eyes up and down and slurred speech
GBS diagnosis
LP- shows increased protein and normal white cel count after 1-2 weeks
amaurosis fugax path
ipsilateral stroke of retinal/ophthalmic artery
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
lhermittes sign
tingling in hands when neck flexed (MS)
Uhthoffs phenomenon
worsening of vision following rise in body temp (MS)
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
oscillopsia in MS
visual fields appear to oscillate
tx = gabapentin
chronic SDH on CT
hypodense (dark)
crescent shaped, not limited by suture lines
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
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
Branches of posterior cerebral artery which supply midbrain (Webers)
ipsilateral oculomotor CN3 palsy
contralateral weakness of upper and lower extrem
myathenia crisis mx
IV ig and plasmapharesis
wernickes encephalopathy triad snd tx
confusion (encephalopathy)
ataxia
nystagmus/ophthalmoplegia (lateral rectus palsy)
chronic alcoholics
tx = Pabrinex (IV B1/C vit)
complication of wernickes encephalopathy
if left untreated by thiamine - may develop to korsakoffs
ie triad + antero&retrograde amnesia
Confabulation
What meds can excerbate MG
beta blockers
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
Glioblastoma on histology and tx
pleomorphic tumor cells border necrotic areas
TX - surgucal w post op chemo/radio
dexameth for oedema
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
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
migraine tx
acute = triptan + (NSAID or paracetamol)
Proph = topiramate or propanol
avoid top in women childbearing age
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
nerves affected during axillary discection
intercostobrachial nerves
= impair sensation in axilla
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
supracondylar fracture
fall on outstretched hands in kids esp = humerus brake just above condyles
= median nerve affected - loss of pronation
carotid endarterectomy in pt w TIA
considered if carotid artery stenosis> 70% on contralateral side to sx
early sign of brain mets
CN6 palsy (lateral rectus)
= medially pointed eye + horizontal diplopia (excerbated by reading)
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
PCA stroke
contralateral homonymous hemanopia w macular sparing
visual agnosia (cant recognise objects)
how long no drive after first unprovoked/isolated seizure if brain imaging and EEG normal
6 months
phenytoin side affects
peripheral neuropathy - glove and stocking distribution
gingival hyperplasia
lymphadenopathy
what should you always do before giving folate
replace b12 - otherwise precipitate subacute degen of spinal cord
klumpkes paralysis
damage to t1
traction injury
= loss of intrinsic hand muscles (no thumb adduction and inger abduction)
loss of sensation of medial epicondyle
temporal arteritis vision testing for what complications
anterior ischaemic neuropathy (most)
temp vision loss (amaurosis fugax)
diplopia
permenant vision loss often sudden !!!
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
frontal lobe siezure
(motor)
head/leg movements
posturing
post ictal weakness
jacksonion march
parietal lobe seizure
(sensory)
paraesthesia
occipital lobe seizure
(visual)
floaters/flashes
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
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
supracondylar fracture
ulnar nerve damage
axillary nerve damage present
flattened deltoid
impaired shoulder abduction
causes of axillary nerve damage
frac of humeral neck
or proximal humerus
how would you differentiate brain abcess from high grade tumor ie glioblastoma
abcess = restricted diffusion on diffusion weighted imaging
Homonymous quadrantopia superior lesion
Superior = temporal
therefore
lesion of inferior optic radiation in temp lobe (meyersloop)
Homonymous quadrantopia inferior lesion
inferior = parietal
lesion of superior optic radiation in parietal lobe
migraine precip factors
CHOCOLATE
Chocolate
hangovers
orgasms
cheese/caffeime
Oral pill
lie ins
alcohol
travel
exercise
where does HSV encephalitis affect
temporal lobe (medial)
ie = aphasia
also intferior frontal lobe
seen on CT
HSV encephalitis tx ans what may you see on EEG
IV aciclovir
lateralised periodic discharges at 2Hz
Jarisch-Herxheimer reaction and tx
Fever, rash, chills and headache occurs following antibiotic administration for syphilis (24hrs)
supportive tx and antipyretic (use paracetamol)
symptomatic chronic subdural bleeds
burr hole evacuation
lumbar spinal stenosis ix and tx
MRI showing canal narrowing
tx = laminectomy
neuroleptic malignant syndrome and serotonin syndrome both sx
drug reaction
tachycardia, inc BP
pyrexia sweating
muscle rigidity
both tx iv fluids and benzos
neuroleptic malignant syndrome over serotonin
caused by antipsychotics
slower onset ie hours -days
reduced reflexes, lead pipe rigidity
normal pupils
neuroleptic malignant severe cases tx
dantrolene
serotonin syndrome over neuro mal
caused by ssri, moai, mdma, norval psychoactive stimulants
faster onset (hours)
increased reflexes, clonus, dilated pupils
mc of severe serotonin syndrome
cyproheptadine
chlorpromazine
features of lithium tox
course tremor (fine tremor = in therapeutic range)
hyperreflexia
acute confusion
polyuria
seizure
come
lithium tox tx
mild -mod = volume recuss w saline
severe = haemodialysis
bacterial meningitis LP
opening pressure up
turbid
inc wbcs neutrophuls
low glucose
high protein
viral meningitis LP
normal pressure
clear
wbc lymphocytes
normal glucose
high protein
neoplastic spinal cord compression cause
lung breast prostate
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
neoplastic spinal cord compression ix and tx
urgent MRI 24 hrs
high dose oral dex
urgent onco assessment for radiotherapy or assessment
CT head SAH
blood appears white (hyperdense)
will be mixed with CSF
this will be interhemispheric fissure, basal ganglia and ventricles
CT normal in SAH next ix
LP
Xanthrochromia
what four bones meet at pterion
parietal
temporal
sphenoid
frontal
extradural arterial or venous
arterial (middle meningeal)
subdural arterial or venous
venous
extradural CT
pther fx
len shapes biconvex
midline shift
compression of ventricles
causes of seizure
space occupying lesion
hypoglycaemia
alcohol/withdrawal
benzo withdrawal
hepatic enceph
infection ie menin n eceph
trauma head injury
advice for seisures while waiting
avoid heavy machinerv
shower instead od bath
watch out alcohol/drugs/sleep deprivation
when to call ambulance
median nerve muscles
LOAF
lateral 2 lumbricals
thenar mucles:
opponens pollicus
abductor pollicus
flexor pollicis brevis
carpal tunnel ix
electromyography
why carbidopa
peripehal dopa-carboxylase inhib
reduces periph breakdown = reduces SE and less levodopa needed
