Neuro Flashcards
In ischaemic stroke and new AF, when is anticoagulation started?
After 14 days
What are the indications for thrombolysis in ischaemic stroke?
4.5 hours of onset of symptoms
Haemorrhagic definitively excluded
What are the contraindications for thrombolysis in ischaemic stroke?
Seizure Intracranial neoplasm Uncontrolled hypertension Pregnancy Stroke in prev 3 months
What are the indications for mechanical thrombectomy?
Within 6 hours of ischaemic PCA stroke (with IV thrombolysis within 4.5 hours)
Between 6-24h of symptoms (including wake up strokes) of PCA strokes, AND imaging showing limited infarct core volume
What is the secondary prevention in ischaemic stroke?
300mg aspirin 14 days then 75mg clopidogrel long term
What is secondary prevention in TIA?
75mg aspirin for 14 days followed by 75mg clopidogrel long term
What is the arcuate fasciculus?
Bundle of axons that connects Broca’s area and Wernicke’s area
Where is the lesion that causes bitemporal hemianopia?
Optic chiasm
What type of bitemporal hemianopia is caused by pituitary tumour/craniopharyngioma?
Pituitary - inferior chiasmal compression - upper>lower
Craniopharyngioma - super chiasmal compression - lower>upper
What is the possible cause of transient global amnesia?
Transient ischaemia of the thalamus
What are 6 causes of cerebellar syndrome?
Friedreich's ataxia/ataxia telangiectasia Cerebellar haemangioma Stroke Alcohol MS Hypothyroidism
What is the mechanism of action of phenytoin?
Binds to sodium channels which increases their refractory period
What are the acute side effects of phenytoin?
Dizziness, diplopia, slurred speech, ataxia, seizures
What are the chronic side effects of phenytoin?
Gingival hyperplasia Hirsuitism Megaloblastic anaemia Peripheral neuropathy Osteomalacia TEN Lupus Hepatitis
What is seen on EEG in absence seizures?
Bilateral symmetrical 3Hz spike and wave pattern
Which anti-epileptics worsen absence seizures?
Carbamazepine
Phenytoin
Gabapentin
What is the triad of normal pressure hydrocephalus?
Urinary incontinence
Dementia
Bradyphrenia
What is the cause of normal pressure hydrocephalus?
Reduced CSF absorption at the arachnoid villi
What is the pathophysiology of SDH?
If acute - high impact injuries associated with diffuse axonal injuries
Chronic - rupture of cortical bridging veins and bleeding into the outermost meningeal layer
What are the features of SDH?
Chronic: fluctuating consciousness
Acute: comatose from outset
What is seen on CT in SDH?
Crescent shape collection of blood
What is the cause of extradural haematoma
Temporal region blow - skull fracture causes a rupture of middle meningeal artery
What are the features of extradural haematoma?
Lucid interval
What is seen on CT on extradural haematoma?
lemon shaped collection of blood
What is the condition where there is sudden enlargement of a pituitary tumour secondary to haemorrhage of infarction?
Pituitary apoplexy
What are the features of pituitary apoplexy?
Mimics SAH
Extra-ocular nerve palsies
Hypotension/hyponatraemia secondary to hypoadrenalism
What is the main cause of upbeat nystagmus?
Cerebellar vermis lesions
What are 2 causes of downbeat nystagmus?
Arnold-Chiari malformation
Foramen magnum
Which antibiotics are used in cerebral abscess?
IV 3rd gen cephalosporin and metronidazole
What are the risk factors for IIH?
Obesity Female Pregnancy COCP Steroids Tetracyclines Vitamin A
What is Arnold-Chiari malformation?
Downward displacement/herniation of the cerebellar tonsils through the foramen magnum
What are the features of Arnold-Chiari malformation?
Non-communication hydrocephalus
Headache
Syringomelia
What causes the symptoms of syringomelia?
Dilation of a CSF spacee within the spinal cord, causing compression of the spinothalamic tracts decussating in the anterior white commissure
What are the features of syringomelia?
Dissociative loss of sensation of pain, temperature, non-discriminative touch
Cape like distribution of sensory loss
What are the features of Gerstmann’s syndrome?
Alexia
Acaculi
Finger Agnosia
Right-left disorientation
Where is Broca’s area?
Inferior frontal gyrus
What is seen in parietal lesions?
Apraxia
Asterognosis
Inferior homonymous quadrantanopia
Sensory inattention
What is seen in occipital lesions?
HH with macula sparing
Cortical blindness
Visual agnosia
What is seen in temporal lobe lesions?
Wernicke’s aphasia
Superior homonymous quadrantanopia
Auditory agnosia
Prosopagnosia
What is seen in frontal lobe lesions?
Broca's (expressive aphasia) Disinhibition Perserveration Anosmia Inability to generate a list
What is the pathophysiology of Lambert Eaton myasthenic syndrome?
Antibody against pre-synaptic voltage gated calcium channels
Associated with SCLC, breast, ovarian Ca
What are the features of Lambert-Eaton myasthenic syndrome?
Repeated muscle contractions lead to increased muscle strength Proximal muscles Hyporeflexia Dry mouth Impotence
Which antibody is associated with cerebellar syndrome and ovarian/breast cancer?
Anti-Yo
Which antibody is associated with painful sensory neuropathy, cerebellar syndrome, SCLC/neuroblastoma?
Anti-Hu
Breast Ca/SCLC and ocular opsoclonus-myoclonus is associated with which antibody?
|Anti-Ri
What is Steele-Richardson-Olszewski syndrome?
Progressive supranuclear palsy
What are the features of progressive supranuclear palsy?
Postural instability and falls Stiff broad based gait Impairment of vertical gaze Parkinsonism with prominent bradykinesia Cognitive impairment within months
What are the features of multiple system atrophy?
Parkinsonism
Autonomic disturbance - ED, postural hypotension, atonic bladder
Cerebellar signs
What is the pathophysiology of neuroleptic malignant syndrome?
Dopamine blockade by anti-psychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage
What is the treatment of neuroleptic malignant syndrome?
Dantrolene
Decreases excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, decreasing calcium release from sarcoplasmic reticulum
What is the treatment of severe serotonin syndrome?
Cyproheptadine
Chlorpromazine
What are the features of Meniere’s disease?
Hearing loss
Vertigo
Tinnitus
Sensation of fullness/pressure
Which drugs are ototoxic?
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
Which tracts does anterior spinal artery syndrome affect?
Lateral corticospinal and spinothalamic
What are the features of anterior spinal artery syndrome?
Bilateral spastic paresis
Bilateral loss of temperature and pain sensation
Which arteries supply Broca’s and Wernicke’s area?
Broca’s - superior division of left MCA
Wernicke’s - inferior division of left MCA
What is the syndrome of anterior cerebral artery stroke?
Contralateral hemiparesis and sensory loss
L limbs>U limb
What is the syndrome of middle cerebral artery stroke?
Contralateral hemiparesis and sensory loss, U limb>L limb
Unilateral facial droop
Aphasia
Contralateral HH
Stroke of the arcuate fasciculus results in what?
Conduction aphasia
What are the features of PCA stroke?
Contralateral HH with macular sparing
Visual agnosia
What is Weber’s syndrome a stroke of?
Medial portion of midbrain supplied by PCA branch
What is Benedikt syndrome a stroke of?
Tegmentum of midbrain and cerebellum supplied by PCA branch
What are the features of Weber’s syndrome?
Contralateral hemiparesis and 3rd nerve palsy
Stroke of posterior inferior cerebellar artery results in which syndrome?
Lateral medullary syndrome (Wallenberg syndrome)
What are the features of lateral medullary syndrome?
Ipsilateral dysphagia, facial numbness, CN palsy
Contralateral sensory loss
What are the symptoms of lateral pontine syndrome (AICA stroke)?
Ipsilateral facial paralysis and deafness
Cerebellar signs
Quadraplegia can result from a stroke of which artery?
Basilar artery
What is Millard-Gubler syndrome?
Stroke of pons
Ipsilateral 6th and 7th nerve palsies
Contralateral hemiparesis
What are the features of lacunar strokes?
Isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia
