Neuro Flashcards
what drugs are antiemetics used mainly in the management of chemo related nausea
5- HT 3 antagonists eg ondansetron and palonsetron
what arteries are Brocas area and wernickes area supplied by
brocas- superior divison of the left middle cerebral artery
wernicks - inferior division of the left middle cerebral
wernickes area is in what lobe
temporal
what is a connection between the wernickes and brocas area
arcuate fasiculus (conduction aphasia)
global aphasia affects all 3 areas examples being
brocas, wernickes and arcuate fasiculus
what is poor in conduction aphasia
repitition
what describes the downward displacemtns or herniation of the cerebella tonsils through the foramen magnum
arnold chairi malformation
what part of the cerebellum causes gait ataxia
cerebellar vermis
what part of the cerebellum causes finger to nose ataxia
cerebellar hemisphere
autonomic dysreflexia occurs if have spinal cord injury above what level
T6
autonomic dysrefelxia most commonly triggered by
faecal impaction or urinary retention
how does autonomic dysreflexia present
extreme hypertension, flushing and sweating above the level of the cord lesiomn
bells palsy is more common in
pregnant woman
in bells palsy what other signs may the patient notice
post auricular pain, altered taste, dry eyes, hyperacusis
what supplies the tip of the fingers on the back of the hand of thumb, index and middle finger
medial nerve
what brachial plexus injury can cause a winged scapula and what can cause loss of instrinsic hand muscles
winged scapula - erb duchenne
hand muscles - klumpkes
mx of brain abscess
srugery - to debride and IV antibitocs
what is the syndrome in the dominant parietal lobe that has - inabiloity to read, calculate, finger agnosia and right left disorientation
gerstmann syndrome
what area forms the speech before sending it to brocas area
wernickes
3 main facts about the temporal lobe
wernickes, hearing, and diffuclty recognising faces
wernickes and korsakoff syndrome can affect what area
mammilary body
huntingtons chorea affects what part of the brain
striatum (caudate nucleus) of the basal ganglia
most common cancer to metastases to the brain is
lung
5 cancers that most commonly metastasise to the brian
skbbl
skin
kidney
breast
bowel
lung
what is the most common primary tumour in adults
glioblastoma
glioblastoma multiforme is associated with what
vasogenic oedema
what has pleomorphic tumour cells
glioblastoma
second most common primary brain tumour in adults
meningioma
what tumour has spindle cells and calcified psammoma bodies
meningioma
most common primary brain tumour in children
pilocytic astrocytoma (rosenthal fibres -corkscrew eosinophilic bundle)
brain tumour associated with von hippel lindau
haemangioblastoma
what tumour is derived from the remnants of Rathke pouch
craniopharyngioma
carbamazepine is a first line in what kind of seizures
partial
mechanism of action of carbamazepine
binds to sodium channels
what cells in the choroid plexus produce csf
ependymal
csf is reabsorbed where
arachnoid granulations
most common herediatry peripheral neuropathy
charcot marie tooth disease - may be a history of frequently sprained ankles, foot drop
cluster headches are more common in
men and smokers
what can tigger an attack of a cluster headache
alcohol
clusters of cluster headahces typically last
4-12 weeks
what is the investigation of choice in cluster headahces
MRI with gadolinium
best scan for brain tumours
MRI
loss of blink (AFFERENT), mastication muscles and jaw jerk is what cranial nerve
trigeminal
loss of blink is what 2 cranial nerves
trigeminal (afferent)
facial (efferent)
loss of taste is what cranial nerve
facial
loss of gag reflex is what 2 nerves
glossopharynheal (afferent)
vagus (efferent)
jaw jerk is esspecial what CN
V3
pupillary nerve reflex involves what cranial nervs
optic and occulomtor
corneal reflex involves what cranial nervs
V1 and facial
hoffmans sign relates to
degenerative cervical myelopathy
what is hoffmans sign
postivie sign is -flicking one finger of the patients hand results in twitching of the other fingers on the same hand in response to the flick
what is the gold standard test for degenerative cervical myelopathy
MRI of the cervical spine
only treatment for degenerative cervical myelopathy
decompressive surgery
big toe and dorsum of foot is what dermatome a
L5
inguinal ligament is what dermatome
L1- L for ligament and 1 for 1inguinal
first seizure how long can they not drive for
6 months
if got epilsepsy need to be seizure free for how long
12 motnhs
if have stroke or TIA need to have how long off driving
1month
responsible for most cases of encephalitis
HSV 1
what should be started in all cases of suspected encephalitis
IV aciclovir
around 30% of patietns with — have epilepsy
cerebral pasly
alcohol withdrawl leads to what
decreased inhibition of GABA
patietns are often given what following cessation of drinking alcohol to reduce the risk of seizures
benzos
consciosness is lost immediately in what kind of seizures
generalised
investigation patient will have after first seizure
EEG ( electronencephalogram) and MRI
when to start antiepileptic meds
following second epileptic seizure
breastfeeding is geenrally considered safe if on antiepileptics with exception being the
barbiturates
some side effects of sodium valpraote
weight gain and alopecia
what epileptic med you need to watch out for stevens johnson syndrome
lamotrogine
what are often termed rescue medication for seizures
benzos such as diazepam
an aura is typically a
rising epigastric sensation
female treatment of tonic clonic seizures
lamotrogine or levetiracetam
first line for everyone for focal seizures
lamotrogine or levetiracetam
first line for everyone for a focal seizure
lamotrogine or levetiracetam
essential tremor has what inheritance
autosomal domiantn
what tremor is worse when arms are outstrethced
essential tremor
after extradural haemorrhage can get what hernaition causeing dialted pupil
uncal
biconvex
extradural
what haemorrhage is limited by the suture lines of the skull
extradural
what is the definitive treatment of extradural
craniotomy and evacuation
what is suggestive of L5 radiculopathy
weakness of hip abduction
mx of common peroneal nerve injury
conservative managemt
GAA repeat
friedrichs ataxia
how is friedrichs ataxia unusual in that it is a trinucleotide repeat disorder
it does not demonstrate anticipation
gait ataxia and what are the most common presenting feeatures of friedrichs ataxia
kyphoscoliosis
most common cause fo death in friedrichs ataxia
hypertrophic obstructive cardiomyopathy
guillian barre is classicaly triggered by
campylobacter jejuni
investigation in guillian barre
lumbar puncture to see rise in protein with a normal white cell count
herepes simplex encephalitis tends to affect what lobes of the brain
temporal
csf in encephalitis shows
lymphocytosis and elevated protein
big thing that affects prognosis of encephalitis
how quickly aciclovir is started
huntingtons disease has what inheritance
autsomal dominant
trinucelotide repeat disorder of CAG
huntingtosn
antibiotic that is a rf for IIH
tetracyclines
why is topiramate good in IIH
inhibits carbonic anhydrase and causes weight loss
what has impaired adduction of the eye on the same side as the lesion
horizontal nystagmus of the abducting eye on the contralateral side
internuclear opthalmoplegia
where is the lesion in internuclear opthalmoplegia
medial longitudinal fasciculus
what is gold standard for intracranial venous thrombosis
MRI venography
what symptoms are more common in myasthenia gravis as opposed to lambert eaton syndrome
opthalmoplegia and ptosis
lamotrogine mechanism of action
sodium channel blcoker
posterior inferior cerebella artery syndrome affects what contralteraly
limb sensory loss
what drug can cause reddish discolouration of urine upon standing
levodopa
levodopa ussually has reduced effectiveness after how long
2 years
managemetn of medication overuse headache
should stop algesics or triptans abruptly even though it may initially worsen the headache. however opiod analgesics should be gradually withdrawn
most comon complication of meningitis is
sensorineural hering loss
in children migraine attacks is more commonly
bilateral and Gi disturbances are more promient
5HT agonists are used in the acute treatment and 5HT ANTagonists are used in prophylaxis for what
migraine
firsst line for acute migraine
oral triptan and NSAID, oral triptan and paracetemol
3 options for prophylaxis of a migraine
propanolol, topiramate and amitryptiline
what migraine prophylaxis should be avoided in women of child bearing age
topiramate
what is first line for migraine during pregancy
paracetemol
why is combined oral contraceptive pill contraindicated in migraine
increased risk of stroke
what is the most common presentation of ALS
asymetric limb weakness
watsting of what muscels is common in MND
hand muscles adn tibilais anterior
MND does not affect what muscels
external ocular muscles
nerve conduction studeis in MND will show
normal motor conduction - so can exclude a neuropathy
what is usually performed in suspected MND to exlude cervical cord compression and myelopathy
MRI
prolongs life in ALS
riluzole
what MND has UMN signs only
primary lateral sclerosis
what MND has LMN signs only, affects distal muscles before proximal and carries best prognosis
progressive muscular atrophy
MND that has the worst prognosis
progressive bulbar palsy
what MS typically occurs afetr relapsing remitting
secondary progressive
what disorders are generally seen in secondary progressive MS
gait and bladder disorders
Uhthoff’s phenomenon: worsening of vision following rise in body temperature - occurs in??
MS
lhermittes syndrome is paraestheis in limbs on neck flexion is seen in what
MS
high signal T2 lesions
periventricular plaques
Dawson fingers: often seen on FLAIR images - hyperintense lesions penpendicular to the corpus callosum
seeen in what
MS
csf can show oligoclonal bands in CSf and
increased synthesis of igG
first line drug for preventing relapse in MS
natalizumab or ocrelizumab
medication that can be sued for fatigue in MS
amantadine
the other first line for spasticity
gabapentin
features of multiple system atrophy
parkinsonism, autonmic stuff and cerebellar signs
myasthenia gravis is asscociated with what
thymomas
invesigations for myasthenia gravis
electromyography is highly sensitive and CT thorax to exclude thymoma
first line management for myasthenia gravis
pyridostigmine
management of myasthenic crisis
plasmaphereiss
drugs that can exacerbate myasthenia gravis one example
beta blcokers
narcolepsy is associated with – , a protein which is responsinle for controlling apeteite and sleep patterns
hypocretin
investigation for narcolepsy
multiple sleep latency EEG
neurlopetic malignnat syndrome can occur with atypcial antipsychotics but also with
levodopa usually when the drug is stopped or dose reduced
bromocriptine adn dantrolene may be used for
neuroleptic malignant sydnroem
