Neuro Flashcards
WHat causes lateral medullary syndrome? What is this supplied by
Infarction of the lateral portion of the medulla oblingata
Posterior inferior cerebellar artery or vertebral artery
Features of lateral medullar syndrome
Loss of pain and temp sensation on the contralateral side of the body and on the ipsilateral side of the face (dysphagia, vertigo, dysarthria, horners syndrome and nystagmus)
Definition of parkinsonism
Collective term for a clinical syndrome that includes bradykineasia alongisde one other of
- tremor
- rigidity
- gait disturbance
Causes of parkinsonism
PD
Drug induced
Cerebrovascular disease
Dementia with lewy bodies
MSA
Progressive supranuclear palsy
Pathology of PD
Chronic progressive neurodegenerative disease linked to decreased dopamine production in the substrantia nigra
What gait is seen in PD
Shuffling
Diagnosis of PD
Mainly clinical
MRI
SPECT
What are parkinsons plus syndromes
A group of neurodegenerative diseases that consit of cardinal features of PD, alongside additional symptoms which include a reduced response to levodopa, dysarthria, autonomic dysfunction and supranuclear gaze palsy
Examples of the parkinsons plus syndromes
Multiple system dystrophy
Dementia with lewy odies
Progressive supranuclear palsy
Corticobasal degeneration
MEdications that are known to cause parkinsonism
Antipsychotics
metoclopramide
prochloperazine
tetrabenazine
sodium valproate
lithium
Signs and symptoms more consistent to the diagnosis of PD
Unilateral onset and patient asymmetry
Resting tremor
good response to levodopa
Levodopa induced dyskinea
Long disease course >10 yrs
Treatment of PD
- Levodopa or co-carledopa
- pramipexole or ropinorole
What drug can you use to improve dyskinesia affects of anti-parkinson medications?
Amantadine
What is the triad of NPH
Gait disturbance
Memory loss
Urinary Incontinence
Symptoms of L5/S1 disc prolapse
Low back pain
Sciatica
Limited straight leg raisiing
Loss of ankle reflex
Weakness of plantar flexion
Sensory loss in affected dermatome
A young otherwise healthy person who suddenly develops a stroke is likely to be caused by what?
Paradoxical embolus
Due to a patent foramen ovale
Imaging of choice if you were suspecting a paradoxical emboli secondary to patent FO
transoesophageal ECHO with doppler colour imaging
What is a common S/E of levodopa Tx
Dark urine
What is found in the CSF of patients with MS
Unpaired oligoclonal bands
S/E of topiramate
Weight loss
Renal stones
Congitive/behavioural changes
What is neuroepileptic malignant syndrome
Complication of treatment with antipsychotic drugs or withdrawl of dopamine agonists
Presentation of neuroepileptic malignant syndrome
Muscle rigidity
Autonomic instability
Hyperthermia
Altered mental state
Treatment of neuroepileptic malignant syndrome
Supportive measures
Ceasing of the responsible drug
Risk factors for neuroepileptic malignant syndrome
Dopamine disorders e.g. PD
Structural brain abnormalities
Genetics
Pathology of GBS
Segmental demyelination
Where do anti-Yo antibodies primarily occur?
In patients with paraneoplastic cerebellar degeneration (PCD) who have breast cancer or tumours of the ovary, endometrium and fallopian tube
Pathology of paraneoplasic cerebellar degeneration
Tumour cells express proteins normally expressed in the cerebellum, triggering an autoimmune reaction
S/Es phenytoin
Fatigue
Bone pain
Tingling and numbness in lower limbs
Gum hypertrophy
Antibodies of lambert eaten myasthenic syndrome (LEMS)
Anti voltage gated calcium channel Ab
Antibodies of myasthenia gravis
Acetylcholine receptor ab
When does labert eaten syndrome most often occur
As a paraneoplastic phenomenon - particular assosiation with small cell lung cancer
Reflexes - LEMS vs MG
LEMS - absence of reflexes
MG - reflexes unaffected
Autonomic features - LEMS vs MG
LEMS - autonomic features present
MG - uncommon
Fatgiue - LEMS vs MG
In contrast to MG, LEMS - temporary increase in muscle power post exercise
Treatment of LEMS
2,4-diaminopyradie (DAP)
IV immunoglobulins
and/or plasma exchange
Treatment of underlying cancer
Features of idiopathic intracranial HTN
High pressure headache
Worse on lying flat
Worse in the morning
Assosiated with papilloedema
What should be excluded if you are suspecting idiopathic intracranial HTN
Cerebral venous sinus thrombosis
Diagnosis of spontaenous intracranial hypotension
CSF opening pressure at LP (low)
CSF analysis NORMAL
MRI - diffuse pachymengineal enhancement, frequently in assosiation with sagging of the brain, tonsilar descent and posterior fossa crowding
Treatment of spontaenous intracranial hypotension
Conservative
Epidural blood patch
Is the headache better or worse lying down in spontaenous intracranial hypotension
Better lying down
Test for bradykinesia
Finger pinch test
Treatment of essential tremor
Propranolol
Primidone
What is tinels sign
Symptoms reproduced when tapping over the medial nerve
Seen in carpal tunnel syndrome
3 rules of the effects of paresis on diplopia
- Direction in which the distance between the images is at a maximum in the direction of the action of the paretic muscles
- Paresis of the horizontally acting muscles tends to produce mainly horizontal diplopia
- The image projected further from the centre belongs to the paretic eye
Which arteries are most commonly affected by thromboembolic disease in lateral medually syndrome
Vertebral or posterior inferior cerebellar arteries
What is multifocal motor neuropathy with conduction block closely related to
Chronic inflammatory demyelinating polyneuropathy
Antibodies of multifocal motor neuropathy with conduction block
Anti-GM1 antibodies
Presentation of multifocal motor neuropathy with conduction block
Asymmetrical motor neuropathies - usually in the upper limb
Reflexes may be preserved or slightly elevated at the onset of disease (causing frequent misidentification with MND)
Electro diagnostic hallmark of multifocal motor neuropathy
Motor conduction block
When would you do a sural nerve biopsy
If suspecting a vasculitc neuropathy
Presentation of progressive muscular atrophy (subtype of MND)
Lower motor neurone weakness distal upper and lower limbs
Without sensory loss
What does an upper motor neurone area involve
Brain
Spinal cord
What does a lower motor neurone area involve
Anterior horn cell
Motor nerve roots
Peripheral motor nerve
Signs of an UMN lesion
Disuse atrophy (minimal) or contractures
Increased tone (spasticity/rigidity) +/- ankle clonus
Pyramidal pattern of weakness (extensors weaker than flexors in arms, vise versa in legs)
Hyperreflexia
Upgoing plantars (Babinskis sign)
Signs of a LMN lesion
Marked atrophy
Fasiculations
Reduced tone
Variable pattern of weakness
Reduced or absent reflexes
Downgoing plantars or absent response
Presentation of primary lateral sclerosis (subtype of MND)
UMN weakness
Spascitity
Hyperreflexia
More likely to have bulbar involvement
Predominant symptoms of progressive bulbar palsy (subtype of MND)
Speech and swallowing difficulties
Presentation of sagital sinus thrombosis
Seizures
Focal neurological deficits
Predisposing factors for saggital sinus thrombosis
Dehydration
Haematological disorders
- anti-phospholipid, thrombophilia, protein S deficency, antithrombin III deficiency, thrombocythaemia, polycythaemia
Systemic conditions
- SLE, carcinoma, Behects disease, sarcoidosis, nephrotic syndrome
Local infections e.g. mastoiditis
What does botulism show on electromyography
Repeitive nerve stimulatio
What gene is mutated in huntingtons disease
Huntington gene (HTT)
Features of cavernous sinus syndrome
Eye muscle weakness
Proptosis
Chemosis (swelling of conjunctiva)
Horner syndrome
and/or facial sensory loss
Key structures that run through the cavernous sinus
CN III (oculomotor)
CN IV (trochlear)
CN V1 and V2 (opthalmic and maxillary divisions of the trigeminal nerve)
CN VI (abducent)
Sympathetic plexus surrounding the internal carotid artery
Cavernous part of the internal carotid artery
Presentation of vertebral artery dissection
Neck pain
Symptoms of posterior circulation stroke
What is the most common hereditary ataxia
Friedrichs ataxia
Pathology of friedrichs ataxia
Degeneration of the cerebellum, certain spinal cord tracts and peripheral nerves
Presentation of fredrichs ataxia
Ataxia
Dysarthria
Optic atrophy
Hearing impairment
LDs
Sensory neuropathy
Extensor plantar responses
Diabetes
Cardiomyopathy
Pes cavus
Kyphoscolosis
What is the most common type of partial seizure
Temporal lobe epilepsy
Presentation of temporal lobe seizures
Subjective abdo symptoms
Staring
Lip smacking
Period of disorientation
How is the vestibulo-ocular reflex tested
Caloric test
- monitoring of eye movements during or following the slow injection of at least 50ml of ice cold water over 60s into each external auditory meatus in turn
Where is the lesion if the vestibulo ocular reflex is negative
Brainstem
Treatment for generalised tonic clonic seizures
Sodium valpriate
Carbamazepine
Lamotrigine
Treatment for focal seizures
Carbamazepine
Lamotrigine
Treatment for abscence seizures
Ethosuximide
Treatment of GBS
Plasma exchange therapy
IV immunoglobulin
CSF analysis of GBS
Albuminocytolocigal dissociation (i.e. elevated protein)
However may be entirely normal
What features make up aphasia
Fluency
Repetition
Comprehension
Where is Brocas area and what is it for
Inferior frontal lobe
Centre for the motor part of speech and sentence formation
EXPRESSIVE DYSPHASIA
lesions - imparied fluency, intact comprehension and impaired repetition
Where is wernickes area and what is it for
Posterior, superior temporal lobe
Centre for comprehension and planning words
Lesions - cannot understand written or spoken words, speech remains fluent but meaningless RECEPTIVE DYSPHASIA
Treatment of filles de la tourette sydnrome (rare - mutliple tics with both motor actions and vocalisations)
Risperidone
Visual field testing results of indiopathic intracranail HTN
Loss of visual acuity when changing posture
Enlargment of blind spots and circumferential restriction in visual fields
Papilloedema
Most common cause and subsequant treatmnet of a 6th CN palsy
Microvascular nerve palsy (benign prognosis)
Vascular risk be addressed
Review in 4 weeks
What CNs pass through the pons
Facial nerve
Abducens
What does cervical radiculopathy refer to
One nerve root
What is synringomyelia
Sensory loss over a cape like distribution over the upper body, rather than peripheral sensory loss
What happens to cause syngobulbia
A synrinx forms in rhe brainstem
Typical CT findings of HSE
Hypodense areas in temporal lobes
Features of an extradural haemorrahage
Injury
Brief loss of consciousness
Recovery (lucid interval)
Delayed deterioration
What causes an extradural haemorrhage
Ruptures the middle meningeal artery (trauma)
Features of von hippel lindau (VHL) syndrome
Cerebellar haemangioma
Retinal angioma
Pancreatic and/or hepatic cysts
Adrenal and renal tumours
WHen do cluster headaches often occur
Nighttime
Assosiated symptoms with cluster headache
Runny nose
Watery eye
ptosis
WHat can bilateral bells paly sometimes be the first presenting symptom of
guillian barre syndrome
What condition is interferon B liscened for
RRMS who are able to walk unaided
Definition of RRMS
At least 2 attacks of neurological dysfunction (relapses) over the previous two years
How to test for CJD
LP
Presentation of new variant CJD in young adults
Psychiatric symptoms
followed by
- non specific painful sensory symptoms - most often in lower limbs
Cognitiv impairment
pyramidal signs
myoclonus
primitive relfexes
MRI findings of new variant CJD
High signal on T2 weighed imagines in the pulvinar (posterior aspect of the thalamus)
What are dorsal midbrain lesions assosiated with
Failure of vertical gaze
WHat controls vertical eye movements
Bilateral control of the cortex and upper brainsteam
Treatment of trigeminal neuralgia
Anti convulsants e.g. carbamazepine
What is hemibaslism
kinetic movement disorder
violent involuntary limb movements on one side of the body
WHat does hemibasilsm occur secondary to
Damage to the subthalamic nucleus (stroke, tumour, abscess)
Treatment of hemibasilsm
Dopamine antagonists
Treatment of cluster headache attacks
Sumatriptan injection
Oxygen inhalation
Prevention of cluster headaches
Verapamil
Lithium
Presentation of classic synringomyelia
Comonly assosiated with Arnold CHairai malformation and presents at 20-30 yrs of age
Upper limb pain excerbated by coughing or laughing
Pain and temp loss leads to painless upper limb burns and trophic changes
Difficulty in walking and paraparesis develop later
Gradually progressive condition
What is suggestive of an axonal neuropathy on a nerve conduction studies
Reduced compound muscle action potential amplitude
Myelin disorders nerve conduction studies
Reduction in velocities or blocks
Axonal disorders nerve conduction studies
Loss of action potential size/amplitude
WHat drugs commonly exacerbates weakness in myasthenia gravis
D-penicillaemine
Aminoglycoside and fluroquinolone antibiotics
Antiarrythmics e.g. quinidine, procainamide
B blockers e.g. propranolol
Neuromuscular blocking agents e.g. succinycholine
What is highly suggestive of spinal bulbar muscular atrophy (kennedy syndrome)
Perioral fasciculations
Androgen insensitivity
WHat is the safest anti epileptic to use in pregnancy
Lamotrigine
WHat nerve is commonly injured in THRs
Sciatric nerve
WHo is at higher risk of cavernous sinus thrombosis
Pregnancy
Acne
Treatment of tourette syndrome
Risperidone
Ocular pathology assosiated wit arnold chiari and formaen magnum lesions
Downbeat nystagmus
Typical features of fascioscapulohumeral muscular dystrophy (FSHMD)
Variable condition
May go unrecognised until later in life
Facial weakness
Winging of the scapula
Proximal upper limb weakness
Foot drops
What would distal wasting and pes cavus indicate
Very chronic neuromuscular disorder with axonal loss
Presentation of subacute combined degeneration of the cord due to B12 deficiency
Selective involvement of the dorsal columns and the pyramidal tracts
Evidence of peripheral nerve invovlement
50% absent ankle jerks with hyperreflexia at the knees
Plantars inititally flexor, then extensor
WHat is fibromuscular dysplasia
Non atherosclerotic, non inflammatory condition that principally affects the carotid and renal arteires
Assosiations of fibromuscular dysplasia
Ehler Danlos
Marfans
Phaechromocytoma
Takayasus disease
MRI appearance of fibromuscular dysplasia in carotid arteries
String of beads appearance (medial hyperplasia)
Causes of both UMN and LMN signs
Vitamin B 12 deficiency (subacure combined degeneration of the cord with peripheral neuropathy)
Tertirary syphillis (taboparssis)
MND
Friedrichs ataxia
Conus medullaris lesion
DM
WHat would indicate a lacunar infarct affecting the corticospinal tract at the level of the internal capsule or the upper pons
Weakness inolcing face, arm and legs
Absence of language disturbance, hemineglect or visual field deficit
What does mild sensory changes in temperature and touch sensations favour
A small infarct
What is multifocal motor neuropathy
Inflammatory neuropathy that causes multi focal demyelination with conduction block
Features of mutlifocal motor neuropathy
Progressive weakness and wasting
Intermittent fasiculations
Nil sensory features
Nerve conduction studies - demyelination and conduction block, normal sensory conduction
Poor prognostic factors of GBS
> 40
Rapid symptom progression
Requirment for ventilatory support
Previous Hx diarhroeal illness (specifically campylobacter)
High Anti-GBM antibody titre
Presentation of GBS
Ascending paralysis
Flaccid muscle tone
Hyporeflexia/areflexia
Autonomic disturbances
Neuromuscular ventinatory failure
CSF findings of GBS
High protein
normal otherwise
Presentation of common peroneal nerve injury
Failure to dorsiflex and evert foot
Senosry loss over dorsum of foot and anterolateral leg
WHat is internuclear opthalmoplegia caused by
Lesion in the medical longitudinal fasiculus (MLF) which connects the sixth nerve nuclei (supplying the lateral rectus muscle, which controls abduction) to the contralateral third nerve nuclesus (supplying medial rectus, which controls adduction)
What does unilateral INO (internuclear opthlamoplegia) cause
Loss of adduction of the ipsulateral medial rectus on attempted conjugate gaze
Abducting nystagmus of the contralateral eye
What is bilateral INO strongly assosiated with
MS
Causes of internuclear opthamoplegia (IMO)
MS
Cerebrovascular disease
Prophylaxis of migraine
Propranolol
Topiramate
Causes of rapidly progressive dementing syndrome
Sporadic CJD
HIV related disease
CNS vasculitis
Limbic encephalitis
Is sensation preserved or affected in MND
Preserved
(unless co exists with another pathology e.g. diabetic neuropathy)
What makes up neuropathies
Reflex loss
Sensory disturbance
Where are roth spots found and what are the causes
FOUND IN THE EYES - white cenetered haemorrhages consisting of perivascular collections of lympchytes
Carbon monoxide poisoning
Myeloma
Trauma
Hypoxia
Anaestheia
PET
HIV retinopathy
Abnormality in which vessels are most frequently asosiated with lateral medually syndrome
- Vertebral artery
- Posterior inferior celebellar artery
- Superior middle and inferior medually arteries
WHat sensory disturbance occurs with common peroneal nerve palsy
Dorsum of the foot
Where is the lesion to cause a homonymous hemianopia
Occipital cortex
Presnetaiton of pos ttraumatic synringomyelia
Loss of pain and temp sensation
Preservation of light touch
Weakness
Pathology of synringomyelia
Synrinx is a fluid filled cyst existing in the spinal cord, compresses the anterior horn (LMNs) and spinothalamic tract (pain and temp sensation)
Dorsal colums (light touch and proprioception) are usually spared but as the syrinx expands it may involves these tracts
Diagnosis of syringomyelia
MRI
What may be seen preceeding an enterovirus meningitis
Cold / diarrhoeal illnesses
Antibodies of paraneoplastic cerebellar degeneration
Anti bodies against the ani-Yo antigen
Cerebellar signs
Dysdiadochinesia
Ataxia (gait and posture)
nystagmus
intention tremor
Slurred, staccato speech
Hypotonia
What is ramsay hunt syndrome caused by
Infection of the geniculate ganglion of the facial nerve , together with the invasion of the VIIIth nerve ganglia, by the herpes zoster virus
Presentation of ramsey hunt syndrome
Ear pain
Hearing loss
Vertigo
Facial nerve paralysis
Vesicular rash on outer ear, sometimes also the soft apalate or anterior 2/3rds of the tognue
CN II
Optic nerve
(NO MOTOR FUNCTION)
CN III, IV and VI
Oculomotor, trochlear and abducens nerves
MOTOR EYE AND EYELID FUNCTION
oculomotor - parasympathetic fibres for pupillary constrictoon
CN V
Trigeminal nerve (3 subdivisons)
Senosyr information about facial sensation and motor to the muscles of mastication
CN VII
Facial nerve
MOTOR TO THE MUSCLES OF FACIAL EXPRESSION
SENSORY COMPONSANT TO ANTEIOR 2/3RDS OF THE TONGUE
CN VIII
Vestibulocochlear nerve
SENSORY ABOUT SOUND AND BALANCE
CN IX AND X
Glossopharyneal and vagus
glossopharyneal - elevates pharynx during swallowing and speech. sensory to posterior togue
Vagus - motor to several muscles of the mouth and gag reflex
CN XI
Accessory nerve (SCM and trapezius muscles)
CN XII
Hypoglossal nerve
Motor - extrinsic muscles of the tognue
Diagnosis and Tx of BPPV
Diagnosis - Dix hallpike
Treatment - Epley
Presentation of subacute degeneration of the spinal cord (i.e. vit B12 deficiency)
Myeloneuropathy
Consists of spinal cord signs and peripheral neuropathic signs
Cuases of mononeuritis multiplex
Vasculitis
Diabetes
Sarcoidosis
Paraneoplastic syndrome
Amyloidosis
Presentation of brown sequard sundrome (hemisection of the cord)
Ipsilateral paralysis
Ipsilateral loss of vibration and position sense
Hyperreflexia below level of the lesion
Contralteral loss of pain and temp sensation (usually begin 2 or 3 segements below the level of the lesion)
(In a clinical situtaiton - a mix of these signs is usually seen as a hemisection is rarely complete)
Features of post infectious transverse myelitis
Complete cord syndrome with involvement at sensory level, vibration loss and UMN signs
Predominatly lymphocytes in CSF, with normal protein and glucose
Driving restriction for both strokes and TIAs
1 month
What does amyloidosis assosiated neuropathy classically assosiated with
Autonomic neuropathy
Causes of autonomic neuropathy
MSA
PD
Wernickes encephalopathy
Syndrinmyelia/bulbia
Famial dysautonmia
Familal amyloidosis
GBS
DM
Tabes dorsalis
Alcoholic nutritional neuropathy
LEMS
Mechanism of action of ropinirole
Dopamine receptor agonist
What is webers syndrome and presentation
A midbrain stroke syndrome usually occuring as a result of occlusion of the paramedian branches of the posterior cerebral artery
Presents as
- ipsilateral CNIII palsy
- contralaterla hemiparesis and hemiparkinsonism due to the involvement of the corticospinal tract and substanstia nigra, respectively The crossed nature of these ffeatures (i.e. contralteral to the CNIII palsy) indicates that the lesion is within the brainstem and above the medually decussation
is mononeuritis painful?
YES
What is holmes aide pupil thought to be secondary to
A mild autonomic neuropathy
What is addies tonic pupil commonly assosiated with
Areflexia (loss of deep tendon reflexes)
RFs for alzheimers
Vascular risk factors
FH
APOE4 genotype
Traumatic brain injury
Downs syndrome
What level does the spinal cord end at
L1
What is miller fischer syndrome
Rare variant of guillane barre syndrome
Begins with proximal muscle weakness, affecting the eye muscles then spreading distally
(Contrast to GBS which begins peripherally in the lower limbs)
Features of fascioscapulohumeral muscular dystrophy
Facial, proximal liimb and abdominal muscle weakness
Winged scapulae
Footdrop
Elevated CK
What should be used i nthe context of SAH to reduce chances of cerebral artery vasospasm, risk of cerbral infarct and worsening neurological outcomes
Nimodipine
Presentation of cauda equina vs cons medullaris syndrome
Cauda equina
- gradual and unilateral onset
- both ankle and knee jerks affected
- More severe radicular pain
- Less lower back pain
- Numbness tends to be more localised to the saddle area, asymmetrical and may be unilateral. No sensory dissociation, Loss of specific dermatomes in lower limbs
- Asymmetric areflexic paraplegia, fasciculations rare, atrophy common
- urinary retention tends to occur late course of the disease
Cons medullaris syndrome
- Sudden onset with bilateral symptoms
- Knee jerks preserved by ankle jerks affected
- Less severe radicular pain but more severe back pain
- Numbness tends to be more perianal area, symmetrical and bilateral, sensory dissociation occurs
- Symmetrical hyperreflexic distal paresis of lower limbs, fasciulations may be present
- Urinary and faecal incontinence
Presentation of inclusion body myositis
Slowly progressive weakness
Wasting of finger flexor and quadriceps
10-15% of people with myasthenia gravis have a what
Thymoma
What should you consider when exercise has caused a stroke
Dissection of a carotid artery
Cardioembolism from an ASD
Most common cause of stroke in patients < 40 with no vascular risk factors
Carotid artery dissection
What is meralgia paraesthetica
A syndrome which includes numbness, paraesthesia and pains in the anterolateral thigh, resulting from either entrapment neuropathy or neuroma of the lateral femoral cutaneos nerve
Obsesity / weight gain a risk factor
People with MS commonly feel their symptoms get worse with what
Exercise
Heat
Multifocal motor neuropathy is most commonly assosiated with which of the following
Anti-GMB1 antibodies
What does the sciatic nerve divide into
Tibial nerve
Common peroneal nerve
What innervates flexion of the hip
Femoral nerve
What is the major determinant of the need for intubation and ITU admission in GBS
Forced vital capacity (FVC)
WHat is menieres disease
Paroxysmal episodes of vertigo, N/V, and deafness lasting for hours
Audiogram - unilateral low frequeny sensorineural deafness
Treatment of menieres disease
Acute attacks - prochloperazine, cyclizine
Prophylaxis - betahistine, low salt diet
Presentation of vestibular schwannoma
Unilateral hearing loss
Tinnitus
Trigeminal neuropathy
Treatment of an acute attack of ocular myasthenia gravis
Pyridostigmine - initially 30mg QDS PO for 2-4 days, titrate up to find the lowest effective dose
What innervates the intrinsic muscles of the hand
T1 nerve root
What artery supplies brocas area
Brocas area is in the dominant frontal lobe
Middle cerebral artery
What does a history of coming down the stairs and the prescence of downbeat nystamus highly suggestive of
Structural lesion at the foramen magnum .e.g chairi malformation
What post op visual field deficit may be seen in a unilateral temporal lobe lobectomy
Superior homonymous quadrantonopia
MRI signs of new CJD variant disease
Increased signal in the pulvinar of the thalamus (pulvinar sign)
Where usually is the site of damage in dysarthria clumsy hand syndrome
Internal capsule
Pons
Key clue to P dementia with lewy bodies
Hallucinations
What does the radial nerve supply and why is it particularly susceptible to injury
muscles controlling elbow, wrist and finger extension
Sensation over the posterior forearm and small patch at the base of the thumb
Susceptible to compression or traumatic damage as it winds around the humerus
Nerve conduction studies results in peripheral neuropathy secondary to DM
Decreased sensory nerve amplitude responses
WHat is the most common form of genetic vascular dementia
Cerebral autosomal dominant arteriopathy with subcottical infarcts and leukoencepalopathy (CADASIL)
Presentation of CADASIL
Variable phenotype
High prevalnce of migraine with aura (often atyical aura)
Strokes at young age
Easy vascular subcortical dementia
How does parietal lobe damage manifest
Defect of inattention in the contralateral visual field
Asteregnosis
Constructional apraxia
Dressing apraxia
Ideomotor aprazia
Right hemisphere (i.e. non dominant) parietal lesions particularly prone to producing visual neglect
What is amaurosis fugax
Painless, transient, monocular vision loss (TIA)
Issues with treatment of dementia with lewy bodies
It can be hard to treat the parkinsonism, as levodopa therapy may worsen the confusion
What surgical procdure is preferred for a cerebral aneurysm
Endovascular coil
Syringomyelia vs syringobulbia
Synribulbia - lower brainstem is involved e.g. tongue fasiculations
Presentation of myotonic dystrophy type 1
AD condition
Ptosis
Facial weakness
Dysphagia
Sleep apnoea
Distal weakness
atrophy of the temporalis
Frontal balding
Cardiac conduction problems
Cataracts
Impaired mental function
Is lamotrigine safe to use in pregnancy
Yes
Is valoproate safe to use in pregnancy
No
Is phenytoin safe in pregnancy
No
WHat does diabetes increase the suscepitbility of your peripheral nerves to
Damage/compression
What nerve is affected to cause pain and sensory abnormalities in the anterolateral thigh
Lateral cutaneous nerve of the thigh
Which side is the lesion on in INO regarding symptoms
Lesion on the side of the eye that fails to adduct
Function of the medial longittudinal fascilucus
Brainstem structure connecting the 6th and 3rd nerve nuclei on opposite sides of the brainstem in order to coordination abduction of one eye with the adduction of the other (horizontal conjungate gaze)
What is chairari type 1 malformation
Elongated cerebellar tonsils are displaced into the upper cervical canal through the formamen magnum
Symptoms develop as a result of disordered anatomy, compression of the medulla and upper spinal cord, compression of the cerebellum and disruption of CSF flow through the formaen magnum
Weakness
Unsteadiness
Headache / neck pain
Nystagmus
Cerebellar signs
Dissosiated sensor loss (cape anaesthesia)
What is chairi type 2 malformation
Also known as the arnold - chairi malformation
Presents at a younger age than type I with symptoms of brainstem dysfunction
90% of patients who have syringomyelia also have what
Type 1 chiari malformation
Where in the brain is affected in wilsons disease
Basal ganglia
What do nasal regurgitations and a weak cough point towards
Bulbar dysphagia
Prophylaxis of cluster headache
Verapmil
Lithium
Sodium valproate
Gabapentin
Triad of miller fisher syndrome
Opthalmoplegia
Ataxia
Areflexia
What is miller fiseher syndrome
Variant of GBS
Affects the brainstem, Cranial nerves and peripheral nerves
Like GBS, often follows an infective illness
CSF findings in miller fisher syndrome
CSF protein high
No cellular response (cytoalbuminologic dissosiation)
Which antibody is assosiated with miller fisher syndrome
Antiganglioside antibody GQ1B
Treatment of miller fisher syndrome
Immunoglobulins and plasma exchange for those with more severe disease (i.e. non ambulant)
What aneurysm is characteristically assosiated with a third nerve palsy
A posterior communicating artery aneurysm
Features of middle cerebral artery aneurysm
Contralateral hemiparesis
Hemi sensory loss in the face, upper and lower extremetiries
Features of anterior communicating artery aneurysm
Bitemporal heminaopia
MRI findings of subacute combined degeneration of the cord
Increased signal on T2 weighted imaging, predomiantely in the dorsal columns
Features of holmes aide syndrome and prognosis
A tonic pupil that is usually larger, fails to react to light, with sluggish reaction to accomodation
Diminished reflexes
BENIGN CONDITION
Features of argyll robertson pupil
Small, usually bilateral
React to accomodation, but not to direct light
What does essential tremor tend to improve with
Alcohol
What needs checked before immunoglobulin therapy for the diagnosis of miller fisher syndrome
IgA levels
What is inclusion body myositis
Idiopathic inflammatory myopathy
Most common acquired myopathy in those > 50 y/o and more common in men
Most common acquired myopathy in patients > 50
Inclusion body myositis
Features of inclusion body myositis
Patterns of muscle weakenss (e.g. quads and long finger flexors)
Asymmetry of signs
Falls
Normal CK
Strokes affecting the occipital lobe will cause what
Contralateral homoonymous hemaniopia with macular (central field) sparing
Criteria for IV steriods rather than oral in patients with MS
Oral steriods failed to be tolerated
Who need admitted to hospital for severe relapse or monitoring of medical or psychollogical conditions, such as diabetes or depression
Treatment of relapse of MS
Oral merthylpresnisolone 0.5g daily for 5 days
What is the commonest inherited polyneuropathy
Charcot marie tooth disease (known as hereditary motor sensory polyneuropathy)
Treatment of paroxysmal hemicrania
Indomethacin
Salicylates, NSAIDs and prednisolone may help
CSF findings of MS
Oligoclonal bands
Increased rates of IgG synthesis
What is brown sequard syndrome most commonly seen in
MS
CT head findings that support the diagnosis of NPH
Enlarged ventricles
1st line treatment of cervical dystonia
Botulinum toxin
What is picks disease also known as
Frontotemporal dementia
Features of injury to the posterior interosseous nerve
Deep branch of radial nerve
Purely motor syndrrome
- finger drop
- radial wrist deviation on extension
Features of ulnar neuropathy
finger abduction, adduction and flexion weakness
What would a lesion / stroke in the vestibular nuclei cause
Vomiting
Vertigo
Nystagmus
What would a lesion / stroke in the inferior cerebellar peduncle cause
Ipsilateral cerebellar signs
- atazia
- dysmetria
0 dysdiadochokinsea
What does a laesion in the lateral spinothalamic tract casuse
Contralteral deficits in pain and temp sensation
What does a lesion in the spinal trigeminal nucleus and tract cause
Ipsilateral loss f pain, temp sensation from face
What would a lesion in the dececning sympathetic fibres cause
Ipsilateral horners syndrome
Presentation of lead poisoning
Abdo pain and vomiting
Reduced distal power
Absent reflexes
Tests for lead poisoning
Blood film - basophilic stripping
Elevation in urinary delta-ALA level
What is typically spared in anterior spinal artery occlusion and why
Proproiception and vibration sense spared
They are conducted in the posterior columns
What is semantic dementia
A form of FTD
Very speficic deficic in semantic memory (the ability to asssosiate meaning to objects presented via visual or audotry modalities)
Pathology primarily affects the temporal lobes
3 types of frontotemporal dementia
Behavioural variant
Semantic dementia
Progressive non fluent aphasia
What supplies the thenar eminence
Median nerve
(minus the adductor pollicus, which is ulnar)
L5 radiculopathy affects 3 nerves;
PERONEAL NERVE
- ankle dorsiflexion
- ankle eversion
TIBIAL NERVE
- ankle inversion
SUPERIOR GLUTEAL NERVE
- hip abdcution
- leg internal rotation
Sensation over anterior shin and dorsum of the foot
What would indicate an occlusion of the middle superior cerebral artery rather than the anterior cerebral artery
Contralateral hemiparesis that affects the face, arm and hands but with RELATIVE SPARING OF THE LEGS
Contralteral hemisensory deficit in the same distribution
No homonymous hemianopia
If dominant hemisphere involved - expressive aphasia
Treatment of CVST
LWMH
IV fluids
What does anticipation mean in terms of inheritance
Symptoms begin at an earlier stage in successive generations
What does the weakness in LEMS tend to improve with
Exertion
What nerves are supplied by the S1 nerve root
INFERIOR GLUTEAL NERVE
- hip extension
SCIATIC NERVE
- knee flexion (hamstrings)
TIBIAL NERVE
- ankle plantar flexion
Sensation over the plantar aspect of the foot and the skin overt the achilles tendon
40% of patients with myotonic dystrophy may develop what
LV dysfunction
Painful 3rd nerve palsy is what until proven otherwise
Posterior communicating artery aneurysm
Tendon reflexes in spinal cord compression
Increased below the level of the lesion
Absent at the level of the lesion
What points towards osteomalacia
Low calcium and low phosphate
Raised ALP
Cause of osmotic demyelination (when correcting hyponatraemia)
Astrocyte apoptosis
Neurological findings of Vit B12 deficiency
Impaired proprioception, and fine touch
Who is vit B12 deficiency seen in
Abusers of nitrous oxide
Where would the lesion be if a patient had anomia with impaired repetition, but otherwise fluent speech and good reading comprehension
Subcortical lesion near the left superior temporal gyrus (i.e. the dominant hemisphere)
Pathology of lambert eaton myasthenic syndrome
antibodies against voltage gated calcium channels
Treatment of lambert eaton myasthenic syndrome
Treatment of underlying cancer AND
Amifampridine
What produces CSF
Choroid plexus
Where is CSF absorbed
Arachnoid granulations
What drugs can precipitate a myasthenia crisis
BETA BLOCKERS
Macrolide and quinolone antibiotics
Statins
What is a posterior communicating artery aneurysm associated with
Third nerve palsy
