neuro Flashcards
ACA vs MCA vs PCA stroke?
ACA:
contralateral sensory and motor loss
Lower> upper
MCA: (most common)
Contralateral sensory and motor loss
Upper> lower
aphasia
contralateral homonymous hemianopia
PCA:
Contralateral homonymous hemianopia with macular sparing
Visual agnosia (can’t recognise objects seen)
Webers syndrome vs basilar artery stroke vs lacunar stroke?
Webers:
Affects branches of PCA which supply midbrain
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Basilar artery: Locked in syndrome
Lacunar stroke: either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
common sites include the basal ganglia, thalamus and internal capsule
Management of ischaemic stroke?
A combination of thrombolysis AND thrombectomy is recommend for patients with an acute ischaemic stroke who present within 4.5 hours
NICE guidelines recommend that a thrombectomy can be provided within 6 hours of an acute anterior ischaemic stroke. This is still within the time limits since this patient’s onset of symptoms.
aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded
Management of suspected temporal arteritis with visual loss and without visual loss?
- Steroids: give urgent high dose steroids as soon as suspected, before biopsy IF no visual loss.
If visual loss IV methylprednisolone is given prior to PO steroids as above.
there should be a dramatic response, if not the diagnosis should be reconsidered - urgent ophthalmology review
- bone protection with bisphosphonates due to high dose steroids
cubital tunnel syndrome presentation?
Compression of ulnar nerve
Motor to:
medial two lumbricals
aDductor pollicis
interossei
hypothenar muscles: abductor digiti minimi, flexor digiti minimi
flexor carpi ulnaris
‘claw hand’ - hyperextension of the metacarpophalangeal joints and flexion at the distal and proximal interphalangeal joints of the 4th and 5th digits
Sensory to:
medial 1 1/2 fingers (palmar and dorsal aspects) - little finger
What type of brain bleeding can present several weeks after head injury?
chronic subdural haematoma
Wernickes vs brocas area?
Spoken word is heard at the ear. This passes to Wernicke’s area in the temporal lobe (near the ear) to comprehend what was said. Once understood, the signal passes along the arcuate fasciculus, before reaching Broca’s area. The Broca’s area in the frontal lobe (near the mouth) then generates a signal to coordinate the mouth to speak what is thought (fluent speech).
What are the indications for an urgent vs less urgent CT head according to NICE guidelines? What timeframe should they be done in?
CT head within 1 hour
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
CT head scan within 8 hours of the head injury - for adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury:
age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, what should you do?
they should be admitted immediately for imaging to exclude a haemorrhage
Wernicke’s encephalopathy triad
Confusion, gait ataxia, nystagmus + ophthalmoplegia are features
Korsakoffs?
non-reversible
Confabulation
Anterograde and
Retrograde amnesia
Temperament altered
SDH vs SAH vs extradural haemtoma on CT? What vascular involvement?
SDH: crescent (banana shape), crosses sutures , involved bridging veins
Epidural haemorrhage is associated with the middle meningeal artery
Subarachnoid haemorrhages are associated with vessels of the circle of Willis, such as basilar and anterior circulating arteries.
Frontal vs temporal vs occipital vs partial lobe epilpesy?
Jacksonian movements are a feature of frontal lobe epilepsy. clonic movements travelling proximally
Temporal lobe seizures are associated with aura, lip smacking and clothes plucking.
Occipital seizures are associated with visual abnormalities.
Parietal seizures are associated with sensory abnormalities.
What is the long term mx of an ishcaemic stroke? what if have allergies to normal long term anti-platelet?
What is the long term mx of stroke?
Aspirin + clopi for two weeks
Clopidogrel 75mg once daily (alternatively aspirin plus dipyridamole) for life
What is internuclear opthalmoplegia?
Internuclear ophthalmoplegia (INO) occurs due to a lesion of the medial longitudinal fasciculus (MLF), a tract that allows conjugate eye movement. This results in impairment of adduction of the ipsilateral eye. The contralateral eye abducts, however with nystagmus.
Basically the pathway that normally works to allow the 3rd nerve and 6th nerve to move together is broken (usually on one eye) - so if you have a right internuclear opthalmoplegia you look to the right the left eye will abduct but the right eye wont and will get double vision and nystagmus
How does spinal stenosis present?
Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnostic
In B12 and folate deficiency what should be replaced first?
vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord
What features are seen in tuberous sclerosis
Cutaneous features:
depigmented ‘ash-leaf’ spotswhich fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum(angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
cafe-au-lait spots may be seen, more common in neurofibroma
Neurological features: developmental delay, LD, epilepsy
Mx of generalised seizures vs focal seizures?
Generalised tonic-clonic/ myoclonic/ tonic seizures
males: sodium valproate
females: lamotrigine or levetiracetam
Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine,
Mx of absence seizures?
Absence seizures (Petit mal)
first line: ethosuximide
second line:
male: sodium valproate
child beaeing female: lamotrigine or levetiracetam
carbamazepine/ phenytoin may exacerbate absence seizures
Mx of meningitis in non-immunocomp adults?
IV ceftriaxone
If raised ICP then LP CI
Dexamethasone (CI in sepsis)
How long after your first seizure can you not drive for? (if ix are normal vs abnormal)
first unprovoked/isolated seizure: 6 months off if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG.
If these conditions are not met then this is increased to 12 months
