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Final Year > Neuro > Flashcards

Neuro Flashcards

1
Q

What is the definition of a TIA?

A

temporary neurological dysfunction lasting less than 24 hours cuased by ischaemia but without infarction

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2
Q

What are crescendo TIAs

A

two or more TIAs within a week -> high risk of stroke

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3
Q

What risk factors increase the risk of stroke in patients taking the COCP?

A

COCP +:
migraine with aura
smoker over 34
history of stroke or TIA

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4
Q

How do you manage a stroke initially?

A

Exclude hypoglycasemia
Non-contrast CT head - exclude haemorrhage
Aspirin 300mg daily if not haemorrhage
Admit to specialist stroke centre
Alteplase - thrombolyse

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5
Q

When should alteplase be given in strokes?

A

within 4.5 hours of symptom onset

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6
Q

What conditions should patients be investigated for if they have a TIA or stroke?

A

Carotid artery stenosis - carotid ultrasound
Atrial fibrillation - ECG / holter monitoring

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7
Q

What shape are subdural bleeds?

A

crescent shape

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8
Q

What shape are extradural bleeds?

A

bi-concave shape

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9
Q

What usually causes an extradural haemorrhage?

A

Middle meningeal artery rupture in temporoparietal region associated with fracture of temporal bone

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10
Q

Which types of haemorrhage have a lucid period?

A

Extradural haemorrhage

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11
Q

What are the surgical options for extradural or subdural haematomas?

A

Craniotomy - open removal of section of the skull
Burr holes - to drain the blood

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12
Q

What is the mortality of a SAH?

A

30%

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13
Q

Which conditions is SAH common in?

A

Sickle celll
Marfan’s / Ehlers Danlos
Neurofibromatosis
AD Polycystic kidney disease

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14
Q

At what time frame is a CT less reliable for a SAH?

A

More than 6 hours after the start of symptoms

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15
Q

When may a lumbar puncture be performed for a SAH diagnosis after a normal CT head?

A

Wait at least 12 hours after onset of symptoms - it takes time for bilirubin to accumulate in CSF

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16
Q

What does a positive CSF sample show in SAH?

A

Raised RCC
Xanthochromia - caused by bilirubin

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17
Q

What is gold standard diagnostic tool to confirm diagnosis of SAH?

A

CT angiography

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18
Q

What is the treatment/management of a SAH?

A

endovascular coiling by an interventional neuroradiologist or neurosurgeon

Platinum coils are used

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19
Q

What prevents vasospasm in SAH and what class of drug is it?

A

Nimodipine - a calcium channel blocker

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20
Q

What is a severe complication of SAH?

A

Hydrocephalus

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21
Q

How may hydrocephalus be managed post-SAH?

A

Lumbar puncture
External ventricular drain
Ventriculoperitoneal shunt

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22
Q

Which neuronal cells provide myelin in the CNS?

A

Oligodendrocytes

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23
Q

Which neuronal cells provide myelin in the PNS?

A

Schwann cells

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24
Q

Which cells does multiple sclerosis affect?

A

Oligodendrocytes in the CNS

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25
Q

What are lesions in MS described as?

A

Disseminated in time and space

26
Q

What is Oscillopsia?

A

This is the visual sensation of the environment moving and being unable to create a stable image

27
Q

Eye movement abnormalities can be caused by lesions affecting whihc cranial nerves?

A

Oculomotor (III)
Trochlear (IV)
Abducens (VI)

28
Q

Where is the lesion if the patient has internuclear ophthalmoplegia

A

Medial longitudinal fasciculus

29
Q

What does the medial longitudinal fasciculus connect?

A

The cranial nerve nuclei that conctrol eye movements - 3,5,6

30
Q

Where is the lesion if the patient has a conjugate (connected) lateral gaze disorder - both eyes look laterally to the left or right

A

Abducens nerve (VI)

31
Q

What focal weakness symptoms may MS present with?

A

Incontinence
Horner syndrome
Facial nerve palsy
Limb paralysis

32
Q

What focal sensory symptoms may MS present wiht?

A

Trigeminal neuralgia
Numbness
Paraesthesia
Lhermitte’s sign

33
Q

What is Lhermitte’s sign

A

an electric shock sensation that travels down the spine and into the limbs when flexing the neck

34
Q

What does Lhermitte’s sign indicate

A

MS disease in the cervical spinal cord in the dorsal column

It is caused by stretching the demyelinated dorsal column

35
Q

What does sensory ataxia refer to?

A

It is due to the loss of proprioception and the inability to sense the position of the joint - Positive Romberg’s

It can also cause pseudoathetosis

36
Q

What is pseudoathetosis

A

Involuntary writhing movements

37
Q

Where is the lesion if the patient has sensory ataxia

A

Dorsal columns of the spine

38
Q

What condition is associated with muscle weaknes and diminished response to repetitive stimulation on EMG?

A

Myasthenia gravis

39
Q

What is the first-line drug for ocular myasthenia gravis?

A

Pyridostigmine

40
Q

What is first-line management for focal seizures?

A

Lamotrigine
Levetiracetam

41
Q

When can extended target time of 24hrs for thrombectomy be considered?

A

If there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

42
Q

What is lateral medullary symptoms?

A

Left posterior inferior cerebellar artery infarction

PICA lesion

Cerebellar signs
Contralateral sensory loss
Ipsilateral Horner’s

43
Q

What are the signs of a posterior cerebral artery stroke?

A

Contralateral homonymous hemianopia with macular sparing and visual agnosia

44
Q

What nerve damage is common in a mid shaft humeral fracture and what is the presenting sign?

A

Radial nerve
–> Wrist drop

45
Q

Which cranial nerve is susceptible to damage early in the course of raised ICP?

A

Abducens nerve
Due to its long intracranial course

46
Q

Damage to which nerve results in RAPD?

A

Optic nerve

47
Q

What is syringomyelia

A

Dilatation of CSF space within the spinal cord

48
Q

What is the sensory loss distribution in syringomyelia?

A

Dissociative loss of sensation of pain, temperature and non-discriminative touch

In a cape-like distribution

49
Q

What nerve palsy causes “vision worse going down the stairs”

A

4th nerve palsy = trochlear nerve

50
Q

What medication is used to treat Idiopathic intracranial hypertension

A

Acetazolamide

Carbonic anhydrase inhibitor

51
Q

What is prescribed in absence seizures?

A

Ethosuximide

52
Q

What are tongue fasciculations a sign of

A

bulbar onset motor neurone disease

53
Q

What is the classic triad of normal pressure hydrocephalus

A

Dementia
Ataxia
Urinary incontinence

54
Q

What diet is useful in epilepsy non-responsive to medications?

A

Ketogenic diet

55
Q

Which nerve is affected if a patient cannot abduct their left eye?

A

CN 6 = abducens nerve

56
Q

Which muscles are typically spared in MND?

A

Ocular msucles

57
Q

What can be found in the CSF of patients with MS?

A

Oligoclonal bodies / bands

58
Q

Chronic haemorrhage is hypo or hyperdense?

A

Hypodense

59
Q

What would a CT head showing infective picture and temporal lobe changes (low-density enhancement in the anterior and medial aspects) suggest?

A

Herpes simplex encephalitis

60
Q

What is autonomic dysreflexia?

A

T4-level spinal cord injury, bradycardia, flushing, severe hypertension, and sweating above the lesion strongly indicates this condition

61
Q
A

Final Year (7 decks)

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