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Neuro Flashcards

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1
Q

difference between ischaemia and infraction

A

ischaemia= reduced tissue supply
infarction= death of tissue due to reduced blood supply

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2
Q

what tool is use to identify stroke in an acute medical setting

A

ROSIER

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3
Q

how are TIAs mx

A

start 300mg aspirin daily

refer to a specialist TIA clinic within 24 hrs (within 7 days if it was more than 7 days ago)

diffusion weighted MRI scan to image

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4
Q

how are TIAs imaged

A

diffusion weighted MRI scans

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5
Q

how is aspirin given in suspected stroke

A

300 mg daily for 2 weeks

start after haemorrhage excluded by CT

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6
Q

how is blood pressure managed in a stroke

A

blood pressure is not lowered in ischaemic stroke

blood pressure is agressively lowered in haemorrhagic stroke

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7
Q

alteplase moa

A

tissue plasminogen activator

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8
Q

in what time frame of presentation is thrombectomy done for stroke

A

within 4.5 hrs

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9
Q

when is thrombectomy indicated in stroke

A

complete block of the posterior or anterior circulation

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10
Q

what 2 conditions are screened for when someone has a IA or stroke

A

carotid artery stenosis
AF

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11
Q

secondary prevention of stroke

A

ABCD
atorvastatin 20-80mg
blood pressure control
clopidogrel 75mg daily
diabetes control

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12
Q

what dose of statin is given in secondary prevention of stroke and when

A

20-80mg atorvastatin
not immediately delay by 48 hrs

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13
Q

what is given for secondary preventation of stroke/TIA when clopidogrel cant be given

A

aspirin plus dipyrimadole

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14
Q

blood vessel implicated in extradural haemorrhage

A

middle meningeal artery

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15
Q

blood vessels implicated in subdural haemorrhage

A

bridging veins

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16
Q

when is CT reliable for imaging in an SAH

A

first 6 hrs
after this its less reliable

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17
Q

how many hrs after CT head should lumbar puncture be done in SAH

A

after 12 hrs (to allow for build up of bilirubin)

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18
Q

what medication is given after SAH to prevent vasospasm

A

nimodipine

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19
Q

what part of the nervous system does multiple sclerosis affect

A

central
specifically oligodendrocytes

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20
Q

symptoms of optic neuritis

A

unilateral loss of vision
enlarged blind spot (central scotoma)
opthalmoplegia
red desaturation (impaired colour vision)
relative afferent pupillary defect

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21
Q

what is RAPD

A

when the pupillary light reflex is reduced when shining a light into the affected eye, but the consensual reflex in the affected when shining a light into the normal eye is normal

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22
Q

causes of optic neuritis

A

MS
sarcoidosis
SLE
measles/mumps
lyme disease
syphilis

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23
Q

optic neuritis mx

A

high dose steroids

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24
Q

what is intranuclear opthalmoplegia

A

a lesion in the medial longitudinal fasciculus (connects the cranial nerve nuclei that control eye movements)

there is impaired adduction in the affected eye and nystagmus in the contralateral eye

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25
what eye movement abnormality is seen in intranuclear opthalmoplegia
inability to adduct the affected eye and nystagmus on abduction in the other eye
26
lhermittes sign
electric shock like pain down the spine when flexing the neck- occurs due to demyelination in the spine in MS
27
2 types of ataxia
sensory cerebellar
28
what sign is positive in sensory ataxia
rombergs
29
a lesion in what spinal column causes sensory ataxia
dorsal column
30
lumbar puncture results in MS
may find oligoclonal bands
31
what is progressive bulbar palsy
a type of motor neurone disease that primarily affects the muscles of talking and swallowing
32
what medication can be given in MS to slow progression
riluzole
33
what is affected in MND
upper and lower motor neurones
34
triad of parkinsons disease
resting tremor bradykinesia rigidity
35
tremor in parkinsons disease
unilateral pill rolling worse when distracted/nit using the hand
36
what is rigidity
resistance to the passive movement of a joint
37
how does alcohol affect a benign essential tremor
improves with alcohol
38
what are the 4 parkinsons plus syndromes
multiple system atrophy progressive supranuclear palsy dementia with lewy bodies corticobasal degeneration
39
main side effect of levodopa
dyskinesia this could be dystonia, athetosis or chorea
40
what can be given with levodopa to reduce dyskinesia sx
amantadine
41
what are COMT inhibitors
they reduce the metabolisation of levodopa used in parkinsons
42
prolonged use of dopamine agonists can cause
pulmonary fibrosis
43
monoamine oxidase b inhibitors moa
reduce the breakdown of dopamine, serotonin adrenaline used in parkinsons
44
dopamine agonist examples
bromocriptine cabergoline
45
COMT inhibitors example
entacapone
46
monoamine oxidase b inhibitors
selegiline rasagiline
47
medications for benign essential tremor
propanolol
48
describe a benign essential tremor
a bilateral symmetrical tremor worse on intentional movement better with alcohol worse with caffeine, stress, tired not present when asleep
49
differentials for tremor
benign essential tremor parkinsons MS hyperthyroidism huntingtons chorea antipsychotics
50
are patients awake and aware in focal seizures
awake yes aware if simple, not aware if complex
51
describe a tonic clonic seizure
period of muscle tensing followed by a period of muscle jerking
52
describe a myoclonic seizure
sudden brief muscle contractions, patients are awake
53
describe a tonic seizure
sudden onset increased muscle tone, may result in a fall
54
describe an atonic seizure
sudden loss in muscle tone, often results in a fall
55
what are infantile spasms also known as
west syndrome
56
what is found on EEG in infantile spasm
hypsarrhythmia
57
seizure medications for men/ non child bearing women
sodium valproate first line apart from lamotrigine/ levitiracetam for focal seizure ethosuximide for absence seizure
58
seizure medications for women
lamotrigine first line apart from levitiracetam for myoclonic seizure ethosuximide for absence seizure
59
sodium valproate moa
increases GABA
60
benzo options and dosing for status
rectal diazepam (10mg) buccal midazolam (10mg) IV lorazepam (4mg)
61
status mx
2 x benzo 1 x IV infusion (phenytoin/kepra/sodium valp) GA or phenobarbitol
62
definition of status
seizure lasting over 5 mins multiple seizures without regaining consciousness
63
examples of weak opioids
codeine tramadol
64
examples of strong opioids
morphine oxycodone fentanyl buprenorphrine
65
what can be given for chronic primary pain
antidepressants avoid the use of paracetamol, NSAIDs, opiates, anti epileptics
66
treatments for neuropathic pain and how they are given
amitriptyline gabapentin duloxetine pregabalin only use them as monotherapy
67
how do vessels over the optic disc look in papilloedema
they will be curved as they are travelling over a raised surface- usually they are flat as they are travelling over a flat surface
68
bilateral acoustic neuromas are associated with
neurofibromatosis type 2
69

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