Neuro Flashcards
Affected cranial nerves for acoustic neuroma
cn8: vertigo, unilat sensorineural h loss, unilat tinnitus
cn5: absent corneal reflex
cn7: facial nerve palsy
Ix for acoustic neuroma
urgent ent referral
mri cerebellopontine angle
Symptoms of GBS
Ascending leg pain then weakness
LMN = hyporeflexia
Resp muscle + facial muscle weakness
Autonomic involvement: retention, diarrhoea, ileus
Gold standard ix for GBS
LP - inc protein and normal wcc
+ decreased velocity nerve conduction studies
Migraine mx : acute vs prophylaxis
acute: triptan + paracetamol, or triptan + nsaid (nasal If 12-17)
prophylaxis: topiramate (avoid if childbearing age!!) or propranolol
Symptoms of MS
visual: optic neuritis, uhthoffs phenomenon, internuclear ophthalmoplegia
sensory: pins, trigeminal neuralgia, lhermittes sign
motor: spastic weakness esp in legs
cerebellar signs
urinary incontinence, sexual dysfunction
GS ix for MS
MRI t2 gadalonium contrast brain = white matter plaques
LP + csf electrophoresis = oligoclonal bands of igG + inc protein
What does ulnar nerve do
hypothenar eminence
finger abduction
thumb adduction
What vision defect does pituitary tumour cause
bitemporal hemianopia upper quadrant defect
Features of focal seizure:
- temporal
- frontal
- parietal
- occipital
- temporal: aura (epigastric sensation, deja vu, hallucination), lip smacking
- frontal: movements, Jacksonian march, post ictal weakness
- parietal: parasthesia
- occipital: flashes/floaters
Triad for wernickes
ocular dysfunction
confusion
ataxia
Triad for korsakoffs
amnesia
confusion
confabulation
Mx for focal seizures
lamotrigine
levetiracetam
if not then carbamazepine
Types of aphasia:
- wernickes
- brocas
- conduction
- global
- brocas: can understand but speech not fluent - in inferior frontal (superior left MCA)
- wernickes: receptive, can’t understand - in superior temporal (inferior left MCA)
- conduction: can understand speech but can’t repeat - in arcuate fasciculus
- global: can’t understand or repeat
Symptoms of syringomyelia
Cape like loss spinothalamic (temp/pain/crude touch)
spastic weakness of Lower limbs
neuropathic pain
upgoing plantars
Imaging for TIA
MRI diffusion weighted
Mx for brain abscess
iv cephalosporin + metronidazole
craniotomy to debride
Features of juvenile myoclonic epilepsy
teenage girls
absence seizures
tonic clonic seizures
myoclonic seizures
exacerbated by sleep deprivation
Meds for parkinsons
levodopa + carbidopa
entacapone
rasagiline
ropinirole/ rotigotine
Ix for encephalitis
EEG: lateralised periodic discharges at 2hz
csf: high wcc, high protein
MRI: medial temporal (HSV) and inferior frontal changes of petechial haemorrhages
When to withdraw epilepsy meds
if >2 years no seizure, over 2-3 months
Features of Charcot Marie tooth disease
hereditary motor and sensory polyneuropathy
distal weakness + atrophy
high arched feet
foot drop so high steppage gait
hyporeflexia
Symptoms of MND
Assymmetrical weakness upper limbs first
Wasting hands
Slurred speech/face weakness
Resp issues
UMN + LMN signs
Fasciculations
Symptoms of MG
fatiguable weakness
diplopia, ptosis
Jaw fatigue
Speech/swallow
Triggers for MG
pencillamine
b blockers
procainamide
lithium
phenytoin
gentamicin/macrolides/quinolones
Ix for MG
Fatigue recovery test
Ice test
Tensilon test - iv edrophonium reduces muscle weakness
Achr, musk, lrp4
ct thorax
single fibre emg
Contraindications for tensilon test
arrhythmia
asthma
Features of Huntingtons disease
auto dom condition where degeneration cholinergic and gabaergic neurones in basal ganglia
personality change
chorea
dystonia
saccadic eye movements
Med for huntingtons
tetrabenazine
What artery supplies wernickes and brocas areas
Middle cerebral artery (usually left)
Mx for restless leg syndrome
ropinirole
treat iron deficiency
Symptoms of subacute combined degeneration of sc
dorsal column: fine touch/prop/vib loss legs first
spinocortical: weakness, spasticity, hyperreflexia, brisk knee reflexes, absent ankle jerk, extensor plantar
spinocerebellar: ataxic gait, + rombergs
Sign for cervical myelopathy
Hoffman’s sign: flick finger and + if other fingers twitch
needs decompressive surgery!!
What to do if first seizure
discharge
refer to urgent outpatient neuro clinic
bloods 4 seizure vs pseudoseizure
prolactin / lactate
Causes of horners
central (anhidrosis everywhere): stroke, swelling, syringomyelia
pre-gang (face only): thyroid, trauma, tumour
post-gang: carotid art dissection, cs thrombosis, Cluster headache
Symptoms of CJD
rapid onset dementia
myoclonus
aphasia
anxiety
Ix for CJD
LP - protein or normal
EEG - biphasic high amp sharp waves
MRI - hyperintense signals in basal ganglia/thymus + cortical ribboning
1st line for myoclonic seizures
levetiracetam
Venous thrombosis mx
abx
lmwh acutely
warfarin long term
Mx for syphilis induced argyll Robertson pupil
IM benzathine benzylpenicillin
oral probenecid
tuberous sclerosis vs neurofibromatosis
tuberous: auto Dom where benign tumours everywhere, epilepsy, developmental delay, depigmentation spots, patches on lumbar spine, butterfly rash on nose, fibromata beneath nails
neurofibromatosis: auto dom where phaeochromocytomas, axillary freckles, cafe au lait spots, acoustic neuromas
Triad for brain abscess
headache
fever
focal neurology
Symptoms of brown sequard syndrome
ipsilat dorsal column loss
contralat spinothalamic loss
ipsilat corticospinal loss (umn signs)
Indications for CT in 1 hour
gcs <13
suspected fracture
neurological deficit/seizure
vomiting
Indications for CT within 8 hours
amnesia/LOC +
- > 65
- bleeding disorder
- anticoagulant
- dangerous injury
CT head indications for child
LOC >5 mins
drowsy
3 or more vomiting
skull fracture suspected
neurological deficit
bruising
dangerous mechanism
Signs of increased ICP
dec conscious
headache
n+v
papilledema
dilated pupils (cn3 comp)
cushings triad (irreg breathing, bradycardia, widening pulse pressure)
Complications of SAH
Vasospasm
Recurrence
Hydrocephalus
Hyponatraemia due to SIADH
Seizures
Definitive mx for SAH
coiling if aneurysm
CT results for acute vs chronic subdural haemorrhage
Acute will be hyper dense (white)
Chronic will be hypodense (dark)
Subdural haemorrhage symptoms
FLUCTUATIONS in conciousness
Headache
Weakness/ visual field defects (unilat dilated = cn3 compression)
Seizures
Papilledema
Ataxia
N+V if inc ICP
Cognitive/behaviour problems
Mx bad subdural
Decompession via burr holes
Extradural mx
craniotomy + evacuation of haematoma
Antiemetic for vestibular neuronitis
prochlorperazine
Webers test
in conductive goes to bad ear
in sensor goes to good ear
Mx for rosacea
brimonidine gel if flushing only
ivermectin if pustules/papules +/- doxycycline
refer for laser if telangiectasia
Mx for severe urticaria where cetirizine hasn’t worked
oral steroids
What is head impulse test
+ means disruption during head movement + corrective saccades = peripheral cause
Features of SCC skin lesion
rapid growth
necrotic centre
tethering of skin
raised edges
Features of lichen planus
itchy papules on palms/soles
white lines (wick hams striae)
koebner phenomenon
oral mucosa involvement
nail thinning
needs POTENT topical steroids
Triggers for erythema multiforme
hsv
penicillins/allopur/carba/cocp
mycoplasma pneumonia
Primary vs secondary haemorrhage for tonsillectomy
primary within 8 hours and needs theatre
secondary if 5-10 days and needs admit + abx
Fever pain criteria
fever within 24 hours
attends rapidly
no cough
purulence
inflamed tonsils
Centor criteria
no cough
exudate
lymphadenopathy
fever
Causes of TEN
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
GS mx for TEN
IvIG
Hypersensitivity type in scabies
4
Glue ear in adults
2ww referral for nasopharyngeal cancer
Conditions causing acanthosis nigricans
t2dm
gastric cancer
pcos
obesity
cushings
Referral for laryngeal cancer
> 45 with
- persistent hoarseness
- unexplained neck lump
Oral cancer referral
ulcer >3 weeks
unexplained lump
erythroplakia/erthroleukoplakia
Features of pyoderma gangrenosum
lower limbs
painful ulcer purple
systemic upset
Common in ibd, sle, haem conditions
Mx for extensive fungal nail infections = dermatophyte vs candida
dermatophyte (trichophyton) : terbinafine
yeast (candida): itraconazole
Mx pleomorphic adenoma
surgical removal as risk malignant transformation + facial nerve palsy
Features of glandular fever
epstein barr virus
sore throat
enlarged tonsils
splenomegaly
2 weeks post mono spot test (heterophile ab)
Most common malignant thyroid malignancy
papillary
Maintenance check for thyroid cancer
thyroglobulin yearly (calcitonin if medullary)
Causative organisms for sinusitis
strep pneum
haem influ
rhinovirus
Mx acute sinusitis
if >10 days nasal steroids
If v unwell 7 days coamox/phenoxymethylpeniclin
Mx if conservative mx for perforated ear drum not worked
myringoplasty
Types of tympanogram
A: normal: bell curve
B: middle ear effusion: flat line
C: eusch tube dysfunction: peaks at start
Indications for amoxicillin in otitis media
> 4 days
<2 years + bilateral
perforation
<3 months
systemically unwell
Surgical mx for cholesteatoma
ossiculoplasty otherwise erodes into bone causing mastoiditis, perforation, meningitis
Features of pityriasis rosea
post viral infection
herald patch on trunk
then scaly macules in fir tree appearance
Self limiting for 6 weeks
First line mx for seborrhoeic dermatitis
topical ketoconazole
Features of pityriasis versicolor
hypo pigmented patches
itchy
in immunosupressed
ketoconazole shampoo
Causes of erythema nodosum
NO - idiopathic
Drugs - penicillin
Oral cocp/preg
Sarcoidosis/tb
Uc/crohns
Micro (mycoplasma)
Mx dermatitis herpetiformis
dapasone
When to give IV fluids for burns
> 15% adults
10% child
Parkland formula
volume of fluid= total body surface area of the burn % x weight (Kg) x4
Half the fluid given within first 8 hours
Prognostic marker for melanoma
breslow thickness (Strat granulosum -> deep-set point)
ulceration
subtype
mitotic rate
Eron classification for cellulitis
- no systemic toxicity
- toxicity or Comorb
- signif
- sepsis
Bullous pemphigoid vs pemphigus vulgaris
bullous: itchy + tense blisters in older. Needs dressing, steroids + tetracycline
pemphigus: flaccid + mucosal involvement - needs steroids, dressing
Grades for diabetic retinopathy
bg: cotton wool spots, retinal haemorrhages, micro aneurysms, hard exudates
pre-prolif: blot haemorrhages, venous bleeding, intraretinal microvascular abnormality
prolif: neovascularisation, vitreous haemorrhage
How to differentiate orbital from preseptal cellulitis
reduced visual acuity
proptosis
painful eye movements
GS ix for macular degeneration
OCT
Features of central retinal vein occlusion on fundoscopy
several retinal haemorrhages (looks like cheese + tomato pizza)
dilated tortuous veins
cotton wool
hard exudates
GS ix for glaucoma
goldmann applanation tonometer for open, gonioscopy for closed
GS mx for closed angle glaucoma
laser iridotomy
Carotid artery dissection symptoms
localised headache
neck pain
neurological signs (horners)
Risk factors for retinal detachment
myopia
diabetes
age
previous cataracts surgery
Features of retinal detachment
flashes/floaters
then shadow vision loss
RAPD
Absent red reflex + pale retinal folds
Causative organism for amoebic keratitis
acanthamoebic keratitis
Complication of IIH
blindness
What does internuclear ophthalmoplegia show
lesion in medial longitudinal fasciculus
impaired adduction on same side of lesion + horizontal nystagmus on contralateral side that is abducting
Causes of papilloedema
space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia
Fundoscopy for papilloedema
venous engorgement: usually the first sign
loss of venous pulsation
blurring of the optic disc margin
elevation of optic disc
loss of the optic cup
Paton’s lines: concentric/radial retinal lines cascading from the optic disc
Keith wagener classification
- mild narrowing arterioles
- focal constriction bv + av nicking
- cotton wool patches, exudates, haemorrhages
- papilloedema
Tests for squint
hirschbergs test: light should be central and symmetrical on cornea
Single cover test: when covering an eye if the contralateral eye moves then bad
Cover-uncover test: when cover eye then uncover it and it moves back to its squint position
Features venous sinus thrombosis
young female
sudden onset headache
n+v
facial pain
raised d dimer
Triggers for autonomic dysreflexia
urinary retention
faecal impaction
FEV1/FVC for neuromuscular diseases
FEV1/FVC > 0.7, FVC < 0.8
what criteria determines likelihood of stroke after tia
abcd
HINTs exam
Head impulse: In peripheral vertigo, this test will show a corrective saccade (positive result) if the vestibulo-ocular reflex is disrupted. This occurs when the head is turned toward the affected side, causing the eyes to make a saccade to re-fixate on the target. If the reflex is intact (in a healthy individual or on the unaffected side), the eyes will stay fixed on the target when the head turns toward the normal side.
Nystagmus: In peripheral vertigo, horizontal nystagmus may also be present, unlike the direction-changing nystagmus seen in central vertigo cases.
Test of skew: When a patient focuses on their nose while their eyes are alternately covered, vertical misalignment may occur in central vertigo, leading to corrective movements. This finding is absent in peripheral causes.
AION fundoscopy findings
swollen pale optic disc with blurred margins
Mx if parkinsons drugs don’t work
deep brain stimulation (stroke risk)
Meds generalised seizures
sodium valp M, lamotrigine F
Testing for resp support in neuromuscular diseases
FVC
if <20 then needs intubation
Mx absence seizures
sodium valproate
ethosuximide
Triad for normal pressure hydrocephalus
urinary incontinence
dementia and bradyphrenia
gait abnormality (may be similar to Parkinson’s disease)
Neuroimaging changes for normal pressure hydrocephalus
hydrocephalus with ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement
Mx IIH
weight loss
acetazolamide
optic nerve sheath decompression
Mx benign tremor
avoid caffeine/stress
propranolol
primidone
gabapentin
CN3 palsy
down and out
Most common organism for otitis media
haem influ
Mx staph scalded skin syndrome
iv erythromycin
fluids
emollients
Where to treat carotid endarterectomy
when >50% stenosis on the contralateral side
Cloudy hazy cornea
anterior uveitis
Cycloplegic examples
atropine + cyclopentolate are antimusc
Mx for open angle glaucoma >24mmhg
laser trabeculoplasty
MOA eye drugs
latanoprost: increases outflow
pilocarpine: increases outflow
acetazolamide : reduces aq production
timolol: reduces aq production
brimonidine : both
central retinal artery mx
- ocular massage
- dec iop via: acetazolamide, timolol, iv mannitol, ant chamber paracentesis
- dilate artery: carbogen, subling isosorbide dinitrate, oral pentoxifylline
definitive: thromboylsis or steroids
Complications of chicken pox
otitis media
pneumonia
nec fasciitis if given with nsaids
encephalitis
