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Sheff 3a > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

Who normally gets idiopathic (benign) intracranial hypertension?

A

Young, obese women

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2
Q

Features of idiopathic intracranial hypertension?

A

N+v
Worse in morning
Can get visual disturbance, especially with change in posture
CN VI palsy’s (false localising sign)

LP -> increased pressure

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3
Q

Complication of untreated IIH?

Mx?

A

Vision loss

Acetazolamide (carbonic anhydrase inhibitor)
Weight reduction is advisable if obese.
Stop causative medication
Multiple LP -> reduce pressure

Acute treatment - prednisolone

VP shunt / bariatric surgery

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4
Q

What medication can be useful for tension headaches that don’t well respond to simple NSAIDS

A

Amitriptyline

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5
Q

Bar trigeminal neuralgia what is the other main cause of trigeminal pain? How long does it last? Mx?

A

Post-herpetic neuralgia
-shingles of the trigeminal branch

Can be 2-3 years

Amitriptyline / carbamazepine

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6
Q

2 types of oedema which accompany CNS ischemia?

A

Cytotoxic oedema - accumulation of water in damaged glial cells and neurones

Vasogenic oedema - Extracellular fluid accumulates due to breakdown of BBB

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7
Q

If ESR is raised in stroke what further Ix?

A

?infective -> blood cultures

->Transoesophageal echocardiogram (exclude IE or myxoma)

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8
Q

Mx of spasticity after stroke?

A

Neurophysiotherapist

Baclofen

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9
Q

Seen in superior Sagittal sinus thrombosis

A

Headache, papilloedema + other similar to IIH
-EARLY seizures
Bilateral neuro deficit -> Progressive -> LOC

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10
Q

Features of cavernous sinus thrombosis?

A

Red swollen eyelid and conjunctiva
3,4,6,5a,5b palsies
Papilloedema

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11
Q

Lateral sinus thrombosis features

A

Raised ICP
Seizures
Drowsiness

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12
Q

Mx of Venous sinus thrombosis?

A

Look for signs of infection -> heparin those without

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13
Q

Name 3 Conditions that could mimic stroke

A 
Todd’s paresis (post seizure) 
Tumour / abscess 
Migraine (hemiplegic) 
Hypoglycaemia 
Psychogenic 
Spinal cord / peripheral nerve / Cranial nerve pathology
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14
Q

Ix in SAH

A

CT- SA blood, mass effect, obstructed ventricles

LP- frank blood -> xanthochromia later

Clotting screen + LFT - exclude clotting disorders

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15
Q

Why are old people more at risk of subdural

A

Atrophy of brain -> stretches bridging arteries / veins

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16
Q

Complications of haemorrhagic stroke?

A

Hydrocephalus

  • > herniation of cerebellum through foramen magnum
  • > Uncal herniation (temporal lobe pushes Against midbrain)
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17
Q

Features of Arnold chiari malformation?

A

6th nerve palsy
Ataxia
+babinski
->LOC, irregular breathing and apnea

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18
Q

Features of uncal herniation?

A

CN III palsy (fixed dilated pupil)

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19
Q

Causes of chorea

A

Hungtingtons
Drug induced - L-dopa, phenytoin, neuroleptic
Thyrotoxicosis

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20
Q

Mx of chorea in hungtingtons

A

Tetrabenazine

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21
Q

Mx of essential tremor

A

Propranolol

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22
Q

Cause of myoclonus

A

Often physiological - Eg falling asleep jerk

Metabolic disturbance (Liver/renal failure, increased CO2, decreased Na)
Neurodegenerative
Myoclonic epilepsy

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23
Q

What is dystonia? 3 types?

A

Prolonged muscle contractions -> abnormal posture or repetitive movements

Idiopathic generalised
Focal dystonias
Acute dystonia

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24
Q

Eg of a focal dystonia

A

Spasmic torticollis - head pulled to one side

Writers cramp

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25
Usual cause of acute dystonia? Sx? Mx?
Drugs - antipsychotics, some antiemetics (Metoclopramide) Torticolis - head pulled back Trismus - lock jaw Oculogyric crisis - Eyes pulled up Rapid response to anticholinergic - Eg procyclidine
26
Uses of procyclidine
Drug induced Parkinsonism, akathisia, acute dystonia
27
Give 4 causes of blackout
``` Vasovagal syncope Other syncope Epilepsy Stokes Adams attacks Orthostatic hypotension Anxiety Hypoglycaemia ```
28
What causes vasovagal syncope ? | Speed of onset? Any other features?
Reflex bradycardia ± peripheral vasodilation -provoked by emotion, pain or standing too long Onset over seconds [NOT INSTANT] Can get pre-syncope (nausea, pallor, sweating...) Falls to the floor and remains unconscious for ~2 mins -may get brief jerking Urinary incontinence is rare, tongue biting does not occur
29
3 egs of situation syncope
Cough - following a paroxysm of coughing Effort - on exercise (may have cardiac origin Eg Aortic stenosis) Micturition - During or after micturition
30
What is carotid sinus syncope
Hypersensitive baroreceptors cause excessive reflex bradycardia on minimal stimulation -Eg head turning
31
What is a stokes Adams attack? Cause? Features? Recovery?
Transient arrhythmia (Eg bradycardia due to 3rd degree heard block) -> Low CO and LOC Only warning is palpitations Rapid recovery and flushing
32
Causes of orthostatic hypotension
Autonomic neuropathy Antihypertensives Multi system atrophy
33
Ix in blackout
``` Collateral hx ECG (±24hr to detect arrythmia, Long QT - Eg haloperidol / neuroleptic) Blood glucose FBC, U+E Echocardiogram ```
34
3 common modes of presentation in MS
Visual disturbance Limb weakness Sensory disturbance
35
Sx and signs of optic neuritis
Pain on eye movement, blurring of vision, loss of colour vision Visual field defect - usually central Scotoma (dark spot) Relative afferent pupillary defect (RAPD) Optic disk may appear pink and swollen on fundoscopy (if inflammation behind)
36
What is RAPD ? Cause?
Where pupils respond differently to light being shone in them when alternating between eyes CN II lesion
37
Ix in MS
MRI - Plaques not very specific ->useful to monitor progress + detect new lesions LP - oligoclonal bands of IgG on CSF electrophoresis Evoked potentials - Decreased visual, auditory + somatosensory
38
Mx of relapse of MS? Long term relapse prevention
Methylprednisolone InterferonB Monoclonal Abx - natalizumab
39
``` Mx of MS sx Spasticity? Bladder disturbance? Depression? Erectile dysfunction? Pain? ```
Spasticity? - Baclofen / diazepam Bladder disturbance? - Anticholinergics Eg oxybutin Depression? - SSRIs Erectile dysfunction? - Phosphodiesterase inhibitors Eg sildenafil Pain? - Amytriptiline
40
Difference between MS and clinical isolated Sx
Multiple CNS lesions that are 1 Last >24hrs 2 disseminated in space - clinically / MRI 3 disseminated in time - >1month 4 cannot be attributed to other causes
41
Which spinal tract decussated in medulla? What sense does it carry?
Dorsal | Ipsilateral proprioception and vibration
42
Which is main tract in motor pathway? Damage ->?
Corticospinal Spastic gait, hyperreflexia, babinski, clonus, loss of finger movements (treacle hands)
43
What happens in brown sequard
Cord hemisecition Ipsilateral position and vibration sense lost Contralateral pain and temperature loss Ipsilateral UMN signs
44
Usual pattern of what with extrinsic cord compression?
Saddle anaesthesia
45
What is the pathology of syringomyella? Pattern of sensory loss? Motor?
CSF filled cavity in spinal cord Cape distribution of temp and pain LMN signs in upper limbs
46
Common cause of myelopathy in >50? <40?
>50 - Cervical spondylitis -Degereative disease of. Cervical spine -> cord compression <40 - MS
47
What happens in cervical spondylitis?
Osteoathrosis Calcification, degeneration and protrusion of intervertebral disks -bony outgrowths (osteophytes)
48
What is a radiculopathy? Features? Most common presentation? Common cause?
Spinal root disease Loss / impaired sensation + Weakness + wasting in specific myotomes Reflexes are absent / reduced PAIN Weak legs Lumbar disk damage 2 to malignancy (brain, lung, prostate, thyroid, kidney)
49
Main difference between cauda equina / conus medullaris and lesion higher up spinal cord?
Flaccid and arefelxic rather than spastic and hypereflexic
50
Cauda equina features?
Back pain pain down legs Often asymmetrical, areflexic paralysis of legs Sensory loss Loss of sphincter tone -> Do a PR
51
Where is damage in conus medullaris? | Features?
L1 - bottom of spinal cord Main features are - Urinary retention, constipation ``` Mixed LMN/UMN Leg weakness Back pain Sacral sensory disturbance Erectile dysfunction ```
52
Differentiate MND from MS and peripheral neuropathies and MG?
No sensory disturbance No sphincter disturbance Never affects eye movements - Distinguish from MG
53
Which nerves affected in progressive bulbar palsy ? LMN/UMN? Features
CN 9-11 LMN Flaccid fasiculation of tongue Absent / quiet speech Reduced gag reflex
54
What is pseudobulbar palsy ? Features? Cause?
UMN lesion Slow tongue movements and slow speech Increased jaw jerk + pharyngeal / palate reflexes (absent in true bulbar) Emotional incontinence MS, stroke, MND
55
Ix in MND
Nerve conduction studies | Imagine - MRI of Brian / cord excludes other causes
56
Mx of MND
Anticholinergic Eg TCAs - reduce saliva when swallowing Baclofen / diazepam - spasticity Antidepressants Riluzole Communication aids Ventilation support Analgesia
57
What class of drug is riluzole
Antiglutametric
58
Cause os status epliepticus in an epileptic? Non epileptic?>
Drug withdrawals - eg non compliance Infection Progression of diseases ``` SOL (50%) Infection Head injury Hypoglycaemia Alcohol withdrawal Electrolyte disturbance ```
59
Mx of status
1- ABC + O2 if required 2 IV access and take blood -U+E, LFT, glucose, Ca, toxicology, anticonvulsant levels 3 Thiamine / glucose if alcoholism / malnourishment 4 fluid resuscitation 5 IV lorazepam (can give twice if needed ) 6 IV Phenytoin - monitor ECG and BP 7 General anaesthesia
60
Complications of status
``` Hypoxia Lactic acidosis Rhabdomyosis Hypoglycaemia Electrolyte imbalance Aspiration pneumonia Pulm oedema ```
61
3 DDx of neuromuscular respiratory failure
CNS - compression of C3-5 (Phrenic nerve) Peripheral neuropathies - Guillian barre Neuromuscular junction - MG
62
Mx of neuromuscular resp failure
O2 Bedside Pulm function tests - FVC, ABG Transfer to ITU, Nil by mouth Intubate if PO <70mmHg, PCO2 >50mmHg with acidosis pH<7.2 Inability to protect airway Eg pharyngeal paresis VC decreased <15ml/kg
63
GCS level for coma?
<8
64
Median nerve mononeuropathy Root? Features?
C6-T1 Precision grip Sensory loss of radial 3 1/2 fingers Carpal tunnel syndrome
65
Ulnar nerve nerve mononeuropathy Root? Features?
C7-T1 Weakness / wasting of wrist flexors Loss of interrossi -> cant cross fingers Sensory loss of medial 1 1/2 fingers
66
Radical nerve mononeuropathy Root? Features?
C5-T1 Can’t open fist, wrist drop / finger drop Sensory loss in anatomical snuff box
67
Common peroneal nerve mononeuropathy Root? Features?
L4-S1 Foot drop, weak ankle dorsiflexion / eversion Sensory loss over dorsum of foot
68
What happens in mononuritis multiplex? Usual cause?
Individual nerves picked off randomly Systemic - vasculitis - Connective tissue disorders Eg sarcoid
69
Ix of neuropathy
Neuropathy screen FBC, ESR, TFT, ANA, B12/ folate Vasculitis screen FBC, ESR, CRP, ANA, ANCA
70
Mx of neuropathic pain
Amitriptyline Gabapentin Mx of underlying cause Eg autoimmune, inflammatory ....
71
3 main CI to LP
Bleeding disorders - eg Von Willie brand Cardiovascular compromise Raised ICP
72
Mx of cauda equina if trauma? SOL? inflam? infection? Following treatment?
Immobilise the spine if due to trauma Surgery is indicated to remove blood, bone fragments, tumour, herniated disc or abnormal bone growth. Lesion debulking is required for space-occupying lesions - eg, tumours, abscess. Steroids if inflammatory causes - eg, ankylosing spondylitis. Infection causes should be treated with appropriate antibiotic therapy. Patients with spinal neoplasms should be evaluated for chemotherapy and radiation therapy. Postoperative care includes addressing lifestyle issues (eg, obesity), and also physiotherapy and occupational therapy, depending on residual lower limb dysfunction.

Sheff 3a (30 decks)

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