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Core Conditions > Neuro > Flashcards

Neuro Flashcards

0
Q

Masked face is a typical sign of which condition ?

A

Parkinson’s disease

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1
Q

What are the 4 Cardinal signs of Parkinson’s disease ?

A
  • tremor
  • rigidity
  • bradykinesia
  • postural instability
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2
Q

Of visual hallucinations and dementia are present or occur within a year of Parkinsonism, what is the likely diagnosis ?

A

Lewy body dementia

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3
Q

Impaired vertical eye movements would suggest which diagnosis ?

A

Progressive supra nuclear palsy

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4
Q

When are tremors due to Parkinson’s worst ?

A

When distracting patients with mental tasks

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5
Q

Micrographia is typical of which condition ?

A

Parkinson’s disease

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6
Q

What are the main secondary motor symptoms of Parkinson’s (4)?

A
  • freezing
  • micrographia
  • masked face
  • unwanted accelerations

Others include: dystonia, dysphagia, sexual dysfunction, cramping etc

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7
Q

What are the early non motor symptoms experienced by those with Parkinson’s disease ? (4)

A
  • loss of sense of smell/constipation
  • REM behaviour disorder
  • mood disorders
  • orthodontic hypotension
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8
Q

What are the age peaks of epilepsy ?

A

First 15 and last 15 years of life

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9
Q

What are common characteristics of an aura before epileptic seizure ?

A
  • strange feeling in gut
  • feeling of déjà vu
  • change in mood or behaviour
  • strange smell
  • flashing lights
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10
Q

What are the characteristic post octal symptoms of epilepsy?

A
  • headache
  • confusion
  • myalgia
  • sore tongue
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11
Q

Post ictal temporary weakness suggests a focal seizure where ?

A

Motor cortex (todds palsy)

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12
Q

Post ictal dysphagia suggests focal seizure where ?

A

Temporal lobe

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13
Q

Causes of epilepsy ?

A
  • idiopathic/familial
  • structural: cortical scarring e.g. Head injury, tumour, stroke
  • tuberous sclerosis
  • SLE
  • sarcoidosis
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14
Q

What is epileptogenesis ?

A
  • The process by which a normal brain becomes epileptic

- the sequence of events that turns a normal neuronal network into a hyper excitable one

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15
Q

What are the excitatory neurotransmitters that can cause seizures in excess ?

A
  • glutamate
  • aspartate

*stimulated by influx of sodium and calcium

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16
Q

Which are the inhibitory neurotransmitters which can reduce seizures ?

A
  • GABA

* stimulated by inward ionic influx of chloride and efflux of potassium

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17
Q

What is status epilepticus ?

A
  • life threatening condition, medical emergency
  • brain in constant state of seizure
  • > 30 min of activity or 2 or more seizures spanning this period without full recovery
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18
Q

What are partial seizures and what are the types of partial seizures ? (3)

A

Focal onset with features referable to a part of one hemisphere:

  • simple partial:
  • complex partial
  • partial seizure with secondary generalisation
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19
Q

What is a simple partial seizure ?

A
  • awareness unimpaired
  • focal motor, sensory, autonomic or psychic symptoms
  • no post ictal symptoms
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20
Q

What are complex partial seizures .

A
  • awareness impaired

- may have simple partial onset (=aura) or impaired awareness onset

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21
Q

Where do complex partial seizures most commonly arise from .

A

Temporal lobe

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22
Q

What is common post ictal symptom following seizure arising from temporal lobe ?

A

Confusion

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23
Q

What is the common post ictal symptom followng seizure arising from frontal lobe ?

A

Rapid recovery

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24
Q

What is a partial seizure with secondary generalisation ?

A

Electrical activity starts vocally (as either simple or complex partial seizure) then spreads widely causing a secondary generalised seizure which is usually convulsive

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25
Q

What are primary generalised seizures and what are the different types ? (4)

A

Simultaneous onset of electrical discharge throughout cortex, with no localising features referable to only one hemisphere:

  • absence seizure
  • tonic clonic seizure
  • myoclonic seizure
  • atonic seizure
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26
Q

What are absence seizures ?

A

Brief (

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27
Q

What are tonic clonic seizures ?

A
  • loss of consciousness
  • limbs stiffen (tonic), then jerk (clonic)
  • may have one and not the other
  • post ictal confusion and drowsiness
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28
Q

What are myoclonic seizures ?

A
  • Sudden jerk of limb, face or trunk

- patient may be thrown to ground, or have a violently disobedient limb

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29
Q

What are atonic seizures ?

A
  • Sudden loss of muscle tone causing a fall

- no loss of consciousness

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30
Q

First line treatment for generalised tonic clonic seizures ?

A

Sodium valproate or lamotrigine
- usually better tolerated and less teratogenic

Second= carbamazepine

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31
Q

Drug treatment for absence seizures ?

A

Sodium valproate, lamotrigine or ethosuximide

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32
Q

Carbamazepine and oxcarbazepine should be avoided in which types of seizures and why ?

A

Tonic, atonic and myotonic - may worsen seizures

Use sodium valproate or lamotrigine

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33
Q

Which drug treatment is first line for partial seizures ?

A

Carbamazepine

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34
Q

What are the causes of Parkinsonism

A
  • idiopathic Parkinson’s disease
  • drugs (neuroepileptics, metoclopramide, prochlorprerazone)
  • trauma/boxing (rare)
  • encephalopathy post flu
  • manganese or copper toxicity (Wilson’s disease)
  • HIV
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35
Q

Pathogenesis of Parkinson’s disease

A

Mitochondrial DNA dysfunction causes degeneration of dopaminergic neurons in substantia nigra pars compacta (associated with Lewy bodies), hence decreased striatal dopamine levels

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36
Q

Management of Parkinson’s

A
  • postural exercises and weight lifting show to improve disability and cognition
  • dopamine agonists or MAO-B inhibitors can push back use of levodopa
  • anticholinergics may help tremor but cause confusion in the elderly
  • levodopa
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37
Q

What are the Parkinson plus syndromes? (5)

A
  • supra nuclear palsy
  • multiple systems atrophy
  • Lewy body dementia
  • cortico-basal degeneration
  • vascular Parkinsonism
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38
Q

What are the red flags for progressive supra nuclear palsy? (6)

A

early postural instability AND vertical gaze eye palsy +/-:

  • falls
  • rigidity of trunk > limbs
  • symmetrical onset
  • speech and swallowing problems
  • little tremor
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39
Q

Red flag symptoms for multiple systems atrophy

A
  • early autonomic features e.g. Impotence/incontinence
  • postural hypotension
  • cerebellar + pyramidal signs
  • ## rigidity > tremor
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40
Q

Red flag symptoms for Lewy body dementia

A
  • fluctuating cognition
  • visual hallucinations
  • early dementia
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41
Q

Rad flag symptoms for corticobasal degeneration

A
  • akinetic rigidity involving one limb
  • cortical sensory loss e.g. Astereognosia (inability to recognise object by active touch)
  • apraxia (e.g. Alien limb syndrome)
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42
Q

Red flag signs for vascular Parkinson’s

A
  • pyramidal signs (legs) e.g. Ataxia (no festination)

E.g. In diabetic/hypertensive patient with falls or has gait problems

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43
Q

Cause if multiple sclerosis

A
  • discrete plaques of demyelination occur at multiple sites in CNS
  • due to T cell mediated immune response
  • demyelination heals poorly causing remitting and relapsing disease
  • prolonged demyelination causes axonal loss and clinically progressive symptoms
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44
Q

Who is most likely to present with MS ?

A

Females 30 yrs

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45
Q

Presentation of MS?

A

usually monosymptomatic:

  • unilateral optic neuritis (pain on eye movement and rapid decrease in central vision)
  • numbness and tingling in limbs
  • leg weakness
  • brainstem and cerebellar symptoms (diplopia, ataxia)
  • symptoms may worsen with with heat or exercise
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46
Q

Treatment of MS

A
  • steroids e.g, methylprednisolone reduce acute attack
  • interferons: decrease no. Of relapses
  • monoclonal antibodies: e.g. Alemtuzumab acts against T cells in relapsing-remitting MS
  • no good drugs for primary progressive MS
47
Q

What is a tension headache ?

A
  • bilateral, non pulsatile headache +/- scalp muscle tenderness
  • NO vomiting or sensitivity to head movements
  • stress relief, massage and antidepressants may help
48
Q

Characteristic signs and symptoms of raised ICP

A
  • pain worse on waking, lying, bending forward or coughing
  • vomiting, papilloedema, seizures, false localising signs,
  • odd behaviour

*imaging to exclude space occupying lesion, consider idiopathic raised intracranial hypertension

49
Q

Which analgesics are common causes of episodic headache becoming chronic daily headache ?

A
  • cocodamol
  • ergotamine
  • triptans
50
Q

Characteristic signs/symptoms of cluster headaches

A
  • rapid onset excruciating pain around one eye that may become watery or bloodshot with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis +/- ptosis
  • pain strictly unilateral and almost always affects the same side
  • lasts 15-60 mins
  • occurs once or twice a day and often nocturnal
  • clusters last 4-12 weeks and followed by pain free periods of few months
  • sometimes chronic and non episodic
51
Q

Symptoms of trigeminal neuralgia

A
  • paraoxysms of intense, stabbing pain, lasting seconds in trigeminal nerve distribution
  • unilaterally, usually affecting mandibular or maxillary divisions
  • face screws up in pain
52
Q

Classical and alternative symptoms of migraine

A

Classically:
- visual or other aura lasting 15-30 mins followed within 1hr by unilateral, throbbing, headache
OR
- isolated aura with no headache
- episodic severe headache without aura, often premenstrual, unilateral , with nausea, vomiting +/- photophobia/phonophobia
- may also be allodynia- all stimulus painful

53
Q

What is a migraine prodrome ?

A

Precedes headache by hours/days e.g. Yawning, cravings, mood/sleep changes

54
Q

Common migraine auras:

A
  • Visual: chaotic, cascading, distorted , melting and jumbling lines, dots, zigzags, scotomata, or hemianopia
  • somatosensory: parathesiae spreading fingers to face
  • motor: dysarthria, ataxia, opthalmoplegia, hemiparesis
55
Q

Partial triggers of migraine seen in >50% of cases

A

CHOCOLATE:

C- chocolate
H- hangovers
O- orgasms
C- cheese
O- oral contraceptives
L- lie-ins
A- alcohol
T- tumult
E- exercise
56
Q

Pharmacological prophylaxis of migraine ?

A

If frequency >2/month or not responding to as needed NSAIDS:
1st line: propanolol, amitriptyline, topiramate or Ca channel blockers
2nd line: valproate, gabapentin, pregablin

57
Q

Causes of subarachnoid haemorrhage ?

A
  • ruptured saccular aneurysm
  • arteriovenous malformation
  • no cause found in 15%
58
Q

Typical age presenting with subarachnoid haemorrhage

A

35-65

59
Q

Risk factors for subarachnoid haemorrhage

A
  • smoking
  • alcohol abuse
  • hypertension
  • bleeding disorders
  • family history
60
Q

Common sites for berry aneurysms ?

A
  • junction of posterior communicating with internal carotid
  • anterior communicating with anterior cerebral artery
  • bifurcation if mid cerebral artery
61
Q

Which conditions are associated with berry aneurysms ?

A
  • polycystic kidneys
  • coarctation of aorta
  • ehlers-danlos syndrome
62
Q

Symptoms of SAH ?

A
  • Sudden, devastating, typically occipital headache
  • vomiting
  • collapse
  • seizure
  • coma
63
Q

Signs if SAH ?

A
  • neck stiffness
  • kernig’s sign (6h to develop)
  • retinal, subhyaloid and vitreous bleeds (=Terson’s syndrome)
  • focal neurology suggesting site e.g. Pupil changes indicating 3rd nerve palsy with a posterior commutating artery aneurysm
64
Q

Differential diagnosis of ‘thunderclap’ headache?

A
  • SAH
  • meningitis
  • migraine
  • intra cerebral bleeds
  • cortical vein thrombosis
65
Q

Investigations and findings in SAH ?

A
  • CT detects >90% SAH within 48h
  • if CT -ve after 12h do LP
  • CSF in SAH usually bloody early on and becomes xanthochromic (yellow) - this finding confirms SAH
66
Q

Management of SAH

A

Refer to neurosurgery immediately!

  • maintain cerebral perfusion by keeping well hydrated, only treat high BP if severe
  • nimodipine prevents vasopasm and so reduces cerebral Ischaemia
  • endo vascular coiling preferred over surgical clipping
  • CT angiography to identify aneurysms before operating
67
Q

Complications of SAH ?

A
  • rebleeding
  • cerebral Ischaemia
  • hydrocephalus
  • hyponatraemia q
68
Q

What are the cardiac causes of stroke ? (7)

A
  • non-valvular AF
  • external cardioversion
  • prosthetic values
  • acute MI
  • paradoxical systemic emboli - via venous circulation in those with patent foramen ovale and atrial/ventricular septal defects
  • cardiac surgery
  • valve vegetations e.g. Infective endocarditis
69
Q

Define TIA

A

Sudden onset of focal CNS phenomena due to temporary (

70
Q

Signs of anterior cerebral artery stroke

A
  • weak, numb, contralateral leg +/- similar arm symptoms
  • face unaffected

*supplies frontal and medial part of cerebrum

71
Q

Patient presents with: hemiplegia/hemiparesis of face, sensory loss, hemianopia and dysphagia. Where is this patient likely to have had a stroke ?

A

Middle cerebral artery/internal carotid, in dominant hemisphere (as presents with dysphagia, non dominant = Visuo-spatial disturbance
- hemisphere affected is contralateral to side with deficits

*this type of stroke usually consciousness preserved, and limbs begin weak and areflexive but return within few days and become exaggerated, headache unusual

72
Q

Stroke presenting with homonymous hemianopia with macula sparing is likely to have affected which part of the brain ?

A

Contralateral posterior cerebral artery

73
Q

How can you tell the difference between cerebral haemorrhage and infarct ?

A

You can’t tell the difference clinically, requires imaging

- haemorrhage more likely to produce headache. But unreliable

74
Q

Signs of lacunar infarct (I.e. Occlusion of one of the deep penetrating arteries of the brain)

A
  • pure motor stroke
  • pure sensory stroke
  • sudden unilateral ataxia and sudden dysarthria with a clumsy hand
75
Q

Which cranial nerve nuclei are in the midbrain ?

A
  • occult motor (3)

- Trochlear (4)

76
Q

Which cranial nerve nuclei are in the pons ?

A

Trigeminal (5)
Abducens (6)
Facial (7) (on border of pons and medulla)

77
Q

Which cranial nerve nuclei are in The medulla ?

A

Glossopharyngeal (9)
Vagus (10)
Accessory (11)
Hypoglossal (12)

78
Q

What is amaurosis fugax ?

A

Sudden transient loss of vision in one eye due to passage of small emboli through the retinal arteries
- often first sign of carotid artery stenosis

79
Q

Treatment following stroke

A
  • control CV risk factors e.g. BP, cholesterol etc
  • anti platelet: clopidogrel, aspirin
  • warfarin if mural emboli
  • carotid endarterectomy if stenosis >70%
80
Q

What is the most common cause of meningitis ?.

A

Viral infection

81
Q

Risk factors for meningitis

A
  • patients with CSF shunts or dural defects
  • spinal procedure
  • DM,
  • alcoholism
  • splenectomy, sickle cell disease (encapsulated organisms)
  • crowding
82
Q

Most common organisms causing meningitis in neonates ?.

A
  • group B strep
  • listeria monocytogenes
  • E. coli
83
Q

Most common organisms causing meningitis in infants and young children ?

A

H influenzae

If under 4 and unvaccinated: N meningitidus and strep pneumoniae

84
Q

Most likely organism causing meningitis in adults

A
  • s pneumoniae

- H influenzae

85
Q

Most common organisms causing meningitis in elderly and immunocompromised ?

A
  • S pneumoniae
  • L monocytogenes
  • TB
86
Q

Most common organisms causing hospital acquired meningitis ?

A
  • Klebsiella pneumoniae
  • E. coli
  • pseudomonas aeruginosa
  • staph aureus
87
Q

Signs of meningitis in neonate?

A
  • non specific
  • fever
  • respiratory distress
  • episodes of apnoea and bradycardia
  • feeding difficulty
  • irritability
  • reduced activity
88
Q

Who is at risk of fungal meningitis ?

A
  • AIDS
  • leukaemia
  • immunosuppressed
89
Q

Which fungi are likely to cause meningitis?

A
  • cryptococcus
  • histoplasma
  • coccidioides
90
Q

What is the most common cause of eosinophilic meningitis ?

A

Angiostrongyliasis - parasitic infection by nematode (from consuming raw giant African snail)

91
Q

What is mollarets meningitis ?

A

Chronic recurrent, benign, inflammation of meninges

92
Q

What are the non infective causes of meningitis ?

A
  • malignant cells e.g. Leukaemia, lymphoma
  • chemical meningitis e.g. Intrathecal drugs
  • drugs e.g. NSAIDs, trimethoprim
  • sarcoidosis
  • SLE
  • Behçet’s disease
93
Q

Conditions presenting similarly to meningitis

A
  • malaria
  • encephalitis
  • septicaemia
  • SAH
  • dengue
  • tetanus
94
Q

Early features of meningitis ?.

A
  • headache
  • leg pains
  • cold hands and feet
  • abnormal skin colour
95
Q

Later features of meningitis?

A
  • meningism (neck stiffness, photophobia, kernig’s sign)
  • reduced consciousness level
  • seizures +/- focal CNS signs
  • non blanching petechial rash
96
Q

Signs of galloping sepsis (e.g. In meningitis)

A
  • slow cap refill
  • DIC
  • ,hypotensive
  • raised temp and pulse
97
Q

Signs of disease causing meningitis

A
  • HSV: cold sore/genital vesicle
  • HIV: lymphadenopathy, dermatitis, candiasis, uveitis
  • leptospirosis: bleeding +/- red eye
  • mumps: parotid swelling
98
Q

Prophylaxis for those who have been in close contact with someone who has developed meningitis

A

Rifampicin OR ciprofloxacin

99
Q

Tests for bacterial meningitis ?

A
  • CRP
  • WCC
  • CSF (LP) - inc. WCC, total protein and glucose concentrations, gram stain and microbial culture
  • PCR (LP) - N meningitidis, S pneumoniae (only do PCR if CSF culture negative)

If CRP and WCC normal and CSF not available to interpretable then treat as confirm bacterial meningitis anyway

100
Q

Treatment for bacterial meningitis

A
  • empiric antibiotics: cefotaxime + (if
101
Q

Pathogenesis of bacterial meningitis ?

A
  • pia-arachnoid congested with polymorphs
  • layer of pus forms, may organise to form adhesions causing CN palsy and hydrocephalus
  • cerebral oedema in any bacterial meningitis
  • mortality 15%
102
Q

Pathogenesis of viral meningitis

A
  • lymphocytic inflammation if CNS
  • no pus formation, polymorphs or adhesions
  • little or no cerebral oedema unless encephalitis develops
103
Q

When do most meningococcal infections occur ?

A

Winter and early spring

104
Q

Causes of mononeuropathies?

A
  • Trauma

- entrapment

105
Q

Causes of mononeuritis multiplex ?

A

= if 2 or more peripheral nerves are affected , causes tend to be systemic: WARDS PLC

W- wegeners 
A- aids / amyloidosis
R- rheumatoid
D- diabetes
P- pan ?
L- leprosy
C- carcinomatosis
106
Q

What investigation can help find site of lesions in mononeuritis multiplex ?

A

Electromyography

107
Q

Muscles supplied by median nerve (C6-T1)?

A

LOAF- muscles of precision grip

L- lumbricals
O- opponens pollicis
A- abductor pollicis brevis
F- flexor pollicis brevis

108
Q

Pathogenesis of carpal tunnel syndrome

A

Mononeuropathy of median nerve due to compression at the wrist (increased pressure in the carpel tunnel)

  • characterised by tingling, numbness or pain on distribution of median nerve (thumb, index and middle fingers and medial half of ring finger on palmar aspect)
  • often worse at night and causes wakening
  • weakness in hand grip and opposition of the thumb
  • muscle wasting In thenar eminence
109
Q

Damage to the median nerve at elbow or forearm causes what symptoms ?

A
  • inability to flex index finger and distal phalanx of thumb
  • weak flexion of Middle finger
  • defective opposition of thumb
110
Q

Treatment for carpel tunnel

A
  • likely to resolve in 6 months if
111
Q

Signs of ulnar nerve compression (C7-T1)

A
  • weakness/wasting of ulnar side wrist flexors, interossei (can’t cross fingers) and medial two lumbricals (claw hand)
  • hypothenar wasting -> weak little finger abduction
  • sensory loss over medial 1.5 fingers
112
Q

Wrist drop is caused by which peripheral mononeuropathy ?

A

Radial nerve compression

113
Q

What is Guillain-Barré syndrome ?

A
  • Acute, predominantly motor, inflammatory, demyelination neuropathy
  • symmetrical, ascending muscle weakness begins few weeks after an infection
  • progressive phase up to 4 weeks followed by recovery
  • proximal muscles more affected
114
Q

What is thoracic outlet syndrome?

A

Mononeuropathy of brachial plexus

  • pain in arm
  • paraesthesia in arm and hand (usually C8 and T1 dist)
  • weakness in arm

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