neuro Flashcards
1
Q
what will a CT contrast imaging show of a basal subarachnoid haemorrhage
A
blood in the interhemispheric fissure and the sylvian fissure and all the sulci ventricles can be enlarged
2
Q
what are the acute demyelinating polyneuropathies
A
Guillain-Barre syndrome
AIDS-seroconversion phase
lymphoma
3
Q
pathological spreading is a sign of
A
UMN lesion
4
Q
treatment of ischaemic stroke
A
alteplase
decompressive craniotomy
angiography - remove clot
5
Q
why do you give vancomycin in the AB cocktail for meningitis
A
to try and gain some cover for high level resistant strains of strep pneumonia
6
Q
what is claudication
A
ischaemic pain in exercising muscles - due to the imbalance between workload of muscles and the ability to maintain aerobic metabolism
7
Q
how do you tell which eye is the dud one in diplopia
A
the one that moves the least = dud
8
Q
lacunar infarcts affect which vessels
A
vessels to the basal ganglia, thalamus or deep white matter
9
Q
differential diagnosis in someone with a new onset headache with cancer or IS
A
meningitis
brain abscess
metastasis
10
Q
What is the term for worsening of sensory symptoms with heat?
A
Uhthoff’s phenomenon - relatively specific for MS
11
Q
what is dystonia
A
abnormal muscle activity/tone leading to sustained postures and movements
12
Q
treatment for ecephalitis
A
dexamethasone preceding ceftriaxone + vancomycin + penicillin (to cover for meningitis) + ACYCLOVIR
13
Q
two common causes of acute vestibulopathy
A
vestibular neuronitis
brainstem/cerebellar stroke
14
Q
what causes aneurysms (pathology)
A
weakness in elastin and collagen in the adventitia and media
15
Q
how do mass lesions/tumours in the brain cause headache
A
- traction on large blood vessels and dura
- direct pressure on pain-sensitive areas
- elevated ICP from hydrocephalus, mass effect or haemorrhage into or around the tumour
16
Q
3 most common triggers for seizures
A
alcohol
sleep deprivation
non-compliance from meds
17
Q
symptoms of carpal tunnel
A
pain in the whole hand, tingling discomfort which is most prominent at night
patients tend to shake their hand for the pain
fingers feel like sausages
18
Q
major diagnostic finding to diagnose myopathy
A
CK >1000
19
Q
what is primary lateral sclerosis
A
similar to ALS but no LMN signs –> better prognosis
20
Q
how do you diagnose myasthenia gravis
A
- tensilon test with short acting ACh antagonist (edrophonium)
- blood test for autoantibodies
- ACh R, MuSK
- CT chest (for thymoma)
- EMG studies
21
Q
when someone has an intention tremor.. what do you think
A
cerebellar lesion
22
Q
what are the complications of subarachnoid haemorrhage
A
hydrocephalus –> increased ICP vasospasm –> infarction
hypernatraemia
seizures
neurogenic pulmonary oedema
MI
late complications = PE, pneumonia
23
Q
what are the common features of raised ICP headache
A
worse in the mornings
better after vomiting
exacerbated by cough or straining
drowsiness
24
Q
what are the clinical features of myasthenia gravis
A
no muscle wasting or fasiculations
proximal weakness > distal normal reflexes and sensation weakness increasing with repetitive exercise
early involvement of extraocular muscles and lid opening muscles
25
signs and Sx of optic neuritis
RAPD
Swelling of the optic disc
painful eye movements
decreased visual acuity
decreased red colour saturation
26
tests for cranial nerves III, IV and VI
H test
27
treatment for demyelinating polyneuropathy
intragam
plasma exchange
Steroids (CIDP only)
immunosuppression
28
signs of motor neuron disease
muscle wasting
fasiculations
LMN and UMN signs
generalised weakness
reflexes preserved unti late
plantars may be upgoing
no sensory loss
29
why do you give dexamethosone to patients with suspected meningitis prior to giving them ABs
to try and prevent 8th nerve damage
30
how can you tell the difference between peripheral and central nystagmus
peripheral - nystagmus doesnt direction change (beats away from affected ear), mixed horizontal and torsional nystagmus
central - nystagmus direction changes, any kind of nystagmus
31
what 3 inherited conditions can predispose you to getting a brain tumour
neurofibromatosis 1 and 2
Li Fraumeni syndrome (p53 loss --\> glioma)
32
what is a positive Head impulse test
when you see the correctional movement of the eyes going back onto the target (catch up sarcade)
33
acute treatment of stroke before knowing whether ischaemic or haemorrhagic
NIL oral
IV fluids of Normal saline
aspirin
clexane 40mg
neurological examinations 2 hourly
inform relatives
34
what signs do PD patients get due to their rigidity
stooped posture
reduced arm swing
stiffness through ROM in a joint
- cog wheeling or lead pipe
35
explain the 2 phases of nystagmus
slow phase - retinal slip
fast phase - re-fixate on target alternate between slow and fast phases
36
what are the 2 prognostic factors that make it more likely for a patient to progress to having MS from a single presentation
- the number of inflammatory lesions of baseline MRI brain
- the presence of oligoclonal bands in the CSF
37
symptoms of severe ischaemia of the lower limbs
pain
parasthesia
pale
coolness
pulseless
38
how can you tell the difference in presentation between vestibular neuronitis and brainstem stroke
vestibular neuronitis - can stand on their own, unidirectional nystagmus, may be suppressed by fixation, HIT positive
brainstem stroke - cannot stand on their own, head impulse test negative, direction change nystagmus
39
what is the characteristic sign of BPPV during a Hallpike
period of latency and then a torsional nystagmus, then passess
40
explain the gait of someone with PD
- short, shuffling
- reduced speed
- narrow base
- forward trunk flexion (stooping)
- reduced arm swing
- festination or freezing
- difficulty turning/changing direction
41
characteristic histological sign for meningioma
meningioma "whorls"
42
what are the red flags for headache
- first/worst headache
- abrupt onset
- change or progression of pre-existing headache pattern
- abnormal findings on physical/neurological exam
- new headache in patients aged \>50
- new headache in patients with cancer, IS, pregnancy
- triggered by exertion, sexual activity, Valsalva
43
most common cause of encephalitis
HSV
44
secondary prevention of stroke
BP lowering
statins
antiplatelet
AF prevention
carotid revascularization
anticoagulation
45
what disorder/disease is associated with myasthenia gravis
thymic hyperplasia
thymoma
46
in which reflex is spreading normal
brachioradialis
47
risk factors for stroke
hypertension, AF, acute MI, ventricular aneurys, RHD, prosthetic valves, Diabetes, cigarette smoking, increased W:H, heavy alcohol intake, polycythaemia, hypercholesterolaemia
48
meningiomas are most common in which population
women middle age
49
difference between simple and complex seizures
simple - no effects on awareness
complex - affects awareness
50
two main DDx for headache + seizures
tumour
haemorrhage
51
main treatment for PD
Levodopa + carbidopa (peripheral decarboxylase inhibitor)
52
localisation of a tumour in a patient with dysphasia
dominant frontal or temporal lobes
53
what causes the meningism symptoms associated with sub arachnoid haemorrhage
due to blood in the subarachnoid space
54
what is the acute treatment of MS flare
1g IV methylprednisolone for 3-5 days
55
most common symptom of low grade glioma
seizures
56
which primary tumours commonly metastasise to the brain
lung, breast, melanoma, kidney, GI
57
causes of peripheral nystagmus
BPPV
vestibular neuronitis
Meniere's disease
Trauma
58
What is it called when a focal seizure starts off and then spreads for eg. up the arm
Jacksonian March
59
treatment of myasthenia gravis
ACh antagonists
plasma exchange
IV immunoglobulin
immunosuppression - steroids, azathioprine thymectomy
60
principles of treatment of brain metastases
- commence dexamethasone
- reduction in ICP and oedema
- surgery to remove the metastasis if solitary or the patient has a reasonable life expectancy (occasionally some are removed for palliation)
- whole brain radiotherapy
- for multiple mets
- stereotactic radiotherapy
- for 1-3 mets
61
what are the signs/symptoms associated with segmental radiculopathy
pain/paraesthesia in a dermatomal distribution
weakness of muscles innervated by the root --\> may atrophy
May have diminished/absent reflexes
62
lacunar infarcts are associated with
hypertension!
63
differential diagnosis in someone with headache triggered by exertion/sexual activity/valsalva
aneurysm
chiari malformation
posterior fossa tumour
64
what causes spinal compressive syndrome
epidural abscess - extension from spinal discitis or bacterial
osteomyelitis - bacteriaemia with seeding to epidural space
65
treatment of raised ICP caused by subarachnoid haemorrhage
elevation of the head (encourages venous return)
diuresis to reduce cerebral oedema/ECF
hyperventilation - intubate and ventilate if necessary
sedate/paralysis
remove mass
drain hydrocephalus
66
what are the causes of transverse myelitis
MS (common)
infectious
autoimmune disorders
No aetiology
67
What is Tod's paresis/palsy
after a focal seizure the part where the seizure started in may have paralysis/paresthesia for a while after the seizure
68
survival with a low grade glioma
years to decades - eventually will progress to a higher grade and death
69
what is an ataxic gait
gait with a broad base (10-15cm) - looks drunken
70
how much time must pass between presentations for MS to classify them as disseminated
at least 1 month
71
what are the 4 common disorders of neuromuscular junctions
post synaptic - myaesthenia gravis
pre synaptic - Lambert Eaton myasthenic syndrome
botulism
tick paralysis
72
how to test for dysphasia
No ifs ands or buts
73
what are the clinical patterns of generalised epilepsy
absence
myoclonus
tonic-clonic
74
what is the histological feature typical of gliomas
necrotic region with tumour cells "pallisading" at margin
75
most common cause of nerve root injury
herniated intervertebral disk
76
what is dysmetria
overshooting (in finger-nose test)
77
primary prevention of aneurysms
stop smoking
control of hypertension
78
the level of sensory deficit tells you what about the level of injury
the lowest possible level of injury (could be anywhere higher than this)
79
explain the pathology behind parkinson's
reduction in dopaminergic neurons in the pars compacta of the substantia nigra --\> reduction of dopamine in the striatum --\> increased inhibition of cortical motor areas
80
two causes of motion induced vertigo
uncompensated peripheral vestibular lesion (following vestibular neuronitis)
BPPV
81
3 surgical options for claudication
- angioplasty +/- stenting - best for short segments in proximal arteries
- endarterectomy - for short segments
- bypass- for longer blocks
82
tests for cranial nerve II
pupil reflexes
visual fields
acuity
83
what is ischaemic rest pain
perfusion is so poor that there is pain at rest in the most distal part of the limb - some relief from perfusion by gravity
84
symptoms of radial nerve lesion
wrist drop and cant extend their fingers
sensory disturbances in the dorsal, lateral part of the hand
85
which is more common in Australia - infarct or haemorrhage
infarct (80%)
86
what is an intention tremor
when the tremor gets larger when closer to the object
87
hallmarks Sx for: meningitis encephalitis SOL syndrome spinal compressive syndrome
meningitis = headache
encephalitis = altered conscious state
SOL syndrome = focal neurological problems
spinal compressive syndrome = agonizing back pain
88
differential diagnosis for abrupt onset headache
Subarachnoid haemorrhage until proven otherwise
- pituitary apoplexy
- bleed into a mass or AVM
- mass lesion (especially posterior fossa)
89
principles of treatment of a meningioma
- total surgical excision and obliteration of the dural attachment is the most effective treatment
- Rx for small, residual recurrent or malignant tumours
90
what is oscillopsia
sensation that the visual world is moving
91
management of ALS
speech pathology - swallow and communication
NIV
mobility
aids
riluzole (glutamate antagonist)
92
what is dyskinesia
reversible levodopa-induced motor complication - abnormal involuntary movements
93
principles of treatment for an astrocytoma
- commence dexamethasone
- reduction of cerebral oedema and ICP
- resection of as much of the tumour as safely possibly
- adjuvant therapy
- Rx and Cx
94
how can you tell if someone has internuclear opthalmoplegia
when you do the horizontal part of the H test - eyes wont move together - failure of adduction of one eye (stops at midline) with the other eye having nystagmus
95
system for grading power
0 = nothing
1 = visible twitch
2 = movement with gravity
3 = suboptimal movement against gravity
5 = normal movement against resistance
96
in the hospital, what is the likely Tx given to someone with suspected meningitis
dexamethasone preceding ceftriaxone + vancomycin + penicillin -\> then do CT -\> LP
97
how do you die of a stroke (if you were to die of the stroke and not pneumonia)
oedema --\> brain swelling --\> raised intracranial pressure --\> brainstem herniation --\> death
98
explain the blood supply to the brain
via internal carotid arteries (70%) and vertebral arteries (30%) which anastomose at Circle of willis (base of brain)
99
what is the difference in the effect on the 3rd nerve between an intracranial mass and diabtes
intracranial mass - affects dilatory fibres more = pupillary dilation
diabetic = affect motor fibres more = pupillary constriction
100
pharmacological treatment of generalised seizures
first line = Sodium Valproate
- benzos
- lamotrigine
- ethosuximide
- ?phenytoin
101
what are the 4 clinical stages of spinal compressive syndrome
nuchal pain --\> nerve root pain --\> weakness --\> paralysis
102
describe the headache associated with a subarachnoid haemorrhage
sudden, severe headache at the back of the head associated with nausea and vomiting and photophobia and neck pain
103
proximal weakness suggests which DDx
myopathy
myasthenia gravis
104
what causes myasthenia gravis
antibodies that cross react with the ACh receptor as the neuromuscular junction
105
How do you test cranial nerve V
- Mastication/bite down on own teeth and feel masseter bulk
- Corneal reflex (also tests VII)
- check sensation in the 3 areas
- ask to open their mouth
- if weakness the jaw will move across
- jaw jerk = absent is normal
106
What do you think of with vertigo that lasts hours
migraine
Meniere's disease
107
goals of management for a subarachnoid haemorrhage
prevent rebleed - secure the aneurysm prevent complications pain relief
108
types of delirium
hyperactive
hypoactive
mixed
109
What do you think of with vertigo that lasts seconds
BPPV
uncompensated peripheral lesion
110
how do you test for cranial nerve XI
- ask to shrug shoulders and leave them up and then try to push them down (upper trapezius)
- ask to get them to turn their head (opposite SCM to the way the head is turning)
111
what is the most common type brain tumour
glioma (52%) - of these astrocytoma is the most common 44%
112
what is the clinical sign of brainstem herniation
fixed dilated pupil (3rd nerve palsy (squished against cerebellar peduncle))
113
what is an aneurysm
a focal dilatation of the artery
114
management of spinal compressive syndrome
MRI ASAP --\> neurosurgery or AB alone is neurosurgeons say so
115
when you see multiple cerebral infarcts.. what should you think
watershed infarcts, emboli or vasculitis
116
metabolic causes of secondary headache
OSA
present upon awakening
thyroid disease
B12 deficiency
exposure to CO and other toxins
hepatitis, renal disease, anaemia
117
what inflammatory causes can cause myopathy
polymyositis
dermatomyositis
includion body myositis
118
what is transverse myelitis
inflammatory demyelination of segment/s of spinal cord
119
why do you give penicillin in the AB cocktail for menigitis
to treat for Listeria
120
common levels of cervical stenosis
C5-6
C6-7
121
What is Brown-Sequard syndrome
hemisection of the spinal cord causing:
- contralateral impairment of pain and temp
- ipsilateral weakness and impairment of proprioception, vibraction and light touch
122
where are watershed infarcts
at the edge of two vascular territories
123
signs/symptoms for spinal cord injury
reduced reflexes
weakness
paraesthesia
pain in the distribution of the nerve root
124
what is a hemiplegic and diplegic gait
hemiplegic - circumduction with one leg (because foot is plantar flexed)
diplegic - cirumduction of both legs
125
when is the peak incidence for gliomas
6-8th decade
126
normal ICP
10-15mmHg
127
what are the red flags associated with headache flagging sub-arachnoid haemorrhage
sudden onset
family history
hypertension
128
when is the greatest risk of rebleed of a subarachnoid haemorrhage
first 24-48 hours
129
how do you test for cranial nerve XII
- muscle bulk
- deviated tongue on protrusion (deviation will be towards the affected side)
130
typical histological findings in polymyositis biopsy
inflammatory infiltrate around and INTO the muscle fibres
131
what causes the raised ICP with a brain tumour
tumour mass surrounding oedema
hydrocephalus if CSF pathways are blocked
132
most common form of motor neuron disease
amyotrophic lateral sclerosis
133
how is nystagmus named
as per direction the quick phase
134
typical bacterial meningitis LP
\>1000 polymorphs, mostly leukcocytes protein \>1g/L sugar decreased
135
how do you test cranial nerve VII
- corneal reflex (with V)
- close your eyes tightly (orbicularis occuli) -\> dont let me open your eyes (weakeness = opens)
- smiling and bearing teeth
- bear teeth and tighten neck muscles
136
list the different ways an intracranial mass can present
Sx of raised ICP - headache, photophobia, drowsiness, confusion, seizures
focal neurological deficit
137
safest seizure medication if pregnant
tegretol (carbamazepines)
138
average life expectancy for ALS
if bulbar onset - 6-12 months
if limb onset - 2-5 years
139
what is critical limb ischaemia
ischaemic rest pain with ulcers/gangrene and low trans-cutaneous oxygen pressure
140
most dangerous seizure medication if pregnant
sodium valproate = Epilim (teratogenic)
141
2 broad categories of seizures
generalized
focal/partial - often due to structural abnormalities
142
what are the 4 primary symptoms of Gerstmann syndrome
dysgraphia/agraphia
dyscalculia/acalculia
finger agnosia
left-right disorientation
143
prognosis for gliomas
7-14 months
144
Treatment of Meniere's disease
strict sodium restriction
diuretics
Surgery
145
what do you see in a lumbar puncture for a subarachnoid haemorrhage
- bloodstained CSF that does not clear on 3 consecutive collection tubes
- xanthochromia (yellow staining due to breakdown of haemoglobin)
146
what do you see in the CSF in someone with MS
oligoclonal bands (90%)
147
common first presentations of MS
transverse myelitis
optic neuritis
brainstem/cerebellar presentations
148
How do you diagnose MS
At least 2 clinical presentations disseminated in time and space, unattributable to other causes
149
pharmacological treatment of partial seizures
carbamazepine
Sodium valproate
phenytoin
benzos
vigabatrin
lamotrigine
gabapentin
150
definition of stroke
sudden cerebrovascular accident with abrupt onset of symptoms
151
common presentation of a meningioma is symptomatic
raised ICP
focal neurological deficit
seizures
152
What do you think of with vertigo that lasts days
vestibular neuronitis
stroke
153
work up for an abrupt onset headache
neuroimaging
lumbar puncture
154
what are the signs of anterior horn cell diseases
early muscle wasting
fasiculations
common diffuse weakness
reflexes normal or increased sensation normal
155
which type of brain tumour can typically grow very large without symptoms
meningioma
156
other treatments for PD
COMT inhibitors
MAO-I
Dopamine agonists
anticholinergics
amantadine
157
what common drugs can cause myopathy
alcohol
statins
158
two main bacterial causes of bacterial meningitis
N. meningitidis Strep pneumonia
159
how do you test for cranial nerves IX and X
- Gag reflex
- look for normal movement of the soft palate
- look for central uvula (deviation will be towards normal side)
160
what causes dysarthria
impaired movement of the muscles required for speech
161
severe/sudden ischaemia in the lower limbs is usually due to
embolus
162
side effects of reperfusion of the lower limb in acute severe ischaemia
acute: shock
chronic: compartment syndrome
163
how do you test balance
Romberg test - standing feet together and eyes closed standing on one foot and hopping
164
symptoms of ulnar nerve lesion
wasting of pretty much all the small muscles of the hand
weakness and fasciculations
numb/tingling in medial 1.5 fingers
165
Explain the look of an MS plaque on MRI
hyperintense lesion on T2 weighted MRI with active lesions showing enhancement with gadolinium
166
Crossed sensory signs indicates
damage to spinal cord (on one half)
167
cardiogenic embolism usually obstructs which cerebral artery
MCA
168
4 main motor features of Parkinsons
rigidity
bradykinesia
pill rolling tremor
postural instability
169
what sign is distinct for a headache caused by decreased ICP
headache relieved by lying down
170
typical signs of claudication
pain on exertion
onset and severity related to workload
relieved with rest reproducible
171
clinical presentation of cauda equina syndrome
acute lower back pain radiating to legs
bilateral sensory loss
**saddle anaesthesia**
172
What is Meniere's disease
Oedema of the inner ear
173
which imaging would you order if you suspected subarachnoid haemorrhage
CT
174
explain the principles of treatment of a low grade glioma
- removal of as much as the tumour as safely possible
- defer Rx and Cx until tumour progression
175
what are the other symptoms of meningitis other than headache
- fever/constitutional symptoms
- photophobia
- vomiting
- neck stiffness on FLEXION
- altered conscious state
- vomiting
176
what are the MS subtypes
relapsing remitting
secondary progressive
primary progressive
