Neuro Flashcards
Wernicke’s aphasia
Temporal lobe affected with receptive aphasia or fluent aphasia (comprehension intact but difficulty forming words )
Lateral medullary syndrome or Wallenberg’s syndrome
Occlusion of PICA
4 S structures
Spinothalamic tract - contralateral pain and temperature, crude touch, itch
Sympathetic Nervous System -horner’s
Spinocerebellar - ataxia
Sensory nuclei of CN V- ipsi loss of facial sensation
4 midline structure at medulla
Motor nuclei of CN 3,4,6,12
Motor tract - corticospinal tract
Medial lemniscus tract - proprioception?
MEDIAL LONGITuDinaL FASCICULUS —-> intranuclear opthalmoplegia
Fatiguable ptosis/ fatigue on climbing stairs/ teacher with sloppy handwriting towards the end of the day
Myasthenia gravis
Autoantibodies against ACh receptors?
Paraneoplastic NMJ manifestation ?
Arising from small cell Lung carcinoma
Ease of movement improves with more motion
Wernicke’s encephalopathy classic triad
- Confusion
- Ataxia - wide based gait
- Opthalmoplegia ( nystagmus, LR or conjugate palsy. Supranuclear opthalmoplegia)
Due to thiamine B1 deficiency
Korsakoff’s syndrome
Hypothalamic damage and cerebral atrophy due to thiamine (B1) deficiency.
Decrease ability to form new memories, confabulation (inventing memories) lack of insight and apathy.
Broca’s aphasia
Frontal lobe affected with expressive aphasia or non fluent aphasia (difficulty comprehending but formation of non logical sentences)
Down and out gaze with ptosis
Cranial Nerve III palsy
Multiple sclerosis is associated with
Intranuclear opthalmoplegia
Optic neuritis
Patchy neurological symptoms
Investigations for Stroke
Bedside:
ECG and holter
Bloods: FBE, ESR, Coags, Troponin,
Non contrast CT, Echo
Mx of Stroke
Ischaemic Stroke: O2 control, BSL, alteplase, Maintain BP, DVT prophylaxis, aspirin
Haemorrhagic Stroke: reverse , refer to Nsx, decrease BP, manage seizure
Pathology of Brain Infarcts <24 hours 1-3 days (S-L-O) 3-5 days (Liq-M -G) Long term
<24 hours - no change
1-3 days - soft swollen pale/ loss of grey white differentiation/ oedema
3-5 days - liquefactive necrosis, macrophage infiltrate, gliosis
Long term - fluid filled cystic change
Cause/location of extradural haemorrhage
B/w dura and skull
rupture of middle meningeal artery
Typical presentation of extradural haemorrhage
Head trauma, unconscious lucid interval coma
CT finding of extradural hx
Biconvex finding, adherance to sutures
Subdural haematoma
- rupture
- CT
- presentation
- bridging emissary vein (b/w dura and arachnoid)
- elderly pt from fall (brain atrophy, rattle in skull)
- crosses sutures, crescent shape
Subarachnoid hx
- presentation
- location
- Ix
- Management
-Gradually increasing neuro symtom - thunderclap headache, meningism, preceded by sentinel headache ‘warning leak’
-Rupture of berry aneurysm
- Ix - CT and LP (xanthochromia, blood in CSF)
- Clip and coil. Increase volume, increase BP, decrease Hct
induce hypertension, hypervolaemia, haemodilution (Triple H)
What are common causes of coma?
COMA
CO2 narcosis: COPD, asthma, GBS, respiratory depression
Overdose: alcohol, opiates, benzo, antidepressants,
Metabolic: Hypo/hyperglycaemia, hypo/hypernatraemia, uraemia, hypothyroid, adrenal failure
Apoplexy: stroke, head trauma, encephalitis, epilepsy,
Mx of decrease consciousness
First aid: DRSABCD- immobilise C spine, O2, 2 large bore IV cannula
Examination: Vital BSL,
Ix:
Manage underlying cause:
Causes of headache x 4
Tension headache migraine Cluster headache Trigeminal neuralgia OR ( meningitis, sinusitis, temporal arteritis, raise ICP)
Don’t forget rebound headaches - caffeine or med withdrawal
Tension Headache
- Epi
- Rx
Most common in adults, tight band like sensation
Paracetamol, NSAID, amitriptyline
Migraine Headache
- presentation
- Rx
Common in females, and ED presentation Prodrome: photophobia --> prodrome:aura --> severe unilateral throbbing headache 4-7 hours --> nausea, vomiting -->postdrome: lethargy Rule out others with MRI Acute: Paracetamol, NSAID Dark room, avoid triggers
MIGRAINE triggers: CHOCOLATE
Chocolate cheese Hydration OCP, menstruation Caffeine withdrawal Odours Light loud noise alcohol red wine Travel Eating poorly Sleep deprivatoin Stress
Cluster headaches
- presentation
- rx
- most common in males, triggered by alcohol
- severe consecutive unilateral headaches alternating with headache free period
- pain behind eyes, lacrimation, rhinorrhoea (sinusitis ddx)
triptan, verapamil, HIGH flow oxygen for 15 minutes.
Trigeminal neuralgia
Treat with carbamazepine (antiepileptic)
Extreme pain with trigger points
‘suicide disease’
Temporal arteritis
- classic presentation
- rx
> 50 year old with high ESR
Scalp tenderness, jaw claudication, amaurosis fugax,
Treat with : high dose prednisolone, then temporal artery biopsy.
What is associated with PMR
Temporal arteritis
Due to inflammation of medium and large vessel arteries in body containing elastin
Benign intracranial hypertension
- presentation
Overweight female with daily headaches worse in the morning.
Assoc with vomiting, diplopia and tinnitus
Indications for CT
- First or worst severe headache
- Change in pattern
- Neurological signs
- Over 50
- Fever (consider LP)
- Occipital headache (seizure syndrome)
Occipital headache can be associated with:
Subarachnoid haemorrhage
Triad for brain abscess
Presentation and treatment
Fever
Headache
Focal neurology
fluclox
metro
ceftaz
Encephalitis
- cause
- rx
Commonest cause: viral
HSV, EBV, varicella, adenovirus
Empirical: acyclovir
Commonest primary brain tumours
Meningiomas (good prognosis) 36%
Gliomas - 2nd commonest (good prognosis except GBM)
Pituitary adenomas
schwannomas
CT MRI findings of
- abscess
- metastases
- primary
- Abscess and metastases found at corticomedullary junction
- A: central necrosis, reactive edge
- M: small, multiple, rounded satelite
- P: solid tissue, single large
5 causes of peripheral neuropathy
DEBUT Diabetes ETOH B12 deficiency Uraemia (kidney failure) Thyroid (hypo)
Charcot Marie tooth has what typical gait
Flat footed - crane like?
High arched foot
Most common bacterial pathogens for bacterial meningitis
Strep pneumoniae Neisseria meningitides Haemophillus influenzae Listeria monocytogenes Mycoplasma tuberculosis
Most common viral causes of viral meningitis
Herpes simplex virus HSV
Coxsackie virus
Echovirus
Causes of SeizuresL TIMED P
Trauma Infection Metabolic glucose Mass Epilepsy DRugs Pseudoseizure
Triggers for Seizures IFSSAD
Illness Flashing lights stress sleep deprivation alcohol withdrawal drugs (illicit/noncompliance)
If icp is raised, first cranial nerve to be affected ?
CNVI
