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PPE OSCE > Neuro > Flashcards

Neuro Flashcards

1
Q

Define stroke

A

Sudden onset of focal neurological symptoms caused by interruption of the vascular supply to part of the brain, or intracerebral haemorrhage

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2
Q

Define epilepsy

A

Episodes of increased electrical activity within the brain leading to recurrent seizures

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3
Q

What is ataxia?

A

Loss of coordination of movements

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4
Q

What is rigidity?

A

Hypertonia characterised by increased resistance to passive stretch

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5
Q

Where is lumbar puncture performed and why?

What is the major contraindication and why?

A

Between L3 and L4 - spinal cord ends at L1

RICP - risk of tonsillar herniation

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6
Q

Where does an extradural haemorrhage occur?
Where does the blood come from?
Describe 2 radiological features

A
  • Between the skull and the dura mater (or really between the periosteal and meningeal layers of dura mater)
  • Arterial - usually middle meningeal artery
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7
Q

Why is extradural haemorrhage more likely to occur in younger patients?

A

In older people, the dural layers are more adhesive - less likely to split apart

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8
Q

Between which meningeal layers does a subdural haemorrhage occur?
Where does the blood come from?

A
  • Meningeal layer of dura, and arachnoid mater

- Venous - bridging veins which drain from cerebrum into DVSs

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9
Q

What is it called if blood accumulates in the subarachnoid space?
What is the most likely cause?
What is the typical presenting feature?

A
  • Subarachnoid haemorrhage
  • Rupture of berry aneurysm
  • Thunderclap headache
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10
Q

From which vessel does the anterior cerebral circulation originate?
What about the posterior circulation?

A
  • ICAs

- Vertebral arteries

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11
Q

Outline the course of the ICAs in terms of landmarks and major branches

A
  • Enters cranial cavity via carotid canal
  • Passes through cavernous sinus - pierces dura - enters middle cranial fossa
  • Gives off:
    ophthalmic artery
    posterior communicating artery
    anterior cerebral artery
  • Continues as middle cerebral artery
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12
Q

Which areas are supplied by the anterior cerebral artery?

What would the symptoms be if it was occluded unilaterally?

A

Medial aspects of frontal and parietal lobes, and corpus collosum
Contralateral lower limb motor and sensory deficit

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13
Q

Which areas does the middle cerebral artery supply?

What would be the symptoms of unilateral occlusion?

A
  • Lateral surfaces of cerebral hemispheres
  • Occlusion causes contralateral sensory and motor deficit, particularly upper limb
  • Contralateral hemianopia
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14
Q

Outline the course of the vertebral arteries in terms of landmarks and major branches

A
  • Ascend in transverse foramina
  • Enter via foramen magnum
  • Give off
    Anterior and posterior spinal arteries to SC
    Posterior inferior cerebellar artery (PICA)
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15
Q

Which areas are supplied by the PICA?

What would happen in occlusion?

A
  • Lateral medulla and cerebellum
  • Contralateral loss of pain and temp
  • Ipsilateral nystagmus/ataxia, Horner’s, dysphagia
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16
Q

What happens in occlusion of one of the vertebral arteries?

A

Usually anastomoses mean it’s fine

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17
Q

Which arteries converge to form the basilar artery?

A

Vertebral arteries

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18
Q

What does the basilar artery supply?

What would be the symptoms of occlusion?

A

Cerebellum and pons

Very serious - often coma, bilateral motor and sensory deficit, cerebellar signs, CN signs

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19
Q

How does the basilar artery terminate?

A

Bifurcates into posterior cerebral arteries

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20
Q

Which areas does the PCA supply?

A

Posterior hemispheres - posterior parietal and occiptal

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21
Q

Name 3 major vessels which could be occluded in a posterior circulation stoke

A
  • Vertebral
  • Basilar
  • PCA
22
Q

Which modalities are carried by the dorsal columns?

A

Fine (tactile) touch
Vibration
Proprioception
2-point discrimination

23
Q

Where are the cell bodies of the 1st order neurones of the DCML?

A

Dorsal root ganglion

24
Q

In which dorsal column do fibres from the upper body run?

Lower body?

A 
Upper = lateral
Lower = medial
25
Q

In Brown-Sequard syndrome, why are DCML modalities lost ipsilaterally?

A

Lesion occurs below the level of decussation - decussation occurs in medulla, but lesion is in SC

26
Q

Give some examples of causes of DCML lesion

A

Vitamin B12 deficiency

Tabes dorsalis

27
Q

Which modalities are carried by the lateral and anterior spinothalamic tracts respectively?

A

Lateral - pain and temperature

Anterior - crude touch and pressure

28
Q

In Brown-Sequard syndrome, why are the spinothalamic tract modalities lost contralaterally?

A

Lesion occurs above the level of decussation

29
Q

What is Brown-Sequard syndrome?

A

Hemisection of the spinal cord resulting in:

  • Ipsilateral loss of vibration/proprioception/fine touch
  • Contralateral loss of pain and temperature sensation
  • Ipsilateral UMN signs
30
Q

What is syringomyelia?

A

CSF cyst in central canal of spinal cord resulting in selective loss of bilateral lateral spinothalamic tracts - hence loss of pain and temp in both upper limbs.

31
Q

What is an upper motor neurone?

A

A motor neurone whose cell body is in the cortex, and whose axon remains in the CNS

32
Q

What is a lower motor neurone?

A

A motor neurone whose cell body is int he ventral horn of the spinal cord (or brainstem) and whose axon projects to the musculature

33
Q

What gives rise to extrapyramidal signs?

A

Damage to basal ganglia

34
Q

Give some examples of extrapyramidal signs

A
  • Resting tremor
  • Cog-wheel rigidity
  • Bradykinesia
  • Festinating gait
35
Q

What are pyramidal signs?

A

UMNL signs

36
Q

Give some signs of cerebellar dysfunction

A
  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia
37
Q

Give some causes of cerebellar dysfunction

A
  • Posterior fossa tumour
  • Alcohol
  • MS
  • Trauma
  • Rare
  • Inherited - e.g. Friedrich’s ataxia
  • Epilepsy medication
  • Stroke
38
Q

Are cerebellar symptoms contralateral or ipsilateral?

A

Ipsilateral

39
Q

What are the 4 cardinal signs of Parkinsons?

A
  • Bradykinesia
  • Rigidity
  • Postural instability
  • Resting tremor
40
Q

List 6 UMN signs

A
  • Hyperreflexia
  • Hypertonia
  • Positive Babinski
  • Clonus
  • Pronator drift
  • Clasp-knife reflex
41
Q

List 5 LMN signs

A
  • Hyporeflexia
  • Hypotonia
  • Wasting
  • Weakness
  • Fasciculations
42
Q

What produces the hyperreflexia in an UMN lesion?

A

Lack of descending inhibition

43
Q

What is clonus?

A

Repetitive, sustained plantarflexion when the ankle is suddenly, passively dorsiflexed

44
Q

What causes clasp-knife rigidity?

A

Activation of the Golgi tendon organ causing subsequent sudden relaxation while a spastic muscle is passively stretched

45
Q

What is pyramidal weakness?

A

Weakness affecting extension of upper limbs and flexion of lower limbs

46
Q

Describe decorticate posturing

Where is the lesion?

A

Legs extended at knee and ankle
Elbows and wrists flexed
Lesion above the red nucleus

47
Q

Describe decerebrate posturing

Where is the lesion?

A

Everything extended
Forearm pronated
Lesion below red nucleus

48
Q

What is a positive rhombergs?

A

Unsteady with eyes shut - sign loss of proprioception - problem with dorsal columns
Shows sensory ataxia (whereas in negative rhomberg’s the ataxia is cerebellar)

49
Q

List some features of a Broca’s aphasia

A
  • Staccato speech
  • Lack of fluency
  • Understand question, problem is with expression - hence can write down answer
50
Q

List some features of a Wernicke’s aphasia

A
  • Fluent and grammatical speech, just doesn’t make sense
  • Inappropriate answers to questions
  • No problem with expression - problem is comprehension
51
Q

List some signs of a basal skull fracture

A
  • Periorbital ecchymosis
  • Mastoid ecchymosis
  • CSF rhinorrhoea/otorrhoea

PPE OSCE (8 decks)

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