Neuro Flashcards by Anna Czesak

Ascending tracts (2) - where do they decussate and what modalities?

Dorsal column (fasciculus gracilis [medial] and cuneatus) - decussation brainstem - light touch, vibration and proprioception

Spinothalamic tract - cross over segmentally - pain, temperature, deep pressure

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Levels of reflexes:

biceps and brachioradialis - C5,6
triceps - C7

quads - L3, 4
gastrocnemius - S1

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Important descending tracts - what they do? where cross? - describe one most important
mention others (3)

Corticospinal - fine movement - pyramidal tract - 85% cross at decussation of the pyramds in medulla

Tectospinal tract
Reticulospinal tract
Vestibulospinal tract

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Duchenne muscular dystrophy is the deficiency of which protein?

dystrophin

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Pathology of Alzheimer (3)

- loss of what? -what intracellular? -what extracellular?

Loss of cortical neurones
Neurofibrillary tangles (intracellular)
Senile plaques (extracellular) - amyloid beta protein

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Age and most common organisms for bacterial meningitis?

Neonates: listeria, group B streptococci, E. coli
Children: H. influenza
10 to 21: meningococcal
21 onward: pneumococcal >meningococcal
Elderly: pneumococcal>listeria

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Treatment for TB meningitis?
Treatment of listeria meningitis?
Treat bacterial in general?
Treat viral?

What other medication for bacterial?

isonizid + rifampicin (add pyrazinamid + ethambutol)
IV ampicillin/amoxicillin (if pen allergic: cotrimoxazole)
Ceftriaxone (chloramphenicol+ vancomycin)
Aciclovir

Steroids

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Meningitis - blanching or non-blanching?

Non-blanching

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What kind of meningitis?

Lymphocytes, -ve Gram stain, -ve antigen detection, normal or slightly high protein, normal glucose?

Viral

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What kind of meningitis?

Polymorphs, +ve Gram stain, +ve antigen detection, high protein, less than 70% glucose?

Bacterial

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What kind of meningitis?

Lymphocytes, +ve or -ve Gram stain, -ve antigen detection, high or v high protein, less than 60% glucose?

Tuberculous

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Types of MS (4)

Relapsing-remitting (most)
Primary progressive (don't get relapses)
Secondary progressive (get relapses and stuff, then becomes progressive)
Progressive relapsing (is progressive from beginning but also have flare ups)

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Oligoclonal bands present or absent in MS?

Present

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Which steroid in MS?

Methylprednisolone

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What is baclofen used to treat?

Is it an NSAID?

It’s not an NSAID

Muscle relaxant for spasticity

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First line in relapsing remitting MS?

tecfidera

Treatment for myasthenia gravis

Pyridostigmine (ACh-ase inhibitor)
thymectomy
Emergency - plasma exchange or Ig

Heliotrope rash on the face is which disease?

Dermatomyositis

Acute renal failure (or DIC) and muscle disease (anya), which one?
Triad of symptoms?

Rhabdomyolysis

myalgia, muscle weakness, myoglobinuria (black urine)

UMN signs

Pseudobulbar (UMN of IX-XII CN)
Moderate weakness
Spasticity
Hyperreflexia
Babiński

LMN signs

Severe weakess
Fasciculations (excited denervated muscle)
Muscle cramps
Hypotonia
Muscle atrophy
Hyporeflexia

Headache that is wakes you up, worse on leaning forward and coughing, and may be associated with vomiting?
Can also be new neurological deficit or seizure

BRAIN TUMOUR

may have raised ICP

Increased ICP (or suspicion) - do a lumbar puncture or not?

Cabergoline is used for?

Pituitary tumours

Headache red flags?

``` New onset headache >55 •Known/previous malignancy •Immuno-suppressed •Early morning headache •Exacerbation by valsalva (coughing, sneezing etc) ```

``` Migraine: where, what kind of pain duration worse by? (which substance contributes?) aura? ```

``` unilateral, throbing 44-72 hours worse on movement, light, noise (substance P) visual, sensory, motor or language; before or during headache ```

Treatment of migraine

Abortive - NSAID, triptans aspirin, naproxen, ibuprofen (+- antiemetic) prophylaxis: propranolol, topiramate, amitriptyline

Cluster headache: where when? severity, duration

Unilateral circadian and seasonal variation severe, 45-90 mis, 1-8 days

Treat cluster headache

100% O2 SC sumatriptan steroids verapamil for prophylaxis

``` Paroxysmal hemicrania who? where? duration? frequency treat ```

``` elderly, women unilateral, severe, unilateral autonomic 10-30 mins (shorter and more frequent than cluster) 1 to 40 day Ix: indomethicin ```

Treat trigeminal neuralgia

carbamazepine, gabapentine, phenytoin

Treat partial seizures

Carbamazepine, lamotrigine

Treat generalized seizures

Sodium valproate

Treat delayed ischaemia (as a complication of SAH)

Nimodipine (Ca channel blocker so no vasospasm) | Triple H therapy - hypertension, hypervolaemia, hemodilution

Charcot-Bouchard microaneurysms associated with what?

Hypertensive Intracerebral Haemorrhage | haematoma can be present too

Brown Sequard syndrome - what is (not) felt/moved and which side?

motor - ipsilatera dorsal column - ipsilateral (fine touch, proprioception, vibration) spinothalamic - contralateral (pain, temp, crude touch)

treat epilepsy - prolonged seizures treated by carers at home

rectal diazepam (buccal midazolam) immediate control - also lorazepam, drugs above as IV

Management of status epilepticus

Give glucose (hypoglycaemia?) with thiamine (esp if suspicion of nutritional deficiency) Phenytoin ITU, EEG (within 1 hour of admission)