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Neuro Flashcards

1
Q

Extradural

A

Lucid interval before LOC

Arterial bleed

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2
Q

Subdural

A

Hx of falls and progressive confusion

Venous bleed between dura and arachnoid layers

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3
Q

Subarachnoid

A

Sudden severe headache

Half of patients lose conciousness and altered mental status is common

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4
Q

Raised ICP, SOL causes

A

Abscess, haemorrhage, infarction, tumours, odema and head injury

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5
Q

Compressive signs

A 
Headache 
N&V
Altered GCS
Papillodema
Focal neurology
Pupil changes down and out 
Pupil dilation
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6
Q

Herniation

A

CNIII - opthalmoplegia
Ataxia
Apnoea

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7
Q

Uncal/transtentorial

A

CN3 - dilated ipsilatetal pupil, opthalmoplegia, contra lateral hemiparesis

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8
Q

Tonsilar/transformanial

A

CNVI, ataxia, babinski positive, LOC, apnoea

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9
Q

Subfalcine/cingulate

A

Stroke

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10
Q

Carotid sinus syncope presents as

A

Head turning, shaving

Excessive bradycardia and vasodilation on MINIMAL stimulation

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11
Q

Situational syncope

A

Cough, effort eg exercise, micturation

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12
Q

Drugs causing postural hypotension

A

Nitrates
Diuretics
Anti hypertensives
Antipsychotics

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13
Q

Peripheral neuropathy causing postural hypotension

A

DM, Parkinsons , MSA, autonomic neuropathy

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14
Q

Endocrine causes of postural hypotension

A

Addisons

Hypopituitarism (decreased ACTH)

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15
Q

Other causes of postural hypotension

A

Elderly

Hypovolemia

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16
Q

AS is due to

A
  • congenital bicuspid valve

- calcification of all three valves

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17
Q

Non diabetic causes of hypoglyceamia

A

Insulinomas
Alcohol
Liver failure
Addisons

Alcohol and liver failure decrease hepatic glucose production

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18
Q

Pronator drift (UMN or LMN?)

A

Upper motor neurone

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19
Q

Types of generalised seizures

A

Convulsive: tonic, tonic clonic, clonic, myoclonic

Non convulsive:

  • atonic: sudden loss of muscle tone, no LOC
  • absence: no post ictal phase
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20
Q

Types of partial seizures

A

Simple - no loss of consciousness, no post ictal phase

Complex - LOC, post ictal phase

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21
Q

Treatment of status epileptics (can start at 5 mins)

A

ABC approach
Oxygen
Stop seizures:
1. Rectal diazepam (if not it hospital setting) repeat at 15 mins
2. Slow IV bolus Lorazepam (2-4mg). Repeat if no response. Plus give any usual anti epileptic drugs they may use
3. Continuing seizures: IV infusion phenytoin
4. GA phenytoin

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22
Q

Bell’s palsy symptoms

A 
Full facial droop 
LMN CN7
Hypersensitivity to sound 
Tearing or drying of exposed eye 
Loss of taste
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23
Q

What is not effected in BPPV

A

Hearing is not a feature
Tinnitus is not a feature

NB they are in meniers

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24
Q

Test for BPPV

A

Dix hallpike test

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25
Q

Mmse cut off for dementia

A

<27

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26
Q

Sister causes of headache

A

VIVID

  • vascular (SAH/haematoma)
  • Infection (meningitis or encephalitis)
  • Vision threatening (temporal arteritis or acute glaucoma)
  • Intracranial pressure (SOL, hydrocephalus)
  • Dissection (carotid)
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27
Q

Management of migraine

A 
1. Conservative: headache diary 
(Avoid precipitating factors) 
2. Acute medical treatment:
-+NSAIDs 
-+Antiemetic (Metroclopramide)
-sumitriptan +/- magnesium --> 2nd ergot alkaloids 
3. Prophylaxis : 
1st: propranolol or topiramite
2nd. Amitriptyline

Rescue remedy:
high flow oxygen, sumatriptan or magnesium sulphate

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28
Q

Cluster headache presentation

A

Unilateral headache
Pain behind the eye
(Swollen eye lid, forhead swelling, nasal congestion, horners syndrome)

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29
Q

Tx for cluster headaches

A
  1. Acute: 100% oxygen in non rebreathable mask
    Sumitriptan
  2. Prophylactically: verapamil
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30
Q

Red flag ICP symptoms

A

Seizures, papillodema, focal neurology

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31
Q

Gold standard diagnosis for increased ICP

A

MRI

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32
Q

Headache worse when lying down, bending over or coughing

A

Increased ICP

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33
Q

Causes of increased ICP

A

SOL (abscess, tumor, haemorrhage)
Hydrocephalus
Trauma

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34
Q

SAH is usually due to what?

A
  • berry aneurysm in circle of Willis

- risk of berry aneurysm increases with Hx or FH of polycystic kidney disease

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35
Q

Ix of SAH

A
  1. Urgent CT within 12hrs
  2. LP within 12 hrs if CT is normal
    - -> xanthocromia and oxyhaemaglobin
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36
Q

Tx of SAH

A

SAH has a 50% mortality
Refer immediately to neurosurgery

Acute medical treatment
Cardiopulmonary support
AB: Maintain airway and breathing
C: Maintain cerebral perfusion
Keep well hydrated (oral/IV)
Maintain blood pressure
Further supportive measures
Reduce high ICP
Osmotic diuretic (mannitol) or hypertonic saline
Prevent cerebral artery vasospasm
Nimodipine

Definitive surgical treatment
Surgical clipping or endovascular coil embolization

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37
Q

Subdural and Epidural Haemorrhage Ix of choice

A

Urgent Non Contrast CT

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38
Q

Shape of subdural haemorrhage on NON contrast CT

A

Cresent Shape

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39
Q

Shape of epidural haemorrhage on NON contrast CT

A

Lenticular shape

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40
Q

EMQ feautres of subdural haemorrhage

A

Alcoholics who fall over

Elderly (brain atrophy–> pulls on venous sinuses –> tear)

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41
Q

NB a headache is not always present in meningitis

A

XOXO

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42
Q

Ix for meningitis

A
  • Lumbar puncture –> CSF
  • Blood culture
  • CT head
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43
Q

Temporal arteritis is associated with what?

A

Polymyalgia rheumatica

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44
Q

Ix for temoral arteritis

A
  • ESR, CRP, FBC

- Temporal artery USS and biopsy

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45
Q

Risk Factor for Trigeminal neuralgia

A

MS

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46
Q

Tx for trigeminal neuralgia

A

Anticonvulsants eg carbamazepine

47
Q

Management of medication overuse headache

A

Withdrawal from medication, NB headaches will worsen first before they improve

48
Q

Px of acute glaucoma

A

Headache, painful eye, visual changes vomiting

49
Q

Tx for acute glaucoma

A
  • Acetazolamide (carbonic anhydrase inhibitor)

- Timolol (beta blocker)

50
Q

Anti AchR antibodies

A

Myasthenia Gravis

51
Q

Anti Rho and Anti La

A

Sjorens syndrome

52
Q

Define Bell’s Palsy

A

LMN facial nerve lesion

53
Q

NOT Forehead sparing

A

Bells Palsy

54
Q

What is Bell’s sometimes preceeded by?

A

URTI, suggesting viral aetiology –> HSV1

55
Q

Bell’s phenomenon

A

Eyeballs roll up but eyes remain open when trying to close eyes

56
Q

Most common aetiology of encephalitis

A

Viral : HSV

NB. HSV will produce a characteristic odema of the temporal lobe

57
Q

If you suspect encephalitis what is important in the history?

A

TRAVEL HISTORY

58
Q

LP will show what in encephalitis

A

Increased lympocytes, monocytes, protien

59
Q

Secondary causes of seizures:

A
  1. Tumor
  2. Infection/inflammation (meningitis/encephalitis)
  3. Toxic/metabolic: hyponatermia (ecephalopathy or diuretics) , hypocalaemia (thyroidectomy)
  4. Drugs
  5. Vascular
60
Q

Complications of antiepileptic Drugs

A
  1. Phenytoin = gingival hypertrophy
  2. Carbamazepine = neutropenia, osteoporosis
  3. Lamotrigine = Steven Johnson’s Syndrome
61
Q

Tx of Epilepsy

A
  • FoCaL = carbamazepine or lamotrigine
  • Generalized = sodium valporate
  1. Monotherapy
  2. Monoterapy with second line drug
  3. Dual therpay
    NB/ When changing drugs withdraw gradually
62
Q

CNS or PNS + onset type

  1. Gullien Barre
  2. MS
A
  1. Gullien Barre = PNS, rapid onset days - hrs

2. MS = CNS - gradual onset and plateaus

63
Q

Preceding infection, commonly campylocabcter jejune ot HIV/Herpes

A

Guillain Barre

64
Q

Px of Guillian Barre

A
  1. Ascending parasthesia (from legs upwards)
  2. Ascending symmetrical limb weakness
  3. Cranial nerve involvement
  4. Respiratory muscle involvement
65
Q

LP in Gullian Barre shows

A

Increased CSF albumin

66
Q

Management of Gullian Barre

A

Supportive: monitor vital capacity, peak flow, ECG, DVT prophylaxis
Disease modifying: IV Ig, plasma exchange

67
Q

What is Brudzinski’s sign?

A

Flexion of knees or hips on neck flexion. Seen in meningitis

68
Q

CSF: bacterial meningitis

A

increased neutrophils, protein
decreased glucose
cloudy

69
Q

CSF: viral

A

increased lymphocytes and protein

normal glucose

70
Q

CSF: TB meningitis

A

fibrinous CSF
increased lymphocytes and protein
decreased glucose

71
Q

Tx of meningitis

A

look up med ed please
abx - 3rd gen cephalosporin (ceftriaxone)
dexamethasone (avoid in HIV)

72
Q

Motor neurone disease:

  • definition
  • Px
A

-a progressive disease involving the destruction go the motor neurones and wasting of muscles
-Px:
bilateral progressive worsening muscle weakness
difficulty swallowing and speaking
brisk lower limb reflexes

73
Q

Ix for MS:

A
  • MRI of brain and spinal chord

- FBC/metabolic panel.TSH/Vit B12 = normal

74
Q

Myasthenia Gravis is associated with what conditions?

A
  • AI conditions e.g pernicious anaemia

- Thyoma development (breakdown in immune tolerance)

75
Q

Tx for Myasthenia Gravis

A

Anticholinesterases eg pyridostigmine

Beware SEs of bradycardia and diarrhoea

76
Q

Lambert Eaton effects where?
What is it associated with?
How do reflexes present?

A
  • Pre synaptic voltage gated calcium channels
  • Associated with oat cell lung cancer
  • reflexes are decreased
77
Q

What are cafe un last spots associated with? Define the condition

A

Neurofibromatosis type 1

Genetic condition that causes tutors to grow along nerves

78
Q

Causes of Parkinson’s Disease:

A
  1. Idiopathic
  2. Drug induced: metroclopramide, lithium, antipshyotics
  3. Parkinson Plus Syndromes
  4. Athersclerotic pseudoparkinsoniu
79
Q

ischemic stroke with venous sinus thrombosis

A

give heparin instead

80
Q

Score which predicts risk for stroke if had TIA already

A

ABCD2 Score
>6 = stoke likelihood of 35% in coming week
>4 = should be seen within 24hrs
Any suspected TIA should be seen within 7 days

81
Q

TIA management between atherosclerotic and cardioembolic events

A
  • atherosclerotic: antiplatelets (clopidogrel and aspirin)

- cardioembolic: anticoagulate warfarin, apixibam

82
Q

What else can give signs of meningism?

A

SAH

83
Q

Management of subdural haemorrhage

A
  • observation if <10mm
  • > 10mm and near dysfunction: surgery and monitoring
  • prophylaxis anti epileptics, correction of coagulopathy and ICP lowering regime (raising head, osmotic diuresis)
84
Q

Define: Wernicke’s Encephalopathy
RFs:
Triad
Tx

A

Neurological symptoms that occur after exhaustion ig vitamins B reserves
RFs: alcohol dependance, AIDS, cancer, bone marrow transplantation, eating disorders and malnutrition, Hx of GI surgery
Triad: opthalmoplegia, ataxia, confusion
Tx: IV thiamine (pabrinex)

85
Q

Vit B12 deficency Px:

A

Weakness in all limbs, tinglining sensation, loss of proprioception

86
Q

BeriBeri Px

A

Inflammation of nerves and heart :

  1. imparied sensory perception
  2. weakness and pain in limbs
  3. irregular HR
  4. cardiac failure
87
Q

Wernikes triad

A
  1. Opthalmoplegia
  2. Mental change
  3. Gait dysfunction
88
Q

Alzhimer’s PX

A 
Amnesia 
Amnosia 
Apraxia 
Agnosia 
Aphasia 
\+/- depression and paranoid dellusions
89
Q

RFs for dementia

A

Age, genetics and DOWNS SYNDROME

90
Q

Which dementia has sudden onset and step wise deterioration

A

Vascular dementia

91
Q

Px of vascular dementia

A

±Like AD
Location-specific deficits
Emotional and personality changes
Focal neurology

92
Q

Tau protien

A

Picks

93
Q

Pick’s Dementia Px

A 
Personality change
Disinhibition
Emotional blunting
Relative preservation of memory
Overeating, preference for sweet foods

Silver staining Tau

94
Q

-synuclein and ubiquitin

A

Lewy Bodies

95
Q

Fluctuating Dementia

A

Lewy Body Dementia

96
Q

Lewy Body Dementia Px and Dx

A 
Classic Δ (2+ needed for Dx)
Fluctuating confusion and consciousness 
Visual hallucinations (people, animals)
New onset Parkinsonism

±Repeated falls
±Syncope
97
Q

6 Ms of Parkinsons

A 
6Ms
Monotonous, hypotonic speech
Micrographia
HypomiMesis (expressionless face)
March a petit pas
Misery → depression 
Memory loss → dementia
98
Q

Movement chnages in Huntingtons

A

Involuntary movements
Chorea (purposeless, dance-like movements)
Athetosis (writhing movements of hands)

Also can get dementia, personality changes, depression

99
Q

Gullien Barre O/E

A

Flaccid paralysis
Absent reflexes
History of recent URTI or gastroenteritis

100
Q

Miller Fisher Varient Guillen Barre

A

Opthalmoplegia
Ataxia
Arreflexia

101
Q 
`Autonomic: 
Dry mouth
Constipation
Incontinence
With Hyporeflexia
A

Lambert Eaton Syndrome

102
Q

Associated with oat cell lung disorder

A

Lambert Eaton

103
Q

Associated with thymic hyperplasia and thyoma

A

Myasthaenia Gravis

104
Q

Neurofibromatosis Type 1 presentation

A

Café-au-lait spots
Freckling in skin folds (axilla, groin, neck base, under breast)
Neurofibromas
Lisch nodules (eye)
Spinal scoliosis
Short stature and mild learning difficulties

105
Q

Autosomal Dominant Ch17

A

Neurofib Type1

106
Q

Autosomal Dominant Ch22

A

Neurofib Type2

107
Q

Neurofibromatosis Type 2 presentation

A

Sensorineural hearing loss: Bilateral vestibular Schwannomas (acoustic neuromas), becoming symptomatic by age 20

No or fewer café-au-lait spots than NF1
±Tinnitus
±Vertigo

108
Q

Thiamine Deficency Pathology

A

Wernike’s (acute)

Korsakoff’s (chronic)

109
Q

Wernicke’s Px

A

Classic Δ: ACE
Ataxia
Confusion
Eye signs: opthalmoplegia; nystagmus

110
Q

Guillian Barre definitive diagnosis

A

Multifocal decreased motor conduction speed with/without

conduction block

111
Q

Normal Pressure Hydrocephalus commonly presents with the triad of….

A
  1. dementia
  2. gait disturbance and
  3. urinary incontinence.
112
Q

Dx and Tx of Normal Pressure Hydrocephalus

A

Diagnosis is by lumbar puncture (to
demonstrate a normal CSF opening pressure) followed by head computed tomography (CT)/magnetic resonance imaging (MRI) (showing enlarged ventricles).

Treatment is with ventriculo-peritoneal shunting.

113
Q

Tensilon test

A

myasthenia gravis

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