Neuro Flashcards
1
Q
Extradural
A
Lucid interval before LOC
Arterial bleed
2
Q
Subdural
A
Hx of falls and progressive confusion
Venous bleed between dura and arachnoid layers
3
Q
Subarachnoid
A
Sudden severe headache
Half of patients lose conciousness and altered mental status is common
4
Q
Raised ICP, SOL causes
A
Abscess, haemorrhage, infarction, tumours, odema and head injury
5
Q
Compressive signs
A
Headache N&V Altered GCS Papillodema Focal neurology Pupil changes down and out Pupil dilation
6
Q
Herniation
A
CNIII - opthalmoplegia
Ataxia
Apnoea
7
Q
Uncal/transtentorial
A
CN3 - dilated ipsilatetal pupil, opthalmoplegia, contra lateral hemiparesis
8
Q
Tonsilar/transformanial
A
CNVI, ataxia, babinski positive, LOC, apnoea
9
Q
Subfalcine/cingulate
A
Stroke
10
Q
Carotid sinus syncope presents as
A
Head turning, shaving
Excessive bradycardia and vasodilation on MINIMAL stimulation
11
Q
Situational syncope
A
Cough, effort eg exercise, micturation
12
Q
Drugs causing postural hypotension
A
Nitrates
Diuretics
Anti hypertensives
Antipsychotics
13
Q
Peripheral neuropathy causing postural hypotension
A
DM, Parkinsons , MSA, autonomic neuropathy
14
Q
Endocrine causes of postural hypotension
A
Addisons
Hypopituitarism (decreased ACTH)
15
Q
Other causes of postural hypotension
A
Elderly
Hypovolemia
16
Q
AS is due to
A
- congenital bicuspid valve
- calcification of all three valves
17
Q
Non diabetic causes of hypoglyceamia
A
Insulinomas
Alcohol
Liver failure
Addisons
Alcohol and liver failure decrease hepatic glucose production
18
Q
Pronator drift (UMN or LMN?)
A
Upper motor neurone
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
20
Q
Types of partial seizures
A
Simple - no loss of consciousness, no post ictal phase
Complex - LOC, post ictal phase
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
22
Q
Bell’s palsy symptoms
A
Full facial droop LMN CN7 Hypersensitivity to sound Tearing or drying of exposed eye Loss of taste
23
Q
What is not effected in BPPV
A
Hearing is not a feature
Tinnitus is not a feature
NB they are in meniers
24
Q
Test for BPPV
A
Dix hallpike test
25
Mmse cut off for dementia
<27
26
Sister causes of headache
VIVID
- vascular (SAH/haematoma)
- Infection (meningitis or encephalitis)
- Vision threatening (temporal arteritis or acute glaucoma)
- Intracranial pressure (SOL, hydrocephalus)
- Dissection (carotid)
27
Management of migraine
```
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
28
Cluster headache presentation
Unilateral headache
Pain behind the eye
(Swollen eye lid, forhead swelling, nasal congestion, horners syndrome)
29
Tx for cluster headaches
1. Acute: 100% oxygen in non rebreathable mask
Sumitriptan
2. Prophylactically: verapamil
30
Red flag ICP symptoms
Seizures, papillodema, focal neurology
31
Gold standard diagnosis for increased ICP
MRI
32
Headache worse when lying down, bending over or coughing
Increased ICP
33
Causes of increased ICP
SOL (abscess, tumor, haemorrhage)
Hydrocephalus
Trauma
34
SAH is usually due to what?
- berry aneurysm in circle of Willis
| - risk of berry aneurysm increases with Hx or FH of polycystic kidney disease
35
Ix of SAH
1. Urgent CT within 12hrs
2. LP within 12 hrs if CT is normal
- -> xanthocromia and oxyhaemaglobin
36
Tx of SAH
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
37
Subdural and Epidural Haemorrhage Ix of choice
Urgent Non Contrast CT
38
Shape of subdural haemorrhage on NON contrast CT
Cresent Shape
39
Shape of epidural haemorrhage on NON contrast CT
Lenticular shape
40
EMQ feautres of subdural haemorrhage
Alcoholics who fall over
| Elderly (brain atrophy--> pulls on venous sinuses --> tear)
41
NB a headache is not always present in meningitis
XOXO
42
Ix for meningitis
- Lumbar puncture --> CSF
- Blood culture
- CT head
43
Temporal arteritis is associated with what?
Polymyalgia rheumatica
44
Ix for temoral arteritis
- ESR, CRP, FBC
| - Temporal artery USS and biopsy
45
Risk Factor for Trigeminal neuralgia
MS
46
Tx for trigeminal neuralgia
Anticonvulsants eg carbamazepine
47
Management of medication overuse headache
Withdrawal from medication, NB headaches will worsen first before they improve
48
Px of acute glaucoma
Headache, painful eye, visual changes vomiting
49
Tx for acute glaucoma
- Acetazolamide (carbonic anhydrase inhibitor)
| - Timolol (beta blocker)
50
Anti AchR antibodies
Myasthenia Gravis
51
Anti Rho and Anti La
Sjorens syndrome
52
Define Bell's Palsy
LMN facial nerve lesion
53
NOT Forehead sparing
Bells Palsy
54
What is Bell's sometimes preceeded by?
URTI, suggesting viral aetiology --> HSV1
55
Bell's phenomenon
Eyeballs roll up but eyes remain open when trying to close eyes
56
Most common aetiology of encephalitis
Viral : HSV
| NB. HSV will produce a characteristic odema of the temporal lobe
57
If you suspect encephalitis what is important in the history?
TRAVEL HISTORY
58
LP will show what in encephalitis
Increased lympocytes, monocytes, protien
59
Secondary causes of seizures:
1. Tumor
2. Infection/inflammation (meningitis/encephalitis)
3. Toxic/metabolic: hyponatermia (ecephalopathy or diuretics) , hypocalaemia (thyroidectomy)
4. Drugs
5. Vascular
60
Complications of antiepileptic Drugs
1. Phenytoin = gingival hypertrophy
2. Carbamazepine = neutropenia, osteoporosis
3. Lamotrigine = Steven Johnson's Syndrome
61
Tx of Epilepsy
- 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
CNS or PNS + onset type
1. Gullien Barre
2. MS
1. Gullien Barre = PNS, rapid onset days - hrs
| 2. MS = CNS - gradual onset and plateaus
63
Preceding infection, commonly campylocabcter jejune ot HIV/Herpes
Guillain Barre
64
Px of Guillian Barre
1. Ascending parasthesia (from legs upwards)
2. Ascending symmetrical limb weakness
3. Cranial nerve involvement
4. Respiratory muscle involvement
65
LP in Gullian Barre shows
Increased CSF albumin
66
Management of Gullian Barre
Supportive: monitor vital capacity, peak flow, ECG, DVT prophylaxis
Disease modifying: IV Ig, plasma exchange
67
What is Brudzinski's sign?
Flexion of knees or hips on neck flexion. Seen in meningitis
68
CSF: bacterial meningitis
increased neutrophils, protein
decreased glucose
cloudy
69
CSF: viral
increased lymphocytes and protein
| normal glucose
70
CSF: TB meningitis
fibrinous CSF
increased lymphocytes and protein
decreased glucose
71
Tx of meningitis
look up med ed please
abx - 3rd gen cephalosporin (ceftriaxone)
dexamethasone (avoid in HIV)
72
Motor neurone disease:
- definition
- Px
-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
Ix for MS:
- MRI of brain and spinal chord
| - FBC/metabolic panel.TSH/Vit B12 = normal
74
Myasthenia Gravis is associated with what conditions?
- AI conditions e.g pernicious anaemia
| - Thyoma development (breakdown in immune tolerance)
75
Tx for Myasthenia Gravis
Anticholinesterases eg pyridostigmine
| Beware SEs of bradycardia and diarrhoea
76
Lambert Eaton effects where?
What is it associated with?
How do reflexes present?
- Pre synaptic voltage gated calcium channels
- Associated with oat cell lung cancer
- reflexes are decreased
77
What are cafe un last spots associated with? Define the condition
Neurofibromatosis type 1
| Genetic condition that causes tutors to grow along nerves
78
Causes of Parkinson's Disease:
1. Idiopathic
2. Drug induced: metroclopramide, lithium, antipshyotics
3. Parkinson Plus Syndromes
4. Athersclerotic pseudoparkinsoniu
79
ischemic stroke with venous sinus thrombosis
give heparin instead
80
Score which predicts risk for stroke if had TIA already
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
TIA management between atherosclerotic and cardioembolic events
- atherosclerotic: antiplatelets (clopidogrel and aspirin)
| - cardioembolic: anticoagulate warfarin, apixibam
82
What else can give signs of meningism?
SAH
83
Management of subdural haemorrhage
- 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
Define: Wernicke's Encephalopathy
RFs:
Triad
Tx
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
Vit B12 deficency Px:
Weakness in all limbs, tinglining sensation, loss of proprioception
86
BeriBeri Px
Inflammation of nerves and heart :
1. imparied sensory perception
2. weakness and pain in limbs
3. irregular HR
4. cardiac failure
87
Wernikes triad
1. Opthalmoplegia
2. Mental change
3. Gait dysfunction
88
Alzhimer's PX
```
Amnesia
Amnosia
Apraxia
Agnosia
Aphasia
+/- depression and paranoid dellusions
```
89
RFs for dementia
Age, genetics and DOWNS SYNDROME
90
Which dementia has sudden onset and step wise deterioration
Vascular dementia
91
Px of vascular dementia
±Like AD
Location-specific deficits
Emotional and personality changes
Focal neurology
92
Tau protien
Picks
93
Pick's Dementia Px
```
Personality change
Disinhibition
Emotional blunting
Relative preservation of memory
Overeating, preference for sweet foods
```
Silver staining Tau
94
-synuclein and ubiquitin
Lewy Bodies
95
Fluctuating Dementia
Lewy Body Dementia
96
Lewy Body Dementia Px and Dx
```
Classic Δ (2+ needed for Dx)
Fluctuating confusion and consciousness
Visual hallucinations (people, animals)
New onset Parkinsonism
±Repeated falls
±Syncope
```
97
6 Ms of Parkinsons
```
6Ms
Monotonous, hypotonic speech
Micrographia
HypomiMesis (expressionless face)
March a petit pas
Misery → depression
Memory loss → dementia
```
98
Movement chnages in Huntingtons
Involuntary movements
Chorea (purposeless, dance-like movements)
Athetosis (writhing movements of hands)
Also can get dementia, personality changes, depression
99
Gullien Barre O/E
Flaccid paralysis
Absent reflexes
History of recent URTI or gastroenteritis
100
Miller Fisher Varient Guillen Barre
Opthalmoplegia
Ataxia
Arreflexia
101
```
`Autonomic:
Dry mouth
Constipation
Incontinence
With Hyporeflexia
```
Lambert Eaton Syndrome
102
Associated with oat cell lung disorder
Lambert Eaton
103
Associated with thymic hyperplasia and thyoma
Myasthaenia Gravis
104
Neurofibromatosis Type 1 presentation
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
Autosomal Dominant Ch17
Neurofib Type1
106
Autosomal Dominant Ch22
Neurofib Type2
107
Neurofibromatosis Type 2 presentation
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
Thiamine Deficency Pathology
Wernike's (acute)
| Korsakoff's (chronic)
109
Wernicke's Px
Classic Δ: ACE
Ataxia
Confusion
Eye signs: opthalmoplegia; nystagmus
110
Guillian Barre definitive diagnosis
Multifocal decreased motor conduction speed with/without
| conduction block
111
Normal Pressure Hydrocephalus commonly presents with the triad of....
1. dementia
2. gait disturbance and
3. urinary incontinence.
112
Dx and Tx of Normal Pressure Hydrocephalus
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
Tensilon test
myasthenia gravis
