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Neuro Flashcards

1
Q

Bacterial meningitis: what exudate covers the brain in chronic infection?

A

Viscous, grey-green exudate with meningeal tubercles

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2
Q

Bacterial meningitis: pia-arachnoid becomes invaded by what? What does this cause?

A

Polymoprhs - produce pus that forms adhesions leading to cranial nerve palsies and hydrocephalus

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3
Q

Viral meningitis: Inflammation caused by what?

A

Infiltration of lymphocytes

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4
Q

Viral meningitis: pus/no pus?

A

No pus

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5
Q

Bacterial meningitis: causative organisms (2)

A

Neisseria meningitides and Strep. pneumoniae - combined (70%)

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6
Q

Viral meningitis: causative organisms

A

Enterovirus, poliomyelitis, mumpmps, HSV, HIV, EBV, CMV

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7
Q

Fungal meningitis: causative organisms (2)

A

cryptococcus neoformans, candida albicans

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8
Q

Meningism: signs (3)

A

Neck stiffness, photophobia, Kernig’s sign

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9
Q

Type of rash in meningitis

A

Petechial, non-blanching (may only be 1 or 2 spots)

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10
Q

Triad of signs in meningitis

A

Headache, neck stiffness, fever

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11
Q

Differentials of meningitis

A 
SAH
Migraine
Intracranial mass lesion
Epilepsy
Cerebral malaria
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12
Q

Meningitis: investigations

A

FBC, U&Es (WBC dec. = immunocompromised), LFT, glucose, co-ag screen, cultures, throat swabs, serology, lumbar puncture if GC5 15 and no Sx of increase ICP and no focal neurology, CXR is signs of TB

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13
Q

Treatment of viral meningitis (1)

A

Acyclovir

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14
Q

Treatment of pneumococcal meningitis

A

Dexamethasone + ABx

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15
Q

Treatment of TB meningitis

A

Rifampicin, isoniazid and pyrazinamide
& ABx
For 9 months

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16
Q

Prophylactic treatment of contacts

A

Rifampicin/ciprofloxacin

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17
Q

If <55, treat bacterial meningitis with

A

cefotaxime

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18
Q

If >55, treat bacterial meningitis with

A

cefotaxime & ampicillin

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19
Q

% of population that have reported migraine Sx

A

> 20%

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20
Q

Most common type of primary headache

A

Tension headache

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21
Q

Symptoms of tension headache

A 
Radiation to back of head, neck and eyes
Band-like pressure
Non-pulsatile
Without vomiting or sensitivity to movement
Typically last 4-6h
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22
Q

Causes of tension headache

A 
Stress
Sleep deprivation
Bad posture
Hunger
Eye strain
Muscle tension
Microvascular irritation
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23
Q

Prevention/Rx of tension headache

A

Keep hydrated, use stress management techniques, reduce alcohol intake, improve posture
OTCs - paracetamol, ibuprofen
Tricyclic ADs in severe cases

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24
Q

Type of headache that lasts for hours/days with generalised, band-like pain, with depression as a common accompaniment

A

Chronic (benign) recurrent headache

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25
IC lesions stretching meninges, increasing CSF pressure, causing cerebral oedema and vomiting, cause what type of headaches?
Pressure headaches - worse when lying down, straining, coughing and sneezing
26
Scalp tenderness
Giant cell arteritis
27
headache lasting weeks/months
Trauma headache
28
Type of headache with SAH
Severe, sudden onset
29
Facial pain
Cluster headache
30
Triggers of Migraine
CHOCOLATE | Chocolate, Hangobers, Orgasms, Cheese, OCP, Lie-ins, Alcohol, Tumult, Exercise
31
Prodrome
Symptoms preceding a migraine or an epileptic seizure by hours/days: yawning, cravings, mood/sleep changes
32
Aura
Symptoms preceding migraine/epileptic seizure by minutes and perhaps persisting during: visual cascading, distorting, scotoma, hemianopia, paraesthesia, ataxia, ophthalmoplegia, dysphasia, flashes of light, tingling, numbness
33
Headache that feels like the head is splitting (hemicranial)
Migraine
34
Clinical triad of Parkinsonism:
1) Pill-rolling tremor (worst at rest) 2) Cogwheel rigidity 3) Bradykinesia
35
Pathology of Parkinsonism
Mitochondril DNA dysfunction causing degeneration of DA neurons in the substantia nigra - associated with Lewy Bodies
36
Neuropsychiatric complications of PD
Depression, dementia and psychosis
37
Pharmacological treatment of PD
Levodopa and/or decarboxylase inhibitor
38
Parkinson Plus Syndrome: Red flags
``` Early postural instability Vertical gaze palsy Early autonomic features Fluctuating cognition (LB dementia) Akinetic rigidity involving one limb ```
39
Symmetrical disease of proximal muscle fibres resulting in weakness
proximal myopathy
40
Usually monosymptomatic e.g. unilateral optic neuritis, numbness/tingling in limbs, leg weakness, brainstem/cerebellar problem
MS
41
Poor prognostic signs of MS (6)
``` Older Female Axonal loss Motor signs at outset Many MRI lesions Many relapses early on ```
42
Cause of demyelination in MS
T-cell mediated immune response
43
Rx of MS
Steroids: methylprednisolone (shortens relapses) Interferons - reduce relapse and lesion accumulation MAb - alemtuzumab - better than IFN, acts against T cells
44
Criteria for diagnosing MS
McDonald: heavily reliant on MRI >2 attacks with >2 lesions >2 attacks with 1 lesion 1 attack with >2 lesions 1 attack and 1 lesion (monosymptomatic presentation) Insidious neurological progression suggestive of MS (primary progressive)
45
Partial seizure
focal onset with features referable to a part of one hemisphere
46
Simple seizure
Awareness unimpaired
47
Complex seizure
Awareness impaired
48
Simple partial seizure
awareness unimpaired, no post-ictal Sx
49
Complex partial seizure
Awareness impaired, may have aura, if temporal lobe then will have post-ictal confusion, if frontal lobe, rapid recovery
50
Partial seizure with secondary generalisation
Most common type of partial seizure (66%) | Electrical disturbance starts focally and spreads widely, typically causing a convulsive seizure
51
Primary generalised seizure
simultaneous onset of electrical discharge throughout the cortex, with no localising features
52
Absence seizure
Brief pause (10s), more common in childhood
53
Tonic clonic seizure
LoC, limb stiffening (tonic) and jerking (clonic) | Post-ictal confusion and drowsiness
54
Myoclonic seizures
Sudden jerk of limbs, face or trunk - pt. may be thrown to ground or have disobedient limb
55
Atonic (kinetic) seizure
Sudden loss of muscle tone leading to fall | No LoC
56
Infantile spasms
Commonly associated with tuberous sclerosis
57
Stroke:
Syndrome of rapid onset of cerebral deficit (usually focal), lasting >24h or leading to death - no cause other than vascular
58
Completed stroke
Deficit has become maximal (6h)
59
Minor stroke
Pt. recovers with minor deficit/ no deficit (usually within a week)
60
Stroke in evolution
Progression during the first 24h
61
Biggest cause of stroke
Thromboembolic infarction (ischaemic stroke) - 80%
62
CHADS2 score
``` Congestive HF (1) Hypertension (BP >140/90) (1) Age (>75) (1) DM (1) S2 prior stroke, TIA or thromboembolism ```
63
Signs of cerebral infarct
``` 50% Contralateral sensory loss/hemiplegia Dysphasia Homonymous hemianopia Visuo-spatial deficit ```
64
Signs of brainstem infarct
25% Quadriplegia Disturbance of gaze/vision Locked-in syndrome
65
Signs of lacunar infarct
25% Basal ganglia, internal capsule, thalamus & pons 5 syndromes: ataxic hemiparesis, pure motor, pure sensory, sensorimotor, dysarthria/clumsy hand Cognition/consciousness are in tact unless thalamic stroke
66
TIA risk scoring:
ABCD2 Age >60 (1) BP >140/90 (1) Clinical features - unilateral weakness (2), speech disturbance without weakness (1) Duration of Sx (>1h (2), 10-59mins (1)) DM (1) Score of 4 or more - referral to neurologist
67
Carpal tunnel syndrome signs
Median n. compression Nocturnal tingling and pain in hand/forearm, followed by weakness of thenar muscles and sensory loss in palm Positive Tinnel's and Phalen's test
68
Ulnar nerve compression signs
Cubital tunnel in elbow following recurrent pressure or fracture Weakness and wasting of ulnar-innervated muscles leading to clawing of the hand and sensory loss
69
Radial nerve compression signs
Compressed against humerus causing wrist drop and weakness | Recovery in 1-3 months
70
Common peroneal nerve palsy signs
Compression against head of fibula Foot drop and ankle eversion Patch of numbness on antero-lateral border, dorsum of foot and/or lower shin Usually recover within several months
71
Guillan-Barre syndrome signs
Polyneuropathy Usually demylinating but sometimes azonal Paralysis 1-3 weeks following infection Antibody production against peripheral nerves May progress to complete paralysis 15% ar eleft disabled or die
72
Treatment for presentation of headache, pyrexia, neck stiffness and altered mental state
SUSPECT MENINGITIS | Give benzylpenicillin 1.2g (IV/IM) immediately

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