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Neuro Flashcards

1
Q

What are the common symptoms of GCA?

A

Severe headache in temporal area

Jaw claudication

Visual problems (sudden blindness in 1 eye)

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2
Q

What type of headache is associated with polymyalgia rheumatica symptoms?

What are these ‘symptoms’ of polymyalgia rheumatica?

A

Temporal Arteritis

Inflammation of the muscles and joints affecting the shoulder, neck, hip as well as associated muscles

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3
Q

What age range and sex are affected by MS?

A

Symptoms are first seen between ages of 20-40

F : M
2 : 1

Twice as likely

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4
Q

What are the most common symptoms of MS?

A

MS is MONOSYMPTOMATIC. Only one symptom AT A TIME.

Blurred vision
Numbness and tingling
Muscle weakness and tightness
Muscle pain
Tiredness
Mobility and balance issues
Bladder and bowel problems
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5
Q

What is the standard treatment and duration of treatment for an MS relapse?

What are some rare and common, acute and chronic side effects of this treatment?

A

High Dose (1g/d) Methylprednisolone 3-5 days helps shorten the relapses.

Max use: 2x per year

Acute Side Effect: GI irritation (give PPI), agitation, restlessness, insomnia.

Chronic Side Effect: Osteoporosis, Weight Gain, Diabetes, Infection risk

Rare Side Effect: Avascular Necrosis of the hip can occur with ST High Dose steroid use.

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6
Q

What pharmacological and non-pharmacological treatments can be given to reduce muscle spasms and spasticity in MS?

A

Physiotherapy

If severe: muscle relaxants such as BACLOFEN or GABAPENTIN

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7
Q

What side-effects may interferon beta cause?

A

Mild flu-like symptoms for 48 hours post injection

i.e. headaches, chills, mild fever

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8
Q

Who is interferon beta NOT suitable for?

A

Anyone under the age of 18

Women who are PREGNANT or BREASTFEEDING

Men or Women who are trying for a baby. Must stop 3 months prior.

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9
Q

What questions should you ask in a patient suspected of sensory ataxia in order to further confirm a diagnosis?

A

Any numbness, pins and needles in the limbs or trunk? (sensory disturbances)

Do you find your balance is worse in the dark or when you’re not looking at your feet?

Do you find you fall over when you close your eyes to wash your face in the sink or in the shower? (Rhomberg’s)

Do you find you get tingling sensations when you look up (extension) or down (flexion) or get a tight-band like sensation around your torso? Do you feel you need to go to the toilet more often?
(both these questions for sensory ataxia due to a spinal cord lesion)

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10
Q

What questions or symptoms may help you differentiate Vertigo and Nausea caused by vestibular pathology vs cerebellar pathology?

A

Vestibular: Room spinning around, worse on head movement, nausea (+/- vomiting), hearing loss (+/- tinitus)

Cerebellar: Unsteadiness when walking, poor coordination of the arms, change in their voice (staccato dysarthria).
Does one side of the body feel worse than the other? If unilateral pathology (i.e. cerebellar stroke), patient will complain of ipsilateral (same side) arm and leg ataxia.

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11
Q

What is the criteria for ‘disease-modifying treatment’ for MS?

A

Patients who have had two or more relapses over a two year period

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12
Q

What is the role of oxybutinin and gabapentin in patients with MS?

A

Oxybutinin is an Anticholinergic drug used to combat the effects of bladder urgency and frequency. However a side effect is that it results in incomplete bladder emptying leaving a pool of residual urine left post micturition.

Gabapentin is an anticonvulsant which is also used as neuropathic pain which is common in MS.

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13
Q

What are the cardinal signs of optic neuritis?

A

Pain on eye movement
Blurring of vision
Red colour desaturation

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14
Q

What does the Romberg’s sign test for?

A

Sensory ataxia (i.e. spinal cord demyelination)

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15
Q

Extrapyramidal symptoms may indicate a lesion in which area of the brain?

A

The basal ganglia

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16
Q

List the red flags for headache

A

Sudden onset high severity (SAH)

Fever, neck stiffness (MENINGISM)

New onset focal neurological, cognitive or personality deficit (STROKE)

Trauma within the last 3 months

Halos around lights, worse in the dark (AACG)

Triggered by cough, sneeze, exercise or changes in posture (RAISED ICP)

Associated with jaw claudications and scalp tenderness (GCA)

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17
Q

What are the three P’s of syncope?

A

Posture - Upright only
Provocation - Pain, Dehydration, Emotion
Prodrome* - Lightheadedness, dizzy, ringing in ears, visual blurring

*NB: Syncopy w/o prodromal features may indicate a cardiogenic cause. Refer!

18
Q

When performing a neuro exam, a lesion in which region may result in a pronator drift?

What type of lesion is this? UMN or LMN

A

Pyramidal tracts, therefore an UMN lesion

19
Q

How might an extrapyramidal lesion present in a neurological examination?

A

‘Lead pipe’ RIGIDITY
Non-velocity dependent
Parkinsonian features
Stiffness throughout the movement

20
Q

How might a pyramidal lesion present in a neurological examination?

A

Velocity-dependent spasticity

‘Clasped knife’

21
Q

Rx for Guillain-Barre Syndrome?

A

IV Immunoglobulins

Plasma exchange

22
Q

What are the symptoms of Myasthenia Gravis?

A

Ptosis
Proximal fatigable weakness (exercise)
Diplopia
Bulbar failure (swallowing and chewing)

23
Q

What are the first line medications for epilepsy?

A 
Valproate
Carbamazepine
Phenytoin
Phenobarbital
Primidone
24
Q

What are the second line medications for epilepsy?

A 
Lamotrigine
Levitiracetam
Topiramate
Tiagibine
Vigabitrin
Gabapentin
25
Q

What are some common side effects of anti-epileptic medications?

A 
Nausea
Abdo pain
Drowsiness
Dizziness
Irritability and Mood Changes
26
Q

Describe the pattern of symptoms in Brown-Sequard Syndrome

A

Lateral disruption to one side of the spinal cord

Therefore

  • CONTRAlateral loss of PAIN and TEMP
  • IPSIlateral loss of LIGHT TOUCH, PROPRIOCEPTION & VIBRATION
27
Q

Name some causes of Brown-Sequard Syndrome

A

Trauma
Pressure from vertebral metastases
Cervical spondylosios
Transverse Myelitis & MS

28
Q

What is transverse myelitis?

A

Transverse Myelitis is an inflammatory disorder of the spinal cord that is diverse in character.

It is characterised by acute symptoms of

  1. Motor weakness
  2. Sensory impairment
  3. Autonomic dysfunction

MRI may find white matter hyperintensity lesions within the spine. CSF analysis will show pleocytosis (raised lymphocytes in CSF)

29
Q

Name 6 Sx of Cauda Equina Syndrome

A 
Back pain RADIATING down the legs
Reduced SPHINCTER tone
Saddle ANAESTHESIA (sensory loss)
Faecal INCONTINENCE and Urinary RETENTION
Reduced REFLEXES in legs
FLACCID PARALYSIS of the legs
30
Q

Which nerve roots contribute to the sciatic nerve?

A

L3-L4

31
Q

What are the causes of foot drop?

A 
Common Peroneal Injury
L4-L5 nerve root lesion
Stroke
MND
Charcot-Marie-Tooth syndrome
32
Q

Which dermatome covers the dorsal surface of the big toe?

A

L5

Also covers bottom 2/3rd of knee

33
Q

Which nerve roots supply ankle jerk?

A

S1

34
Q

What are some Ddx for unilateral leg weakness? (UMN vs LMN)

A

UMN

  • Stroke
  • MS
  • Tumor

LMN

  • Root lesion
  • Nerve Lesion
35
Q

What are some causes of a positive Romberg’s Test?

A

+VE therefore Sensory Ataxia

Dorsal Column Loss

  • Syphilis
  • SCDC
  • MS

Sensory peripheral neuropathy

36
Q

What muscles in the hand are supplied by the median nerve?

A

Medium sized slices of LOAF

L - lateral two lumbrical (1 & 2)

(thenar eminence)
O - opponens pollices
A - adductor pollicis brevis
F - flexor pollicis brevis

37
Q

Name 3 conditions associated with CARPEL TUNNEL syndrome

A

Trauma
Acromegaly (enlarged bones press on nerve)
Pregnancy
Diabetes (neuropathy?)
Rheumatoid Arthritis (inflammation of nerve)
Hypothyroidism

38
Q

What is a common site of trauma to the ULNAR nerve?

A

Cubital Tunnel of the Elbow

Guyon’s Canal of Wrists

39
Q

RADIAL nerve receives fibres from which nerve root?

A

C5-T1

40
Q

What is claw hand and sign of benediction and what is the difference between the two in signs and aetiology?

A

Claw hand is weakened flexion of 4th & 5th phalanges due to an ULNAR NERVE PALSY distally (around the wrist i.e. Guyon’s Canal Compression) causing wasting of the
- hypothenar eminence,
- medial 2 lumbricals,
- interossei
- wrist flexors
There is an inability to fully extend the fourth and fifth fingers due to wasting of the interossei and lumbricals.

Sign of BENEDICTION is a MEDIAL NERVE PALSY where, when asked to make a fist, the 1st 2nd and 3rd phalanges are unable to flex whereas the 4th and 5th can. There are no issues with extension of the hand.

https://youtu.be/GyqaKGg3HmM

41
Q

Which nerve may be involved in a patient with a winged scapula and which nerve roots are affected in this?

A

Long thoracic nerve supplied by nerve roots C5 C6 C7

42
Q

What are some differentials for ophthalmoplegia?

A 
Myasthenia Gravis
Cranial nerve palsy
Graves disease
Wenickes encephalopathy (upward gaze X)
Progressive supranuclear palsy (vertical gaze)

Revision (21 decks)

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