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6th Year > Neuro > Flashcards

Neuro Flashcards

1
Q

What is a myelopathy

A

problem with the spinal cord

stiffness
tongling numbness weakness more prominent than pain

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2
Q

What is a radiculopathy

A

problem with the spinal nerve root

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3
Q

What is a neuropathy

A

Disease of the peripheral nerve

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4
Q

What kind of neurology presents with cervical or lumbar degenneration?

A

if central - myelopathy, if lateral then radiculopathy

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5
Q

What are the causes of myelopathy

A 
sponylosis 
rheumatoid arthiritis
disc prolapse
spinal stenosis
vertebral collapse

most tend to be older. men over 60 and women over 50

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6
Q

what is the treatment for spondylosis?

A

stiff collar or surgical decompression

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7
Q

How do you distinguish a myopathy from a neuropathy?

A

neuropathy - distal weakness, paraesthesia

myopathy - proximal weakness, preserved reflexes

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8
Q

What are the causes of cerebellar syndrome

A 
PASTRIES
Paraneoplastic - bronchial carcimona
alcohol - b12/thiamine
Stroke - vertibrobasilar
Tumour
Rare - freisdricks, MSE
Iatrogenic phenytoin
Endocrine - hypothyroid
Sclerosis
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9
Q

What distribution of weakness would you find with ACA stroke

A

Legs > arms with facial sparing

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10
Q

What distributoin of weakness would oyu see in MCA stroke

A

Facial and arms >legs (forehead sparing)

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11
Q

What does the posterior CA supply?

A

occipital lobes

presents with homonymous hemianopia with macula sparing

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12
Q

What does the vertibrobasilar circulation supply?

A

cerebellum ?occipital lobe and brainstem

would cause cerebellar signs plus CN and hemi/quadraplegia

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13
Q

What is lateral medullary syndrome?

A

blockage of one single vertebral artery or one posteria inferior cerebellar artery (PICA)

DANVAH
Dysphagia
ataxia(ipsilateral)
Nystagmus
vertigo
Anaesthesia - numbness in face ipsilaterally and pain loss on contralateral side.
Horners  (ipsi)
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14
Q

What causes locked in syndrome

A

lesion of the pons usually basilar artery infarction

central pontine demyelinolysis

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15
Q

What is subclavian steal syndrome

A

retrograde flow through vertebral arteries to supply arm due to a blockage in the proximal part of the subclavian artery

causes syncope dizziness, arm symptoms
bp difference in arms

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16
Q

What is cerebellar pontine angle syndrome

A

myriad of symptoms caused by compression within the brain. usually due to a growing mass - schwannoma, met, meningioma astrocytoma. C5678 palsys on same side and cerebllar signs.

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17
Q

Muscle weakness differentials

A

Cortex - infarct, SOL, haemorrhage encephalitis, MS

Cord - Myelopathy, trauma, anterior spinal artery infarction, MS

Anterior horn: MND, polio

Nerve roots - spondylosis of lower spine, cauda equina

motor neurones - MMN, GB

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18
Q

What is CIDP

A

Chronic inflamatory demyelinating polyradiculoneuropathy

Lower motor neurone signs

NCS - slow velocities
LP - high protein

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19
Q

Management of CIDP

A

methylpred
IVIg

therapy for pain management - gabapentin

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20
Q

Difference between CIDP and AIDP/GBS

A

rate of onset. GBS is less than 1 month

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21
Q

What type of neuropathy do you get with diabetes

A

Peripheral pattern rather than distal with greater sensory symptoms compared to motor symptoms

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22
Q

Differentials for a neuropathy

A 
Diabetes
b12/folate
alcohol
thyroid disease
amyloid
SLE
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23
Q

What sensory disturbance is typically present in GBS

A

tingling in extremeties

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24
Q

What is charcot marie tooth also known as?

A

hereditary motor and sensory neuropathy

most common form is demyelinating

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25
Features of charcot marie tooth?
Hereditary - positive fhx pes cavus champagne bottle legs due to muscle wasting poor extensor and dorsoflexion. foot drop, high stepping gait. symptoms are symetrical. variable loss of sensation usually in a glove and stocking distribution
26
What is the common gene involved in charcot marie tooth?
PMP22
27
What conditions present with a mixture of upper and lower signs?
MND | Cervical spondylosis with myelopathy and radiculopathy - upper below the lesion and lower at the level of the lesion
28
What is the most common type of dystrophy?
duchenne - x linked dystrophin abnormalities weak muscles abnormal postures due to weakness. pseudohypertrophy of calves (fat deposition) tight achiles - tip toe walking protruded stomach presents by 4/5 years old and need a wheelchair by teens
29
How do you investigate duchenne?
CK - raised due to breakdown and loss
30
What is the difference between beckers and duchenne?
beckers is less severe - later onset - partially functioning dystrophy
31
Key features of MSA?
multi system atrophy is a parkinsinsons plus syndrome parkisnons autonomic dysfunction - orthostatic hypotension, urogenital dysfunction - incont +ED cerebellar ataxia
32
lesions in which lobe cause inferior quandrantopias
parietal
33
Lesions in which lobe cause superior quandrantopias
temporal
34
Cabergoline well know side effect?
pulmonary fibrosis
35
Causes of a medical third nerve palsy?
Diabetes - mononeuritis MS midbrain infarct migraine
36
Causes of a surgical third nerve palsy
Riased ICP - causes transtentorial uncal herniation PCA infarct (painful) cavernous sinus thrombosis
37
riluzole?
MND -confers survival benefit prevents stimulation of glutamate recepters used in ALS 3 months additional life
38
mydriasis
blown pupil
39
miosis
contricted pupil
40
why do shoulder and upper thoracic injuries cause horners?
sympathtic neurones which supply the retractor lids and sweating and pupil dilators come out at c8-t2 and travel back up via the cerivical ganglia brachial plexus injuries damage this area
41
what drugs used to sedate someone?
offer oral lorazepam 2mg and then go to IM olanzapine?
42
commonest risk factor for bells palsy
pregnanacy
43
Features of wernickes encephalopathy?
``` CAN OPEN confusion ataxia nystagmus opthalmoplegia perihpheral neuropathy ```
44
What things can cause dizziness?
Illusion of self motion ``` Cardiovascular disease - LOW BP hyperventialation Anxiety - hyperventilation migraine epilepsy ```
45
Migraine of menopause?
dizziness, light headed, myalgic weak
46
vestibular funcrion?
absolute motion of the head through space. allows us to interpret things the rest of our proprioceptive skills and interpretations of light cannot
47
Menieres disease (true vestibular)
Dilation of endolymphatic spaces within the labyrinth: ``` Episodes last hours upto 12 aural fullness tinitus vertigo nausea and vomiting progressive hearing loss!!(sensorineural) ```
48
functional vertigo
may arise from high anxiety states and stressful situations. like still being on a boat/ on the sea etc. near miss in a car crash.
49
What is BPPV
Benign parxysmal positional vertigo due to debris in the canals from the otoliths classically middle aged after head trauma comes on with sudden rotational vertigo caused by head turning causes nystagmus hangover(functional state) from the single 1 minute episode
50
How do you diagnose BPPV?
hall pike manoevre - causes upbeat torsional nystagmus
51
How do you treat BPV
epley manoevre - self limiting - betahistine can help
52
what do you call the infection which would commonly cause vertigo?
viral labrynthitis or vestibular neuronitis Causes sudden severe vertigo can cause vomiting. may last a couple of days but wil pass. cyclizine for sickness
53
treatment for menieres disease?
avoid triggers - alcohol, tiredness, caffeine. salt. | betahistone -histamine agonist?
54
What is ramsay hunt syndrome?
Reactivation of herpes zoster in the geniculate ganglion of facial 7th nerve distibution. rash in the hard palate, and in the auditory meatus may cause ear pain or stiff neck causes a palsy, hyperacusis, lack of taste in anterior 2/3 of tongue
55
What is the treatment and prognosis for those with ramsay hunt syndrome?
give valaciclovir and steroids within 72hr. 75% do well. upto 1in 3 do poorly and are left with weakness. some may stay the same.
56
What are the 4 main signs and symptoms of MS?
``` TEAM Tingling Eyes - optic neuritis - loss of vision(particularly central) and pain on moving, colour vision loss, and acuity loss Ataxia and cerebellar signs Motor sx - spastic paraparesis. ```
57
What would you see on LP of MS
IgG oligoclonal bands
58
Mainstay of treatment for MS?
Methylpred IFN beta Natalizumab Alemtuzamab Require whole host of other medications usually to manage other effects of the disease ``` Spasticity - physio baclofen, botox Fatigue - modafinil Tremor - depression - citalopram pain - amytriptiline or gabpentin urgency - oxybutinin/tolteridine ED - sildenafil ```
59
Classical symptoms of lumbosacral spondylosis?
low back pain paraestheisa on straight leg raise limited spinal flexion L5 - foot drop due to reduced dorsoflexion and inversion
60
foot drop with STRONG inversion
common peroneal lesion
61
foot drop with WEAK inversion
L5 Radiculopathy
62
What are the risk factors for wernickes
alcohol post GI surgery - eg bariatrics malnutrition AIDS
63
signs of wernickes
gait disturbance, opthalmoplegia, confusion confabulation is a sign of permanence i think?
64
Another name for extradural?
epidural
65
Indications for a CT head in trauma?
``` Immediately(less than 1hr) if: GCS less than 13 after GCS less than 15 after 2 hours neurological deficit seizure more than 1 episode of vomiting suspected basal skull fracture ``` within 8 hours if LOC with: Amnesia - more than 30 mins coagulopathy over 65
66
Risk factors for subdural haematoma?
old age Alcoholism falls anticoagulation - warf
67
Signs of coning?
HTN - to adequately perfuser the brain Cushings triad Widening of the pulse pressure Irregular breathing (cheyne stokes) bradycardia Also - unreactive pupils
68
diffuse axonal damage?
occurs from rapid acceleration and deceleration tearing brain axons and causing many haemorrhages brain dead possibly

6th Year (19 decks)

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