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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
Q

Features of charcot marie tooth?

A

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

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26
Q

What is the common gene involved in charcot marie tooth?

A

PMP22

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27
Q

What conditions present with a mixture of upper and lower signs?

A

MND

Cervical spondylosis with myelopathy and radiculopathy - upper below the lesion and lower at the level of the lesion

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28
Q

What is the most common type of dystrophy?

A

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
Q

How do you investigate duchenne?

A

CK - raised due to breakdown and loss

30
Q

What is the difference between beckers and duchenne?

A

beckers is less severe - later onset - partially functioning dystrophy

31
Q

Key features of MSA?

A

multi system atrophy is a parkinsinsons plus syndrome

parkisnons
autonomic dysfunction - orthostatic hypotension, urogenital dysfunction - incont +ED
cerebellar ataxia

32
Q

lesions in which lobe cause inferior quandrantopias

A

parietal

33
Q

Lesions in which lobe cause superior quandrantopias

A

temporal

34
Q

Cabergoline well know side effect?

A

pulmonary fibrosis

35
Q

Causes of a medical third nerve palsy?

A

Diabetes - mononeuritis
MS
midbrain infarct
migraine

36
Q

Causes of a surgical third nerve palsy

A

Riased ICP - causes transtentorial uncal herniation
PCA infarct (painful)
cavernous sinus thrombosis

37
Q

riluzole?

A

MND -confers survival benefit
prevents stimulation of glutamate recepters
used in ALS
3 months additional life

38
Q

mydriasis

A

blown pupil

39
Q

miosis

A

contricted pupil

40
Q

why do shoulder and upper thoracic injuries cause horners?

A

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
Q

what drugs used to sedate someone?

A

offer oral lorazepam 2mg and then go to IM olanzapine?

42
Q

commonest risk factor for bells palsy

A

pregnanacy

43
Q

Features of wernickes encephalopathy?

A 
CAN OPEN
confusion
ataxia
nystagmus
opthalmoplegia
perihpheral neuropathy
44
Q

What things can cause dizziness?

A

Illusion of self motion

Cardiovascular disease - LOW BP
hyperventialation
Anxiety - hyperventilation
migraine
epilepsy
45
Q

Migraine of menopause?

A

dizziness, light headed, myalgic weak

46
Q

vestibular funcrion?

A

absolute motion of the head through space. allows us to interpret things the rest of our proprioceptive skills and interpretations of light cannot

47
Q

Menieres disease (true vestibular)

A

Dilation of endolymphatic spaces within the labyrinth:

Episodes last hours upto 12
aural fullness
tinitus
vertigo
nausea and vomiting 
progressive hearing loss!!(sensorineural)
48
Q

functional vertigo

A

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
Q

What is BPPV

A

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
Q

How do you diagnose BPPV?

A

hall pike manoevre - causes upbeat torsional nystagmus

51
Q

How do you treat BPV

A

epley manoevre - self limiting - betahistine can help

52
Q

what do you call the infection which would commonly cause vertigo?

A

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
Q

treatment for menieres disease?

A

avoid triggers - alcohol, tiredness, caffeine. salt.

betahistone -histamine agonist?

54
Q

What is ramsay hunt syndrome?

A

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
Q

What is the treatment and prognosis for those with ramsay hunt syndrome?

A

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
Q

What are the 4 main signs and symptoms of MS?

A 
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
Q

What would you see on LP of MS

A

IgG oligoclonal bands

58
Q

Mainstay of treatment for MS?

A

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
Q

Classical symptoms of lumbosacral spondylosis?

A

low back pain
paraestheisa on straight leg raise
limited spinal flexion

L5 - foot drop due to reduced dorsoflexion and inversion

60
Q

foot drop with STRONG inversion

A

common peroneal lesion

61
Q

foot drop with WEAK inversion

A

L5 Radiculopathy

62
Q

What are the risk factors for wernickes

A

alcohol
post GI surgery - eg bariatrics
malnutrition
AIDS

63
Q

signs of wernickes

A

gait disturbance, opthalmoplegia, confusion

confabulation is a sign of permanence i think?

64
Q

Another name for extradural?

A

epidural

65
Q

Indications for a CT head in trauma?

A 
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
Q

Risk factors for subdural haematoma?

A

old age
Alcoholism
falls
anticoagulation - warf

67
Q

Signs of coning?

A

HTN - to adequately perfuser the brain

Cushings triad
Widening of the pulse pressure
Irregular breathing (cheyne stokes)
bradycardia

Also - unreactive pupils

68
Q

diffuse axonal damage?

A

occurs from rapid acceleration and deceleration tearing brain axons and causing many haemorrhages
brain dead possibly

6th Year (19 decks)

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