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4th Year > Neuro > Flashcards

Neuro Flashcards

1
Q

Treatment for cluster headache?

A

Subcut sumatriptan and 100% O2

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2
Q

Cranial nerve signs ipsilateral and motor signs contralateral is what type of stroke?

A

A brainstem infarct

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3
Q

Migrain treatment in acute event and for prophylaxis?

A

acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol

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4
Q

If you’re able to lift the upper eyebrow area is that a lower or upper motor neurone issue?

A

Upper

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5
Q

If you’re unable to lift the upper eyebrow area is that a lower or upper motor neurone issue?

A

Lower

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6
Q

Wasting and paralysis of hypothenar eminence is as a result of dysfunction in what nerve?

A

Ulnar

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7
Q

When can you be considered seizure free in epilepsy?

A

> 2 years no seizure and 2-3 months without medication.

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8
Q

Spinal tracts involved in descending motor control?

A

Corticospinal (body) Corticobulbar (Head)

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9
Q

Tracts involved in proprioception and vibration?

A

DCML (conscious)

Spinocerebellar (unconscious)

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10
Q

Tracts involved in pain and temperature?

A

Lateral Spinothalamic (conscious)

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11
Q

Dorsal root is for sensory or motor information?

A

Sensory

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12
Q

Ventral root is for sensory or motor info?

A

Motor (somatic and autonomic)

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13
Q

Triad in normal pressure hydrocephalus?

A

Ataxia, urinary incontinence and dementia.

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14
Q

Dietary management for kids with epilepsy?

A

The ketogenic diet is a high fat, low carbohydrate, controlled protein diet. It is an established treatment for children with epilepsy that is hard to control and is generally unresponsive to antiepileptic medications.

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15
Q

Mid shaft humeral fracture associated with what nerve, how would you test this?

A

Radial nerve, test by doing wrist extension.

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16
Q

Subdural haemorrhage is caused by?

A

Bleed of bridging veins from sinus to cortex.

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17
Q

What is the sylvian fissure, what does it contain?

A

Separates the frontal and temporal lobe

Contains branches of the MCA

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18
Q

CSF ventricles of the cranium?

A 
2 lateral ventricles
3rd ventricle (below them)
4th Ventricle (below that)
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19
Q

Openings into the 4th ventricle?

A

Paired lateral foramina of Lushka

Median foramen of magendie

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20
Q

Small pupil is caused by what (miosis)?

A

Impaired sympathetic function e.g. horners

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21
Q

Large pupil (mydriasis), is caused by what?

A

Impaired parasympathetic function e.g. 3rd nerve palsy (will also have ptosis) - could be posterior comm artery aneurysm.

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22
Q

RAPD is a sign of dysfunction of what nerve?

A

Optic nerve.

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23
Q

Action of the obliques?

A

Inferior: elevates in ADDUCTION
Superior: depress in ADDUCTION

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24
Q

What muscle (and nerve) is responsible for elevation of abducted eye?

A

Superior rectus (CN II)

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25
Q

Parasympathetic fibres (for pupil constriction carried in what nerve?)

A

CN III

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26
Q

What symptoms do you get in 3rd nerve palsy?

A

Eye in down and out position - can only abduct and intort (elevate in adduction)

Pupil is fixed and dilated

Complete ptosis

If painful the posterior communicating artery aneurysm.

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27
Q

What are some causes of a third nerve palsy?

A

Aneurysm, diabetes, Cavernous sinus lesion, tentorial herniation.

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28
Q

6th Nerve palsy presentation? Causes?

A

Can’t abduct

Pupils and eyelid normal

Raised ICP, diabetes

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29
Q

4th Nerve palsy presentation?

A

Can’t depress in adduction

Pupils normal, eyelid normal

Head trauma

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30
Q

Corneal reflex af/efferent aspect nerves?

A

Afferent - trigeminal (opthalmic)

Efferent - Facial

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31
Q

What muscles are controlled by the trigeminal nerve?

A

muscles of mastication:

  • Temporalis, masseter pterygoids
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32
Q

Rinnes test abnormal result?

A

BC > air = conductive loss

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33
Q

Role of the IX CN ?

A

Glossopharyngeal:

Gag reflex and palatal sensation

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34
Q

X CN function?

A

Motor to palate and larynx

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35
Q

XI CN function?

A

Accessory (traps and sternocleidomastoid)

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36
Q

XII CN function?

A

Hypoglossal

Motor to tongue (will deviate to side of lesion in palsy)

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37
Q

What is bulbar palsy?

A

Bulbar palsy is a lower motor neurone dysarthria.

A condition in which the lower cranial nerves (8-12) are dysfunctional.

Causes, w/ assoc. feats:

  1. Wasting and fasciculation of masticatory muscles (MND)
  2. Fatiguable dysarthria (MG)
  3. Facial weakness (GBS)
  4. Brainstem stroke
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38
Q

What is psuedobulbar palsy?

A

Upper motor neurone dysarthria

CNS dysfunction of the corticobulbar tract.

May have extensor plantar response, brisk jaw reflex, dysphagia.

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39
Q

In a UMN/LMN lesion what type of wasting is observed?

A

UMN: Late, disuse atrophy
LMN: Early, neurogenic wasting.

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40
Q

Does fasciculation occur in UMN or LMN lesions?

A

LMN

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41
Q

Tone in UMN and LMN lesions?

A

Hypotonia (LMN)

Spasticity (UMN)

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42
Q

Pattern of weakness in UMN and LMN lesions?

A

UMN:
- yes, flexors stronger than extensors in upper limb and reverse in lower

LMN:
- Yes, may follow single nerve, may be predominantly distal.

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43
Q

Plantar reflex in UMN/LMN lesions?

A

UMN: extensor
LMN: flexor or absent

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44
Q

What tracts decussate at the level in the spinal cord?

A

Spinothalamic

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45
Q

Reflex dysfunction in radial nerve dysfunction?

A

Biceps reflex loss

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46
Q

What is brown sequard’s syndrome?

A

Hemisection of the spinal cord - so the spinothalamic tract has not decussated yet and is affected contralaterally

loss of pain and temperature contralaterally, and all others ipsilaterally

Signs are UMN, SO spasticity and upwards going plantars.

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47
Q

Median nerve compression at wrist Motor, sensory and reflex changes?

A

Motor:
- Thenar muscles

Sensory:
- Thumb, index, middle and half of ring

Reflex:
- Nil

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48
Q

Ulnar nerve compression at elbow: motor, sensory and reflex changes?

A

Motor:
hypothenar, interossei and flexor carpi ulnaris (wrist flexion)

Sensory:
- medial 1 and 1/2 fingers

Nil reflex dysfunction

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49
Q

Radial nerve compression at upper arm: motor, sensory and reflex changes?

A

Motor:
Wrist extension,

Sensory 
anatomical snuffbox (very little)

Triceps reflex may be lost (if higher then biceps I guess)

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50
Q

Peroneal nerve compression at neck of fibula motor, sensory and reflex changes?

A

Motor:
tibialis anterior - foot flexion

Sensory :
lateral calf and foot dorsum

nil reflex loss

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51
Q

C7 nerve root loss motor, sensory and reflex changes?

A

Motor: Triceps, wrist extensors

Sensory: central strip of forearm

Reflex: loss of triceps

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52
Q

L5 nerve root loss motor, sensory and reflex changes?

A

MotorL Extensor hallucis longus (toe extension)

Sensory: sole of foot

Nil reflex loss

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53
Q

S1 nerve root loss motor, sensory and reflex?

A

Gastrocnemius, soleus

sole of foot

loss on ankle reflex

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54
Q

What nerve does knee reflex?

A

Femoral

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55
Q

What nerve does ankle reflex?

A

Sciatic

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56
Q

Key finding on LP for SAH?

A

bilirubin

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57
Q

LP done at what level?

A

L3/4

58
Q

LP elevated protein differential?

A

VERY HIGH:

  • GBS
  • TB/fungal Meningitis

HIGH:

  • encephalitis
  • malignancy
  • meningitis
59
Q

LP low glucose finding DDx?

A

Meningitis

HSV encephalitis

60
Q

LP lymphocytes finding DDx?

A

Lymphoma/leukaemia
SLE
Viral encephalitis/meningitis

61
Q

LP oligoclonal bands in CSF?

A

MS
CNS Lymphoma
SLE
GBS

62
Q

Dysfunction in complete spinal cord lesion?

A

Motor:
LMN at site of lesion

UMN below lesion

Sensory dysfunction below lesion

Bladder involvement

63
Q

Brown sequard dysfunction, motor and sensory?

A

Motor:
Ipsilateral UMN below lesion

Sensory:
Contraleral loss of pain and temp
Ipsi loss of everything else

64
Q

Central cord lesion motor and sensory dysfunction?

A

Motor:
LMN at site, UMN below

Sensory:
Loss of pain and temp, others may be preserved

65
Q

Migraine features?

A

throbbing (60% unilateral) moderate-severe pain. Nausea and vomiting, photophobia, visual, sensory, motor and speech disturbance FH, better ON SLEEP.

66
Q

Tx for acute migraine attack?

A

Paracetamol/NSAID/Aspirin

Triptan (HT1 antag)

NO OPIOIDS

67
Q

Tx for prophylaxis of migraines?

A

Beta blocker
Topiramate
Riboflavin Candeartan

68
Q

Cluster presentation and Tx?

A

15-2 and a half hours pain (behind eye) intense unilateral.

Have clusters of headaches for a week or so then better for a while (months).

rhinnorhoea, redness of eye, can have horners

Acute: High flow O2 Triptans, prednisolone
Prophylaxis: Lithium, topiramate, verapamil

69
Q

Venous sinus thrombosis symptoms?

A

Severe headache w/ nausea and vomiting +/- seizures, focal neurological signs.

Papilloedma is common

Recent infection, dehydration or immobility

70
Q

Presentation of carotid artery dissection?

A

Unilateral headache, traumatic or spontaneous, can have cranial nerve signs such as (horners), pulsatile tinnitus

Classic triad (<1/3rd)

  • Ipsilateral pain
  • Horner’s syndrome
  • Delayed ischaemia
71
Q

Typical pt with subdural haematoma? Prognosis?

A

Old, alcoholic, bad prognosis

72
Q

Typical pt with extra dural haematoma?

A

young, good prognosis

73
Q

Most common meningitis agent in UK?

A

Neisseria meningitidis, (meningococcus) B is most common.

74
Q

Frontal lobe seizure pres?

A

progression of clonic sezure over one side of the body

75
Q

Temporal lobe seizure pres?

A

De ja vu, then wide eyed stare and automatisms

76
Q

What epilepsy drugs can’t you take with COCP?

A

Carbemazepine and phenytoin

77
Q

Management of status epilepticus?

A

Prehospital:
- diazepam rectally or midazolam buccally

Then lorazepam

then phenytoin or phenobarbitone

Can go on to give anaesthesia (propofol)

78
Q

Clinical presentation of tumour?

A

Focal neurological deficit

Symptoms of raised ICP e.g. early morning headache

Seizures

79
Q

MS treatment?

A

Interferon B and glatiramer

Biologics e..g Nataluzimab

80
Q

polyneuropathy normal presentation?

A

distal sensorimotor deficits w/ hyporeflexia

81
Q

Causes of polyneuropathy?

A

GBS, Cancer, Diabetes

82
Q

Presentation of myopathy?

A

Proximal symmetrical weakness without sensory or autonomic symptoms

83
Q

Cauda equina syndrome typical pres?

A

Bilateral leg pain w/ sensory disturbances

Incontinence

saddle anaesthesia

Needs decompression

84
Q

What is radiculopathy and spondylosis?

A

Radiculopathy - compression of nerve root normally causes pain with weakness and sensory disturbance

Spondylosis - degeneration of spine, may cause radiculopathy

85
Q

Signs/symptoms of raised ICP?

A

Signs:

  • Papilloedema (after 48 hours)
  • ptosis/3rd and 6th nerve palsy (can’t abduct - diplopia)

Symptoms

  • Headache, worse on lying down, or after sleeping
  • Vomiting
86
Q

What can caused raised ICP?

A

SOL:

  • tumour
  • Abscess

Haemorrhage

  • Extra dural
  • Subdural
  • Sub arachnoid
  • Intracranial (HTN - cocaine)

Hydrocephalus
- Communicating and non-communicating (ventricular blockage)

87
Q

Presentation in brain tumour?

A

New onset headache, worse in mornings

Nausea and vomiting

Seizures

Focal neurological signs

88
Q

Types of brain tumour?

A

From brain itself:

  • Glioma (e.g. astrocytoma)
  • Microglioma (primary lymphoma)
  • Pituitary gland

From lining:
- meningioma

From nerves:
- vestibular schwannoma

89
Q

Ankle reflex nerve root value?

A

S1-2

90
Q

Knee reflex nerve root value?

A

L3-L4

91
Q

Biceps reflex nerve root value?

A

C5-6

92
Q

Triceps reflex nerve root value?

A

C7-8

93
Q

LMN lesion presentation?

A

Symptoms:

  • Pain
  • Tingling
  • Weakness

Signs:

  • Hyporeflexia
  • Early wasting
  • Fasciculation
94
Q

UMN lesion presentation?

A

Symptoms:

  • weakness
  • spasticity

Signs:

  • Hypertonia
  • Hypereflexia
  • upwards going plantars
95
Q

Tract involved in crude touch?

A

Spinothalamic

96
Q

Tract involved in fine touch?

A

DCML

97
Q

What gene is implicated in ALS?

A

SOD1

98
Q

Lumbar puncture normal findings?

A 
8-20 pressure
<5 lymphocytes
No red cells
0.15-0.5 g/L protein
Glucose 60-80% of blood glucose
99
Q

What nerve roots supply the pelvic floor?

A

S3 S4

100
Q

MS presentation?

A

20-40, more common in women

Depends on location

  • Optic neuritis - optic nerve will cause blurred vision, pain on eye movement, impaired colour vision
  • Cervical cord: get transverse myelitis, ascending numbness and parasthesia, often asymmetrical
  • Brainstem: vertigo, dyscoordination, diplopia

UMN signs on examination

101
Q

Types of multiple sclerosis

A

Relapse-remitting

  • 65% of cases
  • after 10 years 50% will go on to get secondary progressive

Primary-progressive

  • No relapses
  • Patients become progressively disabled from onset

Relapsing-progressive
- 15% of cases, a combination of the above two

102
Q

What would you see on an MRI for an MS patient?

A

Multiple T2 high signal lesions, seen as white dots.

Old lesions may be seen on T1 as black holes

103
Q

LP findings for MS?

A

Oligoclonal bands
Mild WBC rise (<10)
Normal protein and glucose
High IgG index

104
Q

What is an evoked potential and what would an evoked potentials investigation say in MS?

A

Assess brainstem and somatosensory pathways, if these regions have been damaged or delayed the potentials may be delayed.

105
Q

What are the different stroke syndromes and their presentations?

A

General presentation:

  • Focal loss of function
  • No warning, sudden / rapid onset
  • Maximal loss in all parts, no gradual spread

The following criteria should be assessed:

  1. contralateral hemiparesis and/or hemisensory loss of the face, arm and leg
  2. contralateral homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia (not dysarthria)

Total anterior circulation infarcts (TACI, 15%)
involves middle and anterior cerebral arteries
all 3 of the above criteria are present

Partial anterior circulation infarcts (PACI, 25%)
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the above criteria are present

Lacunar infarcts (LACI, 25%)
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. Complete contralateral hemiparesis (and/or sensory deficit) 
Posterior circulation infarcts (POCI, . 25%)
involves vertebrobasilar arteries
presents with 1 of the following:
1. Ipsilateral cerebellar signs
2. Contralateral homonymous hemianopia
3. Brainstem stroke
106
Q

Management of ischaemic stroke?

A

Blood glucose, hydration, oxygen saturation and temperature should be maintained within normal limits

300mg aspirin

VTE prophylaxis: intermittent pneumatic compression

Cholesterol >3.5 then start statin

Thrombolysis within 4.5 hours, when haemorrhagic stroke excluded:
- Alteplase

Mechanical thrombectomy - can do, may be better, with stent

Secondary prevention :

  • Clopidogrel recommended ahead of aspirin and dipyramole
  • Carotid artectomy if significant stenosis and suffered TIA or Stroke
107
Q

Stroke risk factors?

A

Age - the biggest risk factor of all
Sex - a small male excess
BP - most important modifiable risk factor

Diabetes – doubles risk, but better glycaemic control doesn’t seem to lower this

Cholesterol – complex: observational data show no overall impact, but statins clearly lower risk

Other cardio-vascular disease – AF, MI, PVD, AAA

Smoking – dose response effect

Alcohol

Diet – high salt, low F+V, low fish

Obesity & lack of exercise

Social deprivation

108
Q

Common causes of ischaemic stroke?

A 
AF 
Mitral stenosis
MI
Endocarditis
Prothetic valve

Atheroma in large artery

Micro-atheroma and atherosclerosis in small arteries

109
Q

Common causes of haemorrhagic stroke?

A

Arteriosclerosis
Amyloid angiopathy
Anticoagulation

Uncommonly: berry aneurysm, tumour

110
Q

Management of haemorrhagic stroke?

A

Surgery in select patients

BP control (<140)

VTE prophylaxis Intermittent pneumatic compression

111
Q

Definition of epilepsy, and of epileptic seizure?

A

Epileptic seizure:
Synchronous, excessive discharge of neurones in the cerebral cortex causing a clinically discernable event

Epilepsy
- Tendency to recurrent epileptic seizures (2 or more)

112
Q

Causes of epilepsy?

A

Identifiable cause in about 50% of cases

Structural causes

  • Perinatal
  • Head injury
  • Stroke
  • Tumours

Infection

Genetic

Autoimmune

Metabolic

113
Q

Investigations for seizure?

A

Clinical diagnosis, but to aid classification and to determine aetiology

ECG

EEG

Neuroimaging

114
Q

Principles of epilepsy management?

A

Focal seizures

  • Lamotrigine
  • Carbamazepine

Generalised seizures

  • Valproate
  • Lamotrigine
115
Q

SAH presentation?

A

Sudden onset very very severe headache that reaches peak intensity within 5 minutes

Associated brief LOC, nausea and vomiting

Neck stiffness and photophobia

May have focal neurological signs

116
Q

Investigations for SAH?

A

First CT scan - this does not rule it out, but can rule it in

Then LP >12 hours after

Bilirubin peak = SAH

117
Q

Investigations and diagnosis of cerebral venous sinus thrombosis?

A

Plain non-contrast CT brain

CT venogram

MR venogram

118
Q

Treatment of venous sinus thrombosis?

A

Treat underlying infection plus anticoagulation

119
Q

Presentation of vertebral artery dissection

A

Vertebral artery dissection

  • Posterior neck pain
  • Headache
  • Different to migraine or musculoskeletal pain
  • Lateral medullary syndrome (ataxia, dyspagia)
120
Q

Pituitary apoplexy presentation and Tx?

A

SAH mimic with thunderclap headache:

  • Neurosurgical emergency

Focal neurological signs

Rapid progressive visual loss

Extra-ocular nerve palsies

Acute pituitary insufficiency

Addisonian crisis, hypotension:

  • Metabolic acidosis
  • Hypoglycaemia
121
Q

What is hypokinesia?

A

Akinesia / Bradykinesia = Lack of / Slowness of movement

122
Q

Types of hyperkinetic movement?

A

Tremor
- involuntary, repetitive, rhythmic oscillation of a body part,

Dyskinesia
- Excessive involuntary non-rhythmic jerking

Myoclonus
- Sudden jerk

Dystonia
- Abnormal posturing

123
Q

What is incoordinated movement called?

A

Ataxia

124
Q

Idiopathic Parkinsons disease presentation?

A

Tremor - worse with distraction, better with movement
Rigidity
Bradykinesia
Postural instability

Micrographia
Difficulty terning over in bed
Difficulty with fine manual tasks

125
Q

Parkinsons disease treatment?

A

Motor symptoms
- Levodopa, carbidopa

  • Amantadine (NMDA antag)
  • Entacapone (COMT inhibitor)
  • Selegiline (MOB inhibitor)
  • benhexedol (anticholinergic)
126
Q

What are the different causes of tremor?

A

Resting tremor
- Parkinsons

  • Benign essential - can be genetic, worse on movement

Dystonic tremor
- asymmetric, rhythmic, action tremor, bilateral

Intention tremor
- tries to get to target and then when you get there that’s when problems arise

127
Q

C5 nerve root (C4/C5 disc level) compression in cervical radiculopathy symptoms?

A

Pain from neck to shoulder and numbness over deltoid, biceps diminished reflex.

128
Q

C6 nerve root (C5/C6 disc level) compression in cervical radiculopathy symptoms?

A

Pain over lateral arm and forearm, sensory distrubance in lateral forearm thumb and index finger

Motor weakness in biceps and brachioradialis

Biceps and supinator reflex damage

129
Q

C7 nerve root (C6/C7 disc level) compression in cervical radiculopathy symptoms?

A

Pain down middle forearm and middle, sometimes ring finger

Motor weakness in wrist and finger extensors

Diminished triceps reflex

130
Q

C8 nerve root (C7/8 disc level) compression in cervical radiculopathy symptoms?

A

Pain medial forearm to hand, sensory disturbance in medial forearm and hand

Hand grip and intrinsic muscle weakness

No reflex changes

131
Q

Presentation of cervical spondylotic myelopathy

A

Numb clumsy hands

Unsteady gait

Bladder symptoms, should do MRI cervical spine

132
Q

Myasthenia gravis presentation and treatment?

A

Autoimmune (to ach receptors)

Fatigueability is key

  • In talking
  • look up at finger

Weakness in proximal muscles

No muscle wasting, fasciculations, tone is normal

Treat with acetylcholinesterase
- pyridostigmine

If they don’t respond then corticosteroids, azathioprine and thymectomy are options

133
Q

What is syringomyelia?

A

Cystic cavitation of the spinal cord caused by a number of things such as post trauma, cancer and chiari malformation

Sensory loss (loss of pain and temp and preserved vibration sense and proprioception)

Normally do decompressive surgery

134
Q

Meningitis presentation?

A

Fever, headache, neck stiffness, photophobia nause and vomiting and reduced GCS

135
Q

Encephalitis presentation, normally caused by?

A

Inflammation of the brain parenchyma, normally viral almost always HSV in the UK

Present with

  • Non-specific headache, malaise and myalgia with fever
  • Can either then be mild and self-limiting or progress to meningism, personality change and confusion
136
Q

How does sporadic CJD present, how does variant CJD?

A

Rapidly progressive dementia with akinetic mutism (don’t move, don’t talk) cortical blindness and myoclonus

Variant presents with behaviour change ataxia and involuntary movements

137
Q

Causes of hydrocephalus?

A

Increased CSF production
- very rare, choroid plexus cancer

Obstruction to CSF pathways

  • can either be communicative or non-communicative
  • Communicative in subarachnoid space obstruction, all 4 ventricles will be dilated, this could be post SAH or infective
  • Non-communicative could be a tumour, post-infectious, post-haemorrhagic or congenital malformations

Impaired absorption

138
Q

presentation of hydrocephalus in kids?

A

Head will expand as kids bones have not fused, OFCircumference would be crossing centiles, may have be failure to thrive and stuff later on

139
Q

tension headache presentation?

A

Bilateral dull persistent headache, episodic or chronic - not affected by physical activity, can last from 30 mins to days or weeks

pressure or tightness - may be associated with the neck

140
Q

Tension headache Tx?

A

Acupuncture or amitryptiline

4th Year (15 decks)

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