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Neuro Flashcards

1
Q

Causes of sudden Vs Gradual onset neural symptoms

A

Sudden

  • Cerebrovascular event
  • Space occupying lesion
  • Frontotemporal dementia
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2
Q

Features of temporal lobe lesion

A 
Receptive aphasia (difficulty with comprehension - Wernickes)
Contralateral upper quadranopia (piTS)

Altered auditory/visual perception

Altered personality/sexual behaviour

long term memory impaired

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3
Q

Features of a Frontal lobe lesion

A

Change in personality

Anosmia (lost smell)

Expressive aphasia (Brocas, broken words)

Contralateral hemiparesis

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4
Q

Features of Parietal lesion

A

Hemiparesis

Decreased 2-point discrimination

Astereogenesis (cant recognise object in hand)

Sensory inattention (e.g. will only draw half clock face

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5
Q

Gerstmann Syndrome

  • Site of lesion
  • 4 symptoms
A

Lesions near the temporal and parietal lobe junction

Dysgraphia (lost ability to write)

Dyscalculia (cant do maths)

Finger agnosia (cant distinguish fingers on hand)

Left-right disorientation

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6
Q

Features of occipital lesion

A

Contralateral homonymous hemianopia

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7
Q

Features of midbrain lesion

A

Short term amnesia
Confabulation
Strong desire to sleep

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8
Q

What can cause a cerebellar lesion?

Pres?

A

Cerebrovascular event
SOL
Infection
Wernicke’s

DANISH (Dysdiadokinesia - hand turn, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia/Heel-toe

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9
Q

Which tumour is seen in cerebellar pontine angle?

How can it present?

A

Acoustic neuroma

Ipsilateral deafness, Tinnitus, Facial/ trigeminal palsy (Facial numb/weakness)

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10
Q

Vision for:
1) Optic nerve lesion

2) Optic chiasm (central) lesion
3) Prechiasmal lesion
4) Optic tract lesion

A

Blindness on affected side

Bitemporal vision loss

Homonymous hemianopia of contralateral side of vision to lesion (3/4)

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11
Q

GCS

A

EVM 456

Best eye movement (out of 4)

Best verbal response (out of 5)

Best motor response (out of 6)

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12
Q

Headache Red Flags

A

New/change in pattern (if over 50)

Seizure

Systemic ill (fever, malaise, weight loss)

Personality change

Acute onset worst ever headache

Scalp tender jaw claud

Focal signs

Raised ICP (vomiting)

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13
Q

Meningism triad

A

Headache
Photophobia
Nuchal rigidity

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14
Q

Meningitis RF

A 
CSF shunts
Spinal anaesthetic
DM
Alcohol
IVDU
Crowding
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15
Q

Meningitis organism

A

Viral: mumps, HSV

Bacterial:

  • neonate: GBS
  • children: H.influenza b
  • adults: Strep pneumoniae, Neisseria meningitidis, Hib
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16
Q

Non infective causes meningitis

A

Malignancy
Sarcoidosis
SLE

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17
Q

Meningitis pres

A

Meningism Triad (headache, photophobia, nuchal rigid)

Opisthotonos (arching back)

Altered mental state

If Bacteraemia (purpuric rash)

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18
Q

Meningitis Ix

A

LP - gram stain, Ziehl nelson, glucose, protein, culture

Blood: FBC, Glucose, U&E, culture

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19
Q

Raised ICP symptoms

A

Vomiting

Reduced consciousness

Headache

Fits

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20
Q

CSF Bacterial meningitis

  • Opening pressure
  • Appearance
  • Predominant cell type
  • Protein
  • Glucose
A

High pressure

Turbid

Neutrophils

Protein high

Glucose low

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21
Q

CSF Viral meningitis

  • Opening pressure
  • Appearance
  • Predominant cell type
  • Protein
  • Glucose
A

High pressure

Clear

Mononucelar lymphocytes

High/Normal protein

Normal Glucose

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22
Q

TB LP

  • Opening pressure
  • Appearance
  • Predominant cell type
  • Protein
  • Glucose
A

High

turbid (fibrin web)

Mononuclear lymphocytes

Very High protein

Low gulcose

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23
Q

Lumbar puncture contraindications

A

Raised ICP (focal neurology, bradycardia, hypertension, GCS under 9)

COag abnormlities

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24
Q

LP complications

A

Postpunctural headache

Infection

Bleeding

Cerebral herniation (if high ICP)

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25
Q

Meningitis management

A

Fluids, antipyretic, antiemetic

Viral - acyclovir

Bacterial IV ceftriaxone (add vancomycin if penucoccla)

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26
Q

Community Abx for meningitis

A

Benzylpenicillin

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27
Q

Meningitis complications

A 
Sepsis/septic shock
DIC
Seizures
Coma
Raised ICP
SIADH
Deafness
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28
Q

Meningitis prevention

A

Vaccination (Hib, Neisseria, S.Pneum)

Ciprofloxacin to contacts (prophylaxis

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29
Q

Usual organism for meningococcal septicaemia?

Describe the organism..

A

Neisseria meningitidis

Gram -ve diplococci

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30
Q

Meningococcal septicaemia Presentation

A

Non-blanching petechial rash

Meningism

Septic (cold periph, cap refill over 2s, hypotensive)

Give IV/IM Benpen if suspected

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31
Q

Meningococcal septicaemia investigations

A

FBC: low Pts

Blood cultures

LP

Pharyngeal swab

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32
Q

Meningococcal septicaemia management in hospital

A

<3months - cefotaxime + amoxicillin >3 months - ceftriaxone

Resuscitation if needed

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33
Q

Suspected Meningococcal septicaemia community management

A

IV/IM Benzylpenicillin

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34
Q

Prevention of meningococcus

A

Ciprofloaxcin ± menigicoccal vaccine prophylaxis (esp for uni student)

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35
Q

Encephalitis

  • What is
  • Common cause
  • Pres
  • Pres in neonate
A

Inflammation of brain parenchyma

Viral - HSV - 1

Fever, headache, altered mental state, headache, seizures.

lethargy, poor feeding, bulging fontanelle

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36
Q

Encephalitis causes

A

HSV-1 (Most commonly)
HSV-2, CMV

Bacterial (TB, Listeria)

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37
Q

Encephalitis IX

A

Bloods (leukocytosis), CT to exclude stroke/SOL

LP - Viral picture + viral PCR

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38
Q

Encephalitis Tx

A 
IV acyclovir
IV Benpen (if bacterial)
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39
Q

Encephalitis complications

A

SIADH
Cardiac/Resp arrest
Epilepsy (esp temporal)
Prsonality change

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40
Q

SAH

  • Usual cause
  • Other causes/RF
A

Berry aneurysm

SVM, vasculitis, HTN, cocaine, ADPKD, MArfans/Ehlers-Danlos

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41
Q

Pres of

SAH

A

Sudden occipital headache, vomiting, dizziness, confusion

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42
Q

Common place for berry aneurysm

A

Junction of anterior communicating artery and anterior cerebral artery (front part circle of willis)

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43
Q

SAH signs

A

Meningism (6h following headache)

Altered GCS

Intraoccular haemorrhage

Focal neurology

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44
Q

CNIII palsy aneurysm location

A

Posterior communicating artery - Internal carotid junction

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45
Q

SAH Ix and findings

A

CT head: sub arach bleed

LP: xanthochromia. yellow discolouration of CSF after 12 hrs

Cerebral angiography to locate aneurysm

ECG - QT prolongation (risk arrest)

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46
Q

CSF

  • Prod
  • Absorbed
A

Choroid plexus in ventricles make CSF

Flows in subarachnoid space

Absorbed by dural venous sinuses

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47
Q

SAH management + complications

A

Labetalol for HTN, Nimodipine for vasospasm

Coiling (femoral catheter) or clipping (craniotomy)

Complications: Haemorrhagic stroke, Rebleeding, cerebral ischaemia (vasospasm - give Nimodipine) hydrocephalus, cardiac arrest

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48
Q

Most common cancer mets to brain

A
  1. Lung
  2. Breast
  3. Colon
  4. Melanoma
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49
Q

Raised ICP presentation

A

Headache worse on waking, bend, cough

Papilloedema

Vomitng without nausea

Altered mental state

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50
Q

Raised ICP presentation

A

Headache worse on waking, bend, cough

Papilloedema

Vomitng without nausea

Altered mental state (irritable, lethargy, COMA)

6th nerve palsy

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51
Q

What is seen in Papilloedema

A

Venous engorement give blurred disc margins

Haemorrhage

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52
Q

Investigating raised ICP

A

CT/MRI head

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53
Q

Management of ICP

A

Anticonvulsants for seizures

Mannitol (diuretic used in ICP)

Analgesia

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54
Q

What may SOL mimic (false localising sign)

A

CNVI palsy (inward turned eye, cant abduct) most vulnerable CN as longest

Horner’s syndrome - sympathetic trunk (Miosis, ptosis, anhidrosis)

Cerebellar signs (DANISH)

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55
Q

Common vessel in Extra dural haemorrhage

A

Middle meningeal artery

Blood between bone and dura

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56
Q

Extra-dural

  • Cause
  • Initial pres
  • Later pres
A

Trauma + LOC

Lucid interval
Headache

Deterioration
N+V, Seizure, altered GCS, Bradycardai

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57
Q

Reason for deterioration following lucid interval in Extra-dural

A

ICP due to metabolites cause osmotic swelling and deterioration

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58
Q

Extra-dural

  • Ix
  • Mx
A

CT head (haematoma)
Bloods - FBC, U&E, Coag
X-ray skull fracture

Mannitol/hypertonic saline

Surgery: Burr hole craniotomy and clot evacuation

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59
Q

Extra-dural complication

A

Neurological deficits, Post-Trauma seizures

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60
Q

Preventing extradural

A

Helmets

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61
Q

Extradural CT

A

Lens shaped haematoma

Doesn’t cross suture lines

Might have midline shift

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62
Q

Subdural haematoma

  • Location of blood
  • Mech
  • Pres timing
  • Cause to remember
A

Blood in space between dura and arachnoid

Bridging vein tear (cortex to venous sinus). Elderly - cerebral atrophy. tension on veins = inc risk.

Acute, subacute (3-7d post trauma), chronic (2-3w)

Could be NAI …

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63
Q

Subdural RF

A

Elderly (cerebral atrophy)
Alcoholism (prolonged bleeding)
Anticoagulation

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64
Q

Subdural presentation pattern

A

Lucid interval (can be hours - acute, or days/weeks - chronic)

Gradually worsening anorexia, N&V, headache, limb weakness, speech impair, Raised ICP

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65
Q

Subdural Ix and Tx

A

Non-contrast CT
Bloods

Resus and Mannitl/hypertonic saline

Surgery: Craniotomy + clot evacuation

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66
Q

Subdural Complications

A

Cerebral herniation /oedema

Seizures

Permanent neurological deficit

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67
Q

Subdural cT

A

Crescent shaped haematoma crossing suture lines

Mid line shift

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68
Q

Fracture base of skull signs

A

Panda eyes
Battle sign (bruising over mastoid process)
Blood in middle ear
CSF: Rhinorrhoea, otorrhoea

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69
Q

Migraine triggers mnemonic

A

CHOCOLATE

CHeese
Oral contraceptive
Caffeine
alcOhoL
Anxiety
Exercise
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70
Q

Types of migraine

A

With aura

With aura

Aura without headache

Hemiplegic (headache + hemiplegia)

Menstrual

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71
Q

Migraine pres

A

Aura in 1/3 before headache (scintillating scotoma, somatosensory - unilateral numbness hand/arm/face)

Headache: unilateral, pulsating, 4-72hrs

N&V, photophobia/phonophobia
Irritable

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72
Q

Management of migraine (acute attack)

A

Analgesia (para, aspirin)
Triptan
Ergotamine (vasoconstrictor)

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73
Q

When are triptans CI

A

5-HT (serotonin) Receptor agonist - serotonin mediated vasoconstriction

Uncontrolled HTN, CHDm CVD, Angina

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74
Q

Migraine preventative Tx

A

1st line: Beta-blocker

2nd: Topiramate (anticonvulsant)

Amitriptyline, Gabapentin

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75
Q

CI to beta blockers

A

Asthma
Peripheral vascular disease (lower systemic vasc pressure bad for claudication)
Myasthenia gravis (inc weakness)

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76
Q

Migraine and COCP

  • relationship
  • why
A

COCP CI in migraine (esp with aura)

Inc risk of ischaemic stroke

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77
Q

Migraine in preg. What drugs cant be given

A

Aspirin (Reyes)

Triptans

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78
Q

Cluster headache

  • who
  • usual pattern
A

Male 20-40 yr

45-90mins, 1-2 times day over 6-12 weeks
Usually yearly

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79
Q

Cluster headache pres

A

Sharp, localised around the eye

Autonomic features (Lacrimation, rhinorrhoea, flushing, partial horners)

Restless/cant keep still (opposite of migraine)

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80
Q

Cluster headache

  • triggers
  • acute stage Tx
A

Alcohol, GTN (vasodilation)

Subcut Sumatriptan + O2

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81
Q

Cluster headache prevention

A

Stop smoking / alc

1st line: Verapamil
Prednisolone

2nd line: Lithium

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82
Q

Tension headache presentation

A

Gradual onset bilateral band like

fronto-occipital/neck radiation

No other disturbance (photo/phonophobia, visual, sensory)

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83
Q

Tension headache Tx

A

Stress, anxiety decrease

NSAID, Paracetamol, Amitriptyline

84
Q

Trigeminal neuralgia

  • Who
  • Pathology/cause
  • Triggers
A

Females 50-60
Neuropathic/sharp pain in trigeminal distribution (maxillary/mandibular)

Idiopathic, Compression by loop of artery, tumour, AMV, MS.

Shaving, brushing teeth, washing, eating

85
Q

Pattern in trigeminal neuralgia

A

Sudden facial Pain for Secs/Mins
Sharp, shock-like
Can have 100s of attacks a day

86
Q

Trigeminal neuralgia management

A

MRI to exclude secondary cause

Carbamazepine/Lamotrigine
Surgery: Gamma-knife, microvascular decompression if due to organic pathology

87
Q

Giant cell arteritis
- Pathology
RF

A

Immune mediated vasculitis of medium/large arteries

Age (60-80)
Female

88
Q

GCA Pres

A

Headache - temporal, severe scalp tenderness, Jaw claudication, Amaurosis fugax

89
Q

Ix and Tx of GCA

A

Raised ESR ± CRP
Temporal artery biopsy/USS

Prednisalone (High dose)

90
Q

GCA complications

A

Aortic aneurysm/dissection

Loss of vision (20% in severe)

CNS - seizures

Steroid complications: immunosuppressive, osteoporosis, thinning skin, narrow angle glaucoma

91
Q

TIA pathology

A

Temporary iscahemia of part of the brain

Usually embolic - Carotid (80%), AF, valve disease, Pos MI mural thrombus

92
Q

Carotid Vs Vertebrobasillar TIA

A

Hemiparesis, Motor, dysphasia, amaurosis fugax

Homonymous hemianopia
hemiparesis
cerebellar signs

93
Q

RF stroke/TIA

A 
HTN
Smoking
DM
Heart disease (iscahemia, Valve, AF)
COCP
Carotid bruit
Polycythemia
94
Q

Examinatiory finding for cause of TIA

A

AF
HTN
HEart murmur
Carotid bruit

95
Q

What score estimates stroke risk following TIA

A

ABCD2 score

Age
BP (0ver 140)
Clinical features of TIA
Duration (over 60min)
Diabetes
96
Q

TIA Tx & complications

A

Aspirin in acute TIA

Secondary prevention of stroke with Clopidogrel
(If CI then Aspirin + Dipyridamole-ADP PT block)

If AF, Warfarin

Stroke, MI

97
Q

ABCD2 use

A

Indicates for use of diffusion weighted MRI

2day stroke risk
4-5 moderate
6-7 high

98
Q

Causes of stroke in young Vs old

A

Young: Vasculitis, thrombophilia, SAH

Old: Thromboembolism, atherosclerosis (carotid, heart - AF, HTN), Aneurysm rupture

99
Q

Stroke types

A

Ischaemic (thromboembolic)

Haemorrhagic (SAH/Aneurysm)

100
Q

Ischaemic Vs Haemorrhagic signs

A

Carotid bruit, AF, TIA Hx

Meningism (from haemorrhage), severe headache, Coma within hours

101
Q

Cerebral hemisphere stroke pres

A

Cantrlateral hemiplegia (Flaccid–> Spastic)
Contralateral sensory loss
Homonymous hemianopia
Dysphasia

102
Q

Brainstem stroke pres

A

Quadrplegia
Visual changes
Cerebellar signs
Locked in syndrome (aware, can only blink and move eyes)

103
Q

Lacunar stroke pres

A

Pure sensory or pure motor or mixed
ataxia

Intact cognition/consciousness

104
Q

Rosier score

  • what is
  • what score indicative
A

Score of over 0 means a stroke is likely

105
Q

What is TACI

A

TACI = total anterior circulation infarct. Middle and anterior cerebral arteries

Has all 3 in Bamford criteria
(hemiparesis/hemisensory loss, hemianopia, cognitive dysfunction - dysphasia)

106
Q

PACI

A

Involves a division of meddle cerebral artery supply (partial anterior circulation)

2 of Bamford criteria

107
Q

Bamford criteria

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
108
Q

What is Lacunar infarct

A

Infarct involving perforating arteries around internal capsule

pure sensory, pure motor or mixed. cognition intact

109
Q

Long term stroke complication

A 
Motor impair
Communication (dysphasia)
Bed sores
Malnutrition
Aspiration pneumonia 
Depression
110
Q

CI to thrombolysis

A 
Haemorrhagic stroke
Seizures (suggest SAH)
Head injury
Bleed (GI, Uro, surgery)
AVM/Anuerysm
111
Q

Stroke prevention

A

Lifestyle + BP control

AF (warfarin)

112
Q

Anticoagulation following TIA

A

Aspirin in acute phase

Give Clopidogrel 1st line

If not tolerated then Dipyridamole ± Aspirin

Statins

113
Q

How to assess baseline cognition in delerium

A

Collateral history from family etc

114
Q

RF Delerium

A

Age
Male
PRe-exhisting cognitive impair
Operation/Infection

115
Q

Causes of Delerium

A

Acute infection

Drug: Benzo, anticonvulsants

Surgery

Toxic withdrawal

Hypoxia, hyper/hypoglycaemia

Traum - head

etc …

116
Q

Delerium presentation

A

Acute onset, fluctuating course

Disordered thinking

Fearful/Angry

Language disorders

Hallucination, Delusions and Illusions

Short term memory deficit

117
Q

Types of Delerium

A

Hypo and hyperactive

118
Q

Delerium Ix

A

Abbreviated mental test

CAM-ICU (confusion assessment)

Bloods- FBC, U&E, culture, TFT, Glucose, B12

Urine - dipstick m culture

119
Q

Delerium Tx

A

Supportive: communication, orientation (clock, familiar staff/room)

Try and normalise sleep and nutrition

Haloperidol

120
Q

Delerium prevention

A

Prevent:
Polypharmacy
Hospital acquired infection

121
Q

Triad of dementia symptoms

A

Cognitive impairment - Short term memory, orientation

Psych - depression, delusions

Difficulty with ADLS - drive, shop

122
Q

Dementia assessment

A

GPCOG, MMSE, AMT:

  • tests memory, orient, spacial awareness

Blood (FBC, U&E, culture, LFT, TFT, Glucose B12)

MSU

CXR

MRI head

123
Q

Wholistic management in dementia

A

Advanced statements
Lasting power of attorney
DVLA

Therapy: dance, art, music

Challenging behaviour: Haloperidol, lorazepam

Carer groups & Respite

124
Q

Alzheimer’s Pathology

A

Increased beta amyloid plaques

Neurofibrillary tangles

Decreased Ach

Widespread cortical atrophy

125
Q

RF for dementia

A 
Age
Caucasian
FH
Female
Head injury
Vascular RF
126
Q

Early Pres Dementia

A

ST memory loss, difficulty finding words

127
Q

Later pres dementia

A

Language difficulty, confusion, disorientation, depression, hallucination/delusion, disinhibition

128
Q

Pathology Vascular dementia
&
RF

A

Ischaemia ± haemorrhage fro CVD

Multiple small infarcts gives stepwise progression

Hx of stroke TIA, AF, HTN, DM, Smoking, Obesity

129
Q

Diagnosis of Vascular dementia

A

Memory loss, impaired cognitive function

Cerebrovascular disease (on clinical Ex/Imaging)

Relationship between the above (deterioration following stroke or stepwise deterioration of cognitive decline)

130
Q

Vascular dementia imaging

A

MRI head

infarcts, cortical lacunae, white matter changes

131
Q

Tx Vascular dementia

A

Tx vascular RFs

AchE inhibitors: Donepazil, Galatamine, Rivastigmine

132
Q

Lewy body dementia Pathology

A

Eosinophilic intracytoplasmic neuronal inclusion bodies (Lewy bodies) in brainstem and cortex

133
Q

Lewy body dementia Ix

A

Dementia test: GPCOG, MMSE, AMT, Bloods, MRI head

SPECT scan = low dopamine uptake in BG

134
Q

Clinical features Lewy Body dementia

A

Dementia
Fluctuating attention
Well formed visual hallucination
Spontaneous Parkinsonism (Dementia is prominent sympt in contrast to parkinson’s)

135
Q

Management Lewy Body

A

Rivastigmine + Holistic management

DO NOT give antipsychotics, dopamine block = severe deterioration

136
Q

FTD pathology

A

Atrophy in frontal and temporal lobe

No plaques/protein inclusions

Tau in cells

Seen in MND, Corticobasal syndrome

137
Q

FTD pres

  • Behaviour
  • Semantic
  • Progressive non-fluent aphasia
A

Behaviour
- Disinhibition, lost motivation/empathy, change in personality

Semantic
- Loss of vocabulary or recognition of people/things

Progressive non-fluent aphasia
- diffucult/slow speech, grammar errors

138
Q

Investigation FTD

A

GPCOG, MMSE, AMT

MRI head - frontal/temporal atrophy

Genetics (Huntingtons)

LP - Tau protein

139
Q

Management

A

Power of attorney etc, Therapy (mscis etc),
AchE,
If challenging: Haloperidol

140
Q

Parkinsonism

A

Tremor: resting, pill rolling

Rigidity: inc tone, leadpipe

Bradykinesia: reduced arm swing, shuffle, mask like face (reduced expression)

141
Q

Causes of Parkinsonism

A 
PD
Multiple cerebral infarcts
Lewy body
Antipsychotics
Metochlopramide (dopamine block)
Wilsons disease (copper in BG)
142
Q

PD presentation

A

Insidious unilateral (gives instability) onset

Parkinsonism

Dementia (less prominent the Lewy)

Micrographia

143
Q

PD pathology

A

Reduced dopamine from Substantia Nigra in BG

Reduced BG to cortex communication, reduced movement initiation

144
Q

PD investigations

A

PET with flouradopa can localise dopamine deficiency in BG

Trial of dopaminergic agent = improve

145
Q

PD management

A

1st line Levodopa + Decarboxylase inhib ](Carbidopa - prev periph breakdown)

2nd line Dopamine agonist Bromocriptine, ropinirole

3rd line COMTI, or MAO-B inhib

DVLA
Carer suport

146
Q

PD complications

A

Dementia (AchEi)

Infections, aspiration pneumonia, pressure sores, depression

147
Q

Levodopa complications

A

On-Off phenomenon (dyskinesia and wearing off effect)

- Add Dopamine agonist or smaller freq doses of L-dopa

148
Q

What is Parkinsonian crisis

A

Acute kinesia

149
Q

Triad in normal pressure hydrocephalus

A

Urinary Incontinence

Dementia

Abnormla gait

150
Q

Normal pressure hydrocephalus Ix & Tx

A

MRI/CT head

(enlarged 4th ventricle)

VP shunting

151
Q

Huntington’s genetics and Pathology

A 
Autosomal dominant (50% chance in offspring)
CAG repeats = huntingtin protein
Progressive neurodegenerative disease
152
Q

Huntington’s age onset

A

Determined by number of CAG

30-50

153
Q

Hunttingtons Pres

A

Personality changes, self neglect, apathy, clumsy

Later:
chorea, Parkinsonism, Dementia, Dysarthria (unclear speech), dysphagia, Aggression

154
Q

Huntington’s Ix

A

Exclude SLE (ESR, ANA), Thyroid (TSH, T3/T4), WD (caeruloplasmin)

MRI/CT - loss striata volume

Genetic testing/counselling

155
Q

Huntington’s Tx

A

Benzodiazepines
Parkinsonism - L-Dopa/Bromocriptine

Depression - SSRI

Psychosis - clozapine

Deep brain stimulation

156
Q

Left hemiparesis and sensory loss legs more than arms. which vessel?

A

Right anterior cerebral artery (supplies “mohawk)

Top part of parietal homunculus is legs

157
Q

Right hemiparesis and sensory loss in arms more than legs

A

Left middle cerebral artery

supplies outer aspect of brain

158
Q

Epilepsy investigations

A

EEG
ECG
MRI head

159
Q

When to do MRI in epilepsy

A

Onset before age of 2 or new epilepsy i adult

Suspected focal illness

Continued despite meds

160
Q

1st Tx for Epilepsy

A

Focal/Partial
- Carbamazepine

Generalised
- Sodium Valproate

In preg: Lamotrigine

161
Q

Grand mal

Petit mal

A

Both types of generalised seizure

Gran mal - tonic clonic

Petit - absence

Both get Valproate

162
Q

Status epilepticus

1st line

  • No Iv
  • IV

2nd line

A

Buccal midazolam
IV Lorazepam

Sodium Valproate

163
Q

Motor tracts

A 
Pyramidal (corticospinal)
Extra pyramidal (reticulospinal, vestibulospinal)
164
Q

Sensory motor tracts

A

Dorsal column (Gracile - medial, to legs and cuneate - lateral, to arms fasciculus)

Anterior and posterior spinocerebellar

Anterolateral system (Spinothalamic tracts)

165
Q

Brown Sequard syndrome

A

Incomplete lesion of spinal cord

  • ipsilateral paralysis + proprioception loss (corticospinal, dorsal column)
  • Contralateral loss of pain and sensation (Spinothalamic - cross immediately)
166
Q

Corticospinal tract:

  • Function
  • Where does it cross
A

Decussate in medulla

Voluntary movement

Loss = hemiplegia and spasticity (Babinski +ve)

167
Q

Dorsal column Functions and deficit

A

Light touch/two-point discrimination, Vibration, Proprioception

Numbness, Position and vibration loss

168
Q

Lateral spinothalamic function +

Where it crosses.

A

Sensory: Crude touch and pain, Temp

Crosses in cord (deficit = contralateral loss pain and temp)

169
Q

Corticospinal tract Route

A

From cerebral cortex
Fibres in the internal capsule
Cross at the medulla to contralateral spinal cord to form lateral tracts

170
Q

UMN and LMN, Where to where?

A

UMN from cerebral cortex to anterior horn cell (or CN nucleus)

LMN form the peripheral nerve to NMJ

171
Q

UMN signs

A

Pronator drift
Hypertonia
Hyperreflexia
Babinski sign

172
Q

Features of Pyramidal UMN lesion in upper Vs Lowe limb

A

Upper limb: Flexor stronger than extensor

Lower limb: extensor stronger than flexor

173
Q

Babinski sign

A

Normal = Flexor plantar

Babinski +ve = Extensor plantar

174
Q

LMN lesions

A

Muscle wasting
Fasciculations (motor unit denervation)
Hyporeflexia, hypotonia

175
Q

Guillain Barre

A 
Acute inflammatory demyelination
Immune attack (anti-gm1) of peripheral nerves. E.g. post Campylobacter gastroenteritis

Distal to proximal weakness, 25% resp involvement Iwatch for failure - O2)

Nerve conduction studies
LP - raised protein
Spirometry

IVIg, Plasma exchange, SC heparin (VTE prophylaxis)

176
Q

Cerebellar causes of dysfunction

A

INfarct
MS
Alcohol abuse
Compression (Tumour, abscess)

177
Q

Two scoring systems in deciding whether to anticoagulate

A

CHA2DS2VASc

HASBLED

178
Q

What are you likely to see on MRI for stroke

A

Cerebral oedema

179
Q

What is a Jacksonian seizure

A

Partial seizure in the motor cortex

180
Q

Features of Epileptic seizure

A

Prodrome
Rhythmic jerk (Tonic clonic)
Tongue biting
Incontinence

181
Q

Antiepileptic in preg

A

Lamotrigine

182
Q

Driving in Epilepsy

A

Seizure free for 1 year

183
Q

What is Myasthenia Gravis

A

Autoimmune against AChR on NMJ

184
Q

Myasthenia Gravis signs & symptoms

A

Muscular fatigue

Chewing, swallowing

Ptosis, diplopia,

185
Q

MG Ix

A

AntiAChR, Anti MuSK (Muscle tyrosine kinase)

CT thorax (thymoma)

Ice test: crushed ice improves ptosis

186
Q

MG Tx

A

Acetylocholinesterase inhibitors - Pyridostigmine

Immunosuppressants - steroids, MTX, azathioprine

Thymectomy

IVIg for exacerbations

187
Q

Myathenic crisis

  • Def
  • When does it occur?
A

Severe weakness including resp muscles

need intubation and mechanical ventilations

Infection, post surgery

188
Q

What is MND

A

Loss of motor cortex and Anterior horn cells causing weakness, wasting, fasciculations

No sensory, Never affects eyes

189
Q

MND 4 types

A

ALS:muscle atrophy and UMN affect of corticospinal tract (weakness and spasticity)

Progressive bulbar palsy: CN VII - XII)

Progressive muscular atrophy: pure LMN

Primary lateral sclerosis: pure UMN

190
Q

ALS signs

A

LMN: limb weakness, wasting, fasciculations

UMN: Hypertonia, Brisk reflexes, upgoing plantars

191
Q

Muscles affect in Bulbar palsy

A

Talking, chewing, swallowing

Flaccid, fasciculation tongue

192
Q

MND Mx

A

Respiratory support

Riluzole (delays need for tracheostomy)

OT and speech and language therapist
Feeding support

Antidepresants

Spacticy - Baclofen (muscle relaxant)

193
Q

LP level

A

L3/4

194
Q

Excitatory NT + Receptor

A

Glutamate NMDA (Ca2+)

195
Q

Inhib NT + Receptor

A

GABA

GABA-R

196
Q

MS Pathophysiology

What cells

A

Demyelination of brain and spinal cord

T-cell mediated agains Oligodendrocytes

Autoimmune, Type 4 hypersesnsitivity

197
Q

Cytokines from T-Cells

A

IL-1
IL-6
TNF-Alpha
Interfernon-gamma

198
Q

RF for MS

A

Genetics
Female
Env (clean hypothesis)

199
Q

MS Usual age of onset

A

20-40

200
Q

Types of MS

A

Relapsing remitting (maths-yrs between bouts)

Secondary progressive (relapsing remitting initially but progressive)

Primay progressive: progressive from the start

201
Q

Triad of symptoms in MS

A

Charcots dysarthria (unclear speech - brainstem plaques)

Nystagmus (optic nerve plaques, may get loss of vision)

Intention tremor (motor pathway plaques)

Other: muscle weakness, ataxis, spasm, numbness, parasthesia

202
Q

Lhermittes and Unthoffs

- KEY signs in MS

A

Lhermittes: electric shock down back to limbs when bend neck forward

Unthoffs: Symptoms worse with heat e.g. bath/exercise

203
Q

Effect of ANS plaques in MS

A

Incontinence (bowel/bladder)

Sexual dysfunction

204
Q

MS investigation

A

Hx: spread over space and time

MRI: white matter plaques, periventricular

LP: Oligoclonal bands on gel electrophoresis (immunoglobulins)

205
Q

MS Tx

  • Relapse
  • Prevention of relapse
A

Corticosteroids (high dose Methylprednisolone)
Plasmapherisis (removes autoantibodies)

Immunosuppressants: Beta-Interferon, Deimethyl fumarate, alentuzumab

Other: BOTOX for spasticity

Final (26 decks)

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