Neuro

Question 1

Loss of sensation on one side loss of another sensation on the other

Answer 1

Brown-Séquard syndrome is a rare spinal disorder that results from an injury to one side of the spinal cord resulting in hemisection of the cord. The damage to the corticospinal tract, spinothalamic tract and dorsal columns, results in ipsilateral upper motor neurone signs, contralateral spinothalamic signs, and ipsilateral dorsal column signs respectively.

Question 2

Guillain-Barre syndrome describes an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).

Answer 2

The characteristic features of Guillain-Barre syndrome is progressive weakness of all four limbs. The weakness is classically ascending i.e. the lower extremities are affected first, however it tends to affect proximal muscles earlier than the distal ones. Sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs. Some patients experience back pain in the initial stages of the illness

Other features
areflexia
cranial nerve involvement e.g. diplopia
autonomic involvement: e.g. urinary retention

Question 3

Test to see if it’s csf emergency

Answer 3

In trauma, to test if the fluid draining from the nose or ear is CSF, check for glucose
Testing for lymphocytes and erythrocytes would take time as you have to send the sample to the labs and await results.

Xanthochromia usually takes at least 12 hours to present, therefore it is redundant.

Beta-2-transferrin would be the gold standard, not beta-3-transferrin.

Glucose test would show positive as it is not present in mucus and is present in CSF.

Question 4

Cerebellar hemisphere - finger-nose ataxia

Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)

Parietal lobe - sensory symptoms, dyslexia, dysgraphia

Frontal lobe - motor symptoms, expressive aphasia, disinhibition

Answer 4

Lol

Question 5

Stoke management

Answer 5

Thrombolysis

Thrombolysis should only be given if:
it is administered within 4.5 hours of onset of stroke symptoms (unless as part of a clinical trial)
haemorrhage has been definitively excluded (i.e. Imaging has been performed)

Alteplase is currently recommended by NICE.

Question 6

Contra indications to thrombolysis

Answer 6

Previous intracranial haemorrhage

• Seizure at onset of stroke
• Intracranial neoplasm
• Suspected subarachnoid haemorrhage
• Stroke or traumatic brain injury in preceding 3 months
• Lumbar puncture in preceding 7 days
• Gastrointestinal haemorrhage in preceding 3 weeks
• Active bleeding
• Pregnancy
• Oesophageal varices
• Uncontrolled hypertension >200/120mmHg