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Finals Revision Progress > Neuro > Flashcards

Neuro Flashcards

1
Q

How might you investigate MS?

A

Bloods: anti NMO

MRI; would show inflammation in periventricular white matter

LP: would show IgG oligoclonal bands

Evoked potentials: would show delayed auditory, visual and sensory

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2
Q

6th nerve palsy presentation

A

failure to abduct, cross eyed appearance

Can be a sign of raised ICP due to it having the longest course, so it goes first

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3
Q

causes of horner’s syndrome?

A

central/1st order neurones: MS, vascular disease

pre ganglionic/2nd order: pancoast’s tumour, T1 nerve root lesion, carotid endarterectomy

post ganglionic/3rd order: cavernous sinus thrombus

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4
Q

Management of stroke?

A

Acutely…ABCDE approach and call for help

Haemorrhagic:
Conservative: neuro obs
Medical: BP control, correct INR
Surgical: Neurosurgery referral

Ischaemic:
If <4.5 hours
Thrombolysis, repeat CT and start aspirin after 24h

If >4.5 hours
Aspirin 300mg
Then aspirin with clopidogrel lifelong

After initial acute management, admit to stroke unit for full investigation and neuro rehab with MDT and “secondary prevention mx”

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5
Q

homonymous hemianopia - lesion?

A

optic tracts

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6
Q

Causes of a bulbar palsy?

A

Motor neurone disease
Myasthenia gravis
Brainstem lesions: stroke/tumour

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7
Q

macular sparing homonymous quadrantinopia - lesion?

A

striate cortex

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8
Q

Define multiple sclerosis

A

A chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space

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9
Q

Causes of complex opthalmoplegias?

A

Diabetes
Multiple sclerosis
Myasthenia graves
Thyrotoxicosis

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10
Q

Mimics of 3rd nerve palsy?

A

Thyrotoxicosis
Raised ICP
Myasthenia

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11
Q

4th nerve palsy presentation

A

nasal upshoot, failure to depress during adduction

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12
Q

causes of enlarged blind spot?

A

Optic neuritis

Papilloedema

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13
Q

Effect of stroke in anterior cerebral artery?

A

Contralateral motor/sensory loss in the legs > arms

Face is spared

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14
Q

Effect of stroke in middle cerebral artery?

A

Contralateral motor/sensory loss in face and arms >legs
Contralateral homonymous hemianopia
Cognitive changes; aphasia, neglect, apraxia

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15
Q

What is the Mx of Parinson’s?

A

MDT approach; neurologist, specialist nurse, physio, OT, GP, carers

Medical:

  • Dopamine agonists: Bromocriptine, cabergolhne
  • L-DOPA or peripheral DOPA decarboxylase inhibitor (carbidopa)
  • MAO-B inhibitors and COMT inhibitors

Give anti emetics, anti psychotics and anti depressants

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16
Q

Causes of peripheral neuropathy?

A

INVITED MD

Infective; Guillan-Barre
[Neoplastic/Vascular/Inflammatory &amp; AI]
Trauma
Endocrine: Hypothyroidism, DM
[Degenerative]
Metabolic: B12, lead
Drugs: Alcohol, chemotherapy
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17
Q

How might MS present?

A

“SATO”

Spastic parapesis
Ataxia
Tingling
Optic neuritis

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18
Q

Posterior circulation stroke presentation?

A

Cerebellar syndrome
Brainstem syndrome
Homonymous hemianopia

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19
Q

secondary prevention of ischaemic stroke?

A

Aspirin 300mg initially for 2 weeks, then reduce dose
Clopidogrel
Statin
Address risk factors e.g. DM and HTN

20
Q

Causes of 3/4/6th nerve palsies?

A

Central NS: MS, vascular, SOL

Peripheral: DM (mononeuritis), compression, trauma

21
Q

What are poor prognostic signs in MS?

A

Older female
Motor signs at onset
Many relapses early on
Many MRI lesions

22
Q

Causes of cerebellar syndrome?

A

DAISIES

Demyelination
Alcohol
Infarct; brainstem stroke
Space occupying lesion
Inherited; e.g. Frederich's Ataxia/Wilson's disease
Epilepsy medications: Phenytoin
System atrophy, multiple
23
Q

Ddx for Parkinsonism?

A

Progressive supra nuclear palsy

Corticobasilar degeneration

Lewy Body Dementia

24
Q

causes of unilateral vs bilateral ptosis?

A

bilateral: myasthenia gravis, myotonic dystrophy, congenital
unilateral: 3rd nerve palsy, horner’s syndrome

25
Q

Risk factors for stroke?

A 
Hypertension
Smoking
AF
DM
Vascular disease
Family history
26
Q

homonymous quadrantinopia - lesion?

A

optic radiations

27
Q

Clinical picture of Charcot Marie Tooth

A

Inspection: Bilateral pes cavus, Inverted champagne bottle, distal wasting & weakness

Tone:

Power: Weakness of ankle dorsiflexion & toe extension

Sensation:+/- Glove and stocking sensory neuropathy

Reflexes: Absent ankle jerk and plantar response

Gait: Stamping gait with foot drop, broad based. Positive Romberg sign (due to lack of proprioception)

28
Q

Classify the types of MS

A

Relapsing remitting (80%)
Secondary progressive
Primary progressive
Progressive relapsing

29
Q

Eye problems in MS?

A

Optic neuritis
INO
diplopia

30
Q

Causes of 3rd nerve palsy?

A

Mononeuritis
MS
Tumours
Aneurysms

31
Q

What medications are commonly used in MS?

A

Methylprednisolone - acute attacks

Interferon beta - disease modifying

Natalizumab - biologics preventing relapse

Baclofen - spasticity

32
Q

Causes of unilateral facial nerve palsy?

A

Categorised by anatomical level:

Supranuclear: SOL, vascular, MS

Brainstem: haemorrhage, infection

Cerebellopontine angle: acoustic neuroma, meningioma

Facial canal: Ramsay-Hunt, trauma

Systemic: DM

33
Q

Other causes of Parkinson presentation?

A

Parkinson plus syndromes:

Multi system atrophy:
- autonomic dysfunction, parkinsonism, cerebellar ataxia

Progressive supranuclear palsy:
- vertical gaze palsy, pseudobulbar palsy, parkinsonism

Lewy body dementia

34
Q

What is lateral medullary syndrome/ Wallenberg’s

A 
Occlusion of vertebral artery or PICA; signs are ipsilateral apart from body anaesthesia to pain
"DANVAH"
Dysphagia
Ataxia
Nystagmus
Vertigo
Anaesthesia
Horner's syndrome
35
Q

Features of vestibular schwannoma?

A

sensorineural hearing loss, tinnitus, vertigo, headache, facial anaesthesia and facial nerve palsy

36
Q

Features of Friedrich’s ataxia?

A

Autosomal recessive mitochondrial disorder

PAWAH

Pes cavus
Ataxia
Wasting in legs 
Areflexia in legs but extensor planters
HOCM
37
Q

Myasthenia gravis features on inspection

A 
Thymectomy scar
Bilateral ptosis
Complex ophthalmoplegia
Myasthenic snarl
Nasal voice +deterioration
38
Q

Ix for myasthenia gravis?

A

Bloods
Abs:Anti AChR, Anti MuSK

Spirometry:

EMG: reduced response to titanic train of impulses

!!! Tensilon test: improvement with edrophonium

Imaging:
CT mediastinum: thymoma

39
Q

Management of myasthenia gravis?

A

Acute: ABCDE approach! If rest dysfunction, ITU

  • Plasmapheresis
  • IVIg

Chronic
- Anti muscarinics, e.g pyrdostigmine

40
Q

Classification of tremors

A

Active

  • Postural tremor (benign essential, anxiety)
  • Intention tremor

Passive
- Parkinsonian

Benign essential: Postural tremors get worse with lack of sleep and caffeine and better with alcohol

41
Q

Tx of acute delirium

A

Haloperidol or olanzipine

42
Q

Difference between HSMN1 and 2?

A

1: demylination - reduced conduction velocity
2. decreased amplitude - axonal degeneration

Mutated peripheral myelin protein

43
Q

NMO vs MS?

A

NMO can be more severe, is not progressive in nature

NMO attacks aquaporin 4 protein in the CNS

44
Q

Medical vs surgical 3rd nerve palsy

A

Medical: pupil sparing (e.g. diabetes, MS)
Surgical: pupil dilated (e.g. tumour)

45
Q

Classification of LMN lesions

A 
Anterior horn (old polio)
Nerve itself (diabetes)
Neuromuscular junction (Myasthenia)
46
Q

Syringomyelia presentation

A

Syrinx = tubular cavity in spinal cord

Cape distribution: loss of pain and temperature
wasting/weakness of hands, loss of UL reflexes, charcot joints

Finals Revision Progress (16 decks)

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