Neuro Flashcards
Trinary incontinence, gait abnormality and dementia
Normal pressure hydrocephalus
Features of normal pressure hydrocephalus
Trinary incontinence, gait abnormality and dementia
Short shuffling
Features of progressive supranuclear palsy
Progressive supranuclear palsy: parkinsonism, impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)
Features of shy dragger
A type of multi system atrophy, parkinsonism, autonomic dysfunction (atonic bladder, postural hypotension, erectile dysfunction), and cerebrllar signs
Syndrome that causes hemiplegia on one side and parasthesia on the other
Brown Sequard syndrome
First line meds for focal seizures
Carbemazipine or lamotrigine
First line meds for focal seizures
Carbemazipine or lamotrigine
Treatment of meningeal TB
12 months of RIPE and pred
Features of miller fisher syndrome
Variant of GBS, ophthalmoplegia, areflexia, ataxia. Eye muscles affected first
Descending paralysis unlike GBS which is ascending,
Anti GQ1b antibodies in 90%
Syndrome with persistent or recurrent complex hallucinations occurring in clear consciousness. BG of visual impairment
Charles bonnet syndrome. Usually not transient
What is the most common cause of hereditary cerebral small-vessel disease and vascular cognitive impairment in young adults?
CADASIL (also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) caused by NOTCH3 mutation
What is CADASIL?
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy -the most common cause of hereditary cerebral small-vessel disease and vascular cognitive impairment in young adults
most common complication following meningitis
Sensorineural hearing loss is the most common complication following meningitis
Causes of Horner’s
Central lesson: anhidrosis of face arm and trunk
Stroke, Syringomyelia multiple Sclerosis
Preganglionic lesion: anhidrosis of face
Trauma, pancoast Tumour, Thyroidec
Post ganglionic lesion: no anhidrosis
Carotid artery dissection, Carotid aneurysm, Carvernous sinus thrombosis, Cluster headache
Treatment for cluster headaches
Subcutaneous sumatriptan and 100% o2
What neuropeptide is associated with narcolepsy
low orexin (hypocretin) levels…
You want high levels of you meet a t-rex-in
Treatment for bells palsy
Prednisolone
Features of bells palsy
Lower motor neuron facial palsy so forehead included
may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
Creutzfeldt-Jakob disease features
Rapidly (over months) progressive dementia
Myclonus
C cerebellar signs
J jerks (myoclonus)
D dementia
10% familial
Features of bells palsy
LMN facial nerve palsy Affecting forehead
Sometimes hyperaccusis, post-auricular pain (can precede), altered taste, dry eye…
Features of bells palsy
LMN facial nerve palsy Affecting forehead
Sometimes hyperaccusis, post-auricular pain (can precede), altered taste, dry eye…
patient found to be in AF post TIA
Commence 300mg aspirin…. And warfarin
In ischaemic stroke wait two weeks before warfarin in case haemorrhagic transformation
Which viral meningitis can be associated with low CSF glucose
Mumps and lymphocytic choriomeningitis
May also be seen in herpes encephalitis
Viral is usually 60-80% of plasma glucose
Treatment for absence seizures
sodium valproate and ethosuximideare first-line treatment
Usually resolves by adolescence
Patient with left ulnar nerve palsy, then right radial palsy, then right sided facial palsy… diagnose
Mononeuritis multiplex syndrome
E.g. Polyarteritis nodosa
What wasting is carpal tunnel assx with
Thenar eminence not hypothenar
Treatment windows for acute ischemic stroke
Thrombolysis 4.5 hr — alteplase, once haem excluded
thrombectomy 6hr
Patient presenting with ataxia, nystagmus and reduced sensation ipsilateral facial and contralateral body. Diagnosis and bloods vessel
Lateral medullary syndrome.
Posterior inferior cerebellar artery
Patient with extra Dural haematoma suddenly drops GCS and develops eye deviation inferiorly and laterally… Diagnosis
3rd nerve palsy due to trans tentorial herniation secondary to raised ICP
Patient with frontal headaches difficulty sleeping and periorbital swelling is treated for severe sinusitis. He develops dysarthria, pyrexia and nystagmus. Diagnosis?
Cerebellar abscess
Diagnosis of lewy bodies
Usually clinical
But sensitivity of SPECT is around 90% with a specificity of 100%
Features of subacute degeneration of the spine
Lateral and dorsal columns
Loss of vibration and proprioception, then distal parasthesia
UMN signs
Features of CJD
C cerebellar signs
J jerks (myoclonus)
D dementia
10% familial
What is the diagnosis with patient who lose ability to look up?
Parinaud’s syndromeis an inability to move the eyes up and down. It is caused by compression of the vertical gaze center at therostral interstitial nucleus of medial longitudinal fasciculus(riMLF)
Often lose açcommodation reflex, have slight eyelid retraction,
Also Progressive supranuclear palsy sometimes loose vertical gaze
Which cranial nerve is source of Ramsey hunt syndrome
Reactivation of varicella in geniculate ganglion of cranial nerve 7
What treatment for MND extends life longest?
NIV extends 7 m
Riluzole extends 3m
Good prognostic features of MS
Female
Young age of onset
Classical features
What is dementia pugilato
Pugilato means boxing in italian language.
Dementia pugilistica = punch drunk syndrome
Due to repeated head trauma.
Parkinsonism
What meds are contraindicated in absence seizures
Carbamazepine, phenytoin, vigabatrin and gabapentin can all worsen them
Treat with Ethosuximide or sodium valproate
Treatment of absence seizures
Ethosuximide or sodium valproate
Which features are more common in drug-induced Parkinson’s rather than Parkinson’s disease
Bilat symps are more in drug induced
Rigidity and rest tremor are uncommon in drug induced
Where is damage is hemiballism?
subthalamic nucleus
Involuntary sudden linging movements
What is the cause of post LP headaches
Leaking of cerebrospinal fluid from the dura is the most likely explanation for post-lumbar puncture headaches
CT signs of HSV encephalitis
CT medial temporal and interior frontal changes - petichial patchy haemorrhagic changes
Normal in 1/3
Cause and features of neuroleptic malignant syndrome?
Pyrexia rigidity, hypertension tachycardia tachypnea, delirium confusion
Either taking antipsychotic meds or Parkinson’s meds stopping /reducing
Distinguish between neuroleptic malignant syndrome and serotonin syndrome
SS is caused by SSRI maois ecstasy… Onset of hours, increased reflexes, MYOCLONUS, dilated pupils……tx cyproheptadine or chlorpromazine
MMS antipsychotic or stopping PD meds. Raised CK more assx with
Mx dantrolene.
Mx of post LP headaches
Supportive, analgesia and rest
Blood patch (surg procedure wgere you inject blood into epidural space and the clot “patches” the Dura)
or epidural saline or IV caffeine
Causes of cerebellar syndrome
Friedrich's ataxia, ataxic telangiectasia Cerebellar hemangioma Stroke Alcohol MS Hypothy Phenytoin Paraneoplastic i.e. lung ca
What is anti NMDA receptor encephalitis associated with?
Presents with agitation hallucinations disordered thinking
Ovarian teratomas are detected in half of all female patients!
Patient presents with bilat sensorineural hearing loss. MRI shows bilat vestibular schwannomas. Diagnosis
Neurofibromatosis type 2
2 schwannomas, type 2
Signs of stroke in middle cerebral artery
miDDle cerebral uPPer extremity
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Presentation of syringomyelia
Cape-like (neck and arms) loss of sensation of temperature and pain
Due to compression on spinothalamic tract in anterior commissure
Distinguish between Lambert Eaton syndrome and MG
Both have weakness
LES improves with exercise, MG doesn’t
LES presents later, MG peaks in 3rd or 6th decades
What is CADASIL
Cerebral auto dominant arteriopathy with subcortical infarcts and leukoencephalopathy
…. Presents w migraine
Multi infarcts
NOCTH3 gene mutation
Cerebral toxoplasmosis treatment
Sulfadiazine + pyrimethamine
In normal toxo, no treatment required unless severe/immunocompromised
Which vessel is most likely implicated with extra dural haem?
Middle meningeal artery
Which vessel is most likely implicated with sub dural haem?
Bridging veins
Fluctuating conciseness
Broccas Vs Wernicke’s
Wernicke's is receptive, Superior temporal gyrus Fluent Abnormal comprehension Can't repeat words or phrases
Brocca's is expressive Inferior frontal gyrus Non fluent Normal comprehension Can't repeat words or phrases
What autonomic symptoms are most likely with GBS?
Tachycardia and urinary retention
Contra pain/temp loss and weakness, Ipsi facial paralysis and deafness
Lateral pontine syndrome
Ant inf cerebellar artery
Without facial palsy/deafness: Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Anterior has paralysis
Contra pain/temp loss and weakness, Ipsi facial pain and temp loss
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Would be anterior, and lat pontine if facial paralysis too
Transient global amnesia Vs psychogenic amnesia
Transient memory loss
Psychogenic can’t remember personal info
Features of subacute combined degeneration of spinal cord
Lateral and dorsal columns so Loss of proprioception and vibration, then distal paraesthesia
sudden and transient loss of muscular tone caused by strong emotion
Cataplexy
Parkinson’s drug management
If motor symps not an issue then Dop R agonist like ropinirole/bromocriptine, or Levodopa/MAO-B inhib
If motor is an issue then Levodopa
Add dop r agonist/MAO-B inhib/COMT if motor worsens or dyskinesia develops
Prognosis of Duchennes
Usually can’t walk by 12 and need ventilation support by 25
Cerebellar ataxia presenting at 1-5yr Vs 10-15yr
1-5 = ataxia telangiectasia 10-15 = Friedreich's ataxia (more common)
Which is more common hereditary ataxia? ataxia telangiectasia vs Friedreich’s ataxia
Friedreich’s
Presents later but more common
Usually die from HOCM. (90%)
GAA: Friedrich Ataxia =( gAA- friedrich AtAxiA- so many As)
Trinucleotide repeats mnemonic
GAA: Friedrich Ataxia =( gAA- friedrich AtAxiA- so many As)
HUNT for CAGe
CTG: Myotonic dystrophy = (cTg- myoTonic dysTrophy- T in the middle of both words)
CGG: Fragile X syndrome = (cGG - fraGile XX syndrome- XX and GG)
isolated weakness of foot dorsiflexion and eversion. Reflexes normal
Common peroneal nerve palsy
Advise to not cross legs.
Which brain bleed has lucid interval
Extra dural
Causes of bilat facial nerve palsy
Sarcoidosis GBS Lyme's Bilat acoustic neuroma (NF2) Bells accounts for 25% of bilat cases but only 1% of bells are bilat
Cerebellar tonsillar herniation Vs trans tentorium herniation
Both can have third CN palsy (down and out,fixed dilated)
Former is from post communicating artery aneurysm
Latter is from intracranial mass (like haematoma from trauma)
When do you consider thrombectomy
If good baseline, proximal anterior circulation within 6h
Or 6-24h if potential to salvage
Consider with proximal posterior circ
Painful third nerve palsy - what do you need to rule out
posterior communicating artery aneurysm
bilateral vitreous haemorrhage
Von Hippel lindau has Retinal and cerebellar haemangiomas
Mx after anneurysmal SAH
coil, then 21-day course of nimodipine to prevent vasospasm (a calcium channel inhibitor targeting the brain vasculature)
Anti epileptic causing visual problems
V for Vigabatrin - V for Visual field defects
30%(!)
Temporal lobes Vs subcortical white matter on MRI FLAIR
Herpes - Temporal lobes
acute disseminated encephalomyelitis - Subcortical white matter
ECG of myotonic dystrophy
prolonged PR interval is seen in around 20-40% of patients
Third nerve palsy with pupillary involvement…
Must exclude compressive lesion if pupil involved
Alcoholic with bilateral ophthalmoplegia
Wernicke’s
Wernicke’s aphasia
Receptive
Superior temp gyrus
Inf division of L MCA
Broca’s
Expressive
Inferior frontal gyrus
Superior division, L MCA
