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Neuro Flashcards

1
Q

Trinary incontinence, gait abnormality and dementia

A

Normal pressure hydrocephalus

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2
Q

Features of normal pressure hydrocephalus

A

Trinary incontinence, gait abnormality and dementia

Short shuffling

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3
Q

Features of progressive supranuclear palsy

A

Progressive supranuclear palsy: parkinsonism, impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)

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4
Q

Features of shy dragger

A

A type of multi system atrophy, parkinsonism, autonomic dysfunction (atonic bladder, postural hypotension, erectile dysfunction), and cerebrllar signs

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5
Q

Syndrome that causes hemiplegia on one side and parasthesia on the other

A

Brown Sequard syndrome

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6
Q

First line meds for focal seizures

A

Carbemazipine or lamotrigine

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6
Q

First line meds for focal seizures

A

Carbemazipine or lamotrigine

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7
Q

Treatment of meningeal TB

A

12 months of RIPE and pred

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8
Q

Features of miller fisher syndrome

A

Variant of GBS, ophthalmoplegia, areflexia, ataxia. Eye muscles affected first

Descending paralysis unlike GBS which is ascending,

Anti GQ1b antibodies in 90%

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9
Q

Syndrome with persistent or recurrent complex hallucinations occurring in clear consciousness. BG of visual impairment

A

Charles bonnet syndrome. Usually not transient

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10
Q

What is the most common cause of hereditary cerebral small-vessel disease and vascular cognitive impairment in young adults?

A

CADASIL (also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) caused by NOTCH3 mutation

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11
Q

What is CADASIL?

A

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

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12
Q

most common complication following meningitis

A

Sensorineural hearing loss is the most common complication following meningitis

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13
Q

Causes of Horner’s

A

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

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14
Q

Treatment for cluster headaches

A

Subcutaneous sumatriptan and 100% o2

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15
Q

What neuropeptide is associated with narcolepsy

A

low orexin (hypocretin) levels…

You want high levels of you meet a t-rex-in

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16
Q

Treatment for bells palsy

A

Prednisolone

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17
Q

Features of bells palsy

A

Lower motor neuron facial palsy so forehead included

may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

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18
Q

Creutzfeldt-Jakob disease features

A

Rapidly (over months) progressive dementia
Myclonus

C cerebellar signs
J jerks (myoclonus)
D dementia

10% familial

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19
Q

Features of bells palsy

A

LMN facial nerve palsy Affecting forehead

Sometimes hyperaccusis, post-auricular pain (can precede), altered taste, dry eye…

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20
Q

Features of bells palsy

A

LMN facial nerve palsy Affecting forehead

Sometimes hyperaccusis, post-auricular pain (can precede), altered taste, dry eye…

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21
Q

patient found to be in AF post TIA

A

Commence 300mg aspirin…. And warfarin

In ischaemic stroke wait two weeks before warfarin in case haemorrhagic transformation

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22
Q

Which viral meningitis can be associated with low CSF glucose

A

Mumps and lymphocytic choriomeningitis

May also be seen in herpes encephalitis

Viral is usually 60-80% of plasma glucose

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23
Q

Treatment for absence seizures

A

sodium valproate and ethosuximideare first-line treatment

Usually resolves by adolescence

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24
Patient with left ulnar nerve palsy, then right radial palsy, then right sided facial palsy... diagnose
Mononeuritis multiplex syndrome E.g. Polyarteritis nodosa
25
What wasting is carpal tunnel assx with
Thenar eminence not hypothenar
26
Treatment windows for acute ischemic stroke
Thrombolysis 4.5 hr --- alteplase, once haem excluded | thrombectomy 6hr
27
Patient presenting with ataxia, nystagmus and reduced sensation ipsilateral facial and contralateral body. Diagnosis and bloods vessel
Lateral medullary syndrome. | Posterior inferior cerebellar artery
28
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
29
Patient with frontal headaches difficulty sleeping and periorbital swelling is treated for severe sinusitis. He develops dysarthria, pyrexia and nystagmus. Diagnosis?
Cerebellar abscess
30
Diagnosis of lewy bodies
Usually clinical | But sensitivity of SPECT is around 90% with a specificity of 100%
31
Features of subacute degeneration of the spine
Lateral and dorsal columns Loss of vibration and proprioception, then distal parasthesia UMN signs
32
Features of CJD
C cerebellar signs J jerks (myoclonus) D dementia 10% familial
33
What is the diagnosis with patient who lose ability to look up?
Parinaud's syndrome is an inability to move the eyes up and down. It is caused by compression of the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF) Often lose açcommodation reflex, have slight eyelid retraction, Also Progressive supranuclear palsy sometimes loose vertical gaze
34
Which cranial nerve is source of Ramsey hunt syndrome
Reactivation of varicella in geniculate ganglion of cranial nerve 7
35
What treatment for MND extends life longest?
NIV extends 7 m | Riluzole extends 3m
36
Good prognostic features of MS
Female Young age of onset Classical features
37
What is dementia pugilato
Pugilato means boxing in italian language. Dementia pugilistica = punch drunk syndrome Due to repeated head trauma. Parkinsonism
38
What meds are contraindicated in absence seizures
Carbamazepine, phenytoin, vigabatrin and gabapentin can all worsen them Treat with Ethosuximide or sodium valproate
39
Treatment of absence seizures
Ethosuximide or sodium valproate
40
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
41
Where is damage is hemiballism?
subthalamic nucleus | Involuntary sudden linging movements
42
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
43
CT signs of HSV encephalitis
CT medial temporal and interior frontal changes - petichial patchy haemorrhagic changes Normal in 1/3
44
Cause and features of neuroleptic malignant syndrome?
Pyrexia rigidity, hypertension tachycardia tachypnea, delirium confusion Either taking antipsychotic meds or Parkinson's meds stopping /reducing
45
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.
46
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
47
Causes of cerebellar syndrome
``` Friedrich's ataxia, ataxic telangiectasia Cerebellar hemangioma Stroke Alcohol MS Hypothy Phenytoin Paraneoplastic i.e. lung ca ```
48
What is anti NMDA receptor encephalitis associated with? | Presents with agitation hallucinations disordered thinking
Ovarian teratomas are detected in half of all female patients!
49
Patient presents with bilat sensorineural hearing loss. MRI shows bilat vestibular schwannomas. Diagnosis
Neurofibromatosis type 2 2 schwannomas, type 2
50
Signs of stroke in middle cerebral artery
miDDle cerebral uPPer extremity Contralateral hemiparesis and sensory loss, upper extremity > lower Contralateral homonymous hemianopia Aphasia
51
Presentation of syringomyelia
Cape-like (neck and arms) loss of sensation of temperature and pain Due to compression on spinothalamic tract in anterior commissure
52
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
53
What is CADASIL
Cerebral auto dominant arteriopathy with subcortical infarcts and leukoencephalopathy .... Presents w migraine Multi infarcts NOCTH3 gene mutation
54
Cerebral toxoplasmosis treatment
Sulfadiazine + pyrimethamine | In normal toxo, no treatment required unless severe/immunocompromised
55
Which vessel is most likely implicated with extra dural haem?
Middle meningeal artery
56
Which vessel is most likely implicated with sub dural haem?
Bridging veins Fluctuating conciseness
57
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 ```
58
What autonomic symptoms are most likely with GBS?
Tachycardia and urinary retention
59
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
60
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
61
Transient global amnesia Vs psychogenic amnesia
Transient memory loss | Psychogenic can't remember personal info
62
Features of subacute combined degeneration of spinal cord
Lateral and dorsal columns so Loss of proprioception and vibration, then distal paraesthesia
63
sudden and transient loss of muscular tone caused by strong emotion
Cataplexy
64
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
65
Prognosis of Duchennes
Usually can't walk by 12 and need ventilation support by 25
66
Cerebellar ataxia presenting at 1-5yr Vs 10-15yr
``` 1-5 = ataxia telangiectasia 10-15 = Friedreich's ataxia (more common) ```
67
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)
68
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)
69
isolated weakness of foot dorsiflexion and eversion. Reflexes normal
Common peroneal nerve palsy Advise to not cross legs.
70
Which brain bleed has lucid interval
Extra dural
71
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 ```
72
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)
73
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
74
Painful third nerve palsy - what do you need to rule out
posterior communicating artery aneurysm
75
bilateral vitreous haemorrhage
Von Hippel lindau has Retinal and cerebellar haemangiomas
76
Mx after anneurysmal SAH
coil, then 21-day course of nimodipine to prevent vasospasm (a calcium channel inhibitor targeting the brain vasculature)
77
Anti epileptic causing visual problems
V for Vigabatrin - V for Visual field defects | 30%(!)
78
Temporal lobes Vs subcortical white matter on MRI FLAIR
Herpes - Temporal lobes | acute disseminated encephalomyelitis - Subcortical white matter
79
ECG of myotonic dystrophy
prolonged PR interval is seen in around 20-40% of patients
80
Third nerve palsy with pupillary involvement...
Must exclude compressive lesion if pupil involved
81
Alcoholic with bilateral ophthalmoplegia
Wernicke's
82
Wernicke's aphasia
Receptive Superior temp gyrus Inf division of L MCA
83
Broca's
Expressive Inferior frontal gyrus Superior division, L MCA

Mrcp (21 decks)

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