Neuro Flashcards
Bitemporal hemianopia, upper quadrant > lower quadrant
inferior chiasmal compression, commonly a pituitary tumour
Bitemporal hemianopia, lower quadrant > upper quadrant
superior chiasmal compression, commonly a craniopharyngioma
Patient able to speak clearly post stroke, but content unrelated to questions. Ask them to repeat a series of phrases, which they are unable to do. Where is the lesion?
Wernicke’s aphasia is due to a lesion of the superior temporal gyru
What is Wernicke’s aphasia
- receptive aphasia
- due to a lesion of the superior temporal gyrus
- results in patients being able to produce fluent speech, but comprehension and repetition is impaired.
What is Broca’s aphasia
- lesion of the inferior frontal gyrus
- Speech is non-fluent, laboured, and halting
- Comprehension is normal
what is Lambert Eaton Syndrome and what cancer is it associated with
NMJ disorder due to the auto-immune destruction of pre-synaptic calcium channels
associated with small cell lung cancer
Patient w/ fever, headache and altered mental status - diagnosis and Ix (plus what is buzzword for what is seen on Ix)
Encephalitis
LP - increased lymphocytes
MRI - temporal lobe encephalitis
what is most common cause of encephalitis
HSV
Mx of encephalitis
IV aciclovir
Patient with headache, neck stiffness, photophobia and rash
Meningitis
common causes of meningitis (neonates, children, 21+, elderly, open head trauma, HIV)
Neonates – Group B strep/Listeria/E.Coli Children – H.influenza 10 to 21 = meningococcal Adults/Elderly – pneumococcal/Listeria Open head trauma – staph aureus
HIV – cryptococcal meningitis
Ix for meningitis and results
LP
- Viral – clear fluid, lymphocytes, normal glucose, normal/slightly raised protein
- Bacteria – cloudy, neutrophils, low glucose, high protein
- TB – lymphocytes, low glucose, high protein
CT scan
Blood Cultures
Throat swab
Mx for meningitis - plus if listeria is suspected, if pen allergic and TB specific Tx
IV Ceftriaxone 2g bd + Dexamethasone 10mg QDS
IF LISTERIA suspected = Add Amox or Ampicillin
If PEN ALLERGIC = IV Chloramephenicol w/ Vancy
TB = RIPE therapy for 12 months
where is the location of the bleed in a subdural haemorrhage
between the dura and the arachnoid
Ix for SAH
Non contrast CT head
LP 12 hours after onset
Mx for SAH
Nimodipine
Endovascular coiling/clipping
complications of SAH
Rebleeding SIADH Hydrocephalus Ischaemia Seizures
what is signs of Total Anterior Stroke
Hemiplegia +/- hemisensory loss
Homonymous Hemianopia
Cortical signs
Signs of partial anterior stroke
1/3 out of TAS
what is signs of lacunar stroke
Unilateral weakness +/- sensory deficit
NO cortical signs
sings of posterior occipital stroke
Cerebellar/Brainstem syndrome
Isolated visual deficit
what Sx do you get with an anterior cerebral artery occlusion
contralateral leg
what Sx do you get with an middle cerebral artery occlusion
Contralateral hemiparesis and hemisensory loss (esp of face arm)
Contralateral homonymous hemianopia
If dominant hemisphere affected – dysphasia
If non dominant hemisphere affected – visuo-spatial disturbance eg cannot dress, gets lost
what Sx do you get with an posterior cerebral artery occlusion
Contralateral homonymous hemianopia often with macular sparing
Ix for strokes
Bloods ECG Urgent non-contrast CT - Ischaemic vs Haemorrhage - Remember CT can be normal in Ischaemic strokes!
Mx for strokes
Aspirin 300mg if CT shows no haemorrhage
If atherosclerosis - start clopidogrel
If cardioembolic – start warfarin/newer anticoagulants
Secondary prevention
what are causes for mononeutritis multiplex i.e. 2+ peripheral nerves in disparate areas of bofy
WARDS PLC
Wegners Amyloidosis Rheumatoid Diabetes SLE PAN Leprosy Carcinomatosis
what is important to monitor in Guillen Barre Syndrome
FVC - worried about resp failure leading to death
what infection is guillen barre associated with
campylobacter
what is Todd’s palsy
temporal seizure that causes weakness
Tx for focal seizures
1st - carbamazepine
2nd - lamotrigine
what is Sx of a simple (awareness) focal seizure
Focal motor/sensory/autonomic
No post-ictal symptoms
E.G one limb jerking
what is Sx of a complex focal seizure
Frontal/Temporal Lobe
Automatisms
Post-ictal confusion
Tx for generalised seizures
Sodium Valproate
Lamotrigdine
what is definition of status epilepticus
A single seizure or serial seizures lasting more than 5 minutes, or two or more seizures without a return of consciousness between seizures
initial Tx of status epilepticus
Lorazepam 4mg IV
[Midazolam 10mg buccally or Diazepam 10−20 mg given rectally if pre-hospital]
Repeat after 5 mins
further Tx of status epilepticus
Within 30 minutes:
Phenytoin 18mg/kg IV at 50mg/min with ECG monitoring orSodium valproate 20-30mg/kg IV at 40mg/min if ECG monitoring or phenytoin is not available
if question talks about soft cheese or France what is it implying
Listeria infection
i.e. might be causing meningitis
what are the accessory muscles [sternocleidomastoid and trapezius] supplied by
CN XI = Accessory nerve
damage to what nerve can cause hoarseness
recurrent laryngeal branch of the vagus nerve
Nerve supplying quadriceps
femoral nerve (L2-L4)
nerve supply lateral of thigh
lateral femoral cutaneous nerve (L2-L3)
nerve that can be injured when did IM injection at the buttock
sciatic nerve (L4 to S3)
if there is a lesion affecting CN XII where will the tongue point
Twelve = Tongue points Towards lesion (TTT)
what is DCML responsible for and in what neuropathy is it lost first in
fine touch (tactile sensation), vibration and proprioception
diabetic neuropathic
what is the Anterior spinothalamic tract responsible for
crude touch and pressure.
what is the lateral spinothalamic tract responsible for
pain and temperature
prophylaxis for meningitis
Prophylaxis – MENINGOCOCCAL meningitis = rifamipicin/ciprofloxacin
ankle jerk reflex
S1
knee jerk reflex
L4
triceps reflex
C7
biceps reflex and supinator reflex
C5-C6
Sx of ALS
weakness, UMN signs and LMN signs
Sx of PLS
UMN signs only
distal muscle groups more than proximal
marked spastic leg weakness
pseudo-bulbar palsy [forehead spared]
Sx of progressive muscular atrophy
LMN signs only
weakness
distal muscle groups more than proximal
Sx of bulbar palsy
LMN lesion of CN IX-XII
tongue weakness
wasting with fasciculations
drooling
dysphagia
triad of sx in parkinsons
tremor
rigidity
bradykinesia
1st line Mx for parkinsons with motor symptoms affecting QOL
levodopa
where is affected in myasthenia gravis
post-synaptic antibodies to ACh receptors
Sx occur when ACh reduced to 30% of normal
1st line for MG
acetylcholinesterase inhibitor
= Pyridostigmine
where is affected in lambert eaton syndrome
associated in SCLC
antibodies to pre-synpatic calcium channels
sx of anterior cerebral artery stroke
weakness or numbness/hemiparesis in contralateral arm and leg [legs more than arms]
sx of middle cerebral artery stroke
weakness or numbness/hemiparesis in contralateral arm and leg [arms more than legs]
aphasia
contralateral homonymous hemianopia
sx of posterior cerebral artery stroke
contralateral homonymous hemianopia with macular sparing
sx of lacunar stroke
pure motor , or pure sensory, or ataxia
stroke of locked in syndrome
basilar artery
1st line Ix for stroke
Non contrast CT
Mx for stroke
Once hemorrhagic stroke ruled out
1st = 300mg Aspirin 2nd = thrombolysis (anteplase) can only be done within 4.5 hours from onset
secondary prevention for stroke
1st line = clopidogrel 75mg daily + Atrovastatin 80mg
[note patient will be on Aspirin 300mg for the first two weeks post stroke]
If Clopidogrel not tolerated = aspirin + MR Dipyridamole
Lifelong
nerve roots of ulnar nerve and what action can test it
C7 - T1
peace sign
nerve roots of radial nerve and what action can test it
C5 - T1
thumbs up
[get wrist drop if compressed]
nerve roots of median nerve and what action can test it
C6 - T1
ok sign
nerve roots of phrenic nerve
C3 - C5
nerve roots of common fibular nerve and signs of compression
L4 - S1
foot drop
weak dorsiflexion/eversion, reduced sensation over dorsum of foot
nerve roots of tibial nerve and signs of compression
L4 - S3
weak plantarflexion/inversion, reduced sensation over plantar of foot
nerve roots of sciatic nerve and signs of compression
L4 - S3
weak hamstrings, numbness and tingling down the back of the leg
