Neuro Flashcards
presentation extradural haemorrhage
young person, Hx of injury with lucid interval
appearance extradural haemorrhage CT
umbrella shape
presentation subdural haemorrhage
old person, Hx of falls
appearance subdural haemorrhage CT
convex shape
parkinsonism triad
- akinesia
- tremor
- rigidity
Mx Parkinsons
- MAO-inhibitor (Rasigiline, Selegiline) OR Dopamine Agonist (pramiprexole, bromocriptine)
- Add Levodopa
what is levodopa combined with and why
Carbidopa - prevent peripheral conversion of Levodopa
s/e of Levodopa
reduced efficacy w time postural hypotension n+v dyskinesias psychosis visual hallucinations red colour of urine on standing
Mx of n+v due to Levodopa
domperidone
Man with parkinsons disease, started on new med and has falls - Dx and due to what med
postural hypotension
caused by Levodopa
MAO-inhibitors
rasigiline
selegine
cabergoline
dopamine agonists
bromocriptine
pramiprexole
ropinorole
drugs causing parkinsonism
chlorpromazine (typical antipsychotic) haloperidol (typical antipsychotic) prochlorperazine lithium metoclopramide valproic acid
multisystem atrophy
parkinsons + syndrome
- early autonomic stuff (impotence/incontinence, postural hypo)
(ANS involvement + cerebellar)
progressive supranuclear palsy
parkinsons + syndrome
- vertical gaze palsy - diplopia
cortico-basal degeneration
parkinsons + syndrome
- akinetic rigidity of one limb
cushings reflex triad
- HTN
- Bradycardia
- Irregular breathing
what is cushings reflex a sign of
imminent coning/brain herniation (usually pre-terminal)
pt in a coma after motorbike crash - Dx?
diffuse axonal injury (mechanical shearing)
eqn for CPP
CPP = MAP - ICP
normal CPP
70-100 mmHg
normal MAP
70-110 mmHg
normal ICP
0-20 mmHg
aiming CPP after head injury
> 60 mmHg
aiming MAP after head injury
> 80 mmHg
aiming ICP after head injury
< 20 mmHg
criteria for brainstem death testing
- Deep coma of known aetiology.
- Reversible causes excluded
- No sedation
- Normal electrolytes
6 tests to confirm brainstem death
corneal reflex oculovestibular reflex pupillary reflex cough reflex absent response to supraorbital pressure no spontaneous ventilation
RTA hit on R side of head, lucid period and then deteriorated in A&E - Dx?
Extradural haematoma
pt has had a SAH and normal CT and no RF for coning - next best Ix?
LP (1`2h after onset of symp)
alcoholic person is confused and drowsy - Dx?
subdural haemorrhage
pt has papilloedema, headache and hemi paresis - Ix?
CT brain
pt with supratentorial haemorrhage and on warfarin - INR 3.3. Given IV Vit K, what is next best thing to give
Prothrombin Complex
common conseqence of SAH
SIADH
why is LP performed 12h after symptom onset in SAH
allow time for xanthochromia (result of RBC breakdown). Helps to distinguish between bleed and traumatic LP
prevention of vasospasm in SAH
21d course of nimodipine
thrombolytic window for stroke
<4.5h after symptom onset AND exclusion of haemorrhagic stroke
locked in syndrome
basilar artery infarct
Mx stroke
Ix - non contrast CT - need to rule out haemorrhage first
then PR aspirin 300mg
thrombolyse (alteplase) if <4.5h after symptom onset and haemorrhage ruled out
2 prevention for stroke
clopidogrel + dipyridamole
brachioradialis reflex
C6
biceps brachii reflex
C5,,6
triceps reflex
C71
knee jerk reflex
L4
ankle jerk reflex
S1
Mx idiopathic intracranial HTN
AcetozolamiDE
site of lesion in inferior quadrantanopia
Parietal lobe (PITS mneumonic)
site of lesion in superior quadrantanopia
Temporal lobe (PITS mneumonic)
site of lesion in homonymous hemianopia
optic tract
site of lesion in homonymous hemianopia with macula sparing
Occipital cortex
site of lesion in bitemporal hemianopia
optic chiasm
Mx tremor in Parkinsons
anti-cholinergic e.g. procyclidine
Parkinsons drug that has been ass. with pulmonary fibrosis
cabergoline
role of DCML
vibration, fine touch & proprioception
where do fibres in DCML cross - lesion results in what symptoms
medulla
ipsilateral symptoms
where do fibres in spinothalamic cross - lesion results in what symptoms
1 or 2 above entry point
contralateral symptoms
where do fibres in corticospinal tract - lesion results in what symptoms
medulla
contralateral symptoms
L2 dermatome
ant thigh
L3 dermatome
ant knee
L4 dermatome
medial malleolus
L5 dermatome
dorsum of foot
S1 dermatome
heel
S2 dermatome
back of knee
S3 dermatome
buttock
S4 dermatome
perineum
S5 dermatome
perianal skin
myotome lateral leg
superficial branch of common fibular
myotome anterior leg
deep branch of common fibular
mnemonic of cerebellar lesion causes
MAVIS
MS Alcohol Vascular Inherited ataxias Space occupying lesion
Mx migraine
Triptan (5HT agonist) +/- NSAID
contraindications to triptans
CVS disease
cluster headache
headache around 1 eye
+ autonomic features (nasal stuffiness, lacrimation)
clusters last 4-12w then few m headache free
1-8x day
Mx cluster headache
100% O2 + sumitriptan
prophylaxis cluster headache
verapamil
Mx paroxysmal hemicrania
indomethacin
SUNCT
short lived unilateral neuralgiform headache with conjunctival injection and tearing
Mx SUNCT
lamotrigine or gabapentin
Mx trigeminal neuralgia
carbamazepine
what groups into trigeminal autonomic cephalgia (TAC)
SUNCT
cluster headache
paroxysmal hemicrania
what must all pt presenting with a TAC headache get
MRI brain + MR angiogram
risk factors for MS
FHx
young female
high latitude
previous EBV infection
MS presentation
pyramidal dysfunction (UMN signs) ocular symp (optic neuritis) sensory symp cerebellar signs (DANISH) autonomic dysfunction (bladder symp)
sensory symptoms in MS
sensation of water tricking down skin
DCML tract loss
numbness/paraesthesia
Lhermitte’s sign
sensory sign in MS
electric shock down upper limb + trunk on neck flexion
Uhthoff’s phenomenon
sensory sign in MS
exacerbation of symp from hot environments
Ix MS
MRI and CSF analysis (IgG oligoclonal bands)
Mx acute MS relapse
moderate - oral pred 5d
severe - IV pred 5d
Mx MS
- Interferon beta
Others:
- tysabri (natalizumab)
- fingolomid
Mx fatigue in MS
amantadine +/- modafinil
Mx spasticity in MS
baclofen or gabapentin
Mx bladder symptoms in MS
catheter or oxybutinin
pathology MS
demyelination of axons in white matter - loss saltatory conduction
cause of temporal lobe oedema on MRI
HSV
Kernig’s sign
meningitis sign
resisted knee extension when hip flexed
Most common cause meningitis in adult
- Strep. pneumoniae
Most common cause meningitis in child/adolescent
- Neisseria meningitidis
Mx meningitis in community
IM benzylpenicillin
“fibrin web” appearance of lumbar puncture
TB meningitis
meningitis prophylaxis
ciprofloxacin
simple focal seizure
awareness intact, specific to lobe it arises
presentation of temporal lobe focal seizure
"HEAD" hallucinations epigastric rising automatisms deja vu
presentation of frontal lobe focal seizure
head/leg movements
posturing
jacksonian march
presentation of parietal lobe focal seizure
paraesthesia
presentation of occipital lobe focal seizure
flashes/floaters
complex focal seizure
awareness impaired. temporal lobe most common
myoclonic seizure
small twitch or severe jerk
tonic seizure
LOC, fall to ground, extension of neck, back arching
clonic seizure
flex and relax rapidly
MX generalised epilepsy
- sodium valproate or lamotrigine
2. levetiracetam
Mx of absence seizures
Ethosuxamide
car driver, has an awake seizure - how long no driving
1 y
car driver, has seizures when asleep - how long no driving
can drive - must not have had an awake attack for 3y
bus /lorry driver, has one off seizure - how long no driving
5 y
bus/lorry driver, has Dx of epilepsy - how long no driving
must be seizure and medication free for 10 y
mononeuritis multiplex
2 or more peripheral nerves affecting distinct areas
causes of mononeuritis multiplex
“WARDS PLC”
Wegeners Aids Rheumatoid Diabetes Sarcoidosis pAN Leprosy Carcinomatosis
sciatic nerve
L4-S3
sign of a common peroneal nerve mononeuropathy
sensory - loss over dorsum of foot
motor - foot drop, loss of ankle dorsiflexion/eversion
sign of a tibial nerve mononeuropathy
sensory - loss over sole of foot
motor - loss of plantarflexion/inversion
pathology of a polyneuropathy
demyelination
or
axonal degeneration
(or both)
metabolic causes of polyneuropathy
diabetes B12/folate deficiency hypothyroidism renal failure hypoglycaemia
drug causes of polyneuropathy
alcohol isoniazid phenytoin nitrofurantoin amiodarone metronidazole chemo drugs - vincristine, cisplatin
presentation guillain barre syndrome
ascending paralysis
CNVII symptoms
post campylobacter syndrome
Ix guillain barre
LP - increased protein
EMG
monitor FVC (resp muscle)
MX guillain barre
IVIG
brown-sequard syndorme
cord hemisection
- lateral corticospinal
- lateral spinothalamic
- dorsal columns
pathology alzheimer’s
neurofibrillary tangles (tau protein) beta-amyloid plaques deficit of Ach
Mx alzheimer’s
- cholinesterase inhibitor - Donepezil, Rivastigmine, Galantamine
- n-methyl-d-aspartate antagonist (NDMA) - memantine
pathology of LBD
lewy body inclusions - alpha synuclein
Mx LBD
same as Alz
- Cholinesterase inhibitors - Rivastigmine, Donepezil, Galantamine
- NDMA antagonist - memantin
Mx of REM sleep disorder in LBD
clonazepam or melatonin
“wet wobbly and wacky”
normal pressure hydrocephalus
picks disease
frontotemporal dementia
inheritance of huntingtons
autosomal dominant
subgroups of MND
amyotrophic lateral sclerosis
primary lateral sclerosis
progressive muscular atrophy
progressive bulbar palsy
amyotrophic lateral sclerosis
subgroup of MND (most common)
UMN - legs
LMN - arms
primary lateral sclerosis
subgroup of MND
UMN signs only
progressive muscular atrophy
subgroup of MND
LMN signs only
progressive bulbar palsy
subgroup of MND
affects CN IX - XII
palsy of tongue, chewing muscles and swallowing
Mx MND
anti-glutamate drugs - Riluzole
channel down in lambert eaton syndrome
pre-synaptic ca channels
receptor down in myasthenia gravis
post-synaptic Ach receptors
lambert eaton synd - associated with what conditiion?
small cell lung ca
paraneoplastic syndrome
presentation lamber eaton syndrome
limb girdle weakness
hyporeflexia
autonomic symptoms (dry mouth, impotence)
mneumonic for cerebellar disease
DANISH
Dysdiadokinesia Ataxia Nystagmus Intention tremor Stacato speech Hypotonia
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L3 nerve root compression
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
L5 nerve root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
S1 nerve root compression
sensory loss dorsum of foot - level of nerve compression?
L5
sensory loss of lateral foot - level of nerve compression?
S1
weakness of dorsiflexion of foot - level of nerve compression
L5
weakness of plantarflexion of foot - level of nerve compression
S1
ocular symptoms MS
optic neuritis
bilateral internuclear ophthalmoplegia
tysabri (MS Mx) is associated with what?
PML - must test first for JC virus