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Neuro Flashcards

1
Q

red flags for headaches

A

Easier to do this in reverse

>50 
SAH - FND, meningism, thunderclap 
SOL - ICP, FND 
Meningitis - fever, meningism 
Cluster - horner's 
GCA - jaw claudication, scalp tenderness 
Migraine - FND
Personality ∆ - frontal lobe stroke
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2
Q 
Migraine 
Aetiology 
Presentation 
Investigations 
Management
A 
Aetiology 
Chocolate 
Hangover
OCP
Cheese/caffiene 
Orgasm
Lack of sleep 
Alcohol
Travel
Exercise 
Presentation 
Unilateral 
Throbbing 
<72 hrs 
Parasthesia 
Photophobia 
Phonophobia 
Allodynia 
N+V 
FND 
Can have aura - flashing lights etc 
Investigations 
Clinical 
Ophthalmoscopy! 
BP 
H+N exam 
Management
Attack 
- NSAIDS 
- Sumatriptan 
Metoclopramide for antiemetic

Prevention

  • Propranolol
  • Amitriptylline
  • Topiramate
  • Acupuncture
  • Riboflavin in pregnancy

COCP CONTRAINDICATED

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3
Q

Sumatriptan CI

A

HTN
SSRI
IHD

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4
Q 
Tension headache 
Aetiology 
Presentation 
Investigations 
Management
A

Aetiology
Stress, dehydration, neck pain, lack of sleep

Presentation 
Bilateral 
Mild- moderate 
Up to 1 week 
Tension type pain / pressing

Investigations
Clinical diagnosis

Management
Sleep hygiene etc
Attack - NSAIDS/ aspirin

Prevention

  • TCA
  • Acupuncture
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5
Q 
Cluster headache 
Aetiology 
Presentation 
Investigations 
Management
A 
Aetiology 
Males
Stress 
Alcohol/ smoking 
Exercise 
Heat 
Presentation 
Sudden onset 
Stabbing nature 
Acute attacks - last 15 - 180 mins 
usually periorbital 
Associated symptoms 
- Horner's syndrome 
- Lid swelling 
- Lacrimation 
- Rhinorrhoea 
- Facial flushing

Investigations

  • Refer to specialist
  • Optic assessment

Management
Attack
- O2 and sumatriptan

Prevention

  • Verapamil
  • Topiramate
  • Prednisolone
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6
Q 
Trigeminal neuralgia 
Aetiology 
Presentation 
Investigations 
Management 
When to refer
A

Aetiology
Associated with MS

Presentation

  • Worse on innoculus stimuli - touching the face
  • Electric shock like pain
  • Often in V2
  • Uop to 100 attacks per day - lasts 1-180 seconds

Investigations

  • Optic assessment
  • H+N exam
  • CT - rule out MS
Management 
Carbamazapine 
Other 
- Lamotrigine 
- Phenytoin 
- Gabapentin 
- Surgical decompression
When to refer 
FHx of MS 
<40 
Optic symptoms 
Sensory ∆
Optic neuritis
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7
Q 
GCA 
Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology

Presentation 
Sudden onset 
Orbital/temporal region 
Jaw claudication 
Scalp tenderness 
Amuorosis fugax --> blindness 
Associated with polymyalgia rheumatica - so proximal weakness think GCA 
B symptoms 
Investigations 
Bloods 
- ESR/CRP^ 
- ALP^ 
- Platelets ^ 
- Hb - low

Dolour duplex scan
Temporal artery biopsy = GS - granulomatous lesions - can have SKIP lesions

Management
Prednisolone
Low dose aspirin
Bisphosphonates + PPI

Complications
BLINDNESS - think if optic symptoms - urgent referral
Aneurysm/ CVA

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8
Q 
SAH 
Aetiology 
Presentation 
Investigations 
Management 
Complications
A 
Aetiology 
Aneurysm 
Ant comm + ACA 
MCA bifurcation 
Post comm and ICA 
PKD
HTN 
CoA
Ehler danlos 
Presentation 
Can have warning leak signs - visual ∆, sensory ∆
Thunderclap headache - worst ever 
FND 
Meningism 
Vomiting
LOC 
CN III palsy (post comm)

Investigations

  • CT - star shaped lesion hyperdense - in basal cistern
  • Hyponatraemia
  • LP ^protein and xanthachromia
  • ECG ∆ long QT etc
  • EYES - intraocular haemorrhages, loss of light reflex

Management

  • Endovascular coiling
  • Rx hyponatramia/ monitor
  • Nimodipine
  • VP shunt if ICP^
Complications 
REBLEED - 20% 
Stroke from vasospasm 
Hyponatraemia 
Sympathetic - ^^^HTN, cardiac arrest
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9
Q

Investigations for SAH

A

CT - star shaped lesion in basal cistern

LP - xanth + Protein ^

ECG ∆ - 12hrs after (long QT, ST elevation)

EYES

  • loss of light reflex
  • intraocular haemorrahge
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10
Q

Sub dural haematoma

Aetiology
Presentation
Investigations
Management

A 
Aetiology 
Alcohol 
Elderly 
Shaken baby 
Tearing of the bridging veins

Presentation
Head trauma –> lucid interval of up to 9 months –> LOC/ personality ∆/ ∆ consciousness/ headache

Investigations
CT - convex lesion - does go beyond suture lines

Management
Burr holes
Craniotomy
If chronic (darker region) and no symptoms can manage conservatively
Sub-acute - chronic but then got oedema –> ^ICP

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11
Q

Extradural haematoma

Aetiology
Presentation
Investigations
Management

A

Aetiology
Hit on da pterion
MMA rupture
dural venous sinuses

Presentation
Trauma - lucid interval (can be hours) –> LOC
SKull frac symptoms - CSF rhinorrhoea
Brisk reflexes, upgoing plantars

Investigations
CT - convex lesion - doesn’t cross suture lines
XR - check for skull fraccy

Management
Burr holes

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12
Q

Parkinson’s

Aetiology
Presentation

A 
Aetiology 
- Age 
- FHx 
- Head trauma? 
DRUGS 
- metoclopramide/ neuroleptics

Cytoplasmic inclusions of alpha synucelin
lewy bodies
In the
- Substantia nigra –> loss of dopaminergic cells

Presentation 
CORE 
Bradykinesia + 1 or 2 of 
Tremor - 4Hz, resting, pill rolling
Rigidity - cogwheel/leadpipe
Other 
REM sleep disorders 
Shuffling gait 
Psych 
- Depression 
- Hallucinations 
- Dementia 
Micrographia 
Monotone voice 
Expressionless face 
Anosmia 
Urinary incontinence 
Sexual dysfunction
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13
Q

Parkinsons
Investigations
∆∆

A

Clinical diagnosis
CT if want to rule out other causes

∆∆
Cerebellar disorders 
Wilson's disease 
LBD 
NPH 
Other causes of tremor eg hyperthyroid and salbutamol/ lithium use/ Delirium tremens tremor/ amphetamines 
EPSE
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14
Q

Drugs causing parkinson’s

A

Metoclopramide

Antipsychotics - EPSE!

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15
Q

Management of parkinson’s

A

Increase dopamine levels
Levodopa + dopa decarboxylase
Ropinirole

Decrease dopamine breakdown
MOA-B inhibitors - rasagiline, selegiline
COMT inhibitors - entacapone

For the tremor
Amantadine
Anticholinergic

Non pharmacological 
Deep brain stimulation 
Physio/ occy T/ S+L therapy 
SSRI for depression 
Surgical interruption of BG 
Housekeeping 
delay start on increased dopamine drugs as they become resistant after 5-10 years 
Ropinirole SE 
- Drowsiness 
- Impulsivity/ inhibition disorder 
- N+V 
- Dizziness 
- Hallucinations

Levodopa problems
On off
wear off
freezing

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16
Q 
NPH 
Aetiology 
Presentation 
Investigations 
Management
A

Aetiology

  • Usually idiopathic
  • Meningitis
  • SAH
  • Head injury
  • Tumour

Presentation
WET, WHACKY, WOBBLY
Brisk reflexes

Investigations
Enlarged IVth ventricle

Management
Acetazolamide
VP shunt

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17
Q 
Hydrocephalus 
Aetiology 
Presentation 
Investigations 
Management
A 
Aetiology 
Non obstructive 
- NPH 
- Increased production
Obstructive
- Tumour 
- Bleed

Presentation
- Symptoms of raised ICP

Investigations
MRI
LP is diagnostic and therapeutic

Management
- VP shunt

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18
Q

Syncope
Definition
Causes

A

Global and transient cerebral hypoperfusion

Reflex (most common)
Vasovagal
Situational
Carotid sinus hypersensitivity

Cardiogenic 
- Structural 
Valve - eg AORTIC STENOSIS
- Arrythmia 
BBB (R) 
Heart block 
WPWS 
Brugada syndrome 
Orthostatic hypotension 
Volume depletion 
- Diarrhoea 
- Haemorrhage 
LBD 
Parkinsons
Diabetic neuroapthy 
Drugs 
- Diuretics/ alcohol/ vasodilators
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19
Q

Syncope investigations

A

BP lying and standing >20/10
Cardio exam
ECG 24 hr tape
Tilt test

Others

  • CT
  • ECHO if suggestive features on ECG
  • FBC - anaemia
  • Glucose
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20
Q

NEAD

Aetiology
Presentation
Investigations
Management

A

Aetiology
RF include
someone in the fam with epilepsy
Child abuse

Presentation 
Pelvic thrusting 
Eyes closed lie still 
Wild jerking movements 
Can localise symptoms 
post -ictal Upset/ crying 
Long duration >2mins 
Gradual onset 
Attacks only when people are present

Can have tongue biting+ incontinence but rare

Investigations
Prolactin not raised
Video telemetry - can tell from the seizure that its NEAD

Management
CBT ??

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21
Q

Syncope v epilepsy v NEAD

A

re-write the table and test urself

Shite brainscape wont let me import the table

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22
Q

Shingles

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
Re-activation of the VZV
- Immunocompromised
Age, chemo, HIV, TB, steroids

Presentation
Pre-eruptive phase
No rash but ithcing, burning, tingling in the area
Eruptive phase - red macules that are dermatomal and PAINFUL

Posst herpetic neuralgia

Investigations
N/A clinical diagnosis - can do PCR swab
REMEMBER: if >1 dermatome invovled consider ∆∆or immunocompromised

Management 
Acyclovir - aim to start within 72hrs 
Pain 
- Paracetamol 
- Gabapentin 
- Amytriptylline

Complications
Bells palsy as a result of VII involvement = ramsay hunt syndrome + can leave permanent motor and visual symptoms

Orbital involvement (herpes zoster ophthalmicus - V1 (+ hutchinson sign tip of nose involved - nasociliary branch) –> Blindness (need urgent referral)

Post herpetic neuralgia

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23
Q

Complications of shingles

A

HERPES ZOSTER OPHTHALMICUS
Where V1 is affected - can –> blindness - need urgent referral

Post herpetic neuralgia

Ramsay hunt syndrome - where VII is involved

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24
Q

Bell’s Palsy

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Idiopathic transient paralysis of CN VII - LMNL

Aetiology 
Idiopathic 
Infection - lyme disease, EBV
Tumour - parotid (remember LMNL) 
Forceps delivery 
^ risk in pregnancy and diabetes

Presentation
LMNL CN VII - facial paralysis with no forehead sparing
Cannot close eye so dry eye/ corneal dryness
Hyperacusis - stapedius
Taste loss ant. 2/3 tongue
Post auricular pain/ numbness

Investigations
Exam - no forehead sparing
CT if suspect tumour
Blood cultures for infection eg borellia for lyme disease

Management
Prednisolone
PROTECT THE EYE

Complications
Ramsay hunt syndrome if caused by VZV –> permanent damage
Permanent 15%

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25
Q

Huntington’s

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
Autosomal dominant - Ch4
Trinucleotide repeat - CAG
–> GABAnergic neurone decrease -

Presentation 
Personality ∆ 
Clumsiness 
Chorea, tics, myoclonus
Self neglect 
Supranuclear gaze palsy 
Seizures, spacticity

Psych
Apathy
Dementia
Depression

Investigations
MRI
Genetic testing

Management
Benzoes
Valproate
Terabenzene

SSRI
Antipsychotics

Complications
Depression

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26
Q

GBS

Aetiology 
Presentation 
Investigations 
Management 
Complications

Guillain*

A

Autoimmune demyelinating polymyopathy

Aetiology
Post viral
- Campylobacter jejuni
- CMV/ EBV

Presentation 
Ascending weakness 
Areflexia 
Autonomic - arrythmias, urinary retention, tachycardia 
Abnormal eye 
Parasthesia can occur 
NOT painful 
Remember resp depression
Investigations 
Nerve conduction studies 
Anti-ganglioside 
ECG 
Spirometry 
LP - ^Protein

Management
IV IG
Plasmapheresis
VTE prophylaxis

Complications
Resp depression –> death

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27
Q

Presentation of GBS

Guillain

A 
It is SYMMETRICAL 
AAAA
Ascending weakness - proximal 
Areflexia 
Autonomic - arrhythmia, urinary retention, tachycardia 
Abnormal eyes - diplopia 
Parasthesia 
Resp depression
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28
Q

Investigations for GBS

Guillain

A

Nerve conduction studies (GS)
Anti-ganglioside antibodies
LP ^ protein

Spirometry monitoring
ECG - arrhythmia monitoring

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29
Q

MS

Aetiology 
Presentation 
Investigations 
Management 
Complications
A 
Aetiology/ epidemiology 
F>M
20-40
Far from equator 
Previous mononucleosis 
Autoimmune demyelination 
Presentation 
EYES 
Optic neuritis 
Internuclear ophthalmoplegia 
Optic atrophy

MOTOR
Spastic weakness

SENSORY
Trigeminal neuralgia
Lhermitte’s shocks
Numbness

UROGEN
Sexual dysfunction
Urinary incontinence

CEREBELLAR

  • Ataxia
  • Tremor

Uhthoff’s phenomenon
Can have cognitive impairment

Investigations

  • MRI - 2 lesions disseminated in time and space
  • Anti MOG antibodies
  • Oligoclonal bands

Management
Acute
- Methylprednisolone

Chronic
Interferon/ galantamir
Natalizumab

Beta blocker - for tremor
alentuzumab

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30
Q

Investigations for MS

A

MRI - 2 lesions disseminated in time and space

LP - oligoclonal bands

Bloods - anti MOG antibodies

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31
Q

Presentation of MS

A

EYES
Optic neuritis
Intranuclear ophthalmoplegia
Optic atrophy

MOTOR
Spastic weakness

SENSORY
Lhermitte’s shock
Trigeminal neuralgia
Numbness

CEREBELLAR
Ataxia
Tremor

UROGEN
Seuxal dysfunction
Urinary retention

Can have cognitive impairment

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32
Q

MS

Investigations + management

A

Investigations

  • MRI 2 lesions disseminating in time and space
  • Anti MOG antibodies
  • LP - oligoclonal bands

Management
Acute
methylprednisolone

Chronic 
- Interferon/galantamir 
- Natalizumab 
Other 
muscle relax - baclofen 
reduce tremor - BB
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33
Q

Types of MS

A

Relapsing and remitting
Primary progressive
Secondary progressive

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34
Q

Myasthenia gravis

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

WEAKNESS AND FATIGUABILITY

Aetiology
Antibodies to Ach receptors
Assocaited with thyroid/addisons/parkinsons/thymoma

Presentation 
weakness and fatiguability 
voice trails off + cant walk up the stairs + struggle watching TV 
Myasthenic snarl 
Peek sign

EYES

  • Diplopia
  • Ptosis - better on ice
BULBAR 
Dysphagia 
Dysphasia 
Dysphonia
Difficulty chewing

reflexes normal
Proximal weakness

Investigations 
Electromyography - decreased evoked potentials 
AntiMuSK antibodies 
AntiAchR antibodies 
CT thymoma 
Spirometry

Management
Pyridostigmine
Other - steroids/azathioprine

Complications
- Resp

Exacerbations

  • Drugs - BB, opioids, lithium, gent
  • Pregnancy
  • Infection
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35
Q

Myasthenia gravis

aetiology

A 
autoimmune to AchR 
Associated with 
Thyroid 
Thymoma 
Addisons 
Parkinsons
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36
Q

MG

presentation

A

WEAKNESS AND FATIGUABILITY

EYES

  • diplopia
  • ptosis - better on inte

BULBAR

  • dysphagia
  • dysphasia
  • dysphonia
  • difficulty chewing

voice trails off etc
snarl sign
peek sign

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37
Q

MG

investigations

A 
Electromyography - decreased evoked potentials 
CT thymoma 
Bloods 
- Anti MuSK 
- Anti AchR
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38
Q

MG

management

A

pyridostigmine

Other
- steroids/ azathioprine

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39
Q

MG

exacerbation causes

A

drugs
- BB, lithium, gent, opioids
pregnancy
infection

40
Q

Spinal cord

Aetiology 
Presentation 
Investigations 
Management 
Complications compression
A 
Aetiology 
Vascular - EDH 
Infection - potts 
Trauma - BSS
Autoimmune - SLE? sarcoid?
Metabolic 
Iatrogenic 
Neoplasm - spinal cord tumour, METS 
Degenerative - osteophytes, disc prolapse

Presentation
unilateral leg pain +/- FND
^ reflexes

Investigations
MRI

Management
Dexamethasone + Rx cause

Complications
- cauda equina

41
Q

What mets to bone (in regard to SCC)

A

Breast
Bronchus
Kidney
Prostate

42
Q

Cauda equina

A

Herniated disc = most common cause

Same as SCC but with impingement of the cauda equina

Incontinence
saddle anasethesia

Do a PR!
MRI - URGENT

Urgent surgery

Complications - paralysis

43
Q

MND

Aetiology 
Types 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
SOD1 mutation

Types

Presentation 
MOTOR ONLY 
- UMNL and LMN signs mixed is common 
tongue fasciculations, foot drop 
thenar wasting 
wasting of tibialis anterior 
Bulbar signs 
- Dysphagia, dysphona, dysarthria, dysphasia, drooling 
Investigations 
clinical diagnosis 
Management 
RILUZOLE 
Benzos - for spasticity 
NIV for ventilation 
PEG/NG for feed 
Large cutlery 
Complications 
aspiration pneumonia
resp failure 
UTI 
constipation 
speech difficulty 
immobility issues eg ulcers
44
Q

Types of MND

A 
Amyotrophic lateral sclerosis
Motor cortex - UMN + LMN 
Progressive bulbar palsy 
CN 9-12 
Worst prognosis 
Progressive muscular atrophy 
Primary lateral sclerosis
45
Q

Meningitis

Aetiology 
Presentation 
Investigations 
Management 
Complications
A 
Aetiology 
Bacterial, fungal, viral, NSAIDS, tumour, autoimmune, vasculitis 
BACTERIA 
Neonates 
- GBS, e. coli, listeria

Adolescent

  • N. men
  • Strep pneumonia
  • Hib

Adult

  • N. men
  • Strep pneumonia

Elderly

  • N. men
  • Strep pneumonia
  • Listeria

Presentation
Headache, neck stiffness, fever
Other
photophobia, symptoms of raised ICP, Seizures, RASH, meningism signs

Investigations

  • LP - unless symptoms of ^ICP(see LP slide for results)
  • Bloods - cultures, FBC, clotting, glucose, ?ABG if v ill

Management

  • IM ben pen in community
  • Cefotaxime
  • Dex if penumonia
  • Cipro for contacts
  • call PHE if N. men
  • Amox and gent for listeria
Complications 
Sensorineural deafness 
Seizures 
Coma/death 
Sepsis 
Abscess
46
Q

abx for listeria meningitis

A

amox and gent

47
Q

Encephalitis

Aetiology
Presentation
Investigations
Management

A

Aetiology

  • HSV
  • Enterovirus
  • Mumps
  • measles - remember SSP
  • VZV

Presentation
Triad of fever, headache and personality change

Investigations
LP - LYMPHOCYTES
MRI - change in temporal lobe

Management
- IV acyclovir

48
Q

Cerebral abscess

A 
Aetiology - strep anginosus 
Infection near 
- Meningitis 
- Mastoiditis 
- otitis media

Infection far

  • Endocarditis

Presentation
FND
Fever
Headache

Investigations

  • CT/MRI - ring enhancement
  • Blood cultures

Management

  • Ceftriaxone
  • Fungal? - fluconazole
  • Drain - burr hole etc
49
Q

Parkinson plus syndromes

A

VIVID

Vertical gaze palsy - SNGP
Incontinence/ impotence - MSA
Visual hallucinations - LBD
Interfering limb - corticobasal degeneration
Diabetes/ HTN - vascular parkinsons

SNGP and MSA have poor response to LDOPA

50
Q

Bilateral acoustic neuromas

A

neurofibromatosis II

51
Q

Acoustic neuroma

A

Aetiology
- Ass. with NFM II

Presentation 
CN VIII 
unilateral tinnitus and sensorineural deafness
Vertigo 
CN V - absent corneal reflex 
CN VII - facial paralysis

Investigations
- CT/ MRI + urgent ENT referral

management
Surgery radio etc

52
Q

UMN signs

A 
upgoing plantars 
increased reflexes 
clasp knife/ spasticity 
clonus 
no muscle wasting
53
Q

LMN signs

A

muscle wasting
decreased reflexes
fasciculations

54
Q

Status epilepticus Rx

A

ABC + o2

Buccal midaz, rectal daiz, IV loraz
Do this twice then move on

IV phenytoin or phenobarnital

RSI

55
Q

Status epilepticus

Causes and complications

A

Causes
AED withdrawal
alcohol withdrawal

Complications
renal AKI due to rhabdo

cardiac/ resp - aspiration

Autonomic - incontinence

metabolic
lactic acidosis and hypoxia + hypercapnia

56
Q

Stroke classification

part I

A

Bamford and oxford

Total anterior (ACA and MCA)
All 3 of 
Hemiparesis/sensory loss 
Homonymous hemianopia 
higher cognitive disorder eg bulbar/ dysphagia 
Partial anterior (some ACAor MCA)
any 2 of the above

Posterior (vertebrobasilar)

  • Isolated homonymous hemianopia
  • LOC
  • Cerebellar disorder
  • CN palsy AND contralateral motor or sensory deficit

Lacunar (perforating - BG etc)

  • pure motor
  • pure sensory
  • ataxic hemiparesis
  • mixed motor sensory
57
Q

How to differentiate between

MCA and ACA stroke

A

MCA upper limb more affected

ACA lower limb more affected

58
Q

Stroke classification par II

A

Weber - PCA
CN III and contralateral hemiparesis

Wallenberg - PICA 
Ipsilateral: 
face pain sensation loss 
Horners 
Loss of gag reflex 
Cerebellar signs

Contralateral: pain sensation loss (body)

lateral pontine syndrome AICA
- same as wallenberg but ipsilateral facial paralysis and deafness

Locked in - basilar artery - can move eyes and extraocular muscles

59
Q

Types of aphasia

A

Wernicke’s (receptive)
Speech fluent
Comprehension impaired
Sentences do not make sense

Broca’s (epsressive)
Speech non fluent
Good comprehension

Conductive 
Arcuate fasciculus 
Fluent speech 
Comprehension normal 
Poor repetition and aware of the errors they are making
60
Q

Stroke management (acute and secondary)

A 
ACUTE 
ABC
ensure not haemorrhagic --> 
300mg aspirin 
Urgent CT head 
Thrombolysis if <4.5hrs etc (alteplase) 
\+ Thrombectomy within 6hrs if proximal ant circulation

Then 300mg aspirin for 2 weeks then clopidogrel for life
Statin offered if cholesterol >3.5 (48hrs)
anticoags can be offered after 2 weeks if indicated for AF patients

61
Q

Contraindications for thrombolysis

A 
Unknown time of onset 
>4.5hrs
Pregnancy Head injury or surgery in 3 months 
On anticoags 
Clotting disorder 
Liver disease

Anuerysm
Tumour

62
Q

Driving after a stroke

A

1 month minimum

63
Q

TIA

Definition
Presentation
Investigations
management

A

Definition
Stroke symptoms last <24hrs

Presentation
Same as stroke but can also often include amaurosis fugax

Investigations
24hr ECG
MRI
Carotid doppler

Management 
300mg aspirin and urgent neuro referal within: 
24hrs if <7 days since TIA 
1 week if >7 days since TIA 
Carotid endarterectomy if need (>70%)
64
Q

Lateral pontine syndrome

A

AICA

Same as wallenberg except ipsilateral facial paralysis and deafness

65
Q

Horner’s syndrome

Aetiology
Presentation
Investigations
Management

A

STC

Aetiology
Central
Stroke
S - multiple Sclerosis

Pre-ganglionic 
Trauma 
Tumour 
Thyroidectomy
Cervical rib

Post ganglionic
Cluster headaches
Carotid disection
Cavernous sinus thrombosis

Presentation 
Ptosis 
Meosis 
Anhidrosis 
Enophthalmous

Investigations
Apraclonidine - affected eye does not dilate
CT - lung tumour

Management
Rx cause

66
Q

Cerebellar disorder

Aetiology
Presentation
Investigations
Management

A

Aetiology

Presentation - DANISH 
Dysdia
Ataxia (vermis)
Nystagmus
Intention tremor 
Slurred speech
Heel shin/ pendular reflexes 
Investigations 
Vascular - stroke 
Infection - meningitis/encephalitis/VZV/mumps 
Trauma
Autoimmune/alcohol!
Metabolic - hypopara/thyroid, B12
Iatrogenic*
Neoplasm 
Degenerative - MS

Drugs

  • Lithium
  • metronidazole
  • Isoniazid
  • Phenytoin

Management
Rx causes yay

67
Q

Anterior cord syndrome

Aetiology
Presentation
Investigations
Management

A

Aetiology
Vascular impairment of the anterior spinal artery (from vertebral, from aorta) so most comes from aortic insufficiency eg aortic dissection/ aneurysm/ atherosclerosis

Presentation 
Dorsal column intact 
loss of pain 
loss of motor 
Arreflexia 
Autonomic failure

Investigations
CT angio?

Management
Rx cause

68
Q

Seizure types

not the localising lobes the general one

A 
Focal 
Simple - no loc 
Complex - loc - symptoms in one area 
Jacksonian march 
Todd's paralysis 
Can go simple --> complex 
Generalised (both sides, LOC)
Tonic clonic - falss then jerking 
Atonic - pt falls 
Myoclonic - jerks 
Absence - stares blankly
69
Q

Localising features of focal seizures

A

Temporal

  • Hallucinations
  • Automatism (lip smacking, pulling)
  • Post ictal dysphasia
  • Deja vu

Frontal

  • Jacksonian march
  • Movements
  • Todd’s paralysis

Parietal
- parasthesia

Occipital

  • flashes
  • floaters
70
Q

Valproate side effects

A 
Vomiting
Anorexia/ ataxia 
Liver toxicity 
Pancreatitis 
Retention of weight
Oedema 
Alopecia 
Tremor/ Teratogenic (NTD) 
Enzyme inhibitor
71
Q

Epilepsy

A

2 or more unprovoked seizures >24hrs apart

Aetiology

  • Cerebral palsy
  • Tuberous sclerosis
  • Downs
  • Tumours

Investigation

  • EEG
  • MRI
Management 
AED 
- 2nd seizure 
OR 
- 1st seizure and 
MRI structural abnormality 
- FND
72
Q

Epilepsy Rx

A 
Focal 
Carbamazepine 
OR 
Lamotrigine 
Valproate 
Generalised (valproate)
Absence 
Valproate 
Ethosuxamide 
Not carbamaz

Tonic clonic
Valproate
Lamotrigine/carb

Myoclonic
Valproate
Lamotrigine
Not carbamaz

73
Q

Seizures + DVLA

A

No drive for 6 months after a seizure

Can drive if seizure free for 12 months

74
Q

Organic causes of a seizure

A 
Vascular - stroke/ SAH
Infeciton -men/enceph/abscess
Trauma 
Autoimmune - SLE 
Metabolic  -alcohol withdrawal, low Na, Ca, O2, glucose, high uraemia, Ca,Na 
Iatrogenic - TCA/BDZ/tramadol
Neoplasm - primary and secondary

D

75
Q

Side effects of ropinirole

A 
Drowsiness 
Impulsivity 
N+V 
Dizziness 
HAllucinations
76
Q

Parkinsons

A

Neuroleptics

Metoclopramide

77
Q

Cerebellar

A

Lithium
Phenytoid
Isoniazid
Metronidazole

78
Q

Seizures

A

TCA

Benzos

79
Q

Syncope

A

ACEi

TCAs

80
Q

Tremor

A 
Beta agonist 
Caffiene 
Lithium 
Valproate 
Amphetamine 
TCAs
SSRI
81
Q

Meningitis

A

NSAIDS

Trimethoprim

82
Q

Peripheral neuropathy

A

Isonizid
metronidazole
Phenytoin

83
Q

MG precipitants

A 
Pregnancy 
Infection 
Opioids 
Gentamycin 
BB
84
Q

Types of tremor

A

Parkinson’s
Resting - 4-6Hz

Cerebellar
DANISH signs

Essential
Can have vocal
Worse on arms outstretched
Better on alcohol and rest

Orthostatic

Multiple system atrophy
Has autonomic symptoms eg incontinence

85
Q

Neurofibromatosis

Aetiology
Presentation

A

Type I
Chr 17
AD

Skin lesions 
Cafe au lait 
axillary freckles 
optic lesions 
scoliosis 
pheo

Type II
Chr 20
AD

tumours

Bilateral Acoustic neuromas
Ependymoma
schwannoma
meningioma

86
Q

Peripheral neuropathy

Causes
Investigations

A

Causes
Mainly motor
GBS
Infection - diptheria/HIV

Mainly sensory
Diabetes
Uraemia
B12

Other: Autoimmune, SLE
Drugs - isoniazid, pheny, metronidazole

Investigations
B12, U+E, blood cultures, nerve conduction studies
Anti RO/La for SLE

87
Q

Coma and causes

A 
Vascular - stroke/ SAH
Infection - meningitis etc
Trauma - HI
Autoimmune 
Metabolic 
Hypoglycaemia/ DKA/ uramiea/ hepatic encephalopathy/wernickes
Iatrogenic - opiates/ alcochol 
Neoplasm
88
Q

Mononeuropathies

A

Median
Ulnar

Radial

Common peroneal

Intercostobrachial

89
Q

Median nerve mononeuropathy

Causes
Presentation
Investigations
management

A

C6-T1

PRADAH

P
Regnancy 
Arthritis 
Diabetes
Acromegaly 
Hypothyroid

Colle’s supracondylar fracture

Presentation
- Motor - wasting of APB
Sensory - lateral 3.5 fingers + palm
Relieved by dangling off bed - wake and shake

Investigations
Tinnels/phalens
Neurophysiology = diagnostic
Clinical diagnosis

Management

  • Rx cause
  • Wrist splinting
  • Corticosteroid injection
  • Neuropathic pain releif - gabapentin/ pregabalin
90
Q

Ulnar nerve palsy

A

C7-T1

Associations

  • Trauma to elbow
  • Handlebar palsy
Presentation
Weakness 
- wrist flexors 
- interossi 
- hypothenar eminence (pinky abduction) 
Sensory - medial 1.5

Management

  • Splint
  • Surgical decompression
91
Q

Radial nerve

Presentation

Management

A

C5 - T1

Association
- something about alcoholics falling asleep on a chair

Presentation
Motor - wrist drop
Sensory - anatomical snuffbox

Management
Splint
Surgical decompression

92
Q

Common peroneal nerve

A

L4- S2
Sitting cross legged
trauma

FOOT DROP

∆∆ MND

93
Q

Bulbar palsy

A 
Aetiology 
MND 
MG 
GBS 
Brainstem tumour

Presentation - LMNL!!!!!
CN 9-12
9 + 10 - gag reflex/ vagus nerve, taste posterior 1/3 , swallowing
11 - accessory - trap + SCM
12 - hypoglossal - drooling, fasciculation

Management - Rx cause

just remember MND is main ∆∆

94
Q

Pseudobulbar palsy

A

of corticobulbar tracts - UMNL!!!

DONALD DUCK SPEECH

Stroke
MS
MND

Difference to bulbar 
its UMNL so: 
No fasciculations 
^Jaw jerk 
- Emotionally labile
95
Q

Tuberous sclerosis

A

Aetiology
Autosomal dominant

Presentation
SKIN AND NEURO

NEURO
Epilepsy
Intellectual impairment

SKIN

  • Ash leaf spots - ^under UV
  • Shagreen patches - over lumbar spine
  • Adenoma sebaceum - in butterfly distribution under nose
96
Q

Narcalepsy/ cataplexy

A

Aetiology

Presentation

1) Excessive daytime sleepiness
2) Cataplexy - loss of tone due to extreme emotion
3) Sleep paralysis
4) Hypnagognic hallucinations

Investigations

  • Sleep clinic
  • EEG

Management
STOP DRIVING
Sleep hygeine

Pharma

  • Modafanil
  • methylphenidate
97
Q

Syringomyelia

A

Fluid filled cavities in the spinal cord
Pressure –> compression of spinal cord tracts

Presentation 
Pain + temp loss in shawl like distribution 
LMNL lesion 
Dorsal column can be affected 
Autonomic - bowel and bladder 
others - scoliosis

Investigations
MRI

Management
Pain meds - surgery

3a (6 decks)

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