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Neuro Flashcards

1
Q

discharge management of a stroke

A

clopidogrel over aspirin. Statin if cholesterol over 3.5

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2
Q

neuroleptic malignant syndrome, what seen on invesgtigations

A

raised WCC, raised CK

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3
Q

sodium valproate adverse effects

A 
p450 inhibitor
alopceia
weight gain,
hepatitis,
teratogenicity
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4
Q

indications for thrombolysis in stroke

A

within 4.5 hours
haemorrhage excluded
thrombolyse with alteplase

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5
Q

cranial nerve pathologies with acoustic neuroma

A

cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

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6
Q

GCS M

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None
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7
Q

GCS V

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
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8
Q

GCS E

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
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9
Q

management of nausea

A

Ondansetron for chemotherapy-induced nausea
Haloperidol for intracranial causes (raised ICP, direct effect of tumour)
Prochlorperazine for vestibular causes
Metoclopramide for gastrointestinal causes

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10
Q

management of acute relapse of MS

A

high dose methyl pred

for spasticity baclofen and amitryptiline are first line

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11
Q

uhthoff’s phenomenon

A

uti leading to flare in MS symptoms

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12
Q

multiple system atrophy features

A

Shy-Drager syndrome is a type of multiple system atrophy.

Features
parkinsonism
autonomic disturbance (atonic bladder, postural hypotension, erectile dysfunction)
cerebellar signs

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13
Q

test for CSF in trauma leakage

A

glucose

beta 2 transferrin (gold std)

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14
Q

when to treat epilepsy

A

following a second epileptic seizure. NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:
the patient has a neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable

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15
Q

painful 3rd nerve palsy

A

posterior communicating artery aneurysm

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16
Q

3rd nerve palsy

A

eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)

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17
Q

causes of 3rd nerve palsy

A

diabetes mellitus
vasculitis e.g. temporal arteritis, SLE
false localizing sign* due to uncal herniation through tentorium if raised ICP
posterior communicating artery aneurysm (pupil dilated)
cavernous sinus thrombosis
Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes
other possible causes: amyloid, multiple sclerosis

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18
Q

causes of foot drop

A

L5 radiculopathy
sciatic nerve lesion
common peroneal nerve lesion
superficial or deep peroneal nerve lesion
other possible includes central nerve lesions (e.g. stroke) but other features are usually present

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19
Q

klumpke paralysis trunks and muscles

A

c8-t1. weakness of intrinsic hand muscles. traction injuries

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20
Q

erbs palsy trunks

A

c5-6

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21
Q

Lateral medullary syndrome

A

posterior inferior cerebellar artery PICA
aka Wallenberg’s syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

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22
Q

Lacunar infarcts presents with

A
  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis
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23
Q

carpal tunnel syndrome nerve and muscles

A 
median
LOAF
lat lumbricals
opponens pollicis, abductor pollicis brevis
flexor pollicis brevis
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24
Q

roughened patches of skin over lumbar spine + seizures

A

shagreen patches found in tuberous sclerosis

subungual fibroma also seen

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25
Q

management of migraines

A

acute: triptan + nsaid/ paracetamol
prophylaxis: topiramate or propranolol(child bearing age)

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26
Q

neurolaptic malignant syndrome pentad

A

hyperthermia, muscle rigidity, autonomic instability, altered mental status

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27
Q

c8 dermatome and myotome

A

medial side of the hand over little finger
flexion of DIP and MCP joints
(elbow extension is weak as contains roots from C7 and C8)

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28
Q

NF2 associated with

A

bilateral vestibular schwannomas

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29
Q

roots for reflexes

ankle, knew, biceps, triceps

A 
Ankle
S1-S2
Knee
L3-L4
Biceps
C5-C6
Triceps
C7-C8
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30
Q

30 yo with tunnel vision

A

retinitis pigmentosa.

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31
Q

metoclopramide side effects

A

extrapyramidal side effects common in children and young adults

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32
Q

management of trigeminal neuralgia

A

carbamazepine or urgent referral if red flags present

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33
Q

what to avoid in lewy body dementia

A

Avoid neuroleptics in Lewy body dementia- may cause irreversible parkinsonism

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34
Q

Lip smacking + post-ictal dysphasia are localising features of

A

temporal lobe seizure

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35
Q

window for thrombectomy

A

6 hours

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36
Q

facial nerve complication due to paralysis of stapedius muscle

A

hyperacusis

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37
Q

most common complication of meningitis

A

sensorineural hearing loss

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38
Q

side effects of pheytoin

A

lymphadenopathy, peripheral neuropathy, gingival hyperplasia

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39
Q

todd’s paresis

A

post ictal weakness, common in focal seizures

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40
Q

Internuclear ophthalmoplegia features

A

impaired adduction of the eye on the same side as the lesion

horizontal nystagmus of the abducting eye on the contralateral side

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41
Q

EEG features of absence seizure

A

EEG: bilateral, symmetrical 3Hz spike and wave pattern

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42
Q

Brain abscess on imaging

A

parenchymal
ring enhancing
restricted diffusion on weighted imaging

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43
Q

Sinusitis + focal neurology and fever →

A

?brain abscess

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44
Q

Hereditary sensorimotor neuropathy features

A

includes charcot marie tooth
type 1:
autosomal dominant
due to defect in PMP-22 gene (which codes for myelin)
features often start at puberty
motor symptoms predominate
distal muscle wasting, pes cavus, clawed toes
foot drop, leg weakness often first features

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45
Q

precipitating factors for migraines

A 
Chocolate
Hangovers
Orgasms
Cheese
Caffeine
The oral contraceptive pill
Lie-ins
Alcohol
Travel
Exercise
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46
Q

Temporal lobe seizures HEAD

A

Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing/plucking), Deja vu/Dysphasia post-ictal)

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47
Q

temporal arteritis associated with

A

polymyalgia rheumatica (proximal weakness)

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48
Q

Relative Afferent Pupillary Defect where is pathology

A

retina or optic nerve

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49
Q

horners syndrome triad and cause

A

miosis (contriction), ptosis, anhidrosis (no sweating). Sympathetic nerves of face affected

50
Q

syringomyelia features

A

first cause compression of the spinothalamic tract as they decussate in the anterior white commissure.

associated with chiari malformations

51
Q

autonomic dysreflexia lowest lesion level

A

T6

52
Q

indications for CT head in headache

A

Vomiting more than once with no other cause.
New neurological deficit (motor or sensory).
Reduction in conscious level (as measured by the Glasgow coma score).
Valsalva (associated with coughing or sneezing) or positional headaches.
Progressive headache with a fever.

53
Q

homonymous quadrantanopias: PITS

A

Parietal-Inferior, Temporal-Superior) contralateral to defect

high pituitary= lower bitemporal loss and vice cersa

54
Q

ulnar nerve function

A

Overview
arises from medial cord of brachial plexus (C8, T1)

Motor to
medial two lumbricals
aDductor pollicis
interossei
hypothenar muscles: abductor digiti minimi, flexor digiti minimi
flexor carpi ulnaris

Sensory to
medial 1 1/2 fingers (palmar and dorsal aspects)

55
Q

Hoffman’s sign

A

examiner should flick the patients distal phalanx (usually of the middle finger) to cause momentary flexion. A positive sign is exaggerated flexion of the thumb.
Hoffmans sign is a sign of upper motor neuron dysfunction and points to a disease of the central nervous system

56
Q

depigmented ‘ash-leaf’ spots which fluoresce under UV light

A

tuberous sclerosis

57
Q

DVLA advice with
-TIA/stroke
-epilepsy
epilepsy and category c

A
  • 1 month off may not need to inform DVLA if no residual neurological deficit. If defecit, DVLA do assessment
  • 6 months seizure free
  • 10 years seizure free
58
Q

Contra indications to triptans

A

ischaemic heart disease and risk factors

59
Q

stoppin of anti epileptic drugs

A

seizure free for >2 years, AEDs stopped over 2-3 months

60
Q

Useful for managing tremor in drug-induced parkinsonism

A

procyclidine

61
Q

parkinsons drug associated with pulmonary fibrosis

A

cabergoline

62
Q

parkinsons drug with reduced effectiveness over time

A

levodopa

63
Q

normal pressure hydrocephalus triad

A

wet, wobbly and whacky
urinary incontinence
dementia and bradyphrenia
gait abnormality (may be similar to Parkinson’s disease)

64
Q

charcot marie toot inheritance

A

autosomal dominant

pmp-22 gene which codes for myelin

65
Q

friedrich waterhouse syndrome

A

rare complication of meningococcal sepsis involving bilateral adrenal haemorrhage. This would be a patient who is extremely unwell, or who has been recently treated for meningitis and presents with collapse and salt-wasting

66
Q

side effects of levodopa

A 
dyskinesia
'on-off' effect
postural hypotension
cardiac arrhythmias
nausea & vomiting
psychosis
reddish discolouration of urine upon standing
67
Q

pontine haemorrhage presentation

A

quadriplegia, miosis, absent horizontal eye movements

68
Q

LES vs MG

A

strength improves with activity, in MG it’s the opposite

MG associated with thymomas

69
Q

mx seizures

A

Generalised tonic-clonic seizures
sodium valproate
second line: lamotrigine, carbamazepine

Absence seizures* (Petit mal)
sodium valproate or ethosuximide
sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Myoclonic seizures**
sodium valproate
second line: clonazepam, lamotrigine

Focal seizures
carbamazepine or lamotrigine
second line: levetiracetam, oxcarbazepine or sodium valproate

70
Q

Laughter → fall/collaps

A

cataplexy

71
Q

mid shaft humeral fracture. nerve and test

A

radial. extend wrist

72
Q

jacksonian march and type of seizure

A

starts peripherally and spreads (focal aware)

frontal lobe

73
Q

degenerative cervical myelopathy presentation

A

Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

74
Q

?meningitis with altered mental state and aura jamais vu

A

encephalitis start aciclovir to cover HSV1

75
Q

myotonic dystrophy vs beckers dystrophy

A

myotonic muscles do not relax

76
Q

CTZ is where

A

medulla oblongata

77
Q

falls soon after new dx of parkinsons

A

progressive supranucear palsy (park plus) test eye movements (diplopia)

78
Q

restless leg syndrome mx

A

management includes dopamine agonists such as ropinirole

79
Q

raised ICP and third nerve palsy

A

transtentoral herniation

80
Q

LES antibodies

A

voltage gated calcium channel antibodies

81
Q

anterior circulation infarct

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
    all for total, 2 for partial
82
Q

posterior circulation

A

presents with 1 of the following:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
83
Q

An isolated result of high protein in the CSF

A

GBS

84
Q

lamotrigine s/e

A

SJS

85
Q

mx of bell’s palsy

A

prednisolone (more common in pregnancy)

lubricating eye drops and tape eyes shut

86
Q

numb armpit nerves

A

intercostobrachial nerve - axillary clearance surgery

87
Q

loss of pronation nerve

A

median nerve

88
Q

essential tremor mx

A

propranolol

89
Q

MND mx

A

Riluzole
prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months

Respiratory care
non-invasive ventilation (usually BIPAP) is used at night
studies have shown a survival benefit of around 7 months

90
Q

blood test to differentiate true and pseudoseizure

A

prolactin

91
Q

spontaneous intracranial hypertension

A

Spontaneous intracranial hypotension is a very rare cause of headaches that results from a CSF leak. The leak is typically from the thoracic nerve root sleeves.

Risk factors include connective tissue disorders such as Marfan’s syndrome.

92
Q

hoovers sign

A

true and fake leg weakness

93
Q

neuropathic pain 1st line tx

A

amitriptyline, duloxetine, gabapentin or pregabalin.

94
Q

subdural vessel

A

bridging veins between cortex and venous sinus

95
Q

complex regional pain syndrome

A

Complex regional pain syndrome (CRPS) is the modern, umbrella term for a number of conditions such as reflex sympathetic dystrophy and causalgia. It describes a number of neurological and related symptoms which typically occur following surgery or a minor injury. CRPS is 3 times more common in women.

96
Q

phenytoin s/e

A

peripheral neuropathy

proarrhythmic

97
Q

anterior cerebral artery vs mca infact

A

Anterior cerebral artery stroke causes leg weakness but not face weakness or speech impairment

98
Q

idiopathic intracranial hypertension mx

A

weight loss

acetazolamide

99
Q

when to perform carotid endarterectomy

A

50 or 70 percent stenosis

100
Q

cluster headache prophylaxis

A

verapamil
(acute- o2 and sub cut triptan)
(alcohol is a trigger)

101
Q

syringomyelia

A

collection of csf in cord

‘cape-like’ (neck and arms) loss of sensation to temperature but preservation of light touch

102
Q

3rd nerve palsy, lesion ipsi or contralateral

A

ipsilateral

103
Q

stroke ct with or without contrast

A

without contrast

104
Q

anti emetic that can be used in parkinsons

A

domperidone- does not cross BBB

105
Q

congruous vs incongruous homonymous hemianopia

A

contralateral optic radiation/cortex vs contralateral optic tract

106
Q

ondansetron MOA

A

5HT3 blocker

107
Q

cerebellar vermis vs hemisphere lesion

A

hemisphere causes finger nose ataxia

108
Q

ix in young stroke

A

autoimmune and thrombophilia screening if stroke <55

109
Q

mx neuroleptic malignant syndrome

A

stop antipsychotic, dantrolene or bromocriptine

110
Q

types of MS

A

Relapsing-remitting disease
most common form, accounts for around 85% of patients
acute attacks (e.g. last 1-2 months) followed by periods of remission

Secondary progressive disease
describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
around 65% of patients with relapsing-remitting disease go on to develop secondary progressive disease within 15 years of diagnosis
gait and bladder disorders are generally seen

Primary progressive disease
accounts for 10% of patients
progressive deterioration from onset
more common in older people

111
Q

initial mx of stroke in a chadvasc high pt

A

still high dose aspirin, move to anticoag after 14 days rather then low dose clopi for secondary prevention

112
Q

Lhermitte’s sign

A

tingling in her hands which comes on when she flexes her neck

indicates disease near the dorsal column nuclei of the cervical cord. It is also seen in subacute combined degeneration of the cord and in cervical stenosis

113
Q

dermatome aid memoirs

A 
c6- make a six with index and thumb
t4- teat pore
t10- belly butTEN
L1- Ligament 1nginal
L4- on aLL 4s (knee caps)
L5- Largest of 5 toes
S1- small 1 (little toe)
114
Q

Cushing reflex

A

response to increased intracranial pressure (ICP) that results in hypertension and bradycardia

115
Q

Mx of stroke in GP within 7 days

A

High dose aspirin immediately- specialist review within 24 h

116
Q

Cavernous sinus syndrome

A

Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner’s syndrome.

117
Q

intracranial venous thrombosis ix

A

MR venogram

118
Q

parkinsons drug (1st one for motor symptoms affecting qol)

A

levodopa

119
Q

associated with bilateral vestibular schwannomas

A

NF2 (mri cerebellar pontine angle)

120
Q

dementia associated with MND

A

frontotemporal

121
Q

MRC scale

A

Grade 0 No muscle movement
Grade 1 Trace of contraction
Grade 2 Movement at the joint with gravity eliminated
Grade 3 Movement against gravity, but not against added resistance
Grade 4 Movement against an external resistance with reduced strength
Grade 5 Normal strength

122
Q

adenoma sebaceum

A

(angiofibromas): butterfly distribution over nose found in tuberous sclerosis

revision (24 decks)

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