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Neuro Flashcards

1
Q

Pres of frontal lobe lesion?

A
  • Personality change
  • Anosmia
  • Motor aphasia
  • Contralat hemiparesis
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2
Q

Pres of parietal lobe lesion?

A
  • Hemiparesis
  • Atereognosis
  • Inattention (draws half clockface)
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3
Q

Gersmann’s syndrome?

  1. which lobe
  2. 4 features
A
  1. parietal

2. dysgraphia, acalculia, finger agnosia, inability to distinguish L and R side of body

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4
Q

Pres of occipital lobe lesion?

A

contralat homonymous hemianiopia

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5
Q

Pres of midbrain lesion?

A
  • Unequal pupils
  • Inability to move eyes up/down
  • short term amnesia + confabulation
  • Somnolence
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6
Q

Cerebellar lesion?

  1. pres
  2. causes
A
  1. DANISH [dysdiadochokinesia, ataxia, nystagmus, intention tremor + dysmetria, staccato speech]
  2. CVE, SOL, infection, wernickes
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7
Q

Cerebellar pontine angle

  1. which tumour here
  2. pres
A
  1. Acoustic neuroma

2. ipsilat deafness/tinnitus, facial/trigeminal palsy, cerebellar

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8
Q

Vision in X –> lesion

  1. R optic nerve
  2. optic chiasm (central)
  3. R optic tract
A
  1. blindness of R eye
  2. bipolar hemianopia
  3. left homonymous hemianopia
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9
Q

GCS /15

A

BEM /4
BVR /5
BMR /6

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10
Q

DDx of headache

A
  • Subarachnoid
  • migraine
  • meningitis/encephalitis
  • tension
  • medication-induced
  • GCA
  • raised ICP
  • CVE/TIA
  • IIH
  • Cervical spondylosis
  • glaucoma
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11
Q

Red flags of headache

A
  • Change in pattern
  • New onset >50yo
  • Seizures
  • Systemic illness
  • Personality change
  • Worst headache ever
  • scalp tenderness/jaw claudication
  • focal neuro signs
  • raised ICP eg vomiting
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12
Q

Triad of meningism

  1. symptom
  2. signs
A
  1. headache, photophobia, nuchal rigidity
  2. kernigs [hip flexion + knee extension = pain]
    Brudzinski [lift head off couch = invol lifting of legs]
    Nuchal rigidity [inability to flex neck]
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13
Q

Meningitis

  1. rfs
  2. usual cause
  3. non infective
A
  1. CSF shunt, spinals, DM, EtOH, IVDU, malignancy
2. Viral [mumps, HSV, HIV]
Fungal [crytococcus]
Bacterial [neonate=GBS, 
young children= HIb,
adults= S.pneumoniae, HIb, N.meningitidis
immunocomp=listeria]
  1. malignancy, sarcoid, SLE
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14
Q

Pres of meningitis

A
  • meningism
  • fever
  • bulging fontanelle
  • opisthotonos
  • altered mental state
  • shock
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15
Q

Ix in menigitsi

A
  • LP
  • bloods [FBC, CRP, culture, coag, U+E, ABG]
  • urine, nasal swab, stool culture
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16
Q

Sx of raised ICP

A
  • vomiting
  • reduced consciousness
  • headache
  • fits
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17
Q

CI to LP

A
  • raised ICP
  • shock
  • Coag abnorm
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18
Q

Complications of LP

A
  • post LP headache
  • infection
  • bleeding
  • herniation
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19
Q

Mx of meningitis

A
  • fluids, antipyretic, antiemetic
  • Meningococcus –> IV ceftriaxone
  • Pneumococci –> vancomycin + ceftriaxone
  • GBS –> IV cefotaxime
  • Listeria –> IV amox + gent

+dexamethasone in children

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20
Q

Comps of meningitis

A
  • sepsis, septic shock, DIC
  • seizures, coma, raised ICP
  • septic arthritis
  • haemolytic anaemia
  • SIADH
  • deafness
  • Friedrichsen-Waterhouse
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21
Q

Prevention of meningitis

A
  • vaccination

- Prophylaxis –> ciprofloxacin/rifampicin

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22
Q

Meningococcal septicaemia
1. usual organism
2 type

A
  1. Neisseria meningitidis
  2. Gram -ve diplococcus
    [often found in nasopharynx]
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23
Q
  1. Pres of meningococcal septicaemia

2. pres hosp mx

A
  1. non-blanching petechial rash + sepsis

2. IV/IM benpen

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24
Q

Meningococcal septicaemia Ix

A
  • Blood cultures
  • FBC, U+E, LFT, CRP
  • Coag
  • LP +/- CT
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25
Q

Hospital mx of meningococcal septicaemia

A

-Resus
-<3m [cefotaxime + amoxicillin]
>3m [ceftriaxone]

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26
Q

Comps of meningococcal septicaemia

A
  • seizure
  • raised ICP
  • DIC
  • adrenal failure (F-W syndrome)
  • deafness
  • hydrocephalus
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27
Q

Encephalitis

  1. what
  2. usual cause
  3. pres
A
  1. inflam of brain parenchyma
  2. HSV
  3. headache, altered mental state, seizures
    [in neonate –> + lethargy, irritable, poor feeding, bulging fontanelle]
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28
Q

Encephalitis

  1. ix
  2. mx
  3. risk
  4. comps
A
  1. bloods, CT head, LP (+PCR), EEG, MRI
  2. IV aciclovir
  3. IV fluids good but risk of cerebral oedema
  4. SIADH, DIC, cardiac arrest, epilepsy, personality change
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29
Q

SAH

  1. causes
  2. RF
  3. pres
A
  1. berry aneurysm, AV malform, vasculitis
  2. HTN, smoking, cocaine, ADPKD, Ehlers-Danos, Marfans, NF
  3. sudden onset severe headache, vom, confusion, seizure
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30
Q

Places for berry aneurysm?

A
  • junction of AComA + ACA
  • bifurcation of MCA
  • junction of PComA + IC
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31
Q

Signs of SAH

A
  • meningism (6hr post headache)
  • altered GCS
  • Intaoccular haemorrhage
  • focal neuro
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32
Q

ix for SAH

A
  • CT Head (non-contrast)
  • LP [xanthocromia after 12h]
  • cerebral angiography
  • ECG
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33
Q
  1. Where is CSF prod?
  2. Which layer of meninges?
  3. Absorbed where?
A
  1. choroid plexus in Vs
  2. flows into subarachnoid space
  3. dural venous sinuses
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34
Q

mx of SAH

A
  • resus
  • nimodipine
  • labetalol
  • coiling / clipping
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35
Q

comps of SAH

A
  • rebleeding
  • ischaemia
  • hydrocephaleus
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36
Q

raised ICP causes

A
  • neoplasm
  • haematoma
  • oedema
  • hydrocephalus
  • cerebral venous thrombosis
  • idiopathic intracranial hypertension
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37
Q

mets to brain from where

A
  • lung
  • breast
  • colon
  • melanoma
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38
Q

pres of raised ICP

A
  • headache (worse on waking / coughing / bending forward)
  • papilloedema
  • vomiting (no nausea)
  • altered mental state
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39
Q

ICP

  1. ix
  2. mx
A
  1. CT/MRI

2. resus, anticonvulsant, CSF drainage, analgesia, sedation, mannitol

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40
Q

Cause of extradural haematoma

A
  • fracture of temporal/parietal bone

- causing damage to middle meningeal artery

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41
Q

pres of extradural

A
  1. trauma + LOC
  2. lucid interval
  3. deterioration

headache, N+V, seizures, CSF otorrhoea/rhinorrhoea, altered GCS

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42
Q

extradural

  1. ix
  2. mx
A
  1. bloods, XR skull, CT head

2. resus, mannitol , clot evacuation (craniotomy)

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43
Q

Subdrual haematoma

  1. usual cause
  2. pres
  3. chronic
A
  1. tear in bridging vein
  2. acute, decreasing GCS –> LOC
  3. gradual decline, headache, can be aSx
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44
Q

subdural

  1. ix
  2. mx
  3. comps
A
  1. CT non contrast, FBC, U+E, LFT, coag
  2. resus, clot evacuation
  3. raised ICP, oedema, recurrence, seizures,
45
Q

Migraine triggers

A 
CHeese
OCP
Caffeine
AlcohOl
Anxiety
Travel
Exercise
46
Q

Types of migraine (5)

A
  1. w/ aura
  2. w/o aura
  3. migraine aura w/o headache
  4. hemiplegic
  5. menstrual
47
Q

pres of migraine

A
  • fatigue, irritable
  • aura in 1/3 [visual, somatosensory, paraesthesia]
  • headache = u/l, pulsating, severe 4-72h
  • photo/phonophobia
48
Q

migraine

  1. acute mx
  2. prophylaxis
A
  1. triptan

2. propanolol/topiramate

49
Q

CI to triptan

A
  • uncontrolled HTN, angina

- triptan = 5-hydroxytryptamine agonist

50
Q

how many migraines before prophylaxis

A

> =2 attacks/month

medication >2d/w

51
Q

COCP CI in migraine?

A

risk of ischaemic stroke in migraine with aura

52
Q

Cluster headache

  1. who
  2. pres
  3. acute mx
  4. prophylaxis
A
  1. young men (smokers)
  2. headache, sharp, around eye + autonom fts, restless
  3. O2 + SC triptan
  4. verapamil
53
Q

Tension headache

  1. pres
  2. mx
A
  1. headache, b/l like band

2. NSAID / pcm, amitriptyline

54
Q

Trigeminal neuralgia

  1. what
  2. who in
  3. pres
  4. ix
  5. mx
A
  1. neuropathic disorder of trigeminal nerve
  2. F 50-60y
  3. sudden sharp/shock like, facial pain ‘tic doloureux’
  4. MRI r/o 2dary cause
  5. carbamazepine
55
Q

GCA

  1. pathology
  2. who in
  3. pres
  4. ix
  5. mx
  6. comps
A
  1. vasculitis (m,l)
  2. > 60 yo
  3. headache severe, scalp tenderness, jaw claudication, visual disturbance
  4. ESR, CRP, temporal artery biopsy
  5. prednisolone high dose
  6. loss of vision
56
Q

mx of TIA

A
  • aspirin 300mg
  • statin
  • carotid endartectomy
  • no driving for 1m
57
Q

signs of stroke

  1. ischaemic
  2. haemorrhagic
A
  1. carotid bruit, AF, hx of TIA

2. meningism, severe headache, coma

58
Q

mx of stroke

  1. acute
  2. LT
A
  1. o2, glucose, bp
    ischaemic [aspirin 300, clopidogrel 75, alteplase in 4.5h, thrombectomy in 6h]
  2. 2dary prevention
59
Q

prevention of stroke

A
  • lifestyle
  • BP
  • AF - anticoag
  • aspirin/clopidogrel/dipyridamole
  • statin
60
Q

Cause of delirium

A
  • acute infection
  • drugs (inc withdrawal)
  • post-op
  • vascular (CVE, IHD)
  • metabollic (hypoxia, glycaemia, hypercalcaemia)
  • Vit deficiency
  • endo
  • trauma
  • malignancy
61
Q

pres of delirium

A

-acute onset + fluctating course
-DELIRIUM
Disordered thinking
Euphoric/fearful
Language (gabbling, rpt)
Illusions/delusion/hallucination
Reversal of sleep/wake
Inattention
Unaware
Memory deficit

62
Q

2 types of delirium

A
  • Hypoactive (apathy, quiet, confusion)

- Hyperactive (agitation, delusion, disoreintation)

63
Q

Delirium

  1. ix
  2. mx
A
  1. bloods, urine dip, blood culture, ecg, cxr

2. supportive, environmental, stop drugs

64
Q

groups of sx in dementia (3)

A
  • Cognitive impairment [ST memory, language, attention, orientation]
  • Psych disturb [depression, delusion, hallucination]
  • Difficulty with ADLs [driving, dressing etc]
65
Q

Dementia

  1. assessment
  2. ix
  3. mx
A
  1. GPCOG, MMSE, AMT
  2. bloods, CXR, MRI head
  3. Advanced directives, LPAs, therapy, routines, palliative care,
    benzos in challenging behaviour
66
Q

Alzheimers pathology

A
  • progressive degen of cerebral cortex –> widespread cortical atrophy
  • beta amyloid plaques
  • neurofibrillary tangles
67
Q

RF for dementia

A
  • age
  • FH
  • head injury
  • vascular RFs
68
Q

Pres of dementia

  1. early
  2. later
  3. late
A
  1. ST memory loss, difficulty finding words
  2. apraxia, confusion
  3. disorientation, apathy, depression, disinhibition, aggression
69
Q

Ddx of dementia

A
  • normal ageing
  • NPH
  • PD
  • hypothyroid
  • Vit B12 deficiency
  • Depression
  • delirium
70
Q

Ix in dementia

A
  • MRI

- HMPAO SPECT (differentiate AD vs VD vs FTD)

71
Q

Vascular Dementia

  1. pathology
  2. cause
  3. RF
A
  1. cognitive impairment due to ischaemia from CVD
  2. stoke related (multiple tiny infarcts
  3. hx of stroke/TIA, HTN, DM, smoking, obesity
72
Q

Vascular demntia

  1. diagnosis
  2. ix
  3. mx
A
  1. based on clinical/brain imaging. Stepwise decline
  2. MRI
  3. adress CVRFs, donepezil/galatamine
73
Q

Dementia with Lewy-Bodies

  1. pathology
  2. pres
  3. ix
  4. mx
A
  1. LB = eosinophilic intracytoplasmic neuronal inclusino
  2. fluctating attention, visual hallucinations, parkinsonism
  3. Spect scan. MIBG scintography
  4. rivastigmine
74
Q

Fronto-temporal dementia

  1. pathology
  2. assos
  3. pres
  4. ix
  5. mx
A
  1. frontal+temporal lobe atrophy, Tau inclusions in cells
  2. PSP, CBD, MND
  3. disinhibition, loss of vocab, progressive aphasia, parkinsonism
  4. MRI
  5. dementia mx
75
Q

Parkinsonism

  1. pres (triad)
  2. other sx
  3. causes
A
  1. tremor, rigidity, bradykinesia
  2. mask-like face, shuffling gait, anosmia, depression
  3. idiopathic, DLB, PSP, MSA, CBD, drugs [antipsychotic, metoclopramide]
76
Q

IPD

  1. pres
  2. pathology
  3. RF
  4. dx
A
  1. insidious, u/l onset, parkinsonism, depression, dementia
  2. reduced dopamine in SN
  3. age, male,
  4. bradykinesia, rigidity, tremor (resting, 4-5Hz), post instab
77
Q

DDx of Parkinson’s

A
  • Benign essential tremor (worse on movement, less at rest)
  • Drug induced
  • HD, WD, vascular
  • Parkinson’s plus
78
Q

Parkinson’s plus conditions + feature

A 
VIVID 
Visual hallucinations (LBD)
Incontinence (MSA)
Vertical gaze palsy (PSP)
Interference (CBD)
DM
79
Q

Parkinson’s ix

A
  • trial dopaminergic agent

- transcranial sonography

80
Q

Parkinsons mx

A
  • MDT
  • Pharma [carbidopa, ropinirole, selegiline]
  • surgery / DBS
81
Q
  1. Comps of PD

2. comps of L-dopa

A
  1. infections, aspiration pneumonia, pressure sores, falls, depression, dementia
  2. wearing off, on-off, dyskinesias
82
Q

Normal Pressure Hydrocephalus

  1. triad
  2. ix
  3. mx
A
  1. urinary incontinence, gait abnorm (magnetic), dementia (reversible!!)
  2. MRI/CT, CSF tap test
  3. Pharma [acetazolamide], Surgery [VP shunt]
83
Q

Huntington’s

  1. pathology
  2. age of onset
  3. pres
  4. ix
  5. mx
A
  1. Autosomal dominant, chromosome 4, CAG rpts
  2. 30-50yo
  3. Early [personality change, apathy, clumsiness, depression]
    later [chorea, parkinsonism, dementia, dysarthria/phagia]
  4. r/o SLE, WD, TFT. MRI/CT, genetic testing
  5. chorea–> benzo
84
Q

Initial stroke management

A
  • ABCDE
  • Neuro imaging
  • Haemorrhagic –> control BP, nimodipine, consider surgery
  • Ischaemic –> aspirin 300mg (2w), thrombolysis in 4.5h, thrombectomy in 6h
85
Q

Topiramate consideration

A

teratogenic –> contraception/alternate if of child bearing age

86
Q

Epilepsy ix

A

EEG (+video=gold standard), MRI, ECG

87
Q

Epilepsy 1st line mx

  1. focal seizures
  2. GTC seizures
  3. absence seizures
  4. myocloinc seizures
  5. tonic
  6. other mx points1
A
  1. carbamazepine/lamotrigine
  2. sodium valproate
  3. ethosuximide
  4. sodium valproate
  5. sodium valproate
  6. ketogenic diet, surgery
88
Q

considerations for sodium valproate

A

teratogenic

89
Q

CI in absence seizures

A

carbamazepine

90
Q

Status Epilepticus

  1. 1st line
  2. 2nd line
  3. if in hospital
A
  1. buccal midazolam
  2. rectal diazepam
  3. IV lorazepam
91
Q

Dorsal column

  1. function
  2. decussation
  3. deficit –>
A
  1. Sensory [vibration, proprioception, light touch, 2-point discrim]
  3. . tingling, clumsiness, numbness, electric shock like, position and vibration sense lost
92
Q

Lateral spinothalamic tract

  1. function
  2. decussation
  3. deficit –>
A
  1. Sensory [crude touch, pain, temp]
  2. synapse with dorsal horn in cord, cross within cord
  3. contralat loss of pain + temp
93
Q

Corticospinal tract

  1. function
  2. decussation
  3. deficit –>
  4. aka
A
  1. Motor
  2. cerebral cortex to IC, cross in medulla to anterior horn cell
  3. ipsilateral spastic paresis below the lesion
  4. pyramidal / UMN
94
Q

UMN lesion signs

A
  • pronator drift
  • weakness
  • hypertonia
  • hyperreflexia
  • +ve babinski
95
Q

LMN lesion signs

A

-muscle wasting
-fasciculation
-

96
Q

Guillain-Barre

  1. what
  2. pres
  3. ix
  4. mx
A
  1. acute inflam demyelinating polyradiculopathy (AI to peripheral nerves)
  2. symmetrical ascending muscles weakness (3w post infection)
  3. NCS, LP (raised protein), spirometry if resp involvement [?ITU]
  4. O2, IVIg, SC heparin
97
Q

Myasthenia Gravis

  1. what
  2. pres
  3. signs
  4. ix
  5. mx
A
  1. Anti-AChR antibodies [+/- Anti-MuSK], thymic hyperplasia in 70%
  2. weakness and fatiguability of muscles [ocular, bulbar, proximal], no pain
  3. ptosis, diplopia, snarl, peek sign
  4. NCS, Anti-AChR, Anti-MuSK, CT thorax
  5. Pyridostigmine +/- thymectomy
98
Q

Trigeminal neuralgia

  1. what
  2. ix
  3. mx
A
  1. knife-like pain in distribution of trigem nerve
  2. MRI to r/o 2dary cause
  3. carbamazepine +/- surg decomp
99
Q

GCA

  1. what
  2. pres
  3. ix
  4. mx
A
  1. vasculitis (m,l)
  2. headache, scalp tenderness, jaw claud
  3. ESR, CRP, temporal artery biopsy
  4. prednisolone high dose
100
Q

Cerebellum

  1. function
  2. cause of dysfunction
  3. mx
A
  1. coordinator for all movements (IPSILATERALLY)
  2. infarct, MS, alcohol, compression
  3. treat cause + involve: SALT, physio, OT
101
Q

Jacksonian seizure

A

Partial seizure in motor cortex

102
Q

Pseudo seizure features

A
  • hip thrusting
  • tiring + restarting
  • awareness
103
Q

Driving in epilepsy

A
  • must be seizure free for 1y

- for HGV - seizure free + off meds for 10y

104
Q

4 types of MND

A
  1. ALS [UMN + LMN]
  2. Prog bulbar palsy [CN VII - XII]
  3. prog muscular atrophy [pure LMN]
  4. Primary lateral sclerosis [pure UMN]
105
Q
  1. Bulbar palsy features

2. psuedobulbar palsy

A
  1. muscles of speech, chewing, swallowing –> flaccid, fasciculating tongue
  2. tongue paralysed, no fasciculations
106
Q

Rare forms of MND

  1. PMA
  2. PLS
A
  1. progressive muscular atrophy [wasting, often small muscles of hand; starts u/l –> quick progress to b/l]
  2. primary lateral sclerosis [weakness, spasticity]
107
Q

MND

  1. ix
  2. mx
  3. mx for drooling
  4. mx for spasticity
A
  1. evidence of mixed UMN/LMN, NCS
  2. Conservative [resp support, OT/SALT, ?PEG]
    Pharma [antidepressants, riluzole (slows progress)]
  3. hyoscine
  4. baclofen
108
Q

4As of Alzheimers

A
  • apraxia
  • amnesia
  • agnosia
  • aphasia

Finals (20 decks)

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