Neuro Flashcards
Gold-standard investigation for cervical myopathy?
MRI of surgical spine
How does cervical spondylotic myopathy present?
Over 50 Segmental symptoms Signs in the arms
What often precedes absence seizures?
Hyperventilation Stress
Absence seizures - EEG?
bilateral, symmetrical 3Hz spike and wave pattern
EEG - bilateral, symmetrical 3Hz spike and wave pattern ?
Absence seizures
First line treatment of absence seizures?
Sodium valproate + ethosuximide
What classification system is used for stroke?
Bamford classification
What criteria are in the Bamford classification for stroke?
- unilateral hemiparesis +/- hemisensory loss in face, arms, leg 2.
How do you remember which causes which homonymous quadrantanopias?
PITS Parietal = Inferior Temporal = Superior
Gold standard test for central venous sinus thrombosis
MR venogram
Most common cause of radiculopathy?
Disc herniation
Which dermatome supplies medial arm?
C8, T1
Which dermatome is lateral arm?
C5, C6
Which dermatome is palmar thumb, fingers2 + 3 and half of finger 4?
C6 - 8 (radial nerve)
Sensation of radial nerve in hand?
Dorsal thumb, fingers 2, 3, and half of 4. Excluding fingertips
Sensation of ulnar nerve in hand?
Little finger and half of finger 4
Sensation of median nerve in hand?
Palmar thumb, fingers 2 + 3 and half of 4
Most common pattern of progression for MS
relapsing-remitting
A 65-year-old male presents with diplopia. Examination reveals a right-sided fixed pupil, ptosis and inability to adduct or supraduct his eye. What is the most likely cause of this presentation?
Right third nerve palsy
Hypsarrhythmia on EeG
Infantile spasms (West’s syndrome)
When does juvenile myoclonic epilepsy typically present?
Teenage
Which nerve is at risk in fracture of surgical head of humerus?
Axillary nerve
Causes of facial nerve palsy
Alexander Bell with STDz AIDS Lyme disease Bell’s palsy Sarcoid Tumour Diabetes herpes Zoster
What is Bell’s palsy?
Complete destruction of the facial nucleus itself or its branchial efferent fibers Peripheral ipsi facial paralysis with inability to close eye on affected side Usually idiopathic
What is the function of the lateral corticospinal tract?
Movement of contralateral limbs
Where does the lateral corticospinal tract originate and decussate?
Origin - primary motor cortex Decussation - pyramidal at cervicomedullary junction
What is the function of the dorsal column medial lemniscus?
Fine touch, vibration, conscious proprioception
Where does the dorsal column medial lemniscus originate and decussate?
Origin - Pacini’s and Meissner’s tactiles discs Decussation - arcuate fibers at medulla
What is the function of the spinothalamic tract?
Pain, temperature
Where does the spinothalamic tract originate and decussate?
Origin - free nerve endings, pain fibres Decussation - ventral white commissure at level of spinal cord
What spinal cord regions are spared in complete occlusion of the anterior spinal artery?
Dorsal columns Tract of Lissauer (posterolateral tract)
What are the 4 deadly D’s of posterior circulation strokes?
Diplopia Dizziness Dysphagia Dysarthria
MCA stroke can cause CHANGes:
Contralateral paresis + sensory loss in face and arm Homonymous hemianopia Aphasia (dominant) Neglect (nondominant) Gaze preference towards side of lesion
Adverse effects of carbamazepine
Diplopia, ataxia Liver toxicity + induction of CYP450 Blood dyscrasias
Adverse effects of phenytoin
Gingival hyperplasia Anaemia Hirsutism Nystagmus
Appearance of astrocytoma on imaging
May cross corpus callosum May have a multicentric appearance with satellite lesions
Most common type of brain tumour in adults
Astrocytoma, e.g. gliobastoma multiforme
Main contraindications to thrombolysis
Stroke or head trauma in past 3 months Recent MI Major surgery in last 14 days
Common site of a hypertensive brain cleed
Basal ganglia and thalamu Small perforator arteries come directly off much larger vessels
Non-neurologic causes of seizuer
Hypoglycaemia / hyponatraemia Hyperosmolar states Hepatic encephalopathy Drug overdose / withdrawal
What would be seen in a typical EEG during a grand mal seizure?
10-Hz activity during tonic phase and slow waves during clonic phase
What would be seen in a typical EEG during an absence seizure?
3-per-second spike-and-wave discharges
What sign is seen in patients with BPPV?
Mixed upbeat-transitional nystagmus triggered by changes in head position
When should nystagmus cause concern?
>1 minute Gait disturbance Disproportionate N/V Think central lesion
“High risk” factors in patients with acute peripheral vestibulopathy + investigation?
Atypical eye findings / neuro signs Cannot stand or have head/neck pain > 50 yr Any risk factor for stroke MRI with diffusion-weighted imaging
Name 2 drugs to avoid in patients with MG
aminoglycosides –> inhibit ACh beta blockers / CCBs
What are the 5 A’s of guillain-barre syndrome?
Acute inflammatory demyelinating polyradiculopathy Ascending paralysis Autonomic neuropathy Arrhythmias Albuminocytologic dissociation
Summary of alzheimer’s disease compared to other dementias
Diffuse atrophy w/ enlarged ventricles, senile plaques, and neurofibrillary tangles
Features on imaging of NPH
Ventricular enlargement
EEG in CJD
Pyramidal signs + periodic sharp waves
Classical triad of NPH
Wet, wobbly, and wacky Urinary incontinence Gait apraxia Dementia
What is the “Parkinson’s tetrad”?
Resting tremor Rigidity Bradykinesia Postural instability
Alzheimer’s - features on imaging
Cortical and subcortical atrophy is seen in patients with later stage disease, although this is only mildly greater when compared to age-matched controls Atrophy may be more prominent in the parietal and temporal lobes, particularly the hippocampi
How can you differentiate NPH from atrophy on non-contrast CT?
Ventricular enlargement WITHOUT sulcal enlargement
Features suggesting cerebellar tumour?
IPSILATERAL ATAXIA –> tends to fall towards side of lesion + titubation on standing Other –> nystagmus, intention tremor, ipsilateral hypotonia, co-ordination defects
How might a cerebellar tumour lead to inc. ICP?
Obstruction of CSF flow
Gait in muscular dystrophy?
Waddling gait due to weakness of gluteal muscles
How does pronator drift detect UMN lesion?
Upper motor neuron lesions cause more weakness in the supinator muscles compared to the pronator muscles of the upper limb. As a result, the affected arm drifts downward and the palm turns (pronates) toward the floor
What is syringomyelia?
fluid-filled cavity in the spinal cord that may represent dilation of the central canal or a separate cavity within the spinal parenchyma. It is usually located within the cervical and thoracic spine but can also involve the brainstem (syringobulbia)
How does syringomyelia present?
Cape distribution loss of pain/temp sensation Preservation of vibration/proprioception –> dissociated sensory loss Areflexic weakness (as progresses to interrupt anterior horn grey matter)
What condition is syringomyelia most commonly associated with?
Arnold Chiari malformation type I
Investigation and treatment of vasospasm in SAH patients?
CT angiography is preferred for detecting vasospasm, which can best be prevented with initiation of NIMODIPINE
What is the most effective pharmacological treatment of trigeminal neuralgia?
Carbamazepine Note –> can cause aplastic anaemia with chronic use
Most common cause of lobar haemorrhage
Cerebral amyloid angiopathy
What is central cord syndrome?
Central cord syndrome may result from hyperextension injuries, particularly in elderly patients with spondylosis. It is characterized by weakness that is more pronounced in the upper extremities than the lower and may be accompanied by a localized deficit in pain and temperature sensation.
Seems like GBS but no autonomic dysfunction
Tick-borne paralysis –> search for ticks
What features of tinnitus would warrant further investigation?
Unilateral tinnitus Pulsatile tinnitus
Causes of pulsatile tinintus
Vascular malformations Pseudotumor cerebri
Site of lesion in cauda equina syndrome?
Compression of spinal nerve roots below level of L1-L2
What does cauda equina innervate?
Sensory innervation to saddle area Motor innervation to sphincters Parasympathetic innervation to bladder + lower bowel
How does CES usually present?
Gradual onset of severe back pain Unilateral radiculopathy Saddle area numbness Hyporeflexia Marked asymmetric lower-extremity weakness
Typical features of cerebellar haemorrhage
Occipital headache –> neck + shoulders Neck stiffness N/V Nystagmus Ipsilateral hemiataxia
Why is the hemiataxia ipsilateral in cerebellar haemorrhage?
The corticopontocerebellar fibres decussate twice
What location would a haemorrhage cause a left hemineglect?
Lobar haemorrhage in right (usually nondominant) parietal lobe
What location would a haemorrhage cause pinpoint pupils
Large pontine haemorrhage
Hemineglect - where is the lesion?
Contralateral PARIETAL cortex
Receptive aphasia - where is the lesion?
Left temporal lobe
Visual disturbances - which lobe?
Occipital lobe
Acute unilateral pure motor hemiparesis - where is the lesion?
Lacunar stroke of posterior limb of internal capsule
Contraindications to tPA therapy SAMPLE STAGES
Stroke / head trauma within last 3 months Anticoagulation with INR > 1.7 or inc. PTT MI (recent) Prior ICH Low platelets <100 Elevated BP (> 185/100) Surgery (in past 14 days) TIA Age <18 GI bleed in past 21 days Elevated (or decreased) glucose Seizures present
CNIII with pupillary involvement is associated with?
Berry aneurysms
Causes of SAH?
Trauma Berry aneuryms AVM Trauma to circle of willis
SAH - best investigation?
CT w/o contrast
Findings on LP in SAH?
RBCs, xanthochromia, inc. protein, inc. ICP
Conditions associated with berry aneuryms MAKE a SAH
Marfan’s Aortic coarctation Kidney disease (ADPKD) Ehlers-Danlos Sickle cell anaemia Atherosclerosis History (familial)
Definite treatment of aneurysms
Surgical clipping 2nd = endovascular coiling
Risk factors for intracranial haemorrhage
Hypertension Tumour Anticoagulation Vascular malformations Amyloid angiopathy
Cluster headaches - management
Initial - avoid stressors / triggers Abortive - oxygen + triptans Prophylactic - prednisolone, lithium, CCBs
Restless leg syndrome - Rx?
Dopamine agonists, eg. ropinirole
Bell’s palsy - Rx?
Prednisolone 10 days
What is Hoffman’s sign?
Flick distal phalanx of (usually) middle finger to cause momentary flexion –> exaggeration flexion of thumb Sign of UMN dysfunction
Signs of L5 nerve lesion
Weakened dorsiflexion, inversion and eversion of ankle
Weakened dorsiflexion, inversion and eversion of ankle - diagnosis?
L5 nerve lesion
weak dorsiflexion, inversion, and eversion but would also cause weak plantarflexion.- diagnosis?
sciatic nerve lesion
Weakened plantarflexion + reduced sensation around lateral malleolus - diagnosis?
S1 lesion
Sensory component of common peroneal nerve?
Posterolateral part of leg + knee
Motor component of common peroneal nerve?
Dorsiflexion + eversion of ankle
Migriane prophylaxis
Topiramate or propranolol
Stroke 2019 guideline changes
Thrombectomy within 6 hours for anterior circulation non-harmorrhagic stroke
Visual field defect in primary open angle glaucoma
Unilateral PERIPHERAL visual field loss
Visual field defect in stroke w/ right hemiplegia
Right homonymous hemianopia
Long-term prophylaxis of cluster headaches?
Verapamil
Cerebral oedema in pt with brian tumour - Rx?
dexamethasone
Seizure w/ clonic movements travelling proximally?
Jacksonian movement Frontal lobe epilepsy
Seizure w/ aura, lip smacking, clothes plucking
Temporal lobe epilepsy
Seizure w/ visual abnormalities
Occipital lobe epilepsy
Seizure w/ senory abnormalities
Parietal lobe epilepsy
Laughter –> fall / collapse
Cataplexy
Which MND has worst prognosis?
Progressive bulbar palsy
How do you treat idiopathic intracranial hypertension?
Acetazolamide (carbonic anhydrase inhibitor)
Parkinson’s + dementia
Lewy body dementia
GP management of Parkinson’s disease?
Refer to neurology but NOT to initiate management
Optimal treatment of intracranial aneurysm causing SAH?
Coiling by interventional neuroradiologist
Treating spasticity in MS
Baclofen + gabapentin
What is only drug to have shown to improve survival in patients with MND?
Riluzole
ABCD2 score
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