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Neuro Flashcards

1
Q

Gold-standard investigation for cervical myopathy?

A

MRI of surgical spine

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2
Q

How does cervical spondylotic myopathy present?

A

Over 50 Segmental symptoms Signs in the arms

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3
Q

What often precedes absence seizures?

A

Hyperventilation Stress

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4
Q

Absence seizures - EEG?

A

bilateral, symmetrical 3Hz spike and wave pattern

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5
Q

EEG - bilateral, symmetrical 3Hz spike and wave pattern ?

A

Absence seizures

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6
Q

First line treatment of absence seizures?

A

Sodium valproate + ethosuximide

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7
Q

What classification system is used for stroke?

A

Bamford classification

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8
Q

What criteria are in the Bamford classification for stroke?

A
  1. unilateral hemiparesis +/- hemisensory loss in face, arms, leg 2.
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9
Q

How do you remember which causes which homonymous quadrantanopias?

A

PITS Parietal = Inferior Temporal = Superior

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10
Q

Gold standard test for central venous sinus thrombosis

A

MR venogram

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11
Q

Most common cause of radiculopathy?

A

Disc herniation

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12
Q

Which dermatome supplies medial arm?

A

C8, T1

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13
Q

Which dermatome is lateral arm?

A

C5, C6

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14
Q

Which dermatome is palmar thumb, fingers2 + 3 and half of finger 4?

A

C6 - 8 (radial nerve)

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15
Q

Sensation of radial nerve in hand?

A

Dorsal thumb, fingers 2, 3, and half of 4. Excluding fingertips

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16
Q

Sensation of ulnar nerve in hand?

A

Little finger and half of finger 4

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17
Q

Sensation of median nerve in hand?

A

Palmar thumb, fingers 2 + 3 and half of 4

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18
Q

Most common pattern of progression for MS

A

relapsing-remitting

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19
Q

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?

A

Right third nerve palsy

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20
Q

Hypsarrhythmia on EeG

A

Infantile spasms (West’s syndrome)

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21
Q

When does juvenile myoclonic epilepsy typically present?

A

Teenage

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22
Q

Which nerve is at risk in fracture of surgical head of humerus?

A

Axillary nerve

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23
Q

Causes of facial nerve palsy

A

Alexander Bell with STDz AIDS Lyme disease Bell’s palsy Sarcoid Tumour Diabetes herpes Zoster

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24
Q

What is Bell’s palsy?

A

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

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25
Q

What is the function of the lateral corticospinal tract?

A

Movement of contralateral limbs

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26
Q

Where does the lateral corticospinal tract originate and decussate?

A

Origin - primary motor cortex Decussation - pyramidal at cervicomedullary junction

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27
Q

What is the function of the dorsal column medial lemniscus?

A

Fine touch, vibration, conscious proprioception

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28
Q

Where does the dorsal column medial lemniscus originate and decussate?

A

Origin - Pacini’s and Meissner’s tactiles discs Decussation - arcuate fibers at medulla

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29
Q

What is the function of the spinothalamic tract?

A

Pain, temperature

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30
Q

Where does the spinothalamic tract originate and decussate?

A

Origin - free nerve endings, pain fibres Decussation - ventral white commissure at level of spinal cord

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31
Q

What spinal cord regions are spared in complete occlusion of the anterior spinal artery?

A

Dorsal columns Tract of Lissauer (posterolateral tract)

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32
Q

What are the 4 deadly D’s of posterior circulation strokes?

A

Diplopia Dizziness Dysphagia Dysarthria

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33
Q

MCA stroke can cause CHANGes:

A

Contralateral paresis + sensory loss in face and arm Homonymous hemianopia Aphasia (dominant) Neglect (nondominant) Gaze preference towards side of lesion

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34
Q

Adverse effects of carbamazepine

A

Diplopia, ataxia Liver toxicity + induction of CYP450 Blood dyscrasias

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35
Q

Adverse effects of phenytoin

A

Gingival hyperplasia Anaemia Hirsutism Nystagmus

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36
Q

Appearance of astrocytoma on imaging

A

May cross corpus callosum May have a multicentric appearance with satellite lesions

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37
Q

Most common type of brain tumour in adults

A

Astrocytoma, e.g. gliobastoma multiforme

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38
Q

Main contraindications to thrombolysis

A

Stroke or head trauma in past 3 months Recent MI Major surgery in last 14 days

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39
Q

Common site of a hypertensive brain cleed

A

Basal ganglia and thalamu Small perforator arteries come directly off much larger vessels

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40
Q

Non-neurologic causes of seizuer

A

Hypoglycaemia / hyponatraemia Hyperosmolar states Hepatic encephalopathy Drug overdose / withdrawal

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41
Q

What would be seen in a typical EEG during a grand mal seizure?

A

10-Hz activity during tonic phase and slow waves during clonic phase

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42
Q

What would be seen in a typical EEG during an absence seizure?

A

3-per-second spike-and-wave discharges

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43
Q

What sign is seen in patients with BPPV?

A

Mixed upbeat-transitional nystagmus triggered by changes in head position

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44
Q

When should nystagmus cause concern?

A

>1 minute Gait disturbance Disproportionate N/V Think central lesion

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45
Q

“High risk” factors in patients with acute peripheral vestibulopathy + investigation?

A

Atypical eye findings / neuro signs Cannot stand or have head/neck pain > 50 yr Any risk factor for stroke MRI with diffusion-weighted imaging

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46
Q

Name 2 drugs to avoid in patients with MG

A

aminoglycosides –> inhibit ACh beta blockers / CCBs

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47
Q

What are the 5 A’s of guillain-barre syndrome?

A

Acute inflammatory demyelinating polyradiculopathy Ascending paralysis Autonomic neuropathy Arrhythmias Albuminocytologic dissociation

48
Q

Summary of alzheimer’s disease compared to other dementias

A

Diffuse atrophy w/ enlarged ventricles, senile plaques, and neurofibrillary tangles

49
Q

Features on imaging of NPH

A

Ventricular enlargement

50
Q

EEG in CJD

A

Pyramidal signs + periodic sharp waves

51
Q

Classical triad of NPH

A

Wet, wobbly, and wacky Urinary incontinence Gait apraxia Dementia

52
Q

What is the “Parkinson’s tetrad”?

A

Resting tremor Rigidity Bradykinesia Postural instability

53
Q

Alzheimer’s - features on imaging

A

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

54
Q

How can you differentiate NPH from atrophy on non-contrast CT?

A

Ventricular enlargement WITHOUT sulcal enlargement

55
Q

Features suggesting cerebellar tumour?

A

IPSILATERAL ATAXIA –> tends to fall towards side of lesion + titubation on standing Other –> nystagmus, intention tremor, ipsilateral hypotonia, co-ordination defects

56
Q

How might a cerebellar tumour lead to inc. ICP?

A

Obstruction of CSF flow

57
Q

Gait in muscular dystrophy?

A

Waddling gait due to weakness of gluteal muscles

58
Q

How does pronator drift detect UMN lesion?

A

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

59
Q

What is syringomyelia?

A

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)

60
Q

How does syringomyelia present?

A

Cape distribution loss of pain/temp sensation Preservation of vibration/proprioception –> dissociated sensory loss Areflexic weakness (as progresses to interrupt anterior horn grey matter)

61
Q

What condition is syringomyelia most commonly associated with?

A

Arnold Chiari malformation type I

62
Q

Investigation and treatment of vasospasm in SAH patients?

A

CT angiography is preferred for detecting vasospasm, which can best be prevented with initiation of NIMODIPINE

63
Q

What is the most effective pharmacological treatment of trigeminal neuralgia?

A

Carbamazepine Note –> can cause aplastic anaemia with chronic use

64
Q

Most common cause of lobar haemorrhage

A

Cerebral amyloid angiopathy

65
Q

What is central cord syndrome?

A

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.

66
Q

Seems like GBS but no autonomic dysfunction

A

Tick-borne paralysis –> search for ticks

67
Q

What features of tinnitus would warrant further investigation?

A

Unilateral tinnitus Pulsatile tinnitus

68
Q

Causes of pulsatile tinintus

A

Vascular malformations Pseudotumor cerebri

69
Q

Site of lesion in cauda equina syndrome?

A

Compression of spinal nerve roots below level of L1-L2

70
Q

What does cauda equina innervate?

A

Sensory innervation to saddle area Motor innervation to sphincters Parasympathetic innervation to bladder + lower bowel

71
Q

How does CES usually present?

A

Gradual onset of severe back pain Unilateral radiculopathy Saddle area numbness Hyporeflexia Marked asymmetric lower-extremity weakness

72
Q

Typical features of cerebellar haemorrhage

A

Occipital headache –> neck + shoulders Neck stiffness N/V Nystagmus Ipsilateral hemiataxia

73
Q

Why is the hemiataxia ipsilateral in cerebellar haemorrhage?

A

The corticopontocerebellar fibres decussate twice

74
Q

What location would a haemorrhage cause a left hemineglect?

A

Lobar haemorrhage in right (usually nondominant) parietal lobe

75
Q

What location would a haemorrhage cause pinpoint pupils

A

Large pontine haemorrhage

76
Q

Hemineglect - where is the lesion?

A

Contralateral PARIETAL cortex

77
Q

Receptive aphasia - where is the lesion?

A

Left temporal lobe

78
Q

Visual disturbances - which lobe?

A

Occipital lobe

79
Q

Acute unilateral pure motor hemiparesis - where is the lesion?

A

Lacunar stroke of posterior limb of internal capsule

80
Q

Contraindications to tPA therapy SAMPLE STAGES

A

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

81
Q

CNIII with pupillary involvement is associated with?

A

Berry aneurysms

82
Q

Causes of SAH?

A

Trauma Berry aneuryms AVM Trauma to circle of willis

83
Q

SAH - best investigation?

A

CT w/o contrast

84
Q

Findings on LP in SAH?

A

RBCs, xanthochromia, inc. protein, inc. ICP

85
Q

Conditions associated with berry aneuryms MAKE a SAH

A

Marfan’s Aortic coarctation Kidney disease (ADPKD) Ehlers-Danlos Sickle cell anaemia Atherosclerosis History (familial)

86
Q

Definite treatment of aneurysms

A

Surgical clipping 2nd = endovascular coiling

87
Q

Risk factors for intracranial haemorrhage

A

Hypertension Tumour Anticoagulation Vascular malformations Amyloid angiopathy

88
Q

Cluster headaches - management

A

Initial - avoid stressors / triggers Abortive - oxygen + triptans Prophylactic - prednisolone, lithium, CCBs

89
Q

Restless leg syndrome - Rx?

A

Dopamine agonists, eg. ropinirole

90
Q

Bell’s palsy - Rx?

A

Prednisolone 10 days

91
Q

What is Hoffman’s sign?

A

Flick distal phalanx of (usually) middle finger to cause momentary flexion –> exaggeration flexion of thumb Sign of UMN dysfunction

92
Q

Signs of L5 nerve lesion

A

Weakened dorsiflexion, inversion and eversion of ankle

93
Q

Weakened dorsiflexion, inversion and eversion of ankle - diagnosis?

A

L5 nerve lesion

94
Q

weak dorsiflexion, inversion, and eversion but would also cause weak plantarflexion.- diagnosis?

A

sciatic nerve lesion

95
Q

Weakened plantarflexion + reduced sensation around lateral malleolus - diagnosis?

A

S1 lesion

96
Q

Sensory component of common peroneal nerve?

A

Posterolateral part of leg + knee

97
Q

Motor component of common peroneal nerve?

A

Dorsiflexion + eversion of ankle

98
Q

Migriane prophylaxis

A

Topiramate or propranolol

99
Q

Stroke 2019 guideline changes

A

Thrombectomy within 6 hours for anterior circulation non-harmorrhagic stroke

100
Q

Visual field defect in primary open angle glaucoma

A

Unilateral PERIPHERAL visual field loss

101
Q

Visual field defect in stroke w/ right hemiplegia

A

Right homonymous hemianopia

102
Q

Long-term prophylaxis of cluster headaches?

A

Verapamil

103
Q

Cerebral oedema in pt with brian tumour - Rx?

A

dexamethasone

104
Q

Seizure w/ clonic movements travelling proximally?

A

Jacksonian movement Frontal lobe epilepsy

105
Q

Seizure w/ aura, lip smacking, clothes plucking

A

Temporal lobe epilepsy

106
Q

Seizure w/ visual abnormalities

A

Occipital lobe epilepsy

107
Q

Seizure w/ senory abnormalities

A

Parietal lobe epilepsy

108
Q

Laughter –> fall / collapse

A

Cataplexy

109
Q

Which MND has worst prognosis?

A

Progressive bulbar palsy

110
Q

How do you treat idiopathic intracranial hypertension?

A

Acetazolamide (carbonic anhydrase inhibitor)

111
Q

Parkinson’s + dementia

A

Lewy body dementia

112
Q

GP management of Parkinson’s disease?

A

Refer to neurology but NOT to initiate management

113
Q

Optimal treatment of intracranial aneurysm causing SAH?

A

Coiling by interventional neuroradiologist

114
Q

Treating spasticity in MS

A

Baclofen + gabapentin

115
Q

What is only drug to have shown to improve survival in patients with MND?

A

Riluzole

116
Q

ABCD2 score

A

d

Finals (19 decks)

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