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Neuro Flashcards

1
Q

Describe hallmarks of Horners syndrome and causative pathologies

A

Ptosis (drooping eyelid), miosis (constriction pupil) and anhidrosis (decreased sweating on affected side)

May result from carotid artery dissection, tumour in neck, pancoast tumour, brain lesion, trauma.

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2
Q

Symptoms associated with central cord syndrome and cause

A

When at cervical region, Cape like distribution of pain and temp loss, weakness in upper limbs and hand wasting. Decussating fibres at that level are effected, so ventral corticospinal and spinothalamic tracts.

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3
Q

Symptoms of anterior cord syndrome

A

Spinothalamic and corticospinal tracts are affected, and dorsal column is spared. This causes variable sensory and motor presentations including loss of pain, temperature and autonomic function below level of lesion.
SPARING of vibration, proprioception and coarse touch.

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4
Q

Symptoms of posterior cord syndrome

A

Posterior column is affect (only decussate in medulla) so ipsilateral loss of fine touch, vibration, and proprioception.

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5
Q

Symptoms of Brown squared syndrome and what it is

A

Half of the spinal cord is damaged (sagitally), leading to ipsilateral loss of fine touch, vibration and proprioception, and contralateral loss of pain and temp and coarse touch.

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6
Q

Saddle, anaesthesia, fecal and urinary incontinence and neurogenic bladder are symptoms of… (spinal level too pls)

A

Cauda equina syndrome (often L4/5 or L5/S1)

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7
Q

spinothalamic tracts function, location on cord, where decussation of fibres occurs

A

Lateral: pain and temperature
Ventral: coarse touch and pressure
They cross at the level of the cord

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8
Q

Dorsal column location, function and decussation location

A

Fine touch, proprioception, vibration
Posterior location
Cross at the craniocervical junction

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9
Q

Lateral and ventral corticospinal tract location, function, decussation

A

Lateral: motor function located laterally at cord and decussates in brain
Ventral: motor function located anteriorly and decussates at the level of the spinal cord

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10
Q

General pattern of decussation in the spinal cord

A

Anterior tracts; decussate at the level of the cord

Posterior + lateral corticospinal; decussate higher up

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11
Q

Myeloradiculopathy what it is and causes

A

A compression causing damage of spinal nerve roots and spinal cord in the cervical vertebrae. It is often caused by facet osteophytes, disc herniation, ossification if ligaments etc…

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12
Q

Periodic rhythmic ocular oscillation is called

A

Nystagmus

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13
Q

Key features of vestibular nystagmus

A

Horizontal, maximal in direction of gaze, suppresses with fixation

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14
Q

Patient presents with dizziness and vertigo. They have no associated hearing loss, but have been vomiting and are unable to get out of bed. Had a sore throat few days ago. Diagnosis and management?

A

Labyrinthitis. Anti-emetics, vestibular suppressants (for short time) and wait it out.

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15
Q

Patient presents with diziness and vertigo. Episodes last about 1 min, especially when getting out of bed in the morning. They have no other significant history. Investigation and management?

A

Dix-hall pike manoeuvre to investigate. If positive, treat for BPPV by epley manoeuvre

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16
Q

Patient with diziness and vertigo. They have been getting frequent episodes lasting 30min-1h. they know it will come on because feel pressure in side the ear, and feel exhausted afterwards. Also have been suffering from gradual hearing loss, especially low frequencies. Diagnosis and management.

A

Ménière’s disease. To prevent attacks, low salt diet and diuretics. To stop attacks, vestibular suppressant.

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17
Q

Patient presents with dizziness and vertigo. These episodes are associated with certain trigger. she had a hex of migraine but her headaches are not related to episodes of dizziness

A

Vestibular migraine

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18
Q

Sodium valproate use and main side effects

A

First line for generalised seizures. P450 enzyme inducer so beware of interactions, very teratogenic, increased appetite and weight gain.

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19
Q

Carbamazepine use and main side effects

A

first line for focal seizures. P450 inducer, visual disturbance SIADH.

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20
Q

Lamotrigine use

A

Second line for variety of generalised and partial seizures. Can cause stevens Johnson syndrome

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21
Q

Management of status epilepticus

A

IV lorazepam 4mg repeated after 10 min if needed. then phenobarbital or phenytoin. IN community, buccal midazolam/ rectal diazepam

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22
Q

First line investigation in a TIA

A

Carotid Doppler US - required. MRI and CT up to specialist opinion

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23
Q

What to do if suspected TIA

A

Urgent (24h) referral to specialist Center

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24
Q

Post stroke medical management

A

Aspirin 75mg 2 weeks, followed by clopidogrel 75mg and Astor a statin 80mg pn.

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25
Q

Acute stroke management

A

If within 4.5h since onset, give altepase (unless INR>1.7, unknown onset of symptoms, haemorrhagic stroke). And consider mechanical thrombectomy

If altepase contraindicated or >4.5h, give aspirin 300mg and consider mechanical thrombectomy

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26
Q

Contralateral hemiparesis, sensory loss of lower > upper extremities is a stroke involving…

A

The anterior cerebral artery

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27
Q

Contralateral hemiparesis, sensory loss, upper > lower limb involvement, aphasia, contralateral homonymous hemianopia is a stroke involving the…

A

Middle cerebral artery

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28
Q

Contralateral homonymous hemianopia with macular sparing and visual agnosia is a stroke involving the…

A

Posterior cerebral artery

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29
Q

Aphasia due to a lesion of the superior temporal gurus. Fluent speech but sentences make no sense (word substitution and neologisms). Impaired comprehension. What is this and affected artery

A

Wernicke’s (receptive) aphasia. Supplied by inferior division of the left MCA

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30
Q

Non-fluent, laboured and halting speech, normal comprehension

A

Broca’s (expressive) aphasia, due to a lesion to the inferior frontal gyrus, supplied by the superior division of the left MCA.

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31
Q

Fluent speech with poor repition, patient aware of the errors they are making. Normal comprehension

A

Conduction aphasia - classically due to a stroke affecting the connection between wernickes and broca (accurate fascicles).

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32
Q

Severe expressive and receptive aphasia

A

Global aphasia caused by a large lesion affecting broca’s, wernicke’s and arcuate fasciculus.

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33
Q

Difference in CT scans between subdural and extraldural haemorrhage

A

Subdural: banana shaped hyper dense extra axial collection
Extradural: bi-convex shape lemon limited by cranial sutures,

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34
Q

Typical duration of a migraine headache

A

4-72h

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35
Q

First line management of moderate and severe migraine. And what to do if pregnant.

A

Moderate: NSAID 1st line + metoclopramide (anti-emetic) if needed.
Severe: Triptan + metoclopramide

If pregnant, try to avoid triptan and NSAIS, opt for paracetamol instead. + antiemetic.

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36
Q

Preventive management of migraines

A

Topiramate (anti-epileptic, teratogenic), reducing triggers, triptans, propranolol

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37
Q

Tension headache symptoms and cause

A

Ache in the forehead in a band-like patter to back of head. Can be due to facial or skull muscle tension.

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38
Q

45 y old make smoker presents with unbearable unilateral headache 10/10. Focalised around eye. He has eye tearing and nasal congestion. It comes in waves between headache-free periods. Diagnosis and management

A

Cluster headache - high flow 100% O2 for 15-20 min. Consider triptan injection subcutaneous.

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39
Q

Low frequency, rest tremor, unilateral

A

Parkinson’s tremor

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40
Q

Bilateral action tremor, worst with outstretched arms and may get better with alcohol.

A

Essential tremor

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41
Q

Jerky tremor associated with painful, prolonged muscle contractions resulting in abnormal posture (usually arms or head)

A

Dystonic tremor

42
Q

Tremor with sleep issue and visual hallucinations

A

Lewy body dementia

43
Q

Enhanced physiologic tremor

A

Tremor worst in situation of stress, anxiety or excessive caffeine use.. can also be thyrotoxicosis, alcohol withdrawal, phaechromocytoma.

44
Q

Asymmetrical rest tremor, disorder of skilled, learned, purposeful movement, dystonic limb posturing. Family hx

A

Cortical degeneration tremor

45
Q

How to manage extraocular foreign body

A

Topical anaesthetic, remove with needle attached to cotton-tipped applicator. Visualise under slit lamp. Follow up with chloramphenicol.

46
Q

INvestigation in intraocular foreign body

A
  1. CT scan head and orbits. Ophthal can do fluorescein staining. NO MRI.
47
Q

Commonest presentation of painful red eye. Investigation and management

A

Corneal abrasion. Fluorescein stain for best view of abrasion. If <50% SA, send home with chloramphenicol ointment. If >50% of SA affected, mydriatic (tropicamide).

48
Q

Chemical ocular injury management

A

copious irrigation >30min. Check pH.

49
Q

Commonest orbital fracture

A

Blowout fracture involving the orbital floor.

50
Q

Optic neuritis signs

A

Painful vision loss with central scotoma, colour desaturation, RAPD.

51
Q

Investigation of optic neuritis and considerations

A 
MRI: could be a presentation of MS. And do in any case to confirm. 
FBC/ CRP: infection 
ESR: giant cell arthritis 
Serum ACE: elevated in sarcoidosis
ANA: positive in SLE
52
Q

Typical presentation of acute angle closure glaucoma

A

Unilateral vision loss in hypermetropic person, painful eye, headache, mid dilated pupils.

53
Q

First line investigation in angle closure glaucoma

A

Gonioscopy (trabecular meshwork not visible)

54
Q

Primary open angle glaucoma mechanism

A

Due to a progressive ineffectiveness of the trabecular meshwork, causing a progressive increased in IOP and damage to the optic nerve.

55
Q

Symptoms of primary open angle glaucoma. And findings on ophthalmoscope

A

Bilateral progressive loss of peripheral visual field. Shows a cupped optic nerve head with increased cup-disk ratio.

56
Q

First line management of acute retinal vascular occlusion.

A

Ocular massage (15 seconds pressure, then release).

57
Q

2 things that predispose to central retinal vein occlusion

A

Diuretics and oral contraceptives.

58
Q

Painless unilateral incomplete vision loss (usually inferior half of visual field cause)

A

Non-arthritic anterior ischemic optic neuropathy (caused by an occlusion of the short posterior ciliary ateries)

59
Q

Retinal detachment signs

A

Classically floaters, photopsia (flashing lights), partial visual field loss.

60
Q

Investigation for retinal detachement

A

Dilate pupils and perform ophthalmoscopy.

61
Q

Cataract mechanism and symptom

A

Loss of transparency of the crystalline lens over time (related to age quite strongly) leading to a gradual reduction in visual acuity with blurred vision.

62
Q

Age related macular degeneration two presentations and treatments

A

Dry AMD: gradual loss of central vision. No treatment
Wet AMD: acute or semi-acute loss of vision, distorted central vision. More serious and treated with anti-VEGF injections.

63
Q

Oculomotor palsy signs and urgent considerations

A

Down and out gaze, ptosis, mydriasis. Urgent consideration is posterior communicating artery aneurysm (painful unilateral palsy)

64
Q

Conjunctivitis differential between viral and bacteria

A

Viral: usually bilateral, rapid resolution
Bacterial: mucopurulent discharge, unilateral, eyelids stuck together in the morning.

65
Q

Bacteria and virus causing conjunctivitis

A

Bacterial causes include staph aureus, strep pneumo.

Viral causes are usually adenovirus type 3.

66
Q

Keratitis what is it and association

A

A microbial invasion of the cornea. Can progress to blindness, so emergency. Commonly a contact lense user

67
Q

Anterior uveitis associations

A

HLA B27 ankylosis spondylitis, psoriatic arthritis, IBD, reiter syndrome. Chronic disease with idiopathic cause and attacks that can last some time.

68
Q

Management of open angle glaucoma

A

Protaglandin eye drops

Beta blocker eye drops. Important to exclude contraindications to it (asthma, COPD…)

69
Q

4 causes of swollen optic disc

A

Papilloedema (high ICP), raised blood pressure, optic neuritis (e..g MS), anterior ischaemic optic neuropathy (including temporal or giant cell arthritis)

70
Q

Pathophysiology of MS

A

Inflammatory process and immune response to oligodendrocytes and myelin, slowing down nerve conduction.

71
Q

Explain Lhermitte’s and Uhtoff sign

And what pathology

A

Lhermitte’s : electrical sensation going down spine, especially when head is flexed.

Uhtoff’s: worsening of symptoms when body gets overheated or during exercise

Multiple sclerosis

72
Q

Mechanism proposed for guillian barre syndrome

A

Molecular mimicry - antibodies against pathogen also match proteins on nerve cells so they are attacked.

73
Q

Guillian Barre presentation

A

Acute onset symmetrical ascending weakness with a recent infection (gastroenteritis, campylobacter jejuni, CMV, EBV)

74
Q

Signs of an upper motor neuron lesion

A

Up going plantar reflex, hyperreflexia, increased tone, no fasciculations or muscle waisting

75
Q

Signs of lower motor neuron lesion

A

Hyporeflexia, down going plantar reflex, decreased tone, muscle wasting, fasciculations

76
Q

Associated condition with myesthenia gravis,

A

Thymoma - look for thymectomy scar

77
Q

Pathophysiology behind myesthenia gravis

A

ACh receptor antibodies produced which block ACh singnallkng ag neuromuscular junction.

78
Q

Investigations in myesthenia gravis

A

Antibodies test (ACh receptor, musk antibody, LRP4). Tensilon test, lung function test (if low FVC and NIF, indicates myasthenia crisis and consider ventilation)

79
Q

Presentation of keratoconus

A

Late teen/ 20s with astigmatism and myopia, bulging of the lower lid on down gaze

80
Q

Keratocunjlunctivitis main causes

A

Keratoconjunctivitis sicca: inflammation due to dryness
Vernal keratoconjunctivitis: usually due to allergens
Epidemic keratoconjunctivitis: due to adenoviruses

81
Q

Keratitis cause

A

Usually staph aureus, although commonly pseudomonas aeruginosa in contact lense wearers.

82
Q

What does a pancoast tumour cause

A

Hand wasting, weakness in the hand muscles, horners syndrome, sensory loss

83
Q

Nerve affected in foot drop

A

Common perineal nerve

84
Q

Cause of trachoma and treatment

A

Chlamydia trachomatis. Single high dose azithromycin

85
Q

One thing vit a deficiency causes

A

Night blindness

86
Q

Diff between scleritis and episcleritis

A

Episcleritis is usually idiopathic, while scleritis often has a systemic cause. Scleritis presents with deep severe pain and is more serious.

87
Q

Dendritic ulcer treatment

A

Topical acyclovir (herpes simplex)

88
Q

Parietal lobe lesion

A

Inferior homonymous quadrantanopia, sensory in attention, apraxia

89
Q

Occipital lobe lesion

A

Homonymous hemianopia with macula sparing
Cortical blindness
Visual agnosia

Vision things

90
Q

Temporal lobe lesion

A

Wernickes (receptive) aphasia
Superior homonymous quadrantanopia
Auditory issues

91
Q

Frontal lobe lesion

A 
Expressive aphasia (broca’s)
Disinhibition (personality changes)
Anosmia
92
Q

Sciatic nerve damage Sx

A

Foot drop, loss of power be,ow knee, loss of knee flexion,

93
Q

Webber test

A

Unilateral sensorineural hearing loss or unilateral conductive hearing loss through tuning fork on forehead

94
Q

Rinne test

A

Rines test is looking for conductive hearing loss by vibrating next to ear

95
Q

Intention tremor when finger to nose test

A

Cerebellar tremor

96
Q

Retinoblastoma inheritance

A

Autosomal dominant, .8 pénétrante

97
Q

Headache, hypertension, rhinorrhoea

A

Empty sella syndrome

98
Q

Patient with lung cancer, proximal muscle weakness, gets better with movement. Diagnosis and pathophysiology

A

Antibodies against voltage gated calcium channels - lambert Eaton syndrome

99
Q

Posterior communicating artery aneurysm Sx

A

Third nerve palsy, vision loss?

100
Q

Orange halo and grittiness

A

Iron containing corneal foreign body

101
Q

Superior Homonymous quadrantanopia caused by

A

A lesion of inferior optic chiasm in the temporal lobe

102
Q

Inferior Homonymous quadrantanopia is caused by

A

Lesion in superior optic radiation’s of parietal lobe

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