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F year medicine facts > neuro > Flashcards

neuro Flashcards

1
Q

what level does SC (conus medullaris) finish at in foetus

A

s2

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2
Q

what level does SC (conus medullaris finish at in newborns)

A

l3

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3
Q

what level does SC (conus medullaris finish at in adults)

A

l1-l2

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4
Q

where does the dura end in the SC

A

S2

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5
Q

what are the radicular artery levels

A
  • c3, c6,c8, t4-t5, t9-l2
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6
Q

what level is the vertebral artery at

A

c3

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7
Q

what level is the intercostal artery at

A

t4-t5

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8
Q

what level is artery of adamkiewicz and what does it do

A

t9-l2

supplies to cord from t8 to conus

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9
Q

what vessel do the 2 posterior spinal arteries arise from

A

posterior inferior cerebellar artery

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10
Q

which area of posterior spinal cord is most vulnerable to injury and why

A

mid thoracic as has poor blood supply and is a watershed zone

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11
Q

small vessel stroke cause

A
  • HTN and age
  • hyaline arteriosclerosis
  • leads to vascular dementia
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12
Q

vertebrobasilar stroke sx

A
  • dysarthria
  • bilateral weakenedd or sensory loss
  • ataxia
  • diplopia
  • swallowing issues
  • impaired consciousness
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13
Q

what classification system is used for sx of stroke

A
  • bamford
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14
Q

lacunar stroke symproms

A
  • pure motor
  • pure sensory
  • sensorimotor
  • ataxic hemiparesis
  • impacts deep perforators
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15
Q

posterior stroke sx

A
  • cerebellar
  • conjugate eye movement disorder
  • bilaterla motor.sensory
  • ipsilateral cranial nerve palsy with contralateral motor/ sensory deficit
  • cortical blindnedd/ isolated hemianopia
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16
Q

what do you see on eeg for generalised seizures

A
  • spike and wave
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17
Q

what do you see on eeg in status epilepticus

A
  • continuous wave
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18
Q

eeg findings in temporal seizures

A
  • focal cortical spikes
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19
Q

sx temporal seizure

A
  • olfactory/gustatory
  • autamatism
  • jamais vu
  • deja vu
  • emotional disturbance
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20
Q

frontal seizure sx

A
  • jacksonian march
  • dysphasia
  • todds palsy (post ictal weakness)
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21
Q

what can stimulate an absence seizure

A
  • hyperventialtion
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22
Q

hypsarruthmia eeg finding is in which syndrome

A
  • west . / infantile spasms
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23
Q

what is the main rf for hippocampal sclerosis related epilepsy

A
  • childhood febrile convulsions
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24
Q

triggers for juvenile mypclonic epilepsy

A
  • strobe lighting
  • lack of sleep
  • alcohol
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25
Q

CT indications in epilepsy

A
  • adult onset
  • any evidence of focal onset
  • recurrence despire rx 1st line
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26
Q

generalised tonic clonic seizures rx

A
  1. sodium valproate

2. lamotrigine/carbamezapine

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27
Q

focal seizures rx

A
  1. carbemazapine / lamotigine

2. sodium valproate/ keppra

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28
Q

absence seizures rx

A
  1. sodium valproate

2. ethosuximide

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29
Q

atonic seizures rx

A
  1. sodium valproate

2. lamotrigine

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30
Q

myoclonic seizures rx

A
  1. sodium valproate

2. lamotrigine. keppra, topirimate

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31
Q

west syndrome rx

A
  1. pred

2. vigabatrin

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32
Q

SE of sodium valproate

A

HLTTw

  • Hair loss
  • liver disease
  • teratogen
  • tremor ataxia
  • weight gain
  • l
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33
Q

phenytoin SE

A
  • folate and vit d deficiency
  • megaloblastic anaemia
  • osteomalacia
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34
Q

carbamezapine SE

A
  • agranulocytosis
  • asplastic anaaemia
  • cyp450 i
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35
Q

lamotrigine SE

A
  • sjs/dress
  • lEUKOPENIA
  • Blurred vision
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36
Q

ethosuximide SE

A
  • Night terrors

- rashes

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37
Q

Topiramate SE

A
  • Abdo pain
  • agression
  • alopecia
  • anxious
  • confused
  • gi sx
  • movement disorder
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38
Q

CSF findings in bacterial meningitis

A
  • glucose low
  • protein high
  • PMNS
  • high openin pressure
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39
Q

CSF findings in viral meningitis

A
  • glucose normal
  • protein high
  • lymphocytes
  • normal opening pressure
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40
Q

csf findings tb/fungal meningitis

A
  • glucose down
  • protein up
  • lymphocytes
  • high openin gpressure
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41
Q

when to suspect pneumococcal meningitis

A
  • skull fracture
  • ear diseas
    e- congenital cns infection
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42
Q

what should you give before abx if suspect pneumococal meningitis

A
  • dexamethasone
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43
Q

meningitis empirical treatment

A
  • ceftriaxone
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44
Q

cause most common of encephalitis

A
  • hsv –> temporal lobe epilepsy
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45
Q

what are the features you will find in papilloedema

A
  • cotton wool spots
  • blurred optic disk margin
  • small optic cup
  • haemorrhages
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46
Q

medical definition of migraines

A
  • 5 headaches lasting 4-72hrs with N/V/Phono/photophobia + 2of
  • pulsating
  • unilateral
  • impairing
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47
Q

if a patient cannot have propranolol for prophylaxis of migraines, what can they have ?

A

amitryptilline then topirimate

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48
Q

tension type headaches prophylaxis

A
  • amitryptilline
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49
Q

when is botox indicated in chronic migraine

A

= tried at least 3 treatment drugs and failed

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50
Q

cluster headaches prophylaxis

A
  • verapamil 1st

- prednisolone 2nd

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51
Q

trigeminal neuralgia treatment

A
  • carbamezapine

- MRI

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52
Q

rx subarachnoid haemorrhage

A
  • nimodipine

- refer to neurosurgery for coil/clip + angiography

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53
Q

battles sign is indicative of…

A

posterior cranial fossa fracture

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54
Q

indications for CT head in 1h following head injury

A
  • GCS <13 initially or <15 after 2hrs
  • depressed skull fracture
  • open skull fracture
  • echhymoses periorbital
  • postauricular ecchymoses
  • CSF leak
  • haemotympanium
  • post traumatic seizure
  • vomit > 1
  • focal neurological deficit
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55
Q

indications for CT head in 8h if

A
  • Any LOC/ amnesia and any of
  • > 65yrs
  • coagulopathy
  • high impact injury
  • retrograde amnesia >30mins
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56
Q

indications for CT spine in 1h

A
  • GCS <23 initially
  • intubates
  • need dx urgent
  • clinical suspicion and
  • 65+
  • high impact injury
  • focal neuro deficit
  • paraesthesia in UL/LL
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57
Q

what fluid replacement do you not give someone with head injury

A
  • Glucose
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58
Q

medical rx of head injury

A
  • Avoid hypotension and hypoxia
  • hyperventilate after 24hrs to help reduce cp2
  • reduce icp - mannitol
  • csf leaks; abx, vaccines
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59
Q

ping pong gaze indicated what issue

A
  • brainstem lesion
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60
Q

dolls eyes ; eyes remaining fixed when head turned side to side

A
  • brainstem lesion

- surgicla occulomotor palsy

61
Q

papilloedema and subhyaloid retinal heamoorhage = what head injury

A
  • SAh
62
Q

Bilateral midpoint reactive pupils =

A
  • normal or metabolic coma
63
Q

bilateral fixed dilation

A
  • brain death

- deep coma of barbiturates and hypothermia

64
Q

bilateral pinpoint pupils -

A

opiate overdose/ pontine lesions

65
Q

disconjugate eyes =

A

brainstem lesions

66
Q

conjugate gaze deviation =

A
  • away in Frontal eye fields seizure
  • towards in frontal eye fields damge
  • away from lesions in brainstem
  • towards weak limb
67
Q

normal pressure hydrocephalus classical triad

A
  • dementia
  • urine incontinence
  • gait ataxia

DUG

68
Q

reversible causes of dementia

A
  • hypoth
  • b12 deficieny
  • anaemia
  • normal pressure hydrocephalus
69
Q

temporal lobe function

A
  • dominant - language

- non dominant - prosopagnosis

70
Q

alzheimers dementia 4 As for sx

A
  • amnesia
  • apraxia
  • agnosia + anasognosisa
  • aphasia; expressive first
71
Q

what is capgras syndrome

A
  • irrational delusion that someones face has been repalced by an identical one
72
Q

what is MMSE score in severe dementia

A
  • <10
73
Q

signs of raised ICP

A
  • headache
  • altered GCS
  • Papilloedema
  • constricted eyes first then dilate
  • cushing response; BP and low HR
  • peripheral visual field loss
74
Q

what is uncal herniation and what sx are there

A
  • supratentorial mass laterally
  • pushes on ipsilateral inferomedial temporal lobe
  • which pushes on midbrain
  • which compresses 3rd nerve = dilated pupil and ophthalmoplegia
  • and contralateral hemiparesis
75
Q

cerebellar tonsillar herniation - which cranial nerve is affected and what happens to babinski reflex

A
  • 5th

- upgoing plantars

76
Q

what is subfalcinate/cingulate herniation

A
  • pressure on congulate gyrus due to frontal mass. compresses ACA and can cause stroke; contralateral weak legs +/- abulia
77
Q

where does spinothalamic tract decussate

A
  • in spine.

- controls pain and temp

78
Q

where does corticospinal tract decussate

A
  • in medulla for lateral

- uncrossed for anterior

79
Q

where does dorsal column pathway decussate

A
  • in medulla
80
Q

central cord syndrome features

A
  • cape like distribution of burnin sensation - below level of lesion
  • loss of pain and temp at and above level of lesion; spinothalamic tract
81
Q

rx central cord syndrome

A
  • ABCDE
  • Steroids
  • discectomy
  • if c1-c5 tetraplegia; phrenic nerve pacemaker and tracheostomy
  • rehab
82
Q

syringomyelia sx

A

cape like loss of sensation - pain and temp below level of syrinx

83
Q

causes of anterior cord syndrome

A
  • traumatic disc herniation
  • bone fragments
  • vascular; VTE of anterior spinal artery, harmorrhage related compression; AAA surgery, dissection of thoracic aorta
84
Q

anterior cord syndrome symptoms

A

Bilaterla

  • LMN signs at level
  • UMN signs below
  • if at c7 = quadreplegia
  • loss of anterior 2/3rds sensation but preserved dorsal column. especially affected = spinothalamic below
85
Q

posterior cord syndrome causes

A
  • herniation
  • trauma
  • MS
  • tumour
  • ischaemia/ infarct of posterior spinal artery
86
Q

posterior cord syndrome sx

A
  • dorsal column affected

- bilateral

87
Q

sx brown sequard

A
  • ipsilateral loss of joint proprioception and vibration
  • contralateral loss of pain and temp
  • ipsilateral loss o fmotor function; LMN at level. UMN below
  • preserved light touch due ot cortical mapping in multiple paths for this
88
Q

disc prolapse vs lumbar spinal stenosis

A

Pain starts high then lowers in prolapse but to stenosis low goes to high and gets worse

89
Q

lumbar spinal stenosis key feature

A
  • neurogenic claudication; progressive bilatreal leg pain and weakness
90
Q

signs seen in cervical radiculopathy

A
  • Some patients find relief elevating the arm and cupping the back or top of the head with the hand (abduction relief sign)
    • Lhermitte’s sign - electric shock like sensation radiating down the spine
    • Spurling’s sign - radicular pain reproduced when examiner exerts downwards pressure on vertex while tilting head towards symptomatic side. This causes narrowing of intervertebral foramen and possibly increases disc bulge
91
Q

syringomyelia is related to which malformations

A
  • arnold chiari
92
Q

causes of Subarchnoid haemorrhage

A
  • berry aneurysm

- AV malformation(like another path vessel - need to ablate)

93
Q

what are cavernous haemangiomas

A
  • tangle of thin vessels without major blood supply

- can cause haemorrhagae - SAH

94
Q

what is Call flemmin syndrome

A
  • reversible vasoconstriction causing thunderclap headache
95
Q

SAH sign on CT

A
  • star sign in circle of willis
96
Q

subdural haemorrhage sx

A
  • either spontaneous in elderly
  • or after head injury
  • can have some delayed symptoms
  • headache, drowsy etc
97
Q

what does subdural haemorrhage look like on CT

A
  • BANANA
98
Q

What is rx of subdural heamoorhage

A
  • can self resolve

- or surgery

99
Q

extradural haemorrgae symptoms

A
  • lucid interval following loc after head injury
  • then stupor
  • ipsilateral dilated pupil
  • contralateral hemiparesis due to coning

then this leads to bilateral fixed dilation and tetraplegia then resp arrest

100
Q

extradural heamorrhage rx

A
  • surgery ASAP
101
Q

basal ganglia parts

A
  • corpus striatum = caudate and putamen

- lentiform nucleus = globus pallidus and putamen

102
Q

what is neuromyotonia

A
  • peripheral nerve hyperexcitability
103
Q

how does tetanus cause a movement disorder

A
  • blocks GABA at spinal synapses
104
Q

what is stiff person syndrome

A
  • issues with GABA at presynaptic inhibition in the spinal cord
105
Q

define tremor

A
  • oscillatory

- rythymic and regular movements

106
Q

define dystonia

A
  • sustained twisting and frequently repetitice with prolonged abnormal postures, dystonic movement - same group of mucles and patterned
107
Q

define chorea

A
  • involutnary unsustatined abrupt purposeless movement flowing from one body part to another
108
Q

myoclonus definition

A
  • jerks that are sudden, brief, shock like an dinvoluntart. caused by musclar contraction or inhibitions
109
Q

what are tics

A
  • abrupt sudden isolated movement
110
Q

progressive supranuclear palsy sx

A
  • instability with early falls
  • vertical supranucleap gaze palst
  • pseuodbulbar palsy
  • dementia
111
Q

multiple system atrophy sx

A
  • parkinsonism with autonomic sx and ataxia
112
Q

Diagnostic criteria for parkinsons

A
  • TRAP have 2/4 min. if all 4 more likely hospital admissions
  • tremor
  • rigidity
  • akinesia
  • postural instability
113
Q

rx parkinsons

A
  • 1st line
    if QOL affected; Levodopa +/- dopa decarboxylase inhibitor

if QOL not affected; dopamine agonist preferably not ergot derived due to risk of fibrosis

114
Q

chorea causes

A
  • thyrotoxicosis, SLE, Anti phospholipid syndrome, PCV
  • Huntingtons
  • pregnancy, basal ganglia structure disorders, drugs
  • dopamine block
115
Q

GBS rx

A
  • Plasma exchange

- IVIg

116
Q

sx of miller fisher syndrome

A

u cant fish anymore

  • Ataxia
  • Ophthalmoplegia
  • areflexia
117
Q

Multiple sclerosis sx

A

eyes;

  • optic neuritis
  • ophthalmoplegia
  • utthoffs syndrome; worsened vision after rise in body temp

sensory

  • pins and needles
  • lhermitted sign
  • numbness
  • trigeminal neuralgia
spastic weakness
 ataxia
tremor
urinary incontinence
sexual dysfunction 
intellectual impact
118
Q

ix for MS

A
  • FBC, U and E, CRP/ ESR
  • MRI
  • Visual eveoked potentials
  • CSF - oligoclonal bands
119
Q

MS rx in acute relapse

A
  • High dose steroids; helps shorten duration but is not deling with problem
120
Q

MS beta interferon therapy criteria

A
  • Relapsing remitting course with 2 relapses in las t2 yrs and can walk 100m with/out an aid
  • secondary progressive course with 2 relapses in 2years and can walk 10m with/out an aid
  • helps sx
121
Q

other meds used in MS

A
  • glatiremar - acts as immune decoy
  • natalizumab - MAB
  • Fingolimod = stops lymphocytes from leaving LN
  • fatigue; amnatdine after excluding other causes
  • spasticity; gabapentin and baclofen + PT
  • incontinence; USS first. if residual volume = self catheter. if not then anti cholinergic
122
Q

what is the function of the trochlear nerve

A
  • superior oblique motor control
123
Q

optic nerve lesion =

A
  • loss of colour vision
  • RAPD
    as is afferent
  • unilateral blindness +/- scotoma
  • loss of direct reflex
  • dilated pupil
  • consensual eye reflex preserved

if optic neuropathy; pake disc and gradual development of above sx

124
Q

what is holmes adies pupil

A

fixed dilate irregular pupil. slow/no repsonse to bright light
- due to deneervation of ciliary ganglion

125
Q

what is argyll robertson pupil

A

irregular pupil fixed to light but constricts on converfence

126
Q

horners syndrome causes

A

3s, 3t, 4c

Central

  • stroke
  • syringomyelia
  • MS

Pre ganglionic

  • Trauma
  • thyroidectomy
  • Pancoast tumour

post ganglionic

  • Cavernous sinus thrombosis
  • carotid artery dissection
  • carotid aneurysm
  • cluster headahce
127
Q

how to investigate horners syndrome eye problem

A

Hydroxyamphetamine and cocaine test - both usually cause dilation

if preganglionic; then hydroxyamphetamine only will dilate

if post ganglionic only adrenaline will dilate

128
Q

medical vs surgical CN3 palsy

A
  • medical; pupil spared as parasymp fibres run on outside and in MP centre of nerve is affected so can still constrict. painless
  • surgical - fixed and dilate pupil . PCA cause common = compression
    . painful pupil. = hutchinsons pupil
129
Q

CNIV injury sx

A
  • torsional diplopia
130
Q

glossophyaryngela n palsy sx

A
  • deviation of uvula away from lesion side
  • diminished sensation unilaterally on same side of pharynx and post tongue
  • lost gag reflex
  • mild dysphagia
  • throat and ear pain
131
Q

vagus palsy sx

A
  • ipsilateral elevation of soft palate
  • ipsilateral vocal cords and uvula to contralateral side
  • lost gag reflex
  • epiglottitic paralysis; aspiration
  • dysphagia
  • vocal cord paralysis sx
  • gastroperesis
132
Q

hypoglossal palsy which way does tongue deviate

A
  • towards side of lesion
133
Q

what is bulbar palsy

A
  • LMN lesion of CN 9.10.12
  • all sx of LMN signs of 9,10,12 imoact

causes; LMN disease; MND, GB, MG,

134
Q

what is pseudobulbar palsy

A

UMN bilateral lesion in corticobulbar tract with cn 9,10,12

  • umn signs
  • slow thick - hot potato speech
  • emotional liability
  • brisk jaw jerk reflex

causesl in the brain mainly

135
Q

floculonodular lobe function

A
  • balance and eye movements

- also called vestibulocerebellum

136
Q

lateral cerebella aka cerebrocerebella function

A
  • ipsilateral limb coordination
137
Q

vermis/spinocerebellar function

A
  • axial posture and balance
138
Q

what biochemical marker differentiates between a seizure and a pseudoseizure

A

prolacctin

139
Q

4 types of MND

A
  • amyotrophic lateral sclerosis
  • Progressive muscular atrophy
  • progressive pseudibulbar/bulbat palsy
  • primary lateral sclerosis
140
Q

amyotrophic lateral sclerosis features

A
  • UMN and LMN sign

- 1 limb –> other limb –>trunk

141
Q

progressive bulbar/pseudobulbar palsy features

A
  • mouth stuff; dysphagia, dysarthria, tongue fasciculation, slow stiff mvoement, emotional incontnece - random crying in pseudo
142
Q

progressive muscular atrophy features

A
  • LMN only

- best prognosis

143
Q

primary lateral sclerosis sx

A
  • UMN only

- slow progress; tetraparesis + pseudobulbar palsy

144
Q

rx MND

A
  • ALS usually riluzole which blocks glutamate receptors.

- Support

145
Q

myositis sx

A
  • pelvic and shoulder girdle muscle wasting without pain
  • fever
  • weight loss
  • resp failure
  • dysphonia
  • proximal mucles

dermato

  • as above +
  • gottrons papules
  • raynauds
  • periorbital oedema

in kids also get vasculitis and cotnractires

rx= ivig and plasma xchange

146
Q

inclusion body myositis sx

A
  • inflammation
  • men
  • difficult to swallow as weak pharynx
  • progressive distal muscle weak
147
Q

rx MG

A
  • pyrodistogmine = 1. immunesupress = 2

- ivig and plasma xchange for acute

148
Q

LES - lambert sx

A
  • amiframpidine = blocks k+ efflux extending AP

F year medicine facts (19 decks)

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