neuro Flashcards
what level does SC (conus medullaris) finish at in foetus
s2
what level does SC (conus medullaris finish at in newborns)
l3
what level does SC (conus medullaris finish at in adults)
l1-l2
where does the dura end in the SC
S2
what are the radicular artery levels
- c3, c6,c8, t4-t5, t9-l2
what level is the vertebral artery at
c3
what level is the intercostal artery at
t4-t5
what level is artery of adamkiewicz and what does it do
t9-l2
supplies to cord from t8 to conus
what vessel do the 2 posterior spinal arteries arise from
posterior inferior cerebellar artery
which area of posterior spinal cord is most vulnerable to injury and why
mid thoracic as has poor blood supply and is a watershed zone
small vessel stroke cause
- HTN and age
- hyaline arteriosclerosis
- leads to vascular dementia
vertebrobasilar stroke sx
- dysarthria
- bilateral weakenedd or sensory loss
- ataxia
- diplopia
- swallowing issues
- impaired consciousness
what classification system is used for sx of stroke
- bamford
lacunar stroke symproms
- pure motor
- pure sensory
- sensorimotor
- ataxic hemiparesis
- impacts deep perforators
posterior stroke sx
- cerebellar
- conjugate eye movement disorder
- bilaterla motor.sensory
- ipsilateral cranial nerve palsy with contralateral motor/ sensory deficit
- cortical blindnedd/ isolated hemianopia
what do you see on eeg for generalised seizures
- spike and wave
what do you see on eeg in status epilepticus
- continuous wave
eeg findings in temporal seizures
- focal cortical spikes
sx temporal seizure
- olfactory/gustatory
- autamatism
- jamais vu
- deja vu
- emotional disturbance
frontal seizure sx
- jacksonian march
- dysphasia
- todds palsy (post ictal weakness)
what can stimulate an absence seizure
- hyperventialtion
hypsarruthmia eeg finding is in which syndrome
- west . / infantile spasms
what is the main rf for hippocampal sclerosis related epilepsy
- childhood febrile convulsions
triggers for juvenile mypclonic epilepsy
- strobe lighting
- lack of sleep
- alcohol
CT indications in epilepsy
- adult onset
- any evidence of focal onset
- recurrence despire rx 1st line
generalised tonic clonic seizures rx
- sodium valproate
2. lamotrigine/carbamezapine
focal seizures rx
- carbemazapine / lamotigine
2. sodium valproate/ keppra
absence seizures rx
- sodium valproate
2. ethosuximide
atonic seizures rx
- sodium valproate
2. lamotrigine
myoclonic seizures rx
- sodium valproate
2. lamotrigine. keppra, topirimate
west syndrome rx
- pred
2. vigabatrin
SE of sodium valproate
HLTTw
- Hair loss
- liver disease
- teratogen
- tremor ataxia
- weight gain
- l
phenytoin SE
- folate and vit d deficiency
- megaloblastic anaemia
- osteomalacia
carbamezapine SE
- agranulocytosis
- asplastic anaaemia
- cyp450 i
lamotrigine SE
- sjs/dress
- lEUKOPENIA
- Blurred vision
ethosuximide SE
- Night terrors
- rashes
Topiramate SE
- Abdo pain
- agression
- alopecia
- anxious
- confused
- gi sx
- movement disorder
CSF findings in bacterial meningitis
- glucose low
- protein high
- PMNS
- high openin pressure
CSF findings in viral meningitis
- glucose normal
- protein high
- lymphocytes
- normal opening pressure
csf findings tb/fungal meningitis
- glucose down
- protein up
- lymphocytes
- high openin gpressure
when to suspect pneumococcal meningitis
- skull fracture
- ear diseas
e- congenital cns infection
what should you give before abx if suspect pneumococal meningitis
- dexamethasone
meningitis empirical treatment
- ceftriaxone
cause most common of encephalitis
- hsv –> temporal lobe epilepsy
what are the features you will find in papilloedema
- cotton wool spots
- blurred optic disk margin
- small optic cup
- haemorrhages
medical definition of migraines
- 5 headaches lasting 4-72hrs with N/V/Phono/photophobia + 2of
- pulsating
- unilateral
- impairing
if a patient cannot have propranolol for prophylaxis of migraines, what can they have ?
amitryptilline then topirimate
tension type headaches prophylaxis
- amitryptilline
when is botox indicated in chronic migraine
= tried at least 3 treatment drugs and failed
cluster headaches prophylaxis
- verapamil 1st
- prednisolone 2nd
trigeminal neuralgia treatment
- carbamezapine
- MRI
rx subarachnoid haemorrhage
- nimodipine
- refer to neurosurgery for coil/clip + angiography
battles sign is indicative of…
posterior cranial fossa fracture
indications for CT head in 1h following head injury
- 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
indications for CT head in 8h if
- Any LOC/ amnesia and any of
- > 65yrs
- coagulopathy
- high impact injury
- retrograde amnesia >30mins
indications for CT spine in 1h
- GCS <23 initially
- intubates
- need dx urgent
- clinical suspicion and
- 65+
- high impact injury
- focal neuro deficit
- paraesthesia in UL/LL
what fluid replacement do you not give someone with head injury
- Glucose
medical rx of head injury
- Avoid hypotension and hypoxia
- hyperventilate after 24hrs to help reduce cp2
- reduce icp - mannitol
- csf leaks; abx, vaccines
ping pong gaze indicated what issue
- brainstem lesion
dolls eyes ; eyes remaining fixed when head turned side to side
- brainstem lesion
- surgicla occulomotor palsy
papilloedema and subhyaloid retinal heamoorhage = what head injury
- SAh
Bilateral midpoint reactive pupils =
- normal or metabolic coma
bilateral fixed dilation
- brain death
- deep coma of barbiturates and hypothermia
bilateral pinpoint pupils -
opiate overdose/ pontine lesions
disconjugate eyes =
brainstem lesions
conjugate gaze deviation =
- away in Frontal eye fields seizure
- towards in frontal eye fields damge
- away from lesions in brainstem
- towards weak limb
normal pressure hydrocephalus classical triad
- dementia
- urine incontinence
- gait ataxia
DUG
reversible causes of dementia
- hypoth
- b12 deficieny
- anaemia
- normal pressure hydrocephalus
temporal lobe function
- dominant - language
- non dominant - prosopagnosis
alzheimers dementia 4 As for sx
- amnesia
- apraxia
- agnosia + anasognosisa
- aphasia; expressive first
what is capgras syndrome
- irrational delusion that someones face has been repalced by an identical one
what is MMSE score in severe dementia
- <10
signs of raised ICP
- headache
- altered GCS
- Papilloedema
- constricted eyes first then dilate
- cushing response; BP and low HR
- peripheral visual field loss
what is uncal herniation and what sx are there
- supratentorial mass laterally
- pushes on ipsilateral inferomedial temporal lobe
- which pushes on midbrain
- which compresses 3rd nerve = dilated pupil and ophthalmoplegia
- and contralateral hemiparesis
cerebellar tonsillar herniation - which cranial nerve is affected and what happens to babinski reflex
- 5th
- upgoing plantars
what is subfalcinate/cingulate herniation
- pressure on congulate gyrus due to frontal mass. compresses ACA and can cause stroke; contralateral weak legs +/- abulia
where does spinothalamic tract decussate
- in spine.
- controls pain and temp
where does corticospinal tract decussate
- in medulla for lateral
- uncrossed for anterior
where does dorsal column pathway decussate
- in medulla
central cord syndrome features
- cape like distribution of burnin sensation - below level of lesion
- loss of pain and temp at and above level of lesion; spinothalamic tract
rx central cord syndrome
- ABCDE
- Steroids
- discectomy
- if c1-c5 tetraplegia; phrenic nerve pacemaker and tracheostomy
- rehab
syringomyelia sx
cape like loss of sensation - pain and temp below level of syrinx
causes of anterior cord syndrome
- traumatic disc herniation
- bone fragments
- vascular; VTE of anterior spinal artery, harmorrhage related compression; AAA surgery, dissection of thoracic aorta
anterior cord syndrome symptoms
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
posterior cord syndrome causes
- herniation
- trauma
- MS
- tumour
- ischaemia/ infarct of posterior spinal artery
posterior cord syndrome sx
- dorsal column affected
- bilateral
sx brown sequard
- 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
disc prolapse vs lumbar spinal stenosis
Pain starts high then lowers in prolapse but to stenosis low goes to high and gets worse
lumbar spinal stenosis key feature
- neurogenic claudication; progressive bilatreal leg pain and weakness
signs seen in cervical radiculopathy
- 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
syringomyelia is related to which malformations
- arnold chiari
causes of Subarchnoid haemorrhage
- berry aneurysm
- AV malformation(like another path vessel - need to ablate)
what are cavernous haemangiomas
- tangle of thin vessels without major blood supply
- can cause haemorrhagae - SAH
what is Call flemmin syndrome
- reversible vasoconstriction causing thunderclap headache
SAH sign on CT
- star sign in circle of willis
subdural haemorrhage sx
- either spontaneous in elderly
- or after head injury
- can have some delayed symptoms
- headache, drowsy etc
what does subdural haemorrhage look like on CT
- BANANA
What is rx of subdural heamoorhage
- can self resolve
- or surgery
extradural haemorrgae symptoms
- 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
extradural heamorrhage rx
- surgery ASAP
basal ganglia parts
- corpus striatum = caudate and putamen
- lentiform nucleus = globus pallidus and putamen
what is neuromyotonia
- peripheral nerve hyperexcitability
how does tetanus cause a movement disorder
- blocks GABA at spinal synapses
what is stiff person syndrome
- issues with GABA at presynaptic inhibition in the spinal cord
define tremor
- oscillatory
- rythymic and regular movements
define dystonia
- sustained twisting and frequently repetitice with prolonged abnormal postures, dystonic movement - same group of mucles and patterned
define chorea
- involutnary unsustatined abrupt purposeless movement flowing from one body part to another
myoclonus definition
- jerks that are sudden, brief, shock like an dinvoluntart. caused by musclar contraction or inhibitions
what are tics
- abrupt sudden isolated movement
progressive supranuclear palsy sx
- instability with early falls
- vertical supranucleap gaze palst
- pseuodbulbar palsy
- dementia
multiple system atrophy sx
- parkinsonism with autonomic sx and ataxia
Diagnostic criteria for parkinsons
- TRAP have 2/4 min. if all 4 more likely hospital admissions
- tremor
- rigidity
- akinesia
- postural instability
rx parkinsons
- 1st line
if QOL affected; Levodopa +/- dopa decarboxylase inhibitor
if QOL not affected; dopamine agonist preferably not ergot derived due to risk of fibrosis
chorea causes
- thyrotoxicosis, SLE, Anti phospholipid syndrome, PCV
- Huntingtons
- pregnancy, basal ganglia structure disorders, drugs
- dopamine block
GBS rx
- Plasma exchange
- IVIg
sx of miller fisher syndrome
u cant fish anymore
- Ataxia
- Ophthalmoplegia
- areflexia
Multiple sclerosis sx
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
ix for MS
- FBC, U and E, CRP/ ESR
- MRI
- Visual eveoked potentials
- CSF - oligoclonal bands
MS rx in acute relapse
- High dose steroids; helps shorten duration but is not deling with problem
MS beta interferon therapy criteria
- 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
other meds used in MS
- 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
what is the function of the trochlear nerve
- superior oblique motor control
optic nerve lesion =
- 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
what is holmes adies pupil
fixed dilate irregular pupil. slow/no repsonse to bright light
- due to deneervation of ciliary ganglion
what is argyll robertson pupil
irregular pupil fixed to light but constricts on converfence
horners syndrome causes
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
how to investigate horners syndrome eye problem
Hydroxyamphetamine and cocaine test - both usually cause dilation
if preganglionic; then hydroxyamphetamine only will dilate
if post ganglionic only adrenaline will dilate
medical vs surgical CN3 palsy
- 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
CNIV injury sx
- torsional diplopia
glossophyaryngela n palsy sx
- 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
vagus palsy sx
- 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
hypoglossal palsy which way does tongue deviate
- towards side of lesion
what is bulbar palsy
- LMN lesion of CN 9.10.12
- all sx of LMN signs of 9,10,12 imoact
causes; LMN disease; MND, GB, MG,
what is pseudobulbar palsy
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
floculonodular lobe function
- balance and eye movements
- also called vestibulocerebellum
lateral cerebella aka cerebrocerebella function
- ipsilateral limb coordination
vermis/spinocerebellar function
- axial posture and balance
what biochemical marker differentiates between a seizure and a pseudoseizure
prolacctin
4 types of MND
- amyotrophic lateral sclerosis
- Progressive muscular atrophy
- progressive pseudibulbar/bulbat palsy
- primary lateral sclerosis
amyotrophic lateral sclerosis features
- UMN and LMN sign
- 1 limb –> other limb –>trunk
progressive bulbar/pseudobulbar palsy features
- mouth stuff; dysphagia, dysarthria, tongue fasciculation, slow stiff mvoement, emotional incontnece - random crying in pseudo
progressive muscular atrophy features
- LMN only
- best prognosis
primary lateral sclerosis sx
- UMN only
- slow progress; tetraparesis + pseudobulbar palsy
rx MND
- ALS usually riluzole which blocks glutamate receptors.
- Support
myositis sx
- 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
inclusion body myositis sx
- inflammation
- men
- difficult to swallow as weak pharynx
- progressive distal muscle weak
rx MG
- pyrodistogmine = 1. immunesupress = 2
- ivig and plasma xchange for acute
LES - lambert sx
- amiframpidine = blocks k+ efflux extending AP
