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phase 3a mine > neuro > Flashcards

neuro Flashcards

1
Q

cauda equina big 3 presentation

acronym

causes

A

saddle paraesthesia
bilateral shooting pain down legs
bowel disturbance

Presentation = SPINE
Saddle anaesthesia
Pain / paralysis
Incontinence of bladder/ bowel
Numbness
Emergency

Compressive
- Tumours
- discs
Non compressive
- Inflammatory
- Infilitrive
- Granulomatosis
Vascular
- Spinal dural fistula

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2
Q

C5 reflex

A

bicep (5 letters)

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3
Q

c6 reflex

A

tricep (6 letters)

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4
Q

c5 / c6 dermatome

A

c5 - thumb

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5
Q

c5 myotome

A

elbow flex (think bicep - 5 letters)

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6
Q

c6 myotome

A

elbow extension (think tricep - 6 letters)

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7
Q

L5 dermatome

A

top of foot, big toe

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8
Q

C6 dermatome

A

c6- middle finger

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9
Q

L5 myotome

A

dorsiflexion (pathology = foot drop)

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10
Q

S1 dermatome

A

bottom of foot, little foot

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11
Q

S1 myotome

A

plantarflexion

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12
Q

S1 reflex

A

ankle jerk

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13
Q

is dissection of an artery ischaemic or haemorrhgaic stroke?

A

ischaemic

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14
Q

risk factors of dissection –> stroke

A

younger patients
cyclists
hyperextending neck - painting roof, hair salon

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15
Q

long-term BP aim after ischaemic stroke

A

130/80

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16
Q

long-term lipids reduction (%) after ischaemic stroke

A

40%

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17
Q

endartectomy indication

A

Tightening of over 50% (or90% stenosis?) of carotid artery seen in USS

within 6h of symptoms onset

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18
Q

how long after stroke must thrombectomy be completed in

A

6h
can be alongside thombolysis

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19
Q

thrombectomy vs endartectomy

A

endartectomy = surgery to open up vessel and remove clot and stitch back up
thrombectomy = catheter inserted up wrist/groin then clot sucked/ aspirated/ stented

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20
Q

CAA (cerebral amyloid angiopathy)

A

Amyloid beta peptide is deposited in small-medium vessels - makes them fragile

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21
Q

long-term BP aim after haemorrhagic stroke

A

140/90

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22
Q

stroke medication

A

aspirin short term
then clopidogrel
consider dual therapy if high risk of stroke (but balance against risk of bleed)

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23
Q

stroke medication if on AF

A

warfarin

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24
Q

stroke investigations

A

Bloods
- Urea
- Sodium
- CRP/ESR
- LFTs
- WCC
- Lipid profile
- Clotting
ECG
- Looking for AF
USS carotid
Brain imaging - CT/MRI
- Within 1h
Consider echocardiogram
- For ischaemic
24 vs 72h tape
- Heart rhythm if normal ECG - looking for paroxysmal AF

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25
Q

what is small vessel disease SVD

A

Small vessels in brain narrowed and don’t dilate properly

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26
Q

pattern of weakness neuropathy

A

distal>proximal

(mainly hands and feet affected)

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27
Q

pattern of weakness myelopathy

A

below level of lesion

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28
Q

pattern of weakness myopathy

A

proximal >distal

(proximal limbs affected , called limb-girdle position)

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29
Q

pattern of weakness NMJ disorder

A

fluctuating muscle fatigue

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30
Q

deep tendon reflexes neuropathy

A

severe reduction
early loss

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31
Q

deep tendon reflexes myopathy

A

mild reduction
late loss

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32
Q

deep tendon reflexes myelopathy

A

increased

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33
Q

deep tendon reflexes NMJ disorder

A

normal of mildly reduced

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34
Q

posterior stroke symptoms

A

Dysarthria
Dysphagia
Diplopia
Dizziness
Ataxia
Diplegia - both sides affectedq

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35
Q

total(/ partial) anterior circulation ischaemic stroke

A

ACA + MCA infarction

all of
- homononymous hemianopia
- unilateral weakness and or sensory loss of face/arm/leg
- higher cerebral dysfunction (dysphasia, visuospatial disorder)

partial is 2 of these

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36
Q

lacunar syndrome

A

Pure motor hemiparesis
Ataxic hemiparesis
‘Clumsy hand’ and dysarthria
Pure hemisensory
Mixed sensorimotor
No cortical features (dysphasia, apraxia, neglect, visual field loss)

lacunar strokes - Small deep penetrating arteries that supply midbrain

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37
Q

contralateral tongue bite indicates what (until proven otherwise)

A

epilepsy

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38
Q

antidepressants and blackouts?

A

lower seizure threshold

39
Q

automatisms associated with what lobe seizure

A

temporal

40
Q

single limb twitching

A

associated with contralateral tumour

41
Q

what is typical of myoclonic jerks

what type of epilepsy is it

A

Morning
Worse with sleep deprivation/ go out / alcohol night before
Teenagers and young people
Form of generalised epilepsy
Consciousness maintained
Drop cereal

42
Q

how long after no seizure event til drive

A

1y

43
Q

dissociative seizure tx

investigations

driving

A

not with drugs! psychiatry (associated with trauma)

normal EEG (different to epilepsy)

3months without event

44
Q

feel whole body shaking =

A

dissociative (aware still)

45
Q

temporal lobe vs parietal lobe

which lobe is insight ?

A

PARIETAL
Spatial awareness
Judging distances and shapes
Drawing
Body and environment awareness
Sensory function (but not pain)
Angular gyrus - calculation, reading, writing, R-L orientation

TEMPORAL
Medial
- Limbic memory circuit
- Emotional circuits
Lateral
- Word and picture meaning store - lexicon
- understanding speech

insight - frontal

46
Q

proximal myopathy
- symptoms/ description
- test
- cause

A

myopathy - proximal weakness worse
Slower walking, Struggling to walk up and down hill, needs regular rest
Having to leave earlier
Stairs are awkward so affect lectures and home life
Withdrawn socially as a result - embarrassed, not going out, people have made comments

Ask them to do a sort of one leg squat/ crouch - body weight on proximal leg muscles - lose balance/ won’t try

Cause:
- High dose Corticosteroids
- Chemotherapy, radical radiotherapy
- Transplant patients
- Autoimmune disease
- Respiratory disease - emphysema, chronic bronchitis

47
Q

why is myasthenic syndrome associated with partial ptosis (as the day goes on)

A

Smooth muscle 50% has no NMJ - so doesn’t fatigue (so not total)
Skeletal muscle 50% does fatigue
Doesn’t affect eyesight

as day goes on due to the fatiguability

48
Q

myasthenic syndrome eg’s of symptoms and test

A

Struggles to keep up / attention throughout lecture, playing guitar, typing on keyboard. Needs rest at regular intervals walking, even on flat

Ask them to do something related to the story - eg write out a sentence (you’re the control) or walk a distance or do a repeated movement.

49
Q

myasthenic syndrome causes

A

myasthenic gravis, lambert-eaton syndrome

50
Q

peripheral neuropathy
- most common cause
- signs or symptoms first
- large fibre
- small fibre
- examination
- tx

A
  • DM
  • signs (picked up in diabetic screening tests)
  • Large
    —Lost vibration sense, pain pin prick fine
    —Pick up late
    -Small
    —Symptoms early
    — Burning pain at feet at night
    — Numb feet
    — Reduction in pin prick
    (so examine with vibration and pin prick!)
  • pain relief, treat underlying cause (DM, B12 def), prednisolone if inflammatory/vasculitic
51
Q

gloves and stocking vs peripheral neuropathy in terms of symptoms

A

gloves and stocking is sensation loss to above knee (gloves and tights!) otherwise just peripheral neuropathy

52
Q

carpal tunnel
- what nerve
- symptoms/signs
- treatment

A
  • median nerve, wrist (mononeuropathy)

Worst in morning (fetal position at night)
Not sudden onset
Radiates up arm
Shaking out helps
numbness/ tingling in thumb, index
Struggling open jars, pincer grip
Median supplied thumb and that side of the hand front and back, but often the tingling isn’t localised clearly so may feel like whole land
often no signs

treatment
- Splint at night
- Surgery

53
Q

ulnaropathy

axillary nerve mononeuropathy

lower limb

A

funny bone, elbow

Numbness over deltoid muscle
Weakness of shoulder abduction
So need to pin prick deltoid muscle before shoulder relocation

lower limb rare

54
Q

spinal claudication syndrome symptoms

A

Lower limb radicular pain. Only comes on walking (not standing/sitting), maybe after X distance. Stops and starts with rest and continuing
+/- pins/needles/heaviness
Pain all down leg (not just calf with other claudication)

55
Q

vertebral pain syndrome symptoms

A

pain (acheing, non-radiating)
restricted movement
spasm

56
Q

myelopathy syndrome
- symptoms
- signs
- cause

A

Neck pain, lower back pain, NOT legs
Stiffer walking
Bilateral mainly
Clumsy hands, buttons hard, velcro shoes
Less precise, stiff / thick socks
“Legs don’t do what i tell them to do”

Signs before symptoms
Babinksi
Hyperreflexia
Clonus
Hoffman
– Upper limb babinski
– Flick middle finger up
– Thumb flicks in
Cross adductors reflexes
– Feel for medial knee- adductor tendon (proud when knee adducted)
– Tap on it while leg hung relaxed
– Same leg goes in = normal. If both leg goes in = cross adductor reflexes
Pectoralis reflex
– Arm reflexes from tapping anywhere on pectoralis
Treacle hands

Disc osteophyte core compression

57
Q

cerebellar syndrome

A

Ataxia
Nystagmus
Ipsilateral
“Feel drunk”

58
Q

anterior horn cell disorders
- eg cause
- symptoms

A

MND
Descending motor system
No radiating pain
No dermatomal sensory loss
Wasted muscle
Second nerve root affected in relatively short time period

59
Q

parasellar syndrome symptoms

A

bitemporal hemianopia
hypopituitarism

60
Q

glasgow coma scale
- go through each and how many points
- total points out of

A

BEOR (best eye opening response)
Spontaneously 4
to speech 3
to pain 2
None 1
BVR ( best verbal response)
orientated in time/place/person 5
Confused 4
inappropriate words 3
incomprehensible sounds 2
None 1
BMR (best motor response)
obeys commands 6
localises to pain 5
Withdraws from pain 4
flexes to pain 3
extends to pain (goes away from the pain stimulus) 2
None 1

15 max

61
Q

mobility grades 1-7

A

Grade 1 - no problem
2
3 - limited by distance
4 - cant walk independently but can walk with aid
Subsections
5 - cant walk independently with aid but can walk with a person assisting
5a - one person aiding
5b - two people aiding
6- cant walk but can transfer
7 - bed bound, can’t transfer, hoisted

62
Q

CT vs MRI
- acute brain
- acute spine

A

Urgent/ acute brain = CT
- CT accessible 24/day, able to acquire within minutes
MRI - longer waiting time, need to complete checklist about metal so quicker. All kit eg ecg wires, tubes need to be MRI compatible - so this is faff
- Haemorrhage is easy to spot on CT - clear, white. Less so on MRI

urgent/ acute spine = MRI
- MRI gives good visualisation of spinal cord and nerve roots
- CT only good for trauma / fracture

63
Q

CT
- units
- 1000 =
-100 =
0 =
+ 7 =
+25 =
+35 =
+70 =
+1000 =

A

Hounsfield
-1000 = air (black)
-100 = fat
0 = water (none in brain)
+7 = CSF
+25 = white matter
+35 = grey batter
+ 70 = blood
+1000 = bone (white)

64
Q

what to look at on brain scan

A

Is there a mass
- Symmetry
- Is it intra axial or extra axial / intraparenchymal or extraparenchymal (inside or outside brain).
- If outside brain - subdural or extradural

Is there blood
- White

Is there hydrocephalus
- 3rd ventricle is no longer a slit (as it should be) and temporal horns now visible

Bone windows

65
Q

causes of coma

A

Common
- Drugs
- Anoxia (post arrest)
- Mass lesions - Head injury, bleeds, SAH
- Infections (HSV can cause epilepsy)
- Infarctions- brainstem
- Epilepsy
- Metabolic (DKA, hypoG, hepatic encephalopathy, Uraemia )

Uncommon
- Tumours
- Venous occlusion
- Hypothermia
- Psychiatric - catatonic

66
Q

Sudden onset headache with third cranial nerve palsy OR painful 3rd CN palsy = ??? until proven otherwise

A

SAH
eye down out and dilated

67
Q

lumbar puncture
- when following headache
- when in regards to CT

A
  • 12 h post for xanthochromia to form
  • after CT to exclude raised ICP due to space occupying lesion- otherwise risk brainstem herniation
68
Q

status epilepticus
- duration
- tx

A

Length
5min + generalised tonic clonic
10 min + focal
10-15 absence
(in practice, 30+ in definition)

consider non-epileptic seizure/ functional as these are longer than epileptic seizures

1) IV lorazepam / diazepam / clonazepam
2) Phenytoin (cardiac monitoring needed) / sodium valproate / levetiracetam

69
Q

thunderclap headache
- differential
- signs that it is serious

A

SAH, migraine

suggestive of SAH if:
- positive kernig sign (meningism) - laid on back then hip flexed with knee at 90 deg
- seizure
- altered conciousness
- not had anything similar before
- old age
- strenuous exercise/ trauma at time of onset
- back of head (but migrane may be here too)
- no migranous aura
- PMH- coarctation of aorta, polycystic kidneys

70
Q

SAH
- examintation findings
- investigations
- causes

A

Meningism
Neurological deficits
- Rarely: hemiplegic migraine
- More commonly: proprioception/ pronator drift – can appear like weakness but actually power on examination is normal
Retinal haemorrhages / papilloedema

CT (See bleed and whether safe to LP)
LP (12 h after - xanthochromia)
vascular imaging - angiograms
- Looking for
— Arterial filling, narrowing
— Bulging = aneurysm
— Where dye passes too quickly through into veins = AV malformation

Ruptured berry aneurysm
AV malformation

71
Q

central spinal lesions effect where first and why

what are some central spinal lesions

A

Cervical fibres (arm) are medial Fibres to leg more lateral
So central spinal disorder will cause issue to arm before leg
(gracile (Arm) cunneate (leg ) medial and lateral in dorsal column and also in spinothalamic and pyramidal (motor) tracts))

Tumour - intrinsic
Syringomyelia
Whiplash

72
Q

traumatic spinal cord disorder
- cause
- next step

A

whiplash, gunshot, stab, haematoma
MRI spine

73
Q

degenerative disc disease in spinal cord disorder
- cause
- next step

A

cervical and lumbar spondylosis, spinal canal stenosis
MRI/ CT spine

74
Q

inflammatory spinal cord disorder
- cause
- next step

A

MS, Transverse myelitis, NMO
Lumbar puncture, MRI spine, and brain with contrast

75
Q

neoplastic spinal cord disorder
- cause
- next step

A

MRI with contrast
intrinsic spinal cord tumours
- ependymoma
Extrinsic spinal cord tumours
- meningioma, metastatic, lymphoma

76
Q

infective spinal cord disorder
- cause
- next step

A

HIV, HTLV, abscess, empyema
MRI, ESR, BBV, FBC

77
Q

vascular spinal cord disorder
- cause
- next step

A

anterior spinal cord artery occlusion, spinal dural fistula, vasculitis
AAA repair → accidentally clamp artery → spinal cord ischaemia
Owls eyes occlusions on axial imaging
MRI, Angiography, vasculitis screen

78
Q

metabolic spinal cord disorder
- cause
- next step

A

Vit B12 deficiency → degeneration
B12 Folate MMA and fasting homocysteine levels (raised indicates B12 def at cellular level)

79
Q

Granulomatous spinal cord disorder- cause
- next step

A

Sarcoidosis
serum ACE level, MRI, CXR

80
Q

hereditary spinal cord disorder
- cause
- next step

A

Hereditary spastic paraplegia, Fredrich’s ataxia
Genetic panel

81
Q

what presentations are spinal cord emergencies and what needs to be done and why

A

Acute/Subacute onset
- Bladder- bowel weakness
- Saddle anaesthesia
- Leg weakness
- Constant Sensory deficit
- Significant pain (back)
Acute MRI
- Need to rule our cord compression

82
Q

thrombolysis
- what
- how long post stroke
- indications
- contraindications

A

4.5h but earlier the better
IV alteplase
infarct , embolic
if any bleeding anywhere
Recent LP
Acute pancreatitis
Aneurysm
Pregnant
Low platelets

83
Q

blue lips and blackout

A

indicates epilepsy due to not in syncope due to short blackout duration

84
Q

unilateral vision loss differential diagnosis

A

1 Optic neuritis (Acute)
2 MS (acute)
3 Retinal disease (Acute)
- Retinal detachment
- Blurry vision
- Loss of visions from side / edges - curtain across - complete / greying
- Needs repairing - scleral buckle surgery/ virectomy
4 Trauma (acute)
- Outside of eye
- Retina /Optic nerve
5 Glaucoma (acute)
- Drainage of aqueous humour suddenly occluded - rapid rise in intraocular pressure
- vomitting, pain, red eye
6 Retinal artery occlusion (acute)
- Cotton wool spots
7 Anterior ischaemic neuropathy
- corticosteroid asap
- maybe + jaw claudication, scalp tenderness, facial pain
8 Vitreous hemorrhage
- Haemorrhage into vitreous humour - reduces light reaching retina
- See spots - floaters
- blurred vision
- Red tinge to vision
9 cataracts (chronic)
10 Neurosarcoidosis - (Sarcoidosis with chest and neural elements)
- Pain behind eye
- Colours seem less bright
- Difficulty reading
- associated with bells palsy (LMN)
- Investigate with Chest X Ray and serum ACE enzyme

probs more :(

85
Q

optic neuritis
- causes

A

Clinically isolated syndrome, idiopathic
MS
B12 deficiency
Infection - Lymes, syphilis , HIV

86
Q

optic neuritis
- symptoms
- signs

A

Pain in eye
Eye movement pain
Loss of vision
- Central vision blurred
- Reduced colour

RAPD (relative afferent pupil defect) = slower response when light is shone on affected side
RAPD on swinging light test - on affected side - BOTH pupils are dilated not constricted when light shone on
Dyschromatopsia - colour blind

87
Q

optic neuritis
- treatment

A

MS-associated
- Spontaneously improves over 2-3 months (Steroids speeds it up)
- No differences in acuity long term
Not MS-associated
- IV corticosteroids, oral corticosteroids

88
Q

MS presentation symptoms - areas

A

Sites of periventricular demyelination / sclerosis:

Optic nerves (optic neuritis)
- Pain in eye / on movement
- Vision loss
- Central vision blurred
- Reduced colour

Corpus callosum

Brainstem
- Diplopia
- Vertigo
- Facial numbness/weakness
- Dysarthria
- Dysphasia
- Nystagmus
- Brainstem or spinal tract plaque
- Clumsy / poor proprioception - ataxia

Spinal cord
- Weakness (motor)
- Often leg
- Spasticity (continual contraction) → stiffness/tightness
- Movement / function impaired eg speech slurred, gait
- Intention tremor
- numbness/ tingling (Sensory) / pain - Often limb
- Bladder dysfunction
- Sexual dysfunction
- Lhermitte’s sign (tingling down neck, spine)

uhtoffs - worse with heat
also worse with exercise

89
Q

MS types

A

Benign
- Few relapses
- Little disability

Relapsing and remitting
- Most common
- Onset = days (sudden). Recovery (partial/fully) = weeks

Secondary progressive MS
- Follows on from relapsing and remitting, normally after 35 years - late stage MS
- Gradually worsening symptoms with fewer remissions

Primary progressive MS
- Gradually worsening disability without relapses or remission
- Typically presents later
- Associated with fewer inflammatory changes on MRI

90
Q

MS diagnosis vs clinically isolated symptoms

A

MS requires 2 or more attacks of the CNS (seen on MRI)

91
Q

MS pathophysiology

A

Autoimmune: T cell mediated
- T cells stimulate B cells to produce antibody to myelin
So multiple sites of CNS (not PNS ever) are demyelinated in white matter (axons)
Myelin can regenerate but less effectively (thinner and shorter myelin sheaths) and is very sensitive to high heat (Uhtoff’s)
- Sclerosis → slowed, blocked conduction → impaired movement and function
Healing periods = remission periods

Demyelination mostly at periventricular sites
- Optic nerves (optic neuritis)
- Corpus callosum
- Brainstem
- Spinal cord

92
Q

GCS drop causes

A

Head injury
Hypoglycaemia
Stroke
Epilepsy
Overdose

93
Q

ACA/MCA/PCA stroke presentations

A

ACA
- Lower limb
- Gait
- Incontinence
- Drowsiness

MCA
- Face droop
- Upper limb - weakness, numbness
- Hemianopia
- Expressive / receptive dysphasia (brocas, wernickes) -L

PCA
- Headache (rare in ischaemic stroke)
- Visual issues - peripheral vision, face recognition, colour naming, can’t interpret what they can see, cortical blindness

94
Q

what must be done prior to thrombolysis

A

Blood sugars first (quick bedside test not lab bloods) - need to exclude hypoglycaemia
Esp if prev hypoglycemia, can look like deficit, neuro decline

phase 3a mine (16 decks)

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