Neuro Flashcards

Question

Extradural haematoma features and imaging

Answer 1

Collection of blood between the skull and dura, almost always caused by trauma (typically low-impact e.g. blow to head or fall). Collection is usually temporal region since thin skull at pterion overlies the MIDDLE MENINGEAL ARTERY - vulnerable to injury. Classic presentation - initially pt loses then regains consciousness (lucid interval) then loses it again. As haematoma expands - fixed and dilated pupil due to the compression of the parasympathetic fibres of cranial nerve 3 Imaging - biconvex (or lentiform), hyperdense collection around the surface of the brain. LIMITED BY SUTURE LINES.

Answer 2

Radial nerve. Extend wrist. Radial nerve palsy is associated with wrist drop. Extending the elbow would test the radial nerve, but as the injury is at the shaft of the humerus, innervation of the triceps may arise proximal to a radial nerve injury. This would mean that a more distal injury could be missed.

Answer 3

Can occur with antipsychotics or sudden stopping of dopaminergic drugs in e.g. parkinson's Typical features - pyrexia, muscle rigidity, autonomic lability, agitated delirium - Raised CK in most cases. AKI in severe cases Mx - stop antipsychotic - admit - IV fluids to prevent renal failure - bromocriptine - dopamine agonist - may be used - dantrolene in some cases

Answer 4

Severe unilateral pain, usually idiopathic but can be caused by compression of trigeminal roots by tumours or vascular problems Electric shock like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve Pain commonly evoked by light touch (washing, shaving, smoking, talking, teeth brushing etc) Mx - carbamazepine first line - failure to respond or atypical features e.g. <50 years old should prompt referral to neurology

Answer 5

Broca's - lesion of the inferior frontal gyrus. Speech is non-fluent, laboured and halting. Repetition is impaired Conduction - usually stroke at the connection between Wernicke's and Broca's area. Speech is fluent but repetition is poor. aware of the errors they are making. comprehension normal for both

Answer 6

presentation of DCM is very variable. it is a progressive condition. Leads to loss of fine motor function in both upper limbs. commonly misdiagnosed as carpal tunnel syndrome. MRI of the cervical spine is the gold standard test where cervical myelopathy is suspected. It may reveal disc degeneration and ligament hypertrophy, with accompanying cord signal change. Urgently refer to specialist spinal services as early treatment is important. - decompressive surgery is the only effective treatment

Answer 7

Homonymous quadrantanopias - PITS - Parietal - Inferior - Temporal - Superior Incongruous defects - optic tract lesion Congruous defects - optic radiation lesion or occipital cortex

Answer 8

Prolactin - elevates 10 to 20 min after an episode of a true epileptic seizure True epileptic - tongue biting, raised serum prolactin pseudoseizure - pelvic thrusting, family member with epilepsy, more common in females, crying after a seizure, don't occur when alone, gradual onset

Answer 9

TOS is a disorder involving compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet. Can be neurogenic (90% of cases) or vascular. Happens when neck trauma occurs to individuals with anatomical predispositions - can be a single trauma or repeated stresses - presence of cervical rib is a well known osseous anomaly Clinical presentation of neurogenic TOS - painless muscle wasting of hands, pts complaining of hand weakness e.g. grasping - may have sensory symptoms such as numbness and tingling - if autonomic nerves involved may have cold hands, blanching or swelling

Answer 10

Acute relapse - high dose steroids e.g. oral or IV methylprednisolone for 5 days Spasticity - baclofen and gabapentin first line. Other options include dizepam, dantorlene and tizanidine - physio is important

Answer 11

'down and out' ptosis pupil may be dilated (sometimes called a 'surgical' third nerve palsy) diabetes, vasculitis

Answer 12

DANISH ``` D - dysdiadochokinesia, dysmetria A - ataxia N - nystagmus I - intention tremor S - slurred speech, staccato, scnaning dysarthria H - hypotonia ```

Answer 13

Causes - diabetic neuropathy, post-herpetic neuralgia, trigeminal neuralgia, prolapsed intervertebral disc 1st line - amitriptyline, duloxetine, gabapentin or pregabalin - if first does not work, try one of the other three - do not add, switch tramadol may be used as 'rescue therapy' for exacerbations topical capsaicin for localised neuropathic pain e.g. post herpetic pain management clinic if resistant problems

Answer 14

Following a first seizure, anti-epileptic drug treatment should only be started before specialist review in exceptional circumstances. Most start tx after a 2nd epileptic seizure, unless pt has other neuro deficits, structural abnormality, EEG shows unequivocal epileptic activity Sodium valproate first line for generalised and carbamazepine/lamotrigine for focal. (except no valproate in pregnancy for example)

Answer 15

unknown cause which can present with both upper and lower motor neuron signs. It rarely presents before 40 years and various patterns of disease are recognised including amyotrophic lateral sclerosis, progressive muscular atrophy and bulbar palsy. - fasciculations - absence of sensory signs/symptoms - mix of UMN and LMN signs - wasting of small hand muscles/tibialis anterior is common - doesn't affect external ocular muscles - no cerebellar signs

Answer 16

The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula The most characteristic feature of a common peroneal nerve lesion is foot drop. Other features include: - weakness of foot dorsiflexion - weakness of foot eversion - weakness of extensor hallucis longus - sensory loss over the dorsum of the foot and the lower lateral part of the leg - wasting of the anterior tibial and peroneal muscles

Answer 17

Progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra Classic triad - bradykinesia, tremor and rigidity Symptoms classically ASYMMETRICAL Bradykinesia - and poverty of movement also seen - short shuffling steps with reduced arm swinging - difficulty in initiating movement Tremor - most marked at rest 3-5Hz - worse when stressed or tired, improves with voluntary movement - typically pill rolling Rigidity - lead pipe - cogwheel due to superimposed tremor Other characteristic features - mask like facies, flexed posture, micrographia, drooling of saliva, psychiatric features (depression), dementia, sleep disturbances, fatigue, hypotension

Answer 18

Motor symptoms are generally rapid onset and bilateral Rigidity and rest tremor are uncommon

Answer 19

Collection of blood within the subdural space that has been present for weeks to months usually due to rupture of the small bridging veins causing slow bleeding. Affects elderly and alcoholics particularly due to brain atrophy making fragile or taut bridging veins. Several week to month progression of either confusion, reduced consciousness or neurological deficit Crescentic in shape, not restricted by suture lines. Hypodense compared to the substance of the brain (contrasts to acute subdural haematomas) If incidental/small in size/no deficit - conservatively If associated deficit or severe image findings - surgical decompression with burr holes

Answer 20

Wet, whacky, wobbly Reversible cause of dementia seen in elderly patients. Thought to be secondary to reduced CSF absorption at the arachnoid villi. These changes may be secondary to head injury, subarachnoid haemorrhage or meningitis Classic triad - urinary incontinence - dementia and bradyphrenia - gait abnormality (may be similar to PD) Imaging - hydrocephalus with an enlarged fourth ventricle - in addition there is typically an absence of substantial sulcal atrophy Mx - ventriculoperitoneal shunting - around 10% of patients will get complications from this

Answer 21

Collection of free blood within the subdural space and is most commonly caused by high-impact trauma CT first line - crescentic collection not limited by suture lines, hyperdense in comparison to the brain. - large acute subdural haematomas will push on the brain and cause midline hsift or herniation Small or incidental acute subdurals can be observed conservatively. Surgical options include monitoring of intracranial pressure and decompressive craniectomy.

Answer 22

due to vitamin B12 deficiency dorsal + lateral columns affected joint position and vibration sense lost first then distal paraesthesia upper motor neuron signs typically develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks if untreated stiffness and weakness persist