neuro Flashcards
1
Q
what is epilepsy
A
the tendency to have recurrent seizures
2
Q
What are some causes of seizures that are not epilepsy
A
- eclampsia
- alcohol/benzo withdrawal
- hypoglycaemia
- space occupying lesion
- post-trauma
3
Q
What are the three time-periods in a seizure
A
- pre-seizure
- seizure
- post-ictal
4
Q
What might a patient report happening before the seizure?
A
mood/behaviour change in the hours/days before the seizure
5
Q
What is common in the post-ictal period
A
- drowsiness
- nausea
- Todd’s paralysis
6
Q
What are differentials for a seizure (it might not be a seizure)
A
- syncope
- transient ischaemic attack
- migraine
7
Q
What investigations should you order for a seizure
A
- blood - fbc, BM, U&Es, LFTs, calcium
- ECG
- MRI
- EEG
8
Q
What general advice should you give after a seizure
A
- avoid dangerous things like taking baths and swimming
- occupational advice
- inform DVLA
9
Q
What is a partial seizure
A
one that affects a specific part of the brain
10
Q
What is a generalised seizure
A
one that affects both hemispheres of the brain
11
Q
In generalised seizures, patients always (lose consciousness/retain consciousness)
A
Patients always lose consciousness
12
Q
What is the most common type of generalise seizure
A
tonic-clonic
13
Q
Is this really a seizure? Which symptoms would be convincing of a seizure
A
tongue biting and slow recovery
14
Q
Which area of the brain is probably affected if Todd’s paralysis is present in the post-ictal period?
A
The motor cortex
15
Q
Which area of the brain is probably affected if dysphasia is present in the post-ictal period
A
temporal lobe
16
Q
What is an aura pre-seizure
A
part of the seizure the patient is aware of
17
Q
What might the patient experience during an aura
A
- deja vu
- strange smells
- flashing lights
18
Q
What type of seizure is aura indicative of
A
partial seizure
19
Q
What are some anti-epileptic drugs
A
- carbamazepine
- valproic acid
- lamotrigine
20
Q
Which anti-epileptic is highly teratogenic
A
valproic acid
21
Q
What is status epilepticus
A
seizure that goes on for >30 minutes or recurring seizures with no recovery of consciousness between
22
Q
What is the treatment of status epilepticus
A
- secure the airway
- lorazepam
- valproic acid
- give thiamine if alcohol withdrawal, glucose if hypoglycaemic, call obstetrics if eclampsic
23
Q
What is a TIA
A
transient ischaemic attack
* sudden-onset neurologic deficit that lasts less than 24 hours and patient returns completely to normal
24
Q
What are the causes of ischaemic stroke
A
- thrombus
- embolism
- hypoxia
25
What are the types of haemorrhagic stroke
* intra-cerebral
| * subarachnoid
26
What are the classes of Bamford's stroke classification
* TACS
* PACS
* LACS
* POCS
27
What is a TACS stroke? Which vessels are involved?
* anterior and middle ceberal arteries
* these vessels are blocked
* must have all of these three:
(1) homonomous hemianopia
(2) higher cortical dysfunction (eg dysphasia)
(3) hemiplegia and/or hemiparesis
28
What is a PACS stroke?
* affects either anterior or middle cerebral artery
* has two or more of the following:
(1) homonymous hemianopia
(2) higher cortical dysfunction (dysphasia, visuospatial disorder)
(3) hemiparesis +/- hemiplegia
29
What is a POCS stroke?
* posterior circulation stroke
* affecting the occipital lobe, cerebellum or brainstem
* must have one of the following:
(1) cranial nerve palsy and motor/sensory deficit
(2) isolated homonymous hemianopia
(3) conjugate eye movement disorder
(4) cerebellar dysfunction
30
What kind of cerebella dysfunction might you expect following a POCS stroke?
* ataxia
* vertigo
* nystagmus
31
What is a LACS stroke
* lacunar stroke
* stroke of small vessels
* one of the following must be present:
(1) pure sensory stroke
(2) pure motor stroke
(3) sensori-motor stroke
(4) ataxic hemiparesis
32
What is the treatment for an ischaemic stroke
* confirm with CT
* aspirin/ticagrelor
* thrombolysis is an option
* warfarin post-stroke
33
What must you rule out before you give antiplatelets/thromblysis/warfarin for an ischaemic stroke?
haemorrhagic stroke
34
What are the complications of a haemorrhagic stroke
* rebleeding
* hydrocephalus
* ischaemia
35
What are the main primary headache syndromes
* migraine
* tension
* cluster
36
What is a rebound headache
analgesia overuse headache common in chronic migraine/tension patients
37
What are some secondary headache causes?
* space occupying lesion
* meningitis/encephalitis
* subarachnoid haemorrhage
38
What is the most common cause of secondary headache
infection
39
What symptoms are suggestive of meningitis/encephalitis
* headache with neck stiffness and photophobia/phonophobia
40
What examination signs might be positive in meningitis
* Kernig's sign
| * Brudzkinsi's sign
41
What is Kernig's sign
lie patient flat, bend the knee and if extension of the knee is painful then Kernig's postive
42
What is Brudzinski's sign
lie patient flat, passively flex neck and knees will bend if positive
43
What headache is reported in SAH
thunderclap headache
44
Describe a migraine
* severe, unilateral throbbing pain
* photophobia common
* aura may be present
* nausea and vomiting common
45
What medications can you give in acute migrain
* NSAIDs
* triptans
* ergotamines
* metoclopramide
46
What medications can you give for prophylaxis in migraine
* antiepileptics
* tricyclics
* beta-blockers
47
What medication is contraindicated in patients with migraine who get auras
OCP
| - risk of stroke
48
What is a cluster headache
* occurs behind the eye every day at the same time for about 8 weeks
* patient may report tearing, ptosis, myosis, running nose on the affected side
* patients will be restless and pacing
49
Which sex do cluster headaches preferentially affect
males
50
What is the main treatment for cluster headaches
oxygen
51
What kind of headache is described with raised intracranial pressure
* worse after waking up
* bending forward makes it worse
* associated symptoms eg vomiting, seizures, odd behaviour
52
What causes subarachnoid haemorrhage
* spontaneous bleeding into the subarachnoid space
53
What is the most common type of subarachnoid haemorrhage
berry aneurysm
54
What is the main symptom of a subarachnoid haemorrhage
sudden blow to the back the head- 'thunderclap headache'
55
Signs of ____ will appear 3-12 hours after SAH
meningism
| * Kernig's sign, nuchal rigidity
56
What investigations should be done for an SAH
* CT head
| * LP
57
What treatment is required for SAH
surgery
58
What are the main complications of SAH
* rebleeding
* ischaemia
* hydrocephalus
59
what is multiple sclerosis
an autoimmune condition causing demyelination of the CNS
60
What is a common primary presentation of MS
optic neuritis
61
What type of diagnosis is MS
clinical diagnosis - plaques may be seen on MRI but not diagnostic alone
62
MS lesions must be _____ in ___ and ___
MS lesions must be disseminated in space and time
63
What is Lhermitte's sign
an electric shock running down the back and legs when neck is bent forward
64
What condition is Lhermitte's sign associated with
MS
65
What is the typical age presentation for MS
20-40
66
What are the main types of MS
* relapsing-remitting
* secondary progressive
* primary progressive
* progressive-relapsing
67
What imaging modality might MS lesions be visible on?
plaques may be visible on MRI
68
What treatment can be given for ms
* methylprednisolone
* interferons
* monoclonal antibodies (alemtuzumab)
* azathioprine
69
What causes parkinson's disease
loss of dopaminergic cells in the substantia nigra
70
What is the triad of parkinsons'
* bradykinesia
* resting tremor
* rigidity/increased tone
71
What other symptoms might be associated with parkinson's
* postural instability
* hypomimia
* micrgraphia
* fatiguing of repetitive movement
72
Give an example of a parkinson's plus disorder
Lew-body dementia
73
Parkinson's symptoms are (symmetrical/asymmetrical)
Parkinson's symptoms are asymmetrical
74
What kind of tremor is seen in Parkinson's
resting tremor
| pill-rolling
75
What gait is seen in PD
stooped, shuffling gait with increasingly smaller steps and difficulty turning
76
What neuropsychiatric symptoms are common in parkinsons
* depression
* dementia
* psychosis
77
What is the medical treatment of PD
* levodopa + carbidopa/mardopar
* dopamine agonists
* anticholinergic drugs
* COMT-inhibitors
* MAO-b inhibitors
78
What is carbidopa?
a dopa-decarboxylase inhibitor
79
Name some dopamine agonists
bromocriptine, cabergoline, ropinorole
80
Name a COMT-inhibitors
entecapone
81
Name a MAO-B inhibitor
selegiline
| rasagiline
82
What is cervical spondylosis
reduction of the spinal canal caused by annulus fibrosis degradation and osteophyte formation
- wear and tear -
83
What are symptoms of cervical spondylosis
* neck pain (especially on turning)
* crepitus
* Lhermitte's sign
* wrist/forearm pain
84
What are symptoms of cervical spondylosis with cord compression
* foot drop
* leg weakness
* numb hands
* incontinence
85
What is treatment of cervical spondylosis
* anti-inflammatories
* cervical collar
* physio
* surgical cord decompression
86
What is myasthenia gravis
Antibodies for the postsynaptic Ach receptors
87
What are symptoms of myasthenia gravis
* muscle fatiguability
* ptosis, diplopia, myasthenic snarl
* increased muscle weakness at end of day
* reflexes intact
88
What is a myasthenic crisis
acute relapse of MG causing weakness of respiratory muscles
| - medical emergency
89
What might precipitate a myasthenic crisis
infection, medication
90
What is treatment of myasthenic gravis
* anticholinesterase
* immunosuppressants (prednisolone, methotrexate, azathioprine)
* surgical thymectomy
91
Is surgical thymectomy effecting in MG patients who don't have a thymoma?
Yes sometimes
92
Name an anticholinesterase used in myasthenia gravis
pyridostigmine
93
What is motor neurone disease
a group of disorders caused by progressive degeneration of motor neurones in the motor cortex, cranial nerves, or anterior horns of the spinal cord
94
What are the types of motor neurone disease
* ALS
* progressive bulbar palsy
* progressive muscular atrophy
* progressive lateral sclerosis
95
What is the most common type of MND
ALS
96
What type of motor neurones are affected in ALS
upper and lower
97
What is affected in progressive bulbar palsy
cranial nerves IX-XII
98
What is affected in progressive muscular atrophy
mainly LMN
99
What is affected in primary lateral sclerosis
mainly UMN
100
What distribution is typical of peripheral neuropathy? why?
glove and stocking
| length-dependent axonal injury
101
Upper limb neuropathy before lower limb is indicative of what?
demyelination instead of axonal injury
102
What are sensory symptoms of neuropathy
* numbness
* parasthesia
* difficulty with small objects (eg buttons)
* signs of trauma/ joint deformity
103
What are symptoms of motor neuropathy
* weak hands
* difficulty walking
* difficulty breathing
104
What are symptoms of autonomic neuropathy
* erectile dysfunction
* incontinence
* urine retention
* postural hypotension
105
What are causes of motor neuropathy
* lead poisoning
* Charcot-Marie-Tooth
* Guillain-Barre
106
What are causes of sensory neuropathy
* DM
| * renal failure
