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3A > Neuro kNowledge > Flashcards

Neuro kNowledge Flashcards

1
Q

What is Uhthoff’s phenomenom?

A

Worsening of vision following a rise in body temperature

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2
Q

What is Lhermitte’s sign?

A

Tingling in the hand when flexing the neck, seen in subacute combined degeneration of the spinal cord, MS and cervical stenosis

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3
Q

What is progressive supranuclear palsy?

A

Presents in a similar fashion to PD but there is also Sx of dysarthria and reduced verticle eye movements

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4
Q

What is wernicke’s aphasia?

A

Issues with speech comprehension, speech its fluent, repetition is impaired
Caused by inferior L MCA infarct

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5
Q

What is broca’s aphasia? What infarct is responsible?

A

Issues with speech production (speech is non-fluent and haltering) speech comprehension is in tact
Caused by superior L MCA infarct

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6
Q

What is the in hospital Tx for status epilepticus?

A

4mg IV lorazepam

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7
Q

What is an intention tremor?

A

Elicited in the finger-nose test, it indicated cerebellar pathology

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8
Q

What is an essential tremor?

A

Bilateral tremor that worsens with action

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9
Q

How long must a pt stop driving for after a TIA?

A

1 month

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10
Q

How can you differentiate between true seizures and pseudoseizures on a blood test?

A

Prolactin - it will be raised in true seizures

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11
Q

What are the 4 types of MND?

A

Amyotrophic Lateral Scleosis - LMN signs in arms, UMN signs in legs
Primary Lateral Sclerosis - UMN signs only
Progressive Muscular Atrophy - LMN signs only (affects distal muscles first)
Progressice Bulbar Palsy - palsy of the tongue, chewing/swallowing muscles and facial muscles

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12
Q

Which types of MND have the best/wrost prognosis?

A

Progressive Muscular Atrophy = best

Progressive Bulbar Palsy = worst

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13
Q

What is the emergency Tx in severe neuroleptic malignant syndrome?

A

Dantrolene/Bromocriptine and lorazepam

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14
Q

Which part of the optic chiasm is affected if the upper quadrant is more affected than the lower quadrant in a bitemporal hemianopia?

A

Inferior compression so likely to be pituitary tumour

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15
Q

Which part of the optic chiasm is affected if the lower quadrant is more affected than the upper quadrant in a bitemporal hemianopia?

A

Superior compression so likely to be craniopharyngioma

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16
Q

How do you score GCS?

A 
Motor = Obeys commands (6), Localises to pain (5), Withdraws from pain (4), Abnormal flexion to pain (3), Extending to pain (2), None (1)
Verbal = Orientated (5), Confused (4), Words (3), Sounds (2), None (1)
Eyes = Spontaneous (4) To speech (3), To pain (2), No response (1)
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17
Q

Sx of Neuroleptic Malignant Syndrome?

A

Develops over hours to days.
Led pipe rigidity (hypertonia), hyporeflexia, normal pupils.
Tachypnoea, tachycardia, hyperthermia, hypersalivation and hypertension

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18
Q

Sx of Serotonin Syndrome?

A

Increased reflexes, hypertonia, clonus, dilated pupils, sweating, hyerthermia, tachycardia, tachypneoea, hypersalivation, hypertension

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19
Q

Tx of Serotonin Syndrome?

A

Chlorpromazine or cyproheptadine

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20
Q

How can you diagnose guillain-barre syndrome from CSF?

A

Isolated high protein in CSF = GBS

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21
Q

Sx of guillain-barre syndrome?

A

Ascending muscle weakness, absent or reduced reflexes, mild sensory issues (e.g. distal parasethesia)

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22
Q

What are the 1st line treatments for spasticity in MS?

A

Baclofen and Gabapentin

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23
Q

Sx of Bells Palsy?

A

Prodomal pain beind the ear, altered taste, dry eyes, increased sensitivity to sound and facial muscle weakness/paralysis (including the forehead - LMN)

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24
Q

How can you identify if fluid coming from the nose in trauma is CSF?

A

Check for glucose!

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25
Q

What is the treatment pathway for status epillepticus?

A

IV Lorazepam -> (after 10-20 mins) IV Lorazepam -> Phenytoin or Phenobarbital infusion -> General anaesthesia

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26
Q

What is the 1st line Tx of partial seizures?

A

Carbamazepine (but not useful in the Tx of absence seizures) or lamotrigine

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27
Q

What features are seen in a syncopal episode?

A

Rapid recovery and a short post-ictal period. Myoclonic jerks may occur

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28
Q

What should you do if Sx of Bell’s palsy do not show signs of improvement after 3 weeks of corticosteroid treatment?

A

Refer urgently to ENT

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29
Q

Where do brain tumours most commonly metastasise from? Where else can they metastasises commonly from?

A

LUNG!

Breast, bowel, skin and kidney

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30
Q

What often provokes absence seizures?

A

Hyperventilation

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31
Q

What is the Tx for absence seizures?

A

Sodium Valporate and Ethosuximide

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32
Q

What is Arnold-Chiari malformation?

A

Downward displacement of the cerbellar tonsills through the foramen magnum = leads to non-communicating hydrocephalus

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33
Q

What is Ramsay Hunt Syndrome?

A

Occurs when there is reactivation of VZV in the facial nerve - leads to LMN palsy.
Sx = facial paralysis, otalgia and painful red rash with fluid filled blisters in, on or around the ear

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34
Q

When can you consider stoppin epilepsy medications?

A

When pts have been seizure free for >2 years. They should be stopped over 2-3 months

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35
Q

What is the 1st line Tx for neuropathic pain?

A

Amitryptilline, Duloxetine or Gabapentin. If one doesnt work, switch!

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36
Q

What is Lambert-Eaton Syndrome?

A

A myasthenic syndrome seen in association with small cell lung cancer and to a lesser extent breast and ovarian cancer.
Sx = increased muscle strength with use, limb girdle weakness => waddling gait, hyporeflexia, autonomic Sx (e.g. dry mouth, impotence and difficulty urinating)
Tx = treat cancer and prednisolone immunosuppression

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37
Q

Tx Myasthenia Gravis?

A

Pyridostigmine and prednisolone immunosuppresion

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38
Q

What is the most common complication of meningitis?

A

Sensorineural hearing loss

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39
Q

What causes wrist drop?

A

Radial nerve palsy

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40
Q

What happens in CN IV palsy?

A

Eye is turned up and out when looking straight ahead. Verticle diplopia

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41
Q

What are the 4 main Sx of NMS?

A

Rigidity, hyperthermia, altered mental state, autonomic instability (can cause AKI)

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42
Q

How can you localise a homonomous hemianopia?

A

Incongourous (un-even) = lesion of the optic tract
Congorous (even) = lesion of optic radiation or occipital cortex
With macula sparing = lesion of occipital cortex

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43
Q

How can you localise homonomous quadrantopias?

A 
Superior = lesion of the inferior tract in the temporal lobe (Meyer's loop)
Inferior = lesion of the superior tract in the parietal lobe (Baum's loop)
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44
Q

How can you localise bitemporal hemianopias?

A

Upper quadrant defect = inferior chiasmal compression = pituitary tumour
Lower quadrant defect = superior chiasmal compression = craniopharyngioma

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45
Q

True or false passing large amounts of urine with normal bladder scan (DI) is caused by a pituitary tumour?

A

False!

Caused by craniopharyngioma

46
Q

What organism classically causes Guillain-Barre Syndrome?

A

Campylobacter Jejuni

47
Q

What may be causing a painful CN III palsy (e.g. with headache)?

A

Posterior communicating artery aneurysm

48
Q

When cau autonomic dysreflexia occur?

A

Spinal cord injuries at or above T6 - leads to hypertension, sweating and flushing without an increae in HR

49
Q

Which scan can be used to identify early PD?

A

DAT scan

50
Q

What is the first line Tx for benign essential tremor?

A

Primidone and Propanolol.

If severe can give deep brain stimulation

51
Q

True or False alcohol improves the symptoms of Benign Essential Tremor?

A

True

52
Q

What type of respiratory failure is myasthenic crisis? what are the most important investigations to do first if you suspect it?

A

Type 2

Bedside forced vital capacity assessment and ABG

53
Q

Whta is papillitis?

A

Optic neuritis, there will be pain on eye movements, unilateral vision loss and interferance with colour vision.

54
Q

Which type of scan can you use to detect demyelination in MS or to diagnose a spinal problem?

A

MRI - use contrast for MS brain MRI

55
Q

What is the sequence of damage done to nerves in nerve compression?

A

sensory demyelination -> sensory axonal loss -> motor demyelination -> motor axon loss

56
Q

What is a myelopathy?

A

Severe compression of the spinal cord

57
Q

What is myopathy?

A

Muscle disease

58
Q

What is radiculopathy?

A

Symptoms that occur due to the pinching of the nerves in the spinal column

59
Q

What is neuropathy?

A

Damage to the nerves outside of the spinal collumn/brain

60
Q

How does GBS (Fischer variant) classically present?

A

Opthamoplegia, areflexia and ataxia

61
Q

What kind of muscle weakness is seen in GBS, LES and MG?

A

Proximal muscle weakness

62
Q

Sx and Mx of frozen shoulder?

A

Global restriction of shoulder movements, external rotation is most affected and most painful.
Mx = early physiotherapy

63
Q

How can degenerative cervical myelopathy present? What is the most common cause?

A

Spondylosis
Sx = pain, reduced dexterity/motor issues, sensory loss, autonomic function issues (e.g incontinence and impotence) and Hoffman’s sign positive

64
Q

Ix and Mx for degenerative cervial myelpathy?

A

MRI C-spine

Urgent spinal decompression surgery

65
Q

A child falls onto an outstretched arm. He suffers a supracondylar fracture leading to loss of pronation. Which nerve has been damaged?

A

Median nerve

66
Q

Which part of the brain is damaged in Wernicke’s aphasia?

A

Superior temporal gyrus

67
Q

Which part of the brain is damaged in Broca’s aphasia?

A

Inferior frontal gyrus

68
Q

Which part of the brain is damaged in Conductive aphasia?

A

Arcuate fasciculus

69
Q

How is a thyoma imaged? What is seen? What can it cause?

A

CT
Mass in the mediastinum
MG

70
Q

What is seen in a total anterior infarct?

A

All 3 of:

  • Unilateral hemiparaesis and/or hemisensory loss of the face, arm and leg
  • Homonomous hemianopia
  • Higher cognitive dysfunction (e.g. dysphasia or visuospatial disorder)
71
Q

What is seen in a partial anterior infarct?

A

2 of:

  • Unilateral hemiparaesis and/or hemisensory loss of the face, arm and leg
  • Homonomous hemianopia
  • Higher cognitive dysfunction (e.g. dysphasia or visuospatial disorder)
72
Q

What is seen in a luncar infarct?

A

1 of:

  • Unilateral weakness (and/or sensory deficit) of the face and arm, arm and leg or all 3
  • Pure sensory loss
  • Ataxic hemiparaesis
73
Q

What is seen in a posterior circulation infarct?

A

1 of:

  • Cerbellar or brainstem syndrome
  • Loss of consiousness
  • Homonomous hemianopia
74
Q

Which vessels are affected in a total anterior infarct?

A

Middle and anterior cerebral arteries

75
Q

Which vessels are affected in a partial anterior infarct?

A

Smaller arteries of the anterior circulation

76
Q

Which vessels are affected in a luncar infarct?

A

Perforating arteries around the thalamus, internal capsule and basal ganglia

77
Q

Which vessels are affected in a posterior circulation infarct?

A

Vertebrobasilar arteries

78
Q

What is the most common hereditary sensorymotor/peripheral neuopathy? How does it present?

A

Charcot-Marie-Tooth disease.
Sx = frequently sprained anke, foot drop, high arched feet, distal muscle weakness and atrophy, sensory disturbance, hyporeflexia and stork leg deformity

79
Q

What is a meningioma?

A

Tumour which arises from the dura mater of the meninges. Does not arise from the parenchyma and causes symptoms of brain compression

80
Q

What is the most common priamary brain tumour in adults?

A

Glioblastoma multiforme

81
Q

What is the most common priamary brain tumour in children?

A

Pilocytic Astrocytoma

82
Q

How do you diagnosed acoustic neuroma?

A

MRI of the cerbellopontine angle

83
Q

How do you manage spasticity in MS?

A

Baclofen or Gabapentin

84
Q

What is the preventative Tx for cluster headaches?

A

Verapamil

85
Q

A patient presents with weakened dorsiflexion, eversion and inversion as well as sensory loss between the big and little toe. What has been damaged?

A

L5

86
Q

Apart from forehead sparring how does and UMN lesion present differently to a LMN facial nerve lesion?

A 
UMN lesion = contralateral weakness
LMN lesion (bell's palsy) = ipsilateral weakness
87
Q

How do you diagnose MS?

A

MRI with contrast

88
Q

How do you diagnose and grade severity of carotid artery stenosis?

A

Duplex US

89
Q

How should you manage raised ICP (stepwise Mx)?

A
  • Elevate the head to 30 degrees
  • IV mannitol
  • Controlled hyperventilation
  • Removeal of CSF (LP or shunt)
90
Q

In which condition will you see cafe au lait spots AND axillary freckles?

A

Neurofibromatosis type 1

91
Q

Sx of MS?

A

Weakness, fatigue, diplopia/painful eye movements/reduced vision, ascending weakness and sensory disturbances, balance issues, optic neuritis and transverse myelitis.
Reflexes are typically decreased but may increase if spasm

92
Q

Sx of lateral medullary syndrome (Wallenberg syndrome)?

A

Ipsilateral facial pain and temperature sensation loss, contralateral limb/torso pain and temperature loss. Ataxia and nystagmus

93
Q

Sx of lateral pontine syndrome?

A

Ipsilateral facial pain and temperature sensation loss, contralateral limb/torso pain and temperature loss. Ataxia and nystagmus. Also ipsilateral facial paralysis and deafness

94
Q

Where is the infarct in lateral medullary syndrome?

A

Posterior inferior cerbellar artery

95
Q

Where is the infarct in lateral pontine syndrome?

A

Anterior inferior cerbellar artery

96
Q

Sx of a basilar artery stroke?

A

Locked in syndrome

97
Q

How should you treat proximal anterior circulation strokes presenting within 4.5 hours?

A

Alteplase AND thrombectomy

98
Q

What is seen in Tuberous Sclerosis?

A

Roughened patches of skin over the lumbar spine, depigmented ash lead spots anenomoa sebaceum over the nose, nail changes, epilepsy and developmental delay

99
Q

What is subacute combined degeneration of the spinal cord?

A

Occurs due to vitamin B12 deficiency. Presents with impaised proprioception

100
Q

What is required when giving phenytoin?

A

Cardiac monitoring

101
Q

Which drugs can precipitate myasthenic crisis?

A

Penicillaimine, beta-blockers, lithium, pheytoin and some Abx

102
Q

Sx of radial nerve injury?

A

Inability to extend the wrist and fingers

103
Q

Sx of median nerve injury?

A

Loss of thumb oppositoin/abduction and flexion of first 2 fingers. Commonly damaged in colle’s fracture

104
Q

Sx of ulnar nerve injury?

A

Loss of abduction and adduction of the fingers

105
Q

Why should you always ensure B12 levels are checked and replenished before giving folate for macrocytic anaemia?

A

Giving folate to a patient deficient in B12 can precipitate subacute combined degeneration of the cord

106
Q

Sx of Internuclear Opthalmoplegia?

A

Impairment of adduciton of the ipsilateral eye. The contralateral eye abducts but with nystagmus

107
Q

How does hyperventilation help to reduced ICP?

A

Reduces CO2 levels to induce cerebral vasoconstriction

108
Q

Sx Pituitary Apoplexy?

A

Sudden onset severe headache, vomiting, neck stiffness, visual field defects, reduced eye movements and hypotension/hyponatraemia

109
Q

What is Pituitary Apoplexy, how do you investigate and treat?

A

Sudden enlargemetn of a pituitary tumour
MRI
Urgent steroid replacement and surgery

110
Q

What are bilateral vestibular schwannomas associated with?

A

NFT type 1

3A (11 decks)

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