Neuro Misc Flashcards
3 dopamine agonists used in parkinson’s?
Pramipexole
Roprinilole
Apomorphine - acute ‘off’ states
2 Anticholinergics used in Parkinson’s to help tremor?
Trihexiphenidyl
Benzhexol
2 COM-T inhibitors used in Parkinson’s?
Why are they used?
Entecapone
Tolcapone
Lessen ‘off’ time in levodopa therapy
(monitor LFT’s)
Treatment of dyskinesia assoc w treatment of parkinson’s?
Amantidine
NMDA antagonist
What should patients be started on after ischaemic stroke?
Give aspirin 300mg PO/PR as soon as haemorrhagic stroke ruled out, and continue for 14 days.
After 14 days:
1st line = Clopidogrel + statin
2nd line = Aspirin + Dipyramidole + statin
3rd line = Dipyramidole + statin
(wait 14 days to minimise the risk of transitioning to haemorrhagic)
Causes of cerebellar dysfunction?
PASTRIES
Posterior fossa tumour Alcohol multiple Sclerosis Trauma Rare causes Inherited diseases (e.g. Friedrich's ataxia) Epilepsy treatment Stroke
35 y/o male presents with difficulty walking. He has his feet wide apart and staggers, and there is loss of normal heel-toe walk. What is this gait?
Ataxic - cerebellar disease
Inability to adduct fingers of hand - nerve?
Ulnar
Inability to extend fingers of hand- nerve?
Radial
What group of people have a 3x higher risk of developing Bell’s Palsy?
Pregnant women
How long can you not drive for after TIA?
1 month
Rugby player presents after receiving a hard tackle during a match. His arm is hanging loose, it is pronated and internally rotated. What is damaged?
Brachial nerve roots C5/6
This describes Erb’s palsy
Which antipsychotic can cause megaloblastic anaemia?
Phenytoin - alters folate metabolism
Bitemporal hemianopia predominantly affecting upper quadrants?
Pituitary macroadenoma
Bitemporal hemianopia predominantly affecting lower quadrants?
Craniopharyngioma
Elderly lady suffering from hypertension is admitted following a intracranial bleed. Over the course of the day she becomes more unresponsive, responding now to supraorbital pain only. What is the most likely diagnosis? Investigation?
Hydrocephalus
CT brain
How to differentiate acute and chronic subdural haematoma on CT?
Acute - blood is HYPERdense
Chronic - HYPOdense
Medical treatment of delirium?
Haloperidol
NOT if Parkinson’s though, give Lorazepam instead
67 y/o man with CVS Hx presents with sudden onset dizziness and vomiting. Exam reveals vertical nystagmus and inability to stand without support. Likely cause?
Cerebellar stroke -> urgent CT brain
similar presentation to vestibular neuritis, except patients are usually able to stand without support in this
Patient is hit on head with hammer, depressed open skull fracture evident, GCS 6/15 - initial management?
Urgent neurosurgical review, even before CT
Any patient with GCS <8/15 needs urgent neurosurgical review
67 y/o falls down stairs. He has GCS 15/15 and no signs except bruising at mastoid - management?
Urgent CT within 1 hour
Battle’s sign -> basal skull fracture
52 y/o woman falls down stairs. Has no neurology, but is unable to turn neck 45 degrees to left and right - management?
Immobilise with neck brace and arrange CT neck
Woman has sinusitis. Then a week later develops severe frontal headache with difficulty lifting her right arm and leg. She then has a seizure. What does she have?
Cerebral abscess
How does cavernous sinus thrombosis present?
Unilateral facial oedema
Photophobia
Proptosis
CN III, IV, V1 and VI palsy
Can be a complication of sinusitis
First line treatment options for neuropathic pain?
Amitriptyline
Duloxetine
Pregabalin
Gabapentin
Loss of ability to abduct thumb - nerve?
Median
Which medications can cause benign intracranial hypertension?
Tetracyclines Contraceptives Steroids Levothyroxine Lithium
What does taste and general sensory for anterior 2/3 of tongue?
Taste - facial (via chorda tympani)
General sensory - CNV1
How does corticobasal degeneration present?
Parkinsonism
Cortical signs e.g. hyperreflexia, myoclonus, apraxia (difficulty completing simple movements) affecting one limb more than the other.
Can cause ‘alien limb phenomenon’
Prominent gait unsteadiness and falls
How does supranuclear palsy present?
Symmetrical parkinsonism
Vertical gaze palsy, saccadic eye movements, eventually limitation to eye movement
Chewing and swallowing diffuculty
What antibiotic should never be given in myasthenia gravis?
Gentamicin
Affects NMJ so can cause respiratory depression
What is epilepsy partialis continua?
Non-convulsive status
Consciousness preserved but patient is in ‘altered state’, consider this in elderly
Are focal or generalised seizures more common in older patients?
Focal
In focal seizures the brain in structurally abnormal
Side effects of Carbamazepine?
Ataxia
Vertigo
Blurred vision
Hyponatraemia
Which 2 anticonvulsants shouldn’t be given together?
Valproate and Lamotrigine
Febrile convulsions are a risk factor for the development of which type of epilepsy?
Focal temporal seizures
Febrile seizures can cause sclerosis of mesial temporal lobe
Is a lesion of the DOMINANT parietal lobe more likely to present with L/R disorientation or hemispatial neglect syndrome?
L/R disorientation
Meningioma risk factors:
Genetic condition?
Early life exposure to something?
What sex?
NF2
Childhood radiation exposure
Female sex
A lesion of which lobe might cause urinary incontinence?
Frontal - micturition centre is in frontal lobe
A lesion of which lobe is likely to cause a contralateral homonymous hemianopia?
Occipital
Will have macular sparing
What is Foster Kennedy Syndrome?
What is the usual cause?
What can relieve symptoms whilst awaiting surgery?
Ipsilateral optic nerve atrophy, central scotoma and anosmia; contralateral papilloedema
Meningioma in olfactory groove
Dexamethasone whilst awaiting surgery/radio/chemo
Which is the most common extra-axial brain tumour of mesenchymal cells?
Meningioma
What controls consciousness?
Where is it found?
Reticular formation
Network of neurones stretching from upper midbrain to lower medulla oblongata
A stroke affecting which circulation is most likely to present with decreased consciousness? Why?
Posterior
Consciousness mediated by reticular formation in brainstem - posterior stroke is of vertebrobasilar circulation so can affect brainstem
What are Verocay bodies?
What are they found in?
Cellular areas surrounded by nuclear pallisades
Schwannomas
What are hemangioblastomas?
Where are they most commonly found?
Benign tumours which are cystic and highly vascular
Most commonly in posterior cranial fossa
Which tumour has a ‘butterfly appearance’ on MRI?
Glioblastoma multiforme
What thyroid panel would be expected in a patient with a functional thyrotropinoma?
Increased TSH
Increased T3/T4
-> Cause secondary hyperthyroidism by releasing excess TRH
Craniopharyngioma is a rare pituitary tissue tumour. What does it present with?
Lower bitemporal hemianopia
Diabetes insipidus
Which tumour is associated with Von Hippel Lindau Syndrome?
Hemangioblastoma
Along with phaeochromocytoma, renal cell carcinoma, pancreatic cysts
Treatment of a tumour that presents with amenorrhoea, galactorrhoea, decreased libido?
Cabergoline
Prolactinoma - cabergoline is a dopamine agonist
A lesion in which lobe would present with cortical blindness and visual hallucinations?
Occipital
2 brain tumours associated with NF2?
Meningioma
Schwannoma - likely if young and bilateral vestibular schwannoma
Hemispatial neglect syndrome would most likely appear with a lesion on the dominant/non-dominant side?
Non-dominant
Treatment of a tumour which presents with gigantism and acromegaly?
1st - Ocreotide (a somatostatin analogue)
2nd - Pegvisomant (GH antagonist)
7 symptoms of a frontal lobe lesion?
Disinhibition Personality change (antisocial behaviour) Lack of initiative Impaired memory Urinary incontinence Grasp reflex Anosmia
Dominant parietal lobe lesion?
Agraphia
Acalculia
R/L disorientation
Finger agnosia (inability to localise fingers)
(gerstmann syndrome)
Also inferior quadrantopia
Non-Dominant parietal lobe lesion?
Hemispatial neglect
Spatial disorientation
Dressing/Construction apraxia
Inferior quadrantopia
Lesion of Dominant temporal lobe?
Wernicke’s aphasia
Poor memory
Complex hallucinations (sound, smell, visual)
Superior quadrantopia
Non-dominant temporal lobe lesion?
Poor music skills
Poor non-verbal memory
Complex hallucinations (sound, smell, visual)
21 y/o man assaulted outside of pub 3 hours ago. He drank 3 pints of lager. He has bruising on face around eye. GCS 14 (M6 V4 E4) with some difficulty explaining where he is. Management?
Urgent CT head within 1 hour
Do this if GCS < 15 after 2 hours
If suspect subarachnoid haemorrhage but CT normal, how long should you wait before confirming with LP?
12 hours after headache started
What findings prove SAH on LP?
Breakdown products from RBC e.g. bilirubin (Xanthochromia)
Presence of RBC’s could be from bloody tap. Wait 12 hours for RBC’s to be broken down.
75 y/o man falls and hits head and was unconscious for 1 min. Comes to A&E 2 hours later, GCS 15, no neurological signs. management?
CT within 8 hours
Anyone >65y/o who have head injury causing amnesia or unconsciousness should get CT within 8 hours, unless indications suggesting it should be within 1 hour e.g. GCS <15 after 2 hours
30y/o nurse has 24 hour Hx of headache, drowsiness, confusion. GCS 13/15. No signs of meningism, and she is confused. Urgent MRI shows bilateral increased signal in both temporal lobes. What is is?
Herpes Simplex encephalitis
No meningism, confusion, increased temporal lobe signal
