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YR 4 Neurology and special senses > Neuro/Stroke > Flashcards

Neuro/Stroke Flashcards

1
Q

Where in the brainstem do the 3rd and 4th cranial nerves originate?

A

The oculomotor and trochlear nerves arise from the Midbrain

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2
Q

Where in the brainstem do the 6th, 7th and 8th cranial nerves originate?

A

The abducens, facial and vestibulocochlear nerves arise from the Pontine-medulla junction (pontomedullary)

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3
Q

Where in the brainstem does the 5th cranial nerve originate?

A

The facial nerve arises from the Pons

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4
Q

Where in the brainstem do the 9th, 10th, 11th and 12th cranial nerves originate?

A

The glossopharyngeal, vagus, accessory and hypoglossal nerves arise from the Medulla oblongata

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5
Q

Presentation of Syringomyelia?

A

Vibration and joint position sense is spared - dorsal column is fine
Pain and temperature sense lost in both arms - spinothalamic fibres damaged bilaterally in the cervical cord

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6
Q

Signs of an UMN lesion

A

Clonus, no wasting or fasciculation, extensor plantars, hyperreflexia, increased tone,

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7
Q

Signs of a LMN lesion

A

Reduced tone, absent reflexes, muscle wasting, flexor plantars, fasciculation,

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8
Q

What is the epidemiology of MS?

A

F:M ratio is 2:1
25 - 35yrs of age
Typical patient is white woman in her 20s

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9
Q

What are risk factors of developing MS?

A
  1. Genetic component - mutation at the MHC-HLA gene region as well as non-MHC mutations which encode for pro-inflammatory cytokines IL-7 and IL-2
  2. Environmental factors - smoking, diet (Vit D), sunlight, infections
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10
Q

How do patients with MS present?

A
  1. Optic nerve inflammation and diplopia
  2. Ataxia and vertigo (impaired balance or clumsiness)
  3. Weakness, neuropathic pain (trigeminal neuralgia) and sensory loss
  4. Sexual dysfunction
  5. Urinary incontinence

Cognitive impairment occurs later in the diease process

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11
Q

How do we diagnose MS?

A

Atleast two episodes of symptoms occurring at different points in time resulting from involvement with different areas of the CNS
Absence of other treatable causes for the symptoms

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12
Q

What differentials are there for MS like symptoms?

A

Stroke, Lyme disease, Lupus, Migraine, Non-recurrent inflammatory process, Encephalitis, Tumor of the brain or spinal cord

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13
Q

How do we treat MS?

A
  1. Immune modulating drugs e.g. Betaferon
  2. Immune suppressing drugs e.g. Fingolimod

DMTs - dimethyl fumarate

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14
Q

Define Status Epilepticus

A

Recurrent seizures without recovery in between or a single seizure lasting more than 30 mins

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15
Q

Name 5 causes of Status Epilepticus in patients with preexisting epilepsy

A
  • AED withdrawal/non-compliance
  • Alcohol use and withdrawal
  • Illicit drugs
  • Intercurrent infection
  • Progression of underlying disease e.g. tumour
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16
Q

Name 5 causes of Status Epilepticus in patients with NO history of epilepsy

A
  • Cerebral Tumour
  • Intracranial infection
  • Electrolyte imbalance LOW Mg, Na, Ca
  • Hypoglycaemia
  • Hypoxia
  • Head injury
  • Drug withdrawal
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17
Q

How would you manage a patient with Status Epilepticus?

A
  1. A-E assessment - protect airways and put patient into recovery position post-ictal phase
  2. Give high flow O2 - monitor sats
  3. Fluids
  4. ECG
  5. Take bloods when possible - U&Es, BMs, LFTs, FBC
  6. Check drug/toxins screen
18
Q

What drugs will you use in Status Epilepticus?

A

Seizures lasting longer than 5 mins - Lorazepam 4mg IV bolus repeated once after 10 mins (prepare Phenytoin)

Established status (>25 mins) we administer Phenytoin 20mg/kg over 20 mins taking advice from Neurologist

Refractory status (>30mins) general anaesthesia is given e.g. High dose Propofol

19
Q

What systemic complications may arise from a patient with Status Epilepticus?

A

Hypoxia, lactic acidosis, hypoglycaemia, change in blood pressure, dysrhythmias, hyperpyrexia, increased ICP, rhabdomyolysis

20
Q

What management advice would you give to patients/family about a patient who has recently been diagnosed with Epilepsy?

A
  1. Inform DVLA - have to be one year seizure free to drive unless one off seizure then 6 months free
  2. Avoid triggers which may have caused fit e.g. alcohol, illicit drugs
  3. Do not bathe babies alone and also bathe with door unlocked
21
Q

What is the most common type of stroke?

A

Ischaemic stroke 85%
Intracerebral haemorrhage 10%
Subarachnoid haemorrhage 5%

22
Q

What signs would you see in a large vessel stroke e.g. MCA?

A

MCA supplies the lateral aspect of the hemispheres - thus arm weakness would be greater than legs.
Left MCA there would be evidence of aphasia
RIght MCA there would be evidence of neglect, apraxia, topographical difficulty

23
Q

What signs would you see in a large vessel stroke e.g. ACA?

A

ACA supplies the middle aspect of the hemispheres. thus leg weakness would be greater than arm, cognitive impairment, disinhibition and abulia (absence of a persons willpower or ability to act decisively)

24
Q

What signs would you see in a large vessel stroke e.g. PCA?

A

We would see a hemianopia, memory loss/confusion

25
Q

What signs would you see in a large vessel stroke e.g. in the cerebellum?

A

Ipsilateral ataxia

26
Q

Where would you find Broca’s and Wernicke’s area?

A

Broca’s (expressive) found Left inferior frontal gyrus

Wernicke’s (receptive) found superior temporal gyrus

27
Q

Name 4 risk factors for Stroke

A
  1. HTN
  2. HLD
  3. Smoking
  4. Diabetes
  5. Sleep apnea
28
Q

List the etiology of an Intracranial haemorrhage

A
  • Trauma
  • Cocaine/Amphetamine use
  • Hypertensive
  • Aneurysmal rupture
  • AV malformation rupture
29
Q

In SAH where is the most common site for aneurysmal rupture?

A

Anterior communicating artery is the most common site for an aneurysm.

30
Q

How would a patient present with a SAH?

A

Thunderclap headache, signs of meningism e.g. photophobia, neck stiffness, nausea
Reduced consciousness
Retinal haemorrhage and papilloedema

31
Q

What investigations would you do for a SAH?

A

CT brain done asap
MRI brain most sensitive after 3 days
CSF - Xanthochromia, elevated opening pressure, elevated protein
Angiography

32
Q

Treatment of SAH?

A

Surgical clipping of aneurysm
Prevent/treat vasospasm - Nimodipine, hypertensive therapy
Correct electrolyte distrubance
Treat hydrocephalus with a ventricular drain/shunt

33
Q

What is the most common subtype of GBS?

A

AIDP - Acute inflammatory demyelinating polyradiculoneuropathy

34
Q

How would GBS present in patients?

A

Symptoms usually develop 1-3 weeks post infection (resp or GI) where patients complain of backache, pain in the form of cramps or hyperesthesias. These peak by 4 weeks.

Symptoms are relatively symmetrical, bilateral facial weakness, autonomic dysfunction

PROGRESSIVE WEAKNESS IN BOTH ARMS AND LEGS
AREFLEXIA

35
Q

What investigations would you do for a patient with suspected GBS?

A
  • History and physical exam
  • EMG study
  • LP for CSF = increased protein, lymphocytes
  • Campylobacter serology if GI upset
  • Anti-ganglioside antibodies
  • Stool cultures
  • Throat swab
36
Q

Give examples of complications of GBS

A
  1. Autonomic dysfunction - cardiac arrhythmias, postural hypotension, hypertension, urinary retention, ileus
  2. Respiratory - resp failure in 25% of patients

Do ABG to detect type II resp failure, bedside spirometry and FVC

  1. Pain, DVT/PE, SIADH, Renal failure secondary to IVIg, hypercalcaemia
37
Q

How would you manage a patient with GBS?

A
  • Close Obs as weakness is progressive
  • Bedside spirometry and ventilatory support
  • ECG cardiac monitoring
  • Nutritional support
  • DVT prophylaxis
  • Urinary catheter
  • Pain control and laxatives

Medication wise - IV immunoglobulin, Plasmapheresis used within first 2 weeks of onset (no benefit after 3 weeks)
Steroids are ineffective in GBS

38
Q

List some motor symptoms of Parkinson’s disease

A

Symptoms upon onset being UNILATERALLY

Bradykinesia
Shuffling gait
Rest tremor (pin rolling)
Muscular rigidity 
Postural instability
39
Q

List some non-motor symptoms of Parkinson’s disease

A 
Fatigue
Low BP
Speech and communication problems
Bladder and bowel problems
Anxiety, depression, hallucinations
40
Q

List 4 differentials for Parkinson’s disease

A

Drug induced e.g. antipsychotics which are dopamine antagonists such as Risperidone, Quetiapine, Clozapine

Space occupying lesions

Age associated gait disorders

Post traumatic encephalopathy

Metabolic disorders (hypothyroidism)

Stroke

41
Q

What are the three main patterns of clinical presentations in MS?

A
  1. Relapsing remitting
  2. Secondary progressive
  3. Primary progressive
42
Q

What investigations would you do in a person with suspected MS?

A
  1. MRI brain or spinal cord which will show demyelination plaques
  2. LP for obtain CSF - immunoelectrophoresis of CSF will show oligoclonal bands of IgG

YR 4 Neurology and special senses (2 decks)

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