Neurological Flashcards
Define stroke.
Stroke is a neurological emergency caused by an interruption of blood supply to the brain, leading to cell death.
Stroke is the ______ leading cause of death globally.
Second.
True/False: Ischaemic strokes account for 85% of all strokes.
true
What are the two main types of stroke?
Ischaemic stroke and haemorrhagic stroke.
Haemorrhagic strokes are caused by ______ or ______.
Intracerebral haemorrhage; subarachnoid haemorrhage.
True/False: A transient ischaemic attack (TIA) is considered a mini-stroke.
true
List three modifiable risk factors for stroke.
Hypertension, diabetes mellitus, smoking.
Non-modifiable risk factors for stroke include ______, gender, and family history.
Age.
True/False: Atrial fibrillation significantly increases the risk of ischaemic stroke.
true
What is the acronym used to recognize stroke symptoms?
FAST: Face drooping, Arm weakness, Speech difficulties, Time to call emergency services.
Sudden onset of unilateral weakness, sensory loss, or ______ are common features of stroke.
Visual disturbance.
True/False: Aphasia is more common in strokes affecting the left hemisphere.
true
What is the first-line imaging modality for suspected stroke?
Non-contrast CT scan.
MRI is more sensitive than CT for detecting ______ stroke.
Ischaemic.
True/False: Carotid Doppler ultrasound is used to assess stenosis in the carotid arteries.
true
What is the first-line treatment for acute ischaemic stroke within 4.5 hours of symptom onset?
Thrombolysis with alteplase.
Mechanical ______ may be performed for large vessel occlusion strokes.
Thrombectomy.
True/False: Antiplatelet therapy, such as aspirin, is started immediately after thrombolysis.
False. It is started 24 hours after thrombolysis.
What is the immediate goal in managing haemorrhagic stroke?
Lowering blood pressure and managing intracranial pressure.
______ is used to reverse anticoagulation in haemorrhagic stroke patients.
Vitamin K or prothrombin complex concentrate.
True/False: Surgery is rarely needed for haemorrhagic strokes.
False. Surgery may be needed to evacuate haematomas.
Name three measures for secondary prevention of stroke.
Antiplatelet therapy, anticoagulation for atrial fibrillation, and lifestyle modifications.
Statins are recommended for patients with a history of ______ stroke.
Ischaemic.
True/False: Blood pressure control is crucial in preventing recurrent strokes.
true
List two common complications following a stroke.
Dysphagia and post-stroke depression.
Post-stroke ______ is a condition characterized by loss of motor function on one side of the body.
Hemiplegia.
True/False: Seizures can occur as a late complication of stroke.
true
What is the primary feature of frontotemporal dementia (FTD)?
Early-onset dementia with predominant changes in behavior and language.
Name two clinical variants of frontotemporal dementia.
Behavioral variant FTD and Primary Progressive Aphasia (PPA).
What are common behavioral symptoms of frontotemporal dementia?
Apathy, disinhibition, compulsive behavior, and loss of empathy.
What are the key language deficits in Primary Progressive Aphasia (PPA)?
Difficulty with speech production, comprehension, or naming objects.
What genetic mutations are associated with FTD?
Mutations in the MAPT, GRN, or C9ORF72 genes.
What imaging findings are typical in frontotemporal dementia?
Atrophy of the frontal and/or temporal lobes on MRI.
What is the prognosis of frontotemporal dementia?
Progressive with an average survival of 8-10 years from symptom onset.
How is frontotemporal dementia managed?
Symptom-focused management with support for patients and caregivers.
T/F: Frontotemporal dementia primarily affects memory in the early stages.
False – it primarily affects behavior and language.
T/F:Frontotemporal dementia is the most common dementia in individuals under 60.
true
T/F:Cognitive behavioral therapy is the mainstay treatment for FTD.
False – there is no curative treatment; management focuses on symptoms.
T/F:Behavioral variant FTD is often misdiagnosed as a psychiatric disorder.
true
Frontotemporal dementia is often associated with __________ and __________ mutations.
MAPT; C9ORF72.
The two main variants of frontotemporal dementia are __________ and __________.
Behavioral variant FTD; Primary Progressive Aphasia.
Neuroimaging of FTD shows __________ lobe atrophy and sometimes __________ lobe involvement.
Frontal; temporal.
What is the role of multidisciplinary teams in FTD management?
To provide comprehensive care addressing behavioral, cognitive, and caregiver needs
Why is early diagnosis important in FTD?
To initiate symptom management and provide family counseling.
How does FTD differ from Alzheimer’s Disease?
FTD has early behavioral and language changes, while Alzheimer’s typically starts with memory loss.
What is vascular dementia?
A type of dementia caused by reduced blood flow to the brain, leading to cognitive decline due to ischemic or hemorrhagic brain damage.
What are common risk factors for vascular dementia?
Hypertension, diabetes, smoking, hyperlipidemia, atrial fibrillation, and a history of stroke or transient ischemic attacks (TIAs).
Vascular dementia is primarily caused by _________ blood flow to the brain.
Reduced
A history of __________ or transient ischemic attacks increases the risk of vascular dementia.
Stroke
True or False: Vascular dementia is the most common type of dementia.
False (It’s the second most common after Alzheimer’s disease).
True or False: Cognitive impairment in vascular dementia is always sudden.
False (It can develop suddenly or progress gradually depending on the underlying pathology).
What diagnostic tests are commonly used to identify vascular dementia?
MRI or CT imaging to detect vascular damage, cognitive tests like the MMSE, and assessing cardiovascular risk factors.
What findings on imaging might support a diagnosis of vascular dementia?
Evidence of multiple infarcts, white matter changes, or lacunar infarcts.
How is vascular dementia managed?
Managing underlying risk factors (e.g., controlling blood pressure, glucose lipids), antiplatelet therapy if indicated, and cognitive rehabilitation.
Which lifestyle changes are recommended for vascular dementia prevention and management?
Smoking cessation, regular exercise, a healthy diet, and managing hypertension and diabetes.
True or False: Vascular dementia has a slower progression compared to Alzheimer’s disease.
False (It often progresses in a stepwise manner due to repeated vascular events).
What is Alzheimer’s disease?
A progressive neurodegenerative disorder characterized by memory loss, cognitive decline, and behavioral changes, caused by abnormal accumulation of beta-amyloid plaques and neurofibrillary tangles.
What are common early symptoms of Alzheimer’s disease?
Short-term memory loss, difficulty finding words, misplacing items, and subtle personality changes.
Which protein accumulates in the brain in Alzheimer’s disease?
Beta-amyloid plaques and tau protein tangles.
What are the risk factors for Alzheimer’s disease?
Advancing age, family history, Down syndrome, APOE ε4 allele, cardiovascular disease, and a history of head trauma.
True or False: Alzheimer’s disease accounts for about 60-80% of all dementia cases.
true
True or False: Alzheimer’s disease is reversible if diagnosed early.
False (It is a progressive and irreversible disease).
True or False: The APOE ε4 allele is associated with an increased risk of Alzheimer’s disease.
true
Alzheimer’s disease is caused by abnormal accumulation of _________ plaques and __________ tangles in the brain.
beta-amyloid; tau protein.
The main neurotransmitter affected in Alzheimer’s disease is __________.
acetylcholine.
Alzheimer’s disease primarily affects the ___________ lobe early in the disease.
temporal.
What cognitive tests are commonly used to assess Alzheimer’s disease?
Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Addenbrooke’s Cognitive Examination (ACE-III).
What imaging findings support a diagnosis of Alzheimer’s disease?
MRI or CT showing hippocampal atrophy; PET scans showing hypometabolism in the temporal and parietal lobes.
What pharmacological treatments are available for Alzheimer’s disease?
Acetylcholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine.
NMDA receptor antagonist: Memantine (moderate to severe cases).
True or False: Pharmacological treatment can cure Alzheimer’s disease.
False (Treatment can slow progression and manage symptoms but is not curative)
What non-pharmacological interventions are recommended for Alzheimer’s disease?
Cognitive stimulation therapy, occupational therapy, caregiver support, and lifestyle modifications (e.g., regular exercise, social engagement).
True or False: Alzheimer’s disease progresses more rapidly in younger patients.
true
What is the average life expectancy after an Alzheimer’s diagnosis?
8-10 years, but it can vary widely depending on the age of onset and comorbidities.
What is Lewy Body Dementia (LBD)?
A progressive neurodegenerative disorder characterized by the presence of Lewy bodies in the brain, causing cognitive decline, parkinsonism, visual hallucinations, and fluctuating cognition.
What are Lewy bodies?
Abnormal aggregates of alpha-synuclein protein found in the brain, particularly in LBD and Parkinson’s disease.
What are the core clinical features of Lewy Body Dementia?
Cognitive fluctuations.
Visual hallucinations.
Parkinsonism (bradykinesia, rigidity, tremor).
How does Lewy Body Dementia differ from Alzheimer’s disease?
LBD presents with prominent visual hallucinations, fluctuating cognition, and motor symptoms early in the disease course, unlike Alzheimer’s.
True or False: Lewy Body Dementia commonly coexists with Parkinson’s disease.
true
True or False: Memory impairment is an early and dominant feature of Lewy Body Dementia.
False (Early symptoms include visual hallucinations and motor symptoms, with memory impairment occurring later).
True or False: Neuroleptic sensitivity is a hallmark feature of Lewy Body Dementia.
true
Lewy Body Dementia is associated with abnormal aggregation of the __________ protein.
alpha-synuclein.
Common neuropsychiatric symptoms in Lewy Body Dementia include __________ and __________.
hallucinations; delusions.
Lewy Body Dementia is characterized by cognitive __________, which involves periods of good and poor cognitive function.
fluctuations.
What imaging techniques are used in diagnosing Lewy Body Dementia?
MRI: To rule out other causes of dementia.
DaTSCAN: Demonstrates reduced dopamine transporter activity.
True or False: Definitive diagnosis of Lewy Body Dementia requires post-mortem examination.
true
DaTSCAN imaging in Lewy Body Dementia reveals __________ dopamine transporter uptake.
Reduced
What is the mainstay of pharmacological management for Lewy Body Dementia?
Acetylcholinesterase inhibitors (e.g., rivastigmine) for cognitive symptoms.
Why must antipsychotics be used cautiously in Lewy Body Dementia?
Neuroleptic sensitivity can cause severe side effects, including worsening of motor symptoms or neuroleptic malignant syndrome.
What medications can help manage parkinsonian symptoms in LBD?
Levodopa, though it may worsen hallucinations or psychosis.
What is the typical prognosis of Lewy Body Dementia?
Progressive cognitive and motor decline, with an average life expectancy of 5–8 years after diagnosis.
True or False: Lewy Body Dementia progresses faster than Alzheimer’s disease.
true
What is Parkinson’s Disease?
A progressive neurodegenerative disorder caused by the loss of dopaminergic neurons in the substantia nigra.
List the cardinal motor features of Parkinson’s Disease.
Bradykinesia, resting tremor, rigidity, postural instability
What is the pathophysiology of Parkinson’s Disease?
Degeneration of dopaminergic neurons in the substantia nigra leading to a deficiency of dopamine in the basal ganglia.
What are non-motor symptoms of Parkinson’s Disease?
Depression, constipation, anosmia, REM sleep behavior disorder, cognitive decline, and autonomic dysfunction.
True or False: The tremor in Parkinson’s Disease is typically an intention tremor.
False (It is a resting tremor).
True or False: Parkinson’s Disease is associated with alpha-synuclein aggregates called Lewy bodies.
true
True or False: Postural instability occurs early in the course of Parkinson’s Disease
False (It occurs later).
Parkinson’s Disease is caused by the degeneration of __________ neurons in the __________.
dopaminergic; substantia nigra.
The three main classes of drugs used to treat Parkinson’s Disease are __________, __________ agonists, and __________ inhibitors.
levodopa; dopamine; MAO-B.
The tremor in Parkinson’s Disease is described as a __________ tremor and commonly affects the __________.
resting; hands.
What are the clinical diagnostic criteria for Parkinson’s Disease?
Bradykinesia plus at least one of resting tremor or rigidity, and response to dopaminergic therapy.
True or False: MRI is routinely used to diagnose Parkinson’s Disease.
False (Diagnosis is clinical, but MRI may exclude other causes).
A clinical diagnosis of Parkinson’s Disease is supported by a positive response to __________.
Levodopa.
What is the first-line treatment for Parkinson’s Disease in patients under 70 years of age?
Dopamine agonists or monoamine oxidase-B inhibitors.
What is the role of levodopa in Parkinson’s Disease treatment?
It is the most effective symptomatic treatment, often combined with carbidopa or benserazide to prevent peripheral metabolism.
Name two surgical options for Parkinson’s Disease management.
Deep brain stimulation and lesioning procedures (e.g., pallidotomy).
True or False: Anticholinergics are used in Parkinson’s Disease to manage tremor.
true
What is the typical progression of Parkinson’s Disease?
Gradual worsening of motor and non-motor symptoms, with increasing disability over years.
True or False: Parkinson’s Disease is curable.
False (It is a progressive, incurable condition).
The average time from diagnosis to significant disability in Parkinson’s Disease is about __________ years.
37179
What is Benign Paroxysmal Positional Vertigo (BPPV)?
A vestibular disorder caused by displaced otoliths in the semicircular canals, leading to brief episodes of vertigo triggered by head movement.
What are the common symptoms of BPPV?
Episodic vertigo lasting seconds to minutes, triggered by changes in head position, with nausea but no hearing loss or tinnitus.
What is the most common cause of BPPV?
Idiopathic; other causes include head trauma and vestibular neuritis.
True or False: BPPV is associated with tinnitus and hearing loss.
False (BPPV typically does not involve tinnitus or hearing loss).
True or False: BPPV symptoms resolve spontaneously in many cases within weeks to months.
true
True or False: The Dix-Hallpike maneuver is used to diagnose BPPV.
true
The diagnosis of BPPV is confirmed by the __________ maneuver, which elicits vertigo and __________ nystagmus.
Dix-Hallpike; positional.
The Epley maneuver is a __________ technique used to reposition displaced __________.
canalith-repositioning; otoliths.
BPPV most commonly affects the __________ semicircular canal.
Posterior
What clinical test is used to diagnose BPPV?
Dix-Hallpike maneuver.
Describe the findings in the Dix-Hallpike test for BPPV.
Reproducible vertigo with delayed onset of positional nystagmus that fatigues.
What is the first-line treatment for BPPV?
The Epley maneuver.
True or False: Medications such as antihistamines and benzodiazepines are the mainstay of BPPV treatment.
False (Treatment primarily involves physical maneuvers).
If BPPV symptoms persist or recur, patients may require repeated __________ or referral for __________ testing.
repositioning maneuvers; vestibular function.
How long does it typically take for BPPV to resolve spontaneously?
Weeks to months.
True or False: BPPV has a high recurrence rate.
true
What is delirium?
An acute and fluctuating disturbance of consciousness and cognition, often reversible and caused by an underlying medical condition.
List common precipitating factors for delirium.
Infection, medications, dehydration, electrolyte imbalance, hypoxia, metabolic disturbances, and trauma.
What are the two main subtypes of delirium?
Hyperactive (restlessness, agitation) and hypoactive (lethargy, drowsiness).
True or False: Delirium is more common in younger adults than in older adults.
False (Delirium is more common in older adults).
True or False: Hypoactive delirium is harder to recognize than hyperactive delirium.
true
True or False: The Confusion Assessment Method (CAM) is a diagnostic tool for delirium.
true
The hallmark feature of delirium is __________ and __________ onset of symptoms.
acute; fluctuating.
The __________ assessment is commonly used to screen for delirium.
Confusion Assessment Method (CAM).
Common reversible causes of delirium include __________ and __________ imbalances.
infections; electrolyte.
What are the key features in the Confusion Assessment Method (CAM)?
Acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness.
How is delirium differentiated from dementia?
Delirium has an acute onset and fluctuates, while dementia is chronic and progressive.
What is the mainstay of delirium management?
Identifying and treating the underlying cause.
Name non-pharmacological strategies for managing delirium.
Reorientation, ensuring adequate hydration and nutrition, correcting sensory deficits, and maintaining a calm environment.
True or False: Antipsychotics are first-line treatment for all cases of delirium.
False (Antipsychotics are reserved for severe agitation or distress).
True or False: Delirium can increase the risk of long-term cognitive decline.
true
What is the prognosis for delirium if the underlying cause is treated?
Delirium is often reversible, but recovery may take weeks to months, especially in older adults.
