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Revision > Neurological > Flashcards

Neurological Flashcards

1
Q

Gerstmann syndrome

A

Dysgraphia
Dyscalculia
Finger agnosia
Left-right disorientation

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2
Q

Features of TIA affecting ICA

A

Amaurosis fugax
Aphasia
Hemiparesis
Hemisensory loss

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3
Q

Features of TIA affecting vertebrobasilar arteries

A

Transient global amnesia

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4
Q

Lateral medullary syndrome

A

Ipsilateral:

  • Loss of pain/temperature in face
  • Ataxia + incoordination
  • Dysarthria + dysphagia
  • Horner’s syndrome

Contralateral:
-Loss of pain/temperature in body

-Vertigo + nystagmus

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5
Q

Brown-Séquard syndrome

A

Ipsilateral:

  • Paralysis
  • Loss of proprioception/vibration

Contralateral:
-Loss of pain/temperature

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6
Q

Anterior cord syndrome

A

Bilateral paralysis + loss of pain/temperature

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7
Q

Posterior cord syndrome

A

Bilateral loss of proprioception/vibration

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8
Q

Medial medullary syndrome

A

Ipsilateral:
-Tongue deviatoin

Contralateral:

  • Hemiplegia/paresis
  • Loss of proprioception/vibration
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9
Q

Causes of seizures

A

VITAMIN PD:

  • Vascular - stroke, AV malformation
  • Infection - meningitis, encephalitis, syphilis, HIV, Lyme disease, cerebral malaria
  • Trauma
  • Autoimmune - SLE, cerebral vasculitis
  • Metabolic - uraemia, hepatic encephalopathy, hypoglycaemia, hyponatraemia, hypocalcaemia
  • Idiopathic - epilepsy
  • Neoplastic
  • Pseudoseizure
  • Drugs - TCAs, lithium, tramadol, theophylline, flucloxacillin, ciprofloxacin, cocaine, alcohol/benzodiazepine withdrawal
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10
Q

Status epilepticus

A

Seizure >5 min or multiple seizures without break in 5-min period

Management: airway protection, oxygen, benzodiazepine

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11
Q

Lifestyle modification in epilepsy

A 
Avoid swimming and dangeous sports
Leave bathroom doors unlocked
Take showers instead of baths
Avoid triggers (e.g. sleep deprivation, alcohol, drugs)
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12
Q

Driving guidelines in epilepsy

A

Private:

  • Seizure-free for 12 months
  • Compliant with medications

Commercial:

  • Seizure-free for 10 years
  • Compliant with medications
  • No epileptiform activity on EEG
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13
Q

Acute management of migraine

A

General:

  • Rest in quiet, dark room
  • Avoid movement/any activity

First-line drugs:

  • Simple analgesics
  • Antiemetics (domperidone, metoclopramide)

Second-line drugs:

  • Triptans (sumatriptan, zolmitriptan)
  • Dihydroergotamine
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14
Q

Prevention of migraine

A

Non-pharmacological:

  • Avoid triggers
  • CBT/relaxation exercises
  • Acupuncture

Drugs - VASPP:

  • Verapamil
  • Amitriptyline
  • Sodium valproate/topiramate
  • Propranolol
  • Pizotifen
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15
Q

Acute management of tension headache

A
  • Simple analgesics

- Amitriptyline (if frequent/constant)

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16
Q

Acute management of cluster headache

A
  • High-flow (10L/min) 100% oxygen for 15 min with a non-rebreathing mask
  • Sumatriptan (SC/intranasal)
  • Dihydroergotamine (IM)
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17
Q

Prevention of cluster headache

A

Bridging with predinosolone +

  • Verapamil
  • Methysergide
  • Lithium
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18
Q

Management of trigeminal neuralgia

A

Carbamazepine

19
Q

Signs of papilloedema on fundoscopy

A 
Hyperaemia (dilated veins)
Optic disc haemorrhages
Optic margin blurring
Optic disc swelling
Cotton-wool spots/exudates
20
Q

Extradural haemorrhage on CT

A

Biconvex/lenticular hyperdensity (somewhat heterogenous, sharply demarcated - limited to sutures)
Mass effect - midline shift, loss of ventricles

21
Q

Causes of subdural haemorrhage

A

Shearing force causing damage to bridging cortical veins

Infants - shaken baby
Young adults - MVA
Elderly - falls

22
Q

Subdural haemorrhage on CT

A

Acute:
Crescentic hyperdensity (homogenous, spread diffusely)
Mass effect - midline shift, loss of ventricles
Sulcal effacement

Chronic:
Hypodensity

23
Q

Subarachnoid haemorrhage on CT

A

Diffuse hyperdensities

24
Q

Management of subarachnoid haemorrhage

A

Stabilisation
Prevention of rebleeding - bed rest, analgesia, sedation, stool softeners, clipping/coiling
Prevention of vasospasm - CCB, triple H therapy (use of IV fluids to achieve hypertension, hypervolaemia and haemodilution)

25
Q

Meningitis organisms by age group

A

Newborns (GEL): group B streptococci, E. coli, Listeria

Children (SNH): Strep. pneumoniae, Neisseria, Haemophilus

Adolescents/young adults: Neisseria, Strep. pneumoniae

Older adults (SNL): Strep. pneumoniae, Neisseria, Listeria

26
Q

Kernig’s sign

A

Pain on passive knee extension with hip fully flexed

27
Q

Brudzinski’s sign

A

Hip/knee flexion on passive neck flexion

28
Q

Signs of bacterial meningitis on CSF

A

Cloudy/turbid
Raised neutrophils
High/very high protein
Very low glucose

29
Q

Signs of viral meningitis on CSF

A

Clear
Raised lymphocytes
Normal/high protein
Normal/low glucose

30
Q

When is CT head before LP indicated?

A 
F PAIN:
Focal neurological deficits
Papilloedema
Altered mental state
Immunocompromised
New-onset seizures
31
Q

Empirical therapy for meningits

A

Dexamethasone + ceftriaxone

Add benzylpenicillin if immunocompromised, age >50, alcoholic or pregnant (Listeria)

32
Q

Management of multiple sclerosis

A

Lifestyle modification:

  • Weight loss
  • Vitamin D supplementation
  • Smoking cessation

Acute relapses:

  • Mild - rest/reassurance
  • Moderate - prednisolone
  • Severe - methylprednisolone

Ongoing:

  • Immunomodulator (interferon beta, glatiramer acetate) ±
  • Immunosuppresant (azathioprine, methotrexate)

Symptomatic relief:

  • Spasticity - baclofen, diazepam, clonazepam
  • Fatigue - amantadine
  • Bladder dysfunction - anticholinergics
33
Q

Signs of Parkinson’s disease

A
  • Pill-rolling tremor
  • Bradykinesia
  • Rigidity
34
Q

Management of Parkinson’s disease

A

General:

  • Rehabilitation/physiotherapy/balance training
  • Group support
  • Nutrition (dietary fibre and vegetables for constipation)

Drugs - LCD MAC:

  • Levodopa
  • Carbidopa/benserazide
  • Dopamine agonists (bromocriptine, apomorphine, pergolide)
  • MAO-B inhibitors (selegiline)
  • Anticholinergics (benztropine)
  • COMT inhibitors (entacapone)

Surgery:
-Deep brain stimulation

35
Q

Causes of peripheral neuropathy

A

VITAMIN CD:

  • Vascular - vasculitis, PVD, Buerger’s disease
  • Infectious - EBV, CMV, HIV
  • Trauma - compression
  • Autoimmune - Guillain-Barré syndrome
  • Metabolic - DEBUT: DM, ethanol, B12 deficiency, uraemia, thyroid; B1 deficiency, B6 deficiency
  • Iatrogenic - vincristine, metronidazole, amiodarone, isoniazid, phenytoin
  • Neoplastic - paraneoplastic syndrome in SCLC and lymphoma
  • Congenital - Charcot-Marie-Tooth disease
  • Deposition - amyloidosis, sarcoidosis
36
Q

Function, location (anterior/posterior) and site of decussation of three main tracts

A

(Lateral) corticospinal tract - motor, anterior, medulla
Spinothalamic tract - pain/temperature, anterior, anterior white commissure
DCML - proprioception/vibration/fine touch, posterior, medulla

37
Q

Causes of stroke

A

Ischaemic (80%):

  • Arterial thrombosis (atherosclerosis, dissection, vasculitis)
  • Cardioembolism (AF, valvular heart disease, recent MI, endocarditis)
  • Systemic hypoperfusion (cardiac arrest, arrhythmia, MI)

Haemorrhagic (20%):

  • Intracerebral haemorrhage (hypertension, trauma, vasculitis, AV malformations)
  • SAH
38
Q

ACA stroke

A

Contralateral leg paresis/sensory loss

39
Q

MCA stroke

A

Contralateral face/arm paresis/sensory loss
Contralateral homonymous hemianopia
Aphasia (dominant hemisphere)
Neglect (non-dominant hemisphere)

40
Q

PCA stroke

A

Contralateral homonymous hemianopia
Midbrain - CN II/IV palsy, contralateral hemiparesis
Thalamus - contralateral hemisensory loss, amnesia, reduced consciousness

41
Q

Acute changes in ischaemic stroke on CT

A
  • Hyperdense segment of vessel (thrombus/embolus) (earliest change)
  • Loss of cortical white-grey differentiation
  • Well-demarcated region of hypoattenuation (later)
  • Parenchymal swelling and mass effect
42
Q

Acute management of stroke

A
  • Thrombolysis (tPA) - within 4.5 hr
  • Aspirin - after 4.5 hr (withhold for 24 hr after thrombolysis)
  • Clot retrieval - consider in large vessel occlusion
  • Hemicraniectomy - in younger patients
43
Q

Main signs of meningitis in pathology specimen

A

Vasodilation
Neutrophil infiltration (increased opacities, especially in sulci)
Oedema

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