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MD2 lectures > Neurological > Flashcards

Neurological Flashcards

1
Q

The spinal cord and cauda equina may be compressed by lesions that are…

A

Extradural (80%), intrdural/extramedullary (15%) and intramedullary

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2
Q

What motor neuron signs are expected in a degenerative cervical canal stenosis?

A

Lower motor neuron signs in the upper limbs and spastic paraparesis (UMN) in the lower limbs

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3
Q

What investigation should you order if spinal cord compression is likely?

A

MRI

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4
Q

What are the principles of treatment of degenerative canal stenosis?

A
  • Conservative if mild or non-progressive
  • Surgical treatment if moderate, severe or progressive: removal of compressing lesion (posterior approach = laminectomy, anterior approach = discectomy or vertebrectomy)
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5
Q

Compression in which 2 regions particularly cause sphincter disturbance?

A

Conus medullaris and cauda equina

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6
Q

What symptoms occur first in sphincter disturbance?

A

Difficulty initiating urine is usually the first symptom, followed by urinary retention or incontinence

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7
Q

What are the common causes of malignant spinal cord compression?

A

Lung, breast, prostate, kidney, lymphoma, myeloma

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8
Q

What are the principles of treatment of malignant spinal cord compression?

A

Commence dexamethasone

Options include:

  • Palliation/symptom control only
  • Radiotherapy
  • Surgery
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9
Q

In what population and what region are spinal abscesses most common?

A

IVDU; thoraco-lumbar region

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10
Q

What are the FAST signs of stroke?

A
  • Facial weakness
  • Arm weakness
  • Speech difficulty
  • “Time to act fast” = 000
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11
Q

Main causes of intracerebral haemorrhage (2)

A
  1. Deep hypertensive location

2. Lobar (amyloid, AVM, tumour)

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12
Q

What area do you aim to rescue in the treatment of an acute stroke?

A

Penumbra

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13
Q

What is the CHADS2?

A

Scoring system for AF and stroke risk:

  • 1 point for HF, HTN, >75yo, DM
  • 2 points for previous stroke or TIA

If score is >1, oral anticoagulant is recommended

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14
Q

What are some secondary prevention strategies following stroke?

A
  • BP and cholesterol medication
  • Antiplatelet therapy
  • Carotid endarterectomy if carotid artery stenosis (or stenting if
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15
Q

What are the features of a generalised tonic clonic seizure?

A
  • Tonic phase: arms down, eyes open, cry
  • Clonic phase
  • Apnoea
  • Last 1-5 minutes
  • Minor injury common (tongue biting)
  • After going confusion
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16
Q

What are the features of an absence seizure?

A
  • Alteration of consciousness: stay upright, no warning
  • Facial twitch
  • Last 2-10 seconds
  • Present in children or teenagers
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17
Q

What are the features of a myoclonic seizure?

A
  • Sudden, involuntary muscle twitch
  • Action-related
  • Appear as a prodrome to GTCS
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18
Q

What are the features of a focal seizure?

A
  • No alteration of consciousness
  • Usually brief
  • Features depend on location: eg/ temporal = deja-vu
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19
Q

What are the features of a focal dyscognitive seizure?

A
  • Localised region
  • Affects consciousness
  • Similar to absence but longer, less distinct offset, automatisms, less frequent and preceding simple seizure
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20
Q

What are the subsyndromes of genetic generalised epilepsies?

A
  1. Childhood absence epilepsy
  2. Juvenile myoclonic epilepsy
  3. Juvenile absence epilepsy
  4. Epilepsy with tonic-clonic seizures alone
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21
Q

What are the features of childhood absence epilepsy (petit mal)?

A
  • Onset in 4-8 yo (up to 12yo)

- Seizure types: absence seizures, GTCS

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22
Q

What are the features of juvenile absence epilepsy?

A
  • Onset in adolescence

- Seizure types: GTCS, absence seizures (infrequent, absence status)

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23
Q

What are the features of juvenile myoclonic epilepsy?

A
  • Onset in 12-18yo
  • Seizure types: myoclonus, GTCS, absences in 30%
  • Photosensitive
  • Sleep-wake cycle
  • May evolve from CAE
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24
Q

What are the features of a psychogenic pseudoseizure?

A
  • Fluctuating intensity
  • Very long
  • Eyes closed
  • Non-anatomical tremor
  • Reactive
  • Consciousness retained
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25
Q

What investigations are required in epilepsy?

A
  • EEG

- MRI brain

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26
Q

What lifestyle issues should you warn a patient about with epilepsy?

A
  • Swim only with someone who is aware
  • Avoid heights
  • Consider safety at work
  • Triggers: alcohol, sleep
  • Driving: 6-12 months seizure free
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27
Q

What are the features of MND?

A
  • Disorder of upper and lower motor neurons
  • Peak age of onset 55-70yo
  • Muscle wasting including the tongue, generalised weakness
  • Fasciculations
  • Reflexes preserved until late, may have upgoing plantar reflex
  • NO SENSORY LOSS
  • Cranial nerves (except bulbar) spared
28
Q

What clinical features should make you suspect myasthenia gravis?

A
  • History of fatiguability
  • Early involvement of extraocular muscles and lid opening muscles
  • Dysarthria
  • No muscle wasting
  • Weakness increasing with repetitive exercise
  • Reflexes and sensation unaffected
29
Q

What tests are diagnostic for myasthenia gravis?

A
  • Tensilon test
  • Blood test for Autoantibodies-ACh receptor
  • CT chest: thymoma
  • EMG studies: repetitive stimulation, single fibre, post-exercise
30
Q

What is the most common cause of focal mononeuropathy?

A

Compression

31
Q

What is the most common cause of mononeuritis multiplex?

A

Almost always ischaemic

32
Q

What investigations are required in a suspected myopathy?

A
  • Needle EMG
  • CK
  • Family history and genetic testing
  • Muscle biopsy
33
Q

What would be seen on muscle biopsy in muscular dystrophy?

A
  • Varying muscle fibre size
  • Regenerating and degenerating fibres
  • Increased fibrosis
34
Q

What would be seen on muscle biopsy in polymyositis?

A
  • Inflammatory cell infiltrate

- Degenerating and regenerating muscle cells

35
Q

What are the cardinal features of Parkinson’s disease?

A
  • Tremor
  • Bradykinesia
  • Rigidity
  • Postural instability
36
Q

What is dyskinesia?

A

Reversible levodopa-induced motor complication

  • Abnormal involuntary movements
  • Treat by adjusting levodopa dosing
37
Q

What is dystonia?

A

Involuntary muscle contraction and involving abnormal movements and postures
- Can be an undertreated PD motor symptom or a complication of levodopa treatment

38
Q

What are the levodopa-related motor complications?

A
  • Wearing off
  • On-off syndrome
  • Failure to turn “on”
  • Acute akinesia
39
Q

What are the non-motor features of PD?

A
  • Orthostatic hypotension
  • Urine frequency
  • Constipation
  • Depression
40
Q

What is the pain of a migraine like?

A
  • Few hours to 3 days
  • Recurrent, episodic
  • Moderate to severe, building over minutes
  • Unilateral
  • Pulsating
  • Aggravated by exercise
  • With one r both of N+V, photo- or phonophobia
  • Preceded by aura
41
Q

What are the UMN signs?

A
  • Spastic paralysis
  • Increased reflexes
  • Increased tone
  • Babinski sign
42
Q

What are the LMN signs?

A
  • Flaccid paralysis
  • Decreased reflexes
  • Decreased tone
  • Fasciculations
43
Q

What are the 4 types of neuroepithelial tumours (gliomas)?

A
  • Astrocytoma (most common)
  • Ependymoma
  • Oligodendroglioma
  • Medulloblastoma
44
Q

In what age group do gliomas most commonly present?

A

6th-8th decade

45
Q

What are the symptoms of an intracranial mass?

A
  • Symptoms of raised ICP: headache, N+V, drowsiness and eventual coma, papilloedema
  • Seizures
  • Focal neurological deficits
46
Q

What are the typical features of headache in raised ICP?

A
  • Gradually progressive
  • Wore on waking, improves during the day
  • Nausea and vomiting
  • Drowsiness (if critical)
47
Q

Principles of treatment of malignant astrocytoma?

A
  • Commence steroids
  • Resection of as much as possible
  • Adjuvant chemo/radiotherapy
48
Q

What are common sources of metastases to the brain?

A

Lung, brest, melanoma, kidney, GIT, unknown (15%)

49
Q

Principles of treatment of brain metastases?

A
  • Commence steroids
  • Surgery to remove metastasis if solitary and have a reasonable life expectancy, or to confirm diagnosis
  • Whole brain or stereotactic radiotherapy
50
Q

What is the common feature of meningiomas on biopsy?

A

Whorls

51
Q

Principles of treatment of meningioma?

A
  • Total surgical excision and obliteration of the dural attachment
  • Radiosurgery or radiotherapy if small, recurrent or malignant
52
Q

What are the features of a tension-type headache?

A
  • Mild to moderate
  • Band-like, bilateral, pressing
  • Not associated with exercise, nausea and photo/phonophobia
53
Q

What are the features of a chronic daily headache?

A
  • Most days, most of the day

- Can be chronic migraine or chronic tension-type headache

54
Q

What are the features of a subarachnoid haemorrhage?

A
  • Thunderclap onset
  • May have neurological symptoms/signs: weakness/sensory loss and impairment of consciousness
  • Associated photo/phonophobia, nausea
  • May be unilateral
55
Q

What are the causes of a thunderclap headache?

A
  • Sexual headache
  • Exertional headache
  • Vasospastic headache
  • Primary thunderclap headache
  • SAH
56
Q

What are the headaches not to miss?

A
  • SAH
  • Meningitis/encephalitis
  • Subdural haematoma
  • Space occupying lesion
  • GCA
  • Glaucoma
57
Q

If the CT is normal, but SAH is suspected from the history, what should be performed?

A

Lumbar puncture

58
Q

What are the management priorities in SAH?

A
  • Monitor and treat the symptoms and complications: pain, N+V, raised ICP and hydrocephalus
  • Prevent re-bleeding (normotension, CTA or surgical clipping)
59
Q

What are the signs of transtentorial herniation?

A
  • Unilateral dilated pupil (third nerve palsy)
  • Contralateral hemiparesis (midbrain)
  • HTN and bradycardia (Cushing response)
  • Respiratory failure
60
Q

How do you treat raised ICP?

A
  • Elevate the head to encourage venous return
  • Diuresis
  • Hyperventilate and avoid hypoventilation
  • Sedate/paralyse
  • Remove mass
  • Drain hydrocephalus
61
Q

What is Uhthoff’s phenomenon?

A

Worsening of symptoms with heat in MS

62
Q

What are the causes of transverse myelitis?

A
  • MS
  • Infectious/parainfectious inflammation
  • Other autoimmune disorders: vasculitis, systemic autoimmune diseases
  • No specific aetiology
63
Q

What is required for MS diagnosis?

A
  • Dissemination in space in the CNS

- Dissemination in time

64
Q

How do you manage a relapse?

A

3-5 days of IV methylprednisolone, 1g/day

65
Q

What are the first tier drugs for treatment of MS?

A
  • Interferon B
  • Glatiramer acetate
  • Teriflunomide
66
Q

What is a common automatism in complex partial seizures?

A

Lip smacking

MD2 lectures (13 decks)

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