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Year 3 Neuro > Neurological Overview > Flashcards

Neurological Overview Flashcards

1
Q

What anatomy must you consider in neurology cases?

A 
Brain
Spinal Cord
Nerve roots
Peripheral nerves 
NMJ
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2
Q

What categories of pathology can cause lesions?

A

VIITT

Vascular
Infection
Inflammation
Toxic/Metabolic
Tumor
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3
Q

Summarise the cranial nerves

A 
I: sense of smell
II: VA, VF, pupils, fundoscopy
III, IV, VI: diplopia
V: sensation, corneal reflex
VII: facial palsy
VIII: hearing
IX, X: Speech, swallowing
XI: Sternocleidomastoid, trapezius
XII: tongue movements
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4
Q

What is the order when carrying out examinations on upper and lower limbs?

A 
Inspection
Tone
Power
Reflexes
Coordination
Sensation
Gait
Back
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5
Q

What are UMN lesion signs?

A

Increased tone
Hyper-reflexia
Decreased power

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6
Q

What are LMN lesion signs?

A

Decreased tone
Decreased power
Decreased reflexes

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7
Q 
Pt presents with 
Diplopia (bilateral 6th)
 Bilateral ptosis 
 Slurred speech
 Dysphagia
 Sluggish pupillary response to light
 Descending symmetric muscle weakness
 Multiple skin abscesses on arms & legs
Where is the lesion?
A

NMJ
Multiple features relating to multiple parts of body (cranial nerves and limbs)
Botulism

DDx - Myasthenia Gravis

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8
Q

What are cerebellar signs?

A 
Ataxia
Nystagmus 
Dysdiadokinesia
Intention tremor
Speech (slurred,scanning)
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9
Q

What anatomy can result in abnormal sensation?

A

Cerebral cortex (hemisensory loss)

Spinal cord (which level?)

Nerve roots (Radiculopathy, dermatomes?)

Mononeuropathy (specific area)

Polyneuropathy (glove and stockings distribution)

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10
Q 
55 yr old man
Numbness & tingling in hands & feet
PMH: type 1 DM
On basal/bolus insulin
HbA1C: 50 mmol/mol
B12: 500 pg/ml (200 – 900) 
eGFR: 90

Reduced Sensation to PP (glove & stocking distribution)

What to prescribe?

A

Duloextine
Peripheral neuropathy
Toxic/metabolic pathology

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11
Q

How can toxins/metabolism cause pathology?

A 
Drugs
Alcohol
B12 deficency
Diabetes
Hypothyroidism
Uraemia
Amyloidosis (abnormal protein)
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12
Q

What are other causes of peripheral neuropathy?

A

Infection:
HIV

Inflammation/Autoimmune:
Vasculitis, CTD, inflammatory demyelinating neuropathy

Tumour/Malignancy:
Paraneoplastic
Paraproteinaemia

Hereditary:
Hereditary sensory motor neuropathy

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13
Q

What are different causes of blurred vision?

A 
Amaurosis fugax
Anterior uveitis
Papilloedema
Papillitis
Vitreous haemorrhage
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14
Q

What is Amaurosis Fugax?

A

‘transient darkening’ temporary loss of vision through one eye, which returns to normal afterwards

This is usually due to a temporary disturbance of the blood flow to the back of the eye

TIAs/Stroke

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15
Q

What is anterior uveitis?

A

Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision.

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16
Q

What is Papilloedema?

A

Papilledema is the swelling of the optic nerve as it enters the back of the eye due to raised intracranial pressure.

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17
Q

What is Vitreous haemorrhage?

A

Bleeding into vitreous humour

18
Q

What is papilitis?

A

Optic neuritis (papillitis)
Blurred optic disc margins
Blurred vision
Pain on eye movement

19
Q

What is spastic paraparesis?

A

Spinal cord inflammation

20
Q

What is MS?

A

Two lesions
Separated by time and place
e.g. spinal cord and cranial nerve

21
Q

How do you differentiate between lesions in the brain/spinal cord?

A

If in the brain you get contralateral, unilateral signs

22
Q 
60 year old man
Pain & paraesthesia on anteriolateral thigh
PMH: Type 2 Diabetes
Metformin
HbA1C: 60 mmol/mol

BMI: 30 kg/m2
Reduced PP sensation anterolateral thigh

What is the most appropriate next step in his management? Diagnosis?

A

Compression of lateral femoral cutaneous nerve

‘Meralgia parasethetica’

Reassure
Avoid tight garments
Lose weight

If persistent:
Carbamazepine
Gabapentin

23
Q

Sensory innervation of the hand?

A

See diagram

24
Q

What is radiculopathy?

A

Disease of the nerve roots

Can be caused by compression by

  • disc herniation
  • spinal canal stenosis
25
Q

What would compression of the lumbosacral roots result in?

A

Pain in the buttock, radiating down the leg below the knee (‘sciatica’)

26
Q 
60 year old man
Recurrent falls
Tremor at rest
Rigidity
More forgetful
Dysphagia
Micrographia
Limited upgaze
Most likely diagnosis?
A

PSP (Steel-Richardson)

Parkinsonian features with up-gaze abnormality

27
Q

What is Parkinson’s disease?

A

Parkinson’s disease
Dopaminergic neurons
Substantia nigra

28
Q

What are the features of Lewy body dementia?

A

Parkinsonian features with Alzheimer’s symptoms and hallucinations

29
Q

How do we score GCS for eyes?

A 
4 = Spontaneous 
3 = Opens in response to voice
2 = Opens in response to painful stimuli
1 = Does not open
30
Q

How do we score GCS for verbal response?

A 
5 = Oriented
4 = Confused
3 = Words
2 = Sounds
1 = No sounds
31
Q

How do we score GCS for motor response?

A 
6 = Obeys commands
5 = Localizes pain
4 = Withdraws to painful stimuli
3 = Abnormal flexion
2 = Extension
1 = No movements
32
Q

What are some causes of headache in the emergency department?

A

Meningitis
Subarachnoid haemorrhage
Giant cell arteritis
Migraine

33
Q

What are the main features of subarach haemorrhage?

A

Sudden onset
CT
LP (xanthochromia)
yellow discoloration Indicating the presence of bilirubin in CSF

34
Q

What are the main features of giant cell arteritis?

A 
Polymylagia rheumatica
(shoulder girdle pain, stiffness, constitutional upset)
>50 years
ESR
Steroids
Biopsy
35
Q

What are the main features of migraine?

A 
Throbbing
Vomiting
Photo/phonophobia
FHx
Aura
36
Q

What is stroke management if presenting within 4.5 hours?

A

CT: no haemorrhage

Thrombolysis (if no contraindications)

37
Q

What is stroke management if presenting after 4.5 hours?

A 
CT head (exclude haemorrhage)
Aspirin (300mg), Swallow assessment
Maintain hydration, oxygenations, monitor glc
38
Q

What is management for TIAs?

A 
Aspirin
Don’t treat BP acutely
unless > 220/120 or 
other indication
ECG, Echocardiogram
Carotid Doppler
Risk factor modification
39
Q

40 year old
Backache
LMN weakness

Admitted to HDU
Regular FVC
Cardiac monitor
IVIG

Most likely diagnosis?

A

Guillain-Barre Syndrome

rare, autoimmune disorder in which a person’s own immune system damages the nerves, causing muscle weakness and sometimes paralysis.

40
Q

What are the complex causes of collapse?

A 
Vasovagal
Atrial fibrillation
Ischaemic heart disease
Thyrotoxicosis
Sick sinus syndrome
Hypertensive heart disease
Cardiomyopathy
Rheumatic heart disease
SVT
Ventricular tachycardia
Brugada syndrome
Long QT syndrome
Complete heart block
Myocardial infarction
Electrolyte abnormalities
Aortic stenosis
HOCM
Peripheral neuropathy
Anti-hypertensives
Pulmonary embolism
Hypoglycaemia
TIA
Seizures
Trauma
Meningitis/encephalitis
Brain tumour
41
Q

What are simple causes if collapse?

A

Low glucose

Heart
Vasovagal
Arrhythmia
Outflow obstruction
Postural hypotension

Brain
Seizure

Year 3 Neuro (17 decks)

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