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Phase 2a Conditions > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the definition of an Ischaemic stroke?

A

Sustained occlusion of a cerebral artery leads to ischaemic necrosis of the territory of the brain supplied by the affected artery

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2
Q

What is the definition of a haemorrhagic stroke

A

Rupture of a Charcot-Bouchard aneurysm

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3
Q

What is the clinical presentation of a stroke?

A

o Anterior cerebral artery: lower limb weakness and loss of sensation, gait apraxia, incontinence, drowsiness, decrease in spontaneous speech
o Middle cerebral artery: upper limb weakness and loss of sensation, hemianopia, aphasia, dysphasia, facial drop
o Posterior cerebral artery: visual field defects, cortical blindness, visual agnosia, prosopagnosia, dyslexia, unilateral headache

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4
Q

What are the investigations of a stroke?

A

CT scan

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5
Q

What is the treatment of a stroke?

A

o Ischaemic: thrombolysis (IV alteplase), aspirin for 2 weeks, then clopidogrel
o Haemorrhagic: control BP, nimodipine (prevent cerebral artery spasm)
o Long-term: physiotherapy and occupation therapy

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6
Q

What is the definition of a transient ischaemic attack ?

A

An ischaemic, usually embolic, neurological event with symptoms lasting
< 24 hours and resulting in complete clinical recovery

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7
Q

What is the aetiology of a transient ischaemic attack ?

A

Atherothromboembolism, cardioembolism, hyperviscosity, vasculitis

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8
Q

What is the clinical presentation of a transient ischaemic attack ?

A

Amaurosis fugax (unilateral progressive vision loss, like a curtain descending)

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9
Q

What is the treatment of a transient ischaemic attack ?

A

Control CV risk factors, aspirin for 2 weeks, then clopidogrel, anti-coagulation (if cardiac source of emboli), carotid endarterectomy

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10
Q

What score assesses the risk of having a stroke within the next 7 days after a TIA?

A

ABCD2 assess the risk of a stroke occurring within 7 days (Age > 60 (1), Blood pressure > 140/90 (1), Character unilateral weakness (2), speech disturbances (1), Duration 10-60 minutes (1), > 60 minutes (2), Diabetes (1))

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11
Q

What is the definition of a subarachnoid haemorrhage?

A

A spontaneous, non-traumatic bleed into the subarachnoid space

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12
Q

What is the aetiology of a subarachnoid haemorrhage?

A

Rupture of a berry aneurysm, arteriovenous malformation, encephalitis, vasculitis, tumour invading blood vessels

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13
Q

What is the clinical presentation of a subarachnoid haemorrhage?

A

Sudden onset thunderclap headache, vomiting, collapse, seizure, neck stiffness, photophobia, reduced consciousness

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14
Q

What are the investigations of a subarachnoid haemorrhage?

A

o CT scan

o Cerebral angiography

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15
Q

What is the treatment of a subarachnoid haemorrhage?

A

Hydration (maintain perfusion), nimodipine (prevent cerebral vasospasm), mannitol (reduce ICP), surgery (endovascular coiling, surgical clipping)

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16
Q

What is the definition of a subdural haemorrhage?

A

Bleeding from bridging veins between cortex and venous sinuses

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17
Q

What is the aetiology of a subdural haemorrhage?

A

Minor trauma, dural metastases

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18
Q

What is the clinical presentation of a subdural haemorrhage?

A

Fluctuating levels of consciousness, raised ICP, seizures

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19
Q

What are the investigations of a subdural haemorrhage?

A

o CT: crescent-shaped collection of blood over one hemisphere

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20
Q

What is the treatment of a subdural haemorrhage?

A

IV mannitol (reduce ICP), surgery

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21
Q

What is the definition of an extradural haemorrhage?

A

Bleeding from middle meningeal artery with a characteristic lucid period

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22
Q

What is the aetiology of an extradural haemorrhage?

A

Fracture of the squamous temporal bone

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23
Q

What is the clinical presentation of a extradural haemorrhage?

A

Rapid deterioration several hours later, severe headache, vomiting, confusion, seizure, ipsilateral pupil dilates

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24
Q

What are the investigations of an extradural haemorrhage?

A

o CT: biconvex (lemon-shaped), hyperdense haematoma

o X-ray: skull fracture

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25
Q

What is the treatment of an extradural haemorrhage?

A

Clot evacuation, IV mannitol (reduce ICP)

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26
Q

What is the definition of a epilepsy?

A

Recurrent tendency to spontaneous episodes of abnormal electrical activity within the brain which manifests as seizures

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27
Q

What is the clinical presentation of epilepsy?

A

Seizure (30-120 seconds), tongue biting, head turning, muscle pain

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28
Q

What are the investigations of epilepsy?

A

o EEG

o MRI: may show structural lesions

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29
Q

What is the treatment of epilepsy?

A

o Focal epilepsy: carbamazepine

o Generalised epilepsy: sodium valporate

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30
Q

What is the definition of vascular dementia?

A

Disease characterised clinically by dementia and histologically by injury to the brain parenchyma

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31
Q

What is the aetiology of vascular dementia?

A

Multiple infarcts cause diffuse white matter injury

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32
Q

What is the clinical presentation of vascular dementia?

A

Impairment of executive function and slowing of mental processing

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33
Q

What is the definition of dementia with Lewy Bodies?

A

Neurodegenerative disease characterised clinically by dementia and histologically by the presence of Lewy bodies in cortical and subcortical neurones

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34
Q

What is the pathophysiology of dementia with Lewy Bodies?

A

Accumulation of Lewy bodies within neurons leads to damage and cellular loss

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35
Q

What is the clinical presentation of dementia with Lewy Bodies?

A

Progressively worsening, fluctuating levels of cognition, recurrent visual hallucinations

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36
Q

What are the investigations of dementia with Lewy Bodies?

A

Histopathology: intracytoplasmic inclusions (Lewy bodies) within neurone of cortical grey matter and subcortical nuclei

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37
Q

What is the definition of Alzheimer’s disease?

A

Neurogenerative disease characterised clinically by dementia and histologically by neuron loss in the cerebral cortex and numerous amyloid plaques

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38
Q

What is the pathophysiology of Alzheimer’s disease?

A

Abnormal accumulation of beta-amyloid and tau protein in the temporal lobe

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39
Q

What is the clinical presentation of Alzheimer’s disease?

A

Memory loss, agnosia, delusions, loss of motor skills, apraxia

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40
Q

What are the investigations of Alzheimer’s disease?

A

o Macroscopy: cortical atrophy

o Microscopy: abundant amyloid and tau plaques

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41
Q

What is the treatment of Alzheimer’s disease?

A

Acetylcholine esterase inhibitors (galantamine, rivastigmine), behavioural treatment (memantine)

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42
Q

What is the definition of Parkinson’s disease?

A

Neurodegenerative hypokinetic movement disorder characterised clinically by parkinsonism and histologically by neuronal loss and Lewy bodies concentrated in the substantia nigra

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43
Q

What is the aetiology of Parkinson’s disease?

A

Loss of dopaminergic neurons in the substantia nigra

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44
Q

What is the clinical presentation of Parkinson’s disease?

A

Bradykinesia, rigidity, resting tremor, postural instability, depression, psychiatric problems, dementia

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45
Q

What are the investigations of Parkinson’s disease?

A

MRI: atrophy of the substantia nigra

46
Q

What is the treatment of Parkinson’s disease?

A

Levodopa, dopamine agonists (cabergoline), COMT/MAO inhibitor (selegiline)

47
Q

What is the definition of Huntington’s Chorea?

A

Autosomal dominant inherited neurodegenerative disorder

48
Q

What is the pathophysiology of Huntington’s Chorea?

A

Atrophy and neuronal loss of the striatum and cortex

49
Q

What is the clinical presentation of Huntington’s Chorea?

A

Chorea

50
Q

What is the treatment of Huntington’s Chorea?

A

Antipsychotics (risperidone, dopamine receptor antagonist)

51
Q

What is the definition of a migraine?

A

Recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision

52
Q

What are the triggers of a migraine?

A

Chocolate, hangovers, orgasms, caffeine, cheese, OCP, alcohol, travel, exercise, anxiety

53
Q

What is the clinical presentation of a migraine?

A

Unilateral throbbing headache which is associated with photophobia, phonophobia, nausea and vomiting, 4-72 hours

54
Q

What is the treatment of a migraine?

A

Avoid triggers, abortive therapy (triptan, NSAIDs), prophylactic treatment (propranolol, acupuncture, amitriptyline)

55
Q

What is the aetiology of a tension headache?

A

Missed meals, conflict, stress, clenched jaw, overexertion, lack of sleep, depression

56
Q

What is the clinical presentation of a tension headache?

A

Bilateral, tight/pressing headache 30 minutes-7 days

57
Q

What is the clinical presentation of a cluster headache?

A

Unilateral, severe pain around the eye and temporal area which may be associated with cranial autonomic features

58
Q

What is the treatment of a cluster headache?

A

o Acute attack: oxygen, sumatriptan

o Prevention: avoid triggers, verapamil, short term corticosteroids

59
Q

What are the triggers of trigeminal neuralgia?

A

Washing, eating, shaving, talking

60
Q

What is the clinical presentation of trigeminal neuralgia?

A

Unilateral face pain, in the V3 distribution, which is intense, sharp, and stabbing and lasts for a couple of seconds

61
Q

What are the investigations of trigeminal neuralgia?

A

MRI: exclude secondary causes

62
Q

What is the treatment of trigeminal neuralgia?

A

Carbamazepine, surgery

63
Q

What is the aetiology of spinal cord compression?

A

Secondary malignancy, infection, cervical disc prolapse

64
Q

What is the clinical presentation of spinal cord compression?

A

Bilateral leg weakness, preceding back pain, bladder and anal sphincter involvement

65
Q

What are the investigations of spinal cord compression?

A

MRI

66
Q

What is the treatment of spinal cord compression?

A

Immobilisation, dexamethasone, analgesia

67
Q

What is the definition of cauda equina syndrome?

A

Spinal cord compression at the site of the cauda equina (L1)

68
Q

What is the aetiology of cauda equina syndrome?

A

Secondary malignancy, infection, cervical disc prolapse

69
Q

What is the clinical presentation of cauda equina syndrome?

A

Bilateral sciatica, saddle anaesthesia, bladder/bowel dysfunction, erectile dysfunction, variable leg weakness

70
Q

What is the investigations of cauda equina syndrome?

A

MRI

71
Q

What is the treatment of cauda equina syndrome?

A

Immobilisation, dexamethasone, analgesia

72
Q

What is the definition of multiple sclerosis?

A

A relapsing and remitting and demyelinating disease of the CNS

73
Q

What is the clinical presentation of multiple sclerosis?

A

Spasticity, nystagmus and double vision, optic neuritis, weakness, sensory symptoms, paraesthesia, bladder and sexual dysfunction

74
Q

What are the investigations of multiple sclerosis?

A

o MRI: plaques around blood vessels

o CSF: oligoclonal IgG bands

75
Q

What is the treatment of multiple sclerosis?

A

Lifestyle modifications, natalizumab, stem cell transplant, muscle relaxants, IV methylprednisolone in acute attacks

76
Q

What is the definition of Myasthenia Gravis?

A

Autoimmune disease caused by autoantibodies against antigens of the neuromuscular junction (Anti-AChR and MuSK (tyrosine kinase)

77
Q

What is the clinical presentation of Myasthenia Gravis?

A

Muscle fatigability (extraocular  bulbar face  neck  limb girdle  trunk)

78
Q

What are the investigations of Myasthenia Gravis?

A

o Autoantibodies: Anti-AChR or Anti-MuSK
o EMG: decreased muscle response
o Tensilon Test

79
Q

What is the treatment of Myasthenia Gravis?

A

Acetylcholine esterase inhibitors (pyridostigmine), immunosuppression

80
Q

What is Lambert-Eaton syndrome?

A

Autoantibodies against voltage-gated calcium channels on presynaptic neurons.
Gait difficulty develops before eye signs, autonomic involvement (dry mouth, constipation, impotence), hyporeflex and weakness which improves after exercise

81
Q

What is the definition of motor neurone disease?

A

A group of neurodegenerative diseases characterised by selective loss of motor neurones

82
Q

What is the clinical presentation of motor neurone disease?

A

o Muscular atrophy (anterior horn): fasciculations, wasting, weakness
o Amyotrophic lateral sclerosis (motor cortex and anterior horn): progressive spastic tetraparesis
o Progressive bulbar palsy (destruction of Cn 9-12): dysarthria, dysphagia, wasting and fasciculations of the tongue

83
Q

What is the treatment of motor neurone disease?

A

Riluzole (inhibit glutamate release), ventilatory support, PEG feeding

84
Q

What is the definition of Guillain-Barre syndrome?

A

Acute demyelinating polyneuropathy following an upper respiratory tract or GI infections

85
Q

What is the aetiology of Guillain-Barre syndrome?

A

C.jejuni, CMV, EBV

86
Q

What is the pathophysiology of Guillain-Barre syndrome?

A

Immune response mounted to an antigen on a pathogen cross-reacts with components of the peripheral nerve, particularly myelin

87
Q

What is the clinical presentation of Guillain-Barre syndrome?

A

Ascending muscle weakness, reduced or absent reflexes, changes in sensation and pain

88
Q

What are the investigations of Guillain-Barre syndrome?

A

Nerve conduction studies: slowing of motor conduction

89
Q

What is the treatment of Guillain-Barre syndrome?

A

IV immunoglobulin, plasma exchange, ventilatory support if diaphragm involvement

90
Q

What is the definition of meningitis?

A

Infection of the subarachnoid space which leads to inflammation of the meninges

91
Q

What is the aetiology of meningitis?

A

o Bacterial: S. pneumoniae, N. meningitidis, L. monocytogenes
o Viral: enterovirus, herpesvirus

92
Q

What is the clinical presentation of meningitis?

A

Headache, fever, neck stiffness, photophobia, non-blanching purpura rash (N. meningitidis), papilledema

93
Q

What are the investigations of meningitis?

A

o Blood culture
o Lumbar puncture and CSF analysis
o Neuroimaging (if lumbar puncture is contraindicated)

94
Q

What is the treatment of meningitis?

A

o Bacterial: antibiotics, dexamethasone

o Viral: usually life-limiting, supportive, acyclovir (HSV)

95
Q

What is the definition of encephalitis?

A

Infection and inflammation of the brain parenchyma

96
Q

What is the aetiology of encephalitis?

A

Herpes simplex virus (HSV)

97
Q

What is the clinical presentation of encephalitis?

A

: Precedes with flu-like symptoms, confusion, behavioural changes, altered consciousness, seizures

98
Q

What are the investigations of encephalitis?

A

Lumbar puncture and CSF: PCR for HSV

99
Q

What is the treatment of encephalitis?

A

Acyclovir

100
Q

What is the aetiology of shingles?

A

Varicella zoster virus

101
Q

What is the pathophysiology of shingles?

A

Reactivation of virus in sensory ganglia

102
Q

What is the clinical presentation of shingles?

A

Band-like vesicular eruption along the distribution of the sensory nerve

103
Q

What are the investigations of shingles?

A

Viral PCR

104
Q

What is the treatment of shingles?

A

Acyclovir

105
Q

Mononeuropathy: Ulnar nerve (C7-T1)

A

Sensory loss of medial 1.5 fingers

106
Q

Mononeuropathy: Radial nerve (C5-T1)

A

Wrist and finger drop

107
Q

Mononeuropathy: Brachial plexus

A

Pain/paraesthesia and weakness in affected arm

108
Q

Mononeuropathy: Sciatic nerve (L4-5)

A

Foot drop and loss of sensation below the knee

109
Q

Mononeuropathy: Common perineal nerve (L4-S1)

A

Foot drop, weak ankle, sensory loss of foot

110
Q

Mononeuropathy: Tibial nerve (L4-S3)

A

Inability to stand on tiptoe, invert foot or flex toes

Phase 2a Conditions (9 decks)

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