Neurology Flashcards
1
Q
Recall some important initial investigations following a suspected TIA
A
BP
ECG
Carotid USS
Bloods to include cholesterol, lipids, glucose + clotting
2
Q
What is the CHA2DS2VASc score used to estimate?
A
Risk of stroke in patients with atrial fibrillation
3
Q
What scoring system predicts stroke risk following a TIA?
A
ABCD2
4
Q
Recall the mainstay of immediate management for TIA, including some contraindications to this mainstay
A
Aspirin 300mg Contraindicated if: - >7 days since signs and symptoms - Bleeding disorder/ on anti-coagulation - Already on regular low-dose aspirin
5
Q
Recall some cases in which you would admit someone following a TIA to investigate them further
A
>1 TIA ('crescendo' TIA)
Severe carotid strenosis
Suspected cardioembolic source
Patient is on warfarin/DOAC
Patient has bleeding disorder
6
Q
What should be the ongoing management for patients who have had a TIA? (1st and 2nd line)
A
1st line: 75mg clopidogrel OD + statin
2nd line: Aspirin + dypiridamole + statin
7
Q
What is the indication for a carotid artery endarterectomy?
A
Stenosis >50% with <2w of signs/ symptoms
8
Q
Define stroke
A
Rapid onset neurological deficit of a vascular origin that does not completely resolve within 24 hours
9
Q
What % of strokes are ischaemic vs haemorrhagic?
A
Ischaemic = 80% (thrombotic/ embolic) Haemorrhagic = 20% (intracerebral haeomorrhage, SAH)
10
Q
What classification system is used for strokes, and how does it classify them?
A
Bamford classification
Based on initial presenting signs and symptoms
11
Q
What are the 4 broad classifications of stroke under the Bamford classification?
A
Total anterior circulation stroke
Partial anterior circulation stroke
Posterior circulation stroke
Lacunar anterior circulation stroke
12
Q
How does weakness compare in the legs vs arms in anterior vs middle cerebral artery infarcts?
A
Anterior cerebral artery: weakness in legs > arms
Middle cerebral artery: weakness in arms > legs
13
Q
What are the 3 best forms of initial investigation in stroke?
A
Non-contrast CT
ECG
Carotid dopplers
14
Q
Recall 2 scoring systems that can be used acutely in admission for stroke
A
NIHSS (max score 42)
ROSIER (professional version of FAST)
15
Q
What is CT ASPECT?
A
Grading system used to assess early CT ischaemic changes following a stroke
16
Q
What is the ‘penumbra’?
A
Area of hypoxic parenchyma following a stroke that is still salvageable
17
Q
Describe the approach to imaging investigations in suspected subarachnoid haemorrhage
A
1st CT head
If this is negative –> LP to assess for xanthochromia (bilirubin in CSF)
18
Q
Recall the general principles of management of subarachnoid haemorrhage
A
21 day course of nimodipine (CCB)
1st line: Coiling (IR procedure)
2nd line: Surgical clipping (requires craniotomy)
19
Q
Recall the steps of managing an ischaemic stroke
A
- Exclude haemorrhagic stroke using CT
Then:
- If <4.5 hours –> thrombolysis (alteplase)
ALSO do a thrombectomy IF proximal anterior circulation
- If >4.5 hours –>
After 2 WEEKS:
1. 300mg aspirin PO OD + statin
If NO AF: add clopidogrel (aspirin 2nd line)
If AF: add Xa inhibitor (eg apixaban) (warfarin 2nd line)
20
Q
Recall some aspects of management of stroke outside of immediate thrombolysis/ anti-coagulation
A
Control:
- Fluid management (hypo/hypervolaemia can both worsen symptoms)
- Glycaemic control (hyperglycaemia –> tissue acidosis, free radicals and increased BBB permeability)
- BP control - ONLY use if BP is dangerously high as hypotension so dangerous - eg hypertensive emergency + hypertensive encephalopathy/ cardiac failure/ nephropathy/ eclampsia or aortic dissection
- Cholesterol control (eg with statin)
- Feeding assesment and management
21
Q
What is the Barthel index and how is it used?
A
Index of disability post-stroke
10 tasks scored on a scale of independence from 0 to 10 to give a total score out of 100
22
Q
What is the typical frequency of tremor in Parkinson’s?
A
4-6 Hz
23
Q
Recall 3 signs of Parkinson’s disease that might be seen in the eyes
A
Nystagmus (in MSA)
Vertigal gaze palsy (in PSP)
Saccades slow
24
Q
Recall some autonomic nervous system symptoms of Parkinson’s
A
Postural hypotension (in MSA) Urgency/ frequency (in MSA) Constipation Hypersalivation Hyperhidrosis ED
25
What is the glabellar tap?
Confirmatory test of Parkinson's disease
| If you tap the patient's forehead, the eyes blink
26
Recall some symptoms of sleep disturbance that may be seen in Parkinson's
```
Inability to turn
Restless legs
Early morning dystonia (drug wearing off)
Nocturia
OSA
Insomnia is BIG
```
27
Recall the names of 4 Parkinson PLUS syndromes
MSA - multiple systems atrophy
PSP - progressive supranuclear palsy
CBD (corticobasilar degeneration)
DLB (dementia with lewy bodies)
28
Recall some symptoms of multiple systems atrophy
Autonomic dysfunction
Cerebellar dysfunction
Rigidity > tremor
29
Recall some symptoms of progressive supranuclear palsy
Vertigal gaze palsy
Postural insability that leads to falls
Speech disturbance
30
Recall some symptoms of corticobasilar degeneration
Unilateral parkinsonianism
Aphasia
Astereognosis (--> alien limb phenomenon)
31
Recall some symptoms of dementia with lewy bodies
Visual hallucinations
| Fluctuating cognition
32
Recall some differences between Parkinsonism and Parkinson's
Parkinsonism: symmetrical, rapid progression, poor response to levodopa
Parkinson's: asymmetrical, progressive nature, good response to levodopa
33
Recall some causes of Parkinsonism
VITAMIN CD
```
Vascular (strokes)
Idiopathic - nil
Trauma (eg dementia pugilistica)
Autoimmune (encephalitis)
Metabolic (eg neuroglycopaenic)
Infective (eg Syphilis, HIV, CJD)
Neoplasm - nil?
```
Congenital (eg Wilson's)
Drugs (eg antipsychotics)
34
What is a DaTscan and what is it used for?
Dopamine Transporter Scan
Tracer binds to DA neurons to allow visualisation of substantia nigra
Used in Parkinson's to exclude other causes of tremor eg BET
35
What are the 1st line medications used in Parkinson's treatment?
```
Levodopa
MAO-B inhibitors (eg selegiline)
DA agonists (eg ropinarole)
```
36
Recall some side effects of levodopa
```
DOPAMINE
Dyskinesia
On/off phenomena
Psychosis
Arterial BP decrease
Mouth dryness
Insomnia
Nausea and vomiting
EDS
```
37
What is the drug of choice to treat nausea in Parkinson's, and what nausea drug should be avoided in these patients?
Domperidone is best option
| Metoclopramide should be avoided
38
What is the drug of choice to treat psychosis in Parkinson's, and which antipsychotic should be avoided in these patients?
Best choice: quetiapine
| Don't use: haloperidol
39
What might COMT inhibitors be useful for in treating Parkinson's?
Can be given as an adjunct to levodopa to increase compliance, but may increase side effects
40
In a tonic clonic seizure, how does the side the head turns to relate to the side of the seizure?
It's the opposite side
41
For how long does a seizure have to last to be classed as status epilepticus?
>5 mins
42
Recall the 4 steps of status epilepticus management
1. Buccal midazolam/ IV lorazepam
2. IV lorazepam
3. IV phenytoin (or phenobarbital if already on phenytoin)
4. Rapid sequence induction of anaesthesia using thiopental sodium
43
Recall 2 side effects of carbamazepine
Hyponatraemia
| Rash
44
Recall 9 side effects of valproate
VALPROATE
```
Vomiting
Anorexia
Liver toxicity
Pancreatitis
Retention of weight
Oedema
Alopecia
Tetarogenicity
Enzyme inhibition
```
45
Which anti-epileptic drug can cause steven johnson syndrome?
Lamotrigene
46
What is the typical presentation of Alzheimer's?
```
The four 'A's
Amnesia
Aphasia (Broca's)
Agnosia (typically faces)
Apraxia (typically dressing)
```
47
Recall 3 examples of anti-cholineesterases
Donepezil
Galantamine
Rivastigmine
48
What is the mechanism of action of memantine?
NMDA (glutamate) receptor partial agonist
49
What is the first line medical management of Alzheimer's disease?
If mild-moderate: anticholinesterases
| If moderate-severe: memantine
50
Who are you legally required to inform if you make a diagnosis of any type of dementia?
DVLA
| Insurers
51
What is the most important thing to check before prescribing anticholineesterases?
ECG
52
Recall 4 drugs that are absolute contraindications for prescribing anticholineesterases
NSAID
Anticholinergics (prevent ACh from binding)
Beta blockers
Muscle relaxants
53
Recall 3 features of an ECG that are relative contraindications to prescribing anticholineesterases
AV block
Sick sinus syndrome
Bradycardia
54
Recall 2 drugs that can be used in the prophylaxis of migraines
Propranolol
| Topiramate
55
What are the key signs and symptoms of cluster headache?
Intense pain around eye that may cause watering, lasting 15 mins to 2 hours
56
What is the acute management of cluster headache?
100% oxygen
| SC triptan
57
What drug can be used as prophylaxis for cluster headaches?
Verapamil
58
Recall some signs and symptoms of temporal arteritis
Headache
Jaw claudication
Tender scalp
59
Define multiple sclerosis
An autoimmune demyelinating disorder of the CNS characterised by multiple plaques of separate in time and space
60
What are the 4 subtypes of MS?
Relapsing remitting
Primary progressive
Secondary progressive
Progressive relapsing
61
Recall some key signs and symptoms of MS
Tingling
Optic neuritis
Ataxia
Spastic paraparesis eg shoulder paralysis
62
Recall some symptoms of optic neuritis in MS
```
CRAP
Central scomata
RAPD (relative afferent pupillary defect)
Acuity decreased
Pain on movement
```
63
In what ways is acuity affected by optic neuritis?
Decreased central and colour vision
64
What is RAPD?
Relative afferenr pupil defect
| Pupils respond differently to light stimuli shone in one eye at a time
65
What are Lhermitte's sign and Uhthoff's sign?
Lhermitte's sign: Neck flexion --> electric shocks in trunk and limbs
Uhthoff's sign: temporary worsening of MS symptoms following an increase in temperature eg hot bath or exercise
66
What criteria are used for MS diagnosis?
Revised McDonald's criteria
67
What sort of MRI is most useful in MS diagnosis?
Gadalonium-enhanced, T2 weighted
68
What would be seen on LP in MS?
IgG oliclonal bands
69
Recall 2 blood antibodies that might be seen in MS?
Anti-MBP (myelin basic protein)
| NMO-IgG (neuromyelitis optica - only in Devic's syndrome)
70
What is the main drug and dosage used to treat acute attacks of MS?
Methylprednisolone 1g IV/PO OD for 3 days
71
Recall some drugs that can be used in the management of chronic MS
DMARDs such as IFN-beta
| Biologicals eg natalizumab and alemtuzumab (these are first line for RRMS)
72
Recall one drug that can be useful for fatigue in MS
Modafinil
73
Recall 2 drugs that can be used to manage in pain in MS
Amitriptyline
| Gabapentin
74
What are the 1st and 2nd line options for medically managing spasticity in MS
1st line: baclofen + gabapentin
| 2nd line: dantrolene
75
What is the most useful drug to treat tremor in MS?
Clonazepam
76
Are sensory or motor signs at the onset of MS associated with a better prognosis?
Sensory signs at onset = better prognosis than motor signs at onset
77
What is the typical age of onset of myasthaenia gravis in women vs men?
Women: 20-30y
Men: 60-70y
78
Which autoimmune disorder is strongly associated with thymic hyperplasia?
Myasthaenia gravis
79
Recall 2 abnormalities on eye examination that could be seen in myasthaenia gravis
Diplopia
| Ptosis
80
Recall some signs and symptoms of myasthaenia gravis
```
Muscle fatiguability is the main one
Also:
Extra-ocular muscle weakness
Proximal myopathy
Dysphagia
```
81
Recall some drugs that can exacerbate myasthaenia gravis
```
Beta-blockers
Lithium
Phenytoin
Numerous antibiotics
Penicillinamine
```
82
How is a myasthaenic crisis defined?
FVC <1L
Negative inspiratory force<20cmH2O
Need for ventilation
83
How should a myasthaenic crisis be managed?
Plasmapheresis, IV Ig, intubation
84
What is the most important investigation to do to investigate myasthaenia gravis?
Single fibre EMG
85
Recall 2 tests that can be used to assess fatiguability in myasthaenia gravis
Repetitive nerve stimulation
| Serial pulmonary function testing
86
Recall 2 antibodies you might test for when investigating myasthaenia gravis
Anti-ACh-R
| Anti-muscle-specific-receptor tyrosine kinase
87
Describe the tensilon test for myasthaenia
IV edrophonium bromide relives muscle weakness temporarily
88
What is the first line management for symptomatic myasthaenia?
1. Long acting acetylcholine esterase inhibitors eg pyridostigmine, neostigmine
2. Immunosuppression: azothioprine, cyclosporine, mycophenolate mofetil
89
What is the surgical option for treating myasthaenia gravis?
Thymectomy
90
What is Lambert Eaton Myasthaenic Syndrome and what causes it?
Myasthaenia associated with small cell lung cancer
| Caused by antibody directed against pre-synaptic voltage gated calcium channels in the peripheral nervous system
91
How are the symptoms of Lambert Eaton Myasthaenic Syndrome different from Myasthaenia gravis?
Muscles get progressively stronger with use in LEMS, rather than fatiguing like in MG
Eye signs are much less common in LEMS than MG
92
Which cancers are associated with Lambert Eaton Myasthaenic Syndrome?
Small cell lung cancer (key one)
Breast cancer
Lung cancer
93
Where in the nervous system are the lesions that cause symptoms of amyotrophic lateral sclerosis?
Corticospinal tracts
94
Where in the nervous system are the lesions that cause symptoms of primary lateral sclerosis?
Motor cortex (loss of Betz cells)
95
Where in the nervous system are the lesions that cause symptoms of progressive muscular atrophy?
Anterior horn cells
96
Where in the nervous system are the lesions that cause symptoms of progressive bulbar palsy?
Cranial nerves 9-12
97
For each type of motor neuron disease, are the symptoms predominantly UMN or LMN?
ALS: mixed UMN/LN
PLS: UMN
PMA: LMN
PBP: bulbar
98
Which type of motor neuron disease has the worse prognosis?
Progressive bulbar palsy
99
Recall some differentials for a neurological presentation with mixed UMN/LMN signs?
MAST:
Motor neuron disease
Ataxia (Friederich's)
SCDC (subacute combined degeneration of the cord)
Taboparesis (combined tabes dorsalis with general paresis)
100
What are the diagnostic criteria for motor neuron disease called?
Revised El Escorial criteria
101
Recall 3 useful investigations in the investigation of motor neuron disease
MRI brain +/- spinal cord - to exclude structural causes
EMG - to demonstrate faciculations
LP - to exclude inflammatory causes
102
What drug can be used to delay need for ventilation in patients with motor neuron disease?
Riluzole
103
What drug can be used to manage drooling in motor neuron disease?
Amitriptyline
104
How will muscles appear on inspection in an UMN pathology?
Atrophied with no fasciculations
105
How can you use gait to differentiate between unilateral and bilateral UMN lesions?
UL lesion --> circumducting gait
| BL lesion --> scissoring gait
106
What is a positive Babinski's sign and what does it indicate?
```
Extensor plantars (upward movement of great toe)
UMN pathology
```
107
What is the Hoffman sign and what does it test for?
Hoffman sign = involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down
Indicative of UMN pathology
108
Recall the direction of tongue and uvula deviation in UMN pathology
Tongue goes towards side of lesion
| Uvula goes to opposite side
109
What is the difference between the causes of spasticity vs rigidity?
```
Spasticity = pyramidal
Rigidity = extra-pyramidal
```
110
What are the pyramidal tracts?
Corticospinal tract and corticobulbar tracts
111
What is subacute combined degeneration of the spinal cord?
Progressive degenration of the spinal cord due to B12 deficiency (can be caused by NO inhalation)
112
Which antibody is associated with guillain barre syndrome?
Anti-ganglioside (GQ1b)
113
Recall 2 autoimmune causes of proximal myopathy
Myasthaenia gravis
| Polymyositis
114
Recall 3 drugs that can cause proximal myopathy
Ethanol
Statins
Steroids
115
Recall a congenital cause of proximal myopathy
Muscular dystrophy
116
Recall some endocrine causes of proximal myopathy
```
Acromegaly
Cushing's
Diabetic amyotrophy
Hyperthyroid
Osteodystrophy
```
117
What is the eponym by which hereditary motor sensory neuropathy is more commonly known?
Charcot Marie Tooth disease
118
What is the inheritance pattern of charcot marie tooth?
Autosomal dominant
119
What might be seen on inspection in Charcot Marie Tooth?
Pes cavus (high arch of foot that doesn't flatten when weight-bearing)
Distal muscle wasting
Thickened nerves (especially common peroneal)
120
Describe the abnormalities of gait that may be seen in more severe charcot marie tooth disease?
Foot drop
| High stepping gait
121
How can nerve conduction studies differentiate between charcot marie tooth types 1 and 2, and why is there this difference?
Type 1 - decreased conduction velocity
Type 2 - decreased conduction amplitude
Type 1 is caused by demyelination
Type 2 is caused by axonal degeneration
122
Which gene mutations can cause charcot marie tooth disease?
HSMN1
| PMP22 (peripheral myelin protein 22)
123
What are the components of DANISH?
```
Dysatrhria/ dysdiadochokinesia/ dysmetria
Ataxia
Nystagmus
Intention tremor
Speech (scanning/ staccato)
Hypotonia
```
124
Systematically recall some causes of cerebellar syndrome
```
Vascular: vertebrobasilar stroke
Infection: encephalitis/ abscess
Trauma: raised ICP
Autoimmune: multiple sclerosis/ paraneoplastic cerebellar degeneration
Metabolic: ethanol/ poisons (phenytoin)
Iatrogenic: nil
Neoplastic: Posterior fossa tumour
Congenital: Spinocerebellar ataxia
Degenerative: nil
Endocrine: nil
Functional: nil
```
125
How does nystagmus differ depending on whether it is caused by a cerebellar or vestibular lesion?
Fast phase:
- Cerebellar = towards lesion
- Vestibular = away from lesion
Maximal looking:
- Cerebellar = towards lesion
- Vestibular = away from lesion
126
What are the 3 regions of the cerebellum, and what are their functions?
Spinocerebellum - movement and posture
Neocerebellum - motor planning
Vestibulocerebellum - balance and vision
127
Recall the signs and symptoms specific to lesions in each portion of the cerebellum
Spinocerebellum: truncal ataxia
Neocerebellum: dysmetria, intention tremor, dysdiadochokinesia
Vestibulocerebellum: diplopia, nystagmus, vertigo
128
What is Wallenberg's syndrome also known as?
Lateral medullary syndrome
129
What is the most common cause of Wallenberg's syndrome?
Occlusion of the posterior inferior cerebellar artery
130
What are the signs and symptoms of Wallenberg's syndrome?
My PANDAS:
Miosis (Horner's)
nYstagmus
```
Ptosis (Horner's)
Anhidrosis (Horner's)
Nystagmus
Dysphagia (ipsilateral)
Ataxia
Sensory loss of limb (contralateral)
```
131
Where is the lesion in a bitemporal hemianopia?
Optic chiasm
132
What is a Marcus Gunn pupil?
Relative afferent pupil defect (swingint torch test)
133
Recall 3 causes of Marcus Gunn pupil?
MS
Glaucoma
Retinal disease
134
What is Weber's syndrome?
Ipsilateral 3rd nerve palsy ('down and out' pupil) with contralateral hemiplegia - caused by midbrain strokes
135
For how long is driving not permitted following a first episode of unprovoked seizure?
6 months if normal EEG/ imaging
| Otherwise 12 months
136
For how long is driving not permitted following a seizure, in those with established epilepsy?
1 year
| If 5 years seizure-free, license usually kept until 70 y/o
137
For how long is driving not permitted following a nocturnal seizure?
Can drive with nocturnal seizures as long as no daytime symptoms in last 3 years
138
For how long is driving not permitted after withdrawal from epilepsy medication?
Do not drive during withdrawal or within 6 months of last dose
139
For how long is driving not permitted following a stroke or TIA?
1 month if no long-lasting neurological deficit
140
What is the biggest risk factor for clostridium botulinum infection?
IVDU
141
What are the symptoms of clostridium botulinum infection?
Descending paralysis, diplopia, bulbar palsy
142
What is the cause of autonomic dysreflexia?
Usually spinal injuries above T6 - due to lack of splanchnic outflow from T6-12
143
What is autonomic dysreflexia
Sudden onset of severe hypertension
144
What are the key symptoms of normal pressure hydrocephalus?
Wet, wacky, wobbly
Incontinence
Dementia
Falls
145
What are some possible causes of syringomyelia?
Chiari malformations
Trauma
Tumours
Idiopathic
146
What are the symptoms of syringomyelia?
Main symptoms are:
Loss of sensation to pain and temperature, especially in hands
Progressive limb weakness and stiffness
147
What is the best investigation to diagnose syringomyelia?
Contrast MRI of full spine and brain
148
What is the management of syringomyelia?
Shunting
149
What is the main differential in suspected cluster headache?
Paroxysmal hemicrania
150
What medication can completely resolve the symptoms of paroxysmal hemicrania?
Indomethacin
151
What are the components of Horner's sydrome?
Ptosis
Miosis
Anhidrosis
Enopthalmos
152
What sign might point towards congenital Horner's syndrome, rather than another cause?
Heterochromia
153
What does the presence of anhidrosis in a case of Horner's syndrome indicate?
Central lesions = anhidrosis of the face and trunk
Pre-ganglionic lesions = anhidrosis of the face
Post-ganglionic lesions = no anhidrosis
154
Recall some central causes of Horner's syndrome
Stroke
Syringomyelia
Sclerosis (multiple)
155
Recall some pre-ganglionic causes of Horner's syndrome
Tumour (pancoast)
Thyroidectomy
Cervical rib
156
Recall some post-ganglionic causes of Horner's syndrome
Carotid artery dissection (most likely to be cause if painful)
Cavernous sinus thrombosis
Cluster headache
157
What sort of tuning fork should you use for Rinne's and Weber's?
512Hz
158
Describe broadly how Rinne's and Weber's tests are performed?
Rinne's: hold tuning fork to mastoid process until pt can't hear anymore then bring in front of ear to see if they cn hear it again. Tests air vs bone conduction.
Weber's: Place tuning fork in midline of forehead and see which ear they hear it louder in
159
If a patient hears the tuning fork better on the mastoid process than in front of the ear during Rinne's, and Weber's lateralises to the same ear, what does it mean?
Conductive hearing loss
160
What is the pathology if Rinne's demonstrates bone conduction > air conduction, and Weber's also lateralises left?
Conductive loss in left ear
161
What is the most common cause of degenerative cervical myelopathy?
Cervical spondylosis
162
Recall some signs and symptoms of degenerative cervical myelopathy
Pain in the neck and limbs
Loss of ANS fx (incontinence, impotence)
Hoffman's positive
Loss of digital dexterity (fumbling with hands)
Loss of sensory fx and numbness
163
What is the most useful investigation in suspected degenerative cervical myelopathy?
Cervical spine MRI
164
What is the definitive management for degenerative cervical myelopathy?
Neuro/orthopaedic surgery will do urgent decompression surgery (<6 months)
165
What structure is damaged in conduction aphasia?
Arcuate fasciculus - the connection between Wernicke's and Broca's area
166
Describe Wernicke's and Broca's aphasia
Wernicke's = expressive aphasia - can say words but makes lots of mistakes they are unaware of
Broca's = receptive aphasia - speech is non-fluent, halting and laboured - comprehension is normal.
167
What sort of cerebellar lesion would cause someone to have a broad-based, lumbering, ataxic gait?
Midline cerebellar lesion
168
What sort of cerebellar lesion would cause someone to have a veering, ataxic gait?
Unilateral cerebellar lesion, ipsilateral to veering
169
If Romberg's test is positive, what does this indicate?
There is either a loss of vestibular function (eg Meniere's) or proprioceptive function (eg peripheral neuropathy)
170
Where is the lesion if a patient has saccadic dysmetria?
Ipsilateral cerebellar
171
How can you assess for saccadic dysmetria?
Hand at peripheral vision and ask patient to look at finger then your nose - assess for overshoots (hypermetric saccades) and undershoots (hypometric saccades)
172
How do you assess for ataxic dysarthria?
Ask the patient to say 'British constitution'
173
Where is the cerebellar lesion if a patient has ataxic dysarthria?
Left cerebellar hemisphere
174
Where is the lesion if a patient has pronator drift?
Ipsilateral either cerebellar or dorsal column
175
When assessing cerebellar function, what would you assess in the upper limbs?
Tone
Pronator drift
Rebound phenomenon
Coordination (dysdiadochokinesia, dysmetria)
176
In which part of the brain are changes most likely to be found in early Alzheimer’s
disease?
Temporal lobe
177
Which genetic disorder is associated with subarachnoid haemorrhage?
PCKD
