Neurology Flashcards
Cranial n nucleus
1,2
Cerebral cortex
Cranial n nucleus
3,4
Midbrain
Cranial n nucleus
5 6 7 8
Pons
Cranial n nucleus
9 10 11 12
Medulla
Poorly controlled DM + severe leg/thigh pain
Followed by proximal muscle wasting (shoulder, thighs , quadriceps)
Dx?
Diabetic amyotrophy
Chronic alcholic + confusion + ataxia + squint
Dx?
Treatment
Wernicke’s encephalopathy
Give thiamine IV
Chronic alcoholism c+-CAS+ amnesia + confabulation
Korsakoff psychosis
Old man + gait abnormality and dementia like behaviour changes
+- urinary urgency and incontinence
CT shows enlarged ventricles
Normal pressure hydrocephalus
“Wet wobbly wacky grandpa”
Old man + gait abnormality and dementia like behaviour changes
+- urinary urgency and incontinence
+ hx of HTN smoking TIA
MRI shoes multiple lacunar infarcts
Vascular dementia
Old pt + sexual or inappropriate comments , urinates on sofa
Loss of social interest and acts inappropriately or impulsively
Over eats and struggles with word choices
Frontotemporal dementia - Picks disease
Forgetful elderly, easily gets lost and is unable to do simple tasks
Dx?
Alzheimer’s
Acute onset behavioural changes + hallucinations
Delirium
Old age + bradykinesia + resting tremors + rigidity +postural instability +- expressionless face
Parkinson’s
Shy drager syndrome - features
Parkinsonism - bradykinesia, ataxia, resting tremors
Urinary incontinence
Erectile dysfunction
+- postural hypotension - frequent falls
Lewy body dementia
Parkinsonism
Dementia
Visual hallucinations
+- delusions
Progressive supranuclear palsy
Stiff -frozen posture, axial rigidity - falls backwards, shuffling and freezing gait
Restricted downward gaze
Tremors - absent @ rest and don’t resolve with distraction
Dx
Treatment
Essential tremors
Give propanolol
Tremors - absent @ rest , resolve with distraction
Psychogenic tremors
Intentional tremors + ataxia + dysarthria + nystagmus
Affected part of brain -
Cerebellum
=limb ataxia - cerebellar lobe.
= turn all ataxia - cerebellar vermis
Mechanism of Guillain Barre syndrome
Dx?
Autoimmune degeneration of myelin sheets
of the PERIPHERAL neurons
Dx - nerve conduction study
Investigation to confirm myasthenia Gravis
Serum skeletal muscle nicotine ach receptor antibody
Features similar to MG but + hyperreflexia +ve for upper neutron signs + normal autoimmune panel
Dx?
Amyotrophic lateral sclerosis
Motor sensory and reflexes affected + typical loss of pain and temperature (spinothalamic tract affected)
Dx?
Syringomyelia
Syringomyelia+ CN involvement - facial palsy
Syringobulbia
Ocular condition associated with multiple sclerosis
Optic neuritis
Epidural hematoma
- injury to
Middle meningeal a.
Often associated with skull fracture
Lucid interval
Chronic subdural hematoma
Features
What imaging modality is diagnostic
Usually elderly +- on anticoagulant or alcoholic
Hx of minor fall +- minor head injury
Slow onset of sx
CT - diagnostic
Surgical evacuation - dramatic improvement
Affected vessel in chronic subdural hematoma
Bridging vein - Cerebral vein
Most common cause of SAH
Cerebral aneurysm
Common associations of SAH
Ehler danlos
ADPKD - association berry aneurysm ; SIADH = HypOnatremia
Excessive alcohol intake - important RF
Dx of SAH
Ct w/o contrast , if inconclusive
LP - xanthochromia
Management SAH
Nimodipine 5-14 day s
= to diminish anticipated cerebral vasospasm
Unilateral dilated pupil
Space occupying lesion
- abscess tumour hematoma
Bilaterally constricted pupil
Opiate overdose - morphine, heroin
CVA Affecting brainstem
Bilaterally dilated pupils
TCA overdose
Cocaine overdose
Crescent shaped hematoma is characteristic for
Subdural hematoma
To identify origin/ site of SAH —>
Cerebral angio / CT angio
Likely involved blood vessel in subdural haemorrhage
Cerebral vein - rupture of bridging vein
CSF findings in bacterial meningitis
Low glucose
High proteins
WBCs - mainly neutrophils
CSF findings - viral meningitis
Low glucose
Normal/high protein
WBCs- mainly lymphocytes
CSF findings - TB meningitis
Low glucose
High protein
WBCS = early - neutrophils ; later - lymphocytes
Organism causing meningitis
Gram + diplococci - s.pneumonia -ve diplococci - neisseria meningitidis Staph aureus Gram + bacilli - listeria mono -ve coccobacilli - h. Influenza
Turbid/purulent CSF + no rash
- strept pneumoniae
Turbid/purulent CSF + rash
Neisseria meningitidis
Tension headache
Duration
Prophylaxis
Treatment
Around 30 mins , bilateral
Proph - acupuncture
Tx - pain killer
Migraine
Duration
Management
4-72 hrs
1. Sumatriptan
= >17 YO - oral , 12-17 = nasal
2. NSAIDs
Combo therapy
- oral sumatriptan + NSAIDs or
Oral sumatriptan + paracetamol
Transcutaneous vagus n stimulation
Avoid triggers
Migraine prophylaxis
Beta blockers or topiramate
Cluster headache
Location
Duration
Management
Always unilateral 15 min - 3 hrs 100% O2 10 -20 mins Sumatriptan - nasal or subcutaneous If 1st time attack - refer to specialist , may require CT
Cluster headache prophylaxis
CCB - verapamil
Treatment migraine vs cluster
Migraine - oral sumatriptan
= <17 nasal >17 oral
Cluster - nasal / subcutaneous
Fortification spectra
More complicated images that can float in your vision
- aura
Migraine
What medications cant be used in acute phase treatment of migraine
Topimarate and propanolol
- they are PREVENTATIVE
Multiple sclerosis
Age
Gender
Chronic cell mediated autoimmune disorder
- demyelination in CNS
F>M 3:1
20-40 yo
Acute attacks last 1-2 month followed by remission periods
Most common type of multiple sclerosis
Relapsing- remitting MS >85%
Features of MS
Visual - optic neuritis
Sensory - trigeminal neuralgia, numbness , pins and needles, paresthesia in limbs on neck flexion
Motor - spastic weakness = legs commonly
Cerbellar - ataxia, dysarthria , nystagmus , tremors
MS features
Cerebellum + brainstem + transverse myelitis
Cerebellum - ataxia dysarthria , nystagmus
Brainstem - optic problems , facial numbness, ataxia , dysarthria
TM - weakness, spastic quadriparesis/paraparesis , urgency/retention , stiffness , increased tone and brisk reflexes
Definitive dx test of MS
MRI _ demyelination, lesions disseminate in time and place
Treatment of MS
Acute
Long term
Acute cases - initial or during relapse
= oral or IV methyl prednisolone
Long term = glatiramer acetate or interferon beta
Dizziness/vertigo + hx of viral URTI
Vestibular neuritis
Dizziness/vertigo + hearing loss or tinnitus + hx of vital URTI
Labryinthitis
Deafness + vertigo+ tinnitus + pressure/fullness in one ear
Dx
Finding on imagine
Ménière’s disease
MRI - normal
Deafness + vertigo + tinnitus
+ cranial n palsy + fullness/pressure
Dx?
What imaging to be done ?
Acoustic neuroma - vestibular schwannoma
MRI of cerebellar-pontine angle
Treatment of BPPV
Epley’s manoeuvre
Mostly resolves spontaneously
What structure does BPPV involve
Semicircular canal - usually
Posterior semi-circular canal
Features of wernicke’s encephalopathy
Causes
Confusion + ataxia + squint
Chronic alcoholism
Can be caused by hyperemesis gravidarum, stomach ca
= vitamin B1 deficiency
What happens if wernicke’s encephalopathy not treated
Can develop wernicke’s korsakoff syndrome = korsakoff psychosis
CAS+ amnesia + confabulation
2ry prevention of ischemic stroke, TIA
Control BP , statins - all patients,
Antiplatelet or anticoagulants - depends on presence of AFib
AFIB —> warfarin or DOAC
No AFIB —> clopidogrel 75 mg OD
Ischemic stroke pt - presents <45 hrs
Management
Give thrombolytic therapy
= alteplase
Then
Aspirin 300. Mg 2 weeks + clopidogrel 75mg for life
Acute ischemic stroke mgmt
Maintain O2 temp and blood glucose
CT scan head
Thrombolytic therapy if in window ; if > 4.5 hrs or time not given just give aspirin 300mg stat
Aspirin + clopidogrel
Broca vs wernicke’s aphasia
Broca - inferior frontal lobe - usually left
- broken speech but they undertsand
Wernicke’s - superior temporal lobe - mostly left
- problem w/ speech comprehension , fluent speech
Antiepileptic drugs in pregnancy
- before pregnancy
- established pregnancy
B4 -
carbamazepine or lamotrigine
+ folic acid 5mg until 12 weeks
Est. - don’t change drug - even if its sodium valproate
If seizure free for >= 2 years - consider stopping antiepileptics
Cauda equina syndrome
Features
Investigation
Mgmt
Saddle paresthesia Inability to initiate voiding Back pain MRI spine - urgent Urgent referral to orth / surgical decompression
Commonest cause of cauda equina
Central disc prolapse
Parkinson’s disease
- pathology
- features
Progressive neuro degeneration of dopaminergic neurons in substantia nigra
= low levels of dopamine
Triad - bradykinesia + resting tremors+ rigidity
Asymmetrical
Main drugs in treatment of Parkinson’s
- general
- for tremors and dystonia
3- nocturnal and early morning hypokinesia and rigidity
General
- levodopa, co-careldopa, Cabergoline
= dopamine D2 agonists
Tremors + dystonia
- Benzhexol, orphenadrine
(Anti-cholinergics)
3- controlled release preparations
Sudden cessation of. Co-careldopa can cause
Akinesia - inability to move muscles voluntarily
What 2 drugs cant be used in Parkinson patients
Haloperidol ,
Metoclopramide
Antiemetic used in Parkinson
Levomepromazine
Rapid tranquilliser used in Parkinson’s
Lorazepam - IM
Delirium vs dementia
Delirium - acute w/ fluctuating sx Cause - infection , intoxication ,dehydration etc It’s reversible Hallucinations and mood changes Attention/consciousness - impaired
Dementia - chronic, irreversible , hallucination not common except Lewy body - visual , attention and consciousness normals
Huntington’s disease
Jerky random uncontrolled movement - chorea
Appear b/w ages 35-45 YO
Dx of epilepsy
2 unprovoked seizures with > 24 hrs apart
Initial dx of obstructive sleep apnoea
Most appropriate/ gold standard investigation
Pulse oximetry, overnight breathing pattern study
Gold - polysomnography
Treatment of OSA
Conservative - weight loss, stop alcohol
CPAP
Rarely - surgical
Guillian Barre vs Myasthenia Gravis
GBS
- weakness, absent or decreased reflexes, often has pain, no fasciculations
Young age , ascending polyneuropathy , happens after trigger - infection
MG -
Fatigue is hallmark, weakness , no pain or fasciculations , tire easily
D features - droopy eyelid (ptosis), diplopia, dysphoni , dysphagia, dysarthria
D features of myasthenia gravis (5)
droopy eyelid (ptosis), diplopia, dysphonia, dysphagia, dysarthria
Mechanism of guillian barre syndrome
Autoimmune degeneration of myelin sheets of PERIPHERAL neurons
Dx test for guillian barre
Nerve conduction study
Test to confirm dx of myasthenia gravis
Serum skeletal muscle nicotine Ach receptor antibody
Bell’s palsy
Features
Facial n palsy
Loss of forehead and brow movement,
Inability yo close eyes + drooping lid
Loss of nasolabial fold and drooping lower lip
In severe cases - dysarthria and difficulty eating
Cause of Bell’s palsy
Treatment
Viral infection
Prednisolone
N that inner ages voluntary muscles of face
Facial
Muscles of facial expression
N that inner ages involuntary muscles of face
Trigeminal
Muscles of mastication and cornea
Horners syndrome
Cause
Features
Unilateral ptosis miosis and anhydrosis
Caused by. Compression of Ipsilateral sympathetic chain
Trigeminal neuralgia
Treatment
Meds - carbamazepine = 1st line
Other - lamotrigine, phenytoin, Gabapentin
Surgery - micro vascular decompression
*corneal reflexes intact usually
Status epilepticus - def
Seizure > 5 mins or
2 or more seizures in a 5 min period w/o person returning to normal in between
Management of status epilepticus
1- 2 separate doses of (10-20 mins in between)
IV lorazepam - if IV access or in hospital or
Buccal midazolam to rectal diazepam - community
- IV phenytoin
- Refer to ICU - intubation , IV phenobarbital
In suspected stroke
- initial investigation
- most appropriate investigation
Initial - CT brain
Most appropriate - MRI brain
Ataxia and slurred speech - MRI much better than CT ( lesions of posterior fossa)
Hakims triad
= normal pressure hydrocephalus
GDU
Gait abnormality - ataxia, waddling gait, imbalance walking
Dementia - behavioural and cognitive changes, forgetful
- reversible
Urinary urgency +- incontinence
ELDERLY
Dx of normal pressure hydrocephalus
Hakims triad + CT/MRI brain
= enlarged lateral and third ventricles
Lumber infusion test ( nitrate cal infusion test) - new NICE option
Treatment of NPH
CSF shunt
Ventriculoperitoneal or ventriculopleural or ventriculoatrial
Epilepsy vs Non -epileptic attack disorder
Epilepsy
- genetic factors , lasts < 2mins, eyes open - if closed easy to open manually , tongue biting , drooling, self injury , incontinence, post octal confusion, slow post ictal EEG
NEAD -
> 2 mins, eye closed and difficult to open manually y, hx of child abuse sexual or physical , post ictal EEG normal
If in doubt of a NEAD dx what should be done
Dx of NEAXD - video EEG
Video EEG can rule out epilepsy in a patient w/ conversion disorder (attacks of inability to talk + no LOC)
Differentiating tremors Parkinson’s Essential Psychogenic Cerebellar
Parkinsons - present at rest
Essential - absent @ rest , doesn’t resolve w. Distraction
Psychogenic - absent @ rest, resolves w/ distraction
Cerebellar - intentional (tries to touch nose catch something) + other cerebellar features
The likely site of mets to brain
Diencephalon
- diabetes insipidus (polyuria, polydipsia)
Diabetes insipidus vs SIADH
Location
DI - diencephalon
= thalamus, hypothalamus, epithalamus, subthalamus and posterior pituitary
SIADH - cerebrum/cerebellum
Diabetes insipidus
Cranial - hypothalamus
Not enough ADH produced
Nephrogenic - kidneys fail to respond to ADH
Bulbar palsy
10,11,12, sometimes 7 n disturbance Rather than corticobulbar tracts (LMN)
LMN signs present Gag reflex reduced - bovine cough Nasal speech Jaw jerk - normal Wasted tongue, fasciculations Signs in limbs Normal emotions
Pseudobulbar palsy
Degeneration of corticobulbar pathways - 5 7 10 11 12 - UMN LMN signs absent Gag reflex increased/normal Spastic tongue Increased jaw jerk Kabila emotions Bilateral UMN
What is the bulbar area?
Cerebellum medulla pons
Responsible for involuntary functions that keep us alive
Bovine cough
Non explosive cough - someone unable to close glottis
Seen in vagus n (10) lesions
May be associated with dysphonia
Webers syndrome
MIDBRAIN infarct - PCA block - post cerebral a.
Ipsilateral oculi motor n palsy
- ptosis , mydriasis, deviated outwards downwards
+ contralateral hemiparesis
Wallenberg / lateral medullary syndrome
PICA block - post inferior cerebellar a
Ipsilateral horners + loss of pain and temp in FACE
+ contralateral loss of pain and temp LIMBS
Sx of cerebellar lesion
Ataxia
Intentional tremors
Dysarthria
Nystagmus
Most appropriate treatment of alcohol withdrawal
Chlordiazepoxide i.e benzos
Next add thiamine vit B1
Alcohol withdrawal seizures
Treatment
IV lorazepam
Or diazepam
Drug to promote alcohol abstinence
Disulfiram
Drug to reduce alcohol craving
Acamprosate
Weakness + increased reflexes + fasciculations
Motor neurone disease
Tumour lysis syndrome
Raised urate , K+, phosphate
Low Ca ++
After chemo
Important side effects of vincristine (chemo)
Chemo induced peripheral neuropathy
SIADH - dilutional hyponatremia
Fever + low neutrophils after chemo
Febrile neutropenia
Immediate IV ABx
Stroke of cerebellum/brainstem
Site :
Posterior circulation
- do MRI head
Cavernous sinus thrombosis
Features
Chemosis - conjunctival oedema Proptosis 6th CN palsy - diplopia on lateral gaze Pain over medial canthus Severe headache , fever chills hx of sinusitis
Pick’s disease
Features
Frontotemporal dementia
Disinhibition - frontal lobe Struggles w/ word choices - temporal lobe Disengagement Inappropriate/impulsive Personality and behaviour changes Neglects personal hygiene
What is characteristic of picks disease
Focal gyral atrophy w/ knife blade appearance
Macroscopic changes - atrophy of frontal and temporal lobes
Contralateral paralysis + sensory loss (face + arm)
+ Ipsilateral gaze preference
What is affected?
Middle cerebra a. - supplies lateral hemisphere
Other features
Aphasia
Homonymous hemianopia
What does middle cerebra a. Supply?
Lateral part of hemisphere
Anterior cerebral a. Supplies
Frontal and medial cerebrum
Occipital lobe supplied by
Posterior cerebral a.
Basilar a. Supplies
Cerebellum
Brainstem
Occipital
Strongest genetic RF for Alzheimer’s
APOEE e$ gene
Features of Alzheimer’s
Elderly
Short term memory loss
After some time - confusion, inability to make decisions, progressive language deficits
Late - disorientation , behavioural changes , death
Dx of Alzheimer’s
MRI
Single photon emission CT - differentiates from FTD
MMSE - assess cognitive impairment
MMSE score
25-30 normal
21-24 mild
10-29 moderate
<10 - severe
Management of Alzheimer’s
Ruvastigmine - 1st line ( mild to mod)
Others - donepezil, galantamine
2nd line
Memantine - NMDA receptor antagonist
Or in severe cases
Suitable for patients with bradycardia , heart block
Best advice for mechanical lower back pain
Continue or increase mobilisation
Regular analgesia
Back pain elicited after repeated contraction
Relieved my movement and changing position
Myofascial pain syndrome
Parkinsonism + erectile dysfunction + postural hypotension
Shy drager syndrome
Lewy body dementia
Features
Imaging
Dementia
Fluctuating levels of awareness
Mild Parkinsonism
Visual hallucination**
Imaging - MRI brain
Presentation similar to myasthenia gravis but w/ increased reflexes (+UMN) + normal autoimmune panel
Amyotrophic lateral sclerosis = motor neurone disease
- MG has normal reflexes , assoc with autoimmune
Lambert Eaton syndrome
Associated with tumours - e.g lung ca
Same as MG but -
Reflexes absent , elicited after excercise
Increased strength/power of weak muscles after repeating test
Syringomyelia
Loss of pain and temp
Motor sensory reflexes all affected
Syringobulbia
Syringomyelia + CN involvement
Syrinx extends to involve brainstem
Organic brain damage
Features
Memory loss
Agitation
Confusion
Willis Ekbom syndrome
What should be done
Restless leg syndrome
Check iron - ferritin low - give supplements
If normal -
give dopamine agonist = Ropinirole pramipexole rotigotine
Or Gabapentin , pregabalin
Lifestyle change usually enough - alcohol smoking caffeine sleep etc
Dopamine agonist
Ropinirole
Pramipexole
Rotigotine
Dementia vs depressive pseudodementia
Dementia
= progressive , long term sx , mood variations , concealing amnesia , tries to answer questions
Pseudo =
rapid onset, short term sx, consistently depressed mood , short answer negativism, highlight amnesia, fluctuating cognitive impairment
Normal grief response
Stage 1 - hrs to days
= denial disbelief numbness
Stage 2 - wks - 6 mo
Sadness, grief, hallucination , social withdrawal, guilt etc
Stage 3 - wks to months
Symptoms resolve
Social activities resumed
Memories of good times
Denial & isolation - anger - depression - bargaining - acceptance
Inattention/neglect in one side + seizure + neurological deficit
Think of
Space occupying lesion - tumour abscess
It’s a feature of parietal lobe lesion
Lucid intervals seen in
Epidural / extramural hgx
= middle meningeal a.
Cervical spondylosis
Limited + painful neck movement
Occipital headaches
Treatment of absence seizure
Sodium valproate
Intracranial tumour mgmt
High dose dexa - shrink mass
GCS <8 - give mannitol (rapid action)
Intracranial hgx + very low GCS - urgent craniotomy
Sensory n roots L1 L2 L3 L4 L5 S1
L1 - groin , pelvic girdle L2 - anterior thigh L3 - inner medial thigh and distal anterior thigh L4 - inner medial shin L5 - lateral shin and dorsum of foot S1 - lateral foot
Amaurosis fugax
Cause
Features
Transient occlusion of central retinal a.
Painless temporary unilateral recurrent loss of vision
5-15 mins , resolves in <24 hrs
RF of amaurosis fugax
Atherosclerosis (neck bruit)
HTN
Giant cell arteritis
Tia vs amaurosis fugax
TIA - emboli from heart
AF - emboli from internal carotid
Medication absolutely CI in migraine w/ aura
COCP - increased risk of cardiovascular accident
Best contraception to use - copper IUD
Treatment Ménière’s
Buccal or IM - prochlorperazine
NF 1
- features
- association
Presents more with skin lesions - cafe au lait
Axillary/ groin freckles, iris hamartoma, scoliosis
Assoc w/ pheochromocytoma
NF2
CNS tumours
Bilateral acoustic neuroma , schwannoma, meningioma
Definitive diagnosis for multiple sclerosis
MRI spinal cord and brain
= demyelination , lesions disseminated in time and place
Treatment of acute multiple sclerosis
IV methylprednisolone
Myasthenia gravis association
Thyrotoxicosis
Lambert Eaton syndrome association
Tumours - small cell lung ca
Best next modality in TIA
Carotid doppler scanning
When should carotid endarterectomy
Internal carotid a. Stenosis >/= 50% in men
>/= 70% women
Rapid correction of hypernatremia can cause
Cerebral oedema
Suspected meningitis
W/ rash -
W/o rash
Investigation
Rash - blood culture
No rash - LP
TIA
Driving advice
Stop driving at least 1 month
Stop lorry or bus driving 1 year
Inform DVLA if multiple TIA in car driver, 1 TIA in bus/lorry driver
Seizure
Driving advice
1 year of being seizure free - car driver
5 years seizure free - lorry driver
Acute subdural vs SAH
Acute subdural - hx of trauma, rapid deterioration
SAH - thunderclap
Supranuclear palsy
Features
Stiff frozen posture
Axial rigidity
Falling backwards, shuffling freeing gait
Restricted downward gaze
Diabetic amytrophy (proximal diabetic neuropathy) Features
Complication of poorly controlled DM
Severe thigh or leg pain —> proximal muscle wasting (shoulders thighs pelvic girdle )
Usually resolve within months
Good DM control is a must
Vascular is neuropathy vs diabetic amyotrophy
Similar presentation but w/ raised ESR = vasculitis
Treatment of neuropathic pain in diabetics
Amytriptiline - 1st line
Or Gabapentin Duloxetine or pregabalin
Treatment of trigeminal neuralgia
Anticonvulsant - carbamazepine
Others - lamotrigine phenytoin Gabapentin
Vascular dementia
Features
Dementia +
Hx of HTN smoking TIAs
MRI - multiple lacunar old infarcts
Treatment Bell’s palsy
High dose prednisolone - 10 days
Treatment of Ramsay hunt syndrome
Acyclovir
Types of spina bifida
Occulta - mild. = hairy patch, dimple , dark spot or swelling
Meningocele - sac of fluid
Myelomeningocele - severe “ open spina bifida”
-poor ability to walk , impaired bladder or bowel control , hydrocephalus
-tethered spinal cord and latex allergy
Prevention of spina bifida
Folic acid during pregnancy
Healed UTI w/ persistent high bladder pressure and urinary retention
Management
Intermittent self catheterisation
If ongoing UTI - urinary incontinence pads preferred
Folic acid in pregnancy
0.4 mg / 400ug 1/day for 12 weeks
5mg /day 12 weeks if :
DM , BMI >30 , on antiepileptics, FHx of NTD , prev pregnancy w/ NTD
5 mg whole pregnancy
SCD, thalassemia
TIA site of lesion
- leg
- face and arms
- vision and language
Leg = anterior communicating a.
Face and arms = middle cerebral artery
Vision and language - posterior cerebral a.
Gerstmann syndrome
Inability to designate or name different fingers of both hands - finger agnostic
Confusion of R/L side of body
Dyscalculia
Dysgraphia
Word blindness , homonymous hemianopia, lower quandrantopia
Lesion in Gerstmann syndrome
Inferior parietal lobe - angular gurus pr subjacent white matter of left hemisphere
Vessels involved in subdural and epidural hematoma
SDH - bridging veins
EDH - middle meningeal a.
Acute delirium causes
Hyponatremia
Infection, Alcohol withdrawal ,acute MI
Head injury ,DM , thyrotoxicosis
Transverse myelitis
Features
Weakness Spastic quadripartite or paraparesis Urgency/tension Stiffness Increased tone + brisk reflexes
Idiopathic cranial hypertension
Features
Bilateral throbbing headache
Assoc w/ nausea vomiting , tinnitus , visual disturbance
Occurs daily, worse in morning
Improves with standing
Obesity is RFv
When does Parkinson’s disease dementia occur
More than a year after dx of parkinsons
Side effects of co-careldopa
Dyskinesia
+- Hallucinations
Focal tremors
Migraine w/ aura vs stroke/TIA
Migraine - gradual onset, word salad , mainly visual sx
Stroke/TIA - sudden , temporary loss of vision , dysarthria
Safest anti-epileptic in pregnancy
Lamotrigine
Carbamazepine
Hoover’s sign
Dx of functional weakness of LL
+ve = pt supine , flexion of weak hip against resistance is NOT followed by extension of other normal hip
Normal people or organic cause - flexion of weak hip against resistance - followed by extension of other normal hip
(-ve hoover sign)
