Neurology Flashcards
Essential examination in headache?
Neck stiffness
Photophobia
Can do Kernigs signs
Brief Neurological examination incl cerebellar signs and cranial nerves
Findings on LP in bacterial meningitis?
Low glucose, high protein, organism identified, high neutrophils
Findings on LP in viral meningitis?
Normal glucose and protein. Mononuclear cells.
What would you include in your examination of a patient with syncope?
Brief cardio exam: Pulse, HS. Look for PPM or ICD scar.
Ask for LS B/P.
Brief neurological exam: pronator drift, reflexes, eye movements
Investigations in undifferentiated syncope?
ECG or longer monitoring
Echo
Tilt test if orthostatic hypotension considered
EEG and MRI head if seizure suspected
Investigations in undifferentiated syncope?
ECG or longer monitoring
Echo
Tilt test if orthostatic hypotension considered
EEG and MRI head if seizure suspected
What should be advised in orthostatic hypotension? (4)
Careful from sitting to standing
Salt and water replacement
Support stockings
Medication review- occasionally add fludrocortisone.
In what condition would this be found and how are they likely to present?
Tuberous sclerosis, likely to present with Seizures, also cystic lung disease, kidney disease and learning difficulties.
Name these lesions and where they would be found?
Ash leaf, in tuberous sclerosis. Generally found on the trunk.
Name this finding and the other skin complaints found in tuberous sclerosis?
This is adenofibromas
Ash leaf spots
Periungal fibromas
Shagreen patch (commonly found on back)
Aside from the skin changes in tuberous sclerosis what other findings might there be on examination?
Renal enlargement secondary to PKD, signs of dialysis or transplant.
Cystic lung disease.
Seizures- signs of anti epileptic treatment (gum hypertrophy and hirsutism)
What investigations would you consider in tuberous sclerosis?
CT/MRI brain
Echo
Abdominal USS
CT thorax if cystic lung disease suspected
Inheritance of tuberous sclerosis?
Autosomal dominant
What are these (2 conditions) and how many do you need for a diagnosis of this condition?
Neurofibromas, need >2.
Cafe au lait spots >6
What are the skin manifestations associated with neurofibromatosis? (3)
Cafe- au- lait
Cutaneous neurofibromas
Axillary freckling
As well as skin manifestations what would you examine for in neurofibromatosis? (4)
BP- associated with phaeo and renal artery stenosis.
Lungs- fibrosis (fine inspiratory crackles)
Enlarged palpable nerves
Signs of antiepileptic use
What is the inheritance of neurofibromatosis and of the two types which presents with the classical skin lesions?
Autosomal dominant
Type 1 presents with the classical peripheral form and type 2 presents with b/l acoustic neuromas and sensorineural hearing loss.
What are the features of this condition?
Ptosis
Enophthalmos (sunken eye)
Anhydrosis
Small pupil (miosis)
Name 3 causes of Horners sydrome?
Pancoast tumour (apical lung tumour)
MS secondary to demyelination in the brainstem
Syringobulbia
Brainstem stroke
What is a Holmes- Adie pupil?
Moderately dilated pupil with poor response to light and a sluggish response. Associated with loss of deep tendon reflexes. More common in females.
What is this and what is its association?
Argyll robinson pupil.
Small irregular pupil with accommodates but doesn’t react to light. Atrophied and depigmented iris. Typically associated with neurosyphilis but can also be secondary to DM.
Causes of third nerve palsy?
Medical: mononeuritis multiplex- DM, vasculitis, malignancy
Midbrain infarction
Midbrain demyelination (MS)
Surgical: Posterior communicating artery aneurysm
Cavernous sinus thrombosis/tumour (may also affect 4,5 and 6)
In a third nerve palsy how can you demonstrate that 4th nerve is working?
Ask look towards the nose and the eye with intort (rotate towards the nose) which indicates 4th nerve is working.
What might give you a clue that a patient has a fourth nerve palsy?
Controls superior oblique, in a right nerve palsy the patient with turn their head to the left and vice versa.
Issues on looking down.
