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Clinical > Neurology > Flashcards

Neurology Flashcards

1
Q

Symptoms of idiopathic intracranial hypertension

A

The symptoms include:

Headache behind the eyes
Ringing in the ears
Blurred vision
Double vision
Short temporary episodes of blindness
Nausea and vomiting
Dizziness
Papilledema (swelling of the optic disc in the eyeball) (fundoscopy)

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2
Q

Symptoms of raised intracranial pressure (red flag)

A
  • headaches worse in morning and upon bending over
  • headaches improve after vomiting or lying down
  • May be associated with neurological deficits due to compression of cranial structures by a space-occupying lesion, such as a tumour or haemorrhage.
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3
Q

Migraine definition

A
  • headache lastin 4-72hrs
    at least 2 of following characteristics:
  • unilateral location
  • pulsating quality
  • ## moderate or severe pain intensity
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4
Q

Chronic migraines definition

A

Headache > or on 15 days

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5
Q

Acute treatments for migraines

A
  • ## painkillers i.e paracetamol NSAIDs
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6
Q

Preventative treatments for migraines

A
  • Amitryptiline
  • Propanolol

Can also use botox for chronic migraines
New treatment: fremanuzumab

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7
Q

Symptoms of cluster headaches

A
  • recurrent attacks of sudden unilateral periorbital pain
  • associated with watery eyes, runny nose (rhinorrhoea), blood shot eye, lacrimation, miosis, ptosis, lid swelling, and facial flushing
  • last 15 minutes to 3 hours, occur once or twice a day, over a period of 4-12 weeks, and are followed by a pain-free period of months before the next cluster begins
  • pts tend to bang head in first attack as it relieves pain slightly
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8
Q

Management of cluster headaches

A

Acute management:
- high flow oxygen with 100% via non-breathable mask (contraindication COPD) with subcutaneous or nasal Triptan (CI: ischaemic heart disease)
- steroids can also be used

Preventative/avoid triggers:
- prophylaxis with Verapamil (calcium channel blocker)

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9
Q

Definition of cluster headaches

A

1 in 500 people
one sided
cranial autonomic features (tears, runny nose, red eye, drooping eyelid)
30-120 mins (bit shorter than migraines)
pt can be really agitated unlike a migraine
- need a scan - 10% people may have abnormality in pituitary gland

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10
Q

Symptoms of migraines:

A
  • a unilateral throbbing headache preceded by an aura, such as visual (eg. lines, zigzags) or sensory (paraesthesia spreading from fingers to face) symptoms
  • headache may last 4-72 hours
  • associated with photofobia or phonophobia
  • May be identifible triggers
  • vomiting common
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11
Q

Definition of myasthenia gravis

A

autoimmune
progressive muscle weakness
nictitonic acetylcholine receptor antibodies produced by immune system, blocks post synaptic receptors, acetylcholine can’t bind, unable to contract/communication with muscles

linked to thymus gland tumours (thymomas)

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12
Q

Symptoms of myasthenia gravis

A

weakness of proximal limbs, facial muscles, eye lid muscles
worse in evening/end of day, better in morning
worsens with activity, better with rest

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13
Q

Investigations for myasthenia gravis

A

Bloods:
- serum acetylcholine receptor antibody
- muscle-specific tyrosine kinase antibodies (should be ordered if the acetylcholine receptor antibody is negative or equivocal)

  • CT of the chest look for tumours of thymus
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14
Q

Give 3 examples of trinucleotide repeat disorders which result in neurological conditions

A

huntington’s (CAG repeat in HTT gene, chr 4)
Fragile X (CGG repeat in FMR1 gene on chr X)
Myotonic dystrophy (CTG repeat in DMPK gene on Chr 19).

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15
Q

Clinical features of small fibre peripheral neuropathy

A

burning pain
allodynia (non-painful stimuli experienced as pain)
hyperalgesia (painful stimuli experienced as severe pain)

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16
Q

Causes of motor-predominant peripheral neuropathy

A

gullain barre syndrome
hereditory motor neuropathies
acute intermittent porphyria
lead poisoning
paraneoplastic syndrome

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17
Q

definition of motor peripheral neuropathy

A

damage to peripheral nerves responsible for motor functions e.g foot drop

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18
Q

Causes of cerebellar syndrome

A

vascular: stroke
Infective: Lyme disease
Inflammatory: Multiple scleorisis
Traumatic: traum to posterior fossa
Metabolic: alcoholism
Iatrogenix: phenytoin, carbamazapine
tumours
vitamine E deficiecny

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19
Q

What is subdural haemorrhage

A

caused by collection of venous blood accumulating in potential space between dura mate and arachnoid mater (subdural space)

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20
Q

Aetiology of subdural haemorrhage

A

elderly pts following minor trauma

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21
Q

Risk factors for subdural haemorrhage

A

advancing age >65
Bleeding disorders or anticoagulation therapy
chronic alcohol use
recent trauma

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22
Q

Presentation of subdural haemorrhage

A

typically sub acute (within 3 days to 3 weeks) chronic (>3 weeks)
headache, nausea, vomiting, confusion, diminished eye/verbal/motor response
may be focal signs in haematoma site

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23
Q

dx of subdural haemorrhage

A

CT scan

-

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24
Q

What is the ROSIER screening?

A

scoring system used in acute settings such as A&E to recognise stroke

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25
Q

What is the definition of vertigo?

A

Hallucination of movement of oneself or one’s environment
movement often rotatory e.g floor is tilting

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26
Q

Causes of vertigo

A

benign positional paroxysmal vertigo (BPPV)
acute labyrinthitis
Meiniere’s disease
acoustic neuroma
Ramsay hunt
Ototoxicity

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27
Q

features of benign positional paroxysmal vertigo (BPPV)

A

presence of debris in semicircular canals of ears cause vertigo upon head movements
Hallpike manourve is diagnostic
epley manourves treat by clearing debris

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28
Q

Features of acute labyrinthitis

A

inflammation of vestibular nerve causing acute severe vertigo, may be associated with vomiting
hearing loss, and tinitus
associated with recent illness or vascular lesion
often resolves over a month, treatment is conservative

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29
Q

Meniere’s disease features

A

endolymphatic system pressures increase causing recurrent episodes of vertigo, sensorineural hearing loss, tinnitus and feeling or aural fullness
tx: antihistamines and bed rest

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30
Q

features of acoustic neuroma

A

/

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31
Q

Ramsey Hunt syndrome features

A

herpetic infection of facial nerve causing facial nerve palsy, with or without vertigo, tinnitus and hearing loss
Tx: aciclovir and prenisalone

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32
Q

Ototoxicity features

A

Aminoglycoside abx (gentamicin, vancomycin) and loop diuretics (furesomide)

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33
Q

What type of brainstem stroke can cause locked in syndrome?

A

Acute basilar artery infarct

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34
Q

Which is the first line of treatment in cases of optic neuritis?

A

Intravenous methylprednisolone

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35
Q

What is the management of a haemorrhagic stroke following ABCDE assessment?

A

Obtain neurosurgical opinion regarding surgical intervention (e.g decompressive hemicraniectomy)

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36
Q

What are the features of lateral pontine syndrome?

A

Lateral pontine syndrome (anterior inferior cerebellar artery): contralateral loss of pain/temperature on the body , ipsilateral nystagmus & vertigo & nausea/vomiting ipsilateral facial paralysis , ipsilateral deafness and tinnitus, ipsilateral ataxia ipsilateral impaired facial sensation

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37
Q

Features of posterior circulation infarct?

A

cerebellar dysfunction OR
conjugate eye movement disorder OR
Bilateral motor/sensory deficit OR
ipsilateral cranial nerve palsy with contralateral motor/sensory deficit OR
cortical blindness/isolated hemianopia

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38
Q

What is Foville’s syndrome?

A

/

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39
Q

What is Horner’s syndrome

A

interruption of the sympathetic nervous supply to the eye

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40
Q

Causes of Horner’s syndrome

A

pancoast tumour (affecting sympathetic nervous supply)
Stroke
Carotid artery dissection (red flag: neck pain)

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41
Q

Clinical presentation of Wallenburg syndrome

A

DANVAH
Dysphagia
ipsilateral Ataxia
ipsilateral Nystagmus
Vertigo
Anaethesia (ipsilateral facial numbness and contralateral pain loss on the body)
ipsilateral Horner’s syndrome

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42
Q

What causes Wallenburg syndrome

A

infarction of posterior inferior cerebellar artery (PICA)

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43
Q

Features of cerebellar syndrome

A

DANISH

dysdiadochokinesia (inability to perform rapid alternating hand movements)
Ataxia (broad based unsteady gait)
Nystagmus (involuntary eye movements)
Intention tremor (finger nose test)
Slurred speech
hypotonia

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44
Q

Causes of cerebellar syndrome

A

VITAMIN C

vascular: stroke
Infective: Lyme disease
Inflammatory: multiple scleorisis
Traumatic: trauma to posterior fossa
Metabolic: alcoholism
Iatrogenic: phenytoin and carbamezepine
Neoplastic: primary tumours (cerebellopontine angle tumour)
Congenital: Friedrich’s ataxia

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45
Q

A 70 year old male patient presents to the emergency department with sudden onset unsteadiness. His wife reports that his speech is slurred and he appears to be walking as if drunk. He has a past medical history of hypertension and hypercholesterolaemia.

On physical examination there is ataxia, right-sided intention tremor, dysarthria and nystagmus.

Which of the following is the most appropriate urgent investigation?

A

CT head

most appropiate in pts with suspected stoke

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46
Q

A patient presents with unsteadiness on their feet. The doctor performs a test whereby the patient is asked to stand up with their eyes open, and then they are asked to close their eyes. The patient is stable with their eyes open, however upon closing the eyes, they become unsteady. Which of the following is the most appropriate conclusion?

A

pt is Rhomberg’s positive and has sensory ataxia

its sensory because it happens when eyes are closed

47
Q

Clinical features of Herpes Zoster ophthalmicus

A

painful red eye, fever, malaise and headache
precede typical erythematous vesicular rash over trigeminal division of opthalmic nerve

48
Q

Treatment of Herpes Zoster ophthalmicus

A

Oral aciclovir with topical steroids.

49
Q

What is encephalitis

A

infalmmation of encephalon or brain parenchyma

50
Q

Clinical features of encephalitis

A

altered mental state
fever
flu like symptoms
early seizures

51
Q

Cause of encephalitis

A

herpes simplex virus type 1

52
Q

What causes encephalopathy

A

hypoglycaemia
hepatic encephalopathy
DKA
drug induced
SLE

53
Q

Investigations for encephalitis

A

suspected in any pt with sudden onset behavioural change, new seizures and unexplained acute headache with meningism

blood tests, blood cultures, viral PCR
CSF
malaria blood forms

54
Q

treatment of encephalitis

A

broad specturm abx with 2g IV ceftriaxone BD and 10mg/kg aciclovir TDS for 2 weeks

55
Q

side effects of aciclovir

A

generalised fatigue/malaise
GI disturbance
photosensitivity and urticarial rash
acute renal failure
haem abnormalities
hepatitis
neurological reactions

56
Q

What are focal seizures with impairment of consciousness (complex focal seziures)?

A

pts lose consciousness either after an aura or at seizure onset
most commonly originate from temporal lobe
post-ictal sx common e.g confusion in temporal lobe seizures.

57
Q

What are simple focal seizures?

A

without impairment of consciousness

pts don’t lose consciousness, only experience focal sx
post-itcal sx don’t occur

58
Q

What are secondary generalised focal seizures

A

focal seizure –> tonic-clonic

59
Q

Features of temporal-lobe specific focal sezirue

A

automatisms (lip-smacking, deje vu, jamais vu, emotional disturbance ‘sudden terror’, olfactory, gustatory or auditory hallucinations

60
Q

Features of frontal-lobe specific focal sezirue

A

motor features e.g jacksonian features, dysphasia, Todd’s palsy

61
Q

Features of parietal-lobe specific focal sezirue

A

sensory symptoms; tingling and numbness, motor sx: spread of electrical activity to pre-central gyrus in frontal lobe

62
Q

Features of occipital-lobe specific focal sezirue

A

visual symptoms such as spots and lines in visual field

63
Q

What are absent seizures

A

pts often children pause briefly, for less than 10 seconds, then carry on where they left off.

Tx: sodium valporate (SE: weight gain, hair loss, oedema, ataxis, tremor, tetraogenicity) or ethosuximide 1st line

AVOID carbamazepine as makes seizures worse

64
Q

What are tonic clonic seizures

A

pts lose consciouness
limbs stiffen and then start jerking
post-ictal confusion

TX: sodium valporate or lamotrigine 1st line

65
Q

What are myoclonic seizure

A

sudden jerk of limb, trunk or face.

Tx: sodium valporate 1st line unless pt is woman of child bearing age then it’s levetiracetam or topiramate.

AVOID carbamazapine

66
Q

What are atonic seizures

A

sudden loss of muscle tone, causing pt to fall whilst retaining consciousness

Tx: sodium valporate or lamotrigine

67
Q

What are complications of epilepsy

A

status eplicticus (treat with IV lorazepam/buccal midazolam, then phenytoin

depression
suicide
sudden unexpected death in epilepsy

68
Q

mx for focal seizures

A

carbamazepine, gabapentin and phenytoin

69
Q

What is giant cell arteritis

A

arteries on side of head become inflammed

70
Q

Presentation of giant cell arteritis

A

temporal headache
jaw claudication (pain on chewing food)
amaurosis fugax (like dark curtain descending vertically in vision)
thickened, tender temporal artery on examination
scalp tenderness

71
Q

complications of giant cell arteritis

A

stroke
permenant monocular blindness

72
Q

investigations for giant cell arteritis

A

ESR, FBC, LFTS

definitive investigation: temporal artery biopsy

73
Q

mx for giant cell arteritis

A

high dose steroid: 60mg OD prednisolone

74
Q

What is cauda equina syndrome

A

compression of cauda equina

L1

75
Q

Cause of cauda equina syndrome

A

lumbar disc herniation at L4/5 and L5/s1

76
Q

Clinical features of cauda equina syndrome

A

lower back pain
bilateral radicular pain
saddle anaethesia
bladder and bowel disturbance

77
Q

Mx of cauda equina syndrome

A

urgent WHOLE spine MRI
surgical decompression

in pts where malignancy seen or suspicion high: 16mg OD dexamethasone with PPI cover

78
Q

What is brown-sequard syndrome

A

anatomical dsiruption of nerve fibre tracts in one half of spinal cord

79
Q

Clinical features of brown-sequard syndrome

A

disruption of descending lateral corticospinal tracts, ascending dorsal column and ascending spinothalamic tracts

ispilateral hemiplegia
ipsilateral loss of proprioception and vibration
contralateral loss of pain and temp sensation

80
Q

Causes of brown-sequard syndrome

A

cord trauma
neoplasma
disk herniation
demyelination
infective/inflammatory lesions
epidural haematomas

81
Q

Mx of brown-sequard syndrome

A

surgery or medical

82
Q

What is Guillain- Barre syndrome

A

ascending inflammatory demyelinating polyneuropathy

83
Q

Clincial features of Guillain- Barre syndrome

A

progressive ascending symmetrical limb weakness, starts from feet and moves up
reduced reflexes and loss of sensation
4 WEEKS AFTER INFECTION OF GASTRITIS/DIARRHOEA/FOOD POISONING

84
Q

mx of Guillain- Barre syndrome

A

IV immunoglobulins

Intubation/ventiliation IF RESP FAILURE

FVC NEEDS TO BE MONITORED

85
Q

Causes of Guillain-Barre Syndrome

A

Campylobacter jejuni infection

86
Q

what cranial nerve lesion is seen in left sided Bell’s palsy

A

Left 7th cranial nerve LMN lesion

87
Q

mx of TIA

A

300mg aspirin
review in 24hrs

88
Q

1st line treatment of optic neuritis

A

IV methlyprednisolone

89
Q

1st line imaging investigation in acute stroke

A

non-contrast CT head

why? exclude haemorrhage

90
Q

secondary stroke prevention

A

HALTSS
hypertension: anti-tensive therapy
Antiplatlet therapy: clopidogrel 75mg OD
lipid lowering drugs: 20-80mg ON atorvastatin
smoking cessation
diabetes managed appropiately
surgey

91
Q

What type of brainstem stroke can cause locked in syndrome?

A

acute basilar artery infarct

92
Q

cardinal signs of middle cerebral artery stroke

A

contralateral hemiplegia
contralateral homonymous hemianopia
dysphasia

93
Q

how do lesions in medulla present

A

cranial nerve IX, X, XI, XII palsies

94
Q

What are the features of a total anterior circulation infarct according to the bamford classification?

A

contralateral hemiplagia or haemparesis AND
contralateral homonymous hemianopia AND
higher cerebral dysfunction (aphasia, neglect)

95
Q

What are the features of a posterior circulation infarct according to the bamford classification?

A

Cerebellar dysfunction, OR
Conjugate eye movement disorder, OR
Bilateral motor/sensory deficit, OR
Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit, OR
Cortical blindness/isolated hemianopia.

96
Q

What is the Oxford-Bamford criteria for a total anterior circulation stroke?

A

All three of 1) Unilateral weakness and/or sensory deficit in the face, arm and leg 2) Homonymous hemianopia 3) Higher cerebral dysfunction (dysphasia, visuospatial disorder)

97
Q

To be eligible for thrombolysis, which time window must patients with ischaemic stroke present in?

A

less than 4.5 hrs sx onset

98
Q

What are the features of a partial anterior circulation infarct according to the bamford classification?

A

A partial anterior circulation infarct (PACI) is defined by:

2 of the following:

Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect) OR Higher cerebral dysfunction alone.

99
Q

Which stroke syndrome affects the medulla?

A

Lateral medullary syndrome (posterior inferior cerebellar artery)

100
Q

If speech is affected, which hemisphere is affected?

A

Dominant hemisphere strokes (Left side of the brain for most people) can cause dysphasia or aphasia.

101
Q

Which stroke syndrome affects the Pons?

A

Lateral pontine syndrome (anterior inferior cerebellar artery)

102
Q

What symptoms do MCA lesions produce?

A

Middle cerebral artery infarcts affect the contralateral arm, leg and face.

103
Q

4 causes of painless monocular visual loss

A

anterior ischaemia optic neuritis
amaourosis fugaz
vitreous hamorrhage
retinal detachment

104
Q

Risk factors for haemorrhagic stroke

A

age, male, haemophilia, cerebral amyloid angiopathy/hypertension, anti-coagulation, sympathomimetic drugs (cocaine, amphetamines)

105
Q

mx of Myasthenia gravis

A

acute - steroids
long term - acetylcholinesterase inhibitors (pyridostigmine or neostigmine)

106
Q

mx of myasthenic crisis

A

Ventiliation (resp failure)
IV immunoglobulins

107
Q

pathophysiology of guillain-barre syndrome

A

b cells produce antibodies to infection antigen (campylobacter jejuni)
antibodies also match receptors of neurons
antibodies produced attack nerves (motor)

108
Q

pathophysiology of multiple sclerosis

A

demeylenation of CNS neurons
immune system attacks neurones - struggle to commincate –> results in sensory, motor + cognitive problems

109
Q

4 types of multiple sclerosis

A

relapsing - remitting
secondary progressive
primary progressive
progressive relapsing

110
Q

acute progressive weakness
spasitic paraparesis, brisk reflexes
patchy sensory disturbances
white matter plaques on brain MRI
optic neuritis
oligoclonal bands in CSF
periventricular plaques

presentation of what neurological disease?

A

Multiple sclerosis

111
Q

mx of acute attack Multiple sclerosis

A

IV methyl prednisolone (1g)
if doesnt work - plasma exchange

112
Q

chronic mx of Multiple sclerosis

A

injectable beta interferon

113
Q

investigations to support dx of Multiple sclerosis

A

CSF
MRI

Clinical (12 decks)

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