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Phase 2a Revision > Neurology > Flashcards

Neurology Flashcards

1
Q

TIA

A

Acute loss of cerebral/ ocular Function with symptoms lasting <24hrs.

  • Due to atherothromboembolism from an artery.
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2
Q

TIA Risk Factors

A
  • Age
  • HTN
  • smoking
  • CVD
  • AF
  • Diabetes
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3
Q

2 Types of TIAs

A

→ Carotid Artery

→ Vertebrobasilar Artery

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4
Q

Carotid Artery TIA Presentation

A

In anterior cerebral circulation
- Amaurosis fugax (leg weakness, temporary reduction in ciliary blood flow)

  • Aphasia
  • Hemiparesis
  • Hemisensory loss
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5
Q

Vertebrobasilar Artery TIA Presentation

A
  • Diplopia
  • vomiting
  • Choking
  • vertigo
  • Ataxia
  • Hemisensory loss
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6
Q

TIA Investigations

A

1st line = Diffusion weighted MRI or CT.

2nd line = Carotid imaging - doppler ultrasound followed by angiography if stenosis is found.

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7
Q

TIA Management

A

Antiplatelet therapy: 75mg of Aspirin daily + Clopidogrel

Anticoagulation (warfarin) - for those with AF

Carotid endarterectomy

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8
Q

Ischaemic stroke

A

⇒ Blood vessel to / in brain occluded by a clot.

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9
Q

Ischaemic Stroke Types

A
  • Anterior Cerebral Artery
  • Middle Cerebral Artery
  • Posterior Cerebral Artery
  • Vertebrobasilar Artery
  • Lateral Medullary Syndrome
  • Brainstem Infarction
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10
Q

Ischaemic Stroke ACA Presentation

A

→ Contralateral weakness and sensory loss of the lower limb.
→ Incontinence
→ Drowsiness
→ Truncal ataxia

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11
Q

Ischaemic Stroke MCA Presentation

A

→ Contralateral motor weakness + Sensory loss

→ Hemiparesis

→ Speech issues

→ Facial droop

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12
Q

Ischaemic stroke PCA presentation

A

→ Perception

→ Homonymous hemianopia

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13
Q

Ischaemic stroke Vertebrobasilar Artery Presentation

A

→ Coordination and balance

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14
Q

Ischaemic Stroke lateral medullary Syndrome Presentation

A

→ Sudden vomiting & vertigo

→ Ipsilateral Horner ‘s syndrome = Reduced sweating , facial numbness , limb ataxia , dysphagia

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15
Q

Ischaemic stroke Brainstem Infarction Presentation

A

→ Quadriplegia

→ Facial paralysis/ numbness

→ Coma

→ locked in syndrome

→ Altered consciousness , vertigo , vomiting

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16
Q

Ischaemic Stroke Management

A
  • CT / MRI to exclude haemorrhage
  • Aspirin for 2 weeks
  • Then Clopidogrel
  • Anticoagulation (e.g. Warfarin) - Atrial fib. patients
  • Thrombolysis - IV Alteplase
  • Mechanical thrombectomy
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17
Q

Extradural Haematoma

A

Bleeding between the skull and the dura mater - usually due to fracture of the skull affecting the middle meningeal artery.

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18
Q

Extradural haemorrhage Presentation

A
  • Deterioration in GCS [ Glasgow Coma Scale ] - Lucid interval
  • Symptoms of increased Intracranial pressure - headache, vomiting, confusion, fits, hemiparesis
  • Symptoms of brainstem compression - deep irregular breathing, death by cardiorespiratory arrest
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19
Q

Extradural Haematoma Management

A
  • Ventilation
  • Craniectomy → Clot evacuation & ligation
  • IV Mannitol - for Increased ICP
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20
Q

Extradural Haematoma identification

A

Lemon-shaped lesion on a CT Skull fracture - Temporal or Parietal bone

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21
Q

Subarachnoid Haematoma

A

Bleeding between the arachnoid mater & Pia mater.

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22
Q

Subarachnoid Haematoma Presentation

A
  • Sudden onset Occipital Thunderclap headache
  • Meningism (fever, headache, neck stiffness)
  • Collapse
  • Seizures
  • Loss of consciousness
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23
Q

Subarachnoid Haematoma Investigation

A
  • CT

- Lumbar Puncture ( Xanthochromia)

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24
Q

Subarachnoid Haematoma Identification

A

Star - shaped lesion on a CT Berry aneurysm rupture

” Thunderclap headache”

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25
Q

Subarachnoid Haematoma Management

A
  • Nimodipine for 3 weeks (CCB)

- Endovascular coiling

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26
Q

Subdural Haematoma

A

Bleeding between the dura mater & arachnoid mater

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27
Q

Subdural Haematoma Presentation

A
  • Headache
  • Fluctuating GCS
  • Sleepiness
  • Gradual mental / physical slowing
  • Unsteadiness
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28
Q

Subdural Haematoma Investigations

A
  • CT

Midline shift of brain

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29
Q

Subdural Haematoma Management

A

1st = Irrigation via burr-hole craniotomy

2nd = Craniotomy

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30
Q

Subdural Haematoma Identification

A

Banana shaped lesion on a CT clot turns from White to Grey over time

Small trauma long time ago

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31
Q

Epilepsy

A

Recurrent to spontaneous, intermittent, abnormal electrical activity in part of brain - manifesting in seizures

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32
Q

Epilepsy causes

A
  • Idiopathic
  • Cortical scarring
  • Tumour
  • Stroke / alzheimer
  • Alcohol withdrawal
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33
Q

Epilepsy Risks

A

Fx

Cocaine

Premature babies

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34
Q

Epilepsy Criteria

A

2 unprovoked seizures occurring > 24 hr apart

One unprovoked seizure + probability of future seizures

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35
Q

Epilepsy Diagnosis

A

EEG

MRI /CT head

Bloods

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36
Q

Epilepsy treatment

A

Sodium Valproate

Pregnant: Lamotrigine

Myoclinic = Levitiracetam / Topiramate
Absence = Ethosuximide

Partial seizure = Lamotrigine / Carbamazepine

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37
Q

Status epilepticus management

A

IV Lorazepam

if ineffective = Phenytoin

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38
Q

Non epileptic seizures

A

Metabolic disturbance
Don’t occur in sleep
No muscle pain

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39
Q

Components of seizure

A

Prodrome: Weird feeling

Aura: Patient aware, strange feeling in gut, Strange smells, deja vu

Postictal: Temporary weakness after focal seizure in motor cortex = Postictal Todd’s palsy
→ Dysphagia after temporal lobe seizure

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40
Q

Types of Seizures

A

→ Primary generalised
→ Partial focal seizure
→ Partial seizure with 2° generalisation

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41
Q

1° Generalised seizure types

A 
→ Tonic = high hove (stiff limbs)
→ Clonic = muscle jerking
→ Tonic Clonic = muscle jerking & rigidity
→ Atonic = loss of muscle tone (fIoppy)
→ Absence = childhood - Stares blankly
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42
Q

Parkinson’s Disease

A

Destruction of dopaminergic neurons.

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43
Q

Parkinson’s Presentation

A
  • Tremor & rigidity
  • Parkinsonion gait
  • Bradykinesia
  • Dementia
  • Disordered sleep
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44
Q

Parkinson’s Investigation

A

DaTscan

  • B amyloid plaques, Tremor, Cog-wheel walk, Stooped gait
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45
Q

Parkinson’s Management

A

Young & fit:
→ Dopamine agonist = Ropinirole
→ MOA- B inhibitor = Rasagiline
→ Levo-DOPA = Co - Careldopa

Frail & unfit:
→ L-DOPA
→ MOA - B inhibitor

46
Q

Huntington’s

A

Progressive neurodegenerative disorder with 100% Penetrance.

  • Loss of main inhibitory neurotransmitter GABA
47
Q

Huntington’s Pathophysiology

A

Less GABA → Less dopamine regulation to striatum → Increased dopamine levels → Excessive thalamic stimulation & increased movement.

Repeated CAG
Mutation on chrome. 4

48
Q

Huntington’s Features

A
  • Chorea
  • Dystonia
  • Incoordination
  • Cognitive
  • Irritability, Agitation
49
Q

Huntington’s Investigations

A

MRI/ CT = loss of striatal volume

Genetic testing

50
Q

Huntington ‘s Treatment

A
  • Benzodiazepines / Valproic acid for chorea
  • SSRI for depression
  • Haloperidol, Risperidone for psychosis
51
Q

Huntington’s Differential Diagnosis

A

Sydenham’s chorea (Rheumatic fever)

52
Q

Dementia Types

A
  • Alzheimer’s
  • Vascular
  • Lewy body
  • Frontotemporal
  • Other causes : Infection, SLE, Sarcoidosis
53
Q

Alzheimer’s

Ix

Tx

A

B- amyloid plaques Neurofibrillary tangles, Damaged synapses

Ix = MRI

Tx = Acetylcholinesterase e.g. Donepezil, Galantine

54
Q

Vascular Dementia

lx

Tx

A

Multiple infarcts.
Stepwise deterioration pathy deficits.

Ix = MRI - Infarcts

Tx = Manage predisposing factors i.e. hypertension

55
Q

Lewy Body

Sx

Tx

A

Lewybodies in occipito - parietal region.

Sx = Fluctuating cognitive dysfunction, visual hallucinations, Parkinsonism

Tx = Manage Predisposing factors

56
Q

Frontotemporal

Sx

Ix

A

Pick bodies

Sx : Disinhibition, Personality change, early memory present., aphasia

Ix : MRI - frontal or temporal atrophy

57
Q

Headache types

A

1°:
→ Migraines
→ Tension
→ Cluster

2°:
→ Giant Cell / temporal arteritis
→ Trauma
→ Med. overuse

58
Q

Migraine

A

Recurrent throbbing headache often preceded by aura + associated with nausea, vomiting & visual change.

59
Q

Migraine Presentation

A

Prodrome: Yawning, craving, sleep change

Aura: Visual disturbance (line, dots), Somatosensory (Paraesthesia, Pins & needles)

→ Unilateral pain
→ Throbbing pain
→ Photophobia + Phonophobia

60
Q

Migraine Management

A 
Mild = NSAIDs
Severe = Oral Triptans e.g. Sumatriptan

Prophylaxis = Beta blockers, Acupuncture, Amitriptyline, Topiramate

61
Q

Tension headache

A

Most chronic & recurrent daily headache.

62
Q

Tension Headache Causes

A
  • Missed meals
  • Stress
  • Fatigue
  • Depression
63
Q

Tension Headache Presentation

A
  • Bilateral, Pressing headache
  • Not aggravated by movement
  • No Nausea + vomiting
  • Scalp tenderness
64
Q

Tension Headache Management

A
  • Reassurance
  • Stress relief
  • NSAIDs
  • TCA - Amitriptyline
  • Analgesia
65
Q

Tension Headache Diff. Diagnosis

A
  • Migraine
  • Cluster
  • GCA
  • Drug induced
66
Q

Cluster headache

risks

A

→ Pain localised to orbital / Supraorbital region

  • male
  • Smoker
  • Alcohol
  • Genetic
67
Q

Cluster headache Signs & Symp.

A 
→ Rhinorrhoea
→ lid swelling
→ lacrimation & nasal congestion
→ Miosis
→ Sweating
68
Q

Cluster headache
Ix
Management

A

Ix: Clinical exam. & history

Tx:

→ O2
→ Sumatriptan
→ CCB - Verapamil

69
Q

Multiple Sclerosis

A

Chronic inflammation of the CNS - CD4 cell- mediated destruction.

Multiple plaques of demyelination

70
Q

MS Presentation

A
  • Paraesthesia
  • Incontinence
  • Sensory ataxia

Charcot’s Triad :
→ Nystagmus (uncontrolled eye movements)
→ Inattention Tremor
→ Dysarthria (slurred speech)

71
Q

MS investigation

A

MRI Scans - typical lesions

Lumbar puncture - Oligoclonal bands in CSF

72
Q

MS Managment

A

MDT approach
Acute = Methylprednisolone
Relapse = DMARDS or Biologicals (Methotrexate)

73
Q

Myasthenia Gravis Presentation

A

Autoimmune disease.

Muscular fatigue
Worsened by pregnancy, Infection, Emotion, Drugs

74
Q

MG Investigations

A

Positive tensiIon test

75
Q

MG Management

A

Symptom Control

Immunosuppression

76
Q

Meningitis

Risks

A

Inflammation of meninges, due to infection.

Risk = Travel, Immunocompromised, Pregnancy

77
Q

Meningitis Bacterial Causes

A

Bacterial:
Baby = Group B strep.
Child = Strep. Pneumoniae
< 50 = Neisseria Meningitis + Strep. Pneum.
> 50 = Strep. Pneum. + Listeria Monocytogenes

Neis. can cause Meningococcal septicaemia

78
Q

Meningitis Viral & Fungal cause

A

Viral :
Enterovirus, HSV (Herpes)

Fungal :
Cryptococcus , Candida

79
Q

Meningitis Symptoms

A

Triad of Fever, Headache, Neck Stiffness
Photophobia
Non- blanching petechial & purpuric rash

80
Q

Meningitis Signs

A

Kerning’s & Brudzinski’s - + ve

Glass test = blanching or non blanching rash

81
Q

Meningitis Diagnosis

A

1st Line = Blood cultures

Lumbar puncture + CT Scan

CSF analysis:

→ Bacterial = Increased neutrophils, less glucose, release Proteins into CSF.

→ Viral = Increased lymphocytes, increased glucose, small protein release into CSF

82
Q

Meningitis Treatment

A 
Bacterial = Ciprofloxacin
Viral = Acyclovir
83
Q

Guillain - Barre Syndrome

A

Neuropathy often after infection.

84
Q

G- B Syndrome Presentation

A
  • Breathing problem
  • Back pain
  • Sensory disturbance
  • Sweating
  • Urinary retention
85
Q

G- B Syndrome Investigations

A
  • Slow conduction velocities

- Protein in CSP

86
Q

G-B Syndrome

A

Da agonist = Ropinirole

MOA - B inhibitor = Rasagiline

L-DOPA = Co - careldopa

87
Q

Syncope

A

Temporarily losing consciousness due to a disruption of blood flow to brain, leading to a fall.

Syncopal episodes aka. Vasovagal episodes.

88
Q

Syncope Types & Causes

A

1 ° = Dehydration, Missed meal, Vasovagal Stimuli.

2° = Hypoglycaemia, Dehydration, Anaemia, infection

89
Q

Syncope Signs & Symptoms

A

Hot or Clammy
Sweaty
Dizzy
Blurry vision

90
Q

Syncope Investigations

A
  • ECG: long QT syndrome
  • Echo: Struc. heart disease
  • Bloods: Anaemia, electrolytes, blood glucose
91
Q

Syncope Management

A

Avoid triggers, manage underlying

92
Q

Motor Neurone Disease

Risks

A

Group of neurodegenerative disorders by selective loss of neurons in motor cortex, cranial nerve nuclei & anterior horn cells.

Risks: Smoking

93
Q

Motor Neurone Disease Sx

A

Upper Motor Neuron Lesions:
→ Hypertonia : spasticity
→ Clonus - Increased reflex

Lower MNL
→ Hypotonia : Muscle wasting
→ FascicuIations - reduced reflex

94
Q

MND Treatment

A

Riluzole - slow Progression

MDT

Palliative

95
Q

Types of MND

A

→ Amytrophic Lateral Sclerosis = Loss of neurones in motor cortex & anterior horn. [ UMN + LMN signs ]

→ Progressive Bulbar palsy = Cranial nerve 9 -12. [ UMN + LMN ]

→ Progressive Muscular Atrophy = Anterior horn cells. [ LMN ]

→ Primary Lateral Sclerosis = [ UMN ]

96
Q

Cauda Equina Syndrome

A

Nerve roots of cauda equina at the bottom of the spine are compressed.

97
Q

Cauda Equina Pathophysiology

A

Cauda Equina [nerve root collection travelling through spinal cord, terminates at L2/3.
Spinal cord tapers at end called Conus medullaris.
Nerve roots exit at L3, L4, L5, S1, S2, S3, S4, S5

98
Q

Cauda Equina Nerve supply

A

Sensation to lower limbs, Perineum, bladder & Rectum.

Motor innervation to lower limbs & anal & Urethral sphincters.

Parasympathetic innervation of bladder & rectum.

99
Q

Cauda Equina Causes

A

Herniated disc
Tumours - Metastasis
Prostate cancer - metastasise to spine via venous blood flow.

100
Q

Cauda Equina Red flags

A

Lower Motor neuron signs [reduced tone & reduced reflexes]

  • Saddle Anaesthesia
  • Loss of sensation in bladder & rectum
  • Incontinence
101
Q

Cauda Equina Management

A

Immediate Hospital Admission
MRI Scan
Neurosurgical input - Lumbar decompression surgery

102
Q

Metastatic Spinal Cord Compression

Sx

A

Metastatic lesion compresses spinal cord.

Upper motor neuron signs [ Increased tone, brisk reflex,upping plantar response]

Sx = back pain (worse on coughing)

103
Q

MSCC treatment

A
  • Dexamethasone
  • Analgesia
  • Surgery
  • Radio/ Chemotherapy
104
Q

Sciatica -

A

Refers to symptoms associated with irritation of the sciatic nerve.

105
Q

Sciatica Pathophysiology

A

L4 - S3 form sciatica nerve.
It exits through great sciatic foramen, travelling in bullocks area, down the leg. It divides at the knee to tibial nerve & Common peroneal nerve.

106
Q

Sciatica Presentation

A
  • Unilateral electric / shooting pain from buttock radiating to back of thigh to below knee/ feet.
  • Paraesthesia
  • Numbness & tenderness
  • Motor weakness & reduced anal tone
107
Q

Sciatica Diagnosis

A

Sciatic Stretch test
STarT Back Screening Tool
X Ray / CT
MRI

108
Q

Sciatica Management

A

lnitial :
NSAIDs or Codeine
Diazepam

Worsening :
Amitriptyline
Duloxetine
Corticosteroid injection

109
Q

Cancers that metastasise to bone

A 
Prostate
Renal
Thyroid
Breast
Lung
110
Q

Types of MS

A

Relapsing Remitting MS = Autoimmune attack causes rapid development in symptoms followed by remyelination (symptoms improve), & return to constant level, but new baseline has more disability.

Progressive Relapsing MS = Steady increase (symptoms get worse), flares superimpose, some remyelination but Symptoms also get worse.

111
Q

Encephalitis

Sx

Cx

Ix

Tx

A

InfIamm. of brain Parenchyma caused by viruses

Sx: Altered consciousness & cognition, Unusual behaviour

Cx. Herpes Simplex virus or Varicella Zoster virus

Ix: lumbar Puncture with CSF viral PCR testing

Tx: IV acyclovir

112
Q

Carpal tunnel Syndrome

Sx
Ix

A

Pressure & compression on median nerve - Originates from brachial plexus at C6,7,8,T1

Sx: Numbness, tingling, relieved by wake & shake

Ix: Phalen’s test - only flex wrist for 1 minute

Tinel’s test - tapping on nerve causes tingling

Phase 2a Revision (9 decks)

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