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Neurology Flashcards

1
Q

What do the ascending tracts do?

A

Carry sensory information from the body, up SC to the brain

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2
Q

What are the ascending tracts?

A

Dorsal column-medial lemniscus and spinothalamic

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3
Q

What does the dorsal column-medial lemniscus tract do?

A

Carries info about vibration, proprioception, fine touch

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4
Q

What does the spinothalamic tract do?

A

Carries info about crude touch, pain, temperature and pressure

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5
Q

What do the descending tracts do?

A

Carry motor info from the brain to the body

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6
Q

What are the descending tracts made up of?

A

UMNs and LMNs

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7
Q

What are the 2 types of descending tracts?

A

Pyramidal and extra-pyramidal

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8
Q

What do pyramidal tracts do?

A

Control fine, voluntary muscle movements

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9
Q

What are the 2 types of pyramidal tracts?

A

Anterior corticospinal and lateral corticospinal

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10
Q

What do the anterior corticospinal tracts do?

A

Control muscles of the trunk

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11
Q

What do the lateral corticospinal tracts do?

A

Control muscles of the extremities

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12
Q

What do the extra-pyramidal tracts do?

A

Control larger muscles for balance, posture, coordination

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13
Q

Name a condition that shows both UMN and LMN signs.

A

MND

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14
Q

What do UMNs do?

A

Transmit info from brain to brainstem/spinal cord

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15
Q

What do LMNs do?

A

Transmit info from brainstem/spinal cord to skeletal muscles

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16
Q

What are the UMN signs?

A

Hypertonia - spastic paralysis
Brisk reflexes - hyperreflexia
+ve Babinski’s sign

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17
Q

What causes UMN signs?

A

Any damage to brain/brainstem/white matter of spinal cord

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18
Q

Give some examples of conditions which present with UMN signs.

A

Stroke, infection, tumour

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19
Q

What are the LMN signs?

A

Hypotonia - flaccid paralysis
Reduced/absent tendon reflexes
Muscle wasting
Fasciculations

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20
Q

What causes LMN signs?

A

Any damage to axons leaving the spinal cord or the anterior horn of the spinal cord

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21
Q

Give some examples of conditions which present with LMN signs.

A

Peripheral neuropathy, spinal cord injury

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22
Q

What are the 2 types of stroke?

A

Haemorrhagic and ischaemic

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23
Q

What percentage of strokes are haemorrhagic?

A

20%

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24
Q

What percentage of strokes are ischaemic?

A

80%

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25
What conditions are classed as ischaemic events?
TIAs and ischaemic strokes
26
What conditions are classed as strokes?
Ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage
27
What conditions are classed as haemorrhagic events?
Intracerebral haemorrhage Subarachnoid haemorrhage Subdural haematoma Extradural haematoma
28
What are the risk factors for ischaemic stroke?
Alcohol Obesity AF Carotid stenosis Other CVS disease CVS risk factors
29
What CVS risk factors predispose you to ischaemic stroke?
HTN, smoking, diabetes, hypercholesterolaemia
30
Why is AF a risk factor for ischaemic stroke?
Stasis of blood in poorly contracting atria = thrombus formation
31
What CVS diseases predispose you to ischaemic stroke?
Valvular disease, angina, previous MI, PVD
32
What arteries can be affected in an anterior circulation stroke?
Anterior cerebral and middle cerebral arteries
33
The area of the somatosensory cortex supplied by the ACA is responsible for which parts of the body?
Genitals Hip Trunk Neck Head Lower limbs
34
The area of the somatosensory cortex supplied by the MCA is responsible for which parts of the body?
Entire arms Eyes Nose Face Mouth Pharynx
35
How does an ACA occlusion stroke present?
Contralateral hemiparesis Sensory loss in lower limbs Executive dysfunction + emotional disturbance Akinetic mutism
36
How does an MCA occlusion present?
Contralateral hemiparesis Sensory loss of face + upper limb Legs usually spared Affects language centres if occlusion is in dominant hemisphere = dysphasia and aphasia Contralateral homonymous hemianopia
37
How does executive dysfunction present?
Apathy, reduced concentration, impulsivity
38
How does akinetic mutism present?
Drowsy and reduced spontaneous speech (lack of movement and speech)
39
What are the language centres of the brain?
Wernicke's and Broca's areas
40
What is contralateral homonymous hemianopia?
(This would be an occlusion in the right hemisphere)
41
What is contralateral hemiparesis?
Paralysis on the opposite side of the body to the site of the occlusion
42
What are fasciculations?
Twitches
43
What is Babinski's sign?
44
What causes dysarthria?
Damage to motor speech pathway
45
What conditions might cause dysarthria?
Stroke, tumour, MS
46
What is dysarthria?
Slurred speech/difficulty pronouncing words so patient sounds drunk
47
What is dysphasia?
Inability to understand or compose language
48
What area is damaged in expressive dysphasia?
Broca's area
49
What lobe is damaged in expressive dysphagia?
Dominant frontal lobe
50
How does expressive dysphagia present?
Can't generate language - can understand what is said to them but have difficulty getting words out
51
What area is damaged in receptive dysphagia?
Wernicke's area
52
What lobe is damaged in receptive dysphagia?
Dominant temporal lobe
53
How does receptive dysphagia present?
Little/no understanding of spoken/written language - can speak fluently but usually makes no sense
54
Where are the language centres found?
Dominant lobe
55
How do you know which lobe is dominant?
Right handed = left lobe dominant
56
What are the 2 types of dysphagia?
Expressive and receptive
57
What vessels are involved in a posterior circulation stroke?
Basilar and vertebral arteries
58
What areas do the basilar and vertebral arteries supply?
Occipital lobe, cerebellum, hippocampus, brainstem etc.
59
What does a PCA stroke affecting the occipital lobe present with?
Contralateral homonymous hemianopia, cortical blindness
60
What does a PCA stroke affecting the cerebellum present with?
Ataxia, nystagmus, N+V, dysarthria
61
What does a PCA stroke affecting the brainstem present as?
CN palsies causing diplopia, facial sensory loss/weakness, dysphagia etc.
62
What are lacunar strokes?
Small strokes due to blockages in small arteries supplying deep brain structures
63
What structures might be affected by lacunar strokes?
Thalamus, pons etc.
64
How do lacunar strokes present?
Cortical function is preserved Could be purely motor, purely sensory or sensorimotor symptoms
65
What are the purely motor symptoms of a lacunar stroke?
Weakness in contralateral arm, leg, face
66
What are the purely sensory symptoms in a lacunar stroke?
Sudden paraesthesia in contralateral arm, leg, face
67
What are the sensorimotor symptoms of a lacunar stroke?
Ataxia, dysarthria, clumsy hands
68
What is the first line investigation for a suspected stroke? Why?
Immediate non-contrast CT head to rule out haemorrhage
69
Why does a haemorrhage need to be ruled out for a suspected stroke?
Thrombolysis dissolves the clot so can cause bleeding, which is very dangerous to give to a patient with a haemorrhage
70
What does an infarct look like on CT?
Hypodense (dark) area
71
What are the 2nd line investigations for a suspected stroke?
Bloods - look for underlying cause/RFs ECG - look for AF Carotid doppler - look for carotid stenosis CT angiography - find cause MRI later if CT didn't show infarct and still suspected
72
What is the 1st line immediate management for an ischaemic stroke?
Thrombolysis with alteplase
73
When must alteplase be given for a stroke?
Within 4.5 hours of onset of symptoms and after a haemorrhage is excluded
74
What are the contraindications to thrombolysis?
Haemorrhage On anticoagulants \>4.5 hours after onset of symptoms (or unknown onset time) Recent surgery or GI bleed Active cancer HTN cut off = 185/110
75
What 1st line treatment is given for ischaemic stroke if thrombolysis is contraindicated?
Thrombectomy
76
What is the second line treatment for ischaemic stroke?
300mg aspirin for 2 weeks/until discharge
77
What is the long-term management of an ischaemic stroke?
Clopidogrel 75mg daily (antiplatelet) after 2 weeks of aspirin Treat modifiable risk factors If patient has carotid artery disease, consider for carotid endarterectomy within 2 weeks
78
Give some examples of modifiable risk factors can be treated after a stroke.
Manage BP and diabetes Monitor cholesterol levels - start statins Smoking cessation, diet, exercise, weight loss Investigate for AF - consider need for anticoagulants e.g. warfarin
79
What supportive management is provided after a stroke?
Admit patient and must be seen by specialist within 24 hrs BP control - keep high O2 and glucose levels Swallow assessment - NBM/NG tube and nutrition Mobilise ASAP - physio and OT input No driving for 1 month after stroke/longer if symptoms ongoing
80
Why must BP be kept high immediatley after a stroke?
A small fall can massively reduce cerebral perfusion
81
What 2 scores would we consider before starting anticoagulants in a patient with AF?
CHADSVASc – risk of stroke in a patient with AF HASBLED – risk of bleeding in a patient with AF
82
What is a transient ischaemic attack (TIA)?
Transient neurological dysfunction
83
What causes a TIA?
Ischaemia without infarction
84
How does a TIA present?
Presents similarly to an ischaemic stroke Sudden loss of function for a few mins to 24 hours with complete recovery
85
What is the immediate management of a TIA?
None
86
What is the long-term management of a TIA?
Long-term same as stroke 300mg aspirin Secondary prevention for CVD Long-term clopidogrel and physio
87
What is amaurosis fugax?
Sudden transient loss of vision in one eye like 'a curtain coming down'
88
What causes amaurosis fugax?
Occlusion of retinal artery
89
What risk score predicts the risk of a stroke after a TIA?
ABCD2 score - determines management/time to see a specialist
90
What is the ABCD2 score?
**A**ge \> 60 = 1 **B**lood pressure \> 140/90mmHg = 1 **C**linical features: Unilateral weakness = 2 Speech disturbance without weakness = 1 **D**uration of symptoms: Symptoms lasting more than 1 hour = 2 Symptoms lasting 10-59 mins = 1 **D**iabetes = 1
91
What is a subarachnoid haemorrhage?
Bleeding into the subarachnoid space between arachnoid and pia mater
92
What are the risk factors for SAH?
HTN Smoking XS alcohol Cocaine FHx
93
What diseases is SAH associated with?
Autosomal dominant PKD Sickle cell anaemia Connective tissue disorders
94
What causes a SAH?
Rupture of berry aneurysm (most common) Arteriovenous malformation
95
How does an SAH present?
Sudden onset 'worst ever' thunderclap occipital headache Neck stiffness Photophobia N+V May have signs of raised ICP - reduced consciousness
96
What investigations are done for an SAH?
Immediate CT head LP 12 hours after onset of symptoms if CT doesn't confirm SAH CT angiography once confirmed to show source of bleeding
97
What would an LP show 12 hours after the onset of symptoms of an SAH?
Xanthochromia - yellow CSF due to presence of bilirubin (breakdown of haem)
98
What does an SAH look like on CT?
Blood is white (hyperdense) on CT - blood in subarachnoid space, sometimes looks like a star as it fills all the sulci
99
How is SAH managed?
ABCDE management + rapid BP lowering Monitor GCS Surgical = coiling or clipping Treat complications e.g. nimodipine (CCB for vasospasm)
100
What are the complications of SAH?
High mortality Rebleeding Vasospasm which can lead to ischaemia Seizures Hydrocephalus

Phase 2a (25 decks)

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