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Things I don't know, but need to know, for fourth year > Neurology > Flashcards

Neurology Flashcards

1
Q

What should be ruled our initially as causes of Status Epilepticcus?

A

Hypoxia

Hypoglycaemia

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2
Q

If a child under the age of three months presents with meningitis what is the treatment?

A

IV Amoxicillin and Ceftrioxone or Cefotaxim

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3
Q

If a child over 3 months present with meningitis what is the treatment?

A

IV ceftriaxone

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4
Q

What are indications for the use of steroids in children with meningitis?

A

Purulent CSF
>1000 blood cells in CSF
Bacteria in CSF

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5
Q

What antibiotic is used for prophylaxis in close family contacts in meningitis?

A

Ciprofloxacin

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6
Q

In a suspected meningitis. If the CT shows temporal lobe changes or the patient presents with seizures. What must you consider and how does this change your management?

A

Herpes Simplex encephalitis

IV acyclovir

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7
Q

What is used in the secondary prevention of a stroke?

A

Clopidogrel and a statin if indicated.

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8
Q

What medication are linked to Idiopathic Intracranial Hypertension?

A 
COCP
Steriods
Tetracyclines
Lithium
Vitamin A
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9
Q

How should a patient under 55 with no explanation on routine examinations for a stroke be investigated?

A

Autoimmune and Thrombophilia screens

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10
Q

Whats a good way of differentiating Progressive Supranculear Palsy from Multi System Atrophy

A

Progressive Supranuclear Palsy - Vertical Gaze issue + poor levodopa response
Multi System Atrophy - More prominent autonomic issues + No levodopa response

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11
Q

If the forehead is spared what side is the lesion?

A

Contralateral UMN

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12
Q

If forehead is involved what side is the lesion?

A

Ipsilateral LMN

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13
Q

If someone has had a diagnosed TIA what medication are they given? For secondary prevention

A

Clopidogrel 75mg

Aspirin 75mg + Dipydramol 200mg

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14
Q

Contraindications to thrombolysis.

A

Hemorrhagic stroke, Inter-cranial neoplasm, Major surgery in last three weeks, BP >185 or an active bleed

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15
Q

What’s Rolandic Epilepsy

A

Seizures occur during sleep
Generally younger patients
Focal seizures can generalise
Resolves by adolescence.

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16
Q

Jacksonian March - What is it and what does it indicate.

A

Epileptic seizure - focal jerks starting distally and moving proximally
Frontal Lobe Epilepsy

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17
Q

What pathogen would you suspect if the CSF sample was positively stained with India ink?

A

Cryptococcus Neoformens

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18
Q

Post Stroke Secondary prevention

A

Stroke + AF = 300mg aspirin for 2 weeks -> DOAC

Stroke = 300mg aspirin for 2 weeks -> Clopidogrel 75mg

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19
Q

Pain + loss of motor function + reduced digital dexterity + reduced sensory function +/- reduced autonomic function

A

Degenerative Cervical Myelopathy

Referral to neurosurgery within 6 months of symptoms is the target - urgent referal is suspicious

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20
Q

What sign maybe positive in Degenerative Cervical Myelopathy ?

A

Hoffmans signs

Flicking one finger causes all the others to twitch

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21
Q

What is levodopa always mixed with to reduce side effects?

A

Decarboxylase Inhibitor

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22
Q

If the main complaint of someone with Parkinsons is motor what is used first line?

A

Levodopa

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23
Q

If the main complaint of someone with Parkinson’s is non motor what is the management?

A

Dopamine Agonist - Bromocriptine

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24
Q

How is an initial presentation of query Parkinsons managed?

A

Urent referral

Diagnosis and treatment can only be started by a neurologist

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25
Q

A patient on anticoagulation presents with a head injury. What investigation is required?

A

CT scan within 8 hours even if no other indications

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26
Q

A raise in serum prolactin post ictally would indicate what?

A

More likely to be a real seizure rather than. pseudo seizure

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27
Q

Young child
Sudden uncontrollable movement starting with flexing of the head torso and limbs before extending the arms - salaam attacks
Attacks can last 1-2 seconds but can be repeated up to 50 times

A

Infantile spasms

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28
Q

Underlying cause of infantile spasm

A

Serious Neurological abnormality

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29
Q

What is the gold standard imagining for TIA?

A

MRI diffusion weighted

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30
Q

Lip smacking or other automatism
Deja Vu
Hallucinations
Dysphasia post ictally

A

Temporal lobe seizure

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31
Q

Head leg movements
Posturing
Post ictal weakness
Jacksonian marche

A

Frontal lobe seizure

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32
Q

Paraesthesi post ictally

A

Parietal

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33
Q

Floaters and flashers during the seizure

A

Occipital lobe seizure

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34
Q

Spinal Chord transection at C1 - C3

A

No function below the head

Requires a ventilator

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35
Q

Spinal Chord transection C4 - C5

A

Quadraplegia

Can breath by themselves

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36
Q

Spinal Chord transection C6 - C8

A

Loss of trunk and lower limb function

Can feed themselves and mobilise in a wheel chair

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37
Q

Spinal Chord transection T1 - T9

A

Paraplegia

Trunk control depends on level

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38
Q

Spinal Chord transection T10 - L3

A

Some lower limb dysfunction

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39
Q

BrownSequard Lesion

A

Ipsilateral loss of
DCML - Fine touch proprioception
Motor - LMN at that specific level - hyporeflexia + flaccid paralysis
- UMN below that spinal level - spastic paralysis hyper-reflexia up going plantar.

Contralateral loss of
Spinothalamic - Pain and Temperature

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40
Q

A hemisection at the level of T1 can present with

A

Ipsilateral Horners Syndrome

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41
Q

Anterior spinal chord stroke.

A

Spinothalamic - bilateral pain and temperature lost
Anterior horn - LMN presentation at that specific level. Muscle paralysis and atrophy
Lateral Corticospinal - UMN presentation below level of the lesion - spastic paralysis and hyperreflexia develops over days.

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42
Q

At what spinal level is the anterior spinal artery particularly susceptible during AAA repair?

A

Below T8

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43
Q

Posterior Spinal Chord Stroke

A

DCML alone is affected

Fine touch and proprioception

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44
Q

Describe the timeline of symptoms in a syringomelia.

A

First to develop - Cape like bilateral loss of pain and temperature due to destruction of anterior white commissure where spinothalamic tracts cross over.

Secondly, Ventral horns can be destroyed leading to LMN symptoms - flaccid paralysis.

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45
Q

What investigations should be undertaken in a syringomelia?

A

MRI + contrast of brain and spinal column.

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46
Q

What is the commonest cause of syringomelia?

A

Budd Chiari Malformation

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47
Q

Tabes dorsals is caused by what?

A

Tertairy Syphilis

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48
Q

Lose of the DCML - fine touch and proprioception
Sensory ataxia and +ve Romberg test
History of syphilis

A

Tabes Dorsalis

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49
Q

B12 deficiency

A

Subacute Combined Degeneration - SCD

S pinocerbellar - DANISH
C orticospinal - UMN spastic paralysis Hyperreflexia
D CML - loss of two point discrimination Fine touch etc

Atrophic glossitis and other signs of anaemia

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50
Q

Sudden onset
Headache N+V and reduced consciousness
CT scan normal
Slightly elevated D dimer

A

Venous sinus thrombosis

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51
Q

What investigation should be used in a suspected venous sinus thrombosis?

A

MRI venography
CT contrast is normal in 70%
D dimer may be mildly elevated

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52
Q

What is the management of a venous sinus thrombosis?

A

LMWH acutely
Warfarin for long term INR 2-3
- one episode but identifiable risk factors - 3-6 months
- one episode no explainable risk factors -6-12 months
- 2 episodes despite treatment - lifelong

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53
Q

Venous sinus thrombosis symptoms +
Seizures and hemiplegia
Empty delta sign on MRI

A

Sagittal Sinus Thrombosis

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54
Q

Which nerve is affected first in a cavernous sinus thrombosis?

A

6th cranial nerve
3rd and 4th affected later
Trigeminal nerve can lead to hyperaesthesia

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55
Q

Cavernous sinus thrombosis

A

Periorbital oedema
Ophthalmoplegia
Nerve palsy

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56
Q

What nerves can be affected in a lateral sinus thrombosis?

A

Cranial Nerves 6 and 7

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57
Q

Before what age should steroid be avoided in meningitis?

A

3 months

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58
Q

In meningitis in children when should you avoid a Lumbar puncture?

A

Signs of raised ICP
Meningococcal - treat first use Blood cultures and PCR
DIC

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59
Q

Stroke Treatment time scales

A

4.5 hours = Thrombolysis

6 hours = Thrombectomy

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60
Q

Ipsilateral - Ataxia Nystagmus Dysphagia Facial Numbness and Cranial Nerve Palsy
Contralateral - Limb sensory loss

A

Lateral Medullary Syndrome - Posterior Inferior Cerebellar artery

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61
Q

Ipsilateral III palsy

Contralateral limb weakness

A

Webers syndrome

62
Q

If someone has cerebellar ataxia which involves the inability to complete the finger to nose test. What is affected?

A

Cerebellar Hemisphere

Cerebellar vermis = without finger to nose ataxia

63
Q

When is the damage likely to occur to cause cerebral palsy?

A

Antenatal - 80% - malformation, congenital infections ( rubella, toxoplasmosis, CMV)
Intrapartum - asphyxia and trauma
Postpartum - intraventricular haemorrhage, meningitis, head trauma

64
Q

What is someone with cerebral palsy also likely to have?

A

learning difficulties
epilepsy
squints
hearing impairments

65
Q

What is the commonest form of cerebral palsy and how does it present?

A

Spastic - hemiplegia, diplegia, quadriplegia - UMN signs

66
Q

What are some treatments used in spastic cerebral palsy?

A

Oral diazepam
Baclofen
Botulinum toxin injections

67
Q

How does dyskinetic cerebral palsy present? and where in the brain is damaged to cause this?

A

Athetoid movements - slow writhing involuntary movements
Oro motor issues

Substantia nigra and basal ganglia

68
Q

Ataxic cerebral palsy will present like this. And where in the brain is damaged to cause this?

A

DANISH - Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Staccato speech, Hypotonia
Cerebellum

69
Q

Similar presentation to lateral medullary syndrome - Ipsilateral facial spinothalamic loss, Contralateral limb spinothalamic loss, Ataxia and nystagmus

+ facial paralysis and deafness

A

Anterior Inferior cerebellar artery occlusion

70
Q

Vertical diplopia going down stairs
Head tilt
Tilts objects
Affected eye sits superiorly and laterally

A

CN 4 lesion

Superior Oblique

71
Q

Definition of Status Epilepticus

A

1 seizure lasting over 5 minutes

> 2 seizures occurring within 5 minutes

72
Q

Describe how anhidrosis can indicate where about the lesion is that is causing horners sydnrome.

A

Face Arm Trunk = central lesion from syringomelia or stroke
Face = Preganglionic lesion from cervical rib pan coast tumour etc
No anhidrosis = post ganglionic lesion from carotid artery dissection

73
Q

Describe how a TIA is diagnosed

A

It is done on tissue damage not duration of symptoms. So along as no signs of infarction on Diffusion weighed MRI then its a TIA

74
Q

Management of TIA

A

300mcg aspirin unless on an anticoagulant or low dose aspirin
+
If presenting within 7 days urgent <24 hr assessment
If presenting over 7 days since TIA = assessment within 7 days

MRI diffusion weighted + USS carotid arteries

75
Q

List of tri nucleotide repeat genetic diseases

A

Fragile X
Huntingtons
Myotonic dystrophy
Freidrichs ataxia

76
Q

What is used in the prophylaxis of meningitis and how do people qualify for it?

A

CirPROfloxacin

Close household contact within the last 7 days

77
Q

Two commonest focal neurological lesions associated with HIV

A

Toxoplasmosis

Primary CNS lymphoma

78
Q

Headache confusion drowsiness
CT shows multiple ring enhancing lesions
Thalium SPECT -ve

A

Toxoplasmosis = commonest HIV associated CNS lesion

Sulfadiazine + Pyrimethamine

79
Q

CT shows homogenous enhancing lesion

Thalium SPECT +ve

A

Primary CNS lymphoma
Linked to EBV
Steroids + methotrexate +/- irradiation

80
Q

Advice for patients wanting to get pregnant whilst on epileptic medication?

A

Start 5mg folic acid now

See specialist but until then continue to use protection

81
Q

BDZ in status epilepticus

A

Oral - Midazolam 10mg
IV - Lorazepam 10mg
Rectal - Diazepam 10mg

82
Q

How is meningeal TB managed?

A

12 month treatment court of RIPE

83
Q

HIV + Neuro symptoms + widespread demyelination

A

Progressive Multifocal Leucoencephalopathy

JC virus

84
Q

If you are starting phenytoin in status epileptics what must be started?

A

Cardiac Monitoring

85
Q

What is the first line intervention in an intracranial aneurysm?

A

Interventional radiology coiling

86
Q

How is normal pressure hydrocephalus managed?

A

Venticuloperitoneal shunt

10% risk of haemorrhage infection etc

87
Q

What is first line for pain in post herpetic neuralgia?

A

Amitriptyline

88
Q

If someone presents with dizziness during and after they extend their neck. What might it be?

A

Vertebrobasilar Ischaemia

Atherosclerosis + narrowing caused by extending neck lead to temporary ischaemia to cerebellum.

89
Q

Management of a brain abscess

A

IV Ceftriaxone + Metronidazole
+/-
flucloxacillin if S.Aureus
vancomycin if MRSA or pen allergic

90
Q

Sudden onset headache, visual field defect and signs of pituitary insufficiency i.e hypotension hyponatraemia

A

Pituitary apoplexy
MRI is diagnostic

Steroid replacement
Careful fluid replacement
Surgery

91
Q

Rapid onset Dementia and Myoclonus is the hallmark of…

A

CJD

92
Q

Management of spasticity in MS

A

Baclofen and Gabapentin - first line

Diazepam - second line

93
Q

Bladder dysfunction in MS

A

USS before treating
If significant fluid retained post void - intermittent self catheterisation
If little fluid left post void - Oxybutynin

94
Q

Visual field oscillation in MS

A

Gabapentin is first line

95
Q

Develop over years - clumsy and high stepping gait
Peripheral LMN signs - lower leg wasting
Peripheral sensory defect
High arched foot and clawed toes
Family History

A

Charcot Marie Tooth

96
Q

Management of someone post 1st seizure

A

Don’t start medication until seen by a specialist

Unless - seizure seen on EEG, Brain structure deformity, neurological defect, family see it as too high a risk

97
Q

When can buccal midazlolam be given to a patient too self administer if needed?

A

Previous prolonged seizure or history of status epileptics

98
Q

Horners syndrome - Central lesion

A

Anhidrosis of face arm and trunk

Stroke Syringomelia MS Tumour Encephalitis

99
Q

Horners syndrome - preganglionic lesion

A

Anhidrosis of face

Pancaost tumour
Erbs palsy
Cervical rib
Thyroidectomy

100
Q

Horners Syndrome - Post ganglionic lesion

A 
No anhidrosis 
Carotid artery aneurysm
Carotid artery dissection
Cavernous sinus thrombosis
Cluster headache
101
Q

Guillian Bare - investigations

A

Lumbar puncture - increased protein + normal WBC

Nerve conduction studies - reduced transmission due to generalised demyelination

102
Q

Guillian Bare - miller Fischer varient

A

Starts proximally within the eyes and spreads distally

ophthalmoplegia, areflexia and ataxia

103
Q

SAH - diagnosis and management

A

Non contrast CT if -ve CSF at 12 hours
Whilst waiting for positive result - bed rest well controlled BP + Nimodipine
Positive result = CT angiogram -> guided clipping of aneurysm

104
Q

If falls start soon after diagnosis of Parkinsons what should yo be considering?

A

Parkinson + syndrome = test cranial nerves and autonomic function

105
Q

Commonest cause of acute radiculopathy

A

Disc prolapse

106
Q

Ataxia Weakness visual changes disturbance in speech + HIV or immunosuppressed
Multifocal non enhancing lesions

A

JC virus

Progressive Multifocal Leukoencephalopathy

107
Q

CSF - increased opening pressure
Immunosupressed
Increased protein and glucose
India ink stain

A

Cryptococcal Meningitis

108
Q

Comprehension preserved + Non fluent laboured speech

A

Brocas ‘expressive’ Aphasia

Inferior Frontal Gyrus

109
Q

Comprehension reduced + fluent word salad

A

Wernickes ‘receptive aphasia’

Superior Temporal Gyrus

110
Q

Parkinsons + unsafe swallow - medication

A

Dopamine agonist patch

111
Q

What are some reasons the time frame for a thrombectomy may be increased to 6-24 hours?

A

If MRI diffusion weighted scan identifies salvageable tissue or a limited infarct core.

112
Q

First line investigation in narcolepsy

A

Multiple Sleep Latency EEG

113
Q

Management of Alzheimers

A

1st line - Donepezil Rivastigmine
2nd line - Memantine - moderate to severe in addition to Donepezil
- mono-therapy in severe

114
Q

Reduced GCS
Miosis (constricted pupils)
No horizontal eye movements
Quadraplegia

A

Pontine Haemorrhage

115
Q

Someone with a spinal nerve lesion above T6 presents with

Flushing, Extreme Hypertension, sweating

A

Autonomic Dysreflexia
Over sympathetic stimulation due to obstructed parasympathetic output due to central chord lesion.
Generally triggered by faecal impaction or urinary retention

116
Q

Autonomin Dysreflexia - Management

A

Finding and reversing the trigger is first line

Control extreme hypertension or bradycardia if removing the trigger hasn’t helped.

117
Q

How is tight CO2 control used to help an increased ICP

A

Reducing CO2 causes vasoconstriction - reducing ICP

118
Q

Bilateral resting tremor

Disease doesn’t progress from presentation

A

Drug induced Parkinsonism

119
Q

Which emergency surgery is preferred in an increasing ICP?

A

Decompressive craniotomy > Burr holes

120
Q

What surgery is preferred for the management of chronic subdural haematoma?

A

Burr Hole wash out

121
Q

Contraindication to lumbar puncture

A

Increased ICP

Meningococcal septicaemia

122
Q

Internuclear ophthalmoplegia

A

Stroke or demyelination
Failure to adduct on affected side + Nystagmus on contralateral side
Demyelination uses causes bilateral

123
Q

Absence seizure

A

Sodium Valproate or Ethosuximate

124
Q

Tonic Clonic seizure

A

Sodium Valproate

Lamotrigine

125
Q

Myoclonic seizure

A

Sodium Valproate - if not child bearing age

Levetiracetam or Topiramate

126
Q

Gold standard diagnostic investigations for an acoustic neuroma

A

Audiogram + gadolinium enhanced MRI

127
Q

A chronic subdural will present like what on CT

A

Hypodense (dark) Crescent shaped

128
Q

MS management

A

Natilizumab - First line
Fingolimod
Beta Interferon

129
Q

Alcohol withdrawal symptoms

A

Symptoms 6-12 hours later
Seizures 36 hours later
Delerium Tremens 72 hours later

130
Q

Gradual onset
Confusion, movement disorders, behavioural changes, emotional liability, reduced consciousness
Presence of antibodies

A

Autoimmune encephalitis

Onset is faster in younger people

131
Q

Management of autoimmune encephalitis

A

Full neurology exam, FBC, MRI, LP, EEG
Steroids + IVIG
If over 2 weeks and no response add in rituximab and cyclophosphamide

132
Q

Antibodies linked to autoimmune encephalitis

A

Anti Hu - Small cell lung cancer
NMDA receptor antibody - ovarian cancer
Anti Yo - breast cancer

133
Q

Viral meningitis

A

Enterovirus e.g. coxsackie virus are the commonest
HSV-2 causes meningitis
HSV-1 causes encephalitis

134
Q

Management of a Pituitary Incidentaloma

A

Pituitary Function tests even if asymptomatic

135
Q

PWID + descending paralysis + diplopia + bulbar palsy

A

Clostridium Botulinum

136
Q

Indications for an nil by mouth and an urgent SALT swallow assessment

A 
Coughs during or within 1 minute of a swallow
Delayed swallow initiation 
Drooling
Wet sounding voice
Dysphonia
137
Q

A third nerve palsy occurs on which side in regards to a bleed?

A

Ipsilateral side

138
Q

How can creutzfelt Jakob disease be diagnosed pre autopsy?

A

Tonsillar biopsy - doesn’t change prognosis

139
Q

What can a sub arachnoid haemorrhage trigger (cardio)

A

Toursades De pointes

140
Q

Which steroid is used to reduce ICP secondary to metastasis

A

Dexamethasone

141
Q

What is the definition of chronic insomnia?

A

Inability to fall or stay asleep for more than 3 nights a week for over 3months

142
Q

B12 replacement

A

1mg IM 3x a week then

1mg every 3 months

143
Q

What is used to control levodopa induced nausea

A

Domperidone

144
Q

Tremor which gets worse with sustained muscle tone.

Can also affect vocal chords - new onset vibrato

A

Essentail Tremor

Propanolol

145
Q

What dementia is MND linked to?

A

Frontotemporal

146
Q

What is an absolute contraindication to thrombolysis

A 
INR >1.7
>180mmHg
Brain neoplasm 
Recent major surgery <2 weeks
Active major bleeding
147
Q

Hyper-attenuation on a non contrast CT indicates what?

A

Haemorrhage

148
Q

Causes of Autonomic neuropathy

A

Diabetes Mellitus
HIV, Lymes, Chagas
Autoimmune ( SLE)
Amyloidosis

149
Q

Signs of amyloidosis autonomic neuropathy

A

Autonomic dysregulation
Glove and stocking paraesthesia
Oedema, Purpuric lesions around their eyes.

150
Q

The anterior cerebral artery affects which regions of the body/

A

Lower limbs > upper limbs

151
Q

MND subtypes and presentation

A 
Amytrophic Lateral Sclerosis 
   - Spinal - Upper and Lower MN 
   - Progressive Bulbar Palsy  - Early tongue and bulbar involvement 
Progressive Muscular Atrophy - LMN
Primary Lateral Sclerosis - UMN
152
Q

Management of MND

A

Riluzole
Non Invasive Ventilation
Early NG and PEG insertion to meet increased metabolic demands

Things I don't know, but need to know, for fourth year (31 decks)

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