Neurology Flashcards
Features of PSP
- Parkinsons
- Vertical gaze palsy (downwards is worse)
- Postural instability
- Cognitive dysfunction
Poor response to L-dopa
Features of MSA
MSA-P: mostly Parkinsons
MSA-C: mostly cerebellar signs
- Parkinsons
- Autonomic dysfunction e.g. erectile dysfunction, atonic bladder
- Cerebellar signs
Features of DLB
- Parkinsons
- Visual hallucinations
- Progressive cognitive impairment including executive function and attention
Anterior cerebral artery infarct presentation
Contralateral hemiparesis and sensory loss, leg > arm
Middle cerebral artery infarct presentation
Contralateral hemiparesis and sensory loss
Contralateral homonymous hemianopia
Aphasia
Posterior cerebral artery infarct
Visual changes:
- Contralateral homonymous hemianopia with macula sparing
- Visual agnosia
Oxford-Bamford: Total Anterior Circulation Stroke
Affects areas supplied by anterior and middle cerebral arteries
Need all 3 of:
- Unilateral motor or sensory deficit
- Homonymous hemianopia
- Higher cerebral dysfunction e.g. aphasia
Oxford-Bamford: Partial anterior cerebral stroke
Need 2 of:
- Unilateral motor or sensory weakness
- Homonymous hemianopia
- Higher dysfunction e.g. dysphasia
Oxford-Bamford: Posterior circulation stroke
Affects brainstem and cerebellum
Any of the following:
- Cerebellar dysfunction
- BILATERAL motor/sensory deficit
- Cranial nerve palsy
- Eye movement disorder
- Isolated homonymous hemianopia
Oxford-Bamford: Lacunar syndrome
No loss of higher cerebral function
Pure sensory or pure motor stroke
Ataxic hemiparesis
Mono-ocular vision loss: lesion is at…
Ipsilateral optic nerve
Bitemporal hemianopia: lesion is at…
OPTIC CHIASM
Upper > lower quadrant: inferior optic chiasm compression (PIT TUMOUR)
Lower > upper quadrant: superior optic chiasm compression (CRANIOPHARYNGOMA)
Homonymous hemianopia: lesion is at…
CONTRALATERAL optic tract
Quadrantanopia: lesion is at…
PITS
Parietal radiation lesion = Inferior quadrantanopia
Temporal radiation lesion = Superior quadrantanopia
Scotoma: lesion is at…
Contralateral occipital pole
Eye signs in Neurofibromatosis versus Tuberous Sclerosis
NF:
TS: Retinal
Who should triptans be avoided in
Ischaemic heart disease
Cerebrovascular disease
Who qualifies for migraine prevention
Getting 2+ migraines per month
Migraine prevention drugs
1st line: Propranolol or topiramate
2nd line: 10 weeks acupuncture
Trigeminal neuralgia management
1st line: carbamazepine
2nd line: refer to neurology!!!
Trigeminal neuralgia management
1st line: carbamazepine
2nd line: refer to neurology!!!
Transerve myelitis treatment
1) IV steroids
2) Plasmapheresis
Transverse myelitis investigations
LP - isolated neutrophilia
Treatment of valproate encephalopathy
L-carnitine
Posterior inferior cerebellar artery stroke
“Lateral medullary syndrome”
- Vertigo, ataxia and nystagmus
- Loss of pain and temperature in IPSILATERAL face and CONTRALATERAL body
- Horner’s syndrome
- Chewing and swallowing difficulties
Think PICA - EATING weird stuff
Anterior inferior cerebellar artery stroke
“Lateral pontine syndrome”
- Ataxia, vertigo and nystagmus
- FACIAL PARALYSIS (IPSILATERAL) and DEAFNESS
- Horner’s syndrome
- Pain and temperature loss in IPSILATERAL face and CONTRALATERAL body
Think AICA; fAICAl nerve
Midbrain stroke (Weber’s syndrome)
Ipsilateral CN III palsy (down and out + ptosis)
Contralateral hemiparesis
Locked in syndrome is due to an infarct in…
Basilar artery
Amaurosis fugax is due to an infarct in…
Ophthalmic artery
Absolute contraindications to thrombolysis
Stroke in past 3 months Seizure Brain tumour Recent bleeding Raised ICH
Which anti-epileptics do not work on sodium channels?
Valproate: GABA agonist
Ethosuximide: blocks Ca channels on thalamic T-neurons
Which anti-epileptics act on sodium channels?
Carbamazepine: block sodium channels
Lamotrigine: blocks sodium channels
Phenytoin: blocks sodium channels
Topiramate: blocks sodium channels and increases GABA
