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Y4 medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

what is multiple sclerosis?

A

MS is an acquired, autoimmune condition that results in teh demyelination of nerves in teh brain and spinal cord (does not affect the peripheral nerve system)

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2
Q

what are the three main patterns of clinical presenationof MS?

A
  1. relapsing remitting
  2. secondary progressive
  3. primary progressive
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3
Q

what are the inital syptoms of MS and what age do they usually present?

A

20-40s
- visual distubrnaces (optic neuritis, double vision)
- sensory disturbances in face or limbs
- weakness in limbs due to UMN involvemnts
- impaired balance/clumsiness of limbs
- bladder symptoms
- neuropathic symptoms (trigeminal neuralgia)

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4
Q

what are the triggers of MS?

A
  • low vit D levels
  • EBV ifnection
  • smoking
  • obesity
  • lack of sleep
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5
Q

what is the clinical diagnosis of MS based on the 2010 McDonald criteria?

A
  1. lesions consistent with an ainflammatory process
  2. no alternative diagnosis
  3. multiple lesions in time and space (RRMS)
  4. progressive neurological deterioration for 1 year (PPMS)
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6
Q

what investigations are done to support a diagnosis od MS?

A
  1. MRI of brain or spinal cord - show demyelination of plaques (white areas in brain)
  2. immunoelectrophoresis of CSF - show oligoclonal bands of IgG
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7
Q

what drugs can be given to help spasticity in pts with MS?

A
  • physio !!
  • baclofen (muslce relaxant and antispasmodic)
  • possible botulism injections
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8
Q

what drugs can be given in pts with MS who have neuropathic pain?

A

amitriptylline, gabapentin, pregabalin

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9
Q

what drugs to help depressiion in pts with MS?

A
  • duloxetine if have fatigue or neuropathic pain
  • or SSRIs
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10
Q

what drugs needed in MS pts with incontinence?

A

oxybutynin
botulism injection
may need catherisation

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11
Q

drugs given to MS pts with fatigue

A

encourage physical activity and treat depression
then possible modafinil

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12
Q

what drugs are given in pts with MS who are relapsing?

A
  • steroids (oral or IV methylprednisolone)
  • PPI
  • pay attention to mental health and changes in blood glucose
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13
Q

what is the definition of status epilepticus?

A

single seziure lasting mroe than 5 mins or recurrent without gainign consiousness

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14
Q

managment fro status epilepticus?

A

GIVE IV lorazepam 4mg over 2mins (or buccal midazolam or rectal diazepam)
wait 5-10mins -> if not resolved give second dose

if does not respond to two doses of benzodiazepine then give phenytoin infusion 20mg/kg

if still not repsonding then thiopentone/anaesthesia needed

** check glucose levels bcos high chance of hypoglyceamia

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15
Q

what does teh presence of xanthochromia show in CSF?

A

xanthochromia is the yellow discoloration of teh CSF showing bilirubin in the CSF = diagnosis of SAH

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16
Q

what is the deifnition of epilepsy?

A

neurological disorder in which a person experiences recurring seizures
- At least two unprovoked seizures occurring more than 24 hours apart
- one unprovoked seizure and a probability of further seizures simialr to the general recurrence risk after two unprovoked seizures
- diagnosis of an epilepsy syndrome

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17
Q

how would you investigate someone with suspected seziures

A
  • ECG to rule out cardiac causes + bloods
  • MRI (/ CT)
  • EEG
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18
Q

what are teh differences between focal and generalised seizures?

A

generalised - involving the whole brain (both hemispheres)
focal - onyl involving focal segment of the brain (one hemisphere)

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19
Q

what are teh features of aprimary generalised seizure?

A

include absence, atonic, tonic, clonic, tonic-clonic, myoclonic, and febrile seizures
- pt lose consiousness

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20
Q

what are teh features of a seocndary generlaised seizure?

A

partial seizure that develops into a genenrlaised seizure

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21
Q

what are the features of an absence seizure ?

A
  • msot commonyl in chidlren
  • very breif loss of awareness
  • blank stare with/without subtle body movements e.g. lip smacking, eye blinking
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22
Q

what are the features of a focal aware (simple partial) seizure?

A
  • patient remains conscious
    hearing/tasting things
    can get muscle movements
    pt usually remembers seizure
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23
Q

what are the features of a focal impaired awareness (complex partial) seizure/

A
  • patient has impaired consiousness - pt doesnt remember seizure
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24
Q

name some common antiepileptic drugs used in epilepsy

A
  • levatiracetam (reduces NMDA/glutamate release)
  • lamotrigine (Na+ channel blocker + Ca+ effects)
  • sodium valproate (GABAa and Na+ channel blocker)
  • topiramate
  • carbamazepine(Na+ channel blocker)
  • phenytoin (Na+ channel blocker)
  • phenobarbitone
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25
Q

name soem red flags for headaches?

A
  • thunderclap headache
  • associated fever
  • meningism +/ non blnaching skin rash
  • raised ICP (papilloedema, headache worse on waking/lying down, coughing)
  • new neurological deficit
  • new cognitive dysfunction
  • personality change
  • impaired / deteriorating consious level
  • trauma to head
  • new onset headache in elderly (GCA)
  • change in pattern of chronic headache
  • Hx of malignancy or impaired immunity
  • postural headaches
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26
Q

in what situations would a lumbar puncture be useful?

A
  • suspected SAH
  • suspected meningitis/enchephalitis
  • immunlogical disorders e.g. MS or Guillain barre
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27
Q

what woudl typical CSF findiings in bacterial meningitis?

A
  • cloudy
  • high WCC
  • high protein
  • low glucose
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28
Q

what woudl typical CSF findiings in viral meningitis?

A
  • clear
  • low WCC
  • normal to high protein
  • normal glucose (50-80)
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29
Q

what woudl typical CSF findiings in TB meningitis?

A
  • clear
  • high WCC
  • low to normal protein
  • low glucose
  • negative gram stain culture
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30
Q

what woudl typical CSF findiings in SAH?

A

xanthochromia (yellow) due to bilirubin

can be red or yellow BUT yellow AFTER centrifugation whereas a traumatic tap will still be red

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31
Q

what woudl typical CSF findiings in guillian barre syndrome?

A

normal WCC but elevated protein

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32
Q

what is a contraindication for a lumbar puncture?

A
  • raised ICP
  • space occupying lesion
  • trauma to lumbar vertebrae
  • mass on lumbar vertebrae
  • skin infection overlying puncture site
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33
Q

what is parkinsonism?

A

syndrome which manifests as bradykinesia and rigidity +/- tremors

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34
Q

what are the different types of parkinsonism?

A
  • IPD (idiopathic parkinsons disease)
  • vascular pseudoparkinsonism
  • drug-induced parkinsonism
  • benign essential tremor
  • dementia with lewy bodies
  • progressive supranuclear palsy
  • multiple system atrophy
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35
Q

what are the clinical features of vascular pseudoparkinsonism ?

A

(from small strokes linked to motor region of brain)
“lower body parkinsons” = problem with walking and balance
less liekly to experience tremor
can have problems with memory,sleep and mood

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36
Q

what are the clinical features of drug-induced parkinsonsim?

A

(due to neuroleptic drugs used to treat schizophrenia and other psychotic disorders)
tremor, rigidity, bradykinesia, and gait disturbance - more likely to be symmetrical
** features stop after drug is stopped

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37
Q

what are the clinical features of a benign essential tremor?

A

neurological disorder that causes your hands, head, trunk, voice or legs to shake

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38
Q

what are the clinical features of dementia with lewy bodies?

A

Lewy body dementia causes visual hallucination, changes in alertness and attention.
+ rigid muscles, slow movement, walking difficulty and tremors (parkinsonism featureS)

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39
Q

what is idiopathic parkinsons disease?

A

progressive degenerative disorder characterised by neuronal loss in brainstem and basal ganglia
loss of dopaminergic neurones in substantia nigra = reduced dopamine transmission
also get lewy body formation in affected neurones

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40
Q

which investigations are doen to diagnose parkinsons

A

none !
based on clinical daingosis and improvemnt to medication (levadopa)

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41
Q

how is parkinsons disease diagnosed?

A
  1. diagnosis of parkinsonism: bradykinesia + ONE OF muscular rigidity, rest tremor 4-6Hz, postural instability not caused by visual, vestibular, cerebellar or propioceptive dsyfunction
  2. exclusion of OTHER cuases of parkinsonism
  3. supportive prospective +ve criteria for parkinsons disease. 3 or more from:
    - unilateral onset
    - rest tremor presen t
    - progressive disorder
    - persistent asymmetry affecting side of onset most
    - excellent response to levodopa
    - severe levodopa induced chorea
    - levodopa response fro 5+ yrs or mroe
    - clinical course of 10 yrs or more
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42
Q

name some non motor symptoms of parkinsons?

A

fatigue
low BP
bowel (constipation) and bladder problems
restless legs
skin and sweating problems
anxiety
dementia
depression
memory and thinking problems
hallucinations and delusiosn

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43
Q

what rating scales are used to diagnose severity of parkinsons?

A

hoehn and Yahr scale and Unified Parkinsons Disease Rating Scale (UPDRS)

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44
Q

what is the initial (MAIN) therapy for parkinsons?

A

main aim: increase dopamine levels

  • levodopa (works for 4-6 yrs) given with DDCI
  • dopamine agonsits (e.g. ropinirole, pramipexole)
  • MAO-B inhibitors e.g. rasagiline
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45
Q

name the ‘other’ medications given to pt. with parkinsons to control motor symptoms?

A
  • COMT inhibitors e.g. entacapone to inhibit the peripheral breakdown of levodopa
  • Anti-muscarinics (e.g. procyclidine) to help dyskinesia
  • Apomorphine (non-selective dopamine agonist) - subcut injection for advanced disease
46
Q

what surgical options are availbale for patients with parkinson?

A

thalamic or subthalamic surgery
or
deep brain stimulation -> electrodes into the basal ganglia

47
Q

what are teh 4 distinct phases of parkinsons disease?

A
  • early stage: soon after diagnosis, symptoms mild
  • maintenance stage: good response to treatment, no major dsiability
  • advanced stage - poor response to drugs with motor SE
  • pallaitive stage - unable to live independently and in need multidisciplinary support
48
Q

name some of teh complications of advancing IPD?

A

motor:
- motor on off fluctuations
- freezing in gait
- dyskinesia
- falls
- ‘wearing off’ phenomenon towards end of dose

non motor complications:
- Aspiration pneumonia
- Nutritional deficiency
- dysphagia & weight loss
- Bladder, bowel & sexual dysfunction
- Pressure sores
- Sleep disorders
- Dementia & depression
- Postural hypotension
- Impulse control disorders and psychosis

49
Q

what is MND?

A

motor neurone disease is a progressive, degenerative neurological disease with rapid progression and poor prognosis

50
Q

which motor neurones (upper or lower) are involved in MND?

A

both upper and lower in the spina cord and brainstem - therefore get mixed upper and lower motor neurone signs

51
Q

how is the diagnosis of MND made?

A

electromyography (EMG)
plus clinical diagnosis using the presense of both mixed upper and lower motor neurone signs

52
Q

what is EMG?

A

using fine needles to record naturally occurring electrical impulses in the nerves. IN MND muscles have lost their nerve supply + show an abnormal pattern

53
Q

what drug is used to manage MND?

A

glutamate inhibitor (riluzole)
- mildly slows rate of MND BUT MND is incurable
- average survival 3 yrs

54
Q

what are the clinical variants of MND?

A
  • amyotrophic lateral sclerosis
  • progessive bulbar palsy
  • progressive muscular atrophy (LMN) - rare
  • progressive lateral sclerosis - rare
55
Q

how is dysphagia in pts. with MND managed?

A

enteral feeding

56
Q

how is resp failure in pts. with MND managed\/

A

NIV (non invasive ventilation)

57
Q

which medications when overused can cuase chronic headaches?

A
  1. paracetamol, aspirin, or NSAIDs used for 15 days per month or more
  2. triptans, opioids or ergot preps for 10 days or more a months
58
Q

how would a headache caused by a space occupyin g lesion present?

A
  • gradual onset
  • progressive
  • associated neuro features e.g. visual disturbances or focal signs
  • features of raised ICP: early morning headache, N+V, worse on coughing and bending
59
Q

what are the clinical features of a migraine?

A
  • female twice as common
  • most have first attack before age 30
  • unilateral, frontal, throbbing, 4-72hrs
  • can have aura preceding, n+v
  • caused by photophobia or phonophobia, sleep + dark room helps
60
Q

what is teh treatment for migraines?

A

NSAIDs
triptans

61
Q

what are teh clinical features of a tension headache?

A
  • young > old
  • frontal, bilateral, band tightening, neck muscle tension
  • most common type of headahce (due to stress, poor posture, lack of sleep)
  • possible mild nausea
  • worse at end of day
62
Q

definition between episodic and chronic tension headaches?

A

chronic is > 15 times per month
episodic if <15 times a month

63
Q

what is the treatment for tension headaches?

A

simple analgesics

64
Q

clinical features of medication overuse headache?

A

30-40 yo, female> male
- present @ least 15 days of month and using analgesics for @ least 10 days per month

65
Q

treatment for med overuse headache?

A

discontinue meds

66
Q

what are the clinical features of a cluster headache?

A
  • males> female
  • 20-40 yo
  • around one eye, unilateral, stabbing, red eye, watery, ptosis, severe
  • 15mins - 3hrs (1-2x per day)
    -clusters of attacks followed by remissions
  • alcohol + smoking = aggravatign factors
67
Q

what is the treatment fro cluster headaches?

A

simple analgesics

68
Q

what are the clinical features of trigeminal neuralgiA?

A
  • 50-60yo
  • unilateral over distribution of CN V, sharb and stabbing, electric shock, severe
  • lasts seconds to 2 mins
  • aggravated by light touch to face, eating, cold wind, vibrations
  • numbness and tingling preceding an attack
69
Q

Tx for trigeminal neuralgia?

A

carbamazepine

70
Q

clinical features of temporal arteritis?

A
  • unilateral headahce,
  • jaw claudication
  • scalp tenderness
  • visual symptoms: blurring, amaurosis fugax
71
Q

treatment for temporal arteritis?

A

oral prednisolone

72
Q

what are teh clinical features of a SAH?

A
  • Hx of trauma (but also can be spontaenous)
  • sudden onset or thunderclap headache
  • photophobia
  • neck stiffness
  • n+v
73
Q

Ix for suspected SAH?

A
  • A-E
  • CT scan to confirm presence of SAH
  • cerebrospinal fluid analysis to confirm presence by lumbar puncture (needed if CT done > 6hrs after onset of symptoms) - LP needs to be at least 12 hrs after to allow RBC to lyse = bilirubin
74
Q

initial Mx of SAH?

A
  • analgesia, anti-emetics + IV fluids
  • nimodipine 60mg every 4 hours for 21 days
  • external ventricular drain (EVD) if hydrocpehalus present to reduce ICP
75
Q

Tx of SAH?

A

aneurysm coiling (DSA) or clipping (craniotomy)

76
Q

features fo raised ICP?

A
  • headache
  • visual distirbances e.g. blurry or transient loss
  • papilloedema
  • tinnitus
77
Q

Ix done in raised ICP?

A
  • neuroimaging (MRI or CT) to diagnose cause
  • lumbar puncture - see opening pressure (20+ mmHg = elevated)
78
Q

what is the Tx for idiopathic intracranial hypertension?

A

Acetazolamide 500 mg orally BD

  • carbonic anhydrase inhibitor which reduces production of CSF
79
Q

what si teh idfference between GBS and MS?

A

GBS = demyelination of axons in the peripheral nervous system
MS = demyelination of axons in the brain and spinal cord

80
Q

what is guillain barre syndrome?

A

acute, inflammatory polyneuropathy causing progressive, ascending neuropathy

81
Q

name the causes of GBS?

A
  • campylobacter (most common!)
  • cytomegalovirus
  • EBV
  • mycoplasma pneumoniae
82
Q

what Ix are done to diagnose GBS?

A

electromyography, nerve conduction studies
- lumbar puncture - shows high protein with normal WCC

83
Q

Mx of GBS?

A
  • plasmapheresis
  • IV immunoglobulin
  • immunosuppression
84
Q

what is MG?

A

autoimmune disorder, which is due to antibody-mediated blockage of neuromuscular transmission
acetylcholine receptor antibodies that bind to ACh receptors at the NMJ

85
Q

clinical features of MG?

A
  • increased muscle weakness with use
  • ocular: ptosis, diplopia
  • resp: breathlessness, resp failure
  • bulbar: dysarthria, dysphagia, weak chewing
  • limbs/neck: dropped head, arms>legs, proximal>distal
86
Q

how is MG diagnosed?

A
  • ice pack test - ptosis reduced after put ice pack on eye (NMJ works better wehn cold)
  • serological: look for AChR-Ab OR MuSK and LRP4
  • Repetitive nerve stimulation - shows muscle fatiguing
  • electromyography
87
Q

treatment for MG?

A
  • MAIN: pyridostigmine, which is an acetylcholinesterase inhibitor.
  • Corticosteroids (e.g. prednisolone)
  • immunsuppression e.g. azathioprine
88
Q

which cranial nerves does acute bulbar palsy affect?

A

CN 9-12

89
Q

what is bells palsy?

A

unilateral facial nerve palsy of unknown cause
*thought to be related to inflammation and oedema of the facial nerve secondary to a viral infection or autoimmunity

90
Q

clinical features of bells palsy?

A
  • unilateral facial weakness
  • difficulty chewing
  • drooling
  • unilateral ear pain
  • incomplete eye closure
  • NO forehead sparing!
  • onset acute (<72 hrs)
91
Q

Tx of bells palsy?

A

normally resolves itself within 6 months
sometimes croticosteroids can help reduce inflammatoin and speed up recovery

92
Q

name the three cuases of an ischaemic stroke?

A
  • embolic e.g. from afib
  • thrombotic e.g. atherosclerotic plaque burst
  • lacunar e.g. atherosclerotic plaque blocking smaller vessels
93
Q

what are teh two types of heamorrhagic strokes?

A
  • subarachnoid
  • intracerebral
94
Q

frist line Ix for stroke

A

non contrast CT scan

95
Q

Mx for ischaemic stroke?

A

– If within 4.5 hours of onset –> thrombolysis (alteplase)

– If within 6 hours + confirmed occlusion of anterior circulation –> thrombectomy

– If later/other options unavailable –> loading dose of 300mg aspirin.

96
Q

after a pt has had a stroke what is teh ongoing treatment given?

A

– Antiplatelet therapy e.g. clopidogrel/prasugrel.( if contraindicated give aspirin + dipyridamole)

– If cholesterol >3.5mM, give statin

– Anticoag for AF -> started after 2 weeks to reduce risk of bleed e.g. DOAC

– Carotid endarterectomy –> recommended if stroke/TIA in carotid area and carotid stenosis >70%

97
Q

when is carotid endarterectomy recommneded after stroke?

A

if a pt had stroke/TIA in carotid are and carotid stenosis >70%

98
Q

what is a TIA?

A

ischaemic event with same symptoms as stroke that last <24 hours. without intervention, patients will probs have a stroke within a week

99
Q

management of TIA?

A

– Aspirin 300mg + maintenance antiplatelet therapy.

– If more than 1 TIA or carotid stenosis (>70%) –> refer for carotid endarterectomy

– If TIA within last 7 days –> arrange assessment within 24 hours by specialist stroke physician

– It TIA > 7 days ago –> refer to specialist within 7 days

100
Q

what is the managemnt of a intracerebral haemorrhage?

A
  • surgery if heamatoma is >3cm - drained
101
Q

what is amaurosis fugax?

A

transient monocular visual loss of vision that lasts less than 24 hrs.
- due to occlusion of large arteries or small artery occlusion
- may represent TIA deu to clot in retinal/opthalmic artery

102
Q

Tx for amaurosis fugax?

A

treated as TIA: 300mg apsiring and refer to specialist

103
Q

symptoms of intracranial venous thrombosis?

A
  • sudden onset headache
  • n+v
  • seizures or hemiplegia (sagittal sinus)
  • 6th + 7th nerve palsies (transverse sinus)
  • central retinal vein thrombosis, perioribital oedema, hyperparaesthesia of face (cavernous sinus)
104
Q

what are teh investigations done to diagnose intracranial venous thrombosis?

A
  • CT head to exclude SAH
  • thrombophilia screen blood test
  • CT/MRI venogram is the diagnostic test
105
Q

Tx of intracranial venous thrombosis?

A
  • anticoagultation with heparin/LMWH then warfarin
  • if deterioration -> endovascualr thrombolysis
106
Q

what are teh classifications of strokes based on the oxford classifications?

A
  • TACS
  • PACS
  • POCS
  • LACS
107
Q

what three features have to be present to diagnose a TACS?

A
  • homonymous hemianopia
  • unilateral weakness (and/or sensory deficit) of face, arm and leg
  • higher cerebral dysfunction (dysphasia, visuospatial disorder)
108
Q

what 2 features have to be present to diagnose a PACS stroke?

A

2 of:
- homonymous hemianopia
- unilateral weakness (and/or sensory deficit) of face, arm and leg
- higher cerebral dysfunction (dysphasia, visuospatial disorder)

** or higher cerebral dysfunction alone = PACS

109
Q

What signs/symptoms need to be present to diagnose a POCS stroke?

A

1 of the following:
- CN palsy and contralateral motor/sensory deficit
- bilateral motor/sensory deficit
- conjugate eye movement disorder (e.g. horizontal gaze palsy
- cerebellar dsyfunction (vertigo, nystagmus, ataxia)
- isolated homonymous hemianopia

110
Q

what clinical features have to be present to diagnose a LACS?

A

1 of the following:
- pure sensory stroke
- pure motor stroke
- sensori-motor stroke
- ataxic hemiparesis

Y4 medicine (18 decks)

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