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Phase 3a > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the maximum score from the GCS given to eye opening?

A

4

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2
Q

What are the different GCS scores for eye opening?

A

1 - No eye opening
2 - To pain
3 - To speech
4 - Spontaneous

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3
Q

What are the different GCS scores for Best Verbal Response?

A

1 - None
2 - Incomprehensible sounds
3 - Inappropriate words
4 - Patient confused
5 - Patient oriented

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4
Q

What are the GCS scores for Best Motor Response?

A

1 - None
2 - Extensor response to painful stimulus
3 - Flexion to painful stimulus
4 - Withdraws from pain
5 - Localises to pain stimulus
6 - Obeys commands

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5
Q

What does abnormal flexion from a painful stimulus indicate?

A

Decorticate Posturing

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6
Q

What is decorticate posturing?

A

Posturing caused by significant damage to areas such as cerebral hemispheres, internal capsule and thalamus

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7
Q

What is decerebrate posturing?

A

Posturing caused by damage to the brain stem.
Shown by people with lesions or compression in midbrain, cerebellum

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8
Q

What would abnormal extension upon painful stimulus imply?

A

Decerebrate posturing

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9
Q

What would progression from decorticate to decerebrate posturing be an indication of?

A

Coning
(Uncal or tonsilar brain herniation)

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10
Q

What are the diagnostic criteria of restless legs syndrome?

A
  1. An urge to move the legs
  2. Temporary relief with movement
  3. Onset or worsening of symptoms with rest or inactivity
  4. Worsening or onset of symptoms in the evening or night
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11
Q

What is neurapraxia?

A

Local myelin damage usually secondary to compression

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12
Q

What is axonotmesis and what are the degrees?

A

Damage to the axon
Second degree - Axon severed but endoneurium intact
Third degree - Axon discontinuity, endoneurial tube discontinuity, perineurium and fascicular arrangement preserved
Fourth degree - Loss of continuity of axons, endoneurial tubes, perineurium and fasciculi, epineurium intact

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13
Q

What is neurotmesis?

A

Complete physiologic disruption of entire nerve trunk

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14
Q

What would be the presentation of Cranial Nerve III Palsy?

A

Ptosis
Eye pointing “Down and Out”

Larger than normal pupil on one side - anisocoria
(Due to loss of parasympathetic pupillary constriction)

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15
Q

What would be the difference between idiopathic anisocoria and a pathological anisocoria?

A

Idiopathic anisocoria presents with a pupil size difference of less than 0.5mm

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16
Q

How would a patient with Horner’s Syndrome Present?

A

Unilateral pin-point anisocoria
Partial ptosis
Hemifacial lack of sweating (anhidrosis)

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17
Q

What type of dementia would be associated with hallucinations?

A

Lewy-body dementia

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18
Q

What would be the treatment of choice for a ischaemic stroke, and how soon after onset of symptoms must this be administered?

A

Alteplase
Within 4.5hrs (Ideally within 3hrs)

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19
Q

What treatment would be used 24 hours after initial management of an ischaemic stroke?

A

Aspirin 300mg for 2 weeks
(Necessary to rule out haemorrhagic transformation of stroke with CT)

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20
Q

What are the symptoms and signs of optic neuritis?

A

Changes in vision
Pain in the eyes
Slow light reflex
Relative Afferent Pupillary Defect

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21
Q

What pathology is most likely to cause bitemporal hemianopia?

A

Pituitary Adenoma
(Upper visual fields will be affected more - due to compression below the optic chiasm)

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22
Q

What is Guillain-Barre Syndrome?

A

An immune-mediated demyelination of the peripheral nervous system, often triggered due to infection (Campylobacter jejuni, EBV, CMV, Mycoplasma)

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23
Q

What would Guillain-Barre Syndrome present with?

A
  • Ascending, progressive, symmetrical flaccid weakness, starting in legs/arms
  • Neuropathic pain
  • Reduced or absent reflexes
  • Paraesthesia and sensory loss beginning in lower extremities
  • Autonomic symptoms - reduced sweating, reduced heat tolerance, paralytic ileus
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24
Q

What does a bitemporal hemianopia involve?

A
  • Loss of vision in the outer half of both left and right visual field
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25
Q

What would a homonymous hemianopia involve?

A

Visual field loss on both left or right sides from the vertical midline of both eyes

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26
Q

What does Romberg’s Test show?

A

Sensory ataxia
Positive test implicates loss of proprioception

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27
Q

What are the features of cerebellar disease?

A

DANISH:

Dysdiadochokinesia
Ataxic gait
Nystagmus
Intention tremor
Slurred Speech
Hypotonia

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28
Q

What is the treatment for Temporal arteritis?

A

High-dose glucocorticoid therapy:
Prednisolone

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29
Q

What are the clinical features of GCA?

A
  1. New-onset temporal headache
  2. Temporal artery abnormality
  3. Visual disturbances
  4. Scalp tenderness
  5. Jaw claudication
  6. Fever, fatigue, anorexia, weight loss, depression
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30
Q

What can be the complications of GCA?

A
  • Loss of vision
  • Aneurysms, dissections and stenotic lesions of aorta and major branches
  • CNS disease
  • Steroid related complications
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31
Q

What would be the relevant investigations for GCA?

A

Temporal Artery Biopsy

  • CRP elevated
  • Normocytic normochromic anaemia and thrombocytosis
  • LFTs - Alkaline phosphatase elevated
    Colour duplex ultrasonography
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32
Q

Which nerve is responsible for the corneal reflex

A

CN V - Trigeminal - sensory
CN VII - Facial - Motor

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33
Q

What are the symptoms of Bell’s Palsy?

A
  • Abrupt onset of ipsilateral facial weakness
  • Peri-aural pain/numbness
  • Decreased taste
  • sound hypersensitivity
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34
Q

What nerve palsy causes bell’s palsy?

A

Facial nerve

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35
Q

What is the treatment for Bell’s Palsy?

A

Prednisolone within 72 hours
Advise regarding eye care

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36
Q

What is the Bamford classification for POCS (Posterior circulation) Stroke?

A

ANY OF:
1. Cerebellar or brainstem syndromes
2. Loss of consciousness
3. Isolated homonymous hemianopia

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37
Q

What is the Bamford classification for TACS (Total Anterior Circulation) Stroke?

A

ALL 3 OF:
1. Unilateral weakness (and/or sensory deficit) of face, arm, leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (Dysphasia, visuospatial disorder)

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38
Q

What is the Bamford classification for PACS (Partial Anterior) Stroke?

A

ANY 2 OF:
1. Unilateral weakness (and/or sensory deficit)
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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39
Q

What is the Bamford classification for LACS (Lacunar) Stroke?

A

ANY OF:
1. Unilateral weakness (/sensory deficit) of face and arm, arm and leg or all three
2. Pure sensory stroke
3. Ataxic hemiparesis

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40
Q

What is normal pressure hydrocephalus?

A

Enlarged lateral and third ventricles, with CSF opening pressure remaining within normal range

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41
Q

What is the clinical presentation of hydrocephalus?

A
  • Urinary incontinence
  • Deterioration in cognition
  • Gait disturbances
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42
Q

What is the radiological finding of an extradural haemorrhage?

A

Bi-convex hyperdensity in the extradural space

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43
Q

What are the most common types of dementia in order?

A
  1. Alzheimer’s
  2. Vascular
  3. Lewy body dementia
  4. Frontotemporal
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44
Q

What are the risk factors for vascular dementia?

A

Hypertension
Smoking
Diabetes Mellitus
Hyperlipidaemia
Obesity
Hypercholesterolaemia

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45
Q

What is the pathophysiology of vascular dementia?

A

Most commonly small cerebrovascular infarcts, small vessel disease and single cerebrovascular accidents
Most commonly affects white matter of cerebral hemispheres, grey nuclei, thalamus and striatum

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46
Q

What are the symptoms of Brown-Séquard syndrome?

A
  • Contralateral loss of pain and temperature
  • Ipsilateral loss of sensation to light touch, vibration sense and proprioception
  • Ipsilateral UMN weakness below the lesion
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47
Q

What is the main cause of optic neuritis?

A

Multiple Sclerosis

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48
Q

Where do cranial nerves 9, 10 and 11 exit?

A

The lateral medulla

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49
Q

If the uvula is deviated to the right, which side of the brainstem is the lesion on, and which nerve is this affecting?

A

The left side (Contralateral to lesion)
Cranial Nerve X - Vagus

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50
Q

After an unprovoked, isolated seizure, what should the driving advice for a patient be?

A

Do not drive for 6 months and inform DVLA

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51
Q

What is the triad of symptoms in Parkinson’s Disease?

A
  1. Cogwheel rigidity
  2. Bradykinesia
  3. Resting Tremor
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52
Q

What lesion would cause “clasp-knife” phenomenon?

A

An UMN

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53
Q

What is progressive supranuclear palsy?

A

A Parkinson’s Plus syndrome, consisting of:
- Failure of vertical gaze
- Symmetrical extrapyramidal features
- Frequent falls
- Lack of response to levodopa

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54
Q

What is encephalitis?

A

Inflammation of the brain, commonly caused by viral infection

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55
Q

What causes encephalitis?

A
  • Viral - acute viral encephalitis, post-infectious encephalitis (autoimmune process)
  • Herpes Simplex Encephalitis most frequent cause
  • Bacterial - tuberculosis, mycoplasma, listeria, Lyme disease
  • Fungal
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56
Q

What are the symptoms of encephalitis?

A
  • Flu-like illness or headache
  • Followed by rapid development of altered consciousness - confusion, drowsiness, seizures, coma
  • Symptoms of increased intracranial pressure - headache, nausea, convulsions, mental confusion
  • Photophobia, sensory changes and neck stiffness
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57
Q

How is encephalitis diagnosed?

A
  1. CSF
    - Lymphocytosis with normal CSF/plasma glucose ratio
    - CSF proteins high
    - CSF PCR test for HSV
  2. FBC and film
    - Leukocytosis
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58
Q

How would encephalitis be treated?

A
  1. Urgent admission
  2. Parenteral Abx for possibility of meningitis - IV or IM benzylpenicillin
  3. Treatment with acyclovir by IV infusion
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59
Q

What is the treatment for Guillain Barre Syndrome?

A

Plasma Exchange
Intravenous Immunoglobulins
Supportive therapy
DVT Prophylaxis
Pain relief
Admission to ICU

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60
Q

What investigations are used to diagnose Guillain Barre Syndrome?

A

Nerve Conduction studies
Lumbar puncture - elevated CSF protein
Spirometry

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61
Q

What is Lambert Eaton Myasthenic Syndrome?

A

Autoimmune disease of NMJ, characterised by impaired presynaptic release of ACh

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62
Q

What causes Lambert-Eaton Syndrome?

A

Small cell lung cancer

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63
Q

What are the symptoms of Lambert-Eaton Syndrome?

A

Weakness in the proximal muscles of lower limb, affecting gait, better on exertion
Increase of symptom severity with atmospheric temperature

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64
Q

What causes Horner’s Syndrome?

A

Disruption of sympathetic nerves supplying the eye

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65
Q

What investigations may be relevant to Horner’s Syndrome?

A

CXR may show apical carcinoma of the lung
CT/MRI useful in case of cerebrovascular accident
CT angiography may demonstrate dissection of carotid artery
Apraclonidine - dilates pupil affected by Horner’s Syndrome

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66
Q

What is Vernet’s disease?

A

Paralysis of cranial nerves IX, X and XI

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67
Q

What marker would be an indication of LEMS (Lambert-Eaton Syndrome)?

A

Antibodies to voltage-gated calcium channels

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68
Q

What antibodies would be found in Myasthenia Gravis (MG)?

A

Acetylcholine (ACh)

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69
Q

What are the symptoms of frontotemporal dementia?

A

Prominent personality and behavioural changes
Memory impairment
- Loss of awareness, disinhibition, impulsivity, social withdrawal, stereotyped or preservative behaviour and speech output changes

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70
Q

What is the biological treatment for Parkinson’s disease?

A

No one universal first-line drug:
MAO-BIs - selegiline, rasagiline
Oral or transdermal dopamine agonist - pramipexole, ropinirole
Levodopa (Co-careldopa, co-beneldopa) - most effective symptomatic drug
Amantadine

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71
Q

What is donepezil used in?

A

Alzheimer’s disease
- ACh inhibitor

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72
Q

What is the key characteristic feature needed to diagnose multiple sclerosis?

A

More than one nerve lesion disseminated in time and space

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73
Q

What are the risk factors of multiple sclerosis?

A

Multiple genes
Epstein–Barr virus (EBV)
Low vitamin D
Smoking
Obesity

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74
Q

What are the signs and symptoms of multiple sclerosis?

A
  • Optic neuritis (most common)
  • Eye movement abnormalities
  • Focal Weakness - Bells palsy, Horner’s syndrome, limb paralysis, incontinence
  • Focal sensory symptoms
  • Ataxia
75
Q

What can a CN VI palsy cause?

A

Internuclear ophthalmoplegia
Conjugate lateral gaze disorder

76
Q

What are the disease patterns of MS?

A
  • Clinically isolated syndrome
  • Relapsing-remitting
  • Secondary progressive
  • Primary progressive
77
Q

What is the management of MS?

A
  • Relapses treated with methylprednisolone
  • Symptomatic treatments:
    1. Exercise
    2. Neuropathic pain - amitriptyline, gabapentin
    3. Depression - SSRIs
    4. Urge incontinence - anticholinergic medications - tolterodine, oxybutynin
    5. Spasticity - baclofen
78
Q

Which brain structure is most commonly affected by deposition of Huntingtin protein in early Huntington’s disease?

A

Striatum

79
Q

What heritance pattern is Huntington’s?

A

Autosomal dominant
- Causes Huntingtin protein to be misfolded

80
Q

What is the pathophysiology of chorea in Huntington’s?

A

Deposition of Huntingtin protein in the striatum decreases inhibitory GABAergic effects, resulting in excess movement.

81
Q

How would Benign Paroxysmal Positional Vertigo (BPPV) be diagnosed by the bedside?

A

Through a Dix-Hallpike manoeuvre

82
Q

What are the side effects of Ropinirole?

A

Compulsive or disinhibited behaviours e.g. gambling and hypersexuality

83
Q

What are the features of a tonic-clonic seizure?

A
  • Stiffness followed by period of shaking
  • An ‘ictal cry’
  • Urinary incontinence
  • Injuries such as biting of tongue
  • A post-ictal state - confusion, drowsiness normally for 5-30 minutes after
84
Q

What are the complications of GBS?

A

Type 1 respiratory failure

85
Q

What are the common presenting features of myasthenia gravis?

A
  1. Ptosis
  2. Diplopia
  3. Muscle weakness, worse at the end of the day
  4. Weakness in muscles of mastication
86
Q

What disease does Myasthenia Gravis commonly occur alongside?

A

Thymoma
- 10-15% of patients with MG will have a thymoma
- May present through extended neck veins

87
Q

What types of delirium can occur?

A

Hypoactive
Hyperactive

88
Q

What is status epilepticus?

A

A single unremitting seizure lasting longer than five minutes or frequent clinical seizures without an interictal return to the baseline clinical state

89
Q

After treatment of seizure, what would be the course of action in a single unremitting seizure?

A

ABCDE approach

90
Q

In what patient group is sumatriptan contraindicated?

A

In patients with coronary artery disease

91
Q

What features may be present in a prodromal phase of Parkinson’s disease?

A
  • Peripheral autonomic nervous system effects
  • Symptoms such as hyposmia, constipation, rapid eye movement sleep disorders
92
Q

Is symptom onset in Parkinson’s asymmetrical or symmetrical?

A

Asymmetrical

93
Q

Which nerves pass through the cavernous sinus?

A

CN II
CN IV
CN VI
CN V1 and V2

94
Q

What is neurofibromatosis Type 1?

A
  • An autosomal dominant condition caused by mutation of the neurofibromin (NF1) gene
95
Q

What are the symptoms of neurofibromatosis type 1?

A
  • “Cafe-au-lait” spots
  • Multiple neurofibromas
  • Freckling of the skin in axillary or groin regions
    iris hamartomas (Lisch nodules
  • Scoliosis
  • Pheochromocytoma
96
Q

What are the clinical features of neurofibromatosis type 2?

A

Bilateral vestibular neuromas

97
Q

What is Gowers’ Sign?

A

Patients have to resort to using arms and hands to carry them forward from a squatting position due to the proximal weakness of the hip and thigh muscle
- Sign of Duchenne Muscular Dystrophy

98
Q

What is Duchenne Muscular Dystrophy (DMD)?

A
  • A genetic condition affecting the protein dystrophin in young males, leading to progressive muscle weakness, scoliosis and cardiomyopathy
99
Q

What is Tinnel’s Sign?

A

Sensation of pins and needles when an area associated with a specific peripheral nerve is tapped gently.
- Detects impinged nerves

100
Q

What are the symptoms of an essential tremor?

A
  • Distal, symmetrical postural tremor of upper limbs
  • Low amplitude, fairly rapid frequency
  • Control over tremor when concentrating on a motor task
  • Most patients find drinking alcohol to help symptoms
101
Q

What is the investigation of choice for MS?

A

MRI of the brain and spine

102
Q

What is the most likely CSF analysis result from viral encephalitis?

A
  • Raised protein
  • Raised lymphocytes
  • Normal glucose
103
Q

What is the Management for subarachnoid haemorrhage (SAH)?

A
  • Neurosurgical referral for endovascular coiling
  • Nimodipine
  • CT Angiogram may be necessary to locate the site of aneurysm
104
Q

What investigation would be diagnostic for SAH and what would it show?

A

CT Head (Without contrast)
- Hyperdense material filling subarachnoid space, most commonly the circle of Willis

Lumbar puncture:
- Performed at least 12 hours after the onset of symptoms
- Visual inspection and chemical analysis will show xanthochromia

105
Q

How can the location of Horner’s Syndrome lesions be determined?

A
  • Central lesions cause anhidrosis of the arm, trunk and face
  • Pre-ganglionic lesions cause anhidrosis of the face
  • Post-ganglionic lesions do not cause anhidrosis.
106
Q

What treatment is used for prophylaxis against migraines?

A

Propranolol
- Reduces frequency and severity of migraine headaches

107
Q

What treatment is used in the acute management of a migraine?

A

Sumatriptan

108
Q

What is Uhthoff’s phenomenon?

A

Small increases in the body temperature can temporarily worsen current or preexisting signs and symptoms
- Present in MS

109
Q

What is Lhermitte’s sign?

A

Transient sensory symptom described as an electric shock radiating down the spine or into the limbs most often after flexion of the neck
- Most commonly seen in MS

110
Q

What is Charcot’s neurologic triad?

A

The combination of nystagmus, intention tremor, and scanning or staccato speech
- Associated with MS

111
Q

What are the typical symptoms of SAH?

A
  1. Sudden onset severe headache, reaching maximum intensity within seconds - thunderclap headache
  2. Nausea and vomiting
  3. Photophobia
112
Q

What clinical findings would be noted from examination of SAH?

A
  • Reduced level of consciousness
  • Neck stiffness
  • Kernig’s sign - inability to flex the knee due to pain when patient is supine
113
Q

What would pronator drift show?

A

Strongly indicative of UMN dysfunction or pyramidal/corticospinal tract disease

114
Q

What nerve is affected in Bell’s Palsy?

A

Facial Nerve

115
Q

What is the management for myasthenia gravis?

A

Symptomatic treatment with an acetylcholinesterase inhibitor + immunosuppression when not adequately responding to symptomatic treatment

Pyridostigmine - ACh inhibitor
Corticosteroids, azathioprine, thymectomy - immunosuppression

116
Q

What would indicate a central cause of nystagmus?

A

Bidirectional beating
In any direction (Vertical or torsional)

117
Q

What would indicate a peripheral cause of nystagmus?

A

Unidirectional, horizontal beating towards the affected side
Some torsion present
Peripheral causes never change direction

118
Q

What are the typical CSF findings of fungal meningitis?

A

Appearance: Clear or cloudy
Opening pressure: Elevated
WBC: Elevated (10 – 500 cells/µL)
Glucose level: Low
Protein level: Elevated
Gram stain: Positive

119
Q

What would the clinical features of fungal meningitis be?

A
  • Often immunocompromised patients
  • Headache
  • Confusion
  • Nausea
  • Vomiting
  • Fever and neck stiffness
120
Q

What is athetosis and what is it caused by?

A
  • Slow, involuntary and convoluted writhing movements
  • Typically seen within lesions to the corpus striatum in the BG
121
Q

What is asterixis and what would it be caused by?

A
  • A flapping hand tremor
  • Seen in encephalopathy, where ammonia accumulates abnormally
122
Q

What are the early features of Huntington’s disease?

A

Jerky, random and uncontrollable movements - chorea

123
Q

What are the risk factors for idiopathic intracranial hypertension?

A

Female sex
Reproductive age
Obesity

124
Q

What are the symptoms of raised ICP?

A

Headache:
- Worse in the morning
- Worse on sneezing/coughing
Nausea
Tiredness

Can progress to:
Decreased level of consciousness
Bradycardia
Hypertension
Irregular respiration
Extensor posturing
Seizures

125
Q

How would idiopathic intracranial hypertension be diagnosed?

A

Through exclusion
- Brain MRI - rule out other causes - e.g. traumatic, neoplastic

126
Q

What is the presentation of migraine?

A
  • 5+ episodes
  • 4 hours to 3 days (i.e. 72 hours) of duration
  • 2+ of the following: Unilateral headache / Pulsating headache / Moderate to severe pain / Aggravation by physical activity
  • 1+ of the following: Nausea / Vomiting / Photophobia / Phonophobia
127
Q

What is the drug Nimodipine used for?

A
  • To reduce risk of vasospasm, in context of SAH
  • Is a dihydropyridine calcium antagonist
128
Q

What are the typical findings of CSF in bacterial meningitis?

A

Appearance: Cloudy and turbid
Opening pressure: Elevated (>25 cm H2O)
WBC: Elevated >100 cell/µL
Glucose level: Low (<40% of serum glucose)
Protein level: Elevated (>0.5 g/dL)

129
Q

What are the causative bacteria of bacterial meningitis?

A
  1. Newborns: Listeria monocytogenes, E. Coli, Group B Streptococci
  2. Older children: Neisseria meningitidis, Haemophilus influenzae Type B, Streptococcus pneumoniae
  3. Adults: Neisseria meningitidis, Streptococcus pneumoniae, Listeria monocytogenes
130
Q

What are the symptoms of bacterial meningitis?

A
  1. Headache
  2. Fever
  3. Neck stiffness
  4. Photophobia
  5. Meningococcal meningitis presents with a characteristic petechial rash
131
Q

How would bacterial meningitis be investigated?

A
  1. CSF gram stain and cultures
  2. CSF bacterial antigens
  3. CSF PCR
  4. Blood cultures
  5. Imaging to rule out other intracranial pathology – CT / MRI head
132
Q

What would the typical CSF findings in meningitis be?

A
  • Appearance: Clear
  • Opening pressure: Normal or elevated
  • WBC: Elevated (50 – 1000 cells/µL, primarily lymphocytes, can be PMN early on)
  • Glucose level: Normal (>60% serum glucose however may be low in HSV infection)
  • Protein level: Elevated (>0.5 g/dL)
133
Q

What are the causative pathogens of viral meningitis?

A
  1. Herpes simplex virus (HSV 2 is more common than HSV 1)
  2. Enteroviruses
  3. Varicella zoster virus (VZV)
  4. Mumps
  5. HIV
  6. Adenovirus
134
Q

What would the investigations for viral meningitis be?

A

CSF PCR for viruses (e.g. Herpes simplex virus (HSV) / Varicella-zoster virus (VZV))
Blood cultures
Imaging to rule out other intracranial pathology – CT / MRI head

135
Q

What diseases can cause a relative afferent pupillary defect?

A

Advanced glaucoma, total retinal detachment, optic neuropathy, optic neuritis

136
Q

What are the clinical features of Wernicke’s aphasia?

A

Fluent speech with abnormal comprehension

137
Q

What are the clinical features of Broca’s aphasia?

A

Non-fluent speech with normal comprehension

138
Q

What is the pathophysiology of Alzheimer’s disease?

A

Amyloid plaques (clumps of beta-amyloid) + Neurofibrillary tangles (tau protein):

The accumulation of these leads to a reduction in transmission of information, and eventually to the death of brain cells, with abnormal depositions remaining post-mortem.

139
Q

What are the symptoms of Alzheimer’s?

A

Usually begin after the age of 60 (though there are “early-onset” cases, most of which involve genetics).
Can affect all areas of the brain: many functions and abilities can be impacted upon and eventually lost.
The most common presenting symptom is memory loss, with evidence of varying changes in planning, reasoning, speech and orientation.

140
Q

What are the clinical features of an extradural haematoma?

A
  • A pattern of a lucid period post-trauma followed by rapid rise in ICP
  • Can lead to coning
141
Q

Damage to which artery commonly causes a extradural haematoma?

A

Middle meningeal artery

142
Q

What are the clinical features of a subdural haematoma?

A
  • Slower onset - lower pressure of bridging veins damaged bleed more slowly than arteries
  • Increasing headache and confusion
  • Followed by rapid decline
143
Q

What is mild cognitive impairment?

A

The transitional state between cognitive changes of normal ageing and clinical features of dementia

144
Q

What drug is contraindicated in patients with migraine with aura?

A

Combined oral contraceptive pill

145
Q

What drug is used to treat symptoms of trigeminal neuralgia?

A

Carbamazepine

146
Q

What is a Marcus-Gunn pupil?

A
  • Lesion in the optic nerve
  • Pupil is de-afferented - constricts to consensual but not direct light
147
Q

Which cranial nerves carry the pupillary light response?

A

Afferent - CN II
Efferent - CN III

148
Q

How does CSF flow around the brain?

A

lateral ventricles –> foramina of Monro –> third ventricle –> cerebral aqueduct –> fourth ventricle –> foramina of Luschka & Magendie –> subarachnoid space.

149
Q

How can problematic essential tremors be treated?

A

Propranolol

150
Q

What are the features of myoclonic seizures?

A
  • Brief, involuntary jerking movements typically seen in limbs or facial muscles, without LOC
151
Q

What are the features of a clonic seizure?

A
  • Regularly repeating myoclonus (2-3 per second)
152
Q

What are the features of a tonic seizure?

A

Tone is greatly increased which leads to stiffness, usually on both sides of the body.

153
Q

What are the features of absence seizures?

A

Do not usually affect motor function and instead cause the patient to blank out for a few seconds.

154
Q

What is a TIA?

A

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
- Typically lasting less than an hour

155
Q

What are the clinical features of a TIA?

A

Similar to stroke, but resolving within 1 hour usually:

Unilateral weakness or sensory loss.
Aphasia or dysarthria
Ataxia, vertigo, or loss of balance
Visual problems
- Sudden transient loss of vision in one eye (amaurosis fugax)
- Diplopia
- Homonymous hemianopia

156
Q

Which prognostic score is used to risk stratify TIA?

A

ABCD2
- (However this may not be used in the future as NICE no longer recommends)

157
Q

What is the best neuroimaging investigation for TIA?

A

MRI - diffusion weighted and blood-sensitive sequences

158
Q

What would immediate treatment of TIA be?

A

Aspirin 300mg unless contraindicated
Specialist review

159
Q

What would CNIII palsy present with?

A

Deviation of the eye, down and out (abducted and depressed)
- Right-sided ptosis, pupil dilation and an absent light reflex with intact consensual constriction

160
Q

What light reflex fibres does the third CN carry?

A

Efferent fibres
- Palsy will cause dilation of pupil

161
Q

What are the signs of idiopathic intracranial hypertension?

A

Papilloedema
6th nerve palsy

162
Q

What may cause neuropathic pain?

A

Diabetic neuropathy
Post-herpetic neuralgia
Trigeminal neuralgia
Prolapsed intervertebral disc

163
Q

What is the first line treatment of neuropathic pain

A

Amitriptyline, duloxetine, gabapentin, pregabalin
Tramadol may be used as “rescue therapy”

164
Q

What is first line treatment for trigeminal neuralgia?

A

Carbamazepine

165
Q

How is idiopathic intracranial hypertension treated?

A

Advise weight loss
Diuretics e.g. acetazolamide

166
Q

What is the mechanism of ondansetron?

A

5-HT3 antagonist
Act in the chemoreceptor trigger zone in the medulla

167
Q

What would be used as migraine preventatives?

A

Topiramate
Propranolol in women of childbearing age

168
Q

What are the symptoms of middle cerebral artery strokes?

A
  1. Contralateral hemiparesis and sensory loss, upper extremity > lower
  2. Contralateral homonymous hemianopia
  3. Aphasia
169
Q

What are the symptoms of anterior cerebral artery strokes?

A
  1. Contralateral hemiparesis and sensory loss, lower extremity > upper
170
Q

What are the symptoms of posterior cerebral artery strokes?

A
  1. Contralateral homonymous hemianopia with macular sparing
  2. Visual agnosia
171
Q

What are the treatments for Generalised tonic-clonic seizures?

A

Males: sodium valproate
Females: lamotrigine or levetiracetam

172
Q

What are the treatments for focal seizures?

A

First line: lamotrigine or levetiracetam
Second line: carbamazepine, oxcarbazepine or zonisamide

173
Q

What are the treatments for absence seizures?

A

First line: ethosuximide
Second line:
- Male: sodium valproate
- Female: lamotrigine or levetiracetam

174
Q

What is Hoffman’s sign?

A

Reflex test to investigate corticospinal tract lesions

175
Q

What is Romberg’s test?

A

Investigate the cause of ataxia; if positive means sensory ataxia

176
Q

What is Hoover’s sign?

A

Specific manoeuvre in leg paresis to distinguish organic and non-organic paresis

177
Q

What is the Cushing reflex?

A

Physiological nervous system response to ICP
- Results in hypertension and bradycardia

178
Q

What may be seen on CT in acute ischaemic stroke?

A

Hyperdense artery
Visible immediately in contrast to changes in parenchyma

179
Q

What is the treatment for tonic or atonic seizures?

A

Males - sodium valproate
Females - lamotrigine

180
Q

What are the symptoms of cerebellar vermis lesions?

A

Gait ataxia

181
Q

What are the symptoms of cerebellar hemisphere lesions?

A

Finger-nose ataxia

182
Q

How do basal ganglia lesions present?

A

Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)

183
Q

How do parietal lobe lesions present?

A

Sensory symptoms, dyslexia, dysgraphia

184
Q

How do frontal lobe lesions present?

A

Motor symptoms, expressive aphasia, disinhibition

Phase 3a (6 decks)

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