Neurology Flashcards
A Jacksonian seizure is also known as a temporal lobe seizure T/F
F - AKA focal (partial) motor seizure
Note: consciousness preserved; often Todds paralysis afterwards
Carbamazepine is the first line tx for juvenile myoclonic epilepsy T/F
F - it can actually WORSEN seizures.
Note: usually use valproate or topiramate
Patients have excellent prognosis but often require lifelong AED to avoid relapses
Pt with preE coming in post seizure what is the initial mgmt of choice
Mg bolus
Pt with an intracranial bleed at what BP are anti HTNs indicated
> 170 systolic
When is NSGY opinion indicated in intracranial haemorrhage?
If intermediate or reducing GCS
OR cerebellar haemorrhage
Non neurological feature of Friedrich’s ataxia
It is associated with cardiomyopathy, scoliosis, pes cavus and diabetes
1st line treatment of Parkinson’s disease
Levodopa, dopamine agonists, or MAO-B inhibitors (eg selegiline) are the first choice options as there is evidence behind their use in providing symptoms control
Mnemonic for cavernous sinus thrombosis structures involved?
O TOM CAT
O: Oculomotor nerve
T: Trochlear nerve
O: Ophthalmic branch of trigeminal nerve
M: Maxillary branch of trigeminal nerve
C: Internal carotid artery
A: Abducens nerve
T: Trochlear nerve
Typical presentation of neurological AV malformations
seizures and a background of headaches.
Intermittent headaches with neurology affecting multiple cranial nerves is suggestive of ___
Cavernous Sinus Thrombosis
Frontotemporal dementia most commonly presents with memory problems T/F
F - more commonly presents with loss of insight and behavioural changes than memory problems
Presentation of neuralgic amyotrophy
Sudden onset of extreme pain in the upper extremity
followed by rapid multifocal motor weakness and atrophy and a slow recovery in months to years.
Usually proceeded by an upper respiratory tract infection.
Note: NA includes both an idiopathic (also known as Parsonage-Turner syndrome) and hereditary form.
Sporadic vs variant CJD
Sporadic: onset 45 -75 yrs old
- myoclonus
- dementia
-ataxia
-psychiatric/behavioural changes
Variant: average onset 26 yrs old
-Psychiatric prodrome
-Painful sensory symptoms
Investigations for CJD
Sporadic: EEG, LP (abnormal high levels of proteins 14-3-3 and S100B) and MRI brain
Variant : MRI is investigation of choice as EEG and LP are less sensitive
Use of memantine vs donepezil in Alzheimers dementia
Donepezil (or galantamine, or rivastigmine) usually first line
Memantine is for severe dementia or if unable to tolerate anti cholinesterase inhibitors
In the setting of trauma amnesia for greater than 30 minutes of events before impact is an indication for CT brain T/F
T
Acute total (painful) third nerve palsy with a dilated unreactive pupil is caused by_____
Compression of CN III, for example by tumour, posterior communicating or posterior cerebral artery aneurysms.
Features of multi system atrophy
-parkinsonian features
-autonomic insufficiency (leading to postural hypotension, anhidrosis, disturbance of sphincter control, impotence)
-signs of a cerebellar deficit.
Chronic inflammatory demyelinating polyneuropathy is clinically similar to which disease
GBS except follows a more chronic progressive course
18 yr old male presents with painless loss of vision in one eye a few weeks after losing vision in other eye. Most likely dx
Leber’s optic atrophy
Note: typical patient is a young male, LOV is painless but severe.
On MRI brain lesions enhance with gadolinium contrast - which is more likely MS or ADEM
ADEM
Note: MS lesions can sometimes enhance though less likely.
Think ADEM if encephalopathy, fever and focal neurology. May have had a preceding flu like illness or recent vaccinations
Optic neuropathy, proptosis, chemosis, Horner’s syndrome, ophthalmoplegia (sixth nerve palsy) and decreased corneal reflex is typical of ___
Orbital apex syndrome
Note: decreased corneal reflex is due to involvement of V1
What is the most common cause of limbic encephalitis
In 60% of cases it is paraneoplastic. Most commonly malignancy is small cell lung Ca
Benign paroxysmal positional vertigo (BPPV) is associated with hearing loss T/F
F - it is not associated with hearing loss
Note:characterised by brief episodes of severe vertigo accompanied by nausea and vomiting. Vertigo can last for weeks and then self resolves.
Meniere’s disease is associated with hearing loss
Thrombolysis timeframe in ischaemic stroke
4.5 hrs from onset of symptoms
What is the annual % risk of stroke in pt with CHADSVasc of 3
3.2%
target for cerebral perfusion pressure in setting for brain haemorrhage
61-80 mmHg
A patient presents with hemiballism where is the lesion?
Contralateral subthalamic nucleus
Note: commonest cause is infarct. Tx is tetrabenazine.
Hunt and Hess scale grades SAH:
- Asymptomatic or minimal headache & slight neck stiffness
- Moderate or severe headache with neck stiffness, but no neurological deficit other than cranial nerve palsy
- Drowsiness with confusion or mild focal neurology
- Stupor with moderate to severe hemiparesis or mild decerebrate rigidity
- Deeply comatose with severe decerebrate rigidity.
MS flare are typically treated with bolus methylprednisolone T/F
F - only function- or life-threatening relapses should be treated by high doses of bolus methylprednisolone. For example a mild optic neuritis does not require any specific treatment
A pt on beta interferon 1a injections and has been fully compliant with the medication for one and half years. She has presented with five relapses during the past one year. She presents with mild optic neuritis what is mgmt?
D/C interferon - if three or more attacks in a year consider re-evaluation of interferon or glatiramer acetate as they aim is to decrease relapse frequency
1st line treatment of excessive daytime sleepiness in narcolepsy?
Modafinil
Note: Clomipramine, fluoxetine and sertraline are used in the management of cataplexy.
Features of chronic paroxysmal hemicrania?
Similiar features to cluster headaches but shorter duration of headache with increased frequency. Headache can last between 3-45 minutes and occur 20-40 times per day.
Tx is with indomethacin
Note: cluster headache episodic cluster headache, lasts 15-180 minutes, occurs one to three times daily for four to eight weeks, with each cluster occurring several times yearly
Features of myotonic dystrophy?
Frontal baldness in men
Atrophy of temporalis, masseters, facial muscle, and
Bilateral ptosis.
Also:
first degree heart block and complete heart block
Intellectual impairment
Gonadal atrophy
Insulin resistance
Note: most common muscular dystrophy in adults. Diagnosis is with EMG and muscle biopsy
PSEN1 mutations are associated with___
Familial early onset Alzheimers
Note: presenilin 1 gene
Juvenile myoclonic epilepsy is associated with a change on what chr
chr 6
Differential diagnosis of autonomic neuropathy
- Diabetes
- Chronic renal failure
- AIDS
- Primary amyloidosis
- Porphyria
Irregular low frequency tremor which is a combination of a rest, postural and action tremor is most likely?
Holmes’ tremor or rubral tremor
Note: also described as a ‘wing-beating’ type of tremor and is most prominent when the affected person is active or is maintaining a particular posture. Signs of ataxia and weakness can occur. It is secondary to a lesion in the red nucleus and can occur following a stroke in this area
Corneal reflex, response to supraorbital pressure which CN
CN V and VII
Gag reflex which CN
CN IX and X
Cough reflex which CN
CN X
_____ is the commonest cause of down beating nystagmus
Arnold-Chiari malformation
______ is effective in treating cognitive decline in dementia with Lewy bodies.
Rivastigmine
Max dose donezipil?
10mg daily
NICE guidelines recommend discontinuation of cholinesterase inhibitors once the mini mental state examination has fallen below ___
12
Note: could consider starting memantine
Symmetrical stiffness and bradykinesia associated with poor postural reflexes and impaired down-gaze. Likely dx?
Progressive supra nuclear palsy
Note: Idiopathic Parkinson’s disease presents with tremor and asymmetrical hemi-parkinsonism.
Vascular parkinsonism presents as lower limb parkinsonism.
Tearing of the middle meningeal artery results in ___
Extradural haematoma (aka epidural)
Rupture of the anterior and posterior communicating arteries results in _____
Subarachnoid haemorrhage
Oculomasticatory myorhythmia is pathognomonic of ?
Whipples disease
Increased reflexes tetanus vs botulism?
Tetanus
Note: botulism depressed or absent reflexes
Ischaemic stroke, only BP of >___mmHg merits acute intervention.
220/120
A CT scan of the brain showed dilated lateral ventricles with normal-sized third and fourth ventricle. Where is the lesion?
Foramen of Monro (eg a tumor)
Which presents with abnormal lower limb exam discitits or epidural abscess?
Epidural abscess
Most common cause of an isolated deep intracerebral haemorrhage in the basal ganglia is ____
Hypertension
Monitoring for respiratory system is GBS?
Via Vital Capacity
Note: not peak flow
