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AMK > Neurology > Flashcards

Neurology Flashcards

1
Q

WEBERS SYNDROME

A

Mid brain stroke and hemiplegia
eyes go down and out and also hemiparesis (half of the body is paralysed)

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2
Q

eyes go down and out and there is oculomotor nerve palsy

this is caused by?

A

diabetes

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3
Q

effects of temporal lobe epilepsy

A

partial seizure

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4
Q

effects of occipital lobe seizure

A

visual hallucinations

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5
Q

What is trigeminal neuralgia

A

Very severe headache disorder but does NOT cause photophobia and vomiting

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6
Q

What is tension headache

A

Will happen over the head

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7
Q

What are cluster headaches

A

Frequent short lasting headaches that causes lacrimation

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8
Q

Why do you get Biconcave shaped haemotoma on CT

A

Extradural haemorrhage
Risks, arterial bleed

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9
Q

When do you get crescent shaped haemotoma on CT

A

Subdural haemorrhage

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10
Q

When do you see global atrophy

A

Seen in Alzheimer’s
Shrinking of the brain

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11
Q

Autonomic neuropathy

A

Complication if poorly controlled diabetes
Can cause postural hypotension and sensation of being full too soon

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12
Q

What are absence seizures

A

Brief pauses several times a day

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13
Q

what is the Gillian barre syndrome

A

when the immune system attacks the nerve cells
difficulty breathing, swallowing and blurred vision

  • weakness in the lower limbs and then it spreads
  • post infection
    -camlybactor jejuni
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14
Q

what is a non-motor seizure called

A

absence seizure

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15
Q

what type of seizure is this?
long onset >30 mins
jerking of arms and legs

A

satus epilepticus

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16
Q

best management for tonic clonic seizure?

A

lorazepam IV

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17
Q

what is mevalgia paraesthetica

A

numbness of the anterior thigh due to compression of the lateral femoral cutaneous nerve

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18
Q

what is a TIA and side effects

A

can cause transient loss of vision that is one sided and goes away after a few days

medical term: Amaurosis Fugax

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19
Q

multiple sclerosis - what is it

A

demyelination of the nerves
neural impulses get slowed down and gaps in the myelin sheath causes gaps in the neural path
- affects the parasympathetic supply to the bladder which can cause urinary retention - urge to go but cannot pass

  • this can cause urinary symptoms and TIA
  • urinary retention
  • more common in younger people
  • people who have lived away from the equator
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20
Q

Stroke - what is it

A

not enough blood reaching the brain
- subdivided into ischaemic stroke - vascular stenosis

and haemorrhagic stroke - vascular rupture

anterior, middle and posterior cerebral artery supply blood to the brain

anterior -
middle - face and arms and speech to be effected
posterior - occipital lobe and inferior part of temporal lobe, so visual problems

do head CT within 1 hour

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21
Q

ischaemic stroke and haemorrgagic stroke on CT

A
  • ischaemic - looks dark
  • heamorrhagic - looks white
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22
Q

ischaemic stroke management

A
  • check breathing
  • endotracheal intubation

if stroke is confirmed and within 4.5 hours: alteplase (dissolve blood clot) and anti platelet agent

after 4.5 hours
supportive care
thrombectomy and anti platelet agent

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23
Q

thrombolysis window for ishcaemic stroke

A

4.5 hours
give IV aleteplase
mechanical thrombectomy

long term secondary prevention - aspirin 300mg for 2 weeks and then clopidrogrel long term

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24
Q

hemorrhagic stroke management

A

manage airway

neurosurgery and fix ruptured artery

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25
Q

confirmed hemorrhagic stroke management

A

supportive care
anticoagulant
venous thromboembolism

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26
Q

TIA

A

sudden onset neurological deficit

resolves completely in 24 hours

suspected TIA - give aspiring 300 mg loading dose

confirmed TIA - clopidogrel

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27
Q

middle medullary syndrome - what is it

A

stroke that affects the medulla
due to the occlusion of the basilar artery

causes: deviation of the tongue
limb weakness
person is not able to move their limbs

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28
Q

what is used to detect carotid stenosis

A

diffusion weighted MRI brain

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29
Q

when is a MRI done in stroke patients?

A

after the CT head that is done within 1 hour - when the CT comes back normal

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30
Q

3 meninges of the brain

A

dura mater
arachnoid - it doesn’t receive any innervation
under this is where the CSF is
pia - very vascularised

they provide a supportive framework for the cerebral arteries
protect the CSF inside

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31
Q

epidural haemorrhage

A

between the skull and dura mater
due to trauma to the pterion (temple)
damages the middle mengineal artery

contralateral hemiplegia
rapid deterioration then lucid (normal period)

BI CONVEX OR LENTIFORM SHAPE ON CT

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32
Q

subdural haemorrhage

A

between dura and arachnoid mater

increasing headache and confusion
- older patients
gradual

CRESECENT SHAPED HAEMATOMA

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33
Q

subarachnoid haemorrhage

A

under the arachnoid

severe headache and sudden
‘blow to to the back of their head’ ‘thunderclap headache’

decrease in consciousness
CT - WHITE AREA IN CENTRE OF BRAIN THAT IS EXPANDING

red or yellowing of the CSF

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34
Q

when is lumbar puncture contraindicated

A

raised intracranial pressure - as it can cause a release in this pressure and pull the brain down

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35
Q

basal skull fracture can cause?

A

leaking of the CSF from the nose

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36
Q

bacterial meningitis

A

inflammation of meninges

lumbar puncture
antibiotics are started immediately

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37
Q

meningitis symptoms

A

fever
photophobia
rash
confusion
neck stiffness
headache

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38
Q

management of meningitis

A

IM benzylpenniclin

in hospital - IV dexamethasone within 1 hour
ceftriaxone
vancomycin
amoxicillin (if immunocompromised)

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39
Q

viral meningitis management

A

acicilovir

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40
Q

encephalitis

A

inflammation of the brain iteself
caused by herpes simplex virus

altered state of consciousness
fever
headache
ataxia
cranial nerve deficits

41
Q

myasthenia gravis

A

blocks acetyl coline the post synaptic cleft
muscle weakness

acetyl choline asters is given so acetyl choline is not broken down

ptosis
dysphagia

test for the antibodies that bind to the acetyl choline receptors

42
Q

Lambert eaton myasthenic syndrome

A

inhibits calcium current in the neurosynapse

limbs go weak to strong
dry mouth

43
Q

Lambert eaton myasthenic syndrome

A

inhibits calcium current in the neurosynapse

limbs go weak to strong
dry mouth

44
Q

Gillian barre syndrome

A

inflammatory demyelinating polyneuropathy
typical post infection from camplyobacter jejuni

limb weakness
respiratory muscle weakness
cranial nerve palsies eg facial droop

reflexes are absent

45
Q

polymyositis

A

bilateral proximal muscle weakness

myalgia
tenderness

management with: corticosteroids
physio
methotrexate

46
Q

dermatomyositis

A

myositis and skin changes

heliotrope rash - purple rash on eyelids
gottrons papules - red papule on dorsal finger joints
shawl rash - erythema across upper back and shoulders

management:
oral corticosteroids

47
Q

carpal tunnel syndrome

A

median nerve entrapment

tingling in the first 3 digits
worse at night
relived by shaking

management
splinting
steroid injections

48
Q

cauda equina syndrome

A

compression of cauda equina
- nerve roots at the L1 level which get compressed

lower back pain
anaesthesia
bladder and bowel disturbance

mangement - surgery to decompress

49
Q

bells palsy - forhead

A

NOT SPARED

50
Q

stroke - forehead

A

IS SPARED

51
Q

what is an intracerebral haemorrhage

A

bleeding into the brain
- can be due to hypertension
gradual onset
can be due to amyloid deposit - this can weaken blood vessels which can then bleed

52
Q

subarachnoid haemorrhage

A

bleeding around the brain
can be the bleed of the ruptured aneurysms
- can be anywhere in the brain

THUNDERCLAP HEADACHE
very painful

53
Q

what is xanthochromia

A

yellow staining of the CSF
- this is due to an increase content of bilirubin in the CSF
- this indicates that there is a bleed somewhere in the brain

54
Q

intracranial bleeds risk factors

A

head injury
hypertension
aneurysms

  • sudden onset headache
    seizures
    weakness
    vomiting
55
Q

subdural bleed

A

bleed in the veins
- crescent shaped
- gradual onset

56
Q

extradural bleed

A

bleed in the arteries
fast onset
post trauma
lucid interval
biconcave shaped

57
Q

what is spastic paraparesis

A

strong family history of gait disturbances
hyper-reflexia of the limbs

caused by:

58
Q

what is an atonic seizure

A

this is when the patient becomes all limp and have no tone

59
Q

myoclonic seizure

A

this is sudden increase in muscle tone which causes sudden jerking of the upper and lower limbs

60
Q

idiopathic intracranial hypertension

A

raised pressure in the cranial cavity
most common in obese women
those who are on the contraceptive pill
causes blurred vision, headache and is worse in the morning or when lying down

61
Q

when can a lumbar puncture be performed after a subarachnoid haemorrhage

A

only after 12 hours

62
Q

myasthenia gravis - what is it

A

autoimmune disorder - immune system attacks the acetyl choline receptor, so these signals don’t transmit
POST SYNAPTIC

reduced nerve transmission
- so muscle weakness
- rapid fatigue of voluntary muscles
IgG attacks these receptors

  • worse with movement
  • tendon reflexes are preserved

associated with thymic hyperplasia -

63
Q

management of myasthenia gravis

A

acetylcholinesterase inhibitors (e.g., pyridostigmine), immunosuppressants (e.g., prednisone, azathioprine, mycophenolate)

64
Q

What is LEMS

A

It is an autoimmune condition which attacks the presynaptic calcium voltage gated channels causes muscle weakness, which gets better on use and is associated with small cell lung cancer. Other symptoms include dry mouth.

This causes a decrease in calcium

gets better with use

65
Q

What investigation do you do for GBS

A

Bedside/country to check for forced FVC
and anti-ganglioside antibodies

66
Q

management of epilepsy in the community during seizure

A
  1. diazepam rectally x2 15 mins apart
    OR
    midazolam 10mg orally
67
Q

management of epliepsy with IV access

A
  1. IV lorazepam x2 (10-20mins apart)
  2. IV phentoynin
68
Q

raised intracranial pressure - what is it

A
  • headaches worse in the morning
  • worse on bending over
  • gets better on vomiting
  • and lying down

do CT

69
Q

what is idiopathic intercranial hypertension

A
  • worse in the morning and on bending forwards
    common in obese women
    visual disturbances
    visual darkening and bilateral papilooedma seen on fundoscopy

COCP can be a cause
steroids

weight loss is the only intervention

70
Q

what is trigeminal neuralgia

A

recurrent short episodes of stabbing pain
affects one side of the face
may be triggered by eating etc

do MRI

management with carbemezapine

71
Q

most common cause of encephalitis

A

herpes simplex virus

72
Q

presentation of encephalitis and investigation

A
  • fever
  • altered mental status
    -headache
  • seizures
  • CSF and Viral PCR
73
Q

management of encephalitis

A
  • IV acyclovir
74
Q

investigations for subarachnoid haemorrhage

A
  1. CT scan - to identify bleed
  2. if bleed isn’t picked up in this then - Lumbar puncture
    CSF might show blood in CSF or
    Xanthochromia - yellow coloured CSF which means previous bleed and haemolysis
75
Q

management of extradural haemorrhage

A

Ligation of the damaged blood vessel

76
Q

Management of subdural haemorrhage is?

A

Burr hole craniotomy

77
Q

Management of subarachnoid haemorrhage

A

Nimodipine

end-vascular coiling
and then clipping

78
Q

upper motor neurone disease symptoms

A

hyperreflexia /brisk reflexes
spasticity
pyramidal distribution

79
Q

lower motor neurone disease symptoms

A

fascicultations - twitching
atrophy - wastage of muscles

80
Q

where is wernickes area situated

A

in the superior temporal lobe

81
Q

Where is broca’s area situated

A

in the inferior frontal gyrus

82
Q

what is bulbar palsy

A

lower motor neurone condition affecting the cranial nerves 7,9,10,12

83
Q

tonic-clonic and atonic seizures managemnt

A

sodium valproate or lamortigine (are first line)

pregnant women - give lamotrogine

84
Q

absence seizures management

A

sodium valproate
or ethosoximide

do not give CARBAMEZEPINE

85
Q

myoclonic seizure management

A

sodium valproate
women - topiramate or leviterasitam

86
Q

side effects of sodium valproate

A

weight gain
hair loss
oedema
ataxia
tremor

87
Q

what is hemiballism

A

Hemiballism results in involuntary, sudden, jerking movements which occur contralateral to the side of the lesion

basal ganglia

88
Q

what are the features of temporal lobe seizure

A

epileptiform and is preceded by deja vu.

89
Q

presentation of temporal lobe lesions

A
  • mixing up words and saying words that don’t make sense
90
Q

Parietal lobe, lesions presentation

A

Lesions in the parietal lobe can cause apraxia.

91
Q

Occipital lobe lesion presentation

A

Lesions in the occipital lobe can cause changes to vision.

92
Q

frontal lobe lesion presentation

A

Lesions in the frontal lobe can cause speech to become non-fluent.

93
Q

cerebellum lesion presentation

A

Lesions in the cerebellum can cause ataxia, an intention tremor and dysdiadochokinesia.

94
Q

what is the first line treatment for myasthenia gravis

A

Pyridostigmine is a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of myasthenia gravis
it increases the amount of acetylcholine reaching the post-synaptic receptors

95
Q

what is Brown-Sequard syndrome

A

below the level of wound - ipsilateral loss of proprioception and vibration, and contralateral loss of pain and temperature sensation

at the lesion level

96
Q

acute cord compression symptoms

A

severe back pain
numbness
and incontinence

97
Q

side effects of sodium valproate

A

hepatic dysfunction with raised AST and ALT

98
Q

what is Plummer Vinson syndrome

A

characterised by

Dysphagia: Difficulty swallowing due to the presence of webs or strictures in the upper esophagus. This can lead to malnutrition and weight loss.

Iron deficiency anemia: A type of anemia caused by insufficient iron levels in the body, which can lead to fatigue, weakness, and other symptoms.

]Glossitis: An inflammation of the tongue, which can cause soreness, pain, and difficulty speaking or swallowing.

increases chance of squamous cell carcinoma of the oesophageas

AMK (27 decks)

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