Neurology Flashcards
1
Q
What is Brown-Sequard syndrome?
A
Injury to one side of the spinal cord where the cord is damaged but not severed.
2
Q
How does Brown-Sequard syndrome present?
A
Weakness or paralysis and proprioceptive deficits on the side of the body ipsilateral to the lesion and loss of pain and temperature sensation on the contralateral side.
3
Q
What is the basic route of UMNs?
A
They originate in the cerebral cortex and travel down to the brain steam and spinal cord.
4
Q
What is the basic route of LMNs?
A
They begin in the spinal cord and innervate muscles and glands in the body.
5
Q
What type of drug is rotigotine and what are common side effects?
A
Dopamine agonist. Common side effects are pathological gambling, hyper sexuality, binge eating and compulsive shopping.
6
Q
What kind of drug is levodopa and what is it used for?
A
Dopamine agonist - parkinsons’ disease
7
Q
What condition can alter the effects of the COCP?
A
epilepsy (sometimes have to double the dose)
8
Q
What is a contradiction for cholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine)?
A
COPD/asthma
9
Q
What drug helps with opioid withdrawl?
A
Methadone
10
Q
How do you treat bell’s palsy?
A
prednisolone
11
Q
Why is the forehead spared in a stroke?
A
Receives motor innervation from both hemispheres of the brain.
12
Q
What presents with prolonged movements worse at night?
A
Myasthenia gravis
13
Q
What can be used for a benzodiazepine overdose?
A
flumazenil (GABA receptor)
14
Q
What kind of stroke is pure motor?
A
Lacunar
15
Q
What structure is likely to be damaged from kroskoff’s syndrome?
A
mammillary bodies - anterior thalamic nucleus
16
Q
Where is Broca’s area located?
A
left inferior frontal gyrus
17
Q
What are the signs of an UMN lesions?
A
spastic tone, no fasciculations, minimal wasting, hyperreflexia, decreased speed
18
Q
What are the signs of a LMN lesion?
A
flaccid tone, fasciculations present, significant wasting, hyporeflexia, no speed
19
Q
What is the triad for meningitis?
A
Headache, neck stiffness and vomiting
20
Q
What kind of brain bleeds causes a berry aneurysms?
A
Subarachnoid haemorrhage
21
Q
What is the spinothalamic tract responsible for? (sensory)
A
anterior = crude touch and pressure
lateral = temperature and pain
22
Q
What does the dorsal column and medial leminiscus tract (sensory) do?
A
Fine touch and conscious proprioception
23
Q
What does the spinocerebellar tract (sensory) do?
A
Carries unconscious proprioception information to the cerebellum. ( does not decussate)
24
Q
How do you treat delirium in patients with PD or Lewy body dementia?
A
Lorazepam (benzodiazepine)
25
What does the corticospinal tract do and what is it controlled by? (motor)
Voluntary control by the cerebral cortex
26
What is the difference between the lateral CST and ventral CST decussation?
lateral = pyramidal decussation
ventral = fibres stay ipsilateral and decussate more caudally
27
After what is an extradural haemorrhage likely to occur?
Trauma, linear skull fracture
28
What types of epilepsy does carbamazepine worsen?
absence and myoclonic seizures
29
Which type of intercranial bleed present with a crescent shape on head CT?
subdural haematoma
30
What is the triad for normal pressure hydrocephalus?
gait disturbances, cognitive impairment, impaired bladder control
31
How soon does thrombolysis need to be performed?
<4.5hrs
32
When there is a weakness in the SCN which side does the head turn to?
turns to the opposite side
33
For BPPV which is the diagnostic test and the treatment?
dix-hallpike = diagnostic
epley manoeuvre = treatment
34
What does PITS stand for?
parietal inferior, temporal superior
35
What is a risk factor for mononeuritis multiplex?
diabetes, foot drop (peroneal palsy)
36
What is the treatment for MND?
riluzole (sodium channel blocker)
37
What is specific for a lacunar stroke?
No visual field deficits, higher cerebellar dysfunction, brainstem dysfunction
38
What does a lumbar puncture in a SAH look for?
xanthochromia
39
What is Broca's area function?
Language production (anterior):
expressive aphasia
40
What is wernicke's area function?
Language comprehension (posterior):
receptive aphasia
41
What investigations should be done in MG?
blood tests, chest CT (thymoma), nerve conduction studies
42
What is the medical treatment for MG?
anti-cholinesterase inhibitors (e.g. pyridostigmine or neostigmine).
43
What are the layers of the brain from the outermost?
Skull, dura mater, arachnoid mater, subarachnoid space, pia mater, brain parenchyma
44
When CN XII is affected which side will the tongue go towards?
To the affected side.
45
When does guillain-barre syndrome present?
1-3 weeks after infection
46
What is commonly associated with lambert-eaton myasthenic syndrome (LEMS)?
small cell lung cancer
47
What is the pathophysiology of LEMS?
Impaired influx of calcium at the presynaptic nerve terminal which reduces the release of Ach into the synaptic cleft.
48
What tests would you do for LEMS?
bloods - to check calcium
nerve conduction studies - double of muscle action potential
49
How is a diagnosis of MS made and what does it show?
MRI = periventricular white matter lesions
CSF = oligoclonal bands
50
How is acute MS treated?
glucocorticoids:
1g of intravenous methylprednisolone every 24 hours for 3 days
51
How is chronic MS treated?
beta-interferon injections
52
What is the pathophysiology for MG?
An autoimmune disease characterised by antibodies against the nicotinic acetylcholine receptors on muscle fibres. This limits the ability of acetylcholine to cause muscle contraction.
53
Which characteristics are specific to a parietal lobe focal seizure?
sensory symptoms - tingling, numbness
54
If there is a brain bleed and the patient regularly takes warfarin what should be done?
stop warfarin and start IV vit k and prothrombin complex concentrate
55
What is seen on an MRI for MS?
periventricular white matter lesions
56
What is the first line treatment for a migraine?
sumatriptan
57
What medication is used for migraine prophylaxis?
propranolol (CI = asthma), topiramate (if cannot tolerate bb)
58
What vitamin deficiency leads to wernicke's encephalopathy?
B1 - thiamine
59
What medication is started for an extradural haematoma and why?
mannitol to decrease the raised ICP
60
What kind of headache presents at night?
cluster headache
61
What organism causes encephalitis?
HSV 1
62
Which is quicker heparin or warfarin?
heparin
63
How is AD treated?
anticholinesterase inhibitors (e.g. galantamine, rivastigmine, donapezil)
64
What is a common unilateral throbbing headache?
a migraine
65
What drug worsens absence seizures?
carbamazepine
66
Which kind of dementia presents with hallucinations?
lewy body dementia
67
Which type of cell are the CNS and PNS nerves myelinated by?
CNS = oligodendrocytes
PNS = Schwann cells
68
What does a broad based gait imply?
cerebellar ataxia
69
How can encephalitis be differentiated from meningitis?
It presents with personality/behavioural changes, altered levels of consciousness, seizures
70
What are the types of MND?
Spinal ALS - classic
Bulbar ALS - early tongue and bulbar involvement
Progressive muscular atrophy - with only lower motor neuron features
Primary lateral sclerosis - with only upper motor neuron features
71
What is a bulbar palsy?
Lower motor neuron lesion which affects CN XI, X, XII.
72
What are the features of cerebellar syndrome?
DANISH:
Dysdiadochokinesia an inability to perform rapid alternating hand movements, Ataxia,
Nystagmus, Intention tremor,
Slurred speech, Hypotonia
73
Myoclonic seizures vs tonic-clonic seizures?
In myoclonic there is jerking but there is no loss of consciousness.
74
How does a subdural haematoma present on CT?
hypodense, crescent shape
75
Which lobe is responsible for personality changes?
frontal
76
Which part of the brain shows widespread cerebral atrophy in AD?
hippocampus
77
What 2 management options should be done for a patient presenting with stroke <4.5hrs?
1. thrombolysis
2. aspirin 300mg in 24hrs
78
What is the MOA of benzodiazepines?
They facilitate the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS.
79
What is the first line treatment for status epilepticus?
IV lorazepam (benzodiazepine)
80
What are the features of PICA (lateral medullary)?
Ipsilateral: facial pain and temp. loss
Contralateral: limb/torso pain and temp. loss
Ataxia, nystagmus
81
What are the features of basilar artery stroke?
"locked in syndrome"
82
What are the features of anterior inferior cerebellar artery (lateral pontine)?
Ipsilateral: facial paralysis and deafness and PICA symptoms
83
Which antibodies are directed against in MG?
Postsynaptic acetylcholine receptors.
84
What type of headache presents after a head injury with a brief duration of unconsciousness, followed by improvement (lucid interval)?
extradural haemorrhage
85
What is the treatment for MND?
riluzole
86
What headache presents with lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing?
cluster headache
87
What is the treatment for a TIA?
aspirin 300mg
88
Which condition is associated with small cell lung cancer?
Lambert-eaton
89
What brain bleed shows a crescent shape on CT?
subdural haematoma
90
How is the respiratory system monitored in Guillian-barre?
FVC
91
What is the first line treatment for trigeminal neuralgia?
carbamazepine
92
What headache is more likely in a patient with PCKD?
subarachnoid haemorrhage
93
What is modafinil used for?
To treat fatigue in MS.
94
What neurotransmitter is decreased in AD and Huntington's?
acetylcholine
95
What neurotransmitter is decreased in PD?
dopamine
96
What cells make up the BBB?
astrocytes - specialised glial cells
97
What cells are destroyed in MS?
oligodendrocytes - which leads to demyelination
98
Where are schwann cells derived from?
neural crest
99
Where is your circadian rhythm regulated?
suprachiasmatic nucleus part of the hypothalamus
100
What is the difference between the medial and lateral geniculate nucleus?
medial - auditory
lateral - visual
101
What part of the brain if affected in PD?
substantia nigra
102
What is the mode of inheritance for huntington's?
autosomal dominant - on chromosome 4
103
What is seen on a CT for huntington's?
Enlarged lateral ventricles, atrophy of putamen, defined sulci.
104
What part of the brain is responsible for jerky, sudden movements?
basal ganglia
105
What is dysarthria?
Motor inability to speak.
106
What are the 4 types of glial cells and what do they do?
1. oligodendrocytes - produces the myelin sheath in the cns
2. microglial - phagocytic cells
3. astrocytes - support, maintains homeostasis and BBB
4. ependymal - lines the ventricles
107
How is normal pressure hydrocephalus treated?
If suitable for surgery shunting.
108
What is the treatment for encephalitis?
ceftriaxone and acyclovir for 2 weeks
109
How is MG treated?
Anticholinesterase inhibitors (e.g. pyridostigmine or neostigmine).
110
What is the treatment for trigeminal neuralgia?
carbamazepine (first line)
phenytoin
lamotrigine
gabapentin
111
What nerves are responsible for pupillary reflex to light?
CN II - afferent
CN III - efferent
112
What space and level is a lumbar puncture done?
subarachnoid space
Between L3 and L4 / L4 and L5 - to avoid the conus medullaris
113
What do amyloid plaques present in?
AD
114
What is the treatment for cluster headaches (acute and long term)?
acute = high flow 100% oxygen in a non-rebreather mask, subcutaneous sumatriptan can help
chronic = verapamil, topiramate
115
Which artery is torn in an extradural haemorrhage and what layers does the blood pool between?
middle meningeal artery - between dura and pterion bone
116
What are the 3 clinical features of TACS?
1. hemiparesis / hemisensory loss
2. homonymous hemianopia
3. high cognitive dysfunction (e.g. dysphagia)
117
What is the ROSIER scoring system used for?
stroke in A&E
118
What are the 4 types of posterior strokes?
1. Basilar artery occlusion - present with locked in syndrome
2. Anterior inferior cerebellar artery - lateral pontine syndrome (similar to the lateral medullary syndrome) but with addition of pontine cranial nerve nuclei.
3. Wallenberg's syndrome (lateral medullary syndrome) - ipsilateral Horner's syndrome, ipsilateral loss of pain and temperature sensation on the face, contralateral loss of pain and temperature sensation over the contralateral body.
4. Weber's syndrome/medial midbrain syndrome (paramedian branches of the upper basilar and proximal posterior cerebral arteries) - ipsilateral oculomotor nerve palsy and contralateral hemiparesis.
119
Which structures are ruptured and where does the blood pool in a subdural haemorrhage?
Bridging veins - dura and arachnoid
120
Which structure is ruptured and where does the blood pool for a subarachnoid haemorrhage?
aneurysms - between arachnoid and pia mater
121
What are the 6 types of brain herniations?
1. uncal transtentorial - CN III palsy
2. central transtentorial - coma
3. subfalcine - ACA infarct
4. transcalvarial - trauma, surgery
5. ascending transtentorial - coma
6. tonsillar - cardio issues
122
What is the tentorium of the brain?
It is in the cerebellum and a line in the posterior cranial fossa.
123
If a tumour is causing an usual change in personality and behaviour where is it?
frontal lobe
124
What are type of glial cancers?
1. astrocytoma - over half (posterior cranial fossa)
2. oligodendroglioma (frontal)
3. ependymoma - rare
125
What is the most common type of brain cancer in children and where in the brain?
medulloblastoma - near the cerebellum
126
What is a cancer of the meninges called and which lobe is it most likely to be in?
meningiomas (25% of brain cancers and usually low grade) - parietal lobe
127
What are the main risk factors for brain cancer?
females, previous radiotherapy, weakened immune system (HIV), VHL, neurofibromatosis, tubal sclerosis
128
How are astrocytomas graded?
Grade 1 - pilocytic astroma
Grade 2 - low-grade diffuse astrocytoma
Grade 3 - anaplastic astrocytoma
Grade 4 - glioblastoma multiforme (GBM)
129
Which nerve is a space occupying lesion most likely to affect and why?
Abducens - exits the ventral pons and travels upwards before protruding forward through the cavernous sinus and compressed against the sphenoid bone.
130
What is the vestibulospinal tract responsible for?
It controls balance and posture by innervating the anti-gravity muscles (extensors for legs and flexors for arms).
131
What does the limbic system do and where is it?
Medial hemisphere surface surface that encircles the corpus callosum.
The limbic system serves for higher emotional functions and contains a major component of the memory system.
132
What system does the basal ganglia control and what structures make up the BG?
Motor system - caudate nucleus, putamen and globus pallidus.
133
"Butterfly" appearance on MRI indicates what?
glioblastoma multiforme
134
How do cerebellar symptoms present?
ipsilateral
135
What changes is present on scan for AD?
Widespread cerebral atrophy mainly involving the cortex and hippocampus
136
What is a serious side effect of lamotrigine?
Steven Johnson syndrome
137
When is IV acyclovir used for HZV?
orbital involvement
138
Who is topiramate contraindicated in?
women of childbearing age
139
What deficiency causes spinal cord degeneration?
vitamin B12
140
What is a prophylactic medicine for cluster headaches and what is used for relief?
prophylaxis - verapamil (CCB)
relief - sumatriptan
141
What drugs worsen MG?
beta blockers, lithium, antimalarials
142
What is the function of GABA receptors?
To reduce neuronal excitability by inhibiting nerve transmission.
143
What condition increases the chance of third nerve palsy?
diabetes
144
What is a clinically relevant aspect of the cavernous sinus?
They have no valves so the spread of sepsis is potent.
