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Neurology Flashcards

1
Q

What is a tonic-clonic seizure

A

Generalised tonic contractions followed by clonic contractions
Begins with tonic contractions of all four limbs

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2
Q

Ketogenic diet

A

high fat
low fat
controlled high proteins

Used for epilepsy that is resistent to usual AED

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3
Q

Generlised tonic clonic management

A

1st line - Sodium valproate
2nd line - Lamotrigine

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4
Q

Sodium valproate side effects

A

Nausea
Vomiting
Abdominal pain
Liver function abnormalities

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5
Q

Oxcarbazine side effects

A

Sedation
Rash

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6
Q

Lamotrigine side effect

A

Rash

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7
Q

Carbmazepine side effect

A

Ataxia
Sedation
Leukopenia
Thrombocytopenia
Rash

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8
Q

Typical Absence and atypical absence treatment

A

1st line - Ethosuximide
2nd line - sodium valproate

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9
Q

Ethosuximide side effect

A

GI disturbance
Rash

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10
Q

Myoclonic seizures treatment

A

1st line - sodium valproate
Adjunctive - keppra or topiramate

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11
Q

Carbamazepine affect on myoclonic seizure?

A

Worsens it

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12
Q

Tonic or atonic seizure treatment

A

1st line - sodium valproate
2nd line - lamotrigine
Adjunctive - rufinamide or topiramate

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13
Q

Topiramate side effect

A

Sedation
weight loss
Paraesthesia

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14
Q

What is required for seizures

A

-Population of pathologically excitable neurones
- Increase in excitatory glutamatinergic activity through recurrent connections to spread discharge
- Reduction in normal activity of inhibitory gama-aminobutyric acid-ergic projections

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15
Q

Functions of CSF

A
  • Protect brain from impact
  • Remove waste and toxins
  • Help regulates intracerebral blood pressure
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16
Q

Where is CSF produced?

A

Produce in choroid plexus by ependymal cells

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17
Q

Route of CSF

A

Choroid plexus in lateral ventricles
Foreman of munro
Third ventricle
Aqueduct of sylvius
Fourth ventricle
Spinal cord and cerebral hemispheres

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18
Q

What reabsorbs CSF

A

Arachnoid villi

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19
Q

What is Communicating hydrocephalus

A

No obstruction between ventricles and subarachnoid space

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20
Q

Causes of communicating hydrocephalus

A

Increase excretion of CSF - choroid plexus tumour
Failure to reabsorb it - blockage of arachnid granulations by debris after meningitis or haemorrhage

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21
Q

What is non-communicating hydrocephalus

A

Physical obstruction between ventricles and subarachnoid space

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22
Q

Causes of non-communicating hydrocephalus

A

Congenital malformation - aqueduct estenosis, Arnold -Chiari malformation
Acquired obstruction - brain tumour

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23
Q

CSF results in bacterial meningitis

A

wBC 100 -10,000
Lymphocytes <100
Protein >1
Glucose <0.4

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24
Q

CSF in viral meningitis

A

WBC <100
Lympocytes 0 10 - 1000
Protein 0.4 - 1
Glucose - normal

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25
TB meningitis
WBC <100 Lympocytes 50 - 1000 protein - 1-5 glucose <0.3
26
What nerve is affected In Bell's palsy
7th cranial nerve
27
7th cranial nerve branches
temporal branch zygomatic branch buccal branch marginal mandibular branch cervical branch Sensory branch - anterior 2/3 of tongue
28
What pharyngeal pouch is 7th cranial nerve dervived from?
2nd
29
layers of brain
Cerebral cortex Pia mater Subarachnoid space (filled with CSF) Arachnoid mater Dua mater Skull Scalp
30
Where is Subdural space
Dua mater and the arachnoid mater meninges
31
Subdural haemorrhage
Causes by traumatic head injury
32
Subarachnoid haemorrahage
Thunder clap headache
33
Extradural haemorrhage
Between skull and dural mater Lucid period
34
What are EEG findings of focal seizure with partial awareness?
Centrotemporal spikes
35
What happens in a partial (focal) seizure?
Small area of brain has unusual electrical acitivity and does not affect awareness
36
Congenital malformations of brain that lead to partial / focal seizures
Sturge-Weber syndrome tuberous sclerosis focal cortical dysplasia
37
Focal Brian lesions that cause partial / focal seizures
Congenital malformations Brain tumours Benign idiopathic epilepsy syndromes
38
Clinical symptoms of seizures in occipital lobe
Simple visual hallucinations
39
Clinical symptoms of seizures in parietal lobe
Focal sensations
40
Clinical symptoms of seizures in frontal lobe
Generalised difficult to characterise sensation
41
Clinical symptoms of seizures in temporal lobe
complex visual hallucinations
42
Benign childhood epilepsy with centrotemporal spikes
Type of focal seziures Occur at night Start with buccal and throat tingling followed by tonic / clonic contractions down one side of face and drooling and inability to speak Consciousness and comprehension preserved
43
Partial / focal seizure treatment
Oxcarbamazepine Leveitiracetam
44
West syndrome features on EEG
Hypsarrhythmia
45
Absence seizures features on EEG
3 hertz spike and slow wave discharges
46
Lennox-gastaut features on EEG
1 to 2 hertz interictal slow spike waves
47
Lennox-gastuat
Mutliple seizure types Developemental delay
48
Juvenile myoclonic seizures features on EEG
4 to 5 hertz poly spike and slow wave discharge
49
Cause of Rett syndrome
sporadic mutation in MECP 2 X linked dominant inheritance
50
Clinical presentation of Rett syndrome
Aerophagia - abdominal extension and difficulty respiratory Apraxia Aphasia Drooling Abnormal breathing pattern Spinal deformity Hand sterotypes Epilepsy
51
What nerve is damaged to cause foot drop? (Weakness in dorsiflexion and eversion)
Common perineal nerve
52
Inability to plantar flex ankle and toe and invert foot - which nerve is affected?
Tibial nerve
53
How is Friedreich's Ataxia inherited?
Autosomal recessive Most patients have repeat GAA expansion of flaxtaxin gene(defect in FXN gene)
54
What does Friedrich Ataxias include?
Spinocerebellar tracts Dorsal spinal column Pyramidal tracts cerebellum medulla
55
Presentation of Friedreich's ataxia
Progressive ataxia Absence of deep tendon reflex - no achilles reflex Spasticity Peripheral neuropathy Dysarthria MSK - pes cavus, hammer toe Heart - cardiac hypertrophy, myocardial fibrosis, heart failure Diabetes Hearing loss Optic atrophy
56
Investigations for Friedreich's ataxia
Nerve conduction studies - absent sensory action potentials Genetic analysis ECG - ventricular hypertrophy with t wave inversion MRi of brain and spinal cord
57
Treatment of friedreich's ataxia
symptomatic and supportive PT's SALT Annual review of systems
58
Types of cells that line choroid plexus
simple columnar cells (Ependymal cells)
59
What is syringemyelia?
Cysts/ syrinx form on spinal cord As they widen, they compress anterior horn cells and causes fasiculations Ass. Arnold-chaira malformations and spina bifida
60
How to differientiate between neonatal hypotonia having central or peripheral cause?
weakness
61
Presentation of Central cause of neonatal hypotonia
Irritiable Microcephaly Encephalopathy normal strength Normal deep tendon reflexes
62
CNS caused of neonatal hypotonia
Genetics - Trisomy 21, Prader-Willi syndrome, Zellweger syndrome Cerebral malformations Hypoxic ischeamia encephalopathy
63
PNS causes of neonatal hypotonia
Anterior cell horn - spinal muscular atrophy NMJ - congenital myasthenia gravis Muscles- congenital myotonic dystrophy
64
Congenital myotonic dystrophy
Developmental delay Polyhydramnios and premature Baby is week - may need ventilatory support Decrease in facial expressions Decrease in reflexes and strength
65
SMA
Normal facial expressions Generalised weakness
66
Which branch of cranial 5th never has motor and sensory
mandibular
67
Where does inflammation of facial nerve cause bells palsy the most
Through the temporal bone
68

TAS (18 decks)

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