Neurology Flashcards
What is the most common type of stroke?
Ischaemic
List mechanisms of ischaemic stroke
Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis
What area of the brain does the anterior cerebral artery supply?
Anteromedial area of cerebrum
What area of the brain does the middle cerebral artery supply?
Lateral cerebrum
What area of the brain does the posterior cerebral arteries supply?
Medial and lateral areas of the posterior cerebrum
List the Oxford classification criteria for a Total anterior circulation stroke (TACS)
All 3 of the following:
Unilateral weakness of face arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
List the Oxford classification for a Partial anterior circulation stroke (PACS)
Two of the following:
Unilateral weakness of face arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
List the Oxford classification for Posterior circulation syndrome (POCS)
One of the following
Cranial nerve palsy and contralateral motor/sensory deficit
bilateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction ( vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia
List the Oxford classification for a Lacunar stroke (LACS)
One of the following
Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis
common presentation of extradural haemorrhage
lucid intervals followed by unconsciousness - (they’re being EXTRA)
CT scan of extradural haemorrhage
hyperdense biconvex lens appearance
IgG oligoclonal bands in cerebrospinal fluid
Multiple Sclerosis
early clinical signs of huntington’s disease
clumsiness, agitation, abnormal eye movements
What amino acid is overly expressed in Huntington’s disease?
Glutamate
classification of a lacunar stroke
one of the following:
pure sensory
pure motor
ataxic hemiparesis
Main job of vestibulospinal tract
activate anti-gravity extensor muscles
Main job of tectospinal tract
reflex to visual and auditory stimulus
-head automatically moving to watch cool ‘tech’ car go past
main job of the reticulospinal tract
breathing and cardiac control
main job of lateral and ventral corticospinal tract
majority of motor function
what is spasticity?
a stretch reflex disorder that is apparent on repetitive stretching of muscle causing increased tone
is spasticity an upper or lower motor neuron manifestation?
UPPER motor neuron disorder- muscle is in tact but descending controls from brain not working
first line management of status epilepticus
benzodiazepines
common cause of communicating hydrocephalus
subarachnoid haemorrhage and meningitis
common cause of non-communicating hydrocephalus
tumours and lesions
pathophysiology of communicating hydrocephalus
CSF able to exit but absorption into venous system is impeded
what kind of stroke shows hyper attenuation on CT
haemorrhagic stroke
(hyper-attenuation = formation of acute blood clot )
what are the causes of haemorrhagic stroke
vasculitis or vessel wall abnormalities
what is the acute management to reduce severity of Multiple Sclerosis attacks?
methylprednisolone
what is the chronic management of multiple sclerosis?
disease modifying drugs- interferon beta, glatiramer acetate, natalizumab
symptom control- cannabinoids, symptom basis
where is broca’s area located?
frontal lobe
where is wernicke’s area located?
temporal lobe
what is symptom of Broca’s aphasia
Broken speech
what is symptom of Wernicke’s aphasia?
Word scramble/ Weird speech
worsening back pain and leg weakness with walking, with relief on forward bending is a common presentation of what?
spinal claudication
role of the hippocampus?
important in moving stuff from short term to long term memory
location of the hippocampus
deep brain in temporal lobe
what nerve is responsible for afferent limb or corneal reflex?
ophthalmic nerve - CNVi
what is the mechanism of action of baclofen?
agonist of GABA receptors - upregulates inhibition of muscle contraction -> decreases muscle spasms and spasticity
role of the amygdala?
processing of memory and emotional reactions
what artery supplies the amygdala? and what symptoms occur if this becomes damaged?
Kluver-Bucy syndrome - hyperphagia, hypersexuality, pica and docility
anatomical course of the optic radiations from the retina? (parietal and temporal lobes)
parietal lobe carries information from inferior quadrant of retina
temporal lobe carries information from superior quadrant of retina
are cranial nerve lesions ipsilateral or contralateral?
all are ipsilateral (except trochlear)
what is the rule of 4 when it comes to origins of nuclei?
1st 4 (except I and II) = midbrain
2nd 4 (V, VI, VII and VIII) = pons
3rd 4 (IX, X, XI and XII) = medulla oblongata
what are the different types of MS?
relapsing remitting, secondary progressive, primary progressive
what is the medical management for fatigue in MS patients?
Amantadine
what gene is most likely mutated in early onset familiar Alzheimer’s disease?
presenilin 1 gene
(also APP or presenilin 2)
what gene is most likely mutated in sporadic Alzheimer’s disease
APOE e4
what mode of inheritance is Huntington’s disease?
autosomal dominant
(CAG trinucleotide repeat)
symptoms of cerebellar syndrome
DANISH
dysdiadochokinesia
ataxia
nystagmus
intention tremor
slurred speech
hypotonia
what are some causes of cerebellar syndrome
alcohol
Multiple sclerosis
stroke
cerebellar haemangioma
management of motor fluctuations in parkinson’s patients
MAO-B inhibitor - e.g. Risagiline
what should be prescribed alongside Levodopa to increase the bioavailability of it in Parkinson’s patients?
Carbidopa or Benserazide
what class of medications should be avoided in Parkinson’s patients?
anti-psychotics e.g. Haloperidol
– blocks dopamine- worsens motor function
short term side effects of ECT
headache, nausea, memory impairment and cardiac arrythmias
Management of acute confusional state
if treatment of underlying cause and environmental modification not working then
medication = haloperidol
(unless Parkinson’s then use Lorazepam)
First line investigation if vascular dementia is suspected
MRI head
Neuroleptic malignant syndrome presentation
adverse reaction to antipsychotics - e.g. haloperidol
symptoms - sweating, fever, rigidity, confusion, fluctuating blood pressure and tachycardia
signs- increase creatinine kinase diagnostic
lumbar puncture findings for viral meningitis
pleomorphic lymphocytosis, normal glucose and moderately raised protein
clear appearance
lumbar puncture for bacterial meningitis
neutrophilic pleocytosis, decreased glucose and increased protein
cloudy appearance
what are the myelin producing cells in the CNS
oligodendrocytes
what are the myelin producing cells in the PNS
schwann cells
(swans float down the Ponds)
neuropathic pain management
Don’t Get Pain Again
duloxetine
gabapentin
pregabalin
amitriptyline
organism most associated with Guillain Barre syndrome
campylobacter jejuni
hypodense vs hyperdense on CT
hypodense bleeding = dark => chronic
hyperdense bleeding = white => acute
drug used to prevent vasospasm in subarachnoid haemorrhages
nimodipine - calcium channel blocker
medication of choice for patients with primary chronic pain (chronic pain without an obvious underlying cause)
antidepressants - e.g. amitriptyline, duloxetine or an SSRI
first line management of trigeminal neuralgia
carbamazepine
management of status epilepticus
First line - give benzodiazepine immediately - buccal or rectal
OR give IV lorazepam if IV access and facilities available
if not stopping the -> after 5-10 minutes give second dose of benzo/lorazepam
if still no response
give IV phenytoin / levetiracetam / sodium valproate
NICE guidelines for investigating head injury within 1 hour
GCS <13 on initial assessment
GCS <15 at 2 hours post injury
suspected open or depressed skull fracture
any sign of basal skull fracture - ‘panda eyes’ , cerebrospinal fluid leakage, battle’s sign
seizure
focal neurological deficit
> 1 episode of vomiting
NICE guidelines for investigating head injury within 8 hours
adults with following who have experienced some loss of consciousness or amnesia since injury:
age >65
any history of bleeding or clotting disorders
dangerous mechanism of injury
>30 mins retrograde amnesia immediately before injury
Horner’s syndrome presentation
ptosis, miosis and anhydrosis
afferent limb of the jaw jerk reflex
CN V3 - mandibular
where do the preganglionic neurons of sympathetic nervous system originate from
T1- L2/3
mechanism of action of carbamazepine
sodium channel inhibitor - stabilise hyperexcitable neuronal membranes
Characteristics of frontal lobe dysfunction
- perseveration = continued behaviour or action e.g. repeating question over and over
- executive dysfunction e.g. planning, organising and initiating tasks
characteristics of temporal lobe dysfunction
- auditory hallucinations
- memory disturbances
- language comprehension
- emotion changes
where does the blood from the dural venous drain
internal jugular vein
what areas of spinal cord are affected in subacute combined degeneration of the cord
dorsal - fine touch and vibration
lateral - corticospinal tracts -motor
Initial non-motor signs of Parkinson’s
depression
anxiety
memory loss
olfactory problems
sleep disturbance
constipation
balance issues
pharmacological management of idiopathic intracranial hypertension
acetazolamide
medication of choice for Parkinson associated delusions
typical antipsychotics - olanzapine, risperidone
first line medication for medical assisted detoxification
chlordiazepoxide
sensory tracts
dorsal column
spinothalamic
features of Wernicke’s Encephalopathy
CAN OPEN
confusion
ataxia
nystagmus
ophthalmoplegia
PEripheral
neuropathy
name the different Parkinson’s Plus syndromes
multiple system atrophy
cortico-basal degeneration
progressive supranuclear palsy
lewy body dementia
name the different types of Motor Neuron Disease
spinal amytrophic lateral sclerosis- most common - UPPER AND LOWER
progressive muscular atrophy - ONLY LOWER
progressive bulbar palsy
primary lateral sclerosis - ONLY UPPER
name different patterns of Multiple Sclerosis
relapsing-remitting
secondary progressive
primary progressive
describe brown sequard syndrome
ipsilateral weakness and loss of fine touch, joint proprioception and vibration
contralateral loss of pain and temperature
first line treatment for trigeminal neuralgia
carbamazepine
prophylaxis medications for migraine
topimarate- contraindicated in females of childbearing age
propranolol - contraindicated in asthma
amitriptyline
what antibiotics are most commonly associated with lowering the seizure threshold
cirpofloxacin - and other quinolones
what side will the uvula deviate towards if there is a problem with the left vagus nerve
to the right side
cerebellar dysfunction symptoms
D- dysdiadochokinesia
A- ataxic gait
N- nystagmus (horizontal)
I- intention tremor
S- slurred staccato speech
H- hypotonia
what does a lesion in right hypoglossal nerve cause
tongue to deviate to the right
‘tongue towards affected side’
where does Wernicke’s encephalopathy cause neuronal death
mamillary bodies
periaqueductal grey matter
fourth ventricle
thalamus
non-proliferative diabetic retinopathy
cotton-wool spots
dot-blot haemorrhages
venous bleeding
proliferative diabetic retinopathy
neovascularisation
what receptors do autoimmune antibodies target in lambert eaton syndrome
voltage gated calcium channels
pre-synaptic
what nerve supplies sensory innervation to the medial aspect of the leg
saphenous nerve
main neurotransmitter in parasympathetic
acetylcholine
acute management of migraine attack
NSAID and triptans
prophylaxis of migraine
1st - propanalol or amitriptyline
2nd - valproate
acute management of cluster headache
high flow oxygen and triptan
prophylaxis of cluster headache
verapamil
management of hemicrania headaches
indomethicin
management of trigeminal neuralgia
carbamazepine
management of idiopathic intracranial hypertension
weight loss and acetazolamide
