Neurology Flashcards
Which blood vessel is most likely to cause an extradural haemorrhage?
Middle meningeal
Which blood vessel is most likely to cause a subdural haematoma?
Bridging Veins
At what GCS should you consider securing the airway?
<8
What medication is used in subarachnoid haemorrhage and why?
Nimodipine to prevent vasospasm
What is the pupil response in optic neuritis?
Relative afferent pupillary defect
What is the visual field defect in optic neuritis?
Central Scotoma
What is the pathophysiology of Multiple Sclerosis?
Demyelination in the CNS
What would you find on lumbar puncture in MS?
Oligoclonal bands
What is the treatment of relapses in MS?
Methylprednisolone
What is the most common type of MND?
Amyotrophic Lateral Sclerosis
What medication is licensed to slow down progression in MND?
Riluzole
What is Parkinson’s + Autonomic dysfunction called?
Multiple System Atrophy
What is Parkinson’s + Varying alertness called?
Lewy body dementia
What type of seizure might involve memory flashbacks?
Focal Seizure
What type of seizure might involve unresponsive staring?
Absence seizures
What type of seizure might involve ‘‘Drop attacks’’?
Atonic Seizures
What type of seizure might involve muscle jerks?
Myoclonic seizures
What are the typical symptoms of an acoustic neuroma?
- Unilateral Hearing Loss
- Tinnitus
- Balance problems
What type of genetic disorder is Huntington’s chorea?
Trinucleotide repeat disorder
What is the term used in Huntington’s chorea when there is an earlier age of onset and increase in severity in later generations?
Anticipation
What is the specific test used for myasthenia gravis?
Edrophonium test
Stroke in the anterior cerebral artery effects?
Contralateral hemiparesis and sensory loss, lower extremity > upper
Stroke in the middle cerebral artery effects?
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Stroke in the posterior cerebral artery effects?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Bell’s Palsy: UMN or LMN lesion?
LMN facial nerve palsy –> Forehead affected
Management of myasthenic crisis
- Plasmapheresis
- IV immunoglobulins
First line treatment for Trigeminal neuralgia?
Carbamazepine is first line
What is the Barthel index used for?
A scale that measures disability or dependence in activities of daily living in stroke patients
What is the first line drug treatment for Myoclonic seizures?
Levetiracetam
Signs of Subacute combined degeneration of the spinal cord
Distal tingling/burning/sensory loss which is symmetrical and tends to affect the legs more than the arms.
Muscle weakness, hyperreflexia and spasticity
Gait abnormalities
Positive Romberg’s sign
Key diagnostic test for Guillain-Barre syndrome?
Lumbar puncture - rise in protein with a normal white blood cell count
What are the clinical features of Parkinson’s disease?
Bradykinesia
Rigidity
Tremor
Postural instability
Other features include: Depression, REM sleep disorder, autonomic dysfunction, anosmia, dementia
What is required for a diagnosis of MS?
Demyelinating lesions that are separated in space and time
Areflexia, ataxia and ophthalmoplegia, most likely diagnosis?
Miller Fisher syndrome
What is the preferred modality of brain imagine for a suspected TIA?
MRI brain with diffusion-weighted imaging
What is seen in a cerebrospinal fluid sample in a patient with a subarachnoid haemorrhage?
Raised red cell count
Xanthochromia
What is the first-line diagnostic investigation in a suspected subarachnoid haemorrhage?
CT head
What visual field defect is often associated with pituitary tumours?
Bitemporial hemianopia
What term describes the first episode of demyelination and neurological signs and symptoms in patients who may or may not go on to develop multiple sclerosis?
Clinically isolated syndrome
What medication is started while waiting for specialist assessment in a patient with a suspected TIA within the past week, where the symptoms have completely resolved within 24 hours of onset?
Aspirin 300mg daily
What term describes increased resistance to the passive movement of a joint?
Rigidity
What is the characteristic pattern of demyelinating lesions in multiple sclerosis?
Disseminated in time and space (they vary in location over time)
In which part of the brain are changes most likely to be found in early Alzheimer’s disease?
Temporal lobe
What is the most important lung function test to monitor in Myasthenic crisis?
FVC
Myasthenic crisis is an acute respiratory failure characterised by forced vital capacity below 1L, Negative inspiratory force of 20cm H2O or less and the need for ventilatory support
What are the complications of meningococcal sepsis?
- Septic shock
- Hearing loss
- Intellectual impairment
- Seizures
What CT head changes would you see in Herpes simplex encephalitis?
You would see subtle low density changes in the anterior and medial aspects of the temporal lobes
What is the preferred antiplatelet for secondary prevention following a stroke?
Clopidogrel
What is the second like antiplatelet for secondary prevention following a stroke?
Aspirin plus MR Dipyridamole if clopidogrel is not tolerated
How might a patient with MS present?
Non-specific symptoms such as lethargy.
What visual symptoms might a patient with MS have?
- Optic neuritis: Common
- Optic atrophy
- Uhthoff’s phenomenon: worsening of vision following rise in body temperature
- Internuclear ophthalmoplegia
What sensory symptoms might a patient with MS present with?
- Pins/needles
- Numbness
- Trigeminal Neuralgia
- Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion
What motor symptoms might a patient with MS present with?
- Spastic weakness: most commonly seen in the legs
What are the risk factors for idiopathic intracranial hypertension?
- Obesity
- Female sex
- Pregnancy
- Drugs such as COCP, steroids, tetracyclines, retinoids, lithium
What are the features of idiopathic intracranial hypertension?
- Headache
- Blurred vision
- Papilloedema (usually present)
- Enlarged blind spot
- Sixth nerve palsy may be present
What is the management of idiopathic intracranial hypertension?
- Weight loss
- Carbonic anhydrase inhibitors e.g. acetazolamide
- Topiramate
Surgery may be needed
What is the most common complication following bacterial meningitis?
Sensorineural hearing loss
What is Brown-Séquard syndrome characterized by?
Anatomical disruption of nerve fibre tracts in one half of the spinal cord
What are the clinical features of Brown Séquard syndrome?
Disruption of descending lateral corticospinal tracts, ascending dorsal column and ascending spinothalamic tracts leads to the following findings below the level of the injury:
- Ipsilateral hemiplegia
- Ipsilateral loss of proprioception and vibration
- Contralateral loss of pain and temperature sensation
What are the causes of Brown Séquard syndrome?
- Cord trauma (penetrating injuries being the most common)
- Neoplasms
- Disc herniation
- Demyelination
- Infective/inflammatory lesions
- Epidural haematomas
What is the aetiology of cervical spondylosis?
- Aging, leading to degeneration of the discs and joints of the cervical spine
- Mechanical stress of the cervical spine
- Genetic predisposition
- Previous neck injury
How do you diagnose Creutzfeldt-Jakob disease?
Tissue biopsy
What is the medical management of trigeminal neuralgia?
Carbamazepine (first-line)
Phenytoin
Lamotrigine
Gabapentin
What triad of symptoms would you expect to see in Normal Pressure Hydrocephalus?
- Dementia: Often a global cognitive impairment
- Magnetic gait: Characterized by difficulty in lifting the feet off the floor appearing as if they are “stuck”
- Incontinence: Primary urinary incontinence
What is the management of NPH?
Therapeutic lumbar punction
- Ventriculoperitoneal shunt: in patients responsive to lumbar puncture, neurosurgery may insert a shunt to permanently redirect the excess CSF from the brain to the abdomen
What are the clincial manifestations of Friedreich’s ataxia?
- Neurological symptoms: Lower limb weakness, ataxia, frequencyt falls, cerebellar signs and mixed UMN and LMN signs such as absent knee/ankle reflexes and upgoing plantars
- Sensory symptoms: impaired joint position and vibration sense due to dorsal column involvement
- Physical signs: High-arched palate, pes cavus and kyphoscoliosis
- Non-motor features: Hypertrophic obstructive cardiomyopathy, reduced visual acuity, T1DM and deafness
What does a Arnold-Chiari Malformation describe?
The downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum
At what level would the injury be to get Autonomic Dysreflexia?
At or above T6
How does Autonomic Dysreflexia present?
Extreme hypertension
Flushing
Sweating
Agitation
What is the management of a cerebral abscess?
Surgery: Craniotomy with debridement
IV antibiotics
What is the most common primary brain tumour in adults?
Glioblastoma multiforme
What does GBM look like on imaging?
Solid tumours with central necrosis and a rim that enhances with contrast
What are the symptoms of cerebellar disease?
D- Dysdiadochokinesia, Dysmetria
A- Ataxia
N- Nystagmus (horizontal=ipsilateral hemisphere)
I- Intention tremor
S- Slurred staccato speech, scanning dysarthria
H- Hypotonia
How do you calculate the cerebral perfusion pressure?
CPP= MAP-ICP
What is the circulation of CSF?
- Lateral ventricles (via foramen of Munro)
- 3rd ventricle
- Cerebral aqueduct (aqueduct of Sylvius)
- 4th ventricle (via foramina of Magendie and Luschka)
- Subarachnoid space
- Reabsorbed into the venous system via arachnoid granulations into superior sagittal sinus
What are the features of Charcot-Marie-Tooth Disease?
- There may be a history of frequently sprained ankles
- Foot drop
- High-arched feet (pes cavus)
- Hammer toes
- Distal muscle weakness
- Distal muscle atrophy
- Hyporeflexia
- Stork leg deformity
What is Charcot-Marie-Tooth disease?
The most common hereditary peripheral neuropathy
What is internuclear ophthalmoplegia?
A cause of horizonal disconjugate eye movement which is due to a lesion in the medial longitudinal fasciculus (MLF)
What are the features of Internuclear ophthalmoplegia?
- Impaired adduction of the eye on the same side as the lesion
- Horizonal nystagmus of the abducting eye on the contralateral side
What are the causes of internuclear ophthalmoplegia?
Multiple sclerosis
Vascular disease
What condition is Lambert-Eaton Myasthenic syndrome seen with?
Small cell lung cancer and to a lesser extent breast and ovarian cancer
What is LEMS caused by?
Caused by an antibody directed against presynaptic voltage-gated calcium channel in the peripheral nervous system
What are the features of LEMS?
Repeated muscle contractions lead to increased muscle strength (opposite to MG)
Limb-girdle weakness
Hyporeflexia
Autonomic symptoms: dry mouth, impotence, difficulty micturating
What would you see on EMG in LEMS?
Incremental response to repetitive electrical stimulation
What are the features of Neurofibromatosis type1?
Cafe-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
What are the features of Neurofibromatosis type 2?
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, mengiomas and ependymomas
What is the characteristic feature of Tuberous sclerosis?
The development of hamartomas, which are benign tissue growths.
What are some of the skin features of tuberous sclerosis?
Ash leaf spots (depigmented areas of skin shaped like an ash leaf)
Shagreen patches (thickened, dimpled, pigmented patches of skin)
Angiofibromas (small skin-coloured or pigmented papules that occur over the nose and cheeks)
Ungual fibromas (circular painless lumps that slowly grow from the nail bed and displace the nail)
Cafe-au-lait spots (light brown “coffee and milk” coloured flat pigmented lesions on the skin)
Poliosis (an isolated patch of white hair on the head, eyebrows, eyelashes or beard)
What are some causes of transverse myelitis?
Lyme disease
Syphilis
Measles
Viral/Bacterial/Fungal infection
Immune system disorders
Can also be a warning sign of multiple sclerosis
What is a bulbar palsy?
Refers to a set of signs and symptoms linked to the impaired function of the lower cranial nerves ( CNIX, X, XI, XII) Classified as progressive or non progressive
What are some of the symptoms of bulbar palsy?
- Dysphagia
- Reduced/absent gag reflex
- Slurred speech
- Aspiration of secretions
- Dysphonia
- Dysarthria
- Drooling
What are some of the causes of bulbar palsy?
- Brainstem stroke and tumours
- Degenerative diseases (ALS)
- Autoimmune diseases (GBS)
What is the most common cause of anterior cord syndrome?
Anterior spinal artery ischaemia
What is the clinical presentation of anterior cord syndrome?
- Complete motor paralysis below the level of the lesion due to involvement of the anterior horn cells and corticospinal tracts
- Loss of pain and temperature
- Autonomic dysfunction
- Bladder and bowel
What is the investigation for Narcolepsy?
Multuple sleep latency EEG
What is the management for Narcolepsy?
Daytime stimulants and nighttime sodium oxybate
Which is more severe, Duchenne or Becker muscular dystrophy?
Duchenne
What sign would you see in Duchenne muscular dystrophy?
Gower’s sign: child uses arms to stand up from a squatted position
What cells are damaged in MS?
Oligodendrocytes
What criteria are used to confirm a diagnosis of MS?
McDonald criteria
What are the three components of the Cushing’s reflex?
Hypertension
Bradycardia
Irregular breathing pattern
Give some signs of an expanding EDH as it enlarges and before it ultimately results in coning?
- Headache
- Nausea and vomiting
- Slow slurred speech
- Papilloedema
- Seizures
- Reduced GCS
What is coning?
- Herniation of the cerebellar tonsils through the foramen magnum
- Leads to compression to the brainstem (and respiratory arrest)
What is the definition of a stroke?
A Rapidly developing focal neurological deficit of vascular origin lasting over 24 hours or resulting in death
What is the distribution of sensory loss in syringomelia?
Cape like
