Neurology Flashcards

1
Q

What are the features of UMN lesions?

A

Hypertonia, weakness, hyperreflexia

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2
Q

What are the features of LMN lesions?

A

Fasciculations, hypotonia, weakness, hyporeflexxia

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3
Q

What are the features of Parkinsonism?

A

Tremor- resting
Rigidity- cogwheel
Akinesia/Bradykinesia
Postural Instablity

Gait shuffling gait reduced arm movement
Postural tug
Resting tremor tremor will worsen with distraction ask patient to count
Facial
Dyskinesia can be an indication SE of L Dopa
Glabellar tap
Check vertical gaze palsy
Dysdiadochokinesis
Duck move

PSP
Cerebellar and pyramidal
Postural hypotension
Handwriting
Cognitive function
Gaze palsy and cerebellar signs MSA

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4
Q

What are the causes of Parkinsonism?

A
  1. Primary (Degenerative)
    a) Parkinson’s diease
    b) Parkinsons plus syndrome or atypical Parkinson’s
    - PSP
    - Multisystem atrophy
    - Corticobasal degeneration
    - Dementia with levy body
  2. Secondary
    a) Vascular: lower body prominent
    b) Infections: HIV, syphyllis
    c) Drug induced Parkinsonism: metoclopramide, typical antipsychotics, lithium
    d) toxin induced: methanol, manganase
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5
Q

How do you differentiate between the Parkinson’s plus syndrome?

A
  1. PSP: severe postural instability, falls, dysphagia, supra nuclear vertical palsy
  2. Multisystem atrophy: Progressive autonomic dysfunction before motor symptoms with cerebellar signs
  3. Corticobasal degeneration: Asymmetric Parkinsonism, dystonia, myoclonus
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6
Q

What are the types of stroke?

A

Ischemic: embolic, atherosclerotic
Haemorrhagic: intracerebral, SAH, subdural, extrudual
Venous

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7
Q

What are the risk factors for stroke?

A

Smoking, hypertension, DM, AF, TIA, carotid artery stenosis, family history, alcohol abuse, oral contraceptive pill, PFO/ASD

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8
Q

What are the features of lacunar infarct?

A

Pure motor
Pure sensory
Ataxia hemiparesis
Dysarthria

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9
Q

What are the features of anterior circulation infarction (ACA) ?

A

Contralateral leg weakness and sensory impairment with similar but Midler upper limb signs
Face is spared
Loss of voluntary micturition resulting in urinary incontinence

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10
Q

What are the features of middle cerebral artery infarction (MCA)?

A

Contralateral weakness and sensory impairment face and arm > leg
Inability to detect sensory stimuli
Homonymous quarant/hemianopia (PITS)
Expressive and/or receptive dysphasia
Hemi-neglect/inattension usually affects the left side of the body (non-dominant) resulting from right lobe infarct

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11
Q

What are the features of posterior circulation infarction?

A
  1. Posterior inferior cerebellar artery (PICA) [lateral medullary] syndrome
    - ipsilateral pain and pinprick impairment in the face
    - contralateral trunk and extremity pain
    - dysphagia, hoarsenesss of voice
    - ipsilateral horners syndrome
    - ipsilateral cerebellar signs
  2. Anterior inferior cerebellar artery (AICA)
    - ipsilateral sensory impairment in the face
    - contralateral trunk and extremity to pain
    - paralysis of ipsilateral muscles of mastication
    - paralysis of ipsilateral face (LMN)
  3. Posterior cerebral artery (PCA)
    - contralateral homonymous hemianopia with macular sparing
    - contralateral loss of pain and temperature
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12
Q

What is Weber’s syndrome?

A

3rd nerve palsy and contralateral hemiplegia due to infarction of the medial midbrain

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13
Q

What are the causes of an ischaemic stroke?

A

Cardiac: AF, valvular, MI
Structural: carotid/aortic atherosclerosis, vasculitis
Haematological: Sickle cell, polycythaemia, APS
Others: drugs- heroin, MELAS, CADASIL

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14
Q

What are the differential diagnosis of stroke?

A

Structural:
- space occupying lesions, abscess
Infection:
- viral encephalitis, parasitic
Neuroinflammatory:
- MS, neurosarcoid, Behcet
Metabolic: hypoglycaemia
Hemiplegic migraine
Todds paresis following a focal seizure

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15
Q

What are the investigations carried out for stroke?

A

Bedside: vitals- oxygen sats, glucose, BP, 12 lead ECG

Blood test: FBC, clotting ESR, TFT, LFT, ANA and blood culture, fasting glucose, Hba1c and lipids
- thrombophilia screening if young)

Imaging:
CT brain- often normal in the acute phase proceed with MRI

CXR to rule out aspiration

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16
Q

What are the other investigations that should be carried out within 24 hours following a stroke?

A

Holter
TTE
Transcranial doppler
Carotid doppler

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17
Q

Outline the management of stroke

A

Acute:
1. Thrombolysis if within 3 hour window

  1. If more than 3 hours s
    - aspirin 300mg STAT + for 2 weeks then followed by 75mg
    - Statin
    - ACE inhibitor
    - Carotid endartectomy >70%

Conservative:
SLT review
OT , Physiotherapy, MDT

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18
Q

What are the contraindications to thrombolysis?

A

AVM/intracranial haemorrhage/ AVM
Bleeding risk
Pancreatitis/pericarditis
Systolic BP >185 or diastolic >110

19
Q

What is the NIH stroke score?

A

Assess the severity of stroke
NIHSS between 5-20 eligible for thrombolysis

20
Q

What are the findings of a cerebellar syndrome?

A

Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria
Hypotionia/hyporeflexia
DANISH

21
Q

What are the causes of cerebellar syndrome?

A

Paraneoplastic syndrome
Alcoholic cerebellar degeneration
Sclerosis (MS)
Tumour (posterior fossa SOL)
Rare (Friedrich’s and ataxia telangiectasia)
Iatrogenic (Phenytoin texicity)
Endocrine (Hypothyroidism)
Stroke (brain stem vascular event)

22
Q

What are the signs of MS?

A

Ataxia
Cranial nerve palsy
UMN spasticity and weakness, brisk reflexes and altered sensation
- relapsing and remitting
Autonomic: urinary retention or incontinence
Uhtoff phenomenon: worsening symptoms after a hot bath or exercise
Lhermitte sign: lightening pains down the spine on neck flexion due to cervical plaques

23
Q

What investigations would you do for MS?

A

MRI: periventricular white matter plaques
Visual evoked potentials for optic neuritis
CSF: oligoclonal bads

24
Q

What is INO?

A

It is a lesion at the medial longitudinal fasciculus that causes the ipsilateral eye to the lesion to fail to adduct and have nystagmus

25
How would you manage MS?
Acute setting: During a relapse high dose steroids IV methylprednisolone (need to ensure patient is counselled) Chronic: MDT approach - Disease modifying treatments IFN beta and glatiramer to reduce relapse rate, monoclonal antibody therapy - PT/OT/MSW/neurologist
26
Causes of foot drop
Muscle- weak anterior tibialis any cause of myopathy Nerve- common perineal nerve palsy--> Sciatic nerve palsy Lumbosacrap plexopathy L5 root lesion Anterior horn cell Spinal cord/brain lesion
27
Distal weakness Hyporeflexia No fasciculations Wasting of the small muscles Clawing of the hand
Peripheral motor neuropathy 1. Multifocal neuropathy 2. CIDP 3. Hereditary motor neuropathy 4. T2DM although more likely to have sensory componenet
28
What are the features of Friedrich's Ataxia?
Pes cavus Pyramidal weakness in legs Cerebellar signs Impaired vibration and joint sense Distal muscle wasting
29
What else would you examine for in Friedreichs Ataxia?
Check for nystagmus, scanning of speech and intention tremor Examine heart for Hypertrophic cardiomyopathy Eyes- optic atrophy Spine- kyphoscoliosis Urine- sugar Intellectual deterioration
30
What is the mode of inheritance of Friedrich's ataxia?
Autosomal recessive Triple repeat expansion on chromosome 9
31
What are the features of poliomyelitis?
Wasting and deformity of one lower limb or both with one side Clonus and power 0/5 Patient will have splints
32
How will you complete examination for post polio syndrome?
History of vaccinations Perform MRI scan as well as EMG
33
What are the features of facioscapulohumeral dystrophy?
Prominent ptosis Difficulty in closing the eyes Marked facial weakness with dull expressionless face with lips open and slack Wasted sternomastoids Winging of the scapula Inheritance of autosomal dominant localised on chromosome 4
34
What are the features of flaccid paraparesis?
Reduced tone bilaterally Wasting and weakness bilaterally Reduced/absent reflexes Mute/downgoing planters No sensory loss
35
Causes of flaccid paraparesis
Anterior horn cell disease MND/poliomyelitis Cauda equina syndrome Lumbosacral plexomathy Motor neuropathy : - inflammatory: GBS, CIPD, multifocal motor neuropathy, sarcoid, vasculitis - infectious: HIV, diphtheria - toxins - metabolic: diabetic amyotrophy, porphyria - drugs: ciclosporin, gold, penicillamine - congenital: Charcot marie tooth disease (HSMN) NMJ disorders: MG, LEMS LMN lesions
36
What are the features of spastic paraparesis?
Increased tone bilaterally Pyramidal weakness bilaterally Increased reflexes Sponging plantars and clonus
37
What are the causes of spastic paraparesis?
Demyelination (MS) Cord compression Trauma Anterior horn cell disease MND
38
What are the features of Charcot Marie Tooth?
Wasting of calves Clawing of toes Weakness of dorsiflexion Foot drop Absent ankle jerks Associated with clawing of the hands
39
What are the types of Charcot Marie Tooth?
Type 1- Glial myelinopathy a demyelinating neuropathy (marked slowing of conduction in motor nerves) Type 2- An axonal neuropathy (little or no slowing of nerve conduction Distal spinal. muscular atrophy
40
What are the features of myotonic dystrophy?
Frontal bladness Ptosis with a smooth forehead Cataracts Difficulty in opening the eyes after firm closure Expressionless face with temporals/masseter and sternomastoid wasting Other features: Cardiomyopathy and cardiac conduction defects Low serum ing level External opthalmoplegia EMG; waxing and waning of the potentials, dive bomber effect
41
What is the inheritance of myotonic dystrophy?
Autosomal dominant inheritance Type 1- more common and more severe is caused by expansion of CTG repeat
42
Management of Parkinson's disease
Investigations Basic blood test MRI brain to rule out structural abnormalities DAT scan Management
43
MND
Multifocal motor neuropathy → acquired auto immune ALS Progressive Cervical M