Neurology Flashcards
What are the 2 types of stroke
ischemic and haemorhagic
What is the most common type of stroke
ischemic
what are the 2 main arteries supplying the brain
vertebral arteries (posterior supply)internal carotid arteries (anterior supply)h
what do the vertebral arteries arise from and then form in the brain
arise from subclavian arteriesform the basilar artery
what is a TACS
total anterior circulation stroke
what happens in TACS
large cortical stroke, affecting parts of the brain supplied by middle and anterior cerebral arteries
what is the criteria for diagnosing TACS
all 3 must be present:1. unilateral weakness (and/or) sensory deficit of face/ arm or leg2. homonymous hemianopia3. higher cerebral dysfunction
what is PACS
partial anterior circulation stroke
what occurs in PACS
large cortical stroke, affecting parts of the brain supplied by middle and anterior cerebral arteries (Sae as TACS)
what is the criteria for diagnosing PACS
only 2/3 must be present:1. unilateral weakness (and/or) sensory deficit of face/ arm or leg2. homonymous hemianopia3. higher cerebral dysfunction
what is POCS
posterior circulation syndrome
what is the criteria for diagnosing POCS
1 or more needs to be present:1. cerebellar or brain stem syndromes (ataxia, nystagmus, vertigo)2. loss of consciousness3. isolated homonymous hemianopia
what is LACS
lacunar syndrome
what happens in LACS
subcortical stroke- due to small vessel disease
what is the criteria for diagnosing LACS
1 or more needs to be present1. unilateral weakness/ sensory deficit (arm, face, leg or all 3)2. pure sensory stroke3. ataxic hemiparesis
what is chorea
movement disorder that causes sudden, unintended, and uncontrollable jerky movements of the arms, legs, and facial muscles(dance like)
what conditions would you see chorea in
Huntingtons diseaseSLE
what is ataxia
term for a group of disorders that affect co-ordination, balance and speech
what conditions would you see ataxia in
stroke, MS, brain tumour
what is nystagmus
Rhythmical, repetitive and involuntary movement of the eyes. It is usually from side to sidePerson has no control over their eye movements
What conditions would you see nystagmus in
diseases affecting the inner ear balance mechanisms or the brainstem or cerebellum
what is myoclonus
sudden, brief involuntary twitching or jerking of a muscle or group of muscles(think of sleep starts)
what diseases might you see myoclonus in
DystoniaMultiple sclerosisParkinson’s diseaseHuntington diseaseAlzheimer’s disease
what is spasticity
abnormal muscle tightness due to prolonged muscle contraction.Velocity dependant- exaggeration of stretch reflexWill feel it catch
what conditions would you see spastcity in?
cerebral palsybrain injurystrokeMS
What is rigidity
when muscles become stiff or inflexibleindependent of velocity
what causes spasticity
damage to the pyramidal tracts
what conditions cause rigidity
parkinsons
what are the signs of an upper motor lesion
minimal atropy or contracturesincreased tone (spasticity/ rigidity) pyramidal pattern of weakness in power (extensors weaker than flexors in arm, and vise versa in legs)hyperreflexiaupgoing plantars
what are the signs of an lower motor lesion
marked atrophyfasiculationsreduced tonereduced or absent reflexpower is reduced in distribution of affected nerve (flexors weaker in arms than extensors, and vise versa in legs)
where does an upper motor neuron lesion occur
CNS (brain + spinal cord)
where does a lower motor neuron lesion occur
anywhere from anterior horn cell to the muscle
what conditions present as an upper motor neuron lesion
strokeALS (Motor neuron disease)MS
what conditions present as lower motor neuron lesions
peripheral nerve trauma/ compressionspinal muscular atrophyALS (motor neurone disease)guillaine-barre syndrome
Exampls of dopaminergic drugs
LevadopaDopamine agonistsMonoamine oxydase type B inhibitors
What is the main indication for dopaminergic drug use eg. levadopa
Treatment of parkinsons
Why do dopaminergic drugs help parkinsons
alleviates motor symptoms
MOA of dopaminergic drugs
Increase the concentration of dopamine in the brain
Contraindications of dopaminergic drugs
History of addiction, OCD, impulsive personality
Side effects of dopaminergic drugs
Nauseadaytime somnolencepostural hypotensionhallucinationsmotor symptom complications (dyskinesia)
Examples of anti-convulsants
IamotriginePhenytoinCarbamazepine
What is the main indication of anti-convulsants
Prevent epileptic seizures
Side effects of anti-convulsants
Induce hepatic enzymes- can alter efficacy of combined oral contraceptiveDon’t use progesterone only pill
Examples of cholinesterase inhibitors
Rivastigmine, donepezil
What is the main indication for cholinesterase inhibitors
Slow the cognitive decline in some forms of dementia
MOA of cholinesterase inhibitors
Inhibit cholinesterase receptors
Side effects of cholinesterase inhibitors
GI- nausea and diarrhoeaHeadacheMuscle crampsBradykinesia
Examples of opioid analgesics
Morphinediamorphinefentanylbuprenorphinetramadol
MOA of opioid analgesics
Act on G-protein-coupled opioid receptors
Side effects of opioids
Dependence/ addictionapnoeanausea, vomittingconstipationorthostatic hypotension
Examples of opioid receptor antagonists
Naloxone
What is the main indication for ORA
Reverse opioid toxicity
What is the main indication for opioid use
pain relief
What are the main indications for gabapentin and pregabalin
anti-epileptics (also chronic pain treatment)
What can carbamazepine also be used for apart from anti-convulsants
treatment for trigeminal neuralgia pain
what are fasiculi
tracts (bundles of nerve fibres)
where does information that is conscious get processes
the cerebral cortex
where does information that is subconscious get processed
cerebellum
what is another name for the 1st order neuron
primary afferent neuron
do 1st order neurons decussate or stay ipsilateral
ipsilateral
do 2nd order neurons decussate or stay ipsilateral
ducussate
where does ducussation occur
thalamus or medulla oblongata
where are the 3rd order neurons located
cell body is in the thalamus, and it’s axons pass to the somatosensory cortex
what information does the fasciculus gracilis contain
information from lower limb
what information does the fasciculus cutaneous contain
information from the upper limb
what are the 3 ascending tracts
dorsal columns (fasciculus cutaneous and gracilis)spinothalamicspinocerebellarwhat are the
what are the 2 divisions of the descending tracts
pyramidal and extra-pyramidal
what are the 4 extra-pyramidal tracts
rubrospinaltectospinalvestibulospinalreticulospinal
what is the pyramidal tract
corticospinal
what information does the dorsal columns carry
fine touch, proprioception and vibration
what information does the anterior portion of the spinothalamic tract carry
pain and temperature
what information does the lateral portion of the spinothalamic tract carry
crude touch
What information does the spinocerebellar tract carry
proprioception
What information does the rubrospinal tract carry
responsible for limb flexor
What information does the tectospinal tract carry
movement in response to visual sensory information
What information does the vestibulospinal tract carry
maintains posture
What information does the reticulospinal tract carry
reflexes and muscle tone
what information does the lateral portion of the corticospinal tract carry
skilled voluntary movement
what information does the anterior portion of the corticospinal tract carry
axial motor information
What are the 2 main arteries supplying the brain
internal carotid and vertebral arteries
what is the course of the vertebral arteries
vertebral => basilar arteries => posterior cerebral arteries
what is the course of the internal carotid arteries
internal carotid => anterior and middle cerebral arteries
what is the venous system of the brain
dural venous sinuses => internal jugular vein
what areas of the brain does the anterior cerebral artery supply
frontal and parietal cortex
Are ACA stroke common or rare
rare
What is the clinical presentation of an ACA stroke
motor deficits of the contralateral lower limbcontralateral face and arm paresissensory deficits/ memory impairments
what areas of the brain does the middle cerebral artery supply
temporal lobesprecentral/ postcentral gyrus
What is the clinical presentation of an MCA stroke
If precentral gyrus:Contralateral loss of motor innervation for the head, upper limbs or trunkIf postcentral gyrus:loss of sensation from head, upper limb and trunkCan involve broca’s/ wernicke’s area => asphasia (affects speech)
What is the most common artery involved in stroke
MCA
what areas of the brain does the posterior cerebral artery supply
occipital lobe
What is the clinical presentation of an PCA stroke
headachedizzinessvisual changes (loss, diplopia, “curtain coming down”)
