Neurology Flashcards
Other than occipital headache, name 4 symptoms or signs of SAH
Neck stiffness
Photophobia
Vomiting
Collapse
Seizures
Focal neurological signs e.g. hemiplegia, dysphagia
What is Kernig’s sign and what does it demonstrate?
The hip and knee is bent to 90 degrees, it is positive if pain is caused by straightening the knee = meningeal irritation
What would a CT head show in SAH
Blood appears white, mixed in with the CSF lying within the interhemispheric fissure, basal cisterns and ventricles
What further test would you perform if CT head doesn’t demonstrate any abnormality in SAH and what would it show?
LP
Xanthochromia (bilirubin)
RBC may also be present
GCS score eyes
nothing = 1
pain = 2
verbal command = 3
spontaneous = 4
GCS score verbal
nothing = 1
incomprehensible = 2
inappropriate = 3
confused = 4
orientated = 5
GCS score motor
nothing = 1
extension = 2
flexion = 3
withdrawal = 4
localisation = 5
obeys command = 6
What 4 bones meet at the pterion in the skull?
temporal, parietal, sphenoid, frontal
Is the bleed arterial or venous in an extradural haemorrhage?
arterial (middle meningeal)
Is the bleed arterial or venous in a subdural haemorrhage?
venous
What are the differences in the shape of haematoma on CT head scan between extradural and subdural?
extradural: biconvex
subdural: crescent
What other changes can be identified on a CT scan in a haemorrhage?
midline shift, compression of the ventricles
Other than hypertension and smoking, name 4 risk factors for ischaemic stroke
diabetes
atrial fibrillation
excess alcohol
COCP
previous TIA
Definition of a TIA
A period of neurological deficit resulting from ischaemia (but not infarction) lasting less than 24 hours
Other than hemiplegia, give 2 other signs of ischaemic stroke
Hemi sensory loss
Dysphagia
Homonymous hemianopia
What is the commonest cause of cerebral infarct and what surgical technique can be considered?
carotid artery atherosclerosis
carotid endarterectomy for severe stenosis
Name 3 other professionals other than doctor or nurse involved in stroke care
SALT
Physiotherapy
OT
What is epilepsy
transient occurrence of intermittent, abnormal electrical activity of part of the brain
What is Todd’s palsy
Temporary weakness after seizure - usually of affected limb(s)
Name 4 types of seizure
Generalised tonic clonic
Absence
Focal (partial)
Partial with secondary generalised - starts focal then spreads to general
Name 2 metabolic causes of seizures
Hypoglycaemia
Hyponatraemia
Hypernatraemia
Hypocalcaemia
What airway adjunct could you use in a patient not maintaining their airway during a seizure
nasopharyngeal airway
What are the 6 routinely performed tests to assess CN II, III, IV and VI
Visual acuity
Visual fields
Fundoscopy
Pupillary light response
Pupillary accomodation
Eye movements
Damage to what two visual structures can lead to homonymous hemianopia
optic radiation
visual cortex
Clinical test to decide whether dorsal column is intact (in the lower limbs)
proprioception and pressure
Does the dorsal column run anteriorly or posteriorly in the spinal cord
posteriorly
Where does the dorsal column decussate
medulla
What sensory modalities does the spinothalamic tract carry
pain and temperature
hemiplegia of both legs - what part of the spine has been affected
anterior
anterior cord syndrome
spinal artery occlusion causes ischaemia and hemiplegia
Describe the distribution signs found for a patient with a left-sided Brown-Sequard syndrome affecting the lumbar region
ipsilateral (left) spastic paralysis and loss of vibration and proprioception
contralateral loss of pain and temperature
Give the 2 organisms which most commonly cause meningitis in a 22 year old
Neisseria meningitidis
Streptococcus pneumoniae
Prior to performing a lumbar puncture, why might a CT head scan be performed?
To rule out raised intracranial pressure
Once a suspected meningitis patient is admitted to hospital, what group of antibiotics are the empirical treatment of choice?
cephalosporins (cefotaxime, ceftriaxone)
In query meningitis, what antibiotic will the GP give intramuscularly prior to A&E
Benzylpenicillin
Which nerve is compressed in carpal tunnel syndrome
median nerve
Which muscles in the hand are supplied by the median nerve
two lateral lumbricals
opponens pollicis, abductor pollicis brevis, flexor policis brevis
What is a positive Phalen’s test?
wrist flexion for 1 minute elicits paraesthesia in the median nerve distribution
What is a positive Tinel’s test?
tapping over the median nerve at the wrist elicits paraesthesia in the median nerve distribution
GIve 2 risk factors for carpal tunnel syndrome
pregnancy
COCP
obesity
trauma
DM
RA
acromegaly
repetitive activities
One investigation for carpal tunnel syndrome
electromyography
What 2 management options can you do for carpal tunnel syndrome
Splinting
local corticosteroid injection
carpal tunnel release surgery
Give the 3 hallmark features of Parkinson’s disease
pill rolling tremor
bradykinesia / shuffling gait
cog wheel rigidity
what is the name given to lesions seen microscopically in the brain of a parkinson’s disease patient
Lewy bodies
what medication should be commenced with levodopa and why
peripheral dopa-decarboxylase inhibitor (CARBIDOPA)
reduces peripheral breakdown, leading to decreased dose of levodopa required for symptom control and reduced risk of side effects
give 2 complications associated with long-term levodopa treatment
on-off fluctuations
end of dose dyskinesia
dyskinesias
postural hypotension
apart from levodopa, give 2 management options of parkinsons
MOAB e.g. selegiline
dopamine agonist e.g. bromocriptine
at what time of day is the headache in raised intracranial pressure typically worse
morning
what may patients report exacerbates an intracranial pressure headache
bending forward, lying down, coughing
give 2 clinical features other than headache in intracranial pressure
nausea/vomiting
papilloedema
seizures
focal neurology
Give 2 examples of a space-occupying lesion
neoplasm
haematoma
abscess
Give 2 medical managements which may be used to decrease intracranial pressure
Dexamethasone
Mannitol
2 investigations to perform after seizure
EEG
MRI
BM
FBC
U&E
Other than epilepsy, 3 possible causes of seizure
Meningitis
Tumour
Head injury
Haemorrhage
Alcohol withdrawal
Pseudoseizures
2 pieces of advice for epileptic patient
Avoid dangerous work/leisure activities (e.g. working heavy machinery or at heights,
swimming)
Be mindful of safety at home (take showers instead of baths)
Advise about lifestyle factors that may lower seizure threshold (e.g. alcohol,
recreational drugs, sleep deprivation)
Take a witness of the seizure to the specialist appointment if possible
Treatment if status epilepticus does not stop after 2 doses of benzo
Levetiracetam
Phenytoin
Shooting electric shock pain down spine and legs when moving neck
Lhermitte’s sign
Criteria to confirm diagnosis of MS
McDonald criteria (dissemination in time and space)
1 absolute contraindication to performing a lumbar puncture
Infected skin over puncture site
Increased intracranial pressure
Trauma to lumbar vertebrae
Complications of meningococcal septicaemia
Septic shock
Hearing loss
Seizures
Intellectual impairment
Death
Other than idiopathic parkinson’s, name 3 other causes of parkinsonism
Progressive supranuclear palsy
Drug induced (AP)
Dementia with lewy body
Vertical gaze palsy + parkinsonism
Progressive supranuclear palsy
Where is the CSF located
Subarachnoid space
RFs for subarachnoid haemorrhage
PCKD
Cocaine use
HTN
Smoking
Excess alcohol
Healthcare professionals involved in stroke care
Nurse
SALT
Dietician
Physiotherapist
OT
Trigeminal neuralgia features
electricity-like, shooting, stabbing or burning pain
triggered by touch, taking, eating, shaving or cold
Attacks may worsen over time
1st line treatment trigeminal neuralgia and another treatment option
1st - Carbamazepine
Trigeminal nerve block
Investigation to arrange for trigeminal neuralgia
MRI head
