neurology Flashcards
how can you differentiate surgical and medical 3rd nerve palsy
surgical = painful and causes fixed dilated pupil, can be caused by posterior communicating artery aneurysm
medical = pupil sparing, common cause is diabetes
describe symptoms of midbrain infarct (weber’s syndrome)
n ipsilateral third nerve palsy (due to involvement of oculomotor nerve fibres originating in the midbrain)
and contralateral hemiparesis (due to involvement of corticospinal fibres as they pass through the midbrain)
what is chemosis
swelling of the tissue that lines the eyelids and surface of the eye
describe symptoms of cavernous sinus thrombosis
unilateral ptosis and chemosis
oedema
headache
photophobia
what does the triad of urinary incontinence, dementia and gait abnormality indicate
normal pressure hydrocephalus
what is the definitive management for normal pressure hydrocephalus
Ventriculo-peritoneal shunting
what does bilateral medial temporal lobe involvement on an MRI indicate
encephalitis
what mediation is given to reduce the long term neurological symptoms of meningitis
IV dexamethasone
what mediation is given to relatives/close contacts to a pt with meningitis
oral ciprofloxacin or rifampicin
what bacteria does an India ink stain show
Cryptococcal meningitis
likely cause of meningitis in an immunocompromised pt eg with HIV, who has fibrin web CSF, high protein, normal glucose ad high lymphocytes, but normal CXR and no haemoptysis
Cryptococcal meningoencephalitis
(normal CXR and no haemoptysis indicate that its not TB)
Tx for meningitis in a pt with penicillin allergy
IV Chloramphenicol
(cefriaxoen is C/I due to cross-reactivity between cephalosporins and penicillin)
what is the common gram positive rod shaped bacteria that causes meningitis
listeria monocytogenes
what type of encephalitis do IgM or IgG antibodies in the CSF suggest
tick-borne encephalitis
what can be given for status epileptics in the community if IV route can’t be established
PR diazepam or Bucal midazolam
pt had stomach upset 2 weeks ago and now has rapidly progressing ascending weakness
diagnosis?
guillain barre syndrome
what is used to monitor respiratory muscle involvement in Guillain barre syndrome
FVC
which anti epileptic causes gingival hypertrophy, hirsutism and coarsening facial features
phenytoin
side effects of levetiracetam
drowsiness
headaches
irritation
nausea and vomiting
side effects of carbamazepine
drowsiness
ataxia
headache
hyponatraemia
rarely, Stevens-Johnson syndrome
how can temporal lobe epilepsy cause long term memory loss
can cause damage to medial temporal lobe structures eg hippocampus - causes long term memory loss
what is west syndrome
infantile spasms, which usually start between 4-8 months of age and involve myoclonic jerking (or ‘jack-knife’ spasms) that occur in clusters
preceded by an aura followed by automatisms, including fidgeting of the hands, chewing, lip smacking or swallowing
These episodes would usually be accompanied with altered awareness and subsequent amnesia.
which type of focal epilepsy is this
temporal lobe epilepsy
which juvenile epilepsy occurs exclusively in sleep
benign Rolandic seizures
cause of tremor on movement but nothing at rest
essential tremor
facial weakness, unilateral ear pain and vesicles seen in the ear canal
diagnosis?
Ramsay hunt syndrome due to VZV infection (causes inflammation of the geniculate ganglion of the facial nerve)
Tx for Ramsay hunt syndrome due to VZV infection
oral antiviral and steroids
first line tx for GBS
Iv immunoglobulin and supportive treatment
what is the most important thing to monitor regarding pt prognosis in a pt with GBS
FVC
what does an isolated rise in CSF protein indicate
GBS
name 5 drugs which cause idiopathic inter cranial HTN
Oral contraceptive pill
Steroids
Tetracycline
Vitamin A
Lithium
first line Tx for atonic seizures in women of reproductive age
lamotrigine (or levetiracetam)
(sodium valproate is first line for generalised seizures but not for women of reproductive age)
what type of hydrocephalus is caused by problems in the subarachnoid space, often stemming from complications like subarachnoid haemorrhage and infective meningitis.
communicating hydrocephalus
where are the common causes of obstruction in obstructive hydrocephalus
foramen of Monro (e.g. due to colloid cysts), cerebral aqueduct (e.g. due to aqueduct stenosis), or fourth ventricle (e.g. due to posterior fossa tumour).
dilated lateral ventricles and third ventricle
normal fourth ventricles
headache, no other history
diagnosis?
obstructive hydrocephalus due to lesion/obstruction in cerebral aqueduct (aqueduct stenosis)
(obstructive hydrocephalus can affect all the ventricles)
but communicating hydrocephalus would be after meningitis or subarachnoid haemorrhage
what is a secondary generalised seizure
secondary to preceding focal seizure
tx for Ramsey hunt syndrome
prednisolone and oral acyclovir
LMN facial nerve palsy
ringing noise
vesicles in ear
diagnosis?
ramsay hunt syndrome
what is scintillating scotoma
visual phenomenon described in patients suffering from migrainous headache
visual hallucination of zigzags starting in centre and moving out to peripheries of vision
what type of lesion does babinskis sign suggest
UMN lesion
what is the difference between the movements of the foot that are impaired in peroneal/common fibular nerve palsy and L5 root lesion
peroneal/common fibular nerve palsy
= loss of
ankle eversion
ankle dorsiflexion
L5 root lesion
= loss of
ankle eversion
ankle dorsiflexion
ankle inversion
(also causes weakness of hip abduction)
which disorder causes an ascending pattern of weakness that improves on exertion/repetition
LEMS (Lambert-eaton syndrome)
which disorder causes descending weakness that fatigues on repletion/sustained action
myasthenia gravis
effects of autonomic neuropathy
postural hypotension
gastroparesis
effects of spinothalamic tract damage
contralateral loss of coarse touch/pain and temperature sensation
effects of peripheral sensory neuropathy
glove-and-stocking distribution of sensory loss or paraesthesiae
effects of dorsal column damage
ipsilateral loss of fine touch, vibration sense, and proprioception
effects of corticospinal tract damage
ipsilateral weakness below the level of the medulla
contralateral weakness above the level of the medulla
what is raised on bloods in an epileptic seizure
prolactin
what is the difference between a true epileptic seizure and non epileptic attack disorder
true epileptic seizure
- caused by abnormal brain activity
- head remains fixed
- eyes remain open
- post octal confusion / tongue biting / incontinence
- raised prolactin
non epileptic attack disorder
- caused by psychological stress
- pelvic thrusting
- head movements
- eyes closed
- Postictal crying
- normal prolactin
pelvic thrusting, head movements, eyes closed, postictal crying
what kind of seizure/disorder is this
non epileptic attack disorder
what is Todds paresis/palsy
when there is persistent weakness or paralysis in a part of the body following a seizure
what medication can be given through a cannula for a patient who is in status epilepticus
lorazepam
(lorazepam given IV, diazepam given PR)
which nerve is often damaged in fractures of head of fibula
common fibular/peroneal nerve
which seizure involves crazy movements and jerking of limbs but no loss consciousness
myoclonic
what does reflex anoxic seizure involve
faint, causing a brief twitching episode
tx for GBS
IV Ig
or plasma exhcnage if they have vit A deficiciency or renal failure
which epilepsy is seen in children 1-2 hours after waking up, triggered by lack of sleep, and which is seen in children during sleep
juvenile myoclonic epilepsy
- after waking up
- triggered by lack of sleep
- myoclonic
benign Rolandic seizures
- during sleep
- tonic clonic
what is the cause of a fine bilateral tremor associated with anxiety, hair loss, palpitations and breathlessness
thyrotoxicosis
cause of intention tremor, reduced coordination and dysarthria
cerebellar ataxia
which tremor starts following a stressful life event
psychogenic tremor
what is vital to monitor in GBS and why
FVC, the ascending muscle weakness could affect diaphragm which could then cause resp arrest
what is a coryzal illness
inflammation of mucous membranes of nasal cavities
what is the triad for normal pressure hydrocephalus
urinary incontinence
dementia
gait abnormality
what medication can be given through cannula for status epilepticus
IV lorazepam
(diazepam given PR)
which nerve is damaged in a neck of fibula fracture
Common fibular nerve (common peroneal nerve)
which seizure is a faint followed by twitching
reflex anoxic seizure
describe consciousness in a myoclonic seizure
not affected
which child epilepsy occurs after waking up, and which one occurs during sleep
juvenile myoclonic epilepsy
- after waking up
- triggered by lack of sleep
- myoclonic
benign Rolandic seizures
- during sleep
- tonic clonic
what is the cause of a bine bilateral tremor associated with anxiety, hair loss, palpitations, breathlessness
thyrotoxicosis
what is the cause of an intention tremor, associated with reduced coordination and dysarthria
cerebellar ataxia
which tremor starts after stressful life event
psychogenic tremor
why should FVC be monitored in GBS
the weakness may spread to diaphragm which causes resp arrest
first line manager t for idiopathic inter cranial hypertension
weight loss and close monitoring
how do LMN and UMN lessons affect forehead
UMN - forehead sparing
LMN - non forehead sparing
is bells palsy UMN or LMN lesion
LMN
give a cause of acute onset unilateral facial drooping with forehead sparing
acute stroke
cause of unilateral facial weakness with hypersensitivity to loud sounds
Ramsay hunt syndrome
what is the cause of foot drop that involves loss of foot inversion as well as eversion
L5 radiculopathy
what is the cause of foot drop that involves loss of sensation over the big toe
L5 radiculopathy
what is the cause of foot drop that involves loss of sensation over the lateral calf
common perineal nerve palsy
LMN facial palsy with ear pain, hearing loss and vertigo
diagnosis?
Ramsay hunt syndrome
what is the likely diagnosis of a hiker that had illness (fever, fatigue muscle/joint pain) and later developed monoarthiritis or facial nerve palsy or neuropathic pain or palpitations
Lyme disease
what is the diagnostic sign for GBS
albumin-cytologic dissociation
ie raised protein, normal white cell count
(raised WCC would indicate infection, but GBS is usually para-infectious)
pt has urinary incontinence, dementia and gait abnormality
diagnosis?
normal pressure hydrocephalus
tx for normal pressure hydrocephalus
ventriculo-peritoneal shunting
ix for cauda equina due to metatstases
spine MRI (cauda equina due to all causes)
do whole spine MRI rather than just lumbar spine MRI if you think the cause is metastases as you can check the whole spine and pick up multiple lesions if there are some
which seizure involves
Swearing / screaming / laughing
Urinary incontinence
Weakness after the seizure
frontal lobe seizure
pt has a seizure which involves repetitively pulling at his shirt
what kind of seizure is this
temporal lobe
what is this feature and what type of seizure does it present in
twitching in one area of body, that progresses to involve another area of the body as well
Jacksonian march
frontal lobe seizure
CSF: very high proton. normal WCC, normal glucose, normal appearance
diagnosis
GBS
pt was complaining of numbness in his fingers and arm, before he lost consciousness and his arms and legs starting jerking.
type of seizure ?
Generalised seizure secondary to parietal lobe seizure
tx for Ramsay hunt syndrome
acyclovir
what is todds paresis
focal unilateral weakness after a seizure - usually frontal lobe seizure
which antiepileptic can cause hepatic dysfunction
sodium valproate
which condition can the Tensilon Test diagnose
myasthenia gravis
which test confirms Idiopathic inter cranial hypertsenion
lumbar puncture - will have high opening pressure
(do imaging of brain first to rule out a space occupying lesion ads that would contraindicate lumbar puncture)
management of pt with IIH that has new onset visual loss
optic nerve fenestrations - try to relieve the pressure and improve sight
which type of hydrocephalus is after subarachnoid haemorrhage
communicating hydrocephalus
which type of hydrocephalus results from problems with the arachnoid granulations
communicating hydrocephalus
(CSF can exit the ventricular system but there is a problem with CSF absorption at the arachnoid granulations)
what is opthalmoplegia
paralysis of eye muscles
which condition has a prodrome pf gastroenteritis and presents with a triad of ataxia, areflexia and opthalmoplegia
miller fisher syndrome
(Remember that Guillain-Barre starts distally (polyneuropathy) and makes it way up. Miller-Fisher starts proximally i.e. with the eyes)
which antiepileptic can cause renal stones
topiramate
which anti epileptic can cause skin rash, ataxia, dysarthria and nystagmus
carbamezapine