Neurology Flashcards

Question

What are some of the symptoms of MS?

Answer 1

Intranuclear ophthalmoplegia Marcus Gunn Lhermitte's sign Uthoff sign Diplopia Oscillopsia Nystagmus

Answer 2

Internuclear ophthalmoplegia is caused by a lesion in the medial longitudinal fasciculus. The nerve fibres of the medial longitudinal fasciculus connect the cranial nerve nuclei (“internuclear”) that control eye movements (the 3rd, 4th and 6th cranial nerve nuclei). These fibres are responsible for coordinating the eye movements to ensure the eyes move together.

Answer 3

Pill rolling tremor Bradykinesia Cogwheel rigidity

Answer 4

Fine tremor (6-12 Hz) Symmetrical More prominent with voluntary movement Worse when tired, stressed or after caffeine Improved by alcohol Absent during sleep

Answer 5

Propranolol (a non-selective beta blocker) Primidone (a barbiturate anti-epileptic medication)

Answer 6

Excluding underlying malignancy (e.g., small-cell lung cancer) is essential. Amifampridine works by blocking voltage-gated potassium channels in the presynaptic membrane, which in turn prolongs the depolarisation of the cell membrane and assists calcium channels in carrying out their action. Other options include: Pyridostigmine (cholinesterase inhibitor) Immunosuppressants (e.g., prednisolone or azathioprine) IV immunoglobulins Plasmapheresis

Answer 7

Anti AchR antibodies Anti - Muscle-specific kinase (MuSK) antibodies Anti- Low-density lipoprotein receptor-related protein 4 (LRP4) antibodies MuSK and LRP4 are important proteins for the creation and organisation of the acetylcholine receptor. Destruction of these proteins leads to inadequate acetylcholine receptors.

Answer 8

The symptoms most affect the proximal muscles of the limbs and small muscles of the head and neck, with: Difficulty climbing stairs, standing from a seat or raising their hands above their head Extraocular muscle weakness, causing double vision (diplopia) Eyelid weakness, causing drooping of the eyelids (ptosis) Weakness in facial movements Difficulty with swallowing Fatigue in the jaw when chewing Slurred speech

Answer 9

Antibody tests look for: AChR antibodies (around 85%) MuSK antibodies (less than 10%) LRP4 antibodies (less than 5%) A CT or MRI of the thymus gland is used to look for a thymoma. The edrophonium test can be helpful where there is doubt about the diagnosis.

Answer 10

Relieving the problem temporarily

Answer 11

ment options include: Pyridostigmine is a cholinesterase inhibitor that prolongs the action of acetylcholine and improves symptoms Immunosuppression (e.g., prednisolone or azathioprine) suppresses the production of antibodies Thymectomy can improve symptoms, even in patients without a thymoma Rituximab (a monoclonal antibody against B cells) is considered where other treatments fail Myasthenic Crisis Myasthenic crisis is a potentially life-threatening complication of myasthenia gravis. It causes an acute worsening of symptoms, often triggered by another illness, such as a respiratory tract infection. Respiratory muscle weakness can lead to respiratory failure. Patients may require non-invasive ventilation or mechanical ventilation. Treatment is with IV immunoglobulins and plasmapheresis.

Answer 12

Cafe au lait Relative affected Axillary freckles Bone dysplasia Iris harmatomas (Lisch nodules) Neurofibromas Gliomas

Answer 13

Autosomal dominant Chromosome 17 Von Recklinhausen Chromosome 22

Answer 14

Bevacizumab antiVEGF

Answer 15

VEPs MRI brain with diffusion-weighted imaging Oligoclonal bands

Answer 16

A sudden-onset headache, reaching maximum intensity within 5 minutes, is a red flag requiring further evaluation to exclude a subarachnoid haemorrhage

Answer 17

Juvenile myoclonic epilepsy (Janz syndrome) typical onset is in the teenage years, more common in girls features: infrequent generalized seizures, often in morning//following sleep deprivation daytime absences sudden, shock-like myoclonic seizure (these may develop before seizures) treatment: usually good response to sodium valproate

Answer 18

Benign rolandic epilepsy most common in childhood, more common in males features: paraesthesia (e.g. unilateral face), usually on waking up

Answer 19

Jack knife or Salaam seizure Hyparrythmias Steroids and vigabatrin

Answer 20

Dementia, incontinence, gait disturbance

Answer 21

Weber's syndrome is a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

Answer 22

A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately (and be referred for specialist review within 24h)

Answer 23

involves perforating arteries around the internal capsule, thalamus and basal ganglia pure motor or sensory loss

Answer 24

Common features headache (may be sudden onset) nausea & vomiting reduced consciousness

Answer 25

Investigation MRI venography is the gold standard CT venography is an alternative non-contrast CT head is normal in around 70% of patients D-dimer levels may be elevated

Answer 26

anticoagulation typically with low molecular weight heparin acutely warfarin is still generally used for longer term anticoagulation

Answer 27

Sagittal sinus thrombosis may present with seizures and hemiplegia parasagittal biparietal or bifrontal haemorrhagic infarctions are sometimes seen 'empty delta sign' seen on venography Cavernous sinus thrombosis other causes of cavernous sinus syndrome: local infection (e.g. sinusitis), neoplasia, trauma periorbital oedema ophthalmoplegia: 6th nerve damage typically occurs before 3rd & 4th trigeminal nerve involvement may lead to hyperaesthesia of upper face and eye pain central retinal vein thrombosis Lateral sinus thrombosis 6th and 7th cranial nerve palsies

Answer 28

dry mouth, blurred vision and urinary retention. Moreover, Cyclizine may potentially worsen cognitive function i

Answer 29

ophthalmoplegia, areflexia and ataxia.

Answer 30

Fluctuating consciousness = subdural haemorrhage

Answer 31

Admission for a non-contrast CT head, only aspirin and 24 hours if not on medication

Answer 32

Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness - anterior inferior cerebellar artery

Answer 33

sensorineural hearing loss (most common) seizures focal neurological deficit infective sepsis intracerebral abscess pressure brain herniation hydrocephalus

Answer 34

Paroxysmal hemicrania is completely responsive to treatment with indomethacin

Answer 35

Paroxysmal hemicrania (PH) is defined by attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region. These attacks are often associated with autonomic features, usually last less than 30 minutes and can occur multiple times a day. PH sits within the group of disorders called trigeminal autonomic cephalgias which also contains cluster headache, a condition which shares many features with PH. Importantly, PH is completely responsive to treatment with indomethacin.

Answer 36

If clopidogrel is contraindicated or not tolerated, given aspirin and modified release dipyramidole for secondary prevention following stroke

Answer 37

Shy-Drager syndrome is a type of multiple system atrophy. Features parkinsonism autonomic disturbance erectile dysfunction: often an early feature postural hypotension atonic bladder cerebellar signs

Answer 38

'Foot drop' - ?common peroneal nerve lesion

Answer 39

Painful third nerve palsy = posterior communicating artery aneurysm

Answer 40

Creutzfeldt-Jakob disease is characterised by rapid onset dementia and myoclonus

Answer 41

The investigation of choice for narcolepsy is multiple sleep latency EEG

Answer 42

The correct answer is 15 minutes to 2 hours.

Answer 43

Prolactin can be used to differentiate between a true seizure and a pseudoseizure

Answer 44

PTA - propanolol, topirimate and amytriptalline

Answer 45

TIA = T1A = 1 MONTH

Answer 46

Seizure free for 2 years and reduce AEDs over 2-3 months

Answer 47

P450 inhibitor gastrointestinal: nausea increased appetite and weight gain alopecia: regrowth may be curly ataxia tremor hepatotoxicity pancreatitis thrombocytopaenia hyponatraemia

Answer 48

Amaurosis fugax is a form of stroke that affects the retinal/ophthalmic artery

Answer 49

In acute ischaemic stroke, a 'hyperdense artery' sign may be seen on CT - this is usually visible immediately in contrast to changes in the parenchyma

Answer 50

Sagittal sinus thrombosis - 'empty delta sign' seen on venography

Answer 51

All patients with a Bell's palsy should be given oral prednisolone within 72 hours of onset

Answer 52

AIDS (A) Lyme disease (LEXANDER graham) Bell's palsy (BELL) Sarcoidosis (S) Tumour (T) Diabetes (D) Surgery (s)

Answer 53

Baclofen and gabapentin are first-line for spasticity in multiple sclerosis

Answer 54

penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Answer 55

CT - dark and hypodense Thrombolysis 4.5 hours The standard target time for thrombectomy in acute ischaemic stroke is 6 hours

Answer 56

Lateral medullary syndrome (posterior inferior cerebellar artery) aka Wallenberg's syndrome ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss

Answer 57

Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level

Answer 58

Cranial nerves V, VII and VIII are affected in vestibular schwannomas

Answer 59

Contralateral homonymous hemianopia with macular sparing and visual agnosia - posterior cerebral artery

Answer 60

If a patient with Parkinson's disease cannot take levodopa orally, they can be given a dopamine agonist patch as rescue medication to prevent acute dystonia

Answer 61

stop antipsychotic patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units IV fluids to prevent renal failure dantrolene may be useful in selected cases thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum bromocriptine, dopamine agonist, may also be used

Answer 62

Triptans may cause tightness of the throat and chest

Answer 63

common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness megaloblastic anaemia (secondary to altered folate metabolism) peripheral neuropathy enhanced vitamin D metabolism causing osteomalacia lymphadenopathy dyskinesia

Answer 64

headache blurred vision papilloedema (usually present) enlarged blind spot sixth nerve palsy may be present

Answer 65

failure to adduct on the affected side and nystagmus on the contralateral side i.e. right sided opthalmoplegia = right sided inability to adduct eye and contralateral nystagmus

Answer 66

Ipsilateral cranial nerve three palsy along with contralateral weakness.

Answer 67

ALexander Graham Bell has STDs. Remember AIDS Lyme disease Bell's palsy (most likely) Sarcoidosis Tumours Diabetes

Answer 68

Acute (but not sudden) onset of unilateral lower motor neuron facial weakness Mild to moderate postauricular otalgia, which may precede the paralysis. Hyperacusis Nervus intermedius symptoms, such as altered taste and dry eyes/mouth. Patients may subjectively describe "numbness" or "heaviness" without objective facial somatosensory disturbances.

Answer 69

Motor symptoms as most often reduced power with elbow flexion, wrist extension and forearm supination

Answer 70

Forced vital capacity

Answer 71

Loss of pain sensation (analgesia) Loss of temperature sensation (thermoanesthesia) Motor function impairment Loss of autonomic functions

Answer 72

Pain control Physiotherapy for motor function improvement Management of autonomic dysfunctions Skin care for preventing pressure sores

Answer 73

Alcohol, amyloidosis, HIV B12 deficiency Chemotherapies Diabetes (50%) Everything else: lyme disease, sarcoidosis, amyloidosis

Answer 74

Investigate and treat the cause Supportive management such as better blood pressure control, pain relief

Answer 75

Bell's palsy is an idiopathic syndrome characterized by unilateral, lower motor neuron facial weakness, without sparing the extraocular muscles and muscles of mastication. It presents with mild-moderate postauricular otalgia, hyperacusis (rare), and nervus intermedius symptoms such as altered taste and dry eyes/mouth.

Answer 76

HSV, EBV and VZV re-activation

Answer 77

Full blood count (FBC) Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) Viral serology (e.g. HSV-1, EBV, VZV) Lyme serology (if suggestive symptoms or exposure) Otoscopy to see if any vesicular lesions in external auditory meatus Electromyography (EMG) Imaging studies (e.g., magnetic resonance imaging (MRI) or computed tomography (CT))

Answer 78

Erb's palsy: Involving damage to the C5-C6 nerve roots. Traumatic birth Klumpke's palsy: Involving damage to the C8-T1 nerve roots. Radiotherapy in axilla for breast cancer

Answer 79

Ipsilateral hemiplegia Ipsilateral loss of proprioception and vibration Contralateral loss of pain and temperature sensation

Answer 80

Upper motor neurone disease Brisk reflex, breathy speech Emotional lability No nasal speech (because weaker in LMN) Spastic speech

Answer 81

Concerned with CN IX, X, XI

Answer 82

Motor neurone disease: Notably, the progressive bulbar palsy variant. Myasthenia gravis: An autoimmune neuromuscular disorder. Guillain-Barré syndrome: An acute inflammatory demyelinating polyradiculoneuropathy. Brainstem stroke: Particularly the lateral medullary syndrome or Wallenberg's syndrome. Syringobulbia: A rare neurologic condition characterized by a fluid-filled cavity (syrinx) within the spinal cord.

Answer 83

Inherited i.e. Fredrich's ataxia, ataxia telangietasia and Joubert's MS Alcohol Vascular Infection Space occupying lesion

Answer 84

Dysdiadokinesia Ataxia Nystagmus Intention tremor Stocatto speech Hypotonia

Answer 85

Neck pain Radiculopathy resulting from compression of nerve roots at the site of foraminal exit, leading to flaccid upper limb paresis Myelopathy, thought to be due to the dynamic stretch of the spinal cord over impinging spinal osteophytes, manifesting as variable sensory changes (sometimes including the Lhermitte phenomenon) and spastic paraparesis Bladder and bowel disturbance, though this is rare

Answer 86

hereditary motor and sensory neuropathy (HMSN) is also known as Charcot Mary Tooth PMP22 Longest nerves affected first - hence feet AD Champagne bottle leg, pes cavus and claw hand

Answer 87

Dementia, psychiatric impairment and myoclonus PRNP gene

Answer 88

Destruction, Deformity, Degeneration, Dense bones, Debris, and Dislocation

Answer 89

Rare genetic disease like Flatau Sterling Cervical torticollis Anti-dopaminergic medications

Answer 90

Fever Flu-like prodromal illness Seizures Focal neurological deficits Headaches Behavioural changes

Answer 91

6 months - 1 off seizure 12 months - epilepsy 5 years - 1 off seizure as a lorry driver 10 years - epilepsy

Answer 92

Lentiform Lucid Lemon shape

Answer 93

Loss of inversion of ankle inversion and hip abduction

Answer 94

Neuromyelitis optica

Answer 95

Monitoring of forced vital capacity (FVC) for respiratory muscle involvement Cardiac monitoring for autonomic instability Blood tests, including arterial blood gas (ABG) Serological tests: Anti-ganglioside antibodies Lumbar puncture: may show albuminocytological dissociation Nerve conduction studies: may show prolongation or loss of the F wave Identification of the underlying cause: stool cultures, serology, CSF virology

Answer 96

Intravenous immunoglobulin (IVIG) over a 5-day course Plasmapheresis, which has similar efficacy to IVIG but is associated with more side effects.

Answer 97

<13 GCS <15 GCS after 2 hours 1 episode of vomiting Open or depressed skull fracture Focal neurology

Answer 98

4A's age anticoagulant amnesia a worrying mechanism of fall

Answer 99

Focal neurology Instability Neoplasm Coagulation disorder ICP raised Skin infection

Answer 100

Hereditary spastic paresis is a spectrum of conditions that cause UMN and LMN disease The main clinical features involve progressive spasticity and weakness of the legs due to degeneration of the axonal tracts of the corticospinal pathway in the spinal cord. Requires botulinum and baclofen for spasticity

Answer 101

Horner's syndrome is a lesion that affects the sympathetic chain. It can either be central (first-order) like a CVA, (second-order) or third order. Pancoast for example, only cause unilateral Horner's and do not affect the limbs or upper body.

Answer 102

Carotid dissection or third order neurones. In third order neurone lesions, there is miosis and ptosis but no anhydrosis, as the nerves supplying the sweat glands in the face have exited before reaching the internal carotid plexus. Therefore lesions affecting the carotid plexus, as in this case with internal carotid artery dissection, will have the clinical presentation of a third order Horner's lesion. (Prince Andrew has pancoast, but not carotid dissection)

Answer 103

First order = upper limb, and unilateral PAM Second order = unilateral PAM Third order = ptosis and anhidrosis, but not anhidrosis

Answer 104

First order neurone - stroke or tumour Syringomyelia Multiple sclerosis Encephalitis Brain tumors Lateral medullary syndrome

Answer 105

Second order Pancoast Cervical rib traction on stellate ganglion Thyroid carcinoma Thyroidectomy Goiter Bronchogenic carcinoma of the superior fissure (Pancoast tumor) on apex of lung Klumpke paralysis Trauma - base of neck, usually blunt trauma, sometimes surgery. As a complication of tube thoracostomy Thoracic aortic aneurysm

Answer 106

Carotid artery dissection, stenting Cluster headache - combination termed Horton's headache An episode of Horner's syndrome may occur during a migraine attack and be relieved afterwards[6] Cavernous sinus thrombosis Middle ear infection

Answer 107

This is called a ventriculoperitoneal or ventriculoatrial shunt.

Answer 108

IIH is also known as pseudotumor cerebrii Opening pressure >25 Lithium, OCP, steroids, tetracyclines, lymecycline, vitamin A are risk factors Headaches are worse in the morning Bilateral, non pulsatile headaches Bending forward False localising sign Visual disturbances which can result in blindness Treat with weight loss, azetolzolamide, topirimate, shunting

Answer 109

Affected eye cannot adduct Other eye undergoes nystagmus

Answer 110

Unilateral throbbing headache, potentially preceded by an aura (visual or sensory) Headache duration of 4-72 hours Association with photophobia and phonophobia Possible triggers such as oral contraceptives or specific foods (e.g., chocolate)

Answer 111

Cranial nerve VI palsy due to its location

Answer 112

Intracerebral venous thrombosis Hypercoagulable states like pregnancy, COCP, dehydration and smoking are risk factors. Sagittal sinus thrombosis = empty delta sign Cavernous sinus thrombosis = chemosis, exopthalmos

Answer 113

Certain posterior and anterior circulation strokes

Answer 114

Underlying cause management: Cancer treatment options (chemotherapy, radiation, surgery) are required if LEMS is associated with a malignancy. Symptom management: Amifampridine can be used, which blocks pre-synaptic potassium channels in the nerve terminals, augmenting the release of acetylcholine. Severe respiratory or bulbar weakness: Management includes intubation and ventilation, along with plasma exchange or intravenous immunoglobulin (IVIG).

Answer 115

Monro–Kellie doctrine when understanding raised intracranial pressure. It states that the sum of the volume of brain tissue, cerebrospinal fluid and intracranial blood is constant (due to the fixed volume of the skull)

Answer 116

Headache Fever Neck stiffness Photophobia Nausea and vomiting Focal neurology Seizures Reduced conscious level Features of overwhelming sepsis, such as non-blanching petechial rash indicative of impending Disseminated Intravascular Coagulation (DIC).

Answer 117

Compression or entrapment of the lateral femoral cutaneous nerve under the inguinal ligament. Direct injury to the nerve. Conditions or factors that increase pressure on the nerve such as obesity, tight clothing or belts, pregnancy, ascites, and surgical procedures or trauma involving the inguinal area.

Answer 118

Mononeuritis multiplex, occasionally termed polyneuritis multiplex, is a type of peripheral neuropathy which is characterized by simultaneous or sequential involvement of individual non-contiguous nerve trunks

Answer 119

Diabetes mellitus Vasculitis: polyarteritis nodosa, granulomatosis with polyangitis, and eosinophilic granulomatosis with polyangitis Immune-mediated diseases, such as rheumatoid arthritis and systemic lupus erythematosus Infections: leprosy, Lyme disease, Parvovirus B19, HIV Sarcoidosis Cryoglobulinaemia Reactions to exposure to chemical agents, including trichloroethylene and dapsone Rarely, following the sting of certain jellyfish, such as the sea nettle

Answer 120

MND is associated with misfolding of the TDP-43 protein in many cases. It can be an inherited condition, with several associated genes yet to be identified. About 2% of total cases are associated with a mutation in the SOD-1 gene.

Answer 121

Riluzole NIV MDT. Providing pain relief with simple analgesia and treating spasticity and contractures with baclofen and botox injections. Using anticholinergics to manage drooling. Supporting feeding via an NG or PEG tube as bulbar disease progresses. Discussing advanced care planning early in disease progression to minimise distress and complications.

Answer 122

Jugular outlet affects 9, 10, 11 Pseudobular affects 9, 10 and 12

Answer 123

Alcohol B12/Folate Chronic Renal Failure Diabetes Mellitus Everything Else (!) - encompassing Vasculitis and Paraneoplastic syndromes

Answer 124

Radiation therapy to reduce the tumour burden and alleviate pressure on the spinal cord. Surgical decompression: This should be performed urgently, typically within 48 hours. Administration of dexamethasone: Indicated in patients with demonstrated malignancy on MRI or those with high clinical suspicion, given at 16 mg daily in divided doses, along with proton pump inhibitors (PPI)

Answer 125

Proximal middle cerebral artery

Answer 126

SCLC. These cause cerebellar degeneration

Answer 127

Sumatriptan only once the headache starts and not during the aura phase Avoid in heart disease

Answer 128

Give IV chloramphenicol