Neurology Flashcards
Where is Broca’s area? What is its function?
- Left frontal lobe, Brodmann‘s area 44 and 45 - Language production
Where is Wernicke’s area? What is its function?
- Left (usually) temporal lobe, Brodmann’s area 22- Perception of language
What are the layers of brain covering?
Skin - Bone - Dura mater - Arachnoid mater - (Subarachnoid space) - Pia mater
Lateral corticospinal tract
Supplies limbs - Fine motor movement - Decussates at medulla
Ventral corticospinal tracts
Supplies trunk (proximal muscles) - Decussates at level of effector muscle - Also motor movement
Corticobulbar tract
Head and neck via cranial nerves
What structures are in the cavernous sinus?
(OTOMCAT) - Oculomotor nerve - Trochlear nerve - Ophthalmic division of trigeminal nerve - Maxillary division of trigeminal nerve - Carotid artery - Abducens nerve
DCML tract
- Ascending (sensory) - Dorsal root -> medulla, then decussates - Fine touch, vibration and proprioception
Spinothalamic tract
- Ascending (sensory) - Decussates at spine 1-2 levels above dorsal entry - Pain, temperature, crude touch - Anterior - trunk - Posterior - limbs
Brown sequard syndrome
- Ipsilateral DCML loss - decussate at medulla - Ipsilateral corticospinal loss - decussate at medulla - Contralateral spinothalamic loss - decussate at spinal cord (1-2 levels above)
Blood supply to the pituitary gland
Anterior - Superior hypophyseal artery - Posterior - Inferior hypophyseal artery The hypothalamophyseal portal system is a branch of The internal carotid artery
Drug for bacterial meningitis in hospital
- Ceftriaxone (3rd gen cephalosporin) - Cefuroxime if prgenant or under 3 months old - Amoxicillin if listeria suspected - Steroids simultaneously (dexamethasone) within 12 hrs
Pathophysiology of Wernicke’s encephalopathy
Combined B1 deficiency (caused by alcohol) and alcohol withdrawal symptoms
Complication on Wernicke’s encephalopathy
Wernicke Korsakoff syndrome: - Confabulation memory loss - make up stories to fill gaps in memory - Ataxia - Nystagmus
Treatment for Wernicke’s encephalopathy
- Parenteral (IV) pabrinex for 5 days acutely - Oral thiamine prophylactically
Cause of transient ischaemic attack and ischaemic stroke
Carotid thrombo-emboli - Thrombosis - Emboli, eg: from atrial fibrillation
Risk factors of stroke
Hypertension - Atrial fibrillation - Ventricular septal defect - Smoking - T2DM - Obesity/hypercholestrolemia - Cannabis and cocaine
Where do transient ischaemic attacks happen?
90% - internal carotid artery (anterior circulation) 10% - vertebral artery (posterior circulation)
Symptoms of ACA stroke
Contralateral hemiparesis and sensory loss - Lower limbs > upper limbs
Symptoms of MCA stroke
Contralateral hemiparesis and sensory loss with upper limbs > Lower limbs - Homonymous hemianopia - Aphasia affecting dominant hemisphere - Hemineglect syndrome affecting non-dominant hemisphere
Symptoms of PCA stroke
Contralateral Homonymous hemianopia with macular sparing - Visual agnosia
Symptoms of vertebral artery strokes
- Cerebellar syndrome; DANISH with the Romberg test (sensory + motorataxia) - Brainstem infarct - CN lesions 3-12
Amaurosis fugax in transient ischaemic attack
- Decreased blood flow to retina through opthalmic, retinal, ciliary artery - Bad sign; often signals stroke is impending
How to differentiate between stroke and transient ischaemic attack (“mini stroke”)
- Stroke: symptoms last 24+ hours, infarct - TIA: symptoms resolve within 5-15 mins usually, always <24 hours, no infarct