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REVISION > NEUROLOGY > Flashcards

NEUROLOGY Flashcards

1
Q

How does a pontine haemorrhage present?

A

Reduced GCS
Paralysis
Bilateral pinpoint pupils

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2
Q

If a specialist wants imaging for a suspected TIA, what is usually the preferred modality?

A

MRI brain with diffusion-weighted imaging

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3
Q

What type of epilepsy is Jacksonian movement usually associated with?

A

Frontal lobe epilepsy

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4
Q

Side effects of phenytoin?

A

Peripheral neuropathy
Gingival hyperplasia
Lymphadenopathy

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5
Q

From which way up are CT and MRI usually viewed?

A

From feet up

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6
Q

Visual field defect for left temporal lobe infarct?

A

Right superior quadranopia

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7
Q

Visual field defect for left parietal lobe infarct?

A

Right inferior quadranopia

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8
Q

Visual field defect for a craniopharyngioma?

A

Lower bitemporal hemianopia
(Its compressing the superior optic chiasm)

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9
Q

Visual field defect for a pituitary tumour?

A

Upper bitemporal hemianopia (compresses the inferior optic chiasm)

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10
Q

What is the gold standard test for diagnosing degenerative cervical myelopathy?

A

MRI of cervical spine - will show disc degeneration, ligament hypertrophy and cord signal change

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11
Q

Presentation of degenerative cervical myelopathy?

A

Pts over 50 with progressive neurological symptoms
Can cause pain in neck or limbs, loss of motor function, loss of sensory function causing numbness, urinary/facial incontinence, Hoffmann sign

50% are incorrectly diagnosed initially!

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12
Q

Nerve conduction study findings in Guillain-Barré syndrome?

A

Decreased conduction velocity of motor nerves due to demyelination
Also show prolonged distal motor latency and increased F wave latency

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13
Q

How does retinitis pigmentosa present?

A

Loss of night vision that usually starts in childhood
Tunnel vision
May be FHx

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14
Q

When can AEDs be stopped and over what time period do they have to be stopped?

A

Can be considered if seizure free for >2 years
Must be stopped over 2-3 months

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15
Q

How does subacute combined degeneration of the spinal cord present?

A

Affects DCML -> Distal sensory loss and tingling that tends to affect legs more than arms and impaired proprioception and vibration sense

Affects lateral corticospinal tract -> Absent ankle jerks and extensor plantars, brisk knee reflexes, muscle weakness, hyperreflexia and spasticity

Affects spinocerebellar tract -> Gait abnormalities/romberg positive

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16
Q

How is primary lateral sclerosis different to ALS?

A

PLS presents with UMN signs only unlike ALS which presents with a mixture of UMN + LMN

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17
Q

Symptoms of anterior spinal artry infarction?

A

Acute back pain at the level of injury
Bilateral flaccid para/quadriparesis or plegia
Loss of pain and temperature
Preservation of proprioception, vibratory sense, fine touch, and two-point discrimination
Autonomic dysfunction with hypotension, bradycardia, and impaired temperature regulation
Respiratory failure
Spinal shock

It basically affects whole spinal cord except for the DCML!!

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18
Q

What is the most common cause of anterior spinal artery infarct?

A

Aortic surgery iatrogenic

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19
Q

Where is the common peroneal nerve?

A

It comes from the back of the knee and wraps around the proximal head of the fibula

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20
Q

What does the superficial peroneal nerve supply?

A

Innervates muscles of lateral compartment of leg e.g. Eversion of the foot
Supplies sensory function to anterolateral aspect of distal leg and majority of dorsum of foot (apart from webbing between hallux and second digit)

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21
Q

What does the deep peroneal nerve supply?

A

Innervates the anterior compartment of the leg and some intrinsic muscles of tyhe foot = dorsiflexion of ankle and extension of toes
Supplies sensory function to triangular region of skin between 1st and 2nd toes

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22
Q

What is Uhtoff’s phenomenon?

A

temporary, short-lived (less than 24 hours), and stereotyped worsening of neurological function among multiple sclerosis patients in response to increases in core body temperature e.g. after a shower

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23
Q

What is the rhyme for remembering nerve roots for each reflex?

A

S1, S2 tie your shoe - ankle
L3, L4 kick the door - knee
C5, C6 pick up sticks - bicep
C7, C8 close the gate - tricep

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24
Q

When a disc herniation happens why does it cause an impingement rather than corda equina?

A

As the posterior longitudinal ligament stops the disc herniation from impinging the entire spinal canal
Over time degeneration of this ligament can mean pts are predisposed to cauda equina

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25
Q

Are cranial nerves UMN or LMN?

A

LMN

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26
Q

Pathophysiology of GBS?

A

Immune-mediated demyelination of the PNS often triggered by an infection
Thought to be caused by molecular mimicry - cross-reaction of antibodies with gangliosides in the PNS e.g. anti-GM1

27
Q

Which lobe of the brain is Broca’s area found? Which side?

A

Frontal
The dominant side which is usually left!

28
Q

Which lobe of the brain is wernickes area found? Which side?

A

Temporal lobe

The dominant side which is usually left!

29
Q

Which artery supplies blood to brocas and wernickes?

A

MCA

30
Q

What are atonic seizures?

A

Aka drop attacks
Sudden loss of muscle tone that often result in a fall. Only last briefly and pts are usually aware
Often begin in childhood and may be indicative of Lennox-Gastaut syndrome

31
Q

Localising features of parietal lobe seizures?

A

Paraesthesia

32
Q

Localising features of occipital lobe seizures?

A

Flashers and floaters

33
Q

Localising features of frontal lobe seizures?

A

Head/lug movements
Posturing
Post-Ictal weakness
Jacksonian march

34
Q

Localising features of temporal lobe seizures?

A

Aura of rising epigastric sensation, Deja vu or Jamais vu, hallucinations
In seizures - automatisms such as lip smacking are common

35
Q

MS investigations

A

MRI to see high signal T2 lesions, Dawson fingers, and perivetricular plaques
If no clear radiological evidence…
CSF: oligclonal bandd and increased intrathecal synthesis of IgG
Visual evoked potentials - less commonly used

36
Q

Subtypes of MS?

A

Relapsing-remitting in 85%
Secondary progressive (pts who have progressed from relapsing-remitting)
Primary progressive disease - only 10%

37
Q

What % of pts with relapsing-remitting MS go on to develop secondary progressive disease within 15 years?

A

65%

38
Q

How commonly do SLE pts have antiphospholipid syndrome?

A

30%!!

39
Q

What are the anti-phospholipid antibodies?

A

anticardiolipin antibodies
anti-beta2 glycoprotein I antibodies
lupus anticoagulant

40
Q

Features of the tremor in parkinsons?

A

Asymmetrical
Improves with voluntary movement i.e a resting tremor
Worsens with stress
3-5Hz
Pill rolling usually

41
Q

How does drug-induced parkinsonism present differential to parkinsons?

A

Rapid onset and B/L symptoms
Rare to have rigidity and resting tremor

42
Q

Differentials for a tremor?

A

Parkinsonism
Essential tremor
Anxiety
Thyrotoxicosis
Hepatic encephalopathy
CO2 retention e.g. COPD
Cerebellar disease
Drug withdrawal e.g alc or opiates

43
Q

Features of an essential tremor?

A

It’s postural i.e. worse if arms outstretched
Improved by alcohol and rest
Strong FHx
Titubation - tremor of head, neck and trunk

44
Q

Most common cause of an intention tremor?

A

MS

45
Q

What type of stroke can cause isolated sensory loss?

A

Lacunar stroke

46
Q

Until proven otherwise what is a painful third nerve palsy?
What can it occur simultaneously with?

A

A posterior communicating artery aneurysm
Note they can also occur simultaneously with a subarachnoid haemorrhage

47
Q

Risk factors for idiopathic intracranial hypertension?

A

Non-modifiable:
- female
- 20-40 typically
- pregnancy

Modifiable:
- obesity
- drugs: COCP, steroids, tetracyclines, retinoid use (due to high vit A), lithium

48
Q

Which AED can cause Stevens-Johnson syndrome?

A

Lamotrigine
Phenytoin
Carbamazepine

49
Q

What causes Lambert-Eaton syndrome?

A

Small cell lung cancer
(To a lesser extent breast & ovarian cancer)

They cause an antibody directed against presynaptic voltage-gated Ca channels in the PNS

50
Q

Features of Lambert Eaton Syndrome?

A

Repeated muscle contractions -> increased muscle strength
Limb girdle weakness
Hyporeflexia
Autonomic Sx - dry mouth, impotence, difficulty micturating

51
Q

What cause myasthenia gravis?

A

Autoimmune disorder resulting in antibodies against acetylcholine receptors

52
Q

Features of myasthenia gravis?

A

Muscle rating ability
Diplopia (Extraocular muscle weakness)
Ptosis
Proximal muscle weakness
Dysphagia

53
Q

What can myasthenia gravis be associated with?

A

Thymic hyperplasia in up to 70%
Thymomas in 15%
Autoimmune disorders

54
Q

Investigations for myasthenia gravis?

A

Single fibre electromyography
CT thorax to exclude thymoma
Antibodies to acetylcholine receptors

55
Q

Which cranial nerves can acoustic neuromas affect? What are the effects of these?

A

5, 7 and 8

5 - absent corneal reflex
7 - facial palsy
8 - vertigo, U/L sensorineural hearing loss, U/L tinnitus

56
Q

What is amaurosis fungax?

A

Transient monocular visual loss caused by an atherosclerotic embolism that leads to retinal artery occlusion

57
Q

What is syringomyelia?

A

A collection of CSF in the spinal cord

58
Q

What can cause syringomyelia?

A

A chiari malformation
Trauma
Tumours

59
Q

What is a chiari malformation?

A

a structural defect in the cerebellum, characterized by a downward displacement of one or both cerebellar tonsils through the foramen magnum

60
Q

Symptoms of syringomyelia?

A

Cape-like loss of sensation to temp (neck, shoulders and arms)
Spastic weakness, predominantly of lower limbs
Neuropathic pain
Upgoing plantars
Autonomic features e.g. bowel/bladder dysfunction

Scoliosis will occur over a matter of years if not treated

61
Q

Investigations for syringomyelia?

A

Full spine MRI to exclude tumour or tethered cord
Brain MRI to exclude a chiari malformation

62
Q

Which parkinsons Tx gives the best improvement in motor symptoms and ADLs?

A

Levodopa

63
Q

What is the most common hereditary peripheral neuropathy?

A

Charcot-Marie-Tooth disease

64
Q

Features of Charcot-Marie-Tooth disease?

A

Hx of frequently sprained ankles
Foot drop
Pes cavus
Hammer toes
Distal muscle weakness and atrophy
Hyporeflexia
Stork leg deformity

REVISION (25 decks)

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