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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
Are cranial nerves UMN or LMN?
LMN
26
Pathophysiology of GBS?
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
Which lobe of the brain is Broca’s area found? Which side?
Frontal The dominant side which is usually left!
28
Which lobe of the brain is wernickes area found? Which side?
Temporal lobe The dominant side which is usually left!
29
Which artery supplies blood to brocas and wernickes?
MCA
30
What are atonic seizures?
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
Localising features of parietal lobe seizures?
Paraesthesia
32
Localising features of occipital lobe seizures?
Flashers and floaters
33
Localising features of frontal lobe seizures?
Head/lug movements Posturing Post-Ictal weakness Jacksonian march
34
Localising features of temporal lobe seizures?
Aura of rising epigastric sensation, Deja vu or Jamais vu, hallucinations In seizures - automatisms such as lip smacking are common
35
MS investigations
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
Subtypes of MS?
Relapsing-remitting in 85% Secondary progressive (pts who have progressed from relapsing-remitting) Primary progressive disease - only 10%
37
What % of pts with relapsing-remitting MS go on to develop secondary progressive disease within 15 years?
65%
38
How commonly do SLE pts have antiphospholipid syndrome?
30%!!
39
What are the anti-phospholipid antibodies?
anticardiolipin antibodies anti-beta2 glycoprotein I antibodies lupus anticoagulant
40
Features of the tremor in parkinsons?
Asymmetrical Improves with voluntary movement i.e a resting tremor Worsens with stress 3-5Hz Pill rolling usually
41
How does drug-induced parkinsonism present differential to parkinsons?
Rapid onset and B/L symptoms Rare to have rigidity and resting tremor
42
Differentials for a tremor?
Parkinsonism Essential tremor Anxiety Thyrotoxicosis Hepatic encephalopathy CO2 retention e.g. COPD Cerebellar disease Drug withdrawal e.g alc or opiates
43
Features of an essential tremor?
It’s postural i.e. worse if arms outstretched Improved by alcohol and rest Strong FHx Titubation - tremor of head, neck and trunk
44
Most common cause of an intention tremor?
MS
45
What type of stroke can cause isolated sensory loss?
Lacunar stroke
46
Until proven otherwise what is a painful third nerve palsy? What can it occur simultaneously with?
A posterior communicating artery aneurysm Note they can also occur simultaneously with a subarachnoid haemorrhage
47
Risk factors for idiopathic intracranial hypertension?
Non-modifiable: - female - 20-40 typically - pregnancy Modifiable: - obesity - drugs: COCP, steroids, tetracyclines, retinoid use (due to high vit A), lithium
48
Which AED can cause Stevens-Johnson syndrome?
Lamotrigine Phenytoin Carbamazepine
49
What causes Lambert-Eaton syndrome?
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
Features of Lambert Eaton Syndrome?
Repeated muscle contractions -> increased muscle strength Limb girdle weakness Hyporeflexia Autonomic Sx - dry mouth, impotence, difficulty micturating
51
What cause myasthenia gravis?
Autoimmune disorder resulting in antibodies against acetylcholine receptors
52
Features of myasthenia gravis?
Muscle rating ability Diplopia (Extraocular muscle weakness) Ptosis Proximal muscle weakness Dysphagia
53
What can myasthenia gravis be associated with?
Thymic hyperplasia in up to 70% Thymomas in 15% Autoimmune disorders
54
Investigations for myasthenia gravis?
Single fibre electromyography CT thorax to exclude thymoma Antibodies to acetylcholine receptors
55
Which cranial nerves can acoustic neuromas affect? What are the effects of these?
5, 7 and 8 5 - absent corneal reflex 7 - facial palsy 8 - vertigo, U/L sensorineural hearing loss, U/L tinnitus
56
What is amaurosis fungax?
Transient monocular visual loss caused by an atherosclerotic embolism that leads to retinal artery occlusion
57
What is syringomyelia?
A collection of CSF in the spinal cord
58
What can cause syringomyelia?
A chiari malformation Trauma Tumours
59
What is a chiari malformation?
a structural defect in the cerebellum, characterized by a downward displacement of one or both cerebellar tonsils through the foramen magnum
60
Symptoms of syringomyelia?
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
Investigations for syringomyelia?
Full spine MRI to exclude tumour or tethered cord Brain MRI to exclude a chiari malformation
62
Which parkinsons Tx gives the best improvement in motor symptoms and ADLs?
Levodopa
63
What is the most common hereditary peripheral neuropathy?
Charcot-Marie-Tooth disease
64
Features of Charcot-Marie-Tooth disease?
Hx of frequently sprained ankles Foot drop Pes cavus Hammer toes Distal muscle weakness and atrophy Hyporeflexia Stork leg deformity

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