Neurology Flashcards
Stroke: contralateral hemiparesis and sensory loss, lower extremity > upper
Where is the lesion?
Anterior cerebral artery
Stroke: contralateral hemiparesis and sensory loss (upper extremity > lower), contralateral homonymous hemianopia, aphasia
Where is the lesion?
Middle cerebral artery
Stroke: contralateral homonymous hemianopia with macular sparing, visual agnosia
Where is the lesion?
Posterior cerebral artery
Stroke: ipsilateral CN III palsy, contralateral weakness of upper and lower extremity
Where is the lesion?
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
Stroke: ipsilateral: facial pain and temperature loss, contralateral: limb/torso pain and temperature loss, ataxia, nystagmus
Where is the lesion?
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Stroke: ipsilateral CN III palsy, contralateral weakness of upper and lower extremity, facial paralysis and deafness
Where is the lesion?
Anterior inferior cerebellar artery (lateral pontine syndrome)
Stroke: amaurosis fugax
Where is the lesion?
Retinal/ophthalmic artery
Stroke: ‘locked-in’ syndrome
Where is the lesion?
Basilar artery
Describe the presentation of lacunar strokes
- Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
- Strong association with hypertension
What is Miller Fisher syndrome?
- Subtype of Guillain-Barre syndrome characterised by areflexia, ophthalmoplegia, and ataxia
- Descending weakness is also a classic feature of this condition, as opposed to the ascending weakness seen in more common forms of GBS
What are the features of Wernicke’s encephalopathy?
Confusion, gait ataxia, nystagmus + ophthalmoplegia
Fever, headaches, and behavioural changes such as irritability, followed by seizures.
CT head showing temporal lobe changes.
What is the diagnosis?
Herpes simplex encephalitis
What is the first line treatment for tonic/atonic seizures in females?
Lamotrigine
Describe the management of autonomic dysreflexia
Involves removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia
A 65-year-old man presents with a 3 month history of numbness and paraesthesia in his feet. On examination there is widespread numbness of both feet which does not fit a dermatomal distribution. A recent gamma-glutamyl transpeptidase (gamma GT) is 4 times the upper limit of normal.
What is the most likely diagnosis?
Alcohol peripheral neuropathy
A 73-year-old man presents to the emergency department with a left-sided facial droop. On cranial nerve testing, when testing the facial muscles, he is unable to smile on the left side but can close his eyes, raises his eyebrows and wrinkle his forehead.
Where is the lesion located which has caused this particular facial nerve palsy?
Right upper motor neuron
Driving restrictions: first unprovoked or isolated seizure if brain imaging and EEG normal
Cannot drive for 6 months
What findings on nerve conduction studies are associatd with GBS?
Decreased motor nerve conduction velocity on nerve condution studies secondary to demyelination
What type of dysphagia: speech fluent, but repetition poor, comprehension is relatively intact
Conductive dysphagia
How does Creutzfeldt-Jakob disease present?
Rapid onset dementia and myoclonus
Patient presents with stroke. What CT findings would be a contraindication to thrombolysis/thrombectomy?
A hyperdense collection is suggestive of a haemorrhage and hence a contraindication
Headache worse on lying down or coughing. What is contraindicated?
Lumbar puncture (raised ICP until proven otherwise so do CT first)
What complicaton of acute sinusitis presents with headache, fever, and focal neurology?
Brain abscess