Neurology Flashcards
What triad of symptoms is associated with normal pressure hydrocephalus?
Urinary incontinence
Dementia
Gait abnormality
What is the result of a third nerve palsy?
Down and out eye
Diplopia
Ptosis
Fixed dilated pupil
What is the result of a fourth nerve palsy?
Defective downward gaze —>vertical diplopia
What is the result of a sixth nerve palsy?
Defective abduction—> horizontal diplopia
What is the management of neuropathic pain?
Monotheraphy with Amitryptiline, pregabalin, gabapentin, or duloxetine
If doesn’t work then switch medication
Triad for wernickes encephalopathy?
Gait ataxia
Ophthalmoplegia/Nystagmus
Confusion
What is the result of a common peroneal nerve palsy?
Weakness of foot Doris flexion and foot eversion
What marker can be used to differentiate a seizure form a pseudo seizure?
Prolactin
What is the mainstay treatment for a TIA?
Aspirin 300mg for 2 weeks followed by long term use of clopidogrel 75mg
What is the acute management of a cluster headache?
High flow oxygen + SC/intra nasal triptan
Prophylaxis mix of cluster headache?
Verapamil
What is the management of an acute relapse of ms?
High dose steroids
What medication/s reduce risk of relapse in MS
Natalizumab
Fingolimod
Beta interferon
What is the medical management of myasthenia gravis
Acetylycholinesterase inhibitors- Pyradistigmine
What is the 1st line Ix for MG?
Acetylcholine receptor antibodies
What is syringomeylia?
Collection of CSF in spinal cord
What are the key features of syringomyelia/
Cape like distribution
— loss of sensation to temperature but preservation of light touch, proprioception and vibration
—classic- burn hands and don’t notice
Upgoing plantars
Autonomic features e.g. horners
Spastic weakness (predominantly Lower limbs)
What does syringomyelia have a strong association with?
Chiari malformations
What is the ix and management for syringomyelia?
Ix- full spine and brain MRI
Ms- dependent on cause - possibly a shunt
What is a fixed dilated pupil and indication of?
Cn 3
What would be the result of Neuro imaging in NPH?
Ventriculomegaly w/o sulcal enlargement
What is the inheritance pattern of neurofibromatosis?
Autosomal dominance
What chr is affected in NF1 and list 3 features?
Chr 17
> =6, 15mm cafe au lair spots
Axillary/groin freckles
Iris hamatomas
Scoliosis
Phaechromocytoma
What chr is affected in NF2 and list prominent feature?
Chr 22
Bilateral vestibular schwannomas
List 3 Sx of. An acoustic neuroma?
Unilateral hearing loss
Reduced facial sensation
Balance problems
What is the 1st line and GS Ix for acoustic neuromas? Also what sign will be present on GS to be diagnostic?
1st line- Audio gram
GS- gondolinium enhanced MRI scan- will show ‘absence of dural tail’
What is the Rx for prophylaxis of migraines?
Propranolol
Topiramate- avoid in girls of bearing age
Amitryptiline
What nerve is affected in a mid shaft humeus fracture and what happens?
Radial nerve –> Wrist drop
What is the mode of inheritance of charcot marie tooth syndrome?
autosomal dominant
What nerve is affected in amurosis fugax?
retinal/opthalmic artery (branch of ICA)
What is the key diagnostic test in GBS and what does it show?
Lumbar puncture (raised protein, with normal wcc)
How long can a person who suffered from their first unprovoked/isolated seizure with no evidence in imaging/EEG not drive for?
6 months
What is the associated effects of an anterior cerebral artery infarct?
Contralateral hemiparesis
sesnoryt loss lower extremity > upper
What are the associated effects of a middle cerebral artery infarct?
Contralateral hemiparesis
sensory loss greater in upper extremity
contralateral homonymous heminanopia
aphasia
What are the associated effects of a posterior cerebral artery infarct?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
What is werbers syndrome?
Weber’s syndrome is a form of midbrain stroke (posterior cerebral artery) characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
Wha are the characteristics of Progressive supranuclear palsy (PSP)?
postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
What is the tx of choice for an essential tremor?
Propranolol
What are sx and features of an acoustic neuroma?
vertigo
sensorineural hearing loss
unilateral tinnitus
absent corneal reflex
facial palsy
What classification can be used for an acute ischaemic stroke?
The Oxford stroke (Bamford) classification.
What medication should you give to someone within 4.5 hours of having an ischaemic stroke?
Thrombolysis - Alteplase (IV).
What are the contraindications for alteplase?
Haemorrhage.
Suspected SAH.
Active bleeding.
Recent GI infection or UTI.
Recent surgery.
Malignancy.
List the signs of a ACA infarct?
LL weakness and loss of sensation
Gait apraxia
Incontinence
Drowsiness
Decrease in spintaneous speech
List the signs of a MCA infarct?
UL and LL weakness
Contralteral homonymous hemianopia
Aphasia
Dysphasia
Facial droop
List the signs of PCA infarct?
Speech impairment + dysphagaia
Cerebellar dysfunction
Visual disturbances (contralateral homonymous hemianopia with macular sparing)
visual agnosia
prospagnosia
What are the signs of Werber’s syndrome and what artery is affected?
Branches of posterior cerebral artery that supply midbrian
Ipsilaterla CN3 Palsy
contralkaterla weakness of UL and LL
What is the signs of Wallenberg syndrome/lateral medulalry syndrome and what aretry is affected?
Posterior inferior cerebellar artery
ipsialteral facial pain and temp loss
Contralateral limb/torso pain and temp loss
Ataxia, Nystagmus
Give 4 signs of UMN weakness.
Increased muscle tone.
Hyperreflexia.
Spasticity.
Minimal muscle atrophy.
Give 5 signs of LMN weakness.
Decreased muscle tone.
Hyporeflexia.
Flaccid.
Muscle atrophy.
Fasciculations.
Give 3 signs of Myasthenia Gravis.
Generalised fatiguability:
Proximal limbs.
Neck/face - head drop, ptosis.
Extra-occular - diplopia.
Speech and swallowing problems.
Risk of other auto-immune disorders.
Peripheral Neuropathy: describe mononeuritis multiplex.
A patchy process where individual nerves are picked off randomly. Often it has an inflammatory or immune mediated cause. Chronic, slow progression.
What are the 3 main components of the Glasgow Coma scale?
Best motor response.
Best vocal response.
Best eye-opening response.
What spinal tract is responsible for motor response?
Corticospianl tract
What signals does the spinothalamic tract carry?
Anterior- Crude touch, light touch, vibration.
Lateral- pain, temperature,
Give 2 population groups who may be at increased risk of a subdural haematoma.
Elderly and alcoholics - due to cerebral atrophy.
Give 3 symptoms of a subarachnoid haemorrhage.
‘Thunderclap’, maximum severity headache within seconds.
Photophobia.
Neck stiffness.
Nausea and vomiting.
What investigations might you do in someone who you suspect has a subarachnoid haemorrhage?
CT head (star shaped).
Cerebral angiography.
Lumbar puncture - xanthochromia.
How do you manage and treat a patient who has had a subarachnoid haemorrhage?
Nimodipine (CCB).
Early intervention, support and close monitoring is essential.
Give 3 symptoms of Cauda Equina syndrome.
Bilateral sciatica - pain radiates down leg to foot.
Saddle anaesthesia.
Bladder/bowel dysfunction.
Erectile dysfunction.
Leg weakness.
Define frailty.
A state of increased vulnerability resulting from an ageing associated decline in reserve and function across multiple physiologic systems; the ability to cope with everyday stressors is therefore compromised.
What is relative afferent pupillary defect (RAPD)?
It is observed during the swinging light test. The patient’s pupils dilate when the light is swung from the unaffected to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.
What is another name for RAPD?
Marcus Gunn pupil.
In what conditions might you see RAPD?
MS.
Glaucoma.
Severe retinal disease.
Optic nerve lesion.
List 5 RF for stroke?
Smoking
Alcohol
HTN
Hyperlipidaemia
obeisty
DM
AF
What is syncope?
A transient loss of conciousness, loss of postural tone
List 5 differentials for blackouts?
Vasovagal syncope
cardiac syncope
migraine w/ aura
Hypoglycaemia
TIAs
non-epileptic seizures
Intermittent hydrocephalus
What ix couold be done for blackouts
12 lead ECG
Brain imaging
EEG
Video telemtery
Tilt Table Test
List 3 features of Multi System Atrophy?
parkinsonism
autonomic disturbance
- erectile dysfunction: often an early feature
- postural hypotension
- atonic bladder
cerebellar signs
classical history of poor response to levodopa, impotence, urinary retention and age group.
List features of PSP?
impaired balance and therefore being prone to many falls.
vertical gaze palsy.
symmetrical onset and is poorly responsive to levodopa
what should be suspected with a Painful third nerve palsy
Posterior communictaion artery aneurysm
What diagnosis should be suspected in a Obese, young female with headaches / blurred vision
Idiopathic intracranial hypertension
which of the muscles are typically spared in MND
Ocular muscles
What is Brown-Sequard syndrome a result of and list the main feature
BSS is a result of lateral hemisection of the spinal cord
ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation
What is the GS ix for suspected stroke?
Non contrast CT head
List 5 triggers for a migraine?
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult
Exercise
List the triad associated with Horners syndrome
Ptosis, Miosis and Anhidrosis