Neurology Flashcards
How do we reduce ICP?
Head up 30 degrees
Hyperventilate –> low CO2 –> vasoconstriction
What kind of haemorrhage doesn’t tend to cause a midline shift?
Subarachnoid haemorrhage
How do we manage a non-traumatic (aneurysmal) subarachnoid haemorrhage?
CT angiogram to locate site of aneurysm
Nimodipine 60mg 5 per day
Minimise valsalvas (bed rest, codeine to stop coughing, laxatives to stop constipation, antiemetics to stop vomiting)
Don’t give antiepileptic unless prev. seizure
If a pt has a typical subarachnoid haemorrhage history but the CT head comes back normal, what should we consider?
Delayed lumbar puncture
What’s the most common brain tumour in adults?
Metastasis
How do we investigate an abscess?
Diffusion-weighted MRI
If a patient has back pain and insensate incontinence (wet/soiled without realising) then what do we suspect?
Cauda equina
How do we investigate cauda equina?
Lower limb neuro exam, PR exam
Pin-prick saddle exam
Pregnancy test if Female
Post-void bladder scan
MRI non-contrast of the lumbar spine
On a CT head, if we have “white” blood do we do a Burr hole or not?
No bc white blood = thick so Burr hole won’t relieve pressure
On a CT head, if we have “grey” blood do we do a Burr hole or not?
Yes, bc grey blood = thin
If we suspect early hydrocephalus, what can we do to manage it?
External ventricular drain in theatre
What does chorea mean?
Involuntary, random, irregular, purposeless movements
What does the hummingbird sign indicate?
Progressive supranuclear palsy
What does the hot cross bun sign indicate?
Multiple systems atrophy
What are three types of hyperkinetic movement disorders causing involuntary movements?
Tremor, chorea, dystonia
What does finger-thumb tapping getting smaller and slower indicate?
Parkinsonism
What do we need to include in a movement disorder history?
Tone
Power
Reflexes
Sensation
Co-ordination
What’s the pathophysiology of Parkinson’s disease?
Depletion of dopamine in the basal ganglia
Reduction of dopamine-producing neurons in the substantia nigra
Inhibition of the thalamus –> bradykinesia
What are six causes of seizures?
HIP SEA
Hypoglycaemia
Infection: HSV encephalitis
Psych
If you have a left cerebellar infarct, where will you see the problem?
Left side
(Ipsilateral)
Wasting, fasciculations, reflexes present. What are you thinking?
Motor Neurone Disease
What does pronator drift indicate?
Weakness in that arm
Does parkinsons have spastic or rigid tone?
Rigid
What’s the difference between spastic and rigid?
Rigid: all the way through
Spastic: worse at the start
What can cause promixal weakness?
Upper motor neurone lesion
Myopathy
What can cause distal weakness?
Neuropathy
If we just have pain in the dermatome of C7?
Radiculopathy - disc jutting out and compressing the nerve
What kind of conditions can cause a glove and stocking distribution of sensory loss?
Diabetic neuropathy
Alcoholic neuropathy
What could “tripping over small steps” indicate?
Foot drop (common peroneal nerve palsy)
What looks like Guillian Barre but isn’t?
Chronic Inflammatory Demyelinating Polyradiculopathy
- polyphasic unlike GB, and milder symptoms, requires long-term treatment, whereas GB is self-limiting.
Guess the diagnosis: 24M, high plantar arch, lower leg weakness and distal muscle wasting, peripheral sensory loss.
Charcot Marie Tooth disease
What are the causes of peripheral neuropathy?
ABCDE
A – Alcohol
B – B12 deficiency
C – Cancer (e.g., myeloma) and Chronic kidney disease
D – Diabetes and Drugs (e.g., isoniazid, amiodarone, leflunomide and cisplatin)
E – Every vasculitis
What’s characteristic of Myasthenia Gravis?
Variability
What causes dyskinetic cerebral palsy? (slow, writhing movements of the limbs)
Damage to the basal ganglia and substantia nigra
What kind of signs would MS show most? (UMN, LMN, mixed, etc.)
UMN
AKA Pyramidal
AKA Long tract
What is Lhermitte’s sign?
Barber chair sign in MS
When neck is flexed (chin-to-chest), electric shock-like pain
What is Uhthoff’s phenomenon?
In the context of MS, it is the worsening of vision following rise in body temperature
What are the investigations for MS and what would positive results show?
Bloods –> HLAB-27
MRI –> demyelinated (white) T2 lesions, periventricular plaques, Dawson fingers
LP –> oligoclonal bands in the CSF, increased intrathecal synthesis of IgG
Delayed visual evoked potentials
What do we need evidence of to diagnose MS?
Lesions that vary in location and are disseminated in time and space.
–>
Evidence of two or more relapses:
EITHER
objective evidence of =>2 lesions
OR
objective evidence of 1 lesion + history of previous relapse
Parkinsonism + autonomic disturbance (postural hypotension, atonic bladder) = ?
Multiple System Atrophy
