Neurology Flashcards
What is caused by damage to the common peroneal nerve?
Weakness of:
1) foot dorsiflexion
2) foot eversion
How does a patient with lacunar infarct present?
1) Purely motor (most common)
2) Purely sensory
3) Mixed motor and sensory
What symptoms does C8 impingement cause?
1) Pain in neck and arm on flexing neck
2) Sensory loss over middle finger and palm of the hand
What is the pattern of inheritance for essential tremor?
Autosomal dominant
What are the options for migraine prophylaxis?
1) Propranolol
2) Topiramate (avoid in women of childbearing age)
3) Amitriptyline
What is the management of essential tremors?
1st line: propranolol
2nd: primidone
What is the treatment of trigeminal neuralgia?
Carbamazepine
What are second line treatments in status epilepticus?
Levetiracetam, Phenytoin, Sodium valproate
What are the features of third nerve palsy?
1) Ptosis
2) Down and out eye
3) Mydriasis
How does Levodopa work?
increasing dopamine concentrations in the brain, which helps to alleviate motor symptoms
What is management of Parkinson’s?
1st line:
If affecting QoL: Levodopa
If not affecting QoL: Dopamine agonist, Levodopa or monoamine oxidase B (MAO-B) inhibitor
What can be prescribed with Levodopa to improve side effects?
nearly always combined with a decarboxylase inhibitor (e.g. carbidopa or benserazide)
this prevents the peripheral metabolism of levodopa to dopamine outside of the brain and hence can reduce side effects
What are common side effects of levodopa?
- postural hypotension!
- dry mouth!
- anorexia
- palpitations
- psychosis
What are the features of a vestibular Schwannoma (acoustic neuroma)?
-
1) CN V- Absent corneal reflex (CN V)
2) CN VII- facial nerve palsy (CN VII)
3) CNVIII- Vertigo, Hearing loss, Tinnitus (CN VIII)
NOTE: B/L seen in NF2
What is Cushing’s triad?
1) Bradycardia
2) Irregular breathing
3) Wide pulse pressure
NOTE: Also hypertension
Seen in pts with increased ICP
What are the effects of an anterior cerebral artery stroke?
Contralateral hemiparesis and sensory loss
Lower extremity > upper
What are the effects of a middle cerebral artery stroke?
- Contralateral hemiparesis and sensory loss (upper extremity > lower)
- Contralateral homonymous hemianopia
- Aphasia
What are the effects of a posterior cerebral artery stroke?
- Contralateral homonymous hemianopia with macular sparing
- Visual agnosia
What vessels are affected in Weber’s syndrome?
Stroke of branches of the posterior cerebral artery that supply the midbrain
What are the signs in Weber’s syndrome?
- Ipsilateral CN III palsy
- Contralateral weakness of upper and lower extremity
What are the effects of a posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) stroke?
- Ipsilateral: facial pain and temperature loss
- Contralateral: limb/torso pain and temperature loss
- Ataxia, nystagmus
What are the effects of an anterior inferior cerebellar artery (lateral pontine syndrome) stroke?
Symptoms are similar to Wallenberg’s but:
Ipsilateral: facial paralysis and deafness
What are the effects of a stroke of the retinal/ophthalmic artery?
Amaurosis fugax
The hemorrhage of which vessel most commonly leads to the formation of an subdural hematoma?
Bridging vein
The haemorrhage of which vessel most commonly leads to the formation of an extradural haematoma?
Middle meningeal artery
The haemorrhage of which vessel most commonly leads to the formation of an subarachnoid haematoma?
Vessels of the circle of Willis, such as: - basilar artery
- anterior circulating arteries
What visual field defect is caused by pituitary tumour?
- Bitemporal hemianopia, upper quadrant defect >lower quandrant
NOTE: if lower quadrant defect more likely due to craniopharyngioma
Management of neuroleptic malignant syndrome?
- Stop antipsychotic
- IVI
- Sometimes dantrolene
- Sometimes bromocriptine, dopamine agonist
What are the typical 3 features of Parkinson’s?
1) Bradykinesia
2) Tremor (resting)
3) Rigidity
GCS points?
Motor (6)
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None
Verbal (5)
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
Eyes (4)
4. Spontaneous
3. To speech
2. To pain
1. None
Which nerve roots does the ankle reflex test?
S1-S2
Which nerve roots does the knee reflex test?
L3-L4
Which nerve roots does the biceps reflex test?
C5-C6
Which nerve roots does the triceps reflex test?
C7-C8
What is the most common complication following meningitis?
Sensorineural hearing loss
What are some common side effects of phenytoin?
- Megaloblastic anaemia
- Peripheral neuropathy
- Gingival hyperplasia
What nerve is most likely to be damaged as a result of mid-shaft of humerus fracture? Symptom?
- Radial nerve
- Wrist drop
What are the features of Wernicke’s?
Nystagmus
Opthalmoplegia
Ataxia
Confusion
What are the features of Wernicke’s?
Nystagmus
Opthalmoplegia
Ataxia
Confusion
+
Amnesia (antero- and retrograde)
Confabulation
What is the most common presenting symptom of posterior circulation stroke?
Dizziness
What is the long-term management for nutrition in patients with motor neurone disease?
Percutaneous gastrostomy tube (PEG)
What is the management of generalised tonic-clonic seizures?
- males: sodium valproate
- females: lamotrigine or levetiracetam
NOTE: girls aged under 10 years and who are unlikely to need treatment when they are old enough to have children or women who are unable to have children may be offered sodium valproate first-line
What is the management of focal seizures?
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
What is the management of Absence seizures (Petit mal)?
- first line: ethosuximide
- second line:
male: sodium valproate
female: lamotrigine or levetiracetam
NOTE: carbamazepine may exacerbate absence seizures
What is the management of Myoclonic seizures?
males: sodium valproate
females: levetiracetam
What is the management of tonic or atonic seizures?
males: sodium valproate
females: lamotrigine
What is drug prophylaxis for cluster headaches?
Verapamil
What are the features of Huntington’s?
1) chorea
2) personality changes (e.g. irritability, apathy, depression) and intellectual impairment
3) dystonia
4) saccadic eye movements
What is the most appropriate antiemetic in Parkinson’s?
Domperidone
What are some causes of third nerve palsy?
1) Diabetes mellitus
2) Vasculitis
3) Raised ICP
4) Posterior communicating aneurysm
5) Weber’s
