Neurology Flashcards
1
Q
What investigations are used for the peripheral nervous system?
A
- Nerve conduction studies (PNS)
- Electromyography (EMG)
2
Q
What investigations can be used for CNS?
A
- EEG - Seizure classifying
- CT head
- MRI
3
Q
What would a spine neurological problem present with?
A
- Back pain
- Radiating down both legs
- Bilateral
4
Q
What would a brain neurological problem present with?
A
- Headache
- Vision disturbance
- Unilateral
5
Q
What is a GCS score out of?
A
15
6
Q
What is in a GCS?
A
MoVE 654 - take the best reading from both sides
MOTOR - none (1) - abnormal extension - abnormal flexion - flexion to withdraw from pain - localises - obey command (6)
VERBAL - none - incomp - inappropriate - confused - oriented
EYES - none - pain - speech - spontaneous
7
Q
What do the scores from a GCS mean?
A
15 - perfect
<8 - intubate
3 - comatose
8
Q
What are the main spinal tracts?
A
Corticospinal - descending
Spinothalamic - ascending
Dorsal column-medial lemniscus (DCML)- ascending
9
Q
Is the corticospinal tract ascending or descending?
A
Descending
10
Q
Is the spinothalamic tract ascending or descending?
A
Ascending
11
Q
Is the dorsal column-medial lemniscus tract ascending or descending?
A
Ascending
12
Q
What does the dorsal column-medial lemniscus tract transmit?
A
- Light touch
- Proprioception
- 2 point discrimination
13
Q
What does the spinothalamic tract transmit?
A
- Pain
- Temperature
14
Q
What does the corticospinal tract transmit?
A
Motor
15
Q
Where does C5+6 innervate?
A
- Biceps
- Lateral forearm
- Thumb + index finger
16
Q
What reflex is testing C5+6?
A
Biceps reflex
17
Q
Where does C7 innervate?
A
- Triceps
- Middle finger
18
Q
What reflex tests for C7?
A
Triceps reflex
19
Q
Where does C8+T1 innervate?
A
- Medial forearm
- Medial two fingers
20
Q
Where does L5 innervate?
A
- Big toe
- Dorsum
21
Q
Where does S1 innervate?
A
- Heel and sole
- Ankle
22
Q
What reflex tests for S1?
A
Ankle
23
Q
What would be seen in L5 rediculopathy?
A
- Positive ankle jerk
- Positive foot drop
- Poor inversion
24
Q
What would be seen in a common peroneal palsy?
A
- Absent ankle reflex
- Positive foot drop
- Poor eversion
25
What reflex tests for L3+4?
Knee
26
What is a TIA?
<24 hrs transient focal neurology with tissue ischaemia
27
What is a TIA a marker of?
IHD
28
What is the gold standard test for a TIA?
An MRI
29
What is a stroke?
>24hr focal neurological deficit with tissue infarct
30
Can you drive after having a TIA?
Not for 1 month
31
What are the two types of stroke?
Ischaemic (85%) or haemorrhagic (15%)
32
What are the causes of an ischaemic stroke?
- Carotid thromboembolus
- Atherogenesis
- AF
- Atrial septal defect - paradoxical embolus
- Infective endocarditis
33
What are the types of a haemorrhagic stroke?
- Epidural haematoma
- Subdural haematoma
- Subarachnoid haemorrhage
- Intracerebral haemorrhage
34
What are the causes of a haemorrhagic stroke?
- Trauma
- Alcoholism
- Anticoagulants
- Berry aneurysm
35
What are the main risk factors for stroke?
- T2DM
- Obsese
- HTN
- Hypercholesterolaemia
- Males
- Increased age
- Smoking
- AF
- Anticoagulants
36
What are the symptoms of a total anterior circulation stroke?
- Higher cortical dysfunction - speech and co-ordination problems
- Homonymous hemianopia - vision loss
- Unilateral hemiplegia + hemi sensory loss
37
What is a partial anterior circulation stroke?
Either the middle or anterior cerebral artery affected
38
What is a total anterior circulation stroke?
Both the middle and the anterior cerebral artery are affected
39
What are the symptoms of a partial anterior circulation stroke?
2/3 of:
- Higher cortical dysfunction - speech and co-ordination problems
- Homonymous hemianopia - vision loss
- Unilateral hemiplegia + hemi sensory loss
40
What are the symptoms of a posterior circulation stroke?
1 of:
- Isolated vision loss
- Cerebellar symptoms
- Contralateral CN palsy
41
What are the symptoms of a lacunar stroke?
- Pure motor
- Pure sensory
- Ataxic hemiparesis
42
Where is a stroke in the anterior cerebellar artery going to affect the most?
- LOWER LIMB!! - leg weakness
- Urinary-faecal incontinence +/- personality changes
43
Where is a stroke in the middle cerebellar artery going to affect the most?
- UPPER LIMB!!!
- Ipsilateral gaze deviation
- face droop + forehead spared
- Brocas/wernickes
44
What is a painful cranial nerve 3 palsy a sign of?
Vertebral artery dissection
45
What is seen in weber's syndrome (midbrain stroke)?
Ipsilateral CN3 palsy + contralateral hemiplegia (fixed dilated pupil pointing down and out)
46
What is seen in wallenburg's syndrome (stroke of posterior inferior cerebellar artery)?
- Ipsilateral spinothalamic face loss + Contralateral spinothalamic rest of the body loss (pain + temp loss)
- dysphagia
- Ipsilateral horners
- Ipsilateral cerebellar loss
47
What will a basilar artery stroke cause?
Locked in syndrome
48
What will a retinal artery stroke cause?
Amorosis fugax
49
How is a stroke diagnosed?
1st - Non-contrast CT
GS - diffusion weighted MRI
- Bloods
- Consider doppler USS (carotid)
50
How are ischaemic strokes treated if less than 4.5 hours from onset?
- IV alteplase (thrombolysis)
- Consider thrombectomy if clot in large artery and within 6 hours
51
How are ischaemic strokes treated if more than 4.5 hours since onset?
300mg aspirin STAT
52
What is the long term prevention of a ischaemic stroke?
- High dose statin (800mg simvastatin)
- Lifelong clopidogrel
53
What is a sub-arachnoid haemorrhage?
Ruptured circle of Willis
54
What are the causes of sub-arachnoid haemorrhage?
- Trauma - mc
- Berry aneurism
- Mycotic aneurism
55
What are the symptoms of sub-arachnoid haemorrhage?
- 10/10 instant thunderclap headache
- Increased intercranial pressure symptoms (CN3+6 palsy + cushing's triad)
- Meningism
56
What is cushing's triad?
- Irregular breathing
- Widened pulse pressure
- Bradycardia
57
How is a sub-arachnoid haemorrhage diagnosed?
1st - Non-contrast CT head - star shaped haematoma
GS - CT angiogram + LP >12hr later
- Bloods - U+E's - hyponatremia!
58
What are the red flags for headache?
- Worse in morning/at night
- 3+ eps of n+v
- worse on coughing + straining
- worse on changing position (leaning forward)
59
How is a sub-arachnoid haemorrhage treated?
- Decrease ICP - Raise bed head 30 degrees, hyperventilation, IV mannitol, dexamethasone, Burr hole surgery
- Nimodipine to decrease artery vasospasm
- Endovascular coiling surgery
60
What are the possible complications of sub-arachnoid haemorrhage?
- Vasospasm
- Rebleeding
- SIADH
- Hyponatraemic salt losing
- Hydrocephalus
61
What is a subdural haematoma?
Ruptured bridging veins
<3 days acute, >21 days chronic
62
What are the causes of a subdural haematoma?
Acute - traumatic injury
Chronic - shaken baby, low impact trauma, alcoholism
63
What are the symptoms of a subdural haematoma?
- Severe headache if acute
- N+V
- Dysarthria (slurred speech)
- Vision changes
- Increased ICP symptoms
- Decreased GCS
64
How is a subdural haematoma diagnosed?
Non-contrast CT head - crescent haematoma
65
How is a subdural haematoma treated?
- Decrease ICP - Raise bed head 30 degrees, hyperventilation, IV mannitol, dexamethasone, Burr hole surgery
- Craniotomy + clot evacuation
66
Who is at risk of a subdural haematoma?
- Alcoholics
- Elderly
- Babies
67
What is an epidural haematoma?
Ruptured middle meningeal artery
68
What causes an epidural haematoma?
Low impact trauma
69
Who is at risk of an epidural haematoma?
20-30 yrs
70
What are the symptoms of an epidural haematoma?
- Initial LOC
- Lucid interval for hours
- Rapid symptom deterioration - decreased GCS, N+V, Increased ICP
71
What are signs of head trauma?
- Battle sign
- Raccoon eyes
- Hemotympanum
72
How is an epidural haematoma diagnosed?
NCCT head - suture lines confined
73
How is an epidural haematoma treated?
- Decrease ICP
- Craniotomy + clot evacuation
74
What are the possible complications of a subdural or epidural haematoma?
- Cerebral oedema
- Coning
75
Who experiences syncope?
- Older pts
- CV morbidity
76
When do patients suffer with syncope?
- Exercise
- Postural
77
What symptoms do patients experience pre syncope?
- Pale
- clammy
- autonomic
- chest pain
78
What symptoms do patients have in the ictal phase of syncope?
- Floppy
- Loss of colour
- Eyes closed
79
What symptoms do patients experience in the post-ictal phase of syncope?
Immediate recovery + no amnesia
80
Who can suffer from general tonic-clonic epilepsy?
All ages
81
What can cause a generalised tonic-clonic seizure?
- Alcohol
- Decreased sleep
- Meds
82
What can occur in the pre-ictal phase of a tonic-clonic seizure?
- Aura
- Deja-vu
- Automatisms
83
What can happen in the ictal phase of a tonic-clonic seizure?
- Rigid fall to the floor and symmetrical limb jerk
- Eyes open
- Tongue biting
- <5 min
84
What can happen in the post ictal phase of a general tonic-clonic seizure?
- Post-ictal drowsiness for 30 mins
- Confusion
- Todd paralysis
85
Who can suffer with non-epileptic attack disorder?
- Younger pts
- Psych history
- Stress
86
What can cause a non-epileptic attack?
Increased stress and panic
87
What can happen pre-ictal phase of a non-epileptic attack?
- Panicked + unaware
- Abrupt
88
What can happen in the ictal phase of a non-epileptic attack?
- Violent asymmetrical limb jerking
- Waxing+ wanings
- Eyes and mouth variable (no tongue biting)
- Pelvic thrusting
- >5 min
89
What happens in the post-ictal phase of a non-epileptic attack?
- Rapid increased emotional response
- No amnesia
90
What is epilepsy?
A recurrent idiopathic tendency to have seizures
91
What can cause epilepsy?
- Vascular - dementia, strokes
- Infection - meningitis, encephalitis
- Trauma
- Autoimmune - rheumatoid arthritis, SLE, TB
- Mineral - hypoglycaemia, hyponatremia
- Idiopathic
- Neoplasms
- Drugs
- Everything else + eclampsia
92
What are the risk factors for epilepsy?
- Congenital problems (tuberous sclerosis, cerebral palsy)
- Acquired (meningoencephalitis, febrile convulsions)
- Dementia
93
What can decrease seizure threshold?
- Hypoglycaemia
- Alcohol
- Stress
- Meds
94
What medications can decrease seizure thresholds?
- Tricyclic antidepressants
- Lithium
- Ciprofloxacin
- Clozapine
95
What is the difference between a focally aware and a focally unaware seizure?
Focal aware - doesn't involve brainstem
Focal unaware - involves brainstem
96
What is the most common kind of focal epilepsy?
Temporal
97
What are the symptoms of a temporal seizure?
- Visual aura
- Automatisms
- Todd paralysis
98
What are the symptoms of a frontal seizure?
- Motor symptoms
- Bizarre behaviour
- Jacksonian march
99
What are the symptoms of a parietal seizure?
- Vague numbness
- Tingling
100
What are the symptoms of an occipital seizure?
- Visual hallucinations
- Blindness
101
What are the types of generalised seizures?
- Tonic clonic
- Absence
- Tonic/atonic
- Myoclonic
102
How is epilepsy diagnosed?
- Bloods, ECG, LSBP
- CT head
- EEG
103
What is raised in a true epileptic seizure?
Prolactin and lactate
104
What are the rules for informing the DVLA after having a seizure?
Evidence on EEG - no driving for 2 months
No evidence on EEG - no driving for 6 months
105
What is the treatment for general tonic-clonic seizures?
- Sodium valproate (m)
- Lamotrigine (f)
106
What is the treatment for focal seizures?
Lamotrigine or levetiracetam
107
What is the treatment for absence seizures?
Ethosuximide
108
What is the treatment for myoclonic seizures?
Levetiracetam (f) or sodium valproate (m)
109
What are possible complications of epileptic seizures?
Status epilepticus
110
How is status epilepticus treated?
1. IV lorazepam
2. IV lorazepam
3. IV phenytoin/sodium valproate/ carbamazepine
4. IV phenobarbital under special guidance + ITU
111
What is the best investigation for seizures?
EEG
112
What is status epilepticus?
Back-to-back seizures or >5min seizure
113
Which anti-epileptic medications are teratogenic?
- Valproate - spina bifida, cleft palate
- Phenytoin - hydantoin syndrome
114
What are causes of non-epileptic seizures?
C - cardiogenic - MF, arrhythmias, heart block
R - reflex - postural hypo, vasovagal syncope
A - artery insufficiency
S - systemic
H - hypoglycaemia
115
What is parkinsons?
Loss of dopaminergic neurons from the substantia nigra affecting the nigrostriatal pathway
116
What is the most common neurodegenerative disease?
1. Alzheimer's
2. Parkinson's
117
What are the risk factors for parkinson's?
- Idiopathic
- FH
- Males
118
What is the pathology of parkinson's?
Reduction in the nigrostriatal pathway causing less GABA-ergic inhibition therefore gross cortex inhibition + harder to initiate movement
119
What can cause an exacerbation of parkinson's?
- Antipsychotics (e.g. haloperidol)
- Metoclopramide
120
What are the symptoms of parkinson's?
Need 1 of these:
- Bradykinesia
- Rigidity
- Resting tremor
- Postural instability
Plus:
- Anosmia
- Hypomimia (mask like face)
- Micrographia
- Postural hypotension
- REM sleep
121
What is given to a patient who is delirious with parkinson's instead of haloperidol?
Diazepam and benzodiazepines
122
How is parkinson's diagnosed?
- Clinical (bradykinesia + 1 other symptoms)
- MRI - often normal
- DaT - 2 dots instead of 2 commas
- Post excisional biopsy - loss of dopaminergic neurones
123
How is parkinson's treated?
- MDT approach
1. Co-careldopa (L-dopa + decarboxylase inhibitor)
2. Adjuvants - entacapone, ropinirole
3. Deep brain stimulation last line
124
Why does Levodopa need to be prescribed with a decarboxylase inhibitor in parkinson's?
To improve its efficacy over time
125
What is the difference between a parkinson tremor and a benign essential tremor?
A parkinson's tremor is a unilateral resting tremor whereas an essential tremor is a bilateral symmetrical intentional tremor
126
How does alcohol affect a parkinson's tremor and a benign essential tremor?
- Alcohol worsens a parkinson tremor
- Alcohol improves a benign essential tremor
127
How is a benign essential tremor treated?
Propranolol
128
How is a parkinson's tremor treated?
L-DOPA
129
What is Huntington's disease?
CTG expansions on HTT gene on chromosome 4 causing high levels of glutamate and low levels of GABA
130
What is the inheritance pattern of Huntington's?
Autosomal dominant
131
When do Huntington's symptoms typically start to appear?
30-50 years, usually males
132
How is Huntington's staged?
>35 CTG expansion repeats - diagnose
35-55 mod
>55 severe
133
What are the symptoms of Huntington's?
- Subcortical dementia
- Psychosis
- Depression
- Chorea
134
How is Huntington's diagnosed?
- Family history
- MRI - striatum atrophy
135
How is Huntington's treated?
- MDT support, genetic counselling
- Depression -SSRI
- Psychosis - antipsychotic
- Chorea - tetrabenazine
136
What are the main causes of death in Huntington's?
1. Resp arrest
2. Suicide
137
What is the most common cause of a recurrent headache?
Migraine
138
What are triggers of a migraine?
C - Chocolate
H - Hangovers
O - Orgasms
C - Cheese
O - Oral contraceptives
L - Lie ins
A - Alcohol
T - Loud noises
E - Exercise
139
What are the stages of a migraine?
Prodrome (vague behaviour symptoms)
Aura (Visual flashes and floaters)
Migraine event (4-72hrs)
140
How long can a migraine last?
4-72 hours
141
What are the symptoms of migraine?
Needs at least 5 attacks of:
- Typically unilateral
- Pulsatile
- Mod-severe headache
- Exacerbated with motion
- With 1 of photophobia, phonobia, N+V
142
What are the treatments for migraines?
Acute - PO Sumatriptan or aspirin
Prophylaxis - Propranolol, amitriptyline
143
What is the most debilitating primary headache?
Cluster headache
144
How long do cluster headaches last?
15 mins - 3 hours, in clusters of 4-12 weeks
145
What are the symptoms of cluster headaches?
- Periorbital and retroorbital pain with trigeminal autonomic symptoms
>5 attacks with no underlying cause
- Conjunctal injection
- Miosis
- Ptosis
- Rhinorrhoea + lacrimation
146
What is the treatment for cluster headaches?
Acute - SC sumatriptan + 100% high flow oxygen
Prophylaxis - verapamil
147
What are tension headaches associated with?
Stress
148
What is the most common primary headache?
Tension headache
149
What are the symptoms of a tension headache?
- Band like mild pain around temples +/- trapezius radiation
- No eye symptoms
- No aura or motion sickness
150
How long can a tension headache last?
30 min - days
151
What is the treatment for tension headache?
Simple analgesia (paracetamol/NSAIDs)
152
What is the most common type of secondary headache?
Med overuse headache
153
What can cause a medication overuse headache?
> 15d/month ibuprofen, paracetamol, triptans
> 10d/month codeine, tramadol
For more than 3 months
154
How is a med overuse headache treated?
Stop analgesia (simple - immediately, opioid - wean)
155
What trigeminal neuralgia?
Electric shock waves in trigeminal distribution exacerbated by talking, touching, shaving
156
What can exacerbate trigeminal neuralgia?
Talking, Touching, Shaving
157
How long does trigeminal neuralgia last?
15s - 2 mins
158
How many attacks of trigeminal neuralgia are needed for diagnosis?
2
159
What is trigeminal neuralgia related to?
MS!!!!!
160
What is the treatment for trigeminal neuralgia?
Carbamazepine
161
What is giant cell arteritis?
Large cell vasculitis at temporal artery
162
What are the risk factors for giant cell arteritis?
- 50+
- F
- Caucasian
163
What are the symptoms of giant cell arteritis?
- Intermittent jaw claudication
- temporal tenderness
- amaurosis fugax
164
How is giant cell arteritis diagnosed?
- Raised ESR
GS: Temporal artery biopsy (granulomatosis, skip lesions)
165
What is the treatment for giant cell artertitis?
Methylprednisolone
166
What is anterior horn disease?
A number of medical diseases affecting the anterior horn of the spinal cord, resulting in motor symptoms
167
What can cause anterior horn disease?
- Anterior spinal artery infarct
- Polio
- Spinal muscular atrophy
- MND
168
How is polio spread?
Faeco oral spread
169
What are the symptoms of polio?
- 90% asymptomatic
- 1% acute flaccid paralysis + muscle atrophy
170
What is the possible complication of polio?
Bulbar palsy + retrograde travel
171
How is polio diagnosed?
CSF PCR
172
How is polio treated?
Prevent via IPV vaccination
173
What is the most common type of anterior horn disease?
Motor neurone disease
174
Who does MND typically affect?
60 y Males
175
What are the risk factors for MND?
- Idiopathic (mc)
- Familial (SOD1, TDP43, C9 or f72)
- Related to frontotemporal dementia
176
What are the four subtypes of MND?
- Amyotrophic lateral sclerosis - MC - UMN+LMN
- Pseudobulbar palsy - CN9-12
- Primary lateral sclerosis - only UMN
- Progressive muscle atrophy - only LMN
177
What are the symptoms of MND?
- Mixed UMN + LMN
- No sensory
- No eye
- No sphincter
178
What are UMN signs?
- Hyperreflexia
- Hypertonic - rigid, spastic
- Babinski +ve
- Arm flexors and leg extensors stronger
179
What are LMN signs?
- Hyporeflexic
- Hypotonic
- Fasciculations (esp tongue)
- Widespread weakness
180
How is MND diagnosed?
- El escorial criteria (3 spinal regions involved)
- EMG
181
What is the treatment for MND?
- MDT
- Manage symptoms
- Riluzole
182
What is multiple sclerosis?
Type 4 hypersensitivity reaction vs major basic protein of oligodendrocytes
183
Who is at risk of being affected by MS?
- Female
- 20-40 yrs
- FH
- Other autoimmunity
184
What is MS associated with?
Trigeminal neuralgia
185
Where does MS affect?
- Optic nerves
- Brainstem
- Corpus callosum
186
What are the types of MS?
- Primary progression
- Secondary progression
- Relapsing remitting (mc)
187
What criteria is used to make an MS diagnosis?
McDonald's criteria
188
What are the symptoms of MS?
>2 attacks disseminated in time+place,
- UMN only!
- Pyramidal UMN
- Intention tremor, ataxia, dysarthia
- Overactive bladder + impotence
- Heat exacerbates pain
- Neck flexion = electric shock pain
- Eyes - optic neuritis, diplopia etc
189
How is a diagnosis of MS made?
- McDonald's criteria + MRI with contrast
- LP = oligoclonal IgG bands
- NCS = decreased myelination
190
What is the treatment for MS?
Acute = PO methylprednisolone 500mg or IV methylprednisolone
Long term = DMARDS - glatiramer, Beta interferon
191
What is a key differential for optic neuritis/MS?
Neuromyelitis optica
192
Do the DVLA need to be informed of an MS diagnosis?
Must be notified but safe to drive
193
How are symptoms of MS treated?
Spasticity - baclofen
Neuropathic pain - Gabapentin
Bladder - Oxybutynin
Fatigue - Modafinil
194
What are possible complications of MS?
- Gait issues (85%)
- MH issues
195
What is meningitis?
Meningeal infection
196
Who is at risk of meningitis?
- Non vaccinated
- Neonates
- Immunocompromised
197
What are the types of meningitis
Viral (mc) - HSV2, mumps, measles, VZV
Bacterial (more severe) - S.pneumonia, N.meng, GBS, Listeria
198
What is the most likely cause of meningitis in a <3m old?
- Group B strep
- Listeria
199
What is the most likely cause of meningitis in a 3m-6yr old?
- S.pneumonia
- N.meningitidis
- Haemophilus influenza B
200
What is the most likely cause of meningitis in 6-60 yr old?
- S.pneumonia
- N.meningitidis
201
What is the most likely cause of meningitis in a 60+ yr old?
- S.pneumonia
- N.meningitidis
- Listeria
202
How is group b step seen?
+ve coccus in chains
203
How is strep pneumoniae seen?
+ve coccus in chains
204
How is Neisseria meningitidis seen?
-ve diplococcus
205
How is haemophilus influenza b seen?
-ve coccobacillus
206
How is listeria seen?
+ve bacillus
207
What are the symptoms of meningitis?
- headache
- neck stiffness
- photophobia
- Non blanching rash
- fever
- fatigue
- Kernig
- Brudzinski
208
What are the symptoms of meningitis in a neonate?
- Resp distress
- Poor feeding
- Dehydration
- Reduced GCS
- Fever
- Non blanching rash
209
How is meningitis diagnosed?
- Bloods
- CT head
- GS: lumbar puncture analysis
210
When is a lumbar puncture contraindicated in meningitis diagnosis?
If non-blanching rash is present - this is diagnostic of Neisseria meningitidis and meningococcal meningitis
211
What will be seen on LP if bacterial meningitis?
Turbid, neutrophils, <50% glucose , raised protein
212
What will be seen on LP if viral meningitis?
Clear, lymphocytes, >60% glucose , Raised/= protein
213
What will be seen on LP if fungal/TB meningitis?
Fibrinous, lymphocytes, <50% glucose, raised/= protein
214
What is the treatment for meningitis?
GP = IM benpren 1.2g and refer secondary care
Secondary care =
<3m cefotaxime
>3m ceftriaxone + dexamethasone
215
What is prophylaxis for meningitis?
Ciprofloxacin to close contacts STAT dose
216
Does Public Health England need to be notified for meningitis?
Yes
217
What are the possible complications of meningitis?
- Sensorineural deafness
- Waterhouse Friedrichsen syndrome
218
What is the main pathogen involved in encephalitis?
HSV 1
219
What are the symptoms of encephalitis?
- Seizures
- Focal neurological (mc temporal)
- Fever
- Confused
- Changes in GCS
220
What can cause encephalitis?
- HSV1
- TB
- Lyme disease
- Measles
- CMV
- Toxo plasmosis
221
How is encephalitis diagnosed?
CT head - temporal petechial haemorrhage
LP - Viral CSF picture
EEG - periodic 2Hz firing
222
How is encephalitis treated?
IV acyclovir
223
What is a brain abscess?
Pus collection intracranially
224
Who is normally affected by a brain abscess?
- 30-40yr men
- Immunocompromised
- T2DM
225
What is the most common organism that causes brain abscess?
Staph intermedius
226
What are the risk factors for a brain abscess?
- Septic emboli
- Trauma
- Mastoiditis
- Congenital heart disease in children
227
What are the triad of symptoms for a brain abscess?
- Fever
- Headache with red flags
- Focal neurology
+/- raised ICP
228
How is a brain abscess diagnosed?
Contrast enhanced CT head - ring enhancing lesion
229
How is a brain abscess treated?
- Reduce ICP
- IV flucloxacillin
230
How is a patient who is braindead identified?
- Apnoea >5mins
- Brainstem signs - no corneal, caloric, cough reflexes, fixed dilated pupil
- GCS 3 (comatose)
231
Who does MG affect?
Male - 60 yr old with thymoma
Female - 40 yr old with autoimmune disease
232
What meds should be avoided in myasthenia gravis?
- Beta blockers
- Aminoglycosides (gentamicin)
- Lithium
- CCB
- Magnesium sulphate
233
What are the symptoms for MG?
- Fatiguability as day goes on
- diplopia + ptosis
- jaw fatigue
- talking difficulty
- bulbar palsy
234
How is MG diagnosed?
Serology - Anti Acetylcholine receptor antibodies
Electromyogram - Fatiguability
235
How is MG treated?
Neostigmine + pyridostigmine
236
What are the possible complications of MG?
Myasthenic crisis - MG + T2 resp failure
237
What are the symptoms for Lambert-Eaton myasthenic syndrome?
- Weakness in legs
- Autonomic symptoms (incontinence)
- Improves throughout day
238
How is Lambert-Eaton myasthenic syndrome diagnosed?
- CXR - Small cell carcinoma
- Serology
- Electromyogram - incremental increases in activity
239
How is Lambert-Eaton myasthenic syndrome treated?
Diaminopyridine
Immunosuppression
240
What is Guillain barre?
Ascending symmetrical polyneuropathy, schwann demyelination
241
What is demyelinated in Guillain Barres?
Schwann cells
242
What does Guillain Barres usually come after?
Post campylobacter gastroenteritis (or URTI)
243
What are the symptoms for Guillain Barres?
- Reduced tendon reflexes
- Symmetrical leg weakness
244
How is Guillain Barres diagnosed?
- LP - Raised protein + normal WCC
- Serology - Anti GM1
- Nerve conduction studies - decreased conduction speed
245
How is Guillain Barres treated?
IV Ig + plasmapheresis
246
Where can brain tumour mets come from?
Breast, bone, lung, liver
247
What is the most common type of brain tumour?
Astrocytoma - 4= glioblastoma multiforme
248
What are the symptoms of a brain tumour?
- Red flag headache
- Raised ICP Sx
- N+V
- Focal neuro
- Seizures/epilepsy
249
How are brain tumours diagnosed?
1st - NCCT head
GS - MRI head
250
How are brain tumours treated?
- Reduce ICP
- IV dexamethasone
- Consider Surgery in primary tumours
- Consider chemo/radio in secondary tumours
251
What can cause neuropathy?
- Axon damage
- Wallerian degeneration
- Radiculopathy
- Demyelination
252
What are the types of neuropathy?
Mononeuropathy - one nerve
Mononeuritis multiplex - multiple single nerves
Polyneuropathy - symmetrical nerve pathology, glove + stockings
253
What nerve does carpal tunnel affect?
Median (C6-T1)
254
What can cause carpal tunnel?
- Repetitive overuse
- Hypothyroid
- Acromegaly
- Rheumatoid arthritis
- Pregnancy
255
What are the symptoms for carpal tunnel syndrome?
- Tingling in palm distribution
- Wake and shake
- Thenar muscle wasting
256
How is carpal tunnel diagnosed?
Tinel + phalen +ve
257
What is the treatment for carpal tunnel?
Splints + cold compress
258
What does ulnar compression cause?
Claw hand (C8-T1)
259
What can cause ulnar nerve compression?
Medial epicondyle fracture of humerus
260
What does radial compression cause?
Wrist drop (C5-T1)
261
What can cause radial nerve compression?
Midshaft humerus fracture
262
What does LS radiculopathy present with?
Foot drop + weak inversion with present ankle jerk reflex
263
What does common peroneal palsy present with?
Foot drop + weak eversion with absent ankle jerk
264
What does a CN 3 palsy cause?
Down + out
Dilated
265
What does a CN 4 palsy cause?
Diplopia
266
What does a CN 6 palsy cause?
Impaired abduction
267
What does a CN 7 palsy cause?
Bells Palsy
268
What does a CN 5 palsy?
- Weak mastication
- Decreased tongue sensation
269
What does a CN8 palsy present with?
- Hearing loss
- Vertigo + balance problems
270
What does a CN9 + 10 palsy present with?
Bulbar symptoms
- Swallowing
- Coughing
- Uvula - contralateral to CNx lesion
271
What does CN11 palsy present with?
Weak head turn + shrug
272
What does a CN12 palsy present with?
Ipsilateral tongue deviation
273
How is Bells palsy treated?
72hr Prednisolone + eye care
274
What does spinal cord myelopathy present with?
- No saddle symptoms
- Usually cervical
- UMN below lesion
275
What does cauda equina present with?
- Saddle symptoms (+incontinence, anaesthesia)
- Usually LMN
276
What does anterior cord compression cause?
Motor symptoms
277
What does posterior cord compression cause?
Dorsal column medial lemniscus pathway symptoms
278
What are the causes of spinal cord compression?
- Trauma
- Malignancy
- Osteophytes
- Slipped discs
- Spinal stenosis
- Myeloma
- RA
279
What are the symptoms of cord compression?
- Back pain
- Hoffman sign
- Deltopectoral reflex
- Crossed adductors
- Treacle hands
- Babinski +ve clonus
280
How is cord compression diagnosed?
Urgent MRI whole cord
281
How is cord compression
Urgent dexamethasone IV + surgical decompression
282
What is duchenne muscle dystrophy?
Xp21 frameshift mutation deletion in dystrophin gene
283
What is becker muscular dystrophy?
Xp21 missense mutation
284
How is myotonic dystrophy inherited?
Autosomal dominant
285
What are the symptoms for muscular dystrophy?
- Calf pseudohypertrophy
- Gower +ve
- Symmetrical weakness
Beckers = later, less severe
Duchenne = Earlier, more severe
286
How is muscular dystrophy diagnosed?
Bloods - Raised CK
GS = muscle biopsy stained
287
How is muscular dystrophy treated?
- Supportive MDT
- Regular ECHO scan
- Corticosteroid to slow progression
288
What is hydrocephalus?
Accumulation of CSF in cranium
289
What are the two types of hydrocephalus?
- Communicating - no obstruction
- Non-communicating - obstruction in CSF flow(mc)
290
What are the risk factors for hydrocephalus?
- Spina bifida
- Dandy walker
291
What are the symptoms of hydrocephalus?
- Impaired upturn gaze
- Gross cortical enlargement
- Raised ICP symptoms
- Effect on motor + speech milestones
292
How is hydrocephalus diagnosed?
- CT head = ventriculomegaly, obstruction
- LP = Increased opening pressure
293
What is the treatment for hydrocephalus?
- VP shunt
- Endoscopic ventriculostomy
294
What are the symptoms of normal pressure hydrocephalus?
Wet (incontinent)
Wacky (arms)
Wobbly (ataxic gait)
295
How is normal pressure hydrocephalus diagnosed?
LP = normal pressure
CT = ventriculomegaly + sulcal effacement
296
How is normal pressure hydrocephalus treated?
VP shunting
297
What is idiopathic intracranial hypertension?
Raised ICP in an overweight female
298
What are the risk factors for IIH?
- Female 20-50
- Raised BMI
- Vitamin A
- Tetracyclines
- COCP
- Pregnant
299
What are the symptoms of IIH?
- Migraine mimic
- Bilateral papilledema
- Vision changes
300
How is IIH diagnosed?
- CT head
- MRI head (torturous optic nerve)
- LP - >250 opening pressure
301
How is IIH treated?
- Weight loss
- Acetazolemide
302
Where is the most common site for a dural venous sinus thrombosis?
Superior sagittal sinus
303
What are risk factors for dural venous sinus thrombosis?
- Factor V leiden
- SLE
- COCP
- Pregnancy
- Disseminated intravascular coagulation
304
What are the symptoms of dural venous sinus thrombosis?
- Headache - acute, sudden onset, N+V
- Focal neuro (motor)
- Seizures
- Raised ICP
- Papilledema
- Reduced GCS
- Vision changes
305
How is dural venous sinus thrombosis diagnosed?
GS = MR Venogram
- CT + contrast - empty delta sign
306
How is dural venous sinus thrombosis diagnosed?
LMWH
307
What is meniere's?
Excessive endolymph in labyrinth inner ear
308
What are the symptoms of meniere's?
- 40-50y male with aural fullness
- Drop attacks
- Vertigo
- Tinnitus
- Unidirectional nystagmus
- Romberg +ve
309
How is Meniere's treated?
Antihistamines + betahistine
310
What is acoustic neuroma?
90% cerebellopontine tumour
311
Which cranial nerves are affected in acoustic neuroma?
CN5+8
312
What are the symptoms of acoustic neuroma?
- Tinnitus
- Hearing loss
- Vertigo
- Absent corneal reflex
313
How is acoustic neuroma treated?
Urgent ENT referral +/- surgery
314
What is benign paroxysmal positional vertigo?
Around 20s episodes of vertigo triggered by postural changes
315
How is benign paroxysmal positional vertigo treated?
Epley manoeuvre + vestibular rehab
316
What is vestibular neuritis caused by?
Post viral infection
317
What are the symptoms of vestibular neuritis?
- N+V
- Tinnitus
- No sensorineural hearing loss
318
How is vestibular neuronitis treated?
Supportive treatment + antihistamine
319
What is viral labyrinthitis caused by?
Post viral infection
320
What are the symptoms for viral labyrinthitis?
- N+V
- Tinnitus
- Sensorineural hearing loss
321
How is viral labyrinthitis treated?
Supportive treatment + antihistamine
322
What is optic neuritis?
Demyelinated optic nerve
323
What are the symptoms for optic neuritis?
- Central scotoma
- Pale optic disc
- Relative afferent pupillary defect
- T2 white matter hyperintensity
- Dichromatopsia
324
What is central retinal artery occlusion?
Eye stroke
325
What are the symptoms for central retinal artery occlusion?
- Amorosis fugax
- Relative afferent pupillary defect
- Cherry red macular spot
326
What is acute angle glaucoma?
Blockage in aqueous humour - raised intraoccipital pressure + optic nerve damage
327
What are the symptoms of acute angle glaucoma?
- Painful red eye
- Halos around lights
- Hazy cornea
- N+V
328
How is acute angle glaucoma treated?
Pilocarpine + acetazolomide
329
What are flash and floaters a sign of?
Retinal detachment
