Neurology Flashcards
What is lateral medullary syndrome? and what causes it?
Wallenberg syndrome - acute ischaemic infarct of lateral medulla oblongata
What are the symptoms of a medulla oblongata infarct?
eople with conduction aphasia have good comprehension and coherent speech, but have difficulty repeating words or phrases
What is the pneumonic to remember features of cerebellar disease?
DANISH
Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria / slurred speech
Heel-shin test positivity/ hypotonia
If there is a pontine lesion how does it present?
Will affect the cranial nerves - v,v1 and v3 and v4 so ipsilateral weakness of abduction of eye and ipsilateral facial weakness and ipsilateral deafness
What is first line treatment for essential tremor?
Propranolol
If patient has asthma and essential tremor what is treatment?
Topiramate
What anti-platelet should be given after thrombolysis ensuring there is no haemorrhage?
\Aspirin 300mg after 24 hours
What is the most common hereditary peripheral neuropathy?
Charcot-marie-tooth disease
What is charcot marie tooth disease?
Distal muscle weakness
Foot drop
Decreased sensation
What is the inheritance pattern of caharcot marie tooth disease?
Autosomal dominant
If common fibular nerve (common peroneal nerves) was damaged what signs would you expect?
Foot drop
Which dementia is linked to amyotrophic lateral sclerosis?
Fronto-temporal dementia
Which gene is found in amyotrophic lateral sclerosis and fronto-temporal dementia?
C9orf72
What is driving advice for first seizures?
After a one off seizure you can’t drive for a minimum of 6 months
What is preferred treatment for a subarachnoid haemorrhage?
Endovascular coiling
If a CT head is negative for a subarachnoid haemorrhage but it’s still suspected what other test can be done?
Lumbar puncture - as it may reveal blood in CSF or xanthochromia - yellowed CSF from haemolysis - indicates an older bleed
What is brown-sequard syndrome?
Due to damage affecting one half of spinal cord - usually due to knife or gunshot wound. Can also be due to other trauma like falls or malignancy
What are the symptoms of posterior cord syndrome?
Loss of fine touch, proprioception and vibration
Which column tract does posterior cord syndrome affect?
Dorsal column
What symptoms appear with anterior cord syndrome?
Loss of pain and temperature sensation
Which vitamin deficiency is a risk factor for subacute combined degeneration of the spinal cord?
B12
What is first line for seizing patient?
2 doses of IV lorezapam
If after 2 doses of IV lorezapam there is not stopping the seizure what should be tried?
IV infusion of phenytoin
What is used in acute treatment of cluster headaches?
High flow oxygen also triptans can be used
What is initial treatment for trigeminal neuralgia?
Carbamazepine
How does a cluster headache present?
Worst pain ever
Usually temporal around eyes
can last from 15 mins to three hours
Which region in brain is degenerated in parkison’s?
Substantia nigra
What is the definition of status epilepticus ?
Seizure lasting 5 mins or more or multiple seizures occurring within a 5 min windows without regaining full consciousness
What is first line treatment for Myasthenia gravis?
Pyridostigmine
What’s the mechanism of action of pyridostigmine?
Acetylcholinesterase inhibitor
Which nerve supplies sensation to the little finger?
Ulnar nerve
What is the gold standard treatment for symptomatic parkinson’s?
Levodopa + carbidopa
What visual defect is seen with optic chiasm compression?
Bitemporal hemianopia
What is a major complication to be aware of with subarachnoid haemorrhage in the first 12 hours?
Anyeurysmal rebleed
What are the symptoms of an aneurysm rebleed?
Sudden worsening of neuro symptoms after presenting
What is an important side effect of levodopa?
Postural hypotension
In bell’s vs stroke which one is forehead sparing?
Stroke spares forehead but bell’s doesn’t - meaning forehead can’t wrinkle in bells bcos it’s a lower motor neurone disease
What is the gold standard way to measure a patients with breathing difficulty respiratory effort?
FVC
What is myasthenia gravis?
Autoimmune disease - where antibodies that target the post synaptic nicotinic acetylcholine receptors at neuromuscular junction are targeted
What is pathophysiology of myasthenia gravis?
Ability of acetylcholine to trigger muscle contractions is reduced leading to muscle weakness
What is the main demographic of myasthenia gravis?
Women under 40 and men over 60
What’s are the symptoms of myasthenia gravis?
They get worse by end of day or after prolonged movement:
Fatigable limb muscle weakness
Ptosis
Diplopia
Facial palsy
Dysphagia
Dysphonia
Which drugs can exacerbate MG?
Beta blockers
Lithium
Penicillamine
Gent
Quinolones
Phenytoin
What are some investigations for MG?
Ice pack test - ice over eye for 2-5 mins to assess for improvement in ptosis - test is positive if there is an improvement by more than 2mm
Why does the ice pack test work?
Cooling the skeletal fibres decreases the activity of acetylcholinesterase’s - allows more acetylcholine to collect in neuromuscular junctions - increasing muscle contraction
Which antibodies are seen in MG?
Anti-AChR
Anti- muscle specific tyrosine kinase
Anti-LRP4
When should an MG patient receive mechanical ventilation?
If FVC is 15ml/kg or less
What is medical management of MG?
Steroids and anticholinesterase inhibitors: pyridostigmine or neostigmine
In acute cases of MG what should be given?
IV immunoglobulin or plasmapharesis
How would an L3 radiculopathy present?
Hip and thigh pain
Weakness of hip extension and abductions
Reduction of knee jerk reflex
How would S1 radiculopathy present?
Pain in posterior aspect of leg
Weakness of plantar flexion, leg extension and knee flexion
What is the presentation of GBS?
Ascending inflammatory demyelinating polyneuropathy affecting lower limbs first
Ascending flaccid paralysis
Can occur after infection
Which infection does GBC usually occur after?
Campylobacter gastroenteritis
What is first line treatment for GBS?
IV immunoglobulin and supportive therapies
Which area connects Wernicke’s and Broca’s area?
Left arcuate fasciculus
What type of aphasia presents with inability to repeat words and incorrect substitution?
Conduction aphasia
What brain area is affected in conduction aphasia?
Left arcuate fasciculus
What is diagnostic investigation for Idiopathic intracranial hypertension
Lumbar puncture: opening pressure over 20cmH2O
What is a common cause of obstructive hydrocephalus?
Aqueduct stenosis - so site of lesion would be in the cerebral aqueduct
What is first line management of lumbar spinal stenosis?
Analgesia and physio
Which part of brain do Jacksonian marches originate from?
Frontal lobe
What is presentation of amyloidosis?
Proteinuria and oedema of legs and abdomen
Kidneys become small, pale and hard or large
Heart failure
Which cervical root is most affected by cervical myelopathy?
C7
What’s the management for diabetic peripheral neuropathy?
Gabapentin
Pregabalin
Amitriptyline
BUT all monotherapy so must use one at a time
Which investigation is best for a carotidartery dissection?
CT head and neck angiogram
Which antibiotic is most likely to reduce seizure threshold in epileptics?
Ciprofloxacin
What are the two types of charcot marie tooth disease?
Type 1: demyelinating - more common - champagne bottle legs
Type 2: Axonal
What is the only way to definitively confirm diagnosis of Creutzfeldt Jakob disease?
Brain biospy - often post mortem
What is first linetreatment for a cluster headache?
SC sumatriptan and 100% high flow oxygen
What’s first line treatment for a tonic clonic seizure in non women - child bearing age vs child bearing age woman?
Sodium valproate
vs
Lamotrigine
What is first line medication for absence seizures?
Ethosuximide
What is first line medication for focal seizures?
Carbamezapine
What’s the scoring scale used in assessing possible stroke in A&E?
ROSIER
What is first line medical management of MS relapse - e.g. optic neuritis?
Oral methylprednisolone
What is the pathology of MS?
CD4 mediated destruction of oligodendroglia cells and humoral response to myelin binding protein
What are the symptoms of MS?
Patchy parasthesia
Red desaturation
Painful eye movements
Cerebellar ataxia
Bowel and bladder disturbances
What would be seen in CSF with MS?
Oligoclonal bands
What criteria is used to diagnose MS?
Mcdonald’s criteria
What is chronic management of MS?
Beta interferons and glatiramer
Dimethyl fumarate
Natalizumab - and alemtzumab
What type of medication is selegiline?
Monoamine oxidase type b inhibitor - parkinson’s medication - don’t dela administration
What is prophylaxis in migraines?
Propranolol first line unless asthmatic then amitriptyline, topiramate or candesartan
What is special about a lacunar stroke?
The symptoms are motor issues due to small vessel disease usually
What’s the most common cause of subacute combined degeneration of the cord?
B12 deficiency
What is tabes dorsalis?
Late presentation of neurosyphilis
What is lhermitte’s sign?
Pain on neck flexion
What are the symptoms of normal pressure hydrocephalus?
Wet
Weird
Wobbly
- Urinary incontinence
Gait instability
Mild dementia
What is treatment of normal pressure hydrocephalus?
Ventriculoperitoneal shunt
How can creutzfeldt jakob disease present?
Swift cognitive decline
Mood lability
Involuntary muscle jerks (myoclonus)
What marker is used to detect creutzfeldt jakob disease?
CSF 14-3-3 protein
Why can straining in a patient with uncontrolled hypertension lead to acute cerebral haemorrhage?
Straining for pooing = Valsalva - exacerbates the hypertension
What is an oculogyric crisis?
Acute dystonic reaction characterised by upward deviation of eyes and sometimes neck and mouth involvement
Which medications can precipitate a oculogyric crisis?
Metroclopramide and anti-psychotics like haloperidol
What is management of oculgyric crisis?
Procyclidine
What’s the most common cause of a surgical third nerve palsy?
Posterior communicating artery anyeurysm located in circle of willis
What’s a side effect to look out for with lamotrigine use?
Steven johnson sydnrome - blistering rash
What’s a side effect to look out for with phenytoin use?
Gingival hypertrophy
Which artery is affected in locked in syndrome?
Basilar artery
