Neurology Flashcards
Driving advice in TIA?
1 month off driving, don’t need to tell DVLA
Driving advice new seizure?
6 months off driving, tell the DVLA
3rd nerve palsy + contralateral weakness?
Brainstem stroke = Weber syndrome
Which lobe is affected in receptive dysphasia (Wernicke’s)?
Temporal lobe
Which lobe is affected in expressive dysphasia (Broca’s)?
Frontal lobe
If there is no receptive or expressive dysphasia, but there is poor repetition, what is affected?
The conduction pathway between temporal and frontal lobe (ARCUATE NUCLEUS)
What to do if someone with Motor Neurone Disease is unable to feed?
PEG tube
What are the characteristics of trigeminal neuralgia?
Paroxysmal attacks of sharp facial pain along Nerve V distribution, triggered by touch
How do you manage raised BP >200 in acute ischaemic stroke
labetolol
What are the management options for acute ischaemic stroke?
Thrombolysis within 4.5 hours
Thrombectomy within 6
Cabergoline used in PD. What is a side effect of cabergoline?
Pulmonary fibrosis
Which arteries are affected in a posterior circulation stroke?
Vertebrobasillar arteries
NB// there is a single basillar and two vertebral
What are the symptoms of Wallenberg’s/Lateral medullar syndrome? Which artery is affected?
DANNN
Dysphagia, ataxia, ipsilateral nystagmus, numbness, nerve palsy
poster inferior cerebellar artery
What are symptoms of Weber’s?
Brainstem stroke
Ipsilateral 3rd nerve palsy plus hemiparesis
Laughing episode triggering loss of muscle tone?
And which further condition is it associated with?
= Cataplexia
Associated with narcolepsy
causes of peripheral neuropathy?
B12/folate
diabetes
alcohol
uraemia
GBS
side effect of taking too much vit b6 (pyridoxine)?
Peripheral neuropathy
What is the most common cause of B12 deficiency? (+ what are other causes)
Most common = pernicious anaemia
Others:
gastrectomy
Crohn’s (affects ileum, where most of it is absorbed)
What are the neurological sequelae of B12 deficiency?
SCAD - dorsal column (proprioception, vibration)
Peripheral neuropathy
What are the diagnostic criteria for migraine?
5 attacks which fulfil the following criteria
1)lasting 4-72 hours
2) features of unilateral, throbbing, brought on by physical activity
3)nausea + vomiting or photophobia + phonophobia
What is Hoffman’s sign and which condition does it indicate?
Flick down on nail on middle finger, causes involuntary flexion of distal thumb and index finger
Indicates an UMN - seen in DCM
What can exacerbate myasthenia gravis?
Certain medication such as beta blockers and antibiotics
(Note gentamicin can precipitate life-threatening myasthenia crisis and so should never be given in myasthenia gravis)
What is the medical management of Status Epilepticus?
IV lorazepam 4mg
After 10mins, another IV lorazepam 4mg
If no improvement, try second line anti-epilepetic
If after 45mins, no response, will need to be induced under GA
Which bacteria responsible in meningitis and which Abx?
NHS - IV cefotaxime
But if <3 months or >65, susceptible also to Listeria - cover with IV Amxocillin as well
What should be given alongside Abx in bacterial meningitis? In which type of bacteria, is this most important?
IV Dexamethasone to reduce inflammation sequelae
Most important in pneumococcal (i.e. streptococcus pneumoniae)
If Myasthenia Gravis is suspected, what imaging must be done?
CT CHEST TO EXCLUDE THYMOMA
Most common mental health issue in PD?
Depression (not dementia)
Difference between Weber’s and Wallenburg’s?
Weber’s = brainstem (midbrain) stroke - ipsilateral 3rd nerve palsy and contralateral hemiparesis
Dan Wallenburg = DANNN (posterior inferior cerebellar artery)
What is the acute and preventative treatment for migraines?
Acute = oral triptan + paracetamol/NSAID
(in adolescents, use nasal triptans)
Preventative = propranolol
Which nerve roots do these reflexes test?
biceps
triceps
knee
ankle
bicep = c5,c6
tricep = c7,c8
knee = l3,l4
ankle = s1,s2
Which anti-emetics should you use in PD?
DomPeridone (does not cross BBB)
Should NOT use haloperidol or metoclopramide
Criteria for lacunar stroke?
Would have either sensory loss, OR motor loss, OR ataxic hemiparesis OR sensorimotor
since lacunar doesn’t affect cortex, does not usually affect higher cognitive functions such as speech, recognition, awareness etc.
Management of PD?
If motor symptoms main issue -> Levodopa (compared to other drugs, improves motor symptoms better)
If need further meds, can add MAO inhibitor or dopamine agonists (bromocriptine, ropinerole)
Downside of dopamine agonists in PD?
This drug class, compared to Levodopa, and MAO-I, cause hallucinations! Also don’t have as good improvement in motor symptoms.
