Neurology Flashcards by Callum McCabe

Subarachnoid haemorrhage not visible on CT
Next investigation?

Lumbar puncture

shows either frank red blood or “xanthochromia” (yellowing due to haemolysed blood in CSF, indicating an older bleed)

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Status elipticus: 1st, 2nd, and 3rd line management = ?

1st line: 2 doses of benzodiazepines 5-10 minutes apart
2nd line: loading with IV anti-epileptics e.g. levetiracetam, phenytoin or sodium valproate
3rd line: consider IV phenobarbital or general anaesthetic under expert guidance.

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Neuropathic pain drugs? (4)

Don’t (Duloxetine)
Get (Gabapentin)
Pain (Pregabalin)
Again (Amitriptyline)

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Treatment for cluster headaches

(one for relief and one for prevention)

Nasal Sumatriptan +/- high flow oxygen relieves
Verapamil prevents

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Basic epilepsy drugs overview

tonic-clonic / myoclonic/ atonic / tonic
M- sodium valproate
F- lamotrigine/ levetiracetam
focal
lamotrigine/ levetiracetam
absence
ethosuximide

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Describe a tonic-clonic seizure

Loss of consciousness +
1. stiffening (tonic), and
2. jerking (clonic) of limbs.

Post-ictal confusion is common.

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Test to monitor for respiratory involvement in Guillain-Barre syndrome ?

FVC (Forced Vital Capacity)

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Significance of forehead sparing ?

Forehead sparing = stroke

Forehead involvement = Bell’s palsy more likely

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Which other medication should be given with levodopa?

Carbidopa
(reduces peripheral breakdown of levodopa)

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Symptoms of brain cord compression =

Cushing’s triad:
1. bradycardia
2. hypertension
3. irregular/abnormal breathing

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Optic neuritis treatment =

IV methylprednisolone

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Acute ischaemic stroke - how long after onset can thrombolysis be administered ?

4.5 hours

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Normal-pressure hydrocephalus presentation

Dementia, urinary incontinence, and gait abnormalities

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Normal-pressure hydrocephalus treatment

Ventriculo-peritoneal shunting

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Worsening back pain and leg weakness with walking + relief on bending forward

Spinal claudication

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Nutritional method for MND patients?

PEG tube (Percutaneous Gastrostomy tube)

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Right nystagmus is caused by a lesion in what area of the brain?

Right cerebellum

(left nystagmus = left cerebellum)

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Bilateral/vertical nystagmus is caused by what?

Indicates CNS involvement
e.g. due to multiple sclerosis, stroke affecting the brainstem, tumours, trauma, medications

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Management of acute relapse of MS ?

High-dose methylprednisolone

(can be IV or oral)

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Drug to reduce risk of MS relapse ?

Monoclonal antibodies e.g. IV natalizumab

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2nd line in migraine pain (when simple analgesics - paracetamol and NSAIDs - don’t work)

Sumatriptan

(Triptans work by constricting the blood vessels in the brain to relieve headaches, pain, and other migraine symptoms)

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Leg weakness but no face weakness or speech impairment - which artery is affected ?

Anterior cerebral artery

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Upper limb being affected more than the lower limb

+ may have associated aphasia

Which artery is affected ?

Middle cerebral artery

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Homonymous hemianopia with macular sparing and visual agnosia - which artery ?

Posterior cerebral artery

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Lateral medullary syndrome: - ipsilateral facial pain - temperature loss - contralateral limb/torso pain - temperature loss (as the spinothalamic tract is affected) Which artery ?

PICA (Posterior inferior cerebellar artery)

When to conduct JC virus testing in MS patients?

Before starting natalizumab as JC virus is responsible for progressive multifocal leukoencephalopathy which can be reactivated on disease-modifying treatment

Complete paralysis of all voluntary muscles except for some eye movement, but patient is aware - which artery is affected ?

Basilar artery

Vertigo, hearing loss, tinnitus and an absent corneal reflex (+ long course of progression)

Acoustic neuroma a.k.a. vestibular schwannoma

Suspected stroke management

1. Exclude haemorrhagic stroke by CT scan 2. Give Aspirin 300mg

Preferred antiplatelet for secondary prevention following stroke ?

Clopidogrel

Eczema herpeticum treatment

IV aciclovir (potentially life-threatening)

Heberden's nodes =

"Outer hebrides" i.e. Distal Interphalangeal Joints Osteoarthritis

Bouchard's nodes =

Proximal Interphalangeal Joints (Heberden's nodes = DIPs (Outer Hebrides)) Osteoarthritis

Gottron's papules =

Red/purple papules on the knuckles of the hands Dermatomyositis

Swan-neck deformity of fingers = what condition?

Rheumatoid arthritis

Idiopathic intracranial hypertension: Who is most commonly affected? What is first line treatment?

Obese, young women Acetazolamide

Jacksonian march (clonic movements travelling proximally) indicates seizure from where in the brain?

Frontal lobe

Management of myasthenic crisis ?

IV immunoglobulins + plasmapheresis

Stroke affecting the anterior inferior cerebellar artery - symptoms ?

Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness

Craniopharyngiomas vs pituitary adenomas

Craniopharyngiomas push down on the pituitary gland, giving rise to an inferior quadrantanopia/hemianopia Pituitary adenomas push up on the pituitary gland, giving rise to a superior quadrantanopia/hemianopia

What is ophthalmoplegia?

Paralysis of certain eye muscles

Features of Wernicke's encephalopathy

CAN OPEN Confusion Ataxia Nystagmus Ophthamoplegia PEripheral Neuropathy

Lip smacking + post-ictal dysphasia = focal seizure of which lobe?

Temporal lobe

Imaging method for suspected acoustic neuroma (vestibular schwannoma)

MRI of the cerebellopontine angle (MRI because this is a very bony region)

Acute ischaemic stroke which started less than 4.5 hours ago - management ?

Thrombolysis (alteplase) + thrombectomy (following CT head to exclude intracranial haemorrhage)

First line in ocular myasthenia gravis (diplopia occurring later in the day / after watching a lot of TV)

Pyridostigmine (a long-acting acetylcholinesterase inhibitor)

Ladies with generalised tonic-clonic seizures are given which medication?

Ladies given Lamotrigine or Levetiracetam

Metoclopramide exacerbates extrapyramidal side effects

Metoclopyramide ;)

LMN vs UMN signs

LMN: - Wasting, fasciculations - decreased tone - reduced or absent reflexes UMN: - No wasting, no fasciculations - increased tone - brisk reflexes - classically a pyramidal pattern of weakness (upper extensors, lower flexors)

Glasgow Coma Scale

E4 (four eyes) V5 (V = Roman numeral 5) M6

Atonic seizures in women - medical management ?

Lamotrigine (levetiracetam is avoided in atonic seizures)

B12 deficiency - give folate ?

No! This folate can worsen subacute degeneration of the cord

Mixed UMN and LMN signs (usually no sensory deficits)

Mixed + no sensory deficits = ALS

Describe anomic dysphasia

Characteristic word finding difficulties with the use of generic fillers (e.g. 'thing') or circumlocution

Absent seizures management

Ethosuximide (sucks to be absent)

Bilateral vestibular schwannomas

Neurofibromatosis type 2

Weber's syndrome =

- stroke - midbrain - ipsilateral CN III palsy - contralateral hemiparesis

Pituitary adenoma vs craniopharyngioma

UP = Upper, pituitary (PA = Upper quadrant bitemporal hemianopia CP = Lower quadrant bitemporal hemianopia)

Carotid endarterectomy considered when what % of the artery is stenosed?

Over 50%

Biconvex-shaped haematoma

Extradural haematoma = bleeding between the skull and the outermost layer of the brain called dura mater

First-line 4 options for neuropathic pain ?

amitriptyline, duloxetine, gabapentin or pregabalin (if one fails, try another)

Cluster headache management (acute + chronic)

Acute = subcutaneous sumatriptan + 100% O2 Chronic = Verapamil

Quadriplegia + pinpoint pupils

Pontine haemorrhage *Pinpoint pupils point to pons (or oPiates)*

Gram stain of Neisseria meningitides?

Gram-negative diplococci

Difference between PICA and AICA?

PICA = Lateral medullary syndrome AICA = Lateral medullary syndrome + facial paralysis and deafness

What investigation should be performed within 24 hours of TIA (in most patients)?

Carotid doppler (for patients suitable for a carotid endarterectomy)

Wrist drop = palsy of which nerve /

Radial nerve palsy

Trigeminal neuralgia medication ?

Carbamazepine

Sudden monocular vision loss that can last between 2 to 30 minutes - transient darkening

Amaurosis fugax (retinal artery occlusion)

Acoustic neuroma/vestibular schwannoma investigations ?

Audiogram and gadolinium-enhanced MRI head (Audiogram tests extent of hearing loss GE-MRI shows mass in internal acoustic meatus)

Cushing's triad in raised ICP and potential indication?

1. widening pulse pressure 2. bradycardia 3. irregular breathing Can indicate impending brain herniation

GCS less than 8?

Intubate!

Painful third nerve palsy

Posterior communicating artery aneurysm