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Specialities > Neurology 2 > Flashcards

Neurology 2 Flashcards

1
Q

At which level do the nerve roots stop exiting the spinal cord above the vertebrae and instead exit below?

A

C7

*remember C7 has above and below creating a C7 nerve root and C8 nerve root

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2
Q

What are the motor symptoms of radial compression:

A

Weakness in:

  • Wrist extension
  • finger extension
  • Elbow flexion mid pronation (Brachioradialis)

*usually lack of pain

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3
Q

There are two main sites that one can develop ulnar nerve palsy, where are these?

A

Medial epicondyle of the humerus / cubital tunnel

Guyon canal

*paradoxically gets worse the more distal the lesion

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4
Q

List some drugs which commonly cause length dependent polyneuropathy:

A

Amiodarone

Cisplatin

Isoniziade

Alcohol

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5
Q

List some causes of length dependent peripheral neuropathy?

A

Diabetes

Alcohol

Nutrition

Immune

Drugs

HIV

Paraneoplastic

Critical illness

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6
Q

What investigations should be done into peripheral neuropathy and why?

A

FBC
- MCV - B12? Alcohol?

HbA1c/ OGTT

U&Es
- electrolyte imbalance

TFTs
- can cause peripheral neuropathy

B12/ Folate

Electrophoresis
- myeloma

  • if proximal and peripheral signs then:
  • LP
  • EMG/ nerve conduction studies
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7
Q

Name a finding seen on nerve conduction studies which suggest demyelination?

A

Temporal dispersion

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8
Q

What complication of cervical myelopathy can make surgery very difficult?

A

Ossification of the posterior longitudinal ligament

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9
Q

What is the definitive management of lumbar radiculopathy? (sciatica)

A

Lumbar microdiscectomy

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10
Q

List some signs seen on clinical examination which would suggest the cause of vertigo is centrally caused?

A

Negative head impulse test

Bidirectional Nystagmus

Vertical skew (nystagmus vertically)

  • other signs
  • ataxia
  • passed pointing
  • changes to speech
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11
Q

List some causes of Horner’s syndrome listing whether they are central (1st order neuron), preganglionic (2nd order neuron) or post ganglionic (3rd order neuron):

A

1st order:

  • Stroke (Weber’s syndrome)
  • Brainstem tumour
  • MS

2nd order:

  • Pancoast tumour
  • Thyroidectomy
  • Trauma
  • Cervical rib

3rd order:

  • Carotid artery dissection
  • Cavernous sinus thrombosis
  • Posterior communicating artery aneurysm
  • cluster headache
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12
Q

What clinical sign can help localise where the lesion is in Horner’s syndrome and why?

A

Anhidrosis

If lack of sweating is present it localises the lesion to either the:

  • brainstem (1st order neurons)
  • Preganglionic (2nd order)

this is because these nerves are the only ones that branch off to supply the sweat glands. In other words - the 3rd order neurons to the eye are not associated with the sweating

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13
Q

If a patient presents with signs and symptoms suggestive of a posterior stroke, but the CT negative what does this mean?
Which vessel is typically affected?

A

CT is not sensitive for posterior strokes therefore is not reliable.
MRI is more sensitive

Posterior Inferior Cerebellar Artery
- most commonly affected causing lateral medullary syndrome

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14
Q

What is the acute sign seen on CT following an ischemic stroke?

A

Hyperintense vessel sign

- can see the clot in the vessel

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15
Q

Why is it so important to make sure that a person with Parkinson’s disease received their medication at the correct dose at correct time?

A

Avoid development of
- Parkinson’s Hyperreflexia syndrome

Sudden withdrawal of medication can lead to acute dystonia and neuroleptic malignant syndrome

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16
Q

What other areas of management must be considered in someone with Parkinson’s other than medication?

A

Bone health

Exercise

Psychology/ support

Advance care planning

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17
Q

How is Lewy body dementia differentiated between Parkinson’s associated dementia?

A

If dementia is onset is within 12 months then this suggests Lewy body dementia

in other words
- early onset dementia

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18
Q

What is the main side effect of Enzyme inhibitors such as COMT, used in Parkinson treatment?

A

Diarrhea

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19
Q

What are the Parkinson plus syndrome and list some features of them:

A

Progressive Supranuclear Palsy:

  • Postural instability
  • Vertical gaze palsy
  • Truncal rigidity

Multisystem Atrophy:

  • Early autonomic signs (hypotension, incontinence, falls)
  • Cerebellar signs

Corticobasal degeneration

  • Akinetic limb loss affecting one limb
  • progressive aphasia
  • Sensory loss

Lewy body dementia

  • Early onset dementia
  • fluctuates in cognition

Vascular parkinson’s
- Predominant lower limb symptoms >3 years

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20
Q

What are some of the red signs with Parkinson’s disease that may make you query diagnosis:

A

Rapid impairment requiring wheelchair within 5 years

No progression of motor symptoms over 5 years

Marked bulbar dysfunction within 5 years

Severe autonomic dysfunction

UMN signs

Dystonic Anterocollis within 10 years

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21
Q

In suspected bacterial meningitis the first step in management is IV antibiotics. what additional antibiotics should be given to those >60 years old? and what additional symptoms/ features may be seen?

A

Amoxicillin
- cover Listeria monocytogenes

Listeria monocytogenes usually has:

  • prodromal headache of 2-3 days
  • Low sodium - hyponatremia
  • confusion

**babies <3 months are also given amoxicillin to cover for listeria

22
Q

Give some differentials for raised intracranial pressure in a young person:

A

Tumour

Venous cerebral sinus thrombosis

Idiopathic intracranial hypertension (would not cause a seizure)

23
Q

What are the presenting symptoms and How do you diagnosis a venous cerebral sinus thrombosis? and what are some risk factors, and what is the treatment?

A 
Headache 
Vomiting 
Seizure 
Papilloedema 
Periorbital oedema

CT venography/ MRI venography

  • Oral contraceptive
  • pro-coagulative/ thrombophilia
  • nephrotic syndrome
  • Pregnancy
  • Dehydration
  • Mastoiditis/ Sinusitis/ Otitis

Treatment:
- Anti-coagulation

24
Q

Highlight the symptoms you would expect from a seizure affecting particularly lobes:

A

Frontal:

  • motor
  • Personality

Temporal

  • Automatisms
  • dejavu

Parietal:
- sensory

Occipital
- visual (explosion of light or colour)

25
Q

If someone presents with suspected seizure, what is the first investigation that should be ordered?

A

ECG
- to rule out cardiac origin

BM
- dont ever forget glucose

26
Q

What is the fetal elliptic complication that can occur, and what are some associations with it?

A

Sudden Unexpected Death in Epilepsy
- usually occurs after a GTC in the patients sleep

Associations include:

  • poorly controlled epilepsy
  • Frequency GTC attacks
27
Q

What is the distinguishing feature of peroneal nerve palsy vs sciatic damage causing foot drop?

A

Peroneal damage they are still able to invert the foot as this is not supplied by the peroneal branches.

28
Q

Following a TIA - how long till one can drive?

A

1 month if symptom free.

- do not need to inform DVLA

29
Q

In terms of voluntary movement and tremor in Parkinson’s - what would you expect?

A

Expect the tremor to improve upon voluntary movement

30
Q

What symptom is more common in children with migraines?

A

Gastrointestinal symptoms

- N&V

31
Q

What are the signs and symptoms of cerebellar damage?

A

DANISH

D- Dysdiadochokinesia
A - Ataxia 
N - Nystagmus 
I - Intentional tremor 
S - Staccato speech
H - Hypotonia
V - Vertigo
32
Q

What are the causes of Cerebellar signs?

A

PASTRIES

  • Posterior Fossa Tumours
  • Alcohol
  • Stroke
  • Trauma
  • Rare - paRaneoplastic
  • Inherited - Friedreich’s ataxia
  • Epilepsy drugs - Sodium valproate and phenytoin
  • Sclerosis - MS
33
Q

If a patient has a 3rd nerve palsy along with a headache or pain in the eye, what must be considered?

A

Posterior communicated artery aneurysm

Diagnosed via a CT angiogram

34
Q

What is meant by conning?

A

Tonsillar herniation through the foramen magnum compressing the brain stem

35
Q

List several causes of reduced GCS in a patient with alcohol abuse?

A

Hypoglycaemia

Delirium Tremens

Meningitis

Hepatic encephalopathy

Head injury - from falling

Alcohol intoxication

Other substance abuse

36
Q

Which nerve root causes finger abduction weakness?

A

C8 - T1

Abduction is carried out by ulnar nerve

37
Q

Over what period of time can consideration for anti-epileptic medication be stopped?

A

Seizure free for 2 years, stopping over 2-3 months

38
Q

What is the inheritance pattern of an essential tremor?

A

Autosomal dominant

39
Q

What is the usual immediate management of a TIA and when would this not be advisable?

A

300mg immediately.

Not advisable if already on anti-thrombotic medication.
Need urgent CT to rule out bleed.

40
Q

What is the drug of choice for nausea in Parkinson’s disease (usually caused by the medications)

A

Domperidone

  • Doesn’t cross the BBB
41
Q

What are your differentials for causing cauda equina syndrome?

A

Prolapsed disc

Malignancy

Trauma - vertebral subluxation

Iatrogenic - spinal haematoma

Infection

42
Q

What is the preferred anti-platelet following a stroke?

A

Clopidogrel

43
Q

What are the ICP waveforms?

A

A wave:
- continually high pressure above >50mmHg caused by Intracranial lesion

B wave:
- less pressure but still pathological

C wave:
- Moves up and down in pressure. May not be pathological

44
Q

What are the ways the brain can compensate to raised ICP and what additional ways can children compensate?

A

1st: Reduce CSF
2nd: Reduce Venous Flow
3rd: Reduce tissue space - brain herniation

Children:

  • Bulging fontanelle
  • Widening of the suture
45
Q

What is the gold standard investigation into raised ICP and what is the management?

A

MRI head
+/-
Invasive ICP monitoring

Management:

  • Dexamethasone *not suitable in trauma
  • Mannitol or hypersaline solution
  • reduce CO2, decreases vasodilation. PaCO2: 4-5
  • Maintenance of BP to increase MAP over ICP
  • Sedation with Propofol
  • Craniectomy
  • bone part can be placed in the abdomen for later fixation
46
Q

What is the definition of hydrocephalus?

A

Excessive accumulation of CSF within the head caused by a disturbance of flow or absorption. Resulting in high pressure and dilation within the ventricular system.

47
Q

What are the classifications of hydrocephalus?

A

Children:

  • Arnold Chiari malformation - cerebella tonsils descend into the canal *associated with spina bifida
  • Stenosis of the aqueduct
  • Tumour obstruction

Adult:

  • Posterior fossa and brainstem tumours
  • SAH (arachnoid granulation disruption)
  • Choroid plexus papilloma (secretes CSF)
  • Normal pressure hydrocephalus (not actually normal pressure)
48
Q

What are the surgical options for hydrocephalus?

A
  1. Remove cause
  2. Diversion of flow
    - External ventricular shunt
    - Endoscopic third ventriculostomy
    - Shunts
  3. Choroid plexectomy
49
Q

What are the parts to a shunt used for hydrocephalus? and name the most common type:

A

1st: ventricular catheter
2nd: Shunt valve
3rd: Distal catheter

Ventriculo- peritoneal shunt

  • other places can include into:
  • pleura
  • Right atrium
50
Q

How does a subdural haematoma present on CT scan?

A

Hyperdense and make a crescent shape around the brain.
- not limited by suture lines

Appears hypodense (dark) if chronic

51
Q

What drugs are given prophylactically for migraines?

A

Propranolol
or
Topiramate

*propranolol is preferred in females of child bearing age

52
Q

What is the first line for trigeminal neuralgia?

A

Carbamazepine

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