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MHU > Neurology > Flashcards

Neurology Flashcards

1
Q

How does the presentation of ptosis differ in Horner’s Syndrome v CN III Palsy?

A

Horner’s Syndrome: superior tarsal paralysis causing ptosis, pupil constricted, anhidrosis CN III Palsy: levator palpebrae paralysis, dilated pupil, gaze is ‘down and out’

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2
Q

What 4 interventions have been proven to improve outcome after acute ischaemic stroke?

A
  1. Management in a stroke unit 2. Aspirin 3. IV anteplase 4. Hemicraniectomy
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3
Q

What are the most common organisms implicated in community-acquired bacterial meningitis?

A
  1. Strep pneumoniae 2. Neisseria meningiditis 3. Listeria monocytogenes (primarily in patients >50)
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4
Q

What is the classic triad of meningitis?

A

Fever, nuchal rigidity, mental state change

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5
Q

What is the empirical antibiotic regime for the treatment of bacterial meningitis?

A

Cephtriaxone + Vancomycin + Amoxicillin (if >50)

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6
Q

Apart from Parkinson’s Disease, what are other causes of Parkinsonism?

A

Antipsychotics Progressive supranuclear palsy Multiple system atrophy Corticobasal degeneration Postencephalitic parkinsonism

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7
Q

What are the cardinal features of Parkinsonism?

A

Tremor Rigidity Bradykinesia Postural instability Apathy

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8
Q

What are the pharmacolocial treatment options for Parkinson’s Disease?

A

Cabergoline (DA agonist) - in younger patients Levodopa + Carbidopa (DDC inhibitor) COMT inhibitor or MAOI Anticholinergic Amantadine (NMDA antagonist) Deep brain stimulation

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9
Q

What is the first-line treatment of absent seizures?

A

Ethosuxamide

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10
Q

Which anticonvulsant is first-line for generalised epilepsy?

A

Valproate

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11
Q

Which anticonvulsant is first-line for partial epilepsy?

A

Carbamazapine

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12
Q

What are the general adverse effects of anticonvulsants?

A

Sedation, headache, GI symptoms, dizziness, insomnia, ataxia, rash, vision disturbance

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13
Q

What are the contraindications to lumbar puncture?

A

Possible raised ICP Bleeding diathesis Suspected spinal epidural abscess

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14
Q

What is the prognosis of Creutzfeldt-Jakob disease?

A

Incurable, rapidly progressive, death within weeks to months (maximum one year). Also known as mad cow disease.

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15
Q

What is the presentation of Guillian Barre syndrome?

A

Ascending motor paralysis over hours to days +/- sensory disturbance.

*May be preceded by campylobacter jejuni infection*

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16
Q

What is reflex sympathetic dystrophy (also known as complex regional pain syndrome)?

A

Pain, swelling and changes in skin (neurological process)

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17
Q

A stroke in which area of the brain will cause pure motor hemiparesis?

A

Posterior limb of internal capsule (anterior choroidal artery)

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18
Q

A stroke in which area of the brain will cause pure sensory loss?

A

Ventral posterior lateral nucleus of thalamus (PCA)

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19
Q

How will a basal ganglia stroke present?

A

Often asymptomatic or with hemiballismus

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20
Q

What is hemiballismus?

A

Unilateral involuntary flinging motions of limbs due to basal ganglia dysfunction

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21
Q

What are the typical findings of an ACA stroke?

A

Contralateral leg weakness with preservation of speech (left) or visuospacial functioning (right)

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22
Q

What are the typical findings of an MCA stroke?

A

Contralateral face and arm weakness with affected speech (left) or visuospacial functioning (right)

23
Q

Name these types of brain herniation.

A
  1. Subfalcine (cingulate gyrus beneath falx cerebri)
  2. Uncal (temporal lobe beneath tentorium cerebelli)
  3. Central (cerebellar tonsils through foramen magnum)
  4. Transcalvarial (brain through break in skull)
24
Q

How does a subfalcine herniation present?

A

May be asymptomatic or cause contralateral leg weakness / gait abnormality

25
Q

Which type of brain herniation can cause Cheyne-Stokes breathing?

A

Central herniation

26
Q

What is the typical presentation of cavernous sinus thrombosis?

A

CN III - VI palsies + unilateral facial swelling in a young female taking the OCP

27
Q

Plaques in the corpus callosum typically occur in which neurological condition?

A

Multiple sclerosis

28
Q

What are the typical LP findings in Guillian Barre disease?

A

Elevated protien with normal cell count

29
Q

What symptoms of Parkinsonism do anticholinergics treat most effectively?

A

Tremor

30
Q

Which structure produces CSF?

A

Choroid plexus lining the lateral, third and fourth ventricles

31
Q

Which structure reabsorbes CSF?

A

Arachnoid villi in the dural venous sinuses

32
Q

What is the most common site of obstruction in non-communicating hydrocephalus?

A

The cerebral aqueduct (of Sylvius)

33
Q

How might hydrocephalus present in a 6-month old child?

A

Bulging fontanelles

Widened sutures

Poor feeding & irritability

Frequent vomiting

Occular bobbing (setting sun sign)

UMNL signs

Convulsions

34
Q

At which intervertebral space is the needle inserted in a lumbar puncture?

A

Either L3/4 or L4/5

35
Q

Which spinal level corresponds with the iial crests?

A

L4

36
Q

What are the LP findings in Creutzfeld-Jacob disease?

A

14-3-4 protein

37
Q

What complications may develop following a lumbar puncture?

A

Headache

Backache

Infection

Bleeding

Cerebral herniation

Radicular pain / numbness

38
Q

If a SAH is suspected, what may be found on lumbar puncture?

A

Xanthocromia (yellow CSF due to breakdown of erythrocytes)

39
Q

What are the most common aetiological agents in encephalitis?

A

Viruses or an unknown underlying cause

40
Q

What is the first-line treatment of encephalitis?

A

High-dose acyclovir until HSV infection is ruled out

41
Q

What are the clinical features of frontotemporal dementia?

A

Poor executive function

Disinhibition

Personality / behaviour change

42
Q

List 5 differential diagnoses for dementia.

A

Brain lesion (tumour, subdural haematoma)

Neurotoxic drugs

Creutzfeldt-Jacob disease

Normal pressure hydrocephalus

Depression / anxiety

Wernicke-Korsakoff syndrome

Thyroid disease

Episodic damage (e.g. seizures, hypoglycaemia)

Electrolyte imbalance

Severe sleep disorders

43
Q

What are the features of Wernicke’s Encephalopathy?

A

Confusion / cognitive impairment

Ophthalmoplegia

Ataxia

44
Q

What are the features of Korsakoff’s Syndrome?

A

Amnesia (anterograde and retrograde)

Confabulation

Hallucinations

45
Q

What are the clinical features of central brain herniation?

A

Brainstem compression causing Cushing’s Triad:

  1. Bradycardia
  2. Systolic hypertension
  3. Widened pulse pressure

Decerebrate then decorticate positioning

46
Q

What are the clincial features of uncal herniation?

A

Ipsilateral dilated, non-reactive pupil due to compression of CN II

47
Q

Explain:

(a) Decerebrate positioning
(b) Decorticate positioning

A

(a) Decerebrate = head arched back with arms/legs extended, feet turned outwards
(b) Decorticate = arms flexed, hands clenched, legs extended, feet turned inwards

(decerebrate is worse than decorticate)

48
Q

What is the average intracrainial pressure (ICP) in adults?

A

7-15mmHg or 7-20cmH2O

49
Q

What is the most common type of brain herniation?

A

Transtentorial (uncal) herniation

50
Q

What is Todd’s paresis?

A

Post-ictal focal neurological deficit

51
Q

In a person with normal hearing, what will Rinne’s test show?

A

Positive test = Air conduction > Bone conduction

(tests function of middle ear and conductive hearing)

52
Q

In Weber’s test, why does the sound localise to the deaf ear if conductive hearing loss is present?

A

Sound seems louder in deaf ear as conductive deafness prevents the normal masking effect of ambient sound

53
Q

Give 4 metabolic causes of dementia.

A
  • Hypothyroidism
  • B12 deficiency
  • Uraemia
  • Hypercalcaemia
54
Q

What is the most common presentation of Motor Neurone Disease?

A
  • Wasting and weakness of the muscles of the hand
  • Fasciculations
  • Preservation of sensation

MHU (14 decks)

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