Neurology Flashcards
How does the presentation of ptosis differ in Horner’s Syndrome v CN III Palsy?
Horner’s Syndrome: superior tarsal paralysis causing ptosis, pupil constricted, anhidrosis CN III Palsy: levator palpebrae paralysis, dilated pupil, gaze is ‘down and out’
What 4 interventions have been proven to improve outcome after acute ischaemic stroke?
- Management in a stroke unit 2. Aspirin 3. IV anteplase 4. Hemicraniectomy
What are the most common organisms implicated in community-acquired bacterial meningitis?
- Strep pneumoniae 2. Neisseria meningiditis 3. Listeria monocytogenes (primarily in patients >50)
What is the classic triad of meningitis?
Fever, nuchal rigidity, mental state change
What is the empirical antibiotic regime for the treatment of bacterial meningitis?
Cephtriaxone + Vancomycin + Amoxicillin (if >50)
Apart from Parkinson’s Disease, what are other causes of Parkinsonism?
Antipsychotics Progressive supranuclear palsy Multiple system atrophy Corticobasal degeneration Postencephalitic parkinsonism
What are the cardinal features of Parkinsonism?
Tremor Rigidity Bradykinesia Postural instability Apathy
What are the pharmacolocial treatment options for Parkinson’s Disease?
Cabergoline (DA agonist) - in younger patients Levodopa + Carbidopa (DDC inhibitor) COMT inhibitor or MAOI Anticholinergic Amantadine (NMDA antagonist) Deep brain stimulation
What is the first-line treatment of absent seizures?
Ethosuxamide
Which anticonvulsant is first-line for generalised epilepsy?
Valproate
Which anticonvulsant is first-line for partial epilepsy?
Carbamazapine
What are the general adverse effects of anticonvulsants?
Sedation, headache, GI symptoms, dizziness, insomnia, ataxia, rash, vision disturbance
What are the contraindications to lumbar puncture?
Possible raised ICP Bleeding diathesis Suspected spinal epidural abscess
What is the prognosis of Creutzfeldt-Jakob disease?
Incurable, rapidly progressive, death within weeks to months (maximum one year). Also known as mad cow disease.
What is the presentation of Guillian Barre syndrome?
Ascending motor paralysis over hours to days +/- sensory disturbance.
*May be preceded by campylobacter jejuni infection*
What is reflex sympathetic dystrophy (also known as complex regional pain syndrome)?
Pain, swelling and changes in skin (neurological process)
A stroke in which area of the brain will cause pure motor hemiparesis?
Posterior limb of internal capsule (anterior choroidal artery)
A stroke in which area of the brain will cause pure sensory loss?
Ventral posterior lateral nucleus of thalamus (PCA)
How will a basal ganglia stroke present?
Often asymptomatic or with hemiballismus
What is hemiballismus?
Unilateral involuntary flinging motions of limbs due to basal ganglia dysfunction
What are the typical findings of an ACA stroke?
Contralateral leg weakness with preservation of speech (left) or visuospacial functioning (right)
What are the typical findings of an MCA stroke?
Contralateral face and arm weakness with affected speech (left) or visuospacial functioning (right)
Name these types of brain herniation.
- Subfalcine (cingulate gyrus beneath falx cerebri)
- Uncal (temporal lobe beneath tentorium cerebelli)
- Central (cerebellar tonsils through foramen magnum)
- Transcalvarial (brain through break in skull)
How does a subfalcine herniation present?
May be asymptomatic or cause contralateral leg weakness / gait abnormality
