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Specialities > Neurology 3 > Flashcards

Neurology 3 Flashcards

1
Q

What are the symptoms of normal pressure hydrocephalus?

A

Ataxia

Urinary incontinence

Dementia

*wet wacky and wobbly

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2
Q

How long following a TIA till a patient can drive again?

A

1 month

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3
Q

Which type of seizures tends to a have postictal Tod’s paralysis?

A

Focal onset seizures

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4
Q

What are the first line medications for neuralgic pain?

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

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5
Q

Which anti-epileptic medication is most associated with weight gain?

A

Sodium valproate

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6
Q

What are the side effects of sodium valproate?

A

VALPORATE:

V- valporate 
A - appetite 
L - Liver failure 
P - Pancreatitis 
R - reversible hair loss 
O - Oedema 
A - Ataxia 
T - Tremor, telectangestia, tetragenic 
E - Encephalopathy
or: 
WHAT
Weight gain 
Hepatoxicity / Hyponatremia 
Ataxia 
Thrombocytopenia
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7
Q

What is the motor innervation to the uvula?

A

Vagus nerve

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8
Q

What quick bedside test can be done to test if rhinorrhoea is CSF?

A

Glucose test
- CSF has glucose in it.

Beta transferrin -2 is more definitive test

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9
Q

What is an important differential for a headache in a patient on the COCP? and what other condition might this occur?

A

Cerebral venous sinus thrombosis

  • also occurs in nephrotic syndrome
  • should be a differential in a child with nephrotic syndrome
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10
Q

What is the disorder which forms cysts over the spinal cord? and how does it present?

A

Syringomyelia

Causes compression from the centre of the spine leading to loss of spinothalamic tract leading to pain

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11
Q

What are some causes of third nerve palsy?

A

Diabetes mellites

Uncal herniation due to raised ICP

Posterior communicating artery aneurysm
- usually painful as well

Cavernous sinus thrombosis

Thrombotic occlusion of to the vaso nervorum

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12
Q

In Pancoast tumour causing Horner’s syndrome

- where else might the patient experience neuropathy?

A

In the ulnar region as it compresses on the brachial plexus

*T1 nerve root compression

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13
Q

Name some sub-types of hydrocephalus and how they present:

A

Idiopathic intracranial hypertension

  • seen in females who are obese and on the COCP
  • stop pill, loose weight
  • oral tetracyclines make worse

Normal pressure hydrocephalus

  • elderly
  • urinary incontinence
  • ataxia
  • dementia
  • CT scan
  • ventriculi-peritoneal shunt

TB Meningitis / abscess formation

  • CXR
  • History of TB
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14
Q

What bloods should you do in someone with a seizure?

A 
FBC - infection? 
U&Es - electrolyte abnormality? 
Magnesium levels 
Calcium levels 
Glucose  
Lactate - ABG

Anti-epileptic medication levels**

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15
Q

How is a Myasthenia Crisis managed?

A
  • Contact ICU early
  • FVC must be measured - for monitoring purposes
  • *FVC because it will demonstrate the restrictive nature of it

BiPAP ventilation
Plasma exchange / plasmapheresis to remove antibodies
IV immunoglobulins

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16
Q

What is the investigations for diagnosis of Duchene muscular dystrophy?

A

Muscle biopsy
EMG
CK levels

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17
Q

What are some causes of neurological muscle weakness in children?

A

Duchene/ Beckers muscular dystrophy

Spinal muscular atrophy

Myasthenia Gravis

Polio

Dermatomyositis

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18
Q

Name 3 types of cognition you can test along with questions to ask:

A

Orientation
- where are you, time, date place,

Memory recall

Language
- name these objects

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19
Q

What is a common trigger for cluster headaches?

A

Alcohol

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20
Q

What is the management for a massive P.E?

A

Un-fractioned heparin

followed by thrombolysis

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21
Q

How do chronic and acute sub-duras appear on CT scan and what is the management? and what are your differentials for a chonic sub-dura?

A

Chronic:
- hypodense - appearing dark

Acute:
- hypertense - appearing bright

Management:
Chronic:
- reverse any clotting abnormalities
- Craniotomy and washout of clots
- establish reason for fall or injury **
- anti-epileptic medication if you suspect there will be seizures

Acute:

  • Craniotomy/ burr hole
  • should be done within 4 hours

Differentials:

  • dementia
  • stroke
  • tumour
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22
Q

What may be the CT finding on a extra-dural haematoma?

A

Hyperdense - convex lesion with fracture present

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23
Q

What is the management for extra-dural bleed?

A

Conservative: <30ml and normal GCS
- serial CT scans

Acute:

  • ATLS
  • IV resuscitation
  • Neurosurgery *burr hole, craniotomy

*IV hypersaline or mannitol may be considered if hydrocephalus develops

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24
Q

What is the definition and what are the complications of status epilepticus?

A

Definition:
>30 mins seizure or >5mins seizures without recovery to consciousness

Complications:

  • Permanent neurological damage
  • AKI from rhabdomyolysis
  • Behaviour problems
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25
Q

What are the headaches associated with prodromal SAH?

A

Sentile headaches

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26
Q

what percentage of people will have a seizure at some point in their life and what percentage will go on to have further seizures?

A

1 in 20

40% will go on for further seizures

27
Q

What type of seizure is a febrile seizure?

A

Epileptic seizure

*doesn’t mean they have epilepsy but there is generalised overacitivty in the brain which is epilpetic by definition

28
Q

When giving buccal mizadolam where do you place it in the cheeks?

A

Side facing the ground

29
Q

How can you differentiate between a psychogenic and tonic clonic seizure?

A

Complex movement

Eyes shut

Excessive thrashing of movement

Pelvic flexion

Crying afterwards

30
Q

What is the treatment for infantile spasms?

A

Steroids

Anti-epileptic drugs

31
Q

When doing a GCS, if the patient flexes and extends to pain which do you count?

A

Flexing - as an abnormal flexion .

You take the best of the actions

32
Q

What are some symptoms of Parkinson’s disease that might be present prior to the onset of the disease?

A

Anosmia
- loss of sense of smell

REM

Restless leg syndrome

Hyperactive bladder

33
Q

How can bradykinesia be tested for clinically?

A

Asking the patient to open and close their hand rapidly. This will deteriorate in slowing of movement

34
Q

Contrast stiffness and spasticity:

A

Stiffness:
- non-velocity dependent. it is stiff throughout passive movement.

Spasticity:
- Velocity dependent: increased catch as movement speeds up

35
Q

What are some of the late complications of Parkinson’s disease?

A

Drooling
- which can lead to aspiration pneumonia

Lewy Body Dementia

Falls

Depression

36
Q

What is the natural history of Parkinson’s disease?

A

Stage 1.

  • loss of sense of smell
  • unilateral symptoms - easy to ignore

Stage 2.
- Symptomatic

Stage 3.

  • Dementia
  • Falls
  • Terminal events
37
Q

What is a positive Hoffman’s sign?

A

Flicking the middle finger which causes contraction of the fingers, especially the index to the thumb
- sign of UMN

38
Q

What are the aetiologies of cervical myelopathy and some symptoms?

A 
Disc herniation 
Osteophyte formation 
Facet joint degeneration 
Cervical stenosis 
Tumour compression 
Posterior ligamental calcification (common in Asians)

Symptoms:

  • Clumsiness of hands (loss of co-ordinated ability)
  • Neck pain
  • Spastic gait
  • Ataxia
  • Bladder dysfunction

Signs:

  • positive Hoffman’s
  • Ankle Clonus
  • Spastic lower extremities
  • Weakness
39
Q

What are some differentials for cervical myelopathy and how is it investigated? What is the treatment?

A

MND
MS (will have cranial nerve signs as well)
Syringomyelia
Spinal cord tumour

Investigations:
- MRI T2 weighted

*if an MRI cannot be done then a CT myelogram

Treatment: 
- Anterior discectomy 
or 
- Posterior laminectomy
\+/-
Foramotomy
40
Q

What kind of disc herniation causes cauda equina?

A

Central disc prolapse

  • this is different to posterior lateral which causes sciatic pain.
  • remember that nerve root affected is below where the herniation has occurred. I.e. L4/5 disc herniation = L5 symptoms
41
Q

Name two aetiologies of sciatica:

A

Intraspinal:
Disc herniation (posterior lateral herniation, L4/5)
Tumours
Spondylolisthesis

Extra-spinal:
Piriformis syndrome
- directly compresses the sciatic nerve

Pregnancy

42
Q

Define spondylosis, spondylolysis and spondylolisthesis:

A

Spondylosis: Arthritis of the vertebral joints leading to osteophyte formation and radiculopathy

Spondylolysis: Pars inter-articular breaks
- without slippage

Spondylolisthesis:
- Slippage of the vertebral body over each other

43
Q

Which position helps spinal stenosis?

A

Flexion

Pain is made worse by extension

44
Q

What are the nerve roots of the sciatic nerve?

A

L4 - S3

45
Q

List some of the brainstem stroke types:

A

Lateral Medullary syndrome

  • PICA artery
  • Ipsilateral loss of pain and temperature
  • Nystagmus / vertigo
  • Contralateral loss of pain and temperature
  • Ataxia
  • Ipsilateral Horner’s (sympathetic fibres are involved)

Weber’s syndrome:

  • Posterior Cerebral artery
  • contralateral weakness
  • Ipsilateral Ocular nerve palsy

Lock in syndrome

  • basilar artery
  • affects the pons damaging the corticospinal and corticobulbar tracts
46
Q

If someone has a lesion on their right side of their cerebral cortex - what symptoms would you NOT expect?

A

Speech and language difficulty

- Broca’s area and Wernicke’s area is on the left side

47
Q

What features in Parkinson’s would make you think it may be drug induced?

A

Dyskinesia
- this is seen with anti-psychotics and not a feature of the onset of Parkinson’s

Bilateral symptoms
- Parkinson’s tends to develop unilaterally first

Levodopa helps

48
Q

What are some important differentials for a third nerve palsy and what things in the history would make you suspect a worrying cause and how would you investigate?

A

Diabetes
Thrombotic inclusion of the vaso- nervorum
Aneurysm
Internal carotid dissection

Things that suggest a more worrisome feature:

  • Pupillary defect
  • Family history of bleeds
  • Pain
  • Immediate onset
Tests: 
- CT angiogram 
- MRI Angiogram 
or 
- Cather angiogram

*can also do a digital subtraction CT to allow only vessel visualisation

49
Q

What can be a triggering factor for BPPV?

A

Head injury

50
Q

What exercises can a patient do at home to help improve symptoms of BPPV?

A

Cawthorne- Cooksey exercises

51
Q

What test should be done to assess respiratory function in a patient with a muscle dysfunction and why?

A

Forced vital capacity
- this can assess restriction

*one might be tempted to say a PEFR but this can only assess restrictive lung disease

52
Q

What is the definition of epilepsy:

A

> 2 unprovoked seizures

> 1 with a underlying disorder to cause seizures

> 1 with evidence of structural abnormality i.e. ischemic injury

53
Q

What are the causes of epilepsy?

A

VITAMIN-P

Vascular abnormalities (AVMS)
Idiopathic
Trauma 
Alzheimer's
Metabolic (Na, Ca2+, Mitochondrial disorders) 
Infection (meningitis) 
Neoplasm and mass (tubulosclerosis) 
Primary disorder (Juvenile myoclonic epilepsy)
54
Q

What are some of the characteristic findings of a simple partial seizure?

A

Pre-ictal:
- Aura (smells, Deja vu, visual changes)

Ictal:

  • localised seizure (Jacksonian motor seizure which may spread called Jacksonain march)
  • Heard turning with conjugate gaze (away from source)

Post-ictal:
- little no post ictal phase

*last for 10-20seconds

55
Q

What are some symptoms of complex partial seizure?

A

Pre-ictal:

  • Aura
  • Autonisms
  • Loss of consciousness or awareness

Ictal:

  • Autonisms (lip smacking, dressing, walking in circles)
  • may progress to general tonic Clonic

Post ictal:

  • autonisms may continue
  • Tired and confused

*last for 1-2 mins

56
Q

What are some treatment options for epilepsy?

A

Education

Medication

Surgery:

  • corpus collosum dissection
  • Removal of source (temporal lobectomy)

Ketogenic diet

Vagal nerve stimulation

57
Q

Name some chid-hood epilepsy syndromes;

A

West syndrome

  • Salaam attack
  • corticosteroid treatment

Lennox- Gastaut

  • associated with mental impairment
  • regression of milestones
  • non-respondent to medication

Juvenile myoclonic epilepsy

  • 12-18 years old
  • starts with myoclonic jerks and progresses to tonic clonic
  • triggers: alcohol, stress, sleep deprivation and strobe lights

Childhood absent seizures:

  • 10seconds of absence
  • females x2
  • not aware
  • Ethosuximide
58
Q

What are some differentials for a stroke?

A

Hypoglycaemia

Migraine

Post ictal - Todd’s paralysis

Tumour

Encephalopathy

59
Q

What are the risk factors for MS?

A

Genetic

Female

North latitude

Low Vitamin D

EBV

Smoking

60
Q

What is the epidemiology of Myasthenia Gravis?

A

Bimodal distribution

  • younger adults
  • elderly population

*elderly population it is more associated with lung cancer

61
Q

What advice should be given to those starting steroids for Myasthenia Gravis?

A

Steroids can initially worsen symptoms

- may need to be placed on IVIG to begin with

62
Q

What physical examinations can be done to help diagnose Myasthenia gravis?

A

Superior ocular gaze

Abducting one arm up and down
- compare this with other arm

Ice pack over the eye

  • theoretically this should improve symptoms
  • Uhthoff’s effect
63
Q

How is triptans delivered for cluster headaches and why?

A

IM triptans
- due to speed of onset

Clusters tends to last for 15-45mins long therefore need for a quick acting drug

64
Q

What should triptans be avoided in and why?

A

Avoided in ischemic heart disease
Ischemic vascular disease

*causes vasoconstriction

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