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Year 5 Notes > Neurology > Flashcards

Neurology Flashcards

1
Q

Cord compression:

Management

A

Malignant cause - dexamethasone 4mg/IV, then treatment

Epidural abcess - surgically decompressed and ABx

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2
Q

Carotid sinus syncope

A

Hypersensitive barorecptors, eg turning head, shaving

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3
Q

Stokes-Adams attack

A

Transient arrhythmia/bradycardia

Collapses with slow/absent pulse, pulse speeds up and regains consciousness

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4
Q

Causes of cord compression

A

Disc prolapse
Haematoma
Tumor
Atlanto-axial subluxations

MRI definitive Ix

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5
Q

CN I Palsy

A

Can’t smell

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6
Q

CNII Palsy

A

Optic

Blind

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7
Q

CNIII Palsy

A

Oculomotor
Ptosis
Down and out
Dilated fixed pupil

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8
Q

CNIV Palsy

A

Trochlear

Vertical diplopia

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9
Q

CNV Palsy

A 
Trigeminal
Neuralgia
Loss of corneal reflex
Loss of facial sensation
Paralysis of mastication muscles
Deviation of jaw to weak side
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10
Q

CNVI Palsy

A

Horizontal diplopia (defective abduction)

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11
Q

CNVII Palsy

A

Flaccid paralysis of face
Loss of corneal reflex (efferent)
Loss of taste
Hyperascusis

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12
Q

CNVIII Palsy

A

Vesticulocochlear
Hearing loss
Vertigo nystagmus

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13
Q

CNIX

A

Glossopharyngeal

Loss of gag reflex

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14
Q

CNX Palsy

A

Vagus
Uvula deviates away from site of patient
Loss of gag

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15
Q

CNXI Palsy

A

Can’t shrug

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16
Q

CNXII palsy

A

Hypoglossal

Tongue deviates towards side of lesion

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17
Q

Temporal lobe lesion visual field defect

A

Homonymous hemianopia with macula sparing

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18
Q

Wernickes encephalopathy

A 
Thiamine deficiency
Nystagmus
Opthalmoplegia
Ataxia
Confusion
Peripheral sensory
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19
Q

Subclavian Steal Syndrome

A

Stenosis proximal to vertebral artery
When you use arm it steals blood from vertebral artery causing LOC, dizziness
Suspect if BP difference in arms >20

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20
Q

Giant cell arteritis

A

Tender, thickened pulseless temporal
Jaw claudication
ESR >40
Prompt steroids

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21
Q

Medication overuse headache

A

From mixing, eg paracetamol + codiene/opiates, ergos, triptans
Can use analgesia/naproxen for rebound

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22
Q

Cluster headache

A 
Rapid onset
Excruciating on eye 
Watery, bloodshot, lacrimal ion, flushing, rhinorrhea, miosis, ptosis
Often nocturnal 
Give 02 and sumatriptan
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23
Q

Trigeminal neuralgia

A

Sharp stabbing pain over trigeminal nerve
Unilateral
Triggered by eating, washing, shaving
Can be from nerve compression so needs MRI

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24
Q

Migraine

A

Unilateral, throbbing, with aura
Nausea, vom, allodynia, photophobia
Can have produce for dats before

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25
Q

Acute migraine treatment

A

NSAID
triptan
Ergot as it starts

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26
Q

Migraine prevention

A

Propanalol

Amytriptiline

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27
Q

Conus medullaris

A

Mixed UMN/LMN

Let weakness, urinary retention, constipation, back pain, altered sensation

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28
Q

Cauda Equina

A 
Back pain
Shooting leg pain
Asymmetrical areflexic
Atrophi. Paralysis 
LMN only
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29
Q

Spastic gait

A

Stiff
Circumducting legs
Scuffing toes

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30
Q

Extrapyramidal gait

A 
Flexed posture 
Shuffling feet
Slow to start
Postural instability
Eg Parkinson's
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31
Q

Apraxia gait

A

Wide based
Unsteady gait
Tendency to fall
E.g normal pressure hydrocephalus

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32
Q

Ataxic gait

A

Wide based
Can’t heel to toe
Falls worse with eyes closed
Eg cerebellae lesion

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33
Q

Myopathic gait

A

Can’t stand from sit

Waddle gait from hip girdle weakness

34
Q

Chorea

A

Jerky purposeless

Eg huntingtons

35
Q

Athetosis

A

Slow confluent

Eg Cerebral palsy

36
Q

Tics

A

Brief repeated stereotyped

Eg Tourette’s

37
Q

Myoclonus

A

Focal involuntary jerk

38
Q

Tardive dyskinesia

A

Eg chewing grimacing

From chronic dopamine use

39
Q

Immediate stroke management

A 
Pulse, ECG - AF 
Only treat low BP 
BM 4-11
Urgent CT/MRI only if 
\: considering thrombolysis, cerebellae stroke or unusual presentation 
Thrombolysis if
40
Q

When can you thrombolyse in stroke?

A

Less than 1.7)
Facilitates and doctors available
Refer for urgent tPa eg late please
CT 24hr after thrombolysis

41
Q

Prevention of next stroke

A

Reduce risk factors
Clopidogrel (2nd line aspirin+dipyridamole)
If any AF start warfarin only 2weeks after

42
Q

Later Ix for stroke

A

CXR - heart failure
ECG - AF
Echo - ideally TOE for thrombus
Carotid Doppler

43
Q

SAH typical presentation

A

Sign of berry aneurysm
Devastating headache
Collapse, seizure, coma, stiff neck, focal neuro

44
Q

SAH management

A

CT (invades into fissures). If negative
LP >12h shows bloody/yellow CSF
Aim for BP >160 to maintain perfusion
Nimodipine

45
Q

SDH typical presentation

A

From trauma, even minor, up to months ago
Elderly more common
Fluctuating consciousness
ICP gradually increases and structures shift to one side
Sleepy headache, gradual slowing
Personality change or unsteadiness
Seizures local Neuro

46
Q

SDH management

A

CT/MRI shows clot +- midline shift, crescent shift

Irrigate and evacuate

47
Q

EDH typical presentation

A

Lucid interval
From fractured temporal or parietal bone causing tear of middle meningeal
Increasing ICP
Headache vom, confusion, UMNL
Limb weakness, resp depression, blown pupil

48
Q

EDH management

A 
CT - lens/circle shaped
X-RAYS could be fracture 
NO LP!!!
Evacuate and ligamen
Good prognosis if found early
49
Q

Lewy body dementia

A

Fluctuating cognitive impairment
Detailed visual hallucination
Late parkisonism

50
Q

Fronts-temporal dementia

A

Behavioral/personality changes
Disinhibition
Emotional unconcern

51
Q

Alzheimers presentation

A

Progressive global impairment (other dementias affect one at a time)
Role of b amyloid
Some family history

52
Q

Alzheimer’s treatment

A

Acetycholinesterase inhibitors
Antigultaminergics
Folic acid and vit b supplements
Shows beta amyloid senilie plaques on CT

53
Q

Parkinsonism triad

A

Tremor
Rigidity
Bradykinesia

54
Q

Parkisonism features

A 
Resting/pill roll tremor
Increased tone/rigidity - lead pipe/cogwheel
Poor supination and pronation
Bradykinesia - slow to initiate, montonic quiet speech
Micrographics
Reduced arm swing
Festinance
Freezing 
Hypomimia (mask face)
55
Q

Parkinson’s management

A

MDT
Asses cognition and disability
Incurable and progressive but responds well to other measures
Discuss benefits in delaying treatment and wearing off
Complications: depression, dementia, psychosis

56
Q

Parkinson’s meds

A

Levodopa - cause dyskinesia, psychosis, delay alap
Dopamine agonists - mono therapy to avoid above
Apomorphine - rescue pen for freezing
Anticholinergics - for tremor
MAOB inhibitors - alternative to dopamine ags in early PD
COMT - lessen off time

57
Q

MS pathology

A

Demyelination plaques throughout CNS
Relapsing remitting pattern, but repeated relapse leads to progressive atonal loss
More common in women and vit D deficiency

58
Q

MS typical presentation

A 
Unilateral optic neuritis
Numbness/tingling
Diplopia, dystaxia
Stress/heart induced
Women 30ish
Diagnosis made on McDonald's criteria
59
Q

MS management

A 
MRI - plaques
LP - igG oligoclonal 
Steroids - for relapses but not prognosis 
Interferon - reduces relapse rate
Monoclonal antibodies 
Azothiaprine
60
Q

Parkisonism Plus Syndromes

A

1) progressive supranuclear palsy
2) multiple systems atrophy
3) Lewy body dementia
4) corticobasal degeneration
5) vascular Parkinsonism

More severe and Les responsive to PD drugs

61
Q

Progressive supranuclear palsy

A 
Early postural instability 
Loss of vertical gaze
Rigid trunk>limbs
Symmetrical
Speech and swallowing problems 
Not much tremor
62
Q

Multiple systems atrophy

A

Early autonomic features e,g impotence, incontinence
Postural hypotension
Cerebellar and pyramidal signs
Rigidity>tremor

63
Q

Lewy body dementia

A

Fluctuating cognition
early dementia
Visual hallucination

64
Q

Corticobasal degeneration

A

Rigidity in one limb
Cortical sensory loss (higher sensory function)
Apraxia
Alien limb

65
Q

Vascular Parkinsonism

A

Pyramidal
Gait
Ataxia

66
Q

Carpal tunnel

A 
Aching pain and tingling in hand worse at night
Relieving hanging over bed/shaking 
Sensory loss
Thumb middle index
Weakness of abductor pollis brevis- wasting of thenar eminence 
Ax w/ RA preg
Phalens/tinels
Tx: - splint, steroids, surgery
67
Q

Motor neurons disease

A

Loss of upper and lower motor neurons
No sensory loss
4 types: ALS, PBP, PMA, PLS
Awful prognosis

68
Q

Pseudobulbar palsy

A

UMNL
More common than bulbar palsy
Same slow movement but increased jaw jerk, pharyngeal/palatial reflexes

69
Q

Cervical spondylosis

A

Can compress cord causing spastic paraparesis
Painful limited neck movement, crepitus
Lhermittes - neck flexion causes tingling down spine
Radiculopathy: pain, electrical tingling down fingers at levels, dull reflexes, sensory disturbance, UMN signs below weakness level
Needs laminectimy

70
Q

Myasthenia gravis

A

Autoimmune from anti acetylcholine
Sx: increasing muscle fatigue, ptosis, diplopia, myasthenic snarl, fading voice
Ax w/ thymus pathology

71
Q

Myasthenia gravis management

A

Test for anti aCH antibodies, MUSK
CT thymus
Tx: anticholinesterases, steroids, thymectomy
If mysasthenic crisis: vent support, plasmophoresis, IV Ig

72
Q

Lambert Eaton syndrome

A

Not enough pre synaptic relapse of ACH
Paraneoplastic eg SCLC or autoimmune
Gait difficulty followed by eyes signs ( unlike MG), autonomic involvement, hyporeflexia
Do CT in case of cancer

73
Q

Syringomyelia

A

Cyst of CSF in spinal cord
From tumor, infection, blocked CSF
Loss of pain and temp but other ok, at level of syrinx
Wasting/weakness of hand, claw
Syringobulbia is brain stem so involves tongue atrophy, nystagmus

74
Q

Neurofibromatosis type 1

A 
Autosomal dominant
Cafe au lait
Freckling in skin folds
Lisch nodes - in eye slit lamp
Learning disability
75
Q

Neurfibromatosis type 2

A

Autosomal dominant/de novo
Lass cafe au lait
Bilateral vestibular schwannomas

76
Q

Tuberous sclerosis

A 
Ash leaf spots
Shagreen patches on lumbar sound
Developmental delay
Epilepsy
Intellectual impairment
77
Q

Myotonic dystrophy

A 
20-30
Balding 
Ptosis
Myotonic facies 
Cataracts 
Dysarthria
78
Q

Subacute combined degeneration of the cord

A

From low b12
Triad: extensor plantar + absent knee jerk + absent ankle jerk
Fine touch/proprioception+motor (dorsal +corticospinal)
Ataxia, decreasing vision, bilateral spastic paresis

79
Q

Brown-sequard syndrome

A

Damage to spinal cord cussing loss of proprioception and paralysis on ipsilateral side with loss of pain and temp on contra lateral side

80
Q

Charcot Marie tooth

A 
Inherited peripheral neuropathy
Distal Muscle wasting and sensory loss 
Autosomal dominant (but can be others) 
4 types
Wasting of intrinsic muscles of hands and feet 
Pets cavys, hammer toes, pets planus, spinal deformities 
Tremors, cramp, acrocyanosis
Inverted champagne bottle sign

Year 5 Notes (19 decks)

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