Neurology Flashcards
Where do the majority of intracerebral haemorrhages occur?
Basal ganglia
Which nerve roots are being tested by the cremasteric reflex?
L1-2
Which nerve roots are being tested by the epigastric reflex?
T7-9
Which nerve roots are being tested by brachioradialis reflex?
C5-6
Which nerve roots are being tested by the ankle jerk?
S1-3
Which nerve roots are being tested by the anal reflex?
S4-5
What is the normal pH of CSF?
7.31
Describe the electrolyte levels in CSF compared to plasma
CSF: lower K, Ca and protein
Higher Na, Cl, bicarbonate and magnesium
What is a normal white cell value in CSF?
Less than 4/ml
What is a normal opening pressure of CSF?
Less than 20cm of water
What is a normal glucose concentration in the CSF?
Approximately 2/3 of plasma
3.3-4 mmol/L
What is mononeuritis multiplex?
Neuropathy where individual nerves are affected, especially linked with CNIII and VI
What is the diagnostic criteria for delirium?
Disturbance of consciousness: reduced clarity of awareness of environment, reduced ability to focus, sustain or shift attention
Change in cognition: memory deficit, disorientation, language disturbance, perceptual disturbance
Disturbance develops over a short period: hours or days
Fluctuation over the course of the day
What is the diagnostic criteria for delirium?
Disturbance of consciousness: reduced clarity of awareness of environment, reduced ability to focus, sustain or shift attention
Change in cognition: memory deficit, disorientation, language disturbance, perceptual disturbance
Disturbance develops over a short period: hours or days
Fluctuation over the course of the day
In which patient group should bupropion be used with caution as a smoking cessation aid?
History of epilepsy or other seizure disorders such as excessive alcohol consumption
In which patient group should varenicline be used with caution as a smoking cessation aid?
Psychiatric conditions with suicidal ideation or attempts
The foot processes of which cell type support the blood brain barrier?
Astrocytes
Wrap around every capillary in the brain, important for movement of water and glucose between circulation and brain
Which are the cells of the choroid plexus which produce CSF?
Ependymal cells
What neuropathies can be associated with B12 deficiency?
Glove and stocking anaesthesia Optic atrophy Psychosis Sensory ataxia Spastic paraparesis
What signs would you expect in a patient with Parkinson’s disease?
Bradykinesia: slow festinant gait with difficulty changing direction or arm swinging
Rigidity: stiff, lead pipe rigidity during elbow flexion, cog wheel rigidity at the wrist with superimposition of tremor
Tremor: pill rolling tremor of fingers
What symptoms might you get with cervical spondylosis?
Tingling, numbness, weakness and wasting in upper limbs
How is neurofibromatosis inherited?
Autosomal dominant
What is the NIH consensus criteria for diagnosis of neurofibromatosis?
2 or more of the following:
Six or more cafe au lait spots over 5mm diameter in pre pubertal individual
Two or more plexiform neurofibromas
Freckling in the axillary or inguinal regions
Optic glioma
Two or more lisch nodules (iris hamartomas)
Distinctive osseous lesion such as sphenoid dysplasia
First degree relative with NF1
A 70 year old man complains of a 6 month headache, visual disturbances and weight loss. On examination he is sensitive on palpation of the scalp which is tender, what is the likely diagnosis?
Giant cell arteritis
A 22 year old male student presents with a 6 hour history of deteriorating headache. On examination he has a faint purpuric rash over his knees, a temperature of 39 degrees and neck rigidity. What is the likely diagnosis?
Meningitis
What diagnostic markers would you use for giant cell arteritis?
ESR markedly elevated
Temporal artery biopsy show histological inflammation
72 year old female presents with 6 month history of headaches which are worse in the morning, associated with nausea and generally ease as the day progresses. On examination there is blurring of the disc margin in the right eye. What is the likely diagnosis?
Cerebral tumour
What is dementia?
Acquired loss of higher mental function affecting 2 or more domains
Of sufficient severity to significantly cause social or occupational impairment
Occurring in clear consciousness (distinguish from delirium)
Give 3 examples of cholinesterase inhibitors which can be used to treat dementia
Donepezil
Rivastigmine
Galantamine
What is memantine?
NMDA antagonist used in moderate to severe AD where cholinesterase inhibitors are not tolerated
What are symptoms of wernicke Korsakoff’s encephalopathy?
Eye signs: nystagmus, lateral rectus palsy, conjugate gaze palsy
Ataxia: wide based gait, cerebellar signs, vestibular paralysis
Cognitive change: stupor, coma, amnesic syndrome, confabulation
What is mild cognitive impairment?
Memory problems in patients who do not fit a diagnosis of dementia as they are not functionally impaired/ not severe enough to interfere with normal activities of daily living
What regions are involved in episodic memory?
Hippocampus and limbic circuits
What brain areas are involved in working memory?
Prefrontal cortex
Angular gyrus
What brain areas are involved in semantic memory?
Inferolateral temporal lobes
What brain areas are involved in procedural memory?
Basal ganglia
Cerebellum
Supplementary motor area
What is the classic triad of normal pressure hydrocephalus symptoms?
Memory loss
Gait disorder
Urinary incontinence
What are risk factors for haemorrhagic stroke?
HTN Amyloid angiopathy Venous sinus thrombosis Haemorrhagic tumour Arteriovenous malformation
How do you diagnose a subarachnoid haemorrhage?
CT head
Lumbar puncture
A 26 year old female presents with two month Hx of severe headaches that are relieved by standing. On examination it is noted that she is obese. She has no neurological abnormalities or visual disturbances. What is the likely diagnosis?
Idiopathic intracranial hypertension
What are clinical features of giant cell arteritis?
Tender scalp Jaw claudication Headache Malaise Thickened temporal arteries Optic neuropathy
What is frailty?
Loss of metabolic reserve
What is Uhthoff’s phenomenon?
Worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs
What is L’Hermitte’s sign?
Barber chair phenomenon, is an electrical sensation that runs down the back and into the limbs when neck is flexed
Give 3 features of the headache in migraine
Usually Unilateral
Throbbing/pulsating
Moderate - severe
Worse on movement
Give 3 associated features of a headache in migraine
Nausea vomiting
Photophobia
Phonophobia
Aura
In a younger patient with a trigeminal neuralgia, what causes might you want to rule out?
MS
Cerebellopontine angle tumour
What is the emergency treatment for meningococcal meningitis?
Benzylpenicillin slow IV injection or IM
Cefotaxime if penicillin allergy
Give 3 examination findings of a temporal arteritis
Scalp tenderness Thickened temporal artery Reduced temporal pulse Fever Upper limb stiffness Visual disturbance Mono/polyneuropathy Cranial nerve palsy
A child with suspected meningitis is in GP. Whilst waiting for the ambulance what should you do?
Give IM penicillin
What are features of progressive supranuclear palsy?
Supranuclear ophthalmoplegia Dysarthria Gait impairment Balance impairment Dysphagia
What are some viral causes of encephalitis?
Herpes simplex HIV Chlamydia Measles Mumps Epstein Barr Rabies
What are some causes of delirium?
Hypoxia Hypoglycaemia Hyperthermia Anticholinergic toxicity Alcohol withdrawal Infections Metabolic abnormalities Brain lesions Medication adverse effects Post operative state
Which vitamin deficiencies maybe associated with psychosis?
Folate
Vit B12
Niacin
Chronic thiamine
What are features of B12 deficiency?
Anaemia Peripheral neuropathy Weakness Decreased positional and vibration sense Psychosis Delirium Slowed thinking Mood/personality changes
What are some symptoms of Korsakoff’s psychosis?
Memory loss Confusion Amnesia Personality change Confabulation
What are symptoms of wernickes encephalopathy?
Psychomotor slowing
Nystagmus
Ataxia
Ophthalmoplegia
What are some endocrine causes of psychosis?
Thyroid dysfunction
Cushing’s syndrome
Thymoma
Hyperparathryoidism
What are some features of encephalitis?
Aphasia Hemianopia Hemiparesis Ataxia Brisk tendon reflexes Babinskis sign Cranial nerve deficits Tremors Myoclonus Paresthesia Neuropathy Raised ICP signs
What is Holmes adie syndrome?
Pupils large and irregular due to parasympathetic denervation
Reduction in reflexes
Who should be considered for decompressive hemicraniectomy after ishchaemic stroke?
Patients under 60 with a large (>50%) cerebral infarction arising in MCA territory
