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Neurology Flashcards

1
Q

What is the criteria for a migraine if there is no aura?

A 
More than 5 headaches lasting from 4-72 hours 
2 of:
- unilateral 
- pulsating 
- impairing daily life 
1 of:
-nausea/vomiting 
-photo or phonophobia
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2
Q

What symptoms can occur in migraines?

visual, somatosensory, motor, speech

A
  • THROBBING PULSATILE EPISODE UNILATERAL HEADACHE. Worse with movement.
  • Nausea and vomiting
  • Photophobia, phonophobia
  • Allodynia: all stimuli are painful
  • Visual: Chaotic hemianopia
  • Somatosensory: Parasthesia from fingers to face
  • Motor: Ataxia, ophthalmoplegia, hemiparesis (weakness)
  • Speech: Dysphasia, paraphasia (words meaningless), dysarthria
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3
Q

What can occur before a migraine?

A

An aura - 15-30 mins: visual changes, tingling

Prodrome: mood changes, sleepy, cravings

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4
Q

Relieving factors of a migraine?

A

Lying down in a dark room.

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5
Q

Triggers of migraine?

A

Stress (even to light, sound, weather), anxiety, trauma, foods, sleep, OCP

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6
Q

What would you examine if you suspected a migraine?

A

Optic fundi
BP
Head and neck

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7
Q

What medication can be taken as soon as headache starts in a migraine to provide relief?

A

Triptans

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8
Q

What headache would present as an episodic bilateral tight band brought on by stress?

A

Tension headache

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9
Q

What is a cluster headache?

A

A rapid onset unilateral headache behind one eye. Can cause the eye to water and become bloodshot.

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10
Q

When is a cluster headache often worse?

A

At night

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11
Q

Are cluster headaches there all the time?

A

Often pain free months after 1-3 months of headaches.

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12
Q

What is Kernig’s sign?

A

Pain and resistance when the knee is passively extended and the hip fully flexed

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13
Q

When may you see a petechial non-blanching rash?

A

Meningitis

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14
Q

What are the features of a bacterial meningitis LP?

A

Cloudy and turbid.
Increased neutrophils.
High protein.
V. low glucose.

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15
Q

What white cells are raised in viral meningitis CSF?

A

Lymphocytes.

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16
Q

What is the first line ABx for meningitis?

A

Cefotaxime

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17
Q

What is the term for occlusion of an optic artery leading to visual loss?

A

Amaurosis fugax

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18
Q

In a TIA what is the optimum time to start treatment within?

A

72 hours

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19
Q

What is the ABCD2 referral score for?

A 
TIA - score over 6 
Age: over 60 (1)
BP: over 140/90 (1)
Clinical features:
- unilateral weakness (2)
- speech disturbance (1)
Duration: 10-59 mins (1), 1hr+ (2)
Type 2 diabetes (1)
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20
Q

What type of stroke is suggested by meningism, sever headache and potential coma within hours?

A

Haemorrhagic

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21
Q

Where will an ischaemic stroke be located that causes: contralateral sensory loss, hemiplegia, dysphasia, homonymous hemianopia, visuo-spatial deficit?

A

Cerebrum

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22
Q

Where will an ischaemic stroke be located that causes visual disturbances, quadraplegia and locked in syndrome?

A

Brainstem

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23
Q

What type of ischaemic stroke causes ataxia and dysarthria?

A

Lacunar

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24
Q

How are strokes managed?

A

Urgent CT (within 1 hour)
Ischaemic: thrombolysis & antiplatelets.
Nil by mouth.

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25
Q

What are the three common berry aneurysm sites in the brain?

A

1) Junction of posterior communicating and internal carotid.
2) Bifurcation of middle cerebral and anterior communicating artery
3) Anterior cerebral and anterior communicating arteries

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26
Q

What are the symptoms of a subarachnoid haemorrhage?

A 
Thunderclap headache (occipital). 
Vomit. 
Collapse. 
Seizure. 
Coma.
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27
Q

If a subarachnoid haemorrhage involves the posterior communicating artery, what sign may be present?

A

Painful third nerve palsy.

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28
Q

When may you see bloody CSF?

A

In a subarachnoid haemorrhage.

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29
Q

What is the management of a subarachnoid haemorrhage?

A

Immediate neuro-surgical referral.

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30
Q

What are 4 complications following a subarachnoid haemorrhage?

A

1) 20% rebleed within 24 hours
2) Vasospasm cerebral ischaemia
3) Hyponatraemia
4) Hydrocephalus

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31
Q

What is the Parkinon’s triad?

A

1) Tremor: pill rolling, worse at rest.

2) Hypokinesia:
- slow to initiate movement
- reduced blink rate
- monotone
- Gait: flexed trunk shuffle with reduced arm swing.
- expressionless
- freezing

3) Rigidity - Increased tone:
- cogwheeling in pronation and supination

32
Q

How does reduced dopamine in the brain lead to Parkinons?

A

Basilar has a greater inhibitory effect on the thalamus, reducing the excitatory output.

33
Q

What is ‘wearing off’?

A

L-Dopa: towards end of dosage intervals symptoms worsen

34
Q

What is an ‘on off effect’?

A

L-Dopa: Involuntary movements may worsen at the beginning of the dosage interval.

35
Q

What should L-Dopa always be given with in Parkinsons?

A

Peripheral dopa-decarboxylase inhibitor: carbidopa. Reduces systemic effect, lowering therapeutic dose.

36
Q

What is a primary generalised seizure?

A

Simultaneous electrical discharge across the cortex

37
Q

In what seizure will the person loss consciousness, their limbs jerk and stiffen? How may they feel after?

A

Tonic Clonic

Post-ictal drowsiness and confusion

38
Q

What seizure might through someone to the ground due to a sudden jerk?

A

Myoclonic

39
Q

What seizure may cause a fall due to a sudden loss of muscle tone?

A

Atonic

40
Q

What is a seizure known as that’s localised to one hemisphere?

A

Partial

41
Q

In what seizure is someone aware of what is going on?

A

Simple

42
Q

What occurs in a complex seizure?

A

The person’s awareness is impaired.

43
Q

What may happen before a seizure?

A

Aura: deja vu, smells, flashing lights, gut changs

44
Q

Where is the seizure:
a) Hallucinations, lip-smacking, grabbing/fiddling, emotional changes. Complex motor.

b) Tingling and numbness. May have sensory or motor impairment,
c) Visual disturbances
d) Behavioural disturbances, dyphasia & speech arrest, pedalling leg, motor arrest. Jacksonian March: focal motor seizure spreading from face to thumb.

A

a) temporal
b) parietal
c) occipital
d) frontal

45
Q

What is the driving advice in epilepsy?

A

No driving until 1 year seizure free.

46
Q

Name three anti-convulsant medications. What effect do they all have on cytochrome p450?

A

Carbamezapine
Phenytoin
BOTH CP450 inducers
Sodium valproate - CP450 inhibitor

47
Q

What is anti-epileptic hypersensitivity syndrome?

A

Severe skin reaction to medication with fever and lymphadenopathy.

48
Q

What reduces the efficacy of anticonvulsants?

A

Drugs that reduce the seizure threshold: SSRIs, tricyclics, ABxs

49
Q

What can happen in phenytoin over dose?

A

Respiratory depression and cardiovascular collapse.

50
Q

Why does plasma conc of phenytoin have to be monitored?

A

It has a low therapeutic index

51
Q

What structure to carbamezapine and phenytoin both bind to in order to reduced neuronal excitability?

A

Neuronal sodium channels

52
Q

What effect does valproate have in the brain?

A

Increases GABA: primary inhibitory neurotransmitter

53
Q

What effect can valproate have on hair?

A

Can cause it to fall out with curly regrowth.

54
Q

Who should not receive valproate?

A

Women of child bearing age.
Hepatic impairment. (liver monitored for first 6 months)
Severe renal impairment.

55
Q

What causes symmetrical and widespread polyneuropathy?

A

Diabetes

Alcohol

56
Q

What would someone experience with sensory peripheral neuropathy?

A

Numbness, pins & needles
Glove and stocking: starts at extremities
Joint deformities

57
Q

What would someone experience with motor peripheral neuropathy?

A

Progressive weakness and clumsiness
Problems with walking and breathing
Wasting and weakness of hands and feet
Decreased reflexes

58
Q

What type of pain can exist in peripheral neuropathy?

A

Sharp, jabbing
Freezing, burning
Hypersensitivity

59
Q

What autonomic symptoms are there in a peripheral neuropathy?

A

Heat intolerance inc. altered sweating
Bowel and bladder changes
Digestion problems
BP changes: Light headed, postural hypotension

60
Q

Damage to what nerve leads to a claw hand? (for example through elbow trauma)

A

ULNAR

Medial wrist flexors, interossei, medial lumbricals, 1.5 sensory.

61
Q

Damage to what nerve leads to wrist drop?

from a humeral fracture

A

RADIAL

Brachioradialis, extensors, supinator, triceps

62
Q

Damage to what nerve leads to a hand of benediction?

A

Median
Occurs when making a fist.
Can be due to carpal tunnel
2 Lumbricals, opponens pollicis, flexor pollicis brevis and abductor pollicis.

63
Q

How can a peripheral neuropathy be managed?

A

Managing cause
Splinting
Foot care
Amitriptylline for neuropathic pain

64
Q

What is the management of carpal tunnel?

A

Splinting
Local steroid injection
Decompression surgery

65
Q

What are people with peripheral neuropathy at risk of?

A

Burns & trauma to skin
Infection
Falls

66
Q

What type of immune response occurs in MS?

A

T cell mediated

67
Q

What is the mean age of onset of MS?

A

30 years

68
Q

Does MS present with many symptoms or just one?

A

Just one - monosymptomatic

69
Q

How can MS present?

A
  • Unilateral optic neuritis: pain on moving
  • Sensory loss: numbness, tingling
  • Leg weakness
  • Brainstem/cerebellar: diplopia/ataxia
  • urinary symptoms: retention or incontinence
  • Swallowing difficulty
  • Constipation
  • Intention tremor
  • Falls
  • Amnesia
  • Mood changes
70
Q

What can exacerbate MS symptoms?

A

Heat

Exercise

71
Q

What is the definition for diagnosing MS?

A

Requires lesions disseminated in time and space, unattributable to other causes.

72
Q

What is Macdonald’s Criteria?

A

2+ attacks & 2+ lesions
2+ attacks & 1 lesion: MRI/positive CSF
1 attack & 2 + lesions disseminated in time
1 attack & 1 lesion disseminated in space

73
Q

How do steroids help in MS?

A

Shorten length of an acute relapse

74
Q

How do Interferons help in MS?

A

Reduce relapses and accumulation of lesions

75
Q

How to some of the mAbs help in MS?

A
  • Target T cells reducing relapse

- Prevent immune cells crossing blood, brain barrier

76
Q

What do the palliative treatments of MS consist of?

A

Baclophen/diazepam to reduce spasticity
Botox for tremor
Catheterisation for urinary control

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