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3RD YEAR - Long Term Conditions/FOCP > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the features of a subarachnoid haemorrhage?

A

Thunderclap headache that radiates to the neck, associated with nausea and photophobia, usually lasting more than an hour

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2
Q

What is SAH most commonly caused by?

A

Ruptured berry aneurysm

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3
Q

What are the features of temporal arteritis?

A

Unilateral pain over the temporal artery, associated with visual disturbance, jaw claudication, weight loss, malaise, diplopia and scalp tenderness, age >50

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4
Q

How is temporal arteritis treated?

A

High dose oral steroids (prednisolone)

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5
Q

What are the features of a migraine?

A

Any two of:

  • severe
  • unilateral
  • throbbing
  • aggravated with activity

Either:

  • nausea and vomiting
  • photophobia

Lasts between 3-72 hours

Often accompained by an aura for 10-20 mins which comes on very gradually

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6
Q

How is migraine treated?

A

Prophylactic NSAIDS, triptans, topiramate, amitriptyline

NB - patients should not take over 2 doses a week as this could cause medication overuse headache

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7
Q

What are the features of a headache of raised ICP?

A
  • Associated with seizures, nausea, diplopia and neurological deficit
  • Aggravated by straining, bending over, morning
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8
Q

What is the common presentation of meningitis?

A

Headache + neck stiffness + fever

You also get nausea and vomiting and photophobia

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9
Q

What is Kerning’s sign?

A

The thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance). This may indicate subarachnoid hemorrhage or meningitis.

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10
Q

How should meningitis be treated in hospital?

A

IV Cefotazime

NB - treat before investigation, even if viral is suspected

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11
Q

How should meningitis be treated in the community?

A

IV Benzylpenicillin

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12
Q

What test is used to investigate meningitis?

A

Lumbar puncture (between l4/5)

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13
Q

What are the contraindications for LP?

A
  • Anything which makes you suspect raised ICP - severe headache, reducing GCS, papilloedema, seizures
  • Immunocompromised state (as it can introduce infection)
  • Coagulopathy/thrombocytopenia
  • Spinal trauma
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14
Q

What is given prophylactically to anyone who has been in close contact with someone with meningitis?

A

2 day course of rifampicin

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15
Q

What are the signs of cerebellar disease?

A 
DANISH
Dysdiadokinesis
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
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16
Q

What are the signs of an UMN lesion?

A
  • Spastic
  • Hypereflexia
  • Increased tone
  • Weakness
  • Positive babinski sign
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17
Q

What are the signs of a LMN lesion?

A
  • Flaccid
  • Hyporeflexia
  • Decreased tone
  • Weakness
  • Fasciculations
  • Muscle wasting
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18
Q

What does spondylosis mean?

A

Degeneration of the spinal column

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19
Q

What are the red flags for back pain?

A

Neurological - sphincter/gait disturbance, saddle anaesthesia, progressive motor loss
Others - non-mechanical pain, fever, weight loss, extremes of age, thoracic pain, history of cancer, HIV

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20
Q

What is cavernous sinus thrombosis, and what are the symptoms?

A 
A blood clot in the cavernous sinus, that develops when an infection in the face or skull spreads here.
Symptoms include:
- Sharp, severe frontal headache
- Swelling of the eye
- Severe eye pain
- Double vision
- Ptosis
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21
Q

What does decorticate posturing mean?

A

Damage to areas including the cerebral hemispheres, the internal capsule, and the thalamus. It may also indicate damage to the midbrain

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22
Q

What does decerebrate posturing mean?

A

MORE SEVERE - brainstem, midbrain and cerebellar damage

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23
Q

What is a tremor, and what types are there?

A

Abnormal involuntary rhythmical oscillation of a body part:

  1. Resting
  2. Action - postural, kinetic, intention
24
Q

What is titubation?

A

Tremor of the head

25
Q

Describe a typical parkinsonian tremor

A

Asymmetrical resting ‘pill rolling’ tremor

26
Q

What is chorea?

A

Abnormal, unpredictable involuntary movements, often flowing from one part of the body to the other

27
Q

What causes chorea?

A 
Huntingtons disease
Drug induced
SLE
Post strep/pregnancy
Cerebrovascular disease
Metabolic disease (HHS, hyperthyroid)
28
Q

What is hemiballism?

A

Form of chorea, more abrupt

Associated with a sub thalamic nucelar lesion

29
Q

What is dystonia?

A

Sustained muscle contractions, causing twisting and repetitive movements

Can be generalised, focal, segmental (two adjacent body parts) or multifocal

30
Q

What are the types of primary dystonia?

A

Generalised - starts in a single limb in childhood, very disabling

Focal - middle age onset

31
Q

What can cause a secondary dystonia?

A

Any structural lesion affecting cortico-basal-thalamic loops (many are genetic)

32
Q

What is a tic?

A

Involuntary rapid movement or vocalisation that can be SUPPRESSED

eg. Tourette’s

33
Q

What is a myoclonus?

A

Involuntary shock like muscular contraction

34
Q

What causes myoclonus?

A

Drugs or systemic illness

35
Q

What is dysphasia?

A

Impairment of language caused by brain damage

36
Q

What is Brocas dysphasia?

A

Expressive dysphasia - Non-fluent speech, writing and reading, but comprehension is intact

37
Q

What is Wernicke’s dysphasia?

A

Receptive dysphasia - empty but fluent speech, due to impaired comprehension

38
Q

What is conduction aphasia?

A

Damage to articulate fasciculus -

Intact auditory comprehension, fluent (yet paraphasic) speech production, but poor speech repetition.

39
Q

What is dysarthria?

A

Difficulty with articulation due to weakness or incoordination of the muscles of speech

40
Q

What is dysphonia?

A

Difficulty with speech volume due to weak respiratory muscles or vocal cords (myasthenia, GBS)

41
Q

In what tract are pain and temperature carried, and where does it cross?

A

Lateral spinothalamic tract - decussates at the level of the nerve

(spinal cord lesions will be contralateral)

42
Q

In what tract are fine touch, vibration sense and proprioception carried, and where does it cross?

A

Dorsal columns - decussates at the level of the medulla

spinal cord lesions will be ipsilateral

43
Q

In what tract are crude touch and pressure carried, and where does it cross?

A

Anterior spinothalamic tract - decussates at the level of the nerve

(spinal cord lesions will be contralateral)

44
Q

What is Brown-Sequard syndrome?

A

Hemisection (one-sided lesion) of the spinal cord causing:

  • Contralateral pain, temperature, crude touch and pressure loss
  • Ipsilateral fine touch, proprioception and vibration sense loss
45
Q

In what tract is unconscious proprioceptive information carried, and where does it cross?

A

Spinocerebellar tracts - decussate higher up

(spinal cord lesions cause ipsilateral loss of muscle coordination?

46
Q

What is Motor Neurone Disease?

A

Damage to upper and motor neurones without sensory loss, sphincter disturbance or eye changes.

47
Q

What are the 4 clinical patterns of MND?

A
  1. ALS (global)
  2. Progressive bulbar palsy (only affects cranial nerves 9-12)
  3. Progressive muscular strophy (only LMN)
  4. Primary lateral sclerosis (mainly UMN signs, no cognitive decline)
48
Q

How can the following aspects of MND be managed:

a) disease progression?
b) drooling?
c) dysphagia?
d) joint pain?

A

a) riluzole (antiglumatergic drug)
b) propantheline/amitryptiline
c) blend food
d) NSAIDS/opiods

49
Q

What is a bulbar palsy?

A

Disease of CNIX-XII causing problems with talking and swallowing
No jaw jerk

50
Q

What is corticobulbar palsy?

A

An UMN lesion of muscles of swallowing and talking due to lesions of the TRACTS rather than the cranial nerves
Jaw jerk present

51
Q

What is Duchenne’s muscular dystrophy?

A

A progressive myopathy due to genetic mutation in the x chromosome
Positive Gowers sign in children

52
Q

What is Beckers muscular dystrophy?

A

Like Duchennes but later onset, milder progression and better prognosis

53
Q

What is Myasthenia gravis?

A

An autoimmune disease in which antibodies form against acetylcholine receptors at the neuromuscular junction

Treat with pyridostigmine to stop ACh being broken down

54
Q

What are the symptoms of MG?

A

Increasing muscular fatigue

Diplopia and ptosis

55
Q

What is Lambert-Eaton syndrome?

A

Paraneoplastic or autoimmune antibodies against voltage gated calcium channels, causing gait difficulties and autonomic involvement (unlike MG)

56
Q

How does botulinum toxin cause muscle weakness?

A

Inhibits pre-synaptic release of acetylcholine

3RD YEAR - Long Term Conditions/FOCP (39 decks)

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