Neurology Flashcards
What are the features of a subarachnoid haemorrhage?
Thunderclap headache that radiates to the neck, associated with nausea and photophobia, usually lasting more than an hour
What is SAH most commonly caused by?
Ruptured berry aneurysm
What are the features of temporal arteritis?
Unilateral pain over the temporal artery, associated with visual disturbance, jaw claudication, weight loss, malaise, diplopia and scalp tenderness, age >50
How is temporal arteritis treated?
High dose oral steroids (prednisolone)
What are the features of a migraine?
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
How is migraine treated?
Prophylactic NSAIDS, triptans, topiramate, amitriptyline
NB - patients should not take over 2 doses a week as this could cause medication overuse headache
What are the features of a headache of raised ICP?
- Associated with seizures, nausea, diplopia and neurological deficit
- Aggravated by straining, bending over, morning
What is the common presentation of meningitis?
Headache + neck stiffness + fever
You also get nausea and vomiting and photophobia
What is Kerning’s sign?
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.
How should meningitis be treated in hospital?
IV Cefotazime
NB - treat before investigation, even if viral is suspected
How should meningitis be treated in the community?
IV Benzylpenicillin
What test is used to investigate meningitis?
Lumbar puncture (between l4/5)
What are the contraindications for LP?
- Anything which makes you suspect raised ICP - severe headache, reducing GCS, papilloedema, seizures
- Immunocompromised state (as it can introduce infection)
- Coagulopathy/thrombocytopenia
- Spinal trauma
What is given prophylactically to anyone who has been in close contact with someone with meningitis?
2 day course of rifampicin
What are the signs of cerebellar disease?
DANISH Dysdiadokinesis Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
What are the signs of an UMN lesion?
- Spastic
- Hypereflexia
- Increased tone
- Weakness
- Positive babinski sign
What are the signs of a LMN lesion?
- Flaccid
- Hyporeflexia
- Decreased tone
- Weakness
- Fasciculations
- Muscle wasting
What does spondylosis mean?
Degeneration of the spinal column
What are the red flags for back pain?
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
What is cavernous sinus thrombosis, and what are the symptoms?
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
What does decorticate posturing mean?
Damage to areas including the cerebral hemispheres, the internal capsule, and the thalamus. It may also indicate damage to the midbrain
What does decerebrate posturing mean?
MORE SEVERE - brainstem, midbrain and cerebellar damage
What is a tremor, and what types are there?
Abnormal involuntary rhythmical oscillation of a body part:
- Resting
- Action - postural, kinetic, intention
What is titubation?
Tremor of the head
Describe a typical parkinsonian tremor
Asymmetrical resting ‘pill rolling’ tremor
What is chorea?
Abnormal, unpredictable involuntary movements, often flowing from one part of the body to the other
What causes chorea?
Huntingtons disease Drug induced SLE Post strep/pregnancy Cerebrovascular disease Metabolic disease (HHS, hyperthyroid)
What is hemiballism?
Form of chorea, more abrupt
Associated with a sub thalamic nucelar lesion
What is dystonia?
Sustained muscle contractions, causing twisting and repetitive movements
Can be generalised, focal, segmental (two adjacent body parts) or multifocal
What are the types of primary dystonia?
Generalised - starts in a single limb in childhood, very disabling
Focal - middle age onset
What can cause a secondary dystonia?
Any structural lesion affecting cortico-basal-thalamic loops (many are genetic)
What is a tic?
Involuntary rapid movement or vocalisation that can be SUPPRESSED
eg. Tourette’s
What is a myoclonus?
Involuntary shock like muscular contraction
What causes myoclonus?
Drugs or systemic illness
What is dysphasia?
Impairment of language caused by brain damage
What is Brocas dysphasia?
Expressive dysphasia - Non-fluent speech, writing and reading, but comprehension is intact
What is Wernicke’s dysphasia?
Receptive dysphasia - empty but fluent speech, due to impaired comprehension
What is conduction aphasia?
Damage to articulate fasciculus -
Intact auditory comprehension, fluent (yet paraphasic) speech production, but poor speech repetition.
What is dysarthria?
Difficulty with articulation due to weakness or incoordination of the muscles of speech
What is dysphonia?
Difficulty with speech volume due to weak respiratory muscles or vocal cords (myasthenia, GBS)
In what tract are pain and temperature carried, and where does it cross?
Lateral spinothalamic tract - decussates at the level of the nerve
(spinal cord lesions will be contralateral)
In what tract are fine touch, vibration sense and proprioception carried, and where does it cross?
Dorsal columns - decussates at the level of the medulla
spinal cord lesions will be ipsilateral
In what tract are crude touch and pressure carried, and where does it cross?
Anterior spinothalamic tract - decussates at the level of the nerve
(spinal cord lesions will be contralateral)
What is Brown-Sequard syndrome?
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
In what tract is unconscious proprioceptive information carried, and where does it cross?
Spinocerebellar tracts - decussate higher up
(spinal cord lesions cause ipsilateral loss of muscle coordination?
What is Motor Neurone Disease?
Damage to upper and motor neurones without sensory loss, sphincter disturbance or eye changes.
What are the 4 clinical patterns of MND?
- ALS (global)
- Progressive bulbar palsy (only affects cranial nerves 9-12)
- Progressive muscular strophy (only LMN)
- Primary lateral sclerosis (mainly UMN signs, no cognitive decline)
How can the following aspects of MND be managed:
a) disease progression?
b) drooling?
c) dysphagia?
d) joint pain?
a) riluzole (antiglumatergic drug)
b) propantheline/amitryptiline
c) blend food
d) NSAIDS/opiods
What is a bulbar palsy?
Disease of CNIX-XII causing problems with talking and swallowing
No jaw jerk
What is corticobulbar palsy?
An UMN lesion of muscles of swallowing and talking due to lesions of the TRACTS rather than the cranial nerves
Jaw jerk present
What is Duchenne’s muscular dystrophy?
A progressive myopathy due to genetic mutation in the x chromosome
Positive Gowers sign in children
What is Beckers muscular dystrophy?
Like Duchennes but later onset, milder progression and better prognosis
What is Myasthenia gravis?
An autoimmune disease in which antibodies form against acetylcholine receptors at the neuromuscular junction
Treat with pyridostigmine to stop ACh being broken down
What are the symptoms of MG?
Increasing muscular fatigue
Diplopia and ptosis
What is Lambert-Eaton syndrome?
Paraneoplastic or autoimmune antibodies against voltage gated calcium channels, causing gait difficulties and autonomic involvement (unlike MG)
How does botulinum toxin cause muscle weakness?
Inhibits pre-synaptic release of acetylcholine
