Neurology Flashcards
List the advantage of MRI head over CT head
List the CIs of MRI
No ionising radiation in MRI
Any metal containing implants / bullets + shrapnel
Claustrophobic
What are the CSF findings seen in MS? (3)
Lymphocytes upto 50
Protein - moderately raised (<1g)
Oligoclonal IgG bands on electrophoresis
List the Irreversible (6) + Reversible (9) RFs for ischaemic stroke
Age/Gender
PMH/FH
Hypercoagulable state / AF
Poor diet / exercise Smoking / alcohol HTN / Hyperchol DM / Obese COC
List some rarer RFs for ischaemic stroke (6)
Endocarditis / Vasculitis
Migraine / Polycythaemia
Antiphospholipid syndrome / Amyloidosis
List some RFs for haemorrhagic stroke (5)
FH Vascular abns (aneurysm / AVM / HHT) Uncontrolled HTN Coagulopathies / anticoags Heavy recent alcohol intake
What are the 3 diff types of cerebral ischaemia
Regional (affects cortical areas)
Lacunar (subcortical - from microinfarcts/small vessel disease)
Global ischaemia (post-arrest: can reverse/transient sx but risk reperfusion injury // severe can cause cortical laminar necrosis = vegetative)
What are the 3 zones in cerebral ischaemia called?
Infarct core - defo will die
Oligaemic periphery - survives from collaterals
Ischaemic penumbra - uncertain outcome
List the main clinical features of an ischaemic stroke (4)
Contralateral mm weakness / hemiplegia Facial weakness Higher dysfunction Visual disturbance Rare - epileptic fit
List some examples of higher dysfunction (6)
Agnosia Asterognosis Receptive aphasia Expressive aphasia Apraxia Inattention (neglect)
Describe the practical management of ?Stroke coming onto the ward
Quick focussed Hx / NIHSS score
Assess for CIs (fam/GP/Notis)
IV access + baselines (FBC, clotting, Glucose, UEs)
Weight (estimate)
Catheterise (if required)
Consultant review + urgent CT / thrombolysis
Post-thrombolysis, what features would indicate complications/haemorrhage?
What aspects of management should be delayed during thrombolysis infusion?
Acute HTN
Severe headache
Nausea/vomiting
-> discontinue infusion + urgent CT
During 1st 24hrs/ during infusion:
Avoid catherisation
Avoid NG
Avoid aspirin
What are the secondary prevention measures post-stroke? (5)
Antihypertensive therapy Statin Antiplatelet therapy Identify/tackle RFs Manage co-morbidities e.g. AF/DM
What are the laws regarding driving after a stroke?
Cannot drive for 4wks post stroke
After 4wks if clinical improvement satisfactory, may return to driving w/o having to inform DVLA
List some post-stroke complications (8)
Post-stroke pain
Incontinence
Pressure sores
Depression
DVT/PE
Aspiration/hydrostatic pneumonia
Malignant MCA syndrome
Seizure
What is malignant MCA syndrome and its features / Tx
Neuro deterioration due to cerebral oedema following middle cerebral aa stroke
Variable but: Increased agitation Reducing GCS Haemodynamic / thermal instability Signs of raised ICP
Decompressive hemicraniectomy
What are some high-risk features of a further stroke post-TIA?
Recurrent TIAs in short period
TIA on anticoag / AF
ABCDD score of ≥4
Age >60
BP at presentation (>140/90)
Clinical features - unilateral weakness (2) / speech disturbance w/o weakness (1)
Duration of Sx - 60mins+ (2) / <60mins (1)
Diabetes - pre-existing (1)
How are high-risk and low-risk TIAs managed?
High-risk: Statin (e.g. simva 40mg) 300mg aspirin (unless CI) Arrange 24hr urgent clinic Advise don't drive until seen specialist
Low risk:
Same but less urgent clinic referral (1wk)
What further Ix / prophylactic interventions can be done after TIAs (1+2)
Carotid USS in specialist clinic
Carotid endarterectomy if stenosed >50%
OR
Percutaneous luminal angioplasty ± stenting
List the RFs for venous sinus thrombosis (7)
Pro-thrombotic state (85%): Pregnancy / puerperium Oral contraceptive Malignancy Genetic thrombophilia
Head injury
Recent LP
Infection
What are the clinical features for cortical (5) / dural (5) / sagittal lateral (5) venous sinus thrombosis
Cortical: Thunderclap headache Fever Focal signs Seizures Encephalopathy
Dural: (ophthal signs + fever) Proptosis/chemosis Ocular pain Ophthalmoplegia Papilloedema Fever
Sagittal lateral: (raised ICP signs) Headache Vomiting Fever Papilloedema Seizures
What are the diff types of intra-cerebral haemorrhage?
Deep intra-cerebral: subcortical
from micro aneurysms (Charcot-Bouchard) and degen of small penetrating aa’s
Lobar intra-cerebral: in cerebral cortex
Normotensive / >60
Describe the immediate management for intra-cerebral haemorrhage
Reverse anticoag
Lower BP to <140/90 within 1hr (IV betolol)
Neurosurgical intervention possibly
What are the presenting features of a SAH? (5 + 3)
Thunderclap headache (after transient HTN) Vomiting Photophobia Drowsiness / coma Focal signs
Neck stiffness
+ve Kernig’s
Papilloedema
What are the predisposing abnormalities causing SAH? (3)
Berry (saccular) aneurysm (70%)
AVM (10%)
No lesion found (20%)
What are the RFs for berry aneurysm development?
What is the most common site of berry aneurysm?
Polycystic kidney disease FH HTN Smoking Ehlers-Danlos / Marfans
Commonest site is anterior communicating aa
What are some complications of SAH (4)
Death (30% immediate)
Rebleed
Hydrocephalus (from CSF pathway fibrosis)
Cerebral vasospasm (poss -> ischaemic damage)
What investigations are done in SAH? (4)
Bloods: FBC, clotting, UEs, LFTs, ESR
CT*
LP if CT normal
CT angio - for all pts fit for surgery
How is SAH managed? (7)
4wks bed rest HTN control Nimodipine - prevents vasospasm IV fluids - prevents further vasospasm Analgesia Stool-softeners (prevent straining) Neurosurgical referral/discussion
What pt groups are subdural haemorrhages seen in?
Acute: major trauma pts
Subacute/Chronic:
Elderly
Coagulopathy
Alcoholics (clotting)
How do subacute/chronic subdurals present? (4)
S/O raised ICP 3wks post-insult: Headache Drowsy/confusion Focal neuro signs Stupor/coma (late: coning)
How do acute / chronic subdurals look on CT?
Acute: Crescenteric White (increased density) Midline shift Ventricular compression
Subacute: isodensity
Chronic:
Lentiform shape (convex lens)
Darker (radiolucent)
How are subdurals managed?
Serial CT imaging
Neurosurgery
Chronics may self-resolve
How does an extradural (epidural) haemorrhage present?
Young pt minor injury (sports/assault)
Blow to side → middle meningeal aa tear
Brief unconsciousness → lucid recovery period
Over mins-hrs:
Progressive hemiparesis / stupor
Ipsilateral dilated pupil → then bilateral
Resp arrest (untreated)
What is seen on CT in extradural haemorrhage?
How is it managed?
Lentiform shape
Midline shift
Ventricular compression
Urgent neurosurgery – burr hole (release pressure)
If v. minor – conservative/monitoring
What are the 3 cardinal features of Parkinsonism
Resting tremor
Bradykinesia
Rigidity
List some detailed features of the tremor in Parkinsonism
4-7Hz pill rolling
Increases in: rest / anxiety / clenching opposite
Decreases in: movement / finger-nose
List some other detailed features of Parkinsonism
+ve Glabellar tap reflex
↓ Spontaneous blinking
‘Lead pipe’ rigidity
‘Cog wheeling’ effect
Hypersalivation
Hypomimia
Micrographia
‘Walking’ thumb along fingers
List the Parkinson plus syndromes + how they are different
Progressive supranuclear palsy: Early dementia / Early speech probs Postural instability Vertical gaze palsy VS PD - symmetrical / no tremor
Multisystem atrophy:
Autonomic / Cerebellar / Pyramidal
Cortico-basal degen:
Akinetic rigid 1 limb
Cortical sensory loss e.g. astereognosis
Vascular: BG strokes
Pyramidal / Legs worse
LBD:
Early dementia / Visual hallucinations
Symmetrical motor signs later
List features of Parkinsons DISEASE (other than Parkinsonism) (14)
Characteristic stoop Fixed flexed joints (all except PIP/DIP) Dysphagia Constipation Urological Sweating Shuffling (festinant) gait Slurring/monotonous (eventually anarthria) No arm swing Unsteady turning Depression (1/3rd) Dementia/cognition problems (later) Insomnia (later) REM behavioural sleep
What are the SEs of levodopa?(4+3)
N+V (→ domperidone alleviates)
Confusion
Visual hallucinations (→ atypicals alleviate)
Chorea
Later SEs (2-5yrs):
Motor fluctuations (akinesia switching on/off)
Dyskinesia
Dystonia
List other Parkinsons drugs/Tx used (5) (give examples of drug names)
D-r agonists: bromocriptine / cabergoline / ropinirole
MOA-B inhibs: selegeline / rasagiline
COMT inhibs: entacapone
Anticholinergics: procyclidine
Surgery: thalotomy / deep brain stimulation
List the diff patterns of MND (4)
Amylotrophic lateral sclerosis**
Progressive muscular atrophy
Primary lateral sclerosis (rare)
Bulbar presentation
Which areas are affected in MS? (+ what effects does it have)
Optic nn → optic neuritis CST → hemi/mono/para-paresis DST → paraesthesia/proprioceptive loss Cerebellar peduncles → cerebellar signs inc. vertigo Brainstem → bladder/bowel/sexual Cognition → (late) IQ/language
List the classifications of MS (3)
Primary progressive (10-20%)
Relapsing/remitting (80-90%) (to 2o progressive)
Fulminant (<10%)
List the diagnostic tools for MS (5)
Clinical Dx (2+ characteristic episodes)
Bloods before neuro referral:
FBC/UE/LFT/TFT / B12 / Ca / Gluc / ESR / HIV
MRI confirms Dx
CSF: raised WCC/protein / oligoclonal IgG
VER (visual evoked responses) – prev optic nn lesion
List the DDx for MS:
Relapsing-remitting (3)
Primary progressive (3)
Relapsing-remitting:
TIA
SLE w. neuro involvement
CNS sarcoidosis
Primary progressive:
MND
CNS mass
Spinal/cerebellar degen e.g. Alz/Hunt/Park
Outline the general management of MS (6)
MDT Annual R/V Lifestyle (exercise/smoking) Pt education (prompt recog sx / tx) Manage comps Modifying therapy (dimethyl fumarate / teriflunomide / natalizumab for severe)
List the complications of MS (9)
Mental health Fatigue Mobility issues Pressure sores Constipation Bladder dysfunc Sexual dysfunc Ataxia Spasticity
What are good/poor prognostic factors in MS?
Good: sensory onset
Poor: older at presentation / early cerebellar / cognition
How does ALS present?
Progressive spastic tetra-paresis
± Bulbar/pseudo-bulbar
Fronto-temporal dementia
LMN signs: hands → arms + down
UMN signs: legs → up
How does progressive muscular atrophy present?
Painless wasting in small hand mm’s + spreads
Just spinal LMNs
How does primary lateral sclerosis present?
Progressive tetraparesis
Just cortical UMNs
List the diagnostic tools for MND (4)
Clinical (mixed UMN/LMN)
Bloods: exclude DDx
MRI: exclude myelopathy/radiculopathy
Dx – EMG: denervation
Outline the general management of MND (5)
MDT Nutritional support / gastrostomy Resp support (NIPPV) Manage comps (as per MS) Modifying therapy: Riluzole
List possible causes for Dementia (surgical sieve)
V: Multi-infarct / Cerebral infarcts / Binswangers / Lupus
I: HIV / syphillis / CJD / Cryptococcus
T: major head / repetitives
Toxins: Alc / Drugs / heavy metals inc. Wilsons
M: B1/B12/Fol defc / Uraemia / Liver failure / Hypothyroid
Mechanical: Hydroceph (inc. NPH) / Haematomas
N: primary/secondarys
D: Alz (62%) / LBD (4%) / FTD (2%) / PD+ (2%) / Hunt’s
List + describe the diff types of vascular dementia (4)
Post-stroke (25% stroke pts within 1yr)
Multi-infarct (cortical): stepwise decline
Subcortical: h/o HTN
Mixed cortical/subcortical
List the features of LBD (3+5)
Core:
Fluctuating cognition
Visual hallucinations
Parkinsonism
Supporting: Syncope Autonomic e.g. post hypo Falls Neuroleptic sensitivity REM sleep behaviour
List the early features of FTD (7)
Emotional blunting / loss inhibition Personal hygiene Hyperorality Word finding difficulties / less speech Echolalia / aphasia Loss insight Primitive reflexes e.g. grasp
What are the features of CJD? (3)
How is it Dx?
Middle aged dementia
UMN signs limbs
Visual disturbances
Dx; EEG
What are the features of Huntington’s? (2)
Middle aged dementia
Progressive chorea
List the DDx of peripheral neuropathy
V: vasculitic
I: HIV/syphillis / CIDP / GBS
Toxins: Alc / Lead / Chronic liver disease
A: RA / CTDs / Myxoedema
M: DM / B12+Folate / Thiamine defc / Uraemia
I: amio / statins / pheny / hydralazine / abx
N: paraprot (myeloma) paraneoplastic
C: Charcot-Marie Tooth / Friedrich’s ataxia
List the causes of peripheral neuropathy with predominately motor loss (6)
Guillain-Barre syndrome Porphyria Lead poisoning Charcot-Marie-Tooth Chronic inflamm demyelinating polyneuropathy (CIDP) Diphtheria
List the causes of peripheral neuropathy with predominately sensory loss (6)
DM Alcohol B12 defc Uraemia Amyloidosis Leprosy
Describe the difference b/wn demye + axonal neuropathy
List some other nerve damage patterns + what happens
Demyelination: only schwanns / immune-med / regrow
↓ Conduction velocity
Axonal: neuronal bodies degen from axon / can’t regrow
↓ Amplitude
Wallerian: post-section / microinfarction
Compression: focal demye
Infiltration: malignancy / granulomatous
What are the features of GBS? (4)
1-3wks post trivial infection (campylo/CMV)
Ascending paralysis
Loss tendon reflexes
Proximal mm involvement (20%) - Resp/CN
NB sensory loss uncommon
List some complications of GBS
LRTI Pressure sores VTE BP instability / arrhythmia (autonomic involvement) Residual weakness post-recovery (10-20%) Mortality (10% in acute phase)
How is GBS managed?
HDU nursing Monitor FVC ± Ventilation SC heparin / TEDS Prevent complications High-dose IVIG within 2wks (NB steroids useless)
Describe the presentation/progression of shingles
Pain/paraesthesia (days)
Erythema / vesicles / burning / itching / dermatomal
2-3d later become pustular
List poss complications of shingles
Post-herpetic neuralgia (10%)
Corneal scarring / uveitis / panophthalmitis
Facial palsy / sensorineural loss / CN5,9,10 neuropathy
How is shingles managed?
5-7d oral aciclovir
Paracetamol / amitriptyline
How is post-herpetic neuralgia managed?
Amitriptyline
Topical capsaicin
(Gradual recovery over 2yrs)
What are the possible features of MG (4)
Weakness/fatiguability of: Extra-ocular Proximal mm (limb/face/neck) → Ptosis → Dysphagia → Speech difficulties / chewing (facial exp mm) → Proximal mm weakness (arms >legs)
List some conditions assoc w. MG (5)
Pernicious Autoimm thyroid SLE Rheumatoid Thyroid hyperplasia / thymoma
What Ix can be done if suspecting MG? (4)
Anti-ACh-R IgG autoAbs
EMG
TFTs / CT thorax (exclude thymoma)
Describe the management of MG (3+3)
Long-term:
Initial immunosupp – oral pred
Long-acting anticholinesterases e.g. neo/pyridostigmine
Thymectomy
Relapses:
Corticosteroid/Azathioprine
FVC monitoring ± ventilation
Severe: Plasmaphoresis/IVIG
Describe the pathology behind:
- Duchenne’s
- Becker’s
- Myotonic dystrophy
- Duchenne’s: X-linked recessive dystrophin gene mutation
- Becker’s: partially func dystrophin
- MD: autosom dom Cl- channelopathy
What is the difference b/wn:
Muscular dystrophies
Myopathues
Neurogenic disease
Muscular dystrophy: genetic progressive deterioration
Myopathies: predominant effect on mm
Neurogenic: peripheral nn / LMNs → SkM atrophy
What Ix can be done for a suspected myopathy? (3)
CK (serum mm enzyme):
Raised in – dystrophy / inflamm mm disorder
Normal in – MG
EMG – classic traces in:
Myopathy / denervation / myotonic discharge / MG
Mm biopsy: ddx b/wn denervation + mm disease
List the management options for spasticity related motor problems (Con/Med/Surg) (3/4/4)
Conservative:
Physio
Gait retraining
Remove exac stim e.g. constipation
Medical:
Baclofen / Dantrolene / BZDs / Botox
Surg: Tendon lengthening Fixed deformity release Electrostim Orthopaedic referral for contractures
What is the pathological difference b/wn bulbar palsy + pseudo-bulbar palsy?
What neuro disease may present with a mix?
Bulbar: LMN weakness from medullary CNs (9/10/12)
Pseudobulbar: bilateral UMN weakness from medullary CNs (9/10/12)
MND: mixed bulbar/pseudo
What are the features of a bulbar palsy? (6)
LMN tongue (wasted/fascic/flaccid) Speech: quiet/nasal Poor soft palate elevation (ahh) Jaw jerk absent Gag absent Dysphagia
What are the features of a pseudo bulbar palsy? (6)
UMN tongue (stiff/spastic/not wasted) Speech: donald duck/high-pitched/slurred (dysarthria) Normal soft palate elevation (ahh) Jaw jerk exaggerated Gag present Dysphagia
What are the main causes for bulbar/pseudobulbar palsy? (2)
What are some rarer causes? (4+2)
V: Stroke
D: MND
BULBAR: GBS Botulism Brainstem tumours Congenital
PSEUDO:
Trauma
MS
What features may be present in a cerebral lesion in:
- Frontal (5)
- Temp-Par L (dom) (3)
- Temp-Par R (2)
- Occipital (1)
Frontal:
Intellect / personality / Urinary / hemiparesis / Broca’s
L T-P (dom): Contralat neglect / Wernicke’s / Agraphia
R T-P: Contralat neglect / Agnosia
Occipital: Visual field/spatial defects
What are features of a cerebellar lesion? (6)
+ of a midline cerebellar lesion? (4)
Disdiadokinesia / Dysmetria Ataxia Nystagmus Intention tremor Slurred staccato speech Hypotonia
Broad gait
Romberg’s (unsteady when close eyes)
sUpport needed (sit/standing)
Vertigo/vom (sitting forward + arms across chest)
List some causes of unilateral (3) + bilateral (4) cerebellar dysfunc
Unilateral:
Stroke
MS
Tumour (acoustic neuroma, meningioma)
Bilateral: Alcohol Anti-epileptics Severe hypothyroid Paraneoplastic degen (breast, small cell lung)
What is the func of the BG?
What are the BG structures? (7)
Modulates cortical motor activity
Corpus striatum: caudate / globus pallidum / putamen
Subthalamic nucleus
Substantia nigra
Parts of thalamus
What are the features of BG dysfunction? (7)
Bradykinesia (→ akinesia) Mm rigidity Tremor Dystonia (spasms) Athetosis (writhing) Chorea Hemiballismus (violent invol prox arm mm)
Where does the lesion lie in:
Central scotoma
Monocular loss of vision
Bitemporal hemi/quadrantanopia (superficial + inferior)
Homomymous hemianopia
Homonymous quadrantanopia (superficial + inferior)
Central scotoma → macular
Monocular → ipsilateral optic nn
Bitemp hemi/quad:
Superfic = pituitary tumour (below chiasm)
Inf = craniopharyngioma, meningioma, carotid aneurysm
Homonymous hemi = contralateral optic tract
Homonymous quad:
Superfic = Temporal contralat optic tract
Inf = Parietal
What is the difference b/wn Broca’s + Wernicke’s aphasia? How does each manifest
What are some other types of aphasia? (2)
Broca’s = motor speech; expressive
Non-fluent / good comprehension / poor repetition
Wernicke’s = understanding speech; receptive
Fluent / poor comprehension / poor repetition
Global = both Nominal = word finding difficulty
List the different causes of DYSARTHRIA + their different manifestations in speech (5)
Bulbar = high-pitched, nasal Pseudobulbar = donald duck 'gravelly' (UMN)
MG = speech fatigues / dies away
Extrapyramidal = soft / indistinct / monotonous Cerebellar = slow / staccato / slurred
What are the features of Horner’s?
MioSIS (unilateral constriction)
PtoSIS (partial) - just Mullers mm
AnhidroSIS
List the 1st / 2nd / 3rd order causes of Horner’s?
How are they differentiated clinically?
1st order: BRAINSTEM stroke / syphilis / MS / tumour
2nd order:
INTRATHORACIC pancoast / cervical rib / TB
NECK lymphadenopathy / trauma / thyroid surg
3rd order: ICA aneurysm / transient migraine / idiopathic
List the DDx for pathology of a LMN lesion (4)
Ventral horn: MND / Post-polio
Peripheral nn: neuropathy
NMJ: MG
Muscular
List the DDx for a UMN lesion (6)
V: stroke / AVM / haemorrhage I: post-meningitis T: traumatic brain injury A: MS / MND I: drugs N: SOL D: Parkinson's
How would a unilateral cord lesion (hemisection) present? (3)
What is the Eponymous name for it?
List some possible causes (3)
Ipsilateral weakness (CST)
Ipsilateral loss vibration/proprio (DC)
Contralateral loss pain/temp/light (STT)
Brown-Sequard
RTA
Penetrating injury
Facet dislocation
How would a dorsal column lesion present? (3)
What is the Eponymous name for it?
Clumsiness
Electric-shock like sensations / tingling / numbness
Sensory ataxia (loss 2-point discrimination)
List the indications for LP (5)
Dx: Meningitis/Encephalitis Dx: Neurosyph / MS / Behcet's Dx: SAH (if CT normal) Intrathecal drugs Measure CSF pressure ± drain
List the contraindications for LP (5)
Local infection Clotting problems ?Raised ICP (if unconscious → CT first) Haemodynamically unstable Congenital e.g. NTD
List the complications of LP (5)
Infection
Cerebellar tonsillar coning
Spinal nn damage Dry tap (not worked) Spinal tap (post-LP headache: 30%)
List the differentials for causes of secondary headaches
V: Raised ICP / IIH / HTN I: meningitis / sinusitis / SAH T: post-traumatic A: giant cell arteritis M: metabolic disturbances I: nitrates / vasoactives N: SOL
Describe the classic presentation of tension headaches
How are they treated?
Middle-aged woman Depression Band-like (occiput/vertex) Non-pulsatile Episodic
OTC analgesia (NB caution overuse) If >2/wk: low-dose amitriptyline
Describe the classic presentation of cluster headaches
Male
After drinking
Wakes from sleep
Mins-hrs
Severe unilateral pain around eye / poss BG pain
Aura (20%)
Autonomics: ptosis / watering / red eye / vom
How are cluster headaches managed?
What is the main DDx to exclude
Start of attack – SC/Nasal Triptans
During attack – 12L O2 non-rebreather
Prophylaxis – alc avoidance / verapamil (off-licence)
Main DDx: acute angle closure glaucoma
List some common triggers for migraines (6)
Stress / emotional states
Alcohol
Physical exercise
Menstruation
OCP
Specific food groups
Outline the management for migraines
Headache diary
Avoid triggers
Acute:
NSAIDs / para / anti-emetics
(Severe) Sumatriptan / nasal triptan if vom
Prophylaxis:
Menses related: mefanamic acid / triptans 2d prior
1st – topiramate / propanolol (for child bearing)
2nd - amitriptyline / carba
List some possible features of IIH
How is it treated? (2)
Young obese woman OCP Headache Pulsatile tinnitus Diplopia / CN6 palsy Visual disturbances Bilateral papilloedema
Trial corticosteroids VP shunt (to prevent optic atrophy)
How does trigeminal neuralgia typically present?
What is it caused by?
How is it treated?
Sudden severe pain across facial distrib
Sensory trigger
Ageing / Compression / MS
TCAs / Carba
What are the 2 diff types of hydrocephalus
Who are the at risk groups for hydrocephalus (3)
Non-communicating (obstructive)
Communication (non-resorptive)
Congenital malformations
Post-insult (trauma/SAH)
Meningitis
What are the features of hydrocephalus
Headache Vomiting Papilloedema UMN pyramidal signs Cognitive disturbance Ataxia
How is hydrocephalus managed?
Acetozolamide ± furosemide
VA/VP shunt
Endoscopic 3rd ventriculostomy
Brain tumour removal
What are the 3 features of NPH?
How is it treated?
Dementia
Ataxic gait
Urinary incontinence
LP trials (of improvement) + VP shunt
What are the 3 main types of primary brain tumours?
+ their natural progression
Malignant glioma – rapid growth (6m)
Meningioma – slow growth benign
Astrocytoma – slow growth benign
List the commonest locations of origin for brain mets (6)
Thyroid
Melanoma
Kidney
Breast
Bronchus
Bum (colon)
List 4 paraneoplastic syndromes
Myasthenia Gravis
Lambert-Eaton Myasthenic syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration
What types of cancer assoc w. paraneoplastic cerebellar degeneration? (4)
Small cell lung
Hodgkins
Breast
Ovarian
List some viral causative organisms of meningitis (4)
Enteroviruses:
Coxsackie A/B
Echoviruses
HIV
HSV
What features indicate complications in meningitis (4)
What acute neuro complications could these indicate? (3)
What are some other (systemic) acute complications
Progressive drowsiness / LOC
Lateralising signs
CN lesions
Seizures
Hydrocephalus
Severe cerebral oedema
Venous sinus thrombosis
Sepsis
DIC
Adrenal haemorrhage (Waterhouse-Friderichsen)
How does TB meningitis present in contrast to normal?
How is it treated?
More gradual + wt loss
Same as resp (RIPE 12m) + Dexa
List necessary Ix for ?Meningitis (6)
Bloods: FBC / UEs / LFTs / Clotting / Glucose / Lactate LP CT Blood cultures Serum PCR Throat swabs
List possible long-term complications of bacterial meningitis (5)
Brain abscess
Hydrocephalus
Hypotonia
CN palsy (e.g. sensorineural deafness)
List some causes of brain abscess (5)
Paranasal sinus infection Otitis media BActerial endocarditis Neurosurg Trauma
What are the meningitis empirical Abx in:
- Non-blanching rash
- Immunosupp (inc. DM) / >60
- Non-immunosupp / <60
- Ben-pen / PA-cefotaxime (IM + IV)
- Ceftriax / Amoxi / dexa (IV) (PA-chloramphenicol)
- Ceftriax / Dexa (IV)
List the diff types of syncope (7)
Situational: post-prandial / micturition / defacation
Vasovagal: transient parasymp (heat/noxious)
Neurogenic: TIA/Stroke /subclav steal syndrome
Cardiogenic: structural / arrhythmia
Orthostatic: post hypo
Psychogenic
Endocrine: hypogly / anaemic
List the Ix for recurrent syncope
FBC / UE / Gluc ECG LSBP CT head / EEG ECHO
What is subacute combined degeneration of cord (SCDC) due to?
What are the features (4 ± 2)
Due to B12 defc
Can be precipitated by folate
Peripheral sensory neuropathy (vibration/proprio) UMN signs in legs, classic ∆: • +ve Babinski • Brisk knee reflex • Absent ankle reflex
Plus poss also:
Normal tone/power
Ataxic gait
