Neurology Flashcards
trigeminal neuralgia - key features
unilateral pain - brief electric shock like pains
evoked by light touch - shaving, smoking, talking, toothbrushing, or spontaneously
management of trigeminal neuralgia
carbamazepine
what nerve has a palsy if eye deviated down and out?
3rd nerve (oculomotor)
features of a 3rd nerve palsy
deviated down + out
ptosis
dilated pupil
myasthenia gravis - GI effects
dysphagia with liquids + solids
Which nerves supply larynx muscles?
Recurrent + superior laryngeal (branches of vagus)
Functions of trigeminal nerve
Sensation in face
Motor function eg chewing + biting
Role of facial nerve
Motor function + taste sensation
Which is the only CN to enter the thorax?
Vagus
Hallmark blood finding of haemochromatosis
High ferritin
unilateral parkinsonism + severe autonomic disturbance - likely diagnosis?
multiple system atrophy (MSA)
PSP - differentiating feature
ocular pathology
multiple system atrophy - features
unilateral parkinsonism
autonomic disturbance (atonic bladder, postural hypotn)
cerebellar signs
what can be used for long-term prophylaxis of cluster headaches?
verapamil
what is first line for focal seizures?
carbamazepine or lamotrigine
stroke in AF - when do you start anticoagulation?
don’t usually start till 2 weeks after stroke onset
thrombolysis in stroke - what are criteria for giving it?
within 4.5h of stroke onset
imaging excludes haemorrhage
ischaemic stroke - secondary prevention
clopidogrel
2wk after - anticoag if AF
statin - after 48h if cholesterol > 3.5
carotid endarterectomy - if carotid, pt not vv disabled + carotid stenosis is >50-70%
stroke - acute management
maintain hydration, glucose, sats, temp + don’t lower BP
aspirin 300 if haemorrhage excluded
alteplase if <4.5h
role of cerebellum
coordination of movement
what is charcot marie tooth disease?
hereditary sensorimotor neuropathy
types of ischaemic stroke
posterior vs anterior circulation
major vessel vs deep perforating artery (affecting the thalamus, internal capsule or corona radiata - would be a localised ‘lake’ of brain = lacunar)
what is a TACS?
3 of hemianopia, hemiloss + higher cortical dysfunction (eg neglect, speech probs, dyspraxia)
what is a PACS?
2 of hemianopia, hemiloss + higher cortical dysfunction (eg neglect, speech loss, dyspraxia)
hemiloss doesn’t have to be whole side of body
what is a POCS?
1 of:
hemianopia
cerebellar signs
brainstem signs - horner’s, conjugate gaze palsy, ipsi CN lesion with contra hemiparesis)
what is a LACS?
4 features are absent:
no higher cortical dysfunction as cortex not affected
no hemianopia - lesion away from optic radiation
no drowsiness
no brainstem signs
several lacunar syndromes:
pure motor or sensory
sensorimotor
clumsy hand syndrome
why is there relative sparing of upper face in UMN facial weakness as opposed to LMN?
bilateral cortical representation of upper face:
the part of the facial nerve nucleus responsible for the upper face has an UMN input from both cerebral hemispheres
ie there’s bilateral input into the upper part of the facial nerve nucleus
horner’s syndrome - presentation
ptosis + constricted pupil
when is selegiline used in parkinson’s?
late stage when l-dopa alone is failing to control symptoms
when are COMT inhibitors used in parkinson’s? what do they do?
inhibit peripheral breakdown of dopamine
used later in PD - esp when end-dose effect is a problem
B12 deficiency - presentation
large fibre neuropathy
-ve symps: unsteady gait, “walking on cotton wool”
+ve symps: paraesthesiae, band-like feeling around calf
alcoholic neuropathy - presentation
small fibre neuropathy
-ve symps: pain + temp loss
+ve symps: burning, hyperalgesia
