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Year 5 > Neurology > Flashcards

Neurology Flashcards

1
Q

Cerebellar signs (DANISH)

A 
Effects: DANISH
x Dysdiadochokinesia
x Dysmetria: past-pointing
x Ataxia: limb / trunkal
x Nystagmus: horizontal = ipsilateral hemisphere
x Intention tremor
x Speech: slurred, staccato, scanning dysarthria
x Hypotonia
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2
Q

Cerebellar dysfunction causes (PASTRIES)

A 
Common Causes: PASTRIES
x Paraneoplastic: e.g. from bronchial Ca
x Alcohol: thiamine and B12 deficiency
x Sclerosis
x Tumor: e.g. CPA lesion
x Rare: MSA, Friedrich’s, Ataxia Telangiectasia
x Iatrogenic: phenytoin
x Endo: hypothyroidism
x Stroke: vertebrobasilar
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3
Q

ACA infarct signs

A

Anterior Cerebral Artery
x Supplies frontal and medial part of cerebrum
x Contralateral motor / sensory loss in the legs > arms
x Face is spared
x Abulia (pathological laziness)

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4
Q

MCA infarct signs

A

Middle Cerebral Artery
x Supplies lateral / external part of hemisphere
x Contralateral motor / sensory loss in face and arms >
legs.
x Contralateral homonymous hemianopia due to
involvement of optic radiation
x Cognitive changes
ƒ Dominant (L): aphasia
ƒ Non-dominant (R): neglect, apraxia

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5
Q

PCA infarct signs

A

Posterior Cerebral Artery
x Supplies occipital lobe
x Contralateral homonymous hemianopia c¯ macula
sparing.

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6
Q

Vertebrobasilar system infarct signs

A 
Vertebrobasilar Circulation
x Supplies cerebellum, brainstem and occipital lobes
x Combination of symptoms
ƒ Visual: hemianopia, cortical blindness
ƒ Cerebellar: DANISH
ƒ CN lesions
ƒ Hemi- / quadriplegia
ƒ Uni- / bi-lateral sensory symptoms
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7
Q

Causes of Blackouts (CRASH)

A

Cardiac - Brady/Tachy/LVF/AS/HOCM/PE/Stoke-Adams attack
Reflexes -Vagal overactivity/ postural HypoTN
Arterial - Stroke/TIA, Subclavian Steal, shock,HTN
Systemic - hypoglyc, hypoxia, hypercapnia, anaemia
Head - epilepsy, drop attacks

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8
Q

Ix in blackouts

A 
x ECG ± 24hr ECG
x U+E, FBC, Glucose
x Tilt table
x EEG, sleep EEG
x Echo, CT, MRI brain
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9
Q

Definition postural hypotension

A

Postural hypotension: difference of >20/10 after

standing for 3min vs. lying down

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10
Q

Resting tremor

A

Features
ƒ 4-6Hz, pill-rolling
ƒ Abolished on voluntary movement
ƒ ↑ c¯ distraction (e.g. counting backwards)
x Causes: Parkinsonism
x Rx: Da agonists, antimuscarinic (e.g. procyclidine)

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11
Q

Action/postural tremor

A

Features
ƒ 6-12Hz
ƒ Absent at rest
ƒ Worse c¯ outstretched hands or movement
ƒ Equally bad at all stages of movement
x Causes: BEATS
ƒ Benign essential tremor
ƒ Endocrine: thyroxicosis, ↓glucose, phaeo
ƒ Alcohol withdrawal (or caffeine, opioids…)
ƒ Toxins: β-agonists, theophylline, valproate, PHE
ƒ Sympathetic: physiological tremor may be
enhanced: e.g. in anxiety

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12
Q

Intention Tremor

A 
x Features
ƒ >6Hz, irregular, large amplitude
ƒ Worse at end of movement
ƒ E.g. past-pointing
x Causes: cerebellar damage
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13
Q

Benign essential tremor

A 
Autosomal dominant
x Occur c¯ action and worse c¯ anxiety, emotion, caffeine
x Arms, neck, voice
x Doesn’t occur during sleep
x Better c¯ EtOH
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14
Q

Acute Dystonia

A 
Torticollis, trismus and/or occulogyric crisis
x Typically a drug reaction:
ƒ Neuroleptics
ƒ Metoclopramide
ƒ L-DOPA
x Rx: procyclidine (antimuscarinic)
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15
Q

Chorea

A

Non-rhythmic, purposeless, jerky, flitting movements
x E.g. facial grimacing, flexing / extending the fingers
x Causes
ƒ Huntington’s
ƒ Sydenham’s
ƒ Wilson’s
ƒ L-DOPA

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16
Q

Athetosis

A

Slow, sinuous, writhing movements
x Causes
ƒ Cerebral palsy
ƒ Kernitcterus

17
Q

Hemiballismus

A

Large amplitude, flinging hemichorea
x Contralateral to a vascular lesion in the subthalamic
nucleus: often elderly diabetics
x Recovers spontaneously over months

18
Q

Reversible causes of Dementia

A 
Infection
x Viral: HIV, HSV, PML
x Helminth: cysticercosis, toxo
Vascular
x Chronic subdural haematoma
Inflammation
x SLE
x Sarcoid
Neoplasia
Nutritional
x Thiamine deficiency
x B12 and folate deficiency
x Pellagra (B3 / niacin deficiency)
Hypothyroid
Hypoadrenalism
Hypercalcaemia
Hydrocephalus (normal pressure)
19
Q

Biceps reflex

A

C5-6

20
Q

Knee reflex

A

L3-4

21
Q

Triceps reflex

A

C7-8

22
Q

Ankle reflex

A

S1-2

23
Q

Anti emetic in parkinsons

A

Domperidone - doesn’t cross the BBB

24
Q

Lacunar infarct

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

25
Q

Lateral medullary syndrome

A

(posterior inferior cerebellar artery)
aka Wallenberg’s syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

26
Q

Weber’s syndrome

A

ipsilateral III palsy

contralateral weakness

27
Q

Erbs palsy

A

Brachial trunks C5-6.

Pronated and medially rotated arm - waiters tip

28
Q

Klumpke’s palsy

A

Brachial trunks C8-T1. Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner’s syndrome. It occurs as a result of traction injuries or during delivery.

29
Q

Pseudoseizures

A

Phenomenon that can mimic true seizures but generally have findings which are not entirely consistent with a seizure. They are often psychiatric in origin, but it is important to note that while not involuntary, they are usually not deliberate; the movement is compulsive and unwanted. The ability to control the location of symptoms is very typical of a pseudoseizure and does not fit with any of the other options presented

Widespread convulsions without conscious impairment is likely to represent a pseudoseizure

30
Q

Optic neuritis

A

Blurred vision and painful movements of one eye

31
Q

Essential tremor Rx

A

Improved with propanolol and alcohol

32
Q

Reasons to start anti-epileptics after first seizure

A
  • the patient has a neurological deficit
  • brain imaging shows a structural abnormality
  • the EEG shows unequivocal epileptic activity
  • the patient or their family or carers consider the risk of having a further seizure unacceptable
33
Q

stopping AEDS

A

can be considered if seizure free for >2y, with AEDS being withdrawn over 2-3y

34
Q

cataplexy

A

sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

35
Q

Medical Rx Trigeminal Neuralgia

A

carbamazepine

36
Q

Cardinal features of Parkinsons

A

Bradykinesia and 2 of the following

  • postural instability
  • rigidity
  • resting tremor

Year 5 (9 decks)

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