Neurology Flashcards
Which medications can improve symptoms of dementia?
Acetylcholinesterase Inhibitors
Anti-Glutamates - Memantine
What is the gait of somebody with cerebellar ataxia?
Broad Based Gait. Stance becomes incoordinated. When walking, the person tends to veer to the side of the affected lobe. If midline structure affected, there will be a tendency to fall backwards or sideways.
What is the gait of somebody with sensory ataxia?
Stamping gait. Peripheral sensory loss causes ataxia because of loss of proprioception. a broad based high stepping gait develops as feet are placed clumsily, relying in part on vision, s obalance is worse with eyes closed?
What level must a lumbar puncture be performed at?
Between L3 and L5 - Cauda Equina
How does Optic Neuropathy present in MS?
Inflammation of the optic nerve produces blurred vision and unilateral eye pain.
A lesion in the optic nerve head produces disc swelling (optic neuritis) and pallor (optic atrophy) following the attack. When inflammation occurs in the optic nerve further away from the eye (retrobulbar neuritis) examination of the fundus is normal.
What is the difference between an ischaemic and a non-ischaemic stroke?
Ischaemic - blockages to blood vessels - Osmotic potential in certain area changes so water moves into area - swelling - area becomes darker on CT
Non Ischaemic: Bleeding - Intracranial haemorrhages (burst blood vessel) - Cerebral Amyloid …
Amaurosis fugax is associated with problems around which artery?
Ophthalmic Artery
What are the two main patterns of demyelination in MS?
Pattern I - Macrophage mediated demyelination
Pattern II Antibody mediated demyelination
Where does a subarachnoid haemorrhage most commonly occur?
Basilar artery (Berry Aneurysm)
Which nerve is affected in carpal tunnel syndrome, which ligament is it trapped under?
Median Nerve, entrapment under transverse ligament
What is Ménière’s disease?
Ménière’s disease (MD) is a disorder of the inner ear that is characterised by episodes of feeling like the world is spinning (vertigo), ringing in the ears (tinnitus), hearing loss, and a fullness in the ear.
Typically only one ear is affected, at least initially; however, over time both ears may become involved. Episodes generally last from 20 minutes to a few hours. The time between episodes varies. The hearing loss and ringing in the ears may become constant over time.
What is status epilepticus?
This is a medical emergency. There are continuous seizures for 30 minutes or longer. When grand mal seizures follow one another, there is a risk of death from cardiorespiratory failure. Precipitants include stopping treatment, alcohol abuse, intercurrent illness and poor compliance with therapy. Rectal diazepam or buccal midazolam is given out of hospital.
How will a patient with hemiparesis walk?
Stiff and weak leg is circumducted and drags
What are the symptoms of a subdural haemorrhage?
Increased Intracranial Pressure - Headache, Seizures, Vomiting
Where do the biggest ischaemic strokes tend to take place?
Middle Cerebral Artery
Which absent criteria define brainstem death (7)?
Unresponsive Pupils, Corneal Reflex, Caloric Vestibular Reflex, Cough Reflex, Gag Reflex, Respirations, Response to Pain
Where do Berry aneurysms occur?
At the junctions of the circle of willis.
What are the four characteristic features of Parkinson’s disease?
Tremor, Rigidity, Akinesia & Postural Changes
What is Romberg’s test? What could a positive result indicate?
In the Romberg test, the standing patient is asked to close his or her eyes. An increase loss of balance is interpreted as a positive Romberg’s test.
Positive result could indicate drug or alcohol intoxication or sensory ataxia.
What are the four clinical patterns of MS
Relapsing-remitting MS (RRMS) : This is the most common (85-90%) - symptoms occur in attacks with onset over days and typically recovery. Patients may accumulate disability over time if relapses do not recover fully.
Secondary Progressive MS : Gradually worsening disability progressing slowly over years; 75% of patients with RRMS will eventually evolve into this.
Primary Progressive MS (PPMS): (10-15%) gradually worsening disability without relapses or remissions and typically presents later and is associated with fewer inflammatory changes on MRI.
Relapsing Progressive MS: The least common form, similar to PPMS but with occasional supra-added relapses on a background of progressive disability from the outset.
What are the symptoms of Horners Syndrome?
Meiosis, Ptosis, Anhydrosis, Enopthalmos
Which sensory fibres transmit proprioception?
A Alpha
Which conditions could cause sensory ataxia?
Vitamin deficiencies such as Vitamin B12
Conditions affecting the dorsal columns of the spinal cord, such as tabes dorsalis (neurosyphilis), in which it was first described.
Conditions affecting the sensory nerves (sensory peripheral neuropathies), such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
Friedreich’s ataxia
Ménière’s disease
Which three pathological features cause clinical manifestations in Multiple Sclerosis?
Inflammation, Demyelination and Axonal Loss
What is the gait of somebody with lower limb weakness?
High stepping and waddling gait (slapping sound)
Which CNS infection is most indicated when you see a non blanching rash - especially if return travellers?
Haemophilus Influenza
How does Brainstem Demyelination present in Multiple Sclerosis?
Brainstem Demyelination produces diplopia (double vision), vertigo, dysphagia (difficulty swallowing), dysarthria (motor speech disorder), facial weakness/numbness & nystagmus. A typical picture is sudden diplopia and vertigo with nystagmus, but without tinnitus or deafness. Bilateral internuclear ophthalmoplegia is pathognomonic of MS. (Eye shows impairment in adduction & double vision)
What is the Q Risk?
Probability of cardiovascular event in next ten years
What would show on a CT as a crescent shaped mass?
A subdural haemorrhage
What supportive care should be offered to patients who have had a stroke?
Swallowing and Feeding. Dysphasia is common and may cause aspiration pneumonia and nutritional deficit. Speech & Language therapists make assesment within 42-72 hours.
Admission to stroke unit improves outcome.
Unconscious patient - maintenance of hydration, frequent turning.
Prevention of DVT by anti-embolism (T.E.D.) stockings. Heparin is not given.
What are the symptoms of Cerebellar Syndrome?
Vertigo, Headache, Ataxia, Vomiting
A patient presents with leg weakness, sensory disturbance in the legs, gait apraxia, incontinence, drowsiness and akinetic mutism (decrease in spontaneous speech) - you suspect an ischaemic stroke. Which artery is the most likely to be blocked?
Anterior Cerebral Artery
What are some of the signs of an upper motor neurone lesion?
Muscle tone increased (spasticity),
Tendon reflexes are brisk, Plantar responses (babinski sign), Characteristic pattern of limb muscle weakness (pyramidal pattern) -
Upper limbs - extensor muscles weaker than flexors,
Lower limbs flexors weaker than extensors, finer more skilful movements most severely impaired, emotional liability may be present (may laugh or cry easier than normal.
