Neurology Flashcards
Thunderclap headache
subarachnoid haemorrhage
Risk factors for berry aneuryms?
Smoking Hypertension Aduld PKCD Marfans Ehlers danlos
What is xanthochromic CSF?
yellow coloured metabolised and broken down RBCs that forms several hours after a bleed
Why is fresh blood on LP not always indicative of SAH?
it can be blood from inserting the needle (traumatic tap)
Lucid period after head trauma followed by sudden collapse or deterioration?
extradural haemorrhage (between skull and dura mater)
lentiform appearance
extradural haemorrhage
Cogwheel rigidity
Parkinsons Disease
Woody texture muscle swelling with raised CK
duchenne or becker MD
Toe walker or positive gowers sign
MD
Mask-like expression
PD
Fluctuating cognitive defecit
LB dementia or delirium
REM distrubance
LB dementia or PD
Vivid visual hallucination normally of children and non-threatening
LB dementia
Acute onset cognitive disturbance that fluctuates
delirium
Personality/behaviour changes then dementia
frontotemporal dementia (picks disease)
memory and personality problems in someone with a history of CVD
vascular dementia
Stepwise deterioration
vascular dementia (small strokes affecting some functions and not others)
Pain on loud noise
facial nerve palsy
Painful third nerve palsy (reduced eye movements, pupil dilation)
posterior communicating artery aneurysm
myalgia, myositis and myoglobinaemia/uria
rhabdomyolysis
Complications of rhabdomyolysis?
DIC
acute renal failure
Inflammatory myopathy with poor response to steroids
inclusion body myositis
What is inclusion body myositis?
disease of muscle cells characterised by abnormal protein inclusions (misfolded proteins that aggregate and accumulate)
Symptoms of inclusion body myositis?
slowly progressive muscle weakness and wasting in distal and proximal muscles
Weakness, frontal balding, cataracts, ptosis
myotonic dystrophy (onset 30s, +ve FH)
What are nerve cell bodies called?
PNS: ganglion
CNS: nucleus
What are bundles of axons called?
PNS: nerve
CNS: tract
Where is level of T4?
male nipple
Where is level of T10?
umbilicus
Cervical plexus
C1 - C4
Brachial plexus
C5 - T1
Lumbar plexus
L1 - L4
Sacral plexus
L5 - S4
Sympathetic outflow (thoracolumbar)
T1 - L2 (extra lateral horn in grey mater of spinal cord)
travels to sympathetic chains and then passes into all spinal nerve anterior and posterior rami
Parasympathetic outflow (craniosacral)
CN 3, 7, 9, 10
pelvic splanchic nerve S2-4
How do APs relay sensory information?
Duration of firing of APs is duration of stimulus
Frequency of AP firing is proportional to the amplitude of stimulus
release of neurotransmitter is proportional to frequency of APs
afferent meaning
conducting inwards
Spinal damage to dorsal column?
ipsilateral loss of fine touch and vibration below the level (e.g. left side damage to dorsal column causes left sided symptoms as the fibres haven’t crossed yet)
Spinal damage to spinothalamic tract?
contralateral loss of crude touch, pressure, pain and temperature (e.g. left side damage to spinothalamic tract causes right sided symptoms right sided symptoms because fibres have crossed)
sensory cortex damage?
contralateral loss of fine touch, vibration, crude touch, pain and temperature
(both tracts have crossed)
When does a resting tremor occur?
when the muscle is relaxed
When does an action tremor occur and give some examples
occurs with muscle contraction postural (maintaining a position against gravity) intention (purposeful movement towards a target) task specific (when performing certain tasks, writing, speaking)
action tremor that gradually worsens, FH, no associated disease, improved with alcohol
essential tremor
Lesion of optic nerve
ipsilateral monocular visual loss
Lesion of optic chiasm
bitemporal haemianopia
Lesion at optic tract
contralateral homonymous hemianopia
Lesion at parietal upper optic radiation
contralateral homonymous inferior quadrantanopia
Lesion at temporal lower optic radiation
contralateral homonymous superior quadrantanopia
lesion at occipital visual cortex
contralateral homonymous hemianopia with central sparing
Ankle jerk
S1
Knee jerk
L4
Biceps
C5
Brachradialis
C5
Triceps
C7
Babinski positive
toe extension (indicates UMN lesion)
What causes myasthenia gravis?
autoimmune ABs to nicotinic Ach receptors at neuromuscular junction (prevents Ach from LMN from binding to receptors on muscle cells)
Treatment of essential tremor?
propanolol
primidone
Parkinsons tremor
resting tremor (pill rolling)
Cerebeller tremor
slow easily visible tremor of extremities, intention tremor, past pointing
What is myasthenia gravis associated with?
hyperplasia of thymus or thymoma
Treatment of myasthenia gravis?
pyridostigmine (anticholinesterase inhibitor)
steroids
thymectomy
What happens in myasthenia gravis?
inflammation and destruction of muscle cells
skeletal muscle weakness (extraocular muscles commonly affected first)
What separates the hemispheres of the brain?
medial longitudinal fissure
Where are the primary sensory and primary motor cortex located?
primary motor: precentral gyrus
primary sensory: postcentral gyrus
Function of the frontal lobe?
movement, personality, executive functions (making decisions)
Function of temporal lobe?
primary auditory cortex, smell, memory, facial recognition, language
Function of parietal lobe?
processes sensory information (regarding the body in 3D space, interpreting visual information, processing language and maths
Function of occipital lobe?
primary visual cortex
Where are broca and wernickes areas and function of each?
Broca’s area: anterior, production of speech
Wernike’s area: posterior, understanding speech
Function of the cerebellum
coordinates skeletal muscle contraction, balance and fine motor control
Function of brainstem?
essential functions of life (HR, BP, breathing, GI function, consciousness)
receives info from thalamus
What is the corpus collosum?
thick band of nerve fibres, communication between hemispheres
Leg symptoms + midline shift
Falcine herniation (brain herniation due to high ICP)
Back pain worse on coughing?
slipped disc
Headache worse on coughing?
lesion in posterior fossa
Bilateral sciatica, male sexual dysfunction, bowel and bladder symptoms?
cauda equina
Pleocytosis
increased WBC’s in CSF
Migraine prophylaxis
propanolol, topiramate or amitryptaline
valproate, pisotifen, gabapentin, pregabalin (if one doesn’t work by 4months, try another)
Injury to upper brachial plexus
(C5 - C6) erbs palsy (waiters tip, paralysis of the arm)
When does erbs palsy commonly occur?
shoulder dystocia (should fails to deliver after fetal head)
Injury to lower brachial plexus?
(C8 - T1) Klumpke’s palsy (claw hand)
Simmond’s test positive
(no planter flexion when squeezing calf)
achilles tendon rupture
Anti acetylcholine receptor antibody?
myasthenia gravis
purely motor symptoms with ocular sparing
motor neuron disease
Where do signals come from that make up the extrapyramidal system?
cerebellum
basal ganglia
Where do signals come from that make up pyramidal system?
motor cortex (cerebrum)
What causes internuclear ophthalmoplagia?
damage to medial longitudinal fasiculus (in brainstem)
What happens in internuclear ophthalmoplagia?
affected eye cant adduct and other eye will nystagmus on abduction
What is MS?
demyelinating disorder of CNS
T4HS causing inflammation and damage to oligodendrocytes
What is the common trio in MS?
Nystagmus
Dysarthria
intention tremor
What the immunomodulators used in MS?
IFN beta
copaxone
tecfidera
How are acute exacerbations of MS treated?
symptomatically
with oral or IV steroids
Drugs used in MS for urinary symptoms?
oxybutynin (anti-cholinergic)
desmopressin (synthetic ADH)
catheter
Cerebeller lesion symptoms?
Ataxia (affected balance, coordination (gait wobbily, wide based) and speech/dysarthria)
intention tremor, past pointing
Dysdiadochokinesia (impaired ability to perform fast movements)
pendular reflex
Drugs used in MS for spasticity?
baclofen
tizanidine
botox
Drugs used in MS for sensory pain?
gabapentin, amitriptyline
