Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

EOY3 > Neurology > Flashcards

Neurology Flashcards

1
Q

types of pain

A

cancer vs non-cancer

nociceptive vs neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

WHO pain management ladder

A

step 1 - mild analgesic (NSAIDS, paracetamol)
step 2 - weak opioids (codeine, tramadol)
step 3 - strong opioids (morphine, fentanyl, oxycodone, diamorphine, methadone)
step 4 - nerve block, epidurals, PCA pumps, spinal stimulators, neurolytic block therapy
adjuvants (ketamine, gabapentin, clonidine, amitriptyline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

nociceptive pain

A 
aching and localised if somatic 
diffuse if visceral 
associated with movement 
e.g. injury or post-op pain
Rx: conventional analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

neuropathic pain

A

burning, electric, shooting type
independent of movement
e.g. peripheral neuropathy, shingles and cancer pain
Rx: conventional analgesia plus anti-depressants and anticonvulsants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

homunculus

A

somatotopy
face and hands have a disproportionately large area
upper extremity and head is supplied by the middle cerebral artery
the hip, lower extremity and genital are supplied by the anterior cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DCML tract (ascending)

A

fine touch, proprioception and vibration

1st neurone enters the spinal column dorsally, synapses at the medulla (cuneate nucleus if above waist or gracile nucleus if below waist)
2nd neurone decussates at the medulla and synapses at the thalamus
3rd neurone travels to the sensory cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

spinothalamic tract (ascending)

A

pain and temperature (lateral), crude touch and pressure (lateral

1st neurone enters the spinal column dorsally, synapses at the spinal cord (1 or 2 levels above synapse)
2nd neurone decussates at the spinal cord at level of 1st synapse and synapses at the thalamus
3rd neurone travels to the sensory cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

corticospinal tract (descending)

A

lateral (primarily limbs), anterior (primarily axial)

UMN travels from the motor cortex through the lower medulla were it decussates, synapses with LMN in the anterior horn
LMN exits the spinal cord at the anterior horn and travels to the target muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

brain blood supply

A

ANTERIOR CIRCULATION (from the internal carotids)

  • anterior cerebral artery: to frontal lobe and middle cerebrum
  • anterior communicating artery: connects the anterior cerebral arteries
  • ophthalmic arteries: to eyes
  • middle cerebral artery: lateral brain, parietal and temporal lobes
  • anterior choroidal artery
  • posterior communicating artery: supplies circle of Willis, dual supply with the posterior circulation

POSTERIOR CIRCULATION (from the vertebral arties)

  • posterior communicating artery: supplies circle of Willis, dual supply with the anterior circulation
  • posterior cerebral artery
  • superior cerebellar artery: superior cerebellum
  • basilar artery: brainstem
  • pontine arteries: pons
  • anterior inferior cerebella artery (AICA): anterior cerebellum
  • posterior inferior cerebella artery (PICA): inferior cerebellum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

berry aneurysms

A 
predisposing factors "SHAME"
smoking
HTN
adult polycystic kidney disease
Marfans
Ehlers-Danlos

common sites: anterior communicating artery, posterior communicating artery and middle cerebral artery - circle of Willis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

brainstem infarction

A

causes “locked in syndrome”
- basilar artery
reduced GCS, quadriplegia, miosis, absent horizontal eye movements
risk - uncontrolled HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

middle cerebral artery

A

anterior circulation
affects upper body and causes facial paralysis on contralateral side (forehead sparing)
eyes deviate towards lesion, contralateral homonymous hemianopia, if ophthalmic artery affected get amaurosis fugax
verbal deficits - expressive aphasia or receptive aphasia (especially if left sided), verbal agnosia, confusion, apraxia
special defects - hemispacial neglect if parietal lobe affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

anterior cerebral artery

A

anterior circulation
causes contralateral hemiplegia of lower body and affects pelvic floor causing incontinence of urine (no sensory symptoms)
if olfactory bulb affected get anosmia
if frontal lobe affected get personality changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

posterior cerebral artery

A

posterior circulation
(no motor symptoms)
contralateral homonymous hemianopia with macular sparing, visual agnosia
visual hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Weber’s syndrome

penetrating branch of the PCA at midbrain

A

posterior circulation
contralateral hemiplegia - complete facial paralysis and unilateral parkinsonism
ipsilateral CNIII palsy (down and out), ipsilateral Horner’s syndrome
mild contralateral gait disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Benedik’s syndrome (Weber’s plus right nucleus affected)

A

posterior circulation
contralateral hemiplegia - complete facial paralysis and unilateral parkinsonism
ipsilateral CNIII palsy (down and out), ipsilateral Horner’s syndrome
more severe contralateral gait disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Wallenberg’s (PICA)

A

posterior circulation
ipsilateral facial sensory loss (CN V), contralateral body sensory loss
ipsilateral Horner’s syndrome
vertigo, ataxia, dysarthria and dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

total anterior infarcts

A

MCA and ACA

unilateral hemiparesis +/or hemisensory loss of face, arm and leg, homonymous hemianopia, higher cognitive dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

partial anterior circulation infarct

A

smaller arteries, 2 out of 3 of the signs of the total anterior infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

posterior circulation infarct

A

vertebrobasilar artery: 1 of cerebellar or brainstem syndrome, loss of consciousness, isolated hemianopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lacunar infarct

A

perforating artery around the internal capsule, thalamus and basal ganglia
1 of: unilateral weakness of face and arm, arm and leg or all three, pure sensory stroke, ataxic hemiparesis (ipsilateral pyramidal weakness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ischaemic stroke

A

90% of all strokes
- thrombotic or embolic
- commonly caused by AF, HTN, smoking, hyperlipidaemia, DM
TIA symptoms last less than 1 day (use ABCD2 to assess)
treatment of ischaemic stroke - once a haemorrhagic stroke has been ruled out: aspirin 300mg STAT, thrombolysis with alteplase (if <4.5 hrs)
thrombolysis is CI if pregnant, uncontrolled HTN, history of intercranial haemorrhage
secondary prevention - clopidogrel and aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

haemorrhagic stroke

A

10-15% of all strokes
shows as white CT
- intracerebral haemorrhage or subarachnoid haemorrhage
- risk factors include HTN, AV malformations and anticoagulation therapy
more likely to have reduced consciousness, headache, nausea and vomiting and seizures in 25%
if CT/MRI confirms then neurosurgeon consultation to assess suitability for surgery
stop blood thinners or reverse if possible, control blood pressure acutely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

epilepsy treatment

A

chronic condition of recurrent seizures, medication is usually started after 2nd epileptic seizure unless very strong family history or if first seizure was status epilepticus
investigations - EEG and MRI (looks for SoL)

  • sodium valproate for generalised seizures, P450 enzyme inhibitor
  • carbamazepine for partial seizures (and best if pregnant), P450 enzyme inducer
  • lamotrigine - high risk of Steven-Johnsons syndrome
  • phenytoin - P450 enzyme inducer
  • ethosuximide - used for absence seizures
  • benzodiazepines (e.g. diazepam) - status epilepticus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
focal seizure
``` aka partial seizure start in a specific area on one side of the brain often involves an automatism (tic) simple = aware complex = altered consciousness ```
26
generalized seizure
affects both sides of the brain, LOS immediately motor (tonic-clonic) and non-motor (absence) can get secondary generalised which is a focal seizure which progresses to a bilateral seizure may bite tongue, experience incontinence may have a post-ictal phase
27
Multiple Sclerosis
chronic cell mediated AI disorder characterised by demyelination in the CNS MRI is diagnostic different subtypes with the most common being relapsing remitting (65% will progress to secondary progressive within 15 years of diagnosis) management: - acute relapse (high dose methylprednisolone) shortens duration of relapse but not extent of recovery - disease modifying: beta-interferon (has to met criteria, reduces relapse rate by 30%), glatiramer acetate (immunomodulating drug), natalizumab (recombinant monoclonal antibody) - gabapentin, diazepam and dantrolene - smoking cessation
28
UMN vs LMN lesions
UMN - causes: stroke, spinal cord injury, motor neurone disease - signs: clasp-knife reflex/rigidity, no wasting, hypertonia, hyperreflexia, clonus, hemiparetic gait, positive Babinski sign LMN - causes: traumatic injury, peripheral neuropathy, motor neurone disease - signs: muscle weakness, muscle weakness, hyporeflexia, hypotonia, fasciculations, negative Babinski sign
29
peripheral neuropathy
ABCDE - alcohol, B12, CKD and carcinoma, DM and drugs, every vasculitis predominantly motor loss (Guillian-Barre, porphyria, lead poisoning, diphtheria, HSMN e.g. Charcot-Marie-Tooth, CIDP) predominantly sensory loss (DM, uraemia, leprosy alcoholism, vitamin B12 deficiency, amyloidosis drugs (amiodarone, isoniazid, vincristine, nitrofurantoin, metronidazole) alcoholic neuropathy (secondary to toxic effects and reduced B vitamin absorption) vitamin B12 deficiency (subacute combined degeneration of the spinal cord, dorsal column usually affected 1st prior to distal paraesthesia)
30
Wernicke's area
interprets language (left posterior superior temporal gyrus) Wernicke's (receptive) aphasia - due to a lesion of the superior temporal gyrus, "forms" the speech, so sentences make no sense, word substitution and neologisms but fluent speech comprehension is impaired
31
Broca's area
produces speech (left inferior frontal gyrus) Broca's (expressive) aphasia - due to a lesion of the inferior frontal gyrus, speech is non-fluent, laboured and halting comprehension is normal
32
conduction aphasia
classically due to a stroke, affects the arcuate fasiculus (the connection between Wernicke's and Broca's) speech is fluent but repetition is poor, they are aware of the errors they are making comprehension is normal
33
global aphasia
large lesion affecting Wernicke's, Broca's and the arcuate fasiculus resulting in severe receptive and expressive aphasia
34
cerebellar syndrome
``` unilateral cerebellar lesions cause ipsilateral signs causes: "PASTRIES" posterior fossa tumour, alcohol, sclerosis (MS), trauma, rare causes, inherited (Friedreich's ataxia), epilepsy medication, stroke symptoms: "DANISH" dysdiadochokinesia, dysmetria ataxia nystagmus intention tremor slurred speech, scanning dysarthria hypotonia ```
35
epidural haemorrhage
between skull and parietal layer of dura mater LEMON SHAPED presents with: raised ICP, lucid interval followed by unconsciousness location: MMA under the pterion (temporal) causes: acceleration-deceleration or blow target BP: >100-110
36
subdural haemorrhage
between the dura and arachnoid mater BANANA SHAPED presents with: gradual increasing headache and confusion, can be acute or chronic (acute is whiter) location: bridging veins (frontal/parietal) causes: increased age, alcoholism target BP: <140-180
37
subarachnoid haemorrhage
between the pia and arachnoid mater presents with: thunderclap headache, N&V, may lead to coma and death (25% die before they get to hospital) location: berry aneurysm, circle of WIllis causes : HTN and trauma target BP: if spontaneous <140-160, if traumatic then >100-110
38
intracerebral haemorrhage
bleed within the brain parenchyma hyperdense on CT +/- clots possible mass effect location: areas of traumatic contusion which fuse to form a haematoma
39
management of raised intracranial pressure
if life-threatening give IV mannitol/ furosemide, whilst waiting for transfer if diffuse cerebral oedema then decompressive craniotomy
40
syringomyelia
the development of a syrinx in the central canal of the spinal cord, affects the cervical and the upper thoracic slowly progressive, elongates over time - causes compression and pressure ischaemia - get a "cape-like" distribution of pain and temperature sensation loss (spinothalamic), compresses them as they decussate - many cases are linked to Arnold-Chian malformation - may also get wasting and weakness of the arms, loss of reflexes, bilateral upgoing plantars and Horner's syndrome diagnosis - MRI management - neurosurgical evaluation for surgical decompression
41
motor neurone disease
presents with UMN and LMN signs presents before 40 y/o, fatal within 3 years of onset includes amyotrophic lateral sclerosis, progressive muscular atrophy and bulbar palsy features: fasciculations, absence of sensory signs and symptoms, mixture of UMN and LMN signs, wasting of the small hand muscles/ tibialis anterior is common, sphincter dysfunction is a late feature diagnosis is usually clinical but electromyography shows reduced number of action potentials with increased amplitude management; riluzole (increases survival by six months)
42
Brown-Sequard syndrome
ipsilateral loss of fine touch and vibration (DCML) contralateral loss of pain and temperature (spinothalamic) ipsilateral loss of motor function (corticospinal) is the result of a hemisection to the spinal cord - due to trauma, tumour MRI identifies cause classic presentation = one sided motor loss/ spastic hemiplegia with same side loss of fine touch and vibration, opposite sided pain and temperature loss
43
myasthenia gravis
an autoimmune disorder resulting in insufficient functioning of acetylcholine receptors features: muscle fatigability (improves with rest), extraocular muscle weakness - diplopia ix: single fibre electromyography, CT thorax to exclude thymoma, autoantibodies to acetylcholine receptors in 85-90% Rx: pyridostigmine (long acting anticholinesterase), prednisolone (immunosuppression) myasthenic crisis when respiratory muscles are affected --> plasmapheresis, IV immunoglobulins exacerbating factors: exertion, drugs (penicillamine, beta-blockers, quinidine, procainamide, lithium, phenytoin, gentamicin, macrolides, quinolones, tetracyclines patients are resistant to the GA suxamethonium
44
conductive hearing loss
causes: blocjed external auditory meatus, ruptured tympanic membrane, otitis media +/- effusion, otosclerosis bone > air in Rinnes localises to affected ear in Webers
45
sensorineural hearing loss
hair cell destruction due to noise or hair cell death due to ototoxic drugs (gentamycin or streptomycin) air > bone in Rinnes localises to normal ear
46
acoustic neuroma
(vestibular schwannoma) is a benign tumour that develops on the balance (vestibular) and hearing, or auditory (cochlear) nerves leading from your inner ear to the brain, as shown in the top image. The pressure on the nerve from the tumour may cause hearing loss and imbalance.
47
tension headache
recurrent non-disabling, bilateral, often described as a tight band not exacerbated by activities of daily living
48
cluster headache
pain occurs once or twice a day, every day for 4-12 weeks | intense pain around one eye may be accompanied with redness and swelling of that eye
49
temporal arteritis
typically presents >60y/o usually rapid onset (<1month) of unilateral headache with jaw claudication, tender palpable temporal artery and raised ESR may get amaurosis fugax
50
medication overuse headache
present for 15+ days per month | pts taking opioids and triptans are most at risk
51
migraines
recurrent, severe, usually throbbing, associated nausea, aura and photosensitivity, pts describe going to bed, may be associated with menstruation in women triggers "CHOCOLATE" chocolate, hangovers/dehydration, orgasms, cheese/caffeine, OCP, lie-ins/lights, alcohol, travel, exercise management: acute - (5-HT receptor agonist) oral triptan plus NSAID/paracetamol prophylaxis - (5-HT receptor antagonist) topiramate or propranolol (triptan if related to menstruation)
52
headache red flags
immunocompromised patient or history of malignancy vomiting without an obvious cause sudden onset, peaking within 5 minutes (SAH) orthostatic change in personality triggered by cough, sneeze, exercise
53
Guillain-Barre syndrome
immune mediated demyelination of the peripheral nervous system often trigged by infection (campylobacter jejuni) anti-GMI antibodies in 25% features: ascending paralysis - progressive weakness of all four limbs starting in the lower extremities, proximal before distal muscles
54
Parkinson's Disease
degeneration of dopaminergic neurones in the substantia nigra features: bradykinesia, hypokinesia, pill rolling tremor, cogwheel rigidity, micrographia, anosmia, REM sleep behaviour disorder, depression (if unilateral then likely to be multiple system atrophy) treatment of parkinsons: levodopa plus carbidopa, selegiline and amantadine us domperidone as an anti-emetic do not use haloperidol
55
dementia
a syndrome of progressive global decline in cognitive function - alzheimers disease - vascular dementia - lewy body dementia - frontotemporal dementia (Pick's disease) - Huntington's disease - (Creutzfeldt-Jakob disease)
56
Alzheimer's disease
risk factors: downs syndrome (due to increased APP gene), family history, hypothyroidism, previous head trauma signs and symptoms: amnesia, disorientation, personality changes, reduced self care, apraxia, agnosia, aphasia, lexical anomia, paranoid delusions, depression, wandering, aggression, sexual disinhibiton investigations: mental state exam, blood, ECG, CT, MRI histologically: "BAT" - beta amyloid plaques, acetylcholine reduced, tangles (neurofibrillary) treatment: memantine (inhibits glutamate by blocking NMDA receptors) donepezil (acetylcholinesterase inhibitors) rivastigmine (acetylcholinesterase inhibitors)
57
Vascular dementia
caused by infarcts in the small and medium vessels CVS risk factors follows a stepwise deteriorating progression 1) following stroke 2) multi-infarct following multiple strokes 3) binswanger disease following microvascular infarcts - amnesia, disorientation, personality changes, UMN signs, seizures, reduced self care, depression, issues with planning and concentrating investigation - vasculitis screen, cholesterol levels, ECG, CT/MRI head treatment - manage HTN, treat DM, aspirin, smoking cessation, statins
58
Lewy body dementia
avoid antipsychotics, is associated with Parkinson's features: parkinsonism, visual hallucinations, fluctuating course of disease investigations: alpha-synuclein cytoplasmic inclusions in substantia nigra, paralimbic and neocortical areas management: avoid antipsychotics levodopa (but may worsen symptoms), donepezil and rivastigmine
59
Huntington's dementia
(disease is the progressive degeneration of the indirect basal ganglia pathway - autosomal dominant) features: uncontrollable choreiform movements, depression, irritability, anxiety, psychosis, OC behaviour diagnostic genetic testing treatment - no cure but treat symptoms chorea (use and atypical antipsychotic) OC thoughts and irritability (use SSRIs)
60
Creutzfeldt-Jakob disease
caused by prions from infected meat rapidly progressive (4-5 months), no cure, is fatal EEG - triphasic spikes seen, LP 14-3-3 protein, CT/MRI

EOY3 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions