Neurology Flashcards
What is a hemi-Parkinsonian gait?
Parkinsonian gait with reduced arm swing on 1 side
What gait is most commonly seen in stroke? Describe it.
Hemiplegic gait: 1 leg is stiffly extended and swung to avoid toe catching
In what condition would you expect a high-stepping gait?
Peripheral neuropathy - tabes dorsalis
How might you test for impaired proprioception?
Romberg’s test
Describe Romberg’s test and what a positive result looks like
Stand with feet together and eyes closed. Swaying or falling indicates a positive Romberg’s.
What are the 2 most common causes of “black outs”?
Seizures and Syncope
Describe the typical history of syncope
Prodrome: feeling light headed before <30 seconds unconscious Quick recovery Urine incontinence No tongue biting
What are the brains excitatory and inhibitory neurotransmitters?
Glutamate and GABA
How do you treat status epilepticus?
Benzodiazipines
How do benzodiazepines work to treat status epilepticus?
Enhance GABA
How long until a seizure becomes status epilepticus?
> 5 minutes
First line treatment of focal epilepsy?
CARBAMAZEPINE
First line treatment of generalised epilepsy?
VALPROATE
Which 2 areas of the brain are responsible for consciousness?
Cortes and Reticular Activating System of the brain stem
What is an infratentorial lesion? What may cause it?
Lesion below the tentorium cerebelli - tumour
How may a supratentorial lesion cause coma/brain death?
Increased pressure causes herniation
Give examples of supratentorial lesions which may cause herniation
subarachnoid haemorrhage, subdural haematoma, extradural haematoma
What are the most common causes of coma?
Drug overdose and head trauma
Supportive management of coma?
ABC, DVT prophylaxis, NG tube, Catheter
What may cause coma with neck stiffness?
Subarachnoid Haemorrhage and Meningitis
What do focal neurological signs suggest in a comatose patient? What would you use to treat the problem?
Herniation
Drugs to reduce intracranial pressure: Mannitol and dexamethasone
What are the most common causes of coma without neck stiffness, focal signs or fever?
Drug overdose and hypoglycaemia
What are the 3 diagnostic criteria for brain death?
- Irreversible cause
- Unresponsive patient with no function
- Brain stem death
Describe the Doll’s Head Eye Maneuver.
Open eyes and move head: if the eyes watch the ceiling the brain stem is intact, POSITIVE result
If the eyes are fixed in the head, brain stem is not intact - NEGATIVE result
What is Amaurosis Fugax?
Sudden visual loss caused by an occlusion of the retinal artery
What causes painful visual loss?
Optic Neuritis
How might Multiple Sclerosis first present?
With optic neuritis- painful visual loss, loss of colour vision
What pattern of visual loss is present in giant cell arteritis?
“Altitudinal” field defect- patient feels as if they are looking over a wall
What symptoms would be present in a lesion of the optic nerve? (4)
- loss of colour vision
- loss of visual acuity
- loss of pupillary reflexes
cenrtal scotoma
What visual defect would you get in a parietal lobe lesion?
Avoidance of half of the visual field on the contralateral side e.g. drawing half a clock with all the numbers on the right hand side
What is agnosia?
Not being able to recognise things by sight
Describe the pattern of weakness in an Upper Motor Neurone Lesion.
Strong flexors in the arm and weak extensors, the opposite pattern in the legs
What would cause proximal weakness and opthalmoplegia?
Myasthenia Gravis
What is the most common cause of peripheral neuropathy?
Diabetes
What is the treatment for Guilian Barre?
IV Immunoglobulins
What is the treatment for Myasthenia Gravis?
Acetylcholine esterase inhibitors e.g. donezepil
A patient presents with ataxia, headache and confusion - her symptoms are progressive… What could be causing these symptoms?
Raised intracranial Pressure
What drug is used to reduce cerebral oedema?
Mannitol
What eye signs might you see in raised ICP?
Tramps palsy (CN III) 6th nerve palsy
If someone has CSF leakage through the nose and a headache which is worse on standing what is wrong?
Reduced intracranial pressure
What are the symptoms of foramen magnum herniation?
neck pain
erratic breathing
tetraparesis
What is the most common cause of stroke?
Ischaemia (80% of strokes are ischaemic, 20% are haemorrhagic)
What is the treatment for ischaemic stroke?
Thrombolysis
When should you treat an ischaemic stroke with thrombolysis?
Within 4.5 hours
What drug is used for thrombolysis?
Alteplase, tissue plasminogen activator
Name 2 acute and 2 long term treatments of migraine?
Acute - NSAIDs, triptans
Chronic - beta blockers, amitriptyline
What is the management of a cluster headache?
Oxygen
Sumatriptan
What should you do if you suspect trigeminal neuralgia?
MRI head
Treatment of trigeminal neuralgia?
Carbamazepine, microvascular decompression
What would the blooods of someone with giant cell arteritis look like?
raised CRP, Platelets and Alk Phos
What is the management for giant cell arteritis?
60mg Prednisolone
What should you prescribe alongside steroids and why?
Bisphosphonates and PPI to protect stomach lining and bone density
15% of strokes are….
haemorrhagic
85% of strokes are…
ischaemic
How long do TIA symptoms last?
<24 hours
What is the risk stratifying score for TIA?
ABCD2: Age >60 = 1 Blood pressure > 140/90 = 1 Clinical Features: weakness = 2, speech disturbance = 1 Duration >60 mins = 2, <60 mins = 1 Diabetes = 1
If your ABCD2 score is high risk what needs to happen? And if medium/low risk?
Specialist assessment within 24 hours, all TIAs assessed within 7 days
What is the medical treatment for TIA?
75mg clopidogrel
Surgical treatment for TIA?
Carotid endarterectomy if >70% occulsion
Which arteries are occluded in Total Anterior CIrculation Infarcts? (TACIs)
Anterior and middle cerebral artery
What is the presentation of a TACI involving the middle and anterior cerebral artery?
unilateral hemiparesis and hemisensory loss
homonymous hemianopia
dysphasia
dysarthria
Waht artery is occluded in posterior circulation infarcts?
Vestibulobasilar arteries
What is the presentation of an occulsion in the posterior circulation (vetibulobasilar arteries)
cerebellar syndromes
LOC
homonymous hemianopia
What is a lacunar infarct?
Infarct of the perforating arteries supplying the internal capsule and basal ganglia
How do lacunar infarcts present?
ataxic hemiparesis
Name the stroke: ipsilateral III nerve palsy, contralateral weakness of arm and leg?
Weber’s syndrome: branches of the posterir cerebral artery that supply the midbrain
Name the stroke: locked in syndrome
Basilar artery
Name the stroke: contralateral paralysis and weakness, usually the leg
Anterior cerebral artery
Name the stroke: contralateral paralysis and weakness, usually the arm + aphasia
Middle cerebral artery
Name the stroke: contralateral homonymous hemianopia with macular sparing
posterior cerebral artery
Acute management of ischaemic stroke?
300mg aspirin
thrombolysis with alteplase IF within 4.5 hours of stroke
After a head injury someone has a lucid interval… what type of brain bleed do they have?
Extra dural haemorrhage
What is the treamtent for an extra dural haemorrhage?
Burr hole
Who gets sub-dural haemorrhages and why?
Elderly people and other people who fall e.g epileptics and alcoholics
Someone who has fallen over presents with Fluctuating consciousness, insidious intellectual slowing, personality change, sleepiness, headache, unsteadiness - what’s the bleed?
Subdural haemorrhage
What do berry aneurysms and arterio-venous malformations increase your risk of?
Sub-arachnoid haemorrhage
Name 3 conditions associated with subarachnoid haemorrhage.
Ehlers Danlos, COarction of Aorta, PKD
What gives a thunderclap headache?
Subarachnoid haemorrhage
What is the treatment for subarachnoid haemorrhage?
calcium channel blocker e.g. nimodipine OR surgical clipping
A seizure with brief, rapid muscle jerks is?
Myoclonic
What is anoher word for an “atonic” seizure?
Drop-attack
What is the treatment for generalised seizures?
Sodium valproate
What is the treatment for partial/focal seizures?
Carbamazepine
What drug is contraindicated in absence seizures? What is the drug treatment?
Carbamazepine makes it worse, sodium valproate is used
Pathophysiology of MS?
T - Cell mediated immune response causing demyelinated plaques in the CNS
What is optic neuritis and what condition is it seen in classically?
Unilateral eye pain on movement and loss of central vision, multiple sclerosis
What would you give to shorten an acute relapse of MS?
Methylprednisolone
Which drug reduces relapses in MS?
Beta-interferon
What is the histological finding of Parkinson’s disease?
Lewy bodies
Name a dopamine receptor agonist. What does it treat?
Bromocriptine, Parkinson’s
Where is the Huntingtin gene?
Chromosome 4
What is diseased in Huntingdon’s?
cholinergic and GABA neurons in striatum of basal ganglia
Personality change and lack of co-ordination are the first features to develop in….?
Huntingdon’s
What drug can be used to treat chorea symptoms?
Tetrabenazine, dopamine antagonist
What muscles are always spared in motor neuron disease?
Eye muscles!
Which infections classically precede Guillian-Barre?
campylobacter, EBV
What is the treatment for Guillian-Barre?
IV Immunoglobulin
What do the antibodies attack in Myasthenia Gravis?
Post synaptic acetylcholine receptors
What is the treatment for Myasthenia Gravis?
Acetycholine esterase inhibitors e.g. pyridostigmine
Name an acetylchlineesterase inhibitor used in alzheimer’s treatment?
Rivastigmine
What would indicate a haemorrhagic stroke?
meningism, severe headache, coma, drowsiness, reduced GCS, vomiting, focal deficit.
What do you get if a berry aneurysm ruptures?
Subarachnoid haemorrhage
What do you get if you rupture the bridging vein?
Subdural haemorrhage
What are the risk factors for subdural haemorrhage?
Age, alcohol and anti coagulatns
What do you get if you hit your head and tear your middle meningeal artery?
Extra dural haemorrhage
When would you see a latent phase?
Extra dural haemorrhage
What is Brudzinski’s sign?
Positive for meningitis: flexion of the neck causes knee flexion