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MBChB 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

Define ‘Ischaemic Stroke’

A

An episode of neurological dysfunction
caused by focal cerebral, spinal, or retinal
infarction.

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2
Q

Definition of ‘intracerebral haemorrhage’

A

A focal collection of blood within the brain
parenchyma or ventricular system that is not caused
by trauma.

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3
Q

Definition of stroke caused by intracerebral haemorrhage.

A

Rapidly developing clinical signs of neurological
dysfunction attributable to a focal collection of blood
within the brain parenchyma or ventricular system that
is not caused by trauma.

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4
Q

Causes of intracranial bleed?

A

Small vessel disease, amyloid angiopathy, abnormalities in blood vessels. blood clotting deficiencies, haemorrhagic transformation of a infarct, tumours, drugs usage: cocaine, amphetamine.

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5
Q

Hyper-acute stroke treatment

A

1) IV Thrombolysis. Within 4.5 hours of symptom onset.
2) Thrombectomy
3) Admission toa stroke unit

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6
Q

What is an aneurysm?

A

A dilation of an artery. Happens in haemodynamic stress.

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7
Q

What are the predisposing factors for aneurysmal SAH?

A

Smoking, female sex, hypertension, positive fmaily history, ADPCK, Ehlers Danlos, Coarctation of aorta.

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8
Q

Factors that affect consciousness

A

Trauma, elevated ICP, fever, hypothermia, seizure, sepsis, medications, hypoxia, hypercapnia and more.

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9
Q

What is consciousness?

A

Reflects level of arousal (RAS) and presence of cognitive behaviour (cerebral hemispheres).

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10
Q

Most common cause of radial nerve palsy and symptoms?

A

Entrapment at spiral groove-‘Saturday night palsy’. Wrist and finger drop, usually painless.

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11
Q

Most common cause of ulnar nerve palsy and symptoms?

A

Entrapment at ulnar groove. May be history of trauma at elbow. Sensory disturbance and weakness. Usually painless.

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12
Q

Most common cause of median nerve palsy and symptoms?

A

Entrapment within carpal tunnel at wrist. History of intermittent nocturnal pain, numbness and tingling. weak grip”. Positive Tinel’s sign/ Phalen’s test.

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13
Q

Most common cause of median nerve- anterior interosseous branch- palsy and symptoms?

A

Trauma to forearm. History of forearm pain, “weak grip” of keys, unable to make okay sign.

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14
Q

Most common cause of femoral nerve palsy and symptoms?

A

Haemorrhage/trauma. Weakness of quadriceps, weakness of hip flexion, numbness in medial shin.

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15
Q

Most common cause of common peroneal nerve palsy and symptoms?

A

Entrapment at fibular head. Possible history of trauma, surgery or external compression. Acute onset foot drop and sensory disturbance. Usually painless.

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16
Q

What is mononeuritis multiplex?

A

Simultaneous or sequential development of damage to 2 or more separate nerves. Common causes: diabetes, vasculitis, rheumatological, infective, sarcoidosis, lymphoma.

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17
Q

What is a primary headache?

A

When the headache and it’s associated features is the disorder (no underlying cause) eg. migraine, tension-type headache, cluster headache.

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18
Q

What is a secondary headache?

A

The headache is secondary to an underlying cause. eg. Subarachnoid haemorrhage, space-occupying lesion, meningitis, temporal arteritis etc.

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19
Q

‘Red flag’ features of headaches

A

SNOOPT.
S- Systemic symptoms
N- Neurological symptoms or signs
O- Older age at onset
O- Onset is acute (under 5 minutes)
P- Previous headache history is different/absent
T- Triggered headache (valsalva or posture)

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20
Q

What is a ‘Medication overuse headache’ (MOH)?

A

Headache lasting over 15 days per month associated with frequent use of acute relief mediations eg. NSAIDs, paracetamol, opioid. Patients advised to take acute treatments no more than 2-3 times per week to prevent MOH.

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21
Q

What is a chronic migraine?

A

Headache on more than 15 days per month.

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22
Q

What is a ‘thunderclap headache?’

A

Abrupt-onset of severe headache which reaches maximal intensity <5 minutes (and lasts >1hr). Should be considered subarachnoid haemorrhage (SAH) until proven otherwise. “worst headache of my life” “like being hit over the head”.

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23
Q

What are the causes of a thunderclap headache?

A

Subarachnoid haemorrhage unless proven otherwise. Other causes: intracerebral haemorrhage, arterial dissection, cerebral venous sinus thrombosis, bacterial meningitis, spontaneous intracranial hypotension.

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24
Q

Lumbar puncture for subarachnoid haemorrhage?

A

Needs to be performed after at least 12 hours to look for the presence of xanthochromia- a blood breakdown product.

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25
Q

What is the normal intracranial pressure?

A

ICP normally 7-15mmHg.

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26
Q

Why is raised ICP a problem?

A

CPP=MAP-ICP. Global brain perfusion is reduced when ICP is elevated and cerebral metabolism is reduced.

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27
Q

What history findings make you think someone has a raised pressure headache?

A

Worse on lying flat, worse in the morning, persistent N&V, worse on valsalva (eg. coughing, laughing, straining), worse on physical exertion, transient visual obscurations with change in posture.

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28
Q

What will you find on examination in someone with a raised pressure headache?

A

Papillodema, impaired visual acuity/colour vision, restricted visual fields/blind spot, 3rd nerve palsy, VIth nerve palsy, focal neurological signs.

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29
Q

What are the causes of raised ICP?

A

Mass effect, increased venous pressure, obstruction to CSF flow/absorption, idiopathic.

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30
Q

What are the features of lower CSF pressure headaches?

A

Headache worse on sitting/standing up and relieved by lying over. Results from CSF leakage, loss of CSF volume causes traction on meninges, cerebral/cerebellar veins and CN V, IX and X.

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31
Q

What are the causes of low CSF pressure headaches?

A

Post lumbar puncture- affects up for 1/3 cases, 90% develop with 3 days, most resolve spontaneously. Spontaneous intracranial haemorrhage- results from spontaneous dural tear.

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32
Q

What is Multiple Sclerosis?

A

Idiopathic inflammatory demyelinating disease of the CNS. Acute episodes of inflammation are associated with focal neurological deficits.

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33
Q

What are the 4 subtypes of MS?

A
  • Relapsing remitting MS
  • Primary progressive MS
  • Secondary progressive MS
  • Benign MS
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34
Q

What syndromes can develop into MS?

A
  • Optic neuritis
  • Clinically isolated syndromes
  • Transverse myelitis
  • Radiologically isolated syndromes
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35
Q

What is optic neuritis?

A

Painful visual loss that comes on over a few days. 30% develop MS by 5 years, 50% develop MS by 15 years.

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36
Q

What is transverse myelitis?

A

Inflammation of the spinal cord that leads to weakness and sensory loss. Incontinence can be the only symptom. Many other causes than MS.

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37
Q

What is a clinically isolated syndrome?

A

A single episode of neurological disability due to focal CNS inflammation.

38
Q

What is the diagnostic criteria for MS?

A

When there is evidence of 2 or more episodes of demyelination disseminated in space and time.

39
Q

What is dysarthria?

A

Difficult or unclear articulation of speech that is otherwise linguistically normal.

40
Q

What is a radiologically isolated syndrome?

A

MRI scan performed in patients who do not have signs or symptoms of MS but there is an incidental finding that looks like MS. May or may not develop MS- can cause unnecessary distress for the patient.

41
Q

How do you investigate suspected MS?

A

MRI brain and cervical spine with gadolinium contrast. Can also do LP, bloods (to exclude other conditions), visual evoked potentials, CXR (to exclude sarcoidosis).

42
Q

How do you show ‘dissemination in space’ on an MRI?

A

If you see evidence of demyelination in 2 regions eg. periventricular and spinal cord.

43
Q

How do you show ‘dissemination in time’ on an MRI?

A

If there are enhancing and non-enhancing areas of demyelination this can indicate dissemination in time.

44
Q

What are oligoclonal bands and what do they suggest?

A

Immunoglobulin bands seen in blood and spinal fluid after protein electrophoresis. Presence of bands in CSF but not blood suggests immunoglobulin production in CNS. Supports diagnosis of MS but can be seen in other conditions.

45
Q

What blood tests do you do in suspected MS?

A

Blood tests are done to rule out other causes. B12/folate, serum ACE, lyme serology, ESR/CRP, ANA/ANCA/RF

46
Q

What is visual evoked potentials?

A

Measure conduction of nerve signals in optic nerve to look for subclinical optic neuritis. Conduction will be slower if a patient has had optic neuritis in the past.

47
Q

In MS, what is a ‘relapse’?

A

Usually involves a new neurological deficit that lasts for more than 24 hours in the absence of pyrexia or infection.

48
Q

In MS, what is a ‘pseudo-relapse’?

A

The reemergence of previous neurological symptoms or signs related to an old area of demyelination in the context of heat or infection.

49
Q

What is primary progressive MS?

A

At least 1 year of disease progression. MRI scan supports diagnosis of MS. Oligoclonal bands support diagnosis of MS.

50
Q

What is secondary progressive MS?

A

Relapsing remitting MS but not progressive disease without relapse or inflammation on scan.

51
Q

Predisposing factors to aneurysmal SAH

A

Smoking, female sex, hypertension, positive family history, autosomal dominant polycystic kidney disease, Ehlers Danlos, coarctation of the aorta.

52
Q

What are the complications of SAH?

A

Rehaemorrhage, delayed iscahemia, hydrocephalus, hyponatreamia, ECG changes, Tako-tsubo cardiomyopathy,

53
Q

What is the Fisher Scale?

A

Classifies the amount of subarachnoid haemorrhage on CT scans and is useful in predicting the occurence and severity of cerebral vasospasm.

54
Q

Where do aneurysms form?

A

At areas of haemodynamic stress.

55
Q

What percentage of SAH are caused by aneurysms?

A

80-85%. Other causes of SAH include arteriovenous malformations and neoplasia.

56
Q

What are you looking for in a lumbar puncture for suspected SAH?

A

Must wait 12 hours. Look for xanthochromia.

57
Q

What percentage of SAH patients will have a rehaemorrhage within 72 hours of the first?

A

5-10%.

58
Q

Delayed ischaemia in SAH

A

Day 3-10 after SAH. Angiographic spasm. Keep them hydrated and on nimodipine.

59
Q

What is ‘Cerebral salt wasting?”

A

Cerebral salt wasting (CSW) is another potential cause of hyponatremia in those with CNS disease, particularly patients with subarachnoid hemorrhage. CSW is characterized by hyponatremia and extracellular fluid depletion due to inappropriate sodium wasting in the urine.

60
Q

What 2 conditions can lead to hyponatraemia in SAH?

A

1) Cerebral salt wasting

2) Syndrome of inappropriate ADH secretion.

61
Q

Cardiovascular complications of SAH?

A

Sympathetic stimulation and cathecolamine release can lead to myocardial injury “stunned myocardium”. Elevation of troponin I can occur in 35%.

62
Q

What is a stroke?

A

CNS infarction (which includes brain, spinal cord and retinal cells attributable to ischaemia) based on objective evidence of focal ischaemic injury in a defined vascular distribution or clinical evidence of the former with other aetiologies excluded.

63
Q

What does a stroke in the middle cerebral artery cause?

A

Face and arm weakness.

64
Q

What are potential causes of ischaemic stroke?

A

Ischaemic stroke accounts for 88% of strokes.

  • Atherosclerotic cerebrovascular disease
  • Small vessel disease
  • Cardiac embolism
  • Cryptogenic
65
Q

TACS

A

Total Anterior Circulation Syndrome (TACS).Hemiparesis + Higher cortical dysfunction + hemianopia.

66
Q

PACS

A

Partial Anterior Circulation Syndrome (PACS).Isolated higher cortical dysfunction OR
Any 2 of hemiparesis, higher cortical dysfunction, hemianopia.

67
Q

POCS

A

Posterior Circulation Syndrome.Isolated hemianopia OR

Brainstem syndrome.

68
Q

LACS

A

Lacunar Syndrome.Pure motor stroke OR pure sensory stroke OR sensorimotor stroke OR
ataxic hemiparesis OR clumsy hand-dysarthria.

69
Q

What are the 4 types of ischaemic stroke?

A

1) Total anterior circulation syndrome (TACS)
2) Partial anterior circulation syndrome (PACS)
3) Posterior circulation syndrome (POCS)
4) Lacunar syndrome (LACS)

70
Q

TACS is normally caused by?

A

Usually proximal middle cerebral artery or internal carotid artery occlusion.

71
Q

PACS is normally caused by?

A

Usually branch middle cerebral artery occlusion.

72
Q

POCS is normally caused by?

A

Can include perforating arteries, posterior cerebral artery or cerebellar arteries.

73
Q

LACS is normally caused by?

A

Perforating artery/small vessel disease.

74
Q

Common secondary prevention for stroke?

A

Stop smoking, anti-platelets- clopidogrel or aspirin. If AF need anti-coagulants- warfarin or NOACs. BP and cholesterol needs to be managed.

75
Q

What are the functions of the PNS?

A

Sensory input to the CNS, motor output to muscles, innervation of viscera.

76
Q

What are collections of nerve cell bodies in the PNS known as?

A

Ganglia.

77
Q

What is Guillain-Barre syndrome?

A

Acute inflammatory demyelinating neuropathy.

78
Q

What are the symptoms of proximal limb weakness?

A

Difficulty raising arms above head and arising from a seated position.

79
Q

What are the symptoms of facial weakness?

A

Characteristic myopathic facies, drooling.

80
Q

What is myopathic facies?

A

A facial appearance characteristic of myopathic conditions. The face appears expressionless with sunken cheeks, bilateral ptosis, and inability to elevate the corners of the mouth, due to muscle weakness.

81
Q

What are the symptoms of eye muscle disease?

A

Ptosis, ophthalmoplegia.

82
Q

What are the symptoms of bulbar (cerebellum, pons, medulla) weakness?

A

Dysarthria, dysphagia.

83
Q

What are the symptoms of neck and spine weakness?

A

Head drop, scoliosis.

84
Q

What are the symptoms of respiratory weakness?

A

Breathlessness (especially on lying flat).

85
Q

What are the symptoms of myocardial weakness?

A

Exercise intolerance, palpitations.

86
Q

What are some of the causes of muscle disease?

A

Muscular dystrophies, metabolic muscle disorders, mitochondrial disorders, myotonic dystrophies, inflammatory muscle disorders, NMJ disorders.

87
Q

What is myasthenia gravis?

A

An autoimmune disorder with antibodies to the ACh receptor at the post-synaptic NMJ. Leads to fatiguable weakness of ocular, bulbar, neck, respiratory and/or limb muscles.

88
Q

How do you manage myasthenia gravis?

A

With pyridostigmine (anti-acetylcholine esterase) and immunosuppressive therapies eg. steroids and IV immunoglobulin.

89
Q

Why do you do cognitive assessment?

A

To assess the severity and pattern of impairment.

90
Q

What is Gower’s sign?

A

Unusual pattern of arising from floor- seen in Duchenne’s. It indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to “walk” up their own body from a squatting position due to lack of hip and thigh muscle strength.

MBChB 3 (13 decks)

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