Neurology Flashcards
Which muscles are affected in radial palsy?
Extensor Carpi Radialis Longus
Externsor Digit communis
Brachioradialis
Which muscles are affected in ulnar palsy?
Abductor Digit Minimi
Adductor Pollicis
Flexror Carpi Ulnaris
1st Dorsal Interreous
What muscles are affected in median nerve palsy?
Lumbricals - I and II
Opponens pollicis
Abductor pollicis
Flexor Pollicis Brevis
What muscles are affected in anterior interossei branch of the median nerve?
Pronator quadratus
Flexor Pollicis longus
Flexor digitorum Profundus
List come causes of mononeuritis multiplex:
Diabetes
Vasculitis
INfective
Sarcoidosis
What is the pathology of Guillain Barre Syndrome? and what are some symptoms?
How is it treated?
Break-down in self tolerance due to post infection
- campylobacter
- EBV
Symptoms:
Progressive ascending motor weakness
flaccid paralysis
Loss of reflexes
delayed impulses on EMG
Treatment:
- immunoglobulins
- ventilation
What is Mysthenia Gravis? what is it related too - and list some symptoms?
Autoimmune condition where antibodies target acetylocholine receptor at post synpatic junction
associated with:
- thymic hyperplasia
- thyoma
Symptoms:
- fluctuating weakness
- ptosis
- diplopia
- dysphasia
How is Myasthenia Gravis treated?
Pyridostigamine
Steroids
Immunoglobulins
What are the types of stroke?
Thrombotic stroke
- atheroscleerotic plaque
embolic stroke
Lucunar stroke
Hemorrhagic
In order to have a Total Anterior circulatory stroke, what symptoms must one have?
What arteries are involved?
anterior and middle cerebral:
Contra- lateral hemiparesis
Contra - lateral homonymous heminopia
HIgher cererbral dysfunction
- dysphasia
- visual spatial disorder
- contralateral hemisensory
**all 3 of these things must be present
In order to have a partial anterior circulatory stroke, what symptoms must be present?
What arteries are involved?
Middle cerebral:
Contra- lateral hemiparesis
Contra - lateral homonymous heminopia
HIgher cererbral dysfunction
- dysphasia
- visual spatial disorder
- contralateral hemisensory
At least 2/3 out of these
or
Higher dysfunction
- dysphagia etc.
In order to have a Lucunar Syndrome stroke, What symptoms must be present?
What arteries are involved?
Small perforating arteries?
- pure sensory
- pure motor
- sensori motor stroke
- Ataxia hemiparesis
In order to have Posterior Circulating Syndrome stoke what symptoms must be present?
What arteries are involved?
Posterior cerebral artery
perforating cerebral artereis
cerebellar arteries
- cranial nerve palsies
- eye movement disorder
- pupil disorders
- cerebellar dysfunction
- vertigo
- nystagmus
- ataxia
What is the tissue around the area of ischemia, which can potentially be saved called?
Penumbra tissue
On arrival at hospital for a stroke, what things much be checked/ done immediately?
- take full history
- ABCD assessment
- Medical history
- checking for bleeding disorders
*blood glucose
- ECG
- AF
- IV access
- NIL by mouth
- Imagingin
What is the immediate treatment for an ischemic stroke?
*admission to stroke unit
- Alteplase
- <4.5 hours
*Aspirin
(thromboectomy if available)
What is secondary treatment of an ischemic stroke?
- 24 hour CT scan
- Aspirin 300mg for 14 days or till discharge
then:
Clopidogrel
or
Dipyridamole + Aspirin
+
Simvastatin
+
Anti- hypertensives
- *retraining
- physio
- speech therapy
- smoking
What type of hypersensitivity is MS?
Type IV
List some causes thought to be responsible for MS
HLA DR2
Environmental
Infections
- EBV
- HHV-6
Lack of Vit D
List the types of MS:
Relapsing Remitting
- 70% like this
Secondary Progressive
Primary Progressive
Progressive relapsing
List some common features of MS:
Optic Neuritis
Parasthesia
Weakness
Clumsiness
Hearing dysfunction
What is it called when symptoms of MS are made worse when the patient is hot?
UHthoff’s Phenomenon
What investigations are done in suspicion of MS?
MRI T2 weight
- Gadolinium contrast
Lumbar puncture
- Oligoclonal IgG Bands
Outwith imaging, what other investigations should be done for MS?
FBC
ESR
B12
ANCA
ANA
- exclude inflammatory conditions
Visual Evoked serology
- subclinical neuritis
Chest x-ray
- sarcoidosis
To diagnose MS, what criteria must there be?
> 2 attacks of demyelination dissemination within space and time.
What is a pseudo-replase in MS?
Reemergence of of a previous symptom in the presence of an infection or increased heat.
What is first line treatment for MS? with brief explanations of how they work?
Steroids for flare ups.
- methylprednisolone
Interferon Beta
- infectable
Glatiramer
- immune modulator
Dimethyl Fumarate
- reduces lymphocyte count
Teriflunomide
- supresses immune system
What is second line treatment?
Fingolimond
Natalizumab
What is the 3rd line treatment for MS?
Alemtuzumab
How do you stain for cryptococcus meningitis?
Indian Stain
What are some common syndromes that may develop into MS?
Optic neuritis
- 50% develop into MS within 15 years
Transverse myelitis
- inflammation of spinal cord
often present as incontinence in young people
Clinically isolated syndromes
Radiological isolated syndromes
- presents as MS on radiographic findings - usually incientenal
What is a seizure?
Episode of neuronal hyperactivity within the brain, either localised or generalised.
What is it called when there is a seizure, leading to jerking movements over one side of the body, and the patient remains conscious?
Simple focal Seizure
Following a complex focal seizure what a person may be confused and have a set of syndromes following after about 2 minutes, what are these?
Speech arrest
Automatism
- lip smacking
- dystonic limb posturing
What is it called when a person has both hemispheres involved during a seizure which results in loss of consciousness?
Generalised Seizures
What are the subtypes of a generalised seizure?
Typical absence seizure
- often associated with masses in the brain
Generalised tonic clonic seizures / bi -lateral convulsive
- tonic - stiffening
- clonic - rapid relaxing and tensing
Myoclonic
- sudden jerks
Tonic seizures
- whole body contrats
Atonic seizure
What is it called when a seizure lasts for >5 mins/ >30mins (depending on definition) or does not return to normal between 2 seperate seizures?
Status Epilepticus
an medical emergency where there is cardiovascular risk along with metabolic changes that can occur in the brain
recognised mortality due to these changes
Name some things that can occur following a seizure:
Confusion and fatigue
Postictal confusion
Todd’s paralysis
- temporary suppression
What investigations are done following a seizure?
Clinical history
- eye witness really important, since patient loses consciousness
MRI
- establish if any structural problem
EEG
- hour long test
- with photo-stimulation
Bloods
- Ca2+ levels
Glucose level
- hypoglycemia can mask
ECG
- QT interval
when someone arrives in A&E following a seizure, what are the differentials and what can help you establish the cause?
Syncope
witnesses
how quickly they come round
how the felt prior to onset
What is the definition of Epilepsy?
At least two unprovoked episodes of a seizure
tendency towards seizures.
*must be unprovoked
Whats the life time risk of a seizure?
5-10%
What is a focal seizure?
Area discharge from a irritated part of brain, from an other wise normal brain
What is a bilateral convulsive seizure?
Generalised tonic clonic
What immediate treatment of someone having a seizure?
Recovery position
ABCD
if no ABCs abnormalities then no need for hospitalisation
What are some features of a focal epilepsy?
History of trauma
Aura
Post attack confusion
Automatisms
nocturnal events
What are some features of Generalised seizure?
Photosensitivity
age of onset - young
lack of aura
Myoclonus - especially in morning
seizures in the morning
family history
EEG abnormalities
What things do you get the patient to do during an EEG?
lie at rest
hyperventilate
Relax and make drowsy
Photic stimulation
What is the treatment for focal epilepsy?
Lamotrigrine
Carbamazepine
Levetiractem
What is the treatment for generalised?
Valproate
Levetriactem
Lamotrigrine
What are the symptoms of optic neuritis?
Fogging of vision
Painful eye movement
Central vision loss
Colour desaturation
Dense central scotoma
What are the clinical findings of optic neuritis?
RAPD
optic disc pallor
red colour destruction
What are some common symptoms of Intracerebral TB?
Progresses over weeks
Palsy of cranials:
- 3
- 4
- 6
- 9
What brain disease does JC virus cause?
Multifocal Leuco - encephephalopathy
How is cryptococcal meningitis treated?
Amphotericin B
Fluconazole
ICP shunt
What is a complication with cryptococcal meningitis patients who have HIV?
Paradoxical worsening with anti- retroviral medication
What nerve palsy is usually first seen in high intra-cranial pressure?
6th nerve
Which nerve palsy will present with a head tilting away?
Trocheal, 4th nerve.
List some symptoms outwith motor, which occur in parkinson’s:
Dementia
Depression
anxiety
REM sleep behaviour disorder
restless legs
Constipation
urinary urgency
What investigations are done into parkinson’s?
Bloods
- thyroid
- copper levels
MRI
- for vascular changes
Functional imaging
- DAT - SPECT
allows the dopaminergic neurons to be seen
What drug is given to stop status epilepticus?
Lorazepam?
What are the stages of parkinson’s?
Step 1-2:
Medulla/ Pons and Olfactory nucleus
pre-symptomatic stage. Loss of sense of smell
Step 3-4:
Midbrain/ substantia nigra
symptoms of movement
Step 5-6:
Neocortex involvement
- Parkinson’s associated dementia
