Neurology Flashcards
What are the clinical features of internal capsule and corticospinal tract lesions?
UMN signs
Contralateral hemiparesis and sensory loss
What are the clinical features of spinal cord lesions?
LMN signs at the level of the lesion
UMN signs below the lesion
Sensory level
What do the internal carotid arteries supply?
Anterior 2/3 cerebral hemisphere
Basal ganglia
What do the anterior cerebral arteries supply?
Front and middle cerebrum
Occlusion - contralateral leg weakness
What do the middle cerebral arteries supply?
Lateral part of hemisphere
Occlusion - contralateral hemiparesis and sensory loss
Dominant - homonymous hemianopia
Non-dominant - visuospatial disturbance
What do the posterior cerebral arteries supply?
Occipital lobe
Occlusion - contralateral homonymous hemianopia
What are the red flags for headache?
Papilloedema, visual field loss
6th nerve palsy, tender temples
Focal neurology
Purpuric rash
What are the treatments for migraine?
- Triptan + NSAID + paracetamol, anti-emetic
2. Prophylactic topiramate propranolol
What are the treatments for cluster headaches?
O2 therapy + nasal triptan
Prophylactic verapamil
What are some contraindications to triptans?
IHD, TIA, CVA
What are the criteria for prophylactic migraine treatment?
1 of: Quality of life severely affected More than 2 attacks per month Does not respond to acute drugs Frequent/long/uncomfortable auras
What are the clinical features of extradural haematomas?
Arterial bleed - often middle meningeal artery
Lucid interval after initial event
Crescent shaped opacity on scan
What are the clinical features of subdural haematomas?
Venous bleed - can occur after trivial injury
Increased risk in elderly and alcoholics
Fluctuating levels of consciousness
What are the clinical features of trigeminal neuralgia?
Paroxysms of stabbing pain in trigeminal distribution
Washing, shaving, eating, talking
MRI to exclude secondary cause
What are the clinical features of a subarachnoid haemorrhage?
Thunderclap headache
Vomiting, collapse, seizures
Usually due to rupture of berry aneurysm
Urgent CT, if negative do LP
What are the features of temporal lobe seizures?
Automatisms - lip smaking/fiddling Dysphagia Deja-vu Emotional disturbance Hallucinations
What are the features of frontal seizures?
Motor features e.g. posturing
Post-ictal Todd’s palsy
What is the treatment for absence seizures?
Sodium valproate
Ethosuximide
What is the treatment for tonic-clonic seizures?
Sodium valproate
Lamotrigine
What is the treatment for myoclonic seizures?
Sodium valproate
Levetriacetam
What are the clinical features and treatment of Bell’s palsy?
Abrupt onset, complete unilateral facial palsy
Prednisolone in within 72 hours onset
Artificial tears, tape eye closed at night
What are the clinical features and treatment of Ramsay Hunt syndrome?
Shingles of the geniculate ganglion of the facial nerve
Painful vesicular rash on auditory canal and eardrum
Ipsilateral facial palsy, loss of taste, tinnitus, dry eyes and mouth
Aciclovir and prednisolone
What are the clinical features of carpal tunnel syndrome?
Compression of median nerve
Aching pain in arm and hand
Paraesthesiae in thumb, index and middle finger
Wasting of thenar eminence
What are the clinical features of a radial nerve palsy?
Compression against mid-shaft of humerus
Wrist drop and finger drop
What are the features of an ulnar nerve palsy?
Vulnerable to elbow trauma
Hypothenar wasting
Weak 5th digit abduction
What are the features of a CPN palsy?
Prolonged knee flexion - winds round fibular head
Footdrop
Weak dorsiflexion and eversion
Sensory loss over dorsum
What are the features of a sciatic nerve palsy?
Damaged by pelvic and femoral fractures
Footdrop
Reduced sensation below knee laterally
What are the features of a tibial nerve palsy?
Inability to stand on tiptoes
Cannot invert foot or flex toes
Sensory loss over sole of foot
What are some causes of polyneuropathies?
Vascular - RA, GPA Infective - HIV, syphilis, lyme Metabolic - DM, renal failure, hypothyroidism Inflammatory - GBS, sarcoidosis Nutrition - B12, folate, B1 deficiency Drugs - cisplatin, phenytoin, isoniazid
How does Guillain-barre present?
Acute motor demyelinating neuropathy
Follows d+v (campylobacter)
Symmetrical ascending muscle weakness
Autonomic dysfunction - sweating, tachycardia, arrhythmias
What tests should be done for GBS?
LP - cytoalbuminologic dissociation
Nerve conduction
FVC 4 hourly - if <1.5L call ICU
What is the treatment of GBS?
IV immunoglobulins - 0.4g/kg/24hrs for 5 days
What causes myasthenia gravis?
Antibodies to nicotinic acetylcholine receptors
Check anti-ACLR antibodies
Can be due to thyoma - do CT
What is the treatment of myasthenia gravis?
Anticholinesterase e.g. pyridostigmine
Prednisolone
Thymectomy
What are the features of motor neurone disease?
Neurodegenerative diseases - selective loss of neurons in motor cortex, cranial nerve nuclei and anterior horn cells
Gives a mixture of UMN and LMN signs
Does not affect eye movements or sphincters
What are the signs of motor neurone disease?
Under 40, stumbling spastic gait, foot drop, proximal myopathy, weak grip, aspiration pneumonia
What are the fours types of motor neurone disease?
- Amyotrophic lateral sclerosis
- Progressive bulbar palsy
- Progressive muscular atrophy
- Primary lateral sclerosis
What are myopathies?
Primary disorders of muscle with gradual onset symmetrical weakness
Preserved reflexes, no fasisculations
What tests should be done for myopathy?
ESR, CK, AST and LDH
EMG, muscle biopsy
Genetic testing
What are the features of Duchenne muscular dystrophy?
Under 4 Clumsy walking, difficulty standing, respiratory failure x-linked recessive Gower's sign Increased CK
What are the features of Becker muscular dystrophy?
Milder symptoms
Later age
What are the inflammatory myopathies?
Polymyositis and dermatomyositis
Spontaneous pain at rest
Local tenderness on palpation
What is multiple sclerosis?
Inflammatory plaques of demyelination in the CNS disseminated in time and space
How can MS present?
Optic neuritis
Gait ataxia
UMN signs and sensory disturbance
Cerebellar signs
What tests should be done for suspected MS?
B12, CRP, ESR
HIV, syphilis, hep b and c
MR spine and brain
CSF - oligoclonal bands of IgG
How are relapses of MS treated?
Check for infection
High dose methylprednisolone
How are symptoms in MS treated?
Fatigue - TFTs, FBC, vit D, sleep hygiene, amantadine
Gait - physiology, fampridine
Sensory - gabapentin
Spasticity - physiology, baclofen
What are some stroke mimics?
Hypo/hyperglycaemia
Subdural haemorrhage
Hemiplegic migraine
Post-ictal
What are the criteria for TACS?
- Unilateral weakness of face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction
What are the criteria for POCS?
1 of:
- Cerebellar or brainstem syndrome
- LOC
- Homonymous hemianopia
What are the criteria for LACS?
1 of:
- Unilateral face, arm and leg weakness
- Pure sensory stroke
- Ataxic hemiparesis
What is the acute management of stroke?
- ABCDE - glucose and MRI
- CT/MR head within 1 hour
- NIHSS
- Aspirin 300mg
- Thrombolysis if within 4.5 hours
- Consider thrombectomy
- Admit to stroke unit
What tests should be done following a TIA?
FBC, ESR, UEs, glucose, lipids
ECG, echo, carotid doppler
What predicts prognosis following a TIA?
Age over 60
Bp over 140/90
Clinical features - unilateral = 2, speech disturbance = 1
Duration - over 1 hour = 2, 10-59mins = 1
Diabetes
Over 4 - specialist review within 24 hours
What are the side effects of levodopa?
Dyskinesia, dystonia
Hallucinations
Nausea and vomiting
What are ropinorole and pramipexole?
Dopamine agonists
Can be used as monotherapy in early PD
SE: drowsiness, compulsive behaviour
What are rasagiline and selegiline?
MAO-B inhibitors
Can be used as monotherapy in early PD
SE: postural hypotension, AF
What are entacapone and tolcapone?
COMT inhibitors
Can help motor complications in late PD
What are the features of dementia with lewy bodies?
- Dementia
- Parkinsonism
- Visual hallucinations
What are the features of multi-system atrophy?
Autonomic features - hypotension, bladder instability
Symmetrical Parkinsonism
What are the features of progressive nuclear palsy?
Early falls
Truncal rigidity
Vertical gaze palsy
Reduction in mid brain volume on MRI
What are the features of normal pressure hydrocephalus?
- Dementia
- Gait disorder
- Bladder instability
What are the features of portico-basal degeneration?
Asymmetrical Parkinsonism
Dyspraxia
Sensory deficit
