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MBChB > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the most common cause of radial nerve palsy?

A

Entrapment at spinal grove

“Saturday night palsy”

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2
Q

What are the presenting symptoms of a radial nerve palsy?

A

Wrist and finger drop

Usually painless

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3
Q

What motor weakness is associated with extensor carpi radialis longus?

A

Wrist extension

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4
Q

What motor weakness is associated with extensor digitorum communis?

A

Finger extension

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5
Q

What motor weakness is associated with brachiradialis?

A

Elbow flexion in mid-pronation

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6
Q

What is the most common cause of ulnar nerve palsy?

A

Entrapment at ulnar grove (medial epicondyle of humerus)

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7
Q

What are the presenting symptoms of an ulnar nerve palsy?

A

History of trauma at elbow
Dorsal sensory loss
(in cyclists. problem at wrist –> no dorsal sensory loss)
Sensory disturbances and weakness –> weak grip
Usually painless

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8
Q

What motor weakness is associated with 1st dorsal interosseous?

A

Index finger abduction

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9
Q

What motor weakness is associated with abductor digiti minimi?

A

Pinkie abduction

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10
Q

What motor weakness is associated with flexor carpi ulnaris?

A

Wrist flexion

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11
Q

What motor weakness is associated with adductor pollicis?

A

Thumb adduction

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12
Q

What is the most common cause of median nerve palsy?

A

Entrapment within carpal tunnel at wrist

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13
Q

What are the presenting symptoms of an median nerve palsy?

A

History of intermittent nocturnal pain, numbness and tingling - often relieved by shaking hand

Weak grip

Positive Tinel’s sing (gently percuss over the nerve to elicit sensation of parathesia in the distribution of the nerve)

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14
Q

What motor weakness is associated with lumbricals I&II?

A

Flexion at MCP joints

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15
Q

What motor weakness is associated with opponent pollicis?

A

Thumb opposition

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16
Q

What motor weakness is associated with abductor pollicis brevis?

A

Thumb abduction

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17
Q

What motor weakness is associated with flexor pollicis brevis?

A

Thumb flexion

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18
Q

What is the most common cause of anterior interosseous branch (median nerve II) palsy?

A

Trauma to forearm

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19
Q

What are the presenting symptoms of an anterior interosseous branch (median nerve II) palsy?

A

History of forearm pain
Weak grip
Positive Tinel’s sign/Phalen’s test
No sensory change

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20
Q

What motor weakness is associated with pronator quadratus?

A

Flexion at MCP joints

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21
Q

What motor weakness is associated with flexor pollicus longus?

A

Thumb flexion

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22
Q

What motor weakness is associated with flexor digitorum profundus (lateral?)

A

Thumb flexion

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23
Q

What nerve runs at the front of the thigh, and what muscle group does it supply?

A

Femoral

Quads

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24
Q

What nerve runs at the medial aspect of the thigh, and what muscle groups does it supply?

A

Obturator

Adduction

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25
Q

What nerve runs posterior to the thigh, and what muscle groups does it supply?

A

Sciatic

Hamstrings

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26
Q

What is the most common cause of femoral nerve palsy?

A

Haemorrhage/trauma

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27
Q

What are the presenting symptoms of a femoral nerve palsy?

A

Weakness of quadriceps
Weakness of hip flexion
Numbness in medial shin

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28
Q

What motor weakness is associated with quadriceps?

A

Knee extension

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29
Q

What motor weakness is associated with illiopsoas?

A

Hip flexion

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30
Q

What motor weakness is associated with adductor Magnus?

A

Hip adduction

31
Q

What nerve is located at the posterior of the calf, and what muscles does it supply?

A

Tibial

Gastrocnemius, soleus

32
Q

What nerve is located at the anterior of the calf, and what muscle does it supply?

A

Peroneal

Tibialis anterior, peroneii

33
Q

What is the most common cause of common peroneal nerve palsy?

A

Entrapment of fibular head

34
Q

What are the presenting symptoms of a common peroneal nerve palsy?

A

Trauma, surgery, external compression
Acute onset foot drop (can invert food, ankle jerk still present)
Sensory disturbances
Usually painless

35
Q

What motor weakness is associated with tibilalis anterior?

A

Ankle dorsiflexion

36
Q

What motor weakness is associated with extensor hallucis longus?

A

Big toe extension

37
Q

Define mononeuritis multiplex

A

Simultaneous or sequential development of neuropathy of two or more nerves

38
Q

What are common causes of mononeuritis multiplex?

A

Diabetes
Vasculitis - Churg Strauss, polyarteritis nodusa
Rheumatological - RA, SLE, Sjogren’s syndrome
Infective
Sarcoidosis
Lymphoma

39
Q

Describe how an aneurysm forms

A

Haemodynamic stress causes localised dilation of an artery
Extensive immunological and inflammatory processes
Aneurysm will either stabilise or rupture

40
Q

What percentage of SAH are non-aneurysmal, and what are the potential causes of these?

A

15-20%

Trauma
Tumours
Arteriovenous malformation
Anti-coagulants

41
Q

What are predisposing factors to aneurysm SAH?

A

Smoking
Female sex (1.5x risk)
HTN

42
Q

What are the symptoms of a SAH?

A

Sudden onset headache “thunderclap”
LOC, seizures, speech/limb disturbances
Sentinel headaches (30%)

43
Q

What are the signs of a SAH?

A 
Photophobia
Meningism
Subhyaloid haemorrhage
Vitreous haemorrhage
Pulmonary oedema
44
Q

Why can patients with SAH develop pulmonary oedema?

A

Increased catecholamines

Congestive HF and pulmonary oedema

45
Q

Describe the grading system used for assessing SAH

A

WFNS using GCS

Grade 5 = GCS 3-6
Grade 4 = GCS 7-12
Grade 3 = GCS 13-14 (with deficits)
Grade 2 = GCS 13-14 (no deficits)
Grade 1 = GCS 15
46
Q

What investigations are needed for a patient with a suspected SAH?

A 
CT
LP
U&Es
Troponin
ECG
ECHO
47
Q

What is the role of a CT in the investigation of a patient with a suspected SAH?

A

Confirms diagnosis
Clues to aetiology
Identifies complications (infarction, haematoma, hydrocephalus)
Prognostic (Fisher grade - the greater the amount of blood, the worse the prognosis)

48
Q

When does a LP need to be carried out following a suspected SAH, and what is the characteristic finding?

A

~ 6 hours

Xanthochromia - yellow discolouration of CSF caused by the presence of bilirubin

49
Q

Why might there be ECG changes in a patient with SAH?

A

Increased catecholamine release

50
Q

Describe the resuscitation needed for a patient with SAH

A 
Bed rest
Fluids: 2.5-3L of normal saline
Anti-embolic stockings
Nimodipine
Analgesia
51
Q

What is the role of Nimodipine in a patient who has had a SAH?

A

Ca channel antagonist –> prevents dumping of calcium within cells

52
Q

Describe the management of SAH

A

10% surgical clipping
Endovascular - coils, stents, glue
Conservative - patient unsuitable for more invasive intervention

53
Q

What state is induced following a SAH, and what needs to be prescribed as a consequence of this?

A

Prothrombic state

DVT prophylaxis

54
Q

What are some of the complications associated with SAH?

A

Re-haemorrhage - most common within 72h, increased risk with poorer grades or larger aneurysm

Delayed ischaemia - blood is an irritant –> occurs at d3-10 (keep well hydrated, increase BP with inotropes, prescribe nimodipine)

Hydrocephalus - obstruction of CSF (LP, drains, shunts)

Cardiopulmonary complications - myocardial function usually returns to normal in 1-3d, but can develop arrhythmias, wall motion abnormality and sudden death

55
Q

Define stroke

A

Central nervous system 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

56
Q

Describe what happens when a stroke occurs

A

Blood clot disrupts blood flow
Area of brain is starved of oxygen so becomes ischaemic –> loss of function (initially reversible)
Neurons depolarise - instant onset of early symptoms
Cells die –> tissue dies (irreversible)

57
Q

A stroke in which part of the brain will result in weakness affecting the entire one side of the body?

A

Internal capsule

58
Q

What artery is affected if a patient presents with expressive dysphagia following a stroke?

A

Middle cerebral artery (generally the left)

59
Q

If a patient presents with homonymous hemianopia following a stroke, what artery has been affected?

A

Posterior cerebral artery

Middle cerebral artery can also cause hemianopia

60
Q

If the cerebellum has been affected, what clinical signs may be present? What arteries supply the cerebellum?

A

Past-pointing, nystagmus
Basilar artery
Posterior cerebral artery

61
Q

What percentage of strokes are due to ischaemia?

A

88%

62
Q

Define ischaemic stroke

A

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

63
Q

What classification system enables the presenting symptoms and clinical signs to assess the type of ischaemic stroke a patient has had without the need for imaging?

A

Bamford Classification of Ischaemic Stroke

64
Q

Define a Total Anterior Circulation Stroke (TACS), and what criteria does it need to meet?

A

Large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries

3/3 of:

  1. Unilateral weakness (and/or sensory deficits) of the face, arm, leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction (visuospatial disorder, dysphagia)
65
Q

Define a Partial Anterior Circulation Stroke (PACS), and what criteria needs to be met?

A

Less severe form of TACS, in which only part of the anterior circulation has been compromised.

2/3 of:

  1. Unilateral weakness (and/or sensory deficit) of the face, arm, leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction (visuospatial disorder, dysphagia)
66
Q

Define a Posterior Circulation Syndrome (POCS), and what criteria needs to be met?

A

Involves damage to the area of the brain supplied by the posterior circulation eg cerebellum and brainstem

1/5 of:

  1. Cranial nerve palsy and a contralateral motor/sensory deficit
  2. Bilateral motor/sensory deficit
  3. Conjugate eye movement disorder (eg horizontal gaze palsy)
  4. Cerebellum dysfunction (eg vertigo, nystagmus, ataxia)
  5. Isolated homonymous hemianopia
67
Q

Define Lacunar Syndrome (LACS), and what criteria needs to be met?

A

Subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions.

1/4 of:

  1. Pure sensory stroke
  2. Pure motor stroke
  3. Sensori-motor stroke
  4. Ataxic hemiparesis
68
Q

Define an intracerebral haemorrhage

A

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

69
Q

Define a stroke caused by an 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

70
Q

Give three causes of intracranial bleedinig

A 
Small vessel disease
Amyloid angiopathy
Abnormalities in blood vessels 
Blood clotting deficiencies
Haemorrhagic transformation of an infarct
Tumours
Drug use: cocaine, amphetamines
71
Q

Describe the management of an ischaemic stroke

A

IV thrombolysis (within 4.5h)
Thrombectomy ± IV thrombolysis (not in Scotland)
Aspirin

Stroke unit

Hemicranectomy

72
Q

Describe the management of a haemorrhagic stroke

A

Blood pressure control

Stroke unit

Neurosurgical evacuation

73
Q

What are the CV risk factors that are responsible for 85% of strokes?

A 
HTN
Obesity
Lack of exercise
High fat diets
Cigarette smoking

MBChB (14 decks)

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