Neurology Flashcards
1
Q
What substances are hypoattenuating on CT scan?
A
Air
Fat
Fluid
Oedema
2
Q
What substances are hyperattenuating on CT scan?
A
Bleeds
Bone
Mineralisation
3
Q
What is used for CT contrast dye?
A
Iodine- hyperattenuating
4
Q
What is used for MRI contrast dye?
A
Gadolinium
5
Q
What are the risks with angiography?
A
Stroke
Vascular damage
6
Q
Give examples of nuclear medicine scans
A
PET-CT Scan
DAT Scan for Parkinsons
7
Q
What are the signs of UMN lesion?
A
- Hyperreflexia: reflexes brisk
- Hypertonia: the faster you move the patient’s muscle, the greater the resistance, until giving way (clasp knife)
- Spasticity in strong muscle groups (arm flexors and leg extensors)
- Upgoing plantars (positive Babinski)
- Loss of skilled fine finger movements
8
Q
Where do UMN lesions impact?
A
Anywhere along the pyramidal (corticospinal) tracts
Ie. Between the precentral gyrus of frontal cortex to the anterior horn cells in spinal cord
Arm- extensors affected
Leg- flexors affected
9
Q
Where do LMN lesions impact?
A
Anywhere from anterior horn cell distally, to nerve plexuses and peripheral nerves.
10
Q
What are the signs of a LMN lesion?
A
- Hyporeflexia: reflexes reduced or absent
- Hypotonia: limbs feel soft and floppy
- Fasciculations: spontaneous involuntary twitching
- Plantars remain flexor
11
Q
What is the function of the dorsal columns?
A
Vibration
Proprioception
12
Q
What is the function of the Lateral spinothalamic tract?
A
Pain
Temperature
13
Q
What is the normal intracranial pressure?
A
7-15mmHG
14
Q
Which drug decreases the activity of histamine?
A
Cyclizine
15
Q
Which drugs are agonists/ increase the activity of dopamine?
A
Levodopa Pramipexole (dopamine agonist) Cabergoline (hyperprolactinaemia, acromegaly)
16
Q
Which drugs are dopamine antagonists?
A
Chlorpromazine (schizophrenia)
Metoclopramide (nausea)
17
Q
Which drugs are agonists of serotonin?
A
Lithium (mood)
Fluoxetine and Sertraline (SSRIs)
Sumatriptan (migraine)
18
Q
Which drugs are antagonists of Serotonin?
A
Clozapine, Olanzapine (Schizophrenia)
19
Q
Where does the anterior cerebral artery supply?
A
Front and mid cerebrum
20
Q
Where does the middle cerebral artery supply?
A
Lateral cerebrum
21
Q
Where does the posterior cerebral artery supply?
A
Occipital lobe
22
Q
What are the 2 types of oedema?
A
- Cytotoxic- ischemia, cell damage
2. Vasogenic- abnormal vessels lead to fluid leakage. Caused by tumours (angiogenesis), infection, inflammation
23
Q
What are the risks of using contrast?
A
Contrast reaction
Acute renal failure
Diabetic lactic acidosis
Extravasation
24
Q
What primary events can occur following head injury?
A
- Contusions
- Traumatic axonal injury
- Haemorrhage
25
What secondary events can occur following head injury?
1. Ischemia
2. Raised intrcranial pressure
3. Infection
4. Post traumatic epilepsy
5. Chronic traumatic encepalopathy
26
What is the pathophysiology of Alzheimer's?
1. Accumulation of B-amyloid peptide
2. Progressive neuronal damage
3. Neurofibrillary tangles (NFTs)
4. Increased amyloid plaques
5. Loss of Ach neurotransmitter
27
Which brain parts are most affected by Alzheimer's?
Basal nuclei
Hippocampus
Amygdala
Temporal neocortex
28
What are the risk factors for developing Alzheimer's?
```
Age
Head injury
1st degree relative with Alzheimer's
Down Syndrome
Homozygous for ApoE4 allele
Mutation in BAPP gene
Smoking
Vascular risk factors
```
29
The Apolioprotein E4 allele increases the risk of which condition?
Alzheimer's
30
What is vascular dementia?
Dementia due to cumulative effect of multiple small infarcts
Sudden onset dementia and stepwise deterioration
Grey matter loss
31
What is Lewy body dementia?
Lewy bodies of alpha synuclein which are eosinophilic in the brainstem and neocortex
Often in Parkinsons
32
What are the key signs of Lewy body dementia?
Visual hallucinations
Parkinsonism
Fluctuating cognitive impairment
33
Which medications should be avoided in Lewy body dementia?
Antipsychotics
34
What are the key signs of fronto temporal dementia?
```
Personality changes
Behavioural changes
Emotional unconcern
Disinhibition
Memory preserved until later stages
```
35
What is Pick's disease?
A subtype of fronto temporal dementia
Tau positive
PIck bodies on histology
36
What is delerium?
Acute confusion: hours- days
Memory loss
Global cognitive deficit
Reversal of sleep-wake cycle
37
What is uncal herniation?
Type of supratentorial herniation
| Temporal lobe moves towards tentorium and puts pressure on brainstem
38
What are the clinical features of uncal herniation?
```
Compression of cranial nerve 3:
Mydriasis (dilated pupil)
Diplopia
Ptosis (drooping eyelid)
Eye displaced and turned out
```
Ipsilateral hemiparesis
39
What is tonsillar herniation?
Cerebellar tonsils move downward through the foramen magnum, and may compress the brainstem and cervical spine
40
What are the features of tonsillar herniation?
Headache
Headtilt
Decreased consciousness
Respiratory dysfunction
41
What are the signs of a venous sinus thrombosis?
```
Headache
Stroke symptoms
One sided weakness
Difficulty speaking
Seizures
Abnormal vision
```
42
What are the risk factors for a venous sinus thrombosis?
```
Women age 20-35
Pregnancy
Combined oral contraceptive
Nephrotic syndrome
Thrombophilia
Inflammatory diseases
```
43
What is the most aggressive type of brain tumour?
Glioblastoma- originates from glial cells, astrocytes
44
Which cancers most commonly metastasize to the brain?
Lung
Breast
Skin
Kidney
45
What is the most common paediatric brain tumour?
Medulloblastoma
| Originates in the 4th ventricle
46
Which bacteria most commonly cause meningitis in ADULTS?
Strep pneumoniae
| Neisseria meningitidis
47
What are the clinical signs/ symptoms of meningitis?
```
Fever >38 or hypothermia
Photophobia
Neck stiffness
Headache
May have altered consciousness
Kernig's sign- painful to extend the leg towards head when laid supine
Lymphadenopathy
Rash
```
48
Which antibiotics can treat bacterial meningitis?
Cephalosporins
| Vancomycin and or Rifampicin for penicillin resistant
49
What are the complications of meningitis?
```
Seizures
Raised intracranial pressure
Infarction
Venous sinus thrombosis
Cerebral oedema
Hearing loss
```
50
Which bacteria may cause meningitis following travel?
Tuberculous meningitis
51
How is tuberculous meningitis treated?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
52
Which viruses can cause viral meningitis?
HIV
Enterovirus
MMR
HSV1 and 2
53
Which organisms cause fungal meningitis?
Candida
| Cryptococcus
54
How is cryptococcal (fungal) meningitis treated?
Fluconazole
| Amphotericin B
55
What is encephalitis?
Inflammation of the brain parenchyma
56
Which virus causes 90% of encephalitis?
HSV1
57
How does HSV1 infect the brain parenchyma to cause encephalitis?
Oral mucosa infection, spread along CNV to the trigeminal ganglion
58
How can viral encephalitis be treated?
Aciclovir IV
59
What are the potential causes of brain abscesses?
Bacterial meningitis
Encephalitis
Sinusitis
Ear infection
60
What is rabies caused by?
Rhabdovirus
61
What can be seen under the microscope to diagnose rabies?
Negri bodies
62
What are the causes of ischemic stroke?
1. Large vessel disease- plaque rupture at sight of turbulence eg bifurcation of common carotid, leads to acute occluding clot (Eg. Carotid artery disection)
2. Cardioembolism
3. Lacunar infarct
63
What is the commonest cause of stroke in young people?
Carotid artery disection, usually caused by trauma
| Leads to ischemic stroke
64
What is the classic triad of symptoms in a carotid artery dissection?
1. Unilateral face/ neck pain
2. Horner's syndrome (sympathetic dysruption)
3. Anterior stroke/ TIA
65
What are the risk factors for lacunar infarct?
Hypertension
Hyperlipidaemia
Diabetes
66
Which parts of the brain are affected by lacunar infarct?
Subcortical: occlusion of perforating arterioles in the deep white matter/ brain stem
67
How does an infarct appear on CT scan?
Hypoattenuated = dark
Difficult to see early on
Loss of grey/ white matter differentiation
Sulcal effacement (adjacent gyri pushed together)
68
What are the main causes of anterior circulation stroke (TACS/ PACS)?
Ischemia
| Cortical intracerebral haemorrhage
69
What are the clinical signs of an anterior stroke?
1. Contralateral UMN hemiparesis and or sensory loss
2. Homonymous hemianopia
3. Higher mental function problems: dysphasia (language problems)
TACS: 3/3, PACS: 2/3
70
What is Broca's aphasia?
Expressive dysphasia- difficulty expressing language, but comprehension remains intact
71
What is Wernicke's aphasia?
Receptive dysphasia- difficulty comprehending language
72
What are the clinical findings of Lacunar stroke?
1. Contralateral UMN hemiparesis
2. Contralateral hemisensory loss
3. Contralateral positive Babinski sign
4. NO cortical problems (too deep)
73
Which arteries are affected in a posterior circulation stroke?
Vertebral
| Basilar
74
What are the clinical findings of a posterior circulation stroke? (POCS)
1. Dizzyness, Vertigo
2. Diplopia
3. Dysphagia
4. Dsyarthria
5. Limb weakness
6. Ataxia
7. Cranial nerve palsies
Bilateral issues
75
What are the clinical findings of a cerebellar stroke?
```
Nausea and vomitting
Headache
Loss of balance
Vertigo
Nystagmus (involuntary eye movement)
```
76
What are the consequences of a basilar artery thrombi?
Affects brainstem and occipital blood supply
Locked in syndrome
Respiratory arrest
Coma
77
Which symptoms almost NEVER occur in a TIA?
```
POSITIVE sensory symptoms: burning/ stinging
Global symptoms
Seizure like symptoms
Migraine
Symptoms which develop over time
```
78
What is Amaurosis Fugax?
TIA in the retinal artery (due to large vessel disease of carotid)
Causes transient blindness in one eye "like a curtain drawing" which is painless
79
What conditions can cause stroke mimics?
```
Dementia
Seizure
Syncope
Sepsis
Migraine
Labyrinthitis
```
80
What is dysarthria?
Difficulty articulating
81
What is dysphonia?
Difficulty with voice production
82
What can cause ACUTE weakness?
1. Lacunar infarct
2. Transverse myelitis
3. Spinal shock
4. Guillain- Barre syndrome
83
What can cause SUBACUTE weakness?
1. Spinal cord compression
2. Myasthenia gravis
3. Peripheral neuropathy
84
Which CHRONIC conditions can cause weakness?
1. Space occupying lesion
2. Motor neurone disease
3. Cervical spondolysis
4. Myopathy
85
What is transverse myelitis?
Acute inflammation of the spinal cord, usually post viral infection
Usually in younger people
Pain on onset
86
What can cause spinal cord compression?
Disk prolapse
| Secondary malignancy- breast, lung. prostate
87
What are the key clinical features of myasthenia gravis?
SUBACUTE onset
PROXIMAL muscle weakness- difficulty climbing stairs
Remitting and relapsing muscle fatigue
Occular, bulbar, face and neck muscles affected
Ptosis and diplopia
88
What is the pathophysiology of myasthenia gravis?
Autoimmune destruction of NAchR
89
What are the key clinical features of cervical spondolysis?
Neck stiffness
Crepitus
Specific reflexes affected
Pain/ electrical sensation in arms/ fingers at compression level
90
What are the key clinical features of MND?
```
Foot drop
Spastic gait
Upgoing plantars
Speech affected
Proximal myopathy
Weak grip
NO sensory loss or sphincter disturbance
NO affect on eyes
```
91
Which medication taken at a low dose for long term can cause myopathy?
Prednisolone
92
What are the common sites of berry aneurysm rupture?
PCA junction with internal carotid
ACA with anterior communicating
Bifurcation of MCA
93
What does the drug Nimodipine do?
Calcium antagonist
| Reduces vasospasm and morbidity from ischemia
94
What shape is an extra-dural haematoma on CT?
Biconvex/ lens shaped
95
What shape is a sub-dural haematoma on CT?
Crescent shaped
96
What happens to the severity of a migraine when laying down?
It improves
97
What are the common features of migraines?
```
Hemicranial
Photophobia
Auras
Improve on laying down
Nausea
May have associated symptoms: Restless legs, vertigo, neck or muscle pain
```
98
What are the 4 stages of a migraine?
1. Prodrome- hours
2. Aura
3. Migraine headache (with associated symptoms)
4. Post drome
99
What are the best treatments for migraines?
1. Avoid triggers, stop caffeine
2. NSAIDs - avoid opiates
3. Anti emetics
4. Tryptans eg Sumitryptan (serotonin agonist)
5. Prophylaxis- beta blockers, candesartan, monocloncal antibodies
100
What causes Trigeminal Autonomic Cephalalgias?
Autonomic activation on ONE side (hemicranial)
101
What are the types of TAC?
Hemicrania continua
Cluster headaches
Parxoysmal hemicrania
SUNCT
102
What is the treatment for Trigeminal Neuralgia?
Sodium channel blockers eg. Carbamazepine
103
What are the partial triggers for migraines?
```
C- Chocolate
H- Hangovers
O- Orgasms
C- Cheese/ caffeine
O- Oral contraceptive
L- Lie-in
A- Alcohol
T- Travel
E- Exercise
```
104
Compare Parkinson tremor to essential tremor.
Parkinson- Unilateral onset, resting, affects jaws arms and legs, alcohol has no impact, family history is usually negative, also has bradykinesia and rigidity
Essential- Bilateral onset, no associated features, affects arms, head and voice, family history usually positive, alcohol relieves symptoms
105
How is Essential Tremor treated?
Beta blocker- propanolol
Primidone (type of Diazepam)
Alprazolam
106
What are the potential causes of blackout?
1. Vasovagal syncope
2. Situational syncope
3. Epilepsy
4. Orthostatic hypotension
5. Hypoglycaemia
6. Stokes Adams attack
7. Carotid sinus syncope
107
What are the potential causes of vertigo?
1. Benign positional vertigo
2. Labyrinthitis
3. Meniere's disease
4. Ototoxicity- Aminoglycosides, Cisplatin, Loop diuretics
5. Acoustic neuroma
108
What are the key features of a cerebellar lesion?
```
DANISH:
D- Dysdiadochokinesis (impaired rapidly alternating movements) and Dysmetria (past pointing)
A- Ataxia
N- Nystagmus
I- Intention tremor
S- Slurred speech (dysarthria)
H- Hypotonia
```
109
What are some clinical features of Bell's Palsy?
```
CNVII affected:
Unilateral facial weakness (LMN- cant wrinkle forehead)
Numbness around ear
Mouth sagging
Saliva drooling
Hypersensitive to sounds
Decreased taste
```
110
Which class of Parkinson drugs interacts with sinus decongestants?
MAOB Inhibitors (Rasagiline, Selegiline)
111
What are the types of Parkinson's drugs?
1. Levo-dopa
2. Carbidopa
3. Dopamine agonist- Pramipexole, Ropinirole, Bromocrptine
4. COMT inhibitors- Entacapone, Tolcapone
5. MAOB inhibitors- Rasagiline, Selegiline
112
Chorea is associated with ..........
Huntington's
| Levodopa use
113
Hemiballismus is associated with.............
Stroke in subthalamic nucleus
| Diebetes
114
Athetosis is associated with ...............
Cerebral palsy
115
Resting tremor is associated with...........
Parkinsons
116
Intention tremor is associated with.............
Cerebellar lesion (stroke, MS)
117
Postural tremor is associated with.............
Essential tremor
118
Bromocriptine is what type of drug?
Dopamine agonist
119
Pramipexole is what type of drug?
Dopamine agonist
120
What sensory symptoms may be seen in MS?
```
Dyaesthesia
Pins and needles
Visual disturbance
Loss of vibration sensation
Trigeminal neuralgia
```
121
What motor symptoms may be seen in MS?
Trunk and limb atazia
Intention tremor
Falls
Scanning speech
122
What sexual/GU symptoms may be seen in MS?
Incontinence
Erectile dysfunction
Anorgasmia
Urine retention
123
85% of patients who experience a clinically isolated syndrome go on to develop............
Relapsing Remitting MS
124
in MS patients what may be found on lumbar puncture?
Oligoclonal IgG bands (not found in serum)
125
Lhermitte's sign is present in which condition?
Multiple sclerosis
126
What is Charcot's neurological triadf?
1. Nystagmus
2. Intention tremor
3. Scanning speech
Found in MS
127
What are the visual features of idiopathic intracranial hypertension?
1. Reduced visual field
2. Diplopia
3. Blurred vision
4. Blind spot
128
Which drugs are used for treating idiopathic intracranial hypertension?
Acetazolamide
Topiramate
Loop diuretics
Prednisolone
129
Which nerves are affected by a Bulbar Palsy?
```
CN 9-12:
Glossopharyngeal
Vagus
Accessory
Hypoglossal
```
130
What are the signs of a Bulbar Palsy?
1. Quiet / hoarse voice
2. Flacid, fasciculating tongue
3. Normal or absent jaw jerk
131
What are the signs of a PseudoBulbar Palsy?
1. Increased jaw jerk
2. Slow deliberate speech
3. Slow tongue movement
4. Giggling/ weeping
132
Which nerves are affected by a Pseudobulbar palsy?
UMN
Corticobulbar tract
Bilateral
133
What can cause a bulbar palsy? (LMN)
1. MND
2. Myasthenia gravis
3. Gullain Barre syndrome
4. Polio
5. Central pontine myelinolysis
6. Brainstem tumour
134
What can cause a pseudobulbar palsy? (UMN)
1. MND
2. MS
3. Stroke
4. Central pontine myelinolysis
135
Which condition is associated with cafe au lait spots, freckles in folds and Lisch nodules on the iris?
Neurofibromatosis Type 1
136
Which condition results in dissociated sensory loss (loss of pain and temp) with weakness/ wasting of hands?
Syringomyelia
137
Which nerve pathway does a syringomyelia press on?
Lateral spinothalamic
Loss of pain and temp sensation; preservation of fine touch, proprioception and vibration. Due to CSF blockage. May also get hand wasting/ claw hand.
138
Lambert Eaton Myasthenic syndrome affects which part of the neurone?
Voltage gated calcium channels on pre-synaptic membrane
139
Myasthenia Gravis affects which part of the neurone?
NAchR on post-synaptic membrane
140
Which AEDs block voltage gated sodium channels?
Sodium valproate
Phenytoin
Carbamazepine
Lamotrigine
141
Which AED blocks voltage gated calcium channels?
Phenytoin
142
Which AEDs increase GABA levels?
Barbiturates
| Benzodiazepines
143
Which AED decreases glutamate levels?
Topiramate
144
The superior division of the middle cerebral artery supplies where?
Broca's area
