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Year 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

What substances are hypoattenuating on CT scan?

A

Air
Fat
Fluid
Oedema

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2
Q

What substances are hyperattenuating on CT scan?

A

Bleeds
Bone
Mineralisation

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3
Q

What is used for CT contrast dye?

A

Iodine- hyperattenuating

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4
Q

What is used for MRI contrast dye?

A

Gadolinium

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5
Q

What are the risks with angiography?

A

Stroke

Vascular damage

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6
Q

Give examples of nuclear medicine scans

A

PET-CT Scan

DAT Scan for Parkinsons

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7
Q

What are the signs of UMN lesion?

A
  1. Hyperreflexia: reflexes brisk
  2. Hypertonia: the faster you move the patient’s muscle, the greater the resistance, until giving way (clasp knife)
  3. Spasticity in strong muscle groups (arm flexors and leg extensors)
  4. Upgoing plantars (positive Babinski)
  5. Loss of skilled fine finger movements
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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

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9
Q

Where do LMN lesions impact?

A

Anywhere from anterior horn cell distally, to nerve plexuses and peripheral nerves.

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10
Q

What are the signs of a LMN lesion?

A
  1. Hyporeflexia: reflexes reduced or absent
  2. Hypotonia: limbs feel soft and floppy
  3. Fasciculations: spontaneous involuntary twitching
  4. Plantars remain flexor
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11
Q

What is the function of the dorsal columns?

A

Vibration

Proprioception

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12
Q

What is the function of the Lateral spinothalamic tract?

A

Pain

Temperature

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13
Q

What is the normal intracranial pressure?

A

7-15mmHG

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14
Q

Which drug decreases the activity of histamine?

A

Cyclizine

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15
Q

Which drugs are agonists/ increase the activity of dopamine?

A 
Levodopa
Pramipexole (dopamine agonist)
Cabergoline (hyperprolactinaemia, acromegaly)
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16
Q

Which drugs are dopamine antagonists?

A

Chlorpromazine (schizophrenia)

Metoclopramide (nausea)

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17
Q

Which drugs are agonists of serotonin?

A

Lithium (mood)
Fluoxetine and Sertraline (SSRIs)
Sumatriptan (migraine)

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18
Q

Which drugs are antagonists of Serotonin?

A

Clozapine, Olanzapine (Schizophrenia)

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19
Q

Where does the anterior cerebral artery supply?

A

Front and mid cerebrum

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20
Q

Where does the middle cerebral artery supply?

A

Lateral cerebrum

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21
Q

Where does the posterior cerebral artery supply?

A

Occipital lobe

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22
Q

What are the 2 types of oedema?

A
  1. Cytotoxic- ischemia, cell damage

2. Vasogenic- abnormal vessels lead to fluid leakage. Caused by tumours (angiogenesis), infection, inflammation

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23
Q

What are the risks of using contrast?

A

Contrast reaction
Acute renal failure
Diabetic lactic acidosis
Extravasation

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24
Q

What primary events can occur following head injury?

A
  1. Contusions
  2. Traumatic axonal injury
  3. Haemorrhage
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25
Q

What secondary events can occur following head injury?

A
  1. Ischemia
  2. Raised intrcranial pressure
  3. Infection
  4. Post traumatic epilepsy
  5. Chronic traumatic encepalopathy
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26
Q

What is the pathophysiology of Alzheimer’s?

A
  1. Accumulation of B-amyloid peptide
  2. Progressive neuronal damage
  3. Neurofibrillary tangles (NFTs)
  4. Increased amyloid plaques
  5. Loss of Ach neurotransmitter
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27
Q

Which brain parts are most affected by Alzheimer’s?

A

Basal nuclei
Hippocampus
Amygdala
Temporal neocortex

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28
Q

What are the risk factors for developing Alzheimer’s?

A 
Age
Head injury
1st degree relative with Alzheimer's
Down Syndrome
Homozygous for ApoE4 allele
Mutation in BAPP gene
Smoking
Vascular risk factors
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29
Q

The Apolioprotein E4 allele increases the risk of which condition?

A

Alzheimer’s

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30
Q

What is vascular dementia?

A

Dementia due to cumulative effect of multiple small infarcts
Sudden onset dementia and stepwise deterioration
Grey matter loss

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31
Q

What is Lewy body dementia?

A

Lewy bodies of alpha synuclein which are eosinophilic in the brainstem and neocortex
Often in Parkinsons

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32
Q

What are the key signs of Lewy body dementia?

A

Visual hallucinations
Parkinsonism
Fluctuating cognitive impairment

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33
Q

Which medications should be avoided in Lewy body dementia?

A

Antipsychotics

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34
Q

What are the key signs of fronto temporal dementia?

A 
Personality changes
Behavioural changes
Emotional unconcern
Disinhibition
Memory preserved until later stages
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35
Q

What is Pick’s disease?

A

A subtype of fronto temporal dementia
Tau positive
PIck bodies on histology

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36
Q

What is delerium?

A

Acute confusion: hours- days
Memory loss
Global cognitive deficit
Reversal of sleep-wake cycle

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37
Q

What is uncal herniation?

A

Type of supratentorial herniation

Temporal lobe moves towards tentorium and puts pressure on brainstem

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38
Q

What are the clinical features of uncal herniation?

A 
Compression of cranial nerve 3:
Mydriasis (dilated pupil)
Diplopia
Ptosis (drooping eyelid)
Eye displaced and turned out

Ipsilateral hemiparesis

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39
Q

What is tonsillar herniation?

A

Cerebellar tonsils move downward through the foramen magnum, and may compress the brainstem and cervical spine

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40
Q

What are the features of tonsillar herniation?

A

Headache
Headtilt
Decreased consciousness
Respiratory dysfunction

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41
Q

What are the signs of a venous sinus thrombosis?

A 
Headache
Stroke symptoms
One sided weakness
Difficulty speaking
Seizures
Abnormal vision
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42
Q

What are the risk factors for a venous sinus thrombosis?

A 
Women age 20-35
Pregnancy
Combined oral contraceptive
Nephrotic syndrome
Thrombophilia
Inflammatory diseases
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43
Q

What is the most aggressive type of brain tumour?

A

Glioblastoma- originates from glial cells, astrocytes

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44
Q

Which cancers most commonly metastasize to the brain?

A

Lung
Breast
Skin
Kidney

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45
Q

What is the most common paediatric brain tumour?

A

Medulloblastoma

Originates in the 4th ventricle

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46
Q

Which bacteria most commonly cause meningitis in ADULTS?

A

Strep pneumoniae

Neisseria meningitidis

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47
Q

What are the clinical signs/ symptoms of meningitis?

A 
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
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48
Q

Which antibiotics can treat bacterial meningitis?

A

Cephalosporins

Vancomycin and or Rifampicin for penicillin resistant

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49
Q

What are the complications of meningitis?

A 
Seizures
Raised intracranial pressure
Infarction
Venous sinus thrombosis
Cerebral oedema
Hearing loss
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50
Q

Which bacteria may cause meningitis following travel?

A

Tuberculous meningitis

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51
Q

How is tuberculous meningitis treated?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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52
Q

Which viruses can cause viral meningitis?

A

HIV
Enterovirus
MMR
HSV1 and 2

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53
Q

Which organisms cause fungal meningitis?

A

Candida

Cryptococcus

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54
Q

How is cryptococcal (fungal) meningitis treated?

A

Fluconazole

Amphotericin B

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55
Q

What is encephalitis?

A

Inflammation of the brain parenchyma

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56
Q

Which virus causes 90% of encephalitis?

A

HSV1

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57
Q

How does HSV1 infect the brain parenchyma to cause encephalitis?

A

Oral mucosa infection, spread along CNV to the trigeminal ganglion

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58
Q

How can viral encephalitis be treated?

A

Aciclovir IV

59
Q

What are the potential causes of brain abscesses?

A

Bacterial meningitis
Encephalitis
Sinusitis
Ear infection

60
Q

What is rabies caused by?

A

Rhabdovirus

61
Q

What can be seen under the microscope to diagnose rabies?

A

Negri bodies

62
Q

What are the causes of ischemic stroke?

A
  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
Q

What is the commonest cause of stroke in young people?

A

Carotid artery disection, usually caused by trauma

Leads to ischemic stroke

64
Q

What is the classic triad of symptoms in a carotid artery dissection?

A
  1. Unilateral face/ neck pain
  2. Horner’s syndrome (sympathetic dysruption)
  3. Anterior stroke/ TIA
65
Q

What are the risk factors for lacunar infarct?

A

Hypertension
Hyperlipidaemia
Diabetes

66
Q

Which parts of the brain are affected by lacunar infarct?

A

Subcortical: occlusion of perforating arterioles in the deep white matter/ brain stem

67
Q

How does an infarct appear on CT scan?

A

Hypoattenuated = dark
Difficult to see early on
Loss of grey/ white matter differentiation
Sulcal effacement (adjacent gyri pushed together)

68
Q

What are the main causes of anterior circulation stroke (TACS/ PACS)?

A

Ischemia

Cortical intracerebral haemorrhage

69
Q

What are the clinical signs of an anterior stroke?

A
  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
Q

What is Broca’s aphasia?

A

Expressive dysphasia- difficulty expressing language, but comprehension remains intact

71
Q

What is Wernicke’s aphasia?

A

Receptive dysphasia- difficulty comprehending language

72
Q

What are the clinical findings of Lacunar stroke?

A
  1. Contralateral UMN hemiparesis
  2. Contralateral hemisensory loss
  3. Contralateral positive Babinski sign
  4. NO cortical problems (too deep)
73
Q

Which arteries are affected in a posterior circulation stroke?

A

Vertebral

Basilar

74
Q

What are the clinical findings of a posterior circulation stroke? (POCS)

A
  1. Dizzyness, Vertigo
  2. Diplopia
  3. Dysphagia
  4. Dsyarthria
  5. Limb weakness
  6. Ataxia
  7. Cranial nerve palsies

Bilateral issues

75
Q

What are the clinical findings of a cerebellar stroke?

A 
Nausea and vomitting
Headache
Loss of balance
Vertigo
Nystagmus (involuntary eye movement)
76
Q

What are the consequences of a basilar artery thrombi?

A

Affects brainstem and occipital blood supply
Locked in syndrome
Respiratory arrest
Coma

77
Q

Which symptoms almost NEVER occur in a TIA?

A 
POSITIVE sensory symptoms: burning/ stinging
Global symptoms
Seizure like symptoms
Migraine
Symptoms which develop over time
78
Q

What is Amaurosis Fugax?

A

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
Q

What conditions can cause stroke mimics?

A 
Dementia
Seizure
Syncope
Sepsis
Migraine
Labyrinthitis
80
Q

What is dysarthria?

A

Difficulty articulating

81
Q

What is dysphonia?

A

Difficulty with voice production

82
Q

What can cause ACUTE weakness?

A
  1. Lacunar infarct
  2. Transverse myelitis
  3. Spinal shock
  4. Guillain- Barre syndrome
83
Q

What can cause SUBACUTE weakness?

A
  1. Spinal cord compression
  2. Myasthenia gravis
  3. Peripheral neuropathy
84
Q

Which CHRONIC conditions can cause weakness?

A
  1. Space occupying lesion
  2. Motor neurone disease
  3. Cervical spondolysis
  4. Myopathy
85
Q

What is transverse myelitis?

A

Acute inflammation of the spinal cord, usually post viral infection
Usually in younger people
Pain on onset

86
Q

What can cause spinal cord compression?

A

Disk prolapse

Secondary malignancy- breast, lung. prostate

87
Q

What are the key clinical features of myasthenia gravis?

A

SUBACUTE onset
PROXIMAL muscle weakness- difficulty climbing stairs
Remitting and relapsing muscle fatigue
Occular, bulbar, face and neck muscles affected
Ptosis and diplopia

88
Q

What is the pathophysiology of myasthenia gravis?

A

Autoimmune destruction of NAchR

89
Q

What are the key clinical features of cervical spondolysis?

A

Neck stiffness
Crepitus
Specific reflexes affected
Pain/ electrical sensation in arms/ fingers at compression level

90
Q

What are the key clinical features of MND?

A 
Foot drop
Spastic gait
Upgoing plantars
Speech affected
Proximal myopathy
Weak grip
NO sensory loss or sphincter disturbance
NO affect on eyes
91
Q

Which medication taken at a low dose for long term can cause myopathy?

A

Prednisolone

92
Q

What are the common sites of berry aneurysm rupture?

A

PCA junction with internal carotid
ACA with anterior communicating
Bifurcation of MCA

93
Q

What does the drug Nimodipine do?

A

Calcium antagonist

Reduces vasospasm and morbidity from ischemia

94
Q

What shape is an extra-dural haematoma on CT?

A

Biconvex/ lens shaped

95
Q

What shape is a sub-dural haematoma on CT?

A

Crescent shaped

96
Q

What happens to the severity of a migraine when laying down?

A

It improves

97
Q

What are the common features of migraines?

A 
Hemicranial
Photophobia
Auras
Improve on laying down
Nausea
May have associated symptoms: Restless legs, vertigo, neck or muscle pain
98
Q

What are the 4 stages of a migraine?

A
  1. Prodrome- hours
  2. Aura
  3. Migraine headache (with associated symptoms)
  4. Post drome
99
Q

What are the best treatments for migraines?

A
  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
Q

What causes Trigeminal Autonomic Cephalalgias?

A

Autonomic activation on ONE side (hemicranial)

101
Q

What are the types of TAC?

A

Hemicrania continua
Cluster headaches
Parxoysmal hemicrania
SUNCT

102
Q

What is the treatment for Trigeminal Neuralgia?

A

Sodium channel blockers eg. Carbamazepine

103
Q

What are the partial triggers for migraines?

A 
C- Chocolate
H- Hangovers
O- Orgasms
C- Cheese/ caffeine
O- Oral contraceptive
L- Lie-in
A- Alcohol
T- Travel
E- Exercise
104
Q

Compare Parkinson tremor to essential tremor.

A

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
Q

How is Essential Tremor treated?

A

Beta blocker- propanolol
Primidone (type of Diazepam)
Alprazolam

106
Q

What are the potential causes of blackout?

A
  1. Vasovagal syncope
  2. Situational syncope
  3. Epilepsy
  4. Orthostatic hypotension
  5. Hypoglycaemia
  6. Stokes Adams attack
  7. Carotid sinus syncope
107
Q

What are the potential causes of vertigo?

A
  1. Benign positional vertigo
  2. Labyrinthitis
  3. Meniere’s disease
  4. Ototoxicity- Aminoglycosides, Cisplatin, Loop diuretics
  5. Acoustic neuroma
108
Q

What are the key features of a cerebellar lesion?

A 
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
Q

What are some clinical features of Bell’s Palsy?

A 
CNVII affected:
Unilateral facial weakness (LMN- cant wrinkle forehead)
Numbness around ear
Mouth sagging
Saliva drooling
Hypersensitive to sounds
Decreased taste
110
Q

Which class of Parkinson drugs interacts with sinus decongestants?

A

MAOB Inhibitors (Rasagiline, Selegiline)

111
Q

What are the types of Parkinson’s drugs?

A
  1. Levo-dopa
  2. Carbidopa
  3. Dopamine agonist- Pramipexole, Ropinirole, Bromocrptine
  4. COMT inhibitors- Entacapone, Tolcapone
  5. MAOB inhibitors- Rasagiline, Selegiline
112
Q

Chorea is associated with ……….

A

Huntington’s

Levodopa use

113
Q

Hemiballismus is associated with………….

A

Stroke in subthalamic nucleus

Diebetes

114
Q

Athetosis is associated with ……………

A

Cerebral palsy

115
Q

Resting tremor is associated with………..

A

Parkinsons

116
Q

Intention tremor is associated with………….

A

Cerebellar lesion (stroke, MS)

117
Q

Postural tremor is associated with………….

A

Essential tremor

118
Q

Bromocriptine is what type of drug?

A

Dopamine agonist

119
Q

Pramipexole is what type of drug?

A

Dopamine agonist

120
Q

What sensory symptoms may be seen in MS?

A 
Dyaesthesia
Pins and needles
Visual disturbance
Loss of vibration sensation
Trigeminal neuralgia
121
Q

What motor symptoms may be seen in MS?

A

Trunk and limb atazia
Intention tremor
Falls
Scanning speech

122
Q

What sexual/GU symptoms may be seen in MS?

A

Incontinence
Erectile dysfunction
Anorgasmia
Urine retention

123
Q

85% of patients who experience a clinically isolated syndrome go on to develop…………

A

Relapsing Remitting MS

124
Q

in MS patients what may be found on lumbar puncture?

A

Oligoclonal IgG bands (not found in serum)

125
Q

Lhermitte’s sign is present in which condition?

A

Multiple sclerosis

126
Q

What is Charcot’s neurological triadf?

A
  1. Nystagmus
  2. Intention tremor
  3. Scanning speech

Found in MS

127
Q

What are the visual features of idiopathic intracranial hypertension?

A
  1. Reduced visual field
  2. Diplopia
  3. Blurred vision
  4. Blind spot
128
Q

Which drugs are used for treating idiopathic intracranial hypertension?

A

Acetazolamide
Topiramate
Loop diuretics
Prednisolone

129
Q

Which nerves are affected by a Bulbar Palsy?

A 
CN 9-12:
Glossopharyngeal
Vagus
Accessory
Hypoglossal
130
Q

What are the signs of a Bulbar Palsy?

A
  1. Quiet / hoarse voice
  2. Flacid, fasciculating tongue
  3. Normal or absent jaw jerk
131
Q

What are the signs of a PseudoBulbar Palsy?

A
  1. Increased jaw jerk
  2. Slow deliberate speech
  3. Slow tongue movement
  4. Giggling/ weeping
132
Q

Which nerves are affected by a Pseudobulbar palsy?

A

UMN
Corticobulbar tract
Bilateral

133
Q

What can cause a bulbar palsy? (LMN)

A
  1. MND
  2. Myasthenia gravis
  3. Gullain Barre syndrome
  4. Polio
  5. Central pontine myelinolysis
  6. Brainstem tumour
134
Q

What can cause a pseudobulbar palsy? (UMN)

A
  1. MND
  2. MS
  3. Stroke
  4. Central pontine myelinolysis
135
Q

Which condition is associated with cafe au lait spots, freckles in folds and Lisch nodules on the iris?

A

Neurofibromatosis Type 1

136
Q

Which condition results in dissociated sensory loss (loss of pain and temp) with weakness/ wasting of hands?

A

Syringomyelia

137
Q

Which nerve pathway does a syringomyelia press on?

A

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
Q

Lambert Eaton Myasthenic syndrome affects which part of the neurone?

A

Voltage gated calcium channels on pre-synaptic membrane

139
Q

Myasthenia Gravis affects which part of the neurone?

A

NAchR on post-synaptic membrane

140
Q

Which AEDs block voltage gated sodium channels?

A

Sodium valproate
Phenytoin
Carbamazepine
Lamotrigine

141
Q

Which AED blocks voltage gated calcium channels?

A

Phenytoin

142
Q

Which AEDs increase GABA levels?

A

Barbiturates

Benzodiazepines

143
Q

Which AED decreases glutamate levels?

A

Topiramate

144
Q

The superior division of the middle cerebral artery supplies where?

A

Broca’s area

Year 3 (22 decks)

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