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Neurology Flashcards

1
Q

How does a CN1 lesion present?

A
  • Anosia (uni or bilateral) aka loss of smell
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2
Q

What are the common causes of CN1 lesion? (4)

A
  • Trauma
  • Respiratory tract infection
  • Meningitis
  • Frontal lobe tumour
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3
Q

How does a CN2 lesion present?

A
  • Low acuity/visual field defect

- optic disc problems

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4
Q

What can cause a CN2 lesion?

A
  • MS
  • giant cell arteritis
  • diabetes
  • optic chiasm compression
  • glaucoma
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5
Q

How does a CN3 lesion present?

A
  • Eyes go ‘down and out’ due to unopposed action of CN4 and 6
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6
Q

What can cause CN3 lesion?

A
  • MS
  • DM
  • Giant cell arteritis
  • Posterior communicating arterty aneurysm
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7
Q

How does a CN4 lesion present?

A
  • Diplopia on looking down
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8
Q

What can cause CN4 lesion?

A
  • usually due to trauma to orbit

- rare

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9
Q

How does a CN6 lesion present?

A
  • Horizontal diplopia on looking out
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10
Q

What causes CN6 lesion?

A
  • MS

- Pontine stroke

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11
Q

How does a CN5 lesion present?

A
  • Motor = open jaw deviating to side of lesion

- Sensory = V1/2/3 pathology/ diminished corneal reflex

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12
Q

What can cause a CN5 lesion?

A
  • Motor = rare but stroke

- Sensory = trigeminal neuralgia or herpes zoster

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13
Q

How would a CN7 lesion present?

A
  • Droop and weakness

- Loss of taste in anterior 2/3 tongue

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14
Q

What can cause a CN7 lesion?

A
  • Bell’s Palsy
  • Otitis media
  • Skull fracture
  • stroke
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15
Q

What is Bell’s Palsy?

A
  • Paralysis of facial nerve which causes muscular weakness on one side of the face
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16
Q

What can cause Bell’s Palsy?

A
  • TB
  • HIV
  • Polio
  • Sarcoid
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17
Q

What can happen to eyes and ears in Bell’s palsy?

A
  • Eyes rotate up and out when try to close

- Ears hypersensitive

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18
Q

What is a dermatome?

A

An area of skin supplied by a single spinal nerve

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19
Q

What is a myotome?

A

A volume of muscle supplied by a single spinal nerve

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20
Q

Describe the common carotid artery.

A
  • R = arises from brachiocephalic trunk
  • L = arises from aortic arch
  • No branches
  • Bifurcate at approx. C3-4
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21
Q

What are the 4 lobes of the cortex?

A
  • Frontal
  • Parietal
  • Occipital
  • Temporal
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22
Q

What are the two “feeder” arteries into the Circle of Willis?

A
  • Internal carotid

- Vertebral arteries

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23
Q

What is the role of the frontal lobe?

A
  • Voluntary movement on opposite side of body
  • Controls speech and writing
  • Thought processes, reasoning and memory
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24
Q

What is the role of the parietal lobe?

A
  • Receives and interprets sensations e.g. pain, pressure, size and body awareness
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25
Q

What is the role of the temporal lobe?

A
  • Understanding spoken word

- Memory and emotion

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26
Q

What is the role of the occipital lobe?

A
  • Understanding visual images and meaning of written words
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27
Q

What is the role of the cerebellum?

A
  • Co-ordinates movement and balance
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28
Q

What would injury to the cerebellum lead to? (5)

A
  • Movements that are slow and uncordinated
  • Asynergia = loss of coordination
  • Intention tremor = movement tremor
  • Hypotonia = weak muscles
  • Nystagmus = abnormal eye movement
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29
Q

What is the function of the brainstem?

A
  • Special senses
  • regulates consciousness
  • autonomic regulation of body
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30
Q

What is schizophrenia?

A
  • Described as type of psychosis
  • Positive and negative symptoms
  • Mental health disorder
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31
Q

What are some symptoms of schizophrenia?

A
  • Positive include delusions, thought disorder, hallucinations
  • Negative include withdrawn, unemotional, unable to carry on with everyday activities
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32
Q

What are the 6 muscles that move the eyeball?

A
  • Lateral rectus
  • Medial rectus
  • Superior rectus
  • Inferior rectus
  • Superior oblique
  • Inferior oblique
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33
Q

What is the role of the levator palpebrae superioris?

A
  • Lifts the upper eyelid

- Loss of function gives ptosis

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34
Q

What is the function of the 4 rectus muscles?

A
  • Lateral = pulls laterally (abduction)
  • Medial = pulls medially (adduction)
  • Superior = pulls up and medially and rotates
  • Inferior = pulls down and medially and rotates
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35
Q

Describe the semi-circular canals.

A
  • Accelerometers
  • sit in the petrous part of temporal bone
  • the fluid present in the canal stays where it is
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36
Q

What is defective outer or middle ear loss called?

A
  • Conductive hearing loss
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37
Q

What is defective inner ear hearing loss called?

A
  • Sensorineural hearing loss
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38
Q

What are the two types of stress?

A
  • Eustress = good. Positive which is beneficial and motivating
  • Distress = bad. Negative which is damaging and harmful
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39
Q

What is the difference in acute and chronic stress?

A
  • Acute = response to novel situation experience as danger. Examples include illness, noise, short-term danger
  • Chronic = repeated exposure. Examples include physical illness, unemployment, poverty
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40
Q

Describe the HPA axis.

A
  • Perceived danger
  • Hypothalamus
  • Pituitary
  • Adrenal cortex
  • Stress response
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41
Q

What are physiological examples of stress responses

A
  • Breathing rapidly, increasing oxygen
  • Blood flow increase
  • Increase HR and BP
  • Sweating
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42
Q

What are the symptoms of PTSD?

A
  • Flashbacks/nightmares
  • Sweating
  • Nausea
  • Insomnia
  • Impaired concentration
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43
Q

What is allostatic load?

A
  • Refers to cumulative exposure to stressors, leads to ‘wearing out’
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44
Q

What is the difference between acute and chronic pain?

A
  • Acute = pain less than 12 weeks

- Chronic = continuous pain over 12 weeks

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45
Q

What is nociceptive pain?

A
  • Arises from actual or threatened damage and is due to activation of nociceptors
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46
Q

Describe the spinothalamic tract

A
  • Sensory carries pain, temperature and crude touch from the body
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47
Q

Describe the trigemino-thalamic tract

A
  • Sensory pathway carrying pain, temperature and touch from the face/neck/head
  • Contributions from trigeminal, facial, vagus and CNVI
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48
Q

Describe the insular cortex. (2)

A
  • Plays a role in perception, motor control and self-awareness
  • Degree of pain is judged here
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49
Q

Describe the cingulate cortex. (2)

A
  • Linked with limbic system, so associated with emotion formation and processing
  • Maintains connections with pain processing areas
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50
Q

What are some examples of symptoms of depression?

A
  • Low mood, anhedonia, low energy

- Cognitive symptoms include guilt, hopelessness and suicidal thoughts

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51
Q

What is the function of the amygdala? (3)

A
  • Receives highly processed information
  • Emotional memory
  • Mediates fear response
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52
Q

What are the types of head injury?

A
  • Non-missile (blunt)

- Missile, where penetration of skull or brain

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53
Q

What are examples of focal damage through a blunt head trauma?

A
  • Scalp laceration
  • ## Skull fracture
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54
Q

What would a skull fracture lead to?

A
  • Increased risk of haematoma
  • Infection
  • Aerocele (air getting in)
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55
Q

What type of surfaces cause linear fractures?

A
  • Flat surfaces

- One fracture line will not cross a pre-existing fracture line

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56
Q

What is an extradural haematoma? (4)

A
  • Between inner surface of skull and dura
  • Associated with skull fracture
  • Occurs slowly over hours
  • Classified with how deep into the brain meninges it is
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57
Q

Which artery is at danger in a skull fracture?

A
  • Middle meningeal artery as it is slow bleeding
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58
Q

What is a subdural haematoma? (3)

A
  • Between dura mater and arachnoid mater
  • usually due to tears in bridging veins
  • Slow constant bleed, which can be acute or chronic
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59
Q

What are causes of a subarachnoid haematoma? (3)

A
  • Contusion/lacerations
  • Base of skull fracture
  • Vertebral artery rupture
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60
Q

What are superficial cerebral and cerebellar haemorrhages due to?

A
  • Severe contusion

- leaves ‘bruising’

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61
Q

What are deep cerebral and cerebellar haemorrhages due to?

A
  • Diffuse axonal injury or vascular injury
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62
Q

What are infections in the brain due to?

A
  • Skull fracture
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63
Q

What is the damage mechanism for accelerated or decelerated damage?

A
  • Force to head causes DIFFERENTIAL MOVEMENT
  • contusion
  • traction on bridging veins can cause subdural haemorrhage
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64
Q

What is the difference between “coup” and “contre coup”?

A
  • Coup is at the site of impact

- Contre coup is away from the site of impact. If you bouncem the brain goes backwards

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65
Q

What is a contusion?

A
  • Superficial “bruise” of the brain
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66
Q

What is a laceration?

A
  • When contusion is severe enough that it tears the pia mater
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67
Q

What is a diffuse axonal injury?

A
  • Syndrome of widespread axonal damage

- can be caused by a variety of processes

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68
Q

What is a traumatic axonal injury?

A
  • involves acceleration and deceleration of the head
  • If mild, will recover but with variable severity
  • If severe, unconscious from impact and can be severely disabled
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69
Q

What is a diffuse vascular injury?

A
  • Results in near immediate death

- generally the more important vessels and axons

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70
Q

What is brain swelling?

A
  • Occurs in 75% patients

- Leads to increased intracranial pressure

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71
Q

What can herniation be due to?

A
  • Bleeding

- Brain swelling

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72
Q

What is hypoxia-ischaemia?

A
  • Insufficient blood flow
  • Can cause infarction and ischaemic damage
  • Heart finds it heart to keep BP up
  • Can be widespread or confined
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73
Q

What is chronic traumatic encephalopathy?

A
  • type of dementia associated with repeated blows to the head and recurrent episodes of concussion
74
Q

What is meningitis?

A
  • Inflammation of the meninges
75
Q

How can the meningitis infection enter the head?

A
  • Extracranial infection e.g. nasal carriage, otitis media, sinusitis
  • Via bloodstream
  • Neurosurgical complications = trauma, post-op etc
76
Q

Describe the pathophysiology of meningitis. (4)

A
  • bacteria enters CSF, which then replicates
  • blood vessels become leaky
  • WBCs enter CSF, meninges and brain
  • causes brain swelling
77
Q

What are the symptoms of meningitis?

A
  • Fever
  • Headache
  • Neck stiffness = meningism
78
Q

What are the 1st line antibiotics for meningitis?

A
  • Ceftriaxone or cefotaxime
79
Q

If suspected meningitis, what are the steps to do at hospital?

A
  • Assess GCS
  • Blood cultures
  • Broad spectrum antibiotics
  • Steroids (IV dexamethasone)
  • Lumbar puncture
80
Q

What is the definitive investigation to diagnose meningitis?

A
  • Lumbar puncture
81
Q

What are the most common bacteria in meningitis?

A
  • Neisseria meningitidis (gram -ve cocci)

- Strep. pneumoniae (gram +ve cocci)

82
Q

What are the most common viral infections in meningitis?

A
  • Enterovirus
  • HSV
  • Varicella Zoster virus
83
Q

After meningitis has been diagnosed, what should you do?

A
  • Call Public Health England

- Identify close contacts - give antibiotic prophylaxis e.g. rifampicin

84
Q

What is encephalitis?

A
  • Inflammation of the brain
85
Q

What are the causes of encephalitis?

A
  • Usually viral
  • Herpes simplex
  • Varicella Zoster
  • TRAVEL e.g. Japanese, tick-borne, rabies
86
Q

What are the symptoms of encephalitis?

A
  • “Flu-like” illness
  • THEN
  • Altered GCS, fever, seizures, memory loss
87
Q

How do you investigate encephalitis?

A
  • MRI
  • Lumbar puncture
  • HIV test
88
Q

What is the treatment for encephalitis?

A
  • Mostly supportive in neuro rehabilitiation

- If HSV or VSV = aciclovir

89
Q

What is tetanus?

A
  • Inoculation through skin with C. tetani spores

- eg. dirty wounds, stepping on a nail

90
Q

How do you manage tetanus?

A
  • PREVENTION = vaccine

- If symptoms = supportive with muscle relaxants and metronidazole for residual bacteria

91
Q

What is rabies?

A
  • Inoculation through skin with saliva of rapid animal

- if reaches CNS, gives paralytic presentation

92
Q

What is Alzheimer’s Disease?

A
  • Chronic neurodegenerative disease

- Gradual onset and progressive

93
Q

What is the criteria for AD?

A
  • Gradual and progressive changes in memory function over 6 months
  • Amnestic syndrome of hippocampal type
94
Q

What is the pathology for AD?

A
  • Decreased A beta 1-42, with increase T/P-tau in CSF

- Increased amyloid PET

95
Q

What are the symptoms and features for AD?

A
  • Sudden onset
  • Early occurence of gait disturbances and behavioural changes
  • Early hallucinations
  • Cognitive fluctuations
96
Q

What are the key features of Multiple Sclerosis?

A
  • Inflammatory, demyelinating disease
  • Specific to CNS
  • Progressive disability over time
  • usually between 20-40 years
97
Q

Where are the common sites for plaque distribution in MS?

A
  • Cerebral hemispheres
  • Spinal cord
  • Optic nerve
98
Q

What are the typical symptoms in MS?

A
  • Optic neuritis (impaired vision and eye pain)
  • Spasticity
  • Sensory symptoms and signs
  • Nystagmus, double vision
  • Bladder and sexual dysfunction
99
Q

How would you diagnose MS?

A
  • Essential diagnostic criteria for MS includes 2 or more lesions
  • Exclusion of conditions giving a similar picture
100
Q

What is the treatment for mild MS?

A
  • Oral medications e.g. baclofen, diazepan

- Tremor = propanol, phenobarbitone

101
Q

What is the treatment for severe MS?

A
  • Disabiling spasticity = phenol

- Severe = intrathecal baclofen

102
Q

What are the characteristics of an epileptic seizure?

A
  • Duration = 30-120s

- Stereotypical seizures

103
Q

What are the characteristics of a non-epileptic seizure?

A
  • Situational
  • Duration = 1-20 mins
  • dramatic motor phenomena or prolonged atonia
  • Eyes closed
104
Q

What commonly made mistakes are made with diagnosing epilepsy?

A
  • Incomplete history
  • Misinterpretation syncopal, myoclonic jerks
  • Misinterpretation of EEG changes
105
Q

What is focal epilepsy?

A
  • Associated with focal brain abnormality
  • Can start at any age
  • Types of seizures are partial with or without loss of consciousness
106
Q

What is the first line treatment for focal epilepsy?

A
  • Carbamazepine or Iamotrigine
107
Q

What is idiopathic generalised epilepsy?

A
  • No associated brain abnormality
  • Usually <30 years
  • Types of seizures include absence, myoclonic or tonic clonic
108
Q

Which epilepsy types give absence seizures?

A
  • Childhood absence

- Juvenile absence

109
Q

What is treatment for primary generalised epilepsy?

A
  • Emergency = IV lorazepam

- Valproate or Iamotrigine

110
Q

What is ischaemic stroke?

A
  • A blood vessel in the brain that is blocked
111
Q

What is the differential diagnosis of a stroke?

A
  • Hypoglycaemia
  • Labyrinthine disorders
  • Migrainous aura
  • Mass lesions
112
Q

What is an embolic stroke?

A
  • Death of cell bodies in the cortex

- No recovery

113
Q

What is ataxia?

A
  • Will movements are clumsy, ill-directioned or uncontrolled
114
Q

What are the clinical features of upper motor neurone pathology?

A
  • Muscle tone INCREASED
  • tendon reflexes
  • Upper limb extensors WEAKER than flexors
  • Lower limb flexors WEAKER than extensors
  • Emotional lability
115
Q

What are common causes for upper motor neuron pathology?

A
  • Vascular disease
  • Inflammatory e.g. MS
  • Spondylosis
  • Neurodegenerative disease
116
Q

How would you investigate UMN problems?

A
  • MRI
  • Bloods = metabolic disorders
  • CSF examination
117
Q

What is a glioma?

A
  • Most common primary brain tumour of glial cells

- Divided into WHO grades

118
Q

Describe low-grade gliomas (WHO2).

A
  • Slow growing but can undergo transformation

- Median age = 35yrs

119
Q

Describe high-grade gliomas (HGG)

A
  • 85% of all new cases of malignant primary brain tumours
  • Median age onset 45-60
  • Majority - no cause
120
Q

What are some symptoms of brain tumours?

A
  • Depends on type and site
  • headache
  • seizures
  • focal neurological symptoms
121
Q

What are the different focal and non-focal symptoms that patients can get?

A
  • Focal = weakness, sensory loss, visual/speech disturbance, ataxia
  • Non-focal = personality change, memory disturbance, confusion
122
Q

How would you investigate a brain tumour?

A
  • CT and MRI

- brain biopsy

123
Q

What is the treatment for brain cancer?

A
  • Non-curative generally

- Depends

124
Q

What is the treatment for HGG tumour?

A
  • Steroids - reduce oedema
  • Surgery - resection
  • radio and chemo
125
Q

What is the treatment for LGG tumour?

A
  • Surgery - early resection

- radiotherapy - delay disease transformation

126
Q

What is Parkinson’s Disease?

A
  • A condition in which parts of the brain become progressively damaged over many years
127
Q

What are the symptoms of Parkinson’s Disease?

A
  • Brady/akinesia
  • Tremor (may be unilateral)
  • Rigidity (pain)
128
Q

What is the pathology related to PD?

A
  • Substantia nigra has reduced

- Lewy bodies are present

129
Q

What can cause cell loss in substantia nigra?

A
  • Inherited factors = susceptibility factors and Parkinson genes
  • Environmental factors = risk factor and toxin induced
130
Q

What is the treatment for PD?

A
  • No cure or disease-modifying treatment
  • L-Dopa
  • Dopamine agonists
  • COMT/MAO-B inhibitors
131
Q

What are the side effects of anti-cholinergics?

A
  • Cognition
  • Confusion
  • Systemic
132
Q

What are the side effects of L-dopa?

A
  • The higher the dose, the greater the risk

- READ

133
Q

What is the 1st line treatment in younger PD patients?

A
  • DA agonists e.g. ropinirole
134
Q

What are the side effects in DA agonists?

A
  • Tiredness
  • Gambling
  • Hypersexuality
135
Q

What other problems are associated with PD?

A
  • Depression (20-40%)
  • Phobias, anxiety
  • Dementia
  • Autonomic problems
136
Q

What is essential tremor?

A
  • A nerve disorder characterized by uncontrollable shaking in different parts and on different sides of the body
137
Q

What are the symptoms of essential tremor?

A
  • Uncontrollable shaking
  • Shaking voice
  • Nodding head
  • Worsen during stress
  • Lessen with rest
138
Q

What is the treatment for essential tremor?

A
  • Beta-blockers

- Primidone

139
Q

What is contraindicated in beta-blockers for essential tremor?

A
  • Asthma

- Diabetes

140
Q

What is Huntington’s Disease?

A
  • Inherited disorder which results in death of brain cells
141
Q

What are the symptoms in HD?

A
  • Involuntary movements like jerking
  • rigidity
  • muscle contracting (dystonia)
  • dementia
  • psychiatric problems e.g. personality change or depression
142
Q

What is the treatment for HD?

A
  • Chorea = sulpiride
  • Depression = SSRIs
  • Psychosis = haloperidol
143
Q

What is dystonia?

A
  • Movement disorder where the muscles contract uncontrollably
144
Q

What are symptoms of cerebellar dysfunction?

A
  • Slurring of speech
  • Swallowing difficulties
  • Blurred vision (not common)
  • Clumsiness
  • Tremor
145
Q

What are signs of cerebellar dysfunction?

A
  • Dysarthria (speech)
  • Nystagmus
  • Limb ataxia
146
Q

What can help in the diagnostic history for cerebellar dysfunction?

A
  • Congenital vs onset
  • Rate of progression
  • Episodic
  • Speech affected early
147
Q

What is the most common cause of progressive ataxia?

A
  • Sporadic (80%)
148
Q

What are types of primary headache?

A
  • Migraine
  • Cluster
  • Tension type
149
Q

What are types of secondary headache?

A
  • Meningitis
  • Subarachnoid haemorrhage
  • Medication overuse headache
150
Q

In a pt history, what should you think about if considering further investigation of headaches?

A
  • 50+
  • History of HIV, cancer, or trauma
  • Change in personlity
  • Vomiting without other obvious cause
151
Q

In a pt exam, what should you think about if considering further investigation of headaches?

A
  • Fever
  • Altered consciousness
  • Neck stiffness
  • Other abnormal neurological exam
152
Q

If someone describes their headache as ‘thunderclap’, what is it?

A
  • Subarachnoid haemorrhage
153
Q

If someone presents with a red eye(s) and headache, what is suspected?

A
  • Acute glaucoma
154
Q

What is a migraine without aura?

A
  • The headache occurs without the specific signs
155
Q

What are the criteria for a migraine without aura?

A
  • 5 attacks
  • Attacks last 4-72 hours
  • Two of unilateral, pulsing and moderate
  • Have nausea and/or vomiting and photophobia
  • not attributed to another disorder
156
Q

What is the preventive treatment of migraine?

A
  • Topiramate or propranolol
  • Riboflavin may be effective
  • Botulinum toxin type A for chronic migraine
157
Q

How would you investigate SAH?

A
  • CT scan 95% sensitive
  • LP
  • Angiography
158
Q

What is the management for SAH?

A
  • Resuscitation
  • Nimodipine
  • Early intervention to prevent re-bleeding
159
Q

What is papilloedema?

A
  • Optic disc swelling caused by increased ICP
  • Bilateral
  • Can occur over hours-weeks
160
Q

What is idiopathic intracranial hypertension?

A
  • Build-up of pressure around the brain
161
Q

What is the symptoms of IIH?

A
  • constant throbbing headache
  • blurred or double vision
  • temporary loss of vision
162
Q

What is the management of IIH?

A
  • Modify risk factors (obesity and drug use)

- Drugs = acetazolamide, topiramate, diuretics

163
Q

What is Giant Cell Arteritis?

A
  • 50+
  • New headache
  • Temporal tenderness and decreased pulsation
  • ESR elevated
  • Jaw claudication
164
Q

What would a ACA stroke lead to?

A
  • Leg weakness
  • Sensory disturbance in legs
  • Gait apraxia
165
Q

What would a MCA stroke lead to?

A
  • Contralateral arm and leg weakness
  • Contralateral sensory loss
  • Hemianopia
  • Dysphasia
  • Facial droop
166
Q

What would a PCA stroke lead to?

A
  • Contralateral hemianopia
  • Cortical blindness
  • Dyslexia, anomic aphasia
  • Unilateral headache
167
Q

What is a transient ischaemic attack (TIA)?

A
  • Focal, sudden onset lasting less than 24hrs

- Complete clinical recovery

168
Q

What is the investigation for TIA?

A
  • ABCD2 = risk score of a stroke
169
Q

What is the treatment for TIA?

A
  • Modify risk factors
  • Aspirin
  • Clopidogrel
  • Statin e.g. simvastatin
170
Q

What is the pathology behind migraines?

A
  • Changes in brainstem blood flow
  • Unstable trigeminal nerve in basal thalamus
  • Release of CGRP and substance P
  • Vasodilatation
171
Q

What is trigeminal neuralgia?

A
  • Unilateral pain confined to one or more divisions of the trigeminal nerve
172
Q

What are triggers of trigeminal neuralgia?

A
  • Washing affected area
  • Shaving
  • Eating
  • Dental prostheses
  • talking
173
Q

What is the medication for trigeminal neuralgia?

A
  • 1st = carbamazepine (anti-convulsant)

- 2nd = phenytoin or gabapentin

174
Q

What is the investigation for GCA?

A
  • Temporal artery biopsy

- Bloods for raised inflammatory markers

175
Q

What is the treatment for GCA?

A
  • Prednisolone (steroid)
  • aspirin
  • PPI (omeprazole)
176
Q

For chronic MS, what is the treatment?

A
  • 1st = beta interferon
  • 2nd = alemtuzumab
  • symptom management
177
Q

What is spinal cord compression?

A
  • Results in UN signs and specific symptoms depending on where compression is
178
Q

What is radiculopathy?

A
  • Compression of nerve root at LMN
179
Q

What is polyneuropathy?

A
  • Multiple/systemic

- diabetes, MS, Guillian Barre

180
Q

What is Guillian Barre syndrome?

A
  • Demyelinating polyneuropathy in the PNS
  • Progressive ascending muscle weakness
  • Varies from mild-severe
181
Q

What is the treatment for Guillian Barre syndrome?

Yr1 (13 decks)

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