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CP1 > Neurology > Flashcards

Neurology Flashcards

1
Q

What does the anterior cerebral artery supply?

A

Medial surface of cerebral hemisphere until the peri-occipital sulcus

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2
Q

Where does the middle cerebral artery supply?

A

2/3 of the lateral surface of the brain

Central branches supply the corpus striatum, thalamus and internal capsule

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3
Q

Where does the posterior cerebral artery supply?

A

Corpus callosum
Cortex of occipital and temporal lobes
Central branches supply the optic radiation, subthalamic nucleus and thalamus

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4
Q

Which arteries are the brainstem and cerebellum supplied by?

A

Vertebral and basilar

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5
Q

CN I functions

A

Olfactory

Special sensory: smell from nasal mucosa

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6
Q

CN II functions

A

Optic

Special sensory: vision from retina

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7
Q

CN III functions

A

Oculomotor
Somatic motor: medial, superior, inferior rectus muscles, inferior oblique
Visceral motor: pupil constriction

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8
Q

CN IV functions

A

Trochlear

Somatic motor: superior oblique extra-ocular muscle

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9
Q

CN V functions

A

Trigeminal
Opthalmic V1: sensory superior 1/3 of face + cornea
Maxillary V2: sensory median 1/3 of face
Mandibular V3: sensory mandible + lower lip, motor=masseter & pterygoids/muscles of mastication

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10
Q

CN VI functions

A

Abducent

Somatic motor: lateral rectus extra-ocular

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11
Q

CN VII functions

A

Facial
Somatic motor: muscles of facial expression
Visceral motor: submandibular/sublingual glands, lacrimal glands
Special sensory: taste from anterior 2/3 of tongue
General sensory: skin of external acoustic meatus

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12
Q

CN VIII functions

A

Vestibulocochlear

Special sensory: hearing (vestibular) and balance (cochlear)

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13
Q

CN IX functions

A

Glossopharyngeal
Somatic motor: stylopharyngeus
Visceral motor: parotid gland
Special sensory: posterior 1/3 of tongue
General sensory: external ear and pharynx sensation
Visceral sensory: visceral feedback from carotid body

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14
Q

CN X functions

A

Vagus
Somatic motor: palatal/laryngeal/pharyngeal muscles of swallowing
Visceral motor: parasympathetic innervation to smooth muscles of the trachea, bronchi, digestive tract, heart
Visceral sensory: sensation from trachea, bronchi, digestive tract, heart
Special sensory: taste from epiglottis/palate
General sensory: sensation from auricle and external acoustic meatus

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15
Q

CN XI functions

A

Accessory

Motor: sternocleidomastoid & trapezius

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16
Q

CN XII functions

A

Hypoglossal

Intrinsic/extrinsic muscles of the tongue

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17
Q

CN nuclei

A 
CN I: olfactory epithelium
CN II: retinal ganglion cells
CN III & IV: midbrain
CN V, VI, VII: pons
CN VIII: vestibular/spinal ganglion
CN IX, X, XII: medulla
CN XI: spinal cord
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18
Q

Bulbar palsy clinical presentation

A

LMN weakness of muscles supplied by cranial nerves with cell bodies within the medulla: IX, X, XII
Tounge: wasted, flaccid, fasciculating, fast movements
Dysphagia?
Soft palate elevation?
Quiet, nasal speech?
Jaw jerk/gag reflex absent?

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19
Q

Pseudobulbar palsy clinical presentation

A

Bilateral UMN disease of medullary cranial nerves
Tongue: stiff/spastic, slow movements, no wasting
Dysphagia?
Normal soft palate elevation
Gravelly ‘donald duck’ speech / slurred high pitched dysarthria
Exaggerated jaw jerk
Mood disturbances

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20
Q

Causes of bulbar palsy

A 
Degenerative: motor neurone disease
Vascular: stroke
Inflammatory: Guillain-barre
Infective: botulism
Neoplastic: brainstem tumours
Congenital
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21
Q

Causes of pseudobulbar palsy

A

Degenerative: MND
Vascular: stroke
MS
Head trauma

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22
Q

Frontal cerebral hemisphere lesion presentation

A

Intellectual impairment, personality change
Urinary incontinence
Mono/hemiparesis
Broca’s aphasia (if left frontal)

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23
Q

Left temporo-parietal cerebral hemisphere lesion presentation (dominant hemisphere)

A 
Agraphia: inability to write
Alexia: word blindness
Acalculia: inability to calculate
Wernicke's aphasia
Contralateral sensory neglect
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24
Q

Right temporo-parietal cerebral hemisphere lesion presentation

A

Failure of face recognition

Contralateral sensory neglect

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25
Occipital cerebral hemisphere lesion presentation
Visual field defects | Visuospatial defects
26
Lateral cerebellar lesion presentation
Ipsilateral pathological signs Broad, ataxic gait: test heel-toe walking, +ve Rhomberg test suggests sensory (rather than cerebellar) ataxia Titubation: rhythmic head tremor Dysarthria: slurred, staccato speech Nystagmus: towards the side of the lesion Dysmetric saccades: inability to change eye focus Upward drift (if pronator drift also present = UMN pathology also) Rebound phenomenon Hypotonia: decreased in pure cerebellar disease Mild hyporeflexia Dysmetria: imprecise coordination Dysdiadochokinesis: clumsy rapid alternating movements
27
Cerebellar examination investigations
Full neurological exam TFTs Antineuronal antibodies MRI brain
28
Midline cerebellar lesion presentation
Rolling, broad, ataxic gait Difficulty standing/sitting unsupported Cannot perform Rhomberg's with eyes open/closed Vertigo/vomiting if extension into 4th ventricle
29
Causes of bilateral cerebellar dysfunction
Alcohol Drugs: phenytoin, anti-epileptics Paraneoplastic cerebellar degeneration: antineuronal antibodies present, common with breast/SCC of lung Severe hypothyroidism
30
Causes of unilateral cerebellar dysfunction
MS Stroke Tumour: acoustic neuroma, meningioma
31
Components of the basal ganglia
Corpus striatum: caudate nucleus, globus pallidum, putamen Subthalamic nucleus Substantia nigra Parts of the thalamus
32
Basal ganglia lesion presentation
Bradykinesia progressing to akinesia: slowness of movement/loss of power of voluntary movement Muscle rigidity Involuntary movements... Tremor Dystonia: spasms Athetosis: writhing involuntary movements of hands/face/tongue Chorea: jerky involuntary movements Hemiballismus: violent involuntary movements, proximal muscles of one arm
33
Clinical syndromes resulting from basal ganglia pathology
Parkinsonism Huntingtons Hemiballismus
34
Causative lesion of a central scotoma
Macula lesion e.g. diabetic maculopathy
35
Causative lesion of monocular loss of vision
Ipsilateral optic nerve lesion
36
Causative lesion of bitemporal hemianopia/quadrantopia
Optic chiasm lesion Affects the nasal fibres from each eye Superior bitemporal quadrantanopia: pressure from below chiasm (e.g. pituitary tumour) Inferior bitemporal quadrantanopia: pressure from above the chiasm (craniopharyngoma, carotid aneurysm, meningioma)
37
Causative lesion of homonymous hemianopia
Contralateral optic tract lesion
38
Causative lesion of homonymous quadrantanopia
Contralateral optic radiation lesion... Temporal lesion: superior homonymous quadrantopias Parietal lesion: inferior homonymous quadrantopias PITS = parietal inferior, temporal superior
39
Causative lesion of macular sparing homonymous hemianopia/quadrantanopia
Defect in visual cortex (occipital lobe)
40
LMN signs
``` LMN innervate ipsilateral muscles Weakness Wasting Fasciculations Hypotonia Hyporeflexia Ipsilateral facial weakness in muscles of facial expression ```
41
LMN lesion differentials
Ventral horn pathology: MND, post-polio Peripheral nerve pathology Neuromuscular junction pathology: myasthenia gravis Muscular pathology
42
UMN signs
``` UMN innervate contralateral muscles Weakness: upper limb extensors, lower limb flexors No wasting Hypertonia, spasticity Hyperreflexia Loss of fine motor movements Pronator drift Extensor plantar response: Babinski Clonus Contralateral face weakness (sparing frontalis): brow furrowing, eye closing and blinking are preserved ```
43
UMN lesion differentials
``` Vascular: stroke Inflammatory: MS, MND Neoplastic: tumour Degenerative: Parkinson's Infective: post-meningitis Drugs ```
44
Spinothalamic tract anatomy
Trasmits pain, temperature, light touch to the thalamus | Decussates at spinal level
45
Dorsal columns anatomy
Fasciculus cuneatus & gracilis Transmits deep touch, propriception & vibration to pariatel cortex Decussates at brainstem
46
Corticospinal tracts anatomy
Transmits motor axons from the motor cerebral cortex to the spinal cord Decussates at the brainstem
47
Stroke definition
Acute, focal, neurological deficit of cerebrovascular origin that persists >24h
48
Transient ischaemic attack definition
Acute, focal neurological deficit of cerebrovascular origin that persists <1h MRI: no signs of cerebral infarction High risk of stroke within 4w of a TIA
49
Amaurosis fugax definition
Sudden transient loss of vision in one eye Often occurs with TIAs Can be 1st clinical sign of inferior cerebral artery stenosis Can occur due to ocular disease, migraine
50
Irreversible risk factors for ischaemic stroke
Age Personal/family history Hyper-coagulable states AF
51
Reversible risk factors for ischaemic stroke
``` Hypertension Hypercholesterolaemia DM Smoking Alcohol Poor diet Low exercise Increased weight Endocarditis Migraine Polycythaemia APL syndrome Vasculitis Amyloidosis ```
52
Risk factors for haemorrhagic stroke
``` Family history Uncontrolled hypertension Vascular abnormalities: aneurysms, atriovenous malformation, hereditary haemorrhagic telangiectasia Coagulopathies/anticoagulant therapy Recent heavy alcohol intake ```
53
Types of cerebral ischaemia
Regional infarction: thrombosis/embolus in large vessels, usually cortical areas Lacunar infarction: microinfarcts caused by arteriosclerosis, ususally sub-cortical, can be asymptomatic --> pseudoparkinsonism/vascular dementia Global ischaemia: infarcts at arterial boundary zones due to severe hypotension (watershed infarct) Severe: cortical laminar necrosis in 24h = vegetative state
54
Zones of cerebral ischaemic damage
Infarct core: tissue almost certain to die Oligaemic periphery: tissue that will survive due to collateral supply Ischaemic pneumbra: tissue in between
55
Clinical features of ischaemic stroke
``` Contralateral limb weakness/hemiplegia: first flaccid, then hyperreflexia, weakness recovers gradually over weeks/months Facial weakness Higher dysfunction Visual disturbances Epileptic fit (rare) ```
56
Higher dysfunction in ischaemic stroke
Expressive aphasia: Broca's Receptive aphasia: Wernicke's Apraxia: difficulty performing tasks despite intact motor function Asterognosis: inability to recognise objects, persons, sounds, shapes or smells despite senses/memory being intact Inattention: inability to attend to stimuli despite intact senses
57
Subarachnoid haemorrhage clinical presentation
'Thunderclap headache': comes on in seconds, high intensity, often occipital, during transient hypertension Vomiting: post-headache Photophobia Increasing drowsiness/coma Focal signs: may help locate lesion, may reflect raised ICP / cerebral vasospasm Neck stiffness Kernig's sign +ve Papilloedema: + retinal haemorrhages Prior 'sentinel headache': small warning leak from offending aneurysm
58
Subarachnoid haemorrhage predisposing abnormalities
``` Berry aneurysm (70%) Arteriovenous malformations (AVM - 10%) No lesion found (20%) ```
59
Berry aneurysm locations
Developmental (not congenital) In circle of Willis and adjacent arteries... Anterior communicating artery (most common) Posterior communicating artery: at bifurcation from inferior cerebral artery Middle cerebral artery: at bi/trifurcation
60
Berry aneurysm risk factors
``` Polycystic kidney disease Family history Smoking Hypertension Ehlers-Danlos/Marfans ```
61
Arteriovenous malformation pathology
Congenital collection of abnormal arteries/veins 10% rebleed annually Can cause focal epilepsy
62
Subarachnoid haemorrhage complications
Death: 30% Re-bleed: vasospasm clot from aneurysm holds for 3-4 days, AVMs rebleed within a few years Hydrocephalus: fibrosis in the CSF pathway Cerebral vasospasm: severe - delayed ischaemic damage
63
Acute subdural haematoma cause & presentation
Severe acceleration-deceleration head injury with co-existing brain damage Young Dilated pupil No lucid interval before decreased GCS
64
Subacute/spontaneous subdural haematoma risk factors
Spontaneous/minor trauma Elderly: cortical atrophy stretches brittle veins Alcohol abuse: clotting is reduced Coagulopathies
65
Subacute/spontaneous subdural haematoma presentation
``` Symptoms/signs of raised ICP develop around 3w after start of bleed, often fluctuant Headache Drowsiness Confusion Focal neurological signs Eventually: stupor & coma ```
66
CT presentation of acute subdural haematoma
Classical crescenteric shape with increased density (white) Conforms to contour of the skull May be accompanying midline shift & compression of ventricles
67
CT presentation of chronic subdural haematoma
Blood becomes more radiolucent (dark) | Assumes lentiform shape similar to an extradural haematoma
68
Causes of bacterial meningitis
Neisseria meningitidis: classic petechial rash, occurs in small epidemics Streptococcus pneumoniae: more common if skull fractures, ear disease, congenital CNS lesions Remainder (30%): Listeria monocytogenes (elderly/immunosuppressed), Haemophilus influenzae, Staph. aureus, TB
69
Viral causes of meningitis
Enteroviruses: coxsakievirus A/B, echoviruses HSV VZV
70
Clinical presentation of bacterial meningitis
``` Meningitic syndrome: headache, neck stiffness, fever High fever + rigors Photophobia Malaise Vomiting Confusion & seizures Kernig's sign +ve Brudzinski sign +ve Signs of raised ICP / cranial nerve palsies ```
71
Meningitis complications
Venous sinus thrombosis Severe cerebral oedema Hydrocephalus
72
Meningococcal meningitis presentation & causes
Petechial rash: erythematous, non-blanching purpura Carried in nasopharynx Most caused by meningitis C/B Meningitis ACWY jab at 14y
73
Viral meningitis presentation
Almost always a benign, self-limiting condition 4-10d Headache following for months
74
TB meningitis presentation
Insidious illness with fever, weight loss, progressive confusion/cerebral irritation --> coma May present as per bacterial meningitis
75
Meningitis investigations
Bloods: FBC, U&Es, LFTs, clotting, glucose, lactate Serum PCR: pneumococcal & meningococcal antigens Blood cultures: prior to abx Lumbar puncture: if clinical suspicion of a mass lesion: send for MCS protein, glucose, PCR CT prior to lumbar puncture: if suspected raised ICP 2x throat swabs: virology + bacteriology
76
CSF stains demonstrating organisms
Gram +ve intracellular diplococci: Pneumococcus Gram -ve cocci: Meningococcus Ziehl-Neesen stain for acid-fast bacilli: TB Indian stain: fungi
77
CSF findings for bacterial/TB/viral meningitis/encephalitis
Bacteria: tubid fluid, high polymorphs Virus: clear fluid, high lymphocytes, normal glucose TB: raised lymphocytes, raised polymorphs

CP1 (12 decks)

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