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EOY4 > Neurology > Flashcards

Neurology Flashcards

1
Q

What medication can be used for hyperprolactinaemia?

A

Dopamine agonists eg bromocriptine

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2
Q

Is sodium likely to be high or low in raised intracranial pressure?

A

Hyponatraemia

Due to inappropriate ADH secretion

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3
Q

How is Guillain Barre treated?

A

IV immunoglobulins and plasmapheresis

Ventilators support of affecting respiratory muscles

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4
Q

What is the treatment for Ramsay Hunt syndrome?

A

Oral aciclovir and corticosteroids

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5
Q

Lateral medullary syndrome occurs following occlusion of which artery?

A

Posterior inferior cerebellar artery

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6
Q

How can lateral medullary syndrome present?

A

Brainstem features
Ipsilateral: Horners, CN signs, cerebellar signs (DANISH), facial numbness, vocal cord paralysis
Contralateral: reduced pain and temperature sensation (spinothalamic tracts)

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7
Q

What will a lumbar puncture show if there has been a subarachnoid haemorrhage?

A

Xanthochromia

Take 12 hours to develop, more uniform that a blood tap

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8
Q

How does idiopathic intracranial hypertension usually present?

A 
Headache
Blurred vision
Papilloedema
Enlarged blind spot
Sixth nerve palsy
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9
Q

What are some risk factors for idiopathic intracranial hypertension?

A

Young woman
Obese
Pregnancy
Steroids, tetracyclines, COCP, lithium

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10
Q

How would you managed a patient with idiopathic intracranial hypertension?

A 
Weight loss
Diuretics 
Topirimate (also added benefit of causing weight loss)
Repeated LP
Shunt if necessary
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11
Q

How may a patient with Charcot Marie tooth disease present?

A 
High arched foot
Hammer toes
Inverted champagne bottle legs
Reduced tone
Reduced sensation of peripheries 
Weakness in hands and legs
Neuropathic pain
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12
Q

What is the inheritance pattern of spinal muscular atrophy?

A

Autosomal recessive

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13
Q

What is Guillain Barre syndrome?

A

Autoimmune destruction of peripheral nerves often preceded by infection
Causes rapid onset muscle weakness that is symmetrical and usually an ascending polyneuropathy (starts at feet and spreads)
Very few sensory signs, but areflexia

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14
Q

How is Guillain Barre managed?

A

IV immunoglobulins
Ventilation if involvement of respiratory muscles
Most patients will make a complete recovery, may need PT, OT, SALT to rehabilitate

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15
Q

How is sensation affected in motor neurone disease?

A

Characteristically NO sensory involvement

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16
Q

What is the presentation of motor neurone disease?

A

UMN and LMN lesions (LMN signs are more predominant) so weakness, wasting, fasciculations, bulbar signs, reduced reflexes
No sensory involvement, no autonomic involvement, never affects eye movements, no cerebellar signs

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17
Q

What is multiple sclerosis?

A

Autoimmune demyelination of axons in the central nervous system

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18
Q

What are some risk factors for multiple sclerosis?

A 
Female gender
Family history
Living further away form the equator
Smoking 
EPV
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19
Q

How can multiple sclerosis present?

A

Motor: Spastic weakness
Sensory: pins and needles, numbness, trigeminal neuralgia
Visual: optic neuritis
Cerebellar: ataxia, tremor
Other: urinary incontinence, sexual dysfunction

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20
Q

How does pregnancy affect patients with multiple sclerosis?

A

Risk of relapses decreases during pregnancy but increases transiently postpartum

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21
Q

How should MS be managed?

A 
Conservatively: quick smoking, healthy diet, intermittent catheterisation, exercise, reduce stress
Relapse: high dose prednisolone oral or IV 5 days
Long term: DMARDs eg beta interferon
Cannabinoids
Neuropathic pain analgesics
Oxybutynin for urge incontinence
Physio for spasticity
SSRI for depression
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22
Q

What medication may slow the progression of motor neurone disease?

A

Sodium channel blockers eg riluzole

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23
Q

What 3 criteria must be met for a stroke to be classified as a total anterior circulation stroke (TACS) on the bamford classification?

A
  1. Homonymous hemianopia
  2. Unilateral motor +/- sensory weakness
  3. Focal neurological deficit
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24
Q

Wernicke’s aphasia is caused by a stroke affecting which artery?

A

In parietal/ temporal lobe region so is due to anterior cerebral artery stroke

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25
Q

Broca’s aphasia is due to a stroke affecting which artery?

A

Middle cerebral artery (in frontal lobe by the motor homonculus and is very laterally placed hence MCA)

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26
Q

How would you manage an ischaemic stroke?

A

Thrombolysis (IV alteplase) once an haemorrhagic stroke has been excluded and if within 4.5 hours onset

Thrombectomy (for large vessel occlusion, with thrombolysis if within 6 hours, alone if within 6 to 24 hours

Anti thrombotic therapy (300mg aspirin for 2 weeks then 75mg OD, plus clopidogrel 75mg OD

Cardotid endarterectomy If carotid Disease

Also control modifiable risk factors, rehabilitate, driving restriction

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27
Q

Are signs ipsilateral or contralateral for cerebellar lesions?

A

Ipsilateral

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28
Q

For a stroke affecting the anterior cerebral artery, would the motor and sensory loss affect the upper or lower limbs more?

A

Lower limbs

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29
Q

When should anticoagulation be started after an ischaemic stroke?

A

2 weeks after, to prevent transformation to a haemorrhagic stroke

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30
Q

Ho long is driving restricted for after a stroke?

A

4 weeks

31
Q

What investigations would you do after a stroke to find the cause?

A

Carotid Doppler
ECG (AF)
BP (HTN)

32
Q

What are some absolute contraindications to thrombolysis?

A 
Previous haemorrhagic brain bleed
LP in last week
Seizure at onset of stroke
Pregnancy 
Arteriovenous malformation
Active internal bleeding
Intracranial neoplasm
Coagulation disorder
Severe liver disease
Stroke in last 3months
Severe hypertension
33
Q

What is the triad seen in Parkinson’s disease?

A

Cogwheel rigidity
Pill rolling tremor (worse at rest, 4-6Hz)
Bradykinesia (slow to initiate movement)

34
Q

How does Parkinson’s present?

A

Triad (rigidity, tremor and bradykinesia)
Typical asymmetrical
Also depression, micrographia, hypotonia, shuffling gait, “mask face”, dementia, postural instability, sleep disturbance

35
Q

How does benign essential tremor differ to a Parkinson’s tremor?

A

Parkinson’s tremor worse at rest, 4-6Hz, asymmetrical,no change with alcohol, additional Parkinson’s symptoms

Benign essential tremor improves on rest, 6-8Hz, symmetrical, improves with alcohol, no additional Parkinson’s symptoms

36
Q

What medications can be used for Parkinsons?

A

L-dopa + decarboxylase inhibitors
COMT inhibitors e.g. entacapone
MAOBI e.g. seligiline
Dopamine agonists e.g. bromocriptine

37
Q

What is riluzole used for?

A

Sodium chnalle blocker then the only medication show to improve survival in motor neurone disease

38
Q

How is MND distinguished from myasthenia, MS and polyneuropathies?

A

Never ocular involvement unlike myasthenia

No sensory involvement or autonomic involvement unlike MS and pooyneuropathies

39
Q

What can CSF show is multiple sclerosis?

A

Oligoclonal bands of IgG

40
Q

Which criteria is used to diagnose multiple sclerosis?

A

McDonald criteria
Considers number of attacks and lesions on MRI
(“disseminated in time and space”)

41
Q

What is Bell’s palsy?

A

Idiopathic facial nerve palsy

42
Q

How does Bell’s palsy present?

A

Unilateral paralysis of facial muscles, (LMN lesion so not forehead sparing), hyeracusis (stapedius paralysis), drooling

43
Q

How is Bell’s palsy treated?

A

If presenting within 72 hours: 10 days prednisolone course
Lubricating eye drops to prevent eye drying out
Most will recover in a few weeks

44
Q

Is Ramsay Hunt syndrome an UMN or LMN lesion?

A

LMN lesion

45
Q

What triad of symptoms is seen in Wernicke’s encephalopathy?

A

Ataxia
Opthalmoplegia
Confusion

46
Q

Wernicke’s encephalopathy is due to deficiency of what?

A

Thiamine, vitamin B1

47
Q

What causes Guillain Barré syndrome?

A

Autoimmune typically caused by infection

Most commonly campylobacter gastroenteritis

48
Q

What drug is given for benign essential tremor?

A

Propanolol

49
Q

What medication is recommended for migraine prophylaxis other than propanolol?

A

Topiramate

50
Q

What is the investigation of choice for acoustic neuroma?

A

MRI of cerebellopontine angle

51
Q

How can acoustic neuroma present?

A 
Hearing loss (sensorineural)
Tinnitus
Vertigo
Absent corneal reflex due to CN5 palsy
Facial palsy
52
Q

Aural fullness is typical of what condition?

A

Ménière’s disease

53
Q

What tests can be used for a myasthenia gravis diagnosis?

A

Anti AChR antibody titres
MUSK antibodies
Ice test
CT thymus may show thymoma

54
Q

What is Lambert Eaton myasthenic syndrome?

A

Autoimmune damage to voltage gated calcium channel on the presynaptic motor nerve terminal
Associated with small cell lung cancer
Causes weakness and waddling gait as it affect proximal muscles of arms and legs more

55
Q

Lambert Eaton syndrome is associated with what?

A

Small cell lung cancer

56
Q

Weakness of part of the body after suffering a seizure is suggestive of what?

A

Todd’s paresis

57
Q

What is Wilson’s disease?

A

Autosomal recessive condition causing excessive copper deposition

58
Q

How can Wilson’s disease present

A

In children often presents with liver problems (jaundice, heamolysis, hepatitis, hepatomegaly)
In adults, neurological e.g. dementia, parkinonism, chores, behavioural , dsyarthria
Blue nails
Kayser fleischer rings of the eyes

59
Q

What is the treatment for Wilson’s disease?

A

Penicillamine, a copper cheating agent

60
Q

Is an abnormally white lesion on CT described as hyper or hypo dense?

A

Hyperdense

Eg acute bleed, haemorrhagic stroke

61
Q

How will the density of bleeds on the brain present if acute vs chronic?

A

Initially hyperdense when acute (white)
Then become isodense
And chronic bleeds will be hypodense (dark)

62
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine

63
Q

Which anti epileptic medication is most likely to cause peripheral neuropathy?

A

Phenytoin

64
Q

Degeneration of the striatum in seen in which condition?

A

Huntington’s Disease

65
Q

What is the inheritance pattern of Huntington’s?

A

Autosomal dominant

66
Q

When does Huntington’s Disease typically present?

A

Middle age

67
Q

How does Huntington’s typically present?

A 
Chorea 
Rigidity 
Bulbar palsy
Impaired cognition
Sleep disorder 
Psychiatric (anxiety, depression, aggression, compulsive behaviours)
68
Q

Which anti epileptic is associated with a risk of Stevens Johnson syndrome?

A

Lamotrigine

So safety net if px get a rash and feel flu like symptoms

69
Q

What is the antiemetic of choice in Parkinson’s?

A

Domperidone, at it won’t cross the BBB

70
Q

How would trigeminal neuralgia typically present?

A

Unilateral
Acute, brief episodes
Sharp electric shock like pain
Provoked by light touch

71
Q

Which drug is first line in trigeminal neuralgia?

A

Carbamazepine

72
Q

What is the triad of symptoms that present in normal pressure hydrocephalus?

A

Urinary incontinence
Confusion
Gait disturbance

73
Q

As well as Parkinsonism symptoms, what differentiating symptoms would progresssive supranuclear palsy and multiple system atrophy present with?

A

MSA: cerebellar signs and nystagmus
PSP: vertical limitation of up-down eye movements

EOY4 (15 decks)

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