Neurology Flashcards
Define Bell’s palsy
Idiopathic LMN CNVII palsy
What is the most common cause of Bell’s palsy?
Viral infection
Describe the onset of Bell’s palsy
Prodromal pre-auricular pain
Unilateral facial weakness (never >2 days)
Hyperacusis
What is the cause of hyperacusis in Bell’s palsy?
Stapedius paralysis
Does Bell’s palsy affect the ipsilateral or contralateral side to the lesion?
Ipsilateral
How can Bell’s palsy be differentiated from UMN palsies?
Does not spare upper facial muscles
What is Bell’s phenomenon?
When trying to close eyes, eyes roll up but eyelid doesn’t close
What signs would be seen on sensation testing in Bell’s palsy?
None - it should be normal
Recall the steps of management for Bell’s palsy
- Protect cornea with patch
2. Give high dose prednisolone within 72 hours
What is the caution with giving prednisolone in Bell’s palsy?
If they have Ramsay Hunt syndrome (complication of shingles) it shouldn’t be given
What is a cluster headache?
- Unilateral
- Excruciating pain
- Numerous times per day, typically at night
What is the most common trigger for cluster headaches?
Alcohol
What other symptoms are associated with cluster headache?
- Ipsilateral lacrimation
- Rhinorrhoea
- Eyelid/ facial swelling
- Partial Horner’s
Recall the 4 main types of dementia
Alzheimer’s
Vascular
Lewy-body
Frontotemporal
Describe the pathophysiology of alzheimer’s
Degeneration of cortex leading to cortical atrophy and reduced ACh transmission
Describe the pathophysiology of vascular dementia
Brain damage due to several cerebrovascular disease events
Describe the pathophysiology of Lewy Body dementia
Deposition of Lewy Body proteins in BRAINSTEM and NEOCORTEX
Differentiate the onset of each of the 4 main types of dementia
Alzheimer’s: insidious
Vascular: step-wise decline
Lewy-body: fluctuating levels of consciousness
Frontotemporal: changes in behaviour
What is encephalitis?
Inflammation of brain parenchyma
What is the most common pathogen implicated in encephalitis?
HSV
Always viral
Describe the symptoms of encephalitis
Like a subacute version of meningitis in terms of symptoms
May produce seizures
What is Cushing’s response and what is it used to identify
Triad of HTN, bradycardia and irregular breathing - used to identify raised ICP (eg due to encephalitis)
Differentiate simple and complex seizures
Simple does not affect consciousness, complex does
Recall the 5 types of generalised seizure
Tonic-clonic Myoclonic Absence Atonic Tonic
Seizures in which lobe causes motor convulsions?
Frontal
Seizures in which lobe causes aura and hallucinations?
Temporal
What is an absence seizure also known as?
Petit mal
Define absence seizure
Loss of consciousness with maintained posture
Which form of seizure is difficult to differentiate from dementia?
Non-convulsive status epilepticus
Which blood marker is increased following a seizure?
Prolactin
What investigation is used to classify epileptic seizures?
EEG
Recall the 3 steps of management for status epilepticus
- Glucose if hypoglycaemic
- IV/PR diazepam
- Treat cause
After how many seizures should epileptic medication be started?
2
Recall 2 medications that can be used to treat focal seizures
Carbamazepine
Lamotrigene
Which medication is used to treat most generalised seizures?
Valporate
Define guillain-barre syndrome
Acute demyelinating polyneuropathy
Describe the symptoms of guillain barre syndrome
Ascending symmetrical limb weakness, paraesthesia and arreflexia
What would be seen on lumbar puncture in guillain-barre syndrome?
High protein
Recall the triad of symptoms in Horner’s syndrome
Miosis
Anhydrosis
Ptosis
What is Horner’s syndrome caused by?
Disruption of SNS supplying face
What is the most likely neoplastic cause of Horner’s syndrome?
Apical lung tumour
What is the inheritance pattern of Huntingdon’s disease?
Autosomal dominant
What are the 2 main symptoms of Huntingdon’s disease?
Chorea and dementia
What eye sign is produced by Huntingdon’s disease?
Slow, voluntary saccades
What region would be atrophied on a CT scan in Huntingdon’s disease?
Striatum
What are the 2 types of hydrocephalus?
Obstructive (impaired outflow) and non-obstructive (impaired resorption)
What sort of hydrocephalus does meningitis cause?
Non-obstructive
What are the symptoms of obstructive hydrocephalus?
Acute drop in conscious level
Diplopia
Which cranial nerve is most likely to be affected by hydrocephalus?
CNVI
Which meninges become inflamed in meningitis?
Pia and arachnoid
What are the 2 most common bacterial pathogens implicated in meningitis?
Neisseria meningitidis
Streptococcus pneumoniae
What is kernig’s sign and what is it used to diagnose?
Pain on lifting the leg - meningism
What should always be done before a lumbar puncture in suspected meningitis?
CT to exclude mass lesion
What is the first line choice of antibiotic treatment in suspected meningitis?
Cephalosporin
What are the common names of migraine with and without aura?
With aura: classical
Without aura: common
Recall the aetiology of migraine
Intracranial vasoconstriction –> localised ischaemia –> meningeal and extracranial vasodilation
Recall the medical management of migraine both in the acute setting and for prophylaxis
Acute: NSAIDs, anti-emetics, triptans
Prophylaxis: beta-blockers, topiramate, amitryptiline
Recall the 4 types of motor neuron disease
- Amylotrophic lateral sclerosis (UMN and LMN)
- Progressive muscular atrophy variant (only LMN)
- Progressive bulbar palsy variant
- Primary lateral sclerosis (only UMN)
Recall 3 LMN and 3 UMN signs of motor neuron disease
- Hyporreflexia, fasciculations, muscle wasting
2. Spastic weakness, extensor plantars, hyperreflexia
Which immunoglobins may be detectable by serology in motor neuron disease?
Anti-GM1 ganglioside
What would nerve conduction studies show in motor neuron disease?
They would be normal
What is multiple sclerosis?
Inflammatory demyelinating disease of CNS
Recall the 4 types of MS - which of these is most common?
- Relapsing-remitting (most common)
- Clinically isolated (not strictly MS as is single attack)
- Primary progressive (steadily increasing disability)
- Morburg variant (severe fulminant, quickly causes death)
What is the most common symptom of MS?
Optic neuritis
Unilateral decrease in visual acuity and painful eye movement
What is uhthoff’s sign and what is it a sign of?
Worsening of symptoms as body gets overheated
Sign of MS
What is required to diagnose MS?
Location of 2 or more lesions with corresponding symptoms
What is the antibody implicated in myasthenia gravis?
Anti-nACh receptor
Recall 2 tests you can do in an examination to detect myasthenia gravis
- Ask them to look up: eyelids will fatigue
2. Ask them to keep talking (eg count from 1 to 100) and they will fatigue in their speech
What is the characteristic facial appearance of someone with myasthenia gravis?
Myasthenia snarl
Which cranial nerves are considered “bulbar”?
9-12
Recall one bulbar and one ocular sign of myasthaenia
Bulbar: Dysarthria reading aloud
Ocular: ptosis
What improves a ptosis in myasthenia gravis?
Putting ice on eyes
Which endocrine condition is associated with myasthenia gravis?
Hyperthyriodism
What test is specifically used to diagnose myasthenia gravis and how does it work?
Tensilon test (uses drug tensilon which is an anti-cholinesterase)
Give tensilon
ACh levels increase
Positive result = rapid and transient improvement in symptoms
What is neurofibromatosis?
Condition that leads to development of numerous neurocutaneous tumours
Differentiate the type of neurocutaneous tumour produced by type 1 and type 2 neurofibromatosis
Type 1: peripheral and spinal neurofibromas, optic nerve gliomas and phaeochromocytomas
Type 2: schwannomas + meningiomas
Which type of neurofibromatosis causes cafe au lait spots?
Type 1
Differentiate the symptoms of type 1 and 2 neurofibromatosis
Both –> headache
Type 1: skin lesions and learning difficulties
Type 2: hearing changes and facial pain
Recall the aetiology of parkinson’s disease
Neurodegeneration of dopaminergic neurons of substantia nigra
Recall 6 signs of parkinson’s disease
- Asymmetrical pill-rolling tremor
- Cogwheel rigidity
- Shuffling gait
- Postural instability
- Hypomimic face
- Depression
Describe the distribution of LMN and UMN signs in spinal cord compression
LMN at level of lesion
UMN below lesion
What % of strokes are infarcts?
80%
What is a lacunar infarct?
Thrombus blocking small artery
How can hypotension cause a stroke?
If BP is below what is required to maintain flow, perfusion of watershed zones will be insuffucient –> infarct
Where must a stroke affect in order to cause a loss of consciousness?
Thalamus
A stroke affecting which artery causes a “classical” stroke?
Middle cerebral
What is the main symptom of strokes affecting the posterior cerebral artery?
Hemianopia
A stroke affecting which artery would result in Horner’s syndrome?
Posterior cerebellar artery
Recall the management of stroke
<4.5 hours from onset: thrombolysis (alteplase)
>4.5 hours: aspirin and clopidogrel
When can warfarin be started following a stroke?
When INR >2
Why does connective tissue disease predispose to vascular events in the brain?
Associated with saccular aneurysms which can rupture to form a subarachnoid haemorrhage
What is another name for a saccular aneurysm?
Berry aneurysm
Where do berry aneurysms usually appear?
Circle of Willis
Describe the headache produced by subarachnoid haemorrhage
Sudden onset worst headache ever
What is the most common cause of subarachnoid haemorrhage?
Berry aneurysm rupture
Recall 2 consequences of subarachnoid haemorrhage that causes signs
Meningism (photophobia, neck stiffness) Raised ICP (papilloedema, CNIII/IV palsy)
What would be seen on lumbar puncture in subarachnoid haemorrhage?
Xanthochromia
Where do subarachnoid haemorrhages form?
Between arachnoid and dura mater
Recall the classification of subarachnoid haemorrhage
Acute: <3 days
Subacute: 3 days - 3 weeks
Chronic: >3 weeks
Recall 2 acute signs of subdural haemorrhage
Decreased GCS
Ipsilateral fixed dilated pupil
What is the surgical management of subarachnoid haemorrhage?
Burr hole
What is the usual aetiology of TIA
Embolic
Differentiate the clinical features of TIA depending on which of the 2 most commonly affected arteries is affected
Carotid: motor, unilateral, Broca’s dysphasia
Vertebrobasilar: homonymous hemianopia, hemiparesis, hemisensory defects
What is the first step in the management of suspected TIA?
Immediate 300mg aspirin
What score is used to assess stroke risk following a TIA?
ABCD2
Describe the pain caused by trigeminal neuralgia
Sudden, sharp, uniltaeral
Has a trigger
Which deficiencies cause Wernicke’s encephalopathy?
Vit B12
Thiamine
What is the triad of symptoms in Wernicke’s encephalopathy?
Ataxia
Ophthalmoplegia
Confusion
