Neurology Flashcards
1
Q
Define seizure
A
Clinical manifestation of abnormal, excessive and uncontrolled discharge of cerebral neurons
2
Q
What is epilepsy?
A
Tendancy to experience recurrent unprovoked seizures
3
Q
Cause of epilepsy?
A
Idiopathic (70-80%) Cerebral palsy Neurodegenerative disorders Neurocutaneous syndromes Cerebral tumour
4
Q
Metabolic causes of epilepsy
A
Hypoglycaemia
Hypocalcaemia
Hyperammonaemia
5
Q
Autonomic features of seizures
A
Pallor
Vomiting
Sweating
6
Q
Features of a seizure that indicate it is epileptic in nature
A
Eyes open, rolled up Head and eyes deviate to the same side Absent pupillary response Tongue biting Incontinence Cyanosis Postictal confusion
7
Q
Features of a seizure that indicates non-epileptic seizure
A
Eyes close, opening is resisted Present pupillary response Equal flexor and extensor movements Pelvic thrusting Side to side head movements
8
Q
5 childhood epilepsy syndromes
A
Generalised epilepsy Focal epilepsy West syndrome Childhood absence epilepsy Juvenile myoclonic epilepsy
9
Q
What is the first line treatment for a childhood generalised epilepsy syndrome?
A
Sodium Valproate
10
Q
2nd line treatment for childhood generalised epilepsy syndrome?
A
Lamotrigine
11
Q
What is seen on EEG in West Syndrome?
A
Hypsarrhythmia
12
Q
What is the most common cause of west syndrome?
A
Tuberous Scleosis
13
Q
What is the first line treatment of focal epilepsy syndrome?
A
Carbamazepine
+Valproate
+Lamotrigie
14
Q
What does seizures in West Syndrome look like?
A
Violent flexion of head, trunk and limbs followed by extension of arms
Lasts 1-2 seconds but can occur 20-30 times
Often occurs on waking
15
Q
What is the treatment of West Syndrome?
A
Vigabatrin and Corticosteroids
16
Q
What is childhood absence epilepsy treated with 1st line?
A
Sodium valproate or ethosuximide
17
Q
How can you induce an absence seizure?
A
Hyperventilation
18
Q
What is seen on EEG for absence seizures?
A
3 second spike and wave
19
Q
Which childhood epilepsy syndrome presents with morning clumsiness eg spilling drinks/food?
A
Juvenile myoclonic epilepsy
20
Q
How is Juvenile myoclonic epilepsy treated?
A
Valproate or lamotrigine
21
Q
How is status epileptics managed?
A
- ABCDE
- Check blood glucose (if <3mmol/L give IV glucose)
- At 5 mins - IV lorazepam/Rectal diazepam/IM midazolam
- At 15 mins IV lorazepam
- At 25 mins IV phenytoin (or IV phenobarbitol if on regular phenytoin)
- PR paraldehyde after start of phenytoin infusion
- Rapid sequence induction with IV sodium thiopental
22
Q
What are the 4 dopamine pathways and what are they responsible for?
A
Mesolimbic - Reward
Mesocortical - Executive functions
Nigrostriatal - Motor
Tuberoinfundibular - Prolactin
23
Q
What is the pathology of pakinson’s disease?
A
Accumulation of alpha synuclein protein (lewy bodies) in the pars compacta of the substantial nigra
24
Q
Which spinal tract provides motor supply to the muscles in the limbs and digits?
A
Lateral corticospinal tract
25
What is the vestibulospinal tract responsible for?
Balance and posture
26
What does the rubrospinal tract do?
Fine motor control of hand
27
Which spinal tract is responsible for pain and temperature?
Lateral spinothalamic tract
28
Which spinal tract is responsible for fine touch and vibration?
Dorsal column medial lemniscus pathway?
29
At what vertebral level does the spinal cord terminate?
L1-2
30
What nerve supplies the thenar muscles of the hand?
Median
31
Which nerve supplies the muscles of the hypothenar eminence?
Ulnar
32
Which nerve roots form the median nerve?
C6-T1
33
What muscles does the median nerve supply?
Flexor muscles in anterior aspect of forearm, thenar muscles and lateral 2 lumbricals
34
What nerve roots form the ulnar nerve?
C8-T1
35
What nerve roots form the radial nerve?
C5-C8
36
What areas have sensory innervation from the median nerve?
Lateral aspect of palm, lateral 3 and and half fingers on palmer surface and their respective finger tips on palmar and dorsal side
37
What is a stroke?
Rapid onset of focal neurological symptoms associated with infarction (80%) or haemorrhage (20%)
38
How does total anterior circulation stroke present?
Includes all 3 of the following:
- Unilateral weakness of arm, face and leg
- Homonymous hemianopia
- Higher cerebral dysfunction eg dysphagia/visuospatial disorder
39
Which occlusion of which blood vessels cause a total anterior circulation stroke?
Anterior and middle cerebral arteries
40
What is the clinical presentation of a partial anterior circulation stroke?
Includes 2 of the following:
- Unilateral weakness of arm, face or leg
- Homonymous hemianopia
- Higher cerebral dysfunction eg dysphagia/visuospatial disorder
41
Occlusion of which blood vessel causes a partial anterior circulation stroke?
Anterior cerebral artery
42
Symptoms of posterior circulation syndrome
Includes 2 of the following:
- Cranial nerve palsy and contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Eye movement disorder
- Cerebellar dysfunction
- Isolated homonymous hemianopia
43
What type of stroke syndrome is most common?
Lacunar syndrome
44
What is the presentation of a lacunar stroke?
Includes 1 of the following:
- Pure motor stroke
- Pure sensory stroke
- Sensori-motor stroke
- Ataxic hemiparesis
45
1st line investigation for suspected stroke
CT
46
1st line management of ischaemic stroke
Thrombolysis with tissue plasminogen factor eg alteplase
47
What risk is associated with thrombolysis?
Haemorrhage
48
Contraindications of thrombolysis
```
Recent trauma
Recent surgery
Recent internal bleed
HTN >200/100
Pregnancy
Recent stroke
Liver disease
Warfarin
```
49
Within what time frame does Thrombolysis need to happen?
Within 4.5 hours of onset of symptoms
50
Within what time frame does a thromboectomy need to happen?
Within 6 hours
51
What medical therapy is given following stroke?
Aspirin 300mg for 14 days followed by 75mg daily
| Warfarin if AF
52
What risk score calculates the risk of TIA after stroke?
ABCD2
53
What are the risk factors for TIA following stroke?
```
Age >60 (1)
Blood Pressure >140/90 (1)
Clinical features
- Unilateral weakness (2)
- Speech disturbance (1)
Duration of symptoms
- >60 mins (2)
- 10-60 mins (1)
- <10 mins (0)
Diabetes (1)
```
54
What risk score calculates the risk of stroke in patients with AF?
CHA2DS2-VASC
55
What are the risk factors for stroke in patients with AF?
```
Congestive heart failure (1)
Hypertension >140/90 (1)
Age >75 (2)
Diabetes (1)
Stroke (previous stroke/TIA) (2)
Vascular disease (1)
Age 65-75 (1)
Sex category (being female) (1)
```
56
Features of migraines
```
Sensory aura (15-30 mins)
Unilateral throbbing headache
N+V
Photophobia
Allodynia
```
57
Triggers of migraines
```
Chocolate
Heat
Oral contraceptives
Caffeine
O
Lack of sleep
Alchohol
Travel
Exercise
```
+cheese, anxiety,
58
What is the management of migraine in an acute attack?
Oral triptan eg sumatriptan and NSAID/paracetamol
59
What are the medical options for migraine prevention?
Topiramate or propranolol
60
Risk factors for cluster headache
Male
<55yrs
Smoking
Alcohol consumption
61
Features of a cluster headache
Unilateral, around eye
Lasts 30-90 mins, several occur in a week
Red eye, lacrimation, swelling, ptosis,
Rhinorrhoea, facial swelling, vomiting
62
Management of cluster headache
100% high flow oxygen through non-rebreathe mask for 15 mins
| Subcut triptan
63
What medication is used for the prevention of cluster headaches?
Verapamil
64
Features of a subarachnoid haemorrhage
```
Thunderclap headache in back of head - sudden onset
Kernig's sign
LOC
CN signs
N+V
Photophobia
Double vision
Stiff neck
Hemiplegia
Sentinel headache
```
65
What is Kernig's sign?
Flexion of thigh at hip to 90 degrees followed by extension of leg at knee.
In meningitis, this movement is greatly limited by spasm of hamstrings - which in turn causes pain - due to inflammatory exudates around the roots of the lumbar theca.
66
What is Brudzinski's sign?
Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.
67
Investigations in SAH
CT - star shaped lesion
| LP (contraindicated if increased ICP) - 3 samples show visible blood, xanthochromia after a few hours.
68
Management of SAH
ABCDE
| Surgical clipping/endovascular coiling
69
What is meningism?
Stiff neck, headache and photophobia
70
What immediate management is given for patients in the community with suspected meningitis?
IM Benzylpenicillin
71
What is the antibiotic treatment for meningitis?
IV ceftriaxone for 7 days
72
How does a patients with encephalitis present?
Infectious prodrome: fever, malaise, headache, drowsiness
Photophobia, stiff neck, +ve kernig's sign, brudzilski's sign
CN palsy, ataxia, confusion, hemiparesis, seizures, confusion, dysphagia, personality/behavioural change
73
What will CSF show in encephalitis?
Increased WCC (Lymphocytes)
Normal/Decreased glucose
Increased protein
74
What investigations should be done for suspected encephalitis?
Viral serology
Blood PCR for HSV, CMV, VZV, EBV
CT - cerebral oedema
MRI - shows characteristic bilateral temporal lobe involvement in HSV-1 infection
75
How do you manage encephalitis?
IV acyclovir
76
Features of GCA headache
```
Associated with PMR
Generalised headache
Jaw claudication
Scalp tenderness
Fever, fatigue, visual loss (PANIC)
Superficial temporal artery is tender, firm and pulseless
```
77
What is seen on bloods in GCA?
Massively increased ESR and CRP
Increased Platelets
Increased ALP
Decreased Hb (normochromic, normocytic anaemia)
78
What is seen on temporal artery biopsy in GCA?
Granulomatous inflammation and mononuclear infiltration
79
What is the immediate management of GCA?
High dose corticosteroids
80
What are the main neurotransmitters involved in epilepsy?
Glutamate (increased)
| GABA (decreased)
81
What cell produces myeline in the central and peripheral nervous system?
Central - Oligodendrocytes
| Peripheral - Schwaan cells
82
How long can someone not drive for after a TIA/stroke?
4 weeks
83
Wrist drop is due to damage of which nerve?
| What causes it?
Radial
| Nursemaid's elbow due to radial head subluxation, can occur in children due to outward pull on extended pronated arm
84
What is the triad of Wernick's encephalopathy?
Opthalmoplegia, confusion, ataxia
85
What test is gold standard for measuring respiratory muscle strength?
FVC monitoring
86
Which nerve is damaged in foot drop?
Common peroneal nerve
87
What sign on examination is severe electric shock type pain down back on passive flexion of neck?
Lhermitte's sign
88
Early symptoms of Huntington's?
```
Chorea - leads to agitation
Decreased auditory and visual reactions times
Extraoccular movements
Increased reflexes
Postural instability
```
