Neurology

Question 1

Subdural haematoma lies in which space?

Answer 1

Between dura mater and arachnoid mater.

Question 2

Why do subdural haematomas occur?

Answer 2

Stretching of bridging veins makes them vulnerable to tearing.

Question 3

How do subdural haematoma present?

Answer 3

Gradual deterioration in cognitive function - pstients often present with confusion if chronic.

Question 4

Subdural haematoma are more likely to occur in which groups?

Answer 4

• Elderly.
• Dementia.
• Alcoholics.
• i.e. conditions associated with brain shrinkage.

Question 5

Dura mater composed of how many layers?

Answer 5

Two - outer endosteal and inner meningeal.

Question 6

What is enclosed within the two layers of the dura mater?

Answer 6

Venous sinuses.

Question 7

Name the four fibrous flanges/ septae which minimise rotatory displacement of the brain.

Answer 7

• Falx cerebri.
• Falx cerebelli.
• Tentorium cerebelli.
• Diaphragm sellae.

These are formed from the inner meningeal layer of dura mater.

Question 8

Extradural haematoma occurs where?

Answer 8

Between endosteal layer of dura mater and the skull.

Question 9

Extradural haematoma occurs typically due to bleeding of which artery?

Answer 9

Middle meningeal artery.

- Comonly in pterion region.

Question 10

Subarachnoid haematoma occurs where?

Answer 10

In subarachnoid space i.e. between pia and arachnoid.

Question 11

Where do subarachnoid haematoma typically originate?

Answer 11

Circle of Willis region - blood causes CSF contamination on LP.

Question 12

Where do intracerebral bleeds occur?

Answer 12

Within brain parenchyma.

Question 13

Dura mater is richly innervated. True or false?

Answer 13

True - dural stretch causes pain typically perceived as headache (e.g. meningitis, post-dural - LP or epidural).

Question 14

Differential for acute headache?

TICOS

Answer 14

Trauma.
Infection (meningitis, encephalitis).
Cerebrovascular (SAH, intracranial haemorrhage/infarction).
Ocular (glaucoma).
Sinusitis.

Question 15

What is pituitary apoplexy?

Answer 15

Bleeding or impaired blood supply to pituitary gland.

Question 16

How does pituitary apoplexy present?

Answer 16

Sudden onset headache.

Shock - pituitary failure causing adrenal crises.

Question 17

Likely diagnosis and responsible autoantibodies?
In the morning the patient is well and there is no weakness.

As the day progresses he experiences weakness and tiredness, double vision + drooping eyelids + difficulty speaking / chewing / swallowing. He also experiences muscle weakness after exercise which is relieved by resting.

OE there is no muscle fasciculation, muscle atrophy or muscle spasticity. His sensation is normal as are all his reflexes. Pupils are equal and reactive to light.

Answer 17

Myasthenia gravis and acetylcholine receptors.

Question 18

What is myasthenia gravis?

Answer 18

Autoimmune disease of neuromuscular junction - acetylcholine receptor antibody presence at post-synaptic membrane.

Question 19

Symptoms of myasthenia gravis?

Answer 19

• Diplopia.
• Dysphagia.
• Dysarthria.
• Electromyography will show decreased muscle contraction upon repetitive stimulation.

+ usually positive for acetylcholine receptor antibodies.

• Normal pupils.
• Normal reflexes.
• Normal sensation.

Question 20

Management of myasthenia gravis?

Answer 20

Neostigmine.

Pyridostigmine.

Question 21

Which antibodies play a role in multiple sclerosis?

Answer 21

Antibodies to myelin.

Question 22

GCS criteria for eyes?

Answer 22

4 - eyes open spontaneously.
3 - eyes open to speech.
2 - eyes open to pain.
1 - eye do not open.

Question 23

GCS criteria for verbal?

Answer 23

5 - orientated.
4 - confused.
3 - inappropriate words.
2 - inappropriate sounds.
1 - no verbal response.

Question 24

GCS criteria for motor?

Answer 24

6 - obeys commands.
5 - localises pain.
4 - withdraws from pain.
3 - abnormal flexion to painful stimuli (decorticate).
2 - extension to painful stimuli (decerebrate).
1 - no movement.

Question 25

A GCS below which score is indicative of the need for airway protection?

Answer 25

GCS of 8 or below. Patients unable to protect their own airway - usually require intubation.