Neurology Flashcards
1
Q
Where is the motor cortex?
A
Pre-central gyrus
2
Q
Where is the sensory cortex?
A
Post-central gyrus
3
Q
What are the stretch receptors in muscles called?
A
Muscle spindles
4
Q
What are muscle spindles innervated by?
A
Gamma motor neurones
5
Q
What is the middle layer of the cerebellum?
A
Purkinje cell layer
6
Q
What is the only output element of the cerebellum?
A
Purkinje cell
7
Q
What are the 4 main fibres?
A
- ) A alpha
- ) A beta
- ) A gamma
- ) C fibres
8
Q
Give 3 facts about A alpha fibre
A
- ) Large
- ) Myelinated
- ) Proprioception
9
Q
Give 3 facts about A beta fibre
A
- ) Large
- ) Myelinated
- ) Light touch, pressure, vibration
10
Q
Give 3 facts about A gamma fibre
A
- ) Thin, small
- ) Myelinated
- ) Pain, cold sensation
11
Q
Give 3 facts about C fibres
A
- ) Thin, small
- ) Unmyelinated
- ) Pain, warm sensation
12
Q
What does a stroke in the R hemisphere present as?
A
Mania
13
Q
What does a lesion in the orbitofrontal cortex cause?
A
Disinhibited behaviour
14
Q
What does the cavernous sinus contain?
A
O TOM CAT Oculomotor Trochlear Ophthalmic branch Maxillary branch Carotid artery, internal Abducens Trochlear (again)
15
Q
Define weakness/paresis
A
The impaired ability to move a body part in response to will
16
Q
Define paralysis
A
The ability to move a body part in response to will is completely lost
17
Q
Define ataxia/incoordination
A
Willed movements are clumsy, ill-directioned or uncontrolled
18
Q
Define involuntary movements
A
Spontaneous movement of a body part independently of will
19
Q
Define apraxia
A
Disorder of consciously organised patterns of movement/impaired ability to recall acquired motor skills
20
Q
Define a motor unit
A
Basic functional unit of muscle activity
21
Q
What 3 things make up a motor unit?
A
- ) LMN
- ) Axon
- ) Several supplied muscle fibres
22
Q
What is the final common pathway?
A
The way by the CNS controls voluntary movement
23
Q
Give 4 things we need to know in a headache history
A
- ) Types/number
- ) Time
- ) Pain
- ) Associations
- ) Triggers
- ) Response
- ) Between attacks
- ) Changes in attacks
- ) Red flags for brain tumours
24
Q
What is the most common type of headache?
A
Tension
25
Give 2 symptoms of a tension headache
- ) Bilateral
- ) Non-pulsatile
- ) Scalp muscle tenderness
- ) No N&V
26
How do we treat a tension headache (other than painkillers)?
- ) Massage
| - ) Antidepressants
27
Who are cluster headaches more common in?
- ) Smokers
| - ) Men
28
Give 3 symptoms of a cluster headache
- ) Rapid onset excruciating pain around one eye that may become watery ad bloodshot with lid swelling
- ) Lacrimation
- ) Facial flushing
- ) Rhinorrhoea
- ) Miosis +/- ptosis
- ) Unilateral pain, almost always same side
- ) 15-180 mins
- ) 1/2 a day, often nocturnal
- ) Pain free periods of months/years
29
How do we treat an acute cluster headache?
- ) 100% O2
| - ) Sumatriptan
30
Who should we not give O2 in a cluster headache?
COPD
31
Give 2 preventative treatments of cluster headaches
- ) Avoid alcohol
- ) Corticosteroids short term
- ) Verapamil
32
What is the classic presentation of a migraine?
Visual or other aura lasting 15-30 mins followed within 1hr by unilateral, throbbing headache
33
Give the 2 other presentations of a migraine
- ) Isolated aura with no headache
- ) Episodic severe headaches without aura, often premenstrual, usually unilateral with N&V +/- photophobia/phonophobia
34
What is a prodrome? Give an example
Precedes headache by hours/days
- ) Yawning
- ) Cravings
- ) Mood/sleep change
35
What are 3 types of aura?
- ) Visual - chaotic distorting, jumbling, dots, zigzags, lines
- ) Somatosensory - paraesthesiae spreading from fingers to face
- ) Motor - dysarthria and ataxia, ophthalmoplegia, hemiparesis
- ) Speech - dysphasia, paraphasia
36
Give 5 partial triggers for a migraine
CHOCOLATE
- ) Chocolate
- ) Hangovers
- ) Orgasms
- ) Cheese/caffeine
- ) Oral contraceptives
- ) Lie-ins
- ) Alcohol
- ) Travel
- ) Exercise
37
Give an association of a migraine
- ) Obesity
| - ) Fhx
38
What are the diagnostic criteria of a migraine if there is no aura? (5)
- ) 5 or more attacks
- ) Lasting 4-72 hours
- ) N&V
- ) Or P/P
- ) Any 2 of unilateral, pulsating, impairs/aggravated by routine activity
39
Give 2 preventative treatments for migraines
- ) Avoid triggers
- ) Ensure analgesic rebound headache not there
- ) Propranolol or topiramate
40
What is the treatment for an acute migraine attack?
- ) Oral triptan and NSAID/paracetamol
| - ) Anti-emetics even without N&V
41
Give 2 CIs for triptan use
- ) IHD
- ) Coronary spasm
- ) Uncontrolled HTN
- ) Recent lithium
- ) SSRIs
- ) Ergot use
42
Give 2 non-pharmacological treatments for migraines
- ) Hot/cold packs
- ) Rebreathing into bag
- ) Acupuncture
43
Give 3 symptoms for trigeminal neuralgia
- ) Paroxysms of intense stabbing pain
- ) Lasts seconds
- ) In trigeminal nerve distribution
- ) Unilateral
- ) Mandibular or maxillary typically
- ) Face screws up with pain
44
Give 2 triggers for trigeminal neuralgia
- ) Washing area
- ) Shaving
- ) Eating
- ) Talking
- ) Dental prostheses
45
Who is the typical patient with trigeminal neuralgia?
>50 male
46
Give 2 secondary causes of trigeminal neuralgia
- ) Compression of trigemini root (inflammation, tumour)
- ) MS
- ) Zoster
- ) Skull base malformation
47
What is the treatment for trigeminal neuralgia?
- ) Carbamazepine
- ) Lamotrigine
- ) Phenytoin
- ) Gabapentin
- ) Microvascular decompression
48
What part of the brain does the middle cerebral artery supply?
Lateral
49
What part of the brain does the anterior cerebral artery supply?
Anterior and medial
50
What part of the brain does the posterior cerebral artery supply?
Posterior
51
Give 3 symptoms of a MCA stroke
- ) Contralateral arm and leg weakness
- ) Contralateral sensory loss
- ) Hemianopia
- ) Aphasia
- ) Dysphasia
- ) Facial droop
52
Give 3 symptoms of a PCA stroke
- ) Contralateral homonymous hemianopia
- ) Cortical blindness with bilateral involvement of occipital lobe branches
- ) Visual agnosia
- ) Prospagnosia
- ) Dyslexia, anomic aphasia, colour naming and discrimination problems
- ) Unilateral headaches
53
Give 3 symptoms of a posterior circulation stroke
- ) Motor deficits
- ) Dysathria and speech impairment
- ) Vertigo, N&V
- ) Visual disturbances
- ) Altered consciousness
- ) High mortality, locked in syndrome
54
What can a posterior circulation stroke cause?
Hydrocephalus through blockage of 4th ventricle
55
What is a stroke?
Infarction or bleeding into the brain, manifesting with sudden onset focal CNS signs
56
Give 3 causes of a stroke
-) Small vessel occlusion/cerebral microangiopathy/thrombosis
-) Atherothromboembolism (carotids)
-) CNS bleeds (aneurysm, trauma, anticoagulation)
-) Cardiac emboli
-) Sudden BP drop
-) Carotid artery dissection
-) Vasculitis
-) SAH
ETC
57
Give 3 risk factors for a stroke
- ) HTN
- ) Smoking
- ) DM
- ) Heart disease
- ) Peripheral vascular disease
- ) High PCV
- ) Carotid bruit
- ) Combined pill
- ) Hyperlipidaemia
- ) Alcohol
- ) Increased clotting
58
What does PCV stand for?
Packed cell volume
59
What is embolic stroke?
Death of cell bodies, well defined territory, no recovery
60
What is a haemorrhagic stroke?
Compression of the internal capture, large territory, possible complete recovery
61
Give 2 pointers to bleeding
- ) Meningism
- ) Severe headache
- ) Coma
62
Give 2 pointers to ischaemia
- ) Carotid bruit
- ) AF
- ) Past TIA
- ) IHD
63
Give 2 signs of a cerebral infarct
- ) Depends on site
- ) Contralateral sensory loss or hemiplegia
- ) Initially flaccid, becoming spastic
- ) Dysphasia
- ) Homonymous hemianopia
- ) Visuo-spatial deficit
64
Give 2 signs of a brainstem infarct
-) Quadriplegia
-) Disturbances of gaze and vision
-) Locked in syndrome
Very varied
65
Give 2 signs of a lacunar infarct
- ) Ataxic hemiparesis
- ) Pure motor
- ) Pure sensory
- ) Sensorimotor
- ) Dysarthria/clumsy hand
- ) Cognition/consiousness not in thalamic stroke
66
Where does a lacunar infarct occur? (4)
- ) Basal ganglia
- ) Internal capsule
- ) Thalamus
- ) Pons
67
What do we use to estimate the risk of stroke in AF patients?
CHA2DS2-VASc
68
Give the parts of CHA2DS2-VASc (8)
- ) Congestive heart failure
- ) HTN
- ) Age >75 (2 points)
- ) DM
- ) Stroke prior, TIA (2 points)
- ) Vascular disease
- ) Age 65-74
- ) Female
69
Give 3 tests we do for a stroke
- ) HTN
- ) ECG - AF
- ) Echo
- ) Carotid doppler US - for stenosis
- ) MRI/CT
- ) Vasculitis tests - ESR, ANA+
- ) Prothrombin states, hyper viscosity, bleeding disorders
70
Give 3 treatment steps for stroke
- ) Protect airway
- ) Maintain homeostasis
- ) Screen swallow
- ) CT/MRI if thrombolysis/haemorrhage considered, unusual presentation
- ) Antiplatelet agents (not haemorrhagic stroke), aspirin, clopidiogrel long term
- ) Thrombolysis (not haemorrhage)
- ) Thromboectomy
71
What is the agent for thromboylsis, and when must it be done?
Within 4.5 hours, alteplase
72
Give 2 ways to prevent a stroke
- ) Stop smoking
- ) Control BP
- ) Move around/exercise
- ) DM
- ) Hyperlipidaemia
73
How do we treat hyperlipidaemia?
Statins
74
Who do we give anticoagulants to?
AF and prosthetic heart valves
75
How do we detect hypertension? (3)
- ) Retinopathy
- ) Nephropathy
- ) Cardiomegaly on CXR
76
What is a transient ischaemic attack?
An ischaemic (usually embolic) neurological event with symptoms lasting <24hours
77
What is the major risk factor with a TIA?
STROKE
78
What symptom occurs when the retinal artery is occlude?
Amaurosis fungax
79
Are global events (syncope, dizziness) typical of TIAs?
No
80
What suggests a critical intracranial stenosis?
Multiple highly stereotyped/crescendo TIAs
81
Give 3 cause of a TIA
- ) Atherothromboembolism from carotid
- ) Cardioembolism
- ) Hyperviscosity
- ) Vasculitis
82
Give 3 tests we do in a TIA
- ) FBC, ESR, U&ES, glucose, lipids
- ) CXR
- ) ECG
- ) Carotid doppler +/- angiography
- ) CT/diffusion weighted MRI
- ) Echocardiogram
83
What is amaurosis fungax?
Unilateral progressive vision loss 'like a curtain descending'
84
Give 3 parts of the treatment of a TIA
- ) Control CV risk factors
- ) Antiplatelet drugs (aspirin, then clopidogrel)
- ) Anticoagulation indications (if cardiac source of emboli)
- ) Carotid endarterectomy is >70% stenosis
85
What is the ABCD2 risk score?
Risk of stroke following a suspected TIA
86
What makes up the ABCD2 score?
- ) Age >60
- ) BP high
- ) Clinical features (unilateral weakness 2, speech 1)
- ) Dyration of symptoms (>1hr 2, <1hr 1)
- ) DM
87
Give 2 secondary causes of damage in a head injury
- ) Hypoxia
| - ) Infection
88
What is an injury under the site of impact called? (head injury)
Coup
89
What is an injury opposite the site of impact called? (head injury)
Contrecoup
90
What builds up in axonal injury?
Amyloid precursor protein
91
Give 3 causes of brain swelling
- ) Congestive brain swelling
- ) Vasogenic oedema
- ) Cytotoxic oedema
92
What is congestive brain swelling?
Vasodilation and increased cerebral blood volume
93
What is vasogenic oedema?
Extravasation of oedema fluid from damaged blood vessels
94
What is cytotoxic oedema
Increased water content of neurones and glia
95
Why does herniation occur?
Parts of the brain are squashed from one compartment to another
96
Give a long term effect of head injury
Chronic traumatic encephalopathy
97
Give 4 criteria for brainstem death
- ) Pupils
- ) Corneal reflex
- ) Caloric vestibular reflex
- ) Gag reflex
- ) Respirations
- ) Response to pain
98
What is a subarachnoid haemorrhage?
Spontaneous bleeding into the subarachnoid space, often catastrophic
99
What is the typical age of presentation of a SAH?
35-65
100
Give 3 symptoms of a SAH
- ) Sudden onset excruciating headache (thunderclap)
- ) Vomiting
- ) Collapse
- ) Seizures
- ) Coma
- ) Possible preceding sentinel headache
101
Give 3 signs of a SAH
- ) Neck stiffness
- ) Kernig's sign (leg extension)
- ) Retinal, subhyaloidand vitreous bleeds
- ) Focal neurology at presentation may suggest site of aneurysm
102
Give 2 causes of a SAH
- ) Berry aneurysm rupture
- ) Arteriovenous malformations
- ) Encephalitis, vasculitis, tumour, idiopathic
103
Give 3 risk factors for a SAH
- ) Previous aneyrysmal SAH
- ) Smoking
- ) Alcohol misuse
- ) High BP
- ) Bleeding disorders
- ) SBE
- ) Family history
104
Give 2 associations with berry aneurysms
- ) Polycystic kidneys
- ) Aortic coarctation
- ) Ehlers-Danlos
105
Give 2 places a berry aneurysm can occur
- ) Posterior communicating with internal carotid
- ) Anterior communicating with anterior cerebral artery
- ) Bifurcation of middle cerebral artery
106
Give 2 tests for a SAH
- ) Urgent CT
| - ) Consider LP >12hr after headache (yellow due to Hb breakdown)
107
What is the treatment for a SAH?
- ) Fluids and maintaining cerebral perfusion
- ) Nimodipine
- ) Endovascular coiling or surgical clipping
- ) Catheter or CT angiography before intervention
108
What is nimodipine?
Calcium antagonist that reduces vasospasm and consequent morbidity from cerebral ischaemia
109
Give 3 complications of a SAH
- ) Rebleeding
- ) Cerebral ischaemia
- ) Hydrocephalus
- ) Hyponatraemia
110
Where does the bleeding occur in a subdural haematoma?
Bridging veins between cortex and venous sinuses (vulnerable to deceleration injury)
111
Define haemorrhage
The leakage of blood from a blood vessel due to lack of integrity in the vessel wall or clotting mechanism
112
Define haematoma
The accumulation of leaked blood inside the body within tissue planes.
113
What does a subdural haematoma cause?
1) Gradual rise in ICP
2) Shift in midline structures away from side of clot
3) Eventual tentorial herniation and coning
114
What do more subdural haematomas occur from?
Trauma (often minor and forgotton)
115
Give 2 risk factors for a subdural haematoma
- ) Elderly (atrophy makes bridging veins more vulnerable)
- ) Falls (epilepsy, alcoholics)
- ) Anticoagulation
- ) Shaken babies?
116
Give 3 symptoms of a subdural haematoma
```
-) Fluctuating level of consciousness
+/-
-) Insidious physical/intellectual slowing
-) Sleepiness
-) Headache
-) Personality change
-) Unsteadiness
```
117
Give 3 signs of a subdural haematoma
- ) Increased ICP
- ) Seizures
- ) Localising neurological symptoms occur late
118
Give 2 differential diagnoses of a subdural haematoma
Stroke, dementia, CNS masses
119
What does a CT/MRI show in a subdural haematoma?
Clot +/- midline shift, crescent shaped collection of blood over 1 hemisphere
120
What does the sickle shape differentiate a subdural haematoma from on a CT/MRI?
Subdural blood from extradural haemorrhage
121
What is the treatment of a subdural haematoma?
- ) Reverse clotting abnormalities
| - ) Craniotomy/burr hole washout on >10mm or with midline shift >5mm
122
What is an extradural haematoma also known as?
Epidural haematoma
123
What pattern is typical of extradural bleeds?
Lucid interval - deteriorating consciousness after any head injury that initially produced no loss of consciousness/drowsiness
124
What causes an extradural haematoma?
- ) Fractured temporal/parietal bone causing laceration of middle meningeal artery after trauma to temple just lateral to eye
- ) Any tear in a dural venous sinus
125
Give 3 clinical features of an extradural haematoma (initially)
- ) Lucid interval
- ) Decreasing GCS
- ) Increasingly severe headache
- ) Vomiting
- ) Confusion
- ) Seizures
- ) +/- hemiparesis with brisk reflexes and an upping plantar
126
Give 3 clinical features of an extradural haematoma (if bleeding continues)
- ) Ipsilateral pupil dilates
- ) Coma deepens
- ) Bilateral limb weakness develps
- ) Deep and irregular breathing
127
What is death due to in an extradural haematoma?
Respiratory arrest
128
Give 2 differential diagnoses for an extradural haematoma
- ) Epilepsy
- ) Carotid dissection
- ) CO poisoning
129
What does a CT show in an extradural haematoma?
Biconvex/lens shaped haematoma as tough dural attachments keep it localised
130
What test is CI in an extradural haematoma?
LP
131
What may an XR show in an extradural haematoma?
Fracture lines crossing the course of the middle meningeal vessels
132
What is the management of an extradural haematoma?
Clot evaluation +/- ligation of the bleeding vessel
133
What is epilepsy?
The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures
134
What are convulsions?
The motor signs of electrical discharges
135
What are the elements of a seizure? (3)
- ) Prodrome
- ) Aura
- ) Post-ictal
136
What is a prodrome?
Change in mood or behaviour hours or days before
137
What is an aura?
- ) Implies a focal seizures often from the temporal lobe
| - ) Strange feeling in gut, deja vu, strange smells, flashing lights
138
What occurs post-ically?
- ) Headache, confusion, myalgia
- ) Temporary weakness after a focal seizure in the motor cortex
- ) Dysphasia following a focal seizure in the temporal lobe
139
Give 3 structural causes of epilepsy
- ) Cortical scarring
- ) Developmental
- ) Space-occupying lesion
- ) Stroke
- ) Hippocampal sclerosis
- ) Vascular malformations
140
Give 2 non-structural causes of epilepsy
- ) Tuberous sclerosis
- ) Sarcoidosis
- ) SLE
- ) PAN
141
What are the 2 main classifications of seizures?
- ) Focal
| - ) Generalised
142
What is a focal seizure?
Originating within networks linked to one hemisphere and often seen without underlying structural disease
143
What is a generalised seizure?
Simultaneous onset of widespread electrical discharge throughout bilaterally distributed networks with no localising features
144
Give 3 subtypes of a focal seizure
- ) Without impairment of consciousness (simple)
- ) With impairment of consciousness (complex)
- ) Evolving to a bilateral, convulsive seizure (secondary generalised)
145
Give 4 subtypes of a generalised seizure
- ) Absence
- ) Tonic-clonic
- ) Myoclonic
- ) Atonic (akinetic)
- ) Infantile spasms
146
Describe tonic-clonic
Tonic - limbs stiffen
| Clonic - limbs jerk
147
Give 3 localising features of a temporal lobe focal seizure
- ) Automatisms (lip smaking, fumbling, fiddling, complex actions)
- ) Dysphasia
- ) Deja vu
- ) Emotional disturbance (sudden terror, panic, anger, elation, derealisation)
- ) Hallucinations (smell, taste, sound)
- ) Delusional behaviour
- ) Bizarre associations
148
Give 3 localising features of a frontal lobe focal seizure
- ) Motor features (posturing/peddling legs)
- ) Jacksonian march
- ) Motor arrest
- ) Subtle behavioural disturbances
- ) Dysphasia/speech arrest
149
Give 2 localising features of a parietal lobe focal seizure
- ) Sensory disturbances (tingling, numbness, pain)
| - ) Motor symptoms
150
Give a localising feature of an occipital lobe focal seizure
Visual phenomena (spots, lines, flashes)
151
What is a Jacksonian march? (seizures)
Spreading focal motor seizure with retained awareness, often starting with face/thumb
152
When should we suspect non-epileptic attack disorder? (pseudo seizures)
- ) Gradual onset
- ) Prolonged duration
- ) Abrupt termination
- ) Closed eyes +/- resistance to eye opening
- ) Rapid breathing
- ) Fluctuating motor activity
- ) Episodes of motionless unresponsiveness
- ) Tests normal
153
Give 3 provoking causes for seizures
- ) Trauma
- ) Stroke
- ) Haemorrhage
- ) Increased ICP
- ) Alcohol/benzodiazepine withdrawal
- ) Metabolic disturbance
- ) Infection
- ) High temp
- ) Drugs
154
Give 2 tests for epilepsy
- ) EEG
- ) MRI
- ) Drugs screen, LP
155
What type of seizure is it if it begins with focal features and then generalises?
Focal
156
Give 2 triggers for a seizure
- ) Alcohol
- ) Stress
- ) Fevers
- ) Sounds
- ) Lights
- ) Reading
157
What are the non-pharmacological treatment options for epilepsy?
- ) Relaxation, CBT
- ) Surgical resection
- ) Vagal nerve/deep brain stimulation
158
When should we start someone on anti-epileptic drugs?
After 2 or more seizures/high risk of recurrence
159
What do we give for focal seizures? (1st/2nd line)
1) Carbamazepine or lamotrigine
| 2) Levetiracetam, oxcarbazepine, or sodium valproate
160
What do we give for generalised tonic-clonic seizures? (1st/2nd line)
1) Sodium valproate or lamotrigine
| 2) Carbamazepine, clobazam, levetiracetam or topiramate
161
What do we give for absence seizures? (1st/2nd line)
1) Sodium valproate or ethosuximide
| 2) Lamotrigine
162
What do we give for myoclonic seizures? (1st/2nd line)
1) Sodium valproate
2) Levetiracetam or topiramate
- ) Avoid carbamazepine and oxcarbazepine
163
What do we give for tonic or atonic seizures?
Sodium valproate or lamotrigine
164
What is dementia?
A neurodegenerative syndrome with progressive declines several cognitive domains
165
What is the usual initial presentation of dementia?
Memory loss over months/years
166
How do we diagnose dementia?
- ) History
- ) Cognitive testing (AMTS)
- ) Examination for physical cause
- ) Medication review
167
What tests do we do in dementia?
- ) Bloods for reversible/organic causes
- ) MRI can identify reversible pathologies or underlying vascular damage
- ) PET functional imaging
- ) EEG
- ) HIV, syphilis, autoantibodies
168
Give 3 subtypes of dementia
- ) Alzheimer's disease
- ) Vascular dementia
- ) Lewy body dementia
169
What is vascular dementia?
The cumulative effect of many small strokes
170
How does vascular dementia present?
Sudden onset and stepwise deterioration
171
What do we look for in diagnosing vascular dementia?
- ) High BP
- ) Past strokes
- ) Focal CNS signs
172
How does Lewy body dementia present?
- ) Fluctuating cognitive impairment
- ) Detailed visual hallucinations
- ) Parkinsonism
173
Give 3 other causes of dementia
-) Alcohol/drug abuse
-) Repeated head trauma
-) Pellagra
-) Whipple's disease
-) Huntington's
-) CJD
-) Parkinson's
-) HIV
Etc
174
When should we suspect AD? (2)
- ) >40
| - ) Persistent, progressive, global cognitive impairment
175
In what disorder does AD present earlier in?
Down's syndrome
176
Give 4 symptoms of AD
- ) Visuo-spatial skill affected
- ) Memory loss
- ) Verbal abilities affected
- ) Executive function (planning) effected
- ) Anosognosia
- ) Irritability later
- ) Mood disturbance later
- ) Behavioural change later
- ) Psychosis later
- ) Agnosia later
177
What is anosognosia?
The loss of the ability to gain feedback about one's own condition or impairments
178
What accumulates in AD?
Beta-amyloid peptide
179
What is beta-amyloid peptide?
A degradation product of amyloid precursor protein
180
What does the accumulation of beta-amyloid peptide result in? (4)
- ) Progressive neuronal damage
- ) Neurofibrillary tangles
- ) Increased numbers of amyloid plaques
- ) Loss of neurotransmitter ACh
181
What parts of the brain are most vulnerable to neuronal loss in AD? (4)
- ) Hippocampus
- ) Amygdala
- ) Temporal neocortex
- ) Subcortical nuclei
182
Give 3 risk factors for AD
- ) 1st degree relative with AD
- ) Down's syndrome
- ) Homozygosity for apolipoprotein E E4 allele
- ) Vascular risk factors
- ) Decreased physical/cognitive activity
- ) Depression, loneliness
- ) Smoking
183
How do we manage AD?
- ) Acetylcholinesterase inhibitors
- ) Antiglutamatergic treatment
- ) Antipsychotics (severe non-cognitive only)
- ) BP control
184
Give 2 examples of an acetylcholinesterase inhibitor
- ) Donepezil
- ) Rivastigmine
- ) Galantamine
185
Give an example of an antiglutamatergic treatment
Memantine (NMDA antagonist)
186
Give the extrapyramidal triad of Parkinsonism
- ) Tremor
- ) Hypertonia
- ) Bradykinesia
187
Describe the tremor in parkinsonism
- ) Worse at rest
| - ) Often 'pill-rolling' of thumb over fingers
188
Describe the hypertonia in parkinsonism
Rigidity and tremor gives 'cogwheel rigidity' felt during rapid pronation/supination
189
Describe the bradykinesia in parkinsonism
- ) Slow to initiate movement
- ) Actions slow and decrease in amplitude with repetition
- ) Blink rate, micrographic
- ) Gait is shuffling, pitched forwards, reduced arm swing, freezing at obstacles/doors
190
Give 2 causes of parkinsonism
- ) Parkinson's disease
| - ) Drugs, trauma, encephalopathy, copper toxicity, HIV
191
What is the pathogenesis of PD? (2)
- ) Loss of dopaminergic neurons in the substantial nigra
| - ) Associated with Lewy bodies in the basal ganglia, brainstem, cortex
192
What is the mean age of onset of PD?
60
193
Give 3 clinical features of PD
- ) Parkinsonism triad
- ) Autonomic dysfunction (postural hypotension, constipation, urinary frequency/urgency, dribbling of saliva)
- ) Sleep disturbance
- ) Reduced sense of smell
- ) Neuropsychiatric complications
194
Is PD symmetrical?
No
195
How do we treat PD?
- ) Symptom control
- ) Deep brain stimulation (dopamine responsive)
- ) Surgical ablation of overactive basal ganglia circuits
- ) Postural exercises and weightlifting
196
Give 4 medications we can give in PD
- ) Levodopa
- ) Dopamine agonists
- ) Apomorphine
- ) Anticholinergics
- ) MAO-B inhibitors
- ) COMT inhibitors
197
Should we start medication early or late in PD, and why?
- ) Late
- ) Efficacy of therapy reduces with time, requiring larger and more frequent dosing with worsening SEs and response fluctuations
198
What is levodopa? (PD)
Dopamine precursor
199
What should levodopa be given with? (PD)
Dopa-decarboxylase inhibitor (to stop conversion to dopamine in peripheral NS)
200
Give an example of a dopamine agonist (PD)
- ) Ropinirole
| - ) Pramipexole
201
Give 2 side effects of a dopamine agonist (PD)
- ) Tiredness
- ) Hypersexuality
- ) Gambling
- ) Nausea
- ) Hallucinations
202
What is apomorphine? (PD)
Potent dopamine agonist
203
When do we use apomorphine? (2) (PD)
- ) SC to even out end of dose effects
| - ) Rescue pen for one off freezing
204
Give an example of an anticholinergic (PD)
- ) Benzhexol
| - ) Orphenadrine
205
Who should we use anticholinergics on? (PD)
Young - causes confusion in elderly
206
Give an example of a MAO-B inhibitor (PD)
- ) Rasagiline
| - ) Selegiline
207
Give an example of a COMT inhibitor (PD)
- ) Entacapone
| - ) Tolcapone
208
What is Huntington's disease? (HD)
Incurable, progressive, autosomal dominant, neurodegenerative disorder
209
What are the prodromal phase symptoms in HD?
- ) Irritability
- ) Depression
- ) Incoordination
210
What are the later symptoms in HD?
- ) Chorea
- ) Dementia
- ) +/- Fits and death
211
What is the pathology of HD?
Atrophy and neuronal loss of striatum and cortex
212
What is the genetic basis of HD?
Expansion of CAG repeat on chromosome 4
213
How do we treat chorea in HD?
Dopamine antagonists such as tetrabenzine
214
What is multiple sclerosis? (MS)
Inflammatory plaques of demyelination in the CNS disseminated in space and time (multiple sites, >30d between attacks)
215
What does poorly healing demyelination cause in MS?
Axonal loss
216
Which gender does MS occur more in?
Females
217
Is MS an autoimmune disease?
Yes, T cell mediated
218
What is the prevalence of MS geographically?
More common the further away from the equator you go
219
What is the mean age of onset in MS?
30
220
What sort of progression is the in MS?
Relapsing and remitting
221
How does MS present?
- ) Usually monosymptomatic
- ) Unilateral optic neuritis
- ) Numbness/tingling in limbs, leg weakness
- ) Brainstem/cerebellar symptoms (diplopia, ataxia)
- ) ED, anorgasmia, urine retention, incontinence
- ) Charcot's triad
222
What may worsen symptoms in MS?
Heat (hot bath/exercise)
223
How do we diagnose MS? (3)
- ) 2 or more attacks/relapses
- ) 2 or more clinical lesions
- ) Exclusion of other conditions
224
What does the CSF show in MS?
Oligoclonal bands of IgG on electrophoresis that are not present in the serum (CNS inflammation)
225
What does an MRI show in MS?
Plaque detection
226
What evoked potentials are there in MS?
Delayed visual, auditory, somatosensory
227
How do we manage MS? (4)
- ) Lifestyle advice (avoid stress)
- ) Disease modifying drugs
- ) Treat relapses
- ) Symptom control
228
What disease modifying drugs do we give in MS? (3)
- ) Dimethyl fumarate
- ) Alemtuzumab (monoclonal antibody against T cells)
- ) Natalizumab (monoclonal antibody against VLA-4 receptors that allow immune cells to cross the BBB)
229
What drug to we give to treat relapses in MS?
Methylprednisolone
230
What do we give for spasticity symptom control in MS?
Baclofen or gabapentin
231
What do we give for tremor symptom control in MS?
Botulinum toxin type A injections
232
What do we give for urgency/frequency symptom control in MS?
- ) Teach intermittent self-catheterisation if >100mL residual
- ) Tolterodine if <100mL residual
233
What do we give for fatigue symptom control in MS?
Amantadine, CBT, exercise
234
What is myasthenia gravis? (MG)
Autoimmune disease mediated by antibodies to nicotinic acetylcholine receptors on the post-synaptic side of the NMJ
235
What type of immune cells are implicated in MG?
B and T cells
236
What is the presentation of MG?
- ) Slowly increasing or relapsing muscular fatigue
| - ) Muscle groups affected in order: extraocular > bulbar > face > neck > limb girdle > trunk
237
Give 3 signs of MG
- ) Ptosis
- ) Diplopia
- ) Myasthenic snarl
- ) Peek sign of orbicularis fatigability
- ) Voice fades on counting
238
Give 3 things symptoms are exacerbated by in MG
- ) Pregnancy
- ) Decreased K+
- ) Infection
- ) Over treatment
- ) Change in climate
- ) Emotion
- ) Exercise
- ) Gentamicin
- ) Opiates
- ) Tetracycline
- ) Quinine
- ) Beta blockers
239
Give 2 differential diagnoses of MG
- ) Polymyositis/other myopathies
- ) SLE
- ) Takayasu's arteritis
- ) Botulism
240
What is MG associated with when <50?
Commoner in females, associated with thymic hyperplasia
241
What is MG associated with when >50?
Commoner in males, associated with thymic atrophy or thymic tumour
242
What do tests show in MG? (4)
- ) Anti-AChR antibodies increased in 90%
- ) MUSK antibodies if -ve
- ) EMG shows decremental muscle response to repetitive nerve stimulation +/- single fibre jitter
- ) Ptosis improves by >2mm after ice application to eyelid
243
What does MUSK stand for?
Muscle specific tyrosine kinase
244
How do we treat symptoms in MG?
Anticholinesterase (e.g. pyridostigmine)
245
What can we use to treat relapses of MG?
Prenisolone (with osteoporosis prophylaxis)
246
What surgery can we do for MG?
Thymectomy
247
What is a myasthenia crisis?
A life threatening weakness of respiratory muscles during a relapse
248
What is motor neurone disease? (MND)
A cluster of neurodegenerative diseases characterised by a selective loss of neurons
249
Where is the selective loss of neurones in MND? (3)
- ) Motor cortex
- ) Cranial nerve nuclei
- ) Anterior horn cells
250
How do we distinguish MND from MS and polyneuropathies?
MND has no sensory loss or sphincter disturbance
251
How do we distinguish MND from myasthenia?
MND never affects eye movements
252
What are the 4 clinical patterns of MND?
- ) ALS/amyotrophic lateral sclerosis
- ) Progressive bulbar palsy
- ) Progressive muscular atrophy
- ) Primary lateral sclerosis
253
Where and what is ALS?
- ) Loss of motor neurons in motor cortex and anterior horn of cord
- ) UMN and LMN signs
254
What is progressive bulbar palsy?
Only affects cranial nerves IX-XII
255
Where and what is progressive muscular atrophy?
- ) Anterior horn lesion
- ) LMN signs only
- ) Distal muscle groups affected before proximal
256
Where and what is primary lateral sclerosis?
- ) Loss of Betz cells in motor cortex
- ) Mainly UMN sighs
- ) No cognitive decline
- ) Marked spastic leg weakness and pseudo bulbar palsy
257
What is the median age at onset of MND?
60
258
Give 4 presenting features of MND
- ) Stumbling spastic gait
- ) Foot drop
- ) Proximal myopathy
- ) Weak grip
- ) Shoulderabduction
- ) Aspiration pneumonia
- ) UMN signs
- ) LMN signs
- ) Bulbar signs
259
Give 2 UMN signs of MND
- ) Spasticity
- ) Brisk reflexes
- ) Increased plantars
260
Give 2 LMN signs of MND
- ) Wasting
| - ) Fasciculation of tongue, abdomen, back, thigh
261
Give a bulbar sign of MND
Speech or swallowing affected
262
What are the diagnostic criteria for definite MND?
LMN and UMN signs in 3 regions
263
What test excludes structural causes? (MND)
Brain/cord MRI
264
What test excludes inflammatory causes? (MND)
LP
265
What treatments do we give in MND?
- ) Antiglutamatergic drugs
- ) Symptom control
- ) Palliative care
266
Give the main antiglutaminergic drug
Riluzole
267
What drug do we give for excess saliva in MND?
Antimuscarinic (e.g. propantheline)
268
What drug do we give for spasticity in MND?
Baclofen or diazepam
269
What do we give for joint pain and distress in MND?
Analgesia
270
What is Guillain-Barre syndrome?
An acute inflammatory demyelinating polyneuropathy
271
How does Guillain-Barre syndrome present?
Symmetrical ascending muscle weakness a few weeks after an infection
272
Give 3 triggers for Guillain-Barre syndrome
- ) Campylobacter jejuni
- ) CMV
- ) Mycoplasma
- ) Zoster
- ) HIV
- ) EBV
- ) Vaccinations
273
What differentiates Guillain-Barre syndrome from other neuropathies?
Proximal muscles are more affected
274
What is the pathology in Guillain-Barre syndrome?
Triggers cause antibodies to attack nerves
275
Give 3 signs of autonomic dysfunction
- ) Sweating
- ) Increased pulse
- ) BP changes
- ) Arrhythmias
276
What do nerve conduction studies show in Guillain-Barre syndrome?
Slow conduction
277
What does the CSF show in Guillain-Barre syndrome?
High protein
278
Give a symptom of Guillain-Barre syndrome
Back or limb pain
279
What is the treatment for Guillain-Barre syndrome?
- ) IV immunoglobulin
- ) Ventilation if needed
- ) Plasma exchange
280
What is the cause of Creutzfeldt-Jakob disease? (CJD)
A prion, misfolded form of a normal protein that can transform other proteins into prion proteins
281
What do lots of prions lead to in CJD?
Spongiform changes in the brain
282
How is variant CJD transmitted?
Via contaminated CNS tissue affected by bovine spongiform encephalopathy
283
Give 3 causes of CJD
- ) Inherited
- ) Iatrogenic (contaminated surgical instruments, corneal transplants, blood (vCJD only)
- ) Sporadic
284
What does the prion protein resist?
Sterilisation
285
Give 3 signs of CJD
- ) Progressive dementia
- ) Focal CNS signs
- ) Myoclonus
- ) Eye signs
286
What tests do we do for CJD?
- ) Tonsil/olfactory mucosa biopsy
- ) CSF gel electrophoresis
- ) MRI
287
What are mononeuropathies?
Lesions of individual peripheral or cranial nerves
288
Give 2 causes of a mononeuropathy
- ) Trauma
| - ) Entrapment
289
What is mononeuritis multiplex?
2 or more peripheral nerves are affected, usually has a systemic cause
290
What test helps us to define the site in a mononeuropahty?
Electromyography
291
How do we treat a mononeuropathy?
Rest, splinting, decompression
292
What are the roots of the ulnar nerve?
C7-T1
293
How does ulnar nerve mononeuropathy present? (2)
- ) Weakness/wasting of medial wrist flexors, interossei, medial 2 lumbicals, hypothenar eminence
- ) Sensory loss over medial 1.5 fingers and ulnar side of hand
294
How does radial nerve mononeuropathy present? (2)
- ) Wrist and finger drop
| - ) Sensory loss of anatomical snuff box
295
What are the roots of the radial nerve?
C5-T1
296
What are the roots of the median nerve?
C6-T1
297
What is the most common mononeuropathy?
Carpal tunnel syndrome
298
Give 3 clinical features of carpal tunnel syndrome
- ) Aching pain in hand and arm
- ) Pain especially at night
- ) Paraesthesiae in thumb, index and middle fingers
- ) Relieved by dangling hand over edge of bed and shaking
- ) Sensory loss
- ) Weakness of abductor pollicis brevis
- ) Wasting of thenar eminence
- ) Light touch, 2 point discrimination, sweating may be impaired
299
Give 3 causes of carpal tunnel syndrome
- ) Myxoedema
- ) Prolonged flexion
- ) Acromegaly
- ) Myeloma
- ) Local tumours
- ) RA
- ) Amyloidosis
- ) Pregnancy
- ) Sarcoidosis
300
How do we test for carpal tunnel syndrome?
- ) Neurophysiology
- ) Maximal wrist flexion for 1 minute may elicit symptoms
- ) Tapping over the wrist may induce tingling
301
How do we treat carpal tunnel syndrome? (3)
- ) Splinting
- ) Local steroid injection
- ) Possible decompression surgery
302
What is a polyneuropathy?
Motor and/or sensory disorder of multiple peripheral or cranial nerves
303
What is the usual distribution of polyneuropathies? (3)
- ) Symmetrical
- ) Widespread
- ) Often worse distally (glove and stocking)
304
How do we classify polyneuropathies?
- ) Chronicity
- ) Function
- ) Pathology
305
What are the functional classifications of polyneuropathies?
- ) Sensory
- ) Motor
- ) Autonomic
- ) Mixed
306
What are the pathological classifications of polyneuropathies?
- ) Demyelination
- ) Axonal degeneration
- ) Both
307
How do we diagnose a polyneuropathy?
- ) History
| - ) Nerve conduction studies
308
What does sensory neuropathy present with?
- ) Numbness
- ) Paraesthesiae (pins and needles, glove and stocking)
- ) Difficulty handling small objects
- ) Signs of trauma or joint deformation
- ) DM and alcoholic neuropathies typically painful
309
What does motor neuropathy present with?
-) Often progressive
-) Weak or clumsy hands
-) Difficulty in walking
-) Difficulty in breathing
) LMN lesion - wasting and weakness
-) Reduced/absent reflexes
310
What do cranial nerve polyneuropathies present with?
- ) Swallowing/speaking difficulty
| - ) Diplopia
311
What do sympathetic autonomic neuropathies present with?
- ) Postural hypotension
- ) Decreased sweating
- ) Ejaculatory failure
- ) Horner's syndrome
312
What do parasympathetic autonomic neuropathies present with?
- ) Constipation
- ) Nocturnal diarrhoea
- ) Urine retention
- ) Erectile dysfunction
- ) Holmes-Adie pupil
313
Give 4 causes of polyneuropathies
- ) DM
- ) Renal failure
- ) Hypothyroidism/glycaemia
- ) Leprosy
- ) HIV
- ) Syphilis
- ) Lyme disease
- ) PAN
- ) RA
- ) Charcot-Marie-Tooth
- ) Guillaine-Barre
- ) Sarcoidosis
- ) Drugs
- ) Deficiencies
- ) Malignancy
314
Give 4 ways we can treat polyneuropathies
- ) Treat cause
- ) Physio and OT
- ) Foot care and shoe choice
- ) Splinting
- ) Amitriptyline, fluoxetine, gabapentin for neuropathic pain
315
How does a cerebral hemisphere lesion present?
Contralateral, unilateral pattern
316
How does a spinal cord lesion present?
Bilateral, at a level
317
How does a cerebellum lesion present?
Coordination loss, ipsilateral, DANISH symptoms
318
What are the DANISH symptoms?
```
Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria
Heel-shin test positivity
```
319
How does a brainstem lesion present?
Weirdly
320
How do peripheral nerve lesions present?
Mononeuropathy, polyneuropathy
321
How does a lesion in cranial nerve I present?
Cannot smell
322
How does a lesion in cranial nerve II present?
Acuity lost, visual fields, reaction to light
323
How does a lesion in cranial nerve III present?
Ptosis, large pupil, eye down and out
324
How does a lesion in cranial nerve IV present?
Diplopia on looking down and in, head tilting
325
How does a lesion in cranial nerve VI present?
Horizontal diplopia on looking out, nystagmus (away from lesion if acute, towards if chronic)
326
How does a lesion in cranial nerve V present?
Motor palsy
327
How does a lesion in cranial nerve VII present?
Facial nerve lesions - droop and weakness, taste in anterior 2/3 of tongue lost
328
How does a lesion in cranial nerve VIII present?
Hearing, balance, vertigo problems
329
How does a lesion in cranial nerve IX present?
Gag reflex
330
How does a lesion in cranial nerve X present?
Gag reflex, palate pulled to one side on saying 'Ah', problems swallowing
331
How does a lesion in cranial nerve XI present?
Cannot shrug shoulders against resistance, turn head
332
How does a lesion in cranial nerve XII present?
Tongue deviates to side of lesion
333
Give 3 clinical features of a LMN lesion
-) Muscle tone normal/reduced (flaccid)
-) Muscle wasting
-) Fasciculation
-) Reflexes depressed/absent
Everything goes down!
334
Give 3 clinical features of an UMN lesion
-) Muscle tone increased (spasticity)
-) Tendon reflexes/jaw jerk brist
-) Plantar responses extensor (positive Babinski sign)
-) Characteristic pattern of limb muscle weakness
-) Maybe emotional lability
Everything goes up!
335
What is the characteristic pattern of limb muscle weakness in UMN lesions?
Upper limbs - extensor muscles weaker than flexors
| Lower limbs - flexor muscles weaker than extensors
336
What does spinal cord compression usually present with?
Weak legs
337
Is arm or leg weakness more severe?
Leg
338
Give 3 causes of spinal cord compression
- ) Secondary malignancy in spine
- ) Infection causing abscess
- ) Disc prolapse
- ) Cord tumour
- ) Haematoma
- ) Myeloma
339
Give 2 signs of spinal cord compression
- ) Normal above lesion
- ) LMN signs at level
- ) UMN signs below level
340
Give 2 tests for spinal cord compression
- ) MRI
- ) Biopsy if mass
- ) Screening bloods
- ) CXR
341
How do we treat a malignant cause of spinal cord compression?
Dexamethasone IV and consider more specific therapy, possible decompression
342
How may we treat an epidural abscess?
Surgical decompression, antibiotics
343
What are the presenting symptoms of cauda equina syndrome? (6)
- ) Leg weakness is flaccid and areflexic (not spastic and hyperreflexic)
- ) Back pain
- ) Radicular pain down legs
- ) Asymmetrical, atrophic, areflexic paralysis of legs
- ) Sensory loss in root distribution
- ) Decreased anal sphincter tone
344
Give 3 causes of cauda equina syndrome
- ) Secondary malignancy in spine
- ) Infection causing abscess
- ) Disc prolapse
- ) Cord tumour
- ) Congenital lumbar disc disease
- ) Lumbosacral nerve lesions
345
What grade is an anapaestic astrocytoma?
III
346
What are the pathogenic steps in the common pathway to a malignant glioma? (5)
1) Genetic error of glucose glycolysis
2) Mutation of isocitrate dehydrogenase 1
3) Excessive build up of 2-hydroxyglutarate
4) Genetic instability in glial cells
5) Inappropriate mitosis
347
What is the most frequent brain tumour?
Astrocytoma
348
What is a gorilla cell?
Tumour cells in other parts of the brain away from the main tumour that can cause recurrence
349
What do we see in the histology of an oligodendroglioma?
Fried egg nuclei
350
Give 3 of the most common sites that metastasise to the brain
- ) Lung
- ) Breast
- ) Melanoma
- ) GU/GI tract
- ) Kidney
351
Give 3 signs of a brain tumour
- ) Increased ICP
- ) Vomiting
- ) Headache worse on waking/coughing/bending
- ) Focal neurological signs
- ) Ataxia
- ) Fits
- ) Nausea
- ) Papilloedema
- ) Decreased GCS
- ) Subtle personality changes
352
What can tumours physically cause in the brain?
Mass effect, hernias, coning
353
Why does a papilloedema occur?
Prolonged high ICP due to obstruction of venous return from retina
354
How do we diagnose a brain tumour?
- ) CT/MRI
- ) Biopsy
- ) Avoid LP before imaging
355
How do we treat a brain tumour?
- ) Remove
- ) Ventricle peritoneal shunt (for hydrocephalus)
- ) Chemo/radio
- ) Temozolomide for glioblastoma
- ) Mannitol or dexamethasone for cerebral oedema
- ) Analgesia
- ) Phenytoin for seizure prophylaxis
356
Does MGMT wild type or mutant indicate a better prognosis?
Mutant
357
What is myelitis?
Inflammation of the spinal cord
358
What in meningoencephalitis?
Inflammation of the brain and meninges
359
What type of virus is rabies?
RNA
360
What organism is tetanus caused by?
Clostridium tetani
361
What toxin is secreted in tetanus?
Tetanospasmin
362
How does tetanus infect?
Via dirty wounds
363
How is rabies transmitted?
Via the saliva
364
Give 2 symptoms of tetanus
- ) Trismus (lockjaw)
- ) Sustained muscle contraction
- ) Involvement of facial muscles
- ) Paroxysmal generalised spasms
365
Give 2 symptoms of rabies
- ) Rapid, aggressive, odd behaviour
- ) Hypersalivation
- ) Hydrophobia
- ) Fever
- ) Anxiety, confusion
- ) Hyperactivity, uncontrollable excitement, hallucinations
- ) Violent movement
366
What is the prevention for both rabies and tetanus?
Vaccinations
367
What is meningitis?
Inflammation of the meninges
368
Give 3 causes of meningitis
- ) Meningococcus
- ) Pneumococcus
- ) Haemophilus influenzae
- ) Listeria monocytogenes
369
Give a cause of meningitis in the immunosuppressed
- ) CMV
- ) Crytococcus
- ) TB
370
What can viral meningitis be caused by?
Enterovirus
371
Give 2 early clinical features of meningitis
- ) Headache
- ) Leg pain
- ) Cold hands and feet
- ) Abnormal skin colour
372
Give 2 late clinical features of meningitis
- ) NECK STIFFNESS
- ) Photophobia
- ) Kernig's sign
- ) Decreased GCS
- ) Seizures
- ) Focal CNS signs
- ) Non-blanching petechial rash
373
Give 3 tests for meningitis
- ) U&E, FBC, glucose, coagulation
- ) Blood culture, throat swabs, serology
- ) LP usually after CT
- ) CSF for MC&S, gram stain, protein, glucose, virology/PCR, lactate
- ) CXR for TB
374
What does the CSF fluid appear like in meningitis if it is pyogenic?
Turbid
375
What prophylaxis do we give to close contacts of meningitis?
Rifampicin or ciprofloxacin
376
What is the treatment for meningitis? (4)
- ) IV fluids and resus
- ) <55 cefotaxime IV (or ceftriaxone)
- ) >55 cefotaxime and ampicillin IV
- ) Aciclovir if viral suspected
377
What is encephalitis?
Inflammation of the brain
378
Give 3 viral causes of encephalitis
- ) HSV1 and 2
- ) Arboviruses
- ) CMV
- ) EBV
- ) VZV
- ) HIV
- ) Measles
- ) Mumps
- ) Rabies
- ) Japanese B encephalitis
- ) West Nile virus
- ) Tick borne encephalitis
379
Give 2 non viral causes of encephalitis
-) Bacterial meningitis
-) TB
-) Malaria
-) Listeria
-) Lyme disease
-) Legionella
-) Aspergillosis
-) Shistosomiasis
-) Typhus
Etc
380
Give 3 signs and symptoms of encephalitis
- ) Bizarre encephalopathic behaviour or confusion
- ) Decreased GCS/coma
- ) Fever
- ) Headache
- ) Focal neurological signs
- ) Seizures
- ) History of travel/animal bite
381
What investigations do we do for encephalitis?
- ) Bloods
- ) Contrast enhanced CT
- ) LP
- ) EEG
382
What is suggestive of HSV encephalitis on a contrast enhanced CT?
Focal bilateral temporal lobe involvement
383
What is suggestive of meningoencephalitis on a contrast enhanced CT?
Meningeal enhancement
384
What does a LP show in encephalitis? (3)
- ) High protein
- ) High lymphocytes
- ) Low glucose
385
What is the treatment for encephalitis?
Aciclovir
386
What does reactivation of the virus that caused chickenpox cause?
Shingles
387
How do we treat shingles?
Aciclovir
388
Where does the herpes zoster virus lay dormant after infection?
Dorsal root ganglia
389
Give 3 symptoms of ataxia
- ) Slurring of speech
- ) Unsteadiness when walking/worse in dark
- ) Stumbles and falls
- ) Swallowing difficulties
- ) Oscillopsia
- ) Clumsiness
- ) Action tremor
- ) Loss of precision of fine movement/motor skills
- ) Cognitive problems
390
Give 3 signs of ataxia
- ) Nystagmus
- ) Dysarthria
- ) Action tremor
- ) Truncal ataxia
- ) Dysdiadochokinesia
- ) Limb ataxia
- ) Gait ataxia
391
Give 3 types of inherited ataxia
- ) Autosomal recessive (Freidreich's)
- ) Autosomal dominant (SC6, episodic)
- ) Mitochondrial
- ) X-linked
392
Give 3 types of acquired ataxia
- ) Toxic (alcohol, lithium, phenytoin)
- ) Immune mediated (gluten)
- ) Neurodegenerative
- ) Idiopathic sporadic
- ) Vascular/structural
393
Define dermatome
The area of skin supplied by a single spinal nerve
394
Define myotome
The volume of muscle supplied by a single spinal nerve
395
Give 3 symptoms of Brown-Sequard syndrome
- ) Ipsilateral UMN weakness below lesion
- ) Ipsilateral loss of proprioception and vibration
- ) Contralateral loss of pain and temperature
396
Why is there ipsilateral UMN weakness below the lesion in Brown-Sequard syndrome?
Corticospinal tract severed
397
Why is there ipsilateral loss of proprioception and vibration in Brown-Sequard syndrome?
Dorsal column severed
398
Why is there contralateral loss of pain and temperature in Brown-Sequard syndrome?
Spinothalamic tract severed
399
How does the corticospinal tract decussate?
Lateral - 85% in medulla
| Anterior - 15% stays same side
400
What does the corticospinal tract do?
Rapid, skilled, voluntary movement
401
What does the rubrospinal tract do?
- ) Facilitates flexors
| - ) Inhibits extensors
402
What does the vestibulospinal tract do?
- ) Facilitates extensors
| - ) Inhibits flexors
403
What does the tectospinal tract do?
Truncal reflexes from sight
404
What do the fasciclulus gracilis and cuneatus do?
Sensation of touch, vibration, conscious muscle/joint sense
405
Where is the fasciculus gracilis from?
Leg
406
Where is the fasciculus cuneatus from?
Arm
407
What does the spinocerebellar tract do?
Sensation of non-conscious muscle/joint sense
408
Where do the tracts decussate in the spinocerebellar tract?
Posterior - ipsilateral
| Anterior - immediate
409
What does the spinothalamic tract do? (2)
Lateral - pain, temperature
| Anterior - light touch, pressure
410
What does the spina-olivary tract do?
Sensation of proprioception
411
Why do epidural anaesthetics give greater sensory block than motor block?
Cell bodies (sensory neurones in dorsal root ganglia) have a higher SA than axons
412
What does Wernicke's area do?
Understands speech, uses correct words
413
What does Broca's area do?
Motor speech, movements
414
What are the 3 layers of the meninges?
Dura
Arachnoid
Pia
415
Where does the circle of Willis lie?
Subarachnoid space
416
Where do meningeal vessels lie?
Extradural space
417
What can compress the optic pathway?
Pituitary tumours
418
Name the 12 cranial nerves
```
I - Olfactory
II - Optic
III - Oculomotor
IV - Trochlear
V - Trigeminal
VI - Abducens
VII - Facial
VIII - Vestibulocochlear
IX - Glossopharnygeal
X - Vagus
XI - Accessory spinal
XII - Hypoglossal
Oh Oh Oh To Touch And Feel Very Good Vaginas And Hymens
```
419
Which cranial nerves make up the parasympathetic NS?
III, VII, IX, X
420
What type of fibre is each cranial nerve?
```
I - Sensory
II - Sensory
III - Motor
IV - Motor
V - Both
VI - Motor
VII - Both
VIII - Sensory
IX - Both
X - Both
XI - Motor
XII - Motor
Some Say Money Matters But My Brother Says Big Breasts Matter Most
```
421
What is Wilson's disease?
Inherited disorder of copper excretion with excess deposition in liver and CNS
422
Give 2 CNS signs of Wilson's disease
- ) Psychiatric symptoms
- ) Personality change
- ) Mood disturbance
- ) Psychosis
- ) Cognitive impairment
423
What is acute intermittent porphyria?
A metabolic disorder of haem
424
Give 2 symptoms of acute intermittent porphyria
- ) Acute psychosis
- ) Agitation
- ) Mania
- ) Depression
425
What is neuroacanthocytosis?
Blood contains misshapen RBCs - acanthocytes
426
Give 3 symptoms of neuracanthocytosis?
- ) Anxiety
- ) Paranoia
- ) Depression
- ) Obsessive behaviour
- ) Emotional instability
427
What are somatisation disorders?
Physical symptoms are caused by mental/emotional factors
428
What is hypochondriasis?
Fear that minor symptoms may be due to serious disease
429
What is dissociative amnesia?
Periods where they cannot remember information about themselves/events in their past
430
What is dissociative identity disorder?
Feel uncertain about identity, may feel presence of other identities
431
Are you gonna pass phase 2a?
Yassssss
