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Royal College Exam > Neurology > Flashcards

Neurology Flashcards

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1
Q

What are the findings of lateral medullary syndrome?

A

PICA or vertebral artery infarct.

  1. Ipsilateral Horners
  2. Facial loss of pain/temp
  3. Contralateral body loss of pain/temp
  4. Vertigo, nystagmus
  5. Dysphagia and hoarseness
  6. Hiccups
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2
Q

What are the findings in medial medullary syndrome?

A

Anterior spinal artery.

  1. Ipsilateral tongue weakness.
  2. Contralateral arm, leg weakness.
  3. Contralateral body vibration, loss of proprioception.
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3
Q

What are the findings of midbrain infarct (weber’s)?

A

PCA affected.

  1. Ipsilateral CN3 palsy
  2. Contralateral hemiplegia
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4
Q

What are the findings of ACA infarct?

A

Contralateral leg weakness and numbness

Contralateral grasp weakness (frontal signs)

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5
Q

What are the findings of left MCA infarct?

A

Superior branch - Broca’s aphasia, right weakness arm>leg, gaze deviation to the left.
Inferior branch - Wernicke’s aphasia, right cortical sensory loss, right pie in the sky.

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6
Q

What are the findings of right MCA infarct?

A

Superior branch - Left weakness face and arm > leg, gaze deviation to the right.
Inferior branch - left cortical sensory loss, left hemineglect, left pie in the sky.

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7
Q

What are the findings of PCA infarct?

A

Contralateral homonymous hemianopia.

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8
Q

What are the findings of lacunar infarct?

A

Motor - diffuse contralateral weakness

Sensory - diffuse contralateral sensory symptoms

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9
Q

What are neurological signs of B12 deficiency?

A

Subacute combined degeneration: Posterior cord (vibration/proprioception) AND corticospinal tract (motor)
= dorsal/posterior cord syndrome

  1. UMN weakness
  2. Hyper-reflexia and UPGOING toes
  3. Dementia
  4. Loss of proprioception/vibration sensing
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10
Q

What are neurological signs of tertiary syphilis?

A

dorsal/posterior cord syndrome

Preferential loss of vibration sense and proprioception

ALSO associated with
Argyle Robertson Pupils (Prostitute pupils - accomodate, but do not constrict)

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11
Q

When do you need to obtain imaging prior to LP?

A 
focal neuro deficits
new seizures
GCS < 10 or altered LOC
Immunocompromised
Anatomical issue (previous spine sx)
Local skin infection/chiari malformation
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12
Q

What is the BP target in acute stroke?

A

Permissive hypertension.

Treat BP in first 24hr if > 220/120

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13
Q

What is the BP target for acute ICH?

A

systolic < 180

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14
Q

What are indications for PFO closure in setting of stroke?

A

age 18-60
stroke is NON-lacunar by imaging
PFO is most likely the cause after ruling out others

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15
Q

What do you do with antiplatelet therapy if patient presents with stroke > 24 hours after onset?

A

no DAPT. Single antiplatelet

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16
Q

What are side effects of levodopa/carbidopa?

A

Dyskinesias
Orthostatic hypotension
Hallucinations

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17
Q

What are the time and age criteria for TPA?

A

Ischemic stroke causing DISABLING deficits (NIHSS>5) in patients > 18 y.o

Time from last well known < 4.5h

18
Q

What are the exclusion criteria for TPA?

A

Active hemorrhage or any condition that increases risks of major hemorrhage with tPA

Any hemorrhage on brain imaging

Not on DOAC (can consider EVT)

19
Q

What are contraindications to LP?

A

INR > 1.7
Plt < 50
Papilledema/raised ICP secondary to mass
Can’t safely tolerate procedure

20
Q

What is central cord syndrome? How does it present?

A

Often due to cervical spondylosis, hyperextension injury etc

Greater motor deficit in upper than lower extremities with varying degree of sensory loss and autonomic involvement

21
Q

What do you use to treat vertebral/carotid artery dissections?

A

EXTRAcranial: either antiplatelet or anticoagulant (both are reasonable)

INTRAcranial: antiplatelet (no evidence for anticoagulation)

22
Q

What are causes of Horner’s?

A

Stroke - lateral medullary syndrome
Pancoast tumour
Carotid dissection/aneurysm

23
Q

What are stenosis criteria for carotid endararterectmy? When should it be offered?

A

Asymptomatic = medical management

Symptomatic + 50-69% stenosis = CEA MAY be offered

TIA/non disabling stroke + ipsilateral 70-99% stenosis = CEA or CAS if not a CEA candidate

CEA should be:
within 48 hr of symptom onset OR
within 2 weeks if not stable within first 48 hours

CEA better than stenting in pts > 70 y.o

24
Q

How do you differentiate ischemic CN III palsy from compressive?

A

Pupil is spared in ischemic

There is mydriasis in compressive, as well as pain (parasympathetic fibres along the surface of CN III gets compressed)

25
Q

What are symptoms of brown sequard syndrome?

A

Ipsilateral loss of motor function
Ipsilateral loss of vibration and proprioception sense

Contralateral loss of pain and temperature

26
Q

How long do patients remain on DAPT post stroke? when do you start?

A

Ideally start ASAP after brain imaging (<24h, ideally <12)

DAPT x 3-4 weeks, then monotherapy

27
Q

What is the definition of status epilepticus? What makes it refractory?

A 
>= 5min clinical or EEG activity OR
>= 2 seizures without recovery in between

Refractory when:
Failure of benzo + 1 AED

28
Q

What are treatments for Guillain Barre syndrome?

A

IVIG OR
PLEX

STEROIDS NOT INDICATED (indicated for CDIP)

29
Q

When should you intubate for Guillain Barre syndrome or Myasthesia Gravis crisis?

A

20 - 30 - 40 rule

FVC < 20ml/Kg
MIP < 30 cm H2O
MEP < 40 cm H2O

30
Q

What is the classic finding on LP for Guillain Barre syndrome?

A

Albuminocytologic dissociation

Protein > 0.45 + WBC < 5

If WBC also up, check HIV status

31
Q

What are treatments for myasthenic crisis?

A

PLEX OR
IVIG

Need to hold pyridostigamine when intubated due to increased airway secretions
High dose prednisone - caution, can worsen respiratory status

32
Q

What are the 3 subtypes of multiple sclerosis?

A

Relapsing remitting
Secondary progressive
Primary progressive

33
Q

What is the role of steroids in MS?

A

Does NOT alter degree of recovery
Does NOT reduce future attacks
Only speed recovery

34
Q

When are DAPT indicated in acute stroke?

A

<24hr
NIHSS <4 (higher NIHSS associated with hemorrhagic transformation)
ABCD2 > 4

35
Q

What is the ABCD2 score for stroke/TIA

A

A - Age>60
B - BP>140/90
C - clinical features (unilateral weakness = 2, speech disturbance without weakness = 1)
D - Duration of symptoms (10-59 minutes = 1, >1h = 2)
D - Diabetes
TOTAL /7

36
Q

What are inclusion criteria for EVT?

A
  1. > 18 years
  2. Disabling stroke
  3. Functionally independent
  4. Life expectancy > 3months
  5. Anterior circulation occlusion of proximal large vessel
  6. Small to moderate ischemic core (ASPECT>5)
37
Q

What are BP targets when giving tPA

A

Excluded if BP>185/110, target <180/105

38
Q

When can antiplatelets be started post-tPA?

A

After 24h repeat CT head shows no bleed, start heparin for DVT prophylaxis and SAPT.

39
Q

Who should be treated with DAPT

A

Very high risk TIA (ABCD2>/=4) or minor stroke (NIHSS3) of non-cardioembolic origin

40
Q

When can anticoagulants be started post-stroke?

A

TIA - 1 day
Small - 3 days
Moderate - 6 days
Large - 12 days

Royal College Exam (15 decks)

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