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4th Year > Neurology > Flashcards

Neurology Flashcards

1
Q

What is spontaneous intracranial hypotension?

A

Low CSF headaches

  • Worse on standing
  • Improve on lying flat
  • Risk factors = Marfan’s syndrome

Ix: MRI with gadolinium
Rx: Usually conservative

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2
Q

A humeral shaft fracture - which nerve is mostly likely to be damaged and what is the presentation?

A

Radial nerve

Wrist drop + sensory loss to small area between dorsal aspect of 1st and 2nd metacarpals

Tricep paralysis

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3
Q

Out of sodium valproate, carbamazepine and phenytoin which one is most likely to cause megaloblastic anaemia?

A

Phenytoin

by altering folate mechanism

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4
Q

What blood vessel is subdural haemorrhages mostly due to?

What shape is it on CT?

Who are more at risk?

A

Bridging veins between cortex and venous sinuses

Crescent shape

Alcoholics & elderly

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5
Q

What are the functions of the dorsal column?

A

Fine touch, proprioception, vibration

Condition called Neurosyphilis (tabes dorsalis) is due to just dorsal column lesion

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6
Q

What is the first line antiplatelet for secondary prevention following stroke?

A

Clopidogrel

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7
Q

Parkinsonism with associated autonomic disturbance (atonic bladder, postural hypotension) points towards…

A

Multiple system atrophy

Features

  • parkinsonism
  • autonomic disturbance
    - erectile dysfunction: often an early feature
    - postural hypotension
    - atonic bladder
  • cerebellar signs
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8
Q

Treatment for idiopathic intracranial hypertension (2)

A

Acetazolamide
- a carbonic anhydrase inhibitor that is used in IIH to reduce the production of cerebrospinal fluid in order to reduce intracranial pressure

Topiramate

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9
Q

Features of vestibular schwannoma (acoustic neuroma)

A

cerebellopontine angle tumour

cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus

cranial nerve V: absent corneal reflex

cranial nerve VII: facial palsy

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10
Q

What is the Neuroleptic malignant syndrome tetrad?

A

hyperthermia/ pyrexia, muscle rigidity, autonomic instability, altered mental status

A raised creatine kinase is present in most cases. Acute kidney injury (secondary to rhabdomyolysis) may develop in severe cases - deranged U&Es. A leukocytosis may also be seen

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11
Q

What blood test is used to differentiate between a true seizure and a pseudoseizure

A

Prolactin

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12
Q

A 30-year-old man with a family history of early blindness is concerned that he is developing ‘tunnel vision’.

A

This is a common presentation of retinitis pigmentosa. Extensive pigmentation would normally be noted on fundoscopy.

(tunnel vision - macular sparing also happens in glaucoma)

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13
Q

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a….

A

pituitary tumour

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14
Q

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a…

A

craniopharyngioma

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15
Q

What two features suggests the development of Korsakoff’s syndrome

A

An inability to acquire new memories (amnesia) and confabulation (disturbance of memory/ production of fabricated, distorted or misinterpreted memories)

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16
Q

Features of Wernicke’s encephalopathy

Ix?

Tx?

A 
CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral 
Neuropathy

Ix:

  • decreased red cell transketolase
  • MRI

Tx: Pabrinex/ Thiamine (B1) replacement

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17
Q

High stepping gait is due to…

A

compensate for foot drop
Unilateral - usually due to common peroneal nerve lesion

Bilateral foot drop - peripheral neuropathy

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18
Q

What artery supplies both the Wernickes and Broca’s areas of the cortex?

What location are each area in?

A

Middle cerebral artery

  • usually dominant hemisphere which is the LEFT usually

Brocas - inferior frontal gyrus - speech issues

Wernickes - superior temporal gyrus - comprehension issue

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19
Q

How do lacunar infarcts present?

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

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20
Q

How does lateral medullary syndrome present?

A

(posterior inferior cerebellar artery)
aka Wallenberg’s syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

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21
Q

Subacute combined degeneration of the cord

A

Subacute combined degeneration of the cord involves degeneration of the posterior and lateral columns of the spinal cord, often due to vitamin B12 deficiency.
Damage to the posterior columns - loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg’s test).
Damage to lateral columns - spastic weakness and upgoing plantars (UMN signs).
Damage to peripheral nerves - absent ankle and knee jerks (LMN signs).

When there is a mix of UMN and LMN signs in a patient, always consider SCDC.

Replacing folate without vitamin B12 (hinted at in this case) can precipitate subacute combined degeneration of the cord in a patient who is vitamin B12 deficient. Always ensure vitamin B12 levels are checked (and replenished) before giving folate for a macrocytic anaemia.

Amyotrophic lateral sclerosis is a subtype of motor neurone disease. This may present with mixed UMN and LMN signs but no associated sensory deficits.

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22
Q

First line Tx for restless leg syndrome

A

dopamine agonists such as ropinirole

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23
Q

common peroneal palsy can cause…

A

weakness of foot dorsiflexion and foot eversion

sensory loss over the 1st and 2nd toes

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24
Q

What is the Ramsey Hunt Syndrome?

Features?

Tx?

A

caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

Features
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

Management
oral aciclovir and corticosteroids are usually given

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25
Q

An 18-year-old is found unresponsive and lying on the floor. He slowly regains consciousness, is confused and has a right-sided weakness of their arm and face. On arrival, the paramedics notice that he has a medical bracelet with a long-term condition stated on it.

What condition does this patient most likely have?

A

Patients with focal seizures may experience post-ictal weakness (Todd’s paresis)

Frontal lobe

26
Q

What is the management for acute relapse of MS?

A

high dose steroids

27
Q

Brown-Sequard syndrome

A

Unilateral spastic paresis and loss of proprioception/vibration sensation with loss of pain and temperature sensation on the opposite side -

28
Q

Acute Tx or cluster headache

Prophylaxis tx

A

O2 + subcut triptan

verapamil

29
Q

Lip-smacking and post-ictal dysphasia focal seizure is from which lobe location?

A

Temporal lobe

30
Q

What does DANISH stand for?

A

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

31
Q

What is autonomic dysreflexia?

A

Occurs in patient who had a spinal cord injury at, or above T6.

Get symptoms such as severe hypertension, flushing, sweating without a congruent response in heart rate

32
Q

Why is COCP contraindicated in migraines?

A

due to significantly increased risk of stroke

33
Q

Symptoms of progressive supranuclear palsy?

A

Parkinsonism features +

  • dysarthria (slow speech)
  • vertical gaze palsy
34
Q

Painful third nerve palsy, what artery aneurysm must be urgently checked?

A

Posterior communicating artery aneurysm

  • can also have pupil dilation
35
Q

What is weber’s syndrome?

A

Ipsilateral III palsy + contralateral weakness (hemiplegia)

36
Q

Parkinsonism with symmetrical tremor

A

Drug induced Parkisonism

37
Q

Examples of dopamine agonist?

A

Parkinson’s disease drugs eg Bromocriptine, ropinirole, cabergoline

38
Q

Examples of dopamine antagonist drugs

A

Antipsychotics e.g. haloperidol

Anti-emetics (e.g. metoclopramide/ domperidone)

39
Q

Treatment of neuroleptic malignant syndrome

A

IV fluids
Dantrolene

bromocriptine, dopamine agonist, may also be used

40
Q

Drugs that increase the risk of idiopathic intracranial hypertension

A

COCP, steroids, tetracycline, vit A, lithium

41
Q

What is hoffmans sign

A

a sign of UMN dysfunction

42
Q

GCS less than ___- –> what is next step

A

8

intubate and ventilate

43
Q

A low pressure headache commonly develops following a lumbar puncture - what is the treatment?

A

Caffeine and fluids

44
Q

Reflexes for ankle, knee, biceps, tricepts

A

S1, S2,
L3, L4
C5, C6
C7, C8

-Ed

45
Q

Miosis means

A

excessive constriction

46
Q

what is the first line tx for neuropathic pain?

A

amitriptyline, duloxetine, gabapentin or pregabalin

47
Q

What is the criteria for total anterior circulation infarct?

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia

Total anterior circulation infarcts (TACI, c. 15%)
involves middle and anterior cerebral arteries
all 3 of the above criteria are present

48
Q

Symptoms of uncal herniation

A

3rd nerve gets compressed - dilated ipsilateral pupil

- ophthalmoplegia

49
Q

Is gait ataxia caused by cerebellar hemisphere or cerebellar vermis?

A

cerebellar vermis

Cerebellar hemisphere lesions cause peripheral (‘finger-nose ataxia’)

Cerebellar vermis lesions cause gait ataxia

50
Q

Klumpke’s paralysis affecting which roots

A

brachial trunks C8-T1

51
Q

Erb’s palsy affects which roots

A

C5-C6

52
Q

Why is it important to not acutely stop levodopa?

A

To prevent acute dystonia

53
Q

What is refeeding syndrome

A

It is when there are metabolic abnormalities which occur on feeding a person following a period of starvation

  • hypophosphataemia
  • hypokalaemia
  • hypomagnesaemia
  • abnormal fluid balance
54
Q

What is first line ix for MS

A

mri with contrast

55
Q

What is the cushing reflex?

A

Response to increased ICP that results in hypertension and bradycardia

56
Q

What is the long term prophylaxis of cluster headaches

A

verapamil

57
Q

What should you prescribe to a 17 year old girl with tonic clonic seizures

A

Lamotrigine

(Sodium valproate is usually first line but should not be prescribed to female children, adolescents, childbearing age, pregnant woman)

58
Q

What makes essential tremor better?

A

Alcohol and propranolol

59
Q

how to define postural hypotension

A

Postural hypotension is defined as a fall in blood pressure (BP) of at least 20 mmHg systolic and 10 mm Hg diastolic within three minutes in the upright position

60
Q

What is the treatment of a myasthenic crisis?

A

plasmapheresis, IV immunoglobulins, ventilatory support

61
Q

patient with unilateral hearing loss who presents with reduced facial sensation and balance problems…

First line Ix?

A

Acoustic neuroma

Gadolinium enhanced MRI
Audiogram

4th Year (8 decks)

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