Neurology Flashcards
What are the features of narcolepsy?
What is the diagnostic test?
Hypersomnolence
Cataplexy
Sleep paralysis
Hallucinations upon waking
Test:
- Multiple sleep latency EEG
Which antibiotics can induce idiopathic intracranial hypertension?
Tetracycline antibiotics
What is a major diagnosis that needs to be ruled out for a TIA?
Hypoglycemia
What is the time frame for thromboectomy?
Within 6 hours
What is thiamine?
Vitamin B1
Optic chiasm tumours cause bitemporal hemianopias, but they usually affect a quadrant, how does this vary?
Inferior Optic chiasm compression (pituitary tumour) causes:
- Upper quadrant defect
Superior optic chiasm compression (Craniopharyngioma) causes:
- lower quadrant defect
What are the treatment options for neuropathic pain?
Rescue therapy: Tramadol
- exacerbations
1st line are:
- amitriptyline
- duloxetine
- gabapentin
capsaicin - can be trialed for post-herpatic pain
What are the two most important causes of status epilepsy to be ruled out?
Hypoxia
Hypoglycaemia
If a patient develops diplopia when looking to the right, which side is the palsy?
Right side.
the symptoms (diplopia) gets worse the more you look to that side
If some experiences double vision when looking down, say when reading. Where is the palsy?
4th nerve
- trochlear
They get vertical diplopia
Which nerve provides motor innervation to the tongue? What happens if there is damage?
12th
Deviates towards side of lesion
If you had defects in III, IV, V and VI cranial nerves, where may there be a lesion?
Cavernous sinus
What nerves pass though the jugular foramen?
IX, X, XI
What nerves are affect in balbar palsy?
IX, X, XI, XII
- these nerves are within the medulla.
- *it is called bulbar because the medulla means bulb because it looks like a bulb, hence the term “bulbar”
What nerves are associatted with the cerebellopontine angle?
V, VII, VIII
If you had a lesion over the internal capsule where anatomically would you expect to see defects?
Almost entirely across the contralateral side
- since all the fibres filter through this area
What are the signs of an UMN lesion?
Increased tone Spastic weakness Brisk reflexes Clonus - if ankle Up going planters Minimal atrophy *some occurs due to disuse
*UMN signs can take weeks to develop
What is the most commonly inherited neuropathy?
Charcot marie tooth
AD
If there is a lesioni the thalamus, what signs and symptoms would you expect?
Hemi -sensory changes
Drowsiness
If there is weakness on right side of the face, and weakness on the left side of the body, what is this called and where is the lesion likely to be?
What investigation would be most suitable for this?
Crossed sign
- where there is ipsilateral signs on side of lesion on face (distrubution of cranial nerves)
- contralateral weakness/ signs on opposite of body
Lesion will be within the brainstem.
**because certain fibres such as corticospinal tracts haven’t cross over yet. making it contralateral
MRI is needed for investigations. More sensitive than CT
In Brown - Sequard Syndrome - what would you expect the reflexes to be?
Brisk on the ipsilateral side.
- these are controlled via descending fibres on the same side
*plantars will also be up going in these
Which clinical test can be done to differentiate between sensory and cerebellar ataxia and explain how:
Romberg’s test
- in sensory ataxia there will be a postive romberg’s.
- the patient will fall or become unsteady when eyes are shut as they have no tactile sensory input they were relying on their vision.
Name an important neoplastic condition that must be screened for when someone presents with length depentant neuropathy:
Multiple myeloma.
Electrophresis should be conducted in those who present with length depentent axonal neuropathy
Highlight some typical tests that may be carried out in someone presenting with peripheral neuropathy:
Bloods:
- Glucose/ OGTT
- FBC
- U&Es
- B12
- LFTs
- TFTs
- Electrophoresis
What are the main investigation modalities used in neurophysiology? Which are used for central neuropathies?
EEG
- Recording electrical activity within the cortex
EMG
- used to specifically locate the lesion area. i.e. myopathy or neuronal death to the muscle
Nerve conduction studies
Evoked Potentials
- used in MS, usually visual evoked potentials
Central:
- EEG
- EP
In nerve conduction studies, what findings would you expect to see in axonal damage and mylinated damage?
Axonal = low amplitude
- less axons being stimulated
Mylinatation damage = slow wave form
In a peroneal injury what type of paralysis would you expect, how does this differ from sciatic lesion?
Distal (peroneal) - dorsiflexion and eversion is only affected
Proximal (sciatic) - inversion is affected as well
What nerve conduction study is used to diagnose myasthenia gravis and what is the characterstic finding?
Myasthenia repetitive stimulation
or
Single fibre EMG
normally the amplitude remains the same.
in MG the level reduces with continual stimulation
- decreament
What can be done during an EEG and video recording to potentially bring about a non-epileptic event?
Hyperventilation
Photostimulation
Outwith seizures when else is EEG useful?
Coma Encephalitis CJD Dementia (only useful in rare Scenarios) Prognosis of hypoxic brain injury
When doing an EEG on someone in a coma or reduced GCS, what is one of the main things that are being assessed for?
Non- Convulsive status epilepticus
In a patient with bilateral leg pain what question do you want to ask?
Time line Distribution Bladder/ Bowel issues Saddle paraesthesia Lack of sensation on going to toilet Neurological sign in lower limbs
Would you expect LMN or UMN signs in cauda equina syndrome?
LMN
if LMN are present then re-consideration of diagnosis is advised
What clinical examination should be conducted on suspected cauda equina syndrome?
and what is an important bedside test that must be done?
and whats the definitve test?
Lower limb sensation/ motor control
Saddle sensation with pinprick (may trigger anal reflex)
Anal tone (either absent or present)
Anal wink reflex / catheter tug sensation
Test:
- Post-void bladder scan. Assess to see if they were sufficient at emptying it.
- remember to address pain or medication that may be causing the urinary retention
Definitive test:
- MRI lumbar with contrast T2 weighted
What is the history of cauda equina syndrome:
Suspected/ CESS:
- bilateral leg pain
- progressive neurology
- bladder and bowel are fine
Incomplete/ CESI:
- Sphincter involvement but still got tone
- difficult passing urine but not in retention
- prompt MRI and Decompression
- *can get recovery from here
Claude Equina syndrome with retention/ CESR
- complete loss of urinary bladder and bowel
- usually >48 hours
- poor prognosis
When might thrombolytic agents be used >4.5hours after a stroke?
If there is a penumbra area
This is detected via a CT perfusion scan which allows for salvageable penumbra area to be seen.
Who does the coiling in patients with a SAH? and how do you follow up a coiling?
Interventional radiology
Follow up via MRI
In the diagnosis of MS, using macdonald’s criteria explain how these physcially appear:
Dissemination in space:
- a lesion will be present in more than one brain area, i.e. paraventricular, subcortial, spinal cord, sub-tentorium
Dissemination in time:
- one will light up with gadolinium (active) one will not light up (old)
Other than follow up of disease why else might a MS patient be followed up?
Assessing for JC reactivation
- progressive multifocal leukoencepalopathy
What are the symptoms of encephalitis, most common organisms and how will you investigate and treat?
Bizzare behaviour reduced GCS Fever Headache Focal neurology *evidence of previous infections with fever, lymphadenopathy etc
Organisms:
- HSV-1
- VZV
- CMV
- EBV
Investigations:
- Bloods cultures
- PCR for viral cultures
- Toxoplasmosis screen
Head CT- bilateral involvement
*involvement of bilateral temporal involvement is highly suggestive of HSV-1
Treatment:
- Aciclovir immediately.
- toxoplasmosis treatment is toxoplasmosis
What is meant be fatigable weakness?
Change in muscle power with exertion
- power that dimishes throughout the day
Highlight some key characteristics of Lambort Eaton syndrome:
Proximal limb and trunk weakness
Get stronger with exertion
Hyporeflexia
- which improves with repeated contraction of muscle
What do the antibodies in Lambort Eaton syndrome affect?
what is it associatted with?
Voltage gated calcium channel ion receptor on the pre-synaptic neuron
Small cell carcinoma
- therefore CXR is needed
What is the treatment of Lambort Eaton syndrome?
3,4 Diaminopyridine
Immunotherapy
- IV IgG
Tumour
- treatment if tumour is present
What are the drugs that can make MG worse and what is the most important one not to give?
Ineffective doses of pyridostigmine (too much or too little)
Gentamcin
Opioids
Beta blockers
Quinine
Tetracyclines
**gentamicin absolutely must not be given
What can you asked the patient to do clinically to worsen a parkinsomism tremor?
Ask them to count backwards
- co-activation makes it worse
There are 3 major types of wave forms seen in ICP, what are they?
A wave
- consistently high pressure, usually above 50mmHg
- tumours, Haematomas, Abscess, brain trauma
B wave
- consistently high but not as high as A wave.
- usually due to non compliant brain tissue
C- wave
- various in pressure
What is the cerebral blood flow equation, and how is it regulated and what is the doctrine of compensation that takes place?
Cerebral blood flow = Cerebral perfusion pressure / Cerebral vascular resistance
**cerebral perfusion pressure = mean arterial pressure - intracranial pressure
Chemoregulation
- pCO2
- pO2
- pH
- metabolic products
Autoregulation
- Smooth muscle in response to systemic blood pressure
Munro- Kellie Doctrine
- for compensatory mechanisms
What compensatory mechanisms are available to cope with raised ICP, and what additional mechanisms do children have?
Reduce CSF
Reduce venous blood
Reduce extracellular fluid
Children
- expand fontanelle
- skull suture expansion
What is the medical treatment of raised ICP?
Dexamethasone
*condraindicated in traumatic brain injury
Mannitol
- allows for 4-6 hours decreased pressure
- useful when transporting for surgery
Ventilation to reduce CO2
Sedation
- propofol
Craniectomies
- traumatic brain injuries
- extensive ischmic stroke
- intracerebral haemorrhage
