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Neurology Flashcards

1
Q

What gene mutation is the most common cause of late onset Alzheimer’s?

A

ApoE4

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2
Q

What gene mutation is the most common cause of early onset Alzheimer’s?

A

Presenilin 1

[PSEN1]

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3
Q

What proportion of Alzheimers is genetic?

A

15%

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4
Q

What is the most common form of dementia?

A

Alzheimer’s

[Around 50% of cases]

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5
Q

What is the 2nd most common form of dementia?

A

Vascular dementia

[Around 20% of cases]

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6
Q

What is the mean survivial time from the diagnosis of Alzheimer’s?

A

7 years

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7
Q

What are the two pathological hall-marks of Alzheimer’s disease?

A

Beta-Amyloid plaques

Tau tangles

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8
Q

Give two reversible causes of dementia

A 
Vit B deficiency
Cerebral tumour
Diabetes
Syphilis
Depression
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9
Q

Which lobes of the brain are most affected by Alzheimer’s atrophy?

A

Fronto-temporal lobes

[You also see dilated ventricles]

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10
Q

At what threshold of MMSE score would you begin treating ALzheimer’s?

A

<12 points

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11
Q

What treatment would you use for mild alzheimer’s vs severe?

A

Mild = Acetylcholinesterase inhibitors:

  • Rivastigmine
  • Donepezil
  • Galantamine

Moderate-Severe = NMDA antagonists:
- Memantamine

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12
Q

How would you manage vascular dementia?

A

Aspirin/Warfarin therapy

Antihypertensives

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13
Q

What kind of dementia tends to have fluctuating symptoms?

A

Lewy-Body Dementia

[Pick’s disease]

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14
Q

What is the classic triad of Wernicke’s encephalopathy?

A

[CAN]

Confusion
Ataxia
Nystagmus (ophthalmoplegia)

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15
Q

True of false, Wernicke’s encephalopathy is reversible?

A

True

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16
Q

What is the maximum score on the MMSE? What is the threshold for normal?

A

Max = 30

Normal = 24 or above

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17
Q

What is a seizure?

A

Spontaneous, uncontrolled brain activity.

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18
Q

What is epilepsy? What is the diagnostic threshold?

A

A tendency to have seizures

2+ seizures = Dx.

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19
Q

What is the difference between Focal/Partial seizures and Generalised?

A

Focal affect one hemisphere only. Remain conscious.

Generalised affect both hemispheres. Unconscious.

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20
Q

What is Todd’s paralysis?

A

Weakness in limbs following a seizure. Can last up to 2 days.

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21
Q

What is the difference between tonic and clonic?

A

Tonic = Rigid

  • Tongue biting
  • Incontinence

Clonic = Convulsions

  • Eye rolling
  • Tachycardia
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22
Q

How do you differentiate between epileptic seizures and non-epileptic seizures?

A

Epileptic:

  • Short duration
  • Abnormal EEG
  • Eyes open
  • Stereotyped movements
  • Incontinence
  • Self injury

Non-Epileptic:

  • Longer
  • No EEG changes
  • Eyes closed
  • Irregular movements
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23
Q

What is a Jacksonian march?

A

When a focal seizure spreads causing more parts of the body to be affected

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24
Q

How do myoclonic seizures present?

A

Small muscle twitches

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25
Q

What is status epilepticus?

A

A seizure that lasts more than 5 minutes

[Treated with IV lorazepam]

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26
Q

What is the first line treatment for focal epilepsy?

A

Carbamazepine or Lamotrigine

2nd line:
Sodium valproate

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27
Q

What is the first like treatment for generalised epilepsy?

A

Sodium Valproate or Lamotrigine

2nd line:
Carbamazepine

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28
Q

Give a non-pharmacological treatment for epilepsy

A

Surgery:

  • Temporal lobectomy
  • Hemispherectomy

Ketogenic diet

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29
Q

What is the difference between Neuropraxia, Axonotmesis, and Neurotmesis?

A

Neuropraxia: Impaired nerve conduction due to myelin damage. Can fully recover.

Axonotmesis: Axon is damaged. May possibly recover. (Typically from crushing or stretching)

Neurotmesis: Full lesion of the axon. No recovery.

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30
Q

What is Wallerian degeneration?

A

When a nerve is cut/crushed the axon distal to the injury dies. Typically occurs 24-36 hours post injury.

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31
Q

What is a TIA?

A

Transient Ischaemic Attack
- Symptoms must resolve in <24hrs

[80% due to thromboemboli]

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32
Q

What is Amaurosis Fugax?

A

(TIA of the eye)

Sudden loss of vision for a few minutes in one eye “a curtain coming down”.

Caused by an embolus in the retinal arteries.

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33
Q

How would you investigate an Amaurosis Fugax?

A 
Carotid doppler
Echocardiogram
CT
Lipid profile
Clotting screen
LFT
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34
Q

What is FAST?

A

Face, Arms, Speech, Test

Test for signs of a stroke

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35
Q

What are the three kinds of cerebral haemorrhage?

A

EXTRADURAL

  • Skull fracture e.g. RTA
  • Tearing of Middle Meningeal Artery can result in rapid increase in ICP and coning.
  • Biconvex on CT

SUBDURAL

  • Gradual onset headache
  • Lesion of bridging veins
  • Shaken baby
  • Banana shape on CT

SUBARACHNOID

  • Thunderclap headache
  • Berry aneurysm
  • Requires surgical clipping

[There is also intracerebral and intraventricular bleeds caused by hypertension or bleeding disorders]

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36
Q

What is a major risk factor for berry aneurysms?

A

Polycystic Kidney Disease

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37
Q

What is xanthochromia?

A

Yellow CSF

Happens when blood gets into the CSF following a subarachnoid bleed.

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38
Q

Why do you do a CT scan following a head injury prior to doing a lumbar puncture?

A

To avoid coning!

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39
Q

What is lost with Brown Sequard Syndrome?

A

[Call The Police Later]

Contralateral Temperature Pain and Light Touch

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40
Q

Which cells produce the CSF?

A

Ependymal cells of the choroid plexus

41
Q

What two main arteries supply the Circle of Willis?

A 
Internal Carotid (80%)
Vertebral arteries (20%)
42
Q

Which cranial nerves pass through the cavernous sinus?

A

CN 3, 4, 5 (V1 & V2) and 6.

[Internal carotid + Pituitary]

43
Q

What is the triad of Horner’s Syndrome?

A

Miosis (constricted pupil)
Ptosis (eyelid droop)
Anhydrosis (no sweat)

44
Q

What are the three ascending and three descending spinal tracts?

A

Ascending:

1) DORSAL COLUMN
- Touch/Vibration/Proprioception
- Gracilis (lower limb below T6) + Cuneate (upper limb above T6)

2) SPINOTHALAMIC
- Lateral (pain/temp)
- Anterior (crude touch/pressure)

3) SPINOCEREBELLAR
- Proprioception

Descending:

1) CORTICOSPINAL (Pyrimidal)
- Lateral (85% decussate in medulla)
- Anterior (15% decussate in spine)

2) CORTICOBULBAR
- Face and eye movements

3) EXTRAPYRIMIDAL
- Autonomic (tectospinal, vestibulospinal, reticulospinal, rubrospinal)

45
Q

What structures are in the forebrain?

A

Cortex
BG
Thalamus
Hypothalamus

46
Q

What structures are in the midbrain?

A

Tegmentum
Sup/Inf Colliculi
Crus cerebri

47
Q

What is the role of the Superior and Inferior Colliculus?

A

Sup - orientates to vision

Inf - orientates to sound

48
Q

What structures are in the hind brain?

A

Medulla
Pons
Cerebellum

49
Q

How many spinal vertebrae are there?

A

33

7C, 12T, 5L, 5S, 4C

50
Q

How many spinal nerves are there?

A

31 pairs

8C, 12T, 5L, 5S, 1C

51
Q

What is the most common cause of sciatica?

A

Herniation of the vertebral disc into the intervertebral foramina

52
Q

At what level does the spinal cord end?

A

L1-L2

[After this it becomes the Cauda equina]

53
Q

At what level do you do a lumbar puncture?

A

L3-L4

Into the subdural space

54
Q

What nerve passes through the Parotid gland?

A

The facial nerve (CNVII)

55
Q

What are the 5 branches of the facial nerve?

A 
Temporal
Zygomatic
Buccal
Mandibular
Cervical
56
Q

What is the Parkinson’s triad?

A

Resting tremor [pill-rolling = 4-7hz]
Rigidity
Bradykinesia

57
Q

What is the hallmark histological pathology of Parkinson’s disease?

A

Lewy body protein in Dopaminergic neurons of the substantia nigra (esp pars compacta)

58
Q

A patient presents with pain around one eye lasting 30 minutes with reduced vision. Their symptoms are also worse in the dark. What is the most likely diagnosis?

A

Cluster headache

59
Q

What is the first line treatment for cluster headaches?

A

Sumitriptan or Oxygen therapy (100%)

[NB: OTC medications e.g. paracetamol are not effective as they take too long to work. Cluster headaches often only last 30 minutes]

60
Q

Give three triggers of migraines

A 
Cheese
OCP 
Caffeine
Stress
Travel
Alcohol
Lack of sleep
Strong smells 
Weather
61
Q

A patient presents with a tight band sensation around their head. What is the most likely diagnosis?

A

Tension headache

62
Q

What hereditary pattern does Huntington’s disease follow?

A

Autosomal Dominant

[CAG repeat; 40x = 100% penetrance]

63
Q

What is the typical age of onset for Huntington’s

A

Around 40 years old

64
Q

Give two differences between rigidity and spasticity

A

Spastic:

  • Different flexor/extensor response
  • Velocity dependent
  • Weak extremities

Rigidity:

  • Same flexor/extensor response
  • Not velocity depenent
  • Extremities aren’t weak
65
Q

What is the pathophysiology of MS?

A

Chronic autoimmune demyelination of neurons

66
Q

True or false, MS symptoms are often exacerbated by heat?

A

True.

[Uhthoff’s Phenomenon]

67
Q

What are the four main types of multiple sclerosis?

A

Primary Progressive
- Gets worse gradually

Secondary Progressive
- Following relapse it just gets worse.

Relapsing Remitting
- Remits back to normal

Progressive Relapsing Remitting
- Relapses a bit but still gets worse

68
Q

Give two tests you would perform to investigate a diagnosis of multiple sclerosis?

A

MRI (white matter lesions)

Lumbar puncture (oligoclonal IgG bands)

NB: A consultant will make a diagnosis based on the whole clinical picture.

[Visual evoked potentials no longer done due to MRI]

69
Q

What are the two hallmark visual pathologies of MS?

A

Optic neuritis [25% of MS patients] - temporary vision loss (days) and eye pain.

Internuclear Ophthalmoplegia [INO] - lesion of medial longitudinal fasciculus results in impairment of conjugal eye movement. When patient looks right or left, one eye will not pass the midline (unilateral eye movement with one eye covered is fine however!)

70
Q

What is Lhermitte’s sign?

A

Shooting pain down the spine on neck flexion

[Often a sign of spinal cord inflammation eg. MS or meningitis]

71
Q

In MS what is inflammation of the spinal cord called?

A

Transverse myelitis

[This can cause impairment e.g. bladder or bowel dysfunction].

72
Q

What is the treatment for MS relapses and for long term?

A

Relapses:
- Methylprednisolone

Long term:

  • Beta interferon
  • Baclofen (reduces spasticity)
  • Alemtuzumab
73
Q

What are the two main types of Motor Neuron Disease?

A

Amyotrophic Lateral Sclerosis
[Lou Gherig’s disease] = 75% of cases. [UMN + LMN signs]

Progressive Bulbar Palsy = 25% of cases. Speech and swallowing affected.

74
Q

True or false, bladder symptoms are common with motor neuron disease?

A

False.

You don’t get bladder dysfunction or sensory symptoms with MND

75
Q

What treatment is available for motor neuron disease?

A

No cure.

Na channel blocker e.g. Riluzole (delay progression)

GABA agonist (reduce spasticity)

76
Q

What is the pathophysiology of Myasthenia Gravis?

A

Autoimmune degeneration at the neuromuscular junction (Acetylcholine receptors)

77
Q

What test is diagnostic for myasthenia gravis?

A

TENSILON Test:

- Edrophonium (Ach-esterase inhibitor) + atropine (protect heart). If symptoms improve = +ve Dx.

78
Q

Give two investigations you would perform in a patient with myasthenia gravis?

A 
EMG
MRI
Spirometry
Serum IgG (+ve 85% patients)
Thyroid function test
Tensilon test (Diagnostic)
79
Q

What is the treatment for myasthenia gravis?

A

Acetylcholinesterase inhibitors

Immune suppression (steroids or azathioprine)

Thymectomy (Thymus enlarged in 75%!)

Plasmapheresis

IVIG

80
Q

True or false, lifespan with Myasthenia Gravis is normal if treatment is given?

81
Q

What is the difference in presentation between encephalitis and meningitis?

A

Encephalitis produces cognitive impairment

Meningitis does not

82
Q

Give a treatment for viral encephalitis

A

Antiviral IV e.g. aciclovir

Mannitol or hypertonic saline if cerebral oedema.

Steroids (reduce swelling)

Phenytoin (reduce seizure risk)

83
Q

What is the pathophysiology of encephalitis?

A

Inflammation of the parenchyma of the CNS. Typically viral.

[Parenchyma = functional tissue (not structural/supportive)]

84
Q

Give two investigations you would perform in a patient with suspected encephalitis

A 
MRI (gold standard)
Lumbar puncture
Urine/Stool sample
FBC
LFT
Viral PCR (blood)
85
Q

What are the two most common virus types that cause encephalitis?

A

Enterovirus
Herpes

{+ Measles, Mumps, Rubella, Adenovirus etc.]

86
Q

Give two common causes of GBS

A 
Campylobacterjejuni
EBV
Influenza
HIV
CMV
87
Q

Who do you need to involve if you suspect a patient has GBS

A

Anaesthetics (may need intubation)

88
Q

True or false, the CSF of a patient with GBS should be normal?

A

True.

If it is abnormal then consider an alternative diagnosis e.g. Lyme’s disease or HIV.

89
Q

What does a positive Babinski sign indicate?

A

In >2yo

+ve sign = CNS damage

90
Q

What is a stroke?

A

Sudden onset neurological dysfunction

91
Q

Give two investigations you would perform in a patient with a stroke

A 
Carotid Artery Doppler
CT scan (excld. haemorrhage)
ECG
Echocardiogram
FBC
LFT
U&amp;E
ESR/CRP
92
Q

What is the treatment for an ischaemic stroke?

A

Thrombolysis (alteplase) within 4.5hrs

Antiplatelet + PPI

ACE/Diuretic/CCB

Statin

[+Carotid endarterectomy]

93
Q

If you have a stroke with mixed MCA + ACA loss and monocular vision loss (A. fugax) where is the block?

A

Internal Carotid Artery

[Large vessel block]

94
Q

If you have a stroke with CNS palsy, coma, vertigo and dysphagia, where is the block?

A

Vestibular artery

[Large vessel block]

95
Q

If you have a stroke with foot/leg and can’t read, where is the stroke?

96
Q

If you have a stroke with hand and face motor loss, neglect and aphasia where is the stroke?

97
Q

If you get visual loss, hallucination or loss of depth perception, where is the stroke?

98
Q

If you get a 3rd nerve palsy, where is the stroke?

99
Q

If a patientis clumsy, with sensory loss only on one side of their body or dysarthria, where is the stroke?

A

Lacunar

[pure sensory or pure motor, not mixed]

Lacunar are v common and tend to be milder.

Neuro (P4) (1 decks)

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