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Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

Two facts about OCCIPITAL AREA

A
  • Responsible for Vision

- Contains Primary Vision Cortex

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2
Q

Parietal Lobe

A
  • Responsible for SENSATION of the opposite side of the body
  • Responsible for SPATIAL AWARENESS

SOMATOSENSORY CORTEX-

  • Located in ANTERIOR CORTEX
  • Processes PAIN, PRESSURE and TOUCH
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3
Q

Frontal Lobe

A
  • Responsible for MOTOR control of the opposite side of the body
  • Controls EMOTIONS and INSIGHT
  • DOMINANT HEMISPHERE responsible for speech output (BROCA’s AREA)
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4
Q

Where is the Broca’s Area located?

A

FRONTAL LOBE- superior to the LATERAL FISSURE

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5
Q

Primary motor cortex location and function

A

Location- Posterior part of FRONTAL LOBE

Function- plans and executes MOTION

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6
Q

Temporal Lobe

A
  • Responsible for MEMORY and EMOTION

- DOMINANT HEMISPHERE responsible for COMPREHENSION of speech (WERNICKE’s AREA)

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7
Q

Where is the Wernicke’s Area located?

A

TEMPROAL LOBE- posterior to SUPERIOR TEMPORAL GYRUS

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8
Q

Primary auditory complex location and function

A

Location- BILATERALLY within TEMPORAL LOBE

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9
Q

3 parts of CEREBELLUM

A

PAELAEOCEREBELLUM- maintains gait

NEOCEREBELLUM- maintains postural tone and is responsible for coordination of FINE MOTOR SKILLS

ARCHICEREBELLUM- maintains balance

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10
Q

BASAL GANGLIA 4 deep nuclei

A

Putamen and Globus Pallidus (together they form LENTIFORM NUCLEUS)

Caudate nucleus

Substantia nigra

Subthalamic nucleus

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11
Q

The 12 cranial nerves

A

1- Olfactory

2- Optic

3- Oculomotor

4- Trochlear

5- Trigeminal

6- Abducens

7- Facial

8- Vestibulocohlear

9- Glossopharangeal

10- Vagus

11- Accessory

12- Hypoglosseal

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12
Q

Function and Lesion of OLFACTORY (1) NERVE

A

Function- Sense of smell

Lesion- ANOSMIA (loss of smell)

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13
Q

Function and Lesion of OPTIC (2) NERVE

A

Function- Sight

Lesion- Different visual field losses- BASED ON LOCATION OF LESION

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14
Q

Function and Lesion of OCULOMOTOR (3) NERVE

4 innervations

A

Function-
- Innervates SUPERIOR, MEDIAL and INFERIOR RECTUS muscles

  • Innervates LEVATOR PALPEBRAE SUPERIORIS
  • Innervates INFERIOR OBLIQUE
  • INNERVATES SPHINCTER PUPILLAE

Lesion-
- Eye movements DOWN and OUT (as superior oblique and lateral rectus would pull when the others fail)

  • PTOSIS- DROOPING EYELID
  • MYDRIASIS- DILATED PUPIL
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15
Q

Function and Lesion of TROCHLEAR (4) NERVE

A

Function- Innervates SUPERIOR OBLIQUE

Lesion-

  • DIPLOPIA
  • Eyes move DOWN and IN
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16
Q

Function and Lesion of TRIGEMINAL (5) NERVE

A

Function- Sensation of the face and innervation of the muscles of MASTICATION

(test corneal reflex)

Lesion-

  • DECREASED facial sensation
  • JAW WEAKNESS
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17
Q

Function and Lesion of ABDUCENS (6) NERVE

A

Function- Innervation of LATERAL RECTUS

Lesion-
- Eyes deviate MEDIALLY

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18
Q

Functions of FACIAL (7) NERVE

7 things

A

Innervates-

  • Muscles of FACIAL EXPRESSION
  • STEPDIUS
  • Posterior belly of DIGASTRIC MUSCLE
  • STYLOHYOID
  • ANTERIOR 2/3 of TONGUE (taste)
  • LACRIMAL GLANDS
  • SALIVARY GLANDS
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19
Q

Lesions of FACIAL (7) NERVE

A

UPPER MOTOR NEURONE-

  • Asymmetry of LOWER FACE with forehead sparing

LOWER MOTOR NEURONE-

  • Asymmetry of UPPER and LOWER FACE
  • LOSS of taste
  • Eye irritation due to DECREASED LACRIMATION
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20
Q

Function and Lesion of VESTIBULOCOCHLEAR (8) NERVE

A

Function- Sense of SOUND and BALANCE

Lesion- DEAFNESS and VERTIGO

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21
Q

Function and Lesion of GLOSSOPHARYNGEAL (9) NERVE

A

Function-

  • Posterior 1/3 of tongue (taste)
  • Innervates PAROTID GLANDS
  • STYLOPHARYNGEUS

LESION-

  • Decreased GAG REFLEX
  • Uvular deviation away from lesion
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22
Q

Function and Lesion of VAGUS (10) NERVE

A

Function- Innervates-
- LARYNGEAL and PHARYNGEAL muscles (NOT STYLOPHARYNGEUS)

  • Parasympathetic supply to THORACIC and ABDOMINAL VISCERA

Lesion-

  • DYSPHAGIA
  • RECURRENT LARYNGEAL NERVE PALSIES (loss of voice/ hoarse voice)
  • PSEUDOBULBAR PALSIES (inability to control muscles i face)
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23
Q

Function and Lesion of ACCESSORY (11) NERVE

A

Function- Innervates-

  • TRAPEZIUS
  • STERNOCLEIDOMASTOID

Lesion-

  • Patient can NOT SHRUG
  • Patient displays weak hand movement
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24
Q

Function and Lesion of HYPOGLOSSAL (12) NERVE

A

Function- Innervates-
- MUSCLES of the TONGUE (apart from PALATOGLOSSEAL (supplied by VAGUS))

Lesion-
- Tongue deviates TOWARDS the side of weakness during protrusion

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25
Q

Dorsal column (Fasciculus gracilis and Fasciculus cuneatus) responsible for-

A

Proprioception

Fine touch

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26
Q

DORSAL and VENTRAL SPINOCEREBELLAR TRACT (Ascendinf tracts) responsible for

A

Posture

Coordination

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27
Q

SPINOTHALMIC TRACT (Ascending tract)responsible for

A

PAIN

PRESSURE

Non-discriminative touch

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28
Q

Lateral Corticospinal and Ventral Corticospinal Tract (Descending Tracts) responsible for

A

VOLUNTARY skilled movements at DISTAL part of the LIMBS

Lateral (80%) and Ventral (20%)

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29
Q

Rubrospinal (Descending Pathway) function

A

Control of LIMB FLEXOR muscles

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30
Q

Medullary Reticulospinal (Descending) Tract responsible-

A

REFLEXES

Control of BREATHING

Control of ALPHA and GAMMA NEURONES

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31
Q

Lateral Vestibulospinal (Descending) Tract responsible for-

A

Extensor muscle tone posture

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32
Q

Tectospinal (Descending) Tract responsible for-

A

Reflective movements of HEAD

- In response to VISUAL/ AUDITORY stimuli

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33
Q

Signs and symptoms of STROKE

A

FAST

Face- unilateral drooping
Arms- may be weak and numb- patient may be unable to lift them
Speech- Slurring of speech
Time- Time to call 999

Patients may describe AMAUROSIS FUGAX (curtains descending)

TIA- symptoms<24h

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34
Q

Causes of STROKE

A

CR CASE

Haemorrhagic causes-

  • CNS bleeds from trauma
  • Ruptured aneurysm

Ischaemic causes-

  • Cardiac emboli
  • Atherothromboembolism
  • Small vessel occlusion
  • Emboli secondary to ATRIAL FIBRILLATION
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35
Q

Risk factors for STROKE

A
  • —> Cocaine
  • –> Oral contraceptive pill
  • Diabetes
  • —> ATRIAL FIBRILLATION

+ classic risk factors for clotting

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36
Q

Investigations in STROKE

A

Bloods-

  • —> PTT
    • other classic blood tests

Other-

  • —-> ECG for ATRIAL FIBRILLATION
  • ECHO for structural abnormalities

—-> CT IF INDICATION OF STROKE- differentiate between HAEMORRHAGIC and ISCHAEMIC strokes as DIFFERENT TREATMENTS

37
Q

Assessing risk of STROKE in TIA patients

A

ABCD2

  • 1 point for each >6 is high risk, <4 is low risk

Age>60

Blood pressure>140/90

—> Clinical features- unilateral weakness (2 points), isolated speech disturbances (1 point)

Duration of symptoms- >60 min (2 points), 10-59 mins (1 point)

Diabetes (1 point)

38
Q

Treatment for TIA patients

39
Q

Treatment for Ischaemic stroke patients WITHOUT haemorrhage

A

Thrombolysis with ALTEPLASE within 3 hours

Start ASPIRIN unless contraindicated

40
Q

Treatment for HAEMORRHAGIC STROKE patients

A

PROTHROMBIN COMPLEX CONCENTRATE

INTRAVENOUS VITAMIN K

41
Q

Surgical treatment for stroke

A

ACUTE intracerebral haemorrhage

Decompressive HEMICRANIECTOMY

42
Q

Complications of STROKE

A
  • Hydrocephalus
  • APHASIA (impairment of language)
  • DYSPHAGIA
  • Decreased muscle movement
  • Amnesia
  • DEPRESSION
43
Q

9 Risk factors of Alzheimer’s

A
  • Down’s Syndrome due to HIGH APP gene load
  • Familial gene associations
  • APP
  • Presenilin 1
  • Presenilin 2
  • Apoliopoprotein E4 (ApoE4)
  • HYPOTHYROIDISM
  • Previous head trauma
  • Family history of Alzheimer’s
44
Q

The 5A’s of Alzheimer’s

A

Amnesia

Aphasia (language impairment)

—> Apraxia (inability to perform learned movements on command)

Agnosia (inability to recognise things)

Lexical ANOMIA (unable to provide NAMES of object)

45
Q

INVESTIGATIONS in ALZHEIMER’s and VASCULAR DEMENTIA

And 3 ALZHEIMER SPECIFIC tests

A

MSE

Addenbrooke’s Cognition Examination (ACE-III)

Bloods:

  • Normal ones
  • Calcium
  • Magnesium
  • Phosphate

VDRL (test for syphilis)

HIV Serology

B12 and Folate

LUMBAR PUNCTURE

CT

Blood culture

ECG

ALZHEIMER’s TESTS (BAT)

  • Beta Amyloid Plaques
  • Acetylcholine LOW
  • Neurofibrillary TRIANGLES
46
Q

The 3 Treatments for ALZHEIMER’s

A

MEMANTINE- inhibits GLUTAMATE by BLOCKING NMDA receptors

DONEPAZIL- ACETYLCHOLINESTERASE inhibitor

RIVASTAGMINE– ACETYLCHOLINESTERASE inhibitor

47
Q

Complications of ALZHEIMER’s

A

Dysphagia

Increased risk of falls

Urinary incontinence

Amnesia

48
Q

Causes of VASCULAR DEMENTIA

A

Infarcts of small and medium sized vessels

Gene association with CADASIL

CADASIL= Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy

49
Q

Signs of Vascular Dementia

A

Signs of UPPER MOTOR NEURONE LESIONS- BRISK REFLEXES

Disorientation

Seizures

Changes in personality

50
Q

3 Types of VASCULAR DEMENTIA

A

Vascular Dementia- following stroke

Multi-infarct Dementia- following multiple strokes

—> Binswanger Disease- following microvascular infarcts

51
Q

Treatment of VASCULAR DEMENTIA

A

Treat Diabetes and Hypertension

ASPIRIN

52
Q

Complications of Vascular Dementia

A

Cardiovascular and Renal Disease

53
Q

Dementia with LEWY BODIES causes

A

Associated with PARKINSON’s DISEASE

  • so avoid ANTIPSYCHOTICS
54
Q

3 symptoms of Dementia with LEWY BODIES

A

Parkinsonism (bradykinesia and gait disorder)

Hallucinations (visual predominantly- usually of ANIMALS and PEOPLE)

Disease process following a fluctuating course

55
Q

Investigations in LEWY BODY DEMENTIA

A

MSE
ACE-III

ApoE (like Alzheimer’s)

Lewy bodies

–> UBIQUITIN proteins and ALPHA SYNUCLEIN found on histology

56
Q

Treatment for Dementia with LEWY BODIES

A

AVOID ANTIPSYCHOTICS

Levodopa- may be used to treat Parkinson’s but WORSENS psychotic symptoms

57
Q

Causes of FRONTOTEMPORAL DEMENTIA (Pick’s disease)

A

Association with Chromosome 17 and TAU 3 gene

58
Q

Symptoms of Frontotemporal Dementia

A

MUTISM- inability to speak

ECHOLALIA- pointless repetition of another person’s words

OVEREATING

Parkinsonism

59
Q

Investigations in Frontotemporal Dementia

and 3 SUBTYPES

A

MSE

ACE-III

Histology depends on SUBTYPE-

  • Microvacuolar Type- MICROVACUOLATION
  • Pick Type- NO MICROVACUOLATION and GLIOSIS
  • Motor Neurone Disease
60
Q

Treatment for Frontotemporal Dementia

A

Currently none, only SUPPORTIVE

61
Q

Causes of Huntington’s Dementia

A

Complication of Huntington’s Disease

- Causes abnormal CHOREIFORM (Jerky/ Involuntary movements) and DEMENTIA

62
Q

Symptoms of Huntington’s Dementia

A

Uncontrollable CHOREIFORM movements

—–>Obsessive compulsive behaviour

63
Q

Treatment of Huntington’s Dementia

A

For CHOREA- an ATYPICAL ANTIPSYCHOTIC AGENT

For Obsessive Compulsive Thoughts and Irritability- SSRIs

64
Q

Dysphagia is a complication of which two Dementias?
(as well as STROKE)
and which nerve lesion causes this?

A

Alzheimer’s and Huntington’s

VAGUS LESION

65
Q

Causes of Creutzfeldt-Jakob Disease (CJD)

A

PRIONS (misfolded proteins that transfer their shape on to normal proteins)

66
Q

Symptoms of CJD

A

Ataxia (lack of muscle control/ voluntary control)

67
Q

Investigations in CJD

A

EEG- TRIPHASIC SPIKES SEEN

LUMBAR PUNCTURE for 14-3-3 protein

68
Q

Complications of CJD

A

Increased risk of infection

Coma

Heart and Resp failure

69
Q

OTHER CAUSES of DEMENTIA

A

HIV

—> B12 deficiency

—> Wilson’s Disease

Syphilis

Dementia Pugilistica (seen in boxers and people who have suffered multiple concussions)

70
Q

Partial Epileptic Seizure

A

Seizures that occur in ONE DISCRETE PART of the brain

Simple- no change in consciousness

Complex- alteration in consciousness

71
Q

Generalised Epileptic Seizure

The FIVE TYPES

A

Affect the brain GLOBALLY, consciousness in ALWAYS ALTERED

-ABSENCE SEIZURES- usually children- ‘stare into space’- lasts SECONDS

—> TONIC-CLONIC SEIZURES- convulsions and muscle rigidity- lasts MINUTES

  • ATONIC SEIZURES- involves loss of muscle tone
  • MYOTONIC- involves jerky muscle movements
  • SECONDARY GENERALISED- this is a generalised seizure that originates from a PARTIAL SEIZURE
72
Q

Causes of Epileptic Seizures

A

VINDICATE

  • Vascular- history of STROKE
  • —> Infection- history of MENIGITIS or MALARIA
  • Neoplasms- BRAIN TUMOR
  • Drugs- Alcohol and drug use
  • Iatrogenic- DRUG WITHDRAWAL
  • Congenital- Family History
  • Autoimmune- VASCULITIS
  • Trauma- brain damage
  • —> Endocrine (LOW Na/ Ca/ Glucose or HIGH Glucose)
73
Q

Signs and symptoms of Frontal Lobe Epileptic Seizure

A

JAM

  • JACKSONIAN march (type of simple partial seizure)
  • pAlsy (postical TODD’s PALSY)
  • Motor features
74
Q

Signs and symptoms of Temporal Lobe Epileptic Seizure

A

ADD FAT

  • Aura that the epileptic attack will occur
  • Deja vu
  • Delusional behaviour
  • Fear/ panic (HIPPOCAMPAL involvement)
  • Automatisms (actions without thought or consequences)
  • Taste/ smell (UNCAL involvement)
75
Q

Signs and Symptoms of Parietal and Occipital Lobe Epileptic Seizure

A

VISUAL and SENSORY DISTURBANCES (as parietal associated with sensation and occipital associated with vision)

76
Q

Investigations in Epileptic Seizures

A

LUMBAR PUNCTURE

—> Glucose and Calcium levels (cos low amounts can cause epilepsy, and high amount of glucose and low amounts of sodium also)

77
Q

Treatment for Epileptic Seizures

A
  • Inform DVLA
  • Anticonvulsant therapy

Surgery-

  • Anterior temporal lobe resection
  • Corpus CALLOSOTOMY
  • Tumor removal
78
Q

Risk factors of Parkinson’s Disease

A

Male

Genetic component

Exposure to insecticides/ pesticides/ herbicides

79
Q

Pathophysiology of Parkinson’s

A
  • LOW DOPAMINE producing cells in PARS COMPACTA of SUBSTANTIA NIGRA in MIDBRAIN
  • Dopamine produced is secreted to PUTAMEN and CAUDATE NUCLEUS
  • HIGH Lewy Bodies in SUBSTANTIA NIGRA
80
Q

Signs and Symptoms of Parkinson’s

A

Facial TRAPS

Facial- expressionless face
Tremor- pill-rolling tremor
Rigidity- cog wheel rigidity
---> Akinesia- loss or impairment of VOLUNTARY movement
---> Posture (stooped)
---> Shuffling gait
81
Q

Investigations in Parkinson’s

A

ioflupane DATSCAN- measure BASAL GANGLIA dopaminergic function

82
Q

Treatment of Parkinson’s

A

LEVODOPA- crosses BBB and is converted to dopamine

CARBIDOPA- given with LEVODOPA to prevent peripheral effects of LEVODOPA

SELEGILINE- inhibits MAO B (which usually breaks down DOPAMINE)

AMANTIDINE- dopamine agonist- DECEASES PARKINSONIAN SYMPTOMS

83
Q

Risk Factors of MULTIPLE SCLEROSIS

A
  • —> Viruses- like EBV
  • Smoking
  • –> People who live FURTHER away from the equator
  • Type 4 T cell mediated immune response
84
Q

Pathophysiology of Multiple Sclerosis

A

Plaques of DEMYELINATION, disseminated in time and space, interfere with neuronal transmission

Often patients enter remission and relapse as demyelinated neurones do not heal fully

85
Q

Signs and Symptoms of Multiple Sclerosis

A

DOTS

  • Diplopia, DYSAETHESIA (an abnormal unpleasant sensation felt when touched)
  • OPTIC NEURITIS- often presenting symptom- patients present with DIPLOPIA
  • TRIGEMINAL NEURALGIA, Trunk and limb ATAXIA
  • SENSATION of VIBRATION decreased

Symptoms worse in HOT CONDITIONS

86
Q

Investigations in Multiple Sclerosis

A

LUMBAR PUNCTURE- some proteins are altered- like OLIGOCLONAL BANDS

MRI- shows regions affected by inflammation and scarring

87
Q

Treatment of Multiple Sclerosis

6 medicines

A

McDonald DIAGNOSTIC CRITERIA

Medical-

  • Methylprednisolone- corticosteroid
  • Glatiramer acetate- immunomodulator
  • Natalizumab- monoclonal antibody
  • Alemtuzumab- monoclonal antibody
  • Azathioprine- purine analogue (immunosuppressant)
  • Mitoxantrone (doxorubicin analogue)
88
Q

Complications of Multiple Sclerosis

A

URINARY and BOWEL INCONTINENCE

Depression

EPILEPSY

Paralysis

Medicine (15 decks)

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