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Year 4 > neurology > Flashcards

neurology Flashcards

1
Q

UMN signs

A

increased reflexes
increased tone
weakness/spastic paralysis
Positive babinski

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2
Q

LMN signs

A

decreased reflexes
normal/decreased tone
fasciculations
weakness (flaccid paralysis)

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3
Q

def paresis

A

weakness of voluntary movements

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4
Q

def paraparesis

A

partial paralysis of both legs

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5
Q

def tetra paresis/quadreplegia

A

partial or total loss of all four limbs and torso

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6
Q

cerebellar ataxia features

A
  • broad based gait
  • nystagmus
  • vertigo and nausea
  • staccato dysarthria
  • cannot say baby hippopotamus
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7
Q

sensory ataxia features

A

can CNS or PNS

  • stamping gait
  • worse in the dark/ have to look down at their feet
  • sensory disturbances (sensation, proprioception)
  • l’hermitte’s phenomenon
  • tight band sensation around torso
  • bladder disturbances (if in spinal cord)
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8
Q

vestibular ataxia features

A
  • vertigo (made worse by head movement)
  • nausea and vomitting
  • hearing loss/tinnitus
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9
Q

Back pain red flags

A
  • malignancy (weight loss, long lasting pain, doesn’t vary with movement, constant day and night)
  • collapse fracture/trauma (sudden pain, severe and localised, new or worsening kyphosis, osteoporosis)
  • cauda equina (bowel/bladder/sexual involvement, radiates down legs, sudden onset, saddle anaesthesia)
  • infection (weight loss, travel abroad, night sweats)
  • thoracic back pain
  • > 55 yo or <20 yo
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10
Q

Four limb weakness differentials

A
  • acute cervical cord syndrome
  • myasthenia gravis
  • acute myositis
  • Guillaume barre syndrome
  • motor neurone disease
  • myotonic dystrophy
  • polymyositis
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11
Q

Presentation of Guilaine barre syndrome

A
  • infection 1-3 weeks before onset of neuropathy
  • start with symmetrical paresthésie and pain
  • followed by progressive weakness
  • sensory ataxia
  • aréflexie
  • CN involvement (bilateral facial weakness, ophthalmoplegia, dysarthria, dysphasia)
  • diaphragmatic involvement (SoB worse by lying flat, oropharyngeal weakness)
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12
Q

investigations for Guillain Barre syndrome

A

Lumbar puncture:

  • shows cyoalbuminologic dissociation
  • normal cell count
  • elevated protein level

EMG

Nerve conduction studies

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13
Q

measurements in lumbar puncture

A
  • opening pressure
  • WCC
  • RCC
  • protein
  • glucose
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14
Q 
CSF interpretation:
clear, colourless
WCC count: 0.5
Glucose > 2/3 blood glucose
Protein (g/L): 0.15-0.4
A

normal

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15
Q 
CSF interpretation:
turbid appearance
WCC count: 500-10000 polymorphs 
Glucose: v low
Protein (g/L): high
A

bacterial meningitis

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16
Q

CSF interpretation

  • appearance: turbid, viscous, straw
  • WCC count: <500 lymphocytes/polymorphs
  • glucose: low
  • protein: v high
A

tuberculous meningitis

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17
Q

CSF interpretation:

  • appearance: viscous, clear
  • WCC count <500 lymphocytes/polymorphs
  • glucose: low
  • protein: v high
A

fungal meningitis

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18
Q

CSF interpretation:

  • appearance: clear
  • WCC count <1000 lymphocytes
  • glucose: normal
  • protein: raised
A

viral meningitis

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19
Q

differentials for hemiplegia

A
  • stroke
  • MS
  • tumour
  • subdural heamatoma
  • trauma
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20
Q

differentials for brain stem syndrome

A
  • stroke
  • MS
  • tumour
  • trauma
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21
Q

differentials for spinal cord syndrome

A
  • spondylosis
  • haematoma
  • tumour
  • trauma
  • MS
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22
Q

common neuropathoies

A
  • common perineal nerve palsy

- Bell’s palsy

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23
Q

causes of footdrop

A
  • lumbar nerve root lesion (radiculopathy)
  • common perineal nerve palsy (neuropathy)
  • sciatic nerve lesion
24
Q

presentation of lumbar radiculopathy

A
  • foot drop
  • significant back pain
  • loss of ankle reflex on the same side
25
Q

presentation of common perineal nerve pals

A
  • painless
  • often occurs after period of unaccustomed activity (especially kneeling)
  • ankle reflex preserved
26
Q

when do you use nerve conduction studies (EMG)?

A

PNS:

  • peripheral nerves
  • muscles
  • neuromuscular junctions
27
Q

acute pharmacological management of tonic clonic seizure

A

(if seizure lasting for more than 5 minutes)

  • buccal midazolam (first line) OR
  • rectal diazepam
  • IV lorazepam
28
Q

first line pharmacological treatment for generalised seizures

A

sodium valproate

29
Q

first line pharmacological treatment for focal seizures

A

carbamazepine

30
Q

different types of seizures

A
  • generalised:
    • tonic clonic (stiffness, convulsions)
    • absence
    • myoclonic (short muscle twitching)
  • focal/partial
    • simple (remains conscious)
    • complex (impaired consciousness)
31
Q

generalised tonic clonic seizure presentation

A
  • prodromal: aura or no warning
  • tonic phase: stiffness
  • clonic phase: synchronous jerking of limbs, eyes remain open, bitten tongue, double incontinence
  • postictal phase: flaccid unresponsiveness with confusion and drowsiness lasting up to a couple of hours, headaches common
32
Q

myoclonic seizures presentation

A

jerks: momentary brief contractions of a muscle or muscle group

33
Q

temporal lobe seizure aura

A
  • deja vu
  • jamais vu
  • fear
  • olfactory, gustatory or auditory hallucinations
  • altered perception
  • abdominal rising sensation
  • nausea
34
Q

frontal lobe seizure aura

A

conjugate gaze deviate away from epileptic focus, head turns

35
Q

occipital lobe seizure aura

A

visual phenomenas (zigzag lines and coloured scotomas)

36
Q

which metabolic disturbances are likely to increase likelihood of seizure

A

hyponatraemia

hypoglycaemia

37
Q

which symptoms make seizure more likely

A
  • bitten tongue
  • head turning to one side during TLoC
  • no memory of abnormal behaviour before, during or after
  • prolonged limb jerking
  • confusion after the event
  • prolonged deja vu or jamais vu
38
Q

which symptoms make seizures less likely

A
  • prodromal symptoms that have been abolished by sitting or lying down
  • sweating before the episode
  • prolonged standing that appears to precipitate TLoC
  • pallor during the episodes
39
Q

pre syncopal symptoms

A

PPP

  • position (upright)
  • provocation (pain, fear)
  • prodrome (lightheadedness)
40
Q

presentation of non epileptic attack disorder

A

violent shaking, head moving side to side, arching back, episodes of stillness before starting again, forced eye closure/preserved consciousness

41
Q

diagnosis of seizures

A

refer to specialist on 2 week wait

detailed history
EEG
ECG
MRI

42
Q

tension headache presentation

A

tight band like sensation
precipitate by stress
not aggravated by routine activities of daily living

43
Q

migraine presentation

A
  • unilateral
  • multiple triggers, lasts for hours
  • pounding/throbbing
  • aversion to bright lights and loud noises, nausea, can be preceded by aura
  • aggravated by routine activities
44
Q

cluster headache presentation

A

20 minute-2h, unilateral, retroorbital pain
redness, lacrimation, lid swelling
clusters last 4-12 weeks
always affects same side (by attacks)

45
Q

increased intracranial pressure presentation

A

headache triggered by changes in position or exerrcision
changes in vision on leaning forward

+ papilloedema, reduced levels of consciousness, vomitting, cushion’s triad

46
Q

red flag headache

A
  • sudden onset high severity headache
  • headache with fever
  • new onset neurological deficit or cognitive dysfunction
  • change in personality
  • impaired level of consciousness
  • recent head trauma (<3/12)
  • headache triggered by cough, sneeze, exercise, or change in posture
  • headache associated with halos around lights or that gets worse in the dark
  • headache associated with jaw claudication and scalp tenderness
47
Q

pathophysiology of MS

A
  • infection by virus or bacteria that crosses BBB
  • destruction of myelin sheaths in CNS (immune attack against oligodendrocytes):
    loss of nerve fibres, local oedema, glial scaring or sclerosis
48
Q

epidemiology and risk factors for MS

A
  • age of onset: 20-40 yo
  • female:male ration: 3:1
  • affects mainly caucasians
  • risk factors: smoking, vit D deficiency, EBV
49
Q

symptoms of MS

A
  • cerebrum: cognitive impairement, sensory/motor deficit, depression
  • optic neuritis: pain on mint, loss of vision, red colour desaturation, RAPD, Uhthoff’s phenomenon
  • cerebellum: tremor, clumsiness, poor balance
  • brainstem: vertigo, impaired speech and swallowing
  • spinal cord: weakness, stiffness and spasms, Lhermitte’s phenomenon, bowel/bladder/sexual dysfunction, pin (burning/stabbing)
  • worse in heat, infection
50
Q

types of MS

A
  • relapsing remitting
  • secondary progressive
  • primary progressive
  • progressive relapsing
51
Q

diagnosis of MS

A
  • history (2 attacks at 2 different time: disseminated in space and time)
  • MRI
  • CSF (oligoclonal IgG)
  • evoked potentials
52
Q

treatment of MS

A
  • relapse: high dose corticosteroids (oral or IV)

- disease modifying therapy: betaferon

53
Q

Causes of seizures

A
  • genetics
  • structural change (brain injury, infection, stroke, tumour)
  • over/under eating
  • alcohol
  • drugs
54
Q

MS cardinal symptoms

A

Optic neuritis
Weakness
Cerebellar dysfunction

55
Q

Hat are the DANISH symptoms of cerebellar dysfunction

A 
dysdiadochokinesis
ataxia
nystagmus
intention tremor
scanning dysarthria
heel-shin test positivity
56
Q

Uhthoff phenomenon

A

worsening of symptoms when body gets overheated from saunas, shower, hot weather

57
Q

Lhermitte sign

A

brief sudden sensation resembling electric shocks going down your neck and spine (and can radiate down arms and legs)

triggers by bending forwards

Year 4 (13 decks)

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