Neurology Flashcards
What are 5-HT3 antagonists, examples and adverse effects?
- anti-mimetics
- chemotherapy related nausea
- ondansetron, graniestron
- ADR: constipation, prolonged QT
What are absence seizures, features and management?
- generalised epilepsy mostly seen in children
- unaware, quick, triggered by hyperventilation or stress
- EEG: bilateral, symmetrical 3Hz spike and wave pattern
- manage with sodium valproate and ethosuximide
Wernicke’s (receptive) aphasia:
- lesion of superior temporal gyrus
- inferior division of left MCA
- sentences make no sense but speech remains fluent
- comprehension impaired
Broca’s (expressive) aphasia:
- lesion of inferior frontal gyrus
- superior division of left MCA
- speech non-fluent, repetition impaired
- normal comprehension
Conduction aphasia:
- stroke affecting arcuate fascicles (connecting Wernicke’s and Broca’s)
- speech fluent but repetition poor
- aware of errors
- normal comprehension
Global aphasia:
- large lesion affecting all 3 areas
- severe expression and receptive aphasia
- can communicate using gestures
What is an Arnold-Chiari malformation and features:
- downward displacement or herniation of cerebellar tonsils through foramen magnum
- congenital or trauma
- non-communicating hydrocephalus due to CSF outflow obstruction
- headache
- syringomyelia
What causes ataxia?
- cerebellar hemisphere lesions cause peripheral ataxia
- cerebellar vermis lesions cause gait ataxia
Ataxia Telangiectasia
- autosomal recessive
- defect in ATM gene coding for DNA repair enzymes
- early childhood with abnormal movements
- IgA deficiency resulting in recurrent chest infections
- 10% risk of malignancy, lymphoma, leukaemia and non-lymphoid tumours
Autonomic dysreflexia
- spinal cord injury above T6
- briefly afferent signals cause sympathetic spinal reflex
- triggered by faecal impaction or urinary retention
- cord lesion prevents parasympathetic response
- causes extreme hypertension, flushing and sweating above level or lesion
What are the features of Bell’s palsy?
- acute, unilateral, idiopathic, facial nerve paralysis
- lower motor neurone facial nerve palsy (including forehead)
- post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
How do you manage Bell’s palsy?
prednisolone 1mg/kg for 10 days within 73 hours of onset
acyclovir no benefit
Brachial Plexus
see notes
What is Erb-Duchenne paralysis?
- damage to C5-6 roots
- winged scapula
- may be caused by breech presentation
What is Klumpke’s paralysis?
- damage to T1
- loss of intrinsic hand muscles
- due to traction
What can cause brain abscesses?
- extension of sepsis from middle ear or sinuses
- trauma or surgery to scalp
- penetrating head injuries
- embolic events from endocarditis
Features of brain abscesses:
- headache
- fever
- focal neurology
- raised ICP: nausea, papilloedema, seizures
Management of brain abscesses:
- surgery: craniotomy and debridement
- IV antibiotics: IV 3rd generation cephalosporin and metronidazole
- ICP management e.g. dexamethasone
Parietal lobe lesion symptoms:
- sensory inattention
- apraxia
- astereognosis
- inferior homonymous quadrantopia
- Gerstmann’s syndrome (dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation
Occipital lobe lesion symptoms:
- homonymous hemianopia (with macula sparing)
- cortical blindness
- visual agnosia
Temporal lobe lesions:
- Wernicke’s aphasia
- superior homonymous quadrantopia
- auditory agnosia
- prosopagnosia
Frontal lobe lesions:
- Broca’s aphasia
- disinhibition
- perseveration
- anosmia
- inability to generate list
Cerebellum lesions:
- midline lesions: gait and truncal ataxia
- hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus
What condition is associated with the sub thalamic nucleus of the basal ganglia?
Hemiballism
What conditions is associated with the striatum of the basal ganglia?
Huntington’s chorea
What condition is associated with the substantia nigra of the basal ganglia?
Parkinson’s
What condition is associated with the amygdala?
Kluver-Bucy syndrome: hyper sexuality, hyperorality, hyperplasia, visual agnosia
Which cancer spreads most commonly to the brain?
lung
also breast, bowel, skin and kidney
Which primary brain tumour is the most common in adults?
- glioblastoma
- solid tumours with central necrosis and rim
- vasogenic oedema
- pleomorphic tumour cells
Which is the second most common primary brain tumour in adults?
- meningioma
- typically benign
- arise from dura of meninges
- symptoms of compression rather than invasion
- spindle cells in concentric whorls and calcified bodies
What is a vestibular schwannoma?
(acoustic neuroma)
- benign tumour arising from vestibulocochlear nerve
- seen in cerebellopontine angle
- presents with hearing loss, facial nerve palsy and tinnitus
- bilateral assoc with neurofibromatosis type II
- Antoni A or B patterns and verocay bodies seen
What is the most common primary brain tumour in children?
- pilocytic astrocytoma
- rosenthal fibres
What is a medulloblastoma?
- aggressive paediatric tumour
- infratentorial compartment
- spreads through CSF
- small blue cells, rosette pattern of cells
What is an ependymoma?
- 4th ventricle
- may cause hydrocephalus
- perivascular pseudoreosettes
What is an oligodendroma?
- benign, slow-growing tumour common in frontal lobes
- calcifications with fried egg appearance
What is a haemangioblastoma?
- vascular tumour of cerebellum
- associated with von Hippel-Lindau
- foam cells and high vascularity
What is a craniopharyngioma?
- most common paediatric supratentorial tumour
- solid, cystic tumour of cellar region derived from remnants of Rathke’s pouch
- hormonal disturbance, hydrocephalus, bitemporal hemianopia
What is Brown-Sequard syndrome?
- lateral hemisection of spinal cord
- ipsilateral weakness below lesion
- ipsilateral loss of proprioception and vibration sensation
- contralateral loss of pain and temperature sensation
Indications of carbamazepine, mechanism of action, ADR:
- used for epilepsy, trigeminal neuralgia, bipolar disorder
- binds to sodium channels to increase refractory period
- ADR: P450 enzyme inducer, dizziness and ataxia, drowsiness, headache, visual disturbances (diplopia), Steven-Johnson syndrome, leucopenia and agranulocytosis, hyponatraemia
What is cataplexy?
sudden and transient loss of muscular tone caused by strong emotion (2/3 of narcoleptics have cataplexy)
