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FINALS revision - @medicbotanist > Neurology > Flashcards

Neurology Flashcards

1
Q

What are two causes of a spontaneous non traumatic intra parenchyma loss haemorrhage?

What does it look like on imaging ?

A

Amyloid deposits
HTN
anti-coag

On CT they look like hyper dense round elliptical masses

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2
Q

what nerve root is needed for the biceps muscle?

A

C6

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3
Q

What nerve route is needed for the triceps muscle?

A

C7

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4
Q

What does L5 do?

A

Dorsiflexion and big toe

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5
Q

What does S1 do?

A

Plantar flexion

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6
Q

Why can nerves not regenerate after being damaged?

A

They can no longer create GF which is needed for regeneration.

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7
Q

Are motor fibres in the anterior or posterior horn?

A

Anterior Horn

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8
Q

If you had anterior horn syndrome how would you present?

A

You would have a motor deficit

But sensory would be intact

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9
Q

What are 3 locations that strokes can occur?

A

Cerebral

Vertebral

Retinal

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10
Q

What would the clinical presentation be if you had an anterior stroke?

A
  1. Weakness in legs
  2. Sensory loss in legs
  3. Gait apraxia and Truncal Ataxia
  4. Incontience
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11
Q

How would a stroke in the middle cerebral artery present?

A
  1. Contralateral arm and leg weakness.
  2. Contralateral arm and leg sensory loss
  3. Aphasia and Dysphagia
  4. Hemianopia
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12
Q

How would a stroke in the PCA present?

A

Contralateral homonymous hemianopia

cortical blindness

Visual agnosia

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13
Q

From what time of presentation of sx can you give thrombolysis?

A

4.5 hours

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14
Q

What long term therapy will you have to prescribe to someone who has just has a stroke?

A

After 24 hours of presentation start them on clopidogrel

Also start on aspirin

Good HTN control and cholesterol control.

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15
Q

What is the name given to the stroke classification chart used?

A

Bamford

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16
Q

What are the 4 types of stroke mentioned in the Bamford stroke classification?

A

Total anterior classification stroke

Partial anterior stroke

Lacunar syndrome

Posterior circulation syndrome.

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17
Q

What is the criteria for a Total anterior circulation stroke classification?

A
  1. Homonymous hemianopia
  2. Unilateral weakness
  3. Speech disorder

Need all 3

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18
Q

What is the criteria for a partial anterior circulation stroke?

A
  1. Homonymous hemianopia
  2. Unilateral weakness
  3. Speech disorder

Need 2

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19
Q

What is needed in the classification of a lacunar syndrome stroke?

A

One of the following

Pure motor

Pure sensory

Ataxic hemiparesis

Pure sensory/motor

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20
Q

What diagnostic criteria is needed to diagnose posterior circulation syndrome?

A

One of the following:

  1. CN palsy
  2. Eye movement disorder
  3. Cerebellar dysfunction
  4. Isolated homonymous hemianopia
  5. B/l motor/sensory impairment
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21
Q

What is the management of a tension headache?

A
  1. NSAIDs: aspirin and ibuprofen

BE AWARE of med overuse headaches

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22
Q

How do you treat an acute episode of a cluster headache?

A

Oxygen

Sumatriptan

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23
Q

How do you treat chronic cluster headaches?

A

CCB verapamil

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24
Q

What is the presentation of GCA?

A

Scalp tenderness (severe headache) particularly when brushing hair

Jaw claudication

Sudden painless vision loss

Malaise lethargy and fever

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25
Q

How do you diagnose GCA?

A

Look at ESR (raised)

Do temporal artery biopsy

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26
Q

How do you treat simple GCA?

How do you treat GCA with eye involvement?

A

You give high dose steroids + PPI

if there is eye involvement do an IV steroid

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27
Q

Where can mononeuropathies occur ? two places

A

Cranial Nerves

Individual peripheral nerves

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28
Q

What is the term given to when 2 or more peripheral nerves are affected?

A

Mononeuritis Multiplex

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29
Q

What are some conditions part of Mononeuritis Multiplex?

A

Wegners
Amyloid
Rheumatoid arthritis
Diabetes

Polyarteritis nodosa
L eprosy
C ancer

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30
Q

What is the cervical root of the nerve (median nerve) compressed in carpal tunnel syndrome?

A

C6 to T1

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31
Q

What time of day is carpal tunnel syndrome generally worse at?

A

Night

Have to dangle Hand over bed to relieve the pain

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32
Q

What muscles are innervated by the median nerve?

A

LLOAF

Lateral 2 lumbar I also

Opponens Pollicus

Abductor pollicus brevis

Flexor pollicus brevis

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33
Q

What cervical root is the ulnar nerve from?

A

C7 to T1

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34
Q

how would an ulnar nerve palsy present?

A

Weak medial 2 lumbricals : creates a claw hand

Weak little finger
Medial wrist flexors
Interossei can’t do a good luck sign

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35
Q

What are some symptoms of Alzheimer’s Dementia?

A

Agnosia

Short term memory loss
Decline in language
Apraxia

Decline in visual spatial skills

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36
Q

What score out of 30 is classed as normal in MMSE?

A

Above 25

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37
Q

What is a mild cognitive impairment on the MMSE?

A

18-24

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38
Q

How do you manage dementia?

A

Anti acetyl cholinesterase inhibitors

Donepezil

Rivastigmine

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39
Q

What is Myasthenia Gravis?

A

This is an autoimmune condition against the ACh receptors in neuromuscular junction

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40
Q

What is the main cause of myasthenia gravis in

A. Men
B . Females

A

A. Thymic Atrophy or Tumours

B. Thymic Hyperplasia secondary to other AI conditions

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41
Q

How would someone with myasthenia gravis present?

A

Muscle fatigue particularly after strenuous tasks

Normally affects speech and facial expression

Can easily has ptosis and Diplopoda

Respiratory depression can occur

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42
Q

How to diagnose myasthenia gravis?

A

EMG and NCS will be reduced
Antibodies: anti-MUSK and anti-AChr
CT of thymus

Count to 50
Constantly look up- see if there is any lag.

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43
Q

What is the treatment for myasthenia gravis?

A

Anti cholinesterase such as pyridostigmine

+ Immuno supression with prednisolone and immunosuppressive like methotrexate

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44
Q

What is a myasthenia crisis?

How do you treat one?

A

This is when you get Resp muscle involvement and Resp distress occurs

You treat it with plasmapheresis and IV Ig

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45
Q

What causes Wernicke’s korsakoff syndrome?

A

Thiamine deficiency

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46
Q

3 causes of thiamine deficiency?

A

Starvation
Anorexia
Alcoholism

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47
Q

What is the pathophysiology behind Wernicke’s encephalopathy?

A

Haemorrhages and secondary gliosis in the periventricular and peri aqueductal grey matter

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48
Q

What is the tetrad behind Wernicke’s syndrome?

A

Nystagmus
Acute confusion
Opthalmoplegia (mostly due to a 6th nerve palsy)
Ataxia

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49
Q

What are two specific symptoms of Korsakoff Syndrome?

A

Confabulation

Retrograde amnesia: inability to learn and repeat simple tasks.

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50
Q

What vitamin is thiamine?

A

B1

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51
Q

What is the pathophysiology behind Korsakoff psychosis?

A

Haemorrhages and secondary gliossi within the periventricular and peri aqueductal grey matter

You get disconnection of the mammillothalmic pathway

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52
Q

How does Korsakoff psychosis present?

A
  1. Working memory is impaired
  2. Retrograde + Antegrade amnesia
  3. Confabulation
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53
Q

Where are brain tumours more common anatomically in:
A. Children
B Adults

A

Children: posterior fossa

Adults: supratentorial

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54
Q

What is the most common type of brain cancer?

What is the most common subdivision of this?

A

Glioma

Astrocytoma

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55
Q

What are the 4 grades of the WHO brain cancer scale?

A
  1. Pilocytic astrocytoma: benign common in children.
  2. Diffuse astrocytoma: pre malignant
  3. Anaplastic astrocytoma
  4. Glioblastoma Multiforme (GBM)
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56
Q

Do IDH-1 positive or negative tumours have a better prognosis?

A

Positive

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57
Q

What is a common presentation for a patient with oligodendromas ?

A

Seizures

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58
Q

What are 4 common symptoms of a brain tumour?

A

Headache worse on waking , coughing and bending forward

N+V can relieve headache

Drowsiness

Seizures

Papilloedema

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59
Q

What imaging do you do on a suspected brain tumour?

A

CT head

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60
Q

What is the treatment for a brain tumour?

A

Dexamethasone

Chemotherapy: Temozolamide +/- Radiotherapy

Surgery

Secondary epilepsy: Carbamazepine

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61
Q

3 common cancers that metastasise to the brain?

A 
Renal 
Bowel Ca 
SCLC 
NSCLC 
Breast
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62
Q

What gene is associated with MND?

A

SOD-1 gene

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63
Q

Where in the body can MND affect?

A

Anterior horn off spinal canal

Brain

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64
Q

What are the main differences between MND and :

  1. MS
  2. Myasthenia Gravis
A
  1. MS: you get sensory impairment and sphincter involvement

2. Myasthenia Gravis: you get eye involvement

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65
Q

If MND causes bulbar involvement what CN are involved?

A

CN 9 CN 10 CN 11 CN 12

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66
Q

What are the 4 types of MND?

A

ALS

Progressive Muscular Atrophy

Progressive Bulbar Palsy

Primary Lateral Sclerosis

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67
Q

How does the MND ALS normally present?

A
  1. LMN and UMN signs.
  2. Fasiculations + wasting- you will see Split Hand sign
  3. Foot and Wrist Drop
  4. Up going planters, brisk reflexes and hypertonia
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68
Q

How does Progressive Muscular Atrophy present?

A

LMN

Weakness
Fasciulations

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69
Q

How does Progressive Bulbar Palsy present?

A
  1. CN 9, 10, 11 and 12 are involved
  2. Choking, regurgitate and dysphagia and dysarthria
  3. Fasiculating tongue
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70
Q

What is the presentation of Primary Lateral Sclerosis?

A

Loss of Betz cells

Spastic Leg weakness
UMN signs
Pseudobulbar palsy

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71
Q

What do you need for a diagnosis of MND?

A

Affects 3nor more regions LMN + UMN

Slowness seen on EMG

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72
Q

What is the treatment for MND?

A

Anti glutamatergic: Riluzole

Anti spasm: baclofen

Anti cholinergic: for drooling like amitriptyline

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73
Q

What is Bell’s palsy?

A

A LMN facial palsy

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74
Q

What two conditions increase your risk of Bell’s Palsy?

A

Diabetes

Pregnancy

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75
Q

What is the pathophysiology of Bell’s Palsy?

A

Ischaemic compression of the facial nerve

Commonly caused by HSV and VZV

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76
Q

How does Bell’s Palsy present?

A

Ipsilateral Facial Weakness

Ipsilateral numbness or pain

Loss of taste
Hypersensitive to noise

Drooling
Speech difficulties and loopsided smile
Ptsosis of ipslateral side

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77
Q

How would you diagnose Bell’s Palsy ?

A

Diagnosis by exclusion. Thus exclude the following

  • Viral cause: VZV, HSV, Lyme disease
  • MRI scan
  • NCS
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78
Q

What is the management of Bell’s Palsy?

A
  1. Present within 72 hours give prednisolone

2. Protect the eye

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79
Q

Is trigeminal neuralgia more common in males or females?

A

Females

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80
Q

What triggers trigeminal neuralgia?

A
  1. Eating
  2. Talking
  3. Washing
  4. Shaving
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81
Q

How does trigeminal neuralgia present?

A
  1. Unilateral severe electric shock pain

2. Precipated by an inoculus stimuli

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82
Q

How many attacks of trigeminal neuralgia do you need before getting a diagnosis?

A
  1. At least 3 attacks
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83
Q

How do you treat Trigeminal Neuralgia- first and second line?

A
  1. Carbamazepine

2. Gamma Knife Surgery

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84
Q

What is the inheritance of Neurofibromatosis?

A

Autosomal Dominant

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85
Q

How does

  • NF-1
  • NF-2 present?
A

NF-1 bone deformities, cafe au last spots, short statue, large head and freckling of groin

NF-2: benign and slow growing tumours in ears: acoustic neuromas or optic nerve gliomas

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86
Q

In normal pressure hydrocephalus what signs might you see?

A

Papilloedema
UMN signs
Brisk reflexes
Ataxia

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87
Q

How do you treat someone with normal pressure hydrocephalus?

A
  1. Carbonic a hydrate inhibitors

2. Surgical insertion of shunt

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88
Q

An abnormality of what neurotransmitter causes narcolepsy?

A

Hypocretin

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89
Q

To have Cataplexy what other condition do you need to have ?

A

Narcolepsy

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90
Q

What are 4 symptoms of narcolepsy?

A
  • Excessive Daytime Sleepiness
  • Cataplexy
  • Hypnagogic hallucinations
  • Sleep paralysis

Can also have autonomic symptoms like: night sweats, fainting spells and ED

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91
Q

What are 3 ways to manage a patient with narcolepsy?

A
  1. NO DRIVING
  2. Good sleep hygiene + strategic daytime naps
  3. Medication like Modafinil
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92
Q

How do you diagnose Narcolepsy?

A
  1. Epsworth Sleepiness Scale
  2. Sleep Studies
  3. MRI or LP (see low hypocretin)
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93
Q

What is the pathophyisiology of PD?

A

You get breakdown of the substantia Nigra. Causes a reduction in dopamine available.
Less dopamine means that the thalamus will be inhibited and thus causing decreased movements

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94
Q

What two substances are Lewy bodies made from?

A

Ubiquitin

Syn nuclein

95
Q

What is a good diagnosis to do in someone with suspected PD?

96
Q

What are 3 non idiopathic causes of epilepsy?

A 
Ion disturbance 
Alcohol withdrawal 
Sudden withdrawal of medications 
Meningitis 
SAH 
Brain tumours
97
Q

What is the name given to the weakness after a seizure ?

A

Todd’s Palsy

98
Q

What will you see on EEG in a patient with an absence seizure?

99
Q

If you have a temporal lobe epilepsy what symptoms would you expect?

A

Memory
Emotion
Speech

Lip smacking and funny smells

100
Q

What symptoms would be only seen in frontal lobe epilepsy?

A

Motor symptoms like

Post ictal Todd’s Palsy and Jacksonian March

101
Q

What symptoms will you get with a parietal lobe?

A

Tingling and Numbness

102
Q

Give 5 investigations you would want to do in someone with epilepsy?

A

EEG

ECG, electrolytes, glucose, tox screen, calcium, U&E and LFT

MRI

Video subsequent attacks

103
Q

What is the management of status epilepticus?

A
  1. Rectal Diazepam

2. IV phenytoin

104
Q

What is the treatment 1st and 2nd line for:

Generalised Tonic Clonic
Absence
Partial/Focal Seizures

A

Generalised: Sodium Valproate then Lamotrigone

Absence: Sodium Valproate then Lamotrigone

Partial: Carbamazepine then Sodium Valproate.

105
Q

How many seizures do you need to have to get a diagnosis of epilepsy?

106
Q

What causes Huntington’s Disease?

A

A lack of GABA inhibitory neurotransmitter

107
Q

What is the pathophysiology of Huntington’s Disease?

A
  1. Lack of GABA
  2. Decreased inhibition of Dopamine. SO more Dopamine is available
  3. Increased thalamic stimulation -> leading to excessive movements
108
Q

What is the clinical presentation of Huntington’s Disease (4 things)

A
  1. Chorea (only stops when asleep)
  2. Depression and mood changes. Normally has a prodrome of this
  3. Dysphagia and Dysarthria
  4. Dementia
109
Q

What are two investigations you would like to do in someone with suspected Huntington’s disease?

A

Genetic Testing

CT/MRI: caudate nucleus atrophy and increased size of frontal horns.

110
Q

What is the management of Huntington’s Disease?

A
  1. Anti-psychotic as psychosis is common
  2. Benzodiazepines: lorazepam
  3. Anti-depressant: sertraline
111
Q

What cells are attacked in Multiple Sclerosis?

A
  1. Oligodendrocytes of CNS

2. T cell mediated response

112
Q

Where are 4 places where demyelination may occur >?

A

Perivenular

Brain ventricles

Brain stem

Corpus Callosum

113
Q

Name 5 symptoms of MS:

A

Optic neuritis eye pain + loss of colour vision

Pins and needles

Generalised weakness

Sphincter (urinary incontienance)

Sexual dysfunction

114
Q

What are some

Cerebellar Symptoms and Brainstem symptoms of MS?

A

Cerebellar: Ataxia, speech and balance

Brainstem: Diplopoda, vertigo and facial numbness

115
Q

How do you diagnose MS?

A

MRI head + Spine : periventricular, perivenular and multiple scattered plaques

LP: oligoclonal Ig G bands

2 or more CNS lesions that are disseminated in time and space.

116
Q

How do you treat an acute relapse of MS?

A

IV methyl pred

117
Q

How to treat chronic or maintenance MS?

A

SC interferon IB + IA n

DMARDs: dimethylfumarate

Baclofen or Botox infection

118
Q

What are the three parts of the cerebellum?

A

Lingual
Vermis

Flocculonodula

119
Q

What is the most important layer of the cerebellum?

A

Purkinjine Layer

120
Q

What is the aetiology behind Cerebellar disease?

A 
Toxins (alcohol) 
Genetics (freidrich’s ataxia) 
MS
CVS 
Trauma
121
Q

What are 5 ways cerebellar disease can present?

A 
Dysdiakinesia 
Dysphagia 
Dysarthria 
Intention tremor 
Ataxia 
Nystagmus 
Clumsiness
122
Q

What is the best imaging to for the cerebellum ?

123
Q

What is a good definition of cerebral palsy?

A

Non progressive lesion. Pernament and non changing.

124
Q

What is the most common variety of cerebral palsy?

A

Bilateral spastic cerebral palsy

125
Q

What are 3 RF of cerebral palsy?

A
  1. Preterm birth
  2. Low birth
  3. Multiple babies
  4. Maternal illness
126
Q

Up to what age can cerebral palsy occur up to?

A

2 years old

127
Q

How does spastic cerebral palsy present ?

A
  1. Increased tone
  2. Scissoring Gait
  3. All 4 limbs affected
  4. Poor head control
128
Q

What is a RF for presentation of cerebral palsy post birth?

A

Agpar Score (low <5)
Delayed Developmental milestones
Feeding difficulties
Hypotonia and Spasticity

129
Q

What medication can be given to improve spasticity?

130
Q

What are the 3 presentations of Horner’s Syndrome?

A

Miosis

Partial Ptosis

Hemifacial anhidrosis

131
Q

What are 3 causes of Horner’s Syndrome?

A 
CVS accidents 
MS 
Apical tumours: like pan coast tumour 
HZ virus 
Temporal arteritis
132
Q

What 3 investigations might you want to do in someone with Horner’s syndrome?

A

CT head
CXR exclude lung cancer
CT angiogram

133
Q

What artery is involved in an extra dural haematoma?

A

Middle Meningeal artery

134
Q

What are 4 symptoms of extra dural haematoma?

A
  1. Loss of consciousness followed by a lucid interval then another drop in consciousness
  2. Severe headache, nausea and vomiting, confusion and seizures.
135
Q

What are two investigations you would like to do in an extra dural haematoma?

A

Skull X Ray

CT head

136
Q

WHat is the management of extra dural haematoma?

A

IV mannitol

Neurosurgery

137
Q

What normally causes a Sub dural haematoma?

A

A rupture in the bridging vein

138
Q

What two populations are sub dural haematomas common in?

A

Alcoholics

Elderly

139
Q

How long is the period of time between injury and presenting of a SDH?

A

Normally a couple of weeks or months.

Can have chronic sub durals

140
Q

what will be shown on CT head if a person has a sub dural haematoma?

A

Crescent shape collection

141
Q

Management of a Sub dural haematoma?

A
  1. IV mannitol

2. Burr Hole surgery

142
Q

What type of artery is a berry aneurysm?

A

Saccular artery

143
Q

What are 3 conditions that increase the chance of SAH?

A

PKD/

Coarctation of aorta

Erhlers Danlos syndrome

144
Q

What will you see if you look at the eyes of someone with a SAH?

A

Papilloedema

Retinal Viteral Bleeds

Fixed dilated pupils

145
Q

What other symptoms (than headache) do you get in SAH?

A

Collapse
Head and neck stiffness
Nausea and Vomiting

Visual changes

146
Q

What will you see on LP if a person has a SAH?

A

Xanthochromia

147
Q

How do you treat a SAH ?

A

CCB like nifedipine

Surgery: endo vascular coiling

IV fluids

148
Q

What are two common pathogens of meningitis in newborns?

A

E. coli

Group B strep

149
Q

What are 3 of the causative agent in adults for meningitis?

A
  1. Strep pneumoniae
  2. H influenzae
  3. N menigitides
150
Q

What are 6 signs/symptoms of meningitis?

A

Headache
Neck stiffness
Fever

Photophobia
Nausea and Vomiting
Altered consciousness
Sepsis? Non blanching rash

151
Q

What is Brudzinski’s Sign?

A

This is when you lift a patient’s head and in response they draw up their legs

152
Q

What is Kernig’s Sign?

A

Inability to straighten leg when the hip is flexed.

153
Q

If you took the following LPs from these patients what would you see:

  1. Bacterial
  2. Viral
  3. Chronic
A
  1. Bacterial: turbid colour, high protein and high neutrophils, low glucose
  2. Viral: high lymphocytes and normal protein and glucose
  3. Chronic bacteria: raised lymphocytes, raised protein and low glucose
154
Q

what abx do you give to contacts of someone with meningitis?

A

Ciprofloxacin STAT PO

155
Q

If someone had meningitis and presented to GP. What abx would you give them?

A

IV benzlpencillin

Vs IV cefotaxime in hospitals

156
Q

How do you treat meningitis in hospital?

A

IV cefotaxime

In community give IV benzyl penicillin.

157
Q

What are 4 common viral causes of encephalitis?

A

EBV
CMV
HSV
VZV

158
Q

What two lobes are affected in encephalitis?

A

Frontal and temporal

159
Q

How does encephalitis present?

A

Headache
Fever
Altered consciousness

You will also see fatigue, personality changes and possible seizures

160
Q

How do you diagnose encephalitis?

A
  1. MRI head
  2. EEG
  3. LP high lymphocytes and do viral PCR on this
161
Q

What investigations would you like to do in someone with suspected non epileptic attack disorder?

A

EEG
MRI head

Video tape of the seizure
You need a full ECG, blood glucose and BP assessment

Full psych assessment

162
Q

How many NEAD seizures do you need to have to get a diagnosis?

A
  1. You need more than 2 over 24 hours.
163
Q

Do all patients with spinal stenosis develop symptoms?

164
Q

What are is the pathophysiology behind spinal stenosis?

A

Loss of joint space

This then causes you to get root ischaemia and neurogenic claudication.

165
Q

How does cervical spinal stenosis present?

A

You get pain
Reduced ROM
Muscle weakness in upper limbs (struggle with motor things)

166
Q

How do you treat cervical spine stenosis?

A
  1. Physio

2. NSAIDs

167
Q

How does lumbar stenosis normally present?

A
  1. Back pain or buttock
  2. Numbness or weakness in legs
  3. Incontience
  4. Burning or cramping pain.
168
Q

How do you treat lumbar stenosis?

A

NSAIDs
Physio
And Steroids

Then not ok? You need surgery

169
Q

What is Guilin barre syndrome?

A

It is an acute inflammatory ascending demyelinating polyneuropathy

170
Q

What is the No.1 cause of GBS?

What are two other causes?

A

MAIN cause: Campylobacter jejuni

Other causes are CMV and EBV

171
Q

How does GBS typically present?

A

You get it generally 1-3 weeks post infection.

You get an ascending muscle weakness

Reflexes are absent early

Note you normally don’t get numbness

Can go to the respiratory muscles!!! MAY NEED VENTILATING

172
Q

What are some of the autonomic symptoms associated with GBS?

A
  1. Sweating
  2. Raised BP
  3. Raised Pulse
173
Q

How do you diagnose GBS?

A
  1. You do NCS
  2. LP may show raised protein
  3. Routine spirometry so that FVC can be plotted. To see if there is any Resp involvement.
174
Q

How do you treat GBS?

A
  1. IV Ig
  2. LMWH
  3. Still no improvement? Plasmapheresis
175
Q

What is a squint?

A

Abnormality of coordinated eye movement

176
Q

What do the following mean in relation to squints?

Esotropia
Exotropia

A

ESO : when the eyes point in

EXO: when the eyes point out

177
Q

Who are non paralytic squints common in ?

Who are paralytic squints common in?

A

Children

Adults

178
Q

What are two diagnostic tests you can use for squints?

A

Cover Test

Corneal reflection test (if asymmetry they have a squint)

179
Q

If you had a 3rd nerve palsy how would it present?

A

The eye would be down and out

Ptosis of the eyelid

Fixed dilated pupil

180
Q

What is the eye like in a 4th nerve palsy?

A

Up and out!

Generally have their head tilted

CAN”T LOOK DOWN

181
Q

What is a 6th nerve palsy? How does it present

A

Diplopia in horizontal plane

Likely to have eye medially

182
Q

What is the function of the superior oblique?

A

Intorsion

eyelid depression

183
Q

What is the function of the inferior oblique?

A

Extorsion

Eyelid elevation

184
Q

Explain the difference between TIA and Stroke?

A

In a TIA you get ischaemia

In a Stroke you get infarction

185
Q

Give 5 RF for a TIA?

A 
HTN 
Hyperlipidaemia 
Diabetes 
Smoking 
Age 
Past TIA 
Other heart disease
186
Q

What artery do 90% of TIAs occur in?

187
Q

Give 3 symptoms of a TIA?

A
  1. Hemiparesis
  2. Amaurosis Fugax
  3. Contralateral leg weakness or numbness
188
Q

What artery are affected in 10% of TIAs?

A

Posterior circulation arteries

189
Q

Give 5 ways that a posterior circulation TIA may present?

A
  1. Double vision
  2. Vertigo
  3. Choking
  4. Ataxia
  5. Transient global amnesia
190
Q

What scoring system to use to quantify the risk of having a stroke after a TIA?

A

ABCD2 score

Age >60
BP >140/90
Clinical feature: unilateral weakness, speech disturbance
Diabetes
Duration <1 hour 1 point >1 hour 2 points

191
Q

What does a score of 6 and a score of 4 mean in relation to the ABCD2 scoring system?

A

Score 4: specialist in 24 hours

Score 6: strongly predicts stroke. Review immediately

192
Q

What meds should you start someone who had a TIA on?

A

Aspirin + Dipyridamole
Clopidogrel
Simvastatin
ACE inhibitor

193
Q

What does the frontal lobe normally control? 2 things

A

Behaviour

Personality

194
Q

Give 4 functions of the frontal lobe?

A
  1. Behaviour
  2. Personality
  3. Speech (Broca’s) + writing
  4. Voluntary movements on contralateral side
195
Q

is thought process affected In frontal lobe syndrome?

A

YES

Intellectual functioning, thought process and memory are all affected

196
Q

What are 3 blood tests you would want to do in a patient with suspected frontal lobe syndrome?

A

Syphilis
Thyroid
B12

197
Q

Give 3 symptoms of frontal lobe disorder?

A 
Loss of attention 
Personality change 
Normal memory 
Decreased spontaneous activity 
Change of affect
198
Q

If you get spinal cord compression do you get UMN or LMN signs?

199
Q

What are 3 causes of spinal cord compression?

A

Malignancy (vertebral body neoplasm)

Disc herniation
Disc prolapse

200
Q

What are 5 symptoms/signs of a spinal cord compression? Aka myelopathy?

A

Back pain

Progressive weakness of the legs and UMN signs (spasticity and hyper reflexia)

Anal sphincter/ bladder involvement. Can cause painless retention

Sensory loss below the level of the lesion

Can cause arm weakness in cervical cord lesion.

201
Q

If a patient had a spinal cord compression at the following levels would you get a LMN or a UMN sign

  1. At the level of the spinal cord compression
  2. Below the level of the spinal cord compression
A
  1. At the level of the spinal cord compression: LMN signs

2. Below the level of the spinal cord compression: UMN signs

202
Q

What is the gold standard investigation of choice for spinal cord compression?

203
Q

Treatment of spinal cord compression?

A

IV dexametasone

Surgical decompression

204
Q

What CN are involved in a Bulbar Palsy?

205
Q

Disease of what part of the brain leads to dysarthria?

A

The medulla

206
Q

What is the difference between phonation and articulation:

A

phonation: production of sounds as a result of vocal cords

Articulation: contraction of structural muscles

207
Q

What are 3 causes of a bulbar (CN9-12) palsy?

A

MS
MND
Stroke

208
Q

What are 4 symptoms of a bulbar palsy?

A
  1. Dysarthria
  2. Speech is quiet
  3. Drooling
  4. LMN lesion of the tongue: issues talking and swallowing
209
Q

What is the difference between bulbar palsy and pseudobulbar palsy?

A

Bulbar Palsy: LMN

Pseudobulbar palsy: UMN

210
Q

Is bulbar or pseudobulbar more common?

A

Pseudobulbar palsy

211
Q

3 causes of pseudobulbar palsy?

A
  1. MND
  2. MS
  3. Stroke
212
Q

What is the presentation of pseudobulbar palsy?

A
  1. Slow tongue movements
  2. Slow speech
  3. Increased jaw jerk + reflexes
  4. Mood incongruence
213
Q

What is the best investigation for bulbar and pseudo bulbar palsies?

214
Q

What is the best treatment for:
A. Bulbar Palsy
B. Pseudo-bulbar palsy

A

A. Bulbar Palsy: this is when you get drooling and LMN involvement can be useful to give any anti-cholinergic (hyoscyamine)

B. Pseudo Bulbar Palsy: you get increased tone and spasticity so can be helpful to use: baclofen

215
Q

Give the 4 main different types of groups causing myopathies?

A
  1. ) Inherited: duchesses muscular dystrophy
  2. ) Non inflammatory: thyroid, DM and Cushings
  3. )Infection: polio or Lyme
  4. ) Steroid or alcohol
216
Q

How does a patient with myopathy present?

A

You get weakness in the shoulders and the pelvic girdle

Motor delay in children

Myalgia is common in inflammatory myopathies

217
Q

Are reflexes gone or maintained in a myopathy?

A

They are maintained

218
Q

What are two tasks that someone with a myopathy might find hard?

A

Shaving

Going up stairs

219
Q

What tests would you do on a patient with suspected myopathy? (Name 4)

A
  1. ) Creatinine Kinase + serum myoglobin
  2. ) ECG may show Hypokalaemia (increased PR internal and wide QRS)
  3. Muscle biopsy
  4. EMG
220
Q

What two things do you use to treat hypokalaemia?

A

IV K+

Spironolactone

221
Q

What are two types of bacteria that can cause a brain abscess?

A

Staph

Strep

222
Q

What cervical root makes up a radial nerve?

223
Q

What 4 muscles does the radial nerve supply?

A 
BEST 
Brachioradialis 
Extensors
Supination 
Triceps
224
Q

How would a lateral cutaneous nerve entrapment present?

A

Anterior lateral burning thigh pain

225
Q

How would a compression of a sciatic nerve present differently to compression of the lateral cutaneous nerve?

A

Sciatic: you would get loss of sensation below knee laterally + causes foot drop

Lateral cutaneous nerve: presents with antero lateral burning thigh pain

226
Q

Where does the common peroneal nerve originate from?

A

The sciatic nerve @ a site just above the knee

227
Q

What is the presentation of a common peroneal nerve compression?

A

Foot drop
Weak ankle dorsiflexion + Eversion

Can cause a sensory loss over the dorsal

228
Q

If you damage your tibial nerve what movement will you be unable to do?

A

Stand on your toes

229
Q

4 ways a nerve can malfunction

A

Demyelination
Infarction
Infiltration
Compression

230
Q

CAUDA Equina syndrome: where does the damage occur?

A

The cauda equina is formed from nerve roots caudal to the end of the spinal cord at L1/L2

231
Q

What are 3 causes of cauda equina syndrome?

A

Herniation of the lumbar discs
Tumour or metastasis
Trauma
Infection

232
Q

How would cauda equina present?

A

You will get reduced perianal sensation

Loss of sphincter tone

ED + urinary and foecal incontience

Bilateral sciatica

Legs will be flaccid and areflexic

233
Q

What is the investigation of choice in cauda equina?

FINALS revision - @medicbotanist (20 decks)

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