Neurology Flashcards
what should you look for on inspection in a neuro exam
SWIFT scars wasting of muscle involuntary movements: dystonia, tics, chorea fasciculations tremor
what signs indicate an UMN lesion
hypertonia - spasticity hyperreflexia pyramidal weakness: UL extensors, LL flexors clonus \+ve Babinski (extensor response) pronator drift
causes of UMN lesions
stroke tumours MS CP MND pseudobulbar palsy
what signs indicate an LMN lesion
hypotonia - flaccid hypo/arreflexia weakness, wasting, fasciculations no clonus -ve Babinski (flexor response)
causes of LMN lesions
Peripheral neuropathy - ABCDEE GBS Charcot Marie Tooth disease MND Bulbar palsy mononeuritis multiplex Bell's palsy Polio
signs of extra pyramidal disease (hypokinetic)
bradykinesia - slow to think, respond, loss of finger tap amplitude
rigidity - hypertonicity
resting tremor - highlighted when counting backwards
hypomimia, hypophonia
shuffling gait
loss of arm swing
causes of hypokinetic extra pyramidal disease
Parkinsonism - drugs
Idiopathic Parkinsons disease
Parkinsonism is a/symmetrical and PD is a/symmetrical
Parkinsonism = symmetrical PD = asymmetrical
signs of cerebellar disease on examination
DANISH dysdiadichokinesia ataxia nystagmus intention tremor slurred speech hypotonia / heel to toe test
bulbar palsy is UMN/LMN?
bulbar palsy = LMN
pseudobulbar palsy = UMN
MRI with/out contrast is used for imaging MS
WITH contrast
what drug do you give in SAH to prevent cerebral vasospasm
nimodipine
what is the triad in Wernicke’s encephalopathy
ophthalmoplegia/nystagmus
ataxia
confusion
what are the features of Korsakoff’s syndrome
antero/retrograde amnesia
confabulation
causes of cerebellar disease
MAVIS MS Alcohol Vascular (stroke) Inherited (Freidreich's ataxia) Space occupying lesion SOL
where does the spinal cord end?
L1/2
therefore spinal anaesthesia is at L3/4
Broca’s aphasia?
expressive aphasia
Wernicke’s aphasia?
receptive aphasia
red flags for headache
>55 worse in the morning / wakes them up worse with valsalva vomiting immunosuppression history of malignancy
what emergency conditions would you want to rule out in someone with a headache
meningitis SAH temporal arteritis closed angle glaucoma SOL IIH
list causes of peripheral neuropathy
ABCDEE Alcohol B12 deficiency Cancer / CKD DM Every vasculitis Especially ANCA and RA
Hypoventilation causes raised/low CO2 and therefore vasoconstriction/dilatation of cerebral vessels
hypoventilation causes raised CO2
therefore cerebral vasoDILATATION
Hyperventilation causes raised/low CO2 and therefore vasoconstriction/dilatation of cerebral vessels
hyperventilation causes low CO2
therefore cerebral vasoCONSTRICTION
what imaging technique is diagnostic of degenerative cervical myelopathy
MRI
what type of seizure is carbamazepine used to treat
FOCAL seizures!!
never generalised
which antiepileptic drug is considered ‘safe’ in pregnancy
lamotrigine
what is a risk of lamotrigine
SJS
Therefore build up the dose very slowly
which antiepileptics are teratogenic
sodium valproate
carbamazepine
topiramate
phenytoin
side effects of sodium valproate
VALPROATE Appetite increased / weight gain Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenic, thrombocytopaenia, tremor Encephalopathy
also P450 inhibitor
if someone has a one off seizure, how long can they not drive for?
6 months if it is one off
if someone has a diagnosis of epilepsy what are the driving rules for a car
can only drive after having a full year of not having seizures
if someone has a diagnosis of epilepsy what are the driving rules for a bus/lorry
can only drive after being medication free for 10 years
management of status epilepticus
ABCDE
- IV lorazepam / buccal midazolam / PR diazepam
- after 5 min repeat BZD
- phenytoin + call anaesthetics/ICU
- Na valproate
- Keppra
- ICU
describe obstructive hydrocephalus
aka non-communicating
blockage within ventricular system
therefore enlargement of lateral and 3rd ventricles and a normal 4th ventricle
describe communicating hydrocephalus
no blockage within the system, rather outwith the ventricles
all ventricles are enlarged
what are consequences of raised ICP
herniation midline shift impaired blood flow CN palsies low GCS
what are the different types of brain herniation
supratentorial - subfalcine / cingulate (ACA compression) - uncal (CN3 compression) - central - transcalvarial (skull #) infratentorial - tonsilar (cerebellum)
drug causes of parkinsonism
dopamine antagonists - metaclopramide, haloperidol, chlopromazine lithium amiodarone B blockers Na valproate
Management of Parkinsons disease
levodopa + carbidopa (co-careldopa)
MAOB inhibitors - selegeline, resegiline
dopamine agonists - pramiprexole
what drugs are used for tremor relief in Parkinsons?
anticholinergics - procyclidine
what are the Parkinsons plus syndromes
multisystem atrophy - PD plus autonomic instability
progressive supranuclear palsy - impaired upward gaze
features of MS
Pyramidal - weakness, spasticity, hyperreflexia
Ophthalmological - optic neuritis, INO
Sensory - paraesthesia, trigeminal neuralgia
LUTS - frequency, urgency, incontinence
Cerebellar - DANISH
Fatigue
dystonia
abnormal muscle spasm
chorea
irregular jerky involuntary movement
tics
brief repetitive stereotyped involuntary actions
myoclonus
sudden shock like involuntary movement
hemiballism
flinging of one arm
what are the proteinopathies in the following neurodegenerative conditions: Alzheimers Frontotemporal dementia DLB Huntingtons CJD
Alzheimers - extracellular amyloid plaques, intracellular neurofibrillary tangles of tau
Frontotemporal dementia - tau, Pick’s bodies
DLB - alpha synuclein
Huntingtons - huntington, CAG repeat
CJD - prion
pupil is spared/involved in PCOM aneurysm
involved
external compression of CN3
most common ocular CN lesion
CNVI
features of a CN3 palsy
down and out
ptosis
± pupillary involvement
features of a CN6 palsy
LR palsy
INO
features of a CN4 palsy
diplopia exacerbated on down gaze
head tilt down away from affected muscle
inability to adduct and depress the eye
which CN is more vulnerable to traumatic injury
CN4
CN involved in RAPD
CN2 Afferent
CN3 Efferent
causes of RAPD
MS demyelination optic neuritis vitreous haemorrhage ischaemic optic neuropathy
causes of UMN CN7
stroke
tumour
demyelination
causes of LMN CN7
bell palsy
iatrogenic - LA
trauma
infection - Ramsey hunt
Horner’s syndrome features
disruption of sympathetics resulting in:
partial ptosis
miosis
hemifacial anhydrosis
causes of Horners syndrome
1st: stroke, demyelination, neoplasm, syringomyelia
2nd: cervical rib, Pancoast tumour, brachial plexus injury, trauma, iatrogenic
3rd: trauma, iatrogenic, ICA dissection/aneurysm, tumour, cavernous sinus lesion
PBP = UMN lesion, true or false
true
BP = LMN lesion, true or false
true
BP features
fasciculations
tongue wasting
what features in a history make a swallowing problem more likely to be neurological
dysphagia to liquids, then solids
LP of GBS
high protein and no cells
antibody for GBS
anti ganglioside antibodies
differential for papilloedema and loss of vision
SOL
cerebral venous sinus thrombosis
IIH
