Neurology Flashcards

1
Q

Name 5 causes of cerebellar lesions

A
VITAMIN C
Vascular 
Inflammatory - MS 
Trauma 
Alcohol 
Metabolic 
Iatrogenic - Phenytoin and carbamazepine 
Neoplastic 
Congenital - Friedrichs ataxia
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2
Q

What is Fredrich’s ataxia

A

AR trinucleotide repeat disorder

GAA - chromosome 9

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3
Q

Name 3 presentations of Fredrich’s ataxia

A
kyphoscoliosis 
Spinocerebellar tract degeneration 
HOCM 
DM
Cerebellar ataxia 
optic atrophy 
High arched palette
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4
Q

How does a lesion of the cerebellar vermis present

A

Truncal ataxia

gait instability

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5
Q

How does a lesion of cerebellar hemisphere present

A

Ipsilateral limb signs

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6
Q

Name 5 risk factors for an ischaemic stroke

A
Male 
FHx of stroke - < 60 
Old age 
smoking 
AF 
Hypercholesterolaemia 
DM 
Alcohol
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7
Q

Name 4 causes of ischaemic stroke

A

Cardiac emboli - AF / IE

Atherothromboembolism - Carotid artery

Systemic hypoperfusion - cardiac arrest

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8
Q

Describe the investigations in an acute suspected stroke

A

1st line - CT scan

Others

  • MRI with DWI
  • Carotid artery USS
  • Echo
  • ECG +/- 72 hr tape
  • Bloods
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9
Q

Describe the management of acute stroke <4.5 hours

A

< 4.5 hours
IV Alteplase
repeat CT 24 hrs after
300 mg Aspirin

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10
Q

Describe the management of acute stroke > 4.5 hrs

A
> 4.5 hrs 
300mg Aspirin (2 weeks)
75 mg Clopidogrel (lifelong)
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11
Q

When is mechanical thrombectomy offered

A

Patient with Anterior circulation stroke within 6hrs

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12
Q

Name 4 CI to IV alteplase in stroke

A
Haemorrhagic stroke 
Unstable BP 
INR - High 
Recent head trauma 
GI bleed 
Recent surgery 
Platelet count
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13
Q

Describe secondary prevention for strokes

A

HALTSS

HTN - Anti-hypertensives

Antiplatelet - Clopidogrel 75mg

Lipids - Atorvastatin

Tobacco - smoking cessation

Sugar - DM screen

Surgery - >50% Ipsilateral carotid artery stenosis –> carotid endarterectomy

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14
Q

How should a patient diagnosed with AF following a stroke be treated differently in secondary prevention

A

HALTSS - A is different

Initiate Warfarin or DOAC 2 weeks post stroke

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15
Q

STROKE PRESENTATION

TACI

A

ACA + MCA
ALL 3 REQUIRED

contralateral weakness +/- sensory deficits of face / arm / legs 
\+ 
contralateral homonymous hemianopia 
\+
Higher cerebral dysfunction 
- aphasia 
- neglect
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16
Q

STROKE PRESENTATION

PACI

A

ACA OR MCA
2 REQUIRED

contralateral weakness +/- sensory deficits of face / arm / legs
+
contralateral homonymous hemianopia

    OR - This alone 

Higher cerebral dysfunction alone

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17
Q

STROKE PRESENTATION

Lacunar stroke

A
Pure:
- motor 
- sensory 
- sensorimotor 
OR 
Ataxic hemiparesis
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18
Q

STROKE PRESENTATION

Posterior circulation infarct

A
Cerebellar dysfunction
OR
Conjugate eye movement disorder
OR
Bilateral motor/sensory deficit
OR
Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit
OR
Cortical blindness/isolated hemianopia.
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19
Q

What are the rules following a stroke and driving

A

No driving for 1 month

Don’t have to inform DVLA

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20
Q

HAEMORRHAGIC STROKE

Name 4 risk factors

A
older age 
FHx 
Malignancy 
Anti-coagulants 
cocaine 
Haemophilia 
vasculitis
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21
Q

HAEMORRHAGIC STROKE

Name 3 causes of a haemorrhagic stroke

A

ruptured cerebral artery

trauma

AV malformation

reperfusion injury - ischaemic stroke

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22
Q

HAEMORRHAGIC STROKE

Describe the management

A

conservative

  • BP
  • lifestyle advice

Medical

  • Stop anti-coag and anti-platelet
  • Factor 7 concentrate
  • Antihypertensive (Beta blocker / CCB)
  • Nimodipine (vasospasm)

Surgical

  • Clipping
  • Coiling
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23
Q

HAEMORRHAGIC STROKE

Name the reversal agents for

  • warfarin
  • heparin
  • LMWH
  • Apixaban
A

warfarin

  • Beri plex
  • vitamin K

Heparin
- protamine

LMWH
- Protamine

Apixaban
- Beri plex

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24
Q

Describe the ABCD2 risk score

A

A > 60

B - BP >140/80

Clinical features
Unilateral weakness(2)
speech impairment without weakness (1)

Duration
> 60 mins (2)
<59 mins (1)

D - Diabetes (1)

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25
Q

Describe how raised ICP presents

A
Headache - worse on lying down/bending/coughing 
papilledema 
seizures 
reduced consciousness - GCS
N+V - relieves headache 
Cushigs triad
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26
Q

What is Cushing’s triad and what presentation is it commonly found in

A

Raised ICP

Raised BP
Reduced HR
Irregular breathing

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27
Q

Name 2 causes of raised ICP

A

Meningitis
haemorrhages
SOL
Hydrocephalus

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28
Q

What is the management of raised ICP

A

Bed rest and head elevation

IV mannitol

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29
Q

Name 4 risk factors for SAH

A
Family hx 
previous aneurysmal SAH
Smoking 
alcohol 
PCKD 
Increased BP
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30
Q

Name 4 causes of a SAH

A

Aneurysmal

  • ADPCK
  • Rupture of berry aneurysm
  • atherosclerosis
  • HTN

Non aneurysmal

  • Trauma
  • AVM
  • Coagulopathies
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31
Q

How does a SAH present

A
Thunderclap headache 
N+V 
Reduced GCS 
Double vision 
Meningism - photophobia / neck stiffness / pain on flexion 
Seizure 
Kernig's sign 
3rd CN palsy - PCA aneurysm
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32
Q

Describe the investigations for a SAH

A

Non contrast CT head

Serial LP - If CT -ve but clinical signs present

  • 12 hrs post sx onset
  • Xanthochromia
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33
Q

Name 4 SAH complications

A
re-bleeding 
hydrocephalus 
Vasospasm 
Hyponatraemia 
seizures
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34
Q

What is the management of a SAH

A

ABCDE
Analgesia and anti-emetics

Nimodipine

Clipping / coiling

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35
Q

Describe the flow of CSF

A
Lateral ventricles 
Foramen of monro 
3rd ventricle 
cerebral aqueduct 
4th ventricle 
- central spinal canal
- SA cisterns
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36
Q

GCS

Describe the scoring system for eye opening

A

Spontaneous - 4

To sound - 3

To pain - 2

No response - 1

Not testable

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37
Q

GCS

Describe the scoring system for verbal response

A

Can you tell me your name
Do you know where you are
Do you know the date today

Orientated response - 5

confused conversation- 4

Inappropriate / random words - 3

Incomprehensible - 2

No response - 1

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38
Q

GCS

Describe the scoring system for motor response

A

Obeys commands- 6
- 2 part command

Localises to pain - 5

  • trapezius squeeze
  • supraorbital notch

Withdraws to pain - 4
- flexion response

Abnormal flexion response to pain - 3
- decorticate posturing

Abnormal extension response - 2
- Decerebrate posturing

No response - 1

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39
Q

GCS

Describe decorticate posturing

A

Adduction of arm + Internal rotation of shoulder + pronation of the forearm + wrist flexion

40
Q

GCS

Describe decerebrate posturing

A

Head extended + arms and legs extended and internally rotated

41
Q

Name 4 differentials for transient LOC

A

Seizure
NEAD
Hypoglycaemia
Postural hypotension

42
Q

What is cardiogenic syncope

A

L.V outflow obstruction leading to to syncope on exertion

43
Q

Name 5 causes of cardiogenic syncope

A

Aortic stenosis

HCOM

44
Q

Name 5 causes of orthostatic hypotension

A

Drugs

  • Antihypertensive
  • TCA

Hypovolaemia

Primary autonomic failure
- Parkinson’s

Secondary autonomic failure
- Diabetes
-

45
Q

Hydrocephalus - Name 3 causes of a communicating hydrocephalus

A

Damage to arachnoid granulations

  • Intracranial haemorrhage
  • Meningitis
  • Venous thrombosis
46
Q

Name the 3 different categories of syncope

A

Vasovagal
- reflex bradycardia and peripheral vasodilation

Situational - Post:

  • cough
  • micturition

carotid hypersensitivity
- tight collar / shaving

47
Q

Name 8 causes of a seizure

A

Children

  • inherited syndromes
  • Birth hypoxia
  • Infections (meningitis)

Metabolic

  • Hypoglycaemia
  • Hyponatraemia
  • Hypoxia
  • Delirium tremens

Other

  • Head trauma
  • stroke
48
Q

Name 4 factors that reduce seizure threshold

A
Alcohol 
Anti-depressants 
SOL 
Lack of sleep 
Hyponatraemia 
Stroke
49
Q

How do you diagnose epilepsy

A

2 unprovoked seizures occuring >24 hours apart

OR

1 unprovoked seizure and a >60% probability of increased predisposition to further seizures In next 10 years
(eg: MRI - SOL/ Stroke or on EEG)

50
Q

Name and describe the 4 stages of a seizure

A

Prodrome - not part of seizure
- change in mood

Aura

  • deja-vu
  • strange smells

Ictal phase

Post ictal

  • headache
  • confusion
51
Q

Name investigations required following a seizure

A

Bloods - glucose / Ca2+ / Na+

ECG - R/O other conditions

EEG

CT/MRI

52
Q

Name the 5 classifications of a generalised seizure

A

GTC

  • tongue biting
  • incontinence
  • eyes closed
  • confusion

Tonic

Atonic

  • No LOC
  • Falls to floor

Absence
- 3Hz spike in EEG

Myoclonic
- thrown to floor

53
Q

Name the 5 classifications of a generalised seizure

A

GTC

  • tongue biting
  • incontinence
  • eyes closed
  • confusion

Tonic

Atonic

  • No LOC
  • Falls to floor

Absence
- 3Hz spike in EEG

Myoclonic
- thrown to floor

54
Q

What is the management of generalised seizure

A

1st - sodium valproate

2nd - Carbamazepine / Lamotrigine

55
Q

Describe the differences between a simple and complex focal seizure

A

Simple

  • No LOC
  • No post ictal confusion

Complex

  • LOC
  • Post ictal confusion
  • common from temporal and frontal lobes
56
Q

Describe the presentation of a frontal lobe focal seizure

A
pedalling leg movements 
posturing changes 
jacksonian march 
motor arrest 
post ictal - Todd's palsy
57
Q

Describe the presentation of a temporal lobe focal seizure

A

Deja - vu
hallucination - smell / taste / sound
Automatisms - lip smacking / pulling

58
Q

Describe the presentation of a parietal and occipital lobe focal seizure

A

Parietal
- sensory changes (tingling / paresthesia)

Occipital
- Visual disturbance

59
Q

What is the management in status epilepticus

A

1st line - IV 4mg lorazepam
Buccal midazolam
rectal diazepam

2nd line - Repeat if no response after 10 mins

3rd line - IV phenytoin

60
Q

What are the risks / complications if status epilepticus is not managed

A

death
rhabdomyolysis
AKI
Metabolic acidosis

61
Q

What are the driving requirements following a seizure and in epilpesy

A

Must inform DVLA

  • Can’t drive for 6m following a seizure
  • If established epilepsy must be seizure free for 1 year
62
Q

What is required when administering phenytoin

A

cardiac monitoring - risk of arrhythmias

63
Q

Name 4 side effects of sodium valporate

A

teratogenic
weight gain
hair loss
pancreatitis

64
Q

name 4 side effects of lamogitrine

A

rashes
aggression
steven-johnson syndrome

65
Q

Name 4 side effects of carbamazepine

A

Teratogenic
Hyponatraemia - SIADH
Rashes
Agranulocytosis

66
Q

Name 4 side effects of phenytoin

A

gum hypertrophy
cerebellar atrophy
arrhythmias

67
Q

What is the driving advice following a NEAD

A

No driving unless seizure free for 3m

68
Q

Describe NEAD

A

Physical manifestation of trauma

  • Common after childhood sexual abuse
  • no EEG changes

Presents with other MUS
- IBS / Fibromyalgia / chronic fatigue

Mx - Psychotherapy and explanation

69
Q

Describe the presentation of Wernicke’s syndrome

A
Triad:
- ataxia 
- encephalopathy 
- Ocular abnormalities
Ophthalmoplegia 
gaze paresis 
ptosis 
nystagmus 

Peripheral neuropathy

70
Q

Name 3 causes of Wernicke’s syndrome

A

Hyperemesis
Alcohol dependence
Malnutrition / Anorexia

71
Q

Where is vitamin B1 - thiamine absorbed and stored

A

Absorbed - duodenum

stored - liver

72
Q

What is the Mx of wernicke’s syndrome

A

IV Pabrinex

IV glucose - prevent metabolic acidosis

73
Q

How does Korsakoff syndrome present

A

Sx of Wernicke’s +

  • Anterograde and retrograde amnesia
  • Confandibulation
74
Q

What is the pathophysiology behind Korsakoff syndrome

A

Chronic lack of thiamine damages mamillary bodies in limbic system - Degradation visible on MRI

75
Q

CLUSTER

  • Timings
  • RF
  • Causes
  • Presentation
  • Mx
  • Prophylaxis
A

5 - 180 mins

Smoking is a risk factor

Alcohol

Unilateral orbital pain 
- rhinorrhoea 
- lacrimation 
- bloodshot
- ptosis 
Vomiting 

Mx - 100 O2 + Sumatriptan

Prophylaxis - Verapamil

76
Q

TRIGEMINAL NEURALGIA

  • Timings
  • RF
  • Causes
  • Presentation
  • Ix
  • Mx
A

Seconds

> 55 year old female

Compression of trigeminal nerve - Aggravated by: Shaving / smiling / talking / wind

Unilateral - electryfying stabbing pain

Ix - MRI to R/O other conditions

Mx:
Medical
- 1st: Carbamazepine
- 2nd: Phenytoin / Gabapentin

Surgical
- Surgical decompression

77
Q

What drugs commonly cause medication overuse headache

A

opioids
triptans
NSAIDs

78
Q

Name 3 risk factors for GCA

A

Female
PMR
Family hx

79
Q

What is found on temporal artery biopsy in GCA

A

Multinucleated giant cells

80
Q

Name the investigations required in GCA

A

Bloods

  • ESR
  • ALP - raised
  • CRP
  • FBC - normochromic normocytic anaemia

Duplez USS - hypoechoic halo sign

81
Q

What is the presentation of GCA

A
Unilateral temporal headache 
scalp tenderness 
jaw claudication 
blurred / double vision 
vision loss 
fever
weight loss 
fatigue
82
Q

What is the management of GCA

A

Prednisolone - 40/60mg

Decrease stroke and vison loss risk
75mg Aspirin

Gastric protection whilst on steroids
PPI

Bisphosphonates + Coleclacifarol

83
Q

Name 2 risk factors for glaucoma

A

family hx

High BP

84
Q

Describe the pathophysiology in Glaucoma

A

Increased intraocular pressure damages optic nerve

85
Q

Describe the presentation of glaucoma

A

Unilateral orbital pain
swollen eye
visual blurring
Halos in vision

86
Q

What investigations are required in glaucoma

A

Vision testing

Measure IO pressure - Tonometer

87
Q

What is the medical and surgical management of glaucoma

A

Medical
- Iatanoprost (PG analgoues)

Surgical

  • Trabeculoplasty
  • Trabeulotomy
88
Q

Name 4 causes meningitis

A
Strep pneumonia 
Neisseria meningitidis 
H.influenza 
Strep agalactiae 
Listeria monocytogenes
89
Q

What is the prophylaxis for menignitis for close contacts

A

Oral ciprofloxacin

90
Q

Name 3 causes of encephalitis

A

HSV - 1
VZV
CMV
EBV

91
Q

Describe the presentation of encephalitis

A
Sudden onset behavioural change
Headache 
New onset seizures
Decreased GCS
Confusion 
Focal neurology 
Fever
92
Q

Describe the investigations required in suspected encephalitis

A

1st line - Bloods and blood culture
- Viral PCR

2nd line - LP
- Viral PCR

Contrast enhanced CT scan / MRI scan
- Bitemporal and inferior changes

93
Q

What is the infectivity period of shingles

A

infective 1/2 days before rash onset and 5 days post rash

94
Q

Name 2 complications of shingles

A

Ramsey hunt syndrome

Post herpetic neuralgia

  • burning intractable pain
  • poor response to analgesics
95
Q

What is the management of post herpetic neuralgia

A

Amitriptyline