Neurology Clinical Flashcards
What is the acute treatment for cluster headache?
Oxygen
SC triptan
What is the treatment for prophylaxis of cluster headaches?
Verapamil
What drugs are used to reduce the relapse rate in multiple sclerosis?
Beta interferon - reduces relapse rate by up to 30%
Glatiramer acetate
Natalizumab
Fingolimod
What are the absolute contraindications to thrombolysis?
Previous intracranial haemorrhage Seizure at onset of stroke Intracranial neoplasm Suspected subarachnoid haemmorhage Stroke or traumatic brain injury in the past 3 months LP in the last 7 days GI heammorhagge in the last 3 weeks Active bleeding Pregnancy Oesophageal varices Uncontrolled hypertension <200/120
When should thrombectomy be offered in acute stroke?
- As soon as possible within 6 hours of symptoms onset, together with IV thrombolysis (if within 4.5 hours) to people who have a confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA
Whereabouts in the brain does herpes simplex encephalitis characteristically affect?
The temporal lobe
What do you see on a CT scan of someone with HSV encephalitis?
Peticial haemmorhages in the medial temporal and inferior frontal lobes
What is lateral medullary syndrome?
A stroke which presents with ipsilatera; facial numbness, cranial nerve palsy and contralateral limb sensory loss. Also ataxia and nystagmus. It results from an occlusion of the posterior inferior cerebellar artery
What drugs can worsen myasthenia gravis?
Penicillamine Quinidine Beta blockers Lithium Phenytoin Gentamicine, macrolides, quinolones, tetracyclines
What happens in anterior spinal artery occlusion?
- Most common spinal stroke
- Bilateral motor and sensory paralysis below the level of the infarct
Sparing of the dorsal column medial leminniscal pathway (proprioception is preserved) . - Autonomic dysfunction inferior to the level of the lesion
What happens in posterior spinal infarcts?
Sensory loss of proprioception, vibration and light touch sensations
What happens in central spinal infarcts?
Bilateral sensory and spinothalamic defecit
What does the dorsal colum do?
Responsible for fine touch and proprioception (made up of gracile and cuneate pathways)
What does the lateral corticospinal tract do?
carried motor signals to the limbs
What does the ventral corticospinal tract to?
Carries motor signals to the axial muscles
What does the lateral spinothalamic tract do?
carries pain and temperature signals from the body
What does the anterior spinothalamic tract do?
Carries crude touch sense from the body
What is ramsey hunt syndrome?
Herpes zoster of the seventh cranial nerve
What medication is used in subarachnoid haemmorhage?
Nimodipine (prevents vasospasm)
What is wernickes aphasia?
Due to a lesion in the superior temporal gyrus
Lesions results in sentances that make no sense byt speech remains fluent
Comprehension is also impaired
What is brocas aphasia?
Due to a lesion of the inferior frontal gyrus.
Speech is non fluent laboured and halting. Repetition is impaired.
Comprehension is normal
What is conduction aphasia?
Due to a stroke affecting the arcuate fasiculus which is the connection between wernickes and brocas area.
Speech is fluent but repetition is poor.
The patients is aware of the errors in speech.
Comprehension is normal
What is global ahasia?
Large lesion affecting all 3 areas (arcutate fasiculus, inferior frontal gyrus and the superior temporal gyrus
What us von hippel lindau syndrome?
An autosomal dominant condition caused by a mutation in the VHL gene in chromosome 3. This results in an increase in hypoxia inducible factor and causes tumour formation.
What tumours at associated with von hippel landau syndrome?
Retinal haemangiomas Clear cell carcinoma Phaechromocytoma Pancreatic neuroendocrine tumours Cerebella haemangiomas
What is the treatment for neuroleptic malignant syndrome?
IV fluids
Dantrolene
Bromocriptine may be used
How does phenytoin work?
Binds to sodium to increase the refactory period
What is the treatment for secondary prevention of stroke if clopidogrel cannot be given?
Aspirin + Dipyrimadole lifelond
List some drugs that cause peripheral neuropathy?
Amiodarone Isoniazid Vincristine Nitrofurantoin metronidazole
What is a syringomyelia?
A collection of CSF within the spinal cord
What is syringobulbia?
A fluid filled cavity within the medulla of the brainstem
What spinal cord tracts are the first to be affected by syringomyelia?
Spinothalamic tracts in the anterior commissure of the spinal cord.
What is the treatment for idiopathic intracranial hypertension?
Weight loss Diuretics such as acetazolamide Topiraamte Theraputic lumbar puncture LP or VP shunt
What might the lumbar puncture show in guillian barre syndrome?
A rise in protein with a normal white cell count
What immune problem is ataxic telangictasia associated with?
IGA deficiency
Which type of brain presents with a lucid interval followed by collapse?
Extradural haemmorhage
What drugs can cause tinnitus?
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
What is the inheritence pattern of myotonic dystrophy?
Autosomal dominant
Where is the lesion if you have a bitemporal hemianopia predominately affecting the upper quadrants
Superior chiasmal compression usually a craniopharyngioma
Where is the lesion if you have a bitemporal hemianopia predominately affecting the lower quadrants
Inferior chiasmal compression commonly a pituitary tumour
What is miller fisher syndrome?
A variant of guillan barre that presents with opthalmoplegia, areflexia and ataxia.
Presents as a descending paralysis rather than an ascending paralysis
Anti GQ1b antibodies are present in 90% of cases
What are the main features of wernickes encephalopathy?
Nystagmus Opthalmoplegia ataxia Confusion peripheral sensory neuropathy
What symptoms are seen in korsakoffs syndrome but not werneickes encephalopathy?
antero and retrograde amnesia
Confabulation
What is the first line medication for myoclonic seizures?
Sodium valporate
What is lateral medullary syndrome?
A stroke caused by occlusion of the posterior inferior cerebellar artery..
symptoms include:
Cereberllar: nystagmus, ataxia, Brain stem (ipsilateral) horners syndrome, dysphagia
Contralateral limb sensory loss
What is the trinucleotide repeat in huntingtons disease?
CAG
What is the pathophysiology of huntingtons disease?
Degeneration of the cholinergic and GABAergic neurons in the striatum f the basal ganglia
What spinal cord colums are affected first in subacute combined degeneration if the spinal cord?
Dorsal and lateral colums - resulting in loss of fine touch and proprioception
What symptoms do you get from a stroke of the anterior cerebral artery?
Contralateral hemiparesis and sensory loss, lower extremity worse than upper
What symptoms do you get from a stroke of the middle cerebral artery?
Contralateral hemiparesis, worse in the arms.
Contralateral homonymous hemianopia, aphasia
What symptoms do you get from a stroke of the posterior cerebral artery?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Where is the medial longitudinal fasiculus?
Paramedian area of the midbrain and pons
What three drugs cause gingival hyperplasia?
Phenytoin
Ciclosporin
Calcium channel blockers (especially nifedipine)
What are the features of tuberous sclerosis?
Ash leaf spots
Roughened patches of spots over lumbar spine (shagreen patches)
Adenoma sebaceum (angiofibromas) over the nose
Fibromata beneath nails
Cafe au lait spots
What are the causes of a bilateral facial nerve palsy?
Sarcoidosis
Guillain barre syndrome
Lyme disease
Bilateral acoustic neuromas (seen in neurofibromatosis type 2)
What is opsoclous myoclonus syndrome? (OMS)
Random eye movements in all directions and also limb jerks.
Also causes ataxia and loss of speech.
Autoimmune condition that is often due to a paraneoplastic syndrome (often due to lung or breast cancer) In children this may be caused by a brain tumour or infection.
What are the antibodies against in lambort eaton syndrome?
Pre synapric voltage gated calcium channel
What cancer is lambort eaton syndrome associated with?
Small cell lung cancer
also breast and ovarian
What medication can be used in motor neurone disease?
Riluzole
- prevents stimulation of glutamate receptors
- Prolongs life by around 3 months
