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Phase 2 - Marc's Neurology > Neurology Conditions A > Flashcards

Neurology Conditions A Flashcards

1
Q

Ischaemic Stroke - Description

A

rapid onset focal neurological deficit lasting more than 24 hours due to arterial stenosis or occlusion

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2
Q

Ischaemic Stroke - Causes (7)

A

1) small vessel occlusion
2) large vessel atherothromboembolism
3) cardioembolism (AF, MI, IE)
4) vasculitis
5) sickle cell disease
6) polycythaemia
7) hypoperfusion (inc. caused by sepsis)

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3
Q

Ischaemic Stroke - Risk Factors (13)

A

1) older age
2) male
3) family history
4) Afro-Caribbean
5) transient ischaemic attack
6) atrial fibrillation
7) diabetes mellitus
8) hypertension
9) dyslipidaemia
10) hypercoagubility
11) oral contraceptive pill
12) smoking
13) alcohol

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4
Q

Ischaemic Stroke - Symptoms (General) (4)

A

FAST

1) facial drooping
2) arm weakness
3) slurred speech
4) time (sudden onset)

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5
Q

Ischaemic Stroke - Symptoms (Anterior Cerebral Artery) (6)

A

1) contralateral numbness (esp. leg)
2) contralateral weakness (esp. leg)
3) truncal ataxia
4) gait ataxia
5) incontinence
6) drowsiness

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6
Q

Ischaemic Stroke - Symptoms (Middle Cerebral Artery) (4)

A

1) contralateral numbness (arm+leg)
2) contralateral weakness (arm+leg)
3) dysphasia —> aphasia
4) visuospatial disturbances

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7
Q

Ischaemic Stroke - Symptoms (Posterior Cerebral Artery) (5)

A

1) contralateral homonymous hemianopia
2) cortical blindness
3) visual agnosia
4) prosopagnosia
5) unilateral headache (esp. haemorrhagic)

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8
Q

Ischaemic Stroke - Symptoms (Vertebrobasilar Artery) (5)

A

1) quadriplegia
2) dysarthria
3) dysphasia
4) visual disturbances
5) locked in syndrome

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9
Q

Ischaemic Stroke - Complications (5)

A

1) haemorrhage
2) deep vein thrombosis
3) seizure
4) aspiration pneumonia
5) depression

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10
Q

Ischaemic Stroke - Investigations (5/1)

A

initial
1) urgent head CT (brain parenchyma hypoattenuation, dark)
2) brain diffusion weighted imaging MRI (infarct hyperattenuation, bright)
3) serum glucose (exclude hypoglycaemia/hyperglycaemia)
4) ECG + BP
5) FBC
consider
1) CT/MRI angiogram (identify stenosis/occlusion)

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11
Q

Ischaemic Stroke - Management (5/4/1)

A

conservative
1) nil by mouth until swallowing assessment (aspiration pneumonia)
2) maintain oxygen (>95%)
3) maintain hydration
4) head CT post thrombolysis (24 hours later)
5) CVS risk factor control
medical
1) thrombolysis (IV alteplase) (<4.5 hours of onset)
2) aspirin (24 hours after IV alteplase) (2 weeks)
3) clopidogrel (unknown onset or >4.5 hours of onset) (lifelong)
4) prophylactic anticoagulant (DVT)
surgery
1) thrombectomy (large artery occlusion)

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12
Q

Haemorrhagic Stroke - Description

A

rapid onset focal neurological deficit lasting more than 24 hours due to an intracerebral haemorrhage

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13
Q

Haemorrhagic Stroke - Causes (7)

A

1) cerebral amyloid angiopathy
2) hypertension (Charcot Bouchard aneurysm)
3) aneurysm rupture
4) ateriovenous malformation
5) anticoagulants
6) trauma —> carotid artery dissection
7) subarachnoid haemorrhage

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14
Q

Haemorrhagic Stroke - Risk Factors (7)

A

1) older age
2) male
3) Afro-Caribbean
4) family history
5) hypertension
6) haemophilia
7) anticoagulants

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15
Q

Haemorrhagic Stroke - Symptoms (General) (7)

A 
FAST
1) facial drooping
2) arm weakness
3) slurred speech
4) time (sudden onset)
other
5) neck stiffness
6) severe headache
7) impaired consciousness
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16
Q

Haemorrhagic Stroke - Symptoms (Anterior Cerebral Artery) (6)

A

1) contralateral numbness (esp. leg)
2) contralateral weakness (esp. leg)
3) truncal ataxia
4) gait ataxia
5) incontinence
6) drowsiness

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17
Q

Haemorrhagic Stroke - Symptoms (Middle Cerebral Artery) (4)

A

1) contralateral numbness (arm+leg)
2) contralateral weakness (arm+leg)
3) dysphasia —> aphasia
4) visuospatial disturbances

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18
Q

Haemorrhagic Stroke - Symptoms (Posterior Cerebral Artery) (5)

A

1) contralateral homonymous hemianopia
2) cortical blindness
3) visual agnosia
4) prosopagnosia
5) unilateral headache (esp. haemorrhagic)

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19
Q

Haemorrhagic Stroke - Symptoms (Vertebrobasilar Artery) (5)

A

1) quadriplegia
2) dysarthria
3) dysphasia
4) visual disturbances
5) locked in syndrome

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20
Q

Haemorrhagic Stroke - Complications (5)

A

1) hydrocephalus
2) deep vein thrombosis
3) seizure
4) aspiration pneumonia
5) depression

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21
Q

Haemorrhagic Stroke - Investigations (4/1)

A

initial
1) urgent head CT (brain parenchyma hyperattenuation, bright)
2) serum glucose (exclude hypoglycaemia/hyperglycaemia)
3) ECG + BP
4) FBC
consider
1) CT/MRI angiogram (identify aneurysm, arteriovenous malformation)

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22
Q

Haemorrhagic Stroke - Management (5/3/2)

A 
conservative
1) monitor GCS
2) nil by mouth until swallowing assessment (aspiration pneumonia)
3) maintain oxygen (>95%)
4) maintain hydration
5) CVS risk factor control
medical
1) IV prothrombin complex concentrate + vitamin K (anticoagulant reversal)
2) diuretic (mannitol) (lower ICP)
3) prophylactic anticoagulant (DVT) (once haemorrhage controlled)
surgery
1) craniotomy + drainage (severe)
2) cerebral shunt (hydrocephalus)
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23
Q

Transient Ischaemic Attack - Description

A

rapid onset reversible focal neurological deficit lasting less than 24 hours due to arterial stenosis or occlusion

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24
Q

Transient Ischaemic Attack - Causes (7)

A

1) small vessel occlusion
2) large vessel atherothromboembolism* (esp. carotid)
3) cardioembolism (AF, MI, IE)
4) vasculitis
5) sickle cell disease
6) polycythaemia
7) hypoperfusion (inc. caused by sepsis)

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25
Q

Transient Ischaemic Attack - Risk Factors (13)

A

1) older age
2) male
3) family history
4) Afro-Caribbean
5) transient ischaemic attack
6) hypertension
7) atrial fibrillation
8) diabetes mellitus
9) dyslipidaemia
10) hypercoagubility
11) oral contraceptive pill
12) smoking
13) alcohol

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26
Q

Transient Ischaemic Attack - Symptoms (Anterior Circulation) (5)

A

90%

1) dysphasia —> aphasia
2) contralateral numbness
3) contralateral weakness
4) contralateral hemianopia
5) amaurosis fugax (sudden loss of vision in one eye)

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27
Q

Transient Ischaemic Attack - Symptoms (Posterior Circulation) (6)

A

10%

1) dysarthria —> choking
2) contralateral numbness
3) contralateral hemianopia
4) diplopia
5) vertigo
6) transient global amnesia (episode of amnesia/confusion that resolves within 24 hours)

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28
Q

Transient Ischaemic Attack - Complications (2)

A

1) stroke (30% in 5 years)

2) myocardial infarction (15% in 5 years)

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29
Q

Transient Ischaemic Attack - Investigations (5/2)

A

initial
1) brain diffusion weighted imaging MRI (exclude haemorrhage)
2) serum glucose (exclude hypoglycaemia/hyperglycaemia)
3) ECG + BP
4) FBC
5) carotid artery Doppler ultrasound (stenosis)
consider
1) carotid CT/MRI angiogram (if stenosis)
2) echocardiogram (cardioembolism)

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30
Q

Transient Ischaemic Attack - Stroke Risk (ABCD2) (5)

A

> 6 - immediate specialist referral; >4 - <24 hour specialist referral
A) age >60 years old (1)
B) BP >140/90 (1)
C) clinical features: unilateral weakness (2); speech disturbances without weakness (1)
D) duration: <1 hour (1); >1 hour (2)
D) diabetes mellitus (1)

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31
Q

Transient Ischaemic Attack - Management (3/3/1)

A 
conservative
1) specialist referral (<1 week minimum)
2) no driving (4 weeks)
3) CVS risk factor control
medical
1) aspirin (first 2 weeks)
2) clopidogrel (after 2 weeks)
3) anticoagulant (if cardioembolism)
surgery
1) carotid endarterectomy or stent (>50% stenosis)
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32
Q

Subarachnoid Haemorrhage - Description

A

spontaneous bleeding into subarachnoid space (in between arachnoid and pia)

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33
Q

Subarachnoid Haemorrhage - Causes (4)

A

1) berry aneurysm rupture (80%)
2) arteriovenous malformation (15%)
3) vasculitis
4) idiopathic

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34
Q

Subarachnoid Haemorrhage - Risk Factors (10)

A

1) >50 years old (esp. 50-55)
2) female
3) family history
4) Afro-Caribbean
5) hypertension
6) smoking
7) polycystic kidney disease
8) Ehlers-Danlos syndrome
9) Marfan syndrome
10) aorta coarctation

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35
Q

Subarachnoid Haemorrhage - Symptoms (7)

A

1) sudden severe occipital headache (thunderclap)
2) neck stiffness
3) vomiting
4) collapse
5) seizure
6) coma
7) photophobia

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36
Q

Subarachnoid Haemorrhage - Signs (3)

A

1) Kernig’s sign (inability to extend knee when hip is flexed) (6 hour later)
2) Brudzinski’s sign (when neck is flexed, hip and knee also flex)
3) papilloedema

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37
Q

Subarachnoid Haemorrhage - Complications (7)

A

1) rebleeding (20%)
2) vasospasm —> cerebral ischaemia
3) hydrocephalus
4) cerebral oedema
5) hyponatraemia
6) coma
7) death

38
Q

Subarachnoid Haemorrhage - Investigations (1/2)

A

initial
1) head CT* (star shaped lesion)
consider
1) lumbar puncture (if CT negative) (xanthochromic - yellow)
2) CT angiogram (number/extent of aneurysms)

39
Q

Subarachnoid Haemorrhage - Management (0/3/2)

A

medical
1) IV fluids (maintain cerebral perfusion)
2) nimpdipine (CCB) (reduce vasospasm —> cerebral ischaemia risk)
3) dexamethasone (corticosteroid) (reduce cerebral oedema)
surgery
1) endovascular coiling*
2) surgical clipping

40
Q

Subdural Haematoma - Description

A

accumulation of clotted blood in subdural space (in between dura and arachnoid)

41
Q

Subdural Haematoma - Risk Factors (5)

A

1) traumatic head injury (esp. decelerating injuries)
2) aging —> cerebral atrophy
3) alcohol —> cerebral atrophy
4) anticoagulation
5) coagulopathy

42
Q

Subdural Haematoma - Pathophysiology (2)

A

1) rupture of bridging vein between cortex and venous sinus

2) accumulation of clotted blood in subdural space

43
Q

Subdural Haematoma - Symptoms (Acute) (7)

A

1) headache
2) fluctuating consciousness
3) nausea
4) vomiting
5) seizure
6) coma
7) focal neurological deficit (e.g. hemiparesis)

44
Q

Subdural Haematoma - Symptoms (Chronic) (4)

A

1) headache
2) fluctuating consciousness
3) cognitive decline
4) personality change

45
Q

Subdural Haematoma - Complications (5)

A

1) epilepsy
2) stroke
3) cerebral oedema
4) coma
5) death

46
Q

Subdural Haematoma - Investigations (1/0)

A

initial

1) head CT (diffuse hyperdense crescent shaped mass, shifting of midline structures)

47
Q

Subdural Haematoma - Management (1/2/1)

A 
conservative
1) anticoagulant/antiplatelet cessation
medical
1) IV mannitol (high ICP)
2) IV prothrombin complex concentrate + vitamin K (anticoagulation reversal)
surgery
1) craniotomy (haematoma evacuation)
48
Q

Extradural Haematoma - Description

A

accumulation of clotted blood in extradural space (in between skull and dura)

49
Q

Extradural Haematoma - Risk Factors (1)

A

1) traumatic head injury (temporal/parietal fracture)

50
Q

Extradural Haematoma - Pathophysiology (3)

A

1) fracture of temporal or parietal bone
2) laceration of middle meningeal artery
3) accumulation of clotted blood in extradural space

51
Q

Extradural Haematoma - Symptoms (6)

A 
1) post traumatic loss of consciousness —> lucid interval (hours/days) —> decrease in consciousness
high ICP
2) headache
3) nausea
4) vomiting
5) coma
52
Q

Extradural Haematoma - Investigations (2/0)

A

initial

1) head CT* (hyperdense lemon shaped mass adjacent to skull)
2) skull x-ray

53
Q

Extradural Haematoma - Management (1/2/1)

A 
conservative
1) anticoagulant/antiplatelet cessation
medical
1) intubation + ventilation
2) IV mannitol (high ICP)
surgery
1) craniotomy (haemotoma evacuation ± blood vessel ligation)
54
Q

Depression - Description

A

disorders characterised by persistent low mood and anhedonia

55
Q

Depression - Risk Factors (8)

A

1) >65 years
2) female (2x)
3) family history
4) chronic disease (1/3)
5) postpartum (20%)
6) oral contraceptive pill
7) corticosteroids
8) propranolol

56
Q

Depression - Symptoms (10)

A

1) low mood*
2) anhedonia* (decreased interest and/or pleasure in all activities)
3) functional impairment
4) sleep disturbances (insomina/hypersomnia)
5) fatigue
6) guilt (inc. worthlessness)
7) weight change
8) libido change
9) poor concentration
10) suicidal intention

57
Q

Depression - Diagnosis (DSM-5 Criteria) (2/8)

A 
2 week period, ≥5 symptoms nearly everyday, ≥1 major criteria
major criteria
1) low mood
2) anhedonia (decreased interested and/or pleasure in all activities)
minor criteria
1) functional impairment
2) sleep disturbances (insomnia/hyperosomnia)
3) fatigue
4) guilt (inc. worthlessness)
5) weight change
6) libido change
7) poor concentration
8) suicidal intention
58
Q

Depression - Management (5/3/0)

A 
conservative
1) watchful waiting (2 week GP follow-up)
2) regular exercise (inc. yoga)
3) self-help books
4) psychotherapy
5) cognitive behavioural therapy (inc. computer based)
medical
1) SSRI (e.g. fluoxetine)
2) TCA (e.g. amitriptyline)
3) St. John’s wort
59
Q

Epilepsy - Description

A

recurrent spontaneous, intermittent, abnormal electrical brain activity manifesting as seizures

60
Q

Epilepsy - Causes (5)

A

1) idiopathic (2/3)
2) cortical scarring (head injury, cerebrovascular disease, CNS infection)
3) tumour
4) tuberous sclerosis
5) dementia

61
Q

Epilepsy - Risk Factors (9)

A

1) family history
2) premature birth
3) febrile seizure
4) dementia
5) drugs (e.g. cocaine)
6) head trauma
7) cerebrovascular disease (e.g. stroke)
8) CNS infection (e.g. meningitis)
9) tumour

62
Q

Epilepsy - Types (7)

A 
focal (57%)
1) simple
2) complex
3) with secondary generalised (2/3 of focal)
generalised (40%)
4) absence (petit-mal)
5) myoclonic
6) tonic-clonic (grand-mal)
7) atonic
63
Q

Epilepsy - Pathophysiology (Focal) (1)

A

1) electrical discharge limited to one part of the cortex (80% in temporal lobe)

64
Q

Epilepsy - Pathophysiology (Generalised) (1)

A

1) electrical discharge simultaneously throughout whole cortex

65
Q

Epilepsy - Phases (4)

A

1) prodromi
2) aura
3) ictus (i.e. seizure
4) post-ictus

66
Q

Epilepsy - Symptoms (Focal - Temporal) (5)

A

80% of focal

1) deja vu (feeling of unfamiliar feeling familiar)
2) jamais vu (feeling of familiar feeling unfamiliar)
3) auditory hallucinations
4) olfactory hallucinations
5) anxiety —> fear

67
Q

Epilepsy - Symptoms (Focal - Frontal) (1)

A

1) motor features

68
Q

Epilepsy - Symptoms (Focal - Parietal) (1)

A

1) sensory features

69
Q

Epilepsy - Symptoms (Focal - Occipital) (1)

A

1) visual features (e.g. visual hallucinations, visual loss)

70
Q

Epilepsy - Symptoms (Generalised - Absence) (2)

A

1) <10 second pause in activity (e.g. stops talking mid-sentence)
2) unaware of attack

71
Q

Epilepsy - Symptoms (Generalised - Myoclonic) (1)

A

1) sudden jerk of limb, face, trunk (e.g. thrown to ground or violently disobedient limb)

72
Q

Epilepsy - Symptoms (Generalised - Tonic-Clonic) (4)

A

1) loss of consciousness
2) still limbs —> jerking limbs (tonic —> clonic)
3) drowsiness (post-ictus)
4) confusion (post-ictus)

73
Q

Epilepsy - Symptoms (Generalised - Atonic) (1)

A

1) sudden loss of muscle tone —> fall

74
Q

Epilepsy - Complications (4)

A

1) head trauma
2) fractures
3) memory loss
4) sudden, unexpected death in epilepsy (SUDEP)

75
Q

Epilepsy - Investigations (3/2)

A 
initial
1) head CT
2) electroencephalogram (not diagnostic)
3) serum glucose (exclude hypoglycaemia/hyperglycaemia)
consider
1) head MRI (identify causative lesion)
2) genetic testing
76
Q

Epilepsy - Diagnosis (1)

A

1) history of >2 unprovoked seizures >24 hours apart

77
Q

Epilepsy - Management (4/4/2)

A

conservative
1) ABCDE (esp. maintain airways)
2) protect from injury
3) check glucose
4) inform DVLA
medical
1) IV diazepam or IV lorazepam x2 (1st line, during seizure)
2) IV phenytoin (2nd line, during seizure)
3) carbamazepine (focal)
4) sodium valproate (generalised)
surgery
1) surgical resection (hippocampal sclerosis or tumour) (70% resolution)
2) neurostimulation system (e.g. vagal nerve stimulation or deep brain stimulation)

78
Q

Parkinson’s Disease - Description

A

progressive neurodegenerative movement disorder due to decreased DA in substantia nigra

79
Q

Parkinson’s Disease - Causes (1)

A

1) unknown

80
Q

Parkinson’s Disease - Risk Factors (6)

A

1) age* (peak onset 55-65 years old)
2) male
3) family history
4) GBA gene mutation (Gaucher’s disease) (5x)
5) MPTP exposure (e.g. cocaine)
6) insecticide/herbicide exposure

81
Q

Parkinson’s Disease - Pathophysiology (6)

A

1) mitochondrial dysfunction and oxidative stress on substantia nigra
2) progressive degeneration of dopaminergic neurones of substantia nigra
3) decreased DA synthesis in the striatum
4) decreased DA release
5) decreased thalamus activity
6) decreased movement

82
Q

Parkinson’s Disease - Symptoms (Non-Motor Prodrome) (3)

A

up to 7 years prior to motor symptoms

1) anosmia
2) urgency
3) constipation

83
Q

Parkinson’s Disease - Symptoms (Parkinson’s Triad) (3)

A

1) tremor (esp. at rest, in hand)
2) rigidity
3) bradykinesia

84
Q

Parkinson’s Disease - Symptoms (Rigidity) (2)

A

1) leadpipe rigidity (sustained resistance to passive movements)
2) cogwheel rigidity (jerky resistance to passive movements)

85
Q

Parkinson’s Disease - Symptoms (Bradykinesia) (5)

A

1) slow movement initiation
2) slow repetition (e.g. blinking)
3) decreased amplitude in action repetition (e.g. micrographia (small handwriting))
4) hypophonia (decreased voice volume)
5) hypomimesis (expressionless face)

86
Q

Parkinson’s Disease - Symptoms (Other) (2)

A

1) fine motor skill difficulty (e.g. buttons)

2) gait (stooped posture, small shuffling steps, narrow base, reduce arm swing, difficulty turning)

87
Q

Parkinson’s Disease - Complications (7)

A

1) aspiration pneumonia
2) depression
3) anxiety
4) REM sleep disorders
5) postural hypotension
6) Lewy body depression
7) dyskinesia

88
Q

Parkinson’s Disease - Investigations (0/2)

A

consider

1) levodopa trial (symptoms improve) (if unclear clinical diagnosis, confirmation)
2) MRI brain

89
Q

Parkinson’s Disease - Management (3/2/1)

A 
conservative
1) SALT (speech and language therapy)
2) physiotherapy (balance, gait)
3) physical activity
medical
1) levodopa* (>70 years old or severe)
2) decarboxylase inhibitor (e.g. co-careldopa) (decreases levodopa SEs, increases levodopa efficacy)
surgery
1) deep brain stimulation (refractory, party DA responsive)
90
Q

Parkinson’s Disease - Management (Delay Levodopa) (3)

A

1) dopamine agonist (e.g. ropinirole)
2) monomanie oxidase b inhibitors (e.g. selegiline)
3) catechol-o-methyl transferase inhibitors (e.g. tolcapone)

Phase 2 - Marc's Neurology (8 decks)

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