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Phase 2 - Marc's Neurology > Neurology Lectures > Flashcards

Neurology Lectures Flashcards

1
Q

What artery is the most common site of a stroke?

A

Middle cerebral artery.

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2
Q

Define a lacunar stroke.

A

Stroke of deep branches of the middle cerebral artery that supply the basal ganglia.

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3
Q

Define watershed infarct.

A

Ischaemic stroke due to hypoperfusion, sudden BP drop >40mmHg.

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4
Q

Define ischaemic core.

A

Tissue likely to die due to ischaemia.

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5
Q

Define ischaemic penumbra.

A

Tissue preserved for a short period of time due to collateral circulation, potentially able to survive.

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6
Q

What symptom is found in a stroke of Broca’s area?

A

Expressive aphasia —> inability to produce written and spoken language, although comprehension remains intact.

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7
Q

What symptom is found in a stroke of Wernicke’s area.

A

Reactive aphasia —> inability to comprehend written and spoken language, although language production remains intact.

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8
Q

Define dysphasia.

A

Difficulty to comprehend or produce speech.

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9
Q

List 3 general causes/types of stroke.

A

1) ischaemic (80%)
2) haemorrhagic (17%)
3) other (3%)

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10
Q

What percentage of strokes occur secondary to a subarachnoid haemorrhage?

A

5%.

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11
Q

List the 5 possible syndromes in a lacunar stroke.

A

1) pure motor syndrome
2) pure sensory syndrome
3) sensorimotor syndrome
4) ataxic hemiparesis
5) dysarthria/clumsy hand

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12
Q

Define hemiplegia.

A

Paralysis of one side of the body.

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13
Q

Define quadriplegia.

A

Paralysis of all four limbs.

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14
Q

Define locked in syndrome.

A

Inability to respond despite understanding.

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15
Q

List 3 features that point to a haemorrhagic stroke.

A

1) meningism (neck stiffness, photophobia, headache)
2) severe headache
3) coma

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16
Q

List 4 features that point to an ischaemic stroke.

A

1) carotid bruit
2) past TIA
3) AF
4) IHD

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17
Q

When should hypertension be treated in a stroke?

A

Only in a hypertensive emergency (e..g encelopathy or aortic dissection).

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18
Q

When should thrombolysis be carried out for the best result?

A

Within 90 minutes.

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19
Q

What test should be carried out post thrombolysis of an ischaemic stroke?

A

Head CT 24 hours post thrombolysis.

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20
Q

What percentage of deaths does stroke account for in the UK?

A

11%.

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21
Q

What is the leading cause of adult disability in the world?

A

Strokes.

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22
Q

How does a large artery stenosis lead to an ischaemic stroke?

A

Embolism not occlusion.

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23
Q

What should stroke patients with oral anticoagulants always be assumed to have until proven otherwise?

A

Haemorrhagic stroke.

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24
Q

What should always be excluded when diagnosing stroke?

A

Hypoglycaemia.

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25
Q

What should be ruled out before starting thrombolysis for strokes?

A

Haemorrhagic stroke.

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26
Q

List 8 contraindications of thrombolysis.

A

1) recent surgery - last 3 months
2) recent arterial puncture
3) history of active malignancy
4) evidence brain aneurysm
5) anticoagulant
6) severe liver disease
7) acute pancreatitis
8) clotting disorder

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27
Q

List 6 anterior cerebral artery territory ischaemia/infarct symptoms.

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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28
Q

List 4 middle cerebral artery territory ischaemia/infarct symptoms.

A

1) contralateral numbness (arms + legs)
2) contralateral weakness (arms + legs)
3) dysphasia —> aphasia
4) visuo-spatial disturbances

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29
Q

List 5 posterior cerebral artery territory ischaemia/infarct symptoms.

A

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

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30
Q

List 5 vertebrobasilar artery territory ischaemia/infarct symptoms.

A

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

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31
Q

Define dysarthria.

A

Difficulty to articulate speech.

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32
Q

Define truncal ataxia.

A

Inability to sit or stand unsupported, tend to fall backwards.

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33
Q

Define gait ataxia.

A

Inability to coordinate walking.

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34
Q

Define aphasia.

A

Inability to comprehend or produce speech.

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35
Q

Define visual agnosia.

A

Inability to interpret visual information.

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36
Q

Define prosopagnosia.

A

Inability to interpret faces.

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37
Q

Define amaurosis fugax.

A

Sudden loss of vision in one eye.

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38
Q

How might a patient describe amaurosis fugax.

A

Curtain coming down vertically into field of vision.

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39
Q

Define transient global amnesia.

A

Episode of amnesia/confusion that resolves within 24 hours.

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40
Q

What score is used to assess the risk of a stroke post TIA?

A

ABCD2.

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41
Q

What is the most common cause of a TIA?

A

Carotid artery atherothromboembolism.

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42
Q

What is a TIA impossible to differentiate from, and until when?

A

Ischaemic stroke, until a full recovery is made.

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43
Q

How is TIA generally diagnosed?

A

Via history.

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44
Q

List 4 factors that indicate that a TIA patient is high risk for stroke.

A

1) ABCD2>4
2) AF
3) >1 TIA in a week
4) anticoagulation

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45
Q

List 4 factors that indicate a TIA patient should be seen by a specialist within 24 hours.

A

1) ABCD2>4
2) AF
3) >1 TIA in a week
4) anticoagulant

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46
Q

When does amaurosis fugax occur?

A

Retinal artery occlusion in TIA.

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47
Q

What percentage of TIA are due to thromboemboli?

A

80%.

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48
Q

Why is there a star shaped lesions in subarachnoid haemorrhage head CTs?

A

Blood fills gyral patterns around brain and ventricles.

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49
Q

Why is a subarachnoid haemorrhage lumbar puncture xanthochromic and what colour is this?

A

Yellow, break down of RBC haemoglobin to bilirubin.

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50
Q

How is the severity of a subarachnoid haemorrhage graded?

A

GCS score.

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51
Q

What percentage of subarachnoid haemorrhages are diagnosed by head CT?

A

95%.

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52
Q

What is the preferred management for subarachnoid haemorrhages endovascular coiling or surgical clipping, and why?

A

Endovascular coiling, less risk, better outcomes.

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53
Q

What is an important differential to rule out for subarachnoid haemorrhages?

A

Migraine.

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54
Q

What is the target blood pressure for subarachnoid haemorrhage patients?

A

SBP>160.

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55
Q

Where are berry aneurysms found?

A

Branching points in the circle of Willis (esp. anterior cerebral and anterior communicating arteries).

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56
Q

Elderly patient with progressive personality change and decreased GCS, what is the diagnosis?

A

Subdural haematoma.

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57
Q

Why does cerebral atrophy lead to subdural haematoma? (3)

A

1) brain size decreases
2) bridging veins are stretched away from dura
3) bridging veins are more susceptible to burst

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58
Q

Define febrile seizure.

A

Generalised epileptic seizure lasting <15 minutes in a neurologically intact child aged between 6 months and 6 years.

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59
Q

How long do epileptic seizures generally last for?

A

30-120 seconds.

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60
Q

How many types of epilepsy are there?

A

> 40.

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61
Q

What age group do absence seizures present in?

A

Children.

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62
Q

Child stops talking for 10 seconds mid-sentence, pales and stares, then continues sentence, what type of epilepsy is this?

A

Absence epilepsy (generalised).

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63
Q

Patient falls to the floor then experiences generalised bilateral rhythmical muscle jerking, what type of epilepsy is this?

A

Tonic-clonic epilepsy (generalised).

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64
Q

List 3 features of simple focal epileptic seizures.

A

1) no loss of consciousness
2) no loss of memory
3) no post-ictal symptoms

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65
Q

List 3 features of complex focal epileptic seizures.

A

1) loss of consciousness
2) loss of memory
3) post-ictal symptoms (esp. confusion)

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66
Q

What is the difference between focal and partial epilepsy?

A

Nothing, focal is the updated term for partial (2017).

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67
Q

What type of epilepsy has a characteristic guttural cry/grunt?

A

Tonic epilepsy.

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68
Q

List 5 potential post-ictal symptoms of epileptic seizures.

A

1) headache
2) confusion
3) myalgia
4) temporary weakness (focal seizure of motor cortex —> Todd’s palsy)
5) dysphasia (focal seizure of temporal lobe)

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69
Q

What is the aura phase of an epileptic seizure?

A

Patient is aware of upcoming seizure and experiences deja vu, epigastric sensation or sensory hallucinations.

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70
Q

What type of seizure is an aura phase often seen in?

A

Partial focal temporal seizure.

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71
Q

What is the prodrome phase of an epileptic seizure?

A

Mood/behaviour change, rarely precedes seizure.

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72
Q

What imaging is preferred for epilepsy?

A

MRI.

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73
Q

How should long term anti-epileptics be prescribed?

A

One drug prescribed by one specialist slowly build up dose until seizures are controlled or maximal dose (at which point change drug and repeat).

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74
Q

What percentage of epileptic patients require anti-epileptic dual therapy?

A

<10%.

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75
Q

How is Parkinson’s disease diagnosed?

A

Clinically.

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76
Q

What is the Parkinson’s disease triad?

A

1) tremor
2) rigidity
3) bradykinesia

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77
Q

What habit decreases risk of Parkinson’s disease?

A

Smoking.

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78
Q

Which part of the substantia nigra are dopaminergic neurones found?

A

Pars compacta.

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79
Q

Where do substantia nigra dopaminergic neurones project to?

A

Striatum (caudate nucleus and putamen).

80
Q

Define Lewy bodies.

A

Aggregates of α-synuclein and ubiquitin in neurones that contribute to Parkinson’s disease.

81
Q

What histological feature is characteristic of Parkinson’s disease?

A

Lewy bodies.

82
Q

What can worsen Parkinsonian tremors?

A

Anxiety.

83
Q

What can improve Parkinsonian tremors?

A

Voluntary movement.

84
Q

What is the frequency of a Parkinsonian tremor?

A

4-6Hz (slower than a cerebellar tremor).

85
Q

Define passive movements.

A

Clinician moving patient limbs without voluntary movement.

86
Q

Define leadpipe rigidity.

A

Sustained resistance to passive movements, found in Parkinson’s disease.

87
Q

Define cogwheel rigidity.

A

Jerky resistance to passive movements, found in Parkinson’s disease.

88
Q

List 5 features of a Parkinsonian gait.

A

1) stooped posture
2) small shuffling steps
3) narrow base
4) reduced arm swing
5) difficulty turning

89
Q

What percentage of Parkinsonism is caused by vascular pathology?

A

2.5-5% (e.g. diabetes mellitus or hypertension)

90
Q

List 4 Parkinson’s plus syndromes.

A

1) progressive supranuclear palsy
2) multiple system atrophy
3) cortico-basal degeneration
4) Lewy body dementia

91
Q

List 4 features that would rule out early Parkinson’s disease.

A

1) dementia
2) incontinence
3) symmetry
4) early falls

92
Q

What is a tell tale sign of Parkinson’s disease?

A

Asymmetrical motor symptoms.

93
Q

List 4 reasons why prescription of levodopa for Parkinson’s disease is delayed.

A

1) decreasing efficacy
2) decreasing duration (end of dose deterioration)
3) worsening side effects
4) response fluctuations (50% at 5 years, 100% at 10 years)

94
Q

What are MAO-B inhibitors?

A

Drugs that inhibit dopamine break down by monoamine oxidase B enzymes, used in Parkinson’s disease.

95
Q

What are COMT inhibitors?

A

Drugs that inhibit dopamine break down by catechol-o-methyl transferase, used in Parkinson’s disease.

96
Q

List 3 drugs that are prescribed before levodopa.

A

1) dopamine agonists
2) monoamine oxidase B inhibitors
3) catechol-o-methyl transferase inhibitors

97
Q

What drugs is always prescribed with levodopa?

A

Decarboxylase inhibitors.

98
Q

How do decarboxylase inhibitors work in treating Parkinson’s disease? (3)

A

1) inhibit peripheral conversion of levodopa to dopamine
2) decreases peripheral side effects
3) increases levodopa efficacy (more crosses BBB)

99
Q

List 5 side effects of levodopa.

A

1) nausea
2) vomiting
3) arrhythmia
4) psychosis
5) visual hallucinations

100
Q

List 4 side effects of dopamine agonists.

A

1) nausea
2) visual hallucinations
3) drowsiness
4) compulsive behaviour

101
Q

List 2 side effects of MAO-B inhibitors.

A

1) atrial fibrillation

2) postural hypotension

102
Q

What is a side effect of COMT inhibitors?

A

Liver damage.

103
Q

List 2 components of the striatum.

A

1) caudate nucleus

2) putamen

104
Q

List 2 components of the corpus striatum.

A

1) basal ganglia

2) internal capsule

105
Q

Define chorea.

A

Relentlessly progressive jerky, explosive, fidgety movements.

106
Q

How is Huntington’s disease diagnosed?

A

Clinically.

107
Q

Define saccade.

A

Rapid eye movements in between fixation points.

108
Q

Define motor impersistence.

A

Inability to sustain voluntary acts (e.g. closed eyelids).

109
Q

How many CAG repeats do children who present with Huntington’s generally have?

A

> 60.

110
Q

Is Huntington’s disease curable?

A

No.

111
Q

What percentage of migraine patients experience auras?

A

15-30%.

112
Q

How long do migraine auras last for?

A

5-60 minutes.

113
Q

How long between migraine auras and migraines?

A

<60 minutes.

114
Q

How are migraines diagnosed?

A

Clinically.

115
Q

List 6 migraine red flags that indicate a brain MRI.

A

1) thunderclap headache
2) posteriorly located headache
3) migraine pattern change
4) abnormal neurological exam
5) onset >50 years old
6) epilepsy

116
Q

List 2 medications to avoid in migraines and why.

A

1) paracetamol
2) ibuprofen
Medication overuse headaches.

117
Q

How long can tension headaches last for?

A

30 minutes to 7 days.

118
Q

List 3 features that exclude tension headaches.

A

1) vomiting
2) motion sensitivity
3) aura

119
Q

Why should analgesia use be limited when treating tension headaches?

A

Prevent medication overuse headaches.

120
Q

How is analgesia for tension headaches limited to prevent drug overuse headaches?

A

<6 days/month.

121
Q

How long do cluster headache attacks last for?

A

15-160 minutes.

122
Q

During a cluster how many attacks are there per day?

A

Once or twice, usually at the same time.

123
Q

When do cluster headache attacks often occur?

A

Night/early morning.

124
Q

What drugs are not useful for cluster headaches?

A

Analgesics (e.g. paracetamol).

125
Q

What is associated with giant cell arteritis?

A

Polymyalgia rheumatica (50%).

126
Q

What is the prognosis of giant cell arteritis?

A

2 year course, then complete remission (typically).

127
Q

What is the main cause of death in giant cell arteritis?

A

Long term steroid use side effects.

128
Q

When do you reduce prednisolone dose in giant cell arteritis? (2)

A

1) symptoms resolution

2) low ESR

129
Q

When should you suspect encephalitis? (4)

A

1) odd behaviour
2) decrease in consciousness
3) focal neurology or seizure
4) preceding infection symptoms

130
Q

What percentage of encephalitis is the cause unknown?

A

50%.

131
Q

What is the triad of encephalitis? (3)

A

1) fever
2) headache
3) altered mental status

132
Q

What lobes are mostly likely to be affected by encephalitis?

A

Frontal or temporal.

133
Q

List 4 investigations carried out in CSF studies for encephalitis.

A

1) analysis
2) culture
3) PCR
4) serology

134
Q

List 5 things tested for in CSF analysis for encephalitis.

A

1) opening pressure
2) protein
3) glucose
4) RBC
5) WBC

135
Q

List 3 positive findings of encephalitis in a CSF analysis.

A

1) high protein
2) low glucose
3) high lymphocytes

136
Q

What is the mortality of untreated viral encephalitis?

A

70%.

137
Q

How long does empirical antiviral (aciclovir) treatment for encephalitis last?

A

14 days in normal patients, 21 days in immunocompromised patients.

138
Q

Why has meningitis caused by Haemophilus influenzae type B decreased?

A

Hib vaccine.

139
Q

What is the triad of meningism?

A

1) headache
2) neck stiffness
3) photophobia

140
Q

List 3 instances when a lumbar puncture is not performed on a suspected meningitis patient.

A

1) shock
2) petechia
3) high ICP (cerebral oedema)

141
Q

What is meningeal septicaemia? (2)

A

Neisseria meningitides enters bloodstream causing:

1) non-blanching petechiae
2) sepsis signs

142
Q

Who should be identified in meningococcal diseases?

A

Public Health England.

143
Q

Describe viral meningitis.

A

Benign self limiting condition (4-10 days).

144
Q

Why pregnant women told to avoid eating cheese. (2)q

A

1) cheese contains Listeria monocytogenes

2) Listeria monocytogenes causes meningitis

145
Q

What differentiates subarachnoid haemorrhage from meningitis?

A

Headache more sudden in SAH.

146
Q

What differentiates encephalitis from meningitis?

A

Altered mental state is the main symptom in encephalitis.

147
Q

How do you test is a rash is blanching or non-blanching? (3)

A

1) press clear glass against rash
2) rash disappears —> blanching
3) rash doesn’t disappear —> non-blanching

148
Q

What percentage of under 16s have been exposed to varicella zoster?

A

90% (chickenpox).

149
Q

What increases incidence and severity of shingles?

A

Age.

150
Q

Can shingles be contracted from someone with chickenpox?

A

No.

151
Q

When do shingles rash lesions stop being infectious?

A

Crust formation.

152
Q

What causes herpes zoster ophthalmicus?

A

Zaricella zoster reactivation in ophthalmic branch of trigeminal nerve.

153
Q

List 6 conditions associated with herpes zoster ophthalmicus.

A

1) conjunctivitis
2) keratitis
3) corneal ulceration
4) iridocyclitis
5) glaucoma
6) blindness

154
Q

Why is aciclovir administered within 72 hours of rash appearance in shingles?

A

Decrease risk of post heretic neuralgia.

155
Q

What is post herpetic neuralgia?

A

Burning pain that responds poorly to analgesia 4 months after developing shingles.

156
Q

List 5 common multiple sclerosis perivenular demyelination plaque sites.

A

1) optic nerves
2) ventricles
3) corpus callosum
4) brainstem (inc. cerebellar peduncles)
5) cervical spinal tract (esp. corticospinal tract, dorsal column)

157
Q

When do perivenular demyelination plaques form?

A

During MS relapses.

158
Q

What criteria is used to diagnose multiple sclerosis?

A

McDonald criteria.

159
Q

What is often the cause of death in multiple sclerosis?

A

Aspiration pneumonia.

160
Q

How many years does multiple sclerosis take off life expectancy?

A

5-10 years.

161
Q

List 5 poor prognostic signs of multiple sclerosis.

A

1) older age
2) female
3) onset motor symptoms
4) many early relapses
5) many MRI plaques

162
Q

Why is early diagnosis crucial in multiple sclerosis? (2)

A

1) reduces relapse rates

2) reduces disability

163
Q

List 2 unusual migrant incidence facts.

A

1) adult migrants maintain risk of origin country

2) child migrants gain risk of settle country

164
Q

What percentage of relapsing remitting multiple sclerosis develop secondary multiple sclerosis?

A

75% (within 35 years).

165
Q

Describe the 3 types of multiple sclerosis in terms of disability, relapses and remissions.

A

1) primary - worsening disability without relapses or remissions
2) relapsing remitting - worsening disability with relapses and remissions
3) secondary - worsening disability with fewer relapses and remissions

166
Q

What cells are lost in primary lateral sclerosis?

A

Motor cortex Betz cells.

167
Q

List 4 upper motor neurone disease symptoms.

A

1) weakness
2) spasticity
3) brisk reflexes
4) clonus

168
Q

List 4 lower motor neurone disease symptoms.

A

1) weakness
2) hypotonia
3) absent/depressed reflexes
4) fasciculation

169
Q

Define bulbar palsy.

A

CN IX-XII lower motor neurone lesion of speech and swallowing muscles (inc. tongue).

170
Q

Define corticobulbar palsy.

A

CN IX-XII upper motor neurone lesion of speech and swallowing muscles (inc. tongue).

171
Q

List 3 muscle groups spared by motor neurone disease.

A

1) occulomotor
2) bladder sphincter
3) rectal sphincter

172
Q

What is the prognosis of motor neurone disease?

A

50% death in 3 years.

173
Q

Define spasticity.

A

Hypertonia, continuous muscle contraction.

174
Q

Define brisk reflexes.

A

Above average reflex tests, e.g. patellar reflex.

175
Q

Define clonus.

A

Series of involuntary rhythmic muscular contractions and relaxations.

176
Q

Define split hand sign.

A

Thumb sided hand muscle wasting.

177
Q

Define Babinski’s sign.

A

Dorsiflexion (upward) of big toe when sole of for is stimulated by a blunt instrument.

178
Q

Define tongue fasciculation.

A

Tongue twitching, like a sack of worms.

179
Q

List 4 types of motor neurone disease.

A

1) amyotrophic lateral sclerosis —> UMN + LMN
2) progressive bulbar palsy —> CN IX-XII LMN
3) progressive muscular atrophy —> LMN
4) primary lateral sclerosis —> UMN

180
Q

Olfactory nerve palsy symptoms. (2)

A

1) hyposmia

2) anosmia

181
Q

Optic nerve palsy symptoms. (1)

A

Vision loss.

182
Q

Occulomotor nerve palsy symptoms. (3)

A

1) ptosis
2) fixed dilated pupil
3) eyes down and out

183
Q

Trochlear nerve palsy symptoms. (1)

A

Vertical diplopia.

184
Q

Trigeminal nerve palsy symptoms. (2)

A

1) ipsilateral jaw deviation

2) corneal reflex loss

185
Q

Abducens nerve palsy symptoms. (1)

A

Eyes in.

186
Q

Facial nerve palsy symptoms. (2)

A

1) facial droop

2) facial weakness

187
Q

Vestibulocochlear nerve palsy symptoms. (3)

A

1) hearing loss
2) balance loss
3) vertigo

188
Q

Why do CN IX-XII nerve lesions occur together?

A

Close proximity to each other.

189
Q

What causes CN IX-XII nerve lesions?

A

Jugular foremen lesion.

190
Q

Define disc herniation.

A

Nucleus pulposus goes through annulus (inner through outer).

191
Q

Define disc prolapse.

A

Nucleus pulposus pushes against annulus (inner against outer).

192
Q

Why is spinal cord compression relieved of high pressure as soon as possible?

A

Prevent irreversible paraplegia.

193
Q

What differentiates cauda equina syndrome from lesions higher up the spinal cord?

A

Leg weakness is flaccid and areflexic not spastic and hyperreflexic.

194
Q

What percentage of Guillain-Barré syndrome is there infectious cause found?

A

40%.

195
Q

What is the prognosis of Guillain-Barré syndrome? (3)

A

1) 85% complete recovery (inc. near complete)
2) 10% unable to walk unassisted in 1st year
3) 10% mortality

196
Q

When does full recovery from Guillain-Barré syndrome generally occur?

A

After 4 weeks.

197
Q

When does Guillain-Barré syndrome develop post infection?

A

1-3 weeks post infection.

Phase 2 - Marc's Neurology (8 decks)

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