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3A > Neurology - Misc > Flashcards

Neurology - Misc Flashcards

1
Q

Shingles aetiology

A

VZV reactivation

Immunosuppression

  • HIV
  • Steroids
  • Chemo

Age

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2
Q

Shingles presentation

A

Pre-eruptive

  • Itching
  • Burning
  • B symptoms

PAINFUL RASH

  • Dermatomal
  • Small vesicles
  • Clusters

If > 1 dermatome - Consider immunodeficiency or DDx

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3
Q

Herpes zoster ophthalmicus

A

VZV infection in V1

Visual loss
Hutchinson sign - Vesicles on the tip of the nose

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4
Q

Shingles investigations

A

Clinical diagnosis

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5
Q

Shingles management

A

Acyclovir

Pain relief 
- Paracetamol / ibuprofen 
THEN...
- Gabapentin 
- Pregabalin 
- Amitriptyline

Vaccination offered at 70 and 78

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6
Q

Bell’s palsy definition

A

Acute
Idiopathic
Unilateral
Facial nerve palsy

LMNL

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7
Q

Bell’s palsy causes

A

Idiopathic

Infection

  • EBV
  • HSV

SOL - Parotid tumour

GBS

Forceps delivery

^ Risk in pregnancy and diabetes

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8
Q

Bell’s palsy presentation

A

7th nerve palsy

Speech disturbance
Eating disturbance
Dry eyes

Taste - Loss of anterior 2/3

Post-auricular pain and numbness

Hearing - Hyperacusis

Gusto-lacrimal reflex - Crying when you eat

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9
Q

Bell’s palsy investigations

A

Serology
- VZV - Ramsay Hunt syndrome

CT/MRI to check for SOL

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10
Q

Bell’s palsy management

A

Prednisolone

Protect the eye

NO ANTIVIRALS

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11
Q

Bell’s palsy complications

A

Ramsay Hunt syndrome

Permanent in 15%

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12
Q

Spinal cord compression aetiology

A 
Bone mets 
Disc prolapse 
Osteophytes
EDH
Pott's disease 
Infection 
Trauma - Brown sequard syndrome
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13
Q

Spinal cord compression presentation

A

Back pain - Unilateral
Reflexes ^
FND / incontinence - Cauda equina?

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14
Q

Spinal cord compression investigations

A

MRI
Bloods - Serology
FBC/INR - Warfarin
CXR - Mets

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15
Q

Spinal cord compression management

A

Dexamethasone IV

Treat cause

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16
Q

Cauda equina aetiology

A 
Bone mets 
Disc prolapse 
Osteophytes
EDH
Pott's disease 
Infection 
Trauma - Brown sequard syndrome
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17
Q

Cauda equina presentation

A

Back pain
FND
Saddle numbness
Incontinence

Asymmetrical
Areflexia
Atrophic paralysis of leg

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18
Q

Cauda equina investigations

A

PR

Urgent MRI

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19
Q

Cauda equina management

A

Dexamethasone

Surgical decompression

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20
Q

Cauda equina complications

A

Paralysis
Sensory abnormality
Bowel, bladder and sexual dysfunction

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21
Q

MND pathophysiology

A 
Apoptosis of motor neurons 
Superoxide dimutase (SOD1) mutation
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22
Q

MND types

A

Amyotrophic lateral sclerosis - Most common

  • UMN + LMN
  • Loss of neurons in motor cortex

Progressive bulbar palsy - Worst prognosis

  • LMNL
  • CN 9-12

Progressive muscular atrophy - LMN

Primary lateral sclerosis - UMN

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23
Q

UMN signs

A

Upgoing plantars
Increased reflexes
Clonus
Spasticity

NO wasting

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24
Q

LMN signs

A

Fasciculations
Decreased reflexes
Wasting / atrophy

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25
MND presentation
UMN signs LMN signs Foot drop Asymmetrical weakness Wasting - Thenar muscles and anterior tibialis
26
MND bulbar signs
Dysphagia Dysphasia Dysarthria Drooling Emotionally labile
27
MND complications
``` Aspiration pneumonia Respiratory failure UTI Constipation Speech difficulties Immobility complications - Pressure sores ```
28
MND vs MS vs MG
MND - No sphincter involvement - No sensory involvement - No ocular involvement MS - Sphincter involvement - Incontinence MG - Ocular involvement
29
MND investigations
Clinical diagnosis El Escorial diagnostic criteria EMG - Decreased action potential - Increased amplitude
30
MND management
Spasticity - Benzos Feed - NG/PEG Ventilation - NIV Respiratory failure - Opioids Physiotherapy Occupational therapy Speech and language therapy RILULOZE!!!
31
MND prognosis
2-4 years | Death from respiratory failure
32
Meningitis viral causes
HSV EBV Mumps Adenovirus
33
Meningitis bacterial causes
Neonates - GBS - E. Coli - Listeria Adults - N. meningitides - Strep pyogenes
34
Meningitis presentation
1. Fever 2. Neck stiffness 3. Headache Photophobia Rash - Purpuric non-blanching Kernig's sign Brudzinski's sign Seizures Coma
35
Meningitis investigations
LP - Contraindicated if ICP ^ Blood cultures PCR - Viral? ``` FBC U/E CRP/ESR Glucose ABG ```
36
Meningitis LP findings
Bacterial - Cloudy - Polymorphonuclear lymphocytes - Protein ^^ - Glucose - Low Viral - Clear - Lymphocytes - Protein ^ - Glucose - Normal or low TB - Cloudy - Monocytes - Protein ^^^ - Glucose - Low
37
Meningitis management
Community - IV BEN PEN < 3 months - IV cefotaxime + amoxicillin > 3 months - IV cefotaxime Strep P - Dexamethasone Listeria - Amoxicillin
38
Meningitis prophylaxis
Ciprofloxacin
39
Meningitis complications
Sensorineural deafness Abscess Septicaemia
40
Encephalitis aetiology
HSV Enterovirus ``` HIV Mumps Measles Lyme disease TB ```
41
Encephalitis presentation
1. Personality changes 2. Fever 3. Headache FND ICP ^ Seizures/coma
42
Encephalitis investigations
LP Blood cultures PCR Clotting ESR EEG CT - Temporal lobe involvement
43
Encephalitis management
IV acyclovir
44
Cerebral abscess aetiology
Strep anginosus Otitis media Mastoiditis Dental infection Endocarditis
45
Cerebral abscess presentation
Symptoms of SOL - Headache - FND - Raised ICP Symptoms of infection - Fever
46
Cerebral abscess infection locations
Otitis media Mastoiditis Dental infection Endocarditis
47
Cerebral abscess investigations
CT - Halo around lesion - Ring enhancement Bloods - Cultures - Leukocytosis
48
Cerebral abscess management
Ceftriaxone Fluconazole Drainage if ICP ^
49
Horner's syndrome aetiology
STC S - Central - Stroke - Multiple Sclerosis T - Preganglionic - Tumour - Pancoast - Thyroidectomy - Trauma - Cervical rib C - Post-ganglionic - Cluster headache - Cavernous sinus thrombosis - Carotid dissection
50
Horner's syndrome presentation
Ptosis Miosis Anhidrosis Enophthalmus
51
Horner's syndrome investigations
Apraclonidine - Affected eye does not dilate CT - Tumour? CXR - Pancoast tumour?
52
Anterior cord syndrome aetiology
Ischaemia of the anterior spinal artery | - Most commonly due to aortic compromise
53
Anterior cord syndrome investigations
CT angio
54
Anterior cord syndrome presentation
Paralysis Loss of pain and temperature sensation Fine touch preserved - Dorsal column Areflexia Autonomic failure - Urinary/bowel - Sexual dysfunction
55
Acoustic neuroma presentation
Progressive... CN8 - Vertigo - Unilateral sensorineural hearing loss - Unilateral tinnitus CN5 - Absent corneal reflex CN7 - Facial palsy Bilateral in neurofibromatosis 2
56
Acoustic neuroma investigations
ENT referral MRI - Cerebellopontine angle
57
Acoustic neuroma management
Surgery | Radiotherapy
58
Peripheral neuropathy aetiology
Motor - GBS - Infection Sensory - Diabetes - B12 deficiency - Uraemia Alcohol SLE Thyroid Chemo/radiotherapy
59
Peripheral neuropathy investigations
Bloods - FBC - E/E - LFT - Toxicology - Cultures - Infection? - Anti-Ro and anti-La - SLE - Nerve conduction studies - GBS?
60
Neurofibromatosis causes
1. AD - Chromosome 17 | 2. AD - Chromosome 20
61
Neurofibromatosis 1 presentation
SKIN LESIONS ``` Cafe au lait spots Axillary freckles Optic lesions Scoliosis Pheochromocytoma ```
62
Neurofibromatosis 2 presentation
TUMOURS Bilateral acoustic neuromas Ependymomas Schwannomas Meningioma

3A (31 decks)

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