Neurology & Neurosurgery Flashcards
brain lesion on the left side
body symptoms on right side
List of anticholinergics
- Banzhexol
- Levodopa
Brain tumour vs brain abscess
brain tumour enhance on contrast CT
-Rapidly fluctuating cognition + Visual hallucinations + Spontaneous motor Parkinsonism
Lewy bodies
Cardinal symptom of dementia with Lewy bodies
Visual hallucinations
Ptosis + Myosis + anhidrosis
Horner’s syndrome
ptosis + mydriasis
3rd CN palsy
Most common cause 3rd CN palsy
Diabetic neuropathy
key feature of DM 3rd nerve palsy
Normal pupillary reflex
common cause of 6th nerve palsy
diabetes
6th nerve palsy diseases
- diabetes
- Meningitis
- multiple sclerosis
- Wernicke’s encephalopathy
- nasopharyngeal tumour
Ramsay Hunt syndrome treatment
valacyclovir/acyclovir 7 to 10 days + prednisone 5 days
Campylobacter jejuni + Normal cell count + high protein
Guillain-Barre syndrome
muscular weakness +
mild distal sensory loss
Guillain-Barre syndrome
Guillain-Barre syndrome respiratory investigation
Forced vital capacity
Guillain-Barre syndrome treatment
- IV immune globulin
- plasma exchange,
-for severe cases, mechanical ventilation
most common parotid tumour
pleomorphic adenoma
slow growing + parotid gland
pleomorphic adenoma
fast growing + parotid gland involvement + causing symptoms
pleomorphic carcinoma
Unilateral headaches
+ nasal stuffiness + conjunctival injection + lacrimation
Cluster headache
Cluster headache acute treatment
100% oxygen
Cluster headache prophylaxis
CCB
Unilateral headaches +
SS vs NMS
SS: hyperreflexia + nausea/vomiting
NMS: hyporeflexia
short hx of unilateral facial droop + dysphasia
CAS/TIA
TIA dx
Initial: Carotid artery doppler US
Best: CTPA
Parkinsons disease
U/L tremors
Good response to Levodopa
CAS referral cut-off
Asymptomatic:
- < 80% + yearly follow-up with CDUS
- >80 + refer
Symptomatic:
- <50% medical therapy + antiplatelet + follow-up
- >50% surgery -2 weeks of event + medical therapy
pain in lateral shin + dorsum of foot + weakness of eversion + dorsiflexion
Common peroneal nerve injury
diabetic neuropathy treatment
TCA
peripheral neuropathy investigation
- Check B12 level as this can be low -metformin can lead to low b12.
2.thyroid function tests to assess for hypothyroidism. - Assess for autoimmune neuropathy
family hx + acute painful eye loss of vision + hyperreflexia + increase tone
multiple sclerosis (MS)
Migraine treatment
- BB (propranolol)
- TCA
- pizotifen,
- sodium valproate
Migraine treatment in children
1st line: Ibuprofen
2nd: paracetamol
severe “thunderclap” a headache + loss of consciousness
SAH
most common cause of SAH
Rupture of saccular aneurysm
most common location of SAH
anterior circulation on the circle of Willis 85%
Post SAH + stiffness + photophobia + hyperreflexia + unilateral weakness
treatment
Nimodipine
-decreases the probability of stroke
SAH complications
- Re-rupture
- Hyponatremia
- Hydrocephalus
- Hydrocephalus
clock drawing test assesses
severity of dementia
clock drawing test
Frontal and Temporo-parietal functioning
occupational therapist / ophthalmologist referral to drive
persistent hemianopia after stroke
Permanent commercial driving restriction
- stable angina
- ICD (defibrillator)
diseases that cause neck stiffness
– Meningitis.
– Subarachnoid haemorrhage.
– Tetanus.
– Upper lobe pneumonia.
– Tender posterior cervical adenopathy.
– Retropharyngeal abscess.
– Rheumatoid arthritis
degenerative disease of the central nervous system caused by infectious proteins
Creutzfeldt-Jakob disease (CJD)
prion
restless leg syndrome dx
clincal + Iron studies
restless leg syndrome treatment
Dopamine agonist:
- ropinirole
- levodopa
Alzheimer’s vs Fronto-temporal dementia
- behavioural change early in fronto-temporal
Alzheimer EEG
Generalized background slowing
Alzheimer’s lobe atrophy
frontotemporal lobe atrophy
medications avoided in patients with rest less leg syndrome
– Metoclopramide (dopamine antagonists)
– Droperidol (dopamine antagonists)
– Lithium
– Naloxone (opioid antagonist)
– Antidepressants that increase serotonin levels
unexplained falls + axial rigidity + dysphagia +
vertical gaze deficits
supranuclear palsy
ataxia + falls + past pointing + positive Romberg’s sign
+ nystagmus
Cerebellar stroke
resting tremors + cogwheel rigidity +
bradykinesia + festinating gait
Parkinson’s disease
Parkinson speech decrement
Progressively inaudible speech
Parkinson’s disease vs Drug-induced parkinsonism
drug induced:
- bilateral bradykinesia/tremor
- disappear when the offending agent is ceased
- inadequate response to anti-cholinergic agents
Parkinson’s:
- Asymmetric symptoms
- dramatic response to anti-cholinergics
- Dementia
- presence of tremors
Carbidopa/levodopa + dyskinesias + intense akinesia / uncontrollable hyperactivity
Drug-induced dyskinesias
Drug-induced dyskinesias treatment
1st: reduction in dopaminergic supplementation
2nd: alternate medication like amantadine, pergolide
High frequency stimulation for Parkison’s aims at which areas
Globus pallidus, subthalamic nucleus, thalamus
most significant risk factor for falls in elderly
Visual impairment
action tremor which gets worse with doing activity
distal essential tremor
essential tremor treatment
1st line: Propranolol and primidone
tremor which occurs at rest
Parkinsons
resting tremor treatment
anticholinergics
- Benzhexol
- benztropine
children / young adults + hepatic
failure +rigidity + clumsy gait + dysarthria + copper
Wilson’s disease
Acalculia + Dysgraphia + Finger anomia + -Right-left confusion
Gerstmann’s syndrome
Gerstmann’s syndrome lesion location
Inferior parietal lobule (usually left)
Loss of the ability to recognize items based on touch Loss of the ability to recognize items based on touch
posterior parietal lobe
Gerstmann’s syndrome affects which side
contralateral to upper limbs presentation
URTI+ acute onset of vertigo + An absence of tinnitus and hearing loss
Vestibular Neuritis
Dix-Hallpike Test +ve
Likely BPPV
“raccoon eyes” + blood behind the ears + mastoid ecchymosis (battle)
Basilar skull fracture
vascular dementia features
-Sudden onset of memory decline after a stroke with step-wise deterioration
-Variable cognitive impairment and emotional lability.
-Gait abnormalities.
-Urinary dysfunction.
-Parkinsonian motor features.
-Vascular lesions on MRI/CT.
vascular dementia treatment
- prevent strokes
- control hypertension
vascular dementia memory treatment
acetylcholinesterase inhibitor (donepezil)
dementia protective factor
diet rich in polyunsaturated and monounsaturated fats
(nuts, salmon)
raised ICP causes
●Parenchymal brain swelling
●Interstitial and vasogenic Edema
●Alterations in cerebral blood volume (CBV)
●Obstruction of CSF outflow
●Focal cerebral perfusion deficits
●Variable levels of CBF
●Cerebrovascular carbon dioxide (CO) reactivity
●Cerebral vasculitis
Posterior column syndrome
bilateral loss of proprioception below the lesion,
preservation of pain and
temperature sensation
most common manifestation of muscle weakness with myasthenia gravis
Ocular muscle weakness
myasthenia gravis disease location
Neuromuscular junction
Myasthenia Gravis best diagnostic test
Single-fibre electromyography
pubertal patient + inferior portion iris Lisch nodules + an optic pathway glioma + Ectropion uveae
neurofibromatosis type 1 (NF1)
down syndrome most likely to develop what disease
Alzheimer disease
diabetic foot ulcers risk factors
- diabetic neuropathy 80%
- previous foot ulceration
- vascular disease,
- foot deformity
diabetic foot ulcers assessment
Monofilament testing
recurrent continuous convulsions > 5 mins
status epilepticus
status epilepticus treatment
IV diazepam/lorazepam
Alzheimer’s medication
Donepezil
alcoholic + rapid correction of hyponatremia + quadriplegia
central pontine
myelinolysis (CPM)
Focal weakness lasting for 24 hours following a motor seizure
postictal paralysis (Todd)
symmetric upper non sensory motor neuron pattern of weakness involving the face, arm, and leg.
Pure motor stroke
Internal capsule
most common type of
lacunar stroke
Pure motor stroke
Px following MVA alert on hospital arrival loses consciousness when taking tests + pupil dilation + contralateral hemiparesis
epidural hematoma
tear of the middle meningeal artery
epidural hematoma
impaired walk along a straight line touching the heel of one foot to the toe of the other
Tandem gait
Cerebellar dysfunction
poor naming ability + non-fluent
Transcortical motor aphasia
poor naming ability + non-fluent + poor repetition
Broca aphasia
upper torso stooped forward + shuffling feet + lost arm swing
Parkinsonian gait
affected foot is raised higher than normal + brought down with a slap
Steppage gait
painful + limited weight bearing leg
Antalgic gait
Post stroke + stiff leg + foot drop+ flexed/adducted hand
Spastic hemiparetic gait
short steps + extended stiff legs crossing on each other+ foot dragging
Spastic diplegia gait/ scissor gait
abrupt onset of right face and hand weakness +
disturbed speech production, + a right homonymous hemianopsia
Left middle cerebral artery occlusion
young female + weakness after exertion + Diplopia/Ptosis + chewing weakness
myasthenia gravis
Severe myasthenia gravis treatment
Corticosteroids (prednisone)
fluctuating level of consciousness + trivial force
Subdural hematoma
head trauma + no loss of consciousness + deteriorating a few hours/days later
epidural hematoma
Visual hallucinations + Parkinsonism +
+Fluctuation in the mental state
Lewy body dementia
A headache exacerbated by coughing, sneezing or straining
brain tumours and raised intracranial pressure
red flag
TIA 1st line treatment
Aspirin + dipyridamole
Contraceptive pills + headache nausea and vomiting + Visual obscuration
Benign intracranial hypertension
stroke secondary prevention medication
Warfarin
Aspirin
Enalapril
Atorvastatin
symptoms which can aggravate dementia
-Depression.
-Subdural haematoma.
-Neoplasms.
-Alcohol.
-Intracerebral lesions (tumour, normal pressure hydrocephalus).
-Infections (urinary tract, respiratory tract)
sudden, brief and very severe + paroxysms of pain + no sensory loss in the painful area + does not awaken + from
sleep
trigeminal neuralgia
trigeminal neuralgia treatment
1st line: Carbamazepine
2nd line: Gabapentin and amitriptyline
feeling detached/unreal surroundings/deja vu + occasional headaches
Temporal lobe epilepsy
lumbar puncture contraindications
– Unstable patient.
– Altered level of consciousness
– Space occupying lesion in the brain.
– Localised infection in the lumbar region.
– Coagulopathy (High INR)
BPPV investigation
Hallpike manoeuvre
BPPV treatment
Epley manoeuvre
Meniere’s disease treatment
Frusemide
Vestibular neuritis treatment
Steroids
Epileptic px planning to conceive + seizure free 2 years
Gradually cease anti-epileptic over 6 months
partial seizures 1st line treatment
Carbamazepine
Horner’s syndrome + nystagmus + facial sensory deficit + side of the body sensory deficit
- posterior inferior cerebellar artery infarct (PICA)
- lateral medullary syndrome (Wallenberg syndrome)
contralateral hemiparesis + contralateral homonyms hemianopia + aphasia + sensory neglect
middle cerebral artery lesion (MCA)
generalized
tonic–clonic seizures + right eye swelling + testis tenderness + well-defined cystic lesions on cerebral cortex
Neurocysticercosis (tape worm)
Absolute contraindications to thrombolytics therapy
- Uncertainty about the time of stroke onset (e.g. patients awakening from sleep).
- Neurologic surgery, serious head trauma, or previous stroke in past 3 months.
- Hypertension: systolic blood pressure above 180mmHg; or diastolic blood
pressure above 110mmHg on repeated measures. - Clinical presentation suggestive of subarachnoid haemorrhage even if the CT scan is normal.
- History of intracranial haemorrhage.
- Seizure at stroke onset.
- Suspected/confirmed endocarditis
Trigeminal neuralgia vs post-herpetic neuralgia
history of herpes zoster eruption
trigeminal neuralgia involves a young person > 40
adolescent with mild dementia+ tremor, + rigidity + acutely agitated + has jerking limbs when on l-dopa
Huntington disease
Acute loss of peripheral vision + constricted pupils
concussion
ventriculoperitoneal shunting for NPH major complication
Subdural hematoma
abdominal aortic aneurysm repair + nilateral flaccid paresis + mpaired pinprick sensation
Spinal cord infarct
progressive weakness + horizontal nystagmus horizontal nystagmus +ataxia + hyperreflexia + altered mental status
Phenytoin toxicity
corneal abrasion + lack of eye pain
Trigeminal (CN) V lesion
- herpes zoster
(in epidural hematoma)uncal herniation in temporal lobe causes:
- Ipsilateral fixed and dilated pupil from compression of the ipsilateral
oculomotor nerve (CN III) - Contralateral hemiparesis Contralateral hemiparesis (compression of the ipsilateral cerebral peduncle)
-Contralateral homonymous hemianopsia with macular sparing from
compression of the ipsilateral posterior cerebral artery
worsening herniation = psilateral hemiparesis, a false localizing sign known as Kernohan phenomenon
pregnant + obese + papilledema + Pulsatile tinnitus + positional headaches positional headaches worse when lying flat
Idiopathic intracranial hypertension (IIH)
head injury to the left temporal region + unresponsive after a lucid interval + progressive right-sided weakness
epidural hematoma
features Rapid expansion of the EH:
- Increase intracranial pressure (eg, Cushing
-triad of hypertension, bradycardia, and bradypnea),
- compress compress the temporal lobe leads to uncal herniation
Idiopathic intracranial hypertension (IIH) investigation
MRI
linear growth + pubertal delay, + worsening headaches + papilledema
craniopharyngioma
calcified suprasellar mass
craniopharyngioma location
suprasellar region adjacent to the optic chiasm
hemineglect syndrome lovation
ipsilateral parietal cortex
most common risk factor of stoke in young patients
Patent foramen ovale
shoulder-tip pain ddx
- ectopic pregnancy
- Pulmonary embolism
Pneumothorax
Myocardial infarction
Perforation of peptic ulcer disease
Diaphragmatic irritation
Parkinson’s disease vs Atypical parkinsonism
Parkinson’s disease:
- dramatic response to anti-cholinergics
- diplopia while reading
-autonomic dysfunction (constipation, urinary urgency, impotence, orthostasis?
Atypical parkinsonism:
- absence of response to high-dose levodopa
- absence of tremor
