Neurology Passmed Flashcards
Contralateral hemiparesis and sensory loss, lower extremity > upper
Where is the lesion?
Anterior cerebral artery
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Where is the lesion?
Middle cerebral artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Where is the lesion ?
Posterior cerebral artery
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Where is the lesion?
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
What is the site of the lesion in a stroke that causes ipsilateral facial paralysis and deafness?
Anterior inferior cerebellar artery (lateral pontine syndrome)
Locked in syndrome is caused by a lesion of which artery?
Basilar artery
A 56-year-old man presents to the emergency department with sudden onset double vision and right-sided upper and lower limb weakness.
On examination, there is ptosis of the left eyelid and the left eye is shifted downward and laterally. There is reduced power and sensation in the upper and lower right limbs.
What is the most likely diagnosis?
Weber’s syndrome
a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
A 66-year-old woman reports that during the past 6 months she has had several episodes of a sharp, shooting ‘electric shock’ like pain on the left side of her face, which occur when she is combing her hair.
Given the likely diagnosis which one of the following treatments should be initiated?
Trigeminal neuralgia = carbamazepine
Carbamazepine should be started at 100 mg twice daily and titrated up until pain is relieved
A 72-year-old man develops visual problems. He is noted to have a left homonymous hemianopia with some macula sparing.
Where is the lesion?
Occipital cortex - suggested by macular sparing
A 54-year-old man complains of sweating, headaches and reduced visual fields, saying it’s like having ‘blinders’ on. He is noted to have a bitemporal hemianopia on examination.
Where is the lesion?
Optic chiasm
This patient has a pituitary tumour causing compression of the optic chiasm and bitemporal hemianopia. The sweating and headaches are consistent with acromegaly.
A 30-year-old man with a family history of early blindness is concerned that he is developing ‘tunnel vision’.
Where is the lesion?
Retina
This is a common presentation of retinitis pigmentosa. Extensive pigmentation would normally be noted on fundoscopy.
Which is the strongest risk factor for developing Bell’s palsy?
pregnancy (3x higher risk)
Widespread convulsions without conscious impairment =
Psychogenic non-epileptic seizure
Which nerve roots are tested by ankle reflexes?
S1-S2
Which nerve roots are tested by knee reflexes?
L3-L4
Which nerve roots are tested by biceps and triceps lesions?
Biceps C5-C6
Triceps C7-C8
At what GCS should you consider intubating a patient (e.g. with a cuffed endotracheal tube)?
less than 8 = INTUBATE
A woman suddenly has the sensation of smelling roses whilst at work. She is conscious throughout - what is the diagnosis?
focal aware seizure
Head trauma + fluctuating consciousness =
subdural haemorrhage
Normal pressure hydrocephalus presents in elderly patients with urinary incontinence,
reversible dementia and gait abnormality.
How does this appear on neuroimaging?
Ventriculomegaly with relative preservation of cortical sulci
A 30-year-old woman is admitted to hospital with an unprovoked first seizure. She attends neurology clinic and asks for advice regarding driving as she uses her car to drop her children to school. The neurologist has not made a formal diagnosis of epilepsy.
What should you advise her?
She should inform the DVLA and will have to be seizure free for 6 months before she can apply to have her license reinstated
If the patient has a formal diagnosis of epilepsy they must be seizure-free for at least 12 months before they may reapply to the DVLA for their license to be reissued
A 23-year-old rugby player sustains a Smiths Fracture. On examination opposition of the thumb is markedly weakened.
Where is the likely site of the nerve injury?
Median
median nerve damage = loss of function of the muscles of the thenar eminence
A 45-year-old lady recovering from a mastectomy and axillary node clearance notices that sensation in her armpit is impaired.
Where is the likely site of the nerve injury?
Intercostobrachial
The intercostobrachial nerves are frequently injured during axillary dissection.
An 8-year-old boy falls onto an outstretched hand and sustains a supracondylar fracture. In addition to a weak radial pulse the child is noted to have loss of pronation of the affected hand.
Where is the likely site of the nerve injury?
Median
Median nerve is responsible for pronation of the forearm
Brachial artery (responsible for radial pulse) runs alongside the median nerve
A 40-year-old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries it is noticed that she has lost the ability to adduct the fingers of her left hand.
Where is the likely site of the nerve injury?
Ulnar nerve
The interossei are supplied by the ulnar nerve.
A 23-year-old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination he has lost extension of the fingers in his right hand.
Where is the likely site of the lesion?
radial nerve
supplies the extensor muscles of the hand
A 34-year-old contractor has fallen off some scaffolding at work onto his right arm and you suspect a mid-shaft humeral fracture. Which of the following would test the nerve most at risk in this situation?
Extend the wrist
Mid-shaft humeral fractures are associated with radial nerve injury and wrist drop.
What should you rule out in all patients with status epilepticus?
rule out hypoxia and hypoglycaemia
Tx of choice for essential tremor?
propanolol
First line tx for focal seizures?
lamotrigine or levetiracetam
First line radiological investigation for suspected stroke?
non-contrast CT head
An 85-year-old man is admitted with dense right-sided weakness. His blood pressure on admission is 175/95 mmHg .
He has a past medical history of gastric ulcer disease and had a nephrectomy 2 months ago due to renal cell carcinoma.
CT head shows a hyperdense collection in the left basal ganglia with evidence of chronic small vessel disease.
What would be an absolute contraindication to thrombolysis in this case?
CT findings
a hyperdense collection is suggestive of a haemorrhage and hence a contraindication to thrombolysis/thrombectomy
Weakened dorsiflexion, inversion and eversion of the ankle =
L5 nerve lesion NOT a common peroneal nerve lesion
Common peroneal nerve palsy does NOT affect INVERSION of the ankle
Another specific sign to look for is loss of sensation over the first web space between the 1st and 2nd toes - that suggests an L5 nerve lesion
Bitemporal hemianopia with lower quadrants primarily affected =
superior chiasmal compression, commonly a craniopharyngioma
Bitemporal hemianopia with upper quadrants primarily affected =
inferior chiasmal compression, commonly a pituitary tumour
fever, seizure and CT head showing temporal lobe changes =
think herpes simplex encephalitis
Herpes simplex encephalitis (HSE) is the commonest cause of sporadic encephalitis
Start IV aciclovir!!!
What blood marker can be used to differentiate between a true seizure and a pseudoseizure?
Prolactin
What is the most common complication following meningitis?
Sensorineural hearing loss
A lesion of which area causes Wernicke’s aphasia?
superior temporal gyrus
A lesion of which area causes Broca’s aphasia?
inferior frontal gyrus
A 36-year-old man is admitted with an acute episode of mania. He is initially treated with haloperidol which seems to improve his mental state. Later that day he develops a high fever, tachycardia, tachypnoea and muscle rigidity.
What is the diagnosis?
How should you treat?
neuroleptic malignant syndrome
stop antipsychotic, IV fluids to prevent renal failure, consider bromocriptine (dopamine agonist)