Neurology Revision Night Flashcards
what “nucleus” is one of the first parts of the brain affected in alzheimers?
nucleus basalis of meynert
pathophysiological cause of the genetic element of huntingtons?
genetic anticipation
name the symptomatic triad in parkinson’s
rigidity
tremor
bradykinesia
name 2 parkinson’s plus conditions
progressive supranuclear palsy
multiple system atrophy
main presentation of multiple system atrophy?
parkinsonism PLUS:
autonomic features eg orthostatic hypertension
main presentation of progressive supranuclear palsy?
parkinsonism PLUS:
vertical gaze problems
parkinsons plus syndromes respond well to levodopa T or F
F
CT sign of an acute MCA infarction?
MCA sign (hyperdense MCA (white artery) on CT)
your risk of developing alzheimers is higher in down syndrome T or F
T
frequency of the resting tremor in parkinsons?
4-6Hz
hemiballism is a form of what movement disorder?
chorea
cause of hemiballism?
decrease in activity of the subthalamic nucleus of the basal ganglia eg by a lesion
huntington’s presents with chorea T or F
T
how is the onset of vascular parkinsonism different to that of PD?
its more sudden
how does the presentation of vascular parkinsonism differ from PD?
begins in the lower body whereas PD tends to arise in the hands first
who gets sydenham’s chorea?
girls and young women (5-15yrs)
cause of sydenham’s chorea?
rheumatic fever
main symptoms of sydenham’s chorea
widespread chorea
“autosomal, postural tremor” describes what kind of tremor
resting tremor
cerebellar lesions cause what kind of tremor
intention
describe the findings on CSF on an MS patient
presence of oligoclonal bands
opening pressure is/isnt elevated in the CSF of a patient with viral meningitis
isnt
what kind of white cells are found in TB meningitis?
mainly lymphocytes (80%) polymorphs (20%)
opaque CSF that forms a fibrin web when left indicates what type of meningitis?
TB meningitis
protein is __ and glucose is __ in TB meningitis
high
low
xanthochromia in CSF indicates what condition?
SAH
creutzfeldt jakob disease is an example of what group of diseases?
prion disease
symptoms of creutzfeldt jakob disease?
dementia
myoclonus
presence of what in the CSF indicates creutzfeldt jakob disease?
14-3-3 protein
most useful initial investigation for alzheimers?
MMSE
what type of dementia is MMSE not recommended for and why?
FTD
memory not affected as much
1st line Ix for FTD?
MRI
most useful initial investigation for vascular dementia?
SPECT
1st line drug for focal seizures?
lamotrigine
1st line drug for generalised seizures?
sodium valproate
what drug should be given for generalised seizures in young women?
lamotrigine
valproate MoA
increases Na channel inactivation with increased GABA concentration
1st line Tx for absence seizures?
ethosuxamide
valproate can also be used
MoA of ethosuxamide?
blocks T type calcium channels
uncontrolled hypertension causes what kind of stroke?
haemorrhagic
Tx of stroke if under 4.5hrs?
thrombolysis then aspirin + clopidogrel
Tx of stroke if >4.5hrs?
give aspirin and hope for the best
haemorrhagic stroke management?
give mannitol
control hypertension with antihypertensives
what should you do if someone with a CVA then has a seizure?
give anti-epileptic eg carbamazepine or lamotrigine
what is phenytoin and when would you use it?
anti-epileptic
status epilepticus only as its v potent
prophylactic drugs for cardioembolic stroke?
rivaroxaban/warfarin
patient with bilateral double vision and ptosis that gets worse throughout the day…
myaesthenia gravis
most useful Ix for myaesthenia gravis?
anti-AchR antibodies
if the thymus is suspected to be involved in MG what should be done?
CT
carbemazepine is teratogenic T or F
T
side effects of carbemazepine?
hyponatraemia
ataxia
blurred vision
vertigo
3Hz spike waves on EEG…
absence seizures
when should you remove the pill in a woman who has migraines and why?
if they have aura
at an increased risk of stroke
pharmacological Tx of migraine?
sumatriptan
NSAID
anti-emetic
triptans are contraindicated in what condition?
heart problems
right supra/retroorbital pain with ipsilateral ptosis and miosis that lasts over 30 mins..
cluster headache
when are cluster headaches worse?
at night
left supraorbital pain with ipsilateral nasal congestion about 20 times a day lasting 10-30mins
paroxysmal hemicrania
why should you avoid metaclopramide in parkinson’s?
crosses the BBB fast so can cause more side effects
what anti-emetic should be used in PD and why?
domperidone
doesn’t enter the CNS as fast as metoclopramide
what anti-psychotic causes extrapyramidal side effects?
haloperidol
what drug should be given in acute psychosis from parkinson’s?
quetiapine
gram positive flagellated rod on gram stain in a patient with suspected meningitis?
listeria
name the 3 groups at risk of listeria?
pregnant women
elderly
children
most common meningitis bacteria in young people?
neisseria
neisseria is gram ___
negative
what bacteria is common in infection from cribriform plate injuries?
strep pneumoniae
number 1 bacterial cause of meningitis in neonates
group b strep
main bacterial causes of meningitis in infants?
meningococcus
haemophilus
main bacterial causes of meningitis in teens?
meningococcus
what neurotransmitter has a sedetary effect
GABA (it is an INHIBITORY neurotransmitter)
drug of choice for spasticity in MS? why is this?
baclofen
is a GABA derivative so works as a sedative
drug of choice for fatigue in MS? what kind of drug is it?
amantadine
dopamine agonist
amantadine should be avoided in what condition?
epilepsy
1st line treatment for trigeminal neuropathic pain?
carbemazapine
what is the internal capsule of the brain and what does it do?
bunch of projection fibres that help the cerebral cortex communicate with the rest of the brain
will damage to the internal capsule of the brain cause sensory or motor symptoms?
BOTH!! (contains both types of fibres)
a lesion in what structure would cause full body paralysis except eye movement? why is this?
basilar artery
branches supply the pons and medulla so only midbrain cranial nerves would work
what investigation confirms diagnosis of guillain barre?
neurophysiology
patient presents with deteriorating paralysis after a campylobacter infection….
GBS
what kind of paralysis does GBS present with?
ascending sensorimotor
what should be done if anti-AchR antibodies are negative in suspected MG?
test anti-musk
lambert eaton syndrome is __synaptic
pre
MG is __synaptic
post
Ix for lambert eaton syndrome?
anti-BGCC
symptoms improve/worsen with exercise in LES?
improve
what muscles are mainly involved in LES?
lower limb big muscles
associated condition with MG?
thymoma
associated condition with LES?
small cell lung cancer
Tx of LES?
3,4-diaminopyridine
4 main symptoms of LBD?
dementia
fluctuating conscious levels
recurrent visual hallycinations
parkinsonian features -> falls
triad of symptoms in NPH?
incontinence, ataxia, dementia
patient presents with visual/auditory hallucinations, seizures and meningism?
herpes simplex encephalitis
why do you get hallucinations in HSV encephalitis?
tends to affect the temporal lobe which contains the meyers loop for superior vision (visual hallucinations) and middle ear (auditory)
what symptoms are more prominent in encephalitis and not in meningitis
headache
fever
altered consciousness
hallucinations
