Passmed Neuro Flashcards
blood findings for neuroleptic malignancy syndrome
raised CK and leukocytosis (high WBC)
parkinson plus syndrome with postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
progressive supranuclear palsy
parkinson plus syndrome with with parkinsonism + autonomic disturbance (erectile dysfunction, postural hypotension, atonic bladder) + cerebellar signs
multiple system atrophy
Parkinson plus syndrome with spontaneous activity by an affected limb or akinetic rigidity of that limb
corticobasal degeneration
dominant hemisphere middle cerebral artery stroke presentation
aphasia
lateral medullary syndrome- artery
posterior inferior cerebellar artery
lateral medullary syndrome presentation
ipsilateral ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy with contralateral hemisensory loss. Can be caused by PICA strokes
lacunar infarct presentation
numbness with no other neurological symptoms
Posterior cerebral artery stroke/occipital stroke presentation
homonymous hemianopia with macula sparing
weber’s syndrome- cause and presentation
midbrain stroke
presents with CN3 palsy and contralateral hemiplegia/hemiparesis
visual field defect when a patient has urinary retention
pt with urinary retention may suggest diabetes insipidus due to a craniopharyngioma; this causes a lower bitemporal hemianopia
posterior cerebral artery/occipital lobe visual field lesion
contralateral homonymous hemianopia with macular sparing
haemorrhage which presents with lucid interval + biconvex (lentiform) on CT
extradural haemorrage
haematoma which presents long after head injury + crescent shaped lesion
subdural haematoma
migraine prophylaxis (a) first line and (b) where patient has asthma
(a) propanolol
(b) topiramate
nerve lesion which presents with weakness of finger abduction + thumb adduction + wasting of the hypothenar eminence
ulnar nerve injury
Mid shaft humeral fracture - nerve injury
radial nerve injury
nerve injury which causes wrist drop
radial nerve injury (mid shaft humeral fracture)
Klumpke’s paralysis + Horner’s syndrome - nerve injury
brachial trunks c8-t1
Arm hanging loose on side, pronated and medially rotated- nerve lesion
Erb’s palsy- c5-c6 lesion
Smith’s fracture- nerve lesion
median nerve
Nerves frequently injured during axillary node clearance
intercostobrachial nerves (causing impaired sensation in the armpit)
nerve lesion causing loss of extension in the fingers
radial nerve injury
nerve lesion causing loss of adduction of fingers
ulnar nerve injury
nerve lesion causing loss of pronation of the affected hand
median nerve injury
drug class which increases the risk of IIHP
tetracyclines
ocular signs of IIHP
third nerve palsy- eye deviated down and out
diuretic used to reduce ICP
mannitol
the most appropriate anti-emetic to prescribe for a Parkison’s patient with nausea
Domperidone
anti-emetic which can make parkinsonian symptoms significantly worse
Metoclopramide
imaging to view demyelinating lesions (MS)
MRI with contrast
triceps reflex nerve roots
C7-C8
biceps reflex nerve roots
C5-C6
causes of cerebellar injury
P - Posterior fossa tumour A - Alcohol S - Multiple sclerosis T - Trauma R - Rare causes I - Inherited (e.g. Friedreich's ataxia) E - Epilepsy treatments S – Stroke
tracts affected in subacute combined degeneration of the spinal cord & presentation
- dorsal columns (loss of proprioception and vibration)
- lateral corticospinal tract (muscle weakness and hyperreflexia)
Presentation- lateral hemisection of the spinal cord (Brown-Sequard sundrome)
SAME-SIDED WEAKNESS & PROPRIOCEPTION/VIBRATION LOSS
OPPOSITE-SIDED LOSS OF PAIN/TEMPERATURE
Hoffman’s sign
Demonstrates UMN lesion. offmans sign is elicited by flicking the distal phalaynx of the middle finger to cause momentary flexion. A positive result is exaggerated flexion of the terminal phalanyx of the thumb.
level of spinal cord where injury must happen for autonomic dysreflexia to occur
above T6 level
treatment for cerebral oedema in patients with brain tumours
Dexamethasone
antibodies in myasthenia gravis
• Classically, serum acetylcholine receptor antibodies are positive in MG but if the result is negative or equivocal, anti-muscle-specific tyrosine kinase antibodies should be measured as these are positive in up to 70% with acetylcholine receptor sero-negative generalised myasthenia gravis
what is syringomelia
a collection of CSF within the spinal cord. Presents with cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine
first line treatment for myasthenia gravis
Pyridostigmine- long acting acetylcholinesterase inhibitor in the neuromuscular junction
restless leg syndrome management
ropinirole (dopamine agonist)
spinal tract lesion associated with cerebral palsy
pyramidal (corticospinal) tracts
trinucleotide repeat disorder in the DMPK or ZNF9 gene
Myotonic dystrophy
epilepsy medication side effect-rash
• Lamotrigine is associated with Stevens-Johnson syndrome, causes a large blistering rash throughout the body
lumbar puncture findings for GBS
Raised proteins and NORMAL WCC on LP
Important sign to monitor during GBS and why
Forced vital capacity is important to monitor due to the risk of respiratory failure
Lambert Eaton syndrome vs Myasthenia Gravis
Lambert eaton syndrome- muscles become stronger with repetition
myasthenia- muscle fatigability is worse with repetition
First line treatment for relapsing-remitting MS
Injectable beta-interferon
