Passmed (Neuro) Flashcards
Two month history of electric shock like pains on the right side of her face. First line medication?
Carbamezapine
Features of a third nerve palsy?
eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)
The temporal lobe is responsible for memory, hearing & understanding language. What are signs of a temporal lobe epilepsy?
Automasations, lip smacking
Automatic behaviours such as fidgeting, undressing, running or walking,
Which nerve inverts abduction of the thumb?
Median nerve (LOAF muscles)
Ulnar does like ring finger side & Adduction of thumb
Required MRI site for acoustic neuromas
MRI of cerebellopontine angle
Explain the vascularisation of the brain stem?
1) Midbrain is part of the PCA
2) Pons & medulla mid is followed by basillar then anterior spinal artery
3) Pons & medulla lateral is followed by AICA & PICA
Explain the Rule of 4s for brainstem stroke
Cortical would either be MCA (FAST), ACA = leg, vision lang = PCA
Medial = motor (corticospinal/eye motor/proprioception)
Lateral = sensory (spinothalamic/sympathetic chain/sensory CN nuclei)
CN 1-4 = midbrain, 5-8= pons, 9=12 = medulla, ones that divide into 12 are midline (i.e. 3,4 |6 | 12)
N.b 1 & 2 aren’t in midbrain. Also Facial pain = PICA
Why do you get contralateral homonymous hemianopia in PCA stroke?
Because right side of the brain controls the right retina side but light is flipped through the lense, i.e. left eye sign block is due to right brain issue
What would webbers syndrome present as?
W like an upside down M
So according to rules of 4 would include occulomotor palsy & random brainstem hemiplegia
What does lacunar infarct mean?
Basically means small pit, so like small blood vessels affected deep in the brain
How would a pontine haemorrhage present as?
Quadriplegia
Pinpoint pupils points to pons
The gold standard for investigating demyelinating lesions?
MRI with contrast (i.e. investigating MS due to optic neuritis)
How does juvenile myoclonic epilepsy usually present as?
JME, usually different types of seizures associated w/ sleep deprivation
Goes from GTC to myoclonic after few months
Homonmyous heminaopia with or with/out?
with macular sparing would be PCA. w/o is MCA
Most common and most severe type of MND?
ALS & PBP (recurrent-remitting is also a type too)
What does amyotrophic lateral sclerosis actually mean?
a-myo-trophic (i.e. wasting) and lateral sclerosis (scarring of lateral tracts) i.e. UMN signs
In GBS: flaccid/spastic hypo/hypereflexia
flaccid & hyporeflexia as these are LMN signs (extra-pyramidal)
The first-line treatment for neuropathic pain?
Pregabalin is
How to manage Bells palsy?
Give prednisolone if w/i 72hr. Ensure eye drops too. Acyclocvir (if rash/ramsey)
Signs of wernikes encephalopathy
Confuison, ataxia, nystagmus & opthalmoplegia
Primary prophylaxis for pregnant woman with migraines?
Propanolol (since topiramate is teratogenic)
First line drug for acute confusion in elderly patient?
Haloperidol (anti-psych)
What is anomic aphasia?
A deficit of having the word to speak
Peroneal nerve vs L5 root nerve radiculopathy
PED vs LIED
Peroneal, Eversion, dorsiflexion
L5 Root, inversion, eversion, dorsiflexion
Features of frontal seizure?
Head/leg movements, posturing,post-ictal weakness,Jacksonian march
Jacksonian march is through the homonculus, so swallow to arm etc
Todd’s Paraesis
What action would mean a seizure isn’t absence seizure?
If they’re having automatisations
What indicates a vascular dementia?
A stepwise deterioration
Which cranial nerves will decussate then with their output being opposite?
Cn4 & Cn7 (trochlear & facial)
Preferred imaging in TIA clinic?
MRI
Which anti-psychotic is contraindicated in parkinsons? Haloperidol or olanzapine?
Haloperidol (apparently)
What are the features of intracranial venous thrombosis?
Headache, N&V, reduced consciousness
Gold standard Ix for venous sinus thrombosis
MRI venography
How does syringomyelia present as?
Spinothalamic things especially cape area
Time window to give alteplase for ischemic stroke? If not what?
4.5 hrs (n.b. 6 for thrombectomy) give aspirin after
Phenytoin haemolytic side effect?
Cause macroblastic (affects folate thing)
Acute treatment of cluster headaches? Side effect of taking the medication?
Subcut sumatriptan + 100% O2
Chest tightness
What are important blood tests in ‘young’ people and why?
Thrombophilia and autoimmune screening
What is presentation of a fracture of the shaft of the humerus?
Wrist drop (radial nerve damage)
How to acutely manage acute stroke? & best prevention
Aspirin 300mg as soon as haemorrhagic ruled out & clopidogrel for prevention!
Apart from the optic neuritis, what are other features of MS? (autoimmune condition of myelin in brain & spinal cord)
Lethargy, parasthesia, spastic weakness
Where does wenickes aphasia lesion come from?
Superior temporal gyrus
CT with or without contrast in the context of a newly presenting SAH
CT w/o contrast (slower and not needed to see particular fistulaes etc)
What is the first line drug for spasticity in MS?
Baclofen ( It works by inhibiting reflexes at the spinal level, thus reducing muscle tone and frequency of spasms)
What is internuclear opthalmoplegia?
When looking to the side, ABducting eye has nystagmus and ADducting eye doesn’t noramlly
A right temporal lobe results in a superior homonymous quadrantanopias. Explain why?
Because the tract for that top left quadrant goes through the opposite. So right temproal lobe
Lowerr would be parietal
How to remember why we get macular sparing and in which lobe?
In an occipital lobe lesion because it’s like evoltionary
What is the difference between type 1 and type 2 neurofibromatosis?
type 1 is more neurofibromas/optic gliomas whereas type 2 associated with schwanomas
What is Ramsay-Hunt Syndrome?
Where there’s facial palsy (due to herpes-zoster). Think ethan hunt ate a rooster?
