Passmed - Neuro Flashcards by Alfie Saunders

Bell’s Palsy features

lower motor neuron facial nerve palsy → forehead affected
(in contrast, an upper motor neuron lesion ‘spares’ the upper face)

post-auricular pain (may precede paralysis)
altered taste
dry eyes
hyperacusis

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Bell’s palsy management?

Oral prednisolone
Eye care (lubricant)

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a simple first-step in the management of patients with raised ICP

Head elevation to 30º

(IV mannitol may be used as an osmotic diuretic)

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Dilated, fixed pupil CN

III

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‘down and out’ eye with a fixed (non-reactive to light), dilated pupil

typical presentation of oculomotor nerve palsy.

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inability to abduct the left eye and worsening double vision when looking to the left are consistent with

left 6th nerve palsy

innervates the lateral rectus muscle, which is responsible for abduction of the eye. When this nerve is affected, it results in medial deviation of the eye (esotropia) at rest and difficulty or inability to abduct the affected eye

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Wernicke’s encephalopathy features? CAN OPEN

Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy

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Middle-aged, personality changes, involuntary movements →

?Huntington’s disease

Autosomal dominant
Features typical develop after 35 years of age
chorea
personality changes (e.g. irritability, apathy, depression) and intellectual impairment
dystonia
saccadic eye movements

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Huntington’s disease fewtures

Features typical develop after 35 years of age
chorea
personality changes (e.g. irritability, apathy, depression) and intellectual impairment
dystonia
saccadic eye movements

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Acoustic neuromas are best visualized by

MRI of the cerebellopontine angle

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Contralateral homonymous hemianopia with macular sparing and visual agnosia

posterior cerebral artery

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ongoing vertigo, tinnitus and hearing loss, absent corneal reflex

Acoustic neuroma

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first line radiological investigation for suspected stroke?

Non-contrast CT head scan

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Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive →

subacute combined degeneration of the spinal cord

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Confusion, ataxia, nystagmus/ophthalmoplegia→ give

Pabrinex (IV B/C vitamins)

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A maximum of ? doses of IV benzodiazepines can be administered during convulsive status epilepticus

Two

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If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be

admitted immediately for imaging to exclude a haemorrhage

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Defective downward gaze and vertical diplopia

eye deviates supero-laterally

CN IV

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MS acute relapse management?

high dose steroids can be used in the management of acute relapse

E.g. oral/IV methylprednisolone

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Tongue deviated towards side of lesiom

CN XII lesion

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Nystagmus?

CN VIII lesion

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loss of facial sensation
loss of corneal reflex
paralysis of mastication muscles
deviation of jaw towards the side of lesion

CN V lesion

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dilated, fixed pupil
ptosis
a ‘down and out’ eye

CN III lesion

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flaccid paralysis of upper + lower face
loss of taste (anterior 2/3rds of the tongue)
loss of corneal reflex
hyperacusis

CN VII lesion

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migraine prophylaxis (woman of childbearing age) and essential tremor treatment?

Propranolol

acute migraine treatment

Triptan + NSAID or triptan + paracetamol

loss of taste (posterior 1/3rd of the tongue) loss of gag reflex hypersensitive carotid sinus reflex

CN IX lesion

weakness turning head to contralateral side

CN XI lesion

loss of sight

CN II lesion

combination of vertigo, hearing loss, tinnitus and an absent corneal reflex

Vestibular schwannoma

x scan is the first line radiological investigation for suspected stroke

Non-contrast CT head

Acetazolamide is a carbonic anhydrase inhibitor that is used to treat

idiopathic intracranial hypertension

Superior homonymous quadrantanopias are caused by lesions of

the inferior optic radiations in the temporal lobe

What can cause hyperacusis

facial nerve palsy hyperacusis is an increased sensitivity to sound.

Jacksonian movement (clonic movements travelling proximally) indicates

frontal lobe epilepsy

Weber's syndrome is

a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

Restless leg syndrome - management includes

dopamine agonists such as ropinirole

Urinary incontinence + gait abnormality + dementia =

normal pressure hydrocephalus

The Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in

hypertension and bradycardia

Fourth nerve palsy -

when looking straight ahead, the affected eye appears to deviate upwards and is rotated outwards

Progressive peripheral polyneuropathy with hyporeflexia suggests

Guillain-Barre syndrome

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg's positive →

subacute combined degeneration of the spinal cord due to vitamin B12 deficiency resulting in impairment of the dorsal columns, lateral corticospinal tracts and spinocerebellar tracts

The classical history of vestibular schwannoma includes a combination of

vertigo, hearing loss, tinnitus and an absent corneal reflex

Vision worse going down stairs?

Think 4th nerve palsy

Lip smacking + post-ictal dysphasia are localising features of a

temporal lobe seizure

Urinary incontinence + gait abnormality + dementia =

normal pressure hydrocephalus

migraine treatment acute vs prophylaxis

acute: triptan + NSAID or triptan + paracetamol prophylaxis: topiramate or propranolol

Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness -

anterior inferior cerebellar artery

homonymous quadrantanopias: parietal vs temporal

PITS (Parietal-Inferior, Temporal-Superior)

Tonic or atonic seizures: females

lamotrigine is first-line for

Epilepsy medication for males:

generalised seizure: sodium valproate focal seizure: lamotrigine or levetiracetam

Third nerve palsy vs Horner's

Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner's

A combination of x AND y is recommend for patients with an acute ischaemic stroke who present within 4.5 hours

x - thrombolysis (alteplase) y - thrombectomy

x imaging is the preferred modality in patients with suspected TIA who require brain imaging

MRI brain with diffusion-weighted

Loss of corneal reflex - think

acoustic neuroma

Cranial nerves ... are affected in vestibular schwannomas

V, VII and VIII

Lacunar strokes can present with

unilateral motor disturbance affecting the face, arm or leg or all 3. complete one sided sensory loss. ataxia hemiparesis.

x are first-line for spasticity in multiple sclerosis

Baclofen and gabapentin

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg's positive →

subacute combined degeneration of the spinal cord

Jacksonian movement (clonic movements travelling proximally) indicates

frontal lobe epilepsy

x lesion can cause weakness of foot dorsiflexion and foot eversion

Common peroneal nerve

Confusion, ataxia, nystagmus/ophthalmoplegia→ give x

Pabrinex (IV B/C vitamins)

x is the preferred modality in patients with suspected TIA who require brain imaging

MRI brain with diffusion-weighted imaging

x is used for long-term prophylaxis of cluster headaches

Verapamil

Absence seizures: x is first-line

ethosuximide

In status epilepticus, x should be given if not responding to benzodiazepines

IV levetiracetam, phenytoin or sodium valproate

x can cause weakness of foot dorsiflexion and foot eversion

Common peroneal nerve lesion

Optic neuritis can be a feature of x

multiple sclerosis

Patients with raised ICP may exhibit Cushing's triad:

widening pulse pressure bradycardia irregular breathing

Cushing's triad?

widening pulse pressure bradycardia irregular breathing late sign indicating impending brain herniation. Systolic hypertension occurs as a reflex to maintain cerebral perfusion pressure in the presence of raised intracranial pressure.

Painful third nerve palsy =

posterior communicating artery aneurysm

In status epilepticus, x, y or z should be given if not responding to benzodiazepines

IV levetiracetam, phenytoin or sodium valproate

Contralateral homonymous hemianopia with macular sparing and visual agnosia - artery

posterior cerebral artery

x is the preferred modality in patients with suspected TIA who require brain imaging

MRI brain with diffusion-weighted imaging

Urinary incontinence + gait abnormality + dementia = x

normal pressure hydrocephalus

x - when looking straight ahead, the affected eye appears to deviate upwards and is rotated outwards

Fourth nerve palsy

Patients cannot drive for x months following a first unprovoked or isolated seizure if brain imaging and EEG normal

x is used to treat cerebral oedema in patients with brain tumours

Dexamethasone

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg's positive → x

subacute combined degeneration of the spinal cord

Patients with a TIA or minor ischaemic stroke who present within 24 hours, who are not considered suitable for DAPT, should be given x

clopidogrel monotherapy

Brain abscess: x + y

If a patient has had a suspected TIA, they should be given x

aspirin 300mg whilst awaiting specialist review, unless contraindicated

Passmed - Neuro Flashcards

(82 cards)