Passmed - Neuro Flashcards
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
Bell’s palsy management?
Oral prednisolone
Eye care (lubricant)
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)
Dilated, fixed pupil CN
III
‘down and out’ eye with a fixed (non-reactive to light), dilated pupil
typical presentation of oculomotor nerve palsy.
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
Wernicke’s encephalopathy features? CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy
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
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
Acoustic neuromas are best visualized by
MRI of the cerebellopontine angle
Contralateral homonymous hemianopia with macular sparing and visual agnosia
posterior cerebral artery
ongoing vertigo, tinnitus and hearing loss, absent corneal reflex
Acoustic neuroma
first line radiological investigation for suspected stroke?
Non-contrast CT head scan
Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive →
subacute combined degeneration of the spinal cord
Confusion, ataxia, nystagmus/ophthalmoplegia→ give
Pabrinex (IV B/C vitamins)
A maximum of ? doses of IV benzodiazepines can be administered during convulsive status epilepticus
Two
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
Defective downward gaze and vertical diplopia
eye deviates supero-laterally
CN IV
MS acute relapse management?
high dose steroids can be used in the management of acute relapse
E.g. oral/IV methylprednisolone
Tongue deviated towards side of lesiom
CN XII lesion
Nystagmus?
CN VIII lesion
loss of facial sensation
loss of corneal reflex
paralysis of mastication muscles
deviation of jaw towards the side of lesion
CN V lesion
dilated, fixed pupil
ptosis
a ‘down and out’ eye
CN III lesion
flaccid paralysis of upper + lower face
loss of taste (anterior 2/3rds of the tongue)
loss of corneal reflex
hyperacusis
CN VII lesion
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
