Passmed Neuro Flashcards
Which nerve does the lingual nerve originate from?
Posterior trunk of the mandibular nerve
The damage of what nerve would cause floor of mouth to feel numb, tingling and painful tongue?
Lingual nerve
The damage of what nerve would cause tongue deviation towards the side fo the lesion?
Hypoglossal nerve
What is the function of the greater auricular nerve?
Provide sesnory nerve innervation to the parotid gland and external ear
What is the function of the occulomotor nerve?
Eye movement, accommodation, eyelid movement and pupil constriction
What is the function of the phrenic nerve?
Supply the diaphrgam, senstaion to the central diaphragm and pericardium
Where does the phrenic nerve originate?
C3,4,5
What is the function of the lingual nerve?
Sensory innervation to mucosa of the presulcal part of the tongue, floor of moth and mandibular lingual gingivae
How may a brain abscess present?
Headache, fever, focal neurology (oculomotor palsy), nausea, papilloedema, seizures
How would you investigate a brain abscess?
CT
How would you manage a brain abscess?
Surgery (craniotomy and debridement)
IV antibiotics
ICP management (dexamethasone)
What type of drug is ondansetron?
5-HT3 antagonist - antiemetic used for chemotherapy induced nausea. Acts on medulla oblongata
What is status epilepticus?
Single seizure >5 minutes
>2 seizures within 5 minutes without the patient returning to normal
1st line management for status epilepticus?
IV lorazepman
2nd line management for ongoing status epilepticus?
Phenytoin
What is a TIA?
Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
Lesions where will cause finger abduction weakness?
T1
What is an ataxic gate?
Wide-based gait with loss of heel toe walking
Causes of cerebellar injury?
*PASTRIES* Posterior fossa tumour Alcohol S(MS) Trauma Rare causes Inherited (Friedreich's) Epilepsy treatment Stroke
How does Parkinson’s present?
Tremor, rigidity and bradykinesia
How does Lewy body dementia present?
Parkinsonism and visual hallucinations
Affects of a stroke in the anterior cerebral artery?
Contralateral hemiparesis and sensory loss, lower extremity
Affect of a stroke in the middle cerebral artery?
Contralateral hemiparesis and sensory loss, upper extremities.
Contralateral homonymous hemianopia
Aphasia
Affect of a stroke in the posterior cerebral artery?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Management of an acute ischaemic stroke who present with 4.5 hours?
thrombolysis and thrombectomy
What nerves are frequently injured during axillary dissection?
Intercostobrachial
What nerve supplies sensation to the medial aspect of the thigh?
Obturator nerve
What if the function of the obturator nerve?
Supplies sensation to the medial aspect of the high.
Causes adduction and internal rotation of the thigh.
Where does the obturator nerve originate from?
L2,L3,L4
What are ependymal cells?
Provide the inner lining of the ventricles and are responsible for CSF production
What are oligodendrocytes for?
The myelin sheath in the CNS
What is the function of astrocytes?
Maintaining the blood brain barrier
What is the function of Schwann cells?
Form the myelin sheath in the PNS
What is the function of microglia?
CNS macrophage cells. First and main form of active immune defence in the CNS
What is GBS?
Immune-mediated demyelination of the PNS, often triggered by an infection
How does GBS present?
Ascending motor neuropathy, often rapidly advancing.
Proximal muscles
Back/leg pain
Absent reflexes
What supplies Wernicke’s area?
Inferior division of the left MCA
Symptoms of Wernicke’s aphasia?
Poor comprehension but normal fluency of speech
What is Broca’s aphasia?
Lesion of inferior frontal gyrus causing non-fluent, laboured and halting speech. Repetition is impaired but comprehension is normal
What supplies Broca’s area?
Superior division of the left MCA
What is conduction aphasia?
Due to stroke affecting arcuate fasciculus (connection between Wernicke’s and Broca’s area).
Speech is fluent but repetition is poor. Aware of errors making
What is global aphasia?
Large lesion affecting Broca’s, Wernicke’s and arcuate fasciculus. Causing severe expressive and receptive aphasia - may still be able to communicate during gestures
What accompanies the radial nerve in the radial groove?
Profunda brachii artery
What pattern of cell death explains the mixed upper and lower motor neurone lesion signs observed in ALS?
Motor cortex neuronal cells and anterior horn cells
What does damage to anterior horn cells cause?
Lower motor lesion signs
What does damage to the motor cortex neuronal cells cause?
Upper motor lesion signs
What is a fasciculation?
Muscle twitch
What signs suggest MND?
Fasciculations, absence of sensory symptoms, mixture of lower and upper motor neurone signs, wasting of small hand muscles
What can cerebellar vermis lesions cause?
Upbeat nystagmus
What can a lesion in the foramen magnum cause?
Downbeat nystagmus
What can a lesion in the substantia nigra of the basal ganglia cause?
Parkinson’s disease
- bradykinesia, tremor and rigidity
What can a lesion in the temporal lobe cause?
Superior homonymous quadrantopia
Changes to speech (word substitutions and neologisms)
What can a lesion in the hypothalamus cause?
Wernicke and Korsakoff syndrome
- ataxia, nystagmus, ophthalmoplegia, confabulation, amnesia
How does a third nerve palsy present?
Eye is deviated ‘down and out’
Ptosis
Pupil may be dialated
Causes of a third nerve palsy?
Diabetes mellitus
Vasculitis
Posterior communicating artery aneurysm
Cavernous sinus thrombosis
What is carpal tunnel syndrome?
Median nerve compression as it travels through the carpal tunnel
Which branch of which nerve innervates the lateral aspect of the palm of the hand, and is therefore spared in carpal tunnel?
Palmar cutaneous nerve of the median nerve
What is the function of the palmar cutaneous nerve of the median nerve?
Innervate the lateral aspect of the palm of the hand
What is the function of anterior interosseous nerve branches of the median nerve?
Supply deep muscles of the anterior forearm
What is the function of the palmar digital branch of the median nerve?
Innervates palmar aspect of the thumb, index finger and lateral aspect of ring finger.
How do you differentiate between LEMS or MG?
In LEMS, weakness improves after exercise.
In MG, weakness worsens after exercise.
Which antibodies are important in the diagnosis of LEMS?
Voltage-gated calcium channel antibodies
Which antibodies are important in the diagnosis of MG?
ACh receptor antibodies
What is trigeminal neuralgia?
Sever unilateral pain
Electric shock like, evoked by light touch such as shaving
What does 4th nerve palsy cause?
Defective downward gaze -> vertical diplopia
What can lesions on the 5th nerve cause?
Trigeminal neuralgia Loss of corneal reflex Loss of facial sensation Paralysis of mastication muscles Deviation of jaw to weak side
What can a 6th nerve palsy cause?
Defective abduction -> horizontal diplopia
What can lesions on the 7th nerve cause?
Flaccid paralysis of upper and lower face
Loss of corneal reflex
Loss of taste
Hyperacusis
What can lesions on the 9th nerve cause?
Hypersensitive carotid sinus reflex
Loss of gag reflex
What can lesions on the 10th nerve cause?
Uvula deviates away from site of lesion
Loss of gag reflex
How to tell the difference between LMN lesion and UMN lesion of the facial nerve?
UMN spares upper face
LMN affects all facial muscles
What is Bell’s Palsy?
Acute, unilateral, idiopathic, facial nerve palsy
Features of Bell’s Palsy?
Lower motor neurone facial nerve palsy (forehead affected)
Altered taste, dry eyes, hyperacusis
1st line treatment for neuropathic pain?
Amitryptyline, duloxetine, gabapentin
