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5th Year > Passmed Neuro Stuff > Flashcards

Passmed Neuro Stuff Flashcards

1
Q

What condition are bilateral acoustic neuromas associated with?

A

Neurofibromatosis Type 2 (NF2)

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2
Q

How can you distinguish between a CSF leak and mucus coming from a patient’s nose?

A

Check glucose - CSF has glucose

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3
Q

What is syringomyelia?

A

Fluid-filled cavity develop in central canal of spinal cord

This compresses the spinal cord tracts

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4
Q

Which part of the spinal cord is compressed first in syringomyelia?

A

Anterior white commissure

Spinothalamic tract decussates here at level of entry

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5
Q

Which sensory fibres are carried in the spinothalamic tract?

A

Pain and temperature

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6
Q

Which sensory fibres are carried in the dorsal column?

A

Light touch, vibration and proprioception

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7
Q

What is a typical presentation for someone with syringomyelia?

A

Bilateral loss of pain and temperature at level of syrinx
Often present with burns on fingers

Progresses to ‘shawl-like’ sensation loss of arms, shoulders and torso

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8
Q

What malformation is syringomyelia associated with?

A

Chiari Type 1 malformation

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9
Q

What imaging is required if you suspect syringomyelia?

A

MRI Full Spine

MRI Brain - check for Chiari malformation

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10
Q

What is tuberous sclerosis?

A

Autosomal Dominant condition with cutaneous, neurological and other features

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11
Q

What are the cutaneous features of tuberous sclerosis? (4)

A

‘Ash leaf’ spots under UV light = depigmented patches
Shagreen patches = roughened skin over lumbar spine
Adenoma sebaceum (angiofibromas) - facial, butterfly distribution
Subungual fibromata
(Cafe au lait spots - more often in NF)

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12
Q

What are the neurological features of tuberous sclerosis? (3)

A

Developmental delay
Intellectual impairment
Infantile spasms/partial seizures

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13
Q

What are the ‘other’ features of tuberous sclerosis? (6)

A

Retinal hamartomas = dense white areas on retina
Rhabdomyomas of heart
Gliomatous changes in brain lesions
Polycystic kidneys
Renal angiomyolipomata
Lymphangioleiomyomatosis -> multiple lung cysts

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14
Q

What is mononeuritis multiplex?

A

Simultaneous/sequential involvement of individual, non-contiguous nerve trunks
This causes acute/subacute sensory and motor loss in asymmetrical pattern

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15
Q

What are the Motor scores of GCS?

A 
6 = obeys
5 = localises to pain
4 = withdraws from pain
3 = abnormal flexion
2 = extending from pain
1 = none
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16
Q

What are the Verbal scores of GCS?

A 
5 = orientated
4 = confused
3 = words
2 = sounds
1 = none
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17
Q

What are the Eye scores of GCS?

A 
4 = spontaneous
3 = speech
2 = pain
1 = none
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18
Q

What is Subacute Combined Degeneration of Spinal Cord?

A

Degeneration of dorsal and lateral columns due to vitamin B12 deficiency
Uncommon in UK, very common in the developing world

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19
Q

What type of fibres are carries in the corticospinal tract?

A

Voluntary motor fibre

Upper limbs are medial, lower limbs are lateral

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20
Q

What are the symptoms of Subacute Combined Degeneration of the Spinal Cord?

A

Loss of proprioception and vibration (dorsal column)
Then distal parasthesia
UMN signs in legs - brisk knee reflex, absent ankle reflex

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21
Q

What medication should you give someone with a cerebral oedema secondary to a brain tumour?

A

Dexamethasone IV

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22
Q

What is the triad of Normal Pressure Hydrocephalus?

A

Wet, wobbly, wacky
Urinary incontinence
Gait ataxia
Dementia

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23
Q

What is the management of normal pressure hydrocephalus?

A

Ventriculoperitoneal shunting

10% risk of complications eg. seizure, infection, haemorrhage

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24
Q

What is the acute management of a migraine?

A

Triptan + Paracetamol

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25
What is the prophylaxis for migraines?
Topiramate | Propranolol
26
What is an essential tremor?
Autosomal dominant tremor Generally of both upper limbs Often have family history
27
What makes an essential tremor better/worse?
Worse with arms outstretched | Better with alcohol/rest
28
What is the management of an essential tremor?
Propranolol
29
What is miosis?
Pupil constriction
30
What is ptosis?
Eyelid drooping
31
What does ptosis + dilated pupil indicate?
CN3 palsy
32
What does ptosis + constricted pupil indicate?
Horner's syndrome
33
What is Weber's syndrome?
Midbrain stroke
34
What are the features of Weber's syndrome?
Ipsilateral CN3 palsy | Contralateral hemiplegia
35
What is a Chiari malformation?
Herniation of cerebellar tonsils through foramen magnum
36
What are the features of neuroleptic malignant syndrome? (6)
``` Pyrexia Muscle rigidity Hypertension Tachycardia Agitated delirium Confusion ```
37
What might bloods show in neuroleptic malignant syndrome?
Increased WCC, K+ and CK | Decreased Ca2+
38
What is the management of neuroleptic malignant syndrome?
Stop antipsychotic Transfer to ITU IV fluids Dantrolene
39
What is Spontaneous Intracranial Hypotension?
Headache secondary to CSF leak | Generally from thoracic N root sleeve
40
What is spontaneous intracranial hypotension associated with?
Marfan's
41
What are the symptoms of spontaneous intracranial hypotension?
Headache | Worse on standing, better with lying
42
What is the management of of spontaneous intracranial hypotension?
Fluids and caffeine | Epidural blood patch = 2nd line
43
What is the treatment of myasthenia gravis?
Neostigmine (long-acting AChE inhibitor)
44
What type of neuromuscular blocks are myasthenia gravis patients more sensitive to?
Non-polarising eg. Rocuronium | As fewer post-synaptic ACh receptors
45
What type of neuromuscular blocks are myasthenia gravis patients resistant to?
Polarising eg. Suxamethonium
46
Which medications may worse myasthenia gravis?
Beta-blockers
47
What may be found in the CSF of Multiple Sclerosis patients?
Oligoclonal bands | NOT found in blood
48
What should you do if a patient has GCS<8?
Get anaesthetist | Intubate and ventilate
49
What is the 1st line management of trigeminal neuralgia?
Carbamazepine
50
What is the management of Degenerative Cervical Myelopathy?
Urgent spinal surgery referral | Decompression surgery within 6m
51
What other neurological condition is frontotemporal dementia associated with?
MND
52
What are the 4 types of MND?
Amyotrophic Lateral Sclerosis Progressive Lateral Sclerosis Progressive Muscular Atrophy Bulbar Palsy
53
What are the main features of MNDs?
``` Fasciculations No sensory symptoms Mixed UMN and LMN signs Doesn't affect extraocular muscles No cerebellar signs ```
54
What do MND EMGs show?
Reduced action potentials with increased amplitude | Not required for diagnosis
55
What are the main functions of the common peroneal nerve?
Dorsiflexion and eversion of ankle | Posterolateral leg sensation
56
What are the main features of L5 radiculopathy?
Foot drop Weakness of hip abduction Sensory loss of big toe
57
Who gets idiopathic intracranial HTN?
Overweight females
58
What is the management of idiopathic intracranial HTN?
Lose weight Acetazolamide/Topiramate Repeated LPs if these fail
59
What is Lateral Medullary Syndrome?
Posterior Inferior Cerebellar Artery stroke | AKA Wallenberg's syndrome
60
What are the features of Lateral Medullary Syndrome?
Ipsilateral FACIAL pain and temperature loss Contralateral BODY pain and temperature loss Ataxia Nystagmus
61
What is Lateral Pontine Syndrome?
Anterior Inferior Cerebellar Artery stroke
62
What are the features of Lateral Pontine Syndrome?
``` Ipsilateral FACIAL pain/temp loss Ipsilateral FACIAL paralysis and deafness Contralateral BODY pain/temp loss Ataxia Nystagmus ```
63
Where must a lesion by above to result in autonomic dysreflexia?
Above T6
64
What is Lhermitte's sign?
Patient bends their neck -> tingling in hands Indicates disease near dorsal column Seen in MS and SCDSc
65
What is Uhthoff's phenomenon?
Worsening of vision following a rise in body temperature | Seen in MS
66
What does a CN3 palsy with dilated pupil indicate?
Surgical cause | Need urgent head CT to rule out bleed/aneurysm
67
What are some features indicative of temporal lobe epilepsy?
Lip-smacking/cloth plucking Aura Deja vu Post-ictal dysphasia
68
How is the MRC muscle power score scored?
``` 0 = no movement 1 = trace contraction 2 = movement with gravity eliminated 3 = movement vs gravity but not resistance 4 = movement vs resistance but weakened 5 = normal ```
69
What are the MOTOR peripheral neuropathies? (6)
``` Guillain-Barre syndrome Porphyria Lead poisoning HSMN (Charcot-Marie-Tooth) Chronic Inflammatory Demyelinating Polyneuropathy Diphtheria ```
70
What are the SENSORY peripheral neuropathies? (6)
``` Diabetes Uraemia Leprosy Alcoholism B12 deficiency Amyloidosis ```
71
What are the features of a venous sinus thrombosis?
Gradual onset headache N+V Depends on sinus
72
What are the features specific to a sagittal sinus thrombosis?
Seizures | Hemiplegia
73
What are the features specific to a cavernous sinus thrombosis?
Periorbital oedema Ophthalmoplegia - CN6 1st Trigeminal N involvement -> hyperaesthesia of upper face and eye Central retinal vein thrombosis
74
What are the features specific to a lateral sinus thrombosis?
CN6+7 palsy
75
What is the gold standard diagnostic investigation for venous sinus thrombosis?
MR venogram
76
What are the myotomes for upper limb reflexes?
``` Biceps = C5-6 Triceps = C7-8 ```
77
What are the myotomes for lower limb reflexes?
``` Knee = L3-4 Ankle = S1-2 ```
78
What is the ideal investigation if you suspect Degenerative Cervical Myelopathy?
MRI spine
79
What is Progressive Supranuclear Palsy?
Parkinson's Plus syndrome | Has poor response to L-dopa
80
What are the features of progressive supra nuclear palsy?
Parkinson's symptoms Dysarthria Reduced vertical eye movements
81
What is retinitis pigmentosa?
Loss of rods -> night blindness | Loss of peripheral retina -> tunnel vision
82
What may be seen on fundoscopy in retinitis pigmentosa?
Black bone spicule-shaped pigmentation of peripheral retina | Mottling of retinal pigment epithelium
83
What are some features of retinitis pigmentosa?
``` Night blindness Tunnel vision Often start in childhood Often have FHx of early (but incomplete) blindness Vitamin A may slow progression ```
84
What is retinitis pigmentosa associated with? (4)
``` Refsum disease Usher syndrome Alport syndrome Abetalipoproteinaemia ( and others) ```
85
What is Guillain-Barre syndrome?
Immune-mediated demyelination post-infection | Typical campylobacter infection
86
What are the features of GBS?
``` Progressive weakness of all 4 limbs Legs progress first Proximal muscles more than distal Few sensory symptoms Diminished reflexes ```
87
What may an LP show in GBS?
Increased protein | Normal WCC
88
What is myasthenia gravis?
Auto-antibodies vs ACh receptor on post-synaptic membrane
89
What are the features of myasthenia gravis? (5)
``` Progressive weakness as day goes on Proximal muscle weakness Diplopia - extraocular muscle weakness Ptosis Dysphagia ```
90
What are the associations of myasthenia gravis?
``` Thymomas (15%) Thymic hyperplasia (50-70%) Other autoimmune diseases ```
91
What investigations should be done for someone with myasthenia gravis?
``` Single fibre electromyography CT thorax - exclude thymoma AChR AutoAb - 85-90% +ve Anti-muscle-specifc tyrosine kinase Ab - 40% +ve (Creatinine Kinase is normal) ```
92
What test is no longer used for those with myasthenia gravis?
Tension test IV edrophium temporarily reduces weakness Not done anymore
93
What is the management of myasthenia gravis?
Pyridostigmine (long-acting AChE inhibitor) Prednisolone (immunosuppression) Thymectomy
94
What is the management of a myasthenic crisis?
IV immunoglobulin + plasma exchange
95
Where are lesions causing inferior and superior quadrantanopias?
Parietal = Inferior Temporal = Superior (PITS)
96
What are the 1st line options for migraine prohpylaxis?
Topiramate | Propranolol
97
What migraine prophylaxis should be used in women taking COCP?
Propranolol | Topiramate can reduce COCP efficacy
98
What are the 2nd and 3rd line options for migraine prophylaxis?
2nd line = 10 acupuncture sessions | 3rd line = Riboflavin 400mg OD
99
What prophylaxis should be used for predictable menstrual migraines?
Frovatriptan or zolmitriptan
100
What is intranuclear ophthalmoplegia?
Lesion of Medial Longitudinal Fasciciulus = tract that allows conjugate eye movements
101
What are the features of intranuclear ophthalmoplegia?
Ipsilateral impaired adduction of eye | Contralateral nystagmus
102
What is the diagnosis if someone has a painful CN3 plasy with dilated pupil?
Posterior Communicating Artery aneurysm
103
What are the causes of CN3 palsy? (7)
``` DWN ANd OUT Diabetes Weber's syndrome Neuro (MS) ANeurysm (posterior communicating artery) Other (SLE, GCA) Uncal herniation Thrombosis (cavernous sinus) ```
104
What are the features of ALS?
LMN signs in arms, UMN signs in legs Most common MND Familial cases involve Chr21
105
How could you distinguish between ALS and PLS?
PLS has UMN signs only | ALS has UMN signs in legs and LMN signs in arms
106
What are the features of Progressive Muscular Atrophy?
LMN signs only Distal to proximal muscles Best prognosis
107
What is Progressive Bulbar Palsy?
MND - loss of brainstem nuclei function
108
What are the features of Progressive Bulbar Palsy?
Palsy of tongue, muscles of mastication and facial muscles | Worst prognosis
109
What are the 5 most common primary tumours to metastasise to the brain?
``` Lung Breast Kidney Melanoma Colorectal ```
110
What is the long term management of a stroke?
Clopidogrel Statin if cholesterol >3.5 (Aspirin STAT after bleed excluded)
111
What is the MoA of Ondansetron?
5-HT3 antagonist Acts on medulla oblongata S/Es = constipation, long QT
112
Which anti-seizure medication may cause peripheral neuropathy?
Penytoin
113
What might be raised following a true seizure but not after a non-epileptic seizure?
Prolactin | Raised 10-20mins after epileptic seizure
114
What are the cerebellar signs?
``` DANISH Dysdidokokinesis Ataxia Nystagmus Intention tremor Slurred speech Hypotonia (signs are ipsilateral to lesion) ```
115
Are cerebellar signs ipsilateral or contralateral to cerebellar lesions?
Ipsilateral
116
Who should get a thrombophilia screen following a stroke?
<55yrs old + no obvious cause
117
What is the ROSIER score?
Assesses likelihood presentation is due to a stroke
118
What are the features of Lacunar infarcts?
ONE of: Ataxic hemiparesis Pure sensory stroke Unilateral weakness
119
What are the features of Weber's syndrome?
Ipsilateral CN3 palsy | Contralateral weakness
120
What are the features of Lateral Medullary syndrome?
Ipsilateral ataxia, nystagmus, facial numbness and dysphagia | Contralateral limb sensory loss
121
What is the acute management of cluster headaches?
100% oxygen + subcut Sumitriptan
122
What is the prophylactic management of cluster headaches?
Verapamil
123
What is the 1st line management of trigeminal neuralgia?
Carbamazepine
124
What are the Red Flags for trigeminal neuralgia, which may warrant urgent referral? (8)
``` Age <40yrs Sensory changes Deafness/ear problems Hx of skin/oral lesions which could be perineurial Pain in ophthalmic division Pain bilaterally Optic neuritis Fix of MS ```
125
What is the most common sequelae of meningitis?
Sensorineural deafness
126
What is Todd's paresis?
Post-seizure focal weakness | Follows focal seizure
127
When does Steven-Johnson syndrome start after starting a new medication?
Typically 2 months | Flu-like prodrome initially
128
What are the features of a low pressure headache post-LP?
Develop 24-48hrs post-LP Worse on standing More common in women with low BMI
129
What is the management of a low pressure headache?
Caffeine and fluids (stay hydrated)
130
What are the symptoms of a subdural haematoma?
Generalised headache with fluctuating GCS
131
What is the first investigation you order if you suspect a stroke?
Non-contrast CT head
132
What role do Diffusion-weighted MRIs have in stroke management?
Can help diagnose a vascular stroke
133
What role do T2-weighted FLAIR MRIs have in stroke management?
Can help with estimate if stroke onset is within thrombolysis window
134
What are the side effects of sodium valproate? (11)
``` Nausea Weight gain Alopecia with curly regrowth Ataxia Tremor Thrombocytopenia Pancreatitis Hepatotoxicity Hyponatraemia Hyperammonic encephalopathy TERATOGENIC ```
135
What relevance does sodium valproate have for other medications?
P450 inhibitor
136
When can someone drive again after having a TIA?
Must be symptom-free after 1 month
137
What can be used as a 'rescue medication' for neuropathic pain?
Tramadol
138
What is the new definition of TIA?
Neurological dysfunction caused by focal CNS ischaemia without infarct Tissue-based, not time-based
139
What are 4 MS risk factors?
Smoking Previous glandular fever Genetics Low vitamin D
140
What is procyclidine?
Antimuscarinic Used to treat tremor and rigidity Most useful in drug-induced parkinson's
141
What is carbergoline associated with?
Pulmonary fibrosis
142
What is Hoover's sign?
Differentiates between organic and non-organic leg weakness | Organic = feels normal leg pushing down to try and raise weak leg
143
What is Romberg's test?
Differentiates between sensory and cerebellar ataxia Stand with eyes closed, +ve if they fall +ve result indicates sensory ataxia Cerebellar ataxia will have +ve result with eyes open and closed
144
What is the characteristic gait of sensory ataxia?
High-stepping gait
145
What is the characteristic gait of cerebellar ataxia?
Broad-based, staggering gait
146
What are the acute causes of sensory ataxia? (3)
Miller-Fisher syndrome Sensory variant of GBS Semisynthetic penicillins
147
What are the subacute causes of sensory ataxia? (3)
Lyme disease Neurosarcoidosis Posterior spinal cord lesions
148
What are the chronic causes of sensory ataxia? (6)
``` CIDP Paraproteinaemia Diabetes Coeliac disease Vitamin E deficiency Isoniazid ```
149
What are 5 examples of posterior spinal cord lesions?
``` MS Cervical spondylosis Tumours Vitamin B12 deficiency Tabes dorsalis (syphilis) ```
150
What are the replacement thresholds for low phosphate during refeeding?
``` <0.80 = low 0.32-0.80 = oral replacement <0.32 = IV replacement ```
151
When do you need to worry about refeeding syndrome?
If not eaten for 5+ days
152
What is the usual replacement regime in refeeding?
``` 10kcal/kg/day - increase to needs over 4-7 days Oral thiamine 300mg OD K+ 2-4mmol/kg/day PO4 0.3-0.6mmol/kg/day Mg 0.2-0.4mmol/kg/day ```
153
What drugs should be used for nausea in those with Parkinson's?
Domperidone | Doesn't cross BBB
154
What is the time window for thrombolysis in strokes?
<4.5hrs from onset | Combined with thrombectomy if CONFIRMED proximal circulation occlusion
155
What is the time window for thrombectomy in strokes?
<6hrs from onset | Must have CONFIRMED proximal circulation occlusion
156
When should you consider thrombectomy +/- thrombolysis for posterior circulation strokes?
If known to be well in the last 24hrs and proximal circulation occlusion
157
What should you do if you suspect a diagnosis of Parkinson's disease?
Urgent neurology referral | All treatment should be initiated by specialist
158
What degree of stenosis is required for a carotid endarterectomy?
>50%
159
How long is L-dopa usually effective for?
2yrs max
160
What are the side effects of L-dopa? (7)
``` Dyskinesia On-off effect Postural hypotension Arrhythmias N&V Psychosis Red urine of standing ```
161
What is complex regional pain syndrome?
Progressive pain in area which is disproportionate to original injury
162
What are some features of complex regional pain syndrome? (6)
``` Progressive pain Allodynia Temperature and skin changes Oedema Sweating Motor dysfunction ```
163
What scoring system is used to diagnose complex regional pain syndrome?
Budapest Diagnostic Criteria
164
What is the management of complex regional pain syndrome?
Early physio and pain team input | Gabapentin/amitriptyline are 1st line
165
Who is at an increased risk of Bell's palsy?
Pregnant women - 3x increased risk
166
What are the two types of Multiple System Atrophy?
Predominantly Parkinsonian | Predominantly cerebellar
167
What are the features of Multiple System Atrophy?
Parkinsonism Autonomic disturbance eg. erectile dysfunction, postural hypotension, atonic bladder Cerebellar signs - DANISH
168
Who gets idiopathic intracranial hypertension?
Fat pregnant females
169
What are the features of idiopathic intracranial hypertension?
Headache + blurred vision Papilloedema Enlarged blind spot Occasionally CN6 palsy
170
What is the management of idiopathic intracranial hypertension?
Weight loss = 1st line Acetazolamide Topiramate = 2nd line, may aid weight loss Repeated LPs if these unsuccessful
171
What are the features of an acoustic neuroma?
``` CN8 = unilateral sensorineural hearing loss, tinnitus, vertigo CN5 = absent corneal reflex CN7 = facial palsy ```
172
What is cataplexy?
Strong emotions cause transient loss of muscle tone Eg. laughing -> fall 2/3 people with narcolepsy have cataplexy
173
What is the triad of symptoms for normal pressure hydrocephalus?
Urinary incontinence Dementia and bradyphrenia Gait abnormalities
174
What would imaging show in normal pressure hydrocephalus?
Hydrocephalus with enlarged 4ht ventricle
175
What is the management of normal pressure hydrocephalus?
Ventriculoperitoneal shunting
176
What are pulling clothes, lip-smacking, aura and deja vu all features of?
Temporal lobe epilepsy
177
What can the acute withdrawal of L-dopa precipitate?
Neuroleptic malignant syndrome
178
What are the features of absence seizures?
Last few seconds, quick recovery Child often unaware they have had one May be precipitated by hyperventilation
179
Who gets absence seizures?
Onset generally 3-10yrs | 90% seizure-free in teens
180
What is the characteristic EEG feature of absence seizure?
Bilateral symmetrical 3Hz spike and wave pattern
181
What is the management of absence seizures?
Sodium valproate or Ethosuximidie
182
What is a common feature of migraines in children but not adults?
GI symptoms
183
What is riluzole?
Glutamate receptor antagonist Prolongs life by about 3m in MND Used mainly in ALS
184
What symptoms does olivopontinecerebellar atrophy cause?
Parkinsonism and cerebellar signs
185
What symptoms does Progressive Supranuclear Palsy cause?
Parkinsonism and ophthalmoplegia
186
What symptoms does Lewy body dementia cause?
Parkinsonism and visual hallucinations
187
What are symptoms of autonomic dysreflexia?
Sever hypertension, flushing and sweating WITHOUT HR increase Due to spinal cord injury above T6
188
What is Hoffman's sign?
Flicking the distal phalanx of the patient's middle finger causes an exaggerated thumb flexion +ve suggests DCM or MS
189
Why the COCP contraindicated in those with Hx of migraine with aura?
Significantly increases risk of ischaemic stroke
190
If a headache is worse on coughing and lying, what does that suggest?
Raised ICP | Need head CT
191
What 4 medications are 1st line treatments of neuropathic pain?
Amitriptyline Duloxetine Gabapentin Pregabalin

5th Year (8 decks)

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