Random Clinical Neuro Flashcards
1
Q
What drugs may lead to drug induced Parkinsonism?
A
Prochlorperazine Metoclopramide Antipschychotics CCBs Amiodarone Choroquinine
2
Q
What type of tremor is present in drug induced parkinsonism?
A
course postural tremor
3
Q
Is there a response to Levodopa in Progressive supranuclear palsy?
A
no
4
Q
When is the age of onset of multiple system atrophy (Shy-Drager)?
A
60s/70s
5
Q
Triad of features in Shy Drager?
A
dysautonomia, cerebellar features eg hyperreflexia and parkinsonism
6
Q
In who does dropped head (Marked Antecollis) occur?
A
Shy drager
7
Q
In what condition does alien limb phenomenon occur?
A
Cortico-basal degeneration
8
Q
What is essentiaal tremor often confused with?
A
PD
9
Q
What type of inheritance does essential tremor have?
A
Autosomal Dominant
10
Q
Is essential tremor a resting tremor?
A
not so much
11
Q
What reduces an essential tremor?
A
small amounts of alcohol
12
Q
In patients with abnormal repeats in FMR1 gene, with a slow progressing disease of Parkinsonism?
A
Fragile X tremor ataxia syndrome
13
Q
What will an MRI show in Fragile X tremor ataxia syndrome?
A
MCP sign (hyperintensity in middle cerebellar peduncles)
14
Q
In whom are there milder symptoms of Fragile X tremor ataxia?
A
females with POF/menopause
15
Q
Most common type of MS?
A
relapsing remitting
16
Q
Describe relapsing remitting MS.
A
Acute attacks lasting 1-2 months, followed by periods of remission
17
Q
What is secondary progressive MS?
A
relapsing/remitting patients who go on to develop neurological signs between relapses/deteriorate
18
Q
Are gait and bladder disturbance issues seen in secondary progressive MS?
A
yes
19
Q
Who is primary progressive disease of MS more common in?
A
older people
20
Q
What is the least common form of MS?
A
progressive relapsing, involving progressive worsening of the condition from the beginning
21
Q
Is cognitive impairment common in MS?
A
no
22
Q
Is MS a disease of white or grey matter?
A
white
23
Q
Where are MS plaques commonly seen?
A
optic nerve, preventricular white matter, corpus callosum, brain stem, spinal cord
24
Q
What are the 3 different types of plaques in MS.
A
active (ongoing myelin breakdown, abundant macrophages) inactive (contain little or no myelin, astocyte growht and gliosis occur) Shadow plaques (border between normal and affeted white matter not clear)
25
What are the two types of active plaques?
acute (yellow/brown)
| chronic (grey brown)
26
Which type of active plaque has well defined edges?
chronic
27
What is the most serious long term complication of measles?
sub acute sclerosis panencephalitis
28
What can cause metabolic demyelination?
vitamin deficiencies
29
What can cause toxic demyelination?
chronic, low grade, solvent
30
In early onset Alzheimer's, what is the trait?
autosomal dominant
31
In what genetic condition is there an increased risk of Alzheimers?
Down's syndrome
32
What happens to sulci in Alzheimer's?
widen
33
What happens to gyri in Alzheimer's?
narrow
34
In alzheimer's, what is seen on micrscopic pathology?
neurofibrillary triangles, AB amyloid plaques, amyloid angiopathy, extensive neuronal loss with atrocytosis
35
Dementia with hallucination/fluctuatin levels of attention?
Lewy Body Dementia
36
What occurs in L B D?
degeneration of substantia nigra
37
How can L B D be detected?
immunochemical staining for ubiquitin
38
Age of onset of Huntington's?
35-50
39
Inheritance of Huntington's?
autosomal dominant
40
Pathology of Huntingtons?
loss of neurons in caudate nucleus and cerebral cortex
| Reactive fibrillary gliosis
41
Early signs of Huntington's?
Clumsiness, agitation, irritability, abnormal eye movements
42
Progression to severe dependency and death in Hungtintons occurs over how many years?
15-20 years
43
Briefly describe the progression of Huntington's.
Chorea ≫ Agitation ≫ Dementia ± seizures ≫ Death
44
Treatment of Huntington's?
Is typically only supportive
| Antipsychotics (e.g. chlorpromazine, haloperidol) can be useful o reduce chorea and agitation
45
What is Pick's disease also known as>
frontotemporal dementia
46
Describe the pathology in the brain in Pick's disease.
```
Pick cells (swollen neurons)
and Pick's bodies (intracytoplasmic filamentous inclusions)
EXTREME ATROPHY of frontal and temporal lobes
```
47
How long does Pick's tend to last?
2-10 years (rapidly progressive)
48
What type of dementia has stepwise progression?
Multi-infarct
49
In mult infarct dementia, are sufferes aware of their mental deficits?
yes - leads to depression/anxiety
50
Diagnosis of stroke?
Urgent CT
51
Secondary prevention in stroke?
clopidogrel = 1st line
Aspirin/dipyridamole
Carotid endartectomy if patient has suffered stroke in carotid territory and are not severely disabled
52
What is the syndrome involving antibodies to the presynaptic calcium channels leading to less vesicle release?
Lambert Eaton Myasthenic Syndrome
53
In what ways does Lambert Eaton Myasthenic Syndrome differ from myasthenia gravis?
- gait problems occur first (before eyes)
- autonomic involvement eg dry mouth, impotence, constipation
- hyporeflexia and weakness improves after exercise
- less response to edrophonium
54
Ratio of F:M in MG?
3:2
55
In whom, men or women, does MG occur younger?
women (occurs in 30s compared to 60s in men)
56
MG is an autoimmune disease in which antibodies to what interfere with neuromuscular transmission?
ACh receptors
57
Describe tendon reflexes in MG.
Normal
58
Give 4 signs of MG.
diplopia
ptosis
Snarl on smiling
peek sign (after gentle lid closure, eyes open to show white sclera)
59
What happens to patients with MG when they count to 40?
voice fades
60
What do symptoms of Lambert Eaton myasthenic syndrome precede?
cancer by 4 years - do CXR/CT
61
Treatment for Lambert Eaton myasthenic syndrome?
3-4 diaminopyridine or IV immunoglobin
62
Treatment for MG?
```
ACh inhibitor (Pyridostigame)
Prednisolone
```
63
Investigation of MG?
check for antiCHR antibodies
64
Imaging in MG?
ct of thymus
65
What may occur in a myasthenic crisis and what should be monitored?
weakness of resp muscles
| monitor FVC
66
Commonest muscular dystrophy?
myotonic dystrophy
67
Inheritance of Myotonic dystrophy?
AD
68
What is myotonia?
tonic spasm of muscle
69
Other symptoms of Duchenne MD?
weakness, cataracts, ptosis, frontal balding, cardiac defects
70
What is the condition in which damage to skeletal muscle causes leakage of large quantities of toxic intracellular contents into plasma?
rhabdomyolysis
71
Causes of rhabdomyolysis?
crush injuries, toxins, post convulsions
72
Triad in rhabdomyolysis?
Myalgia, muscle weakness, myoglobulinuria
73
What complications are there inrhabdomyolysis?
acute renal failure
| DIC
74
What will bacterial meningitis show in the SA space?
neutrophils
75
Bacterial meningitis cause in NEONATES?
listeria, group B strep, E coli
76
Bacterial meningitis cause in CHILDREN?
Haem influenza
77
Bacterial meningitis cause in 10-21 years?
Meningococcal/neisseria
78
Bacterial meningitis cause in over 21a?
Pneumococcal
79
Bacterial meningitis cause in elderly?
pneumococcal
80
Open head trauma Bacterial meningitis cause ?
staph aureus/epidermis
81
Bacterial meningitis cause in AIDs?
cryptococcus neoformans
82
What is Kernig's sign in bacterial meningitis?
pain and resistance on passive knee extension with hip fully flexed
83
In whom are the signs of bacterial meningitis not always present?
elderly, children, immunocompromised
84
Who is most likely to get niesseria meningitis?
young children
85
What type of viruses cause viral meningitis?
enteroviruses eg ECHO cirus
86
Treatment of viral encephalitis?
rapid IV aciclovir, high dose
87
Treatment of viral meningitis?
supportive
88
In whom does crytococcal meningitis occur?
HIV
89
Treatment of HIV meningitis?
IV emphotericin B/Flucytosine
| Fluconoazole
90
Causative organism of meningitis in neonates?
Group B strep, listeria or E coli
91
Treatment of Group B strep/neonate meningitis?
benzylpenicillin and gentamicin
92
Which bacteria which can be found in soft cheeses and pate?
Listeria
93
Treatment of listeria meningitis?
amoxicillin and gentamicin
94
Classic triad in brain abscess?
fever, headache, focal neurological signs
95
Investigation of Brain absceess?
CT brain with contrast
96
Treatment of brain abscess?
antibx (ceftriaxone and metronidazole)
| Drainage
97
Two peaks of onset of narcolepsy?
15 and 36
98
What is cataplexy?
strong emotion causes a person to collapse
99
What is RBC in narcolepsy?
REM behavioural disorder
100
Investigation of narcolepsY?
overnight polysomnography
| record of EEG, muscle activity and eye movement recorded
101
What will a lumbar puncture show in narcolepsy?
lower hypocretin levels
102
Two peak ages of onset of narcolepsy?
15/36
103
Is motor neurone disease treatable?
NO
104
Average survival time in MND?
3 years
105
What can prolong life in MND by about 3 months?
Riluzole
106
What characterizes MND?
selective loss of neurons in motor cortex, cranial nerve nuclei and anterior horn cells
107
Name the 4 types of motor neurone disease.
ALS -occurs in 50%
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis
108
What type of dementia occurs in around 25% of patients with MND?
frontotemporal
109
Describe a typical patient with MND.
40 yr old, stumbling, spatic gait, foot drop, proximal myopathy, weak grip and shoulder abduction - tasks such as hair washing become hard
110
What type of pneumonia may occur in MND?
aspiration pneumonia
111
Progressive muscular atrophy affects which muscle groups first?
distal before proximal
112
In which type of MND is there loss of Betz cells in the motor cortex?
Primary lateral sclerosis
113
Where is the lesion in progressive muscular atrophy ?
anterior horn cell lesion
114
Where is motor neuron loss in ALS?
motor cortex AND anterior horn of the cord
115
Are eye movements affected in MND?
no
116
Babinskis sign (weakness and upper motor neuron signs?
ALS
117
What does progressive bulbar palsy affect?
cranial nerves 9-12
118
Two types of progressive bulbar palsy?
Bulbar
| Corticobulbar
119
Which is the most common type of progressive bulbar palsy?
corticobulbar
120
How do the symptoms of bulbar and corticobulbar palsies differ?
Speech is quiet in bulbar, but slow and deliberate in corticobulbar
Jaw jerk is increased in corticobulbar but normal in bulbar
121
Headache which is worse on coughing and leaning forwards?
Raised ICP
122
What happens to pulse and bp if there is raised ICP?
falling pulse and rising BP (Cushing's response)
123
What type of respiration occurs in raised ICP?
Cheyne-Stokes
Progressively deeper and sometimes faster breathing, following by a gradual decrease,
leading to a temporary apnoea
124
What pupil changes occur in raised ICP?
constriction initially, then dilation
125
Treatment of raised ICP?
ABCDE
Maintain MAP at more than 90mm/Hg
Elevate the head of the bed to 30-40 degrees
Hyperventilate to decrease PCO2 (This causes vasoconstriction and reduces ICP almost immediately
Mannitol can be given
-Corticosteroids only useful in reducing oedema surrounding tumours
-Restrict fluid
-MAKE DIAGNOSIS
126
Is there a diagnostic test for MND?
no
127
Name 3 herniation syndromes.
Uncal herniation
Cerebellar tonsil herniation
Subfalcian/cingulate herniation
128
A subfalcian herniation is silent unless what occurs?
anterior cerebral artery is compressed causing STROKE
129
Which type of cerebral herniation causes dilated ipsilateral pupil then opthalmoplegia due to 3rd nerve compression?
UNCAL herniation
130
What mainly causes Sub dural haematoma?
trauma
131
Is a sub dural haematoma the same as a sub dural haemorrhage?
yes
132
Symptoms of Sub dural Haemorrhage?
```
fluctuating consciousness
insidious physical/intellectual slowing
Sleepiness
Headache
personality change
unsteadiness
```
133
What on the CT/MRI differentiates a subdural haemorrhage from an extradural haemorrhage?
crescent shaped collection of blood over one hemisphere
134
Treatment of SDH?
irrigation/evacuation via BURR TWIST DRILL and craniostomy
135
What term describes the condition of ventricular dilation of the absence of raised CSF pressure on lumbar puncture?
Normal pressure hydrocephalus
136
Is Normal pressure hydrocephalus a cause of dementia?
yes - a potentially reversible cause
137
Triad of features in Normal pressure hydrocephalus?
Gait abnormality
Urinary incontinence
Dementia
138
Treatment of Normal pressure hydrocephalus?
Acetozolamide and repeated lumbar puncture
| Surgical insertion of a shunt
139
Who are more likely to get migraines, females or males?
females
140
Associations with migraines?
obesity, patent foramen ovale
141
Describe a classic migraine.
aura lasting 15-30 mins followed within 1 hr by unilateral throbbing headache
142
What type of drugs are anti migraine?
triptan
143
Describe a tension headache.
pressing tingling quality to pain
Bilateral
NO other features eg nausea, photophobia
144
Describe a cluster headache.
Rapid onset of excruciating pain around 1 eye, eye becomes water and bloodshot with lid swelling
Rhinorrhea, facial flushing
Pain is UNILATERAL and normally affects same side
145
Treatment of cluster headache?
O2
Sumatriptan
Prevention: prednisolone, lithium, verpramil
146
What is the type of headache ass with large vessel vasculitis?
giant cell arteritis
147
Symptoms of Giant Cell arteritis?
headache, temporal artery/scalp tenderness, jaw claudication, am fugax, sudden blindness
148
Can you get skip lesions in giant cell arteritis?
yes
149
Management of GCA?
Start prednisolone immediately
150
What is GCA associated with?
polymyalgia rheumatica (50% of the time)
151
In whom is trigeminal neuralgia more common in?
males, over 50
152
Describe trigeminal neuralgia.
moments of intense stabbing pain for a few seconds, unilateral
153
Investigation for trigeminal neuralgia?
MRI
154
Treatment for trigeminal neuralgia?
- Carbamazepine
- Lamotrigine
- Phenytoin
- Gabapentin
- Surgery
155
Describe an extradural haemorrhage.
Accumulation of blood between the bone and the dura.
156
What often causes an extradural haemorrhage?
fractured temporal/parietal bone, due to traume just lateral to eye
157
What will any tear in the dural sinus cause?
an extradural bleed
158
What will CT show in extradural haemorrhage?
biconvex shape
| may also see skull fracture on X ray
159
Treatment of an extradural haemorrhage?
clot evacuation and ligation of bleeding vessel
160
Subarachnoid haemorrhage - describe the headache?
sudden onset, severe, like being hit on the back of head with a brick
161
What is Subarachnoid haemorrhage usually caused by?
underlying Berry aneurysm
162
Symptoms of Subarachnoid haemorrhage?
meningism eg photophobia neck stiffness etc
| headache
163
Investigation of Subarachnoid haemorrhage?
CT, lumbar puncture
164
How can Subarachnoid haemorrhage be differentiated from a traumatic tap?
by taking 3 CSF samples (blood should decrease)
165
Associations of Berry aneurysms?
Ehler-Danlos
Polycystic kidneys
Coarctation of aorta
166
What does menopause do to risk of Berry aneurysm?
increase risk
167
Gold standard investigation for Berry aneurysm?
cerebral angiography via femoral artery
168
In what does Charcot Bouchard microaneurys,s arise of small perforating artieres?
intracerebral haemorrhage
169
Investigation for intracerebral haemorrhage?
urgent CT
| angiography
170
What about the clot means an improved prognosis in intracerebral haemorrhage?
if it is superficial and there is a good neurological status
171
Who typically gets idiopathic intracranial hypertension?
obese women
172
Symptoms of idiopathic intracranial hypertension?
headache, with diurnal variation
blurred vision and narrowed visual fields
enlarged blind spot and papilloedema
173
Who does hypnic headache affect?
elderyl
174
What type of headache is a hypnic headache?
moderate throbbing headache, wakes patient from sleep
175
Treatment for a hemicrania continua (causes continous one sided head pain)?
indomethacin
176
What drugs are most likely to cause medication overuse headache?
triptans/opoids
177
Investigations in epilepsy?
refer to specialist
| who will do ECG and EEG(confirm type)
178
In which seizure type are there features referable to a part of ONE hemisphere?
partial seizures
179
What is often seen with partial seizures underlying?
structural disease
180
Describe the 2 types of partial seizures.
Simple partial - awareness UNIMPAIRED
| Complex partial - awareness IMPAIRED
181
List the 5 subtypes of Primary generalized seizures.
```
Absence
Tonic clonic
Myoclonic
Atonic (akinetic)
Infantile
```
182
Describe an absence seizure and its treatment.
```
Brief pauses (less than 10 secs)
presenting in childhood
Treatment = sodium valproate
```
183
Describe a tonic clonic seizure and its treatment.
Loss of consciousness, limbs stiffen (tonic) and jerk (clonic), following which there is confusion/drowsiness
Treatment = sodium valproate
184
Describe a myoclonic seizure and its treatment.
Sudden limb/face/trunk jerk, may be suddenly thrown to ground. Violently disobedient limb
Treatment = sodium valproate
185
Describe atonic seizures and treatment.
sudden loss of muscle tone causing fall
NO loss of consciousness
Treatment = sodium valproate
186
Describe treatment for partial seizures.
Carbamazepine
| then lamotrigine
187
Define status epilepticus.
seizures lasting more than 30 mins
188
What is the likely cause if a pregnancy woman has status epilepticus.
pre eclampsia
189
Investigation of status epilepticus?
FBCs
190
Treatment of status epilepticus?
lorazepam, phenytoin, diazepam, dexamethosone if possible oedema
191
What is non epileptiform attack disorder?
Seizures without electrical activity changes in brain, may be functional. Rapid recovery soon after attacks, patients recognise triggers
192
Investigation if a space occupying lesion is suspected?
CT/MRI
| Biopsy
193
Symptoms of space occupying lesion?
headache worse on waking, lying down, bending forward, with coughing etc
seizures in 50%
194
Treatment of benign space occupying lesion?
removal
195
Treatment of malignant SOL?
excision may be difficult, chemoradiotherpy/shunt may be needed
196
Triggers for Guillian Barre syndrome?
campylobacter infection, CMV, mycoplasma, zoster, HIV, EBV, vaccinations
197
Describe Guillian Barre syndrome.
An acute inflammatory demyelinating polyneuropathy, occuring several weeks after an infection
198
Describe the pattern of muscle weakness in Guillian Barre.
symmetrical ascending muscle weakness
| sensory symptoms precede weakness
199
Treatment of Guillian Barre?
IV immunoglobulin
| Plasmapharesis
200
Name the disease of peoneal muscular atrophy causing week legs, foot drop and starting in puberty?
Charcot Marie Tooth
201
Treatment of hereditary spastic paraplegia (causes weakness/stiffness over time, sparing hands and arms)?
muscle relaxants and physio
202
What term is used if 2 or more peripheral nerves are affected?
Mononeuritis multiplex
203
Causes of Mononeuritis multiplex?
```
WARDS PLC
Wegeners
AIDS/Amyloid
Rheumatoid
Diabetes
Sarcoidosis
PAN
Leprosy
Carcinomatosis
```
204
1st line for neuropathic pain?
amitriptyline/duloxetine/gabapentin/pregabalin
| Tramadol can be used as rescue therapy
205
Examples of neuropathic pain?
diabetic neuropathy
trigeminal neuralgia
Prolapsed disc
Post herpetic neuralgia
