Random Neurology Facts/Questions

Question 1

Differentials for Cerebellopontine angle tumours

Answer 1

Schwannoma (8th»5th), Aneuryms, arachnoid cyst, meningioma, mets, epidermoid, ependymoma (SAME)

Question 2

Cranial Nerve 1 name, location and function

Answer 2

Olfactory: sense of smell. Extending across inferior frontal lobe. Runs with anterior cerebral artery

Question 3

Cranial nerve 2 name, location and function

Answer 3

optic, sensory component of vision. located superior to the infundibulum. I.e. the anterior midbrain. Surrounded by anterior communicating artery and opthalmic artery which come from the internal carotid

Question 4

CN 3name, location and function

Answer 4

Occulomotor, inferior to the mammillary body in the midbrain. Eye movements. Comes out between the posterior cerebral and superior cerebellar arteries. Posterior communicating superior to it

Question 5

CN 4 name, location and function

Answer 5

Trochlear, junction of midbrain and pons. Superior oblique muscle. I.e. cant go crosseyed Hugged by the Posterior cerebral artery and superior cerebellar artery

Question 6

CN5 name, location and function

Answer 6

Trigeminal Nerve, Sensory and motor: S:face, sinuses teeth. M: muscles of mastication. 3 branches Opthalmic, mandibular and maxillary. Mandicular is only one with motor component. Appears in the mid pons. Runs out like a chicken foot across the cerebellopontine angle.
Lateral to pontine arteries and inferior to superior cerebellar arteries

Question 7

CN 6 name, location and function

Answer 7

Abducens: lateral rectus, abduction of the eye. Most anterior of ponto-medullary nerves. Sits superior to the AICA

Question 8

CN 7 name, location and function

Answer 8

Facial : Muscles of the face. Temporal, Zygomatic, buccal, marginal mandibular, cervical) Exists with the Vestibulocochlear nerve in the mediolateral ponto-meduallar junction. SUperior to lateral AICA

Question 9

CN 8 name, location and function

Answer 9

Vestibulocochlear Inner ear sensation. Runs with facial nerve in the mediolateral pontomedullary junction. Superiro to lateral AICA

Question 10

CN 9 name, location and function

Answer 10

Glossopharyngeal Motor and sensory: pharyngeal motor, posterior sensation of tongue and pharynx. Supero-lateral medulla Triangulated by AICA, vertebral artery and posterior inferior cerebellar artery.

Question 11

CN 10 name, location and function

Answer 11

Vagus Motor and sensory: Motor to heart, lungs, bronchi etc. Sensory to vicera too. Triangulated by AICA, vertebral artery and posterior inferior cerebellar artery.

Question 12

CN 11 name, location and function

Answer 12

Accessory nerve : Sternocleidomastoid and trapezius muscle. Triangulated by AICA, vertebral artery and posterior inferior cerebellar artery. but then runs paravertebrally

Question 13

CN 12 name, location and function

Answer 13

Hypoglossal Muscles of the tongue. Branches out from anterior medulla. Triangulated by AICA, vertebral artery and posterior inferior cerebellar artery.

Question 14

Cranial nerve not named : name, location and function

Answer 14

Intermediate nerve comes out between the 7th and 8th CN and has motor: submaxillary and sublingular gland. Sensory to anterior part of the tongue and soft palate.

Question 15

Proteins seen in Alzheimers disease

Answer 15

Tau protein and Beta amyloid (42)

Question 16

Mechanism of action of acetazolamide

Answer 16

Carbonic anhydrase inhibitor: acts on the proximal tubule (essentially creating a T2RTA). As carbonic anhydrase is blocked, sodium is wasted at the expense of holding onto H+. It therefore drops intravasc. pressure: can use in glaucoma and also IIH

Question 17

Common deficiency seen in MS

Answer 17

Vitamin D

Question 18

Common deficiency in restless legs syndrome

Answer 18

Iron

Question 19

Cause of vitamin A def.

Answer 19

Uncommon in the developed world. Only seen really in pancreatic insufficiency

Question 20

Causes of Vitamin B12 def.

Answer 20

Often seen in those with drug habit, in particular NANGs i.e. Nitrose oxide.

Question 21

Typical host of werneckies symptoms

Answer 21

B1 is thiamine –> ataxia, opthalmoplegia, nystagmus,

Question 22

Corticobasilar degeneration typical features

Answer 22

asymetric parkinsons, dystonia, myoclonus, apraxia

Question 23

Choice of antiepileptic in those who are young, pregnant or have psychiatric issues

Answer 23

Lamotrigine

Question 24

Treatment for trigeminal neuralgia first line

Answer 24

carbemazepine

Question 25

Treatment for SUNCT and definition/presentation

Answer 25

Lamotrigine short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is one of the rarest of all primary headache syndromes. It is one of the trigeminal autonomic cephalalgias, along with cluster headache and paroxysmal hemicrania

Question 26

Trigeminal autonomic cephalalgias and how to differentiate

Answer 26

Cluster headache, SUNCT, paroxysmal hemicrania Cluster: strictly unilateral, circadian periodicity. 15-90 mins, aggrevated with exercise, alcohol. Treat with O2, subcut sumitriptan, lignocaine topically. Prevent with verapamil Paroxysmal hermicrania: Unilateral, differs due to the shorter duration and higher frequency. Can be centred retro-orbital or occipital. Typically have 5 daily and up to 40. Usually mechanically triggered i.e. bending over. Treatment is with Indomethocin- aborts universally SUNCT: MOST brief and MOST frequent 5-250 seconds. Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Usually opthalmic distribution of trigeminal nerve. Should have MRI- posterior fossa abnormalities are common. Lamotrigine is the most effective

Question 27

Cluster headache

Answer 27

Cluster: strictly unilateral, circadian periodicity. 15-90 mins, aggrevated with exercise, alcohol. Treat with O2, subcut sumitriptan, lignocaine topically. Prevent with verapamil

Question 28

Paroxysmal hemicrania

Answer 28

Paroxysmal hermicrania: Unilateral, differs due to the shorter duration and higher frequency. Can be centred retro-orbital or occipital. Typically have 5 daily and up to 40. Usually mechanically triggered i.e. bending over. Treatment is with Indomethocin- aborts universally

Question 29

SUNCT

Answer 29

SUNCT: MOST brief and MOST frequent 5-250 seconds. Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Usually opthalmic distribution of trigeminal nerve. Should have MRI- posterior fossa abnormalities are common. Lamotrigine is the most effective

Question 30

Contraindications to acetylcholinesterase inhibitors

Answer 30

LBBB, sick sinus, heart blocks.

Question 31

Cause of VI CN palsy that would also lead to pachymeningeal enhancement on MRI

Answer 31

Intracranial hypotension

Question 32

Typical story for vascular cognitive impairment

Answer 32

Increasing impulsivity and also hypomania: eating lots, shouting, sudden emotional change wiht laughing and crying 'pseudobulbar effect'

Question 33

side effect of fingolimod

Answer 33

Maccular oedema first dose can cause bradycardia

Question 34

Immune-mediated necrotising myopathy findings

Answer 34

Necrotising muscle without inflammation. Anti-3-hydroxy-3-methylglutaryl-coA reductase (anti-HMGCR) and anti-signal recognition particle (anti-SRP) antibodies are crucial for dx.

Question 35

Stroke: when to initiate anticoagulation in patient with cardioembolic stroke

Answer 35

1-3-6-12 rule. 1 day post TIA, 3 days post small non-disabling stroke, 6 days post moderate and 12 days to 2 weeks post large artery stroke with significant deficit. Commence aspirin in the interim

Question 36

Cause of subacute combined degeneration of the cord and associations

Answer 36

Combined degeneration of the cord refers to the dorsal and lateral columns being affected demyelinating. B12 deficiency is common as a cause. Which causes a raised homocystine level and elevated methylmalonic acid (MMA)

Question 37

Spinal cord components and function

Answer 37

Lateral corticospinal tract: Motor: decussates at medullary pyramids Posterior column-medial lemniscal pathway: Sensory (Vibration, proprioception, fine touch) - crosses in lower medulla Anterolateral pathways are sensory - pain, temperature, crude touch - decussate in the spinal cord at anterior commissure

Question 38

Brown-sequard syndrome

Answer 38

Hemi-cord lesion Lateral corticospinal tract damage : ipsilateral upper motor neuron weakness Posterior column: ipsilateral vibration and proprioception loss Anteriolateral system: contralateral pain and temperature loss

Question 39

First line management for focal seiures

Answer 39

Lamotrogine: AEs of slow titration and potential for SJS

Question 40

Sensorimotor symptoms and how to work through them:

Answer 40

Symmetric or asymmetric Symmetric: distal, proximal or mixed Proximal = myopathy, ALS or myasthenia Proximal and distal: with no reflexes = GBS or CIDP Brisk reflexes: myelopathy Fluctuating weakness with no sensory deficit = LEMS or myasthenia Distal Symmetric if pure motor = hereditary syndrome sensory + motor is typically metabolic, metastatic (paraneoplastic) or toxic Sensory purely : Diabetes, metabolic, HIV, nutritional, amyloid Painful small fibre without large fibre = HIV, diabetes, amyloid Asymmetric: Purely distal motor = ALS, inclusion body myositis or multifocaly motor neuropathy Motor + sensory Entrapment, radiculopathy, vasculitis, HNPP, HIV Proximal + distal with pure sensory = ganglionopathy: paraneoplastic, sjogrens, HIV Motor + sensory = polyradiculopathy, plexopathy, mononeuritis multiplex

Question 41

Difference between large and small fibre neuropathy

Answer 41

Large fiber neuropathy manifests with the loss of joint position and vibration sense and sensory ataxia, whereas small fiber neuropathy manifests with the impairment of pain, temperature and autonomic functions.

Question 42

Red flag symptoms for Parkinsons plus: dysautonomia

Answer 42

MSA

Question 43

Red flag symptoms for Parkinsons plus: Opthalmoiplegia (can't look up)

Answer 43

PSP

Question 44

Red flag symptoms for Parkinsons plus: Early cognitive impairment

Answer 44

DLB sometimes PSP or vascular parkinsonism

Question 45

Red flag symptoms for Parkinsons plus: Visual hallucinations not provoked by meds

Answer 45

DLB

Question 46

Red flag symptoms for Parkinsons plus: Instability and falls

Answer 46

MSA and PSP (espeically wihtin the first year)

Question 47

Red flag symptoms for Parkinsons plus: Marked asymmetry

Answer 47

anything but parkinsons

Question 48

Red flag symptoms for Parkinsons plus: rapid onset and stepwise deterioration

Answer 48

Vascular parkinsonism

Question 49

Red flag symptoms for Parkinsons plus: lack of response to L dopa

Answer 49

Anything but parkinsons

Question 50

Sensitivity of CT for SAH

Answer 50

Sensitivity at 12 hours is 95%

Question 51

PRES definition, causes, treatment

Answer 51

Posterior reversible encephalopathy syndrome (PRES) is a syndrome of ‘cephalgia, convulsions, confusion, and vision loss’ (CCCV) typically in the context of severe hypertension Severe hypertension, beit from pre-eclampsia or other causes is the driver of pathophysiology MRI-B classically bilateral hyperintense densities in the parieto-occipital regions on T2 weighted images

Question 52

Normal opening pressure for LP

Answer 52

10-25 cm

Question 53

Idiopathic intracranial hypertension

Answer 53

CSF pressure >25 cm - clinical features including increased blind spot with risk factors of being female, obese Can treat with acetezolamide, but the key is weight loss

Question 54

MRI findings of non-nodular pachymeningeal enhancement cause

Answer 54

Low pressure - post LP is the most common. Treat with blood patch

Question 55

Trigeminal neuralgia cause

Answer 55

15% non-vascular or demyelinating, 85% are vascular - typically the superior cerebellar artery loop. However, in young persons presenting with trigeminal neuralgia, think about MS as it is a common presenting symptom of MS in the under 50 age group.

Question 56

Carbemazepine MOA

Answer 56

Sodium channel blocker, SE agranulocytosis and hyponatraemia

Question 57

Treatment trigeminal neuralgia

Answer 57

Carbemazepine: second line gabapentin, baclofen. Can progress to Gamma knife surgery or posterior fossa decompression

Question 58

Contraindication to triptan use

Answer 58

Hemiplegic migraine or migraine with brainstem aura I.e. migraine with hard neurological signs or symptoms (Two or more brainstem-related aura symptoms (ie, dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia, decreased level of consciousness) Also contraindicated in uncontrolled HTN or significant vascular disease

Question 59

Triptans MOA

Answer 59

Selective agonists for 5 hydroxytriptamine receptors (5HT) specifically 1B (reverse intracranial dilatation) and 1D (neuronal inhibition)

Question 60

Cough headache association

Answer 60

MRI-B will lead to discovery of chiari malformation in 50% of cases

Question 61

Triggers for draining extradural haemorrhage

Answer 61

>10mm, GCS <9, Papillary asymmetry, midline shift of 5mm if a chronic bleed

Question 62

Classification of seizures

Answer 62

Focal/partial or generalised If focal/partial: with or without impaired awareness Focal with impaired awareness can then tend to secondary generalised seizure NOTE: absence seizures are a form of GENERALISED seizure

Question 63

Most common structural abnormality that leads to seizures

Answer 63

Mesial-temporal sclerosis with associated temporal lobe epilepsy : auram, loss of awareness, staring, behaviour change and amnesia In patients with concurrent hipocampal atrophy, treatment is particularly difficult

Question 64

'generalised spike waves' on EEG

Answer 64

referring to generalised seizure activity

Question 65

Mutation associated with MND

Answer 65

SOD1 | Glutamate levels increase and are toxic to the neuronal system

Question 66

Pathological signature of MND

Answer 66

TDP 43 inclusions (not associated with SOD1 strangely)

Question 67

Split hand syndrome

Answer 67

First dorsal interossei wasting out of proportion to the wasting seen in abductor digiti minimi (i..e rules out ulnar nerve lesion) Abductor pollicis brevis (thenar eminence) wasting

Question 68

CADSIL meaning

Answer 68

Cerebral autosomal dominant ateriopathy with subcortical infarcts and elukoencephalopathy: NOCTH3 gene Migraines in middle age as clue.

Question 69

B12 deficiency presentation

Answer 69

Also called cobalamin. Elevated MMA and Homocystine. Common in Strict vegetarians or vegans. Sub-acute degeneration of the cord can occur in B12 deficiency. Stores of B12 are 3-5 years

Question 70

Folate deficiency presentation

Answer 70

Also called vitamine B9. Limited stores of Folate, but seldom def. seen unless alcohol etc.

Question 71

Part of the brain responsible for hemibalismus

Answer 71

Subthalamic nucleus

Question 72

Most common imaging finding in someone with focal epilepsy?

Answer 72

Hippocampal sclerosis i.e. mesial temporal sclerosis | Coupling this a history of febrile juvenile seizures is common

Question 73

Focal epilepsy mannifest which clinical seizure syndrome

Answer 73

Temporal lobe epilepsy

Question 74

Temporal lobe epilepsy seminology

Answer 74

Aura is common including gustatory. There is often impaired awareness for a short period of time. Repetitive stereotypes movements or automatisms are seen.

Question 75

Limbic encephalitis associations with cancer

Answer 75

Anti-Hu, which is associated with small-cell carcinoma of the lungs. Anti-Ma2, associated with germ-cell tumours of the testis. Anti-NMDAR, associated with tumors of the ovaries, commonly teratomas.

Question 76

GBS type of nerve fibres affects

Answer 76

Large myelinated fibres