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Neurology > Random Neurology Facts/Questions > Flashcards

Random Neurology Facts/Questions Flashcards

1
Q

Differentials for Cerebellopontine angle tumours

A

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

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2
Q

Cranial Nerve 1 name, location and function

A

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

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3
Q

Cranial nerve 2 name, location and function

A

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

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4
Q

CN 3name, location and function

A

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

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5
Q

CN 4 name, location and function

A

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

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6
Q

CN5 name, location and function

A

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

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7
Q

CN 6 name, location and function

A

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

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8
Q

CN 7 name, location and function

A

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

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9
Q

CN 8 name, location and function

A

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

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10
Q

CN 9 name, location and function

A

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.

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11
Q

CN 10 name, location and function

A

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

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12
Q

CN 11 name, location and function

A

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

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13
Q

CN 12 name, location and function

A

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

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14
Q

Cranial nerve not named : name, location and function

A

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.

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15
Q

Proteins seen in Alzheimers disease

A

Tau protein and Beta amyloid (42)

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16
Q

Mechanism of action of acetazolamide

A

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

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17
Q

Common deficiency seen in MS

A

Vitamin D

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18
Q

Common deficiency in restless legs syndrome

A

Iron

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19
Q

Cause of vitamin A def.

A

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

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20
Q

Causes of Vitamin B12 def.

A

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

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21
Q

Typical host of werneckies symptoms

A

B1 is thiamine –> ataxia, opthalmoplegia, nystagmus,

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22
Q

Corticobasilar degeneration typical features

A

asymetric parkinsons, dystonia, myoclonus, apraxia

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23
Q

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

A

Lamotrigine

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24
Q

Treatment for trigeminal neuralgia first line

A

carbemazepine

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25
Q

Treatment for SUNCT and definition/presentation

A

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

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26
Q

Trigeminal autonomic cephalalgias and how to differentiate

A

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

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27
Q

Cluster headache

A

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

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28
Q

Paroxysmal hemicrania

A

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

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29
Q

SUNCT

A

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

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30
Q

Contraindications to acetylcholinesterase inhibitors

A

LBBB, sick sinus, heart blocks.

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31
Q

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

A

Intracranial hypotension

32
Q

Typical story for vascular cognitive impairment

A

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

33
Q

side effect of fingolimod

A

Maccular oedema first dose can cause bradycardia

34
Q

Immune-mediated necrotising myopathy findings

A

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.

35
Q

Stroke: when to initiate anticoagulation in patient with cardioembolic stroke

A

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

36
Q

Cause of subacute combined degeneration of the cord and associations

A

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)

37
Q

Spinal cord components and function

A

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

38
Q

Brown-sequard syndrome

A

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

39
Q

First line management for focal seiures

A

Lamotrogine: AEs of slow titration and potential for SJS

40
Q

Sensorimotor symptoms and how to work through them:

A

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

41
Q

Difference between large and small fibre neuropathy

A

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.

42
Q

Red flag symptoms for Parkinsons plus: dysautonomia

A

MSA

43
Q

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

A

PSP

44
Q

Red flag symptoms for Parkinsons plus: Early cognitive impairment

A

DLB sometimes PSP or vascular parkinsonism

45
Q

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

A

DLB

46
Q

Red flag symptoms for Parkinsons plus: Instability and falls

A

MSA and PSP (espeically wihtin the first year)

47
Q

Red flag symptoms for Parkinsons plus: Marked asymmetry

A

anything but parkinsons

48
Q

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

A

Vascular parkinsonism

49
Q

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

A

Anything but parkinsons

50
Q

Sensitivity of CT for SAH

A

Sensitivity at 12 hours is 95%

51
Q

PRES definition, causes, treatment

A

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

52
Q

Normal opening pressure for LP

A

10-25 cm

53
Q

Idiopathic intracranial hypertension

A

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

54
Q

MRI findings of non-nodular pachymeningeal enhancement cause

A

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

55
Q

Trigeminal neuralgia cause

A

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.

56
Q

Carbemazepine MOA

A

Sodium channel blocker, SE agranulocytosis and hyponatraemia

57
Q

Treatment trigeminal neuralgia

A

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

58
Q

Contraindication to triptan use

A

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

59
Q

Triptans MOA

A

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

60
Q

Cough headache association

A

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

61
Q

Triggers for draining extradural haemorrhage

A

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

62
Q

Classification of seizures

A

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

63
Q

Most common structural abnormality that leads to seizures

A

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

64
Q

‘generalised spike waves’ on EEG

A

referring to generalised seizure activity

65
Q

Mutation associated with MND

A

SOD1

Glutamate levels increase and are toxic to the neuronal system

66
Q

Pathological signature of MND

A

TDP 43 inclusions (not associated with SOD1 strangely)

67
Q

Split hand syndrome

A

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

68
Q

CADSIL meaning

A

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

69
Q

B12 deficiency presentation

A

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

70
Q

Folate deficiency presentation

A

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

71
Q

Part of the brain responsible for hemibalismus

A

Subthalamic nucleus

72
Q

Most common imaging finding in someone with focal epilepsy?

A

Hippocampal sclerosis i.e. mesial temporal sclerosis

Coupling this a history of febrile juvenile seizures is common

73
Q

Focal epilepsy mannifest which clinical seizure syndrome

A

Temporal lobe epilepsy

74
Q

Temporal lobe epilepsy seminology

A

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

75
Q

Limbic encephalitis associations with cancer

A

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.

76
Q

GBS type of nerve fibres affects

A

Large myelinated fibres

Neurology (4 decks)

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