Selected Notes neuro 2 Flashcards
What would you expect to see on a NCCT head of a patient with an SAH?
<ul><li>Hyperdense blood in basal cisterns/sulci</li></ul>
What would be seen on a LP of a patient with a SAH?
<ul><li>Xanthochromia: breakdown of RBC</li></ul>
What patient group is most commonly affected by an extradural haematoma?
<ul><li>Young patients with head injury-sports etc</li></ul>
What proportion of patients will have <b>bilateral </b>subdural haemorrhages?
<ul><li>15% adults</li><li>80% infants</li></ul>
Why are alcoholics and infants and the elderly more at risk of a subdural haemorrhage?
<ul><li>Brain atrophy</li><li>fragile/taut bridging veins</li></ul>
What proportion of strokes are ischaemic?
<ul><li>85%</li><li>15% haemorrhagic</li></ul>
What scoring system in used for those with a potential ischamic stroke?
<ul><li>ROSIER score</li><li>>0 makes a stroke likely</li></ul>
When is thrombolysis contraindicated in a patient with an ischaemic stroke?
<ul><li>Previous haemorrhage</li><li>GI bleed</li><li>Recent surgery</li><li>Hypertension</li><li>Increased INR</li></ul>
When should thrombectomy be considered as a treatment for an acute ischaemic stroke?
<ul><li>If confirmed occlusion of proximal anterior circulation on CTA or MRA (with IV alteplase if <4.5 hours, on its own if 6-24 hours)</li><li>Consider: <24 hours: confirmed occlusion of prxomial posterior circulation on MRA/CTA/potential to salvage brain tissue</li></ul>
What part of the brain is supplied by the posterior cerebral artery?
<ul><li>Posterior cerebral cortex:</li><li>Occipital lobe, thalamus etc</li></ul>
What symptoms would you expect with a middle cerebral artery infarction?
<ul><li>Contralateral loss of sensation and motor control to face and UPPER limbs</li><li>Broca's aphasia</li></ul>
What symptoms would you expect with an anterior cerebral artery infarction?
<ul><li>Contralateral loss of sensation and motor control to lower body</li></ul>
What symptoms would you expect with a posterior cerebral artery infarction?
<ul><li>Contralateral homonymous hemianopia</li></ul>
What symptoms would you expect with a basilar artery infarction?
<ul><li>Locked in syndrome-> bilateral loss of corticospinal tracts</li></ul>
What symptoms would you expect with an anterior inferior cerebellar artery infarction?
<ul><li>Contralateral loss of pain and temperature sensation</li><li>Lateral pontine syndrome</li></ul>
<div>Ipsilateral:</div>
<div>-CN3 palsy</div>
<div>-Vertigo/nystagmus/deafness</div>
<div>-Poor coordination/tone/balance</div>
What vessels are implicated in Weber’s syndrome?
<ul><li>Upper basilar and posterior cerebral</li></ul>
What vessel is involved in a Wallenberg stroke?
<ul><li>Posterior inferior cerebellar artery</li></ul>
What vessels are implicated in a total anterior circulation stroke?
<ul><li>Middle cerebral/anterior cerebral-> large cortical</li></ul>
What vessels are implicated in a partial anterior circulation stroke?
<ul><li>Only part of anterior circulation-> ACA/MCA</li></ul>
What parts of the brain are affected in a posterior circulation stroke?
<ul><li>Cortical</li><li>Cerebellum</li><li>Brainstem</li></ul>
<div>Vertebrobasilar arteries</div>
What will a CN3 palsy result in?
Occulomotor<br></br><ul><li>Ptosis</li><li>‘down and out’ eye</li><li>Dilated fixed pupil</li></ul>
What will a CN4 palsy result in?
Trochlear<br></br><ul><li>Defective downward gaze-> vertical diplopia</li></ul>
What part of the brain is most commonly affected by HSV1 encephalitis?
<ul><li>Temporal and inferior frontal lobes</li></ul>
Which bacteria is most likley to result in DIC and what does it look like under microbiology?
<ul><li>N.meningitidis</li><li>Gram egative diplococcus</li></ul>
What would be seen on fundoscopy in a patient with giant cell arteritis?
<ul><li>Swollen pale disc and blurred margins</li></ul>
Why is there no forehead sparing in Bell’s palsy?
<div><ul><li>LMN palsy: affects facial nerve after its entered the brainstem</li><li>Contrast stroke: innervation from both hemispheres of the brain</li></ul></div>
<div><br></br></div>
When should patients with Bell’s palsy be referred to specialists?
<ul><li>Urgetn ENT referral if no improvement after 3 weeks</li><li>Plastic surgery referral if long standing weakness(month)</li></ul>
Which medication might worsen absence seizures?
<ul><li>Carbamazepine</li></ul>
Which anti-epileptic is generally considered the least teratogenic?
<ul><li>Carbamazepine</li></ul>
Which antiepileptics are safe for use when breastfeeding?
<ul><li>Generally most of them except for barbituates(ohenobarbitol etc)</li></ul>
When are patients usually commenced on AEDs afer having a seizure?
<ul><li>After the 2nd seizure</li></ul>
Which joints are most commonly affected in charcot arthropathy?
<ul><li>Tarsometatarsal joints</li><li>Can involve any joint in a limb that has lost sensation due to neuropathy</li></ul>
What signs might you see with lesions to the cerebellar vermis?
<ul><li>Truncal ataxia and gait instability with fewer cerebellar signs in the limbs</li></ul>
What signs might you see woth a lesion in the cerebellar hemisphere?
<ul><li>Signs in ipsilateral limb</li></ul>
What would prompt suspicion of multiple system atrophy over Parkinson’s disease?
<ul><li>Early/prominent autonomic dysfunction</li><li>Degree of cerebellar involvement</li></ul>
What would prompt consideration of lewy body dementia vs Parkinson’s disease
<ul><li>Dementia occurs <1yr after onset of motor sx/come first</li><li>Early and prominent cognitive dysfunction/hallucinations</li></ul>
What might be used to treat the peripheral side effects such as n+v in patients on levodopa?
<ul><li>Domperidone</li></ul>
What organisms most frequently cause brain abscesses?
<ul><li>Streptococcus-mc</li><li>Sytaph</li><li>Gram negatives</li><li>TB</li><li>Fungi</li><li>Parasites</li></ul>
Where do malingnat lesiosn in the brain most commonly come from?
<ul><li>Breast</li><li>Lung</li><li>Melanoma primaries</li></ul>
What would be seen on histology of a patient with a glioblastoma multiforme?
<ul><li>Pleomorphic tumour cells border necrotic areas</li></ul>
Where are meningiomas most commonly found?
<ul><li>Falx cerebri</li><li>Superior sagittal sinus</li><li>Convesity</li><li>Skull base</li></ul>
What would be seen on histology of a patient with a meningioma?
<ul><li>Spindle cells in concentric whorls and calcified psammoma bodies</li></ul>
What would be seen on hitology in a pilocytic astrocytoma?
<ul><li>Rosenthal fibres(corkscrew eosinophilic bundle)</li></ul>
What would be seen on histology in a medulloblastoma?
<ul><li>Small, blue cells</li><li>Rosette pattern of cells with many mitotic figures</li></ul>
Where is an ependymoma most commonly seen?
<ul><li>4th ventricle</li></ul>
What might ependymoma cause?
<ul><li>Hydrocephalus</li></ul>
What would be seen on histology of a patient with an ependymoma?
<ol><li>Perivascular ppseudorosettes</li></ol>
What would be seen on histology of a haemangioblastoma?
<ul><li>Foam cells and high vascularity</li></ul>
When iss thee shingles vaccine advised?
<ul><li>One off vaccine advised for those in tehir 70s</li></ul>
Which medications are associated with idiopathic intracranial hypertension?
<ul><li>COCP</li><li>Tetracyclines</li><li>Retinoids</li><li>Lithium</li><li>Thyroxine</li><li>Nitrofurantoin</li></ul>
What signs/symptoms would you NOT expect to find in a patient with MND?
<ul><li>No sensory signs/symptoms</li><li>Doesn't affect external ocular muscles</li><li>No cerebellar signs</li><li>Eye and sphincter dysfunciton usually not present until late</li></ul>
What symptoms will a lesion in the dorsal column cause?
<ul><li>Loss of vibraiton and proprioception</li></ul>
What symptoms will a lesion in the spinothalamic tract cause?
<div><ul><li>Pain, sensation and temperature</li></ul></div>
What symptoms will a lesion in the central cord cause?
<ul><li>Flaccid paralysis of the upper limbs</li></ul>
What sensation is preserved in sub-acute combined degeneration of the spinal cord
<ul><li>Pain and temperature</li></ul>
When should topirimate not be used for migrain prophylaxis and why?
<ul><li>Avoid in women of childbearing age</li><li>Teratogenic and can reduce effectiveness of hormonal contraceptives</li></ul>
What typically causes cavernous sinus thrombosis?
<ul><li>Spreading sinus infection</li></ul>
What tracts are affected in Brown-Sequard syndrome?
<ul><li>Descending lateral corticospinal</li><li>Ascending dorsal column</li><li>Ascending spinothalamic</li></ul>
Which vertebrae/nerve roots are typically affected by cervical radiculopathy?
<ul><li>C5-C7</li></ul>
