Selected Notes neuro 2

Question 1

What would you expect to see on a NCCT head of a patient with an SAH?

Answer 1

<ul><li>Hyperdense blood in basal cisterns/sulci</li></ul>

Question 2

What would be seen on a LP of a patient with a SAH?

Answer 2

<ul><li>Xanthochromia: breakdown of RBC</li></ul>

Question 3

What patient group is most commonly affected by an extradural haematoma?

Answer 3

<ul><li>Young patients with head injury-sports etc</li></ul>

Question 4

What proportion of patients will have <b>bilateral </b>subdural haemorrhages?

Answer 4

<ul><li>15% adults</li><li>80% infants</li></ul>

Question 5

Why are alcoholics and infants and the elderly more at risk of a subdural haemorrhage?

Answer 5

<ul><li>Brain atrophy</li><li>fragile/taut bridging veins</li></ul>

Question 6

What proportion of strokes are ischaemic?

Answer 6

<ul><li>85%</li><li>15% haemorrhagic</li></ul>

Question 7

What scoring system in used for those with a potential ischamic stroke?

Answer 7

<ul><li>ROSIER score</li><li>&gt;0 makes a stroke likely</li></ul>

Question 8

When is thrombolysis contraindicated in a patient with an ischaemic stroke?

Answer 8

<ul><li>Previous haemorrhage</li><li>GI bleed</li><li>Recent surgery</li><li>Hypertension</li><li>Increased INR</li></ul>

Question 9

When should thrombectomy be considered as a treatment for an acute ischaemic stroke?

Answer 9

<ul><li>If confirmed occlusion of proximal anterior circulation on CTA or MRA (with IV alteplase if &lt;4.5 hours, on its own if 6-24 hours)</li><li>Consider: &lt;24 hours: confirmed occlusion of prxomial posterior circulation on MRA/CTA/potential to salvage brain tissue</li></ul>

Question 10

What part of the brain is supplied by the posterior cerebral artery?

Answer 10

<ul><li>Posterior cerebral cortex:</li><li>Occipital lobe, thalamus etc</li></ul>

Question 11

What symptoms would you expect with a middle cerebral artery infarction?

Answer 11

<ul><li>Contralateral loss of sensation and motor control to face and UPPER limbs</li><li>Broca's aphasia</li></ul>

Question 12

What symptoms would you expect with an anterior cerebral artery infarction?

Answer 12

<ul><li>Contralateral loss of sensation and motor control to lower body</li></ul>

Question 13

What symptoms would you expect with a posterior cerebral artery infarction?

Answer 13

<ul><li>Contralateral homonymous hemianopia</li></ul>

Question 14

What symptoms would you expect with a basilar artery infarction?

Answer 14

<ul><li>Locked in syndrome-&gt; bilateral loss of corticospinal tracts</li></ul>

Question 15

What symptoms would you expect with an anterior inferior cerebellar artery infarction?

Answer 15

<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>

Question 16

What vessels are implicated in Weber’s syndrome?

Answer 16

<ul><li>Upper basilar and posterior cerebral</li></ul>

Question 17

What vessel is involved in a Wallenberg stroke?

Answer 17

<ul><li>Posterior inferior cerebellar artery</li></ul>

Question 18

What vessels are implicated in a total anterior circulation stroke?

Answer 18

<ul><li>Middle cerebral/anterior cerebral-&gt; large cortical</li></ul>

Question 19

What vessels are implicated in a partial anterior circulation stroke?

Answer 19

<ul><li>Only part of anterior circulation-&gt; ACA/MCA</li></ul>

Question 20

What parts of the brain are affected in a posterior circulation stroke?

Answer 20

<ul><li>Cortical</li><li>Cerebellum</li><li>Brainstem</li></ul>

<div>Vertebrobasilar arteries</div>

Question 21

What will a CN3 palsy result in?

Answer 21

Occulomotor<br></br><ul><li>Ptosis</li><li>‘down and out’ eye</li><li>Dilated fixed pupil</li></ul>

Question 22

What will a CN4 palsy result in?

Answer 22

Trochlear<br></br><ul><li>Defective downward gaze-> vertical diplopia</li></ul>

Question 23

What part of the brain is most commonly affected by HSV1 encephalitis?

Answer 23

<ul><li>Temporal and inferior frontal lobes</li></ul>

Question 24

Which bacteria is most likley to result in DIC and what does it look like under microbiology?

Answer 24

<ul><li>N.meningitidis</li><li>Gram egative diplococcus</li></ul>

Question 25

What would be seen on fundoscopy in a patient with giant cell arteritis?

Answer 25

<ul><li>Swollen pale disc and blurred margins</li></ul>

Question 26

Why is there no forehead sparing in Bell’s palsy?

Answer 26

<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>

Question 27

When should patients with Bell’s palsy be referred to specialists?

Answer 27

<ul><li>Urgetn ENT referral if no improvement after 3 weeks</li><li>Plastic surgery referral if long standing weakness(month)</li></ul>

Question 28

Which medication might worsen absence seizures?

Answer 28

<ul><li>Carbamazepine</li></ul>

Question 29

Which anti-epileptic is generally considered the least teratogenic?

Answer 29

<ul><li>Carbamazepine</li></ul>

Question 30

Which antiepileptics are safe for use when breastfeeding?

Answer 30

<ul><li>Generally most of them except for barbituates(ohenobarbitol etc)</li></ul>

Question 31

When are patients usually commenced on AEDs afer having a seizure?

Answer 31

<ul><li>After the 2nd seizure</li></ul>

Question 32

Which joints are most commonly affected in charcot arthropathy?

Answer 32

<ul><li>Tarsometatarsal joints</li><li>Can involve any joint in a limb that has lost sensation due to neuropathy</li></ul>

Question 33

What signs might you see with lesions to the cerebellar vermis?

Answer 33

<ul><li>Truncal ataxia and gait instability with fewer cerebellar signs in the limbs</li></ul>

Question 34

What signs might you see woth a lesion in the cerebellar hemisphere?

Answer 34

<ul><li>Signs in ipsilateral limb</li></ul>

Question 35

What would prompt suspicion of multiple system atrophy over Parkinson’s disease?

Answer 35

<ul><li>Early/prominent autonomic dysfunction</li><li>Degree of cerebellar involvement</li></ul>

Question 36

What would prompt consideration of lewy body dementia vs Parkinson’s disease

Answer 36

<ul><li>Dementia occurs &lt;1yr after onset of motor sx/come first</li><li>Early and prominent cognitive dysfunction/hallucinations</li></ul>

Question 37

What might be used to treat the peripheral side effects such as n+v in patients on levodopa?

Answer 37

<ul><li>Domperidone</li></ul>

Question 38

What organisms most frequently cause brain abscesses?

Answer 38

<ul><li>Streptococcus-mc</li><li>Sytaph</li><li>Gram negatives</li><li>TB</li><li>Fungi</li><li>Parasites</li></ul>

Question 39

Where do malingnat lesiosn in the brain most commonly come from?

Answer 39

<ul><li>Breast</li><li>Lung</li><li>Melanoma primaries</li></ul>

Question 40

What would be seen on histology of a patient with a glioblastoma multiforme?

Answer 40

<ul><li>Pleomorphic tumour cells border necrotic areas</li></ul>

Question 41

Where are meningiomas most commonly found?

Answer 41

<ul><li>Falx cerebri</li><li>Superior sagittal sinus</li><li>Convesity</li><li>Skull base</li></ul>

Question 42

What would be seen on histology of a patient with a meningioma?

Answer 42

<ul><li>Spindle cells in concentric whorls and calcified psammoma bodies</li></ul>

Question 43

What would be seen on hitology in a pilocytic astrocytoma?

Answer 43

<ul><li>Rosenthal fibres(corkscrew eosinophilic bundle)</li></ul>

Question 44

What would be seen on histology in a medulloblastoma?

Answer 44

<ul><li>Small, blue cells</li><li>Rosette pattern of cells with many mitotic figures</li></ul>

Question 45

Where is an ependymoma most commonly seen?

Answer 45

<ul><li>4th ventricle</li></ul>

Question 46

What might ependymoma cause?

Answer 46

<ul><li>Hydrocephalus</li></ul>

Question 47

What would be seen on histology of a patient with an ependymoma?

Answer 47

<ol><li>Perivascular ppseudorosettes</li></ol>

Question 48

What would be seen on histology of a haemangioblastoma?

Answer 48

<ul><li>Foam cells and high vascularity</li></ul>

Question 49

When iss thee shingles vaccine advised?

Answer 49

<ul><li>One off vaccine advised for those in tehir 70s</li></ul>

Question 50

Which medications are associated with idiopathic intracranial hypertension?

Answer 50

<ul><li>COCP</li><li>Tetracyclines</li><li>Retinoids</li><li>Lithium</li><li>Thyroxine</li><li>Nitrofurantoin</li></ul>

Question 51

What signs/symptoms would you NOT expect to find in a patient with MND?

Answer 51

<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>

Question 52

What symptoms will a lesion in the dorsal column cause?

Answer 52

<ul><li>Loss of vibraiton and proprioception</li></ul>

Question 53

What symptoms will a lesion in the spinothalamic tract cause?

Answer 53

<div><ul><li>Pain, sensation and temperature</li></ul></div>

Question 54

What symptoms will a lesion in the central cord cause?

Answer 54

<ul><li>Flaccid paralysis of the upper limbs</li></ul>

Question 55

What sensation is preserved in sub-acute combined degeneration of the spinal cord

Answer 55

<ul><li>Pain and temperature</li></ul>

Question 56

When should topirimate not be used for migrain prophylaxis and why?

Answer 56

<ul><li>Avoid in women of childbearing age</li><li>Teratogenic and can reduce effectiveness of hormonal contraceptives</li></ul>

Question 57

What typically causes cavernous sinus thrombosis?

Answer 57

<ul><li>Spreading sinus infection</li></ul>

Question 58

What tracts are affected in Brown-Sequard syndrome?

Answer 58

<ul><li>Descending lateral corticospinal</li><li>Ascending dorsal column</li><li>Ascending spinothalamic</li></ul>

Question 59

Which vertebrae/nerve roots are typically affected by cervical radiculopathy?

Answer 59

<ul><li>C5-C7</li></ul>