TO REVISE NEURO Flashcards
STROKE
What are the causes of ischaemic strokes?
small vessel occlusion by thrombus
atherothromboembolism (e.g. from carotid artery)
cardioembolism (post MI, valve disease, IE)
hyper viscosity
hypoperfusion
vasculitis
fat emboli from a long bone fracture
venous sinus thrombosis
STROKE
What are the causes of haemorrhagic stroke?
Bleeding from the brain vasculature
- Hypertension - stiff and brittle vessels, prone to rupture
- Secondary to ischaemic stroke - bleeding after reperfusion
- Head trauma
- Arteriovenous malformations
- Vasculitis
- Vascular tumours
- Carotid artery dissection
SAH
What is the pathophysiology of a subarachnoid haemorrhage (SAH)?
- tissue ischaemia - less blood, O2 and nutrients can reach the tissue due to bleeding loss -> cell death
- raised ICP - fast flowing arterial blood is pumped into the cranial space
- space occupying lesion - puts pressure on the brain
- brain irritates meninges - these inflame causing meningism symptoms. This can obstruct CSF outflow -> hydrocephalus
- vasospasm - bleeding irritates other vessels -> ischaemic injury
EDH
What are some differentials for EDH?
- Epilepsy,
- CO poisoning,
- carotid dissection
EPILEPSY
Define epilepsy
Recurrent, spontaneous, intermittent abnormal electrical activity in part of the brain, manifesting seizures
PARKINSON’S DISEASE
What is the management of Parkinson’s disease?
- Lifestyle: education, exercise, physio, MDT
young onset + fit
- Dopamine agonist (ropinirole)
- MAO-B inhibitor (rasagiline)
- L-DOPA (co-careldopa)
frail + co-morbidities
- L-DOPA (co-careldopa)
- MAO-B inhibitor (rasagiline)
HUNTINGTON’S DISEASE
What is the pathophysiology of Huntington’s disease?
- Less GABA causes less regulation of dopamine to striatum causing increased dopamine levels resulting in excessive thalamic stimulation and subsequently increased movement (chorea)
MND
What is the general clinical presentation of MND?
- Insidious + progressive muscle weakness affecting limbs, trunk, face + speech
- Often first noticed in upper limbs, may be fatigue when exercising
- May have stumbling spastic gait, weak grip + clumsiness
- Dysarthria, dysphagia, emotional lability in pseudobulbar palsy
- NO SENSORY SYMPTOMS
MND
What medication may be given in MND?
- RILUZOLE – Na+ blocker inhibits glutamate release
- Drooling - ORAL PROPANTHELINE or ORAL AMITRIPTYLINE
- Dysphagia: NG tube
- Spasms: ORAL BACLOFEN
- Non-invasive ventilation
- Analgesia e.g. NSAIDs - DICLOFENAC
MULTIPLE SCLEROSIS
What are the symptoms of MS?
DEMYELINATION –
- Diplopia (CN VI)
- Eye movement pain (optic neuritis, v common)
- Motor weakness
- nYstagmus
- Elevated temp worsens
- Lhermitte’s sign
- Intention tremor
- Neuropathic pain
- Ataxia
- Talking slurred (dysarthria)
- Impotence
- Overactive bladder
- Numbness
MULTIPLE SCLEROSIS
What are some signs of MS?
- UMN = spastic paraparesis, brisk reflexes, hypertonia
- Sensory = loss of sensation, cerebellar signs
- Relative afferent pupillary defect
- Internuclear ophthalmoplegia
- Optic atrophy (pale optic disc) in chronic MS
MULTIPLE SCLEROSIS
What is the general symptomatic management for MS?
Spasticity
- BACLOFEN (GABA analogue, reduces Ca2+ influx)
- TIZANIDINE (alpha-2 agonist)
- BOTOX INJECTION (reduces ACh in neuromuscular junction)
urinary incontinence = catheterisation
incontinence
- DOXAZOSIN (anti-cholinergic alpha blocker drugs
MENINGITIS
What is the management of bacterial meningitis
- IV cefotaxime
- amoxicillin to cover listeria (potential contraction in birth) in <3m
- Dexamethasone to reduce frequency + severity of neurological sequelae
- Adjust treatment according to sensitivities
ENCEPHALITIS
What investigations would you do for encephalitis?
- Blood culture + CSF serology for viral PCR
MRI - shows areas of inflammation, may be midline shifting
EEG - periodic sharp and slow wave complexes
lumbar puncture
BRAIN ABSCESS
What are the most common causative organisms?
- Staph. aureus + strep. pnuemoniae
BRAIN ABSCESS
What is the management of brain abscess?
- CT guided aspiration via burr hole or craniotomy + abscess cavity debridement
- Craniotomy usually if no response to aspiration or if reoccurs
- Abx with IV ceftriaxone + metronidazole, ICP Mx with dexamethasone
BRAIN DEATH + COMA
What are the components of ‘motor’ in GCS?
M6 = obeys commands
M5 = localises pain
M4 = withdraws away from painful stimulus
M3 = flexion to pain
M2 = extension to pain
M1 = no response
MYASTHENIA GRAVIS
What investigations would you do for myasthenia gravis?
mostly clinical examination
positive tensilon test
anti-AChR antibodies
TFTs
EMG
CT of thymus
crushed ice test - ice is applies to ptosis for 3 mins, if it improves it is likely to be myasthenia gravis
GUILLAIN-BARRE
What are the investigations for GBS?
Nerve Conduction Studies (NCS) = diagnostic -> shows slowing of conduction
Lumbar Puncture at L4 = raised protein and normal WCC (cyto-protein dissociation)
bloods - FBC, U&E, LFT, TFT
Spirometry = respiratory involvement
ECG
NEUROPATHY
What are the causes of peripheral neuropathy?
ABCDE –
- Alcohol
- B12 deficiency
- Cancer + CKD
- Diabetes + drugs (isoniazid, amiodarone)
- Every vasculitis
NEUROPATHY
What is Charcot-Marie-Tooth disease?
- Autosomal dominant condition.
- Characterised by high-arched feet, distal muscle weakness + atrophy (inverted champagne bottle legs), hyporeflexia, foot drop + hammer toes
NEUROPATHY
What are the investigations used in neuropathy?
- Neuropathy screen (symmetrical) = FBC, CRP/ESR, U+E, glucose, TFT, B12 + folate
- Vasculitis screen (asymmetrical) = first 3 + ANA, ANCA, anti-dsDNA, RhF, complement
- EMG + nerve conduction studies
SPINAL CORD INJURY
What is Brown-Sequard syndrome?
- Lateral hemisection of spinal cord
- Ipsilateral weakness below the lesion (lateral corticospinal)
- Ipsilateral loss of fine touch, proprioception + vibration (DCML)
- Contralateral loss of pain + temp (lateral spinothalamic)
MYOPATHY
What are the investigations for myopathies?
- CRP/ESR, creatinine kinase elevated
- Autoantibodies (anti-Jo-1), EMG, genetics + muscle biopsy
NEURO PHARMACOLOGY
What are the side effects of Levodopa?
- Postural hypotension
- Confusion
- Dyskinesias (abnormal movements)
- Effectiveness decreases with time (even with dose increase)
- On-off effect
- Psychosis
NEURO PHARMACOLOGY
What are COMT + MAO-B inhibitors?
What is the mechanism of action?
- Catechol-o-methyltransferase (COMT) inhibitor = entacapone
- Monoamine oxidase-B (MAO-B) inhibitor = selegiline
- Inhibit enzymatic breakdown of dopamine
NEURO PHARMACOLOGY
What are some SEs + C/Is of triptans?
- Dizziness, dry mouth, sleepy, nausea
- C/I in CVD
EPILEPSY
Define seizure
Paroxysmal event in which changes of behaviour, sensation, cognition + consciousness caused by excessive, hypersynchronous neurological discharges in the brain
ENCEPHALITIS
What are the non-viral causes of encephalitis?
Bacterial meningitis
TB
Malaria
Lyme’s disease
MYASTHENIA GRAVIS
What medications can exacerbate myasthenia gravis?
Abx, CCBs, beta-blockers, lithium + statins
EDH
what is the appearance of EDH on non-contrast head CT?
lens shaped haematoma = LEMON SHAPE
doesn’t cross suture lines
shows midline shift
SDH
what is the appearance of SDH on non-contrast head CT?
crescent shaped haematoma = BANANA SHAPE (clot turns from white to grey over time)
unilateral
shows midline shift
HUNTINGTON’S DISEASE
what are the signs of Huntington’s disease?
Abnormal eye movements
Dysarthria
Dysphagia
Rigidity
Ataxia
MND
What is the diagnostic criteria for MND?
LMN + UMN signs in 3 regions
El Escorial criteria
Presences of LMN and UMN degeneration and progressive history
Absence of other disease processes
MYASTHENIA GRAVIS
What can weakness due to myasthenia gravis be worsened by?
Pregnancy
Hypokalaemia
Infection
Emotion
Exercise
Drugs
HORNER’S SYNDROME
what are the clinical features of horner’s syndrome?
MAPLE
Miosis
Anhydrosis
Ptosis
Loss of ciliospinal reflex
Endophthalmos (sunken eyeball)
HYDROCEPHALUS
what are the causes of normal pressure hydrocephalus?
excess fluid builds up in the ventricles, which enlarge and press on nearby brain tissue
- injury
- bleeding
- infection
- brain tumour
- brain surgery
CHRONIC FATIGUE SYNDROME
what are the differentials?
mononucleosis
lyme disease
MS
SLE
hypothyroidism
fibromyalgia
depression
sleep disorders
MENIERE’S DISEASE
what is the classical triad of symptoms?
vertigo
hearing loss - worse during attacks
tinnitus
SAH
give 3 possible complications of a subarachnoid haemorrhage
- Rebleeding (common = death)
- Cerebral ischaemia
- Hydrocephalus
- Hyponatraemia
PARKINSONS DISEASE
what is the pathway for dopamine production?
Tyrosine –> L-dopa –> Dopamine
STROKE
How would lateral medullary/Wallenberg’s syndrome present?
What vessel is implicated?
- Cerebellar: ataxia, nystagmus
- Ipsi: dysphagia, facial numbness + CN palsy
- Contra: limb sensory loss
- Posterior inferior cerebellar artery
STROKE
How would lateral pontine syndrome present?
What vessel is implicated?
- Similar to Wallenberg’s but ipsilateral facial paralysis + deafness
- Anterior inferior cerebellar artery
STROKE
What criteria must be met for a posterior circulation syndrome (POCS)?
One of the following –
- Cranial nerve palsy + contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder (e.g. gaze palsy)
- Cerebellar dysfunction (ataxia, nystagmus, vertigo)
- Isolated homonymous hemianopia + cortical blindness
STROKE
What areas can be affected in lacunar syndrome (LACS)?
- Thalamus, basal ganglia, internal capsule
NEUROPATHY
What are the motor signs of ulnar neuropathy?
Weakness/wasting of –
- Interossei (can’t do good luck sign)
- Medial lumbricals (claw hand)
- Hypothenar eminence
- +ve Froment’s sign when grip paper between thumb + index finger
NEUROPATHY
Roots of sciatic nerve?
Causes of neuropathy?
Presentation?
- L4–S3
- Pelvic tumours or pelvic/femoral #
- M = foot drop, S = loss below the knee laterally
NEUROPATHY
Roots of common peroneal nerve?
Causes of neuropathy?
Presentation?
- L4–S1
- Damaged as winds round fibular head by trauma or sitting cross-legged (classic after night out)
- M = foot drop, weak ankle dorsiflexion + eversion with high steppage gait, S = loss over dorsal foot
