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Third year > Week 12 - Neurology > Flashcards

Week 12 - Neurology Flashcards

1
Q

What is internuclear ophthalmoplegia?

A

Disorder of conjugated gaze.

Lesion of medial longitudinal fascicles (connects CN III and VI)

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2
Q

What is herpes zoster ophthalmic? (shingles)

A

Painful skin rash with vesicles
V1 (ophthalmic) dermatomal distribution
Conjuctivitis, iritis, uvitis, keratitis

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3
Q

What are seizure?

A

A sustained or synchronised electrical discharge in the brain causing signs and symptoms

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4
Q

Define relapse and how would you manage it.

A

New neurological deficits, lasting more than 24 hours, in the absence of infection or pyrexia
IV methylprednisolone 3 days or oral for 5 days. + PPi

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5
Q

Define pseudo-relapse

A

Re-emergance of previous neurological symptoms or signs related to an old area of demyelination in the context of infection or pyrexia

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6
Q

Define stroke

A

Rapid onset cerebral deficit (usually focal) lasting more than 24 hour or leading to death, with a vascular cause.

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7
Q

What investigation would you perform to confirm MS?

A

MRI brain and cervical spine with gadolinium contrast.
Must be in at least 2 areas:
Periventricular
Infratentorial (cerebellum)
juxtacortical (Grey:white matter junction)
Spinal cord

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8
Q

What is a TIA?

A

A brief period of neurological dysfunction due to a temporary focal cerebral/retinal ischaemia without infarction e.g. weak limb, aphasia or loss of vision. It usually lasts seconds or minutes and completely resolves.

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9
Q

What symptoms would a person experience if the large vessel stroke was to the MCA?

A

Arm weakness > leg
Right MCA - neglect, apraxia, anosognosia, topographical difficulty
Left MCA - aphasia (can’t understand)

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10
Q

What symptoms would a person experience if the large vessel stroke was to the ACA?

A

Leg > arm

muteness, abulia

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11
Q

What symptoms would a person experience if the large vessel stroke was to the PCA?

A

Hemianopia

Memory loss, confusion, Alexia

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12
Q

Where is Broca’s area located?

A

Posterior, inferior frontal gyrus

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13
Q

Where is wernicke’s area located?

A

Posterior of the superior temporal gyrus

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14
Q

What is an ischaemic stroke?

A

85%
Cerebral infarction mostly due to thromboembolic disease secondary to atherosclerosis.
20% due to thrombosis from the heart (AF)
20% thrombosis in situ (intrinsic(

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15
Q

What is a haemorrhage stroke?

A

15%
Either die to a brain aneurysm burns or a weakened blood vessel leak. Blood seeps round the brain causing an increase in pressure and swelling - damaging cells and tissue of the brain

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16
Q

What is first line treatment for an ischaemic stroke?

A

Alteplase - tPA within 4.5 hours
After 4.5 hours ASPIRIN

Endovascular surgery within 6 hours is effective

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17
Q

What are some Symptoms that might lead you to think the patient is having a brainstem stroke?

A 
Double vision
Problems swallowing
Ataxia
Slurred speech
Facial numbness/ weakness
Vertigo 
Hoarseness
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18
Q

What is a hypertensive stroke?

A

Spontaneous rupture of a small artery deep in the brain

Sites: basal ganglia, pins, cerebellum

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19
Q

What are some clinical manifestations of a cerebellar haemorrhage?

A 
Vomiting
Small sluggish pupils
Altered mental status
Eyes deviate to the opposite side 
Ataxia
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20
Q

Clinical manifestations of a pontine haemorrhage

A

Pin point but reactive pupils
Abrupt onset of coma
Ataxic breathing pattern
Decerebrating posturing or flaccidity

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21
Q

What are some contraindications for tPA?

A 
Haemorrhage
Recent stroke, trauma or surgery 
Coagulopathy 
SBP > 185 or DBP > 110
Glucose < 2.2 
Seziures at onset of Sx
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22
Q

What vessels is affected in total anterior circulation syndrome and what might it manifest as?

A

MCA
Haemiparesis
Haemianopia
Higher cortical dysfunction

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23
Q

What vessels is affected in Partial anterior circulation syndrome and what might it manifest as?

A

Branch of the MCA
Isolated higher cortical dysfunction
and any 2 of
haemapesis, hemianopia, higher cortical dysfunction

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24
Q

What symptom control medication is available in secondary progressive MS

A

Fatigue: amantadine, modafinil
Urinary problems: oxybutynin
Spasticity: Benzodiazepine, gabapentin

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25
Q

Define epilsepsy

A

A tendency to have recurrent unprovoked seizures

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26
Q

What are the immediate measures taken in seizure?

A

Secure airways
Oxygen administration
Assess bp, pulse, RR

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27
Q

What drug is used to treat seizures?

A

Benzodiazapine

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28
Q

What Anti-epileptic drug inhibits VG Na channels to reduce excitability?

A

Carbamezapine, lamotrigine, oxcarbazepine

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29
Q

What anti-epileptic increases K efflux at the pre-synpatic terminal?

A

Retigabine

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30
Q

What Anti-epileptic drug inhibits SV2A?

A

Levetriacetam

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31
Q

What Anti-epileptic drug inhibits VG Ca?

A

Pregabalin, gabapentin

32
Q

What drug inhibits the GABA transporter?

A

Tiagabine

33
Q

What drugs inhibit GABA metabolism?

A

Vigabatrin

Valporate

34
Q

What drugs increase GABA receptor activity?

A

Benzodiazapine
Barbiturates
Felbamate
Topiramate

35
Q

What symptoms might be experienced in a subarachnoid haemorrhage?

A

LOC, Seizures, neck stiffness, sentinel headache, speech and limb disturbances, visual disturbances

36
Q

What tests might you do in subarachnoid haemorrhage?

A

CT

LP- cell count, Xanthochromia (CSF yellowy)

37
Q

Define dementia

A

Chronic, progressive cognitive decline due to brain disease

38
Q

What are some Sx of dementia?

A

Cognitive impairment (language, memory, calculation)
Psychiatric or behavioural disturbances
Affects activities of daily living - cooking, bathing, dressing

39
Q

Acetylcholinesterase inhibitors are used in the treatment of dementia, to increase ACh, give e.g’s.

A

Galantamine, donepizil, rivastigmine

cardiac adverse effects (so need a baseline ECG before), peptic ulcers, dizzy, fatigue

40
Q

What is the action of memantine?

A

NMDA receptor antagonist

Improves memory by restoration of homeostasis in the glutaminergic system.

41
Q

How would you define BPSD (behavioural and psychological symptoms of dementia)

A

Sx of disturbed mood, perception and behaviour

42
Q

Define parkinsons

A

A neurodegenerative disorder of the basal ganglia. loss of dopaminergic neutrons in the substanitia nigra

43
Q

What areas are involved in the different stages of Parkinson’s?

A

Stage 1-2 - pons, medulla, anterior olfactory nucleus = LOSS OF SMELL
Stage 3-4 - midbrain, sunstantia nigra (pars compacts) = Parkinsonism
Stage 5-6 - neocortex involvement = Parkinson’s dementia

44
Q

What investigation shows abnormality in degenerative Parkinsonism.

A

DAT SPECT (MRI)

45
Q

What are some red flags for headaches? (SNOOP)

A

Systemic symptoms, seizures, secondary risk factors
neurological Sx
Rapid onset, age onset
progressive, papilloedema, precipitated by cough, exertion, sleep

46
Q

Define migraine

A

A severe headache described as throbbing pain at the front or side of the head

47
Q

What is a cluster headache?

A

A series of relatively short but extremely painful headaches every day for weeks to months at a time

48
Q

Give some characteristics of a tension headache

A 
Bilateral
Pressing or tightening
Not aggravated by physical activity 
no nausea or vomiting
no photophobia or phonophobia 
at least 10 episodes at least 1 time per month
49
Q

Give some characteristics of a migraine

A 
throbbing pain
last 4-72 hours
unilateral
pulsating
aggravated by physical activity 
N&amp;V, photophobia
50
Q

What medication might you use in chronic migraine?

A

> /=15 headache days per month, 8 oh which are migraine days
Erenumab - CGRP inhibitor
Onabotulinumtoxin A

51
Q

What is impaired executive function?

A

Impaired reasoning and handling of complex tasks, poor judgment

52
Q

What is impaired visuospatial function?

A

Inability to recognise faces or common objects or to find objects in direct view despite good acuity

53
Q

What domains does the addenbrookes cognitive exam test?

A

Memory, attention/concentration, visuospatial, language, executive function

54
Q

What syndromes may develop into MS?

A

Optic neuritis, transverse myelitis, clinically isolated syndromes, radiologically isolated syndromes

55
Q

What is first line for an acute relapse and in secondary progressive in MS?

A

Methylprednisolone IV 3 days or oral 5 days + PPi (gastro protection)

56
Q

What is first line treatment in RR MS?

A

Interfernon (beta-interferons, glatiramer acetate)

Dimethyl fumarate

57
Q

What might trigger Guillain barre syndrome (acute inflammatory demyelinating neuropathy)?

A

CMV, EBV, campylobacter jejuni**
Progressive symmetrical ascending muscle weakness
Steroids and IV Ig

58
Q

How would you grade the results from a MMSE?

A

24-30 - no cognitive impairment
18-23 - mild cognitive impairment
0-17 - severe cognitive impairment

59
Q

What are some complications of a SAH?

Endovascular coil or neurosurgical coiling

A

Hydrocephalus (shunt)
Hyponatraemia (CSWS or SIADH - Hypertonic saline or fludrocortisome)
Haemorrhage
Delayed ischaemia

60
Q

A patient who just had a SAH has progressive deterioration in consciousness (delayed ischamia, a complications) how would you manage?

A

Colloids - fluid management
Nimodipine to prevent vasospasm
Angioplasty

61
Q

When is MS diagnosed?

A

When there is 2 or more episodes of demyelination dissemination in time and space

62
Q

How would you treat secondary progressive MS?

A

Methylprednisolone

63
Q

Natalizumab is a monoclonal Ab that can be used 2nd line to treat RR MS, what is a risk?

A

JC virus - Progressive multifocal leukencephalopathy

64
Q

What may indicate a previous optic neuritis?

A

Red desaturation, optic disc pallor and so atrophy, relative afferent pupillary defect

65
Q

How might Total anterior circulatory syndrome present?

A

Higher cortical dysfunction (aphasia, neglect)
Homonymous Hemianopia
Hemiparesis
MCA or ICA occlusion

66
Q

How might Partial anterior circulatory syndrome present?

A

Isolated Higher cortical dysfunction OR
Any 2 of: Homonymous Hemianopia, Hemiparesis, higher cortical dysfunction
Branch of MCA

67
Q

How might Posterior circulatory syndrome present?

A

Isolated hemianopia OR brain stem syndrome (ipsilateral CN III palsy)

68
Q

How might lacunar syndrome present?

A

Pure motor or Pure sensory, ataxic hemiparesis

69
Q

What is Status Epilepticus?

A

Medical emergency

Tonic clonic seizures lasting >5 min or >2 in 1 hour

70
Q

What is 1st line for focal seizures?

A

Lamotrigine or carbamazepine

then Levetriacetam

71
Q

What is 1st line for generalised seizures?

A

Sodium valproate

then Lamotirgine or Carbamazepine

72
Q

What Autonomic Sx may you get in Parkinson’s?

A 
U CrEEP
Urinary urgency/ nocturne
Constipation
Erectile dysfunction
Excessive sweating/ salivation
Postural instability
73
Q

What Neuropsychiatric Sx may you get in Parkinsons?

A

DAD

Depression, anxiety, dementia

74
Q

What is Parkinsons?

Functional imaging - DAT SPECT

A

Neurodegenerative disorder of the basal ganglia. Loss of dopaminergic neurones in the Pars compacta of the substantial nigra

75
Q

What are some red flags for headaches?

A

SSSNOOPPP
Systemic features, Secondary risk factors, Seizures
Neurological Sx
Age onset >50, rapid onset
Papilloedema, Precipitated (cough, eversion, sleep), progression

76
Q

What is 1st line in migraine?

A 
Sumatriptan PO (or Zolmitriptan)
if vomiting - Metoclopramide or prochlorperazine

Third year (15 decks)

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