Year 4 Neuro document Flashcards
Exposure to which chemicals is associated with Parkinson’s disease
Pesticide
Which lifestyle habit is thought to be protective for Parkinson’s
Smoking??
Which neurones degenerate in Parkinsons disease
Dopaminergic neurones of the pars compacta substantia nigra
Is an idiopathic Parkinsons tremor typically symmetrical or asymmetrical
Asymmetrical
Suspect drug-induced parkinsonism if bilateral tremor
What is an expression to describe the facial expression of someone with Parkinsons disease
Mask-like face
What kind of sleep disorders are seen in Parksinson’s
REM sleep disorders
Which reduced special sense can be an early sign of Parkinson’s
Hyposmia
Reduced sense of smell
What is the Glabella tap and how will it present in Parkinson’s
Tapping on the forehead makes people stop blinking. Blinking will persist in Parkinson’s - Myerson’s sign of frontal release
What is the gold standard treatment of Parkinson’s
Levodopa + Carbidopa
Why might different classes of drugs be used in Parkinson’s
To delay the use of Levodopa until significant disability
What type of drug is Rasagiline
MAO-B inhibitor
What drug should you give for Levodopa associated nausea and why not use metoclopramide
Domperidone
Selective to peripheral dopamine receptors so wont prevent activity of levodopa in the brain (metoclopramide isn’t selective)
Which Parkinsons Plus Syndrome has a lack of a tremor and how does it present
Progressive supranuclear palsy Vertical gaze palsy. Early postural instability and falls. Speech and swallowing problems. Symmetrical trunkal rigidity
What is the triad of Multi-System Atrophy
Parkinsonism
Autonomic Dysfunction
Cerebellar Dysfunction
What sign is seen on MRI in Multi-System Atrophy
Hot Cross Bun sign
Which disease affects the Nucleus Basilis of Meynert
Alzheimer’s Disease
Which genetic disease increases your chances of developing Alzheimer’s in the future
Down’s Syndrome
Hemiballism as a symptom suggests a lesion where in the brain
Subthalamic lesion
Which anti-epileptic drug can cause hyponatraemia
Carbamazepine
Which drug can be given for treatment of fatigue in MS
Amantidine
A defect in which artery will cause full paralysis except blinking and eye movement
Basilar artery
Anti-Musk and Anti-AchR antibodies are associated with which condition
Myasthenia Gravis
Which disease can present with renal and hepatic failure as well as Parkinsonism
Wilson’s Disease
How is a postural tremor different from a resting tremor
postural tremor is a tremor that is absent at rest, present on maintained posture such as holding arms out
What diseases can cause an intention tremor
Cerebellar disease (MS, stroke, hemorrhage) Wilsons disease
What is dystonia
Involuntary, sustained muscle spasms that result in abnormal posturing and repetitive movements in the context of an associated tremor
What is chorea
Non rhythmical irregular purposeless movements that flit and flow from one body part to another
Huntington’s disease shows acceleration- what does this mean
Gets worse as it is passed down though the generations
Syndeman’s chorea can develop after what
Rheumatic fever
Strep throat infection
What is Myoclonus
Sudden, involuntary focal or generalised muscle jerks.
Myoclonus can be normal, with abnormal being defined by over 5 of these jerky movements
What is the median age of onset of MND
60
Which form of dementia does MND have a link to
Frontotemporal Dementia
How can the presentation of MND be differentiated from Myasthenia gravis
Doesn’t affect the eyes
Cogan Lid Twitch
What is the mechanism of action of Riluzole
Blocks glutamatergic neurotransmission in the CNS
Which connective tissue disease is Myasthenia associated with
SLE
Which common cardioprotective drug can worsen Myasthenia symptoms
Beta-Blockers
What is the mainstay of treatment for Myasthenia Gravis
Pyridostigmine
Anti-Cholinesterase
What is the mainstay of treatment for Lambert Eaton syndrome
3,4 - diaminopyridine
What is a Stokes Adams Attack
Transient arrhythmias causing reduced cardiac output and loss of consciousness.
What is a Jacksonian march
A frontal lobe seizure only occurs on one side of the body; it progresses in a predictable pattern from twitching or a tingling sensation or weakness in a finger, a big toe or the corner of the mouth, then marches over a few seconds to the entire hand, foot or facial muscles
A spike and wave pattern at 3HZ on an EEG suggest which type of seizure
Absence seizure
Name a newer anti-convulsant which has the adverse effects of mood swings and depression
Levetiracetam
Which anti-epileptic drug can cause Leucopenia
Carbamazepine
What is non-epileptic attack disorder
Functional seizures that are largely mediated at the subconscious level and have a strong association with past trauma
What is an unusual part of the MS epidemiology
More common in locations which are higher above sea level
What is the diagnostic criteria for MS
Two episodes of symptoms suggestive of MS that last at least 1 hour and are at least 30 days apart as this shows dissemination in time and place
Name 3 disease modifying drugs used 1st line for MS
Beta-interferon
Techfidera
Copaxone
What is Mononeuritis Multiplex
When two mononeuropathies in distinct locations develop at the same time
Which type of fungal meningitis is seen in HIV patients
Cryptococcal
What is Kernig’s sign
Pain and resistance on passive extension of the knee with a flexed hip
Which cells will be seen in CSF in Viral, Bacterial and Tb meningitis respectively
Viral and TB - Lymphocytes
Bacterial - Neutrophils
What is the contact prophylaxis regime for meningitis
Rifampicin 4 doses
Ciprofloxacin 1 dose
Bilateral temporal lobe oedema or bilateral temporal focal enhancement on MRI suggests what
Herpes Simplex encephalitis
What causes Progressive multifocal leukoencephalopathy
JC virus infection
The use of which drug increases risk of JC virus activation
Tysabari (MS 2nd line)
What is the mechanism of action of triptans
5HT (serotonin) agonists
How many times should triptan use be limited to, per week, and why
Shouldn’t be taken more than twice a week as patient can become dependent and experience rebound headaches.
Which gender is Trigeminal Neuralgia more common in and what is the 1st line treatment
More common in Men
Carbamazepine
What are the two peak ages on onset of Narcolepsy
15 and 36??
Which arteries are affected in Total Anterior Circulation Syndrome
Blockage of both anterior and middle cerebral arteries
Which arteries are affected in Partial Anterior Circulation Syndrome
Blockage of one of anterior or middle cerebral arteries
Which arteries are affected in Posterior Circulation Syndrome
Posterior circulation stroke involving vertebral basilar arteries
Which arteries are affected in Lacunar Stroke
Multiple small vessel infarcts in basal ganglia and thalamus.
What is the timescale within which you can offer thrombolysis to a stroke patient
<4.5 hours
What should you do if someone presents with a stroke after 4.5hours of onset
300mg aspirin
continued for at least 14 days
What is the most common cause of Sub-Arachnoid Hemorrhage
Rupture of berry aneurysms
When do berry aneurysms rupture
When they grow greater than 6mm
Which 3 disease are associated with the development of berry aneurysms
Polycystic Kidney Disease
Coarction of aorta
Ehlers Danlos syndrome
What are Charcot-Bouchard aneurysms
Micro-aneursyms associated with chronic hypertension
Most commonly occur within basal ganglia
Rupture of Charcot-Bouchard aneurysms leads to what
Intracerebral haemorrhage
Which chemical imbalance can occur after a sub-arachnoid haemorrhage
Hyponatraemia
Which drug is given to patients following a sub-arachnoid haemorrhage to prevent Delayed Ischaemic Neurological Deficits
Nimodipine
What type of haemorrhage is associated with fluctuating consciousness and insidious mental/physical slowing
Subdural
What type of haemorrhage is associated with a head injury followed by a lucid period
Extradural
What is the most common cause of an extradural haemorrhage
Temporal bone fracture
What is the most common type of primary brain tumour
Astrocytoma (glioma)
What is another name for a grade 4 astrocytoma
Glioblastoma Multiforme
Which tumour is described as having a toothpaste-like morphology
Oligodendroma
Which malignant tumour of the cerebellum is almost exclusively seen in children
Medulloblastoma
Which therapy are oligodendromas very sensitive to
Chemotherapy
Glioblastoma multiforme is sensitive to which drug
Temozolomide
How is cerebral perfusion pressure calculated
MAP - ICP
Which type of herniation will present as lower limb weakness
Subfalcine
frontal lobe under falx cerebri
Which type of herniation will present as ipsilateral 3rd nerve palsy
Uncal
Temporal lobe under tentorium cerebelli
What is the most common cause of painful 3rd nerve palsy
Posterior communicating artery aneurysm
Which type of herniation will present as ataxia, 6th nerve palsy and UMN sign
Tonsillar
Herniation of the cerebellar tonsils through the foramen magnum
What is the triad of normal pressure hydrocephalus
Ataxia
Dementia
Urinary incontinence
Which spinal tracts are affected in Central Cord Syndrome
Corticospinal –> as it lies medially
Spinothalamic –> as the fibres have to cross the ischaemic zone
Which gene is associated with MS
HLA-DR2
How does internuclear ophthalmoplegia present
Failure to adduct with nystagmus in other eye
Which neural cells undergo gliosis
Astrocytes
hyperplasia and hypertrophy
What colour are acute MS plaques
Yellow/brown
What colour are chronic inactive MS plaques
Grey
What are the two ages in which incidences of Myasthenia Gravis peak
Females in the 3rd decade
Males in the 6/7th decade
Alzeheimer’s disease causes a loss of cholinergic neurons where in the brain in particular
Nucleus basalis of Meynert
Which two proteins make up Lewy bodies and which one can be detected by immunochemical staining
Alpha- synuclein
Ubiquitin (staining)
What is the greatest risk factor for Parkinson’s
Age
Which drug treatment for Parkinon’s can cause pathological gambling and hyper-sexuality
Dopamine Agonists
Which chromosome has the abnormality leading to Huntington’s
Chromosome 4
Which basal ganglion atrophies in Huntington’s
Caudate Nucleus
What causes xanthochromia in the context of sub-arachnoid haemorrhage
Yellow discolouration of CSF indicating presence of bilirubin breakdown
Asides from giving Nimodipine, how else can you prevent Delayed Ischaemic Deficit following sub-arachnoid haemorrhage
triple H therapy – hypervolaemia, hypertension, haemodilution
