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Neurology > Yearclub revision session > Flashcards

Yearclub revision session Flashcards

1
Q

unilateral throbbing headache

A

migraine

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2
Q

migraine timeframe

A

4-72 hours

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3
Q

acute treatment of migraine

A

NSAID or triptans (+/- antiemetic)

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4
Q

migraine prophylaxis

A

propanolol or topiramate
avoid triggers

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5
Q

what type of headache is strongly linked to depression and anxiety and often triggered by stress?

A

tension headache

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6
Q

what is a tension headache like?

A

‘a tight band of pressure’ and possible tingling sensation in this distribution

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7
Q

is cluster headache more common in men or women?

A

men

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8
Q

Is cluster headache unilateral or bilateral periorbital pain?

A

unilateral

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9
Q

autonomic features of cluster headache

A
  • ptosis
  • miosis
  • nasal stuffiness
  • eye tearing
  • eyelid oedema
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10
Q

do cluster headaches need MRI?

A

yes, and MRI angiogram.
to rule out secondary causes

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11
Q

acute management of cluster headaches

A

high flow O2 and subcutaneous or oral triptan +/- 2 week reducing course steroids

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12
Q

cluster headache prophylaxis

A

verapamil

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13
Q

Is hemicrania continua unilateral or bilateral?

A

unilateral

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14
Q

hemicrania continua is a pain in which nerve distribution?

A

trigeminal (V1 mainly)

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15
Q

hemicrania continua investigation

A

MRI

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16
Q

Hemicrania continua treatment

A

TOTAL response to indomethacin

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17
Q

typical idiopathic intracranial hypertension patient

A

obese young woman

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18
Q

Idiopathic intracranial hypertension symptoms

A

headache - worse in morning/coughing
nausea and vomiting
blurred vision (papilloedema)

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19
Q

Idiopathic intracranial hypertension fundoscopy findings

A

bilateral papilloedema, englarged blind spot

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20
Q

Idiopathic intracranial hypertension CT/MRI findings

A

“slit like ventricles”

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21
Q

Idiopathic intracranial hypertension treatment

A

weight loss
acetazolamide
shunt CSF from ventricles to peritoneum

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22
Q

trigeminal neuralgia headache

A
  • chronic neuropathic pain in distribution of CN V
  • severe pain when chewing and talking, pain on contact (e.g. washing face) with psychological consequences
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23
Q

trigeminal neuralgia headache treatment

A

pain relief (carbamazepine or amitriptyline)

possibility of surgery: microvascular decompression, balloon compression, radiofrequency ablation

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24
Q

trigeminal neuralgia causes

A
  • compression from superior cerebellar artery
  • AVM
  • tumours
  • MS
  • injury to the nerve (e.g. stroke or trauma)
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25
"worst headache ever"
subarachnoid haemorrhage
26
headache fever stiff neck mental confusion seizures double vision
meningitis
27
headache "behind the eye" and other neuro complications
optic neuritis - think MS
28
what is a new headache which wakes you +/- vomiting a red flag for?
tumour
29
what is the commonest form of dementia
Alzheimer's
30
Alzheimer's disease pathophysiology
proteinopathy of amyloid protein - leads to intracellular neurofibrillary tangles and extracellular amyloid plaques ---> apoptosis
31
Alzheimer's disease progression
- initially affects hippocampus causing forgetfulness - then more widespread cognitive decline - long term memory is relatively preserved from pre-disease state, but can't make new memories gradual, steady decline
31
Alzheimer's investigation findings: MRI, SPECT, CSF, tau
MRI: can show atrophy SPECT: reduced uptake CSF: amyloid decreases tau: amyloid ratio increases
32
Alzheimer's disease treatment (improves symptoms but doesn't slow decline)
1st line: rivastigmine (cholinesterase inhibitor) 2nd line: Memantine (NDMA receptor blocker)
33
what is vascular dementia
dementia due to micro-infarction of brain tissue. can be focal post stroke or generalised.
34
usual age for vascular dementia
>65
35
vascular dementia progression
often step-wise rather than gradual
36
What do MRI and SPECT show in vascular dementia?
MRI: severe small vessel disease SPECT: PATCHY reduced uptake
37
vascular dementia treatment
reduce vascular disease risk factors, monitor disease. often overlap with Alzheimer's in which case Rivastigmine can help
38
which type of dementia is associated with tau proteinopathy?
fronto-temporal dementia
39
at what age does fronto-temporal dementia tend to present?
younger, under 65
40
fronto-temporal dementia symptoms
since frontal lobe: often behavioural symptoms or disinhibition drastic personality change hyperorality/overeating
41
MRI and SPECT findings in fronto-temporal dementia
atrophy, reduced uptake specifically in the frontal/temporal lobes
42
fronto-temporal dementia management
aggressive disease which is hard to manage. - trial of antipsychotics/trazadone (seratonin antagonist and reuptake inhibitor) - manage access to food, money, internet - sort power of attorney
43
which type of dementia has overlap with MND: C9ORF72 gene
fronto-temporal dementia
44
Dementia with lewy bodies and Parkinson's dementia treatment
cognitive symptoms - rivastigmine (cholinesterase inhibitor) parkinsons- levodopa BUT levodopa can worsen hallucinations
45
Huntington's disease mode of inheritance
autosomal dominant
46
Huntington's pathophysiology
degeneration of the basal ganglia and cerebrum. mutations in the huntingtin gene (ch 4). Causes CAG trinucleotide expansion leading to long glutamine strings which are toxic to cells
47
Huntington's typical age of onset
30-50
48
early features of Huntington's disease
irritability disinhibition
49
later signs of Huntington's disease
dystonia chorea
50
dystonia definition
involuntary muscle contractions that cause slow repetitive movements or abnormal postures that can sometimes be painful
51
chorea definition
sudden, unintended, and uncontrollable jerky movements of the arms, legs, and facial muscles
52
gold standard test for huntington's
genetic test
53
Huntington's MRI findings
focal atrophy of caudate heads
54
midline cranial nerves
1,2,3,4,6,12 (factors of 12)
55
cranial nerves exiting pons
5,6,7,8
56
cranial nerves exiting medulla
9,10,11,12
57
TIA investigations
- carotid duplex US - ECG - Blood tests
58
TIA treatment
- immediate antiplatelet (aspirin) - anti-HTN - statins - surgery/stenting
59
anterior/middle cerebral artery affected by ischaemic stroke
numbness, muscle weakness
60
where is broca's area
left frontal lobe
61
where is Wernicke's area
left temporal lobe
62
effect of ischaemic stroke affecting Broca's area
slurred speech
63
effect of ischaemic stroke affecting Wernicke's area
understanding speech
64
ischaemic stroke symptoms
- hemiplegia - hemisensory loss - homonymous hemianopia - dysphagia - sensory neglect
65
treatment for ischaemic strokes
- thrombolysis/thrombectomy - aspirin Longterm: - aspirin - DOAC (rivaroxaban etc) + BP cont. + statins + lifestyle
66
cranium layers, outer to inner
skin periosteum bone dura arachnoid (subarachnoid) pia brain
67
fracture of the pterion can rupture which artery?
middle meningeal artery
68
extradural haemorrhage most common cause
trauma - fracture of pterion causing rupture of middle meningeal artery
69
why may an extradural (aka epidural) haemorrhage patient keep declining?
expanding haematoma until coning of the brainstem
70
extradural haemorrhage investigation
non-contrast CT (biconvex lens shape)
71
extradural haemorrhage management
initially stabilising the patient followed by surgical intervention with a decompression burr hole or craniotomy to evacuate the haematoma
72
subdural haemorrhage - who is usually affected?
older people/chronic alcoholics

Neurology (12 decks)

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