05/06/2021 Flashcards
1
Q
acoustic neuroma diagnosis
A
MRI of cerebellopontine angle
2
Q
axillary freckles
A
neurofibromatosis type 1
3
Q
NF1
A
cafe au lait axillary/groin freckles Peripheral neurofibromas Iris hamatomas Scoliosis Pheochromocytoma
4
Q
NF2
A
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, meningiomas and ependymomas
5
Q
painful third nerve palsy
A
posterior communicating artery aneurysm
6
Q
what causes webers
A
midbrain strokes- ipsilateral 3rd nerve palsy with contralateral hemiplegia
7
Q
what are adenoma sebaceum
A
feature of tuberous sclerosis
8
Q
tuberous sclerosis inheritance
A
autosomal dominant
9
Q
cutaneous features of tuberous sclerosis
A
ash-leaf spots shagreen patches adenoma sebaceum fibromata beneath names café au lait may be seen
10
Q
neurological features of tuberous sclerosis
A
developmental delay
epilepsy
intelluctual impairment
11
Q
where is affected in broca’s aphasia
A
expressive aphasia- left-sided stoke affecting the MCA due to a lesion of the inferior frontal gyrus
12
Q
where is affected in wernicke’s aphasia
A
Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA
13
Q
MOA of 5-HT 2 antagonists
A
chemoreceptor trigger zone in medulla oblongata
14
Q
unilateral spastic paresis and loss of proprioception/vibration sensation wth loss of pain and temperature sensation on the opposite side
A
brown-sequard
15
Q
cluster headache prophylaxis
A
verapamil
16
Q
acute rescue therapy cluster headache
A
sumatriptan with high flow oxygen
17
Q
pain and temperature sensation in brown-sequard
A
loss of contralateral
18
Q
weakness in brown-sequard
A
ipsilateral weakness below lesion
19
Q
proprioception in brown-sequard
A
ipsilateral loss
20
Q
loss of corneal reflex
A
acoustic neuroma
21
Q
assessing stroke in acute setting
A
ROSIER
- LOC/syncope (1)
- seizure activity (1)
- new onset of;
+ asymmetrical facial weakness (1)
+ asymmetric arm weakness (1)
+ asymmetric leg weakness (1)
+ speech disturbance (1)
+ visual field defect (1)
22
Q
Anterior cerebral artery stroke
A
contralateral hemiparesis and sensory loss, lower extremity > upper
23
Q
Middle cerebral artery stroke
A
contralateral hemiparesis and sensory loss, lower extremity > upper
contralateral homonymous hemianopia
aphasia
24
Q
posterior cerebral artery stroke
A
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
25
weber's syndrome (branches of the posterior cerebral artery that supply the midbrain) stroke
ipsilateral CNIII palsy
| Contralateral weakness of upper and lower extremity
26
posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) stroke
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
27
Anterior inferior cerebellar artery (lateral pontine syndrome) stroke
Wallenbergs
| Ipsilateral: facial paralysis and deafness
28
retinal/ophthalmic artery stroke
amaurosis fugax
29
basilar artery stroke
locked-in syndrome
30
how do lacunar strokes present
isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong association with hypertension
Basal ganglia, thalamus and internal capsule
31
diminished response to repetitive stimulation on EEG
myasthenia gravis
32
management of nausea in parkinsons
give domperidone (guy trembling with bottle of demo perignon)
33
motor eyes pnuemonic
LR6 SO4 ao3
34
diagnosis of carotid artery stenosis
duplex ultrasound
35
Management of neuropathic pain
1) amitriptyline, gabapentin or pregabalin
36
management of status epilepticus
ABC
1st- benzodiazepines
2nd- phenytoin or phenobarbital infusion
3rd (refractory status)- general anaesthesia
37
tremor + high pitched voice
essential tremor
38
features of bell's
> lower motor neuron facial nerve palsy - forehead affected
-- in contrast, an upper motor neuron lesion 'spares' the upper face
>patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
39
who is predisposed to bell\s palsy
pregnant women
40
management of bell's palsy
all patients should get oral prednisolone within 24hrs
41
parkinsonism + atonic bladder + postural hypotension
multi-system atrophy
42
features of neuroleptic malignant syndrome
rigidity
hyperthermia
autonomic instability
altered mental status
43
what is an arnold-chiari malformation
downward displacement, or herniation of the cerebellar tonsils through the foramen magnum
44
features of arnold chiari malformation
non-communicating hydrocephalus
headache
syringomyelia
45
what is syringomyelia
dilatation of a CSF space in the spinal cord
46
pathophysiology of syringomyelia
compression of spinothalamic tracts decussating in the anterior white commisure
47
symptoms of syringomyelia
dissociative loss of sensation of pain, temperature and non-discriminative touch
cape-like distribution of sensory loss
48
longevity of cluster headaches
15 minutes to 2 hours
49
dose of rectal diazepam in seizures
child <1yr 5mg
child 2-11 yrs 5-10mg
adult 10-20 mg
elderly 10 (max 15)mg
50
thrombectomy target in acute ischaemic stroke
6 hours
51
when can thrombectomy target be increased in acute ischaemic stroke
> potential to salvage brain tissue, shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
52
how to differentiate between common peroneal nerve lesion and L5 radiculopathy
if isolated peroneal lesion there will be weakness of foot dorsiflexion and eversion, reflexes will be normal
if L5 there will be weakness of hip abduction
53
features of wernickes encephalopathy and korsakoffs syndrome
```
Wernickes;
C- onfusion
O- pthalmoplegia
A- taxia
T- hiamine deficiency
```
```
Korsakoff's;
R- etrograde amnesia
A- neterograde amnesia
C- onfabulation
K- orsakoff psychosis
```
54
saturday night palsy
compression of the radial nerve against the humeral shaft, possibly due to sleeping in a hard chair
55
laughter -> fall/collapse
cataplexy
56
motor innervation of ulnar nerve
```
medial two lumbricals
adductor pollicis
interossei
hypothenar muscles
flexor carpi ulnaris
```
57
thoracic outlet syndrome causes
neurogenic or vascular
58
clinical presentation of neurogenic thoracic outlet syndrome
> painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping
> sensory symptoms such as numbness and tingling may be present
> if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling
59
clinical presentation of vascular thoracic outlet syndrome
> subclavian vein compression leads to painful diffuse arm swelling with distended veins
> subclavian artery compression leads to painful arm claudication and in severe cases, ulceration and gangrene
60
fasciculations
think MND
61
baseline investigation for MS
MRI brain with contrast
62
scale that measures disability or dependence in activities of daily living in stroke patients
barthel
63
vertical diplopia
trochlear nerve palsy- worse when reading or going down stairs
64
```
nerve root landmarks
C2
C3
C4
C5
C6
C7
C8
```
T4
T5
T6
T10
L1
L4
L5
S1
S2
S3
```
C2= Posterior half of skull
C3= high turtleneck shirt
C4= low collar shirt
C5= ventral axial line of upper limb
C6= thumb + index (make a 6)
C7= middle finger + palm of hand
C8= ring + little finger
```
```
T4= nipples (T4 at the teat pore)
T5= infra-mammary fold
T6= xiphoid
T10= umbilicus
```
```
L1= inguinal ligament L for ligament, 1 for 1nguinal
L4= knee caps (down on alL 4's)
L5= big toe, dorsum of foot, except lateral aspect (L5= largest of all 5 toes)
```
```
S1= lateral foot, small toe S1 the smallest 1
S2= genitalia
S3= genitalia
```
65
commonest neurological manifestation of sarcoidosis
facial nerve palsy due to parotid gland enlargement
66
conduction dysphasia
speech fluent, repetition poor. comprehension intact
67
controlled hyperventilation
reduces CO2, causes vascoconstriction of cerebral arteries and reduced ICP
68
management of generalised tonic-clonic seizures
1) sodium valproate
| 2) lamotrigine, carbamazepine
69
management of absence seizures
1) sodium valproate or ethosuximide
70
management of myoclonic seizures
1) sodium valproate
| 2) clonazepam, lamotrigine
71
management of focal seizures
1) carbamazepine or lamotrigine
| 2) levetiracetam, oxcarbazepine or sodium valproate
72
drugs associated with SJS
```
phenytoin
salicylates
sertraline
imidazole
nevirapine
carbamazepine
```
73
large artery acute ischaemic stroke management
mechanical clot review
74
klumpke's paralysis
brachial trunks C8-T1
weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner's syndrome.
75
erbs palsy
brachial trunks C5-6
pronated and medially rotated.
76
Lambert-Eaton syndrome or myasthenia gravis?
Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise
77
features of intracranial venous thrombosis
headache
| N&V
78
test of venous sinus thrombosis
MR venogram
79
what suggests idiopathic parkinsons?
asymmetrical symptoms
80
features favouring pseudoseizures
```
pelvic thrusting
family member with epilepsy
more common in females
crying after seizure
dont occur when alone
gradual onset
```
81
treatment of idiopathic intracranial hypertension
acetazolamide- CAI that reduces the production of CSF
82
facial palsy that spares the upper face
UMN lesion
83
surgical third nerve palsy
ptosis, enlarged pupil, inability to adduct/supradduct
84
cause of normal pressure hydrocephalus
2ry to reduced CSF absorption at the arachnoid villi
| - head injury, SAH or meningitis
85
tried in normal pressure hydrocephalus
urinary incontinence
dementia
gait abnormality
86
Bitemporal hemianopia- lower quadrant defect
inferior chiasmal compression, commonly a pituitary tumour
87
Bitemporal hemianopia- upper quadrant defect
superior chiasmal compression, commonly a craniopharyngioma
88
which medicatons are likey to cause inhibition disorders
dopamine receptor agonists- ropinirole
89
weakness of foot dorsiflexion and elevation
common peroneal nerve lesion
90
screening tests for cause of stroke
- anti-nuclear antibodies(ANA)
- anti-phospholipid (APL) antibodies
- anticardiolipin (ACL) antibodies
- lupus anticoagulant (LA)
- coagulation factors
- ESR
- Homocysteine
- syphillis serology
91
appearance of chronic subdural haematoma on scan
hypodense (dark) crescenteric collection around the convexity of the brain
92
what is autonomic dysreflexia
> unbalanced physiological response
> characterised by;
extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.
93
what causes autonomic dysreflexia
spinal cord injury at, or above T6 spinal level.
94
management of autonomic dysreflexia
removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia
95
smiths fracture injury
median nerve- thenar muscle failure
96
cutaenous sensation to the axilla
intercostobrachial
97
what is todd's paresis?
post-ictal weakness in focal seizures
98
exacerbating factors in myasthenia gravis
```
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracycline
```
99
syncopal episode vs seizure
syncopal episodes have a short post-ictal period
100
management of MND
riluzole- prolongs life by about 3 months
resp care= BIPAP
101
the sensation of fine touch, proprioception and vibration are all conveyed in the ____ ______
dorsal column
102
what is lhermitte's sign?
indicates disease near the dorsal column nuclei of the spinal cord - tingling in hands when flexes neck
103
management of acute relapse of MS
high dose steroids
104
most common inherited sensorimotor neuropathy
charcot-marie-tooth
105
treatment of myasthenia gravis
Pyridostigmine is a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of myasthenia gravis
106
lesions at T1 will cause
finger abduction weakness
107
syringomyelia = ______ sensory loss
spinothalamic
108
investigation in suspected acoustic neuroma
audiogram and gadolinium-enhanced MRI head scan
109
use of anaesthesia in MG
MG: rocuronium 'rocks'
| Suxamethonium sucks
110
when to suspect encaphalitis
altered mental status
111
which nerves are affected in vestibular shwanommas?
cranial nerves V, VII, VIII
112
managing tremor in drug induced parkinsons
procyclidine
113
side effect of cabergoline
pulmonary fibrosis
114
long term use of levodopa
reduced effectiveness with time
115
symptoms of paroxysmal hemicrania
attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region
last less that 30 mins
116
management of paroxysmal hemicrania
indomethacin
117
management of neuroleptic malignant syndrome
stop antipsychotic
IV fluids to prevent renal failure
dantrolene
bromocriptine, dopamine agonist
118
what is internuclear ophthalmoplegia
lesion of medial longitudinal fasciculus- a tract that allows conjugate eye movement
119
presentation of internuclear ophthalmoplegia
impairment of adduction of ipsilateral aye, contralateral eye adducts however with nystagmus
120
jacksonian movement
clonic movements travelling proximally - frontal lobe epilepsy
121
most common psychiatric problem in parkinsons
depression
122
headache, fever and focal neurology
brain abscess
123
what does loss of proprioception and vibration sense point towards?
dorsal columns- subacute combined degeneration of the spinal cord
124
pontine haemorrhage
Patients often present with reduces Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements.
125
barthel index
measures disability or dependence in ADL in stroke patients
126
isolated high protein in CSF
indicative of GBS
