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Y3 Charis > Neuro - general > Flashcards

Neuro - general Flashcards

1
Q

Commonest complication of meningitis

A

hearing loss

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2
Q

RF for SAH

A

Polycystic kidney disease

Alcohol, smoking, HTN

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3
Q

What do lacunar infarcts affect?

A

Small vessels around the basal ganglia, internal capsule, thalamus, pons

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4
Q

Clinical dx of epilepsy

A

need 2 or more unprovoked seizures occuring >24h apart

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5
Q

Commonest organisms in neonate meningitis

A

Extended labour, infection in previous pregnancy –> Group B streptococci
Late neonatal infection-> E. Coli
Listeria monocytogenes

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6
Q

Commonest organisms in infants + young children meningitis

A

Gram +ve cocci –> Strept. Pneumoniniae,
Unvaccinated –> Haemophilus influenzae type B,
Gram -ve diplococci –> Neisseria meningitidis

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7
Q

Commonest organisms in children meningitis

A

Gram +ve cocci –> S pneumoniae
Unvaccinated –> Haemophilus influenzae type B
Gram -ve diplococci –> N. meningitides

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8
Q

Commonest organisms in adult meningitis

A

Gram -ve diplococci –> N. meningitidis (80%)
Gram +ve cocci –> S. pneumoniae

H. Influenzae, L. monocytogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa

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9
Q

Commonest organisms in elderly + immunocompromised meningitis

A

eldelry, cheese/unpastuerised milk, alcoholics –> L. monocytogenes
Alcoholism + recent chest infection –> pneumococcal meningitis
Immunocompromise + CN involvement –> Listeria meningitis
Gram +ve cocci –> S. pneumoniae
TB

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10
Q

Commonest organisms in hospital-acquired + post traumatic meningitis

A

Klebsiella pneumoniae, E. coli, Pseudomonas aeruginosa, Staph. aureus

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11
Q

Contraindications to LP

A
  • signs of increase ICP (decreased consciousness, bad headache, frequent fits)
  • focal neurology
  • severe shock
  • sepsis
  • Coagulopathy
  • open skin lesion at the site of entry
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12
Q

Indications for LP

A 
2/4 of the following are present
•	Headache
•	Fever
•	Altered mental status of unknown aetiology
•	Meningism
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13
Q

Causes of hydrocephalus in young people

A
  • Congenital malformations

- Brain tumours

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14
Q

Causes of hydrocephalus in older people

A
  • Brain tumours

- Strokes

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15
Q

What is a non-communicative hydrocephalus?

A

Also called obstructive

Impaired flow of CSF from the ventricular system

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16
Q

Causes of non-communicative hydrocephalus

A

Lesions of 3, 4 ventricle, cerebral aqueduct
Acquired aqueduct stenosis
SOL in posterior fossa compressing the 4th ventricle
Tentoral herniation
Intraventicular haematoma
Tumours

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17
Q

What is a commmunicative hydrocephalus?

A

Impaired CSF reabsorption in the subarachnoid villi due to either

  • increased production
  • decreased reabsorption
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18
Q

What can cause a comminicative hydrocephalus?

A

Thickining of the leptomeninges +/- involvement of arachnoid granulations

  • infection
  • SAH
  • meningitis
  • tumours
  • NPH

Increased in CSF viscosity - increased protein count
Excessive CSF production - choroid plexus papilloma

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19
Q

What is hydrocephalus ex vacuo?

A

apparent ventricular expansion as a compensatory change due to brain atrophy + shrinkage (e.g. Alzheimer’s) – no increase in CSF pressure

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20
Q

What is normal pressure hydrocephalus?Causes?

A

CSF pressure remains normal or is only intermittently raised as measured by LP
o Idiopathic chronic ventricular enlargement
o Long white matter tracts are damaged leading to gait + cognitive decline
o Probably caused by chronic communicating hydrocephalus

The condition responds to a reduction in CSF pressure and/or a CSF diversion procedure

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21
Q

What is multiple sclerosis?

A
  • Cell – mediated autoimmune condition
  • Repeated episodes of inflammation of the nervous tissue in the brain + spinal cord –> causing loss of the insulating myelin sheath
  • Multiple areas of scar tissue form along the neurones –> this slows/blocks the transmission of signals to + from the brain + the spinal cord –> movement + sensation may be impaired
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22
Q

What is progressive bulbar palsy?

A

A type of MND - LMN

Any lesion affecting cranial nerve 9-12 at nuclear, nerve or muscle level
Nasal speech
Nasal regurgitation of food (esp. fluids - palatal weakness)
Decreased gag reflex
Absent jaw jerk
Wasted fasciculating tongue
Emotions not liable

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23
Q

What is pseudobulbar palsy?

A

A type of MND - UMN

UMN lesion to the lower brainstem (CN 9-11)
result of damage of motor fibres travelling from the cerebral cortex to the lower brainstem
Monotonous speech
Donald duck speech
Dysarthria
Dysphagia
Increased gag reflex
Brisk jaw jerk
Shrunken immobile spastic tongue, no fasciculations
Emotional liability
UMN limb spasticity + weakness

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24
Q

What is myasthenia gravis?

A

Chronic autoimmune disorder of the post-synaptic membrane at the neuromuscular junction in the skeletal muscle resulting from binding of autoantibodies to components of the NMJ (e.g. most commonly against the nicotinic Ach receptor but also to associated proteins)

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25
Q

What is a myasthenic crisis?

A

a complication of MG characterised by worsening muscle weakness resulting in respiratory failure that requires intubation + mechanical ventilation

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26
Q

What is the Eaton-Lambert syndorme?

A

a rare neuromuscular disorder most commonly seen in patients with small cell lung cancer

Proximal muscle weakness that improves on repetition (unlike MG)

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27
Q

DDx for myasthenia gravis and how to differentiate (4)

A

• Eaton-Lambert syndrome
o Proximal muscle weakness improves on exercise

• MS
o Hyperreflexia
o Extensor plantar response

• MND
o Features of UMN + LMN disease

• Horner’s syndrome
o Usually unilateral
o Miosis

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28
Q

Most common muscles to be affected in Myasthenia Gravis

A

Muscles of eyes + face

Condition may progress to affect respiratory muscle function –> myasthenic crisis

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29
Q

Myasthenia gravis assosciations

A
  • Other autoimmune conditions (e.g. pernicious anaemia)
  • Thymoma development (breakdown in immune tolerance thought to arise in thymus)
    Thymic hyperplasia more common than thymoma

Thymomas are present in 20% of patients with MG // Thymic hyperplasia occurs in 75% of MG patents // 30-50% of patients with thymoma also have MG

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30
Q

What is progressive muscular atrophy?

A

A type of MND

Affects LMN only

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31
Q

What is primary lateral sclerosis?

A

A type of MND

Loss of Betz cells in motor cortex
Mainly affects UMN
No LMN signs

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32
Q

Aetiology of GBS

A

Following a GIT or URT infection (2-3 weeks after infection)
Antibodies to the infectious organism also attack antigens in peripheral nervous tissue
Immune mediated attack on myelin sheath or Schwann cells of sensory + motor nerves

Organisms
Campylobacter jejuni
CMV
HIV
EBV
mycoplasma
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33
Q

RF for trigeminal neuralgia

A
  • Old age

- MS

34
Q

Most frequent causes of encephlitis
Infectious encephalitis
Immunocompromised
Autoimmune/paraneoplastic

A
  • Infectious encephalitis - Herpes Simplex Virus (temporal lobes)
  • Immunocompromised - also consider CMV (ventricles), toxoplasmosis, Listeria
  • Autoimmune/paraneoplastic - may be associated with antibodies
35
Q

What is BPPV?

A

Benign paroxysmal positional vertigo

peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo elicited by specific head movements

36
Q

How to differentiate BPPV from

Meniere’s
Viral labyrinthitis or vestibular neuronitis
Migraines
Central disorders

A

Meniere’s disease lasts for hours

Viral labyrinthitis or vestibular neuronitis lasts for days
Migraines are variable

Central disorders can be constant

37
Q

Aetiology of Meniere’s

A
  • Over production or impaired absorption of endolymph in the inner ear
  • Build-up of endolymphatic pressure (known as hydrops, rupture in membrane separating endolymph + perilymph - mixing + possible raise in pressure)
  • Endolymphatic hydrops - Progressive distension of the membranous labyrinth - this may injure the vestibular system (vertigo) or the cochlea (hearing loss)
38
Q

Difference between Type 1 and Type 2 neurofibromatosis

What do they affect
What are they made up of
Where is the mutation
When do the symptoms first appear

A

Type 1
• Typically affects nerves in the extremities + the skin – grow along peripheral spinal nerves + just beneath the skin surface
• Neurofibromas made of a mixture of Schwann cells, fibroblasts, immune cells
• Mutation in NF1 Chr 17
• Symptoms in childhood

Type 2
• Typically affects the brain, spinal cord and cranial nerves
• Neurofibromas are typically schwannomas
• Mutation in NF2 Chr 22
• Symptoms in adults <40 mostly in the 20s

39
Q

Aneurysms of the posterior communicating artery can lead to…

A

Oculomotor nerve palsy

40
Q

Vertigo indicates disturbance to…

A
  1. Inner ear
  2. vestibulocochlear nerve
  3. Brainstem
41
Q

Gentamicin can be toxic to.and it can cause

A

The vestibular apparatus

vertigo

42
Q

Were is the huntingtin (HTT) gene located?

A

On the short arm of Chr 4

43
Q

What does the mutated huntingtin protein do?

A

Induces apoptosis in neurones

Degeneration + death of medium spiny GABAergic neurones in the caudate + putamen

44
Q

Why is chorea a symptom of Huntington?

A

There is pathology in the striatum resulting in atrophy of mainly the caudate but also the putamen
As a result there is loss of inhibition of movements

45
Q

Pathophysiology for Parkinson’s disease

A

Alpha synuclein misfolds and begins to accumulate in cells –> cells lose their ability to degrade the protein –> formation of Lewy bodies and Lewy neurites

46
Q

Clinical course of subdural haematoma

A

Patient is well after the injury but subsequently deteriorates + loses consciousness as haematoma forms

• Fluctuations in consciousness

47
Q

Clinical course of extradural haematoma

A

• Hx of trauma /head injury that causes loss of consciousness, followed by a lucid interval after which the patient deteriorates

48
Q

Aetiology of subdural haemorrhage

A

Tearing of the bridging veins from the cortex to one of the draining venous sinuses
common in alcoholic (coagulation problems, brain atrophy) and elderly pt (brain atrophy)

49
Q

Aetiology of subarachnoid haemorrhage

A

Intracranial aneurysm rupture (usually berry aneurysm in the Circle of Willis)
Traumatic brain injury

50
Q

Aetiology of extradural haemorrhage

A

Pterion fractures

Fractures involving the foramen spinosum (it is where the middle meningeal artery passes through)

51
Q

RF for SAH

A
  • AD PKD
  • Neurofibromatosis T1
  • Ehlers-Danlos syndrome type IV, Marfans
  • FHx
  • HTN
  • Smoking
  • Cocaine
  • Excessive alcohol intake
52
Q

What is the difference between medical + surgical oculomotor palsy?

A

Medical - normal pupillary function (not dlated) with complete loss of eyelid + oculomotor somatic function

  • Non-traumatic
  • Pupil sparing (responds to light, not dilated) - parasympathetic fibres carried on the outside of the nerve not affected
  • Ischaemic cranial neuropathy secondary to microvascular complications
  • Assosciated with DM, HTN, hyperlipidaemia

Surgical - dilated pupil with loss of function with compete loss of eyelid + oculomotor somatic function

  • Traumatic
  • Non pupil spared (pupil is dilated) -parasympathetic fibres carried on the outside of the nerve compressed in trauma + pupil is not spared
  • Posterior communicating artery aneurysm

Partial third nerve palsies with normal papillary function can be related to progressive comprehensive lesions - need to be excluded

53
Q

Conditions that can cause facial paralysis

A 
Herpes zooster
Sarcoidosis
Lyme disease causes bell's palsy (bacterial cause)
Bell's pals
Stroke
54
Q

Anterior circulation of the brain arteries

A

Anterior cerebral artery

Middle cerebral artery

55
Q

Anterior cerebral artery supplies

A

Medial aspect of frontal + parietal lobes

branch of internal carotid

56
Q

Middle cerebral artery supplies

A

lateral surface of hemispheres, subcortical structures

branch of internal carotid

57
Q

Posterior cerebral artery supplies

A

Occipita lobe + inferomedial part of the temporal lobe

arises form the basillar artery

58
Q

a) Normal INR
b) therapeutic range of INR for pt on warfarin for AF or other conditions that increase the risk of thrombosis
c) Stop warfarin if INR…
d) interventions if INR >X or if…

A

a) 1.5
b) 2-3
c) 5-9
d) >9 or if active bleeding- vitamin K, FFP

59
Q

Most important complication of cerebellum or middle cerebral artery infarction

A

Cerebral oedema –> Increased ICP
Can cause brain herniation
Other signs - quadriparesis, oculomotor abnormalities, new facial palsy

60
Q

Which prognosis is worse? Haemorrhagic or ischaemic stroke?

A

Hemorrhagic

61
Q

Difference between simple partial and complex partial seizures

A

In complex partial seizures there is impairment of consciousness + patient cannot remember the events after the attack
In simple partial seizure patient knows that something is happening and can remember what happened afterwards

62
Q

Main causes of LOC in

Young patients
Middle aged patients
Elderly patients

A

Vasovagal syncope

Vasovagal syncope + arrhythmias

Orthostatic hypotension

63
Q

Factors assosciated with a better MS prognosis

A
  • Age onset <25 years
  • Optic neuritis or sensory symptoms at presentation (rather than cerebellar symptoms)
  • A long interval (>1 year) between relapses
  • Few lesions on MRI
  • Full recovery from relapses

Progressive MS has a worse prognosis than relapsing-remitting MS

64
Q

Cause of amaurosis fugax

Symptoms

Fundoscopy

assosciated with

A

retinal artery emboli

painless unilateral loss of vision
short duration
black curtain descending

oedema + cherry red macula

GCA, TIA

65
Q

Spinal claudication = Spinal stenosis

Cause
Presentation
Exacerbating/relieving factors

A

Caused by narrowing of the spinal canal due to spondylosis

Presents with: a)back pain + b) sciatica

Pain worse when spine is extended  going downhill, walking
Pain better when spine is flexed  going uphill, sitting

66
Q

Meningitis buzzwords

  • Long, extended labour
  • Late neonatal infection
  • Gram +ve cocci
  • Gram -ve diplococci
  • Unvaccinated
  • Elderly, cheese/unpasturised milk/alcoholics
A
  • Group B streptococcus
  • E.coli
  • Streptococcus pneumoniae
  • Neisseria Meningitides
  • Haemophilus influenza
  • Listeria monocytogenes
67
Q

Most common type of meningitis in immunocompromised individuals? Causative organism

A

Enteroviruses are the most common cause of meningitis in immunocompetent adults in the UK (viral infection – aseptic meningitis)

68
Q

Duration of migraines vs cluster headaches

A

Migraines - 4-72h

Cluster headaches 15mins - 3h

69
Q

Difference bn TN + temporal arteritis

A

TN usually 2nd and 3rd divisions of trigeminal nerve affected
TN rarely affects forhead alone
TN assosciated with MS

Temporal arteritis usually only affects forhead
Temporal arteritis assosciated with polymyalgia rheumatica

70
Q

What is Meningococcal disease?

A

Meningococcal disease – meningitis +/or septicaemia caused by Neisseria meningitidis

Non-blanching purpuric rash is a sign
IV benzylpenicillin

71
Q

What kind of herniation does LP cause?

A

Uncal herniation

72
Q

3rd CN palsy vs 6th CN palsy

A

3rd - posterior communicating artery aneurysm [eye down + out] (also superior cerebellar artery aneurysm)

6th - increased ICP [convergent squint +/- failure to abduct eye]

73
Q

Where is the

motor cortex
somatosensory cortex

found

A

motor cortex - frontal lobe

somatosensory cortex - parietal lobe

74
Q

Why is there a cherry red spot on fundoscopy in GCA?

A

Occlusion of ciliary and retinal arteries due to inflammation –> pale retina

Macula receives blood supply from choroid (supplied by the posterior ciliary arteries)

75
Q

How to differentiate between the different causes of back pain

Spinal stenosis
Spondylosis
Spondylolisthesis
Spinal tumours

A

Spinal stenosis
Pain relieved when sitting/leaning forwards
Caused by narrowing of the spinal canal due to spondylosis

Presents with: a)back pain + b) sciatica

Pain worse when spine is extended  going downhill, walking
Pain better when spine is flexed  going uphill, sitting

Spondylosis
Pain worse in the morning + following activity

Spondylolisthesis
Pain worse when standing

Spinal tumours
Pain is unremitting
Associated with systemic features e.g. weight loss, night sweats

76
Q

What is a scotoma

A

Area of depressed vision within the visual field

This finding is seen in lesions of the optic nerve which are commonly assosciated with demyelination e.g. MS

77
Q

Which are the 3 clinical phenotypes of MS

A

Relapsing remitting MS (RRMS) – patients most often fine, occasionally suffer from relapses + get acute symptoms which then resolve

Secondary progressive MS (SPMS) – they become gradually more and more disabled, may have more relapses, incomplete recovery

Primary progressive MS (PPMS) – they start progressing immediately without the initial relapsing + remitting stage

Not all RR patients convert to SP

78
Q

Difference between

Essential tremor/familial tremor
PD tremor
Cerebellar tremor

A

Essential tremor/familial tremor
Absent at rest
Appear on action
6-12 Hz
Fine amplitude
May be ameliorated by alcohol or beta blockers
No other parkinsonian symptoms are present

PD tremor
Present at rest, exacerbated by concentration
Disappear on action
3-7 Hz
Coarse amplitude
Commonly affects the distal limbs asymmetrically

Cerebellar tremor
Increases in magnitude throughout the movement to be maximal on approaching the target
4-6 Hz
Associated with other cerebellar signs (DANISH)

79
Q

Where is the lesion

Complete involvement of the legs (either sensory or motor)
Involvement of arms

A

Complete involvement of the legs (either sensory or motor) = lesion is higher than L1

Involvement of arms = lesion is higher than T1

80
Q

Central postural control is maintained by three systems

Cerebellar problem vs proprioceptive problem

A

vestibular
visual
proprioceptive

Cerebellar problem - patients can’t stand with their feet together even if their eyes are open

Proprioceptive loss - patients can stand with their feet together if they have their eyes open but lose their balance once they close their eyes (positive Romberg’s test)

81
Q

What does the Romberg’s test test?

A

Proprioception

82
Q

Straight leg raise test

A

The Straight Leg Raise (SLR) test can be used to determine if patient has true sciatica.

The test is positive when raising the leg between 30 to 70 degrees causes pain to occur and radiate down the leg to at least below the knee, and often all the way down to the great toe

Y3 Charis (35 decks)

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