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2b - grind > Neuro > Flashcards

Neuro Flashcards

1
Q

Define TIA?

A

An ischaemic neurological event with symptoms which last <24 hours.

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2
Q

What is amaurosis fugax?

A

Occurs in TIA/GCA when the retinal artery is occluded. It will cause unilateral progressive vision loss ‘like a curtain descending’

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3
Q

Tx of TIA?

A

Antihypertensives, statins, aspirin and clopidogrel. Anticoagulation if cardiac emboli or carotid endarterectomy if plaque

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4
Q

What is used to calculate the risk of having a stroke following a TIA?

A

ABCD2
Age >= 60 (1)
Blood pressure >= 140/90 (1)
Clinical features: unilateral weakness (2), speech disturbances without weakness (1)
Duration of symptoms: >= 1hr (2), 10-59 mins (1)
Diabetes (1)

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5
Q

Briefly describe symptoms of the 3 main types of anterior ischaemic stroke?

A 
ACA = leg weakness/sensory disturbances, gait apraxia and truncal ataxia and incontinence
MCA = FAST (Facial droop, arm/leg weakness/sensory loss and aphasia)
PCA = unilateral headache, visual agnosia, prospagnosia, blindness
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6
Q

Sx of posterior circulation stroke?

A

Affects Basilar artery and vertebral artery causing brainstem infacrts.
Quadraplegia, visual disturbances, locked in syndrome

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7
Q

What are luncar infarcts? What do they affect?

A

Blockage of smaller arteries. Presents with sensory or motor changes but cognition/consiousness is not impaired

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8
Q

Tx of stroke?

A

CT/MRI to check cause.
If thrombotic = start aspirin immediatley. If stroke was =< 4.5 hours ago perform thrombolysis with alteplase. Consider thrombectomy
Haemorrhagic = endovascular coiling

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9
Q

Sx SAH?

A

Sudden onset excruciating headache, vomiting, collapse, seizures, neck stiffness, kernig’s sign.

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10
Q

What is the main cause of SAH? How do you treat?

A

Ruptured berry aneurysm.

Reverse blood thinners, IV fluids, nimodipine, endovascular coiling

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11
Q

Casue of subdural haemorrhage?

A

Bleeding from the bridging veins between the cotex and venous sinuses leading to increasing ICP.
Seen in the elderly and alcoholics and caused by minor trauma which may have happened long ago

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12
Q

Sx of subdural haemorrhage?

A

Fluctuating consiousness, physical and intellectual slowing, drowsiness, headache, personality change and seizures

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13
Q

Cause of extradural haemorrhage?

A

Head injury causing fracture of the temporal or parietal bone (causes middle meningeal artery laceration), leads to raised ICP.
Seen in head injuries which result in brief loss of consiousness - often in young men who have been in fights

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14
Q

Sx of extradural haemorrhage?

A

Brief loss of consiousness followed by a lucid interval. Increasingly severe headache, vomiting, confusion and seizures - may be signs of UMN damage

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15
Q

How can you differentiate between the types of haemorrhage on CT?

A 
SAH = star shaped blood distribution
Sub-dural = crescent shaped blood distribution
Extra-dural = lemon shaped blood distribution
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16
Q

Tx of cranial haemorrhage?

A

Mannitol to reduce ICP. Surgical management - ligation of bleeding vessels in extra-dural, burr hole washout/craniotomy in subdrual

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17
Q

Briefly describe how to localise focal seizures?

A 
Frontal = motor features e.g. Jacksonian march (spreading motor seizure with maintained awarness), dysphasia and behavioural disturbances
Parietal = sensory disturbances
Temporal = automatisms (motor phenomenom with impaired awarness), dysphasia, emotional disturbance and hallucinations - MOST COMMON
Occipital = visual phenomena
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18
Q

What is a focal seizure? What are the 2 main types?

A

A seizure originating within networks linked to one hemisphere.
Without impaired consiousness = awarness is maintained, no post-ictal symptoms
With impaired consiousness = aura is often present with post-ictal confsuion (often from the temporal lobe)

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19
Q

What are the 4 main types of generalized seizure?

A 
Abscence = brief pauses, presents in childhood
Tonic-clonic = loss of consiousness, limbs stiffen and then jerk - post-ictal drowsiness and confusion
Myoclonic = sudden jerk of limb/face/trunk
Atonic = sudden loss of muscle tone leading to a fall but no LOC
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20
Q

What is Todd’s palsy?

A

Weakness due to neurological defecit after a seizure. May be face/arm/leg weakness or gaze palsy

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21
Q

Tx of epileptic seizures?

A

Focal = carbamazepine
Generalized = sodium valporate (be very careful in women of child-bearing age)
Lamotrigine and Levetiracetam are NOT tetrogenic

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22
Q

Sx of Parkinson’s disease?

A 
Resting tremor (pin-rolling), hypertonia/rigidity (cogwheel rigidity), bradykineasia (slow initiation and reduced amplitude of repetetive movements).
Expressionless face, depression, sleep disturbances and reduced sense of smell
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23
Q

Tx of Parkinson’s disease?

A

Levodopa is the main treatment - dont start until late as its efficacy reduces with time (must be given with a dopa-decarboxylase inhibitor e.g. carbidopa - two can be combined e.g. co-careldopa or co-beneldopa)
Dopamine agonists e.g. ropinirole or MAO-B inhibitors in early PD

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24
Q

What is Huntington’s disease?

A

AD progressive neurodegenerative disorder.

Sx = inital irritability, depression and incoordination. Progresses to chorea, dementia and fits

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25
Q

Classic Sx of migraine?

A

Aura (usually visual) lasting 15-30mins followed by unilateral throbbing headache
OR
Episodic severe throbbing headaches without aura - will be unilateral with nausea, vomiting and photo/phonophobia
Headaches are often worsened by movement and preceeded by a prodrome e.g. yawning and mood changes

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26
Q

Tx of migraine?

A

Avoid triggers
Prophylaxis with propanolol or topiromate
Acute management with oral triptan, NSAIDs and paracetamol

27
Q

Sx of cluster headache?

A

Rapid onset excruciating pain around one eye. The eye may become watery and blood-shot with lid swelling, facial flushing and rhinorrhoea.
Lasts 15-180mins and occurs 1/2 times a day in clusters of 4-12 weeks

28
Q

Tx of cluster headaches?

A

Avoid triggers e.g. alcohol.

Short term corticosteroids, verapamil and lithium

29
Q

Sx of trigeminal neuralgia?

A

Intense stabbing pain in the trigeminal nerve distribution (esp. maxillary and mandibular branches). Pain lasts for seconds and causes the face to screw up

30
Q

Tx of trigeminal neuralgia?

A

Carbamazepine

31
Q

Sx of Giant Cell Arteritis?

A

AKA temporal arterititis.
Headache, temporal artery and scalp tenderness, tongue/jaw claudication, amaurosis fugax/unilateral blindness, malaise, dyspnoea, weight loss and morning stiffness

32
Q

Dx and Tx of GCA?

A 
Dx = very rasied ESR and CRP and temporal artery biopsy
Tx = Prednisolone
33
Q

Sx of spinal cord compression?

A

Sharp shooting pain localised to the point of compression. LMN signs at the level of compression, UMN signs below the level of compression. There may also be weakness and parasthesia

34
Q

Causes of spinal cord compression?

A

Spondylosis, spinal stenosis, spondyloisthesis, spinal tumours, spinal TB, spinal absecess and disc prolapse

35
Q

What are the key UMN and LMN signs?

A

UMN lesion = weakness, brisk reflexes, increased tone, clonus and babinski’s sign
LMN lesion = weakness, decreased reflexes, decreased tone, muscle wasting and fasiculations.

36
Q

Sx of cauda equina syndrome?

A

Pain in the lower back, pain and paraesthesia in the leg muscles, loss of power in the legs, saddle anaesthesia, loss of anal tone, urinary/bowel incontinence

37
Q

Tx of cauda equina syndrome?

A

Emergency lumbar decompression - do an MRI of the lumbar spine and treat quickly!!

38
Q

Sx of MS?

A

Ususally starts off with unilateral optic neuritis (pain on eye movement and decreased central vision), numbness and tingling in the limbs, spasticity and weakness, intenion tremor, ataxia etc.
Symptoms worse on heat e.g. hot bath
Symptoms generally come and go (relapsing and remitting) but dysability will accumulate over time.

39
Q

Tx of MS?

A

Regular exercise, reducing stress and quitting smoking may help.
Monoclonal antibodies e.g. alemtuzumab can be used long term, treat relapses with methylprednisolone.
Baclofen/gabapentin can treat spasticity, botox can treat tremor

40
Q

What is myasthenia gravis?

A

An autoimmune disease against the nicotinic acetylcholine receptors in the neuromuscular junction caused by thymus issues.

41
Q

S&S of myasthenia gravis?

A

Slowly increasing muscular fatigue affectes the extraocular muscles then the bulbar muscles then the face, neck and trunk.
Ptosis, diplopia, myasthenic snarl on smiling, voice fades when counting to 50. Tendon reflexes will be normal.

42
Q

Dx of myasthenis gravis?

A

Anti-AChR antibodies, CT of thymus, ptosis will improve by >2mm after ice is applied for >2mins

43
Q

Tx of myasthenia gravis?

A

Anticholinesterase e.g. pyridostigmine (this will ensure ACh remains in the junction), immunosuppresion with prednisolone, thymectomy

44
Q

What is the most common motor neurone disease? How can you distinguis a MD from MS?

A

Amyotrophic Lateral Sclerosis (ALS)

MD will NOT cause any sensory loss, sphincer disturbances or issues with eye movement where as MS will

45
Q

Sx of ALS?

A

Loss of motor neurones in the motor cortex AND the anterior horn of the spinal cord therefore there will be UMN AND LMN symptoms
Split hand sign (wasting on the side of the thumb but sparring on the side of the little finger), there will be muscle weakness and cramps. Babinski’s sign POSITIVE

46
Q

Tx of ALS?

A

Riluzole (gulamate release inhibitor), baclofen for spasms, amitryptyline for drooling

47
Q

What is Guillain-Barre syndrome?

A

An acute inflammatory demyelinating ascending polyneuropathy which affects the schwann cells and peripheral nerves a few weeks after an infection. This is the most common peripheral neuropathy (causes distal muscle weakness)

48
Q

Sx of Guillain-Barre syndrome?

A

Symmetrical ascending muscle weakness and parasthesia (starts in the feet and legs then spreads upwards). Proximal muscles are more severly affected (esp. resp/trunk/CN7).
Symptoms progress for 4 weeks before recovery

49
Q

Tx of Guillain-Barre syndrome?

A

IV immunoglobulin. Monitor respiratory function!

50
Q

Sx of Carpal Tunnel Syndrome?

A

COMMONEST MONONEUROPATHY
Aching pain and parasthesia in the hand and arm which is worse at night (relieved by hanging the arm over the bed and shaking). Sx are seen along the distribution of the median nerve (thumb to 1/2 of ring finger).
Sensory loss and weakness in the thumb, impaired light touch, 2-point descrimination and sweating

51
Q

Dx and Tx of Carpal Tunnel Syndrome?

A

Phalen’s test = maximal wrist flexion for 1 min elicits symptoms
Tinnel’s test = tap on the nerve at the wrist - this will elicit symptoms
Splint wrist, local steroid injections or surgery

52
Q

Sx of Brown-Sequard Sydrome?

A

Hemisection of the spinal cord
Below lesion:
Ipsilateral weakness and loss of proprioception/fine touch as corticospinal and DCML decussate in the medulla
Contalateral loss of temperature, pain and crude touch as spinothalamic tracts decussate just after entering the spinal cord

53
Q 
What do these terms mean:
Paraplegia
Quadraplegia
Hemiplegia
Flaccid paralysis
Spastic paralysis
A

Paraplegia = paralysis of both legs due to spinal cord lesion
Hemiplegia = paralysis of one side of the body due to brain lesion
Quadraplegia = paralysis of all 4 limbs due to spinal cord lesion
Flacid paralysis = nerve is cut in LMN
Spastic paralysis = nerve is cute above the alpha-motor neurone (UMN)

54
Q

What is the most common types of brain tumours?

A 
Primary = Gliomas e.g. astrocytomas and oligodendrogliomas
Secondary = from lung (especially NSCLC), breast, melanoma, renal and GI
55
Q

Sx of primary brain tumour?

A

Progressive headache which is worse on walking and increased by coughing/straining/bending forward, drowsiness, vomiting, papilloedema, seizures and progressive neurological deficit

56
Q

Sx of encephalitis?

A

Personality/behavioural changes, fever, headache, seizures, decreased consiousness and focal neuropathies preceeded by infectious signs e.g. high temperature, rash, lymphadenopathy etc.

57
Q

Tx of encephalitis?

A

IV acyclovir if viral, IV benzylpenecillin if meningitis is supected, primidone/phenytoin to prevent seizures

58
Q

Sx of meningitits?

A

Headache, neck stiffness, fever, photophobia, Kernig’s sign, Brudzinski’s sign, decreased consiousness, seizures, non-blanching petechial rash

59
Q

Tx of meningitis?

A

Immediate IM benzylpenicillin (1.2g) in GP
If bacterial = ceftriaxone/cefotaxime IV and oral dexamethasone.
Oral ciprofloxacin to close contacts

60
Q

Common causes of bacterial meningits? How can you identify these microbiologically?

A

Streptococcus pneumoniae = gram +ve catalase -ve alpha haemolytic cocci - MOST COMMON
Nisseria meningitidis = gram -ve diplococci
Haemophillus influenzae = gram -ve aerobic bacilli which is grown on chocolate agar and requires clotting factors V/X

61
Q

Sx of shingles?

A

Caused by reactivation of VZV
Fever, myaligia, malaise, headache and a papular AND vesicular rash which does not extend outside the dermatome.
There may be post-herpetic neuralgia after shingles symptoms resolve

62
Q

Sx of chicken pox

A

Caused by inital VZV infection

Fever, malaise, headache, abdominal pain and widespread rash

63
Q

What are the main causes of bulbar palsy? What are the symptoms?

A

MND, Guillain-Bare syndrome, myasthenia gravis and brainstem tumours. Damage to CN 9-12 causes LMN disease of the tongue and muscles of talking/swallowing.
Flaccid fasiculating tongue (like a sack of worms), absent jaw jerk and quiet speech.

64
Q

What is a polyneuropathy?

A

Motor and/or sensory disorder of multiple peripheral or cranial nerves. Usually symmetrical, wide spread and often worse distally (in a glove and stocking distribution)

2b - grind (11 decks)

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