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General Finals & SBA Review > Laz Neurology > Flashcards

Laz Neurology Flashcards

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1
Q

Signs of anterior cerebral artery damage

A

Affects motor cortex
Lower limb weakness (hemiparesis or a hemiplegia)
Contralateral side

Can get contralateral sensory defects, loss of leg and perineum sensation
Also affects frontal lobe -> disinhibition syndrome
Olfactory lobe -> Amosmia

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2
Q

Signs of middle cerebral artery blockage

A 
Contralateral weakness
Hemisensory loss
Facial weakness (forehead sparing, can you raise your eyebrows?)
Hemineglect
Quadrantopia
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3
Q

Which lobes does the anterior cerebral artery supply?

A

Motor
Sensory
Frontal
Olfactory

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4
Q

Which lobes does the middle cerebral artery supply?

A

Motor

Sensory

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5
Q

Which lobe is supplied by the posterior cerebral artery?

A

Occipital lobe

Cerebellum

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6
Q

Signs of posterior cerebral artery infarct

A

Vertigo
Ipsilateral ataxia
Hoarseness
Contralateral pain/temperature sensation loss

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7
Q

Ix for stroke

A

ECG because arrhythmia
Echo because thrombi, endocarditis
FBC because thrombocytopenia or polycythaemia
U&E because renal impairment, looking for kidney disease because can cause HTN
Lipid levels, cause of stroke

Should do a vasculitic screen (think of the stroke ward)

Gold standard = CT head to try and detect haemorrhage
Carotid artery Doppler to see if any carotid artery disease

MRI brain = a lot more sensitive

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8
Q

Mx of ischaemic stroke

A

Timing is crucial
CT head, once haemorrhage is ruled out, can do thrombolysis

If 4.5hr< and excluded haemorrhage, give aspirin 300mg and clopidogrel 75mg

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9
Q

Additional management alongside aspirin, clopidogrel and heparin in stroke

A

SALT review

Long term prophylaxis post discharge

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10
Q

What’s the cut off for considering hemicraniectomy?

A

<48hr

Has to be a mass effect to justify

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11
Q

When can you consider hemicraniectomy?

A

Mass effect

<48hr from onset

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12
Q

Management of haemorrhaged stroke

A 
IV mannitol (lowers ICP) 
Encourage hyperventilation to lower ICP

Surgical = coiling/clipping (for aneurysms)
Evacuation (for haematoma)

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13
Q

Long term management of stroke

A 
Lifestyle and conservative measures 
Rehab = MENDOS 
- MDT
- Eating = SALT review
- Neurorehab 
- DVT prohpylaxis 
- OT management 
- Sores (avoid pressure sores)

The aim is to reduce disability and handicap

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14
Q

Features of extradural haemorrhage

A

Trauma
Damages MCA
Big lenticular lesion (looks like a lens)
ACUTE

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15
Q

Features of subdural haemorrhage

A

Crescent-shaped haemorrhage (along the edge)
Usually in elderly, because its rupture of BRIDGING veins
Slow, insidious onset
Often in patients on blood thinners

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16
Q

Subarachnoid haemorrhage

A

Thunderclap, SUDDEN
Very old people or 20-30yo
Rupture of an aneurysm, usually berry aneurysm in the circle of Willis
On CT see the SCF filled with blood

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17
Q

Management of subdural haemorrhage

A

Supportive!
Monitor GCS
Re-scan if deteriorates

If really large with significant impairment, can consider surgical options

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18
Q

Features of meningitis

A

Photophobia
Headache (because the lining of brain is inflamed which causes increased ICP)
Neck stiffness
Altered mental state (confusion, irritable, drowsy)
Seizures (more common in encephalitis)
Fever

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19
Q

The most common cause of meningitis in adults

A

Viral

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20
Q

Most common bacterial meningitis cause

A

Neisseria meningitis

Streptococcus

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21
Q

What is Kernig’s sign?

A

Meningitis sign

Straightening the leg irritates the meninges

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22
Q

Signs of bactierial meningitis

A

Normal meningitis stuff
Sepsis
Fever
Non-blanching rash

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23
Q

Mx of meningitis

A

Start antibiotics immediately in a side room
Bloods (inflammatory signs)
Raised CRP usually indicates bacterial meningitis
Check for raised ICP (contraindicates a LP) = CT head

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24
Q

Signs of raised ICP

A

Focal neurology
Seizures
Papilloedema
LOC

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25
Why don't you do an LP on raised ICP?
Risk of coning
26
Contraindications to LP acryonym
``` Try LP Unless Contra INdicated Thrombocytopaenia Lateness Pressure Unstable Coagulation disorder Infection Neurological signs ```
27
Where do you aim for the LP?
L4/L5
28
LP viral meningitis
``` NORMAL glucose High WBC High protein Clear Lymphocytes ```
29
LP bacterial menigitis
LOW glucose (being used up) Much higher protein levels Turbid Neutrophils
30
LP for TB features
Low glucose High protein levels Lymphocytes Fibrin web appearance
31
LP for fungal infection
Low glucose High protein Eosinophils!
32
Best way to remember LP results
Glucose levels Cells present ``` Bacterial = neutrophils, low glucose Viral = lymphocytes, normal glucose TB = lymphocytes with low glucose Fungal = eosinophils with low glucose ```
33
Key management of meningitis
Antibiotics + anti-virals IV cefotaxime IV acyclovir
34
What can you give for meningitis if allergic to penicillin?
Chloramphenicol
35
Complete meningitis management
``` IV cefotaxime IV acyclovir Fluids Dexamethasone Electrolyte replacement Anticonvulsants if seizure = lorazepam ```
36
What is encephalitits
Inflammation of the brain parenchyma (the brain itself)
37
Most common causes of encephalitis
HSV/VZV | Bacterial = Neisseria meningitides
38
Ix for encephalitis
Bloods LP Blood cultures CT head for raised ICP
39
What is Parkinson's DISEASE
A neurodegenerative disease of dopaminergic neurones in substantia nigra
40
Parkinsonism is ...
Symptoms of Parkinson's without the Parkinsons | E.g. with antipsychotic medications
41
Parkinsonian plus syndrome is ...
Group of neurodegenerative diseases with parkinsonian features
42
Motor features of Parkinson's
Tremor Rigidity (cog wheel) Akinesia and BRADYKINESIA Postural instability TRAP
43
At what point of loss do Parkinson's patients begin to manifest motor symptoms?
70% dopaminergic loss
44
Prodromal Parkinson disease
Depression, anxiety, fatigue, REM sleep behaviour disorder, memory issues
45
Late-stage Parkinson's features
``` Falls Dysphagia Dementia Psychotic Sx Urinary Sx ```
46
Why do Parkinson's pts have small handwriting?
Struggle to coordinate big movements
47
Ix of Parkinson's
``` Try levodopa and see if it improves Sx (trial) Serum caeruloplasmin (rule out Wilsons) MRI brain to exclude vascular disease/hydrocephalus ```
48
Mx of Parkinson's disease
Parkinson's disease is because dopaminergic neurones are dying L-DOPA + carbidopa (which stops peripheral dopamine breakdown, which would cause really bad nausea)
49
L-DOPA + Carbidopa name of drug
Sinemet
50
How do MAO B inhibitors work?
Dopamine can be broken down by MAO B | So blocking its breakdown keeps dopamine in the brain
51
Why does L-DOPA wear off?
The neurones are still dying | Just improving their production for now
52
Drug for early-onset Parkinsons'
Amantadine Dopamine agonist Saves L-DOPA (sinemet) for later on
53
What is multiple system atrophy and what are its features?
a-synuchleinopathy Causes autonomic dysfunction -> postural hypotension and urinary retention (remember Hillingdon case) Cerebral ataxia Parkinsonian features It is a Parkinson + syndrome
54
What is corticobulbar degeneration?
Alien limb movement Unilateral Parkinson's It's a Parkinson+ syndrome
55
Can't move eyes vertically Parkinsons symptoms Lots of falls
Progressive supranuclear palsy
56
Lewy body dementia features
Visual hallucinations Early dementia Parkinsonian symptoms
57
Features of Alzheimer's
Chronic neurodegenerative disease with insidious onset + progressive slow decline, resulting in memory loss and behavioural changes ``` Amnesia Aphasia Agnosia (can't recognise objects) Apraxia (using a hair brush upside down, difficulty planning movement) Poor abstract thinking ```
58
Cause of Alzheimer's
Cholindergic loss
59
Ix for Alzheimer's
MMSE assesment Rule out Wilsons Thyroid disease and B12 can manifest as dementia, so test for these CT head/MRI to exclude vascular disease Mainly a clinical Dx
60
What might the CT show in Alzheimer's
Cerebral atrophy Big spaces Largened ventricles
61
Mx of Alzheimer's
Donepezil (help to preserve memory and functional abilities) Memantine (second line) +/- antipsychotics = risperidone (reduce behavioural symptoms Appropriate care and support
62
Features of vascular dementia
Stepwise decline | Symptoms depend on site
63
Features of frontotemporal dementia
``` Disinhibition Personality change Inattention Apathy Language impairment ```
64
What is a seizure
Excessive, abnormal, synchronised discharge of neurons -> clinical manifestations
65
Definition of epilepsy
The tendency to have recurrent, unprovoked seizures 2 seizures, more than 24hr apart Unprovoked seizure MUST be Ix appropriately because 60% will have another seizure within 10 years
66
What is a tonic-clonic seizure?
Grand mal Start with LOC, then tonic (stiff) Then clonic (repetitive limb movements)
67
Ix for seizure
``` Septic screen Electrolyte screen ECG EEG CT head (pick up SOL) BM ``` Increased WCC could indicate brain infection Encephalitis can cause them Drug-induced seizures are very common (you've seen one)
68
Which key initial investigation can indicate they've had a seizure?
Lactate
69
Status epilepticus Mx
``` A-E High flow O2 Check BM IV access? -> lorazepam 4mg bolus If not -> buccal midazolam Can give 2 doses If that doesn't work, give IV diazepam ```
70
Stabilised the status episode, now what do you do?
``` Monitor ABG Cultures Think about glucose, alcohol, sepsis! WHAT HAS CAUSED IT? ```
71
Who should you alert with status?
ITU/anaesthetics May be considering vasopressors if it doesn't resolve = ITU stuff Need to keep airway sufficient!
72
Epilepsy long term management
Inform DVLA Got to be seizure free for 12mo Ketogenic diet (because they get into the brain?!) Psychological support Try to keep on very few medications Carbamazepine
73
Management of cluster headache
Avoid alcohol and smoking Acute Mx = oxygen, sumatriptan nasal spray Prevent = verapamil
74
Management of migraine
Avoid CHOCOLATE Med = sumatriptan Anti-emetics in the acute setting Propanalol to prevent
75
Treatment for temporal arteritis
Prednisolone 1mg/kg/day for 4 weeks PPI cover Aspirin to reduce risk of vision loss

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