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Y4 - Finals Edition > Lectures : Neuro > Flashcards

Lectures : Neuro Flashcards

1
Q

Name grading scores used to predict prognosis and outcome in patients with subarachnoid haemorrhage?

A
  1. Hunt and Hess
  2. World Federation of Neurosurgeons
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2
Q

Definitive treatment for SAH

A
  • transfer to specialist neuro unit
  • analgesia and anti-emetic
  • metallic coils (radiological) / surgical clipping
  • ICP monitoring
  • BP management
  • Nimodipine po 60mg / 4hrly (within 48hrs)

Notes: Endovascular coiling

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3
Q

Complications of SAH

A
  • re-bleeding
  • subdural haemorrhage
  • global cerebral ischaemia
  • vasospasm
  • hydrocephalus
  • seizures
  • SIADH / cerebral salt wasting syndrome
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4
Q

What might be given to help reduce risk of re-bleeding in SAH?

A

Nimodipine po 60mg / 4hrly (within 48hrs)

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5
Q

What is used to pathologically classify brain tumours?

A
  • The WHO classification
  • based on cells affected
  • nerves —> schwannoma
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6
Q

The commonest primary brain tumour is glioma, this is further classified onto what the cells look like under a microscope. Name the cells:

A
  1. Astrocytes
  2. Oligodendrocytes (myelin sheath !)
  3. Ependymal cells (line ventricular system)
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7
Q

What genetic deletion is associated with oligodendroglioma?

A

1p 19q deletion

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8
Q

IDH1 mutation is associated with what type of brain tumour?

A

astrocytoma

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9
Q

In patients with glioblastoma what type of genetic change may be seen?

A

MGMT promotor methylation
- patients with methylation will respond better to chemotherapy.
- methylated - blocks

MGMT which would normally break down chemotherapy, does better with treatment

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10
Q

This is used to measure cancer patients ability to carry out ordinary tasks

A

Karnosfsky performance status

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11
Q

What is spectroscopy and why is it used?

A

Looks at chemical composition within defined area of brain.

N-ACETYL-ASPARTATE PEAK
- marker of cell turnover, if cells turning over suggests tumour

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12
Q

What drug is given to patients before brain surgery that will given a deep red hue to the patients tumour?

A

5 -ALA
- tumour lights up under UV light

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13
Q

Name of a chemotherapy that can be placed like wafers on the tumour and gently diffuses into the tumour

A

Gliadel

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14
Q

While chemotherapy does not tend to work that well on the brain given an example of a type of chemotherapy drug that does?

A

temozolamide
- works better in MGMT methylated patients

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15
Q

What two special tests/ signs might indicate meningitis?

A

KErnig sign
- knee extension is painful

Brudzinski sign
- neck flexion leads to knee flexion

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16
Q

What tools may be used for cognitive function assessment?

A
  1. MOCA - Montreal cognitive assessment
  2. Addenbrooke’s cognitive assessment
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17
Q

Presence of hypertension with bradycardia is known as what sign?

A

Cushing’s sign
- systolic BP
- decreased pulse
- decreased respiration

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18
Q

What monitoring is important in the treatment of HSV encephalitis?

A
  • renal
  • aciclovir may lead to crystal nephropathy
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19
Q

In immunocompromised patients, what are the likely viral causes of encephalitis?

A

HHV 6 –> Roseola

HHV 7 –> pityriasis rosea

HHV 8 –> Kaposi sarcoma in HIV individuals

EBV

CMV

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20
Q

Pathophysiology of viral encephalitis

A
  1. via cranial nerves –> HSV
  2. via peripheral nerves –> Rabies
  3. neuroinvasion from blood (in plasma e.g. flaviviruses, Japanese encephalitis) or by infecting leukocytes (HIV)
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21
Q

autoimmune encephalitis caused by what:

A

antibodies against NMDA receptor

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22
Q

How is the diagnosis of epilepsy made?

A
  • at least two unprovoked seizures occurring greater than 24 hours apart
  • one unprovoked seizure and increased probability of further seizures
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23
Q

What is an arteriovenous malformation?

A
  • abnormal connection of blood vessels
  • can be associated with seizures and epilepsy
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24
Q

What investigations are required for a suspected thunderclap headache?

A
  1. URGENT IMMEDIATE CT BRAIN

IF CT unremarkable for cause

  • LP and CSF examination (12hrs post headache)

Why the 12hr gap?

  • if there is blood in CSF not picked up by CT
  • this will break down to bilirubin
  • bilirubin can be picked up on a xanthochromia test
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25
Management of headache caused by low CSF pressure?
- lie flat (1 -2 weeks?) - IV fluids 8hrly or 2-3L oral fluids in 24 hours - gives time for brain to heal dura
26
Red flags for glaucoma
loss of vision and halo effect
27
Give example of neuropeptides involved in the trigemino cervical complex pathway of migraine genesis:
CGRP - calcitonin gene related peptide
28
Management for episodic migraine
1. Triptans AND/OR Aspirin OR NSAIDs should be 1st line therapy 2. **Triptan + NSAID + anti-emetic** 1. after aura! 2. given as one off 3. ensure adequate hydration 4. Rest 5. Don’t use strong painkillers
29
When should migraine suffers be evaluated for use of preventive therapy:
- if getting more than 2-3 episodes a month - or if episodes are severe
30
Chronic headaches are defined as what frequency of headaches:
- more than 15 days a month - for more than 3 months - at least 8 days in the month have features of migraine - triggers!
31
Treatment of cluster headaches - Acute treatment
- Sumatriptan - injection / nasal spray - high flow oxygen
32
Treatment of cluster headaches - short term prevention
- greater occipital nerve blocks - **prednisolone 60-80mg/day 3-5 days and taper off** (counsel on side effects and lansoprazole) - should not be used more than twice a year
33
Treatment of cluster headaches long term prevention
- verapamil - topiramate - lithium - gamma core device
34
Management of neuralgia :
Carbamazepine (usually responsive)
35
Define multiple sclerosis
- multifocal , upper motor neuron disorder - multiple sclerotic lesions - relapsing or progressive - dissemination in time and space
36
radiographic feature of demyelination seen in multiple sclerosis
Dawson's fingers
37
How is the diagnosis of multiple sclerosis made:
**Poser 1983** - 2 attacks with objective clinical evidence - attacks occurring at different times MRI may also be used **Macdonald criteria**
38
Management of MS
1. Relapsing treatment 1. 500mg Methylprednisolone for 5 days 2. Relapse prevention 1. specialist stuff 2. e.g. interferons 3. Slowing progression 4. Neural repair 1. re-myelination? stem cells?
39
Define Parkinson’s disease
- progressive reduction of dopamine - in basal ganglia of brain - leads to disorder of movements Key features 1. Resting tremor (4-6hz) 2. Cog wheel rigidity 3. Bradykinesia
40
What histopathological features are present in Parkinson’s disease:
1. Lewy Body Depositions - composed mainly of **alpha synuclein protein** 2. Diminished substantia nigra
41
Appearance of substantia nigra in Parkinson’s disease:
lighter
42
Parkinson's tremor vs benign essential tremor
**Parkinson's tremor** --> asymmetrical --> 4-6hz --> worse at rest --> improves with intentional movement --> no changes with alcohol **Benign essential tremor** --> symmetrical --> 5-8hz --> improves at rest --> worse with intentional movement --> improves with alcohol
43
Summarise the Parkinson’s plus syndromes which also exist:
1. Multisystem atrophy 2. Dementia w/ lewy bodies 3. Progressive supranuclear palsy 4. Corticobasal degeneration
44
Management of Parkinson’s disease
1. Levodopa a) synthetic dopamine b) usually combined with peripheral decarboxylase inhibitors --> carbidopa or benserazide --> prevents breakdown of levodopa before entering brain Combination drugs are: - Co-benyldopa (***levodopa*** and ***benserazide***) - Co-careldopa (***levodopa*** and ***carbidopa***)
45
Main side effect of high levels of dopamine:
Dystonia --> excessive muscle contraction Chorea --> abnormal involuntary movements jerking Athetosis --> involuntary twisting movements
46
What is the role of COMT inhibitors:
e.g. entacapone - COMT enzyme metabolises L-dopa in both body and brain. - Entacapone is taken with L-dopa (and decarboxylase inhibitor) to **slow breakdown of L-dopa** - extending duration of levodopa!
47
What is the name of enzyme which breakdowns neurotransmitter dopamine
monoamine oxidase B - more specific to dopamine - thus monoamine oxidase-B inhibitors will be used to increase circulating dopamine.
48
What condition is important to consider in a patient with cerebrovascular risk factors and Parkinsonism type symptoms:
- Vascular Parkinsonism - predominant gait and postural instability - tremor less prominent - poor levodopa responsiveness
49
Side effects of dopamine agonists
1. Impulse control disorders: pathological gambling, binge eating and hypersexuality 2. Somnolence: strong desire to fall asleep 3. Confusion, hallucinations
50
Examples of MAO-B inhibitors
Increase amount of dopamine available for receptors in the striatum. Rasagiline and Selegiline
51
MAO-B inhibitor associated with hallucinations, confusion and insomnia
Selegiline
52
Drug which prevents reuptake of dopamine at synapses
Amantadine Used only for the management of levodopa-induced dyskinesia
53
What are 3 other drug induced movement disorders important to be aware of:
1. **Akathisia** - motor restlessness 2. **Tardive Dyskinesia** - smacking of lips - facial grimacing - lateral jaw movements - choreiform (jerking) or athetoid (slow involuntary writhing of fingers) movements 3. **Dystonia’s** - Torticollis - oculogyric crisis
54
What is the precursor for dopamine and how is this converted to dopamine:
55
2 broad categories of dopamine agonists:
1. Ergot-based (not used as much) - pergolide, cabergoline Adverse effects of Ergot based drugs - pulmonary, pericardial and retroperitoneal fibrosis 2. Non-ergot - pramipexole, ropinirole
56
Treatment of essential tremor:
- B-blockers - propranolol
57
Treatment of dystonia:
- botulinum toxin injections - weaken affected muscle
58
Absent seizure AEDs
1st line - ethosuximide 2nd line - sodium valproate
59
Focal seizure AED
1st - Carbamazepine, sodium valproate, levetiracetam
60
Generalised seizu
61
Common side effect of levetiracetam
behavioural problems
62
Common side effects of carbamazepine
Steven Johnson Syndrome Behavioural problems
63
Common side effects of nitrazepam
drowsiness
64
Common side effects of vigabatrin
visual field defects
65
Common side effects of topiramate
weight loss
66
Name the 6, cytochrome P450 hepatic enzyme inducers:
‘Randy’s car smokes and goes poot poot’ - Rifampicin - Carbamazepine - Spironolactone - Griselfulvin - Phenytoin - Phenobarbituate
67
Describe the 3 categories of AEDs and what this means in terms of prescribing:
**Category 1** —> should not switch between brands —> carbamazepine —> phenobarbital —> primidone **Category 2** —> clinical judgement whether to switch or not —> sodium valproate —> lamotrigine —> perampanel **Category 3** —> can switch between different versions —> levetiracetam —> gabapentin
68
Scoring system for myelopathy
mJOA scoring system

Y4 - Finals Edition (40 decks)

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