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Year 3 > MedEd CNS > Flashcards

MedEd CNS Flashcards

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1
Q

What cranial nerve palsy results in an eye that is down and out?

A

III

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2
Q

How many nerves cross over at the optic chiasm?

A

50%

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3
Q

Where will the lesion be to cause monocular blindness?

A

At the optic nerve right beind the eye where there is a loss in vision

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4
Q

Where will the lesion be to cause bitemporal hemianopia?

A

Optic chiasm

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5
Q

Where will the lesion be to cause right homonymous hemianopia?

A

Left optic tract

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6
Q

Where will the lesion be to cause right superior homonymous quadrantanopia?

A

The lower fibres in the left temporal lobe

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7
Q

Where will the lesion be to cause right inferior homonymous quadrantanopia?

A

Left upper fibres in the anterior parietal lobe

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8
Q

Why is there macular sparing in occipital lobe lesions?

A

Lesions in the occipital lobe because the occipital lobes doesnt have the same blood supply

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9
Q

What acronym is used to remember cranial nerve supply to the eye muscles?

A

LR6 SO4

lateral rectus=CN 6
Superior oblique= CN 4

All other muscles= CN 3

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10
Q

What is the traid for 3rd nerve plasy?

A

Ptosis
Mydriasis
Down and out gaze

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11
Q

What is myadriasis?

A

Dilation of the pupil

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12
Q

How will 4th nerve palsy present?

A

Prevents eye moving in and down

Eye is up and out

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13
Q

How will 6th nerve palsy present?

A

Eye can’t move outwards

Eye is abducted

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14
Q

What is the most common cause of bitemporal hemianopia?

A

Pituitary adenoma (compressing the optic chiasm)

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15
Q

What is trigeminal neuralgia?

A

Severe episodic facial pain the in distribution of one or more branches of CN 5

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16
Q

What are the 3 branches of CN5 on the face?

A

Forehead
Cheek
Mouth

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17
Q

What are causes of trigeminal neuralgia?

A

Compression of CN5 nerve root
Most commonly caused by a vascular loop
Otherwise caused by a tumor, chronic meningeal inflammation or MS

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18
Q

What are RF for trigeminal neuralgia?

A

Increasing age

Female

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19
Q

How will trigeminal neuralgia present?

A

Sudden intense stabbing pain that lasts for seconds and is recurrent

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20
Q

How is trigeminal neurgalia triggered?

A 
Talking
Cold wind
Eating
Washing
Shaving
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21
Q

What investigations are done for trigeminal neuralgia?

A

None, diagnosis is clinical

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22
Q

What is Bell’s palsy?

A

Acute unitlateral lower motor neurone nerve palsy

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23
Q

What is Ramsay Hunt syndrome?

A

A complication of varicella zoster infection where there is a lower motor neuron nerve palsy

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24
Q

What causes bells palsy?

A

idiopathic

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25
What are RF for bells plasy
15-45 years of age May be increased in pregnancy Common in DM
26
How does bells palsy present?
Inability to raise the brows Drooping eyelid and cant close eye Drooping mouth, can't smile or pucker lips No muscle tone in cheek Dry eye (keratoconjunctivitis sicca) Hypersensivity to sound on the ipsilateral side (hyperacusis)
27
How do you differentiate bells palsy and stroke?
Bells palsy does not spare the forehead | Stroke does
28
What is bells phemomena?
Eye ball rolls up when the patient tries to close it
29
How is bells palsy investigated?
CT scan to rule out stroke Bloods- WCC to rule out infection Clinical diagnosis after ruling out other things
30
Hw does ramsay hunt syndrome present?
Unilateral facial paralysis and painful blisters in insilateral ear canal, anterior 2/3 of tongue and hard palate
31
What is horner's syndrome?
Triad of miosis, partial ptosis and anhydrosis
32
What is neurofibromatosis
Autosomonal dominant genetic disorder affecting cells of neural crest origin that leads to development of multiple neurocutaneous tumors
33
What are RF for horners syndrome
34
What is miosis?
Constriction of pupil
35
What causes horners syndrome?
Anything that disrupts the face's sympathetic nerve supply eg Brainstem tumor or stroke Pancoast tumor Carotid artery dissection
36
Disruption of what causes horner's syndrome?
Sympathetic nerve supply to the face
37
What is anhydrosis?
Sweating
38
What inevstgations are done for horner's syndrome? Why is each done
CXR- rule out pancoast tumor CT head- rule out stroke MRI angiography- rule out carotid dissection
39
How is horners syndrome managed?
Treat the cause
40
How is neurofibromatosis inherited?
Autosomal dominant
41
What genes are mutated in each type of neurofibromatosis and
NF1- chromosome 17 (mutation in neurofinromin)= type 1 | NF2- chromsome 22 (mutation in merlin)= type 2
42
Which type of neurofibromatosis is more common?
Type 1
43
What are RF for neurofibromatosis?
Fhx | Severe crush trauma
44
What is affected in neurofibromatosis 1 vs 2?
Type 1= whole body | Type 2= ears
45
What happens in neurofibromatosis type 1?
Skin lesions Pain related to skin lesions ``` May also have: Learning difficulties Headaches Disturbed visions Severe constipation ```
46
What happens in neurofibromatosis type 2?
Hearing loss Tinnitus Balance problems Vertigo Can have: Headache facial pain facial numbness MAY BE BILATERAL!!
47
What skin leasions are seen in neurofibromatosis type 1? How many are needed for diagnosis
Cafe au lait macules- need to have over 5 in the body (pre puberty >5mm and post puberty >15mm) Neurofibromas- cutaneous, subcut and diffuse plexiform Armpit freckling
48
What investigations are done for neurofibromatosis?
``` Type 1= full body examination Opthalmological assessment Type 2= hearing test CT/MRI if you are looking for tumors Can also go genetic testing but not common ```
49
How many cafe au lait macules are needed to diagnose neurofibromatosis? What size do they need to be?
over 5 over the body pre puberty= >5mm post puberty= >15mm
50
How do you remember what is affected in neurofibromatosis type 1 v 2?
Type 1= 1 thing is affected= you have 1 body= affects the body Type 2= 2 things are affected= you have 2 ears= affects the ears
51
What eye will be affected and on which side if a lesion is pre chiasmal?
One eye on the ipsilateral side
52
What eye will be affected and on which side if a lesion is chiasmal?
Both eyes, temporal visual field
53
What eye will be affected and on which side if a lesion is post chiasmal?
The contralateral eye, homonymous visual field
54
As an optic nerve lesion gets further back, what generally happens?
The area affected gets smaller
55
As an optic nerve lesion is further farward, what generally happens?
The area affected is larger
56
What are some causes of a prechiasmal lesion?
``` Optic neuritis Amaurosis fugax Optic atrophy Retrobulbar optic neuropathy Trauma ```
57
What are some causes of a chiasmal lesion?
Pituitary adenoma | Suprasellar aneurysm
58
What are some causes of a post chiasmal lesion?
Stroke Tumor Trauma
59
Where in the optic tract is a stroke most likely to cause a lesion?
Post chiasmal
60
What are a lot of cases of Bell's palsy preceded by?
Respiratory tract infection
61
What is ramsey hunt syndrome?
Reactivation of chickenpox
62
What organism causes ramsey hunt syndrome?
Varicella zoster
63
How is Bell's palsy managed?
High dose corticosteroids- 60 mg within 72 hrs (prednisolone or hydrocortisone) Eye protection- eye cover and artificial tears
64
What investigations are done for Bell's palsy?
Borellia serology Electroneurography if symptoms are severe Needle electro myography if electroneurography
65
What pathway is disrupted in horner's syndrome?
Sympathetic
66
What is anhydrosis?
Lack of sweating
67
Why do you get one sided sweating in horner's syndrome?
Anhydrosis occurs on the side of the face where sympathetic supply is lost so the other side appears sweaty
68
How many seizures have to occur for a diagnosis of epilepsy?
2 unprovoked seizures
69
What type of seizures most commonly get aura?
Focal temporal seizures
70
What happens post ictally in epilepsy?
Confusion Myalgia Somnolence
71
How will limb jerking differ in focal vs generalised seizures?
``` Focal= only some limbs may jerk Generalised= all 4 limbs will usually jerk ```
72
What is the cause of epileptic seizures?
They have no cause- are idiopathic
73
What hormone is raised in a true seizure?
Prolactin
74
What are the first and second line drugs for focal and generalised seizures?
``` Focal first line= carbimazepine second line= lamotrigine Generalised first= sodium valproate second= carbimazepine ```
75
What is drug escalation is status epilepticus?
first line= iv lorazepam or buccal diazepam second line= IV phenytoin third line= IV phenobarbitol fourth line= rapid sequence induction
76
What are causes of cord compression?
Slipped IV disc maliganancy Infection Trauma
77
What are symptoms of cord compression?
Back pain Bilateral UMN weakness Parasthesia Sphincter disturbance
78
What are symptoms of spinal shock syndrome?
Flaccid paralysis | Absent reflexes
79
What are the 2 main causes of cord compression?
Slipped disc | Tumor
80
In cauda equina vs cord compression which will have upper and lower motor neurone lesion signs?
Cauda equina= LMN signs | Cord compression= UMN signs
81
How is cord compression managed?
Emergency management of high dose steroids, surgical decompression
82
In cauda equina vs cord compression which will have more sphincter disturbance?
Cauda equina

Year 3 (104 decks)

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