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Year 3 - MedEd Lectures > Neuro 1 > Flashcards

Neuro 1 Flashcards

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1
Q

Which conditions may damage any Cranial Nerve?

A

Diabetes

Multiple Sclerosis

Tumours

Sarcoidosis

Vasculitis

SLE

Syphilis

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2
Q

What could cause changes in a younger person’s sense of smell?

A

Frontal Lobe Tumour

Trauma, the Olfactory Nerve may be sheared as it sits in the Cribiform Plate

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3
Q

How does the presentation of a loss of visual acuity point to the possible cause?

A

Bilateral - Age-Related Macular Degeneration

Sudden - Infarct

Over a few hours - MS Inflammatory Attack (Painful)

If old - Ischaemia/Diabetes

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4
Q

What would be your Ddx in a patient presenting with a decrease in Optic Acuity?

A

Refractive Error

Ocular Media

Age related macular degeneration

Diabetic Retinopathy

Optic Neuropathy (MS/Ischaemia)

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5
Q

What is Conjunctivitis and how does it present?

A

Pink Eye

Chemosis (Eyelid Oedema)

Crust and Discharge

Foreign Body Sensation

Photophobia

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6
Q

How do you distinguish between the causes of Conjunctivitis?

A

Bacterial

  • Thick Yellow/Pus Discharge
  • Reduced Vision
  • Urethritis/Vaginal Discharge ?STD

Viral

  • Watery Clear Discharge
  • Normal Vision
  • Fever/Lymphadenopathy

Allergic

  • Young Adults
  • IGE Mediated
  • Itching, Sneezing, Red, Watery Oedematous eye
  • Typical Allergic cause and presentation
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7
Q

What are cataracts and how do they present?

A

Clouding of the lens and eye.

Visual impariment and glare.

‘Halos’ around lights.

painless

Reduced red reflex OE

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8
Q

What is glaucoma and how does it present?

A

Visual loss due to Optic Nerve damage.

Usually due to Raised Intraocular Pressure

Must be ruled out in a case of Acutely Red, Swollen Eye

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9
Q

How does Glaucoma-related visual loss progress?

A

Begins peripherally, then progresses more centrally.

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10
Q

What are the two main types of Glaucoma?

A

Open Angle

  • Wide angle between the drainage canal and the iris - Good Drainage
  • Trabecular Meshwork Dysfunction
  • Bilateral, progressive, mild

Closed Angle

  • Poor Drainage
  • Trabecular Meshwork is fine, but the angle through which humour drains is smaller
  • Unilateral, sudden, painful
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11
Q

What is Uveitis?

A

Inflammation of the Uvea (Made up of the Iris, Ciliary Body and Choroid)

Anterior involves the Iris and Ciliary Body

Posterior involves the Vitreous Body, Choroid and Retina

SBA - Can be associated with autoimmune disease

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12
Q

How would you differ between Anterior and Posterior Uveitis?

A

Anterior

  • Autoimmune
  • Painful, Pink Eye
  • Increased Tear Production & Photophobia

Posterior

  • Infective
  • Painless
  • Floaters and Scotomata
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13
Q

What are the main causes of Anterior Uveitis?

A

Seronegative Spondyloarthropathies

Rheumatoid Arthritis

Sarcoidosis

SLE

IBD

Behcet’s

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14
Q

What are the main causes of Posterior Uveitis?

A

CMV

EBC

HSC

VZV

Syphilis

TB

Lyme Disease

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15
Q

How could you classify the types of Visual Field Defects?

A

Prechiasmal

  • One eye only
  • Ipsilateral

Chiasmal

-Bitemporal Hemianopia

Post-Chiasmal

  • Homonymous
  • Contralateral
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16
Q

What are the main causes of Prechiasmal visual field defects?

A

Ischaemia (TIA)

Inflammation (MS, Giant Cell Arteritis)

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17
Q

What is Amaurosis Fugax?

A

Visual Field Defect seen in patients experincing a Prechiasmal TIA.

Described a being like ‘A veil coming down over one eye for a few minutes’

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18
Q

What are the main causes of Chiasmal Visual Field Defects?

A

Pituitary Tumour

Craniophyrangioma

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19
Q

How do Bitemporal Hemianopias develop when due to structures compressing the Optic Chiasm?

A

If originating superior to the Optic Chiasm, the visual field defect will begin as a Bitemporal Inferior Quadrantanopia

If originating inferior to the Optic Chiasm, the visual field defect will begin as a Bitemporal Superior Quadrantanopia

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20
Q

What are the main causes of Post-Chiasmal Visual Field Defects?

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A

Tumours

Multiple Sclerosis

Strokes

21
Q

In which lobes are the lesions when patients present with Hemitemporal Quadrantanopias?

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A

Superior - Temporal

Inferior - Parietal

22
Q

What is Neglect Syndrome?

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A

Lesions in the Parietal Lobe lead to patients ignoring one side of their world.

Not Blindness, they can see things, but can’t register them.

Will eat food on one side of their plate

Shave one side of their face

Wash the right side of their body

23
Q

What does the loss of the consensual pupillary light reflex indicate?

Study These Flashcards
A

CN III Lesion

24
Q

What does the loss of the direct pupillary light reflex indicate?

25
What is the triad associated with Horner's Syndrome?
Ptosis Miosis Anhydrosis
26
What can cause Horner's Syndrome?
Benign Causes, such as Migraine and Goitre Neurological Causes, such as MS and Syringeomyelia Life-Threatening Lesions, such as Tumours on the sympathetic pathway or Pancoast's Tumour (Lung Apex) Carotid Dissection
27
Which classic sign would you see upon Cranial Nerve examination of a patient with an Oculomotor Nerve Palsy?
Down and Out Pupil Occurs due to unopposed action of the 4th and 6th Nerves. Ptosis would also be seen
28
What is the difference between a Medical and Surgical 3rd Nerve Palsy?
Medical palsies occur due to medical causes often affecting the blood supply to the nerve. Down and out pupil occurs first. Surgical palsies occur due to compressive lesions from outside. The parasympathetic chain is affected first, hence you see ptosis before a down and out pupil.
29
What are the causes of a Medical 3rd Nerve Palsy?
Diabetes Vasculitis affecting 'Vasa Nervosum' - would see pupillary sparing
30
What are the causes of a Surgical 3rd Nerve Palsy?
Raised ICP Aneurysm Rupture
31
What would you see in a patient with a Trochlear Palsy?
The eye looks Up and In
32
What causes Bell's Palsy?
Idiopathic Commonly due to viruses (Herpes Simplex Virus 1/Varicella Zoster) Compression of Facial Nerve within the Facial Canal Diabetes is a Risk Factor
33
How would you investigate a suspected case of Bell's Palsy?
**_OE_** - Inability to: - Wrinkle Brow - Close Eye - Puff Cheeks - Smile **_Viral Serology_**
34
How would you manage a patient with Bell's Palsy?
Eyepatch - patient can't close eyes so at risk of corneal abrasions Prednisolone
35
What is Ramsay Hunt Syndrome?
LMN Facial Palsy due to Varicella Zoster Shingles in the CNs
36
How does Ramsay Hunt Syndrome present?
Bell's Palsy with more pronounced features Pain Vesicle formation in the Ipsilateral Ear, Hard Palate or Anterior 2/3 of the Tongue. Typical over 60
37
What is the significance of forehead involvement in Bell's Palsy?
Forehead Sparing is seen in UMN lesions, since CN 7 has double innervation from each hemisphere. Suspect a stroke. If forehead shows signs, then it is due to a LMN condition (ie. inflammation due to a viral infection)
38
How is Weber's Test used to localise Neurological deficits?
**Sensioneural Hearing Loss** in one ear will cause the vibration from Weber's Test to be louder in the **unaffected ear.** **Conductive Hearing Loss** causes the vibration to be louder in the **affected ear**.
39
What do the results of Rinne's Test indicate?
Rinne's Positive = Air Conduction \> Bone Conduction - This is normal Rinne's Negative = Bone Conduction \> Air Conduction - This is indicative of **Conductive Hearing Loss**
40
What can cause Conductive Hearing Loss?
**_External Auditory Canal_** Otitis Externa, Foreign Body, Wax **_Drum_** Perforation (Trauma/Infection) **_Middle Ear_** Acute/ Serous Otitis Media **_Oval Window_** Otosclerosis
41
What can cause Sensorineural Hearing Loss?
Inflammation (Meningitis/Viral) Tumour (Acoustic Neuroma) Ototoxic Drugs (Aminoglycosides. eg. gentamycin, Aspirin, Loop Diuretics) Trauma Meniere's Disease
42
What is Neurofibromatosis?
Hereditary condition causing tumours to form on Neuronal tissue. Type 1 \> Type 2 Increased risk of CNS cancer.
43
Describe Neurofibromatosis Type 1.
Autosomal Dominant Peripheral and Spinal Neurofibromas - Affects whole body Cafe au lait spots Freckling Optic Nerve Glioma Learning Difficulties Headaches
44
Describe Neurofibromatosis Type 2
Mainly affects the ears Hearing Loss Tinnitus Balance Issues Headache Facial Pain/Numbness
45
What does a 'Bovine Cough' indicate?
Damage to CN IX and X
46
What is Bulbar Palsy?
A Lesion in the Medulla Oblongata causing LMN signs affecting CN X, XI and XII. Presents with: Absent gag reflex Wasted, fasciculating tongue Nasal Speech Sign of MND
47
What is Pseudobulbar Palsy?
Lesion affecting the UMNs supplying the Bulbar LMNs. See UMN signs. Spastic Tongue Increased Jaw Jerk Monotonous, slurred, high pitched speech Labile Emotions
48

Year 3 - MedEd Lectures (29 decks)

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