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neuro Flashcards

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1
Q

indications for carbamazepine

A

epilepsy, particularly partial seizures (no role in absence seizures)
trigeminal neuralgia
bipolar disorder

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2
Q

imaging for acoustic neuroma

A

MRI of cerebellopontine angle

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3
Q

which vitamin deficiency can lead to Wernicke’s encephalopathy

A

thiamine B1

it is found in Pabrinex

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4
Q

mx of Bell’s palsy

A

prednisolone if seen within 72h of onset

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5
Q

ix for ? Guillain-Barre syndrome

A 
lumbar puncture (rise in protein with normal WCC)
nerve conduction studies
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6
Q

secondary prevention after stroke

A

clopidogrel lifelong

aspirin + dipyridamole lifelong if clopidogrel CI/not tolerated

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7
Q

conduction dysphasia

A

speech fluent, repetition poor

comprehension intact

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8
Q

Broca’s (expressive) dysphasia

A

non-fluent laboured and halting speech
repetition impaired
comprehension intact

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9
Q

Wernike’s (receptive) dysphasia

A

speech is fluent but sentences make no sense, word substitution and neologisms - ‘word salad’
comprehension impaired

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10
Q

driving rules after first unprovoked seizure, normal brain imaging and EEG

A

cannot drive for 6 months

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11
Q

driving rules after first unprovoked seizure, abnormal brain imaging and EEG

A

cannot drive for 12 months

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12
Q

what FBC abnormality can phenytoin cause

A

megaloblastic anaemia

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13
Q

which medication in parkinson’s disease mx can cause impulse control disorders

A

dopamine receptor agonists, e.g. Bromocriptine, Cabergoline

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14
Q

first line mx for spasticity in MS

A

Baclofen and Gabapentin

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15
Q

most appropriate anti-emetic in Parkinson’s

A

Domperidone

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16
Q

features of Cushing’s triad

A 
raised ICP causing:
1. bradycardia
2. irregular breathing
3. widening pulse pressure
(also have hypertension)
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17
Q

sodium valproate effect on P450 system

A

inhibition

increases INR if taking warfarin

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18
Q

first-line options for neuropathic pain

A

amitriptyline
duloxetine
gabapentin
pregabalin

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19
Q

features of anterior cerebral artery stroke

A

contralateral hemiparesis and sensory loss

LL>UL

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20
Q

features of middle cerebral artery stroke

A

contralateral hemiparesis and sensory loss UL>LL
contralateral homonymous hemianopia
aphasia - dominant hemisphere strokes

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21
Q

when is carotid endarterectomy considered

A

in a patient who has had a TIA w carotid artery stenosis >70%

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22
Q

when would you consider multiple system atrophy over parkinson’s?

A

autonomic disturbance, e.g. atonic bladder, postural hypotension

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23
Q

cluster headache prophylaxis

A

Verapamil

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24
Q

cluster headache acute mx

A

SC Sumatriptan and high flow oxygen

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25
features of Bell's palsy
LMN facial nerve palsy therefore forehead is affected inability to raise eyebrow and drooping of mouth on affected side hyperacusis post-auricular pain
26
acute mx of seizures
check airway and give oxygen if appropriate place patient in recovery position benzodiazepines are indicated in prolonged seizures - rectal Diazepam 10-20mg in adults
27
for thrombectomy in acute ischaemic stroke, when would an extended target time of 6-24h be considered?
if there is the potential to salvage brain tissue as shown by advanced brain imaging, e.g. CT perfusion
28
features of Wernicke's encephalopathy
``` CAN OPEN Confusion Ataxia Nystagmus Ophthalmoplegia PEripheral Neuropathy ```
29
what is 'saturday night palsy'
radial nerve palsy caused by compression of the radial nerve against humeral shaft
30
how may cataplexy present
laughter followed by fall or collapse
31
features of median nerve palsy
``` damage at wrist = carpal tunnel syndrome - paralysis and wasting of thenar eminences - weak opposition and abduction of thumb - sensory loss to palmar aspect of lateral 2 ½ fingers - commonly damaged in Colle's fracture damage at elbow = above plus - unable to pronate - weak wrist flexion - ulnar deviation of wrist ```
32
features of ulnar nerve palsy
hypothenar wasting | weak thumb adduction
33
mx of myasthenic crisis
IV immunoglobulins | plasma electrophoresis
34
ix for MS
MRI with contrast
35
bilateral facial nerve palsy and bilateral parotid gland enlargement
sarcoidosis
36
cause of vertical nystagmus vs horizontal nystagmus
vertical - suggests central cause (e.g. cerebellar stroke) | horizontal - suggests peripheral cause (e.g. viral labyrinthitis)
37
what happens when controlled hyperventilation is used for raised ICP?
hyperventilation -> reduced CO2 -> vasoconstriction of cerebral arteries -> reduced ICP
38
indications for urgent CT head in headache
``` vomiting >1 with no other cause new neurological deficit reduction in GCS valsalva or positional headaches progressive headache with fever ```
39
most common primary brain tumours in adults
1. glioblastoma - poor prognosis | 2. meningioma - arise from dura mater
40
most common primary brain tumour in children
pilocytic astrocytoma
41
acute mx of stroke
1. Aspirin 300mg 2. thrombolysis with Alteplase if within 4.5 h of onset and haemorrhage is excluded 3. thrombectomy with thrombolysis if within 6 h of onset for occlusion of proximal anterior circulation 3. 1. thrombectomy within 6-24h for occlusion of proximal anterior circulation and potentially salvageable brain tissue
42
what monitoring is needed when giving phenytoin infusion
cardiac monitoring due to its pro-arrhythmogenic effects
43
features of extradural haemorrhage
lucid interval | biconvex haemorrhage on imaging
44
ix for myasthenia gravis
antibody screen
45
myasthenia gravis vs Lambert-Eaton + which antibodies to check for each
weakness in myasthenia gravis worsens after exercise (check ACh receptor antibodies) weakness in Lambert-Eaton improves (check voltage-gated Ca-channel antibodies)
46
causes of upper vs lower quadrant bitemporal hemianopia
``` upper = inferior chiasmal compression, commonly pituitary tumour lower = superior compression, commonly craniopharyngioma ```
47
ix for venous sinus thrombosis
MR venogram
48
features of venous sinus thrombosis
headache, nausea and vomiting | may use COCP and have FHx of VTE
49
which anti-epileptic may cause weight gain
sodium valproate | "sodium val-pro-weight"
50
mx of idiopathic intracranial hypertension
acetazolamide
51
describe the tremor seen in Parkinson's
unilateral tremor that improves with voluntary movement
52
features of Weber's syndrome
ipsilateral CNIII palsy contralateral weakness weBer's = Brainstem stroke
53
features of normal pressure hydrocephalus
urinary incontinence gait abnormality dementia enlarged fourth ventricle on imaging
54
what can provoke absence seizures
hyperventilation or stress
55
when may stopping anti-epileptic drugs be considered
*>2* years seizure free | AEDs stopped over 2-3 months
56
common biochemical complication of SAH
hyponatraemia
57
which CCB is used to prevent vasospasm in aneurysmal SAH
Nimodipine
58
head injury with signs of meningeal irritation
SAH
59
when should ICP monitoring be used
those with GCS 3-8 and abnormal CT scan | it is also appropriate if CT scan is normal
60
Todd's paresis
post-ictal weakness seen in frontal lobe epilepsy
61
driving rules post-TIA
can start driving if symptom free after 1 month - no need to inform DVLA
62
features of pontine haemorrhage
Pinpoint Pupils (Point to Pons and oPiates) Quadriplegia Life threatening stroke associated with HTN
63
long-term prophylaxis of cluster headaches
Verapamil
64
ECG findings in SAH
Torsades de pointes - polymorphic VT
65
features of Horner’s
miosis (pupillary constriction) ptosis enophthalmos anhidrosis
66
mx of brain abscess
IV ceftriaxone (3rd gen cephalosporin) + metronidazole
67
features of CN III palsy
if due to intracranial bleed, the palsy will be on the same side fixed, **dilated** pupil, unresponsive to light down and out pupil ptosis
68
which anti-emetic (used for migraine attacks) can cause extrapyramidal side-effects in children and young adults
metoclopramide
69
isolated rise in protein on CSF indicates
Guillain-Barre syndrome
70
when does autonomic dysreflexia occur
in spinal cord injury at or above **T6**
71
Jacksonian march
type of focal aware frontal lobe seizure | characteristically affects peripheral body part then spreads
72
CI to triptan use for migraines
history of ischaemic heart disease
73
Nelson's syndrome
rapid enlargement of pituitary adenoma that occurs after bilateral adrenalectomy
74
which dementia is associated with MND
frontotemporal
75
what pathology is proptosis/exophthalmus and down and out pupil seen in
cavernous sinus syndrome
76
features of brain abscess
headache fever focal neurology recent acute sinusitis (source of infection)
77
prophylactic mx of migraines
propranolol and topiramate avoid topiramate in women of child-bearing age as it can cause congenital abnormalities if they fall pregnant avoid propranolol in asthma
78
imaging for stroke
NON-contrast CT head
79
cause of bitemporal hemianopia
compression of optic chiasm, e.g. due to pituitary adenoma
80
mx of temporal arteritis
high-dose prednisolone as soon as dx is suspected BEFORE temporal artery biopsy
81
drug causes of intracranial hypertension
``` COCP steroids tetracyclines vitamin A lithium ```
82
features of temporal lobe seizure
``` HEAD Hallucinations aura (Epigastric rising/emotional) Automatisms (**lip smaking/grabbing/plucking**) Deja vu/dysphasia (post ictal) ```
83
imaging for neck fracture
CT scan
84
features of encephalopathy
fever, headache psychiatric symptoms seizures vomiting
85
most common cause of encephalopathy
herpes simplex virus
86
mx of status epilepticus
ABC, airway adjunct and oxygen as needed check blood glucose pre-hospital - rectal diazepam; hospital - IV lorazepam (can be repeated after 10-20 mins) for established status - second-line agent such as phenytoin no response within 45 min - general anaesthesia
87
features of epidural haematoma
combination of neurological deficit and severe back pain | epidurals are CI in coagulopathies due to this reason
88
most appropriate med for acute confusional state in Parkinson's patients
``` lorazepam AVOID antipsychotics (i.e. Haloperidol) ```

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