Neuro

Question 1

Surgical Sieve

Answer 1

Vascular
Infection
Inflammation
Neoplastic
Degenerative
Episodic

Question 2

Lesions causing homonymous hemianopia

Answer 2

Lesion of left or right optic tract impacting both paths which travel within it

Infarct to middle cerebral artery

Question 3

Lesions causing bitemporal hemianopia

Answer 3

Lesion or compression of optic chiasm

Anterior communicating artery aneurysm

Question 4

Lacunar stroke symptoms

Answer 4

Pure motor - contralateral weakness of face, arm, leg

Pure sensory - contralateral numbness of face, arm, leg

Mixed - contralateral weakness and numbness

Ataxic hemiparesis - ipsilateral lower limb weakness and lack of coordination

Question 5

Total Anterior Circulation Stroke Symptoms

Answer 5

ALL THREE OF:

Unilateral weakness and/or sensory deficit

Homonymous Hemianopia

Higher cerebral dysfunction e.g. dysphagia, visuospatial problems

Question 6

Partial Anterior Circulation Stroke Symptoms

Answer 6

TWO OF:

Unilateral weakness and/or sensory deficit

Homonymous Hemianopia

Higher cerebral dysfunction e.g. dysphagia, visuospatial problems

Question 7

Posterior Circulation Stroke

Answer 7

Cerebellum - ataxia, balance issues, nystagmus, vertigo

Occipital lobe - visual field defects e.g. homonymous hemianopia

Thalamus - sensory deficits

Brain Stem - cranial nerve palsy

Question 8

Arterial supply to lower limb cortex area

Answer 8

Anterior Cerebral Artery

Question 9

Arterial supply to upper limb and face cortex area

Answer 9

Middle Cerebral Artery

Question 10

C5 nerve root lesion symptoms

Answer 10

Sensation in C5 dermatome (upper arm below shoulder)

Diminished reflexes in brachioradialis and biceps tendons

Weakness of shoulder abduction weakness, elbow flexion and forearm supination

Question 11

T1 nerve root lesion symptoms

Answer 11

Sensation in T1 dermatome (top of ribs around the axilla level, ulnar aspect of arm)

Wasting of intrinsic muscles of the hand

Weak ab and adduction of the fingers

Reflexes tend to be normal

Question 12

Upper limb reflexes

Answer 12

Brachioradialis reflex (C5,C6)
Biceps reflex (C5,C6)
Triceps reflex (C6,C7)

Question 13

Amaurosis Fugax

Answer 13

Transient occlusion of the retinal artery causing temporary vision loss in one eye

Described as ‘curtain coming down’

Usually only lasts a few seconds and vision will return gradually over several minutes

Question 14

Radial Nerve Palsy Symptoms

Answer 14

Wrist drop/unable to extend

Loss of sensation over radial nerve distribution

If the injury is at axilla level, can effect triceps and so unable to extend elbow

Question 15

Symptoms of Ulnar Neuropathy at the Elbow

Answer 15

Numbness and/or tingling in digits 4 and 5

Weakness of extending fingers 4 and 5 (claw hand)

Weak finger ab and adduction

Prominent extensor tendons

Question 16

Median Nerve Compression

Answer 16

Numbness in the medial nerve supplied area - thumb and first 2.5 fingers

Weakening and wasting of thenar muscles

Night time pain

Phalen’s test, Tinel’s test etc. positive

Question 17

Link between AF and stroke

Answer 17

Blood can pool in the atria leading to thrombus formation

Question 18

Lower Limb Reflexes

Answer 18

Patella (L3/4)

Achillies (S1/2)

Question 19

Investigating Haemorrhagic Stroke

Answer 19

Non-contrast CT head
Clotting
FBC - is thrombocytopenia cause of bleed?
LFTs - is liver failure the source of bleed?
U&E’s - some stroke treatment contraindicated in renal failure
Toxicology - is this the cause of bleed?
LP if subarachnoid haemorrhage suspected

Question 20

Treating haemorrhagic stroke

Answer 20

Supportive Care
BP control
Neurosurgery referral
Reversal of anticoagulant if applicable

Question 21

Treating ischaemic stroke

Answer 21

Presentation < 4.5 hours

• Thrombolysis (e.g. Alteplase)
• Supportive care
• Antiplatelet therapy (aspirin or clopidogrel)
• High intensity statin
• Consider thromboectomy

Presentation > 4.5 hours OR thrombolysis contraindicated

• Supportive care
• Consider thromboectomy
• Antiplatelet therapy (aspirin or clopidogrel)
• High intensity statin

Question 22

Complications from ischaemic stroke

Answer 22

Conversion to haemorrhagic stroke
DVT due to immobility
Reactions to thrombolysis
Aspiration pneumonia

Question 23

Complications of haemorrhagic stroke

Answer 23

Seizure
Aspiration pneumonia
DVT/PE
Delirium

Question 24

Complications of subarachnoid haemorrhage

Answer 24

Rebleeding 
Seizure 
Vasospasm 
Hydrocephalus 
Neuropsychiatric problems

Question 25

Causes of subarachnoid haemorrhage

Answer 25

Formation of cerebrovascular aneurisms due to factors such as, ADPKD, connective tissue disorders, malformations of arterioles etc. Persistent hypertension Use of anticoagulants Trauma to head

Question 26

Treatment of subarachnoid haemorrhage

Answer 26

Nimodipine (a CCB) to prevent delayed ischaemia Analgesia Anticonvulsant if seizure risk Stop and reverse anticoagulation if indicated LP drainage of hydrocephalus if indicated Neurosurgery input

Question 27

Symptoms of subdural haematoma

Answer 27

``` Headache Nausea and Vomiting Diminished eye, verbal and motor response (acute) Unequal pupils Evidence of head trauma Lucid interval (acute) Seizure Cognitive changes Incontinence Localised weakness ```

Question 28

Causes of subdural haematoma

Answer 28

Most often trauma Less commonly an aneurysm rupture More common in the elderly, heavy alcohol use, anticoagulation

Question 29

Treatment of subdural haematoma

Answer 29

< 10mm OR mid-line shift < 5mm OR non-expansile - Observe and monitor - Prophylactic anticonvulsants - Consider correcting anticoagulation and reducing ICP > 10mm OR mid-line shift > 5mm OR expansile - Surgery - Prophylactic anticonvulsants - Consider correcting anticoagulation and reducing ICP

Question 30

Complications of subdural haematoma

Answer 30

``` Neurological deficits Coma Stroke Surgical infection Epilepsy Rebleed Cerebral oedema Raised ICP ```

Question 31

Meningism Triad

Answer 31

Neck rigidity Positive Kernig's sign - leg cannot be fully extended when raised due to severely tight hamstrings Positive Brudzinski's sign - hips and knees flex when head is flexed

Question 32

Organisms causing bacterial meningitis

Answer 32

ADULTS Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae type b (Hib) NEONATES Group B streptococcus E coli.

Question 33

Treatment of meningitis

Answer 33

``` IV antibiotics (e.g. Ceftriaxone) Corticosteroids ```

Question 34

LP in meningitis

Answer 34

``` High pressure High WCC High proteins High lactate Low glucose ```

Question 35

Diagnosing meningitis

Answer 35

``` Blood cultures Pneumococcal and meningococcal PCR LP FBC with differentials Lactate Clotting LFTs U&Es HIV screen ```

Question 36

Meningitis Complications

Answer 36

``` Sepsis Septicaemia leading to limb loss Seizures Raised ICP Hydrocephalus Subdural effusion ```

Question 37

Broca's aphasia

Answer 37

Understands language but finds it very difficult to talk

Question 38

Wernicke's aphasia

Answer 38

Loss of ability to understand language | Fluent speech but makes little sense - 'word salad'

Question 39

Diagnosing subarachnoid haemorrhage

Answer 39

Non-contrast CT scan LP - be mindful that haemoglobin and bilirubin can take up to 12 hours post symptom onset to appear in CSF