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CC2 - exam preparation > Neuro > Flashcards

Neuro Flashcards

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1
Q

What is the Rosier score?

A

The ROSIER scale was effective in the initial differentiation of acute stroke from stroke mimics in the ER. Introduction of the instrument improved the appropriateness of referrals to the stroke team. The benefits of early assessment and hyperacute treatment of stroke patients with thrombolysis within the first 3 h is well known.

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2
Q

What is the Banford score?

A

Score for TACS (total anterior circilationm stroke)

PACS (partial)

Posterior ciculatoon

Lacunar

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3
Q

What type of dementia is associated with motor neurone disease?

A

Frontotemporal dementia is associated with motor neurone disease

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4
Q

What is the criteria for the Banford score?

A
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5
Q

What are signs of MND?

A

Motor neuron disease is associated with normal motor conduction on nerve conduction studies

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6
Q

What is the Oxford classification of stroke?

A

The Oxford Stroke Classification (also known as the Bamford Classification) classifies strokes based on the initial symptoms. A summary is as follows:

The following criteria should be assessed:

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia

Total anterior circulation infarcts (TACI, c. 15%)

involves middle and anterior cerebral arteries

all 3 of the above criteria are present

Partial anterior circulation infarcts (PACI, c. 25%)

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

2 of the above criteria are present

Lacunar infarcts (LACI, c. 25%)

involves perforating arteries around the internal capsule, thalamus and basal ganglia

presents with 1 of the following:

  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis

Posterior circulation infarcts (POCI, c. 25%)

involves vertebrobasilar arteries

presents with 1 of the following:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
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7
Q

What is the Oxford classifcation of stroke?

A
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8
Q

What is the treatment for post-hepatic neuralgia?

A

This lady has developed post-herpetic neuralgia. NICE recommend using amitriptyline, duloxetine, gabapentin or pregabalin first-line.ot

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9
Q

What are the signs of UMN disease symptoms?

A

Hyperreflexia

Hypertonia

Positive bainski

No faciculations

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10
Q

What is a good way of remembering LMN symptoms?

A

DWARF

Decreased tone/ reflexes

Weakness with wasting

Atrophy

Reflexes diminished

Fascilations

Spacicity

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11
Q

What is a way you can distinguish between a brain and spinal cord lesion?

A

Brain will have a unilateral presentation and spinal cord bilateral

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12
Q

What are the different parts of the peripheral nervous system?

A

Anterior horn cell

Nerve roots

Plexus

Neurones

NMJ

Muscle

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13
Q

What is a sign of muscle damage?

A

Proximal myopathy

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14
Q

What is a sign of nerve root damage?

A

Parasthesia

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15
Q

What is a disease of the anterior horn cells?

A

Motor neurones disease

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16
Q

What is motor neurones disease characterised by?

A

Upper and lower motor neurone symptoms

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17
Q

What is the most common myelopathy?

A

Cervical myelopathy or spondylitis which is arthritis

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18
Q

What are the features of cervical myelopathy?

A

Upper motor neuron signs—weakness, spasticity, clumsiness, altered tonus, hyperreflexia and pathological reflexes, including Hoffmann’s sign and inverted plantar reflex (positive Babinski sign)

Lower motor neuron signs—weakness, clumsiness in the muscle group innervated at the level of spinal cord compromise, muscle atrophy, hyporeflexia, muscle hypotonicity or flaccidity, fasciculations

Sensory deficits

Bowel/bladder symptoms and sexual dysfunction

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19
Q

How is cervical myelopathy diagnosed?

A
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20
Q

What is the differece between PACS and TACS?

A

TACS is total anterior cerebral stroke and refers to a stroke affecting the anterior and middle cerebrum.

PACS is partial anterior cerebral stroke and refers to the middle or anterior cerebrum.

Its part of the Banford score.

For TACS 3/3 or for PACS 2/3: (HUH)

  1. Homonymous heminopia
  2. Unilateral weakness
  3. Higher level function loss
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21
Q
A
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22
Q

What is a lacunar stroke?

A

Pure motor

Pure sensory

Mixed sensory motor

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23
Q

What is amurosis furax?

A

A temporary loss of vision

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24
Q

What are the different types of tremor?

A

Active

Postural

Intention

Kinetic

Isometric tremor

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25
What is unique about essential tremor?
26
How do you treat essential tremor?
Primidone Beta blockers like propanolol Deep brain stimulation Tremors are quite responsive to alcohol (remember akchol stop these tremors unlike DT)
27
What are the differences between Parkinsons and Essential Tremor?
Bilateral Higher frequency Action tremor Voice In the family Calligraphy Alcohol (BAVICA)
28
Compare Parkinsons with Essential tremor\>
29
30
What are the four types of trigeminal autonic cephalagias?
Hemi, Continuing to sink a clusters of parots Hemicranual continua, SUNCT Cluster headaches Paroxysmal hemicrania
31
What condition causes mixed UMN and LMN disease?
Amyotrophic lateral sclerosis (ALS) is a type of motor neurone disease (MND). Degeneration of neurones in the motor cortex and in the ventral spinal cord produces mixed UMN and LMN signs. There are no associated sensory deficits.
32
What are the migraine rules?
1. Better lying flat/ down 2. Episodic 3. Associated symptoms i.e. migraine with aura
33
What are the stages of migraine?
Predrome phase --\> Aura --\> Headache --\> Post drome
34
What are some associated features of migraine?
Macrosomatagnosia Distortion of reality Seeing lights
35
What are some treatments for migraine?
Treatment 1. Lifestyle (Detox, no caffeine, look for triggers, boring life) 2. Rescue treatment – NSAIDS and antiemetic (not opioids) and Triptan 3. Prophylaxis – beta blocker, topiramate, candesartan, valproate tricyclic, SS or SNRI 4. BOTOX CGRP blockade Acute treatment – antagonists • Antogepant • Rimegepant • Ubrogepants Prophylaxis – antibodies • Fremaezumab • Galcenizumab • Erenumab • Eptinezumab
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What are the rules for a tension headache?
.Medication overuse? 2.“Cervicogenic headache” 3.“Need glasses” 4.Consider migraine
38
How do you treat a tension headache?
1.Detox 2.Physiotherapy 3.Tricyclic Antidepressant - Nortriptyline 4.SSRI
39
Name the trigeminal autonomic cephalalgia diseases.
SUNCT – Paroxysmal Hemicrania * Cluster headache – * Hemicrania Continua -
40
How do you treat the trigeminal autonomic cephalgias?
SUNCT – Lamotrigine (Rash) • Paroxysmal Hemicrania – Indometacin (Kidney injury, Ulcer) • Cluster headache – Verapamil (Heart block – can be delayed) • Hemicrania Continua - Indometacin
41
What is trigeminal neuralgia and how is it treated?
Trigeminal Neuralgia • Rules 1. One branch of trigeminal nerve 2. Stabbing pain 3. Triggered (Cold wind, eating/drinking, touch sensitive) 4. Need to detox to get clear picture • Treatment 1. Carbamazepine 2. Maximum Carbamazepine – refer to neurosurgery 3. Oxycarbamazepine 4. Another AED
42
What is hemicrania continua?
Hemicrania continua is a headache disorder. It causes constant pain in one side of the face and head. Unlike other headache disorders, environmental or lifestyle factors don’t trigger hemicranial headaches. People may also have migraine-like symptoms, such as nausea or sensitivity to light. Most people can take medications to manage the pain. Treated with indomethin
43
What is paroxymal hemicrania?
Paroxysmal hemicrania is a rare but treatable primary headache disorder, meaning that it’s not caused by another condition. The name paroxysmal hemicrania describes the hallmark features of this headache: Paroxysmal means sudden recurrence or attack Hemicrania means one-side of the head (unilateral or side-locked)
44
What is malignant hypertension?
Rapid rise in BP that causes end organ damage.
45
What is the rule for epilepsy and the DVLA?
First seizure - 1 month Epilepsy - seizure free 6 months
46
What are some causes of raised intracranial pressure?
Increased arterial blood pressure – Maliganant hypertension, Pre-eclampsia, hypercapnia (Obstructive sleep apnoea) • Increased CSF pressure – Obstruction to flow (intraventricular mass, meningitis), Failure of reabsorption (meningitis), Overproduction (idiopathic intracranial hypertension) • Increased brain pressure – Space occupying lesion (blood, cancer, infection) • Increased venous blood pressure – Cerebral venous sinus thrombosis • Meningeal inflammation – infection, autoimmune, cancer
47
What is temporal arteritis and how is it diagnosed and treated?
Rules 1. Extremely rare below 60 2. ESR and/or CRP raised • Management (from a neurology perspective) 1. Refer immediately to rheumatology 2. Steroids 3. U/S of temporal artery and biopsy within a week
48
What are the risk factors for stroke?
Ischaemic heart disease Hypertension Atrial fibrillation Hypercholesterolaemia Diabetes Previous stroke or TIA Smoking Excessive alcohol intake Hypercoagulable disease (e.g. sickle cell anaemia, polycythemia vera) Prosthetic heart valves Carotid stenosis Poor ventricular function Migraine with aura Combined oral contraceptive pill Family history of stroke in first-degree relatives
49
What are 3 key things to consider when a patient comes in with a susepected stroke?
Is it stroke - CT / MRI Precipitating factors Treatments
50
51
What is a cause of central diabetes insipidus?
Traumatic head injury and subsequent intracranial haemorrhage. This is a central cause of DI which leads to the underproduction of ADH. As a result, central DI responds to desmopressin (an ADH analogue) treatment.
52
53
What is autonomic dysreflexia?
54
What are the treeatments for essential tremor?
The mainstay of treatment is beta-blockers • Primidone can be used if tolerated • AIprazolam
55
What are the types of tremor?
 Postural- occur when a limb is held against gravity  Kinetic - occur with goal directed voluntary movements of the affected body part  Isometric- sustained muscle contraction against a fixed object.
56
What is the frequency of PD tremor?
4-6 hz
57
How can tremors be organised?
- Resting or active (postural, isometric, kinetic) - Anatomical - Frequency
58
What are the different frequencies for headaches?
•Low frequency (\<4 Hz) cerebellar tremor (\<5 Hz). •Medium frequency (4-7 Hz) eg PD tremor (4-6Hz) •High frequency (≥8 Hz) eg physiological tremor (8-12 Hz)
59
What are the features of essential tremor?
 Commonest tremor disorder  Mid-to-late life but sometimes appears during adolescence  AD inheritance pattern  Bilateral symmetrical Can also affect the jaw, voice, head, leg s  Affects activities such as holding objects, writing, pouring drinks  Improves with alcohol. Disappears during sleep  Aggravated by stress, anxiety, fatigue, extremes of temperature
60
What are some of the conditions similar to Parkinsons?
Vascular Drug induced - neuroleptics, valproate Parkinsons +
61
What is another name for orthostatic tremor?
Shaky leg tremor High frequency 8-13hz
62
How is orthostastic tremor treated?
Rx-Clonazepam valproate, gabapentin, primidone, DBS
63
What is dystonic tremor?
 Can occur at rest, posture or be kinetic  Can be suppressed by sensory tricks (geste antagoniste)  Irregular jerky rhythm and amplitude  Task or position specific Treatment  Clonazepam, baclofen, and anticholinergics (trihexyphenidyl).  Botulinum toxin injections  Vim DBS for medically refractory cases
64
What tremor is 3-4 hz?
Holmes tremor
65
What is a cerebellar tremor?
Irregular, often of a high amplitude, postural and action tremors.  Low frequency \<5 Hz (3-5 Hz).  Can affect the head, trunk and limbs.
66
Name some low frequency tremor?
67
What is the difference between ET and PD?
68
What is MS?
A condition discussed by Jean Martin Charcot resulting in brain atrophy and focal demyelination of white and grey. Normally emerges in the 3rd and 4th decade of life. Main symptoms can include sensory and visual disturbance, motor impairment, bladder and bowel problems, fatigue, pain, cognitive deficits Light chains and oligobands found in CNS. CIS, relapsing remitting, secondary, primary MRI Problem with VEPs and SSEPs - visual evoked potentials and sematosensory evoked potentials
69
What are some of the treatments associated with MS?
70
What are the types of MS from most relapsing to least?
Can Rachel Save Pupils CIS, relapsing, secondary, primary
71
72
What are the types of syncope?
73
What is Uhtoff phemomena?
These 'Uhthoff's phenomena', which are a feature of multiple sclerosis (MS) and other demyelinating diseases, can be triggered by factors including the perimenstrual period, exercise, infection, fever, exposure to high ambient temperatures, and psychological stress
74
What is Lhermitte's sign?
Lightning like sensation
75
What is a bulbar palsy?
This is caused by dysfunction in cranial nerves 9-12 from their origin in the medullary nuclei to their termination in the muscles supplying the tongue and the muscles coordinating speech and swallow. It is a 'lower motor neurone' lesion of the bulbar cranial nerves.
76
Loss of CN 9-12 is called a \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Bulbar palsy
77
Hot potato speech is example of a \_\_\_\_\_\_\_\_\_\_\_\_\_
Pseudobulbar palsy
78
Coin shaped brain tumour and hyponatremia is indicative of?
Small (kulchitsky cell) metastasis
79
Which drug is first line for girls with epilepsy?
Lmaotrigine
80
What therapy is preferred for carotidstenosis?
Endarectomy is better than thrombolysis with stenting as recurrence is too risky (Mount Sainai)
81
82
What are the features of multiple systems atrophy? Shy Drager
parkinsonism autonomic disturbance erectile dysfunction: often an early feature; postural hypotension' atonic bladder cerebellar signs
83
What are the clinical features of TIA?
The clinical features are similar to those of a stroke, i.e. sudden onset, focal neurological deficit but, rather than persisting, the features resolve, typically within 1 hour. Possible features include ## Footnote unilateral weakness or sensory loss. aphasia or dysarthria ataxia, vertigo, or loss of balance visual problems sudden transient loss of vision in one eye (amaurosis fugax) diplopia homonymous hemianopia
84
Features of Parkinsons disease?
Shuffling gait Masked facies Akinesia Rigidity Tremor
85
What drug is given in status epilepticus after someone has had a benzodiazepine like buccal midazolam or lorazepam?
Give a phenytoin infusion
86
What drugs increase the risk of IIH?
COMART – ciclosporin, oral contraceptives, mineralocorticoids, amiodarone, retinoic acid, tetracyclines .
87
Suggest some risk factors for IIH?
Risk factors obesity female sex pregnancy drugs\* combined oral contraceptive pill steroids tetracyclines vitamin A lithium
88
How is MS diagnosed via imaging?
MRI with contrast to pick up demyelinating lesions
89
What are the features of Miller Fisher GBS?
ophthalmoplegia, areflexia and ataxia.
90
For acute ischaemic stroke, when might a 24 hour extension be done?
For thrombectomy in acute ischaemic stroke, an extended target time of 6-24 hours may be considered if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
91
How is myaesthenic crisis managed?
Emergency is treated with plasmaphoresis and IVG.
92
What are the stages of treatment for status epillepticus?
1Buccal midazolam/ IV lorazepam 2IV lorazepam 3IV phenytoin (phenobarbital if already on regular phenytoin) 4Rapid sequence induction of anaesthesia using thiopental sodium

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