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Neuro Flashcards

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1
Q

visual field defect in parietal lobe lesions

A

inferior homonymous quadrantanopia

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2
Q

visual field defect in occipital lobe lesiosn

A

homonymous hemianopia

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3
Q

location of lesion in Broca’s aphasia

A

frontal lobe (BF)

= expressive (BE) - speech is non-fluent and laboured

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4
Q

location of lesion in Wernicke’s aphasia

A

temporal lobe (TW)

= speech remains fluent but there are word substitutions and neologisms

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5
Q

midline cerebellum lesions cause

A

gait and truncal ataxia

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6
Q

cerebellum hemisphere lesions cause

A
  • intention tremor
  • past pointing
  • dysdiadokinesis
  • nystagmus
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7
Q

analgesia to avoid in migraine

A

opiates (give ibuprofen etc)

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8
Q

what to give in prophylaxis of migraine

A

propranolol (CI in asthma)

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9
Q

what to give in acute migraine

A

triptans (CI if CV disease/cerebrovascular disease)

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10
Q

prophylaxis of tension headache

A

low dose amitriptyline

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11
Q

treatment of acute cluster headache

A

nasal/SC triptans + high flow oxygen

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12
Q

prophylaxis of cluster headache

A

verapamil (2nd line = prednisolone + lithium)

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13
Q

why can trigeminal neuralgia cause ptosis

A

CNV compression i.e. by superior cerebellar artery

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14
Q

management of trigeminal neuralgia

A

carbamazepine - titrate upwards every 2 weeks until pain relieved

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15
Q

red flags for referral in trigeminal neuralgia

A
  • <40 years
  • pain only in ophthalmic division/bilaterally
  • sensory changes
  • deafness
  • history of skin/oral lesions
  • optic neuritis
  • family history of MS
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16
Q

LP findings in SAH

A

xanthochromia
increased opening pressure
increased protein

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17
Q

medication which can be given in SAH

A

nimlodipine (to prevent vasospasm)

3L normal saline fluids (give lots of sodium)

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18
Q

first line surgery for SAH

A

endovascular coiling

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19
Q

major RF of intracerebral haemorrhage

A

HTN

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20
Q

treatment of intracerebral haemorrhage

A

reverse anticoagulation

don’t give aspirin

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21
Q

what to do if an ischaemic stroke is inappropriate for thrombectomy

A

CT angiogram

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22
Q

how to diagnose carotid/vertebral artery dissection

A

MRA/CTA

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23
Q

symptoms of pituitary apoplexy

A

headhace
visual deficits
ophthalmoplegia
altered GCS

due to pituitary gland enlarging

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24
Q

management of idiopathic intracranial HTN

A
  • weight loss
  • diuretics i.e. ACETAZOLAMIDE
  • topiramate
  • repeat LP
  • surgery? optic nerve sheath decompression
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25
what might a CT venogram show in venous sinus thrombosis
absence of sinus 'hyperdensity' 'empty delta sign' (filling defect)
26
features of Meniere's
vertigo fluctuating tinnitus deafness fullness in one ear 9
27
type of nystagmus in BPPV if superior semicircular canal is involved
rotatory nystagmus
28
type of nystagmus in BPPV if lateral semicircular canal is involved
horizontal nystagmus
29
clinical presentation of lesion in cerebellar hemisphere
limb ataxia IPSILATERAL to lesion tendency to fall towards affected side + nystagmus + dysarthria
30
clinical presentation of lesion in midline vermis of cerebellum
truncal ataxia difficulty sitting/standing (gait ataxia) typically without classic triad of limb ataxia + dysarthria + nystagmus
31
clinical presentation of lesion in flocuclonodular lobe of cerebellum
truncal ataxia vertigo (damage to vestibular reflex pathways) vomiting nystagmus
32
why do cerebellar lesions at midline sites result in headache and vomiting
early obstruction of cerebral aqueduct in midbrain/4th ventricle = hydrocephalus with dilated 3rd and lateral ventricles = headache, vomiting and eventually papilloedema
33
MAVIS (causes of ataxia)
- MS - Alcohol - Vascular (stroke) - Inherited (Friedrich's, spinocerebellar ataxia, ataxia telangiectasia) - SOL
34
generalised seizures
- absence (can be caused by hyperventilation) - tonic-clonic - myoclonic - atopic (often combined with a myoclonic jerk followed by transient loss of muscle tone) - tonic (generalised increased tone)
35
focal seizures are?
either frontal, temporal, occipital, parietal may have aura, LOC, decreased consciousness, tonic-clonic
36
what type of seizure is Jacksonian March
frontal seizure seizure spreads from the distal part of the limb towards the ipsilateral face (clonic movements travelling proximally)
37
HEAD (signs of temporal seizures)
- Hallucinations (auditory/sensory) - Epigastric sensation/emotional - Automatisms (lip smacking, pulling at clothing) - Deja-vu/dysphasia post octal
38
features of occipital seizure
- positive or negative visual phenomena | - flashing lights, spots or simple patterns
39
features of parietal seizure
- somatosensory (tingling, shock sensation, pain) - contralateral altered sensation - distorted body image
40
what is Todd's paresis
focal weakness in a part of the body after seizure - localising to one side - subsides completely within 48hours
41
drugs for tonic-clonic or atonic seizures
- sodium valproate | - lamotrigine/CBZ
42
drugs for focal seizures
- lamotrigine/CBZ | - sodium valproate/levetiracetam
43
drugs for absence seizures
- ethosuximide/sodium valproate NOT CBZ (exacerbates)
44
drugs for myoclonic seizures
- sodium valproate - leviteracetam NOT CBZ (exacerbates)
45
side effects of carbamazepine
agranulocytosis aplastic anaemia teratogenic in first trimester
46
which anti-epileptics are P450 inhibitors
sodium valproate therefore can increase effects of other AEDs
47
which anti-epileptics are P450 inducers
carbamazepine | phenytoin
48
side effects of lamotrigine
Steven Johnson's leukopenia nausea, tremor, vomiting
49
side effects of phenytoin (PHENYTOIN)
- P450 interactions (inducer) - hirsutism - enlarged gums (gingival hyperplasia) - nystagmus - yellow-browning of skin - teratogenicity - osteomalacia - interference with folate metabolism - neuropathies (vertigo, ataxia, headache)
50
effects of phenytoin overdose
``` nystagmus diplopia slurred speech ataxia confusion ```
51
driving after 1st unprovoked seizure
6 months
52
driving after LOC/LOA with no clinical pointers
6 months
53
driving after >2 LOA without reliable prodrome
12 months
54
driving after epilepsy
12 months
55
driving after epilepsy - AED withdrawal
until 6 months post cessation
56
what is motor neurone disease
progressive degeneration of motor neurones in the motor cortex + in the anterior horns of the spinal cord
57
4 types of MND
- progressive muscular atrophy - primary lateral sclerosis - progressive bulbar palsy - amyotrophic lateral sclerosis
58
features of ALS
- 6 months progressive weakness of a limb e.g. foot drop - onset is focal, distal, asymmetrical and progresses segmentally form one limb to another - sphincters and eyes NOT affected - UMN + LMN features - 30% bulbar onset - speech or swallowing impairment (bilateral, asymmetrical tongue wasting)
59
type of dementia associated with ALS
fronto-temporal dementia
60
which drug can you use in ALS (doesn't do much)
riluzole
61
features of progressive muscle atrophy
- LMN signs - wasting, weakness and fasciculation, but tendon reflexes often preserved - begins asymmetrically in small muscles of hands or feed and spread
62
features of primary lateral sclerosis
- UMN lesions - initially in legs before progressing to arms - diagnosis of exclusion + signs remained solely UMN for 3+ years
63
causes of progressive bulbar palsy
- MND - stroke - MG - central pontine myelinolysis - GBS
64
features of pseudo bulbar palsy
- bilateral UMN lesions - spastic tongue, brisk jaw jerk - emotional incontinence
65
causes of pseudo bulbar palsy
- MS - MND - stroke - CPM
66
nerve roots of radial, median and ulnar nerves
- radial = C5-T1 (anatomical snuffbox) - median = C6-T1 (lateral 3.5 digits) - ulnar = C7-T1 (medial 1.5 digits)
67
motor and sensory features median nerve problem
- motor = thenar wasting | - sensory = radial 3.5 fingers and palm, pain in hand, Tinel's and Phalen's positive
68
motor and sensory features of ulnar nerve problem
- motor = partial claw hand, hypothenar wasting, weakness and wasting of 1st dorsal interosseous - sensory = ulnar 1.5 fingers
69
motor features of radial nerve problems
- low = finger drop - high = wrist drop - v high = triceps paralysis, wrist drop
70
motor and sensory features of high brachial plexus problem (C5-6)
Erb's palsy (waiter's tip) C5-6 dermatome
71
motor and sensory features of low brachial plexus problem (C8-T1)
Klumpke's (claw hand) C8-T1 dermatome
72
motor and sensory features of sciatic nerve injury (L4-S3)
- motor = hamstrings, all muscles below know | - sensory = below knee laterally and foot
73
motor and sensory features of common peroneal nerve injury (L4-S1)
- motor = foot drop, weak ankle dorsiflexion and eversion - INVERSION INTACT - sensory = below knee laterally
74
motor and sensory features of tibial nerve injury (L4-S3)
- motor = can't plantar flex (can't stand on tiptoe), weak foot inversion and weak toe flexion - sensory = sole of foot
75
causes of predominantly MOTOR loss peripheral neuropathy
- Guillain-Barre - porphyria - lead poisoning - Charcot-Marie-Tooth - CIDP - diphtheria - inclusion body myositis - myotonic dystrophy
76
causes of predominantly SENSORY loss peripheral neuropathy (ABCDE)
- alcoholism, amyloidosis - B12 deficiency - carcinoma, CMT - diabetes, drugs i.e. isoniazid (causes B6 deficiency) - every vasculitis uraemia, leprosy
77
causes of dysphonia (reduction in sound/volume)
- laryngitis - CNX lesion - Parkinson's
78
what is non-fluent aphasia with comprehension intact
Broca's aphasia (expressive)
79
what is non-fluent aphasia with comprehension impaired
global aphasia
80
what is fluent aphasia with comprehension intact
conduction aphasia
81
what is fluent aphasia with comprehension impaired
wernicke's aphasia - receptive (word salad)
82
cause of wernicke's aphasia
lesion of superior temporal gyrus - supplied by inferior division of left MCA
83
cause of Broca's aphasia
lesion of inferior frontal gyrus - supplied by superior division of left MCA
84
cause of conduction aphasia
stroke affecting arcuate fasiculus Connection between wernicke's and Broca's area)
85
cause of global aphasia
large lesion affecting Broca's, wernicke's and arcuate fasicuclus
86
types of tremor
- physiological (hyperthyroid) - rest (Parkinsonism) - postural (absent at rest, present in maintained posture) - flapping - intention (cerebellar) - holms or rubral tremor = resting + action
87
examples of postural tremor
- benign essential tremor (improves with alcohol) - thyrotoxicosis - anxiety - beta-agonists
88
features of multiple system atrophy
- severe early AUTONOMIC dysfunction - postural BP drop, erectile dysfunction, atonic bladder - Parkinsonism + cerebellar signs - waning levodopa response - atypical dyskinesia
89
what will a SPECT (DaT scan) show in Parkinson's disease
decreased DA in basal ganglia
90
1st line treatment for Parkinson's disease if affecting function
co-beneledopa (levodopa + decarboxylase inhibitor)
91
side effects of L-DOPA (DOPAMINE)
- dyskinesia - on-off phenomena (motor fluctuations - freezing) - psychosis + psych symptoms - impulse control disorder - ABP decreased (postural hypotension) - mouth dryness - insomnia - N+V - EDS (excessive daytime sleepiness)
92
what can happen if you stop L-DOPA suddenly
NMS! pyrexia, muscle rigidity, HTN, tachycardia, tachypnoea, agitated delirium
93
what is often raised in NMS
CK AKI can develop secondary to rhabdomyolysis
94
MRI findings in Huntington's
atrophy of caudate nucleus + putamen
95
downside of doing a non-contract CT head for stroke
normal in first few hours of ischaemic - but excludes haemorrhagic if normal MRI higher sensitivity for infarct
96
investigation to do for stroke if appropriate for thrombectomy
CT angiogram
97
features of anterior cerebral artery stroke
- contralateral hemiparesis - leg weakness > arm weakness - sparing of face
98
features of middle cerebral artery stroke
- arm weakness > leg weakness - contralateral hemiparesis - homonymous hemianopia (same side as paresis) - hemineglect if affecting non-dominant hemisphere - aphasia if affects dominant hemisphere (usually L) - UMN signs
99
cause of lacunar syndrome
small perforating arteries being blocked i.e. internal capsule
100
features of lacunar syndrome
- 'capsular warning syndrome' = sudden onset weakness which relapses/remits - 1 of: pure hemimotor/hemisensory loss/pure sensorimotor loss/ataxic hemiparesis/contralateral lower face paralysis
101
features of posterior cerebral artery stroke
contralateral homonymous hemianopia with macular sparing contralateral loss of pain + temp
102
what is Wallenberg's syndrome
lateral medullary syndrome: - ipsilateral facial loss of pain + temp - ipsilateral Horner's - ipsilateral cerebellar signs - ataxia - contralateral loss of pain + temp, limb sensory loss
103
features of vertebral artery stroke
- ipsilateral CN, contralateral long tract - bulbar dysfunction - ipsilateral cerebellar signs - nystagmus
104
features of basilar artery occlusion (stroke)
locked in syndrome
105
features of Weber's (midbrain infarct)
- oculomotor palsy (CNIII) - contralateral hemiplegia - can have Parkinsonian features
106
causes of 1st order (central) Horner's syndrome
- MS - spondylosis - SOL - syringomyelia - stroke/lateral medullary syndrome (Wallenberg's)
107
causes of 2nd order (pre-ganglionic) Horner's syndrome
- pan coast tumour - cervical rib - thyroid carcinoma/goitre
108
causes of 3rd order (post-ganglionic) Horner's syndrome
- carotid artery dissection | - radial neck dissection
109
when can you do thrombolysis for stroke (alteplase)
- <4.5 hour symptom onset | - must rule out haemorrhage first (CT)
110
contraindications for thrombolysis for store
- head trauma <3 months - >180/>110 BP - anticoagulation (INR >1.7, DOAC within last 24 hours)
111
when can you do thrombectomy for stroke
offer within 6h symptom onset with IV thrombolysis (if <4.5h) if occlusion of proximal anterior circulation (do CTA/MRA) offer within 6-24h if above + potential to salvage brain tissue on CT
112
antiplatelets to give after ischaemic stroke
- aspirin 300mg once haemorrhage excluded for 2/52 - clopidogrel after 2 week aspirin dose (MR dipyridamole if this is CI) only give anticoagulation if in AF
113
driving rules for CAR after stoke
- don't drive for a month (TIA or stroke) - don't need to inform DVLA if no residual neurological deficit - multiple TIAs over a short period = no driving for 3 months
114
driving rules for HEAVY GOODS VEHICLE after stroke
1 year after TIA/stroke
115
when to do a CT in TIA
only if anticoagulated /haemoglobinopathy to exclude haemorrhage
116
treatment of TIA
- aspirin 300mg (+PPI) - refer to TIA clinic in 24h - statins
117
when to do carotid endarterectomy for TIA
within 2 weeks if >70% stenosis and operative risk acceptable
118
treatment of benign essential tremor
propranolol
119
what to prescribe with analgesia for migraine
pro kinetic antiemetic e.g. metoclopramide
120
where are the lewy bodies in LBD
LBs in occipito-parietal cortex
121
what are Pick bodies
Tau protein (in Pick's disease - type of front-temporal dementia)
122
definition of a relapse in MS
new/worsening of pre-existing symptoms attributable to demyelinating disease lasting >24 hours in absence of infection or any cause - after stable period tf 1 month+
123
typical demyelinating syndromes in MS
- optic neuritis - transverse myelitis (SPASTIC PARAPERESIS) - cerebellar-related symptoms: ataxia, vertigo, clumsiness - brainstem syndromes: ataxia, eye movement abnormalities, bulbar muscle problems
124
features of transverse myelitis
- sensory and/or motor symptoms below level of inflammation - 2-3 vertebral segments - Lhermitte's phenomena - trigeminal neuralgia - sphincter disturbance
125
what is Lhermitte's phenomena
neck flexion = electrical shocks in trunk/limbs
126
approach to diagnosis of MS
2+ relapses: - objective clinical evidence of 2+ lesions OR - objective clinical evidence of 1 lesion with a reasonable history of a previous relapse objective evidence = abnormality on neuro exam, MRI
127
findings on LP of MS
oligoclonal bands found in CSD and NOT in serum increased IgG
128
findings indicating MS on MRI brain + spine with contrast
- demyelinating plaques - periventricular plaques are called Dawson's fingers + are found perpendicular to lateral ventricles - high signal T2 lesions in 2+ different CNS areas
129
management of acute MS relapse
oral/IV methylprednisolone for 5 dyas
130
disease modifying drugs for MS
beta interferon
131
treatment of spasticity in MS
baclofen + gabapentin
132
most common primary tumour of brain in adults
grade IV astrocytoma
133
investigations to do for vesticular schwannoma/acoustic neuroma
gadolinium-enhanced MRI cerebellopontine angle + AUDIOMETRY
134
bilateral acoustic neuromas are associated with
NF2
135
myotomes for shoulder abduction and adduction
- abduction = C5 | - adduction = C5, C6
136
myotomes for elbow flexion and extension
- flexion = C5, C6 | - extension = C7
137
myotomes for wrist flexion and extension
- flexion = C7, C8 | - extension (and finger extension) = C7
138
myotomes for finger flexion, abduction and adduction
- flexion = C8 | - abduction/adduction = T1
139
myotomes for hip flexion and extension
- flexion = L1, L2 | - extension = L5, S1
140
myotome for hip adduction
L2, L3
141
myotomes for knee extension and flexion
- extension = L3, L4 | - flexion = L5, S1
142
myotomes for ankle dorsiflexion and plantarflexion
- dorsiflexion = L4, L5 | - plantarflexion = S1
143
which nerve root compressions have a positive femoral stretch test and weak quadriceps
L3 and L4
144
which nerve root compressions have a positive sciatic nerve stretch test
L5 and S1
145
cause of Brown-Sequard syndrome
spinal cord hemisection - due to trauma, radiation, haematoma, disc herniation, neoplasms
146
features of Brown-Sequard syndrome
- ipsilateral spastic paresis below lesion - ipsilateral loss of proprioception + vibration sense - contralateral loss of pain + temp sense below lesion
147
additional symptom of progressive supra nuclear palsy (PSP) compared to Parkinson's disease
same symptoms as PD PLUS vertical gaze palsy
148
common neurological complication of diabetes
autonomic neuropathy - may present with postural hypotension and gastroparesis
149
what is radiculopathy
pain in distribution of dermatome - caused by disease affecting root of spinal nerve
150
cause of syringomyelia
collection of CSF within spinal cord due to e.g. chair malformation, trauma, SOL can cause Horner's if compresses sympathetic chain
151
features of syringomyelia
'cape-like' loss of sensation to temperature and pain but preservation of light touch, proprioception and vibration UMN signs if CST affected LMN signs if anterior horn affected
152
investigations for syringomyelia
- full spine MRI to exclude tumour/tethered cord | - brain MRI to exclude chair malformation
153
cause of SACDC
B12 deficiency = degeneration of dorsal + lateral CSTs + spinocerebellar tracts
154
which reflexes are ABSENT in SACDC
ankle jerks absent - UMN signs typically in legs (extensor plantars, brisk knee reflexes, absent ankle jerks)
155
location of damage in cauda equina
L1-L5
156
1st line analgesia for back pain
NSAIDs AVOID opiates
157
causes of pinpoint pupils
opioids | brainstem haemorrhage
158
normal ICP
7-15mmHg in adults in the supine position
159
initial management of raised ICP
- ABCDE - treat cause - elevate head to 30 degrees - IV mannitol - controlled hyperventilation to decrease CO2 (= vasoconstriction of cerebral arteries) - remove CSF e.g. drain from intraventricular monitor, repeated LP, ventriculoperitoneal shunt
160
normal CSF opening pressure
12-18 mCSF
161
investigation and management for hydrocephalus
MRI do VP shunt
162
visual findings in idiopathic intracranial hypertension
blurred vision CNVI palsy enlarged blind spot
163
CN palsy in extradural haematoma
CNIII
164
gold standard investigation for SAH
CT angiography
165
management of SAD
- nimodipine to prevent vasospasm | - endovascular coiling
166
what is Terson's syndrome
vitreous bleeds secondary to SAH
167
LP finding in Listeria meningitis
clear CSF and high lymphocytes whereas usually is turbid and high polymorphs
168
guidelines for CT before LP in meningitis
- focal neurological signs - papilloedema - GCS <=12 - persistent seizures
169
types of hallucinations you can get in HSV encephalitis (usually HSV2)
olfactory hallucinations
170
LP findings in viral encephalitis
increased CSF protein lymphocytes do PCR
171
treatment of viral encephalitis
- acyclovir (empirical within 30 mins) - if HSV continue 14 days - HIV = HAART - CMV = ganciclovir
172
Antibody screen for AI encephalitis
LGI1 NMDA R CASPR2
173
management of AI encephalitis
1st line = steroids + IV immunoglobulin 2nd line (if not responding within 2 weeks) = rituximab + cyclophosphamide (with 1st line therapy continued)
174
pathogens causing brain abscess
- strep viridians - toxoplasmosis - HIV
175
predisposing factors for brain abscesses
- infections (ear, sinus, dental) - skull fracture - congenital heart disease - endocarditis - immunosuppression
176
infections which can cause peripheral neuropathy
leprosy lyme disease HIV diphtheriae
177
drugs/substances which can cause peripheral neuropathy
``` alcohol organophosphates amiodarone recreational drugs chemotherapy ISONIAZID ```
178
how does Guillain-Barre (GBS) present
acute symmetrical ascending flaccid weakness/paralysis progressing over <14 days proximal > distal muscles starts in legs LMN signs in lower limbs back pain paraesthesia in extremities
179
cause of GBS
preceding illness i.e. campylobacter, CMV, mycoplasma 1-3 weeks before
180
investigation findings in GBS
- absent reflexes - nerve conduction studies = absent/prolonged f waves - CSF - ABG - T2RF
181
CSF findings in GBS
raised protein | NORMAL WCC and glucose
182
management of GBS
- supportive (airway etc) - IV immunoglobulins, steroids exchange NB: steroids don't work
183
CN signs in GBS
- ophthalmoplegia diplopia - bilateral CNVII palsy - bulbar palsy
184
what is Miller-Fisher syndrome
GBS variant - ataxia, ophthalmoplegia + areflexia

Year 5 notes (10 decks)

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