Neuro Flashcards
(258 cards)
1
Q
Alzheimer’s is a progressive degeneration of the cerebral cortex with widespread atrophy. What key thing is happening in affected neurones?
A
Amyloid plaque deposits
2
Q
Alzheimer’s is a progressive degeneration of the cerebral cortex with widespread atrophy. What key thing is happening in affected neurones?
A
Amyloid plaque deposits with reduced Ach production
Neurofibrillary tangles
3
Q
Gene in some alzheimers ?
A
Apolipoprotein E
[APP, PSEN1, PSEN2 - can think of Persons SENile 1 and 2]
4
Q
Dementia with hallucinations/sleep disorder in Q. What else might they mention?
A
Lewy body
Parkinsonism
5
Q
Personality change being a key part of dementia in?
A
Fronto temporal
6
Q
Some dementia symptoms but starting in 30’s with psychosis and abnormal movements
A
huntingtons
7
Q
gait disturbance, cognitive impairment, and impaired bladder control
A
normal pressure hydrocephalus
8
Q
Rapid progression in <50s with myoclonic jerks, seizures and cerebral ataxia
A
prion disease
9
Q
Uncertain but want to make diagnosis of AD
A
Consider PET CT
CSF for tau protein / amyloid B
10
Q
AD and DVLA
A
DVLA must be informed
11
Q
Pharma Rx of AD
A
Cholinesterase inhibitors - Donepezil, rivastigmine, galantamine
NMDA receptor antagonist - memantine
12
Q
Safest antiepileptic in pregnancy
A
Lamotrigine for labias
13
Q
Phenytoin can be used in pregnancy - what needs to happen? 3 parts
A
Ensure pt gets folic acid (as affects synthesis)
Vitamin K from 36weeks gestation to counteract possible neonatal coagulopathy
Detailed US scan at 18-20 weeks
14
Q
Huntington’s - genetics? Which chrom?
A
Huntingtin gene on chromosome 4 -> CAG repeat
Dominant pattern with anticipation
15
Q
What is the common presentation of juvenile Huntingtons
A
Hypo kinetic, rigid picture with parkinsonism
16
Q
CT huntingtons
A
Loss of striatal volume and increased size of the frontal horns of the lateral ventricles
17
Q
Alcohol and diabetes are the most common forms of peripheral neuropathy - what would make you think alcohol rather than diabetes?
A
anaemia with macrocytosis
Derranged LFTs
Low Calcium / Magnesium
18
Q
Cluster headaches are always UNILATERAL and last 15min - 3 hrs. Often associated with ipsilateral autonomic symptoms. Management for acute attack? Prevention?
A
Acute - Oxygen +/- sumatriptan
Chronic - Verapamil
[Topiramate, valproate, and lithium may be used]
19
Q
Why avoid haloperidol in dementia
A
More susceptible to extrapyramidal eg parkinsonism side effects
20
Q
Early Parkinsons associated with what gene?
A
PARK1
21
Q
Bar antipsychotics which other drugs may cause parkinsonism
A
Metoclopramide
proclorperazine
Valproate, litium
22
Q
General buzz pathology of Parkinsons
A
loss of dopaminergic neurones in substantial nigra
23
Q
Parkinsonism with significant autonomic disturbance?
A
Multi-system atrophy
24
Q
Parkinsonism with prominent cerebella signs
A
Multi system atrophy
25
Parkinsonism with the inability to look up. If the neck is flexed the gaze will remain to look forward. What is this called? What is the diagnosis?
vertical supranuclear gaze palsy
Progressive supranuclear palsy
26
Early falls in clinical course with parkinsonism consider?
Normal pressure hydrocephalus
PSP
27
Vascular parkinsonism seen in ?
Corticobasal syndrome
28
Parkinsons DVLA
Must inform
29
1st line Rx of parkinsons
Levodopa with a dopa-decarboxylase inhibitor Eg
Co-caredopa
30
Bar co-careldopa/co-beneldopa what other key medication classes in parkinsons
Dopamine agonists - pramipexole, ropinirole or rotigotine
MAO-B inhibitors - segeligine, rasagiline
[Do NOT cause rection after consumption of tyramine rich food]
COMT inhibitors - entacapone
31
Issue with using ergot-derived dopamine agonists eg cabergoline and pergolide?
Cardiac fibrosis when used for a long time
32
Surgical Parkinsons
Electrodes into deep brain nuclei -> stimulation of thalamic nucleus
33
Hemiballism is what? which brain structure is damaged?
"hyperkinetic involuntary movement disorder characterized by intermittent, sudden, violent, involuntary, flinging, or ballistic high amplitude movements"
Subthalamic nucleus
34
Damage to red nucleus leads to?
tremor
[Tremor with glass of red wine it pours everywhere]
35
Damage to ventral pallidum caudate nucleus
chorea
36
Damage to the dentate nucleus causes?
ataxia
[Dentists dint pay taxes]
37
Most common primary brain tumour
Glioma
38
Glioblastoma multiforme looks greyish macroscopically. What features are diagnostic?
Vascular proliferation and thombois
Necrosis
Astrocytoma (another main type of glioma) wont have these features above and usually looks whiter
39
Most commonly inherited polyneuropathy?
charcot-marie-tooth disease
[Will present with a slow symetrical weakness/ sensory loss / muscle loss / areflexia]
40
How does freidrich's ataxia present? common non neuro issue?
slow progressive cerebellar ataxia in young adults / kids (2-25yrs) with absent reflexes
Cardiomyopathy
41
Rx of migrane acute?
Acute
-Analgesia - Aspirin 900mg, NSAID, para
-Sumatriptin
*Only sumartriptan at START of headache - not when aura starts*
42
Eg of migrane prophylaxis
propranolol
topiramate
amitriptyline
43
Smoker. Proximal weakness which is worse in morning and gets better with exertion. Assoc symptoms of autonomic Eg Dry mouth. Cause/antibodies? Pathology? Ix? Rx?
Lambert-eaten myasthenic syndrome
Paraneoplastic usually associated with small cell lung cancer
-Pre synaptic autoantibodies to voltage gated Ca channels
Nerve conduction studies / CT chest to exclude malignancy
3,4-diaminopyridine [sometimes pyridostigmine / steroids / plasma exchange]
44
Management of Tics
Risperidone if bad
CBT if not
45
Gillian-barre
Most common bug?
CSF finding?
Rx?
C jejuni
Raised protein [can be normal at start]
IVIG + Plasma exchange
46
Variant Creutzfeldt-Jakob disease gives what finding on MRI? Histology?
Increased signal in pulvinar of thalamus
Vacuolar degeneration
47
What would diffuse white-matter disease on t2 weighting indicate?
Vascular dementia
48
myoclonus
dementia
ataxia
psych/behavioural
Age 20s
=
Varient Creutzfeldt-Jakob disease
[Very young]
49
Differentiate sporadic vs Variant Creutzfeldt-Jakob disease
Variant Creutzfeldt-Jakob disease - presents earlier Ie in 20s
Psychiatic prodrome to symptoms
Painful sensory symptoms
50
Actue slurring of speech, horners syndrome, facial pain and vertigo =?Which vessle?
Lateral medullary syndrome
[posterior inferior cerebellar artery syndrome]
Vertebral artery - most common. Then PICA
51
Anterior vs middle cerebral artery if lower limb more affected?
Anterior - paralysis affecting LEGS most
52
'Cape like' distribution loss of pain and temperature? What follow? Pathology?
Syringomyelia
Other symptoms if gets bad eg propioception / power moving up from hands / lower limb sx
[May get horners syndrome if involves sympathetic pathways of cervical cord]
Fluid filled cyst in spinal cord
53
Most common type of MS? Most common mode of presentation
Relapsing remitting
Optic neuritis with visual field loss
54
MS gene risk factor
HLA DRB1
55
2 things on CSF of MS
Oligoclonal bands
Intra theacal IgG synthesis
56
Complete opthalmoplegia of eye. Where is lesion? If raised inflam markers what is it likely?
Cavernous sinus (on ipsilateral side)
Tolosa-hunt syndrome (TotalLoss eye) [Granulomatous process]
57
What do you get in cavernous sinus issues? Eg Neoplastic, vascular, inflamation
CN III, IV, VI -> eye muscle weakness
V (trigeminal) - face sensory
Horners syndrome
Facial paraesthesia
58
Cell type in Lyme disease CSF meningitis
Lymphocyte predominant
High protein
Normal glucose
59
Do you give steroids in GBS
no
60
Loss of pain and temp on face and on CONTRALATERAL side of body? Usual cause?
Lateral medullary syndrome
Vertebral artery dissecition -> PICA occlusion
61
Max time for TIA?
24hrs
62
Who has high risk of berry aneurysms
PCKD
63
Drug of choice for stroke thrombolysis? time frame to treat? When can you do thrombectomy?
altepase if <4.5hrs
Thrombectomy (incombination with altepase) <6hrs
64
PICA occusion leads to? what symptoms
Lateral medullary syndrome
nystagmus and vomiting
Ipsilateral pain and temp sensation in face
-Ipsilateral horners
Contra lateral pain and temp in limbs
[but ipsilateral limb ataxia]
65
Non-epileptic seizures. Important ways of differentiating from true
EEG + video
TONGUE biting - virtually never in pseudo
Serum prolactin - temporary raise in real seizures
66
What happens in loss of dolls eye reflex. When might this be seen.
Pupils dont move on head turning
Brainstem death Eg massive pontine haemorrhage
67
Proptosis not from graves usually?
Malignant
Eg tumour in orbital apex
68
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and virbration
Anterior spinal artery occulusion
Posterior artery suppilies posterior aspect with proprioception and vibration
69
Best antiepileptic if liver impairment
Lamotrigine - also only one which doesnt interfere with warafrin
[Lamotrigine for liver]
Can use keppra - though will still need dose reduced if severe impairment
70
First line drugs for epilepsy are as you'd imagine. Keppra, valproate, carbamazepine, lamotrigine.... What is the one for absence seizures?
Ethosuximide
71
All types of MND have weakness in limbs. AML is the most common type and affects UMN/LMN as well as speech and respiratory involvement.
What are some differentiating factors of the others ?
PBP / PMA / PLS
Progressive bulbar palsy
-Weakness of facial muscles predominant
-Often emotional liability
Progressive muscular atrophy
-Only LOWER motor neurones
Primary lateral sclerosis
-Progressive SPASTIC weakness of limbs
-Sensation intact
-may still get dysarthria / dysphagia
72
Only drug for MND
Riluzole - only adds a couple months to life expectancy
73
Condition which may seem similar to MND -
Lower MND involving limbs and bulbar muscles
with - Gynaecomastia and reduced fertility ?
Kennedy disease (x-linked spinobulbar muscular atrophy)
74
Juvinile myoclonic epilepsy - choice of drug?
Valproate
-Keppra if want to get preg etc..
Kids like a VK drink
75
Blurring of disk and Arcuate visual loss usually in what condition
Glaucoma
[bow-shaped (arcuate) visual field defect]
76
Loss of ability to detect size shape and orientation of objects in one hand. MRI of what
Head - not C spine
Damage to anterior parietal cortex would cause this
77
Brown-Séquard syndrome - neurology
paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.
78
Unilateral dilated pupil which contracts slowly and loss of deep tendon reflexes? Option for management
What is hypohidrosis? What name of syndrome if that happens along with above?
Holmes-aldie syndrome (pupil)
-Usually due to viral damage at some point
-Reading glasses or pilocarpine drops TDS to constrict pupil
Lack of ability to sweat
Ross syndrome
79
Syphilis -> bilateral slighly dilated poorly light reactive pupils with normal accommodation.
Argyll-robertson pupil
80
Broca vs wernickes
Broca - Frontal lobe
- Pure speech disturbance
Wernikes - Temporal lobe
- Comprehension
81
Bells palsy linked to which bug?
Symptoms?
Key other cause to rule out?
HSV-1
Facial muscles palsy
HYPERacuisus
Reduced salivation
May cause pain usually auricular
Dry eyes
Borrelia burgdoferi serology
82
Bells palsy - 2 main parts of Rx?
If complete paralysis ?
Eye protection - artificial tears
corticosteroids
Often aciclovir +/- surgical decompression
83
Bells palsy vs UMN lesion if able to wrinkle head
Preserved ability to wrinkle forehead is UMN lesion
84
Hypo/hyperkalaemia and temporary global muscle weakness
periodic paralysis
85
Periodic paralysis with lots of physical deformities
andersen-tawil syndrome
86
Periodic paralysis usually associated with potassium problems. What is the other type
Thyrotoxic
87
Bells palsy with vesicular rash = ?
CSF findings?
Ramsay hunt - VZV (Herpes Zoster) in the geniculate nucleus
May have lymphocytosis / mildly raised protein
88
Painless intermittent diplopia which worsens through day. Ptosis
?
Occular myasthenia gravis
[most common initial presentation]
89
Interossi muscles of hands and sensory medial upper arm nerve root
T1
90
Tricepts muscle and sensory forearm + hand around middle finger nerve route
C7
91
Elbow and wrist extension issues which brachial plexus nerve ? Sensory issues
Radial
Sensory lateral forearm and lateral dorsal hand (anatomical snuff box)
92
Loss of pain and temperature in arm with preservation of proprioception and vibration? (If repeated trauma in question?) How would it progress?
Syringomyelia
(if trauma eg repeated rugby scrum - cervical spondylosis)
Wasting of small muscles of hand moving proximally
Increased tone bilat lower limb -> spastic paralysis
93
Smoking HTN and cocaine are risks for SAH/Aneurysm. What are inherited risks?
PKD
Marfan, ehlers-danlos
NF type 1
94
Fat, headaches, visual disturbance? Key finding on exam?
idiopathic intracranial hypertension
-swelling of optic disk /papilloedema
95
Rx of IIH? If severe headaches?
Surgical? If threat to vision?
Acetazolamide / topiramate
Pred if severe headaches
Therapeutic LPs to relieve pressure
May get VP shunt for recurrent disease
Optic nerve fenestration if risk to vision
96
Differentiate cauda equina and conus medullaris.
Presentation
Reflexes
Pain
Sensory
Sphincters
Conus
-Sudden and bilart
-Knee jerk preserved. Anke affected
-more severe back pain, less radicular
-Symetrical and bilat sensory disturbance
-Urinary retention and faecal incontinence early
Cauda
-Slower onset
-Areflexic
-Less severe back pain, more sever radicular pain
-Retention presents late in disease
97
wants to get preg. On phenytoin and keppra. What is plan
Wean to a single agent -
Keep keppra at lowest dose for seizure control
Folic acid 5mg daily
98
Arnold-chiari nystagmus type?
Downbeat
99
What is most common cause of pendular nystagmus? (movement equal speed both ways)
MS
100
Symptoms of brown sequard
Ipsilateral - weakness, vibration and proprioception
Contralateral - Pain and temp
101
Muscular dystrophy - what is best predictor of death
Vital capacity
102
Differentiate sporadic / varient CJD.
Best Ix
Sporadic
-Age 45-75
-Myoclous and dementia
-De novo mutation
-LP/MRI
Variant
-Average age 26
-Psychiatric prodrome
-Painful psych symptoms
-MRI best (EEG/LP less sensitive in this one)
103
Rx of myoclonus in CJD
Clonazepam / valproate
104
Most common cause of roth spots
Subacute bacterial endocarditis
105
Unable to pronate arm. Which nerve
Anterior interossus - Branch of median
106
Cushings response to head injury
RR - decreases
Bradycardia
systolic BP increase
107
MRI spine findings of Subacute degeneration of spinal cord (eg b12 deficiency)
Increased T2 signal in posterior columns
108
MS MRI Spine
T2 Diffuse patchy white matter lesions
109
RX ramsay hunt
Acyclovir + pred
Lubricating eye drops
110
Flu like illness -> ophthalmoplegia, areflexia and ataxia
Miller-fisher syndrome
[variant of gillian barre]
111
Left inferior homonymous hemaniopia where is lesion
Right parietal
[Lateral fibres cross at chiasm]
112
Bar CN III, IV and 6, what else goes through cavernous sinus?
Maxillary (sensory) branch of CN V
Carotid artery
113
Most common sight issue in IIH
Enlarged blind spot
(from optic disk swelling)
114
Prev significant spinal trauma with lower limb wasting. Now loss of pain and temp over upper limbs. What has happened
Post-traumatic sryngomyelia
115
Facial weakness, winging of scapular, proximal upper limb weakness, foot drop
Fascioscapulohumeral muscular dystrophy
116
Focal seizures usually from which lobe?
Temporal
117
Epidural / LP then couple days later
Droswsy, severe headaches, raised ICP eg seizures....
Central venous thrombosis
MOST likely Superior sagittal sinus thrombosis
118
For what length of time does xanthachromia remain very specific
12hrs after onset for 2 weeks
(100% sensitivity after 2 weeks still)
119
Essential tremor 2 main drugs for Rx
Propanolol
[Primidone (barbituate)
Topiramate]
120
Inheritance of tremor? how does age of presentation change whats likely?
AD in 50%
If presents after age 40 -> likely sporadic
121
Key drug in neuroleptic malignant syndrome
dantrolene
122
EEG of sCJD
1-Hz periodic discharges
(myoclonic movements)
123
diabetes insipidus, childhood-onset diabetes mellitus, a gradual loss of vision caused by optic atrophy, and deafness.
DI-DM-OA-D
DIDMOAD syndrome also known as
Wolfram syndrome
124
Score for disease status in MS
EDSS
Expanded disability status score
125
Usual first line Rx MS with mpred
Interferon or
Glatiramer acetate
126
Early highly active RRMS rx
Autologus haematopoetic stem cell transplant
127
Relapse of MS doses of pred in hospital
Mpred 1g IV 3 days
500mg oral 5 days
128
What happens to pregnant pts with MS
Usually get less attacks
still treat with steroids / Plasma exchange if needed
129
Finger drop / radial deviated wrist extension. Nerve?
Doral (posterior) interossus nerve
130
Dermatome c5-t1
Dermatome
C5: lateral aspect of arm
C6: lateral aspect of forearm and hand
C7: middle finger and ray
C8: medial aspect of hand
T1: medial aspect of forearm
131
Myotome and reflex C5-T1
C5: Elbow flexion
-Biceps
C6: Wrist extension
-Supinator
-Biceps
C7: Elbow extension
-Triceps
C8: Middle finger flexion
T1: Little finger abduction
132
Disc prolapse -> loss of triceps reflex. Where
C6,7
prolapse affects nerve root below prolapse
133
Multifocal motor neuropathy with conduction block. What is this? Sensory involvement?
Rx first line?
Form of MND
No sensory involvement
Treat with IVIg
134
Multifocal motor neuropathy with conduction block. Key findings on EMG?
Rx first line?
it is what it says on the diagnosis. Eg right hand and left foot symptoms
Conduction block and No sensory involvement on EMG
Treat with IV Ig
135
What is the most common form of GBS called. WHat is the pattern of peripheral nerve pathology
Acute inflammatory demyelinating polyneuropathy
AIDP
Segmental demyelination
136
What is wallerian degeneration
Demyelination which occurs distal to a region of focal (axonal) damage.
->Nerve needs to regenerate
137
DDs for subacute lymphocytic meningitis
TB
Cryptococcus - if immunocompromised and opening pressure >40cmH2O
Lyme diseae
138
Head injury LOC. Quick recovery
Lucid period
-> quick deterioration ?
Extradural
(middle meningeal artery bleed -> more rapid symptoms)
139
cerebral aneurysm which is best Coil or clipping
Coil
140
Cerebellar signs and tremor in a young person ...
Wilsons
141
1st line Ix of wilsons? Gene?
24hr urine copper is Ix of choice - raised
Slit lamp - sunflower cataracts / kayser fletcher rings
[Serum ceurloplasumin and copper - usually low/normal]
ATP7B gene - diagnosis
142
Rx Wilsons
Avoidance of copper containing foods
Penicillamine - copper chelation
143
Juvenile myoclonic epilepsy first line ?
Valproate
144
Differentiate vestibular neuroma and menniers
Cancer - unilateral hearing loss, tinnitus and trigeminal neuralgia. Eg absent corneal reflex
Menniers - hearing loss, tinnitus and vertigo
No pain / trigeminal involvement
145
Key risks for vestibular shwannoma
Neurofibromatosis
Loss of chromosome p22 gene
[Shwannomin gene which is a tumour suppressor gene)
146
Rx of vestibular schannoma
50% small and dont require Rx
Surgery /
radio - 'gamma knife' radiotherapy
147
Upbeat nystagmus. Where is lesion
Lesion in medulla
148
What is spared in anterior spinal artery occlusion?
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and virbration
149
What is spared in anterior spinal artery occlusion?
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and vibration
150
What is spared in anterior spinal artery occlusion?
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and vibration
151
Older diabetic. Transient weakness eg of face. Then couple of months later weakness / sensory loss of common peroneal. Both recovered spontaneously after couple weeks. Dx?
Rx?
Mononeuritis multiplex
Improve BM control
[MS would present <60 usually / UpperMN signs]
152
What can apomorphine be used forr
Alleviate late motor Sx Eg dyskinesia of dopamine therapy in parkinsons
153
Numbness medial thigh and reduced hip adduction nerve
Obturator
154
Weak hip abduction and Trendelenburg gait nerve
Superior gluteal
155
Sciatic nerve route? becomes what?What sx?
L5-S2
Becomes tibial and common perineal
-> eg foot drop
156
Pharma rx of tics
Risperidone
157
Pregnant then excessive vomiting.. Wide-based gait and double vision. Deficient in what
Thiamine (Vit B1)
158
Stroke / TIA DVLA rules
No car for 1 month
No HGV for 1 year
159
Homonymous hemianopia with sparing of macula (central field)
Occipital stroke
If no sparing may be optic tract
160
CN palsies, horners syndrome, and UMN signs in limbs, sensory change
Sryngobulbia
161
Kennedy disease also called
x linked spinobulbar atrophy
[like MND but gynecomastia, diabetes and infertile]
162
Weakness of all ankle movements / ankle jerk =
Sciatic
163
Drug used in SAH to minimise vasospasm and further infaarct
Nimodipine
164
Pyramidal weakness, reduced deep tendon reflexes
Reduced proprioception and vibration but nil else sensory =
b12 deficinecy
165
Which infection causes progressive myelopathy with prominent bladder disturbance
HTLV-1
166
Bilat weakness in upper limbs.
LMN signs. No sensory involvement
Demyelination and conduction block on EMG /conduction studies.
Multifocal motor neuropathy
167
Multifocal motor neuropathy Ix? Antibody? Rx?
EMG /conduction studies.
Anti-aminoglycoside [Anti-GM1] antibody 50%
IV Ig
168
What makes you think idiopathic parkinsons rather than one of the parkinsonsoniam cause
Asymmetry in idiopathic parkinsons
169
differentiate holmes aidie pupil and physiological aniscoria
Aidie - poor constriction to light with normal accommodation
[Due to damage to parasympathetic supply]
Pysiological - difference remains the same in light and dark
170
differentiate holmes aide pupil and physiological anisocoria
Aidie - poor constriction to light with normal accommodation
[Due to damage to parasympathetic supply]
Physiological - difference remains the same in light and dark
171
Upper and LMN signs with sensory changes? What if evidence of brainstem involvement Eg CN palsy
Syringomyelia
syringobulbia if brainstem involved
172
Brainstem stroke with impaired vertical eye movements. Where is the lesion for eye movements?
Dosal midbrain - vertical eye movements
173
Stroke long term secondary prevention? 2nd line?
Clopidogrel 1st line
2nd line aspirin + dipyridamole
174
miller fisher syndrome basics presentation
Weakness affecting eyes and then progresses distally
175
Phenytoin dose change - how long to check level
2 weeks
176
Fevers, lethargy. Painful neuropathies affectting different nerves. Rash. Raised inflam markers. What is the cause of neuropathies? Cause? Ix?
Mononeuritis multiplex
[probably caused by vasculitis given rash ]
Nerve biopsy
177
global wasting of the hand muscles damage to?
T1 (median and ulnar)
178
HIV progressive memory loss. MRI shows global atrophy and mild white matter hyperintensity?
HIV dementia
[PML would usually have some focal neuro symptoms]
179
Pituitary apoplexy (bleeding into adenoma). Ix of choice?
MRI brain
[dont need angio as MRI will show adenoma and haemohharge]
180
Paroxysmal vertigo, deafness lasting for hours? Rx acute? Prophylaxis?
What if old and symptoms only short lived?
Meniers
Prochlorperazine / cyclizine
Beta histine, low salt +/- diuretics
Vertebrobasilar insufficiency if old and short-lived sx
[no hearing loss in BPPV]
181
Labyrinthitis how long for symptoms
Lasts 1-3 weeks and
NO hearing loss
182
Labyrinthitis how long for symptoms? What symptom is absent?
Lasts 1-3 weeks and
NO hearing loss
183
Deliver baby -> severe dehydration
Then develop neuro signs Eg seizure / focal weakness what has happened
Sagittal sinus thrombosis
184
which artery supplies brocca
Middle cerebral
185
Hemiparesis mostly involving llegs
Anterior cerebral
186
40. Unsteady gait, alcoholic, reduced lower limb reflexes, increased tone and spastic bilat . Loss of vibration sense
B12 deficiency
187
Injury to the neck. Weakness down left side 4/5. LMN arm, UMN leg. Dx?
Cervical myelopathy
[Sryngomyelia would have more likely started as cape-like distribution]
188
Miller fisher syndrome antibody
IgG anti‐GQ1b
189
Axonal vs myelin disorder on EMG
Axonal - Loss of action potential size (amplitude)
Myelin - Reduction in velocity Or blocks
190
Painful paraesthesia in CJD means what is involved
Thalamus
191
Old person with CJD best Ix
LP [for RT-QuIC]
192
Right parietal damage in right-handed person -> ?
Visual disturbance
193
Arnold chiari nystagmus
Downbeat
194
agraphia
acalculia
finger agnosia
left-right disorientation .
Gerstmann syndrome
agraphia (inability to write),
acalculia (inability to perform mathematical calculations)
finger agnosia (inability to name, discriminate, or identify fingers)
left-right disorientation (inability to distinguish left from right)
195
Dominant vs non dominant parietal lobe lesion
Dominant - Language, agnosia, apraxia, Gesterman syndrome
Non-dominant - Visuospacial, apraxia
-Eg copy a drawing
196
URTI. Now progressive weakness of lower limbs
CSF - lymphocytes, normal protein
?
Post viral transverse myelitis
[Will have sensory level sensation loss]
197
Difficulties relaxing grip, facial weakness family Hx?
Myotpnic dystrophy type 1
AD
198
Indian with Palpable nodule on skin -> seizure = ?
What is bug causing ?
Cysticercosis
Tape worm (Taenia Solium)
199
GBS poor prognosis
Age
speed of sx
Hx of
Finding in blood
>40
Rapid onset / vent requirement
Hx of diarrhoeal illness(campylobacter)
High Anti-GM1 in blood
200
Bar MRI what 2 Ix good for MS
Visual evoked potentials (or optic neuritis)
LP
201
Presents as Huntington's with Fhx but has Asterixis? What is asterixis?
Wilsons
Asterixis inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements.
202
IV or oral Mpred in MS attack?
Oral .5g for 5 days
IV 1g is reserved for people who need to be admitted for monitoring Eg depression, diabetes
203
Which order of horners if internal carotid?
Syringomyelia?
3rd order (postganglionic)
1st order
204
tetnus Abx
Penicilin or metronidazole
205
Pupil non-reacctive to light and diminished reflexes globally
Holmes aidie
206
Dysarthria and clumsiness + more forgetfulness in 30s. Family hX and has mild hepatomegaly
Wilsons
207
Eyes
Loss of adduction with contralateral nystagmus of the other eye. =?
Damage where? If bilateral what is going on?
Internuclear opthalmoplegia
-Lesion in medial longitudinal fasiculusis
[Connects CN VI to contralateral CN III]
MS very likely if bbilat
208
Sudden onset unilateral weakness without language disturbance or visual field defect or neglect =
Lacunar stroke - affecting the corticospinal tract
209
Lacunar stroke if
Pure sensory
Pure motor
Clumsy hand syndrome
210
Severe headaches confusion hypertensive retinopathy on fundoscopy =
Hypertensive encephalopathy
Needs iv sodium nitroprusside
211
Primary cervical torticolis Rx
Botox
212
What is a chiari type 1 malformation?
Presents with?
Type 2 presents how?
Elongated cerebellar tonsils are displaced into the cervical canal through the foramen magnum
-Presents with cerebellar signs (downbeat nystagmus), weakness of the upper limb and sensory issues
Type 2 presents young with features of brainstem dysfunction
213
On lamotrigine and phenytoin. Seizure free 5 years. Presents during preg with seizure. Plan?
Slowly withdraw phenytoin and keep lamotrigine
[2 agents significantly more risk of teratogenicity]
214
Amyloid neuropathy presents how
Polyneuropathy with Autonomic symptoms eg Postural hypotension
215
Optic neuritis
MRI has >3 white matter lesions what is the chance of developing MS in 5 years?
MRI has 1 lesion, what is the chance of developing MS in 15 years?
50%
50%
216
Most common genetic form of vascular dementia ? Cromosome
CADSIL
Cerebral Autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy
chrome 19q3 - NOTCH3 gene
217
Most common genetic form of vascular dementia ? Cromosome
CADSIL
Cerebral Autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy
chrome 19q3 - NOTCH3 gene
218
Proximal limb aching + headaches then altitudinal visual field loss
GCA
[Altitudinal visual field loss very common way to lose vision in ischemic optic neruitis]
219
Differentiate weber and Wallenberg syndrome...Sx? Where is lesion? Usual vessel?
Both ipsilateral CN 3 palsy
Weber - Contralateral hemiparesis + hemiparkinsonism
-Midbrain, corticospinal tract and substantial nigra
-Paramedian branches of posterior cerebellar artery
Wallenberg - ipsilateral pain temp loss on face with contralateral pain temp on body
-Midbrain / brainstem
-PICA
220
Syndrome with occlusive disease of internal carotids -> lots of collateral vessels. Presents with recurrent TIAs headaches or seizures? How is it described on cerebral angiogram ?
Moya moya
'hazy' or 'puff of smoke'
221
Ipsilateral CN 6 brainstem syndrome?
Millard-gubler
Pons
222
Normal pressure hydrocephalus Rx?
Shunt
[Only large volume LPs if unfit for surgery]
223
COCP with headache pappilodema and CN 6 palsys. CT low-density area with haemorrhagic component. What ix next?
MR Venography
-Likely has CVST
[CTA is not used to look for CVST apparently]
224
CN originates from...
Cerebrum - 1 and 2
Midbrain - 3 and 4
Pons - 5,6,7 and 8
Medulla - 9, 10, 11and 12
2/2/4/4
225
Unable to abduct eye and ipsilateral facial weakness - lesion where?
Pons
226
Whoh gets statins post stroke?
Everyone
227
Parkinsons for 2 years. On sinemet TDS and feels gets off symptoms... what next
Increase to QDS
228
Antiepileptic with weight loss and renal stones?
Topiramate
229
Most common side effect of lamotrigine?
Skin rash
[Some get steven johnsons]
230
Poorly controlled diabetes
Mix of UMN/LMN signs in limbs and weakness
Loss of pinprick sensation to mid shin bilat
Dx?
Amyotrophic lateral sclerosis
Loss of sensation is due to complication from diabetes!
231
Beckers inheritance. Where is the wekaness initially?
X linked
Proximal (so often develop big calves at first)
232
Charcot-marie-tooth symptoms
Purely motor / sensory. Presents in 20s
[NO UMN]
233
Weakness of quadriceps and fingers with asymmetry =? exclude polymyositis?
Inclusion body myositis
CK normal (helps rule out polymyositis)
234
Speech aphasia issues, headache
Left hemiparesis -> deteriorate and new R side CN 3 palsy, Where is the lesion?
Temporal lobe with haemorrhage/oedema -> brainstem compression
[Not midbrain initially as doesn't explain speech]
235
Booze. wakes with weakness brachioradialis, wrist and finger extension =
'Saturday night palsy'
radial nerve at spiral groove
236
Acoustic neuromas often affect which extra nerve? Sx?
Trigeminal sensory ranch - loss of corneal reflex first sign
237
When vit k in coagulopathy
If INR >2
238
R limb weakness with L CN 6 and facial weakness. Lesion where?
Left Pons
239
Pins and needles start in foot and run up body to arm . Happens often
Focal aware seizure
[new name for parital seizures]
240
GQ1B antibodies in
MIller fisher syndrome
241
Right-sided upper limb with fasciculations and wasting. Conduction block on EMG = Antibodies common?
Multifocal motor neuropathy
[Conduction block on EMG key to Dx]
Anti GM-1
242
Presents as encephalitis. Inflam markers normal. Lesions in both temporal lobes =?
HSV encephalitis
[Often has normal inflam markers]
243
BPPV which for Dx which for Rx?
Dix-hallpike
Epley
244
60s presents with difficulty naming things or recognising faces?
Unable to verbalise things normally - - main issue is phone conversations?
Where are the lesions in these conditions
Semantic dementia
-Temporal lobe
Progressive non-fluent aphasia
-Left perisylvian region
[types of FTD]
245
Given Abx for sinusitis. Severe headache
CSF - Lymphocytosis, mild low glucose, mild elevated protein
Partially treated bacterial meningitis
Looks similar to viral
246
Common peroneal sensory
Dorsum of foot
[basically same as motor]
247
Which Abx make MG worse? cardiac?
Aminoglycosides and fluoroquinolones
B blockers
Procainamide
248
Exposure to nitrous oxide leads to what neurological manifestation? Who is at risk?
Sensory and weakness
presents similar to B12 deficiency and people who have b12 deficiency much more at risk
[due oto methionine synthesis ]
249
Long-term use of antiepileptic which leads to lymphadenopathy and Dupuytren's contracture ?
Phenytoin
250
How to prevent neuropathy with isoniazid prescription
Pyridoxine
251
First line primary generalised epilepsy in men
Valproate
Lamotrigine
252
Alternating nystagmus - where is lesion
Cerebellum
253
Nystagmus in pons lesion
Upbeat
254
Facial weakness and sensation issues + tinnitus. Where is lesion
Cerebellopontine angle
V, VII, VIII all close together here
255
Medical fasciculus lesion. Right or left if left eye fails to adduct
Left
256
What do you need to check before giving Igs in rx of gillian barre? Why?
IgA levels
Risk of anaphylaxis when giving Ig to IgA deficiency
257
Child, ataxia and UMN signs
Friedrich's ataxia
CMT - no UMN
258
Ocular MG Rx initial
Pyridostigmine 30mg QQDS
