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Neuro Flashcards

1
Q

Stroke definition

A

Syndrome rapid onset cerebral deficint lasting >24 hours or leading to death

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2
Q

RF ischaemic stroke

A
  • HTN
  • Smoking and alcohol
  • Cholesterol
  • Obesity
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3
Q

S+S ischaemic stroke

A
  • FAST
  • Limb weakness on opposite side infarct
  • Contralateral hemiplegia/hemiparesis
  • Vision loss/deficit
  • HH
  • Aphasia
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4
Q

Ix ischaemic stroke

A
  • NCCT
  • MRI
  • Brachial BP
  • Bloods, XR, ECG
  • If CT shows hyper density = haemorrhagic
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5
Q

Ischaemic stroke acute Mx

A
  • Thrombolysis within 4.5 hours onset
  • IV alteplase
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6
Q

Ischaemic stroke long term Mx

A
  • Antihypertensives
  • Antiplatelet = long term aspirin, clopidogrel
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7
Q

Thrombolysis contraindications

A
  • Recent surgery 3 months
  • Recent arterial puncture
  • Hx active malignancy
  • Brain aneurysm
  • Anticoagulation
  • Liver disease or pancreatitis
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8
Q

Haemorrhagic stroke Mx

A
  • Stop anticoagulants immediately =
  • IV mannitol
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9
Q

TIA definition

A
  • Brief episode neuro dysfunction due to temporary focal cerebral or retinal ischaemia
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10
Q

Carotid TIA S+S

A
  • Amourosis fugax
  • Aphasia
  • Hemiparesis
  • Hemisensory loss
  • HH
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11
Q

Vertebrobasilar TIA S+S

A
  • Diplopia, vertigo, vomiting
  • Choking
  • Ataxia
  • Hemisensory loss
  • HH
  • Tetraparesis
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12
Q

TIA Ix

A
  • FBC, ESR, U+E
  • Carrotid doppler +/- angiography
  • CT or diffuse weighted MRI
  • Echo
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13
Q

TIA Mx

A
  • Immediate = Aspirin 300mg then 75 after 2 weeks (or clopi)
  • Statin
  • If AF = anticoagulation
  • Carotid endarterectomy if >70% carotid stenosis
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14
Q

Epilepsy definition

A
  • Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in brain
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15
Q

Clinical definition epilepsy

A
  • At least 2 unprovoked seizures >24h apart
  • 1 unprovoked seizure and probability of further
  • Diagnosis of an epilepsy syndrome
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16
Q

Partial/focal seizure

A
  • Focal onset that can be referrable to single lobe
  • Simple = no affect on consciousness or memory, no post ictal
  • Complex = memory/awareness affected, post ictal confision
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17
Q

Primary generalised seizure

A
  • Tonic
  • Tonic clonic
  • Clonic
  • Myoclonic
  • Atonic
  • Absence
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18
Q

Temporal lobe seizure

A
  • Aura
  • Anxiety
  • Automatisms = lip smacking
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19
Q

Frontal lobe seizure

A
  • Motor features
    0 Jacksonian march
  • Post ictal todds palsy
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20
Q

Focal seizure mx

A
  • Lamotrigine
  • Levi
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21
Q

Mx tonic seizure

A

SV or lamot

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22
Q

Mx myoclonic seizure

A

SV or levi

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23
Q

Mx TC seizure

A

SV or lamot

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24
Q

Mx absence seizure

A

SV or ethos

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25
Mx atonic seizure
SV or lamot
26
Status epilepticus
- TC seizure lasting 5+ minutes - Buccal midazolam 1st line community - Rectal diazepam or IV lorazepam
27
Extradural haemorrhage characteristic
Head injury followed by brief duration unconsciousness, followed by improvement - Young males
28
Extradrual haemorrhage patho
- Often due ti fractured temporal or parietal bone causing laceration of MMA
29
S+S extradural
- Deteriorating consciousness after head injury - Increasingly severe headache, vomiting and fits - Ipsilateral pupil dilates, bilateral limb weakness
30
Ix and mx extradural
- CT = lemon - Clot evacuation and ligation - anticoag/antiplatelet cessation - IV mannitol
31
Subdural haemmorhage RF
- Elderly = falls, atrophy - Shaking baby
32
S+S subdural
- Fluctating consciousness - Sleepiness - Headache - Personality change and confusion - Unsteadiness - Increased ICP - Seizures
33
Subdural Ix
- CT/MRI = clot +/- midline shift - Banana on CT
34
Mx subdural
- Irrigation/evacuation = Burr twist - AC/AP cessation - IV mannitol - IV prothrombin and Vit K
35
SAH aetiology
- Berry aneurysms (PCKD< ED) - Injury
36
SAH S+S
- Thunderclap - Vomiting - Seizures - Coma/drowsiness - Photophobia/vision changes - Neck stiffness - Kernig and Brudzinski
37
SAH Ix
- CT = star shaped - LP if doubt CT = yellow within 12 hrs and detectable for 2 weeks - CT angiography
38
SAH Mx
- Cerebral perfusion - Nimodipine = ca agonist - Dexamethasone - Endovascular coiling
39
Migraine no aura
At least 2 of - Unilateral pain - Throbbing - Moderate > severe - Motion sensitive and 1 of - N/V - Photophobia/phonophobia
40
Migraine with aura
- 1 or more typically fully reversible aura sx at least 3 of - 1 aura sx spreasd gradually over 5 mins - 2 or more aura sx in succession - 5-60 minute aura duration
41
Aura Mx
- NSAID or analgesics for acute - Triptans (avoid if IHD, HTN uncontrolled) - Propranolol for prevention
42
S+S tension headache
- Bilateral non pulsing headache - Scalp muscle tenderness - Tight band sensations - Pressure behind eyes - Bursting sensations
43
Cluster headache S+S
- Retro orbital pain - Tearing/lacrimation - Swollen eyelid - Facial flushing - Rhinorrhoea - Miosis and ptosis
44
RF cluster
- Male FHx - Smoking - Alcohol
45
Mx cluster
- Smoking cessation - Analgesics unhelpful - Subcut sumatriptan - High flow oxygen (acute) - Prevention = CCB = verapamil
46
RF drug overuse headache
- Analgesic medication (codeine, opiates) - Triptans
47
ALS S+S (MND)
- UMN signs and LMN wasting - Asymmetric onset - Bab +ve - progressive focal muscle weakness and wasting - Fasciculations - Increased plantar
48
PBL S+S (MND)
- Lower CN nuclei - Elderly women - Dysarthria, dysphagia, nasal regurgitation - Fasciculation - Emotional incontinence - 1st affected = talking, chewing, swallowing
49
PMA S+S
- Pure LMN presentation = weakness, wasting, fasc
50
El Escorial criteria ALS
Definite = lwoer and upper in 3 regions Probable = lowe and upper in 2 - Possible = in 1 region - Suspected = U or LMN signs onlu in 1 or mroe
51
Mx MND
- Antiglutamatergic = riluzole - NG tube - Analgesic ladder
52
Triad in Parkinsons
- Tremor = at rest, may be unilateral - Rigidity = pain, cogwheel, - Bradykineia/hypokinesia = buttons, writing, walking, blank face - Postural instability - typically asymmetrical tremor
53
Patho parkinsons
- Decreased dopamine levels - Mitochondrial dysfunction and oxidative stress on substantia nigra - Progressive degeneration of dopaminergic neurones of substantia nigra - Decreased DA synthesis in the striatum - Decreased thalamus activity - Decreased movement
54
Parkinsons Ix
- DaTSCAN - MRI
55
Parkinsons Mx
1. Levodopa (synthetic dopamine) with PDI like carbidopa and benserazide 2. COMT inhibitors = entacapone to slow breakdown of levodopa 3. dopamine agonists 3. MAOB inhibitors = break down NT = rasagiline, selegiline
56
Levodopa complications
- Invol movements or dyskinesia - Response fluctuations - Psychiatric
57
MS S+S
- Optic neuritis = painful reduction vision - Transverse myelitis - Spasticity - Lhermitte = electric shock - Fatigue - Bladder involvement - UMN signs - Worse with heat
58
MS Ix
- Disseminated in time and sspace - MRI = gold - CSF = oligoclonal bands IgG
59
MS Mx
- RR mild = dimethyl fumarate - RR = monoclonal abs = alemtuzumab - Methylprednisolone for acute relapses - Baclofen and gabapentin for spasticity
60
Pathogens bacterial meningitis in age groups
- Neonates = GBS - Children <2 = SP - Up to 50 = NM and SP - >50 = SP
61
S+S meningitis
- Headache - Fever - Neck stiffness - N+V, photophobia, irritability - Confusion, delirium, sleepy - Maculopapular rash
62
Meningitis Ix
- Bloods - Cultures - CT - LP after CT Bacterial LP - Cloudy and purulent - Increased granulocytes - High lactate and protein - Decreased glucose Viral LP - Clear fluid - Cell count variable with increased lymph - Normal or low lactate - Normal protein and glucose - No organisms
63
Meningitis Mx
- Primary care if NB rash = IM benzylpen 1.2mg - Broad spec Abx, steroids (IV dex), LP - 1st line abx empirical therapy before LP or after CT = cefs - amox >60
64
Encephalitis S+S
- Fever, headache, N+V - Seizures - Altered mental state - Rash
65
Enceph Ix
- Bloods - CSF - CT/MRI - Cultures
66
Enceph Mx
- Aciclovir - IV benzylpen
67
S+S carpal tunnel
- Aching in hand and arm esp. night - Paraesthesia in thumb, index and middle finger - Relived by dangling - Sensory loss and weakness abductor pollis brevis
68
Causes carpal tunnel
- Swelling/compression - Prolonged flexion - Acromegaly - Myeloma - RA - Pregnancy
69
Mx carpal tunnel
- Splinting - Local steriod injection - Decompression surgery
70
Myasthenia gravis definition
- Autoimmune disease medaited by antibodies to Ach receptors
71
MG pathophysiology
- Autoantibodies to ach receptors form - AChR lost on postsynaptic membrane of NMJ - Failure to trigger muscle action potential
72
MG S+S
- Increasing muscle fatigue = top down - Proximal and asymetrical - Ptosis - Diplopia - Snarl - Voice deterioration - Tendon reflexes
73
Myasthenic crisis
- Resp muscle weakness - Monitor forced vital capacity - Plasmanephrines or IVIG
74
MG Ix
- Tensilon test - Anti AChR - Decremental muscle response to repetitive nerve stimulation - CT thymus - Ice improves ptosis by >2mm - Nerve conduction
75
MG Mx
- Anticholinesterase = pyridostigmine - Relapses with prednisolone - Thymectomy
76
Drugs that execerbate MG
- Ciprofloxacin - Azithromycin - Propranolol - Atenolol - Verapamil - Lithium - Statins
77
Cauda equina S+S
- Saddle paraesthesia - Sudden onset - Motor problems - Lower back pain - Bilateral LMN weakness - Absent ankle reflex - Decreased sphincter tone - Perianal, perineal or sensory disturbance - Incontinence - Sexual dysfunction - Bilateral motor and reflex deficits
78
CE Ix
- Spine MRI - Femoral stretch test = L4 - Knee flexion test = L5/S1 - Straight leg raining test = L5/S1 - Plantar flexion test = S1/S2
79
CE Mx
- Epidural steroid - Surical decompression - Immobilise spine - Anti inflams
80
HZV
- Shingles - Reactivation of chickenpox = infects dermatomes
81
S+S HZV
- Localised dermatome pain and paraesthesia - Localised dermatome erythematous maculopapular rash --> clear vesicles --> crust - headache, fever, malaise
82
HZV Ix
- PCR - CSF analysis - Clinical
83
HZV Mx
- Vaccine - Aciclovir <72 hours of rash onset - Analgesia - Topical abx - TCA
84
Alzheimers pathology
- Atrophy of cerebral cortex - formation of amyloid plaques and neurofibrillary tangles (contain tau proteins) - Accumulation of B amyloid peptide
85
S+S Alzheimer's
- Loss of recent memory - Difficulty word finding - Aphasia, apraxia, agnosia - Frontal executive function - Anosognosia = lack insight, stubbornness, denial
86
Alzheimers management
- Acetylcholinesterase inhibitors = donepezil, rivastigmine - Memantine in late stage (antiglutaminergic)
87
Vascular dementia
- Multi infarct dementia - Reduced blood supply to brain - Onset can be within 3 months CVA - Stepwise progression
88
Vascular dementia S+S
- Stepwise in severity of symptoms - Gaint and attention problems - Incontinence - Personality change - Focal neuro signs - MRI = widespread small vessel disease
89
Lewy body dementia
- Parkinsonism - LBD when cognitive Sx predate motor by >1 yr - PDD when motor prior to or within 1yr cognitive issues
90
LBD S+S
- Fluctuating cognition - Recurrent visual hallucinations - REM - 1 or more PD Sx - Can treat with rivastigmine or donepezil
91
Fronto temporal dementia
- Common in younger - Progressive degeneration - Personality change and behaviour disturbance - Progressive impairment of language
92
Vascular dementia Mx
- AChE inhibitors - Memantine
93
Parkinsonian plus syndromes
- Progressive supranuclear palsy = PD and vertical gaze - Multiple system atrophy = PD and PHypo, incontinence and impotence - Cortico basal degeneration = PD and spontaneous activity limb - LBD
94
Brown sequard findigns
- Ipsilateral hemiplegia - Ipsilateral loss of vibration and proprioception - Contralateral loss of pain and temperature
95
Wernicke's aphasia
- superior temporal gyrus - Speech fluent but word salad, neologisms, no sense - Impaired comprehension
96
Broca's aphasia
- Expressive - Inferior frontal gyrus - no fluent speech, laboured and halting but comprehension in tact and content words may be preserved
97
anterior cerebral artery
- contralateral hemiparesis and sensory loss - lowe extremity > upper
98
MCA
- contralateral hemiparesis and sensory loss - upper > lower - Contralateral HH - Aphasia
99
PCA
- Contralateral HH with macular sparing - Visual agnosia
100
Weber's syndrome
- Ipsilateral CN3 palsy - Contralateral wekaness lower and upper extremity
101
PICA
- Ipsilateral facial pain and temp loss - contralateral limb/torso pain and temperature loss - ataxia, nystagmus
102
Basilar
locked in syndrome
103
Lacunar strokes
- isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia - HTN assocaited - basal ganglia, thalamus and internal capsule
104
GCS motor response
6 = obey commands 5 = localises to pain 4 = flexes to pain 3 = Mr carrol says no 2 = extends to pain 1 = none
105
GCS verbal response
5 = orientated time place person 4 = confused 3 = innapropriate words 2 = sounds 1 = none
106
GCS eye response
4 = eye open spont 3 = open to speech 2 = open to pain 1 = none
107
Bell's Palsy
- Acute unilateral facial nerve weakness or paralysis of rapid onset - Herpes simplex, varicella zoster and autoimmunity - unilateral LMN palsy (non forehead sparing) - Droop eyebrow, corner of mouth and loss of nasolabial fold
108
Bell's palsy symptoms
- Rapid onset - Facial muscle weakness - Drooping off eyebrow and corner of the mouth and loss of nasolabial fold - Difficulty chewing, dry mouth and changes in taste - Incomplete eye closure, dry eye or excessive tearing - Numbness of tingling of cheek +/- mouth
109
Bell's palsy management
- Keep eye lubricated with drops and ointment and tape - Prednisolone
110
Ramsay hunt
- VZV - Unilateral lower motor neurone facial nerve palsy - Vesicular rash in ear canal - within 72hrs prednisolone and aciclovir
111
Meniere's
- Hearing loss - Vertigo - Tinnitus - Excessive buildup of endolymph in inner ear - Acute = prochlorperazine and antihistamine - Prophylaxis = betahistine
112
total anterior circulation stroke
- Middle and anterior cerebral arteries - Unilateral weakness (+/- sensory) of face, arm and leg - Homonymous hemianopia - Higher cerebral dysfunction = dysphasia, visuospatial
113
Partial anterior circulation stroke
2 of the following - Unilateral weakness of face, arm, leg - Homonymous hemianopia - Higher cerebral dysfunction (and this alone can be PACS)
114
Posterior circulation syndrome
- Cerebellum and brainstem 1 of following - cranial nerve palsy and a contralateral motor/sensory deficit - bilateral motor/sensory deficit - conjugate eye movement disorder - cerebellar dysfunction - Isolated homonymous hemianopia
115
Lacunar stroke
- No loss of higher cererbal function 1 of - Pure sensory stroke - Pure motor stroke - Sensori-motor stroke - Ataxic hemiparesis
116
Common peroneal nerve palsy
The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula Common = foot drop. Other features include: weakness of foot dorsiflexion weakness of foot eversion weakness of extensor hallucis longus sensory loss over the dorsum of the foot and the lower lateral part of the leg wasting of the anterior tibial and peroneal muscles
117
subacute combined degeneration of the cord
due to vitamin B12 deficiency dorsal columns + lateral corticospinal tracts are affected joint position and vibration sense lost first then distal paraesthesia upper motor neuron signs typically develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks if untreated stiffness and weakness persist
118
Red flag for trigeminal neuralgia
- <40 - Sensory changes - Deafness or ear problems - Skin or oral lesions - Pain in Opthalmic division - Optic neuritis - FHx MS -
119
Cushings triad in ICP
- Bradycardia - Wide pulse pressure - Irregular breathing
120
Effect of IIH on the eyes
down and out = 3rd nerve palsy
121
Pontine haemorrhage
- Secondary to chronic HTN - Quadraplegia - Miosis - Absent horizontal eye movements
122
Bell's palsy vs Ramsey Hunt
BP - Lack of rash - Normal otosopy RH - Vesicular rash around ear - Abnormal otoscopy
123
4th CN palsy
- Defective downward gaze = vertical diplopia
124
5th CN palsy
- Trigeminal neuralgia - Loss corneal reflex - Loss of face sensation - Deviation of jaw to weak side
125
6th nerve palsy
- Horizontal diplopia
126
9th nerve palsy
- loss of gag reflex
127
10th nerve palsy
- uvula away from lesion site - loss gag reflex
128
12th nerve palsy
- tongue deviates to side of lesion
129
trigeminal neuralgia
- 5th CN - paroxysmal attacks of pain = eating - carbamezapine
130
Mx IIH
- weight loss - Diuretics = acetazolamide - topiramate - repeat LPs - Surgery

Phase 3a (23 decks)

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