Neuro Flashcards
(111 cards)
1
Q
What microorganism most commonly causes Guillain-Barre?
A
Campylobacter jejuni
2
Q
What is leading cause of death Guillain-Barre?
A
VTE (so need prophylaxis)
3
Q
What is Charcot’s triad?(neuro)
A
Nystagmus, intention tremor and dysarthria (linked to MS)
4
Q
What is Mc Donald criteria?
A
Two or more lesion demspeminated in time & space (MS)
5
Q
What is first line in MND to slow progression?
A
Rituzole
6
Q
What is the first line treatment for Trigeminal Neuralgia?
A
Carbamazepine
7
Q
What is the acute management of cluster headaches?
A
Sumatriptan and high flow 100% O2
8
Q
What is the prophylaxis for cluster headaches?
A
Verapamil (Ca channel blocker)
9
Q
How will third nerve palsy present?
A
Ptosis, “down & out” pupil, dilated pupil with absent light reflex but intact consensual constriction
10
Q
What is the secondary prevention after someone has had a stroke?
A
2-week high dose aspirin (300mg) then clopidogrel (75mg)
11
Q
What is the second line of secondary prevention after someone has had a stroke?
A
Aspirin + modified release dipyramidole
12
Q
What are the possible causes of cerebellar disease?
A
PASTRIES - posterior fossa tumour, alcohol, MS, trauma, rarer causes, inherited, epilepsy treatment and stroke
13
Q
What tremor is seen in Parkinson’s?
A
Unilateral tremor that improves with voluntary movement
14
Q
How do you manage IIH?
A
Prescribe acetazolamide and advise weight loss
15
Q
What is the prophylactic treatment for migraines?
A
Propanolol (not in asthmatics) or Topiramate (not in women of childbearing age)
16
Q
What causes an intention tremor?
A
Cerebellar dysfunction - MS or alcohol or stroke
17
Q
What is the triad for normal pressure hydrocephalus?
A
Gait apraxia, incontinence and dementia
18
Q
What is the triad of Horner’s syndrome?
A
Miosis, Ptosis and Anhydrosis
19
Q
What are the causes of Horner’s syndrome?
A
Damage to sympathetic innervation eye - stroke or tumour eg pancoast
20
Q
What is the first line treatment for focal seizures?
A
Lamotrigine or levetiracetam
21
Q
What is the first line treatment for generalised seizures?
A
Lamotrigine (or sodium valproate but not in women)
22
Q
What is the first line treatment for absence seizures?
A
Ethosuximide (or sodium valproate but not in women)
23
Q
What blood test differentiates seizure from pseudo-seizures?
A
Prolactin is raised in true seizures
24
Q
What is the first-line treatment for spasticity in MS?
A
Baclofen and gabapentin
25
What is the classic presentation of pituitary apoplexy?
Sudden onset headache, visual field defects and evidence of pituitary insufficiency (hypotension)
26
How does a PCA stroke present?
Contralateral homonymous hemianopia with macular sparing and visual agnosia, Oculomotor palsy & contralateral weakness of upper & lower limbs
27
How do subdural and epidural haemorrhages appear on CT?
Epidural - egg or concave
Subdural - sickle or crescent
28
What causes a subdural haemorrhage?
Damage to bridging veins between cortex & venous sinuses
29
What nerve root innervates the ankle reflex?
S1-S2
30
What nerve root innervates the knee reflex?
L3-L4
31
What nerve root innervates the biceps reflex?
C5-C6
32
What nerve root innervates the triceps reflex?
C7-C8
33
What are the key features of Wernicke's encephalopathy?
Nystagmus, ophthalmoplegia, ataxia, confusion, peripheral sensory neuropathy
34
What are the key features of Korsakoff syndrome?
Confabulation antro/retrograde amnesia
35
What causes Ramsay-Hunt syndrome?
Herpes zoster virus
36
What is the treatment for Ramsay-Hunt syndrome?
Aciclovir & prednisolone
37
What are the features of Ramsay-Hunt syndrome?
Facial nerve palsy, auricular pain, vesicular rash around ear, tinnitus and vertigo
38
What causes Charcot Marie Tooth syndrome?
(Most common) Inherited peripheral neuropathy
39
What are the features of Charcot Marie Tooth syndrome?
Foot drop, hammer toes, stork leg deformity, high arch feet, distal muscle weakness & atrophy, repeated ankle sprains
40
What are the features of Shy-Drager (type of multiple system atrophy)?
Parkinsonism, autonomic disturbance (eg hypotension, erectile dysfunction) and cerebellar signs
41
What are the features of Bengin paroxysmal positional vertigo?
Vertigo by head movement, nausea, lasts 10-20 seconds
42
How do you test for Bengin paroxysmal positional vertigo?
Hallpike maneuver - patient experiences vertigo and/or rotatory nystagmus
43
How do you treat Bengin paroxysmal positional vertigo?
Epley manoeuvre
44
How do you treat normal pressure hydrocephalus?
Ventriculoperitoneal shunt
45
What are the features of Bell's palsy?
Facial nerve palsy with forehead involvement, post auricular pain, hyperacusis, dry eyes, altered taste
46
How do you treat the symptoms of Myasthenia Gravis?
Pyridostigmine (acetylcholinesterase inhibitor)
47
What is used to investigate narcolepsy?
Multiple sleep latency EEG
48
How does CN VI palsy present?
Defective eye abduction & horizontal diplopia
49
How does a posterior inferior cerebellar stroke present?
Lateral medullary syndrome:
Ipsilateral dysphagia, ataxia, nystagmus, cranial nerve palsies
contralateral limb sensory loss
50
When is a Carotid endarterectomy considered?
Patient with TIA with > 70% occlusion
51
What are the causes of Lambert-Eaton syndrome?
Autonomic dysorder or paraneoplastic syndrome (small cell lung cancer)
52
What are the features of Lambert-Eaton syndrome?
Proximal muscle weakness (lower limb first), improves with repeated movement (post excersise faciliation), hyporeflexia, ptosis, opthalmoplegia, autonomic dysfunction
53
What are the features of a common peroneal nerve injury and how is it usually injured?
Fibula neck injury. Foot drop, weak dorsiflexion and eversion.
54
What are the features of Amyotrophic lateral sclerosis?
Typically LMN signs in arms and UMN signs in legs
55
What are the features of Primary lateral sclerosis?
UMN signs only
56
What are the features of Progressive muscular atrophy?
LMN signs only & affects distal muscles before proximal
57
What are the features of Progressive bulbar palsy?
Palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
58
What is the best way to provide nutrition in MND?
Percutaneous gastrostomy tube (PEG)
59
What are the features of a Axillary nerve injury and how is it usually injured?
Surgical neck fracture. Unable to abduct the arm & loss sensation in armband region.
60
What are the features of a Radial nerve injury and how is it usually injured?
Saturday night or crutch palsy or midshaft humeral fracture. Wrist drop & unable to extend fingers
61
What are the features of a Ulnar nerve injury and how is it usually injured?
Outstretch fall or medial epicondyle fracture. Claw hand, unable to adduct fingers, sensory loss medial 1½ fingers & hypothenar wasting.
62
What are the features of a Median nerve injury and how is it usually injured?
Carpal tunnel or fracture at elbow. Ape hand (thenar wasting/paralysis) and sensory loss to palmar aspect of lateral 2 ½ fingers.
63
How do you treat Horner's syndrome?
Prednisolone within 72 hours of onset & eye care
64
What are the features of Wernicke's dysphasia?
Is receptive aphasia: Speech fluent, comprehension abnormal, repetition impaired, sentences that make no sense, word substitution and neologisms (word salad)
65
What are the features of Broca's dysphasia?
Is expressive aphasia: Speech non-fluent, halting, laboured, repetition is impaired, comprehension is normal
66
What area of the brain is affected in Wernicke's dysphasia?
Superior temporal gyrus supplied by inferior brnach MCA
67
What area of the brain is affected in Wernicke's dysphasia?
Inferior frontal gyrus supplied by superior branch MCA
68
When should you intubate a patient?
GCS <8
69
How do you treat Wernicke-Korskoff syndrome?
IV thiamine then glucose (don't give glucose first)
70
Why can't you give glucose first in Wernicke-Korskoff syndrome?
Glucose → pyruvate but cannot be converted into energy because no B1 so is converted to lactic acid causing metabolic acidosis
71
What are the features of Multiple system atrophy?
Autonomic failure involving urinary incontinence, erectile dysfunction in males or orthostatic hypotension
AND Parkinsonism that is poorly responsive to levodopa
OR a cerebellar syndrome
72
What are the features of progressive supranuclear palsy?
Impairment of vertical gaze, falls/postural instability, parkinsonism, slurring speech, cognitive impairment and poor response to levadopa
73
What are the features of Charcot-Marie-Tooth syndrome?
A hereditary condition. Patients can present with lower motor neurone signs in all limbs and reduced sensation (more pronounced distally). UMN signs are not present in these patients.
74
How does Syringomyelia classically present?
Cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract
75
What are the features of Lambert-Eaton syndrome?
Autonomic symptoms, limb-girdle weakness (manifesting as a waddling gait), and hyporeflexia
76
Which drugs are associated with Steven-Johnson syndrome?
Carbamazepine, lamotrigine, allopurinol, sulfonamide, phenobarbital, phenytoin
77
What are the signs of Cushing's reflex?
Hypertension, bradycardia, wide pulse pressure and irregular resp rate
78
What are the signs of Cushing's reflex?
Hypertension, bradycardia, wide pulse pressure and irregular resp rate
79
What are the features of an acoustic neuroma?
Unilateral sensorineural hearing loss, unilateral tinnitus, dizziness, fullness in the ear, facial palsy or abscent corneal reflex
80
How long until someone can drive after a first unprovoked or isolated seizure if brain imaging and EEG are normal?
6 months
81
What conditions are associated with MND?
Frontotemporal dementia
82
What are the features of Creutzfeldt-Jakob's disease?
Rapid onset dementia and myoclonus
83
What are the features of a posterior communicating artery aneurysm?
Painful CN III palsy (pain on eye movements, dilated down and out pupil and ptosis)
84
What is used to treat cerebral oedema in patients with brain tumours?
Dexamethasone
85
How do you treat encephalitis?
IV Acyclovir
86
How do you treat suspected meningitis?
IV ceftriaxone
87
Which of the following muscles are typically spared in MND?
Ocular muscles
88
What area of the brain is affected in Wernicke's dysphasia?
Superior temporal gyrus supplied by MCA
89
What is Amaurosis fugax?
A form of stroke that affects the retinal/ophthalmic artery
90
Which Parkinson's medication is associated with disinhibition?
Dopamine receptor agonists
91
What is the first-line drug for myasthenia gravis?
Pyridostigmine
92
What imaging should be used in suspected TIA's?
MRI brain with diffusion-weighted imaging
93
What imaging is used for suspected venous sinus thrombosis?
MR Venogram
94
Which imaging is best for acoustic neuromas?
MRI of the cerebellopontine angle
95
How does a total anterior stroke differ from a partial anterior stroke circulation?
1. unilateral hemiparesis or hemisensory loss of face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
All 3 = total anterior circulation
2 = partial anterior circulation
96
How does a Lacunar infarct present?
Presents with 1 of the following:
1. unilateral weakness (or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
97
What are the common causes of a myasthenic crisis?
Beta blockers, lithium, antibiotics, phenytoin, penicillamine
98
How might a haemorrhagic stroke appear on CT?
Hyperdense region
99
What is the treatment for myoclonic seizures?
Levetiracetam or sodium valproate (in men)
100
How may a pontine stroke present?
Reduced Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements.
101
Which cranial nerves are most commonly affected by a vestibular schwannoma?
cranial nerves V, VII, VIII
102
What are the requirements to diagnose a lacunar infarct by the Bamford classification?
One of the following:
Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis
103
What are the requirements to diagnose a posterior circulation infarct by the Bamford classification?
One of the following:
Cranial nerve palsy & a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia
104
What is the C5 myotome?
Elbow flexors and the biceps reflex
105
What is the C6 myotome?
wrist extension and the brachioradialis reflex
106
What is the C7 myotome?
elbow extension and the triceps reflex
107
What is the C8 myotome?
finger flexion and the finger jerk reflex
108
What is the T1 myotome?
finger abduction
109
How do you treat a brain abscess?
IV ceftriaxone + metronidazole
110
What drugs should be prescribed for Parkinson's if it affects their quality of life?
Levadopa
111
What drugs should be prescribed for Parkinson's if it is not affecting their quality of life or is in the early stages?
Dopamine agonists - Bromocriptine
Levodopa
Monoamine oxidase B (MAO‑B) inhibitors - rasagiline, selegiline
