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Neuro Flashcards

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1
Q

Define transient ischaemic attack

A

Symptoms of a stroke resolving within 24 hours, secondary to ischaemia without infarction

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2
Q

Crescendo TIA

A

2 or more TIAs in one week, high risk for future stroke

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3
Q

Presentation of stroke

A

Sudden onset asymmetrical symptoms
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia
Sudden onset visual/sensory loss

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4
Q

Risk factors for stroke

A

Pre-existing cardiovascular disease
Previous stroke / TIA
Atrial fibrillation
Carotid artery disease
Hypertension
Diabetes
Smoking
Vasculitis
Thrombophilia
COCP

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5
Q

Clinical scoring tool to recognise stroke

A

ROSIER

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6
Q

Management of stroke

A

Immediate CT brain to exclude haemorrhage
Aspirin 300mg STAT (continue for 2 weeks)
Thrombolysis with alteplase if within 4.5hrs
Thrombectomy if within 6 hours
Clopidogrel 75mg after aspirin for life
Admit to stroke centre

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7
Q

Management of TIA

A

Aspirin 300mg
Secondary prevention for CVD
Stroke specialist within 24hrs

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8
Q

Gold standard imaging for stroke

A

Diffusion-weighted MRI

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9
Q

Secondary stroke prevention

A

Clopidogrel 75mg
Atorvastatin 80mg
Carotid endarterectomy or stenting if carotid artery
Treat modifiable risk factors

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10
Q

Major stroke categories

A

Ischaemic stroke
Haemorrhagic stroke

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11
Q

Mechanisms of ischaemic stroke

A

Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis

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12
Q

Which area of the brain is supplied by the anterior cerebral arteries

A

Anteromedial cerebrum

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13
Q

Which area of the brain is supplied by the middle cerebral arteries

A

Lateral cerebrum

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14
Q

Which area of the brain is supplied by the posterior cerebral arteries

A

Medial & lateral areas of the posterior cerebrum

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15
Q

What are the Bamford classification of strokes

A

Total anterior circulation (TACS)
Partial anterior circulation (PACS)
Posterior circulation (POCS)
Lacunar (LACS)

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16
Q

Criteria for TACS

A

Unilateral weakness and/or sensory deficit of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction

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17
Q

Criteria for PACS

A

TWO of:
- Unilateral weakness and/or sensory deficit of face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction

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18
Q

Criteria for LACS

A

ONE of:
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis

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19
Q

Criteria for POCS

A

ONE of:
- Cranial nerve palsy & contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder
- Cerebellar dysfunction
- Isolated homonymous hemianopia

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20
Q

Risk factors for intracranial bleed

A

Head injury
Hypertension
Aneurysm
Ischaemic stroke
Brain tumour
Anticoagulant

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21
Q

Presentation of intracranial bleed

A

Sudden onset headache
Seizures
Weakness
Vomiting
Reduced consciousness

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22
Q

Which vascular structure is involved in subdural haemorrhage

A

Bridging veins

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23
Q

Between which layers does a subdural haemorrhage occur

A

Dura mater & arachnoid mater

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24
Q

Appearance of subdural haemorrhage on CT

A

Crescent/banana

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25
Which vascular structure is involved in extradural haemorrhage
Middle meningeal artery
26
Between which layers does extradural haemorrhage occur
Skull & dura mater
27
Which injury is associated with extradural haemorrhage
Temporal bone fracture
28
Appearance of extradural haemorrhage on CT
Biconvex/lemon
29
Between which layers does a subarachnoid haemorrhage occur
Pia mater & arachnoid membrane
30
Presentation of subarachnoid haemorrhage
Sudden onset occipital headache Strenuous activity Neck stiffness Photophobia Neurological changes
31
Management of intracranial bleed
CT head Check FBC & clotting Discuss with specialist neurosurgical centre Consider escalation to ITU Correct clotting abnormalities Correct severe hypertension
32
Risk factors for subarachnoid haemorrhage
Hypertension Smoking Excessive alcohol consumption Cocaine use Family history Sickle cell anaemia Connective tissue disorders Neurofibromatosis ADPKD
33
CSF findings in subarachnoid haemorrhage
Raised RCC Xanthochromia
34
Pathophysiology of Multiple Sclerosis
Immune cell response causing demyelination of neurons of CNS neurons, reducing nerve impulse transmission
35
Potential causes of Multiple Sclerosis
Multiple genes Epstein-Barr virus Low vitamin D Smoking Obesity
36
Signs & symptoms of multiple sclerosis
Optic neuritis Double vision Conjugate lateral gaze disorder Focal weakness Trigeminal neuralgia Paraesthesia Lhermitte's sign Ataxia Positive Romberg's test
37
Patterns of multiple sclerosis
Relapsing-remitting Primary progressive Secondary progressive
38
What is the most common pattern of multiple sclerosis
Relapsing-remitting
39
What is secondary progressive multiple sclerosis
Started off as relapsing-remitting disease, but now there is progressive worsening of disease with incomplete remissions
40
What is primary progressive multiple sclerosis?
Worsening of disease and symptoms from point of diagnosis, without any initial relapses or remissions
41
Investigations and findings for multiple sclerosis
MRI to visualise lesions Oligoclonal bands in CSF
42
Presentation of optic neuritis
Central scotoma Pain on eye movement Impaired colour vision Relative afferent pupillary defect
43
Management of multiple sclerosis
MDT input Patient education DMARDs Biologics Methylprednisolone for relapses Tolterodine/oxybutynin for incontinence Amitriptyline for neuropathic pain Baclofen for spasticity
44
Types of motor neurone disease
Amyotrophic lateral sclerosis Progressive bulbar palsy Progressive muscular atrophy Primary lateral sclerosis
45
Features of amyotrophic lateral sclerosis
LMN signs in arms UMN signs in legs Family history - Ch21
46
Features of primary lateral sclerosis
UMN signs only
47
Features of progressive muscular atrophy
LMN signs only Distal muscles affected before proximal Carries best prognosis
48
Features of progressive bulbar palsy
Loss of function of brainstem motor nuclei Palsy of tongue and facial muscles Progressive swallowing difficulty Progressive talking difficulty Worst prognosis
49
LMN signs
Muscle wasting Reduced tone Fasciculation Hyporeflexia
50
UMN signs
Hypertonia Spasticity Brisk reflexes Upgoing plantar response
51
Presentation of motor neurone disease
Late middle age (usually) Insidious onset Progressive weakness Increased fatigue when exercises Clumsiness Trips and falls Slurred speech
52
Management of motor neurone disease
Irreversible Riluzole can slow progression & extend survival NIV End of life care planning Advanced directives MDT involvement
53
Pathophysiology of Parkinson's disease
Progressive reduction of dopamine in the basal ganglia due to reduced production by substantia nigra, leading to disorders of movement
54
Classic triad of features on Parkinson's disease
Resting tremor Rigidity Bradykinesia
55
Signs and symptoms of Parkinson's disease
Unilateral 4-6hz pill rolling tremor Cogwheel rigidity Micrographia Shuffling gait Facial masking Difficulty turning Depression Sleep disturbance Anosmia Cognitive impairment
56
Features of Parkinsons tremor
Asymmetrical 4-6 hertz Worse at rest Improves with intentional movement No change with alcohol
57
Feature's of benign essential tremor
Symmetrical 5-8 hertz Improves at rest Worse with intentional movement Improves with alcohol
58
Parkinson's plus syndromes
Multiple system atrophy Dementia with Lewy bodies Progressive supranuclear palsy Corticobasal degeneration
59
Management of Parkinson's disease
Co-careldopa' Entacapone Cabergoline Bromocryptine Selegiline Rasagiline
60
Management of benign essential tremor
Propranolol Primidone
61
Types of seizure
Generalised tonic-clonic seizures Focal seizures Absence seizures Atonic seizures Myoclonic seizures Infantile spasms
62
Features of tonic clonic seizures
Loss of consciousness Muscle tensing Muscle jerking Tongue biting Incontinence Groaning Irregular breathing
63
Management of tonic-clonic seizures
Sodium valproate Lamotrigine/carbamazepine
64
Features of temporal lobe seizures
Automatisms Deja vu Emotional disturbance Auditory/gustatory/olfactory hallucinations
65
Features of frontal lobe seizures
Jacksonian march Localised muscle jerking Dysphasia Todd's palsy
66
Features of parietal lobe seizures
Tingling Numbness Motor symptoms
67
Features of occipital lobe seizures
Spots & lines in visual field
68
Management of focal seizures
Carbamazepine/lamotrigine Sodium valproate/levetiracetam
69
Features of absence seizures
Typically occur in children Blankness Staring into space Very short
70
Management of absence seizures
Sodium valproate/ethosuxamide
71
Features of atonic seizures
"drop attacks" Brief lapses in muscle tone Usually last less than 3 minutes Associated with Lennox-Gastaut syndrome
72
Management of atonic seizures
Sodium valproate Lamotrigine
73
Features of myoclonic seizures
Sudden brief muscle contractions Usually conscious Typical of juvenile myoclonic epilepsy
74
Management of myoclonic seizures
Sodium valproate Lamotrigine/levetiracetam/topiramate
75
Features of infantile spasms (west syndrome)
Clusters of full body spasms 1/3 die by age 25
76
Management of West syndrome
Prednisolone Vigabitran
77
Notable side effects of sodium valproate
Teratogenic Liver damage Hair loss Tremor
78
Notable side effects of Carbamazepine
Agranulocytosis Aplastic anaemia P450 inducer so many drug interactions
79
Notable side effects of Phenytoin
Folate & vitamin D deficiency Megaloblastic anaemia Osteomalacia
80
Notable side effects of ethosuximide
Night terrors Rashes
81
Notable side effects of Lamotrigine
SJS DRESS syndrome Leukopenia
82
Management of status epilepticus
Buccal midazolam / rectal diazepam IV lorazepam 4mg (repeat after 10 minutes) IV phenobarbital
83
Branches of the facial nerve
Temporal Zygomatic Buccal Marginal mandibular Cervical
84
Functions of the facial nerve
Muscles of facial expression, stapedius, posterior digastric, stylohyoid and platysma muscles Carries taste from anterior 2/3 of tongue Parasympathetic supply to submandibular and sublingual salivary glands and lacrimal gland
85
Which motor neurone lesion is forehead sparing
UMN
86
What type of motor neuron is involved in Bell's palsy
LMN
87
Management of Bell's palsy
Prednisolone for 20 days Lubricating eye drops
88
What causes Ramsey-Hunt syndrome
Varicella-zoster virus
89
Features of Ramsey-Hunt syndrome
Unilateral LMN facial palsy Painful & tender vesicular rash affected ear canal, pinna and around the ear
90
Management of Ramsey-Hunt syndrome
Prednisolone Aciclovir Lubricating eye drops
91
Causes of LMN facial nerve palsy
Otitis media HIV Lyme disease Diabetes Multiple Sclerosis Guillain-Barre syndrome Acoustic neuroma Cholesteatoma Nerve trauma Basal skull fracture
92
Causes of raised ICP
Brain tumours Intracranial haemorrhage Idiopathic intracranial hypertension Abscess Infection
93
Red flags for headaches
Constant Nocturnal Worse on waking Worse on coughing, straining or bending forward Vomiting
94
Presenting features of raised ICP
Altered mental state Visual field defects Seizures Unilateral ptosis 3rd & 6th nerve palsies Papilloedema
95
Fundoscopic changes in papilloedema
Blurred optic disc margin Elevated optic disc Loss of venous pulsation Engorged retinal veins Haemorrhages around optic disc Paton's lines
96
Types of brain tumour
Gliomas Meningiomas Pituitary tumour Acoustic neuroma Metastases
97
Which cancers commonly metastasise to the brain
Lung Breast Renal cell carcinoma Melanoma
98
Types of glioma
Astrocytoma Oligodendroglioma Ependymoma
99
Most malignant type of brain tumour
Glioblastoma
100
Benign brain tumour
Meningioma
101
Symptoms of pituitary tumours
Bitemporal hemianopia Acromegaly Hyperprolactinaemia Cushing's disease Thyrotoxicosis
102
Symptoms of acoustic neuroma
Hearing loss Tinnitus Balance problems Facial nerve palsy
103
What disorder is associated with bilateral acoustic neuromas
Neurofibromatosis type 2
104
Treatment of pituitary tumours
Trans-sphenoidal surgery Radiotherapy Bromocriptine Ocreotide
105
Inheritance pattern of Huntington's chorea
Autosomal dominant
106
Type of mutation causing Huntington's chorea
Trinucleotide repeat on Ch4
107
Typical age of onset for Huntington's chorea
30-50 yrs
108
Presentation of Huntington's chorea
Chorea Eye movement disorders Speech difficulties Swallowing difficulties
109
Management of Huntington's chorea
No treatment to slow/stop disease MDT involvement SALT Genetic counselling Advanced directives End of life care planning
110
Which type of tumour has a strong link with Myasthenia Gravis
Thymoma
111
Pathophysiology of Myasthenia Gravis
Acetylcholine receptor antibodies are produced which bind to postsynaptic neuromuscular junction receptors, blocking ACh from stimulating these receptors to trigger muscular contraction. Less ACh transmission gives less muscle contraction
112
Presentation of Myasthenia Gravis
Proximal muscles & small muscles of head and neck most affected Diplopia Ptosis Weakness in facial movement Swallowing difficulty Jaw fatigue when chewing Slurred speech Progressive weakness with repetitive movements
113
Management of Myasthenia Gravis
Pyridostigmine/neostigmine Prednisolone Thymectomy if thymoma Rituximab
114
Important bedside test in Myasthenia Gravis
Spirometry for FVC
115
Management of Myasthenic crisis
IV immunoglobulins Plasma exchange
116
Which type of cancer is associated with Lambert-Eaton myasthenic syndrome
Small cell lung cancer
117
Presentation of Lambert-Eaton Myasthenic Syndrome
Insidious onset Proximal leg muscle weakness Diplopia Ptosis Dysphagia Reduced tendon reflexes
118
Management of lambert-eaton myasthenic syndrome
Investigate for small cell lung cancer Amifampridine Prednisolone IV immunoglobulins Plasmapheresis
119
Inheritance pattern of Charcot-Marie-Tooth
Autosomal dominant
120
Usual age of onset of Charcot-marie-tooth
Before age 10
121
Classical features of Charcot-Marie-Tooth
High foot arches Distal muscle wasting Weakness of lower legs Loss of ankle dorsiflexion Weakness in hands Reduced tendon reflexes Reduced muscle tone Peripheral sensory loss
122
Management of Charcot-Marie-Tooth
MDT involvement Physiotherapy Orthopaedic surgeons for joint deformity Occupational therapy
123
What infections are particularly associated with Guillian Barre Syndrome
Campylobacter jejuni Cytomegalovirus Epstein-Barr virus
124
Presentation of Guillain-Barre Syndrome
Symmetrical ascending weakness Reduced reflexes Peripheral loss of sensation Neuropathic pain History of preceding infection
125
Diagnostic investigations for suspected Guillian-Barre Syndrome
Nerve conduction studies CSF - raised protein
126
Management of Guillian-Barre Syndrome
IV immunoglobulins Plasma exchange Supportive care VTE prophylaxis
127
Prognosis of Guillian-Barre Syndrome
80% full recovery 15% with some persisting disability
128
Inheritance pattern of Neurofibromatosis Type 1
Autosomal dominant
129
Criteria for Neurofibromatosis Type 1
2 of: - Cafe-au-lait spots - Relative with NF1 - Axillary/inguinal freckles - Bony dysplasia - Iris hamartomas - Neurofibromas - Glioma of optic nerve
130
Complications of neurofibromatosis type 1
Migraines Epilepsy Renal artery stenosis Hypertension Learning difficulties Scoliosis Vision loss Gastrointestinal stromal tumour Brain tumours Leukaemia
131
Inheritance pattern of neurofibromatosis type 2
Autosomal dominant
132
Which tumour types are most associated with neurofibromatosis type 2
Acoustic neuromas
133
Most common type of neurofibromatosis
Type 1
134
Characteristic feature of Tuberous Sclerosis
Hamartomas
135
Which genes can be mutated in Tuberous Sclerosis
TSC1 on Ch9 TSC2 on Ch16
136
Skin signs in Tuberous Sclerosis
Ash leaf spots Shagreen patches Angiofibromas Subungal fibromatoma Cafe-au-lait spots Poliosis
137
Non-skin features in Tuberous Sclerosis
Epilepsy Developmental delay Rhabdomyomas Gliomas Polycystic kidneys Retinal hamartomas
138
Management of Tuberous Sclerosis
Supportive care Monitor for & treat complications
139
Differentials for headache presentation
Tension headache Migraine Cluster headache Sinusitis Giant cell arteritis Glaucoma Intracranial haemorrhage Analgesic headache Raised ICP Meningitis Encephalitis Cervical spondylosis
140
Headache red flags
Photophobia Neck stiffness New neurological symptoms Visual disturbance Worse on coughing or straining Pain disturbs sleep Vomiting History of trauma Pregnancy Sudden onset occipital headache
141
Causes of tension headache
Stress Depression Alcohol Skipping meals Dehydration
142
Migraine features
Moderate-severe intensity Pounding/throbbing nature Unilateral Photophobia Phonophobia Aura Nausea & vomiting
143
Features of hemiplegic migraine
Typical migraine symptoms Hemiplegia Ataxia Change in consciousness
144
Common migraine triggers
Stress Bright lights Strong smells Caffeine Chocolate Dehydration Menstruation Abnormal sleep patterns
145
Actions of triptans in migraine
Serotonin receptor agonists Vasoconstriction Inhibit activation of pain receptors Reduce CNS neuronal activity
146
Migraine prophylaxis
Propranolol Topiramate Amitriptyline
147
Symptoms of cluster headache
Red, swollen, watery eye Pupil constriction Ptosis Nasal discharge Facial sweating
148
Acute management of cluster headache
Triptans High flow 100% oxygen
149
Cluster headache prophylaxis
Verapamil Lithium Prednisolone

Special Senses (1 decks)

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