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Neuro Flashcards

1
Q

Presentation of absence seizures

A

girls 3-10
provoked by stress or hyperventilation
pt unaware
EEG: bilateral sym 3Hz spike and wave pattern

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2
Q

Management and prognosis of absence seizures

A

valproate and ethosuximide
90-95% seizure free at adolescence

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3
Q

Classification of epilespy

A

generalised: motor or non motor
Focal: aware/impaired awareness/awareness unknown: motor/non motor/ other feature

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4
Q

Features of focal temporal seizure

A

aura: rising epigastric sensation, psychic, hallucinations
automatisms: lip smacking

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5
Q

features of frontal focal seizure

A

head/leg movements
posturing
post-ictal weakness

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6
Q

features of parietal focal seizure

A

paraesthesia

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7
Q

features of occipital focal seizure

A

floaters/flashes

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8
Q

When do you start management of seizures

A

after 2nd seizure unless
- neurological deficit
- structural abnormality on imaging
- epileptic activity on EEG
- risk of further seizure unacceptable

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9
Q

Management of tonic clonic seizure

A

m: valproate
f: lamotrigine or keppra

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10
Q

management of tonic or atonic seizure

A

m: valproate
f: lamotrigine

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11
Q

management of myoclonic seizure

A

m: valproate
f: keppra

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12
Q

management of focal seizure

A

1st: lamotrigine or keppra
2nd: carbamazepine

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13
Q

Which anti-epileptics can be used in pregnancy

A

carbazmazepine, lamotrigine

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14
Q

which anit-epileptics should be avoided in pregnancy

A

valproate: neural tube defects and neurodevelopment delay

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15
Q

What are the driving rules for epilepsy

A

inform DVLA
after 1st seizure - no driving 6 months
established - can drive if 1 year seizure free
withdrawing meds - no driving until 6 months after last dose

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16
Q

How does sodium valproate work

A

increase GABA activity

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17
Q

Valproate SE

A

p450 inhib
nausea, increased appetite, weight gain
ataxia, tremor
hepatotoxic, pancreatitis
thrombocytopenia, low Na

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18
Q

What causes Bells Palsy

A

unknown but associated with HSV, EBV

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19
Q

How does Bells Palsy present

A

Unilateral lower motor neuron facial nerve palsy - forehead affected
pregnant women 20-40
dry eyes

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20
Q

Management Bells Palsy

A

PO pred within 72h
Debate on anitvirals
artifical tears
tape eye if unable to close
ENT Referral at 3 weeks

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21
Q

Bells Palsy prognosis

A

most fully recover by 3/4 months

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22
Q

What is BPPV

A

vertigo triggered by change in head position can be associated with nausea

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23
Q

How is BPPV diagnosied

A

Dix-Hallpike manoeuvre

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24
Q

Management of BPPV

A

spontaneous recovery weeks-months
Epley helps with symptoms
betahistine limited valve

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25
Causes of brain abscess
sepsis, trauma, embolic event
26
Symptoms of brain abscess
headache, fever, focal neurology, nausea, seizures
27
Investigation and management of brain abscess
CT head Surgery, Abx and dex
28
What is Brown-Sequard syndrome
Lateral hemi-section of spinal cord
29
Features of Brown Sequard syndrome
ipsilateral weakness below lesion ipsilateral loss of proprioception and vibration sensation contralateral loss of pain and temperature sensation
30
Symptoms of cerebellar disease
Dysdiadochokinesia Ataxia Nystagmus Intention tremer Slurred speech Hypotonia
31
What is GBS
immune mediated demyelination of peripheral nerve system triggered by infection
32
Infection associated with GBS
Campylobacter jejuni
33
Presentation of GBS
leg/back pain ascending sym limb weakness reduced/absent reflexes resp muscle weakness
34
Investigation of ?GBS
LP (increased protein, normal WCC) nerve conduction studies -decreased motor nerve conduction -increased distal motor latency -increased F wave latency
35
Management of GBS
IVIG plasma exchange (more difficult and equally as effective) FVC - monitor resp function
36
Poor prognostic factors of GBS
age > 40 years poor upper extremity muscle strength previous history of a diarrhoeal illness (specifically Campylobacter jejuni) high anti-GM1 antibody titre need for ventilatory support
37
Following head injury when does CTH need to be performed in 1 hr
GCS <13 initially GCS <15 after 2 hrs Suspected skull # or basal skull # Seizure Focal neuro deficit >1 episode of vomiting
38
Following a head injury when does a CTH need to be performed in 8 hrs
loss of cons/amnesia + >65 Hx bleeding/clotting disorder dangerous mechanism >30mins retrograde amnesia
39
What causes herpes simplex encephalitis and where does it affect
HSV1 temporal and inferior frontal lobes
40
how does HS encephalitis present
fever, headache, seizure, vomiting, psych focal - aphasia
41
Investigations of herpes simplex encephalitis
CSF: high WCC high protein PCR for HSV CT: petechial haemorrhages temporal/frontal MRI EEG: lateral periodic discharges 2Hz
42
Management and prognosis of herpes simplex encephalitis
IV Aciclovir 10-20% mortality if started early compared to 80% if untreated
43
What kind of disease is Huntingtons?
autosomal dominant
44
Genetics of Huntingtons
Chromosome 4, triplet repeat CAG -> glutamine normal is 10-35 Huntingtons >35
45
Pathophysiology of Huntingtons
degeneration of cholingeric and GABA neurones in striatum of basal ganglia
46
Presentation of Huntingtons
35-40 yo chorea abnormal eye movements dementia, personality change
47
Management of Huntingtons
No treatment to alter prognosis Tetrabenazine for chorea
48
Huntingtons prognosis
death 20 years after the initial symptoms develop
49
What is Lambert Eaton syndrome
antibody directed against presynaptic voltage gated calcium channel in peripheral nervous system
50
What causes Lambert Eaton syndrome
SCLC (ovarian and breast) autoimmune
51
How does Lambert Eaton syndrome present
Muscle weakness that improves with use prox muscles of lower limbs first hypo reflexes autonomic: dry mouth, impotence
52
Lambert Eaton investigation
EMG: incremental response to repetitive electrical stimulation
53
Management of Lambert Eaton syndrome
Treat any underlying cancer Immunosuppression - pred IVIG
54
What is myasthenia gravis
autoimmune insufficient functioning of acetylcholine receptors
54
How does myasthenia gravis present
women<40 or men >60 muscle fatiguability - worse at end of day prox muscle weakness diplopia, ptosis, dysphagia
55
what is myasthenia gravis associated with
thymoma
56
Myasthenia Gravis examination findings
fatiguing when - upward gazing - blinking - repeated abduction
57
Investigations for myasthenia gravis
EMG antibodies - Ach receptor antibodies (85%) CT thymus
58
Management of myasthenia gravis
pyridostigmine immunosuppression thymectomy
59
What is a myasthenia crisis
acute worsening of symptoms, triggered by infection, risk of resp failure requiring NIV/intubation and ventilation Mx: IVIG
60
What is Menieres disease
excessive pressure and progressive dilation of endolymphatic system - unknown cause
61
How does Menieres present
*vertigo* tinnitus, hearing loss aural fullness/pressure lasts mins-hours unilateral->bilateral
62
How do you manage Menieres
ENT referral inform DVLA - no driving until symptoms controlled Acute: prochlorperazine (buc or PO) prevent: betahistine, vestibular rehab
63
Menieres prognosis
most resolve within 5-10 years, likely will be left with some hearing loss
64
Types of MND
1) Amylotrophic lateral sclerosis 2) Primary lateral sclerosis 3) Progressive muscular atrophy 4) Progressive bulbar palsy
65
Hows does ALS present
LMN signs in arms - drop things, stiffness, wasting UMN signs in legs - foot drop, difficultly climbing stairs
66
How does Primary lateral sclerosis present
UMN only, leg weakness
67
How does progressive muscular atrophy present
LMN only distal ->proximal, small muscles of hands/feet
68
How does progressive bulbar palsy present
palsy of tongue, muscles of chewing/swallowing
69
Which types of MND carry the best and worse prognosis What is the general prognosis
Best: progressive muscular atrophy Worst: progressive bulbar palsy General: 50% died within 3 years
70
Investigations for MND
clinical diagnosis NCS: normal EMG: reduced action potential with increased amplitude MRI: exclude cervical cord compression
71
Management of MND
Riluzole - increases life by 3 months BiPAP at night - increases life by 8 months PEG
72
What is MS
chronic cell mediated autoimmune disorder characterised by CNS demyelination
73
Types of MS
1) Relapsing remitting: most common 2) Secondary progressive: RR with symptoms between, 65% with RR develop this within 15 years 3) Primary progressive: deterioration from onset
74
Presentation of MS
*optic neuritis* optic atrophy worsening vision following rise in body temp pins/needles/numbness spastic weakness ataxia urinary incontinence
74
Investigations of MS
MRI: T2 lesions, periventricular plaques, Dawson fingers (white matter perpendicular to corpus callosum) CSF: oligoclonal bands
74
Management of MS relapses
Acute relapse: 5/7 Methypred Reduce risk of relapse: natalizumab, ocrelizumab
75
Management of fatigue in MS
amantadine
76
Management of spasticity in MS
baclofen, gabapentin
77
Good prognostic features of MS
*common presentation female 20-30 onset relapsing remitting long intervals and complete recovery between relapses
78
Symptoms of normal pressure hydrocephalus
1) urinary incontinence 2) dementia 3) gait abnormalilty
79
Imaging findings of normal pressure hydrocephalus
hydrocephalus with ventriculomegaly
80
Management of normal pressure hydrocephalus
ventriculoperitoneal shunt
81
What is Parkinsons
progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in substantia nigra
82
Presentation of Parkinsons
men,65 asym 1) bradykinesia: shuffling gait, reduced arm swelling 2) tremor: resting, pill rolling 3) rigidity: lead pipe, cog wheel
83
Additional Parkinsons symptoms (Not classic trio)
reduced facial expressions depression micrographia drooling
84
Management of Parkinsons
Do motor symptoms affect quality of life yes: levodopa no: dopamine agonist, levodopa, MAO-B inhib
85
SE of levodopa
dry mouth, anorexia, palpitations, dyskinesias
86
Examples of dopmaine receptor agonists + monitoring required
bromocriptine, ropinirole ECHO, CXR, Cr, ESR
87
Causes of SAH
berry aneurysm AVM
88
Presentation SAH
thunderclap headache N&V meningism
89
Investigtion of SAH
CT head: SAH Normal CT: <6hrs - no LP >6hrs: LP after 12hrs - Xanthochromia Cta for cause
90
Management of SAH
Supportive Nimodipine prevents vasospasm coil
91
Types of SDH and causes
Acute: trauma Chronic: rupture of bridging veins (alcoholic /elderly)
92
CT findings in SDH
crescent shape acute: hyperdense chronic: hypodense
93
Management of SDH
acute: monitor, decompressive craniectomy Chronic: conservative if incidental, decompression if symptomatic
94
describe presentation of cluster headache
unilateral sharp pain around eye lasts 15m-2hr lid swelling, redness, restlessness
95
Management of cluster headache
acute: 100% o2, SC triptans prophylaxis: verapamil ?pred
96
Describe medication overuse headache
>=15days/month
97
Which medications can cause medication overuse headache
opioids, triptans
98
management of medication overuse headache
stop triptans/simple analgesia slow wean of opioids
99
What symptoms might a pt experience when analgesia is stopped due to medication overuse headache
vomiting, hypotension, increased HR, restlessness
100
Migraine triggers
tired, stressed, alcohol, COCP, menstruation
101
migraine diagnostic criteria
5 attacks -4-72hrs -N&V and/or photophobia and phonophobia -at least 2 of: unilateral,pulsatile, mod/severe, affects routine - no other cause
102
Management of migraine
acute: PO triptans and NSAID/PCM *nasal in kids prophylaxis: propranolol, topiramate, amitriptyline acupuncture
103
How to manage migraines in pregnancy
PCM NSAIDS in 1st and 2nd trimester
104
Cause of Wernickes
Thiamine def - alcoholics
105
Presentation of Wernickes
1) opthalmoplegia 2) ataxia 3) encephalopathy
106
Investigations of Wernickes
Decreased red cell transketolase MRI: petechial haemorrhages
107
Management of Wernickes
Thiamine
108
Complications of untreated Wernickes
Korsakoffs

MRCP (19 decks)

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