Neuro Flashcards
1
Q
What is the classic histology of a medulloblastoma
A
Small, blue cells with rosette patterns
2
Q
Which CN does not carry any parasymp fibres?
A
2
3
Q
Which allelle has increased risk of developing alzheimers
A
E4
4
Q
What characterises syncope from seizures
A
Short post-ictal period- quick recovery
5
Q
Vision worse going down the stairs
A
4th nerve palsy- limited depression, adduction of eye and persistent dipolopia
6
Q
What signs would you see on examination of a Lower Motor Neurone lesion
A
Hypotonia and hyporeflexia
Because these are anterior horn cells so abolishes voluntary and reflex responses of the muscle
7
Q
What is associated with early onset alzheimers?
A
Amyloid precursor protein
8
Q
Which cells are destroyed in MS
A
Oligodendrocytes- responsible for the myelin production in the CNS
9
Q
What is Broca’s dysphasia and what part of the brain does it affect?
A
Speech is non-fluent, comprehension normal, repetition impaired- affects the inferior frontal gyrus
10
Q
What is Wernicke’s dysphasia and what part of the brain does it affect?
A
Inability to grasp the meaning of spoken words and sentences is impaired.
Speak normal words fluently but doesn’t make sense with a jumble of words. Affects the superior temporal gyrus
11
Q
What brain lobe would be affected in touch perception/asterognosis
A
Parietal
12
Q
Which nerve damage causes weakness of foot dorsiflexion
A
Common peroneal
13
Q
What lobe of the brain is affected in touch perception
A
Parietal
14
Q
What would occlusion of the anterior cerebral artery cause?
A
Contralateral hemiparesis and sensory loss with the lower extremity being more affected than the upper -> supplies the medial side of the cerebral hemisphere
15
Q
What would occlusion of the posterior cerebral artery cause?
A
Contralateral hemianopia with macular sparing -> supply of blood to occipital lobe is blocked so visual processing is lost
16
Q
What would occlusion of the middle cerebral artery cause
A
Supplies the motor and sensory cortices more likely to affect upper limbs than lower.
Unilateral droop of the face.
Language centres affected if stroke on dominant side
17
Q
What is Weber’s syndrome?
A
When branches of the posterior cerebral artery are occluded -> ipsilateral CN 3 palsy, contralateral weakness of upper and lower extremity
18
Q
Locked in syndrome is damage of which artery?
A
Basilar
19
Q
What lobes does the tentorium cerebelli seperate
A
Occipital lobe
20
Q
What lobe lesion may cause acalculia?
A
Parietal lesion
21
Q
Unilateral cerebellar lesions cause problems on which side of the body
A
Ipsilateral
22
Q
What are the afferent and efferent limbs of the corneal reflex
A
Afferent- opthalmic
Efferent- facial
23
Q
What part of the dura mater seperates the cerebral hemispheres?
A
The falx cerebri
24
Q
Which CN is affected in nystagmus?
A
CN VIII (vestibulocochlear)
25
What are astrocytes involved in?
Physical repair, form the blood-brain barrier, remove excess potassium ions, provide physical support
26
Infarcts in which lobes cause superior and inferior quadrantanopia?
PITS- parietal inferior, temporal superior (on contralateral side
27
Hallucinations occur in seizures of which lobe?
Temporal
28
Damage to what part of the thalamus causes hearing impairment?
Medial geniculate nucleus
29
What is myasthenia gravis?
Fatiguable, painless, muscle weakness that improves with rest
30
Degeneration of which neurotransmitters cause Huntingdon's disease?
ACh and GABA
31
In a hypoglossal nerve lesion the tongue will deviate to which side?
The affected side
32
What can lacunar strokes cause?
Isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong association with hypertension
33
In vagus nerve lesions which side will the uvula deviate too?
Contralateral side of lesion
34
Describe lateral medullary syndrome/Wallenbergs
Following the occlusion of the posterior inferior cerebellar artery.
Cerebellar features: ataxia, nystagmus
Brainstem features: ipsilateral- dysphagia, facial numbness, cranial nerve palsy
Contralateral: limb sensory loss
DANVAH mnemonic- dysphagia, ipsilateral Ataxia, ipsilateral nystagmus, Vertigo, Anaesthesia, ipsilateral Horner's syndrome
35
What is the pathophysiology behind myasthenia gravis
Autoimmune condition of the neuromuscular junction where antibodies are made against Ach receptors.
75% of patients have a thymoma
36
What is the tx for myasthenia gravis?
Acute: pyridostigmine, IV immunoglobulin or thymectomy
Long term: steroids eg pred+ azathioprine
37
What is the ix for myasthenia gravis?
Bloods- Ach receptors antibodies
CT chest for thymoma
EMG: single fibre
38
What tract processes crude touch? Where do they cross the spinal cord?
The anterior spinothalamic tract- cross at the spinal segment they enter
39
What tract carries fine touch, proprioception and vibration
Dorsal collumns
40
What tracts is responsible for pain and temp sensation?
Lateral Spinothalamic tract
41
Most common cause of meningitis in adults?
Strep Pneumoniae
42
What nerve promotes secretion from the parotid gland?
glossopharyngeal
43
What receptors do opiods act on?
Delta, Mu and Kappa
Bradycardia, bradypnoea and pinpoint pupils classic findings in an overdose
44
What are upper motor neurone signs?
Muscle weakness, spasticity, hyperreflexia and clonus
45
What are lower motor neurone signs?
Originate in the anterior horn of the spinal cord so asymmetric weakness, flaccid paralysis, fasciculations, hyporeflexia and muscle atrophy
46
First line treatment for migraine with N+V?
NSAID/paracetamol + antiemetic eg sumitriptan
47
What is a contraindication to a lumbar puncture?
Raised ICP
48
What are absence seizures?
Usually in children- patient stares blankly then abruptly returns to normal.
Mx- sodium valproate or lamotrigine
49
What the signs of primary lateral sclerosis?
Progressive and bilateral upper motor neuron weakness
50
What resp measurement should be monitored in guillian-barre syndrome?
Forced Vital Capacity
51
How does a subarachnoid haemorrhage present?
A severe sudden onset occipital headache. May have stiff neck, decreased consciousness and focal neurological deficit
52
Presentation of a cluster headache
Unilateral peri-orbital headaches with ipsilateral ptosis, lacrimation, conjunctival injection and rhinorrhea.
Happen in clusters with silent periods in between
53
What 5HT3 anatagonist can make parkinsons symptoms worse?
Metoclopramide
54
Signs of internuclear opthalmoplegia
Failure to adduct eye on affected side and nystagmus in contralateral side
55
What drug can used to reduce raised ICP?
Mannitol
56
What is spared in stroke
The forehead- indicates lower motor neuron problem
57
First line prophylactic treatment of migraine?
Amitriptyline
58
Are extradural haemoatomas supra or infratentorial?
Supra
59
What is the first step of ix in suspected stroke
non-contrast CT head
60
What to do next if ischaemic stroke is suspected?
Loading dose of aspirin and considered thrombolysis
61
What features suggest frontal lobe epilepsy?
Head/leg movements
Post ictal weakness
Jacksonian march (clonic movements travelling proximally)
62
What can be given to lower mortality in confirmed bacterial meningitis
Dexamethasone IV
63
What does a pyramidal pattern of muscle weakness mean?
In Upper Limb: extensors weaker than flexors
In Lower Limb: flexors weaker than extensors
64
What is neologism?
Making up new words or phrases
65
What is the most common cause of encephalitis?
Usually viral caused by herpes simplex 1
66
Thunderclap headache is associated with what?
Subarachnoid Haemorrhage
67
What are symptoms of a subdural haemorrhage
Fluctuating levels of consciousness and progressive neurology
68
Classic CT sign of a subdural haemorrhage
Cresent shaped collection of blood
69
Characteristics of a extradural haemorrhage
Head injury with deterioration in consciousness followed by a lucid interval.
70
Where is the bleed from an extradural haemorrhage usually from?
The middle meningeal artery or vein -> blood accumulates between the bone and dura mater
71
First line tx of tonic clonic seizures
Sodium Valproate and lamotrigine (women)
72
What does +ve rombergs test indicate?
Dorsal column dysfunction (visual input is required for proprioceptive deficits)
73
In a cerebellar syndrome is Romberg's test positive or negative?
Positive
74
Characteristics of a tonic-clonic seizure?
Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes.
Associated tongue biting, incontinence, groaning and irregular breathing
Prolonged post ictal period
75
Characteristics of an atonic seizure
Brief lapses in muscle tone causing the patient to fall, not more than 3 mins, consciousness is retained
76
Characteristics of a myoclonic seizure
Present as sudden brief muscle jerks of a limb, trunk or face
77
What are upgoing plantars a feature of?
An upper motor neuron lesion on the affected side
78
What do cholinesterase inhibitors do?
Maintain higher levels of acetylcholine to attach to nicotinic acetylcholine receptors to facilitate muscle contraction -> alleviates muscle weakness (used in myasthenia)
79
An INR greater than what is a contraindication for thrombolysis?
INR >1.7
80
A blood pressure greater than what is a contraindication for thrombolysis?
180/110
81
What is the acute tx of a migraine?
NSAID (aspirin, naproxen, ibuprofen), antiemetic if gastroparesis, triptans (5HT agonist) eg sumitriptan, rizatriptan, eletriptan
82
What is the prophylaxis of a migraine?
1st- amitriptyline or propanolol
2nd- topiromate/valproate
3rd- pizotifen
83
What secondary treatment should be commenced post stroke in a patient with atrial fibrillation?
Warfarin or DOAC
84
What secondary treatment should be commenced post stroke in a patient?
Clopidogrel for long term antiplatelet therapy
85
What is guillain barre syndrome?
Progressive, symmetrical, distal weakness associated with flaccidity and hyporeflexia (LMN signs) on a background of a recent viral illness.
86
What is the main surgical intervention for subarachnoid haemorrhage?
Endovascular coiling
87
What is the Cushings Reflex, what does it result in?
A physiological response to raised ICP.
Increased blood pressure, decreased heart rate and irregular breathing
88
Describe the mechanism of the Cushing's reflex
Raised ICP caused sympathetic and parasympathetic nervous systems to be activated.
In the first stage sympathetic > parasympathetic so greater blood flow resistance and hypertension and heart rate.
Barareceptors in the aortic arch detect this and triggers the parasymp response via the vagus nerve -> slows heart rate
Increased pressure on the brainstem can also can irregular breathing
89
Treatment for encephalitis
IV aciclovir
90
What are the features of corticobasal degeneration
Parkinsonian features, apraxia (unable to do tasks when asked to)
91
DANISH mnemonic for cerebellar stroke/syndrome dysfunction
Dysdiadochokinesia (inability to perform rapid alternating movements)
Ataxia
Nystagmus
Intention tremor (tremor during voluntary movement eg finger nose test)
Slurred speech
Hypotonia
92
What is the brains main inhibitory neurotransmitter
GABA- acts of gaba receptor
93
What is the brains main excitatory neurotransmitter?
glutamate acts on the NDMA receptor
94
What are automatisms?
Semicoordinated, repetitive motor activities associated with impaired awareness. eg lip smacking, grabbing, plucking
95
What type of seizures are automatisms seen in?
Temporal Lobe
96
What drugs can worsen symptoms of myasthenia gravis?
Beta blockers, certain antibiotics eg gentamicin, lithium
97
What are the three aspects of the Bamford criteria for a total anterior circulation infarct?
1. Unilateral hemiparesis or hemisensory loss
2. Higher cognitive dysfunction eg dysphasia or hemispatial neglect
3. Homonymous hemianopia
98
What is a posterior circulation syndrome stroke (POCS) and its criteria
Damage to the area of brain supplied by posterior circulation eg cerebellum or brainstem
One of the following for dx:
- Cranial nerve palsy and a contralateral motor/sensory deficit
-Bilateral motor/sensory deficit
-Conjugate eye movement disorder (e.g. horizontal gaze palsy)
-Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
-Isolated homonymous hemianopia with macular sparing
99
What is a lacunar stroke (LACS)
Subcortical stroke (in deep part of brain) that occurs secondary to small vessel disease. No loss of higher cerebral function eg dysphasia
100
What is the diagnostic criteria for a lacunar stroke?
One of the following needs to be present for a diagnosis of a LACS:
-Pure sensory stroke
-Pure motor stroke
-Sensori-motor stroke
-Ataxic hemiparesis (weakness and ataxia on the same side)
101
From what time of symptom onset should thrombolysis be given for ischaemic stroke?
4.5 hours
102
Mx of essential tremor
Propanolol
103
Hyperattenuation would suggest which kind of stroke?
Haemorrhagic
104
Hospital treatment of status epilpticus?
Lorazepam twice within 5-10 mins of last dose then phenytoin
105
What nerves are affected in pseudobulbar palsy and what does it cause?
CN 9,10+12
Causes swallowing and speech difficulties
106
What is the test for impairment of motor function in the muscles served by the L5 nerve root?
Power of dorsiflexion of the big toe
107
What is the test for impairment of motor function in the muscles served by the L4 nerve root?
Foot inversion
108
What is the test for impairment of motor function in the muscles served by the L3 nerve root?
Knee extension
109
What is the test for impairment of motor function in the muscles served by the L2 nerve root?
Hip flexion
110
What would a lacunar stroke result in?
Pure motor dysfunction
111
An UMN lesion affects which tract
The pyramidal/corticospinal tract
112
A TAC stroke affects what vessels
Contralateral anterior and middle cerebral
113
A basal ganglia/extrapyramidal pathway leads to what features?
Parkinsonism/hypokinesis traits
Or hyperkinesis eg huntington's chorea
114
Features of myotonic dystrophy?
Dysarthria, frontal balding, strong grip
115
Progressive muscle atrophy MND affects which motor neurones?
Only lower motor neurones
116
Spinal ALS MND affects what neurones?
Simultaneous upper and lower motor neurones
117
Primary lateral sclerosis affects which motor neurones?
Upper motor neurones
118
Main function of vestibulospinal tract
Activate the anti-gravity extensor muscles
119
Main function of the tectospinal tract?
Reflex to visual and auditory stimulus
120
Main function of reticulospinal tract?
Control of breathing and cardiac control
121
Where does the tectospinal tract originate and end?
Superior colliculus of the midbrain and extends down the cervical spine
122
Describe a subflacine herniation
-When one half of the cerebrum herniates across
the midline.
-cause compression of the anterior cerebral artery
-lead to motor and/or sensory weakness.
123
Describe cerebellar tonsillar herniation
-Cerebellum moves inferiorly
-Compresses medulla
-Lead to resp distress/death
124
Describe central herniation
Central part of the brain inferiorly compresses brainstem
125
Describe transcalvarial herniation
Defect in skull and brain herniates out
126
1st+2nd line treatment for generalised tonic clonic seizure?
1st:Sodium valproate or lamotrogine
2nd: levetiracetam or topiramate
127
1st line treatment for absence seizures?
Ethosuximide or sodium valproate
128
1st +2nd line treatment for myoclonic seizures?
1st-Sodium Valproate
2nd- Levetiracetam
129
Treatment for focal seizure
Lamotrigine/carbamazepine
130
1st+2nd line treatment for unclassified seizures?
1st-sodium valproate
2nd-Lamotrigine/topiramate
131
What the mechanism of action of metoclopromide?
D2 receptor antagonist therefore can block extra-pyramidal pathway leading to side effects such as acute dystonia and chronically tardive dyskinesias
132
Triad of juvenile myoclonic epilepsy?
Myoclonic jerks, absence seizures and generalised tonic-clonic seizures
133
First line treatment in status epilepticus?
Buccal midazolam or Rectal diazepam (benzodiazopines)
134
Treatment for trigeminal neuralgia?
Carbamazepine, gabapentin, pheytoin
135
What is the caution with topiramate?
Contraindicated in pregnancy, need very effective contraception- can impair the effectiveness of hormonal contraceptions.
136
How does Brown Sequard syndrome arise?
Due to hemisection of spinal cord. Anatomical disruption of nerve fibre tracts in one half of spinal cord
137
Pathophysiology of brown sequard syndrome?
Ipsilateral weakness + loss of fine touch, joint proprioception and vibration as fibres decussate in the medulla.
Contralateral loss of pain and temp sensation as fibres of spinothalamic tract decussate in spinal cord
138
Which antibiotic can reduce seizure threshold?
Quinolones such as ciprofloxacin
139
What is the secondary prevention of stroke?
Clopidogrel 75mg once daily (alternatively aspirin plus dipyridamole)
Atorvastatin 20-80mg (not started immediately – usually delayed at least 48 hours)
Blood pressure and diabetes control
Addressing modifiable risk factors (e.g., smoking, obesity and exercise)
140
What would MRI of MS show?
- Periventricular lesions
- Discrete white matter abnormalities
- Areas of focal demyelination
- Active inflammatory plaques can be distinguished from inactive ones by using a contrast agent
141
Ix for trigeminal neuralgia?
MRI head
142
Tx for trigeminal neuralgia?
Carbamazepine first line, gabapentin, phenytoin
143
Foot drop is damage to which nerve
Common peroneal nerve
144
What is given after thrombolysis in ischemic stroke if presenting within 4.5 hours of symptoms?
Aspirin 24hrs after treatment with alteplase for a period of 2 weeks once repeat CT has excluded new haemorrhagic stroke
145
If hyperacute treatments are not offered in stroke what is given?
Aspirin 300mg orally once daily for two weeks
146
In temporal lobe epilepsy which structure could be damaged and what symptoms would it result in?
Hippocampus can cause long term deficits in memory
147
Features of Wernicke's Encephalopathy
- Ataxia
- Confusion
- Ocular abnormalities: this can include gaze-evoked nystagmus, spontaneous upbeat nystagmus, and horizontal or vertical ophthalmoplegia
148
Aetiology of myotonic dystrophy
Genetic mutation leading to trinucleotide repeats in DMPK gene
149
What is obstructive or non-communicating hydrocephalus?
When flow of CSF blocked along one or more narrow passages connecting the ventricles leading to dilation of more upstream ventricles eg third and fourth
150
What is communicating hydrocephalus?
CSF can exit the ventricular system but absorption impaired- commonly due to problems in the subarachnoid space such as haemorrhage
151
Symptoms of hydrocephalus?
Early morning headaches, N+V, lethargy and visual disturbances
152
How long after a TIA or stroke should a patient not drive
1 month if satisfactorily recovered
153
What is conductive dysphasia?
Presents with fluent speech but an inability to repeat words.
154
What is dysarthria?
Inability to coordinate the muscles of speech leading to problems with articulation. They have no problem producing speech but do not pronounce the words well
155
What is global aphasia?
Inability to understand, repeat, and produce speech.
156
First line investigation for MS
MRI brain and spine with contrast
157
How does progressive supranuclear palsy present?
Parkinsonism and vertical gaze palsy (hard to look up)
More symmetric and tremor negative parkinsonism
158
Ix for a TIA
-MRI to look for alternative pathologies
-Carotid ultrasound
-Echo: to look for carotid thrombus
-24hr tape for atrial fibrillation
-Blood tests for glucose and lipids
159
Gold standard ix for cervical myelopathy?
MRI of cervical spine
160
Where does the lateral corticospinal tract decussate and what does it innervate?
Decussates in medulla
Innervates the distal/appendicular muscles
161
Where does the anterior corticospinal tract decussate and what does it innervate?
Decussates in spinal cord at segmental level
Innervates trunk and axial muscles
