Neuro Flashcards
(158 cards)
1
Q
How does MND present on nerve conduction studies?
A
Normal motor conduction
2
Q
What are adverse side effects of phenytoin?
A
Acute: dizziness, visual changes, slurred speech, seizures
Chronic: gingival hyperplasia, drowsiness, megaloblastic anaemia, peripheral neuropathy, lymphadenopathy
Teratogenic: associated with cleft palate and congenital heart disease
3
Q
How do the pattern of signs present in GBS?
A
Flaccid weakness with hyporeflexia
4
Q
What is the management of autonomic dysreflexia?
A
Remove stimulus (distended bowel/bladder) and treat lift-threatening complications e.g. bradycardia
5
Q
reduced GCS, paralysis and bilateral pin point pupils suggests what?
A
Pontine haemorrhage
6
Q
Patient with new onset stroke?
A
Admit to hospital for urgent CT head -> ?stroke assessment
7
Q
What should be considered when starting someone on phenytoin?
A
Cardiac monitoring due to arrhythmogenic effects
8
Q
What is a common side effect of triptans?
A
Tightness of the chest and throat
9
Q
clonic movements travelling proximally suggests what?
A
Jacksonian march - frontal lobe epilepsy
10
Q
What is the most common complication of meningitis?
A
Sensorineural hearing loss
11
Q
What is the management of headache linked to valsalva manoeuvres?
A
Raised ICP until proven otherwise so needs CT
12
Q
Management of seizures?
A
Rectal diazepam
13
Q
What is used to treat idiopathic intracranial HTN?
A
- Weight loss
- Acetazolamide
14
Q
Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity
A
Posterior cerebral artery
15
Q
What is the mode of action of ondansetron?
A
Selective 5-HT3 receptor antagonist which acts in the medulla oblongata
16
Q
Subdural vs extradural?
A
Subdural will have fluctuating consciousness
17
Q
patients with dangerous mechanism of injury, including falling more than 1 metre or from a height of 5 stairs or more require what?
A
CT head within 8 hours
18
Q
criteria for CT head within 1 hour?
A
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
19
Q
CSF findings for SAH?
A
- Normal or raised opening pressure
- Xanthochromia
20
Q
criteria for CT head within 8 hours?
A
age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury
21
Q
Idiopathic vs drug induced Parkinsons
A
Idiopathic - asymmetrical symptoms
Drug induced - symmetrical
22
Q
Seizures vs syncopal episodes
A
Syncopal episodes - rapid recovery and short post ictal period
23
Q
Sudden onset vertigo and vomiting, facial paralysis and sensorineural deafness - which artery
A
Anterior inferior cerebellar artery
24
Q
Progressive supranuclear palsy vs multiple system atrophy?
A
PSP will have an upward gaze impairment
25
What is a patient with alcoholism at risk of?
Subdural haematoma
26
pain, ophthalmoplegia, proptosis, trigeminal nerve lesion and Horner's?
Cavernous sinus syndrome
27
Cerebral Herniation can cause what?
Third nerve palsy: eye down and out with dilated pupil
28
What are the signs of lateral medullar syndrome/PICA stroke?
- Ipsilateral facial pain and loss of temperature
- Contralateral loss of limb and torso pain/temperature
- Ipsilateral Horners syndrome
29
Which anticoagulant is used for prophylaxis post TIA?
Lifelong clopidogrel
30
What visual features will be present in a patient with IIH?
- Blurred vision
- Papilledema
- Enlarged blind spot
31
What imaging is used to diagnose carotid artery stenosis?
Duplex US
32
What drug should be avoided in patients with myasthenia gravis?
Bisoprolol
33
Ventriculomegaly without sulcal enlargement suggests what?
Normal pressure hydrocephalus
34
What is the response that can occur following raised ICP?
Cushings reflex - hypertension and bradycardia with wide pulse pressure
35
Which opiate should be used if standard neuropathic medications are not working?
Tramadol
36
Which Parkinsons medication is linked with impulse control disorders?
Dopamine agonists
37
Which anaesthetic agent would someone with MG be resistant to?
NMBDs e.g suxamethonium
38
reduced GCS, paralysis and bilateral pin point pupils suggests what?
Pontine haemorrhage
39
Fluent speech, comprehension intact but poor repetition?
Conduction dysphasia
40
Gait ataxia is caused by what?
Cerebellar vermis lesions
41
Which drugs are associated with IIH?
A - Vit A and metabolites
L - Lithium/Levothyroxine
O - OCP
S - Steroids
T - Tetracycline
C - Cimetidine
42
What is a very common early symptom of MS?
Lethargy
43
What is associated with autonomic dysreflexia?
Stroke
44
Which cranial nerves are affected in acoustic neuromas?
5,7,8
45
What is the sensory loss in syringomyelia?
Spinothalamic - pain and temperature
46
How long can cluster headaches last?
15 mins - 2 hours
47
Muscle wasting of hands, numbness and tinging with autonomic symptoms suggests what?
Thoracic outlet syndrome
48
Which anti-epileptic drug can cause weight gain?
Sodium valproate
49
What is paroxysmal hemicrania?
- Unilateral headache in the orbital/temporal region
- Similar to cluster headaches
- Responsive to indomethacin
50
Which anti epileptic medication can cause numbness of fingers and feet?
Phenytoin
51
Empty delta sign on venography suggests what?
Sagittal sinus thrombosis
52
Vision worse on going down the stairs?
4th nerve palsy
53
What can be done in patients with raised ICP?
Hyperventilation to reduce blood CO2 to induce cerebral vasoconstriction
54
What can be used to differentiate between a seizures and a pseudo seizure?
Prolactin
55
What is the eye examination signs for 3rd nerve palsy?
Ptosis + dilated pupil + absent light reflex with intact consensual constriction
56
Where is the most common cause of obstructive hydrocephalus?
Cerebral aqueduct stenosis
57
Which anti-epileptic drug causes weight loss, renal stones and cognitive and behaviour changes?
Topiramate
58
sudden and severe back pain, followed immediately by rapidly progressive bilateral flaccid limb weakness and loss of sensation, particularly for pain and temperature?
Spinal cord infarction
59
What is the management of stroke in patients <60 with severe symptoms and atleast 50% infarct of MCA on CT?
Decompressive hemicraniectomy
60
What is the most common cause of third nerve palsy?
Diabetes
61
What causes painful third nerve palsy?
Posterior communicating artery aneurysm
62
What is the gold standard investigation for venous sinus thrombosis?
MR venogram
63
What is the triad for lewy-body dementia?
fluctuating cognition, parkinsonism and visual hallucinations
64
unilateral wide-amplitude flinging movements, usually of the proximal limb post stroke?
Hemiballismus secondary to lesion in the contralateral sub thalamic nucleus
65
Causes of SAH?
PKD, Ehlers Danlos, aortic cortication
66
Other symptoms of SAH except headache?
Vomiting, collapse, coma, visual disturbance, focal neurology
67
What is Kernigs sign?
- Demonstrates meningeal irritation
- Hip and Knee bent to 90 degrees, pain causes when knee is straightened
68
Extradural vs subdural
Extradural - lens shaped/lemon/biconvex, subdural - crescent shaped
69
What is Todds palsy?
T temporary weakness following a seizure - usually of affected limb(s).
70
What are causes of seizures?
Uraemia, hypoglycaemia, hyponatraemia, hypernatraemia, hypocalcaemia
71
What airway adjunct should be used if someone is having a seizure?
Nasopharyngeal
72
Management of seizure?
- Roll the patient into the recovery position and move any items away from him that could cause harm
- Place a pillow under head
73
What is the management of bladder dysfunction/incontinence in someone with MS?
US KUB
74
Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness
Anterior inferior cerebellar artery
75
What is Freidreich's ataxia?
Autosomal recessive neuro condition with weakness, cerebellar signs and scoliosis
76
What signs would be present to indicate GBS?
LMN signs: hypotonia, paralysis, no reflexes
77
What is the most common cause of surgical third nerve palsy?
Posterior communication artery aneurysm
78
Damage to which structures can cause a homonymous hemianopia?
Unilateral damage to optic radiation or visual cortex
79
What are symptoms of raised ICP?
- Headache
- Vomiting
- Papilledema
- Seizures
- Reduced consciousness
80
Drugs to manage ICP?
- Mannitol
- Dexamethasone
81
What are causes of Horners syndrome?
- Pancoast tumour: non-small cell carcinoma
- Stroke
- Carotid artery dissection
82
Atrophy of the caudate nucleus and putamen?
Huntingtons
83
Dementia + Depression/Irritability + Involuntary movements?
Huntingtons
84
Acute cord compression in someone on anticoagulation should make you think what?
Epidural haematoma
85
What can present very similarly to carpal tunnel syndrome?
degenerative cervical myelopathy?
86
What are C/I to thrombolysis?
- Haemorrhagic stroke
- Active bleedig
- Major surgery within 14 days
- Pregnancy
- Previous intracranial haemorrhage
87
Where is the damage in spastic cerebral palsy?
UMN in the periventricular white matter
88
What is the management of myasthenia crisis?
IV Immuniglobulins / Plasmapheresis
89
What is the most common cause of viral meningitis?
Enteroviruses e.g. coxsackie B
90
Vision worse going down stairs?
CN4 - Trochlear
91
What is a common complication of SAH?
Hyponatraemia -> can cause SIADH
92
What should FEV1 increase by when testing for asthma with short acting bronchodilators?
12% or more
93
What genes are associated with Parkinsons?
SNCA, LRRK2, PINK1
94
What are some non motor symptoms of Parkinsons?
- Cognitive impairment
- Depression
- Hallucinations
- Constipation
- Sleep disorders
95
Investigations for TIA?
- CT/MRI
- Echo
- 24 hour ECG
- Carotid doppler
96
What are complications of GCA?
- Visual loss
- Aortic aneurysm
- Seizures
- Stroke
97
Which chromosome is affected in Huntingtons?
Chromosome 4
98
What is the pathophysiology of Huntingtons?
Expansion of CAG triple repeats in the huntingtin gene
99
What are Alzheimers symptoms?
- Confusion
- Apraxia
- Depression
- Hallucinations
100
What are the 2 drugs for Alzheimers?
Cholinesterase inhibitors - Donepezil
NMDA antagonists - Memantine
101
Third nerve palsy with decreasing consciousness and heamatoma?
Trans-tentorial herniation
102
What investigation could be done to investigate suspected trigeminal neuralgia?
MRI head -> assess for underlying cause e.g MS
103
If CT is done within 6 hours of suspected SAH and is normal....
Do not do LP - consider alternative diagnosis
104
weakness of foot dorsiflexion and foot eversion
common peroneal lesion
105
what causes action potential prolongation in both sensory and motor axons?
Carpal tunnel
106
How long should symptoms be present before being able to diagnose chronic fatigue syndrome?
3 months
107
burning and tingling sensation over the upper lateral area of the thigh with no motor deficits
Think merralgia paraesthetica
108
loss of sensation to the palmar and dorsal aspect of the 5th digit
Ulnar
109
What occular signs are seen in Wernickes?
- Nystagmus
- Opthalmoplegia: lateral rectus palsy
110
When should amoxicillin be given to cover for Listeria in meningitis?
Over 60s
111
Fever on alternating days?
Malaria
112
Falling from a tree and grabbing a branch whilst falling -> claw hand?
Klumpke's palsy -> T1 nerve damage
113
What should be given in non falciparum malaria?
Primaquine
114
Why is primaquine used in non-falciparum malaria?
Destroy liver hypnozoites and prevent relapse
115
Which MND has the worst prognosis?
Progressive bulbar palsy
116
lymphocytic CSF with high protein and low glucose
TB meningitis
117
What are options to reduce relapses in MS?
- Natalizumab
118
What are the 2 first line drugs for spasticity in MS?
Baclofen and Gabapentin
119
What are complications of spinal cord compression?
- Aspiration
- Pressure sores
- Depression
- Pneumonia
- Autonomic dysfunction
120
Epilepsy DVLA rules
First unprovoked/isolated seizure - 6 months
Established epilepsy - seizure free for 12 months
121
What causes short headaches before an SAH?
Small leaks from the aneurysm
122
What kind of signs would MS give?
UMN
123
What autoimmune conditions are associated with myasthenia gravis?
- Graves
- Hashimotos
- RA
124
What is the key feature of MG?
Fatigability - muscles become progressively weaker during periods of activity and improve after rest
125
What are the antibodies of MG?
- Anti-acetylcholine receptors
- anti muscle-specific tyrosine kinase antibodies
126
What is the Tensilon test?
IV edrophonium which reduces muscle weakness temporarily
127
What is the main complication with MG?
Acute respiratory failure due to weakness of the muscles of ventilation.
128
CT head showing temporal lobe changes
Herpes encephalitis
129
Sensory loss posterolateral aspect of leg and lateral aspect of foot
S1
130
Which organisms can cause GBS?/
- Campylobacter
- CMV
- Hepatitis
- Mycoplasma pneumoniae
- EBV
- HIV
131
What are types of CNS tumours?
Glioma - most common
Meningioma
Glioblastoma
132
What is the treatment for Lewy-Body dementia?
- Same as Alzheimers
- Donepezil/Rivastigmine
133
What criteria is used for MS diagnosis?
McDonald
134
Cushings reflex
- HTN
- Bradycardia
- Irregular breathing
135
Signs of expanding EDH?
- N+V
- Slurred speech
- Seizures
- Reduced GCS
136
What is coning?
Herniation of cerebellar tonsils through foramen magnum causing compression of brainstem
137
Management of ?brain abscess on CT?
IV Abx
MRI to rule out brain mets
Drainage if confirmed abscess
138
Meningitis complications?
Septic shock
Hearing loss
Seizures
Intellectual impairment
Abscess
139
Memantine side effect?
Constipation
140
CSF antibodies against NMDA?
Autoimmune encephalitis
141
What test should be done before starting acetylcholinesterase inhibitors?
ECG - can prolong QT
142
cerebral venous sinus thrombosis treatment?
LMWH
143
A hyperdense artery sign on CT can be a sign of what?
Ischaemic stroke
144
Effacement of the cerebral ventricles and loss of grey-white matter differentiation
Raised ICP
145
Hyperdense material in the cerebral sulci and basal cisterns
SAH
146
What is cortical basal degeneration?
Parkinson's triad + spontaneous activity of an affected limb
147
What is internuclear opthalmoplegia?
Lesion in medial longitudinal fasciculus causing impaired adduction in affected side and nystagmus in opposite eye
148
What are some factors with worsen prognosis of MS?
- Older
- Male
- Many MRI lesions
- Early relapses
149
What is myotonic dystrophy?
- 20s year old with cataracts, muscle wasting of hands, slow relaxing grip
150
Management of lumbar spine stenosis?
- Pain management, physio
- Surgery only for severe cases e.g. laminectomy
151
Most common cause of spontaneous intracerebral haemorrhage?
HTN
152
REM sleep disturbances is a feature of what?
Lewy body dementia
153
What is decorticate?
Abnormal flexion in response to pain
154
India ink stain is used to test for what?
Cryptococcus -> Fungal meningitis
155
HIV patient with meningitis signs?
Fungal -> Cryptococcus
156
Excessive nitrous oxide inhalation can cause what?
Subacute degeneration of spinal cord
157
Vertigo, nystagmus, dysphagia, Horners?
PICA
158
CAG triple repeat with anticipation through spermatogenesis?
Huntingtons
