neuro Flashcards
(140 cards)
1
Q
what does the Oxford Stroke Classification (also known as the Bamford Classification) assess
A
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
2
Q
what arteries are involved in Total anterior circulation infarcts and what Bamford score is required
A
involves middle and anterior cerebral arteries
all 3 are required
3
Q
what arteries are involved in Partial anterior circulation infarcts and what Bamford score is required
A
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2
4
Q
what arteries are involved in lacunar infarcts
A
involves perforating arteries around the internal capsule, thalamus and basal ganglia
5
Q
what do lacunar infarcts present with?
A
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
6
Q
what arteries are involved in Posterior circulation infarcts
A
vertebrobasilar
7
Q
what does POCI present with
A
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
8
Q
what can myelodysplastic syndrome develop into
A
AML
9
Q
pick bodies/cells
A
frontotemporal dementia
10
Q
what mutation causes huntingtons disease
A
CAG expansion on chromosome 4
11
Q
Progressively worsening headache with higher cognitive function impaired?
A
urgent CT
12
Q
Ptosis + dilated pupil
A
CN III Palsy
13
Q
ptosis + constricted pupil
A
Horner’s
14
Q
A wide-based gait with loss of heel to toe walking is called
A
an ataxic gait
15
Q
hypodense (dark), crescent-shaped and not limited by suture lines
A
chronic subdural haematoma
16
Q
Hyperdense crescentic-shaped collection not limited by suture lines
A
acute subdural haematoma
17
Q
Hyperdense lentiform (biconvex) shaped collection limited by suture lines
A
extradural haematoma
18
Q
Hyperdense collections around the basal cisterns and sulci
A
subarachnoid haemorrhage
19
Q
Hyperdense material in the lateral ventricle
A
intraventricular haemorrhage
20
Q
vertigo, hearing loss, tinnitus and an absent corneal reflex
A
vestibular shwannoma
21
Q
flaccid weakness and hyporeflexia following an infection
A
Guillan - barre
22
Q
roughened patches of skin over lumbar spine (Shagreen patches)
A
tuberous sclerosis
23
Q
wernickes encelopathy symptoms (CAN OPEN)
A
Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy
24
Q
what muscles are usually spared in MND
A
Ocular
25
Headache linked to Valsalva manoeuvres
raised icp until proven otherwise => CT
26
what nerves are associated with vestibular schwanomma
V, VII and VIII
27
treatment for generalised tonic clonic seizures
males: sodium valproate
females: lamotrigine or levetiracetam
young girls or woman who dont want to be pregnant may be offered valproate
28
treatment for focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
29
treatment for abscence seizures (petit mal)
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
30
what treatment may exacerbate absence seizures
carbamazepine
31
treatment for myoclonic seizures
males: sodium valproate
females: levetiracetam
32
treatment for tonic or atonic seizures
males: sodium valproate
females: lamotrigine
33
treatment for bells palsy
oral prednisolone + artificial tears
34
Anterior or middle cerebral artery stroke →
numbness, sudden muscle weakness
35
Broca’s area (left frontal lobe) →
slurred speech
36
Wenicke’s area (left temporal lobe) →
difficulty understanding speech
37
Posterior cerebral artery stroke →
effects vision
38
ROSIER is a clinical scoring tool based on clinical features and duration for what
stroke in ER
39
what is the most common cause of TIA
microemboli
40
sudden transient loss of vision in one eye
Amaurosis fugax - likely ICA stenosis
41
bacterial meningitis in neonates
Listeria monocytogenes, group B Streptococci, E. coli
42
bacterial meningitis age 10-65
- Ages 10 to 21: Neisseria meningitidis, Streptococcus
pneumoniae
- Age over 21: Streptococcus pneumoniae, Neisseria
meningitidis
43
bacterial meningitis in over 65s
Streptococcus pneumoniae, Listeria monocytogenes
44
bacterial meningitis in immunosuppressed
Listeria monocytogenes
45
bacterial meningitis in Neurosurgery/ head trauma:
Staphylococcus, Gram negative
bacilli (Klebsiella pneumoniae, E.coli, Pseudomonas aeruginosa)
46
bacterial meningitis in Fracture of the cribiform plate:
Streptococcus pneumoniae
47
is bacterial or viral meningitis more common
viral
48
pathophysiology of acute bacterial meningitis
- The pia-arachnoid is congested with polymorphs
- A layer of pus forms
- adhesions may form, causing cranial nerve palsies and hydrocephalus
- Cerebral oedema occurs in any bacterial meningitis
49
pathophysiology of meningitis due to Chronic infection (e.g. TB)
- The brain is covered in a viscous grey–green exudate with numerous meningeal tubercles
- Adhesions are invariable
- Cerebral oedema occurs in any bacterial meningitis
50
pathophysiology of viral meningitis
- In viral meningitis there is a predominantly lymphocytic inflammatory cerebrospinal fluid (CSF) reaction without pus formation, polymorphs or adhesions
- There is little or no cerebral oedema unless encephalitis develops
51
Headache, fever and focal neurology
brain abscess
52
what type of haematoma does alcoholism increase the risk of
subdural
53
migraine prophylaxis in asthmatic
topiramate (propanolol is contraindicated)
54
raised ICP treatment
weight loss
carbonic anhydrase inhibitors e.g. acetazolamide
55
scale that measures disability or dependence in activities of daily living in stroke patients
barthel index
56
give CSF findings for viral meningitis commenting on appearance, protein, glucose, WCC and culture
Clear, normal or slightly raised protein, glucose normal, high lymphocytes, culture negative
57
give CSF finding for bacterial meningitis commenting on appearance, protein, glucose, WCC and culture
cloudy, high protein, low glucose, high neutrophils, culture - bacteria
58
when should lumbar puncture be avoided
signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk
signs of raised intracranial pressure
59
restless, fatigue, insomnia, depression, parkinsonism side effects
metoclopramide
60
GI, tremor, unsteadiness, tremor, teratogenic (NTD) side effects
sodium valproate
61
N+V, dizziness, unsteadiness, headache, confusion, double vision side effects
carbemazepine
62
Steven Johnson syndrome (rash), careful in pregnancy/breast feeding
lamotragine
63
dry mouth, diarrhoea, metallic taste, tremor, weight gain, water retention, hypothyroidism, blood test 7 days after starting
lithium
64
agranulocytosis + myocarditis – regular blood checks!
clozapine
65
weight gain atypical antipsychotic
olanzapine
66
tardive dyskinesia, akathisia
* Tardive dyskinesia is most fatal = may be irreversible = fine vermicular movements of the tongue. Choreoathetoid movements, chewing and pouting of jaw
Typical antipsychotics
67
list some typical antipsychotics
chlorpromazine/haloperidol/thioridazine/ fluphenazine/zuclopentixol
68
what group of side effects do typical antipsychotics cause
extra-pyramidal
69
toxicity can cause cerebellar symptoms
phenytoin
70
fine touch, proprioception and vibration – cross at medulla – run posteriorly
dorsal column
71
______ can be used as treatment for MND – anti-glutamate – slows symptoms but is not a treatment
riluzole
72
pain and temperature – cross at spinal level – run from medial to anterior
spinothalamic
73
behaviour and speech problems, slowly progressive
Frontotemperal/Picks
74
hallucination and parkinsonism, REM sleep disorder, fluctuation on a daily basis – loss of ACh producing neurons
Lewy body disease
75
stepwise progression, memory and personality problems, emotional instability – history of vascular disease
vascular dementia
76
sudden onset - post infectious (group A strep/rheumatic fever) (autoimmune) cause of chorea (or tics)
o Sydenhams chorea
77
butterfly pattern on caudate nucleus?
huntingtons
78
what treatment reduces chorea
tetrabenazine
79
Treatment of lewy body dementia
anticholinesterase inhibitor – rivastigmine/ donepezil
80
management for mild to moderate alzheimer's
acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
81
when should the 2nd line treatment for alzheimers (memantine an NMDA glutamate receptor antagonist) be used ?
- intolerance to ACTHI's
- add on therapy
- monotherapy in severe disease
82
rapid progression, autonomic features – impotence/incontinence, postural hypotension, cerebellar + pyramidal signs – rigidity is worse than tremor (aka Shy-Drager syndrome)
multiple system atrophy
83
weird, wet, wobbly – confusion, incontinence, ataxis and treatment
normal pressure hydrocephalus - treat with shunt
84
rugby player trauma of pterion of temporal bone – damage to middle meningeal artery – lucid interval then deterioration – lemon shape on CT – blood between bone and dura mater
extradural
85
elderly or alcoholic with fragile veins – banana on CT – don’t remember trauma – slow onset deterioration – blood between dura and arachnoid mater
subdural
86
sudden onset headache with N+V – FH of CKD – saccular berry aneurysm rupture at bifurcation – CT shows blood under arachnoid – LP after 12 hours shows xanthochromia (yellow) – risk of vasospasm, rebleeding, seizures, hyponatraemia – treat with nimodipine and surgical clipping
SAH
87
Part of brain that controls fevers and temperature being set to a higher level
hypothalamus
88
Neck flexion → electric shocks in trunk/limbs
Lhermitte’s Sign (MS)
89
worsening of MS symptoms when overheated
Uhtoffs sign (MS)
90
antibody against Pre-synaptic Ca channel – squamous cell lung cancer
lambert-eaton syndrome
91
Autoimmune destruction of post synaptic nicotinic AChR – leading to ptosis and fatigueable muscle weakness of proximals – common in 2 peaks, 20-30s and 60+
myasthaenia gravis
92
myasthaenia gravistreatment
pyridostigmine (anti ACh inhibitor) and thymectomy
93
purposeless movement that flit and flow and appear restless
chorea
94
huntingtons outline
CAG repeat on chromosome 4 – movement + mood + dementia – autosomal dominant!!!
95
cause of foot drop
L4/L5 disc herniation – compressing L5!
96
Cranial nerve that travels to the parotid gland then branches off into its 5 branches
facial nerve - CN VII
97
thumb + 2 fingers – carpal tunnel syndrome
median
98
pinky + 1.5 = cubital tunnel syndrome
ulnar
99
wrist drop and back of arm
radial
100
anterior arm
musculocutaneous
101
demylination of midbrain causes
holmes tremor
102
vertical gaze palsy, postural instability, falls, (pseudobulbar symptoms – speech, swallowing)
progressive supranuclear palsy
103
early autonomic features (impotence, incontinence, postural hypotension), cerebellar + pyramidal signs, rigidity
multiple system atrophy
104
fluctuating cognition with visual hallucination and early dementia and parkinsons
LBD
105
poor prognosis signs for MS
Older, male, motor signs at onset, early relapses, many MRI lesions and axonal loss
106
Lymphocytic pleocytosis is found in
tuberculosis meningitis
107
Tau proteins and amyloid proteins are found in
Alzheimer’s
108
Xanthochromia is found in a
subarachnoid haemorrhage
109
ALS is highly associated with
frontotemporal dementia
110
Muscle fasciculations and weakness correspond to
LMN
signs
111
increased tone and brisk reflexes signal
UMN signs.
112
Progressive muscular atrophy presents only with
LMN signs
113
primary lateral sclerosis presents only with
UMN signs
114
Progressive Bulbar and pseudobulbar palsy is caused by damage to cranial
nerves _________
9,10 and 12 and presents with dysphagia
115
reduced jaw and gag reflexes and tongue fasciculations
Bulbar palsy
116
slow speech and brisk jaw reflex.
pseudobulbar palsy
117
Akathisia
inability to remain still
118
occurs when one half of the cerebrum herniates across
the midline. It can cause compression of the anterior cerebral artery and lead
to motor and/or sensory weakness.
A subflacine herniation
119
occurs when the cerebellum moves inferiorly and
compresses the medulla which can lead to respiratory distress and death.
A cerebellar tonsillar herniation
120
occurs when the central part of the brain is inferiorly
compressed towards the brainstem.
A central herniation
121
is where there is a defect within the skull and a part of
the brain herniates out through that opening.
A transcalverial herniation
122
is the genetic
phenomenon which causes each generation to develop the disease at an
earlier age.
anticipation
123
is the transmission of traits from one generation to
another.
Heritability
124
is the proportion of individuals carrying a particular allele
of a gene (genotype) that also express the phenotype.
Penetrance
125
is the
transfer and incorporation of foreign DNA into a host genome.
Transformation
126
what can be prescribes alongside SSRI's to reduce side effects
Mirtazapine - an atypical
antidepressant
127
neutropenic sepsis treatment
piperacillin and tazobactam
128
meningitis treatment
ceftriaxone + dexamethasone
ceftriaxone allergic give chloramphenicol and vanc.
129
Widespread cerebral atrophy
alzheimers
130
Alpha-synuclein cytoplasmic inclusions
LBD
131
café au lait spots, benign tumour of nerve and fibrous tissue
neurofibroma
132
scanning speech, intention tremor and nystagmus
charcots triad
133
atrophy of caudate and putamen
huntingtons
134
Foot drop (especially post hip replacement)
sciatic nerve
135
Raised CK
muscular dystrophy
136
Racoon/panda eyes
basal skull fracture
137
Alzheimer’s diagnosis
MMSE
138
lewy body diagnosis
DAT scan
139
picks disease diagnosis
CT
140
vascular dementia diagnosis
SPECT
