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Neuro Flashcards

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1
Q

What is the definition of a TIA?

A

temporary neurological dysfunction lasting less than 24 hours cuased by ischaemia but without infarction

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2
Q

What are crescendo TIAs

A

two or more TIAs within a week -> high risk of stroke

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3
Q

What risk factors increase the risk of stroke in patients taking the COCP?

A

COCP +:
migraine with aura
smoker over 34
history of stroke or TIA

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4
Q

How do you manage a stroke initially?

A

Exclude hypoglycasemia
Non-contrast CT head - exclude haemorrhage
Aspirin 300mg daily if not haemorrhage
Admit to specialist stroke centre
Alteplase - thrombolyse

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5
Q

When should alteplase be given in strokes?

A

within 4.5 hours of symptom onset

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6
Q

What conditions should patients be investigated for if they have a TIA or stroke?

A

Carotid artery stenosis - carotid ultrasound
Atrial fibrillation - ECG / holter monitoring

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7
Q

What shape are subdural bleeds?

A

crescent shape

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8
Q

What shape are extradural bleeds?

A

bi-concave shape

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9
Q

What usually causes an extradural haemorrhage?

A

Middle meningeal artery rupture in temporoparietal region associated with fracture of temporal bone

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10
Q

Which types of haemorrhage have a lucid period?

A

Extradural haemorrhage

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11
Q

What are the surgical options for extradural or subdural haematomas?

A

Craniotomy - open removal of section of the skull
Burr holes - to drain the blood

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12
Q

What is the mortality of a SAH?

A

30%

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13
Q

Which conditions is SAH common in?

A

Sickle celll
Marfan’s / Ehlers Danlos
Neurofibromatosis
AD Polycystic kidney disease

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14
Q

At what time frame is a CT less reliable for a SAH?

A

More than 6 hours after the start of symptoms

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15
Q

When may a lumbar puncture be performed for a SAH diagnosis after a normal CT head?

A

Wait at least 12 hours after onset of symptoms - it takes time for bilirubin to accumulate in CSF

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16
Q

What does a positive CSF sample show in SAH?

A

Raised RCC
Xanthochromia - caused by bilirubin

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17
Q

What is gold standard diagnostic tool to confirm diagnosis of SAH?

A

CT angiography

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18
Q

What is the treatment/management of a SAH?

A

endovascular coiling by an interventional neuroradiologist or neurosurgeon

Platinum coils are used

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19
Q

What prevents vasospasm in SAH and what class of drug is it?

A

Nimodipine - a calcium channel blocker

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20
Q

What is a severe complication of SAH?

A

Hydrocephalus

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21
Q

How may hydrocephalus be managed post-SAH?

A

Lumbar puncture
External ventricular drain
Ventriculoperitoneal shunt

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22
Q

Which neuronal cells provide myelin in the CNS?

A

Oligodendrocytes

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23
Q

Which neuronal cells provide myelin in the PNS?

A

Schwann cells

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24
Q

Which cells does multiple sclerosis affect?

A

Oligodendrocytes in the CNS

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25
What are lesions in MS described as?
Disseminated in time and space
26
What is Oscillopsia?
This is the visual sensation of the environment moving and being unable to create a stable image
27
Eye movement abnormalities can be caused by lesions affecting whihc cranial nerves?
Oculomotor (III) Trochlear (IV) Abducens (VI)
28
Where is the lesion if the patient has internuclear ophthalmoplegia
Medial longitudinal fasciculus
29
What does the medial longitudinal fasciculus connect?
The cranial nerve nuclei that conctrol eye movements - 3,5,6
30
Where is the lesion if the patient has a conjugate (connected) lateral gaze disorder - both eyes look laterally to the left or right
Abducens nerve (VI)
31
What focal weakness symptoms may MS present with?
Incontinence Horner syndrome Facial nerve palsy Limb paralysis
32
What focal sensory symptoms may MS present wiht?
Trigeminal neuralgia Numbness Paraesthesia Lhermitte's sign
33
What is Lhermitte's sign
an electric shock sensation that travels down the spine and into the limbs when flexing the neck
34
What does Lhermitte's sign indicate
MS disease in the cervical spinal cord in the dorsal column It is caused by stretching the demyelinated dorsal column
35
What does sensory ataxia refer to?
It is due to the loss of proprioception and the inability to sense the position of the joint - Positive Romberg's It can also cause pseudoathetosis
36
What is pseudoathetosis
Involuntary writhing movements
37
Where is the lesion if the patient has sensory ataxia
Dorsal columns of the spine
38
What condition is associated with muscle weaknes and diminished response to repetitive stimulation on EMG?
Myasthenia gravis
39
What is the first-line drug for ocular myasthenia gravis?
Pyridostigmine
40
What is first-line management for focal seizures?
Lamotrigine Levetiracetam
41
When can extended target time of 24hrs for thrombectomy be considered?
If there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
42
What is lateral medullary symptoms?
Left posterior inferior cerebellar artery infarction PICA lesion Cerebellar signs Contralateral sensory loss Ipsilateral Horner's
43
What are the signs of a posterior cerebral artery stroke?
Contralateral homonymous hemianopia with macular sparing and visual agnosia
44
What nerve damage is common in a mid shaft humeral fracture and what is the presenting sign?
Radial nerve --> Wrist drop
45
Which cranial nerve is susceptible to damage early in the course of raised ICP?
Abducens nerve Due to its long intracranial course
46
Damage to which nerve results in RAPD?
Optic nerve
47
What is syringomyelia
Dilatation of CSF space within the spinal cord
48
What is the sensory loss distribution in syringomyelia?
Dissociative loss of sensation of pain, temperature and non-discriminative touch In a cape-like distribution
49
What nerve palsy causes "vision worse going down the stairs"
4th nerve palsy = trochlear nerve
50
What medication is used to treat Idiopathic intracranial hypertension
Acetazolamide Carbonic anhydrase inhibitor
51
What is prescribed in absence seizures?
Ethosuximide
52
What are tongue fasciculations a sign of
bulbar onset motor neurone disease
53
What is the classic triad of normal pressure hydrocephalus
Dementia Ataxia Urinary incontinence
54
What diet is useful in epilepsy non-responsive to medications?
Ketogenic diet
55
Which nerve is affected if a patient cannot abduct their left eye?
CN 6 = abducens nerve
56
Which muscles are typically spared in MND?
Ocular msucles
57
What can be found in the CSF of patients with MS?
Oligoclonal bodies / bands
58
Chronic haemorrhage is hypo or hyperdense?
Hypodense
59
What would a CT head showing infective picture and temporal lobe changes (low-density enhancement in the anterior and medial aspects) suggest?
Herpes simplex encephalitis
60
What is autonomic dysreflexia?
T4-level spinal cord injury, bradycardia, flushing, severe hypertension, and sweating above the lesion strongly indicates this condition
61
What is lambert-eaton syndrome
paraneoplastic myasthenic syndrome - caused by small cell lung cancer
62
What are the features of Lambert-Eaton syndrome?
long-standing cough SOB Autonomic symptoms Limb-girdle weakness -> waddling gait Hyporeflexia
63
What meds can be used for spasticity in MS
Baclofen Gabapentin
64
What drug is used for long-term prophylaxis of cluster headaches
verapamil
65
What sign can be used to diagnose degenrative cerivcal myelopathy
Hoffman's sign
66
If a patient has chronic subdural haematoma, will the CT appear hypodense or hyperdense?
Hypodense (dark)
67

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