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Neuro Flashcards

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1
Q

TACI/PACI criteria

A

Unilateral hemiparesis/hemisensory loss of face, arm and leg
Homonymous Hemianopia
Higher cognitive dysfunction

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2
Q

POCI criteria

A

1 of:
Cerebellar/brainstem syndrome
LOC
Isolated homonymous hemianopia

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3
Q

POCI how common and which arteries

A

Vertebrobasilar, 25%

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4
Q

TACI/PACI how common and which arteries

A

TACI 15%, PACI 25%
Middle/anterior cerebral arteries

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5
Q

Lateral medullary syndrome features

A

Wallenberg’s syndrome, PICA
Ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
Contralateral: limb sensory loss

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6
Q

Weber’s syndrome

A

Ipsilateral III palsy
Contralateral weakness

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7
Q

Neuropathic pain Rx

A

1st line - Amitriptyline, gabapent, pregab, dulox (use as monotherapy)
Tramadol as rescue therapy
Capsaicin for localised

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8
Q

True seizure vs pseudo blood markers

A

Lactate
Prolactin

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9
Q

Acoustic neuroma presentation

A

Vertigo
Tinnitus
Hearing loss
Loss of corneal reflex (compression of V)

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10
Q

HSV encephalitis CT B findings

A

Bilateral temporal lobe hypodensities

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11
Q

Tuberous sclerosis features

A

Cutaneous:
Ash-leaf spots (depigmented areas)
Shagreen patches (roughened patches over lumbar)
Adenoma sebaceum (angiofibromas butterfly over nose)
Subungal fibromata
Cafe-au-Lait spots

Neuro:
Developmental delay/intellectual disability
Epilepsy

Other:
Retinal hamartomas: dense white areas on retina (phakomata)
Rhabdomyomas of the heart
Gliomatous changes can occur in the brain lesions
Polycystic kidneys, renal angiomyolipomata
Lymphangioleiomyomatosis: multiple lung cysts

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12
Q

IIH Mx

A

Weight loss
Acetazolamide
Topiramate
Repeated LP (short-term)
Surgery: LP/VP shunt or optic nerve sheath decompression/fenestration

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13
Q

Migraine acute Mx

A

1st line - triptan + paracetamol/NSAID
Nasal triptan in 12-17yrs
2nd line - Metoclopramide/prochlorperazine

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14
Q

Migraine prophylaxis

A

Propranolol
Topiramate (teratogenic)
Amitriptyline

Riboflavin 400mg OD

Specialist: Candesartan - Erenumab (CGRP receptor)

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15
Q

Cluster headache triggers

A

Nocturnal sleep
Alcohol
Smoking
Men

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16
Q

Cluster headache Ix

A

MRI head with gadolinium contrast

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17
Q

Cluster headache acute mx

A

100% O2
Subcut triptan

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18
Q

Cluster headache prophylaxis

A

Verapamil
Tapering dose of pred
Refer to neuro

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19
Q

POCI most common presentation

A

Dizziness

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20
Q

Phenytoin SEs

A

Acute - cerebellar signs
Confusion, seizures, peripheral neuropathy
Macrocytic anaemia (2ry to folate metabolism), osteomalacia, lymphadenopathy, aplastic anaemia
Hirsutism, gingival hyperplasia, coarsening of face
Rashes e.g. TEN
Hepatitis
Drug induced lupus
Dupuytren’s contracture

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21
Q

Phenytoin monitoring

A

Trough level if:
Dose changes
Suspect toxicity
Check non-adherence

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22
Q

MS acute relapse Rx

A

High dose steroids
Shortens duration but doesn’t change prognosis

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23
Q

MS DMARD indications

A

Relapsing-remitting + 2 relapses in past 2 years + walk unaided 100m
Secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)

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24
Q

MS Mx drugs

A

Natalizumab (anti-alpha-4 beta-1 integrin on leucocytes, often 1st line for preventing relapse)
Ocreluzimab (anti- CD20 also 1st line)
Fingolimod (S1P receptor modulator, stops lymphocytes leaving lymph nodes)

Less effective:
Beta-interferon
Glatiramer (immune decoy)

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25
MS tiredness mx
Amantadine Mindfulness + CBT
26
MS Spasticity mx
Baclofen +/ gabapentin 1st line Diazepam, dantrolene, tizanidine 2nd line Physiotherapy In the future cannabis/botox
27
MS oscillopsia mx
Gabapentin
28
MS bladder dysfunction mx
ISCC if post-void residual Anticholinergics if no PVR
29
MND presentation
Usually over 40 Asymmetric limb weakness LMN + UMN lesions Fasciculations Absence of sensory signs, external ocular signs, cerebellar signs
30
MND Ix
Clinical dx Should have normal nerve conduction studies Normal MRI to exclude MS/DCM
31
MND prognosis
50% die within 3yrs
32
MND mx
Riluzole (prevents glutamate stimulation, prolongs lifespan by 3mths) BIPAP at night (prolongs life by 7mths) PEG for nutrition
33
Lhermitte's sign
Tingling in hands with neck flexion Seen in MS, SCD and cervical stenosis
34
Internuclear ophthalmoplegia
Lesion in medial longitudinal fasciculus in paramedian area of midbrain and pons Impaired ipsilateral adduction, contralateral nystagmus on abduction Caused by MS/Vascular disease
35
Cushing's triad
Bradycardia Irregular breathing Wide pulse pressure (only systolic HTN due to high ICP)
36
MG exacerbating causes
Beta blockers Penicillamine Quinidine, procainamide Lithium Phenytoin Antibiotics: gentamicin, macrolides, quinolones, tetracyclines
37
Huntington's genetics
Autosomal dominant chromosome 4 huntingtin gene defect Trinucleotide repeat disorder, repeat expansion of CAG so see anticipation Causes degeneration of cholinergic/GABAergic neurons in basal ganglia striata
38
PD 1st line mx
If motor sx then levodopa If none then D2 agonist, levodopa or MAO-B
39
Levodopa SEs
Dry mouth Anorexia Palpitations Psychosis Postural hypotension
40
PD drugs
Levodopa + decarboxylase inhibitors (carbidopa, benserazide) COMT inhibitors (entacapone) D2RAs (ropinirole, ergot derived (bromocriptine, cabergoline)) MAO-Bi (selegiline) Amantidine (probs inc dopamine release and inhbits uptake at synapse) Antimuscarinic (procyclidine, benzotropine, benhexol) for drug-induced
41
NMS features
Occurs within hours to days Pyrexia, rigidity, confusion, autonomic dysfunction Raised CK, leukocytosis
42
Doses rectal diazepam seizure
Neonate 1.25 - 2.5 mg Child 1 month - 1 year 5 mg Child 2 years - 11 years 5 - 10 mg Child 12 years - 17 years 10 mg Adult 10 - 20 mg (max. 30 mg) Elderly 10 mg (max. 15 mg)
43
Guillain Barre Ix
LP - normal WCC in 2/3 Nerve conduction studies - dec conduction, prolonged distal motor latency, increased F wave latency
44
Wernicke's aphasia
Superior temporal gyrus supplied by inferior L MCA Receptive aphasia (comprehension)
45
Broca's aphasia
Inferior frontal gyrus, supplied by superior L MCA Expressive aphasia, motor component
46
Conduction aphasia
Arcuate fasiculus (between Wernicke's and Broca's) Speech is fluent, repetition poor, aware of errors
47
Syncope DVLA
Simple faint no restriction Single episode treated - 4wks Single episode unexplained 6mths 2+ episodes 12mths
48
Stroke/intracranial DVLA
TIA/stroke - 1mth, no need to inform unless residual deficit Multiple TIAs in short period - 3mths, inform Craniotomy - 1yr, can reconsider at 6mths if benign meningioma Pituitary tumour - 6mths if craniotomy, trans-sphenoidal can drive when no residual impairment Narcolepsy/cataplexy - stop on dx, start when controlled Chronic neuro disorders - inform DVLA
49
Generalised tonic-clonic Rx
Lamotrigine or keppra
50
Focal seizures Rx
1st line - lamotrigine/keppra 2nd - carbamazepine, oxcarbezapine, zonisamide
51
Absence seizures Rx
1st - ethosuximide 2nd - lamotrigine/keppra Avoid carbamazepine - can make worse
52
53
Tonic seizures Rx
1st - lamotrigine 2nd - clobazam, topiramate, rufinamide
54
Wernicke's presentation
Nystagmus Ophthalmoplegia Ataxia
55
Korsakoff's presentation
Wernicke's + Confabulation Amnesia (both)
56
What is Stokes-Adams
Transient LOC caused by heart block
57
What is Capgras syndrome
Delusion someone close has been switched by a replacement
58
What is Othello syndrome
Delusion partner having an affair with no evidence
59
De Clerembault syndrome
Famous person in love with them
60
Cotard syndrome
Person believes they're dead
61
Fregoli syndrome
Multiple people that a person meets are the same person
62
TIA Mx
DAPT within 24h, aspirin + clopi for 21d (300mg one day loading then 75mg) after give clopi alone TIA clinic 24h with carotid doppler, if >50% stenosis consider endarterectomy
63
Frontal lobe seizures
Motor Post-ictal weakening Jacksonian March
64
Parietal lobe seizures
Paraesthesia
65
Occipital lobe seizures
Floaters/flashes
66
Temporal lobe seizures
Automatisms Aura Impaired or aware
67
Vit B6 over/underdose SE
Peripheral neuropathy
68
Gower's sign
Child using arms to stand from chair, muscular dystrophy
69

MSRA (3 decks)

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