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Sheff 3a > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

Who normally gets idiopathic (benign) intracranial hypertension?

A

Young, obese women

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2
Q

Features of idiopathic intracranial hypertension?

A

N+v
Worse in morning
Can get visual disturbance, especially with change in posture
CN VI palsy’s (false localising sign)

LP -> increased pressure

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3
Q

Complication of untreated IIH?

Mx?

A

Vision loss

Acetazolamide (carbonic anhydrase inhibitor)
Weight reduction is advisable if obese.
Stop causative medication
Multiple LP -> reduce pressure

Acute treatment - prednisolone

VP shunt / bariatric surgery

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4
Q

What medication can be useful for tension headaches that don’t well respond to simple NSAIDS

A

Amitriptyline

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5
Q

Bar trigeminal neuralgia what is the other main cause of trigeminal pain? How long does it last? Mx?

A

Post-herpetic neuralgia
-shingles of the trigeminal branch

Can be 2-3 years

Amitriptyline / carbamazepine

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6
Q

2 types of oedema which accompany CNS ischemia?

A

Cytotoxic oedema - accumulation of water in damaged glial cells and neurones

Vasogenic oedema - Extracellular fluid accumulates due to breakdown of BBB

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7
Q

If ESR is raised in stroke what further Ix?

A

?infective -> blood cultures

->Transoesophageal echocardiogram (exclude IE or myxoma)

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8
Q

Mx of spasticity after stroke?

A

Neurophysiotherapist

Baclofen

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9
Q

Seen in superior Sagittal sinus thrombosis

A

Headache, papilloedema + other similar to IIH
-EARLY seizures
Bilateral neuro deficit -> Progressive -> LOC

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10
Q

Features of cavernous sinus thrombosis?

A

Red swollen eyelid and conjunctiva
3,4,6,5a,5b palsies
Papilloedema

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11
Q

Lateral sinus thrombosis features

A

Raised ICP
Seizures
Drowsiness

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12
Q

Mx of Venous sinus thrombosis?

A

Look for signs of infection -> heparin those without

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13
Q

Name 3 Conditions that could mimic stroke

A 
Todd’s paresis (post seizure) 
Tumour / abscess 
Migraine (hemiplegic) 
Hypoglycaemia 
Psychogenic 
Spinal cord / peripheral nerve / Cranial nerve pathology
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14
Q

Ix in SAH

A

CT- SA blood, mass effect, obstructed ventricles

LP- frank blood -> xanthochromia later

Clotting screen + LFT - exclude clotting disorders

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15
Q

Why are old people more at risk of subdural

A

Atrophy of brain -> stretches bridging arteries / veins

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16
Q

Complications of haemorrhagic stroke?

A

Hydrocephalus

  • > herniation of cerebellum through foramen magnum
  • > Uncal herniation (temporal lobe pushes Against midbrain)
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17
Q

Features of Arnold chiari malformation?

A

6th nerve palsy
Ataxia
+babinski
->LOC, irregular breathing and apnea

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18
Q

Features of uncal herniation?

A

CN III palsy (fixed dilated pupil)

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19
Q

Causes of chorea

A

Hungtingtons
Drug induced - L-dopa, phenytoin, neuroleptic
Thyrotoxicosis

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20
Q

Mx of chorea in hungtingtons

A

Tetrabenazine

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21
Q

Mx of essential tremor

A

Propranolol

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22
Q

Cause of myoclonus

A

Often physiological - Eg falling asleep jerk

Metabolic disturbance (Liver/renal failure, increased CO2, decreased Na)
Neurodegenerative
Myoclonic epilepsy

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23
Q

What is dystonia? 3 types?

A

Prolonged muscle contractions -> abnormal posture or repetitive movements

Idiopathic generalised
Focal dystonias
Acute dystonia

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24
Q

Eg of a focal dystonia

A

Spasmic torticollis - head pulled to one side

Writers cramp

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25
Q

Usual cause of acute dystonia? Sx? Mx?

A

Drugs - antipsychotics, some antiemetics (Metoclopramide)

Torticolis - head pulled back
Trismus - lock jaw
Oculogyric crisis - Eyes pulled up

Rapid response to anticholinergic - Eg procyclidine

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26
Q

Uses of procyclidine

A

Drug induced Parkinsonism, akathisia, acute dystonia

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27
Q

Give 4 causes of blackout

A 
Vasovagal syncope 
Other syncope 
Epilepsy
Stokes Adams attacks 
Orthostatic hypotension 
Anxiety 
Hypoglycaemia
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28
Q

What causes vasovagal syncope ?

Speed of onset? Any other features?

A

Reflex bradycardia ± peripheral vasodilation
-provoked by emotion, pain or standing too long

Onset over seconds [NOT INSTANT]
Can get pre-syncope (nausea, pallor, sweating…)
Falls to the floor and remains unconscious for ~2 mins
-may get brief jerking

Urinary incontinence is rare, tongue biting does not occur

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29
Q

3 egs of situation syncope

A

Cough - following a paroxysm of coughing

Effort - on exercise (may have cardiac origin Eg Aortic stenosis)

Micturition - During or after micturition

30
Q

What is carotid sinus syncope

A

Hypersensitive baroreceptors cause excessive reflex bradycardia on minimal stimulation
-Eg head turning

31
Q

What is a stokes Adams attack? Cause?
Features?
Recovery?

A

Transient arrhythmia (Eg bradycardia due to 3rd degree heard block) -> Low CO and LOC

Only warning is palpitations

Rapid recovery and flushing

32
Q

Causes of orthostatic hypotension

A

Autonomic neuropathy
Antihypertensives
Multi system atrophy

33
Q

Ix in blackout

A 
Collateral hx 
ECG (±24hr to detect arrythmia, Long QT - Eg haloperidol / neuroleptic)
Blood glucose 
FBC, U+E
Echocardiogram
34
Q

3 common modes of presentation in MS

A

Visual disturbance
Limb weakness
Sensory disturbance

35
Q

Sx and signs of optic neuritis

A

Pain on eye movement, blurring of vision, loss of colour vision

Visual field defect - usually central Scotoma (dark spot)
Relative afferent pupillary defect (RAPD)
Optic disk may appear pink and swollen on fundoscopy (if inflammation behind)

36
Q

What is RAPD ? Cause?

A

Where pupils respond differently to light being shone in them when alternating between eyes

CN II lesion

37
Q

Ix in MS

A

MRI - Plaques not very specific
->useful to monitor progress + detect new lesions

LP - oligoclonal bands of IgG on CSF electrophoresis

Evoked potentials - Decreased visual, auditory + somatosensory

38
Q

Mx of relapse of MS? Long term relapse prevention

A

Methylprednisolone

InterferonB
Monoclonal Abx - natalizumab

39
Q 
Mx of MS sx
Spasticity?
Bladder disturbance?
Depression?
Erectile dysfunction?
Pain?
A

Spasticity? - Baclofen / diazepam
Bladder disturbance? - Anticholinergics Eg oxybutin
Depression? - SSRIs
Erectile dysfunction? - Phosphodiesterase inhibitors Eg sildenafil
Pain? - Amytriptiline

40
Q

Difference between MS and clinical isolated Sx

A

Multiple CNS lesions that are

1 Last >24hrs
2 disseminated in space - clinically / MRI
3 disseminated in time - >1month
4 cannot be attributed to other causes

41
Q

Which spinal tract decussated in medulla? What sense does it carry?

A

Dorsal

Ipsilateral proprioception and vibration

42
Q

Which is main tract in motor pathway? Damage ->?

A

Corticospinal

Spastic gait, hyperreflexia, babinski, clonus, loss of finger movements (treacle hands)

43
Q

What happens in brown sequard

A

Cord hemisecition

Ipsilateral position and vibration sense lost
Contralateral pain and temperature loss

Ipsilateral UMN signs

44
Q

Usual pattern of what with extrinsic cord compression?

A

Saddle anaesthesia

45
Q

What is the pathology of syringomyella? Pattern of sensory loss? Motor?

A

CSF filled cavity in spinal cord

Cape distribution of temp and pain

LMN signs in upper limbs

46
Q

Common cause of myelopathy in >50? <40?

A

> 50 - Cervical spondylitis
-Degereative disease of. Cervical spine -> cord compression

<40 - MS

47
Q

What happens in cervical spondylitis?

A

Osteoathrosis
Calcification, degeneration and protrusion of intervertebral disks
-bony outgrowths (osteophytes)

48
Q

What is a radiculopathy?
Features?
Most common presentation? Common cause?

A

Spinal root disease

Loss / impaired sensation +
Weakness + wasting in specific myotomes
Reflexes are absent / reduced
PAIN

Weak legs
Lumbar disk damage 2 to malignancy (brain, lung, prostate, thyroid, kidney)

49
Q

Main difference between cauda equina / conus medullaris and lesion higher up spinal cord?

A

Flaccid and arefelxic rather than spastic and hypereflexic

50
Q

Cauda equina features?

A

Back pain pain down legs
Often asymmetrical, areflexic paralysis of legs
Sensory loss
Loss of sphincter tone -> Do a PR

51
Q

Where is damage in conus medullaris?

Features?

A

L1 - bottom of spinal cord
Main features are - Urinary retention, constipation

Mixed LMN/UMN 
Leg weakness
Back pain 
Sacral sensory disturbance 
Erectile dysfunction
52
Q

Differentiate MND from MS and peripheral neuropathies and MG?

A

No sensory disturbance
No sphincter disturbance
Never affects eye movements - Distinguish from MG

53
Q

Which nerves affected in progressive bulbar palsy ? LMN/UMN? Features

A

CN 9-11
LMN

Flaccid fasiculation of tongue
Absent / quiet speech
Reduced gag reflex

54
Q

What is pseudobulbar palsy ? Features? Cause?

A

UMN lesion

Slow tongue movements and slow speech
Increased jaw jerk + pharyngeal / palate reflexes (absent in true bulbar)
Emotional incontinence

MS, stroke, MND

55
Q

Ix in MND

A

Nerve conduction studies

Imagine - MRI of Brian / cord excludes other causes

56
Q

Mx of MND

A

Anticholinergic Eg TCAs - reduce saliva when swallowing
Baclofen / diazepam - spasticity
Antidepressants

Riluzole

Communication aids
Ventilation support
Analgesia

57
Q

What class of drug is riluzole

A

Antiglutametric

58
Q

Cause os status epliepticus in an epileptic? Non epileptic?>

A

Drug withdrawals - eg non compliance
Infection
Progression of diseases

SOL (50%)
Infection 
Head injury 
Hypoglycaemia 
Alcohol withdrawal 
Electrolyte disturbance
59
Q

Mx of status

A

1- ABC + O2 if required

2 IV access and take blood
-U+E, LFT, glucose, Ca, toxicology, anticonvulsant levels

3 Thiamine / glucose if alcoholism / malnourishment

4 fluid resuscitation

5 IV lorazepam (can give twice if needed )

6 IV Phenytoin - monitor ECG and BP

7 General anaesthesia

60
Q

Complications of status

A 
Hypoxia 
Lactic acidosis 
Rhabdomyosis 
Hypoglycaemia 
Electrolyte imbalance 
Aspiration pneumonia 
Pulm oedema
61
Q

3 DDx of neuromuscular respiratory failure

A

CNS - compression of C3-5 (Phrenic nerve)

Peripheral neuropathies - Guillian barre

Neuromuscular junction - MG

62
Q

Mx of neuromuscular resp failure

A

O2

Bedside Pulm function tests - FVC, ABG

Transfer to ITU, Nil by mouth

Intubate if
PO <70mmHg, PCO2 >50mmHg with acidosis pH<7.2
Inability to protect airway Eg pharyngeal paresis
VC decreased <15ml/kg

63
Q

GCS level for coma?

A

<8

64
Q

Median nerve mononeuropathy
Root?
Features?

A

C6-T1

Precision grip
Sensory loss of radial 3 1/2 fingers

Carpal tunnel syndrome

65
Q

Ulnar nerve nerve mononeuropathy
Root?
Features?

A

C7-T1

Weakness / wasting of wrist flexors
Loss of interrossi -> cant cross fingers
Sensory loss of medial 1 1/2 fingers

66
Q

Radical nerve mononeuropathy
Root?
Features?

A

C5-T1

Can’t open fist, wrist drop / finger drop
Sensory loss in anatomical snuff box

67
Q

Common peroneal nerve mononeuropathy
Root?
Features?

A

L4-S1

Foot drop, weak ankle dorsiflexion / eversion
Sensory loss over dorsum of foot

68
Q

What happens in mononuritis multiplex? Usual cause?

A

Individual nerves picked off randomly

Systemic

  • vasculitis
  • Connective tissue disorders Eg sarcoid
69
Q

Ix of neuropathy

A

Neuropathy screen
FBC, ESR, TFT, ANA, B12/ folate

Vasculitis screen
FBC, ESR, CRP, ANA, ANCA

70
Q

Mx of neuropathic pain

A

Amitriptyline
Gabapentin

Mx of underlying cause Eg autoimmune, inflammatory ….

71
Q

3 main CI to LP

A

Bleeding disorders - eg Von Willie brand
Cardiovascular compromise
Raised ICP

72
Q

Mx of cauda equina if trauma? SOL? inflam? infection?

Following treatment?

A

Immobilise the spine if due to trauma

Surgery is indicated to remove blood, bone fragments, tumour, herniated disc or abnormal bone growth.

Lesion debulking is required for space-occupying lesions - eg, tumours, abscess.

Steroids if inflammatory causes - eg, ankylosing spondylitis.

Infection causes should be treated with appropriate antibiotic therapy.

Patients with spinal neoplasms should be evaluated for chemotherapy and radiation therapy.

Postoperative care includes addressing lifestyle issues (eg, obesity), and also physiotherapy and occupational therapy, depending on residual lower limb dysfunction.

Sheff 3a (30 decks)

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