Neuro Flashcards

Question

How does avastin treat brain tumours?

Answer 1

it Is an anti angiogenic agent which shuts down the tumours blood supply

Answer 2

hypertension, GI haemorrhage, expensive

Answer 3

inoculation of tumour with replication deficient HSV-1 retrovirus so wild type HSV-1 replicates exponentially and causes encephalitis modified HSV-1 fails to replicate in normal brain but replicates rapidly in GBM, causing oncolysis and release of progeny virus tumour cells killed and normal brain cells unaffected

Answer 4

powerful synthetic steroid, given orally, improving brain performance, reduces tumour inflammation and oedema

Answer 5

in the young, rare over 45

Answer 6

tumour transformation into a malignant phenotype, progressive mass effect due to slow tumour growth, progressive neurological deficit from destructional tumour

Answer 7

10-15yrs, can transform into anaplastic or GBM

Answer 8

chemotherapy

Answer 9

chromosomes 1 and 19, IDH1 mutation positive

Answer 10

mass effect of tumour and surrounding cerebral oedema, deficit depends on tumour location

Answer 11

3rd and 6th cranial palsy from stretching of the nerves by downward displacement of the temporal lobes

Answer 12

intercranial mass lesions e.g. cerebral abscess, tuberculoma, subdural haematoma, intercranial haematoma, stroke, benign intracranial hypertension

Answer 13

imaging with CT and MRI, MR angiography, PET scan, CXR for metastases, avoid LP

Answer 14

ionising radiation, genetics, male, Africa, age

Answer 15

multiple sclerosis - an autoimmune, inflammatory, demyelinating disease specific to the CNS which causes chronic neurological disability

Answer 16

inflammation in white matter of the CNS, producing antibodies against EBV nuclear antigens which then attack CNS myelin due to molecular mimicry, causes demyelinations and axonal loss, causing MS plaques

Answer 17

Caucasians due to less vit D, women, predisposition to EBV in children

Answer 18

random attacks over a number of years, mainly in first 3-4 years, recovery varies between patients and between attacks, disabilities accumulate with each attack

Answer 19

slow decline in neurological functions either from the onset (primary) or following a relapse (secondary)

Answer 20

few relapses and little disability

Answer 21

demyelination (breakdown products present), variable oligodendrocyte loss, hypercellular plaque edge due to infiltration of tissue with inflammatory cells, perivenous inflammatory infiltrate, extensive blood brain barrier disruption, older active plaques have central gliosis

Answer 22

demyelination (breakdown products absent), variable oligodendrocyte loss, hypocellular plaque, variable infllamtory infiltrate, moderate to minor blood brain barrier disruption, plaques gliosed

Answer 23

cerebral hemispheres - large variety of symptoms spinal cord - weakness, paraplegia, spasticity, tingling, numbeness Lhermitte's sign, bladder, sexual dysfunction optic nerves - impaired vision and eye pain medulla and pons - dysarthria, double vision, vertigo, nystagmus cerebellar white matter - dysarthria, nystagmus, intention tremor, ataxia

Answer 24

optic neuritis, spasticity, sensory symptoms and signs, Lhermittes sign, nystamus, double vision, vertigo, bladder and sexual dysfunction. gait

Answer 25

aphasia, hemianopia, extrapyramidal movement disturbance, severe muscle wasting, muscle fasciculation

Answer 26

weakness, parasthesiae and visual loss

Answer 27

two or more CNS lesions, disseminated in time and space, exclude other clinical conditions

Answer 28

EP, MRI, CSF electrophoresis shows IgG oligoclonal bands, neurological examination, history, symptoms

Answer 29

SLE, autoimmune disease, lyme disease, syphilis, AIDS, adrenomyeloneuropathy, cardiac embolic event, mitchochondrial encephalopathy

Answer 30

IV methylprednisolone, SC B IFN

Answer 31

injection site reaction, flu like symptoms complex, mild intermittent lymphopenia, mild to moderate rises in liver enzymes, flu like symptoms

Answer 32

oral - baclofen, diazepam peripheral never blocks e.g. phenol, alcohol, botox intrathecal baclofen functional neurosurgery physio remove trigger factors e.g. UTI, bed sores

Answer 33

BBs, low dose barbiturates, gabapentin, isoniazid, wrist bands containing small weights, computer controlled mechanical damping devices, stereotactic thalamotomy, thalamic electro stimulation

Answer 34

sexual counselling, intracorporeal inhection of PGE, penile prosthesis, Viagra, vibrators, lubricating gels, local anaesthetics,

Answer 35

depression, anxiety, euphoria, pathological crying/laughing, cognitive dysfunction

Answer 36

fundamentally different from ordinary fatigue, exacerbating by heat, improved by cool temperatures, makes other symptoms appear worse

Answer 37

trigeminal neuralgia, painful tonic seizures, optic neuritis, vertebral compression fractures, ulnar and peroneal palsies, haemorrhagic cystitis, dysaesthic extremity pain, painful leg spasms, chronic joint and back pain

Answer 38

brief duration, occur frequently, triggered by various factors, positive symptoms, usually respond to anti convulsant therapy

Answer 39

any loss of abnormality or psychological or anatomical structure or function

Answer 40

any restriction or lack of ability to perform and activity in manner or within normal range

Answer 41

a disadvantage for a given individual resulting from an impairment or disability that limits or prevents the fulfilment of a role that is normal for that individual

Answer 42

restoration of the individual to the highest feasible functional level physically, psychologically, socially, economically with the constraints of impairemtns and disabilities and within the context of cultural mileu

Answer 43

special seating, moving ad handling techniques, passive stretching, standing and weight bearing, splints, serial casting

Answer 44

reduces calcium influx, suppresses release of excitatory neurotransmitters and post synaptic increase in potassium conductance

Answer 45

alpha2 agonist, peaks at 2 hours

Answer 46

hepatic impairments

Answer 47

dry mouth, hypotension, acute hepatitis, withdrawal, weakness

Answer 48

causes muscle relaxtion by interfering wuth calcium influx

Answer 49

diarrhoea, avoid in liver disease

Answer 50

relatively localised hypertonia,

Answer 51

CB1 presynaptic receptors inhibit calcium influx, inhibits glutamate release and activates potassium channels

Answer 52

weakness, foot drop, sensory ataxia, cerebellar ataxia, spasticity, drug side effects, fatigue

Answer 53

treat cause, physio, fall education, walking stick, orhoptics, functional electrical stimulation, famipridine, botox

Answer 54

prevents back propagation of action potentials, inhibits postassium channels so there is better conduction along demyelinated axons

Answer 55

frequency, urgency, incontinence

Answer 56

flaccid, large bladder

Answer 57

incomplete bladder emptying

Answer 58

retention and hesitancy

Answer 59

McDonalds criteria

Answer 60

peripheral

Answer 61

sudden onset headache, drowsiness, vomiting, focal deficit

Answer 62

describing symptoms of poor memory and difficulty learning

Answer 63

damage to brain cells, the most common cause being Alzheimer's

Answer 64

a neurodegenerative disease, mainly in the cortex, causing plaques and tangles, leading to dementia

Answer 65

helps neurons in the brain grow and repair itself after an injury

Answer 66

alpha-secretase and gamma-secretase, and the broken up protein parts are soluble and go away

Answer 67

the left over fragment is not soluble and forms the monomer amyloid beta which are chemically sticky and bind together outside the neurons, leading to beta amyloid plaques which can get between neurons and inhibit neuron signalling so memory is impaired and can cause an autoimmune response, damaging surrounding neurons, can also deposit around blood vessels, lead to amyloid angiopathy, increasing risk of haemorrhage, rupture and blood loss

Answer 68

beta amyloid plaques, autoimmune inflammation and amyloid angiopathy

Answer 69

found inside the cell

Answer 70

tau protein

Answer 71

inhibit neuron signally and initiates activation of kinase in the neurons, which transfer phosphate groups to the tau protein so it changes shape and then the tau protein can no longer support the microtubules, clumps together with other tau proteins and gets tangled, leading to neruofibrially tangles

Answer 72

signals cannot be passed along the neurons in the brain and can lead to apoptosis leading to brain atrophy, narrow gyri, wider sulci and larger ventricles in brain

Answer 73

sporadic and familial

Answer 74

late onset, unknown cause, due to genetic and enviromental risk factors, the most common time, risk increased with age, linked to e3 allele of apolipoprotein E gene (APOE-e4), the risk increases if more of these genes were inherited

Answer 75

most common Alzheimer's 1% age 60-65 50% age 85

Answer 76

breaks down beta amyloid

Answer 77

the gene is less effective at breaking down beta amyloid, leading to increased plaques

Answer 78

dominant gene speeds up progression, early onset, caused by ``` gene mutations in PSEN1 (c14) or PSEN2 (c1) gene are linked as they encode for presenilin 1 and 2 which are subunits of gamma secretase, so will change the location of APP splitting, increasing beta amyloid OR Trisomy 21 (Downs) which has an extra copy of c21 which codes for APP gene which increase amyloid plaque build up ```

Answer 79

can be undetectable in early stages then leads to short term memory, loss of motor skills, language is affected, then lose long term memory, until more disorientated and bedridden

Answer 80

infection e.g. pneumonia

Answer 81

brain biopsy (after death) so must just exclude other causes of dementia for diagnosis

Answer 82

no cure, few medications which help and none that hault progression

Answer 83

voluntary and planned motor behaviours, motor speech area, personality, planning

Answer 84

personality and behaviour change followed by breakdown in attention and executive function (behavioural variant FTD)

Answer 85

hearing, language, semantic knowledge, memory, emotional/effective behaviour

Answer 86

severe epilepsy, profound failure to create new memories

Answer 87

surgery to bilateral to remove medial temporal lobes including hippocampus

Answer 88

amnesic prodrome which memory impairment, poor performance on episodic memory tests, cognitive function is preserved, scored on cognitive/memory screening, high risk of developing Alzheimer's

Answer 89

``` what year is it? what month is it? give an address with 5 parts? count down from 20 say months of year in reverse repeat address ```

Answer 90

acquired >6 months affect personal/professional life psychosocial burden/psychological distress verbal memory and attentional capacity >-1.5SD absence of organic cause of cognitive memory absence of major psychiatric disease (severe depression)

Answer 91

consensus criteria Braak 1/2 = low likelihood 3/4 = intermediate likelihood 5/6 = high likelihood diagnosis in intermediate of high likelihood of Alzheimer's are met and patient has clinical history of dementia

Answer 92

parkinson's disease

Answer 93

PET and SPECT, functional MRI

Answer 94

prevention, support, carers, advice, medications, socially active, cognitively active, control vascular risk factors, treat mood and anxiety

Answer 95

no smoking, BMI 18-25, 3 or more portions of fruit/veg, and less than 30% of calories from fat, walking 2 or more miles each day, or vigorous exercise as a regular habit,

Answer 96

AtCh esterase inhibitors e.g. exelon, aricept, reminyl or memanrine (anti glutamate) or NMDA receptor antagonists e.g. namenda

Answer 97

MMSE, mental state questionnaire, clinical dementia rating, global deterioration scale, ACE-R, CERAD, CAMDEX, ADAScog, MoCA

Answer 98

orientation, memory, attention, language, visual processing

Answer 99

address, date, birth, priminister, clock drawing test, fluency test or letters and design, how many animals can you name in one minute, card sorting test, stroop test, visualspatial memory and visuocontructive abilities, constructional apraxia, closing in phenomenon, £D visuoconstructive abilities, non verbal intelligence, abstract reasoning, verbal comprehension, spontaneous speech

Answer 100

manage vascular risk, statins, antioxidants, anti inflammatory drugs, oestrogen, social interventions

Answer 101

recurring, unpredictable siezures

Answer 102

when neurons are synchronously active in the brain, it is a paroxysmal event which changes behaviours, sensations and cognitive behaviour, caused by an abnormal burst of electrical impulses or too little inhibition

Answer 103

fast of long lasting activation of NMDA which causes calcium to come in

Answer 104

There is too little GABA receptors so cannot inhibit signals

Answer 105

primary, or secondary to tumours, brain injury and infection

Answer 106

jerking (typically beginning in corner of mouth and thumb and spreading to the limbs), moving, losing consciousness, starts on one side and then moves to the other, can be followed by a period of complete paralysis

Answer 107

fears, strange smells

Answer 108

generalized or focal/partial - depends on how much of the brain is affected

Answer 109

simple and complex

Answer 110

``` affects small part of brain remain conscious strange sensations and jerking movements can be a warning that another seizure is coming be aware that something is happening remember the seizure sense of deja vu ```

Answer 111

when movements start in on e group of muscles and spreads to other groups

Answer 112

impaired consciousness/impaired awareness unresponsive may not remember may just be small movements e.g. smacking lips, rubbing hands, moving arms

Answer 113

the paralysis post seizure

Answer 114

syncope, non epileptic seizure, epilepsy

Answer 115

When both hemispheres are affected (secondary if starts as a partial seizure)

Answer 116

muscles become stiff and flex, can lead to a fall backwards

Answer 117

muscles become relaxed and can lead to a forward fall

Answer 118

violent muscle contractions (convulsions)

Answer 119

most common generalized seizure, have a tense phase when the patient stiffens up and then the muscles start to rapidly contract

Answer 120

short muscle twitches, can be just a single twitch or can be lots

Answer 121

patient loses consciousness and then quickly regains it, the patient may just look spaced out

Answer 122

seizure >5 mins, or multiple seizures without returning to normal normally tonic clonic type seizure medical emergency

Answer 123

acutely with benzodiazepines, o2, cardiorespiratory monitoring, vitamins IV

Answer 124

enhance effect of the inhibitor GABA

Answer 125

confusion (post ictal confusion), paralysis of arms and legs (normally on one side but can last up to 15 hours - Todds paralysis)

Answer 126

temporary severe suppression of activity in the brain which was affected by the seziure

Answer 127

MRI, CT, EEG - to find anatomical abnormalities evaluation of seizure and eye witness accoutns

Answer 128

detects electrical activity in the brain

Answer 129

anti convulsants based on the patient epilepsy surgery if small part of the brain can be removed nerve stimulation influences vagus nerve to influence neurotransmitter release to reduce frequency and severity of seizures ketogenic diet so body burns fat not carbohydrates which produces ketone bodies which are used as an energy source by the brain instead of glucose stress relievers, avoid triggers, avoid contact sports and swimming, and must be seizure free for a year to drive deep brain stimulation implants electrode into specific areas of the brain, reducing abnormal electricity, reducing frequency of seizures

Answer 130

children, can appear as a stop in conversation or daydream

Answer 131

around 2-3 minutes

Answer 132

flashing lights, CV disease, cerebral tumours, alcohol, post trauma, genetics

Answer 133

Lamotrigine and Carbamarzepine pre synaptic and stop excitary signals

Answer 134

lamotrigine and sodium valproate

Answer 135

memory problems, hepatic enzyme inhibition, weight gain, hair loss, rashes, leucopaenia

Answer 136

start low and gradually build up, until seizures stop or until you develop side effects, aim to achieve control with minimum dosage, and there is risk of intoxication which can lead to ataxia, nystagmus and dysarthria

Answer 137

when only a single part of the brain is causing the seizures and it can be removed without causing any significant loss of brain function

Answer 138

it is a shock every 5 minutes for 30 seconds, hoarseness, sore throat and cough

Answer 139

pelvic thrusting, no tongue biting, eyes closed, crying/speaking, change in amplitude not frequency of activity

Answer 140

bleeding on the brain, depression, memory problems

Answer 141

mental process caused by psychosocial distress, and seizure instead of the emotion, it is situational and can last 1-20 minutes

Answer 142

fainting, changing behaviour sensation and cognitive processes, causing by insufficient blood of O2, from standing or sitting, lasting 5-30 seconds, has less warning and a history of heart disease

Answer 143

a triad of symptoms of tremor, rigidity/increased tone and bradykinseia

Answer 144

0. 3% of population over 40 7. 5 million worldwide more common in men most common at 65

Answer 145

tremors, rigidity, bradykinesia, postural instability hypominia, dysphagia, hypophonia, blurred vision, eyelid opening apraxia, gait (shuffling, freezing) reduced smell, constipation, visual hallucinations, frequency, urgency, dribbling of saliva, depression, dementia

Answer 146

basal ganglia - which is responsible for muscle tone and ease of movemt

Answer 147

caudate nucleus, caudate putamen, globus pallidus (interna and externa), nucleus accumbens, subthalamic nuclei, substantia nigra (2 parts)

Answer 148

cerebral cortex sends signals to the basal ganglia to initiate movement. The basal ganglia will control skeletal muscle tone and coordination of learned movements and then it will send signals back to the cortex (motor) via the thalamus to then be initiated down the spinal cord, out of the ventral horn to have normal movement pattern

Answer 149

problem with the output, so no normal controlled movement pattern

Answer 150

has dopamine neurogic neurons which release dopamine into the striatum which then binds to dopamine 1 or 2 (excitory or inhibitory)

Answer 151

reduced dopamine in the substantia nigra leading to apoptosis or necrosis of dopaminergic neurons caused by protein misfolding, aggregation and toxicity, defective proteolysis, mitchondrial dysfunction, oxidative stress demyelinataion, neuronal loss and glyosis in substantia nigra, presence of Lewy bodies lack of dopamine mean it cannot bind to GABA neuron so the inhibitory GABA is overstimulated causing glutamate secretion, causes excessive inhibitor input to the thalamus causing suppression of thalamocorticospinal pathway, so movement is not smooth

Answer 152

round eosinophilic intra cytoplasmic occlusions in the nuclei of neruone, made up mainly of alpha-synciclein ubiquitin and other proteins

Answer 153

familial, GBA, CNCA, LRRK2, PARK2 and PINK1, pesticides, survivors of the encephalitis lethargica

Answer 154

smoking, coffee, vigorous exercising, NSAIDs

Answer 155

Levodopa, dopamine agonists, monoamine oxidase B inhibitors, catechol-o-methyltransferase inhibitors, BBs, antichloinergics, physio, dietitian, language therapist, specialist nurse, counselling, surgery, DBS

Answer 156

it is a precursor to dopamine to improve symptoms

Answer 157

a peripheral dopadecarboyxlase inhibitor e.g. benserazide to prevent it being converted to dopamine too early in the bloodstream, and reduces it peripheral side effects (nausea and compulsive behaviours)

Answer 158

act as a dopamine agonist and do not need to be converted in the body to become active, but risk of impulsive control disorders and excessive sleepiness

Answer 159

e.g. selegiline and rasagiline inhibit levodopa and dopamine breakdown so the effects last longer

Answer 160

prevent levodopa breakdown, so more of the dose can reach the brain

Answer 161

chronic, acquired, autoimmune neuromuscular disease

Answer 162

autoantiboies to acetylcholine receptors (anti-AChR antibodies) at the post synaptic membrane, causing depletion of working post synaptic receptor sites and interfering with the neuromuscular junction associated with HLAB8 and DR3, or induced by drugs e.g. penicillin

Answer 163

most common in young women under 40 and old men over 60 can be passed onto neonates 15/100,000 but is underdiagnosed

Answer 164

other autoimmune disease, thymic atrophy, tumour of SLE

Answer 165

drooping eye, slurred speech, difficulty breathing, blurred/double vision, weakness in arms and legs, change in facial expression, unable to hold a steady gaze, difficulty chewing, weakness in proximal muscles, affect diaphram and resp troubles

Answer 166

exacerbated in exercise but relieved by rest

Answer 167

bone marrow transplant, or IFN-a medication,

Answer 168

as it is responsible for immune response and the immune system is low at birth, it decreases in size as we get older

Answer 169

abnormal and large, can people can develop thymoma,

Answer 170

examine eyes and muscles for signs of weakness anti AChR positive or anti MuSK positive CT and MRI look for thymoma nerve conduction measured - fatigue will occur quicker in myasthenia gravis single fibre EMG measure elecrtical potential form nerve to muscle, lower in myasthenia gravis ice test, crushed ice in glove over eye for 3 minutes, which leads to imporved ptosis in myasthenia gravis

Answer 171

increase sleep, avoid stress and excessive heat, rest, immunosuppressants e.g. prednisolone, acetylcholinesterae inhibitors inhibitors for temporary symptomatic relief by increasing ACh availiability (but beware of cholinergic crisis), osetoporosis prophylaxis, modified diet if difficultuy swallowing, thymectomy

Answer 172

weakness of the respiratory muscles during a relapse which is life threatening

Answer 173

monitor FVC, ventillatory support, plasmapheresis, IV Ig, identify triggers and treat them

Answer 174

5% mortality with treatment 25-30% without treatment inter current infection and hot weather aggravate it

Answer 175

acute inflammtory demyelinating and occasional axonal polynaruopathy

Answer 176

infection leading to shared epitopes with an antigen in the peripheral nerve tissue (ganglioside GM1 and GQ1b) leading to an autoantibody mediated nerve cell damage

Answer 177

infection with campylobacter jejuni, EBVm CMV, post pregnancy (risk decreases during pregnancy), malignancies, vaccines

Answer 178

1/100,000 a year, everyone equally likely to get it, but more men than female had it and peak ages are 15-35 and 50-75

Answer 179

paraesthesia and sensory loss in lower extremities

Answer 180

ascending symmetrical weakness, neuropathic pain in legs and pain, reduced or absent reflexes early, reduced sweating, reduced heat tolerance, bladder weakness, postural hypertension, cardiac arrhythmias, urinary hesitancy

Answer 181

can lead to paralysis, and can be severe if respiratory and facial muscles are involved which can cause respiratory fialure, hypo/hypertension, cardiac arrhythmia, urinary retention, ileus, pneumonia

Answer 182

stroke, brianstem compression, cord compression, poliomyelitis, myasthanthia gravis, hypokalaemia, vasculitis, botulism, encephalitis

Answer 183

``` high ADH secretion LP - increased CSF protein antibodies present nerve conduction studies ECG MRI to exclude other causes ```

Answer 184

plasma exchange, IV Ig, corticosteroids, DVT prophylaxis, ITU for ventilation and intubation, pain relied, physio, nasogastirc feeding if swallowing problems, counselling

Answer 185

good, but 10% die from resp failure, pulmonary emboli, infection or prolonged paralysis poorer prognosis if old, rapid progression of symptoms, prolonged ventilation, preceding diarrhea, muscle dysfuction

Answer 186

variant of Guillain Barre syndrome that affects cranial nerves to the eye muscles and presents with opthamoplegia and ataxia

Answer 187

``` AIDP (95%) AMSAN (GM1, GM1b and GD1a) AMAM ASN acute pandysautomina ```

Answer 188

aka temporal arteritis - granulomatous arteritis with inflammed medium and large arteries leading to occlusion o the lumen leading to ischemia of the optic nerve

Answer 189

over 60s, related to polymyalgia rheumatic in 50% of cases

Answer 190

fever, fatigue, headache, SCALP PAIN, headache in front or on temples, JAW PAIN and claudication, diplopia, ptosis, blurred vision, amaurosis fugax, symptoms develop quickly, tenderness of temporal artery

Answer 191

jaw claudication and pain, scalp pain

Answer 192

biopsy of temporal artery to confirm with GRANULOMATOUS CHANGES, elevated inflammatory markers, increased platelets and alkaline phosphate, decreased Hb, normonchromic, normocytic anaemia

Answer 193

prednisolone immediately during biopsy, high dose methylprednisolone injection then prednisolone tablets, start high dose and then decrease, low dose aspirin, PPI to protect against stomach ulcers, immunosuppressants during prednisolone reduction, gastric and bone protection

Answer 194

irreversible bilateral visual loss, CV disease

Answer 195

paroxysm of intense, sudden, stabbing pain in trigeminal never distribution from compression of the trigeminal nerve where it enters the brainstem, this pressure wears away at the myelin sheath causing uncontrollable pain

Answer 196

intense, sharp jabbing pain in forehead, cheek or jaw, dental pain, pain on one side of the face

Answer 197

MS, tumours on the nerve, compression of the nerve by a small artery or vein as it leaves the brain stem

Answer 198

mandibular, maxially and opthalamic (least common) the pain is usually in 1 or 2 of the divisions

Answer 199

washing the affected area, shaving, eating, talking, dentist, kissing, cold breeze, head movement, vibrations, hot or cold food, caffeine

Answer 200

root canals

Answer 201

rule out other conditions with MRI and history

Answer 202

anticonvulsants e.g.carbamazipine to relieve nerve pain and slow down electrical impulses in the nerves and reducing the ability to transmit pain, it becomes less effective over time gabapentin, phenytoin thermocoagulation of the trigeminal ganglion or section of the sensory division microvascular decompression to seoarate vessels from nerve root stereotactic knife surgery - effective but has complications of facial numbness, hearing loss, stroke and death injection of glycerol into the nerve

Answer 203

tiredness, dizziness, confusion, nausea, double vision, leukopenia, depression

Answer 204

rare combination of numbeness and continuous pain in trigeminal neuralgia, it is virtually untreatable

Answer 205

Gasserian ganglion

Answer 206

neurodegenerative disease cauign atrophy and neruonal loss of striatum and cortex, leading to depletion in GABA and ACh, also increasing lenght of CAG triplet

Answer 207

a increased in length of a cysteine-adenosine-guanine triplet repeat in the huntington gene on c4, the longer the repeat the earlier the onset of the disease

Answer 208

1/10,000, it is familial, autosomal dominant, 50:50 change of passing it on

Answer 209

clumpsy, restless, muscle twitches and spasms, become more difficult to perform tasks, CHOREA poor communications and starting conversations and undersatnd poor attention spam and memory depression, apathy, change in sexual behavior, anxiety, aggressive,

Answer 210

30-60years, 6% are juvinile though, people die 10-20 years after diagnosis

Answer 211

a normal huntington gene has 20 or less CAG repeats but in Huntington's disease there are 3 types: 1 - 27-35 repeats 2 - 36-39 repeats 3 - over 40 repeats all the repeats code for a mutant huntington gene with long sticky tail of glutamine which all stick together and form clumps which end up in the nucleus and is thought to disrupt signals and kills cells the more repeats, the earlier the onset

Answer 212

no treatment so aim to relieve symptoms, healthy lifestyle, SSRIs for depression, speech and physical therapy, occupational therapy, benzodiazepienes for chorea, levodopa and dopamine agonists for bradykinesia and rigidity genetic testing, counselling and education

Answer 213

parkinsonian features, dystonia, pyramidal tract signs, dementia, epilepsy, mild or absent chorea, behavioural and learning difficulties

Answer 214

a mini/warning stroke, normally last less than 5 minutes and symptoms resolved in 24 hours, caused by brief ischemia from a block blood vessel to the brain, it is not long enough to cause permanent damage

Answer 215

age, FH, male, alcohol, hypertension, smoking, hyperlipidaemia, DM, obesity, high fat diet, stress, emoboli, south asian, african, caribbean

Answer 216

emboli in carotid artery with existing stneosis and plaques, leads to impaired perfusion of the brain

Answer 217

contralateral hemiparesis (weakness on opposite side of body), dysarthria (slurred sppech), vision problems, gait disturbance, carotid bruit from atherosclerosis, increased BP, heart murmur

Answer 218

atherothromboembolism, caridoembolism, mural thrombus post MI or in AF, valve disease, prosthetic valve, hyperviscosity, polycythamia, sickle cell anemia,, leukostasis, myeloma, vasculitis

Answer 219

hypoglycaemia, migraine aura, focal epilepsy, hyperventilation

Answer 220

carotid US, CT of head, test for hypertension , diabetes, cholesterol, ECG, eye exam, doppler and angiography

Answer 221

prevent stroke - antiplatelets, aspirin, warfarin, clopidogrel, statins for cholesterol, carotid endarterectomy to remove plaque and correct stenosis, intraoperative transcranial Doppler to monitor middle cerebral artery flow, healthy lifestyle, avoid driving for 1 month, antihypertensives, stop smoking and drinking

Answer 222

caused by an emboli passing into the retinal artery and causes a temporary loss of vision in one eye due to lack of blood flow to the retina

Answer 223

ABCD2 risk >60(1), BP>140mmHG or 90mmHg diastole(1), unilater weakness(2), speech distubrance without weakness(1), >60mins(2), 15-59mins(1), diabetes(1)

Answer 224

an inflammation of the lepto meninges and underlying subarachnoid CSF

Answer 225

adults - strep. pneumoniae, neisseria meningitis, listeria monocytogenes kids - listeria monocytogenes, pneumococcus, neisseria meningitis neonates - group b strep, e.coli elderly - listeria monocytogenes mainly viral > bacterial > fungal aerobic gram negative bacilli associated with trauma/neurosurgery

Answer 226

immunocompromised, C5-C9 deficiency, injections, VP shunts, splenectomy, transplants, in crowds, DM, alcoholic, cirrhosis, infection, surgery, itrathecal durgs, tumours, SLE,

Answer 227

fever, vomiting, severe headache, stiff neck, dislike of bright lights, seizures, rash, very sleepy/difficult to stay awake, confused/delirious, altered mental sate, non blanching petechial and purpric skin rash, cold hands and feet, papiloedema, Kernigs sign (inability to extend knee when hip is flexed), Brudzinski sign (spontaneous flexion of the hip with active flexion of the neck)

Answer 228

infections in head and neck e.g. pharygitis

Answer 229

VZV, HSV, HIV, priors

Answer 230

botulism, tietanus

Answer 231

Guillian Barre, post infection, ADEM, HLE

Answer 232

CBC w/diff, Chemo10, 2 blood cultures, CT head no contrast (but dont do if no focal neurological findings), LP (but obtain CT first if needed to identify ICP) and CSF studies, gram stain, HSV PCR, cryptococcal Ag, TB PCR, fungal PCR

Answer 233

cloudy/yellow, increasing opening pressure, increased protein, decreased glucose, increased WBC (PMN), gram positive

Answer 234

cloudy/clear, gram negative, increased lymphocytes

Answer 235

cloudy/straw, increased opening pressure, increased protein, gram negative, lymphocyes

Answer 236

hydrocephalus, abscess, cerebritis and cranial nerve lesions, thrombosis, infarct, ventriculitis and ventriculopathy, extra axial collections, seizures, DIC, septic shock, SIADH, decreased hearing

Answer 237

malaria, encephalitis, septicaemia, subarachnoid haemorrhage (have blood in csf), dengue, tetanus

Answer 238

IMMEDIATE ANTIBIOTICS (55 or immunocompromised = cefotaxime and amoxicillin due to listeria risk) - they must be able to pass the blood brain barrier aciclovir is encephalitis suspected IV fluids and inotropes if septicaemia TB meningitis treated for 9 months dexamethasone if pneumococcal menigitis vancomycin added if travelled to area of increased pneuomococcal resistance ganciclovir for CMV infectiosn corticosteroids if hearing loss and neurological sequelae benzylpenicillin if penicillin sensitive organiism

Answer 239

pneuomococcal meningitis

Answer 240

a skin rash caused by infection of the herpes zoster virus (also causes chicken pox)

Answer 241

pain that precede the rash and rash in a cluster or band, headache, burning/itching in affected skin, fever

Answer 242

when the herpes zoster virus becomes reactivated, it normally is dormant, but become reactivated during lowered immunity during stress,

Answer 243

initial red blotches on the skin, just develops into itchy blisters which contain the virus, eventually they become yellow, flatten and dry out, leaving a scab

Answer 244

when it affects one of the eyes when the reactivated virus is in the trigeminal nerve, causing rash over forehead, nose, eye, conjunctivitis, red eye and vision problems

Answer 245

not sharing towels, dont swim or play contact sport, avoid work if rash is weeping and cannot be covered, avoid pregnant women who haven't had it yet, avoid immunocompromised

Answer 246

antiviral medications e.g.acyclovir, preferably become blisters appear prednisolone, analgesics, cool wet compresses zinc containing ointment to dry the blisters loose fitting clothing anticonvulsants relieve nerve pain

Answer 247

decreased GFR, vomiting, encepahlopathy, urtcaria, nausea, abdominal pain, dizziness

Answer 248

postherpetic neuralgia (severe nerve pain) and intense itching even after rash is gone, pain is in affected dermatomes, can last years and it is intolerable opthalamic shingles, ramsay hunt syndrome, infection, scarring,

Answer 249

inflammation of the brain normally due to an infection which can lead to brain damage, swelling, pressure and death

Answer 250

exposure to viruses

Answer 251

young or elderly

Answer 252

herpes simplex virus, varicella zoster virus, CMV, EBV, HIV, measles, mumps, rabies, japanese B encephalitis, west nile tick, tick borne encephalitis

Answer 253

bacterial meningitis, TB, thyphus, malaria, listeeria, Lyme disease, post vaccination, autoimmune ecephalitis, legionella, cryptococcus, vaccination, sphyllis, roundworm

Answer 254

fever, headache, nausea, vomiting, joint pain, seizures, focal neurological deficits, confusion, change in personality, photophobia, hallucinations

Answer 255

subacute sclerosing panencephalitis, progressive multifocal leukodystrophy, chronic progressive HIV encephalitis

Answer 256

LP - increased CSF protein and lymphocytes, decreased glucose culture and PCR of HSV within CSF increased mononuclear cells EEG - shows diffuse abnormalities CT contrast - focal bilateral temporal lobe

Answer 257

acyclovir within 30 mins for 14days (21days if immunocompromised), supportive therapy, antibiotics, immunoglobulin therapy, plasmapheresis, corticosteroids if autoimmune, sedatives for irritability, physical/speech therapy, immunosuppressants, symptomatic treatment

Answer 258

70% mortality in untreated, 20% mortality in treated normally lasts for 1-2 weeks, but can take several months to revocer probable reactivation

Answer 259

permanent brain damage, affecting hearing, memory, msucle control, sensation, speech and vision, personality changes, epilepsy

Answer 260

the rhabdovirus RNA virus, transmitted by saliva of animals, which spreads to the CNS via peripheral nerves and forms Negn bodies, it replicates in the grey matter then trans-located to tissues and salivary glands

Answer 261

prodomal stage - fever, jeadache, malaise, hyperaethesia at bite site encephalitis - excitation, hallucinations, lucent period brain stem dysfunction, cranial never involvement, salivation, hydrophobia

Answer 262

biopsy nape of neck or corneal impression smear of fluorescent antibody, salivary viral culture, PCR investigated, non specific serology

Answer 263

exposure prophylaxis, local wound cleaning, vaccine,

Answer 264

viraemia, types 1, 2 and 3, transmitted by faecal oral route, crosses the blood brain barrier causing meningocephalitis with destruction of motor nuceli of anterior horn of brain stem and spinal cord

Answer 265

paralytic poliomeylitis, asymeme flaccid paralysis, respiratory muscle involvement

Answer 266

vaccine with life attenuated types 1, 2 and 3, inactivated polio vaccine, 3 doses, boosters

Answer 267

reactivation of latent infection, seroprevalence rates 15-50%, CD4 usuallu

Answer 268

ganciclovir

Answer 269

clostridium tetani, a soil organism infecting via dirty wounds, terminal spore, gram positive anaerobe, ubigulitis, toxin secretor (tetanospasmin) and translocates via the peripheral nerve, binds to GABA receptors of inhibitory interneurone

Answer 270

parasthesia of wound, lock jaw, sustained muscle contractins, involvement of facial muscles, paraoxysmal generalised spasm, autoimmune dysfunction

Answer 271

debride wound, benzyle penicillin, human tetanus immunoglobulin, control spasm with dantolen, baclofen, control hypertension, ITU, airway mangement, tetanus toxin vaccination, 3 doses, signle booster

Answer 272

clostridium botulism, spore former, anaerobe, e.g. cans, a neurotoxin seen in IVDU with contaminated heroin, incubation of 18-36 hours

Answer 273

descending paralysis with cranial neuorpathy first, diplopia, dysrathria, dysphagia peripheral weakeness

Answer 274

equine of human antitoxin

Answer 275

acute lower back pain precedes then neurological deficits, neuropathic pain, motor and autonomic dysfunction e.g. sensory loss below lesions (one or 2 segments below), tone and reflexes reduced, leg weakness and sensory loss, arm weakness is less severe

Answer 276

MRI - show site of compression CXR - shows degenerative bone disease and destruction of vertebrae by infection of neoplasm biopsy and surgical exploration serology, ESR, FBC, syphillis serology, serum electrophoresis

Answer 277

cancer patients do to the rich venous plexus which increases haematogenous spread to metastases to the spine

Answer 278

bladder dysfunction, sphincter disturbance, saddle anesthesia (numbess to perineal area), bilateral lower extremity weakness can lead to complete paralysis

Answer 279

malignancy - dexamethasone IV to reduce oedema around lesion and improve outcome before radiotherpay and chemo with decompressive laminectomy epidural abscesses surgically decompression antibiotics anti inflammatories

Answer 280

it is the nerve roots caudal to the spinal cord temination, provides sensory and motor innervation to the hip muscles, lower extremity muscles, urinary and anal sphincters and muscles for sexual function

Answer 281

compression of the spinal cord or spinal damage from L2 down,

Answer 282

lumbar disc prolapse from lumbar disc herniation at L4/l5 and L5/S1

Answer 283

disc herniation, lumbar stenosis, trauma, neoplasm, infection, abscess, inflammatory disease, CIDP, pagets, ankylosing spondylitis, post operative haematoma, spondylolisthesis, sarcoidosis, congenital lumbar disease

Answer 284

depend on where the lesion is compressing the nerves - weakness, anesthsia/sensory deficiency, pain, paraesthesias, loss of sphincter tone resulting in incontinence, sexual problams, fasciculations, reduced of absent DTRs, saddle numbness, back pain and radicular pain down the legs, sexual dysfunction, reduced cremasteric reflex, reduced sensation over particular dermatomes

Answer 285

``` MRI to determine level of compression CXR CSF analysis if meningismal Myelography and CT urodynamic studies to monitor recovery of bladder function post decompression studies ```

Answer 286

conus medullaris syndrome, mechanical lower back pain, prolapsed lumbar discm fracture of lumbar verterbraw due to trauma, spinal tumour, spinal cord compression, peripheral neuropathy, guillain barre syndrome, amyoropjhic lateral sclerosis, MS, diabetic neuropathy, spinal neoplasm

Answer 287

age, cancer patient, trauma,

Answer 288

based on underlying cause, referred to specialist, surgical intervention for trauma, rehabilitation, anti inflammatories, physio, chemo and radiotherapy, lesion debulking for space occupying lesions

Answer 289

paralysis, sensory abnormalities, bladder bowel and sexual dysfunction,

Answer 290

based on cause, but poor treatment leads to long term bladder, bowel and sexual dysfunction, and late diagnosis leads to neurological deficit, poorer diagnosis if bilateral sciatica or complete perianal anesthesia than if it was just unilateral pain.

Answer 291

cluster of degenerative disease with selective loss of neurons in the motor cortex, cranial nerve nuclei and anterior horn cells, upper and low motor neurons are affect but no sesnory loss of sphincter disturbance

Answer 292

MS has sensory and motor loss and causing sphincter disturbance and MDN only affects motor and no distubrance

Answer 293

MND never affects eye movements unlike MG

Answer 294

1 - progressive muscular atrophy - LMN lesion, causing weakness, wasting and fasciculation (spontaneous, irregular and brief contractions of part of a muscle) in hands and arms, affects distal first 2 - amyotrophic lateral sclerosis - combination of lateral corticospinal tracts and anterior horn cells producing progressive spastic tetraparesis or paraperesis UMN signs with added LMN signs 3 - progressive bulbar and pseudobulbar palsy - from destruction of UMN and LMN in lower cranial nerves with dysarthria, dysphagia, wasting and fasciculation of the tongue, cranial nerves 9-12 4 - primary lateral sclerosis - rare with progressive tetraparesis, loss of Betz cells in motor cortex so mainly UMN signs with spastic leg weakness and pseudobulbar palsy, no cognitive decline

Answer 295

5-10% familial, trauma, electric shocks, infection events at the ALD-FTD locus explain 87% of familial ALS and is autosomal dominant

Answer 296

5/100,000 and rare below 30, increasingly common over 50, often fatal within 2-4years

Answer 297

bulbar onset, increased in age, decreased FVC, split hand sign with thumb adrift due to wasting around it

Answer 298

spasticity, brisk reflexes, increased plantars

Answer 299

signs, wasting, fasciculation on tongue, abdomen, back, thigh

Answer 300

diagnosis is clinical, fasciculation is characteritic EMG shows muscle denervation MRI excludes structural causes LP excludes inflammatory causes

Answer 301

cervical spine lesion, idiopathic multifocal motor neuropathy

Answer 302

Riluzole - a sodium channel blocker that inhibts glutamate release, slow progression slightly propantheline and amitriptyline for drooling ventilatory support helps prolong survival and for resp failure feeding via PEG helps dysphagia spasticity drugs neurlogists, dietitian, physio, speech therapist, palliative care

Answer 303

vomiting, increased pulse, somnolence, headache, vertigo and increased LFTs

Answer 304

rare disorder which detroys anterior horn cells of the spinal cord, slowly progressive with symmetrical wasting weakness of the limbs

Answer 305

sensory (affects touch, temperatire, pain and other sensations), motor (affects movement) and autonomic (affects involuntary bodily processes can have a combination of them at one time e.g. sensorimotor polyneuropathy

Answer 306

group of conditions in which the periopheral nervous system is damaged

Answer 307

tingling in the affected body part, numbeness, reduced feeling of pain and changes in temperature (feet), burning/sharp pain in feet and legs, allodynia (pain from light touch), loss of balance or coordination

Answer 308

twitching, muscle cramps, muscle weakness and paralysis, muscle wasting, foot drop

Answer 309

depends on location, constipation, diarrhea, nausea, bloating, hypotension, tachycardia, excessive or lack of sweating, sexual dysfunction, bowel incontinence, dysphagia

Answer 310

affects a single nerve caused by acute compression, particularly where the nerves are exposed anatomically or entrapment where the nerve passes through a relatively tight anatomical passage (carpal tunnel) or caused by direct damage

Answer 311

carpal tunnel syndrome, leading to tingling, pain or numbness in the fingers due to irritation of the median nerve

Answer 312

a systemic disorder, when 2 or more peripheral nerves are affected and it is a systemic cause

Answer 313

tingling, numbness and pin i the thumb, index finger, middle finger and half of ring finger discomfort in hand and arm, paraesthesia in hand, dry skin, swelling, hypoaesthesiia, atrophy of muscles, worse pain on repetitive use or in same position, impaired dexterity, drop things a lot, Tinnel's sign

Answer 314

25% FH, pregnancy, menopause, injuries to wrist, manual labour, playing an intrument, diabetes, arthritis, hypothyroidism, obesity in the young, breast cancer medications, abnormal wrist structure

Answer 315

assess ability of hand and arm, look for weakness and wasting around thumb, Tinnel's sign, flexing wrist or holding above head will cause pain, nerve conduction study, EMG, x-ray, US of median nerve

Answer 316

avoid triggers, treat underlying cause, wrist splint to prevent bending of wrist which can aggrevate symptoms, no direct pressure on it, corticosteroids for inflammation (tablets of injection into wrist), carpal tunnel decompression surgery

Answer 317

infection, recurring pain, scarring, nerve injury, post op bleeding, failure to separate root of carpel tunnel resulting in persistent symptoms

Answer 318

symmetrical disease process, can be sensory, motor or autonomic, and leads to symptoms of numbness, tingling, pins and needles, pain in extremities, unsteadiness of feet, weakness, postural hypotension, urinary retention, erectile dysfunction, diarrhea, dimished sweating, impaired pupillary reponses, cardiac arrhythmias

Answer 319

DM, guillain barre sundrome, toxins, vitamin deficiency, leprosy, renal failure

Answer 320

FBC, ESR, serum vit b12, glucose, urea, electrolytes, LFTs, nerve conduction tests

Answer 321

chronic alcohol dependent patients when little food is consumed, starvation, beriberi

Answer 322

Wernicke Korsakoff syndrome, polyneuropathy and cardiac failure

Answer 323

thiamin for 3 days, anaphylaxis in parenteral thiamin, given before IV glucose in high risk patients

Answer 324

isoniazid therapy for TB, give prophylactic pyridoxine with isoniazid, it mainly cuases a sensory neuropathy

Answer 325

polyneuropathy with subacute combined degeneration of the cord, distal sensory loss, absent ankle jerks, evidence of cord disease

Answer 326

IM vit B12 to reverse peripheral nerve damage but has little affect on the CNS

Answer 327

large and complex group with variable mutations, most common being Charcit-Marie-Tooth disease (peroneal muscular atrophy)

Answer 328

distal limb wasting and weakness that progresses over many years, mostly in legs with variable loss of sensation and reflexes, legs can resemble inverted champagne bottles due to the wasting

Answer 329

progressive and reversible

Answer 330

symmetrical sensory polyneuropathy and autonomic neuropathy

Answer 331

acute painful neruopathy, mononeuropathy and mononeuritis multiplex with cranial nerve or isolated peripheral never lesions, diabetic amyotrophy

Answer 332

occlusion of the vase nervorum (small arteries that supply the peripheral nerves)

Answer 333

accumulation of fructose and sorbitol (metabolized from glucose in the peripheral nerve) which disrupts the structure and function of the nerve

Answer 334

symmetrical mainly sensory neuropathy

Answer 335

affects the feet first, loss of vibration sense, pain sensation and temperature sensation in the feet, then 'walking on cotton wool' and lose balance due to impaired proprioception, hand involvement is uncommon.

Answer 336

trauma, blistering from ill fitting shoes causing ulceration, abnormal mechanical stress, repeated minor trauma, neuropathic arthropathy (Charcot's joints) in ankle and knee, distorted foot with high arch, clawing of toes, insensitive foot ulceration

Answer 337

burning or crawling pains in lower limbs, worse at night and with bed clothes pressure, treat with good diabetic control, tricyclic antidepressants, gabapentin and carbamazepine

Answer 338

3rd and 6th, which supply the extraoccular muscles, presenting with unilateral pain, ptosis and diplopia with sparing of pupillary function

Answer 339

painful wasting, usually asymmetrical, or quadriceps, wasting may be marked and knee reflexes may be diminished or absent

Answer 340

affects CV system (tachycardia, loss of sinus arrhythmia, postural hypotension, peripheral vasodilation), GI (diarrhea, gastroparesis and intractable vomiting), bladder (incomplete emptying) and male ED - treatment is symptomatic

Answer 341

treat symptoms, physio, splints, viagra, male prosthesis, catheter, botulinum toxin, stand up slowly, amitiptyline, duloxteine, pregabalin, tramadol, lidocaine plasters

Answer 342

a rapid onset of neurological deficit caused by blood flow to the brain being stopped by a blockage or rupture

Answer 343

ischemia - caused by blockage from emboli of thrombus haemorrhagic - caused by breakage in blood vessel in the brain of the membrane surrounding the brain intracranial venous thrombus - caused by space occupying lesion in the brain e.g. tumoru, abscess, MS carotid or vertebral artery dissection - allowing blood to track the wall of the artery and occlude the lumen - 20% of young strokes

Answer 344

a completed stroke has reached it's maximum in 6 hours, turns into evolution when the signs and symptoms are getting worse, usually within 24 hours of onset

Answer 345

patient recovers without a significant neurological deficit and recovers in about 1 week

Answer 346

difficulty walking, loss of balance and coordination, dysarthria and difficulty understanding, unilateral face paralysis and weakness, blurred or darkened vision, sudden headache with nausea, vomiting and dizziness

Answer 347

sensory loss, hemiplegia, dysphagia, homonymous hemianopia, visual spatial deficit

Answer 348

quadriplegia, disturbances of gaze and vision, locked in syndrome

Answer 349

ataxic hemiparesis, pure motor, pur sensory, sensorimotor and dysarthria

Answer 350

hypertension, DM, smoking, hyperlipidaemia, obesity, oestrogen containing oral contraceptive, excessive alcohol consumption, polycythaemia, atrial fibrillation, migraine, vasculitis, cocaine, antiphospholipid syndrome, thrombophilia

Answer 351

check reflexes, vision, speaking and senses, check for carotid bruit which indicated abnormal blood flow, blood tests, angiogram to find location of black, carotid US, CT, MRI, ECHO, carotid artery stenosis, doppler uS (>70% stenosis is significant), vasculitis shows increased ESR and ANA positive, hyperviscosity with polycythaemia and sickle cell disease

Answer 352

difficulty speaking, moving, thinking which can improve but others need care, aspiration pneumonia, contractures, depression, constipation, stress in spouse

Answer 353

protect airway, urgent CT/MRI, thrombolysis, nil by mouth, hydrate, antiplatelets

Answer 354

control risk factors, antihypertensives, treat DM and hyperlipidaemia, exercise, folate supplements, smoking cessation, lifelong anticoagulation if rhuematic or prosthetic heart valves, chronic non rheumatic atrial fibrillation

Answer 355

antiplatelet drugs e.g. clopidogrel monotherapy, anticoagulation, lower BP, repair ruptured blood vessel, remove blockage with clot dissolving drugs or blood thinners

Answer 356

12% die by day 56

Answer 357

migraine, cluster or tension type hemicrania continua, new daily persistant headache, chronic paraoxysmal hemicrania

Answer 358

meningitis, subarachnoid haemorrhage, GCA, idiopathic intracranial hypertension, medication overuse, low CSF pressure, post traumatic

Answer 359

>50, HIV, cancer, trauma, change in personality, vomiting, jaw claudication, severe eye pain, change in frequency, postural, sudden onset, exercise, focal neuorlogical symptoms, fever, altered consciousness, neck stiffness etc

Answer 360

subarachnoid haemorrhage

Answer 361

not benign, headache with raised ICP, visual disturbance with acuity/fields, papilloedema, normal constituents of CSF

Answer 362

obesity, drugs e.g. tetracycline

Answer 363

modify risk factors, monitor visual fields with Goldman fields, acetazolamide/topiramate/diuretics repeated LPs, CSF shunt, optic nerve fenestration

Answer 364

>50, new headache with localised pain, tenderness, decreased pulsation, raised ESR, abnormal biopsy

Answer 365

headache on 15 or more day per month

Answer 366

1/4 women and 1/12 men develop it at some point, commonly starts in childhood or as a young adult, many stop in adult life, can be several attacks a week or once every few years

Answer 367

with aura (classic) and without aura (common)

Answer 368

headache on one side of head, typically at front or side, sometimes both, then spreads all over, throbbing pain nausea, vomiting, photophobia, being off food, blurred vision, poor concetration, stuffy nose, hunger, abdo pain, pale, sweating

Answer 369

most often in morning, but can be at any time, then gradually gets worse and peaks 2-12 hours after and then eases off, can last from 4-72 hours

Answer 370

a warning sign before a migraine, which can be visual, numbness, speech, smells etc lasts a few minutes but can last up to an hour, then the migraine develops soon after

Answer 371

visual aura - temporary loss of vision, flashed of light, objects rotate, shake or boil numbness, pins and needles, travel up the arm and involve face, lips and tongue problems with speech old smells, food craving, feeling odd

Answer 372

irritability, aura, headache, irritable

Answer 373

menstrual - only during periods abdominal - in children, with nausea, and turns to normal migraine in later years ocular - temporary loss hemiplegic - severe, on one side of the body, can cause severe dizziness, double vision, hearing problems basilar type - in the back of the head

Answer 374

narrowed blood vessels in the brain, which then soon dilate, causing the headache

Answer 375

increased signals in the brain, confusing the brain, familial, dieting too fast, irregular meals, smokey rooms, glaring light, flickering TV, loud noises, depression, tiredness, stress, HRT, contraceptibe pill, periods, shift work, bad sleep patterns, menopause

Answer 376

paracetamol, aspirin, NSAISs, anti emetics, oral triptam medicine e.g. almotriptan which interfere with 5HT (don't take too early on in attack though), CI in pregnant women, even though migraine can rarely be worse in pregnancy but migraine improves in most cases with pregnacy and breatfeeding

Answer 377

topiramate or propanolol, acupuncture, amityriptaline, riboflavin, botulinum toxin type A

Answer 378

the most common type of headache, 50% of adults have it at least every month and 1/30 adults have chronic tension type headaches

Answer 379

episodic = occur on less than half of the days in the month chronic = occur more than half of the days in the month

Answer 380

band across the forehead, uncomfortable, tiring, worse on activity, sensitive to light and noise, sore neck

Answer 381

from few hours to several days, usually a few hours, they don't disturb sleep and most people can work through them, you are normally well in between headache

Answer 382

tightness of neck muscles or ones over the scalp, poor posture, stress, anything that can make the back of the neck muscles tense, may be more genetically prone to develop them due to being stressed and anxious, painkillers too often due to increasing the number of pain receptors in the head and they become excessively sensitive

Answer 383

significant head injury in past few months, pain getting worse, accompnaying fever, problems with speech, balance or memory, headache start when coughing/sneezing, worse when sitting or standing, red or painful eyes, worse headache than ever, low immunity, previous cancer

Answer 384

exercise, change routine, shoulder massage, hot flannel on neck, warm batch, less caffeine, balanced diet, more water, less pillows, avoid excessive noise and reading in low light, diary of frequent headaches, avoid stress triggers

Answer 385

paracetamol but not for more than a couple of days at a time, codeine, amitriptyline

Answer 386

severe unilateral pain, localised in or around the eye with ipsilateral autonomic features, rare

Answer 387

occurs in periods lasting from several days to one year, usually 2-9 weeks, separated by pain free periods of a month or longer

Answer 388

CHs occuring for one year without remission or short lived remissions of less than a month (can start as this or develop from episodic)

Answer 389

rare, 1/1000, more men than female, with a bigger difference between them in chronic then episodic but episodic being more common overall, usually occurs 20-40 years

Answer 390

later onset, sporadic attacks occur, higher frequency of cluster periods, shorter periods of remission

Answer 391

1/20 have a 1c family member, associated with HCRTR2 gene

Answer 392

ipsilateral hypothalamic grey matter has dysfunction causing dilation of cranial vessels mediated by trigeminoparasympathtic reflexes, changes in melatonin in relation to the light and dark cycle affect CH

Answer 393

rapid onset of pain over 10 minutes which maintains intensity, excruciating, sharp and penetrating, centered behind the eye/temple/forehead (occasional neck), unilateral pain, lacks 45-90 minutes, 1-2x/day ipsilateral lacrimation, rhinorrhoea, nasal congestion, eyelid swelling, facial sweating, flushing, conjunctival injection restless (unlike migraine), band head against wall, nausea

Answer 394

alcohol, heat, exercise, solvents, disruption of sleep habits

Answer 395

for at least 5 attacks: severe unilateral orbital, supaorbital and/or temporal pain lasting 15-180 minutes if untreated and at least one: Ipsilateral conjunctival injection and/or lacrimation. Ipsilateral nasal congestion and/or rhinorrhoea. Ipsilateral eyelid oedema.Ipsilateral forehead and facial sweating. Ipsilateral miosis and/or ptosis Restlessness or agitation. One every other day to eight times daily.

Answer 396

paroxysmal hemicrania | short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)

Answer 397

change in pattern of headache, new headache aged 50, seizures, headache with systemic illness, personality change, raised ICP symptoms, worst headache ever

Answer 398

suppress attack and reduce frequency and severity of attack

Answer 399

stop smoking, abstain from alcohol, regular sleep pattern and good hygiene acute attack - SC sumatriptam and 100% o2, antiinflammatories, lidocaine

Answer 400

verapamil, ECG monitoring, prednisolone, lithium is verapamil not effective, melatonin, sodium valproate in chronic, ergotamine before predicted attack, deep brain stimulation, trigeminal nerve blockage, acupuncture

Answer 401

constipation, flushing

Answer 402

a spontaneous arterial bleed into the subarachnoid space

Answer 403

6/100,00 pa, usually around 50years and more common in women

Answer 404

rupture of berry aneurysm (80%) or congenital arteriovenous malformations

Answer 405

sight problems, pain on one side of face or around the eye, persistent and severe headaches, painful third nerve palsy, nausea, vomiting, loss of consciousness, meningeal irritation, focal neurological signs, sub hyaloid haemorrhages between the retina and vitreous membrane with or without papilledema, coma, drowsiness

Answer 406

smoking, high blood pressure, excessive alcohol consumption, family history, bleeding disorders, mycotic aneurysm, post menopause from decrease in oestrogem, ADPKD, Ehlers Danlos Syndrome, coartation of aorta

Answer 407

CT shows subarachnoid blood, lumbar punctureshows biliruibin or oxyHb, must be at least 12 hours after symptoms so that Hb can degrade into the bilirubin and turn the CSF xanthochromic (yellow) which can then be detected by spectrophotometry of the supernatant after centrifugation, should therefore be protected from light, MRA find the source of the bleeding

Answer 408

hydrate to maintain cerebral perfusion, treat hypertension, CCB (nimodipine), analegics, anticonvulsants, antiemtics, intracranial stents, neurosurgical clipping, endovascular coiling, occupational therapist, antidepressants, CBT

Answer 409

clipping to shut off the aneurysm to prevent it growing or rupturing again coiling inserts a catheter into an artery in the leg into head and passes coils through the aneurysm so blood can't enter it again so cant rupture, it has increased survival over clipping but increased risk of bleeding

Answer 410

rebleeding (commonest cause of death), delay cerebral ischemia from vasospasm causing vessel to narrow, hydrocephalus, hyponatraemia, epilepsy, cognitive dysfunction, depression, PTSD

Answer 411

50% die suddenly or soon after haemorrhage, 10-20% from rebleeding, variable outcome, glasgow coma score on admission has the most prognostic significance which checks level of consciousness and brain injury severity (12 or more has good prognosis)

Answer 412

eye opening response, best verbal response, best motor response

Answer 413

where the blood collects in the subdural space following a rupture of a vein running from the hemisphere to the saggital sinus, increasing pressure on the brain (intracranial hypertension) causing brain damage (head injury)

Answer 414

develop soon or can be days or weeks after

Answer 415

progressively bad hangover, feeling and being sick, confusion, personality changes, drowsiness, speech problems, problems with vision, paralysis on one side of the body, problems with walking, frequent falls, seizures, loss of consciousness, localising neurlogical symptoms (unequal pupils)

Answer 416

older, blood thinning medication, drink excessively, accident prone, atrophic brains which makes the connecting veins more susceptible to rupture due to the increased tension

Answer 417

CT and MRI to rule out other illnesses shows clot and midline shift and a CRESCENT shape collection of blood over 1 hemisphere

Answer 418

surgery to remove haematoma, or if small, monitor to see if they can heal spontaneously

Answer 419

further bleeding on the brain, infection, deep vein thrombosis, seizures, stroke

Answer 420

an injury that fractures the temporal bone and ruptures the underlying middle meningeal artery causing a collection of blood in the potential space between dura and bone

Answer 421

males, rare in small children due to the plasticity of the skull, less common over 60 due to dura being tightly adherent

Answer 422

there is a brief period of unconsciousness followed by a lucid interval of recovery which can be a few hours to a few days before a bleed with decrease GCS from rising ICP with rapid deterioration with focal neurological signs and deterioration in consciousness level if surgical drainage is not immediately carried out

Answer 423

a coagulation or platelet defect

Answer 424

increasingly severe headache, nausea, vomiting, seizures, confusion, bradycardia indicating raised ICP, skull fractures, haematomas, lacerations, CSF otorrhoea or rhinorrhoea, alteration in consciousness and deterioation of the glasgow coma scle, unequal pupils, facial never injury, weakness of limbs, hemiparesis, visual field defects, numbness, coma, death from respiratory arrest

Answer 425

x ray - skull fracture, fracture lines crossing the middle meningeal vesicles ct san - haematoma LENS SHAPE (not sickle like subdural) as the tough dural attatchments to the skull keep it more localised MRI - AVOID LUMBAR PUNCTURE fbc, u and e

Answer 426

ABC, O2, full trauma assessment, IV fluids to preserve cerebral perfusion, osmotic diuretics if ICP raised, intubation and ventilation and mannitol if ICP decreased, Burr holes to evacuate haematoma, DVT prophylaxis

Answer 427

neurological deficits (temporary or permanent), death, PTS seizures 1-3 months post injury

Answer 428

post concussion syndrome which has headaches, dizziness, vertigo, restlessness, emotional liability, inability to concentrate and fatigue

Answer 429

spasticity, neuropathic pain, urinary complications

Answer 430

excellent in children, low GCS is bad prognosis, prognosis worse if older, intradural lesions, volume of haematoma, temporal location, rapid clincal porogrssion, pupillary abnormalities, increased ICP

Answer 431

0.3-0.9mm, a hypertensive hemorrhage arising from deep perforator arteries that can lead to lacunar infarct, microbleeds and hemorrhage

Answer 432

large and superficial, common in elderly people

Answer 433

warfarin check urgent INR, consider reversal with Beriplex and vitamin K, if low platelets have platelet transfusion

Answer 434

surgical decompression

Answer 435

external ventricular drain

Answer 436

deteriorating GCS, hydrocephalus, coning, large cerebellar hemorrhage >3cm, distortion of the 4th ventricle with gcs >8

Answer 437

on type of injury, distribution of the lesions, time course of damage following the traumatic event

Answer 438

``` focal: scalp - contusions, lacerations skull - facture meninges - haemorrhage, infection brain - contusion, lacerations, hemorrhage, infection ``` ``` diffuse: diffuse axonal injury diffuse vascular injury hypoxia-ischemia swelling ```

Answer 439

considerable force, increased risk of haematoma and infection and aerocele angled or pointed objects cause localised fractures that are open or depressed flat surfaces cause linear fractures that can extend into skull base and be called contrecoup factures

Answer 440

contact damage - at or just deep to point of impact acceleration/deceleration damage - causes differential movement of skull, brain and brain tissue causing traction and damage blood vessels contusions - superficial bruises of the brain, coup at site of impact/contre coup away from site of impact, first become haemorrhagic then become brown and soft then indented and cavitated after months lacerations - when the contusion is sufficientlu severe to tear the pia mater

Answer 441

diffuse axonal injury - a clinicopathological syndrome of widespread axonal damage diffuse traumatic axonal injury traumatic axonal inury - involving acceleration and decelaration axonal injury swelling - increasing ICP, caused by vasodilation, increased cerebral blood volume, extravasation of oedema fluid from damaged vessels, increased water content of neurons and glia hypoxia-ichemia - diffuse vasuclar injury - results in near immediate death, multiple petechial hemorrhages throughout the brain

Answer 442

bleeding and brain swelling

Answer 443

can be a depressed injury that does not penetrate the skull, penetrating injuries, or perforating injuries

Answer 444

a neurodegenerative condition seen 8-10 years after repetitive mild traumatic brain injury, 1/3 are progressive initally irritability, impulsivity, aggression, depression, memory loss e.g. dementia, gait, speech problems, parkinsonism

Answer 445

an atrophic neocortex, hippocampus, diencephalon and mamillary bodies enlarged ventricles with fenustrated cavuum septum tau positive neurofibrillary and astrocytic tangles frontal and temporal cortex and limbic regions especially around depths of sulci and limbic regions

Answer 446

a state of abnormal muscle tone resulting in muscular spasm and abnormal posture usually caused by a neurological disease, side effect of drug therapy and trauma

Answer 447

either subnormal muscle spindles responsiveness to stretch improves with fatigue of the muscle or subnormal responsiveness of the CNS to the afferent input improves after fatigue of muscle

Answer 448

result of presynaptic neuron loss and post synpatic receptor supersensitivity

Answer 449

leg weakness, sensory disturbance in legs, gait apraxia, truncal ataxia, incontinence, drowsiness, akinetic mutism, decrease in spontaneous speech, stuporus state

Answer 450

contralateral arm and leg weakness, contralateral sensory loss, hemianopia, aphasia, dysphasia, facial droop

Answer 451

contralateral homonymous hemianopia, cortical blindness with bilater involvement of the occipital lobe branches, visual agnosia, prosopagnosia, dyslexia, anomic, aphasia, colour naming, discrimination problems, unilateral heaches

Answer 452

motor deficits, dysarthria, speech impairment, vertigo, nausea, vomiting, visual disturbances, altered consciousness

Answer 453

muscle fibres, which are long multinucleated structures bound by sarcolemma

Answer 454

the contractile element within the myofibre, with thin (I actin) or thick (A myosin) filaments, they are multinucleated and bound by sarcolemma

Answer 455

excitation force along the whole length simultaneously, and release calcium from SR, it is a T tubule system with invaginations of sarcolemma

Answer 456

loss of structural proteins, defective enzymes, disruption of sarcolemma repair, loss of signalling molecules, non coding region mutations, defective post translational modifications

Answer 457

a group of familial disorders causing replacement of muscle tissue with fibrous connective tissue causing progressive muscle weakness and muscle wasting

Answer 458

X linked inheritance (Xp21), muscle degeneration, large deletions and duplications and point mutations disrupting the reading frame causing absence of dystrophin (which connects cytoskeleton to ECM to protect the muscle during force of contraction)

Answer 459

DMD 1/3500 males, manifesting at 5 years of age, leading to wheelchair dependence by 13, survival is rare over 30

Answer 460

muscle degeneration, thin weak thighs, tip toeing, weak stomach muscles causing stomach to protrude out, shoulders and arms back awkwardly, swayed back, weak butt muscle pushing body out further, thick calves from fat, tight leg muscles, poor balance, awkward walking, cardiac involvement

Answer 461

DMD but less severe, slower progression, later onset in 20s, and death around 40, worse cardiac involvement

Answer 462

autosomal dominant, with a CTG trinucelotide repeat expansion in DMPK on c19, most common muscular dystrophy in adults mutation causes RNA toxicity, downstream, effect causing missplicing of proteins, the CLCN1 is misspliced

Answer 463

sustained involuntary contraction (difficult releasing grip after hand shake) as the muscles are still contracting, prominent forehead, narrow face, boldness, cataracts, poorly developed chin, dysphagia and difficulty breathing, diabetes, frontal balding

Answer 464

supportive, scoliosis corrective surgery in children, manage heart problems, NIV for resp failure, steroids (prednisolone with slows down disease progression given when motor functions plateau), gene therapy (anti sense oligonucleotides weekly sc injections to promote ribosomal read)

Answer 465

supportive, treat cardiac complications, experimental AON knows down expansions, fleicanide of mexilitine for symptom relief of myotonia

Answer 466

autosomal dominant, presenting at 20 years, 20% need a wheel chair, normal life expectancy, contraction in macrosatallite repeat D4Z4 on 4q35, only occurs if polyadenylated, usually 11-100 repeats but only

Answer 467

scapular fixators and ankle dorsiflexor weakness, retinal telangectasia and sensorineural hearing loss

Answer 468

sudden onset, in response to injury and infection which resolves as the condition resolves, recurrent acute pain is not chronic pain

Answer 469

a neurological condition resulting from damage to or dysfunction of the sensory nervous system, persists in the absence of tissue damage

Answer 470

burning hot and cold sensations, electric shocks, shooting pains, deep severe ache, poorly localised, numbness, paraesthesiae, recognisable dermatomal pattern, skin area may be hypersensitive, exacerbated by contact with hot or cold air, worse at night, distracted by activity associated with depression

Answer 471

cultural beliefs, ongoing litigation, claims, benefits, work pressures, social circumstances, family support

Answer 472

poorly understood level of damage to sensory pathway, pain fibres small unmyelinated C fibres, increased afferent activity or increased synaptic transmission at level of spinal cord in pain pathway

Answer 473

neuralgia, neuropathy, hyperalgesia, causalgia, hyperpathia, allodynia, lumbagp

Answer 474

try and find cause, neurological examination to identify nerve root compression, X rays, MRI spine, serology, MDT approach, pain management programme, reassurance, encourage activities, exercise drugs - opioids (pre synaptic inhibition), antidepressants, anti convulsants, N-Methyl D-aspartate receptor antagonists (pre synaptic excitation) nerve blocks to support physiotherapy and increased activities, TEN stimulators, spinal cord nerve stimulator implantation, dorsal column fiber ablation capsaicin topical cream and lignocaine gel, acupuncture

Answer 475

regional blocks as an adjuvant to surgery to reduce post amputation phantom limb pain, peri operative gabapentin or pregabelin, holistic approach to surgery

Answer 476

tolerance, increased metabolism, down regulation of opioid receptors, neuroplasticity of CNS target areas

Answer 477

the brachiocephalic trunk dividing into the right common carotid and subclavian arteries and the aortic arch splits into the left common carotid, subclavian and vertebral

Answer 478

cervical - no narrowings, dilations or branches, lies posterior and lateral to ECA at origin, ascending behind then medial to the ECA petrous - penetrates temporal bone, running horizontally in the carotid canal, small branch to middle/inner ear, vidian artery to ECA cavernous - turns superiorly at foramen lacerum entering cavernous sinus, piercing dura, small branches supply dura, cranial nerves 3-6 and posterir pituitary, and connects to ECA via ILT supraclinoid - opthalmic artery (to optic canal), superior hypophyseal (to pituitary gland, stalk, hypothalamus, optic chiasm), posterior communicating artery and anterior chorodial artery (choroid plexus, optic tract, cerebral peduncle, internal capsule, medial temporal artery)

Answer 479

the lateral lenticulostriate arteries (lentiform nucleus, caudate nucleus, internal capsule), insular cistern, onto brain surface to supply vessel on brain surface

Answer 480

medial lenticulostriate arteries to supply head of caudate nucleus and internal capsule, recurrent artery of Heubner, cortical branches from calllosomarginal and pericallosal arteries

Answer 481

neck muscles, spinal meninges, spinal cord, anastomoses with other neck vessels

Answer 482

the subclavian arteries (left can arise directly from arch)

Answer 483

anterior spinal artery, small meduallry perforators and posterior inferior cerebellar artery to supply the medulla and the inferior cerebellum

Answer 484

cortical territories including the inferior temporal lobe, posterior third of the interhemispheric surface and visual cortex and occipital lobe

Answer 485

``` cervial - 7 - 8 thoracic - 12 - 12 lumbar - 5 - 5 sacral - sacrum - 5 coccygeal - coccyx - 1 ```

Answer 486

grey - dorsal horn, intermeddiate zone, ventral horn, lateral horn white - dorsal funiculus, dorsolateral funiculus, ventrolateral funiculus, ventrolmedial funiculus

Answer 487

white mater decreases down the spine, grey mater increased in the cervical and lumbosacral enlargements, lateral horn is present in the thoracic and upper lumbar segments

Answer 488

monosynaptic reflex, important postural reflex, basis of tendon jerk

Answer 489

polysynaptic reflex, withdrawal of a limb in response to pain

Answer 490

receives >20,000 synaptic contacts, has primary efferent tracts from the dorsal root, with interneurons and descending tracts, primary sensory afferent neurones

Answer 491

ascending fibres, ipsilateral discriminative touch, sensation and proprioception cuneatus (lateral) - arms gracilis (medial) - legs

Answer 492

``` olfactory -s optic - s occulomotor - m trochlear - m trigeminal nerve - opthalamic, mandibular, maxially - b abducens - m facial - b vestibulacochlear - s glossopharengeal - b vagus - b accessory - m hypoglossal - m ```

Answer 493

olfaction (smell) damage causes anosmia (loss of smell) and hyposmia (reduced smell) and calcosmia (smell a bad smell always) causes by trauma, meningitis, nasal congestion, tumours on floor of anterior fossa

Answer 494

for visual acuity, colour vision damage can cause optic atrophy, visual field defects, blurred vision, scotomata (decreased vision in visual field)

Answer 495

optic and oculomotor nerve damage caused by ichemia, edema, hemorrhage and trauma

Answer 496

monocular - damage to eye or nerve bitemporal - lesion at chiasm homonymous hemianopia - lesions in tract, radiation or lesion in visual cortex

Answer 497

paracentral scotoma

Answer 498

mononuclear field loss (if complete destruction, leads to blindness and loss of pupillary light reflex)

Answer 499

bitemporal hemianopia

Answer 500

homoymous hemianopia (macular involvement)

Answer 501

homoymous quandrantopia (macular involvement)

Answer 502

homonymous quadrantopia (macular involvement)

Answer 503

homoymous hemianopia (macular sparing)

Answer 504

homoymous hemianopia (macular sparing)

Answer 505

demyelination, nerve compression, occlusion of retinal artery, trauma, papilloedeme, severe anemia, drugs, toxins

Answer 506

pituitary adenoma compressing the decussating fibres from the nasal half of each eye, craniopharyngioma, secondary neoplasm

Answer 507

tumour, vascular accident

Answer 508

in ischemic lesions due to the dual blood supply of this area from the middle and posterior cerebral arteries

Answer 509

disc oedema develops, enlargement of a blind sport and blurring of vision, leading to optic neuritis and visual loss

Answer 510

raised ICP from tumour, abscess of meningitis, retinal vein obstruction form thrombosis or compression, optic neuritis from demyelination causing inflammation or accelerated hypertension

Answer 511

bright light, stimulates the Edinger-Westphal nucleus in the midbrain (via the optic tract and the convergence centre in the midbrain) and oculommotor nerve causing contriction

Answer 512

sympathetic fibres in the hypothalamus running through the brainstem into the cervical cord and emerge in the spinal cord at T1 to ascend to the neck

Answer 513

third cranial nerve palsy, antimuscarinic eyedrops, myotonic pupil (Holmes-Adie pupil) which is a delayed/absent reaction to light and convergence seen in young women

Answer 514

parasympathetic eyedrops for glaucoma, Horner's syndrome, Argyll Robertson pupil, opiate addiction

Answer 515

interruption of the sympathetic fibres to one eye, causing unilateral pupillary constriction, slight ptosis, enophthalmos, loss of sweating on ipsilateral side of the face

Answer 516

small irregular pupil fixed to light and contricts on convergence, caused by neruosyphilis and DM

Answer 517

control ciliary muscles in the eye, change the shape of the eyes for accommodation for viewing objects damage can cause dipilopia (double vision), unilater complete ptosis and ocular nerve palsy causes deviation down and out of the eyes caused by trauma or berry aneurysm in the posterior communicating artery which runs alongside the nerve

Answer 518

Controls extrinsic eye muscles (suoerior oblique muscle) damage can cause eye problems and vertical diplopia (WHEN LOOKING DOWN OR AWAY FROM AFFECTED SIDE) and nerve palsy (weakness or inability of the nerve) caused by grave's disease

Answer 519

for mastication muscles and skin sensation of face and scalp, supplies mucus membranes of sinuses, nose, mouth, tongue and teeth damage can cause face pain (forehead) and difficulty clenching the jaw, pain when eating, jaw deviates to side of lesion caused by neurlagia, herpes virus, carcinoma

Answer 520

extrinsic eye movement via the lateral rectus muscle damage causes one eye to face inwards permanently this produces a squint and diplopia when looking at the side of the lesion caused by nerve palsy, cerebral vascular accidents, combined damage from cranial nerve 4

Answer 521

for taste, saliva and tear secretion and facial expression damage causes lack of facial expression on the affected side of the face (bells palsy), impaired taste severe damage can cause face paralysis caused by versticular voster virus and trauma

Answer 522

lesion of the cerebellopontine angle, from a meningioma or acoustic neuroma

Answer 523

oculomotor nerves, opthlamic, maxialy division

Answer 524

DM, sarcoidosis, vasculitis, syphilis, brain stem tumours, MS, infarction

Answer 525

acute isolater unilateral facial nerve palsy caused by a viral infection (herpes simplex) cause swelling of the 7th nerve within the petrous temporal bone, peak incidence between 65-74 and more common in pregnancy

Answer 526

for hearing and vestibular function (balance) damage can cause sensorineural deafness and tinnitus (noise ringing in ear), veritgo (illusion of movement which can cause vomiting), loss of air conduction in ear, nystagmus and loss of balance caused by perilymph fistula, cochlear concussion and auditory oscicle disruption and damage to nerve directly

Answer 527

rhythmic oscillation of the eyes can be pendular (pendular movement of the eyes, no rapid phase, occurs with poor visual fixation or congental lesion) or jerk (fast and slow component)

Answer 528

horzontal can be peripheral (transient minutes or hours) or central lesions (weeks, months)

Answer 529

taste, tongue sensation, saliva secretion, o2 and co2 monitoring in blood damage causes pain in tongue, throat, tonsils and ear from compression of nerve damage caused by combination to 10 and 11

Answer 530

taste, pharyngeal activity, epiglottis sensation, innervation of GI tract, control trachea and cardiac muscles damage causes dysphgaia, difficulty speaking, vocal cord weakness, damage to nuclear amygus, cause aphonia (harsh voice), pain

Answer 531

pharynx, larynx and soft palate muscles, sternocleoidmastoid and trapezius muscles damage causes paralysis of the sternocleoidmastoid muscle leadness to flatness of neck and inability to rotate the neck, paralysis of trapezius muscle causing drooping of muscle and inability to raise shoulders damage usually involves nerves 9 and 10, cuased by wound to neck

Answer 532

for tongue muscles damage cause lingual paralysis, dysarthria, and dysphagia, muscle tongue atrophy, so half of tongue cannot be controlled and deviates to side of lesion. caused by tumour, stroke, infection

Answer 533

carry information between CNS and periphery

Answer 534

posterior columns - carrying sensory modalities for vibration, joint position sense, two point discrimination and light touch, they ascend uncrossed to the gracile and cuneate nuclei in the medulla, then the second oder neurons cross the midline to form the medial lemniscus and pass to the thalamus spinothalamic tracts - carry sensations of pain and temperature, fibres synapse in the dorsal horn of the cord, crossing the midline and ascend as the spinothalamic tracts to the thalamus

Answer 535

paraesthesiae, numbness and pain

Answer 536

felt in the distribution of the affected peripheral never e.g. median nervem has bilateral symmetrical, distal sensory loss and burning

Answer 537

symptoms in the dermatome supplied by that root, tinglign discomfort (if it was a lesion of the sensory tract there would be general symptoms no specific dermatomes

Answer 538

evident below level of lesion spinothalamic leads to contralateral pain and temperature sensation loss below lesions proprioception lesion results in loss of this ipsilaterally below lesion

Answer 539

loss of all forms of sensation on opposite side of lesion

Answer 540

complete contralateral sensory loss and spontaenous pain (caused by thalamic infarct)

Answer 541

sensory loss, neglect of one side of the body, subtle disorders of sensation , no pain

Answer 542

oppssite side to lesion fasciculation absent, no muscle wasting, spasticity, clonus, weakness in arm extensors and leg flexors, exaggerated tendon reflexes, extensor plantar response, drift of the outstretched hand downwards

Answer 543

signs are on the same side fasiculation present, wasting, hypotonia, loss of tendon reflexes

Answer 544

visible contraction of single motor units, appearing as a twitch

Answer 545

transient flaccid weakness and hyporeflexia

Answer 546

hemiparesis - weakness of the limbs on one side, usually caused by lesion within brain or brainstem e.g. stroke paraparesis - weakness of legs, bilateral damage to corticospinal tracts caused by lesions below T1, tetraparesis in quadriplegic, weakness of arms and legs indicating high cervical cord damage from trauma - cord lesions result in UMN signs below lesion, LMN signs at lesion and unaffected muscle above lesion

Answer 547

anterior horn cell lesions (MND and poliomyelitis) spinal root lesions (cervical and lumbar disc lesions) peripheral nerve lesions (trauma, compression, polyneuropathy)

Answer 548

sudden - vascular (GCA) acute - inflmmatory/infectious (optic neuritis, TB) subacute - inflammatory/infectious/neoplastic chronic - neoplastic/degenerative episodic - migraine

Answer 549

headache - migraine, tumour, raised ICP malaise, fever, myalgia, headache, jaw claudication - giant cell arteritis painful monocular visual loss - optic neuritis systemic weakness, dysarthria, dysphagia - MG dysarthria and ataxia - posterior fossa lesion

Answer 550

smoking, alcohol - carcnoma and tobacco alcohol amblyopia diet - nutritional optic neuropathy occupation

Answer 551

Leber's herditary optic neruopathy and AD/R optic neuropathy, MS

Answer 552

contains >90% of all retinal nerve fibres in the optic nerve, projecting images from the macula, with a high metabolic activity lesions causes a central or centro caecal scotoma (lebers hereditary optic neuropathy, toxic and nutritional optic neurpathy and optic neuritis)

Answer 553

lesion of Meyers loop inferior striate cortex below the calcarine fissure lesion

Answer 554

parietal lobe lesions and superior striate cortex lesions

Answer 555

the defects do not match up between the two eyes

Answer 556

with occipital lesions that spare the posterolateral striate cortex due to the contralateral blood supply

Answer 557

partial - horners syndrome complete - third nerve palsy varying/fatiguing - MG

Neuro Flashcards

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