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Neuro Flashcards

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1
Q

Where do the demyelinating plaques occur in MS? and what symptoms does this give?

A

Occurs:

  • Optic nerves: optic neuropathy & pain on movement
  • Paraventricular regions: slow gait speed and mental ability
  • Brainstem: sudden diplopia and nystagmus
  • Spinal cord: spastic paraparesis + urinary symptoms
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2
Q

Explain Unthoffs phenomena

A

Unthoffs phenomena - symptoms worse on heat and exercise

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3
Q

What investigations could you do to someone with MS and what would they show?

A

MRI - multiple plaques seen in paraventricular regions, corpus callosum, cerebellar peduncles, brainstem and cervical cord

LP - Oligoclonal bands IgG electrophoresis

EV - evoked potentials

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4
Q

What do you have to have to make a diagnosis of MS?

A

Lesions disseminated in time and space

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5
Q

What treatment can you give for

a) acute relapses
b) Active relapsing and remitting
c) Severe relapsing and remitting

A

a) Acute relapses = steroids: methylprednisolone
b) Active relapsing and remitting = beta interferons,
c) Severe relapsing and remitting = monoclonal antibodies: Natalizumab

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6
Q

What are the different types of MS?

A

Relapsing and remitting
Rapdily progressive
Primary progressive
Secondary progressive

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7
Q

What are the differentials for MS?

A

SLE

CNS sarcoidosis

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8
Q

Describe Gillian-barre syndrome

A

= acute inflammatory demyelinating polyneuropathy

Trigger = infection
Progressive symmetrical weakness/numbness of the distal muscles which can eventually progress to the proximal muscles
Areflexia
Autonomic neuropathy: arrhytmias, increased HR, Sweating and urinary retention

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9
Q

What are the diagnostic features of GBS?

A

Required: progressive weakness of all 4 limbs & areflexia
Supportive: progressive over 4 weeks, symmetrical, mild sensory impairment, autonomic dysfunction, no fever at onset
Recovery 2 weeks after the period of progression has stopped

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10
Q

How do you treat BGS?

A 
Suportive AAAA 
Airway support 
Analgesia: NSAID 
Autonomic: catheters 
Antithrombin: LMWH

Iv Immunoglobulin
Plasma exchange

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11
Q

Which gland is associated with MG?

A

Thymus

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12
Q

What type of medication is pyridostrigmine?

A

Anticholinesterase

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13
Q

What are the treatment options for MG?

A

Symptoms: anti cholinesterase = pyridostigmine
Immunosuppression: Prednisolone/methotrexate
Thymectomy

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14
Q

Which nerve is involved in carpal tunnel syndrome?

What movement does this nerve do?

A

Median nerve - C6-T1

Pincer grip

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15
Q

What is dysphonia?

Give some causes

A

Dysphonia = difficulty producing sound of the voice - hoarse/whispered speech
Causes: laryngitis, CNX lesions, Parkinsonism

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16
Q

What is dysarthria?

Give some causes

A

Difficulty speaking - poorly articulated/slurred
Basal ganglia - parkinsonism, dystonic
Motor-end plate - MG
Brainstem- bulbar

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17
Q

What is dysphagia?

A

Disorder of language content

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18
Q

What are the two different types of aphasias?

A

1) Fluent/receptive aphasia
Problem understanding - werkicke’s aphasia

2) Non-fluent/expressive aphasia
Problem articulating
Broca’s aphasia

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19
Q

Contralateral homonymous hemianopia with macular sparing
Visual agnosia
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

c) PCA

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20
Q

Amaurosis fugax

a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)

A

Amaurosis fugax

d) retinal/opthalamic artery

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21
Q

‘Locked-in’ syndrome

a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)

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A

‘Locked-in’ syndrome

e) Basilar artery

22
Q

Contralateral hemiparesis and sensory loss, lower extremity > upper

a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)

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A

Contralateral hemiparesis and sensory loss, lower extremity > upper
a) ACA

23
Q

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)

24
Q

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)

25
Ipsilateral CN III palsy Contralateral weakness of upper and lower extremity a) ACA b) MCA c) PCA d) Retinal/opthalamic artery e) Basilar Artery f) Weber's syndrome (branches of the PCA that supply the mid brain) g) PICA (lateral medullary syndrome, Wallenberg syndrome)
Webbers syndrome
26
What is menieres disease?
Disorder of the inner ear - intermittent endoolymph HTN | Attacks of severe vertigo, N&V, low frequency hearing loss, tinnitus and a feeling of a full ear
27
How do you diagnose benign paroxysmal positional vertigo?
Hallpikes Manoeuvre
28
How do you diagnose menieres disease?
Audiomety documented low to medium frequency sensioneural hearing loss >2 episodes of vertigo between 20m-12 hours long Fluctuating aural symptoms
29
How do you treat menieres disease?
Low sodium diet Thiazide diuretic - bendroflumethiazide Surgical - endolymphatic sac removal
30
What spinal cord disorders can cause dizziness?
MS | B12 deficiency
31
What are the 3 parts of GCS and what are they out off? | What is the value for a comatose patient and a totally unresponsive patient?
``` Eye opening /4 Verbal /5 Motar /6 Comatose = 8/15 Totally unresponsive = 3/15 ```
32
Give some causes of coma
V = cerebrovascular disease, hypoxic-ischamic injury I = meningitis, encephalitis, sepsis T = trauma A M = Hypoglycemia, DKA, hyperglycaemia hyperosmolar state, hypothyroid, acute renal failure, hepatic encephalopathy I = Opioid (give naloxone) Benzodiazepine (flumazenil)
33
How can you tell if someone is brain stem dead?
Eyes: 1) pupil 2) blink 3) move side-side Ears: Eye movement to temp Gag, cough and pain Pupillary light reflex Corneal reflex - V & VII Oculocephalic reflex - eyes move side to side when head is move to remain looking at a fixed position Caloric reflex - eyes move to ear when warm/cold water is added Pharyngeal gag reflex, laryngeal cough reflex Response to pain in the trigeminal distribution
34
What is a apnea test?
This is mandatory to diagnose someone as brain stem dead - ventilatory support is slowly turned off and their co2 levels are monitored +ve - if they rise and there is no response/increased respiratory effort made
35
What is Guillian-Barre syndrome?
It is an acute demyelinating polyneuropathy with absent reflexes
36
What can trigger GBS?
Campylobacter jejuni EBV CMV HIV
37
What are the signs that you might see with GBS?
``` Observation - fasciculations T: Hypotonia P: reduced power S: Altered sensation R: absent or reduced reflexes ```
38
What might you see in LP of GBS?
Increase in CSF proteins but not cells
39
How do you treat GBS?
Supportive - analgesia, catheters or LMW heparin (DVT prophylaxis is essential) - Plasma Exchange (remove the abs) or// - IV immunoglobulins (reduce to immune response)
40
What are the complications of GBS?
Persistent paralysis Resp failure (measure FVC 4 hourly) VTE Cardiac arrhythmias
41
What is MG?
Its an AI disease with auto-abs to the ACh receptors at the NMJ
42
Which drugs can exacerbate MG?
``` BB Aminoglycoside abs (gentamicin) ```
43
What is Lambert-eaton syndrome and what conditions is it associated with?
It is opposite to MG Repeated muscle contractions leads to increased muscle strength (less fatiguability following repetition) Its due to abs against the pre-synaptic voltage gated calcium channels in the peripheral NS Associated with SCLC, breast and ovarian ca
44
The Revised El Escorial Criteria is used to make sure other possible causes have been ruled out before making a diagnosis on MND. What pointers are suggestive of MND?
Asymmetrical distal weakness Brisk reflexes in a wasted limb No major sensory/pain Relentless progression of signs and symptoms
45
What are the SE of levodopa?
Dyskinesia "on/off" effects Postural hypotension Psychosis
46
Give examples of the dopamine receptor agonists | & SE
Bromocriptine, ropinirole + cabergoline | SE: impulse control, excessive daytime sleeping, hallucination, postural hypotension
47
What can you give for prophalaxis of cluster headaches?
Verapamil
48
What are the red flags of headaches?
Signs of raised ICP (worse in the morning, vomiting) Headache with new onset seizure/focal neurological deficit Thunderclap Jaw claudication/visual disturbances Signs of meningism - neck stiffness/photophobia Progressively worsening
49
What are SAH associated with?
HTN + Poly cystic kidney disease
50
What would you see on a LP of SAH?
Xathnochromia
51
How would you treat SAH?
A-->E Prevent vasospasm = Nimodipine Prevent re-bleeding = endovascular clipping and coiling

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