Neuro Flashcards
(195 cards)
1
Q
causes of blackout
A
syncope [decreased cerebral perfusion]
epilepsy
non-epileptic attacks
2
Q
what is described: a drop in blood pressure, quickly followed by faster then slower heart rate resulting in poor blood and oxygen flow to the brain which results in temporary loss of consciousness
A
vaso-vagal /neurocardiogenic syncope
3
Q
epilepsy - definition and cause
A
tendency to recurrent seizures
disordered electrical activity in the brain
4
Q
triggers for syncope
A
stress, fear, standing, heat, micturition, cough, venepuncture
5
Q
triggers for epileptic seizure
A
sleep deprivation flashing lights menstruation alcohol withdrawal
6
Q
syncope prodrome vs epilepsy
A
syncope: hot, vision loss, dizzy, pale
epilepsy: aura [visual, auditory, gustatory]
7
Q
time difference between syncope, non-epileptic seizures and epileptic attack
A
syncope seconds>mins
epilepsy 2>3 mins
N.E.A.s >30mins
8
Q
phases of generalized tonic clonic seizure
A
tonic phase - rigid
clonic - muscles jerk rhythmically
post-ictal - drowsiness
9
Q
incontinence and tongue biting in syncope and epilepsy
A
rare in syncope
yes in epilepsy
10
Q
Ix for blackout
A
echo 24 hr ECG CT - rule out tumour lying and standing BP, table tilt EEG
11
Q
eyes and mouth open or closed in tonic clonic vs non-epileptic seizure
A
tonic clonic- open
non-ep - closed
12
Q
eyes roll up slightly and eyelids flicker. Type of seizure?
A
absence
13
Q
best investigation for diagnosing MS
A
MRI brain
14
Q
relapsing and remitting optic neuritis, neurological deficits of cranial nerves and limbs over several years followed by secondary progressive neurological problems. Diagnosis?
A
MS
15
Q
MS patient with worsening mobility, long term catheter, pyrexia, chest clear. Most appropriate investigation to find cause of current state?
A
MSU
16
Q
oligoclonal bands in the CSF = ?
A
MS
17
Q
neuro features of sarcoidosis
A
bells palsy neuropathy meningitis brainstem and spinal syndromes space occ lesion
18
Q
18 yr old. Sudden onset, back pain, numbness, diff walking, proximal thigh weakness, glove and stocking loss of sensation, loss of reflexes. Diagnosis
A
Guillain-Barre syndrome
19
Q
relapsing remitting MS usual age of onsset
A
15-25
20
Q
oxybutynin treats
A
urge incont
21
Q
obesity, morning headaches, enlarged blind spots
A
raised intracranial pressure probably due to idiopathic intracranial HTN
22
Q
quick assessment of cognitive state
A
AMTS
23
Q
neurological side effect of TB drug isoniazid
A
peripheral neuropathy
24
Q
what deficiency is wernicke korsakoff’s due to
A
thiamine
25
causes of papilloedema
tumour
hydrocephalus
cavernous sinus thrombosis, meningitis
idiopathic intracranial HTN
26
causes of Homonymous hemianopia
stroke, tumour
27
cause of Bitemporal hemianopia-
optic chiasm compression e.g. pituitary tumour
28
3rd nerve palsy signs
ptosis, large pupil, eye down and out
29
nystagmus is due to lesions where
cerbellum, vestibular
30
headache history Red flags?
New headache >60yrs
thunderclap
infective sx
hx of malignancy
31
is proximal/distal weakness caused by a muscle/nerve problem?
proximal weakness is muscular
| distal weakness is nerve
32
is peripheral neuropathy sensory or motor
Sensory or motor or both
33
symptoms of GBS
parasthesia, weakness, paralysis, numbness, areflexia, balance/coord probs
34
GBS Tx
IVIG
35
mechanism of GBS
complement activation
demyelination by WBCs
/trigger [infection] causes antibodies which attack nerves
36
name some conditions which can lead to Mononeuritis Multiplex
```
Vasculitis
RA
DM
SLE
sarcoid
```
37
give an examples of a mononeuropathy
carpal tunnel syndrome
38
describe distribution of mononeuropathy, mononeuritis multiplex and polyneuropathy
mononeuropthy: one nerve
MM: random individual nerves
polyneuropathy: glove and stocking
39
Ix of neuropathy
```
FBC
ESR
glucose
B12
coeliac
TFT
U and E
```
40
non-neurological causes of peripheral neuropathy
```
hypothyroidism
coeliac
B12 deficiency
chronic kidney disease
diabetes
```
41
what part of the nervous system is affected by myasthenia gravis and how?
neuromuscular jn
| autoimmune antibodies bind ACh receptors on post-synaptic membrane
42
what is the main symptom of MG?
fatigue-able muscle weakness
43
MG worse in morning or evening?
evening
44
what eye symptoms might MG patients experience?
diplopia
| ptosis
45
describe link between MG and cancer
MG can occur as a PARANEOPLASTIC syndrome in thymoma or bronchogenic carcinoma. Cancer produces the autoimmune antibodies
46
what is a myasthenic crisis?
life threatening manifestation of MG e.g. resp muscles affected
47
Tx for MG
acetylcholinesterase inhib [pyridostigmine]
prednisolone/ [azathoprine] for relapse
thymectomy
IVIG for myasthenic crisis
48
Ix for MG
CT thorax
ACh receptor antibodies
EMG
tensilon test [rarely]
49
causes of myasthenic crisis
Infection
natural disease cycle
under/over dosing of medication
50
what drugs can cause myopathy?
steroids
| statins
51
investigations in myopathy
```
CK
EMG
CRP
genetics for Duchennes/Becker
biopsy
```
52
acute and chronic Tx for migraine
acute - NSAIDs, triptans
| chronic - BB, amitryptiline
53
describe cluster headache and some Sx
get a number of headaches over a short period, then may have none for yrs.
red painful eye, rhinorhoea
54
Tx of cluster headaches
O2, triptans
55
treatment of trigeminal neuralgia
carbamazepine
56
what Ix in patient with trigem neuralgia and why?
MRI for tumour
57
ix for GCA
temporal artery biopsy
| ESR
58
complication of GCA
blindness
59
what scoring system estimates risk of stroke after TIA
```
ABCD2
Age >60
BP >140/90
Clinical - 1=speech 2=unilat weakness
Duration - 1= 10-60, 2= >60mins
DM
```
60
treatment for TIA
aspirin [clopidogrel as alternative intolerant]
+ secondary prevention
61
acute Mx of ischaemic stroke
CT
TPA [tissue plasminogen activator] [alteplase]
then aspirin 24 hrs later
or aspirin alone asap if no TPA
62
how does an extradural haemorrhage appear on CT
elliptical, doesnt follow lobe shape
63
how does extradural haemorrhage present
loss of consciousness after trauma
then lucid phase
then rapid deterioration in GCS
headache dizzy vomiting
64
causes of extradural heamorrhage
skull fracture [parietal bone]
| middle meningeal artery rupture
65
Ix for extradural haemorrhage
CT to look at bleed
| xray to look for fracture
66
cause of subdural haemorrhage
ruptured bridging veins, falls
67
people at risk of subdural haemorrhage
elderly, alcoholics, epileptics, bleeding disorders
68
Sx of subdural
confusion, headache
69
Mx subdural
conservative, improves by self. Surgery in severe
70
Mx extradural haem
surgery
71
cause of SAH
berry aneurysm
72
where are berry aneurysms
aneurysms at branch points in the circle of willis
73
associations/ risk factors for berry aneurysms
PKD
HTN
ehlers danlos
coarc aorta
74
symptoms of SAH
thunderclap headache
| can get meningism - neck stiffness
75
Ix SAH
CT, LP after 12 hrs
76
what drug do you give to SAH patients before surgery
oral nimodipine
77
what would you see on an LP 12 hrs after SAH
yellow csf, xanthachromia
78
diff between simple and complex partial seizures
complex - altered consciousness
79
treatment for absence seizures and one treatment you should never use and why
valproate or ethosuximide
| never use carbamaz - makes worse
80
after how many seizures do you start treating someone for epilepsy
2
81
MS presentations and how/when do they happen
optic neuritis, trigem neur, numbness
| dissemminated in time and spacce
82
parkinsons triad of Sx
and 3 other Sx
bradykinesia
cogwheel rigidity
resting tremor
```
[depression
dementia
shuffling gait
sleep disturbance
hypokinesia
postural instability
bladder + bowel dysfn
speech + lang probs
weight loss
swallowing probs]
```
83
parkinsons pathophysiology
Degeneration of dopamine neurons in substantia nigra of basal ganglia
84
Tx for parkinsons
levodopa (with co-careldopa [carbidopa] or co-beneldopa)
non-ergot-derived dopamine-receptor agonists [ropinirole]
MAOIs [selegiline]
COMT inhibitors [entacapone] with levodopa
if not controlled: ergot-derived [bromocriptine]
still not controlled: amantadine
85
name some parkinsons plus syndromes and what added systems affected /symptoms
lewy body dementia
progressive supranuclear palsy [EYES]
multiple system atrophy [POST HYPO]
86
define parkinson's plus syndromes
classical features of PD plus other additional features that dintinguish them from simple parkinsons
87
what inheritance pattern is huntingdons and therefore how likely is child to get it
auto dom, 50%
88
pathophys of huntingdons
| & associated gene defect
atrophy of striatum [part of basal ganglia] + cortex
CAG repeat in gene that codes for huntingtin protein on chr4
89
symptoms of huntingdons
chorea [extra movements]
depression, dementia, personality change,
cognitive impairment, psychiatric illness
90
average age of huntingdon onset
40
91
causes of death in huntingdons patients
aspiration pneumonia
| suicide
92
Ix for huntingdons
genetic test
93
Mx of huntingdons
tetrabenazine [dopamine-depleting]
olanzapine [dopamine receptor antagonists]
OT/physio
antidepressants/mood stabilisers
94
main features of MND
muscle wekaness, wasting, increased or decreased reflexes depending on UMN/LMN affected, fasciculations
95
what symptoms are never present in MND
sensory, eye, cerebellum
96
GBS Ix
CSF [high protein]
| nerve conduction study [features of demyelination]
97
Mx of GBS
IVIG
98
GCS - scores for verbal response
5. orientated in time/place/person
4. confused
3. inappropriate words
2. incomprehensible sounds
1. none
99
GCS scores for eye response
4. spontaneously
3. to speech
2. to pain
1. none
100
GCS score for motor response
6. obeys commands
5. localises
4. normal flexion
3. abnormal flexion
2. extension
1. none
101
3rd nerve palsy does what to pupil?
fixed dilated
102
are the following likely to be of spine or brain origin?
1. Radiating limb pain
2. Bilateral limb deficit
3. Contralateral deficit
1. radiating limb pain - spine
2. Bilateral limb deficit - spine
3. Contralateral deficit - brain
103
C6 nerve root resonsible for which arm action and reflex
elbow flexion
| biceps reflex
104
C7 nerve root responsible for which arm action and which reflex
elbow extension
| triceps
105
nerve root responsible for dorsi and plantar flexion of the foot
dorsiflexion [standing on heels] - L4, L5
| plantar flexion [tip toes] - S1, S2
106
corticospinal motor tract decussates at what level ?
medulla
107
spinothalamic sensory tract decussates where?
spinal cord
108
posterior column sensory tract decussates where?
medulla
109
what is brown sequard syndrome
weakness on one side
sensory loss on other
due to damage to one side of spinal cord
110
cerebellar lesion. Deficit on same or ipsilateral side?
same side
111
cerebellar symtoms
ataxia
nystagmus
intention tremor
slurred speech
112
symptoms of raised intracranial pressure
headache, vomiting, visual disturbance, gait unsteadiness
113
signs of raised intracranial pressure on examination of the eyes
papilloedema, limitation of upward gaze, reduced visual acuity
114
timeframe for TIA
less than 24 hrs
115
63 year old HGV driver. Stopped to take a break and has word finding problems. Rt arm felt ‘heavy’. Improved after 15 minutes. Diagnosis?
TIA
116
what factors would constitute a high risk TIA?
ABCD score ≥4
>1 TIA in last 7 days (Crescendo TIAs)
New arrhythmia
Known high grade ipsilateral carotid stenosis
117
immediate management for high risk TIA
Aspirin (300 mg daily) start immediately for 2 weeks
118
what investigations might you want to carry out in a patient who has just had a high risk TIA?
MRI
Carotid dopplers- to look for significant stenosis of internal carotid artery
24 Hour ECG
119
causes of haemorrhage
```
HTN
Trauma
Anticoagulation
Tumour
AVM
```
120
management of confirmed cerebral haemorrhage
surgery
121
Investigation to look for cause of confirmed brain haemorrhage
MRI - space occupying lesion or arteriovenous malformation
122
what is todd's paresis
post ictal weakness
123
```
23 year old woman
Blurring of vision R eye, Gradual numbness affecting left hand and lip.
Headache
O/E- Normal
Diagnosis?
```
migraine
124
stroke bloods
FBC, ESR, clotting, U & E, LFT’s, glucose, cholesterol
125
stroke patient with raised ESR. What other Ix might you consider and why?
blood cultures [endocarditis]
| temporal artery biopsy [vasculitis]
126
risk of tPA thrombolysis in stroke
fatal haemorrhage
127
contraindications for tPA
```
>4.5 hrs after symptom onset
peptic ulcer
surgery/trauma in last 3 months
haemorrhagic stroke
on heparin
BP >185/110
```
128
in what situations might you treat HTN immediately in stroke patient
```
HTN encephalopathy
HTN nephropathy
pre-eclampsia
haemorrhage
aortic dissection
MI
thrombolysis candidates
```
129
what is the policy on feeding for stroke patients?
all stroke patients must remain nil by mouth until theyve had dysphagia screen
IV nutrition
>24 hrs - NG
>7 days - PEG
130
what are ventriculo-peritoneal shunts used for in stroke patients
for primary intracranial haemorrhage with hydrocephalus
131
3 options for ANTIPLATELETS in secondary STROKE prevention
clopidogrel, aspirin, dipyridamole
132
what is the most common 'anterior horn cell disease'
MND
133
list some long tract (UMN) signs
```
Spastic gait
Hypertonia
Hyper-reflexia
Babinski
Clonus
Hoffman’s
```
134
common causes of coma
```
meningitis/encephalitis
head injury
bleed/SAH
opiates/alcohol
anoxia post MI
epilepsy
hypo
```
135
adverse complications of Amphetamine + other stimulants
```
intracranial haemorrhage
ischaemic stroke
seizures
psychosis/delirium
coma
```
136
define wernickes encephalopathy and give some Sx
neuro consequences of thiamine deficiency due to alcohol abuse.
ataxia, confusion, opthalmoparesis
137
define korsakoffs and give some Sx
permanent neuro damage due to alcohol abuse (thiamine def) follows wernickes encephalopathy.
Ataxia, confusion, abnormal eye movements
138
what cranial nerve palsy is seen in SAH
3rd nerve
139
triad of horners syndrome and cause
```
constricted pupil
ptosis
anhidrosis
ON ONE SIDE OF FACE
damage to sympathetic nerve supple to eye
```
140
59-year-old developed acute bilateral flaccid leg weakness.
Had shifted her weight while sitting on the sofa and suddenly felt sharp pain in lower back + R leg.
Legs numb, over 1 hr because unable to move them.
Couldn't urinate + dribbling incontinence.
Differentials?
cauda equina /lower spinal cord lesion (myelopathy)
| numbness makes muscular or NMJ unlikely
(sudden onset suggests vascular or compression)
141
Causes of acute/subacute myelopathy
```
trauma
malignancy (compression)
infection
disc
inflamm (MS/transverse myelitis)
vascular
```
142
72 yr old with back pain and progressive lower limb weakness, sensory loss and bladder dysfn.
MRI - vertebral destruction and cord compression.
CXR - lung mass.
Dx?
lung malignancy spinal mets
143
```
18 yr old male
flu-like illness
Tingling feet and hands then slurred speech, facial weakness, limb weakness progressive over days
O/E hyporeflexic, weakness
Diagnosis?
```
GBS
144
warning signs after head injury
```
change in consciousness
pupils unequal or slow to react
seizures
vomiting
blurred vision
loss of sensation
slurred speech
blood/watery from nose/ears
```
145
commonest iatrogenic cause of proximal myopathy
corticsteroids
146
commonest underlying disease entity for Peripheral neuropathy.
diabetes mellitus
147
treatment of benign essential tremor
propanolol
| 2nd line primidone
148
how do you differentiate a clinically isolated syndrome form MS
one episode/ one MRI feature
| vs MS = 2 separate relapses within 2 years
149
pathophysiology of MS
[autoimmune] demyelination in the brain and spinal cord
150
what is found in the CSF in MS
^protein
151
MS Tx in pregnancy
all drugs contraindicated, steroids not recommended
152
define progressive multifocal leukoencephalopathy
opportunistic brain infection caused by JC virus, seen in MS patients who are on disease modifying drugs
153
what causes optic neuritis
demyelination of the optic nerve
154
headache + papilloedema -> CT normal. You suspect a sagittal sinus thrombosis. How would you investigate this?
CT venogram
155
Ix idiopathic intracranial HTN
LP pressure
156
multiple family members with headache, otherwise well. Possible cause
CO poisoning
157
what is status epilepticus & main risk
when a seizure is not self limiting - medical emergency
cerebral ischaemia due to cardiorespiratory failure
158
management of status epilepticus
rectal diazepam/ buccal midazolam
159
risk of tensilon test for MG
bradycardia
160
MND Mx
riluzole
quinine for muscle cramps
baclofen for spasticity
glycopyronium bromide for secretions
morphine for breathless, ?NIV
antidepressants
OT, PT, palliative
161
microscopic changes in alzheimers brain
Amyloid plaques
| Neurofibrillary tangles
162
Lewy-body Dementia drug Tx
donepazil or rivastigmine
| if not tolerated: galantamine or memantine
163
GBS what infections
campylobacter, CMV, mycoplasma, zoster, HIV, EBV
164
bulbar palsy denotes disease of the nuclei of which cranial nerves in the medulla?
9-12
165
signs of bulbar palsy
flaccid fasiculating tongue [like a bag of worms]
| quiet/hoarse/nasal voice
166
causes of bulbar palsy
```
MND
GBS
polio
MG
syringobulbia
brainstem tumour
central pontine myelinosis [rapid correction of hyponat]
```
167
bulbar and corticobulbar [pseudobulbar] palsies both affect the muscles of swallowing and talking. What is the difference?
```
bulbar = LMN/ medulla
pseudobulbar = UMN/ pons
```
168
psuedobulbar/ corticobulbar palsy causes
stroke
MND
central pontine myelinosis
MS
169
1st line anti-epileptic for focal/ partial seizure?
carbamaz or lamotrigine
170
1st line anti-epileptic for generalised tonic clonic seizure?
sodium valproate or lamotrigine
171
1st line anti-epileptic for myoclonic seizure?
sodium valproate
172
other possible interventions for epilepsy other than anti-epileptic drugs
psych therapies e.g. relaxation/ CBT, [but dont improve freq]
surgery -if single focus
vagal nerve stimulaiton
173
give 2 valproate SEs
```
abdo pain
alopecia
agitation
anaemia
behaviour change
poor concentration
confusion
deafness
diarrhoea
drowsy
haemorrhage
headache
hepatic
menstrual
nausea
nystagmus
seizure
tremor
weight gain
thrombocytopenia
```
174
Mx of intracranial venous thrombosis
anticoag [heparin/LMWH, then warf]
thrombolysis
thrombectomy
175
describe some different clinical presentations of MS
red. vision in 1 eye w/ painful movements
double vision
ascending sensory disturbance and/or weakness
problems with balance, unsteadiness or clumsiness
altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte's symptom)
176
what bloods would you request in someone with suspected MS to rule out other diagnoses before R/F ing to neuro
full blood count
ESR/CRP
liver function tests
renal function tests
calcium
glucose
thyroid function tests
vitamin B12
HIV serology.
177
people involved in the multidisciplinary team looking after someone with MS
consultant neurologists
MS nurses
PT, OT
speech and language therapists, psychologists, dietitians, social care and continence specialists
GP
178
modifiable risk factors that you can counsel MS patients on
Preg [may get better then worsen Sx after delivery]
smoking increases progression
exercise
vaccine - flu, live ones may be contraindicated if on disease‑modifying therapies
179
define MS
chronic, immune-mediated, demyelinating inflammatory condition of the central nervous system, which affects the brain, optic nerves and spinal cord, and leads to progressive severe disability.
180
what are the 4 types of MS
relapsing remitting [most common]
secondary progressive [develops from R-R, ^ing disability unrelated to relapses]
primary progressive [gradual worsening, no relapses or remissions]
progressive relapsing [worsening from beginning + relapses]
181
drug treatment for secondary progressive MS [not including Sx management]
interferon beta 1b
182
drug treatment for primary progressive +
progressive relapsing MS
no specific, interferon beta sometimes used [unlicensed] for primary progressive
183
acute drug management of relapse in relapsing remitting MS
Oral methylprednisolone
[IV methylpred if oral failed /not tolerated /hospitalisation required]
184
management of fatigue in MS patients
exercise
CBT
Amantadine hydrochloride [unlicensed]
185
what factors might aggravate spasticity in MS patients?
constipation, infection, poor mobility aids, pressure ulcers, posture and pain
186
Mx of spasticity in MS
1st line: baclofen/gabapent
2nd line: Tizanidine or dantrolene sodium
3rd line: Benzos
187
management of oscillopsia in MS
gabapent [1st line]
| memantine hydrochloride [2nd]
188
drug treatment for relapsing-remitting MS [not including Sx management]
active: beta interferon + glatiramer acetate
OR methyl fumurate + teriflunomide [ORAL]
more active: natalizumab/ alemtuzumab
for highly active or ^risk of PML: fingolimod
189
in a patient already on anticoag for prosthetic valve, who has an ischaemic stroke w/ risk of haemorrhagic transformation, how would you manage their anticoagulation?
anticoagulant treatment stopped for 7 days and substituted with aspirin
190
non-pharmacological Mx of parkinsons
PT
speech and lang therapy
OT
dietician
191
possible SEs of parkinsons meds
psychotic sx
drowsy
sudden onset of sleep
192
parkinsons drug Mx for postural hypotn
1st line: midodrine hydrochloride
| 2nd: fludrocortisone acetate
193
Mx of psychotic Sx in parkinsons
reduce parkinsons meds
quetiapine, 2nd line clozapine
194
mx of drooling of saliva in parkinsons
1st line: glycopyronium bromide
| 2nd: botox
195
drug mx of parkinsons dementia
rivastigmine/ donepazil/ galantaine
memantine if not tolerated/ contraI
