Neuro Flashcards
(196 cards)
1
Q
Functional divisions of the motor nerves
A
Somatic, branchial or autonomic
2
Q
Functional divisions of the sensory nerves
A
Somatic, autonomic or special
3
Q
Where are somatic nerves found in the embryo
A
Spread throughout
4
Q
Where are autonomic nerves found in the embryo
A
Arise in the most primitive parts. No conscious control. Smooth and cardiac muscle and glands.
5
Q
Define dermatome
A
area of skin supplied by a single spinal nerve
6
Q
Define myotome
A
volume of muscle supplied by a single spinal cord
7
Q
What function does the corticospinal tract supply
A
Rapid, skilled, voluntary movement
8
Q
What function does the rubrospinal tract supply
A
Facilitates flexors, inhibits extensors
9
Q
What function does the vestibulospinal tract supply
A
Facilitates extensors, inhibits flexors
10
Q
What function does the tectospinal tract supply
A
Truncal reflexes from sight
11
Q
What sensation do the fasciculus gracilis and cuneatus provide
A
Touch, vibration and conscious joint/muscle
12
Q
What sensation do the spinocerbellar tracts supply
A
Nonconcious muscle/joint sense
13
Q
What sensation does the lateral spinothalamic tract supply
A
Pain and temperature
14
Q
What sensation does the anterior spinothalamic tract supply
A
Light touch and pressure
15
Q
What sensation does the spinoolivary tract supply
A
proprioception
16
Q
What sensation does the spinotectal tract supply
A
Spinovisual reflexes
17
Q
In brown sequard at T10 you will get ipsilateral loss of
A
Tactile discrimatin, vibration, proprioception and spastic paralysis
18
Q
In brown sequard at T10 you will get contralateral loss of
A
Pain and temperature and impaired tactile sense
19
Q
At what level does the spinal cord stop
A
L1
20
Q
Where does the basilar artery lie
A
The anterior surface of the pons
21
Q
Which arteries contribute to the posterior circulation
A
The vertberal arteries
22
Q
What does the posterior circulation supply
A
The brainstem, cerebellum and back of hemispheres
23
Q
What supplies the lateral surface of the hemispheres
A
Middle cerebral artery
24
Q
What supplies the median surface of the hemispheres
A
Anterior cerebral artery
25
From the internal carotid where do blood clots tend to go
The middle cerebral artery as they want to go straight
26
Where are the meningeal vessels
In the extradural space
27
Where are bridging veins
They cross the subdural space
28
Where does the circle of willis lie
In the subarachnoid space
29
Are there any vessels deep to the pia mater
No. It forms part of the blood brain barrier
30
What is a parenchymal haemorrhage
A intracerebral haemorrhage
31
Bleeding from which artery causes an extradural haemorrhage
Middle meningeal artery
32
Shape of an extramural haemorrhage on imaging
Convex
33
What causes an extradural haemorrhage
Trauma to middle meningeal artery causes bleeding between the dura mater and the brain
34
What causes a subdural haemorrhage
Bleeding from the bridging veins, especially in small brains. Pressure slowly builds
35
What is the shape of a subdural haemorrhage on imaging
Crescent shaped
36
What is a subarachnoid haemorrhage
Rupture of the arteries forming the circle of willis,often because of berry aneurysms
37
What is a thunderclap headache suggestive of
Subarachnoid haemorrhage
38
What is a berry aneurysm
Weakening outpouching of the circle of willis
39
Which stroke has death of cells in a small area, with a well defined area and no recovery
Embolic
40
Which stroke has a large area affected, conmpression of the internal capsule and possible complete recovery
Haemorrhagic
41
Anterior segment of the internal capsule
Sensory
42
Posterior segment of the internal capsul
Sensorimotor
43
The pituatry tumours are likely to affect the...
optic chiasm
44
Why do you get forehead sparing
Facial has bilateral supply to forehead but contralateral to the rest of the face
45
Define meningitis
Inflammation of the meninges
46
Define encephalitis
Inflammation of the brain
47
Define encephalopathy
Reduced level of consciousness/diffuse disease of brain substance
48
Define neuropathy
Damage to peripheral nerves.
49
Infective causes of neuropathy
Diptheria, guillan-barre, leprosy, rabies
50
Define mononeuritis multiplex
Inflammation and damage to 2 or more individual nerves
51
Infective causes of mononeuritis multiplex
HIV, leprosy, lyme, Hep A
52
Define polyradiculopathy
Damage to multiple nerve roots
53
Infective causes of polyradiculopathy
HIV and CMV/syphilis/HMV
54
Define myelitis
Inflammation of the spinal cord
55
Define meningoencephalitis
Inflammation of the brain and meninges
56
Clinical signs of meningeal irritation
Reduced GCS, headache, stiff neck, papilloedema. Kernigs and Brudzinskis signs
57
What is kernigs sign
Hip at 90 degrees, cant extend leg
58
What is Brudzinskis sign
Passive neck flexion= leg and thigh flexion
59
What is papilloedema
Swelling of the optic disc on fundoscopy
60
Which vertebrae are epidurals normally entered between
L3 and L4
61
Which vertebrae are lumbar punctures normally done between
L4 and L5 (or L3/4 or L5//S1)
62
Side effects of lumbar puncture
Headache, paraesthesia, CSF leak, damage to spinal cord, cerebral herniation and death
63
When should you CT before lumbar puncture
60+, immunocompromised, history of CNS disease, new onset, decreasing consciousness, focal neurological signs, papilloedema, atypical history
64
What does xanthochromia mean
Blood stained
65
Causes of natural immunossupression/immunocompromised
Pregnancy, diabetes, chronic alcoholics age>60
66
Bacterial causes of menigitis in neonates
E coli, GroupB strep, listeria monocytogenes
67
What gram and shape is Ecoli
Gram negative bacilli
68
What gram and shape is Group B strep
Gram positive cocci
69
What gram and shape is listeria monocytogenes
Gram positive bacilli
70
What gram and shape is neisseria meningitidis
Gram negative diplococcus
71
What gram and shape is strep pneumoniae
Gram negative diplococcus
72
What gram and shape is haemophilus influenzae
Gram negative coccobacilli
73
What is meningitis prophylaxis of contacts for influenzae
Only need prophylaxis if havent had Hib, inform public health
74
What is meningitis prophylaxis of contacts for pneumococcal
No prophylaxis needed, consider pneumococcal vaccine, inform public health
75
What is meningococcal meningitis prophylaxis of contacts
Ciprofloxacin as prophylaxis for household contacts
76
What is the most common cause of viral meningitis
Enterovirus
77
What test is used to identify viruses
PCR
78
Sympoms of encephalitis
Fever, headache, lethargy and behavioural change
79
Trismus is a symptom of tetanus, what is trismus
Lock jaw
80
Opsithotonus is a symptom of tetanus, what is opsithotonus
Sustained muscle contraction
81
Should you lumbar puncture in suspected meningitis
Normally yes but not if signs of raised intercranial pressure or sepsis or rapidly evolving rash
82
Define epileptic seizure
Paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by excessive, hypersynchronous neuronal discharges in the brain
83
Define nonepileptic seizure
Paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by mental processes associated with psychological distress
84
Tongue biting, head turning, muscle pain, LOC >5mins, cyanosis and postictal confusion are suggestive of which type of seizure
Epileptic
85
Prolonged upright position, sweating prior to LOC, nausea, pre* symptoms and pallor are signs of which type of seizure
Syncope
86
Pelvic thrusting, long duration, ictal crying, change in amplitude but not frequency (poorly observed normally) is suggestive of
Non epileptic seizure
87
First line treatment for focal epilepsy
Carbamazepine or iamotrigine
88
First line treatment for absence epilepsy
Valproate or iamotrigine
89
What is curative epilepsy surgery for refractive epilepsy
Resective surgery or hemispherectomy
90
What is palliative epilepsy surgery for refractive epilepsy
Tractotomy or Vagal nerve electrostimulation
91
At what level do the common carotid arteries bifurcate
C3-4 with internal carotid more posterior
92
What can lead to anastamoses in the internal carotid
Persisting embryonic vessels
93
Petrous ICA branches
Corticotympanic artery to the middle/inner ear and the vidian artery which can connect to ECA
94
When do blood clots cause the worst strokes
When it is an end artery, like the M1 segment of the middle meningeal artery
95
Where in the brian is effected by the worst strokes
Deep brain structures with end arterial supply like the lentiform nucleus, caudate nucleus and internal capsule
96
In which compartment do childhood tumours tend to be
Intratentorial
97
In which compartment do adult tumours tend to be
Supratentorial
98
What are the clinical manifestations of CNS tumour
Loss of function, seizures and raised ICP
99
Is temporal lobe epilepsy more likely to be caused by which grade cancer
Low grade
100
Define astrocytic tumour
Tumour which shows differentiation towards astrocytes
101
What are the two types of astrocytic tumours
Diffuse astrocytomas (Grades 2,3,4) and other eg pliocytic (grade 1)
102
Oligodendroma diagnostic test
Using FISH to see 1p19q deletion and IDH 1 mutant
103
What are rosenthal fibres suggestive of
Pilocytic ostrocytoma
104
Optic nerve fibre cancers
Pilocytic ostrocytomas
105
Medulloblastoma signs of aggression
Large cells, N-MYC and C-MYC
106
Medulloblastoma signs of better prognosis
Desmoplastic in infants and Wnt molecular marker
107
Which tumours metastasise to the brain
Lung, breast, melanoma, GI tract and kidney
108
What causes raised intracranial pressure
Anything which causes an mass within the cranial cavity. Trauma, stroke, infection
109
Where should you look to spot mass effect
Sylvian fissure and thalamus
110
How does the brain initially compensate for raised intracranial pressure
Reducing CSF
111
What will happen when the occulomotor nerve is compromised
Pupil dilation as it was the only parasympathetic supply
112
What is a missile head injury
Where there is penetration of the skull or brain
113
What is a primary head injury
Due to immediate biophysical forces of trauma
114
What is a secondary head injury
Presenting some time after the traumatic event
115
What is aerocele
Air getting into the brain
116
What is a contusion
A superficial bruise of the brain
117
What is a lasceration
A tear
118
What is an cut
An incised wound with a neat edge
119
Which type of haemorrhage is caused by damage to bridging veins
Subdural haematoma
120
What is a superficial haemorrhagic brain injury from
Contusion
121
What is a deep haemorrhagic brain injury from
Diffuse axonal injury
122
What does the impact of inner surface of the skull and the brain cause
Contusion
123
What is the result of differential movement of brain tissue
Shearing, traction and compressive stresses which damage blood vessels and axons
124
What is a coup
Superficial 'bruise' at the site of impact
125
What is a contrecoup
Superficial 'bruise' away from the site
126
What is a contusion
A superficial bruise of the brain
127
What is difffuse axonal injury
A clinicopathological syndrome of widespread axonal damage (inc brainstem)
128
What are retraction balls
Areas on microscopy where following traumatic axonal injury the protein has built up when azon flow was interrupted
129
Long term signs of traumatic axonal injury
Corpus callosum thinning, myelin pallor, frontal lobe glydeine contusion
130
Three causes of brain swelling
Congestive brain swelling (vasodilation), vasogenic oedema (extravasation), cytotoxic oedema (increased water)
131
How is congestive brain swelling caused
Lose ability to regulate blood supply to the brain, results in vasodilation
132
Three things which increase the risk of hypoxia-ischaemia
Hypoxia, hypotension and raised intracranial pressure
133
Which cells are susceptible to hypoxia-ischaemia
Large neurones (central cortex) and purkinje cells
134
Define traumatic brain injury
Brain injury which results in loss of consciousness
135
How does MS prevalence change with latitude
Nearer equator is associated with a lower risk
136
What is the main cause of the inflammation in MS
Activated autoreactive T lymphocytes
137
Which cells maintain the myelin in the CNS
Oligodendrocytes
138
Where is the most common site of MS
Periventricular in the brain
139
What is the most common cause of Brown-Sequard syndrome
MS
140
MS pattern 1 pathology is mediated by
Macrophages
141
MS pattern 2 pathology is mediated by
Antibodies
142
Define primary progressive MS
Disease progression from onset with occasional plateaus and temporary minor improvements allowed
143
Define secondary progressive MS
Initial relapsing-remitting disease course followed by progression with or without occasional plateaus, remissions and relapses
144
What are the two essential diagnostic criteria for MS
1) two or more CNS lesions disseminated in time and space 2) exclusion of conditions giving a similar clinical picture
145
What is an EP test
Measures the electrical activity of the brain and spinal cord
146
In MS a lumbar puncture is done, looking for which protein in the CSF
Oligoclonal IgG
147
What are the two phases of MS
inflammatory stage and degenerative stage
148
What is unusual about fatigue in MS
It is exacerbated by heat and made better by cool
149
Which basal ganglia diseases are "hardware problems" with something mechanically wrong
Parkinsons disease and huntingtons disease
150
Which basal ganglia diseases are "software problems" without something mechanically wrong
Essential tremor, dystonia and tourettes
151
Presentation of parkinsons
Assymetrical at first. With gradual worsening. Tremor, stiffness, dull ache joint pain, reduced arm swing, problems doing up buttons and writing smaller.
152
What causes rigidity
Extrapyramidal disease
153
What causes spasticity
Upper motor neurone disease
154
Three cardinal features of parkinsons disease
Brady/akinesia, tremor, rigidity
155
What is the walking like in parkinsons
Small stepped gait, stooped posture, reduced armswing, L>r
156
How do you assess a rest tremor
Hands should be at rest and limp
157
How do you assess an action tremor
Hold the hands straight forward
158
What does symmetrical action tremor suggest
Essential tremor disease
159
Where is the lesion to cause an intention tremor
Cerebellum
160
Where is the disease to cause bradykinesia
Basal ganglia
161
How does bradykinesia present
Decreasing amplitude and accuracy of repetitive movements
162
What are the three types of tremor
Rest, action, intention
163
What are the two common pathological signs of parkinsons disease
Lewys bodies and loss of dopaminergic neurones
164
How can the reduced dopamine supply to the striatum seen in parkinsons disease be imaged
DaTSCAN (innit)
165
What are four factors which cause cell loss in the substantia nigra
Inherited factors, environmental factors, oxidative stress and mitochondrial dysfunction
166
What are inherited factors which cause parkinsons
Susceptibility factors and parkinson genes
167
What are enviromental factors which cause parkinsons
Risk factors and toxin induced
168
What are the two aims of parkinsons disease treatment
Symptomatic relief through higher dopamine levels. Increase availability of dopamine, slow dopamine loss.
169
Anticholinergics side effects
Cognition, confusion, systemic
170
What is on dyskinesias
Hyperkinetic, choreiform movements whenever drugs work
171
What is off dyskinesias
Fixed, painful dystonic posturing, typically on feet when drugs dont work
172
What should you look out for signs of alongside neural conditions
Depression
173
Do you get incontinence in parkinsons
NO
174
What shouldnt be present in early PD
Incontinence, dementia, symmetry, fails
175
What are incontinence, dementia and magnetic gait suggestive of
Normal pressure hydrocephalus
176
How can normal pressure hydrocephalus be treated
A shunt to the abdomen
177
Huntingtons disease cardinal features
Chorea , dementia, psychiatric problems, positive family history
178
What is chorea
Jerky involuntary movements
179
Examples of psychiatric problems
Personality change, depression and psychosis
180
What is generalised dystonia
A syndrome of sustained muscle contraction
181
What is the key sign of 3rd nerve palsy
Fixed dilated pupil
182
Define ataxia
Loss of full control of body movements, limb unsteadiness
183
Three features of cerebellar disease
Ataxia, nystagmus and deficit on the same side as the cerebellar lesion
184
Define nystagmus
Rapid eye movements
185
Which cranial nerves are associated with the brainstem
3-12
186
What is the reticular activation system
Periaqueductal grey matter on the floor of the fourth ventricle
187
What is the reticular activating system responsible for
Alertness, sleep/wake, REM/non REM, respiratory centre, cardiovascular drive
188
What colour is bone on CT
White
189
What colour is bone on MRI
Black
190
How can you treat a non functioning eye
Prisms/squint surgery
191
How can you treat corneal injury
Eye drops and lubricant/ gold weight/ lateral tarsorrhaphy
192
How can you treat a non functioning smile
Cross facial nerve graft
193
How can you treat a non functioning swallow
NG tube/ Tracheostomy/ Percutaneous enterogastrostomy (PEG)
194
How can you treat a non functioning voice
Vocal cord injection
195
Disorders affecting the brainstem
Tumour, inflammatory, metabolic, trauma, spotaneous haemorrhage, infarction and infection
196
Criteria for brainstem death
Pupils, corneal reflex, caloric vestibular reflex, cough reflex, gag reflex, respirations and response to pain
