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Neuro Flashcards

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1
Q

How might you investigate MS?

A

Bloods: anti NMO

MRI; would show inflammation in periventricular white matter

LP: would show IgG oligoclonal bands

Evoked potentials: would show delayed auditory, visual and sensory

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2
Q

6th nerve palsy presentation

A

failure to abduct, cross eyed appearance

Can be a sign of raised ICP due to it having the longest course, so it goes first

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3
Q

causes of horner’s syndrome?

A

central/1st order neurones: MS, vascular disease

pre ganglionic/2nd order: pancoast’s tumour, T1 nerve root lesion, carotid endarterectomy

post ganglionic/3rd order: cavernous sinus thrombus

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4
Q

Management of stroke?

A

Acutely…ABCDE approach and call for help

Haemorrhagic:
Conservative: neuro obs
Medical: BP control, correct INR
Surgical: Neurosurgery referral

Ischaemic:
If <4.5 hours
Thrombolysis, repeat CT and start aspirin after 24h

If >4.5 hours
Aspirin 300mg
Then aspirin with clopidogrel lifelong

After initial acute management, admit to stroke unit for full investigation and neuro rehab with MDT and “secondary prevention mx”

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5
Q

homonymous hemianopia - lesion?

A

optic tracts

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6
Q

Causes of a bulbar palsy?

A

Motor neurone disease
Myasthenia gravis
Brainstem lesions: stroke/tumour

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7
Q

macular sparing homonymous quadrantinopia - lesion?

A

striate cortex

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8
Q

Define multiple sclerosis

A

A chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space

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9
Q

Causes of complex opthalmoplegias?

A

Diabetes
Multiple sclerosis
Myasthenia graves
Thyrotoxicosis

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10
Q

Mimics of 3rd nerve palsy?

A

Thyrotoxicosis
Raised ICP
Myasthenia

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11
Q

4th nerve palsy presentation

A

nasal upshoot, failure to depress during adduction

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12
Q

causes of enlarged blind spot?

A

Optic neuritis

Papilloedema

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13
Q

Effect of stroke in anterior cerebral artery?

A

Contralateral motor/sensory loss in the legs > arms

Face is spared

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14
Q

Effect of stroke in middle cerebral artery?

A

Contralateral motor/sensory loss in face and arms >legs
Contralateral homonymous hemianopia
Cognitive changes; aphasia, neglect, apraxia

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15
Q

What is the Mx of Parinson’s?

A

MDT approach; neurologist, specialist nurse, physio, OT, GP, carers

Medical:

  • Dopamine agonists: Bromocriptine, cabergolhne
  • L-DOPA or peripheral DOPA decarboxylase inhibitor (carbidopa)
  • MAO-B inhibitors and COMT inhibitors

Give anti emetics, anti psychotics and anti depressants

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16
Q

Causes of peripheral neuropathy?

A

INVITED MD

Infective; Guillan-Barre
[Neoplastic/Vascular/Inflammatory &amp; AI]
Trauma
Endocrine: Hypothyroidism, DM
[Degenerative]
Metabolic: B12, lead
Drugs: Alcohol, chemotherapy
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17
Q

How might MS present?

A

“SATO”

Spastic parapesis
Ataxia
Tingling
Optic neuritis

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18
Q

Posterior circulation stroke presentation?

A

Cerebellar syndrome
Brainstem syndrome
Homonymous hemianopia

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19
Q

secondary prevention of ischaemic stroke?

Study These Flashcards
A

Aspirin 300mg initially for 2 weeks, then reduce dose
Clopidogrel
Statin
Address risk factors e.g. DM and HTN

20
Q

Causes of 3/4/6th nerve palsies?

Study These Flashcards
A

Central NS: MS, vascular, SOL

Peripheral: DM (mononeuritis), compression, trauma

21
Q

What are poor prognostic signs in MS?

Study These Flashcards
A

Older female
Motor signs at onset
Many relapses early on
Many MRI lesions

22
Q

Causes of cerebellar syndrome?

Study These Flashcards
A

DAISIES

Demyelination
Alcohol
Infarct; brainstem stroke
Space occupying lesion
Inherited; e.g. Frederich's Ataxia/Wilson's disease
Epilepsy medications: Phenytoin
System atrophy, multiple
23
Q

Ddx for Parkinsonism?

Study These Flashcards
A

Progressive supra nuclear palsy

Corticobasilar degeneration

Lewy Body Dementia

24
Q

causes of unilateral vs bilateral ptosis?

Study These Flashcards
A

bilateral: myasthenia gravis, myotonic dystrophy, congenital
unilateral: 3rd nerve palsy, horner’s syndrome

25
Risk factors for stroke?
``` Hypertension Smoking AF DM Vascular disease Family history ```
26
homonymous quadrantinopia - lesion?
optic radiations
27
Clinical picture of Charcot Marie Tooth
Inspection: Bilateral pes cavus, Inverted champagne bottle, distal wasting & weakness Tone: Power: Weakness of ankle dorsiflexion & toe extension Sensation:+/- Glove and stocking sensory neuropathy Reflexes: Absent ankle jerk and plantar response Gait: Stamping gait with foot drop, broad based. Positive Romberg sign (due to lack of proprioception)
28
Classify the types of MS
Relapsing remitting (80%) Secondary progressive Primary progressive Progressive relapsing
29
Eye problems in MS?
Optic neuritis INO diplopia
30
Causes of 3rd nerve palsy?
Mononeuritis MS Tumours Aneurysms
31
What medications are commonly used in MS?
Methylprednisolone - acute attacks Interferon beta - disease modifying Natalizumab - biologics preventing relapse Baclofen - spasticity
32
Causes of unilateral facial nerve palsy?
Categorised by anatomical level: Supranuclear: SOL, vascular, MS Brainstem: haemorrhage, infection Cerebellopontine angle: acoustic neuroma, meningioma Facial canal: Ramsay-Hunt, trauma Systemic: DM
33
Other causes of Parkinson presentation?
Parkinson plus syndromes: Multi system atrophy: - autonomic dysfunction, parkinsonism, cerebellar ataxia Progressive supranuclear palsy: - vertical gaze palsy, pseudobulbar palsy, parkinsonism Lewy body dementia
34
What is lateral medullary syndrome/ Wallenberg's
``` Occlusion of vertebral artery or PICA; signs are ipsilateral apart from body anaesthesia to pain "DANVAH" Dysphagia Ataxia Nystagmus Vertigo Anaesthesia Horner's syndrome ```
35
Features of vestibular schwannoma?
sensorineural hearing loss, tinnitus, vertigo, headache, facial anaesthesia and facial nerve palsy
36
Features of Friedrich's ataxia?
Autosomal recessive mitochondrial disorder PAWAH ``` Pes cavus Ataxia Wasting in legs Areflexia in legs but extensor planters HOCM ```
37
Myasthenia gravis features on inspection
``` Thymectomy scar Bilateral ptosis Complex ophthalmoplegia Myasthenic snarl Nasal voice +deterioration ```
38
Ix for myasthenia gravis?
Bloods Abs:Anti AChR, Anti MuSK Spirometry: EMG: reduced response to titanic train of impulses !!! Tensilon test: improvement with edrophonium Imaging: CT mediastinum: thymoma
39
Management of myasthenia gravis?
Acute: ABCDE approach! If rest dysfunction, ITU - Plasmapheresis - IVIg Chronic - Anti muscarinics, e.g pyrdostigmine
40
Classification of tremors
Active - Postural tremor (benign essential, anxiety) - Intention tremor Passive - Parkinsonian Benign essential: Postural tremors get worse with lack of sleep and caffeine and better with alcohol
41
Tx of acute delirium
Haloperidol or olanzipine
42
Difference between HSMN1 and 2?
1: demylination - reduced conduction velocity 2. decreased amplitude - axonal degeneration Mutated peripheral myelin protein
43
NMO vs MS?
NMO can be more severe, is not progressive in nature NMO attacks aquaporin 4 protein in the CNS
44
Medical vs surgical 3rd nerve palsy
Medical: pupil sparing (e.g. diabetes, MS) Surgical: pupil dilated (e.g. tumour)
45
Classification of LMN lesions
``` Anterior horn (old polio) Nerve itself (diabetes) Neuromuscular junction (Myasthenia) ```
46
Syringomyelia presentation
Syrinx = tubular cavity in spinal cord Cape distribution: loss of pain and temperature wasting/weakness of hands, loss of UL reflexes, charcot joints

Finals Revision Progress (16 decks)

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