Neuro Flashcards
(141 cards)
1
Q
Criteria for a Total Anterior circulation Stroke?
A
All three of :
Unilateral weakness or sensory deficit
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia or visuospatial)
2
Q
Criteria for Partial anterior circulation stroke?
A
Two of:
Unilateral weakness or sensory deficit
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia or visuospatial)
3
Q
Lacunar syndrome stroke criteria?
A
One of:
Pure sensory
Pure motor
Sensori-motor
Ataxic hemiparesis
4
Q
Posterior circulation syndrome (stroke)?
A
One of:
Cranial nerve palsy
Bilat motor/sensory deficit
Congate eye movement
Cerebellar dysfunction
Isolated homonymous hemianopia
5
Q
Person presents with unilateral weakness and dysphasia what stroke?
A
Partial anterior
6
Q
Person presents with isolate homonymous hemianopia, stroke type?
A
Posterior syndrome
7
Q
Unilateral weakness, Homonymous hemianopia and dysphasia?
A
TACS
8
Q
TACS stroke involves which arteries?
A
Middle and anterior cerebral arteries
9
Q
Scoring system after TIA?
A
ABCD2
10
Q
High risk ABCD2 score?
A
4 or greater
11
Q
What classifies as a crescendo TIA?
A
Two or more TIAs in a week treat as high risk
12
Q
Initial treatment of TIA?
A
Give aspirin 300mg unless already taking if so continue normal dose. Unless on anticoagulation or bleeding problem
13
Q
Suspected TIA within last week? When to refer?
A
Urgently within 24hrs
14
Q
What is ABCD2 score?
A
Age >60 BP >140/90 Clinical presentation Weakness retinal or speech Duration >60mins (2) 10-59 mins) 1 Diabetes
15
Q
If TIA occured >1 week ago referral time?
A
Within a week
16
Q
Antiplatelets in TIA and stroke ?
A
The standard treatment is clopidogrel 75mg daily- off licence in TIA
or if cannot tolerate clopidogrel and have dipy and aspirin
or dipyridamole alone if clopidogrel and aspirin contraindicated
17
Q
Target systolic BP in pts after stroke or TIA?
A
130mmHg
18
Q
Initiation of anticoagulation in stroke/TIA? When started
A
If AF or atrial flutter once haemorrhage ruled out.
Immediately in TIA
after 14 days in Stroke(disabling) use aspirin 300mg
19
Q
DVLA rules for TIA/Stroke?
A
Don’t need to tell DVLA if no complications and recovered. Only if >1 TIA or disabling stroke.
Stop driving for 1 months
20
Q
DVLA rules for heart attack?
A
Don’t need to tell but stop driving for 1 week after angioplasty
or 4 weeks if no angioplasty or unsuccessful angioplasty
21
Q
Score for ruling in strokes in A&E?
A
ROSIER
22
Q
When is thrombolysis indicated in stroke?
A
Within 4.5 hrs and only if imaging has ruled out haemorrhage
23
Q
Absolute contraindications to thrombolysis?
A
Previous haemorrhage, Seizure at onset
Stroke in previous 3 months
GI haemorrhage
Active bleeding
24
Q
Relative contraindication for thrombolysis?
A
Major surgery in previous 2 weeks, anticoagulated already
25
When is carotid endarterectomy recommended?
TIA or non disabling stroke in carotid territory
26
USS of carotids for surgery?
50-99% for north american
| >70% european system
27
If brain imaging needed in TIA what used?
MRI
28
Which arteries involved in lacunar stroke?
Perforating arteries
29
What is ataxic hemiparesis?
Hemiparesis usually worse in lower extremity, and hemiataxia (loss of muscle control
30
Posterior stroke involves which arteries?
Vertebrobasilar
31
Most common cause of SAH?
Berry aneurysm ~85% Polycystic kidneys associated
32
Classic SAH questions?
Thunderclap’ or ‘baseball bat’), severe (‘worst of my life’) and occipital
Nausea and vomiting
Meningism (photophobia, neck stiffness)
33
Imaging in SAH?
CT- brights on CT basal cisterns and sulci severe cases ventricular
34
CT negative in SAH now what?
>12hrs laters Lumbar puncture to confirm xanthochromia(differentiate from traumatic tap)
35
Confirm SAH then?
Refer to neurosurgery immediately
36
Investigation to find cause of SAH?
CT intracranial angio
37
Vasospasm in SAh use what?
Nimodipine
38
SAH complications?
Re-bleed, vasospasm, hyponatremia (SIADH)
39
What nerve may be damaged in colles fracture?
Median
40
Fasciculations think?
MND
41
Big toe nerve root?
L5
42
Subdural haemorrhage results from what?
Bridging veins
43
Essential tremor presentation? Risk factors?
A bilateral upper limb action tremor, with absence of other neurological signs, such as dystonia, ataxia, or parkinsonism is the core sign of essential tremor
No resting tremor
Family history
44
Essential tremor is stopped by consumption of what ?
Alcohol
45
Ptosis plus dilated pupil =
Third nerve palsy
46
Ptosis plus constricted pupil =
Horners syndrome
47
Clonic movements travelling proximally? Which lobe?
Jacksonian frontal lobe
48
Loss of corneal reflex which cranial nerve?
CN V trigeminal
49
Weakness in myasthenia gravis characteristics?
Gets worse with exercise
50
Plucking at clothes and lip smacking often seen in which lobe seizure?
Temporal
51
Deviation of Jaw to or away from lesion? WHich Cn?
CN V toward lesion
52
Loss of facial sensation which CN?
Cranial never V
53
Nystagmus feature of which CN lesion?
CNVIII
54
A man loses consciousness then is seen to have rapid jerks of his facial and limb muscles?
Tonic-Clonic seizure
55
Confusion, ataxia, nystagmus/ophthalmoplegia?
Wernickes- give IV pabrinex
56
Frontotemporal dementia feature?
Disinhibition- often family history
57
Which drugs can cause problem gambling etc in parkinsons?
Dopamine agonists biggest risks
58
Differentiate between pseudo and true seizure?
Prolactin
59
ocular myasthenia gravis?
Looks like CN3 lesion but pupil is normal
60
Urinary incontinence + gait abnormality + dementia?
normal pressure hydrocephalus
61
Pre-renal AKI urea vs creatinine?
Urea a lot higher than creatinine
62
Intrinsic and post renal AKI Creat and Urea?
Urea lower in contrast to creatinine
63
General screen for stroke?
FAST
64
Investigations for TIA ?
Peripheral nerves, Pulse and BP is this AF?
65
Aspiring for how long before clopidogrel in stroke?
2 weeks
66
DANISH mnemonic?
```
dysdiadochokinesis.
ataxia.
nystagmus.
intention tremor.
scanning dysarthria slurred
heel-shin test positivity.
```
67
CSF results in Bactrial meningitis?
Cloudy, Low glucose, High protein and neuts
68
CSF in Viral?
Clear usually, Glucose 60-80% plasma, Protein normal usually, lymphs predominant
69
CSF TB?
FIBRIN web, slightly cloudy,Low glucose but HIGH protein and lymphs
70
Wegeners ganulomatosis antibody?
CANCA
71
Churg strauss (Eosinophillic) antibody?
P-ANCA
72
Status epilepticus treatment?
Initially up to 4mg lorazepam IV repeated after 5-10 mins if necessary
or buccal midaz 10mg or rectal diazepam 10mg
Consider phenytoin 20mg/kg - get senior help if not responding after 5 mins
73
Definition of status epilepticus?
>5mins seizure or seizures that stop very briefly and restart
74
Management of status epilepticus?
A-E Protect airway (adjuncts)
Oxygen blood FBC, U&E, calcium magnesium glucose
Consider anaesthetic support
75
Most important investigation in Meningitis?
Lumbar puncture
76
When to give Ben pen?
If non blanching rash
77
Most common causes of meningitis in adults?
S. pneumoniae, H. influenzae type b, N. meningitidis
78
Extra-dural haematoma ct sign?
Lentiform extra lentils
79
Subdural Haematoma CT signs?
Crescent shaped
80
Risks for subdural haematoma?
Trauma or anticoagulants >65years
81
Classic history for extradural?
Trauma LOC and then lucid interval. Can then rapidly go down hill third nerve palsy and a fixed dilated pupil
82
Definitive management of extradural?
Craniotomy and clot evacuation
83
Acute subdural haematoma mechanism of injury?
High speed injuries often
84
Subdural haematoma treatment?
Craniectomy
85
SAH treatment?
Directed at bleed cause
86
Most common complication meningitis?
deafness
87
Criteria for CT head in 1 hr ?
CS <13 on initial assessment
GCS <15 at 2h post-injury
Suspected open/ depressed skull fracture
Sign basal skull fracture – panda eyes, Battle’s sign,
Focal neuro deficit
Post-traumatic seizure
>1 episode vom
88
On warfarin head injury no other signs? When to CT?
Within 8 hrs
89
LP contraindications?
ICp pappiloedema, Cardiorespiratory unstable, Coagulopathy, DIC, FOCAL neurology
90
Post ictal confusion focal unaware which lobe?
Temporal
91
Rapid recovery from focal unaware? Lobe?
Frontal
92
Focal aware?postictal?
No post ictal symptoms
93
First investigations after possible epilepsy ?
Bloods and ECG
94
How long seizure free for driving normal car and how long bus?
1 year 10 years
95
Remission of MS symptoms must be present for at least?
24hrs
96
Relapse of MS how long between symptoms?
30days and symptoms must be >24hr in length
97
MS features?
Optic neuritis
Pins and needles trigeminal neuralgia and numbness
Spasticity of legs
Ataxia
98
Unilateral pain behind eye and scotoma?
Optic neuritis
99
MS give what nutrient?
Vit D
100
MS lifestyle?
Smoking stop exercise etc
101
Parkinsons triad?
Increased tone or rigidity, slow to move and tremor(pill rolling)
102
Median nerve palsy symptoms?
Abduct and oppose thumb, and lumbrical problems.
103
Ulnar nerve palsy ?
Claw hand, inability to flex and abduct fingers
104
Radial nerve palsy?
Wrist drop and anatomical snuff box loss of sensation
105
Erbs palsy?
Waiters tip upper brachial
106
Klumpsies ? assoc with what? Lower brachial plexus
Horners, claw hand
107
Axillary nerve damage by what and causes what?
Humeral head damage or dislocation anterior, regimental badge and no abduction first 15degrees
108
Sciatic nerve problems, what happens?
Foot drop
109
Foot drop and loss of dorsiflexion nerve and eversion?
Common peroneal
110
Tibial nerve palsy?
Plantarflexion cant stand on toes sole of foot loss
111
Management of alzheimers pharmacological?
Acetycholinesterase inhibitors are options for mild to moderate alzheimers
112
Moderate alzheimers and intolerent to acetylcholinesterses? Use what?
Memantine
113
When to use memantine as monotherapy in alzheimers?
Severe disease
114
Moderate severe alzheimers which drugs?
ACetyl inhib and can add on memantine
115
Depression in alzheimers?
Nice dose not recommend anti-deps in mild to severe depression
116
Patient with bradycardia which alzheimers drug to avoid? What other side effect can it cause?
Donepazil
| Can cause insomnia
117
What features point more towards a vascular dementia?
Stepwise progression, significant atheroma history,, can be sudden onset, neurological deficits present, gait disturbances early on. Memory not impaired hugely initially.
118
Potentially treatable causes of dementia?
Addisons Hypothyroid, B12/folate/thiamine deficinet
Brain tumour
Hydrocepahlus
Depression
119
Pellagra what is it signs and symptoms?
Pellagra is a caused by nicotinic acid (niacin) deficiency
3 D's - dermatitis, diarrhoea and dementia.
120
Initial areas of change in MRI alzheimers?
Temporal lobe initially and then parietal
121
Vascular dementia treatment?
Underlying causes- do not offer meds unless co-morbid alzheimers
122
Frontotemporal dementia and AChE?
Do not offer, can make worse
123
Frontal temporal dementia symptoms?
Disinhibition, personality change. Often younger than other dementias mid 50s
124
Fronto temporal dementia treatment?
None as such supportive can use benzos or antipsychotics for aggression and agitation. If parkinsonism use quetiapine
125
Depression vs dementia?
short history, rapid onset
Biological symptoms- weight loss
Worried about memory
126
Focal and tonic clonic seizures treatment?
Carbamazepine
127
Tonic or atonic seizures treatment?
Sodium valproate
128
Myoclonic seizures treatment?
Keppra
129
Absence seizures treatment?
Lomotrigine or ethosuximide
130
Diagnosis of MS clinically?
episodic neurological dysfunction in at least two areas of the central nervous system (brain, spinal cord, and optic nerves) separated in time and space
131
Specificity of MRi spine for MS?
Very High
132
Primary options for relapsing remitting MS?
Interferon
133
Myasthenia gravis signs/symptoms?
Dysphagia, diplopia, ptosis, dysarthria
proximal limb weakness worsens with activity (better in morning)
often autoimmune disorder
134
Most specific test for Myasthenia gravis?
serum acetylcholine receptor antibody
135
FVC useful in which neuro disorder?
Myasthenia gravis
136
Pyridostigmine treats what?
Myasthenia gravis
137
Severe myasthenia treatment?
intubate plasma exchange and immunoglobulin
138
Clinical diagnosis of ALS?
presence of upper and lower motor neuron signs fasciculations present
Wasting of small hand muscles
Absent sensory signs
139
Mix of signs in ALS where?
UMN -Arms Hyperreflexia
| LMN-Legs fasciculations
140
Treatments of ALS pharmacological and supportive?
Riluzole and Bi-pap
141
Motor neurone progressive bulbar?
Facial problems chewing and swallowing
