Neuro Flashcards by S B

Bitemporal hemianopia, upper quadrant > lower quadrant

inferior chiasmal compression, commonly a pituitary tumour

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Bitemporal hemianopia, lower quadrant > upper quadrant

superior chiasmal compression, commonly a craniopharyngioma

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Patient able to speak clearly post stroke, but content unrelated to questions. Ask them to repeat a series of phrases, which they are unable to do. Where is the lesion?

Wernicke’s aphasia is due to a lesion of the superior temporal gyru

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What is Wernicke’s aphasia

receptive aphasia
due to a lesion of the superior temporal gyrus
results in patients being able to produce fluent speech, but comprehension and repetition is impaired.

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What is Broca’s aphasia

lesion of the inferior frontal gyrus
Speech is non-fluent, laboured, and halting
Comprehension is normal

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what is Lambert Eaton Syndrome and what cancer is it associated with

NMJ disorder due to the auto-immune destruction of pre-synaptic calcium channels

associated with small cell lung cancer

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Patient w/ fever, headache and altered mental status - diagnosis and Ix (plus what is buzzword for what is seen on Ix)

Encephalitis

LP - increased lymphocytes
MRI - temporal lobe encephalitis

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what is most common cause of encephalitis

HSV

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Mx of encephalitis

IV aciclovir

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Patient with headache, neck stiffness, photophobia and rash

Meningitis

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common causes of meningitis (neonates, children, 21+, elderly, open head trauma, HIV)

Neonates – Group B strep/Listeria/E.Coli
Children – H.influenza 
10 to 21 = meningococcal
Adults/Elderly – pneumococcal/Listeria
Open head trauma – staph aureus

HIV – cryptococcal meningitis

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Ix for meningitis and results

Viral – clear fluid, lymphocytes, normal glucose, normal/slightly raised protein
Bacteria – cloudy, neutrophils, low glucose, high protein
TB – lymphocytes, low glucose, high protein

CT scan

Blood Cultures

Throat swab

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Mx for meningitis - plus if listeria is suspected, if pen allergic and TB specific Tx

IV Ceftriaxone 2g bd + Dexamethasone 10mg QDS

IF LISTERIA suspected = Add Amox or Ampicillin

If PEN ALLERGIC = IV Chloramephenicol w/ Vancy

TB = RIPE therapy for 12 months

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where is the location of the bleed in a subdural haemorrhage

between the dura and the arachnoid

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Ix for SAH

Non contrast CT head

LP 12 hours after onset

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Mx for SAH

Nimodipine

Endovascular coiling/clipping

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complications of SAH

Rebleeding
SIADH
Hydrocephalus
Ischaemia
Seizures

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what is signs of Total Anterior Stroke

Hemiplegia +/- hemisensory loss
Homonymous Hemianopia
Cortical signs

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Signs of partial anterior stroke

1/3 out of TAS

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what is signs of lacunar stroke

Unilateral weakness +/- sensory deficit

NO cortical signs

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sings of posterior occipital stroke

Cerebellar/Brainstem syndrome

Isolated visual deficit

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what Sx do you get with an anterior cerebral artery occlusion

contralateral leg

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what Sx do you get with an middle cerebral artery occlusion

Contralateral hemiparesis and hemisensory loss (esp of face arm)

Contralateral homonymous hemianopia

If dominant hemisphere affected – dysphasia
If non dominant hemisphere affected – visuo-spatial disturbance eg cannot dress, gets lost

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what Sx do you get with an posterior cerebral artery occlusion

Contralateral homonymous hemianopia often with macular sparing

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Ix for strokes

``` Bloods ECG Urgent non-contrast CT - Ischaemic vs Haemorrhage - Remember CT can be normal in Ischaemic strokes! ```

Mx for strokes

Aspirin 300mg if CT shows no haemorrhage If atherosclerosis - start clopidogrel If cardioembolic – start warfarin/newer anticoagulants Secondary prevention

what are causes for mononeutritis multiplex i.e. 2+ peripheral nerves in disparate areas of bofy

WARDS PLC ``` Wegners Amyloidosis Rheumatoid Diabetes SLE PAN Leprosy Carcinomatosis ```

what is important to monitor in Guillen Barre Syndrome

FVC - worried about resp failure leading to death

what infection is guillen barre associated with

campylobacter

what is Todd's palsy

temporal seizure that causes weakness

Tx for focal seizures

1st - carbamazepine | 2nd - lamotrigine

what is Sx of a simple (awareness) focal seizure

Focal motor/sensory/autonomic No post-ictal symptoms E.G one limb jerking

what is Sx of a complex focal seizure

Frontal/Temporal Lobe Automatisms Post-ictal confusion

Tx for generalised seizures

Sodium Valproate | Lamotrigdine

what is definition of status epilepticus

A single seizure or serial seizures lasting more than 5 minutes, or two or more seizures without a return of consciousness between seizures

initial Tx of status epilepticus

Lorazepam 4mg IV [Midazolam 10mg buccally or Diazepam 10−20 mg given rectally if pre-hospital] Repeat after 5 mins

further Tx of status epilepticus

Within 30 minutes: Phenytoin 18mg/kg IV at 50mg/min with ECG monitoring orSodium valproate 20-30mg/kg IV at 40mg/min if ECG monitoring or phenytoin is not available

if question talks about soft cheese or France what is it implying

Listeria infection | i.e. might be causing meningitis

what are the accessory muscles [sternocleidomastoid and trapezius] supplied by

CN XI = Accessory nerve

damage to what nerve can cause hoarseness

recurrent laryngeal branch of the vagus nerve

Nerve supplying quadriceps

femoral nerve (L2-L4)

nerve supply lateral of thigh

lateral femoral cutaneous nerve (L2-L3)

nerve that can be injured when did IM injection at the buttock

sciatic nerve (L4 to S3)

if there is a lesion affecting CN XII where will the tongue point

Twelve = Tongue points Towards lesion (TTT)

what is DCML responsible for and in what neuropathy is it lost first in

fine touch (tactile sensation), vibration and proprioception diabetic neuropathic

what is the Anterior spinothalamic tract responsible for

crude touch and pressure.

what is the lateral spinothalamic tract responsible for

pain and temperature

prophylaxis for meningitis

Prophylaxis – MENINGOCOCCAL meningitis = rifamipicin/ciprofloxacin

ankle jerk reflex

knee jerk reflex

triceps reflex

biceps reflex and supinator reflex

C5-C6

Sx of ALS

weakness, UMN signs and LMN signs

Sx of PLS

UMN signs only distal muscle groups more than proximal marked spastic leg weakness pseudo-bulbar palsy [forehead spared]

Sx of progressive muscular atrophy

LMN signs only weakness distal muscle groups more than proximal

Sx of bulbar palsy

LMN lesion of CN IX-XII tongue weakness wasting with fasciculations drooling dysphagia

triad of sx in parkinsons

tremor rigidity bradykinesia

1st line Mx for parkinsons with motor symptoms affecting QOL

levodopa

where is affected in myasthenia gravis

post-synaptic antibodies to ACh receptors Sx occur when ACh reduced to 30% of normal

1st line for MG

acetylcholinesterase inhibitor = Pyridostigmine

where is affected in lambert eaton syndrome

associated in SCLC antibodies to pre-synpatic calcium channels

sx of anterior cerebral artery stroke

weakness or numbness/hemiparesis in contralateral arm and leg [legs more than arms]

sx of middle cerebral artery stroke

weakness or numbness/hemiparesis in contralateral arm and leg [arms more than legs] aphasia contralateral homonymous hemianopia

sx of posterior cerebral artery stroke

contralateral homonymous hemianopia with macular sparing

sx of lacunar stroke

pure motor , or pure sensory, or ataxia

stroke of locked in syndrome

basilar artery

1st line Ix for stroke

Non contrast CT

Mx for stroke

Once hemorrhagic stroke ruled out ``` 1st = 300mg Aspirin 2nd = thrombolysis (anteplase) can only be done within 4.5 hours from onset ```

secondary prevention for stroke

1st line = clopidogrel 75mg daily + Atrovastatin 80mg [note patient will be on Aspirin 300mg for the first two weeks post stroke] If Clopidogrel not tolerated = aspirin + MR Dipyridamole Lifelong

nerve roots of ulnar nerve and what action can test it

C7 - T1 peace sign

nerve roots of radial nerve and what action can test it

C5 - T1 thumbs up [get wrist drop if compressed]

nerve roots of median nerve and what action can test it

C6 - T1 ok sign

nerve roots of phrenic nerve

C3 - C5

nerve roots of common fibular nerve and signs of compression

L4 - S1 foot drop weak dorsiflexion/eversion, reduced sensation over dorsum of foot

nerve roots of tibial nerve and signs of compression

L4 - S3 weak plantarflexion/inversion, reduced sensation over plantar of foot

nerve roots of sciatic nerve and signs of compression

L4 - S3 weak hamstrings, numbness and tingling down the back of the leg

Neuro Flashcards

(76 cards)