Neuro Flashcards

Question

Huntington's ``` Aetiology Presentation Investigations Management Complications ```

Answer 1

Aetiology Autosomal dominant - Ch4 Trinucleotide repeat - CAG --> GABAnergic neurone decrease - ``` Presentation Personality ∆ Clumsiness Chorea, tics, myoclonus Self neglect Supranuclear gaze palsy Seizures, spacticity ``` Psych Apathy Dementia Depression Investigations MRI Genetic testing Management Benzoes Valproate Terabenzene SSRI Antipsychotics Complications Depression

Answer 2

Autoimmune demyelinating polymyopathy Aetiology Post viral - Campylobacter jejuni - CMV/ EBV ``` Presentation Ascending weakness Areflexia Autonomic - arrythmias, urinary retention, tachycardia Abnormal eye Parasthesia can occur NOT painful Remember resp depression ``` ``` Investigations Nerve conduction studies Anti-ganglioside ECG Spirometry LP - ^Protein ``` Management IV IG Plasmapheresis VTE prophylaxis Complications Resp depression --> death

Answer 3

``` It is SYMMETRICAL AAAA Ascending weakness - proximal Areflexia Autonomic - arrhythmia, urinary retention, tachycardia Abnormal eyes - diplopia Parasthesia Resp depression ```

Answer 4

Nerve conduction studies (GS) Anti-ganglioside antibodies LP ^ protein Spirometry monitoring ECG - arrhythmia monitoring

Answer 5

``` Aetiology/ epidemiology F>M 20-40 Far from equator Previous mononucleosis Autoimmune demyelination ``` ``` Presentation EYES Optic neuritis Internuclear ophthalmoplegia Optic atrophy ``` MOTOR Spastic weakness SENSORY Trigeminal neuralgia Lhermitte's shocks Numbness UROGEN Sexual dysfunction Urinary incontinence CEREBELLAR - Ataxia - Tremor Uhthoff's phenomenon Can have cognitive impairment Investigations - MRI - 2 lesions disseminated in time and space - Anti MOG antibodies - Oligoclonal bands Management Acute - Methylprednisolone Chronic Interferon/ galantamir Natalizumab Beta blocker - for tremor alentuzumab

Answer 6

MRI - 2 lesions disseminated in time and space LP - oligoclonal bands Bloods - anti MOG antibodies

Answer 7

EYES Optic neuritis Intranuclear ophthalmoplegia Optic atrophy MOTOR Spastic weakness SENSORY Lhermitte's shock Trigeminal neuralgia Numbness CEREBELLAR Ataxia Tremor UROGEN Seuxal dysfunction Urinary retention Can have cognitive impairment

Answer 8

Investigations - MRI 2 lesions disseminating in time and space - Anti MOG antibodies - LP - oligoclonal bands Management Acute methylprednisolone ``` Chronic - Interferon/galantamir - Natalizumab Other muscle relax - baclofen reduce tremor - BB ```

Answer 9

Relapsing and remitting Primary progressive Secondary progressive

Answer 10

WEAKNESS AND FATIGUABILITY Aetiology Antibodies to Ach receptors Assocaited with thyroid/addisons/parkinsons/thymoma ``` Presentation weakness and fatiguability voice trails off + cant walk up the stairs + struggle watching TV Myasthenic snarl Peek sign ``` EYES - Diplopia - Ptosis - better on ice ``` BULBAR Dysphagia Dysphasia Dysphonia Difficulty chewing ``` reflexes normal Proximal weakness ``` Investigations Electromyography - decreased evoked potentials AntiMuSK antibodies AntiAchR antibodies CT thymoma Spirometry ``` Management Pyridostigmine Other - steroids/azathioprine Complications - Resp Exacerbations - Drugs - BB, opioids, lithium, gent - Pregnancy - Infection

Answer 11

``` autoimmune to AchR Associated with Thyroid Thymoma Addisons Parkinsons ```

Answer 12

WEAKNESS AND FATIGUABILITY EYES - diplopia - ptosis - better on inte BULBAR - dysphagia - dysphasia - dysphonia - difficulty chewing voice trails off etc snarl sign peek sign

Answer 13

``` Electromyography - decreased evoked potentials CT thymoma Bloods - Anti MuSK - Anti AchR ```

Answer 14

pyridostigmine Other - steroids/ azathioprine

Answer 15

drugs - BB, lithium, gent, opioids pregnancy infection

Answer 16

``` Aetiology Vascular - EDH Infection - potts Trauma - BSS Autoimmune - SLE? sarcoid? Metabolic Iatrogenic Neoplasm - spinal cord tumour, METS Degenerative - osteophytes, disc prolapse ``` Presentation unilateral leg pain +/- FND ^ reflexes Investigations MRI Management Dexamethasone + Rx cause Complications - cauda equina

Answer 17

Breast Bronchus Kidney Prostate

Answer 18

Herniated disc = most common cause Same as SCC but with impingement of the cauda equina Incontinence saddle anasethesia Do a PR! MRI - URGENT Urgent surgery Complications - paralysis

Answer 19

Aetiology SOD1 mutation Types ``` Presentation MOTOR ONLY - UMNL and LMN signs mixed is common tongue fasciculations, foot drop thenar wasting wasting of tibialis anterior Bulbar signs - Dysphagia, dysphona, dysarthria, dysphasia, drooling Investigations clinical diagnosis ``` ``` Management RILUZOLE Benzos - for spasticity NIV for ventilation PEG/NG for feed Large cutlery ``` ``` Complications aspiration pneumonia resp failure UTI constipation speech difficulty immobility issues eg ulcers ```

Answer 20

``` Amyotrophic lateral sclerosis Motor cortex - UMN + LMN Progressive bulbar palsy CN 9-12 Worst prognosis Progressive muscular atrophy Primary lateral sclerosis ```

Answer 21

``` Aetiology Bacterial, fungal, viral, NSAIDS, tumour, autoimmune, vasculitis BACTERIA Neonates - GBS, e. coli, listeria ``` Adolescent - N. men - Strep pneumonia - Hib Adult - N. men - Strep pneumonia Elderly - N. men - Strep pneumonia - Listeria Presentation Headache, neck stiffness, fever Other photophobia, symptoms of raised ICP, Seizures, RASH, meningism signs Investigations - LP - unless symptoms of ^ICP(see LP slide for results) - Bloods - cultures, FBC, clotting, glucose, ?ABG if v ill Management - IM ben pen in community - Cefotaxime - Dex if penumonia - Cipro for contacts - call PHE if N. men - Amox and gent for listeria ``` Complications Sensorineural deafness Seizures Coma/death Sepsis Abscess ```

Answer 22

amox and gent

Answer 23

Aetiology - HSV - Enterovirus - Mumps - measles - remember SSP - VZV Presentation Triad of fever, headache and personality change Investigations LP - LYMPHOCYTES MRI - change in temporal lobe Management - IV acyclovir

Answer 24

``` Aetiology - strep anginosus Infection near - Meningitis - Mastoiditis - otitis media ``` Infection far - Endocarditis - Presentation FND Fever Headache Investigations - CT/MRI - ring enhancement - Blood cultures Management - Ceftriaxone - Fungal? - fluconazole - Drain - burr hole etc

Answer 25

VIVID ``` Vertical gaze palsy - SNGP Incontinence/ impotence - MSA Visual hallucinations - LBD Interfering limb - corticobasal degeneration Diabetes/ HTN - vascular parkinsons ``` SNGP and MSA have poor response to LDOPA

Answer 26

neurofibromatosis II

Answer 27

Aetiology - Ass. with NFM II ``` Presentation CN VIII unilateral tinnitus and sensorineural deafness Vertigo CN V - absent corneal reflex CN VII - facial paralysis ``` Investigations - CT/ MRI + urgent ENT referral management Surgery radio etc

Answer 28

``` upgoing plantars increased reflexes clasp knife/ spasticity clonus no muscle wasting ```

Answer 29

muscle wasting decreased reflexes fasciculations

Answer 30

ABC + o2 Buccal midaz, rectal daiz, IV loraz Do this twice then move on IV phenytoin or phenobarnital RSI

Answer 31

Causes AED withdrawal alcohol withdrawal Complications renal AKI due to rhabdo cardiac/ resp - aspiration Autonomic - incontinence metabolic lactic acidosis and hypoxia + hypercapnia

Answer 32

Bamford and oxford ``` Total anterior (ACA and MCA) All 3 of Hemiparesis/sensory loss Homonymous hemianopia higher cognitive disorder eg bulbar/ dysphagia ``` ``` Partial anterior (some ACAor MCA) any 2 of the above ``` Posterior (vertebrobasilar) - Isolated homonymous hemianopia - LOC - Cerebellar disorder - CN palsy AND contralateral motor or sensory deficit Lacunar (perforating - BG etc) - pure motor - pure sensory - ataxic hemiparesis - mixed motor sensory

Answer 33

MCA upper limb more affected | ACA lower limb more affected

Answer 34

Weber - PCA CN III and contralateral hemiparesis ``` Wallenberg - PICA Ipsilateral: face pain sensation loss Horners Loss of gag reflex Cerebellar signs ``` Contralateral: pain sensation loss (body) lateral pontine syndrome AICA - same as wallenberg but ipsilateral facial paralysis and deafness Locked in - basilar artery - can move eyes and extraocular muscles

Answer 35

Wernicke's (receptive) Speech fluent Comprehension impaired Sentences do not make sense Broca's (epsressive) Speech non fluent Good comprehension ``` Conductive Arcuate fasciculus Fluent speech Comprehension normal Poor repetition and aware of the errors they are making ```

Answer 36

``` ACUTE ABC ensure not haemorrhagic --> 300mg aspirin Urgent CT head Thrombolysis if <4.5hrs etc (alteplase) + Thrombectomy within 6hrs if proximal ant circulation ``` Then 300mg aspirin for 2 weeks then clopidogrel for life Statin offered if cholesterol >3.5 (48hrs) anticoags can be offered after 2 weeks if indicated for AF patients

Answer 37

``` Unknown time of onset >4.5hrs Pregnancy Head injury or surgery in 3 months On anticoags Clotting disorder Liver disease ``` Anuerysm Tumour

Answer 38

1 month minimum

Answer 39

Definition Stroke symptoms last <24hrs Presentation Same as stroke but can also often include amaurosis fugax Investigations 24hr ECG MRI Carotid doppler ``` Management 300mg aspirin and urgent neuro referal within: 24hrs if <7 days since TIA 1 week if >7 days since TIA Carotid endarterectomy if need (>70%) ```

Answer 40

AICA Same as wallenberg except ipsilateral facial paralysis and deafness

Answer 41

STC Aetiology Central Stroke S - multiple Sclerosis ``` Pre-ganglionic Trauma Tumour Thyroidectomy Cervical rib ``` Post ganglionic Cluster headaches Carotid disection Cavernous sinus thrombosis ``` Presentation Ptosis Meosis Anhidrosis Enophthalmous ``` Investigations Apraclonidine - affected eye does not dilate CT - lung tumour Management Rx cause

Answer 42

Aetiology ``` Presentation - DANISH Dysdia Ataxia (vermis) Nystagmus Intention tremor Slurred speech Heel shin/ pendular reflexes ``` ``` Investigations Vascular - stroke Infection - meningitis/encephalitis/VZV/mumps Trauma Autoimmune/alcohol! Metabolic - hypopara/thyroid, B12 Iatrogenic* Neoplasm Degenerative - MS ``` Drugs - Lithium - metronidazole - Isoniazid - Phenytoin Management Rx causes yay

Answer 43

Aetiology Vascular impairment of the anterior spinal artery (from vertebral, from aorta) so most comes from aortic insufficiency eg aortic dissection/ aneurysm/ atherosclerosis ``` Presentation Dorsal column intact loss of pain loss of motor Arreflexia Autonomic failure ``` Investigations CT angio? Management Rx cause

Answer 44

``` Focal Simple - no loc Complex - loc - symptoms in one area Jacksonian march Todd's paralysis Can go simple --> complex ``` ``` Generalised (both sides, LOC) Tonic clonic - falss then jerking Atonic - pt falls Myoclonic - jerks Absence - stares blankly ```

Answer 45

Temporal - Hallucinations - Automatism (lip smacking, pulling) - Post ictal dysphasia - Deja vu Frontal - Jacksonian march - Movements - Todd's paralysis Parietal - parasthesia Occipital - flashes - floaters

Answer 46

``` Vomiting Anorexia/ ataxia Liver toxicity Pancreatitis Retention of weight Oedema Alopecia Tremor/ Teratogenic (NTD) Enzyme inhibitor ```

Answer 47

2 or more unprovoked seizures >24hrs apart Aetiology - Cerebral palsy - Tuberous sclerosis - Downs - Tumours Investigation - EEG - MRI ``` Management AED - 2nd seizure OR - 1st seizure and MRI structural abnormality - FND ```

Answer 48

``` Focal Carbamazepine OR Lamotrigine Valproate ``` ``` Generalised (valproate) Absence Valproate Ethosuxamide Not carbamaz ``` Tonic clonic Valproate Lamotrigine/carb Myoclonic Valproate Lamotrigine Not carbamaz

Answer 49

No drive for 6 months after a seizure | Can drive if seizure free for 12 months

Answer 50

``` Vascular - stroke/ SAH Infeciton -men/enceph/abscess Trauma Autoimmune - SLE Metabolic -alcohol withdrawal, low Na, Ca, O2, glucose, high uraemia, Ca,Na Iatrogenic - TCA/BDZ/tramadol Neoplasm - primary and secondary ``` D

Answer 51

``` Drowsiness Impulsivity N+V Dizziness HAllucinations ```

Answer 52

Neuroleptics | Metoclopramide

Answer 53

Lithium Phenytoid Isoniazid Metronidazole

Answer 54

TCA | Benzos

Answer 55

ACEi | TCAs

Answer 56

``` Beta agonist Caffiene Lithium Valproate Amphetamine TCAs SSRI ```

Answer 57

NSAIDS | Trimethoprim

Answer 58

Isonizid metronidazole Phenytoin

Answer 59

``` Pregnancy Infection Opioids Gentamycin BB ```

Answer 60

Parkinson's Resting - 4-6Hz Cerebellar DANISH signs Essential Can have vocal Worse on arms outstretched Better on alcohol and rest Orthostatic Multiple system atrophy Has autonomic symptoms eg incontinence

Answer 61

Type I Chr 17 AD ``` Skin lesions Cafe au lait axillary freckles optic lesions scoliosis pheo ``` Type II Chr 20 AD tumours Bilateral Acoustic neuromas Ependymoma schwannoma meningioma

Answer 62

Causes Mainly motor GBS Infection - diptheria/HIV Mainly sensory Diabetes Uraemia B12 Other: Autoimmune, SLE Drugs - isoniazid, pheny, metronidazole Investigations B12, U+E, blood cultures, nerve conduction studies Anti RO/La for SLE

Answer 63

``` Vascular - stroke/ SAH Infection - meningitis etc Trauma - HI Autoimmune Metabolic Hypoglycaemia/ DKA/ uramiea/ hepatic encephalopathy/wernickes Iatrogenic - opiates/ alcochol Neoplasm ```

Answer 64

Median Ulnar Radial Common peroneal Intercostobrachial

Answer 65

C6-T1 PRADAH ``` P Regnancy Arthritis Diabetes Acromegaly Hypothyroid ``` Colle's supracondylar fracture Presentation - Motor - wasting of APB Sensory - lateral 3.5 fingers + palm Relieved by dangling off bed - wake and shake Investigations Tinnels/phalens Neurophysiology = diagnostic Clinical diagnosis Management - Rx cause - Wrist splinting - Corticosteroid injection - Neuropathic pain releif - gabapentin/ pregabalin

Answer 66

C7-T1 Associations - Trauma to elbow - Handlebar palsy ``` Presentation Weakness - wrist flexors - interossi - hypothenar eminence (pinky abduction) Sensory - medial 1.5 ``` Management - Splint - Surgical decompression

Answer 67

C5 - T1 Association - something about alcoholics falling asleep on a chair Presentation Motor - wrist drop Sensory - anatomical snuffbox Management Splint Surgical decompression

Answer 68

L4- S2 Sitting cross legged trauma FOOT DROP ∆∆ MND

Answer 69

``` Aetiology MND MG GBS Brainstem tumour ``` Presentation - LMNL!!!!! CN 9-12 9 + 10 - gag reflex/ vagus nerve, taste posterior 1/3 , swallowing 11 - accessory - trap + SCM 12 - hypoglossal - drooling, fasciculation Management - Rx cause just remember MND is main ∆∆

Answer 70

of corticobulbar tracts - UMNL!!! DONALD DUCK SPEECH Stroke MS MND ``` Difference to bulbar its UMNL so: No fasciculations ^Jaw jerk - Emotionally labile ```

Answer 71

Aetiology Autosomal dominant Presentation SKIN AND NEURO NEURO Epilepsy Intellectual impairment SKIN - Ash leaf spots - ^under UV - Shagreen patches - over lumbar spine - Adenoma sebaceum - in butterfly distribution under nose

Answer 72

Aetiology Presentation 1) Excessive daytime sleepiness 2) Cataplexy - loss of tone due to extreme emotion 3) Sleep paralysis 4) Hypnagognic hallucinations Investigations - Sleep clinic - EEG Management STOP DRIVING Sleep hygeine Pharma - Modafanil - methylphenidate

Answer 73

Fluid filled cavities in the spinal cord Pressure --> compression of spinal cord tracts ``` Presentation Pain + temp loss in shawl like distribution LMNL lesion Dorsal column can be affected Autonomic - bowel and bladder others - scoliosis ``` Investigations MRI Management Pain meds - surgery

Neuro Flashcards

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