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Phase 3a Medicine > Neuro > Flashcards

Neuro Flashcards

1
Q

List the Bamford criteria for TACS

A

All of:

Unilateral weakness and/or sensory deficit of the face, arm, and leg.

Homonymous hemianopia.

Higher cerebral dysfunction.

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2
Q

List the Bamford criteria for PACS

A

2 of:

Unilateral weakness
and/or sensory deficit of the face, arm, and leg.

Homonymous hemianopia.

Higher cerebral dysfunction.

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3
Q

List the Bamford criteria for a lacunar stroke

A

One of:

  • Pure sensory.
  • Pure motor.
  • Sensori-motor stroke.
  • Ataxic hemiparesis (weakness and ataxia on one side.)
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4
Q

Define a lacunar stroke

A

Deep brain structures such as basal ganglia, internal capsule, thalamus, and pons effected.

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5
Q

Define Posterior Circulation stroke

A

Vertebrobasilar arteries effected.

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6
Q

List the Bamford criteria for a posterior circulation stroke

A

One of:

  • Cranial nerve palsy and contralateral motor/sensory deficit.
  • Bilateral motor/sensory deficit (may cause LOC.)
  • Conjugate eye movement (gaze palsy) disorder.
  • Cerebellar dysfunction.
  • Isolated homonymous hemianopia.
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7
Q

Common cause of stroke in young people and description?

A

Arterial dissection.

Movement/extension of neck.

Carotid or vertebral arteries.

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8
Q

What part of the body does MCA stroke commonly effect? ACA stroke?

A

MCA - arms.

ACA - legs.

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9
Q

What is the difference between dysarthria and dysphagia and what type of stroke do they present in and why?

A

Dysarthria - slurred speech due to muscular weakness.

Dysphagia - language issue to to brain involvement.

Dysarthria is in POCS because it effects cranial nerves.

Dysphagia is in LACS/PACS as it effects the language regions of the brain.

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10
Q

DDx for stroke

A 
Todd's paresis: following seizure.
Hemiplegic migraine.
Syncope.
Hypoglycaemia.
Bell's palsy (no forehead sparing as is LMN.)
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11
Q

Ix and Tx of ischaemic stroke.

A

Urgent CT head.

Ischaemic: <4.5hrs = Alteplase.

Give 300mg orally if not dysphagia (rectally or enteral if do.)

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12
Q

When to offer surgical thrombectomy?

A

Within 6 hours.
Confirmed proximal anterior circulation occlusion shown by CTA/MRA.
Or up to 24 hours if potential to salvage brain tissue.

Up to 24 hours if proximal posterior circulation occlusion confirmed by CTA/MRA.

Alongside thrombolysis.

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13
Q

Ix and Tx of haemorrhagic stroke.

A

Urgent CT head.

If receiving Warfarin/high INR: use IV Vitamin K to reverse it.

Control BP: 130/140 systolic within 1 hour.

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14
Q

Initial Mx of TIA

A

No CT.

300 mg immediately, and daily.

Refer to be seen in TIA clinic within 24 hours.

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15
Q

How to assess and manage carotid stenosis as a cause of stroke/TIA?

A

If on imaging, the stroke was in the carotid territory, or if was a TIA:

Doppler USS to show carotid stenosis.

> 70% perform carotid endarterectomy.

Alternatively stent.

Within 2 weeks.

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16
Q

What Ix should be done if the underlying cause was dissection?

A

MRA.

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17
Q

What investigation is important in the follow up care, and what is it looking for?

A

ECG for AF.

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18
Q

What are the ‘young stroke’ bloods and when should they be done?

A
  • HIV and vasculitic screen.
  • Thrombophilia screen.
  • Homocysteine.
  • Done on Px <45.
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19
Q

A Px with a ischaemic stroke is stabilised but then the GCS begins to fall, what is the likely diganosis?

A

Haemorrhagic transformation.

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20
Q

What secondary prevention steps are implemented after stroke or TIA?

A

Antiplatelet: 300mg Aspirin for 2/7 or until discharge. Lifelong Clopidogrel.

Anticoagulation with NOAC such as Rivoroxiban if have AF.

Anti-HTN (pathway) to keep at <130/80.

Statin.

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21
Q

When deciding on what therapy for AF, following a stroke, what scores should be used and what do they show?

A

HASBLED risk of someone with AF bleeding on anticoag.

CHADSVASc risk of stroke with AF.

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22
Q

What score is used to calculate risk of stroke after AF?

A

ABCD2

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23
Q

What are the contraindications for use of thrombolysis?

A

Previous intracranial haemorrhage.

Seizure at onset of stroke.

Suspected SAH.

Stroke/brain injury in prev 3 months.

LP in prev week.

GI haemorrhage in prev 3 weeks.

Active bleeding.

Pregnancy.

Uncontrolled HTN >200/120 mmHg.

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24
Q

Explain the GCS.

A

Motor

  1. Obeys commands.
  2. Localise to pain.
  3. Withdraw from pain.
  4. Abnormal flexion to pain.
  5. Extending to pain.
  6. None.

Verbal

  1. Orientated.
  2. Confused.
  3. Words.
  4. Sounds.
  5. None.

Eye opening

  1. Spontaneous.
  2. To speech.
  3. To pain.
  4. None.
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25
Q

Myasthenia Gravis

  • Define.
  • Pathophys.
  • Sx.
  • Ix.
  • Mx.
A
  • Reduction in Ach receptors at NMJ leading to weakness.
  • anti-AChR Ab, or anti-MuSK Ab.
  • Painless muscle weakness on repetition. Proximal muscle weakness.
  • Often facial and ocular involvement.
    Ptosis, snarl.
  • Serum anti-AchR Ab/ anti-MuSK Ab assays.
    Repetitive nerve stimulation.
    Single-fibre EMG.
  • Pyridostigmine.
    Add in Prednisolone/Azathioprine (eye Sx.)
    Plasmapheresis.
    Thymectomy.
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26
Q

Parkinson’s Disease

  • Define.
  • Pathophys.
  • Sx.
  • Ix.
  • Mx.
A
  • Progressive neurodegenerative disorder.
  • Degeneration of dopaminergic neurones in pars compacta of substantia nigra. Presence of Lewy bodies.
  • Triad:
    Tremor: resting, worse on one side, pill rolling, slow.
    Cogwheel rigidity/bradykinesia.
    Postural instability: shuffling gait, takes a while to start back up again, stoop, expressionless face, micrographia.

Before this: anosmia, sleep disturbances.

  • Clinical. MRI/CT normal or atrophy.
  • Levodopa with dopa-decarboxylase inhibitor (more reaches brain, prevents SE) = Co-beneldopa.

Dopamine receptor agonists: Ropinitrole.

MOA-B inhibitors: Selegiline.

Amantadine.

COMT inhibitors: Entacapone.

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27
Q

Huntington’s Disease

  • Define.
  • Pathophys.
  • Sx.
  • Ix.
  • Mx.
A
  • Autosomal dominant neurodegenerative disease.
  • Gene on Chromosome 4, CAG repeat expansion.
  • Personality and behaviour change, dementia, chorea, saccadic eye movements, dystonia (spasm and abnormal posture.)
  • Genetic testing.
    CT/MRI, not diagnostic but shows caudate nucleus atrophy.
  • Sx management.
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28
Q

Motor Neurone Disease

  • Define.
  • Pathophys.
  • Sx.
  • Ix.
  • Mx.
A
  • Group of neurodegenerative disorders so NO sensory problems.
  • Loss of neurones in motor cortex.
    Men:women 3:2.
  • ALS: UMN + LMN.
  • PBP: cranial nerves 9-12. LMN.
  • PMA: LMN only.
    PLS: UMN only.
  • Never eyes or sphincters (so no incontinence.)
  • Clinical.
  • Riluzole.
    Sx: amitriptyline/ carbocisteine for salvia, Baclofen for spasticity.
29
Q

Multiple Sclerosis

  • Define.
  • Pathophys.
  • Sx.
  • Ix.
  • Mx.
A
  • Multiple demyelinated CNS lesions.
  • Destruction of myelin by auto-Ab. Only oligodendrocytes of CNS, not Schwann cells of PNS.
    RRMS, SPMS, PPMS, PRMS.
- Optic neuritis often first pres.
Bladder and sexual dysfunction.
Lhermitte (shock) and Uhtoffs (heat.)
Transverse myelitis (tight band at level of lesion.)
RAPD in eyes.
  • Disseminated in space and time.
    MRI with contrast = periventricular plaques. Is always done after episode of ON
    LP = oligoclonal bands can prove dissemination in time.
  • Steroids (IV Methylpred) hasten recovery in flare.
    Rule out pseudo-relapse (infection.)

Disease modifying: SC Interferon beta 1a.

30
Q

Define Myasthenic Crisis, triggers, diagnosis, and Tx.

A

An acute flare of MG requiring NIV.

Triggered by: infection usually.

Intubate if FVC <15.

Tx: plasmapheresis.

31
Q

Guillain-Barre syndrome

  • Define.
  • Pathophys.
  • Sx.
  • Ix.
  • Mx.
A
  • A type of peripheral neuropathy (acute polyneuropathy), LMN.
  • Auto-immune, sensory and motor neurones. Usually preceded by a gastro infection 3-6 weeks prior. AIDP = motor and sensory demyelination, AMAN = motor axonal damage only.
  • Sudden onset toes to noes weakness +/- paraesthesia (rarely; severe back pain.) Peaks at 4/7.
  • LP = raised protein, normal WCC = cyto-protein dissociation.
  • IVIG for 5 days.
32
Q

Describe the types of MS and the pattern they follow.

A

Relapsing-remitting MS: Flares then return to slightly worse baseline.

Secondary Progressive MS: starts off as RRMS, then gradually becomes constant decline.

Primary progressive MS: consistently getting worse.

Progressive-relapsing MS: continually worse with additional flares.

33
Q

Tx pathway for status epilepticus?

A

Prehospital = Buccal Midazolam or rectal Diazepam.

Hospital: IV Lorazepam.

Phenytoin infusion.

Phenobarbital infusion.

General anaesthetic.

34
Q

Define generalised seizure

A

Initial activation in both hemispheres.

35
Q

Define focal seizure

A

Initial activation in one hemisphere.

36
Q

When is an MRI needed in suspected epilepsy?

A

Focal seizures or new onset seizure in >25 year old.

37
Q

What is first line drug Tx for generalised tonic-clonic seizures?

A

Valproate.

38
Q

What should be avoided in absence seizures?

A

Carbamazepine.

39
Q

First line drug Tx in focal seizures?

A

Lamotrigine.

40
Q

First line drug Tx in myoclonic seizures?

A

Valproate.

41
Q

First line drug Tx in juvenile myoclonic epilepsy?

A

Lamotrigine.

42
Q

Tx pathway for epilepsy?

A

Monotherapy.
Increase dose.
Switch monotherapy.
Add in 2nd line.

43
Q

1st line Tx for migraine prevention?

If this is CI? Why might it be?

2nd line?

A

Propranolol.

Topiramate if asthmatic.

Amitriptyline.

44
Q

What are the hallmarks of multiple system atrophy?

A

Orthostatic hypotension, urinary incontinence, erectile dysfunction.

45
Q

What are the hallmarks of progressive supranuclear palsy?

A

Downward gaze abnormality (difficulty reading or descending stairs.)

Frontal lobe abnormalities.

Postural instability.

46
Q

What are the hallmarks of cortico-basal degeneration.?

A

Alien limb phenomenon.

Dementia at any stage.

Asymmetrical motor abnormalities.

47
Q

Which AED’s are safest in pregnancy?

A

Lamotrigine and Carbamazepine at lower doses.

48
Q

Define radiculopathy.

State the pathology and list 3 common causes.

List the common locations and associated findings for a radiculopathy.

What is the Ix and Mx?

A

Compression of root nerve.

Spinal stenosis due to:

  • Herniated disc.
  • Bone spur/overgrowth from spinal arthritis (spondylosis.)
  • Thickened spinal ligament.

C6: LOS in thumb, loss of elbow flexion.

C7: LOS in middle finger. Loss of elbow extension.

L5: LOS in big toe and top of foot. Foot drop (decreased dorsiflexion.)

S1: LOS in small toe, side of foot, sole. Can’t stand on toes (loss of plantarflexion.)

  • MRI.
  • NSAIDs, collars, steroid injections.
    Final option = decompression surgery.
49
Q

Define myelopathy

Name the commonest cause.

Describe the Sx.

What is the Ix and Mx?

A

Compression of spinal cord.

Disc osteophytes due to spondylosis.

  • Loss of fine movement, increased reflexes (is UMN) and sensory loss below lesion. Bladder and bowel involvement. Lower back pain radiating distally (outwards.)
  • Analgesia + physio. Definitive = decompression surgery.
50
Q

Preferred meds for absence seizures?

A

Valproate or Ethosuximide.

51
Q

Define transverse myelitis

List the 2 common causes.

List the Sx.

Ix.

Acute and chronic management.

A

Inflammation of the spinal cord.

Multiple sclerosis, optica spectrum.

Weakness, sensory loss, pain and autonomic dysfunction (bowel and bladder involvement.)

Acute: corticosteroids, 2nd line: plasmapheresis.
Chronic: Treat as MS.

52
Q

Extradural haematoma:

  1. Common cause and define.
  2. Common site of bleed.
  3. Sx.
  4. CT findings.
  5. Tx.
A
  1. Trauma. Bleed between dura and skull.
  2. MMA.
  3. Immediate LOC, lucid interval, then LOC again.
  4. Lens shaped, limited by suture lines.
  5. Decompressive craniotomy +/- clot evacuation.
53
Q

Subdural haematoma:

  1. Common cause and define.
  2. Common site of bleed.
  3. Sx.
  4. CT findings.
  5. Tx.
A
  1. Bleed into space between arachnoid mater and dura mater.
  2. Bridging vein. Chronic: alcoholics. Acute: trauma (shaken baby is common.)
  3. Chronic: slow bleed = increasing rICP signs. Acute: like extradural (rICP signs.)
  4. Crescent shaped, not limited by suture lines.
  5. Acute: as with extradural, craniotomy +/- clot evacuation. Chronic: burr holes.
54
Q

Subarachnoid haematoma/haemorrhage:

  1. Common cause and define.
  2. Common site of bleed.
  3. Sx.
  4. CT findings.
  5. Tx.
A
  1. Bleed between pia mater and arachnoid mater of brain.
  2. Rupture of Berry aneurysm (commonly anterior communicating.)
  3. Sentinel headaches for 2 weeks, then sudden, thunderclap headache. rICP Sx and meningism.
    Painful 3rd nerve palsy.
  4. Star shaped.
  5. Endovascular coil, or clipping. Prevent vasospasm with Nimodipine.
55
Q

List the causes of increased ICP

A 
Haemorrhage.
Tumour.
Hydrocephalus.
Abscess/infection.
Idiopathic.
56
Q

Define LEMS and the cause.

Clinical findings?

Ix?

Mx?

A

Lambert-Eaton Myasthenic Syndrome. NMJ disorder.

40% small cell lung cancer, if without = autoimmune.

Fatigue and pelvic girdle wekaness; initially improves with repeated exercise.
- Dry mouth

Anti-voltage-gated Ca channel Abs.
Low frequency repetitive nerve stimulation.

Tx underlying cause, pyridostigmine.

57
Q

First line Tx for polyneuropathy/mononeuritis multiplex of a a) inflammatory origin b) vasculitic origin

A

a) IV Pred and Azathioprine.

b) Pred and oral cyclophosphamide.

58
Q

Define mononeuritis multiplex and the causes.

A

At least 2 different peripheral nerves in separate areas affected.

Vasculitis: churg strauss, Wegener’s, scelroderma.

Diabetes.

Connective tissue disorders e.g. sarcoidosis.

59
Q

What are the types and causes of syncope?

A
  • Neurogenic: vasovagal, reflex, carotid sinus hypersensitivity.
  • Orthostatic.
  • Cardiac.
60
Q

Define Bell’s Palsy.

Signs.

Tx

A

Weakness or paralysis of 7th (facial) nerve. LMN.

No forehead sparing.
Dropping and dry eyes and mouth.
Hypersensitive to loud noises (stapedius muscle.)

Most recover in 6/12, Pred may aid recovery if severe.

61
Q

Define BSS.

Causes?

What are the findings and why?

A

Brown-Sequard Syndrome.
Complete hemisection of the spinal cord.

Verterbal bone fracture.
Penetrating trauma such as being stabbed.
Spinal cord tumour.

Ipsilateral weakness below lesion.
Ipsilateral loss of proprioception and vibration below lesion.

Contralateral loss of pain and temperature sensation below lesion.

This is because spinothalamic, which carries these, crosses as soon as it enters the spinal cord so can still carry the signal to the brain.

62
Q

What do the DCML, spinothalamic, and corticospinal tracts carry?

Which one as soon as it enters the spinal cord?

A

DCML - ascending: fine touch, vibration, pressure, proprioception.

Spinothalamic - ascending: pain, temperature, crude touch. Decussates
as soon as it enters spinal cord.

Corticospinal - descending: motor signals from brain to muscle.

63
Q

Define CMTD.

Clinical Fx.

Ix and Mx.

A

Charcot-Marie-Tooth Disease.
Hereditary peripheral sensory and motor neuropathies.

Family Hx.
Clumsiness as a child.
Weak ankles.
Steppage gait.
Pes cavus.

NCS shows symmetrical changes.

Physio and exercise.

64
Q

Differences between GBD and CIPD?

A

GBS: Acute, peak onset in 4 weeks.
CIPD: Chronic, peak onset in >8 weeks.

GBS: axonal damage or demyelination (AIPD vs AMAN.)
CIPD: only demyelination.

GBS: Corticosteroids do not help and may make it worse. CIPD: Corticosteroids can help.

65
Q

Definition, features, and 2 main causes of Horner’s Syndrome?

A

Damage to sympathetic nerves of the face.

Miosis (constricted pupil.)
Ptosis (drooping eyelid.)
Anhidrosis (no sweat.)

Pancoast tumour of the lung, hereditary (will have heterochromia.)

66
Q

Define normal pressure hydrocephalus, give the DDx, and features, and Tx.

A

Clinical features of hydrocephalus without raised CFS pressure (non-obstructive/communicating.)

DDx: dementia and PD.

Triad of: L-dopa unresponsive gait apraxia.
Mild dementia.
Impaired bladder control.

VP shunt.

67
Q

Describe a 3rd nerve palsy and list aetiology.

A

Damage to 3rd cranial nerve (oculomotor). Generally due to reduced blood flow or compression.

Eye is deviated down and out.
Fixed dilated (unlike a 2nd nerve palsy)
Ptosis.

DM, HTN, Vasculitis, herniation of ipsilateral uncus through tentorium.
SOL.
Berry aneurysm.

68
Q

Tx for Alzheimer’s, LBD?

A
  • AchE inhibitors: Donepazil, Rivastigmine, Galantamine.

- Memantine. AchE inhibitors: Donepazil, Rivastigmine.

Phase 3a Medicine (4 decks)

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