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Year 4 > neuro > Flashcards

neuro Flashcards

1
Q

what is epilepsy

A

the tendency to have recurrent seizures

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2
Q

What are some causes of seizures that are not epilepsy

A
  • eclampsia
  • alcohol/benzo withdrawal
  • hypoglycaemia
  • space occupying lesion
  • post-trauma
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3
Q

What are the three time-periods in a seizure

A
  • pre-seizure
  • seizure
  • post-ictal
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4
Q

What might a patient report happening before the seizure?

A

mood/behaviour change in the hours/days before the seizure

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5
Q

What is common in the post-ictal period

A
  • drowsiness
  • nausea
  • Todd’s paralysis
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6
Q

What are differentials for a seizure (it might not be a seizure)

A
  • syncope
  • transient ischaemic attack
  • migraine
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7
Q

What investigations should you order for a seizure

A
  • blood - fbc, BM, U&Es, LFTs, calcium
  • ECG
  • MRI
  • EEG
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8
Q

What general advice should you give after a seizure

A
  • avoid dangerous things like taking baths and swimming
  • occupational advice
  • inform DVLA
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9
Q

What is a partial seizure

A

one that affects a specific part of the brain

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10
Q

What is a generalised seizure

A

one that affects both hemispheres of the brain

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11
Q

In generalised seizures, patients always (lose consciousness/retain consciousness)

A

Patients always lose consciousness

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12
Q

What is the most common type of generalise seizure

A

tonic-clonic

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13
Q

Is this really a seizure? Which symptoms would be convincing of a seizure

A

tongue biting and slow recovery

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14
Q

Which area of the brain is probably affected if Todd’s paralysis is present in the post-ictal period?

A

The motor cortex

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15
Q

Which area of the brain is probably affected if dysphasia is present in the post-ictal period

A

temporal lobe

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16
Q

What is an aura pre-seizure

A

part of the seizure the patient is aware of

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17
Q

What might the patient experience during an aura

A
  • deja vu
  • strange smells
  • flashing lights
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18
Q

What type of seizure is aura indicative of

A

partial seizure

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19
Q

What are some anti-epileptic drugs

A
  • carbamazepine
  • valproic acid
  • lamotrigine
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20
Q

Which anti-epileptic is highly teratogenic

A

valproic acid

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21
Q

What is status epilepticus

A

seizure that goes on for >30 minutes or recurring seizures with no recovery of consciousness between

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22
Q

What is the treatment of status epilepticus

A
  • secure the airway
  • lorazepam
  • valproic acid
  • give thiamine if alcohol withdrawal, glucose if hypoglycaemic, call obstetrics if eclampsic
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23
Q

What is a TIA

A

transient ischaemic attack

* sudden-onset neurologic deficit that lasts less than 24 hours and patient returns completely to normal

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24
Q

What are the causes of ischaemic stroke

A
  • thrombus
  • embolism
  • hypoxia
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25
Q

What are the types of haemorrhagic stroke

A
  • intra-cerebral

* subarachnoid

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26
Q

What are the classes of Bamford’s stroke classification

A
  • TACS
  • PACS
  • LACS
  • POCS
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27
Q

What is a TACS stroke? Which vessels are involved?

A
  • anterior and middle ceberal arteries
  • these vessels are blocked
  • must have all of these three:
    (1) homonomous hemianopia
    (2) higher cortical dysfunction (eg dysphasia)
    (3) hemiplegia and/or hemiparesis
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28
Q

What is a PACS stroke?

A
  • affects either anterior or middle cerebral artery
  • has two or more of the following:
    (1) homonymous hemianopia
    (2) higher cortical dysfunction (dysphasia, visuospatial disorder)
    (3) hemiparesis +/- hemiplegia
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29
Q

What is a POCS stroke?

A
  • posterior circulation stroke
  • affecting the occipital lobe, cerebellum or brainstem
  • must have one of the following:
    (1) cranial nerve palsy and motor/sensory deficit
    (2) isolated homonymous hemianopia
    (3) conjugate eye movement disorder
    (4) cerebellar dysfunction
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30
Q

What kind of cerebella dysfunction might you expect following a POCS stroke?

A
  • ataxia
  • vertigo
  • nystagmus
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31
Q

What is a LACS stroke

A
  • lacunar stroke
  • stroke of small vessels
  • one of the following must be present:
    (1) pure sensory stroke
    (2) pure motor stroke
    (3) sensori-motor stroke
    (4) ataxic hemiparesis
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32
Q

What is the treatment for an ischaemic stroke

A
  • confirm with CT
  • aspirin/ticagrelor
  • thrombolysis is an option
  • warfarin post-stroke
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33
Q

What must you rule out before you give antiplatelets/thromblysis/warfarin for an ischaemic stroke?

A

haemorrhagic stroke

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34
Q

What are the complications of a haemorrhagic stroke

A
  • rebleeding
  • hydrocephalus
  • ischaemia
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35
Q

What are the main primary headache syndromes

A
  • migraine
  • tension
  • cluster
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36
Q

What is a rebound headache

A

analgesia overuse headache common in chronic migraine/tension patients

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37
Q

What are some secondary headache causes?

A
  • space occupying lesion
  • meningitis/encephalitis
  • subarachnoid haemorrhage
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38
Q

What is the most common cause of secondary headache

A

infection

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39
Q

What symptoms are suggestive of meningitis/encephalitis

A
  • headache with neck stiffness and photophobia/phonophobia
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40
Q

What examination signs might be positive in meningitis

A
  • Kernig’s sign

* Brudzkinsi’s sign

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41
Q

What is Kernig’s sign

A

lie patient flat, bend the knee and if extension of the knee is painful then Kernig’s postive

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42
Q

What is Brudzinski’s sign

A

lie patient flat, passively flex neck and knees will bend if positive

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43
Q

What headache is reported in SAH

A

thunderclap headache

44
Q

Describe a migraine

A
  • severe, unilateral throbbing pain
  • photophobia common
  • aura may be present
  • nausea and vomiting common
45
Q

What medications can you give in acute migrain

A
  • NSAIDs
  • triptans
  • ergotamines
  • metoclopramide
46
Q

What medications can you give for prophylaxis in migraine

A
  • antiepileptics
  • tricyclics
  • beta-blockers
47
Q

What medication is contraindicated in patients with migraine who get auras

A

OCP

- risk of stroke

48
Q

What is a cluster headache

A
  • occurs behind the eye every day at the same time for about 8 weeks
  • patient may report tearing, ptosis, myosis, running nose on the affected side
  • patients will be restless and pacing
49
Q

Which sex do cluster headaches preferentially affect

A

males

50
Q

What is the main treatment for cluster headaches

A

oxygen

51
Q

What kind of headache is described with raised intracranial pressure

A
  • worse after waking up
  • bending forward makes it worse
  • associated symptoms eg vomiting, seizures, odd behaviour
52
Q

What causes subarachnoid haemorrhage

A
  • spontaneous bleeding into the subarachnoid space
53
Q

What is the most common type of subarachnoid haemorrhage

A

berry aneurysm

54
Q

What is the main symptom of a subarachnoid haemorrhage

A

sudden blow to the back the head- ‘thunderclap headache’

55
Q

Signs of ____ will appear 3-12 hours after SAH

A

meningism

* Kernig’s sign, nuchal rigidity

56
Q

What investigations should be done for an SAH

A
  • CT head

* LP

57
Q

What treatment is required for SAH

A

surgery

58
Q

What are the main complications of SAH

A
  • rebleeding
  • ischaemia
  • hydrocephalus
59
Q

what is multiple sclerosis

A

an autoimmune condition causing demyelination of the CNS

60
Q

What is a common primary presentation of MS

A

optic neuritis

61
Q

What type of diagnosis is MS

A

clinical diagnosis - plaques may be seen on MRI but not diagnostic alone

62
Q

MS lesions must be _____ in ___ and ___

A

MS lesions must be disseminated in space and time

63
Q

What is Lhermitte’s sign

A

an electric shock running down the back and legs when neck is bent forward

64
Q

What condition is Lhermitte’s sign associated with

A

MS

65
Q

What is the typical age presentation for MS

A

20-40

66
Q

What are the main types of MS

A
  • relapsing-remitting
  • secondary progressive
  • primary progressive
  • progressive-relapsing
67
Q

What imaging modality might MS lesions be visible on?

A

plaques may be visible on MRI

68
Q

What treatment can be given for ms

A
  • methylprednisolone
  • interferons
  • monoclonal antibodies (alemtuzumab)
  • azathioprine
69
Q

What causes parkinson’s disease

A

loss of dopaminergic cells in the substantia nigra

70
Q

What is the triad of parkinsons’

A
  • bradykinesia
  • resting tremor
  • rigidity/increased tone
71
Q

What other symptoms might be associated with parkinson’s

A
  • postural instability
  • hypomimia
  • micrgraphia
  • fatiguing of repetitive movement
72
Q

Give an example of a parkinson’s plus disorder

A

Lew-body dementia

73
Q

Parkinson’s symptoms are (symmetrical/asymmetrical)

A

Parkinson’s symptoms are asymmetrical

74
Q

What kind of tremor is seen in Parkinson’s

A

resting tremor

pill-rolling

75
Q

What gait is seen in PD

A

stooped, shuffling gait with increasingly smaller steps and difficulty turning

76
Q

What neuropsychiatric symptoms are common in parkinsons

A
  • depression
  • dementia
  • psychosis
77
Q

What is the medical treatment of PD

A
  • levodopa + carbidopa/mardopar
  • dopamine agonists
  • anticholinergic drugs
  • COMT-inhibitors
  • MAO-b inhibitors
78
Q

What is carbidopa?

A

a dopa-decarboxylase inhibitor

79
Q

Name some dopamine agonists

A

bromocriptine, cabergoline, ropinorole

80
Q

Name a COMT-inhibitors

A

entecapone

81
Q

Name a MAO-B inhibitor

A

selegiline

rasagiline

82
Q

What is cervical spondylosis

A

reduction of the spinal canal caused by annulus fibrosis degradation and osteophyte formation
- wear and tear -

83
Q

What are symptoms of cervical spondylosis

A
  • neck pain (especially on turning)
  • crepitus
  • Lhermitte’s sign
  • wrist/forearm pain
84
Q

What are symptoms of cervical spondylosis with cord compression

A
  • foot drop
  • leg weakness
  • numb hands
  • incontinence
85
Q

What is treatment of cervical spondylosis

A
  • anti-inflammatories
  • cervical collar
  • physio
  • surgical cord decompression
86
Q

What is myasthenia gravis

A

Antibodies for the postsynaptic Ach receptors

87
Q

What are symptoms of myasthenia gravis

A
  • muscle fatiguability
  • ptosis, diplopia, myasthenic snarl
  • increased muscle weakness at end of day
  • reflexes intact
88
Q

What is a myasthenic crisis

A

acute relapse of MG causing weakness of respiratory muscles

- medical emergency

89
Q

What might precipitate a myasthenic crisis

A

infection, medication

90
Q

What is treatment of myasthenic gravis

A
  • anticholinesterase
  • immunosuppressants (prednisolone, methotrexate, azathioprine)
  • surgical thymectomy
91
Q

Is surgical thymectomy effecting in MG patients who don’t have a thymoma?

A

Yes sometimes

92
Q

Name an anticholinesterase used in myasthenia gravis

A

pyridostigmine

93
Q

What is motor neurone disease

A

a group of disorders caused by progressive degeneration of motor neurones in the motor cortex, cranial nerves, or anterior horns of the spinal cord

94
Q

What are the types of motor neurone disease

A
  • ALS
  • progressive bulbar palsy
  • progressive muscular atrophy
  • progressive lateral sclerosis
95
Q

What is the most common type of MND

A

ALS

96
Q

What type of motor neurones are affected in ALS

A

upper and lower

97
Q

What is affected in progressive bulbar palsy

A

cranial nerves IX-XII

98
Q

What is affected in progressive muscular atrophy

A

mainly LMN

99
Q

What is affected in primary lateral sclerosis

A

mainly UMN

100
Q

What distribution is typical of peripheral neuropathy? why?

A

glove and stocking

length-dependent axonal injury

101
Q

Upper limb neuropathy before lower limb is indicative of what?

A

demyelination instead of axonal injury

102
Q

What are sensory symptoms of neuropathy

A
  • numbness
  • parasthesia
  • difficulty with small objects (eg buttons)
  • signs of trauma/ joint deformity
103
Q

What are symptoms of motor neuropathy

A
  • weak hands
  • difficulty walking
  • difficulty breathing
104
Q

What are symptoms of autonomic neuropathy

A
  • erectile dysfunction
  • incontinence
  • urine retention
  • postural hypotension
105
Q

What are causes of motor neuropathy

A
  • lead poisoning
  • Charcot-Marie-Tooth
  • Guillain-Barre
106
Q

What are causes of sensory neuropathy

A
  • DM

* renal failure

Year 4 (13 decks)

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