neuro high yield Flashcards
(130 cards)
1
Q
following a first seizure, treat?
A
no, wait for specialist review
2
Q
tonic clonic MX
A
males: sodium valproate
females: lamotrigine or levetiracetam
3
Q
focal seizure Mx
A
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
4
Q
absence seizure
A
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures
5
Q
myoclonic seizure Mx
A
males: sodium valproate
females: levetiracetam
6
Q
tonic or atonic seizure Mx
A
males: sodium valproate
females: lamotrigine
7
Q
speech non-fluent, comprehension normal, repetition impaired
A
Broca’s dysphasia
B = Broken speech
8
Q
sentences that make no sense but is fluent
A
Wernicke’s
W = Wild speech
9
Q
speech is fluent but repetition is poor, aware of errors
A
conduction aphasia
10
Q
migraine Mx
A
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
11
Q
which haemorrhage: sudden collapse and loss of consciousness
A
SAH
12
Q
which haemorhhage has a lucid interval
A
extra dural
13
Q
initial mx TIA within 24 hours
A
aspirin immediately unless contraindicated
-assessed by stroke specialist within 24 hours
all patients on anticoag or similar risk factors need urgent imaging to exlcude haemorrhage
14
Q
imaging for TIA (if haemorrhage not suspected)
A
MRI
-after seeing stroke specialist
15
Q
Mx TIA: reviewed by specialist, initial 21 day Mx
A
aspirin and clopidogrel
16
Q
long term secondary prevention of TIA after 21 days
A
clopidogrel
17
Q
which cancer is myasthenia gravis associated with
A
thymoma
18
Q
which cancer for lamber-eaton myasthenic syndrome
A
SCLC
19
Q
TIA definition
A
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
it’s not time based anymore
20
Q
raised ICP eye defect
A
third nerve palsy
-down and out
-due to herniation
21
Q
lambert’s sign
A
when muscle weakness improves after repeated contraction of the muscle
-lamber eaton myasthenic syndrome
22
Q
Lhermitte’s sign
A
paraesthesia in limbs in neck flexion
-seen in MS, cervical stenosis and subacute combined degeneration of the cord
23
Q
Mx brain abscess
A
ceftriaxone and metronidazole
and surgery
24
Q
S+S of cluster headache
A
intense sharp stabbing pain around the eye
-15 mins to 2 hours
-redness, lacrimation, lid welling
25
Mx cluster headache
acute:
- oxygen
- triptan (CI: CAD)
prophylaxis:
-verapamil
26
significant risk factor for bell's palsy
pregnancy
27
Mx of Bell's palsy
within 72 hours of onset: prednisolone
eye care is important
-artificial tears and eye lubricants
if no improvement in three weeks - ENT referral urgent
28
symptoms of parietal lobe seizure
paraesthesia
29
symptoms of frontal lobe seizure
head/leg movements
posturing
post-ictal weakness
jacksonian march
30
symptoms of occipital lobe seizure
floaters/flashes
31
what does a high stepping gait indicate
it develops to compensate for foot drop
-unilateral: peroneal nerve injury
-bilateral: peripheral neuropathy
32
ACA stroke
Contralateral hemiparesis and sensory loss, lower extremity > upper
33
MCA stroke
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
34
PCA stroke
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
35
Weber's syndrome
| branches of PCA that supply midbrain
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
36
PICA (lateral medullary syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
37
anterior inferior cerebellar artery stroke (lateral pontine syndrome)
**ipsilateral facial paralysis and deafness**
contralateral: limb/torso pain and temp loss
ataxia nysatgmuc
38
retinal/opthalmic artery stroke
amourosis fugax
-temporary painless vision loss
39
basilar artery stroke
locked in syndrome
40
lacunar stroke
present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule
41
first line Ix for myasthenia gravis
acetylcholine receptor antibodies test
42
which artery is ruptured in a extradural haemorrhage
middle meningeal artery
43
someone has a homonymous quadrantopia
-where is the lesion
PITS (Parietal-Inferior, Temporal-Superior)
depends if it's inferior or superior
44
what ruptures in a subdural haemorrhage
bridging veins
45
ruptured cerebral aneurysm
sub arachnoid haemorrhage
46
Ix for guillain barre
LP - rise in protein and normal white cells
nerve conduction studies - decrease in motor nerve conduction
47
Mx of stroke
- monitor BP if within 6 hours and systolic > 150
- aspirin asap (unless haemorrhage)
-thrombolysis within 4.5 hours onset or:
- within 9 hours of symptom onset if CT/MRI shows evidence of salvagable brain tissue
- blood pressure must be lowere to 185/110 before thrombolysis
THROMBECTOMY
- within 6 hours with thrombolysis IF confirmed occlusion of the proximal anterior circulation
- or between 6 and 24 hours if confirmed proxminal anterior stroke and salvagable brain tissue
48
secondary prevention of stroke
clopidogrel
- if contraindicated or not tolerated then aspirin
49
who gets a CT head within an hour for head injury
- GCS < 13 on initial assessment
- GCS < 15 at 2 hours post-injury
- suspected open or depressed skull fracture
- any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign).
- post-traumatic seizure.
- focal neurological deficit.
- more than 1 episode of vomiting
50
who gets CT head within 8 hours after trauma
- 65 or older
- bleeding disorder/on anticoag
- dangerous mechanism of injury
- more than 30 mins retrograde amnesia of events before the head injury
51
periorbital and post auricular bruising
basilar skull fracture
52
tremor in parkinsons
unilateral
-worse at rest
-improves with voluntary movement
-pin-rolling
53
if someone can't speak in stroke what artery
middle cerebral
-usually left if not given any other info
54
CSF result for MS
oligoclonal bands
55
winged scapula what nerve roots damaged (brachial plexus)
C5, 6
56
loss of intrinsic hand muscles and sensory loss over medial epicondyle
T1 nerve root injury
- ulnar nerve
57
Mx of cerebral oedema due to brain injury
mannitol
58
when do you do a CT head before aspirin in a TIA
- symptoms over 24 hours
- fluctuating consciousness
- anticoagulant use
- coagulopathy
- suspected heamorrhage
59
treatment of acute relapse of MS
| this includes optic neuritis
high dose steroids
(oral or IV methylprednisolone) for 5 days
60
drugs to reduce relapse in MS
**natalizumab**
- best evidence
ocrelizumab
fingolimod
61
medication for spacticity in MS
1) baclofen and gabapentin
2) diazepam, dantrolene and tizanidine
62
Mx bladder dysfunction in MS
ULTRASOUND FIRST (assess bladder emptying)
- if loads residual volume - self catheterisation
- if not much residual volume - anticholinergics (oxybutynin, tolterodine)
63
middle aged, personality changed, involuntary movement
huntingtons disease
- chorea
- personality chnages
- dystonia
- saccadic eye movement
64
genetics of huntingtons
autosomal dominant
- trinucleotide repeat disorder: repeat expansion of CAG
- phenomenon of anticipation is seen (presents at an earlier age as passed down)
65
unilateral pupil dilation
third nerve palsy
66
can you do a LP in raised ICP
no
67
68
management of myasthenic crisis
- plasmapheresis
- IV immunoglobins
69
presentation of myasthenic crisis
severe exacerbation of symptoms
- breathing difficulties
- swallowing difficulties
70
GCS less than 8, next steps
review by anaesthetist for possible intubation and ventilation
71
glasgow coma scale: motor
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None
| numbers in wrong order
72
GCS: verbal
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
| numbers in wrong order
73
GCS: eyes
4. Spontaneous
3. To speech
2. To pain
1. None
| numbers in wrong order
74
bitemporal hemianopia where is the lesion?
- upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
- lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
75
Ix for SAH
non-contrast CT head
76
when would you do an LP for SAH
if CT head is done more than 6 hours after symptom onset and is normal
- must be done at least 12 hours after symptoms to let xamthochromia develop
77
Mx of SAH
CT intracranial angio
- supportive
- nimodipine (to prevent vasospasm)
- intervention usually within 24 hours - treated with coil
78
features of wernicke's encephalopathy
CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy
79
korsakoff's features
amnesia (retrograde and anterograde)
confabulation
80
management of idiopathic intracranial hypertension
weight loss
acetazolamide
topiramate
repeated LP
81
first line treatment of parkinson's
if the motor symptoms are affecting the patient's quality of life: levodopa
if the motor symptoms are not affecting the patient's quality of life: dopamine agonist, levodopa or MAO-B inhibitor
82
MS investigation/diagnosis
MRI of the brain and spinal cord with contrast
- demyelinating lesions separated in space and time
83
temporal arteritis presentation
- rapid onset of unilateral headache (throbbing)
- jaw claudication
- tender, palpable temporal artery
- raised ESR
84
trigeminal neuralgia presentation
electric shock like pain thar starts above ear and moves across forehead
- intense
- lasts a few seconds
- occurs 2-3 times a day
- worse when brushing teeth
85
management of trigeminal neurlagia
carbamazepine first line
- failure to respone = refer to neuro
86
red flags of trigeminal neuralgia that suggest serious underlying cause
- Sensory changes
- Deafness or other ear problems
- History of skin or oral lesions that could spread perineurally
- Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
- Optic neuritis
- A family history of multiple sclerosis
- Age of onset before 40 years
87
differentiate types of MND
spinal
- UMN and LMN in limbs
bulbar
- UMN and LMN starts in mouth
- difficulty speaking, swallowing, regurg
progressive muscular atrophy
- only LMN signs, distal muscles
primary lateral sclerosis
- only UMN
88
which drug increases life expectancy of MND
riluzole
89
muscle cramp Mx MND
quinine
baclofen
90
muscle spasm Mx MND
baclofen
tizanidine
gabapentin
91
sialorrhoea Mx MND
buscopan
botox
suction
92
SOB Mx MND
lorazepam
93
diagnosis migraine without aura
at least 5 attacks
-4-72 hours
-2 of: moderate/severe, unilateral, throbbing pain, worst movement
-1 of: autonomic features, photophobia/phonophobia
94
menstrual migraine Mx
fovatriptan or zolmitriptan
95
sciatica compression of what
L5/S1
96
pathophysiology of Alzheimer's
disruption of cholinergic pathways in the brain with synaptic loss
- deficit in acetylcholine
97
presentation of alzheimer's
- gradual onset decline of short term memory
- personality change
- poor concentration, sleep, low mood
98
CSF in alzheimers
decreased amyloid:tau ratio
99
Mx of alzheimer's
1) acetylcholinesterase inhibitor (donepezil, galantamine and rivastigmine) for mild to moderate
2) memantine - mod and intolerant to above, add on for severe/mod, monotherapy in severe
100
what age for early onset alzheimers
< 65
101
fronto-temporal dementia presentation (Pick's disease)
personality change and impaired social conduct
- relatively preserved memory
102
which dementia causes non-fluent speech, lack of grammer but cognition impaired
primary progressive aphasia
- form of fronto temporal
103
vascular dementia presentation
sudden or stepwise decline in cognitive function
- seizures
- focal disturbance
- speech
- memory
- emotional
- gait
104
lewey body dementia presentation
- progressive cognitive imapirment, cognition may fluctuate
- parkinsonism
- visual hallucinations
| motor signs start at same time as cognitive impairment in contrast to pa
105
Mx lewy body dementia
acetylecholinesterase inhibitors and memantine
106
what drugs should be avoided in Lewy body dementia
Neuroleptics must be avoided:
- Clozapine
- Haloperidol
- Aripiprazole
Other antipsychotics
107
parkison's presentation
Classic motor symptoms
Tremor
Rigidity
Akinesia/bradykinesia
Postural instability
The symptoms are characteristically asymmetrical
also: dementia, memory loss, facial masking, shuffling gait
108
whats progressive supranuclear palsy
parkinson's plus
- postural instability
- gaze palsy
can't see planes
109
most common brain tumour in adults
gliobastoma multiforme
then meningioma
110
brown sequard
Cord hemisection
-ipsilateral motor level and dorsal column sensory level
-contralateral spinothalamic sensory level
111
cape like spinothalamic sensory loss
central cord syndrome
112
guillan barre Mx
IV immunoglobin
plasma exhancge
113
Mx lambert eaton
2,3 diaminopyridine
114
bacterial meningitis LP
cloudy
-high protein
-low glucose
-high neutrophils
-raised opening pressure
115
viral meningitis LP
clear
-mildly raised or normal protein
-normal glucose
-high lymphocytes
-negative culture
116
when is LP delayed in meningitis
* signs of severe sepsis or a rapidly evolving rash
* severe respiratory/cardiac compromise
* significant bleeding risk
* signs of raised intracranial pressure
○ focal neurological signs
○ papilloedema
○ continuous or uncontrolled seizures
○ GCS ≤ 9
117
Mx meningitis adults
ceftriaxone + dexamethasone
- add vanc if recent antibiotic use
- add aciclovir if encephalitis suspected
118
when do you add amoxicillin to meningitis Mx
if ≥ 60 years, immunocompromised, neonatal, alcoholic, DM
119
Mx meningitis <3 months
* <3 months Cefotaxime + Amoxicillin
○ 3 months 1st dose Cefotaxime followed 6 hours later with once daily Ceftriaxone
* No corticosteroids under 3 months
* Chloramphenicol if penicillin allergic
Dexamethasone if LP shows: purulent CSF, wbc >1000, raised WBC + protein>1g/litre , bacteria on gram stain
120
treatment for exposure to bacterial meningitis
oral ciprofloxacin or rifampicin
- if close contact within 7 days of onset
121
causes of meningitis in neonates
- listeria monocytogenes
- group B strep
- e. coli
122
meningitis cause in 3 months to 6 years
- h. influenza
- neisseria meningitidis
- strep pneumoniae
123
causes of meningitis 6 - 60 years
- strep pneumoniae
- neisseria meningitidis
124
causes of meningitis in over 60
- strep pneumonaia
- listeria monocytogenes
- neisseria meningitis
125
meningitis in immunocompromised
listeria monocytogenes
126
Mx status epliepticus
benzodiazepines
127
Mx of subdural haemorrhage
burr hole craniotomy
128
Ix for cervical myelopathy
MRI
129
neoplastic spinal cord compression - Ix and Mx
WHOLE SPINE MRI within 24 hours
high dose dexamethasone
130
