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Neuro kNowledge Flashcards

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1
Q

What is Uhthoff’s phenomenom?

A

Worsening of vision following a rise in body temperature

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2
Q

What is Lhermitte’s sign?

A

Tingling in the hand when flexing the neck, seen in subacute combined degeneration of the spinal cord, MS and cervical stenosis

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3
Q

What is progressive supranuclear palsy?

A

Presents in a similar fashion to PD but there is also Sx of dysarthria and reduced verticle eye movements

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4
Q

What is wernicke’s aphasia?

A

Issues with speech comprehension, speech its fluent, repetition is impaired
Caused by inferior L MCA infarct

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5
Q

What is broca’s aphasia? What infarct is responsible?

A

Issues with speech production (speech is non-fluent and haltering) speech comprehension is in tact
Caused by superior L MCA infarct

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6
Q

What is the in hospital Tx for status epilepticus?

A

4mg IV lorazepam

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7
Q

What is an intention tremor?

A

Elicited in the finger-nose test, it indicated cerebellar pathology

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8
Q

What is an essential tremor?

A

Bilateral tremor that worsens with action

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9
Q

How long must a pt stop driving for after a TIA?

A

1 month

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10
Q

How can you differentiate between true seizures and pseudoseizures on a blood test?

A

Prolactin - it will be raised in true seizures

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11
Q

What are the 4 types of MND?

A

Amyotrophic Lateral Scleosis - LMN signs in arms, UMN signs in legs
Primary Lateral Sclerosis - UMN signs only
Progressive Muscular Atrophy - LMN signs only (affects distal muscles first)
Progressice Bulbar Palsy - palsy of the tongue, chewing/swallowing muscles and facial muscles

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12
Q

Which types of MND have the best/wrost prognosis?

A

Progressive Muscular Atrophy = best

Progressive Bulbar Palsy = worst

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13
Q

What is the emergency Tx in severe neuroleptic malignant syndrome?

A

Dantrolene/Bromocriptine and lorazepam

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14
Q

Which part of the optic chiasm is affected if the upper quadrant is more affected than the lower quadrant in a bitemporal hemianopia?

A

Inferior compression so likely to be pituitary tumour

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15
Q

Which part of the optic chiasm is affected if the lower quadrant is more affected than the upper quadrant in a bitemporal hemianopia?

A

Superior compression so likely to be craniopharyngioma

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16
Q

How do you score GCS?

A 
Motor = Obeys commands (6), Localises to pain (5), Withdraws from pain (4), Abnormal flexion to pain (3), Extending to pain (2), None (1)
Verbal = Orientated (5), Confused (4), Words (3), Sounds (2), None (1)
Eyes = Spontaneous (4) To speech (3), To pain (2), No response (1)
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17
Q

Sx of Neuroleptic Malignant Syndrome?

A

Develops over hours to days.
Led pipe rigidity (hypertonia), hyporeflexia, normal pupils.
Tachypnoea, tachycardia, hyperthermia, hypersalivation and hypertension

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18
Q

Sx of Serotonin Syndrome?

A

Increased reflexes, hypertonia, clonus, dilated pupils, sweating, hyerthermia, tachycardia, tachypneoea, hypersalivation, hypertension

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19
Q

Tx of Serotonin Syndrome?

A

Chlorpromazine or cyproheptadine

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20
Q

How can you diagnose guillain-barre syndrome from CSF?

A

Isolated high protein in CSF = GBS

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21
Q

Sx of guillain-barre syndrome?

A

Ascending muscle weakness, absent or reduced reflexes, mild sensory issues (e.g. distal parasethesia)

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22
Q

What are the 1st line treatments for spasticity in MS?

A

Baclofen and Gabapentin

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23
Q

Sx of Bells Palsy?

A

Prodomal pain beind the ear, altered taste, dry eyes, increased sensitivity to sound and facial muscle weakness/paralysis (including the forehead - LMN)

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24
Q

How can you identify if fluid coming from the nose in trauma is CSF?

A

Check for glucose!

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25
What is the treatment pathway for status epillepticus?
IV Lorazepam -> (after 10-20 mins) IV Lorazepam -> Phenytoin or Phenobarbital infusion -> General anaesthesia
26
What is the 1st line Tx of partial seizures?
Carbamazepine (but not useful in the Tx of absence seizures) or lamotrigine
27
What features are seen in a syncopal episode?
Rapid recovery and a short post-ictal period. Myoclonic jerks may occur
28
What should you do if Sx of Bell's palsy do not show signs of improvement after 3 weeks of corticosteroid treatment?
Refer urgently to ENT
29
Where do brain tumours most commonly metastasise from? Where else can they metastasises commonly from?
LUNG! | Breast, bowel, skin and kidney
30
What often provokes absence seizures?
Hyperventilation
31
What is the Tx for absence seizures?
Sodium Valporate and Ethosuximide
32
What is Arnold-Chiari malformation?
Downward displacement of the cerbellar tonsills through the foramen magnum = leads to non-communicating hydrocephalus
33
What is Ramsay Hunt Syndrome?
Occurs when there is reactivation of VZV in the facial nerve - leads to LMN palsy. Sx = facial paralysis, otalgia and painful red rash with fluid filled blisters in, on or around the ear
34
When can you consider stoppin epilepsy medications?
When pts have been seizure free for >2 years. They should be stopped over 2-3 months
35
What is the 1st line Tx for neuropathic pain?
Amitryptilline, Duloxetine or Gabapentin. If one doesnt work, switch!
36
What is Lambert-Eaton Syndrome?
A myasthenic syndrome seen in association with small cell lung cancer and to a lesser extent breast and ovarian cancer. Sx = increased muscle strength with use, limb girdle weakness => waddling gait, hyporeflexia, autonomic Sx (e.g. dry mouth, impotence and difficulty urinating) Tx = treat cancer and prednisolone immunosuppression
37
Tx Myasthenia Gravis?
Pyridostigmine and prednisolone immunosuppresion
38
What is the most common complication of meningitis?
Sensorineural hearing loss
39
What causes wrist drop?
Radial nerve palsy
40
What happens in CN IV palsy?
Eye is turned up and out when looking straight ahead. Verticle diplopia
41
What are the 4 main Sx of NMS?
Rigidity, hyperthermia, altered mental state, autonomic instability (can cause AKI)
42
How can you localise a homonomous hemianopia?
Incongourous (un-even) = lesion of the optic tract Congorous (even) = lesion of optic radiation or occipital cortex With macula sparing = lesion of occipital cortex
43
How can you localise homonomous quadrantopias?
``` Superior = lesion of the inferior tract in the temporal lobe (Meyer's loop) Inferior = lesion of the superior tract in the parietal lobe (Baum's loop) ```
44
How can you localise bitemporal hemianopias?
Upper quadrant defect = inferior chiasmal compression = pituitary tumour Lower quadrant defect = superior chiasmal compression = craniopharyngioma
45
True or false passing large amounts of urine with normal bladder scan (DI) is caused by a pituitary tumour?
False! | Caused by craniopharyngioma
46
What organism classically causes Guillain-Barre Syndrome?
Campylobacter Jejuni
47
What may be causing a painful CN III palsy (e.g. with headache)?
Posterior communicating artery aneurysm
48
When cau autonomic dysreflexia occur?
Spinal cord injuries at or above T6 - leads to hypertension, sweating and flushing without an increae in HR
49
Which scan can be used to identify early PD?
DAT scan
50
What is the first line Tx for benign essential tremor?
Primidone and Propanolol. | If severe can give deep brain stimulation
51
True or False alcohol improves the symptoms of Benign Essential Tremor?
True
52
What type of respiratory failure is myasthenic crisis? what are the most important investigations to do first if you suspect it?
Type 2 | Bedside forced vital capacity assessment and ABG
53
Whta is papillitis?
Optic neuritis, there will be pain on eye movements, unilateral vision loss and interferance with colour vision.
54
Which type of scan can you use to detect demyelination in MS or to diagnose a spinal problem?
MRI - use contrast for MS brain MRI
55
What is the sequence of damage done to nerves in nerve compression?
sensory demyelination -> sensory axonal loss -> motor demyelination -> motor axon loss
56
What is a myelopathy?
Severe compression of the spinal cord
57
What is myopathy?
Muscle disease
58
What is radiculopathy?
Symptoms that occur due to the pinching of the nerves in the spinal column
59
What is neuropathy?
Damage to the nerves outside of the spinal collumn/brain
60
How does GBS (Fischer variant) classically present?
Opthamoplegia, areflexia and ataxia
61
What kind of muscle weakness is seen in GBS, LES and MG?
Proximal muscle weakness
62
Sx and Mx of frozen shoulder?
Global restriction of shoulder movements, external rotation is most affected and most painful. Mx = early physiotherapy
63
How can degenerative cervical myelopathy present? What is the most common cause?
Spondylosis Sx = pain, reduced dexterity/motor issues, sensory loss, autonomic function issues (e.g incontinence and impotence) and Hoffman's sign positive
64
Ix and Mx for degenerative cervial myelpathy?
MRI C-spine | Urgent spinal decompression surgery
65
A child falls onto an outstretched arm. He suffers a supracondylar fracture leading to loss of pronation. Which nerve has been damaged?
Median nerve
66
Which part of the brain is damaged in Wernicke's aphasia?
Superior temporal gyrus
67
Which part of the brain is damaged in Broca's aphasia?
Inferior frontal gyrus
68
Which part of the brain is damaged in Conductive aphasia?
Arcuate fasciculus
69
How is a thyoma imaged? What is seen? What can it cause?
CT Mass in the mediastinum MG
70
What is seen in a total anterior infarct?
All 3 of: - Unilateral hemiparaesis and/or hemisensory loss of the face, arm and leg - Homonomous hemianopia - Higher cognitive dysfunction (e.g. dysphasia or visuospatial disorder)
71
What is seen in a partial anterior infarct?
2 of: - Unilateral hemiparaesis and/or hemisensory loss of the face, arm and leg - Homonomous hemianopia - Higher cognitive dysfunction (e.g. dysphasia or visuospatial disorder)
72
What is seen in a luncar infarct?
1 of: - Unilateral weakness (and/or sensory deficit) of the face and arm, arm and leg or all 3 - Pure sensory loss - Ataxic hemiparaesis
73
What is seen in a posterior circulation infarct?
1 of: - Cerbellar or brainstem syndrome - Loss of consiousness - Homonomous hemianopia
74
Which vessels are affected in a total anterior infarct?
Middle and anterior cerebral arteries
75
Which vessels are affected in a partial anterior infarct?
Smaller arteries of the anterior circulation
76
Which vessels are affected in a luncar infarct?
Perforating arteries around the thalamus, internal capsule and basal ganglia
77
Which vessels are affected in a posterior circulation infarct?
Vertebrobasilar arteries
78
What is the most common hereditary sensorymotor/peripheral neuopathy? How does it present?
Charcot-Marie-Tooth disease. Sx = frequently sprained anke, foot drop, high arched feet, distal muscle weakness and atrophy, sensory disturbance, hyporeflexia and stork leg deformity
79
What is a meningioma?
Tumour which arises from the dura mater of the meninges. Does not arise from the parenchyma and causes symptoms of brain compression
80
What is the most common priamary brain tumour in adults?
Glioblastoma multiforme
81
What is the most common priamary brain tumour in children?
Pilocytic Astrocytoma
82
How do you diagnosed acoustic neuroma?
MRI of the cerbellopontine angle
83
How do you manage spasticity in MS?
Baclofen or Gabapentin
84
What is the preventative Tx for cluster headaches?
Verapamil
85
A patient presents with weakened dorsiflexion, eversion and inversion as well as sensory loss between the big and little toe. What has been damaged?
L5
86
Apart from forehead sparring how does and UMN lesion present differently to a LMN facial nerve lesion?
``` UMN lesion = contralateral weakness LMN lesion (bell's palsy) = ipsilateral weakness ```
87
How do you diagnose MS?
MRI with contrast
88
How do you diagnose and grade severity of carotid artery stenosis?
Duplex US
89
How should you manage raised ICP (stepwise Mx)?
- Elevate the head to 30 degrees - IV mannitol - Controlled hyperventilation - Removeal of CSF (LP or shunt)
90
In which condition will you see cafe au lait spots AND axillary freckles?
Neurofibromatosis type 1
91
Sx of MS?
Weakness, fatigue, diplopia/painful eye movements/reduced vision, ascending weakness and sensory disturbances, balance issues, optic neuritis and transverse myelitis. Reflexes are typically decreased but may increase if spasm
92
Sx of lateral medullary syndrome (Wallenberg syndrome)?
Ipsilateral facial pain and temperature sensation loss, contralateral limb/torso pain and temperature loss. Ataxia and nystagmus
93
Sx of lateral pontine syndrome?
Ipsilateral facial pain and temperature sensation loss, contralateral limb/torso pain and temperature loss. Ataxia and nystagmus. Also ipsilateral facial paralysis and deafness
94
Where is the infarct in lateral medullary syndrome?
Posterior inferior cerbellar artery
95
Where is the infarct in lateral pontine syndrome?
Anterior inferior cerbellar artery
96
Sx of a basilar artery stroke?
Locked in syndrome
97
How should you treat proximal anterior circulation strokes presenting within 4.5 hours?
Alteplase AND thrombectomy
98
What is seen in Tuberous Sclerosis?
Roughened patches of skin over the lumbar spine, depigmented ash lead spots anenomoa sebaceum over the nose, nail changes, epilepsy and developmental delay
99
What is subacute combined degeneration of the spinal cord?
Occurs due to vitamin B12 deficiency. Presents with impaised proprioception
100
What is required when giving phenytoin?
Cardiac monitoring
101
Which drugs can precipitate myasthenic crisis?
Penicillaimine, beta-blockers, lithium, pheytoin and some Abx
102
Sx of radial nerve injury?
Inability to extend the wrist and fingers
103
Sx of median nerve injury?
Loss of thumb oppositoin/abduction and flexion of first 2 fingers. Commonly damaged in colle's fracture
104
Sx of ulnar nerve injury?
Loss of abduction and adduction of the fingers
105
Why should you always ensure B12 levels are checked and replenished before giving folate for macrocytic anaemia?
Giving folate to a patient deficient in B12 can precipitate subacute combined degeneration of the cord
106
Sx of Internuclear Opthalmoplegia?
Impairment of adduciton of the ipsilateral eye. The contralateral eye abducts but with nystagmus
107
How does hyperventilation help to reduced ICP?
Reduces CO2 levels to induce cerebral vasoconstriction
108
Sx Pituitary Apoplexy?
Sudden onset severe headache, vomiting, neck stiffness, visual field defects, reduced eye movements and hypotension/hyponatraemia
109
What is Pituitary Apoplexy, how do you investigate and treat?
Sudden enlargemetn of a pituitary tumour MRI Urgent steroid replacement and surgery
110
What are bilateral vestibular schwannomas associated with?
NFT type 1

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