Neuro Misc Flashcards by Joe McAuley

3 dopamine agonists used in parkinson’s?

Pramipexole
Roprinilole
Apomorphine - acute ‘off’ states

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2 Anticholinergics used in Parkinson’s to help tremor?

Trihexiphenidyl

Benzhexol

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2 COM-T inhibitors used in Parkinson’s?

Why are they used?

Entecapone
Tolcapone

Lessen ‘off’ time in levodopa therapy

(monitor LFT’s)

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Treatment of dyskinesia assoc w treatment of parkinson’s?

Amantidine

NMDA antagonist

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What should patients be started on after ischaemic stroke?

Give aspirin 300mg PO/PR as soon as haemorrhagic stroke ruled out, and continue for 14 days.

After 14 days:
1st line = Clopidogrel + statin
2nd line = Aspirin + Dipyramidole + statin
3rd line = Dipyramidole + statin

(wait 14 days to minimise the risk of transitioning to haemorrhagic)

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Causes of cerebellar dysfunction?

PASTRIES

Posterior fossa tumour
Alcohol
multiple Sclerosis
Trauma
Rare causes
Inherited diseases (e.g. Friedrich's ataxia)
Epilepsy treatment
Stroke

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35 y/o male presents with difficulty walking. He has his feet wide apart and staggers, and there is loss of normal heel-toe walk. What is this gait?

Ataxic - cerebellar disease

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Inability to adduct fingers of hand - nerve?

Ulnar

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Inability to extend fingers of hand- nerve?

Radial

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What group of people have a 3x higher risk of developing Bell’s Palsy?

Pregnant women

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How long can you not drive for after TIA?

1 month

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Rugby player presents after receiving a hard tackle during a match. His arm is hanging loose, it is pronated and internally rotated. What is damaged?

Brachial nerve roots C5/6

This describes Erb’s palsy

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Which antipsychotic can cause megaloblastic anaemia?

Phenytoin - alters folate metabolism

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Bitemporal hemianopia predominantly affecting upper quadrants?

Pituitary macroadenoma

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Bitemporal hemianopia predominantly affecting lower quadrants?

Craniopharyngioma

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Elderly lady suffering from hypertension is admitted following a intracranial bleed. Over the course of the day she becomes more unresponsive, responding now to supraorbital pain only. What is the most likely diagnosis? Investigation?

Hydrocephalus

CT brain

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How to differentiate acute and chronic subdural haematoma on CT?

Acute - blood is HYPERdense

Chronic - HYPOdense

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Medical treatment of delirium?

Haloperidol

NOT if Parkinson’s though, give Lorazepam instead

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67 y/o man with CVS Hx presents with sudden onset dizziness and vomiting. Exam reveals vertical nystagmus and inability to stand without support. Likely cause?

Cerebellar stroke -> urgent CT brain

similar presentation to vestibular neuritis, except patients are usually able to stand without support in this

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Patient is hit on head with hammer, depressed open skull fracture evident, GCS 6/15 - initial management?

Urgent neurosurgical review, even before CT

Any patient with GCS <8/15 needs urgent neurosurgical review

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67 y/o falls down stairs. He has GCS 15/15 and no signs except bruising at mastoid - management?

Urgent CT within 1 hour

Battle’s sign -> basal skull fracture

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52 y/o woman falls down stairs. Has no neurology, but is unable to turn neck 45 degrees to left and right - management?

Immobilise with neck brace and arrange CT neck

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Woman has sinusitis. Then a week later develops severe frontal headache with difficulty lifting her right arm and leg. She then has a seizure. What does she have?

Cerebral abscess

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How does cavernous sinus thrombosis present?

Unilateral facial oedema
Photophobia
Proptosis
CN III, IV, V1 and VI palsy

Can be a complication of sinusitis

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First line treatment options for neuropathic pain?

Amitriptyline Duloxetine Pregabalin Gabapentin

Loss of ability to abduct thumb - nerve?

Median

Which medications can cause benign intracranial hypertension?

``` Tetracyclines Contraceptives Steroids Levothyroxine Lithium ```

What does taste and general sensory for anterior 2/3 of tongue?

Taste - facial (via chorda tympani) General sensory - CNV1

How does corticobasal degeneration present?

Parkinsonism Cortical signs e.g. hyperreflexia, myoclonus, apraxia (difficulty completing simple movements) affecting one limb more than the other. Can cause 'alien limb phenomenon' Prominent gait unsteadiness and falls

How does supranuclear palsy present?

Symmetrical parkinsonism Vertical gaze palsy, saccadic eye movements, eventually limitation to eye movement Chewing and swallowing diffuculty

What antibiotic should never be given in myasthenia gravis?

Gentamicin Affects NMJ so can cause respiratory depression

What is epilepsy partialis continua?

Non-convulsive status Consciousness preserved but patient is in 'altered state', consider this in elderly

Are focal or generalised seizures more common in older patients?

Focal In focal seizures the brain in structurally abnormal

Side effects of Carbamazepine?

Ataxia Vertigo Blurred vision Hyponatraemia

Which 2 anticonvulsants shouldn't be given together?

Valproate and Lamotrigine

Febrile convulsions are a risk factor for the development of which type of epilepsy?

Focal temporal seizures Febrile seizures can cause sclerosis of mesial temporal lobe

Is a lesion of the DOMINANT parietal lobe more likely to present with L/R disorientation or hemispatial neglect syndrome?

L/R disorientation

Meningioma risk factors: Genetic condition? Early life exposure to something? What sex?

NF2 Childhood radiation exposure Female sex

A lesion of which lobe might cause urinary incontinence?

Frontal - micturition centre is in frontal lobe

A lesion of which lobe is likely to cause a contralateral homonymous hemianopia?

Occipital Will have macular sparing

What is Foster Kennedy Syndrome? What is the usual cause? What can relieve symptoms whilst awaiting surgery?

Ipsilateral optic nerve atrophy, central scotoma and anosmia; contralateral papilloedema Meningioma in olfactory groove Dexamethasone whilst awaiting surgery/radio/chemo

Which is the most common extra-axial brain tumour of mesenchymal cells?

Meningioma

What controls consciousness? | Where is it found?

Reticular formation | Network of neurones stretching from upper midbrain to lower medulla oblongata

A stroke affecting which circulation is most likely to present with decreased consciousness? Why?

Posterior Consciousness mediated by reticular formation in brainstem - posterior stroke is of vertebrobasilar circulation so can affect brainstem

What are Verocay bodies? | What are they found in?

Cellular areas surrounded by nuclear pallisades | Schwannomas

What are hemangioblastomas? | Where are they most commonly found?

Benign tumours which are cystic and highly vascular | Most commonly in posterior cranial fossa

Which tumour has a 'butterfly appearance' on MRI?

Glioblastoma multiforme

What thyroid panel would be expected in a patient with a functional thyrotropinoma?

Increased TSH Increased T3/T4 -> Cause secondary hyperthyroidism by releasing excess TRH

Craniopharyngioma is a rare pituitary tissue tumour. What does it present with?

Lower bitemporal hemianopia | Diabetes insipidus

Which tumour is associated with Von Hippel Lindau Syndrome?

Hemangioblastoma Along with phaeochromocytoma, renal cell carcinoma, pancreatic cysts

Treatment of a tumour that presents with amenorrhoea, galactorrhoea, decreased libido?

Cabergoline Prolactinoma - cabergoline is a dopamine agonist

A lesion in which lobe would present with cortical blindness and visual hallucinations?

Occipital

2 brain tumours associated with NF2?

Meningioma | Schwannoma - likely if young and bilateral vestibular schwannoma

Hemispatial neglect syndrome would most likely appear with a lesion on the dominant/non-dominant side?

Non-dominant

Treatment of a tumour which presents with gigantism and acromegaly?

1st - Ocreotide (a somatostatin analogue) | 2nd - Pegvisomant (GH antagonist)

7 symptoms of a frontal lobe lesion?

``` Disinhibition Personality change (antisocial behaviour) Lack of initiative Impaired memory Urinary incontinence Grasp reflex Anosmia ```

Dominant parietal lobe lesion?

Agraphia Acalculia R/L disorientation Finger agnosia (inability to localise fingers) (gerstmann syndrome) Also inferior quadrantopia

Non-Dominant parietal lobe lesion?

Hemispatial neglect Spatial disorientation Dressing/Construction apraxia Inferior quadrantopia

Lesion of Dominant temporal lobe?

Wernicke's aphasia Poor memory Complex hallucinations (sound, smell, visual) Superior quadrantopia

Non-dominant temporal lobe lesion?

Poor music skills Poor non-verbal memory Complex hallucinations (sound, smell, visual)

21 y/o man assaulted outside of pub 3 hours ago. He drank 3 pints of lager. He has bruising on face around eye. GCS 14 (M6 V4 E4) with some difficulty explaining where he is. Management?

Urgent CT head within 1 hour Do this if GCS < 15 after 2 hours

If suspect subarachnoid haemorrhage but CT normal, how long should you wait before confirming with LP?

12 hours after headache started

What findings prove SAH on LP?

Breakdown products from RBC e.g. bilirubin (Xanthochromia) Presence of RBC's could be from bloody tap. Wait 12 hours for RBC's to be broken down.

75 y/o man falls and hits head and was unconscious for 1 min. Comes to A&E 2 hours later, GCS 15, no neurological signs. management?

CT within 8 hours Anyone >65y/o who have head injury causing amnesia or unconsciousness should get CT within 8 hours, unless indications suggesting it should be within 1 hour e.g. GCS <15 after 2 hours

30y/o nurse has 24 hour Hx of headache, drowsiness, confusion. GCS 13/15. No signs of meningism, and she is confused. Urgent MRI shows bilateral increased signal in both temporal lobes. What is is?

Herpes Simplex encephalitis No meningism, confusion, increased temporal lobe signal

Neuro Misc Flashcards

(65 cards)