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Flashcards in Neurological Deck (43):
1

Gerstmann syndrome

Dysgraphia
Dyscalculia
Finger agnosia
Left-right disorientation

2

Features of TIA affecting ICA

Amaurosis fugax
Aphasia
Hemiparesis
Hemisensory loss

3

Features of TIA affecting vertebrobasilar arteries

Transient global amnesia

4

Lateral medullary syndrome

Ipsilateral:
-Loss of pain/temperature in face
-Ataxia + incoordination
-Dysarthria + dysphagia
-Horner's syndrome

Contralateral:
-Loss of pain/temperature in body

-Vertigo + nystagmus

5

Brown-Séquard syndrome

Ipsilateral:
-Paralysis
-Loss of proprioception/vibration

Contralateral:
-Loss of pain/temperature

6

Anterior cord syndrome

Bilateral paralysis + loss of pain/temperature

7

Posterior cord syndrome

Bilateral loss of proprioception/vibration

8

Medial medullary syndrome

Ipsilateral:
-Tongue deviatoin

Contralateral:
-Hemiplegia/paresis
-Loss of proprioception/vibration

9

Causes of seizures

VITAMIN PD:
-Vascular - stroke, AV malformation
-Infection - meningitis, encephalitis, syphilis, HIV, Lyme disease, cerebral malaria
-Trauma
-Autoimmune - SLE, cerebral vasculitis
-Metabolic - uraemia, hepatic encephalopathy, hypoglycaemia, hyponatraemia, hypocalcaemia
-Idiopathic - epilepsy
-Neoplastic
-Pseudoseizure
-Drugs - TCAs, lithium, tramadol, theophylline, flucloxacillin, ciprofloxacin, cocaine, alcohol/benzodiazepine withdrawal

10

Status epilepticus

Seizure >5 min or multiple seizures without break in 5-min period

Management: airway protection, oxygen, benzodiazepine

11

Lifestyle modification in epilepsy

Avoid swimming and dangeous sports
Leave bathroom doors unlocked
Take showers instead of baths
Avoid triggers (e.g. sleep deprivation, alcohol, drugs)

12

Driving guidelines in epilepsy

Private:
-Seizure-free for 12 months
-Compliant with medications

Commercial:
-Seizure-free for 10 years
-Compliant with medications
-No epileptiform activity on EEG

13

Acute management of migraine

General:
-Rest in quiet, dark room
-Avoid movement/any activity

First-line drugs:
-Simple analgesics
-Antiemetics (domperidone, metoclopramide)

Second-line drugs:
-Triptans (sumatriptan, zolmitriptan)
-Dihydroergotamine

14

Prevention of migraine

Non-pharmacological:
-Avoid triggers
-CBT/relaxation exercises
-Acupuncture

Drugs - VASPP:
-Verapamil
-Amitriptyline
-Sodium valproate/topiramate
-Propranolol
-Pizotifen

15

Acute management of tension headache

-Simple analgesics
-Amitriptyline (if frequent/constant)

16

Acute management of cluster headache

-High-flow (10L/min) 100% oxygen for 15 min with a non-rebreathing mask
-Sumatriptan (SC/intranasal)
-Dihydroergotamine (IM)

17

Prevention of cluster headache

Bridging with predinosolone +
-Verapamil
-Methysergide
-Lithium

18

Management of trigeminal neuralgia

Carbamazepine

19

Signs of papilloedema on fundoscopy

Hyperaemia (dilated veins)
Optic disc haemorrhages
Optic margin blurring
Optic disc swelling
Cotton-wool spots/exudates

20

Extradural haemorrhage on CT

Biconvex/lenticular hyperdensity (somewhat heterogenous, sharply demarcated - limited to sutures)
Mass effect - midline shift, loss of ventricles

21

Causes of subdural haemorrhage

Shearing force causing damage to bridging cortical veins

Infants - shaken baby
Young adults - MVA
Elderly - falls

22

Subdural haemorrhage on CT

Acute:
Crescentic hyperdensity (homogenous, spread diffusely)
Mass effect - midline shift, loss of ventricles
Sulcal effacement

Chronic:
Hypodensity

23

Subarachnoid haemorrhage on CT

Diffuse hyperdensities

24

Management of subarachnoid haemorrhage

Stabilisation
Prevention of rebleeding - bed rest, analgesia, sedation, stool softeners, clipping/coiling
Prevention of vasospasm - CCB, triple H therapy (use of IV fluids to achieve hypertension, hypervolaemia and haemodilution)

25

Meningitis organisms by age group

Newborns (GEL): group B streptococci, E. coli, Listeria

Children (SNH): Strep. pneumoniae, Neisseria, Haemophilus

Adolescents/young adults: Neisseria, Strep. pneumoniae

Older adults (SNL): Strep. pneumoniae, Neisseria, Listeria

26

Kernig's sign

Pain on passive knee extension with hip fully flexed

27

Brudzinski's sign

Hip/knee flexion on passive neck flexion

28

Signs of bacterial meningitis on CSF

Cloudy/turbid
Raised neutrophils
High/very high protein
Very low glucose

29

Signs of viral meningitis on CSF

Clear
Raised lymphocytes
Normal/high protein
Normal/low glucose

30

When is CT head before LP indicated?

F PAIN:
Focal neurological deficits
Papilloedema
Altered mental state
Immunocompromised
New-onset seizures

31

Empirical therapy for meningits

Dexamethasone + ceftriaxone

Add benzylpenicillin if immunocompromised, age >50, alcoholic or pregnant (Listeria)

32

Management of multiple sclerosis

Lifestyle modification:
-Weight loss
-Vitamin D supplementation
-Smoking cessation

Acute relapses:
-Mild - rest/reassurance
-Moderate - prednisolone
-Severe - methylprednisolone

Ongoing:
-Immunomodulator (interferon beta, glatiramer acetate) ±
-Immunosuppresant (azathioprine, methotrexate)

Symptomatic relief:
-Spasticity - baclofen, diazepam, clonazepam
-Fatigue - amantadine
-Bladder dysfunction - anticholinergics

33

Signs of Parkinson's disease

-Pill-rolling tremor
-Bradykinesia
-Rigidity

34

Management of Parkinson's disease

General:
-Rehabilitation/physiotherapy/balance training
-Group support
-Nutrition (dietary fibre and vegetables for constipation)

Drugs - LCD MAC:
-Levodopa
-Carbidopa/benserazide
-Dopamine agonists (bromocriptine, apomorphine, pergolide)
-MAO-B inhibitors (selegiline)
-Anticholinergics (benztropine)
-COMT inhibitors (entacapone)

Surgery:
-Deep brain stimulation

35

Causes of peripheral neuropathy

VITAMIN CD:
-Vascular - vasculitis, PVD, Buerger's disease
-Infectious - EBV, CMV, HIV
-Trauma - compression
-Autoimmune - Guillain-Barré syndrome
-Metabolic - DEBUT: DM, ethanol, B12 deficiency, uraemia, thyroid; B1 deficiency, B6 deficiency
-Iatrogenic - vincristine, metronidazole, amiodarone, isoniazid, phenytoin
-Neoplastic - paraneoplastic syndrome in SCLC and lymphoma
-Congenital - Charcot-Marie-Tooth disease
-Deposition - amyloidosis, sarcoidosis

36

Function, location (anterior/posterior) and site of decussation of three main tracts

(Lateral) corticospinal tract - motor, anterior, medulla
Spinothalamic tract - pain/temperature, anterior, anterior white commissure
DCML - proprioception/vibration/fine touch, posterior, medulla

37

Causes of stroke

Ischaemic (80%):
-Arterial thrombosis (atherosclerosis, dissection, vasculitis)
-Cardioembolism (AF, valvular heart disease, recent MI, endocarditis)
-Systemic hypoperfusion (cardiac arrest, arrhythmia, MI)

Haemorrhagic (20%):
-Intracerebral haemorrhage (hypertension, trauma, vasculitis, AV malformations)
-SAH

38

ACA stroke

Contralateral leg paresis/sensory loss

39

MCA stroke

Contralateral face/arm paresis/sensory loss
Contralateral homonymous hemianopia
Aphasia (dominant hemisphere)
Neglect (non-dominant hemisphere)

40

PCA stroke

Contralateral homonymous hemianopia
Midbrain - CN II/IV palsy, contralateral hemiparesis
Thalamus - contralateral hemisensory loss, amnesia, reduced consciousness

41

Acute changes in ischaemic stroke on CT

-Hyperdense segment of vessel (thrombus/embolus) (earliest change)
-Loss of cortical white-grey differentiation
-Well-demarcated region of hypoattenuation (later)
-Parenchymal swelling and mass effect

42

Acute management of stroke

-Thrombolysis (tPA) - within 4.5 hr
-Aspirin - after 4.5 hr (withhold for 24 hr after thrombolysis)

-Clot retrieval - consider in large vessel occlusion
-Hemicraniectomy - in younger patients

43

Main signs of meningitis in pathology specimen

Vasodilation
Neutrophil infiltration (increased opacities, especially in sulci)
Oedema