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Neurological Flashcards

(43 cards)

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1
Q

Gerstmann syndrome

A

Dysgraphia
Dyscalculia
Finger agnosia
Left-right disorientation

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2
Q

Features of TIA affecting ICA

A

Amaurosis fugax
Aphasia
Hemiparesis
Hemisensory loss

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3
Q

Features of TIA affecting vertebrobasilar arteries

A

Transient global amnesia

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4
Q

Lateral medullary syndrome

A

Ipsilateral:

  • Loss of pain/temperature in face
  • Ataxia + incoordination
  • Dysarthria + dysphagia
  • Horner’s syndrome

Contralateral:
-Loss of pain/temperature in body

-Vertigo + nystagmus

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5
Q

Brown-Séquard syndrome

A

Ipsilateral:

  • Paralysis
  • Loss of proprioception/vibration

Contralateral:
-Loss of pain/temperature

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6
Q

Anterior cord syndrome

A

Bilateral paralysis + loss of pain/temperature

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7
Q

Posterior cord syndrome

A

Bilateral loss of proprioception/vibration

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8
Q

Medial medullary syndrome

A

Ipsilateral:
-Tongue deviatoin

Contralateral:

  • Hemiplegia/paresis
  • Loss of proprioception/vibration
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9
Q

Causes of seizures

A

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
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10
Q

Status epilepticus

A

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

Management: airway protection, oxygen, benzodiazepine

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11
Q

Lifestyle modification in epilepsy

A 
Avoid swimming and dangeous sports
Leave bathroom doors unlocked
Take showers instead of baths
Avoid triggers (e.g. sleep deprivation, alcohol, drugs)
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12
Q

Driving guidelines in epilepsy

A

Private:

  • Seizure-free for 12 months
  • Compliant with medications

Commercial:

  • Seizure-free for 10 years
  • Compliant with medications
  • No epileptiform activity on EEG
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13
Q

Acute management of migraine

A

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
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14
Q

Prevention of migraine

A

Non-pharmacological:

  • Avoid triggers
  • CBT/relaxation exercises
  • Acupuncture

Drugs - VASPP:

  • Verapamil
  • Amitriptyline
  • Sodium valproate/topiramate
  • Propranolol
  • Pizotifen
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15
Q

Acute management of tension headache

A
  • Simple analgesics

- Amitriptyline (if frequent/constant)

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16
Q

Acute management of cluster headache

A
  • High-flow (10L/min) 100% oxygen for 15 min with a non-rebreathing mask
  • Sumatriptan (SC/intranasal)
  • Dihydroergotamine (IM)
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17
Q

Prevention of cluster headache

A

Bridging with predinosolone +

  • Verapamil
  • Methysergide
  • Lithium
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18
Q

Management of trigeminal neuralgia

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A

Carbamazepine

19
Q

Signs of papilloedema on fundoscopy

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A 
Hyperaemia (dilated veins)
Optic disc haemorrhages
Optic margin blurring
Optic disc swelling
Cotton-wool spots/exudates
20
Q

Extradural haemorrhage on CT

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A

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

21
Q

Causes of subdural haemorrhage

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A

Shearing force causing damage to bridging cortical veins

Infants - shaken baby
Young adults - MVA
Elderly - falls

22
Q

Subdural haemorrhage on CT

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A

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

Chronic:
Hypodensity

23
Q

Subarachnoid haemorrhage on CT

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A

Diffuse hyperdensities

24
Q

Management of subarachnoid haemorrhage

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A

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

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