Neurology Flashcards by a b

Thrombolysis absolute CI

previous haemorrhagic stroke
ischaemic stroke in last 3m
CNS damage/neoplasm
major surgery/HI/major trauma in last 3wks, active internal bleeding
GI bleed in last 1 month
aortic dissection
known bleeding disorder
proliferative diabetic retinopathy

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Nausea
Vertigo
Nystagmus

MOA: otolith detachment into the semicircular canals of the inner ear

BPPV

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subacute or acute onset of pain in the eye 
/headache
pain with eye movements
loss of vision
central scotoma

optic neuritis

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80M
difficulty moving and memory problems

tremor + bradykinetic
Unable to look down falls
not orthostatic

Progressive supranuclear palsy
(parkinson’s plus)
- UNABLE TO LOOK DOWN

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diarhoeal illness, then

drowsiness
double vision
ataxia
BRISK reflexes

Bickerstaff’s encephalitis

NB in GBS DON’T get drowsiness + have absent reflexes

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postural hypotension and urinary retention
parkinsonism

Dx?

multi-system atrophy

autonomic dysfunction

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12 months cognitive impairment, parkinsonism, confusion, generalised myoclonus

started on L dopa

then visual hallucinations

Dx?

diffuse lewy body disease
- early cognitive impairment

(no hallucinations in PSP or MSA)

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diffuse disease of small arteries

recurrent ischaemic events

may present with migraine

severe mood disorders, dementia

leukoencephalopathy on MRI

CADASIL

(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)

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dysphagia 
absent gag reflex
nasal voice/dysarthria
difficulty chewing
tongue wasting/fasciculations

Bulbar palsy

LMN affects CN 9 - 12

Cause = brainstem stroke, GBS

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hot potato voice
inc jaw jerk/gag reflex
UMN signs in UL
uncontrollable laughter

psudobulbar palsy

UMN

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can you get CN III palsy in migraine?

Yes

ophthalmoplegic migraine

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orogenital ulceration
iritis
pathergy (xs skin injury post minor trauma)

Behcets

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weakness of dorsiflexion of the left foot

sensory loss Dorsum of foot

L5 radiculopathy

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ataxia
encephalopathy
ophthalmoplegia

Wernicke’s encephalopathy

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homonomous hemianopia
    (often upper quadrantic)
Cortical blindness
Hemivisual neglect
Visual hallucinations 
verbal dyslexia

posterior cerebral artery stroke

supplies occipital lobe

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Coarse tremor

drug cause

cyclosporin

dose dependent manner

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R wRist drop

sensory loss dorsum of hand

nerve affected

Radial nerve

supplies serratus anterior
winging of the scapula

nerve affected

long thoracic nerve

cannot abduct and oppose the thumb weakness in forearm pronation + finger flexion
sensory loss plantar thumb + 1st two fingers

nerve affected

median nerve

elbow injury
numbness in the 5th finger/ lateral aspect hand
+/- claw hand

ulnar nerve

70M
L sided weakness resolves in 2 hours

Next step?

next day TIA clinic

CT/MRI head and carotid duplex within 1 wk.

If carotid endarterectomy indicated - within 2 weeks necessary

phenytoin toxicity gait

broad based gait

cerebelalr syndrome

suspected TIA

which scoring system?

ABCD score

suspected TIA
ABCD >/= 4 9high risk stroke)

Mx?

aspirin 300 mg OD

next day TIA clinic

which anti HTN | dry mouth and dizziness on standing

doxazosin | alpha blocker

horizontal gaze palsy impaired adduction ipsilateral to the lesion abduction nystagmus contralateral to lesion

INO Internuclear ophthalmoplegia lesion at the medial longitudinal fasciculus

Causes Internuclear ophthalmoplegia

MS brainstem infarction syphilis and Lyme disease

drooling, tongue and lip swelling and tachypnoea which drug can cause?

ACEi ARB does not necessarily occur as soon as the medication is started

cortisol level in hypoglycaemia

cortisol should increase

sodium valproate risk to foetus

neural tube defects

sodium valproate carbamazepine p450 effect

sodium valproate - INHIBITOR | carbamazepine - INDUCER

proximal lower limb weakness areflexia (reflexes normalise with repetitive muscle contraction) no wasting or fasciculations sensory examination is normal which Abs test for

VG Ca channel Abs | lambert-eaton syndrome

Pt started on carbamazepine 2 weeks later have to increase dose to maintain therapeutic range whuch?

auto induction carbamazepine carbamazepine p450 inducer therefore metabolism increases so need more for same therapeutic effect

Vertigo Vomiting Pressure within the ear Deafness

Ménière's disease

URTI | then acute disabling vertigo

Labyrinthitis

Nausea Vertigo Nystagmus

BPPV

Sudden onset of painless monocular visual loss in patients aged 50 or more is commonly due to ischaemic optic neuropathy

Nonarteritic ischaemic optic neuropathy | arteritic ION = GCA

carotid endarterectomy in dense stroke?

dengue fever initial Mx

normal saline

right sided weakness | Leg >arms

anterior cerebral artery stroke | MCA = UL > LL weakness

foot drop nerve affected

common peroneal nerve palsy