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Year 3 > Neurology > Flashcards

Neurology Flashcards

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1
Q

What is a glioma?

A

A Neuroepithelial tumour usually seen within the hemispheres though can be anywhere in CNS
2 main types; astrocytomas and oligodendrogliomas

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2
Q

Why are tumours of neuronal cells only present in childhood?

A

Fully differentiated neurons can’t multiply or give rise to neoplasms so tumours have to occur before completion of differentiation

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3
Q

What is a medulloblastoma?

A

Childhood brain tumour arising from the cerebellum

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4
Q

What is a neurofibroma?

A

Tumours deriving from endoneurium which is a layer of connective tissue around the myelin sheath of each nerve in the PNS

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5
Q

Personality changes and disinhibition would indicate a tumour located where?

A

Frontal lobe

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6
Q

Describe the sensory (ascending) tracts in the Dorsal Horn

A

Responsible for fine touch, vibration and proprioception
Ipsilateral (decussates in medulla)
Fasciculus cuneatus (lateral) responsible for T6 and above
Fasciculus gracilis responsible for below T6

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7
Q

Describe the anterolateral part of the sensory tract?

A

Anterior spinothalamic responsible for crude touch and pressure
Lateral spinothalamic responsible for pain and temperature
Contralateral (decussates in spinal cord)

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8
Q

Describe the pyramidal tracts of the motor (descending) pathway

A

Anterior corticospinal and lateral corticospinal tracts are responsible for voluntary movement of the limbs
Anterior is ipsilateral and lateral is contralateral

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9
Q

Which tracts are known as the extrapyramidal motor tracts?

A

All coordinate INvoluntary movements

Tectospinal = head and neck movements in response to visual stimuli
Vestibulospinal tract = posture and balance
Rubrospinal = fine motor control
Reticulospinal = medial for contraction and increases tone, lateral inhibits contraction and decreases tone

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10
Q

What does DANISH stand for?

A

Dysdiadokinesia = impairment of rapid alternating movements
Ataxia = broad gait
Nystagmus
Intention Tremor
Scanning dysarthria = slow or poorly articulated speech
Hypotonia

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11
Q

Headache red flags

A

Worse in morning
Wakes you up
Worse when coughing or leaning forward
Associated with vomiting

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12
Q

Gold standard test for the brain tumour

A

MRI

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13
Q

Describe a subfalcine herniation

A

Asymmetrical expansion of a hemisphere causes compression of the cingulate gyrus under the falx cerebri
Can cause compression of the anterior cerebral artery branches
Symptoms = weakness in contralateral leg

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14
Q

Describe a tentorial herniation

A

Medial part of the temporal lobe hernaites over the tentorium cerebelli
Causes compression of ipsilater 3rd cranial nerve -> pupil dilation, reduced eye movements

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15
Q

Describe tonsillar hernation

A

Displacement of the cerebellar tonsils through the foramen magnum
Compresses brainstem so compromises the respiratory centre in the medulla -> life threatening

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16
Q

Describe transcalvarial herniation

A

Swollen brain herniated through any defect in the dura and skull

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17
Q

What’s the main cause of a subarachnoid haemorrhage?

A

A ruptured berry aneurysm

These are formed from a congenital weakness of the elastic tissue in the artery wall

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18
Q

Symptoms of a subarachnoid haemorrhage?

A

Sudden onset of a thunderclap headache - worst, occipital, during strenuous activity “hit on back of head”
Nausea and vomiting
Neck stiffness and photophobia if meningeal irritation

3rd nerve palsy if aneurysm is on posterior communicating artery

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19
Q

Investigation if you suspect a brain haemorrhage

A

Unenhanced CT

If inconclusive then a lumbar puncture looking for blood

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20
Q

Treatment for a subarachnoid haemorrhage

A

Bed rest and support
Control any hypertension
Nimodipine (Ca channel blocker) prevents vasospams which can cause ischaemia

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21
Q

How would you treat a brain aneurysm?

A

Endovascular treatment placing platinum coils via a catheter into the aneurysm to promote thrombosis and ablation of the aneurysm
Direct surgical clipping may be needed

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22
Q

Causes of a subdural haemorrhage

A 
Acute = trauma ruptures the bridging veins
Chronic = brain atrophy causes bridging veins to be stretched
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23
Q

Symptoms of a subdural haemorrhage

A

Altered state of consciousness following trauma or a fall

Chronic = headaches, confusion, urinary incontinence, weakness, seizures…

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24
Q

What does a subdural haemorrhage look like on a CT scan?

A

Semilunar shape

Midline shift

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25
Management of a subdural haemorrhage
No immediate treatment as they often resolve on their own Must involve neurosurgery Serial imaging Can be drained surgically
26
What is the pterion?
Thinnest part of the skull | Join of the temporal, parietal, frontal and sphenoid bones
27
Causes of an extra dural haemorrhage
Trauma causes shearing stress that separates the bone and the dura Most commonly trauma to the pterion which damages the middle meningeal artery
28
Symptoms of an extra dural haemorrhage
Head trauma that causes a brief loss of consciousness, then lucidness then further deterioration Headache Contralateral hemiparesis - damage to stalks that attach cerebrum to brain stem and contain ascending and descending tracts Ipsilateral pupil dilation - temporal lobe can herniate and compress oculomotor nerve
29
Management of an extra dural haemorrhage
If expanding, immediate neurosurgical treatment | If small and patients are neurologically intact then conservative treatment
30
What produces the myelin sheath?
In CNS, oligodendrocytes | In PNS, Schwann cells
31
How many spinal nerves are there?
``` 31 pairs C1-8 T1-12 L1-5 S1-5 Co1 ```
32
Which dermatome is the nipple in?
T4
33
Which dermatome is the umbilicus
T10
34
At what level does the spinal cord end?
L1-2
35
Where should a lumbar puncture be inserted?
Between L3-4
36
Myoclonus
Quick involuntary muscle jerk E.g. hiccups, hypnic jerk when falling asleep Brief activation of muscles
37
Dystonia
Sustained or intermittent muscle contractions that cause abnormal movements Often initiated or worsened by voluntary action Associated with overflow muscle activation
38
Chorea
Brief, irregular movements that move flit and flow from one body part to another Patients often appear restless or fidgety
39
Tics
‘Un” voluntary repetitive movements or vocalisations | Suppressible for a short period of time but this causes a lot of anxiety
40
Pathology of Parkinsons Disease
Loss of dopaminergic neurons in the substantia nigra | Surviving cells contains Lewy bodies
41
Early signs of Parkinsons Disease
``` Anosmia Depression and anxiety Sleep disorder Urinary urgency and constipation Hypotension Restless leg syndrome ```
42
Motor problems associated with Parkinson’s Disease
``` Akinesia Tremor (pin-rolling) Rigidity Stooped posture Shuffling gait with reduced arm movements Speech and swallowing difficulties ```
43
Investigations for Parkinsons Disease
Dopamine Transporter Imaging using SPECT or PET
44
Management of Parkinson’s Disease
1st Line for those with motor symptoms = Levodopa = converted to dopamine in the brain - need more over time, on-off problems No motor symtoms = L Dopa, dopamine agonists or MAO inhibitors
45
What is Parkinsonism?
Any conditions that causes TRAP (extrapyramidal) symptoms = Tremor, Rigidity, Akinesia, Postural disturbances Can be caused by anything affecting the nigrostriatal dopamine pathway e.g. antipsychotics (block D2 receptors)
46
What is MS?
Multiple Sclerosis T-cell mediated inflammatory disorder causing multiple plaques of demyelination throughout the brain and spinal cord (CNS only) occurring sporadically over years
47
Investigations for MS
MRI = areas of demyelination | Lumbar puncture = oligoclonal bands in CSF with no corresponding bands in the serum
48
Management of MS
Symptoms - physiotherapy or baclofen for pyramidal dysfunction. Gabapentin for neuropathic pain Acute - oral or IV steroids Disease modifying - Tecfidera (oral), interferons, glutamir acetate (injection)
49
What is myaesthenia gravis?
Auto-immune disorder of the NMJ | Antibodies to ACh receptors -> signals don’t get through
50
Symptoms of myaesthenia gravis
Weakness that gets worse throughout day - fatigability. Particularly, extraocular, facial and bulbar weakness Drooping eyelids Double vision that comes and goes Can cause a respiratory crisis cos of weak muscles of respiration
51
Investigations for myaesthenia gravis
Anti-AChR antibodies | Anti-MuSK antibodies
52
Management of myaesthenia gravis
Acute - acetylcholinesterase inhibitors, IVig Steriods then move to steroid-sparing e.g. azathioprine AVOID GENTAMICIN
53
What is Guillan-Barre Syndrome?
Acute demyelination disorder that usually occurs after infection with campylobacter or CMV Causes ascending weakness
54
Symptoms of Guillan-Barre Syndrome
Post infection Weakness and sensory loss Loss of tendon reflexes
55
Investigation and treatment of Guillan-Barre syndrome
Confirm with nerve conduction studies | IVIg given within first 2 weeks can reduce severity and duration of paralysis
56
Pathogenesis of Huntington’s Disease
Autosomal dominant with age-dependent penetrance (Anticipation) Extra CAG repeats (>20) so increased glutamines on the protein -> neurotoxic. Unstable during meiosis so it gets worse each time its passed down and appears earlier Loss of basal ganglia which causes flattening of ventricles Caudate nucleus is atrophic Loss of cells in cerebral cortex
57
Presentation of Huntington’s disease
Fidgetiness, difficulty concentrating, clumsiness Chorea, inability to walk Difficulty speaking and swallowing Patients usually die 10-20 years after 1st onset of symptoms
58
What is Duchenne Muscular Dystrophy?
X-linked recessive disorder (1/3 spontaneous) causing progressive muscle wasting and weakness The mutation is in the dystrophin gene which codes for dystrophin proteins that connect actin filaments to cell membrane and ECM. -> progressive loss of muscle cells -> muscle wasting and weakness
59
Presentation of DMD
``` Developmental delay (boy not walking by 18 months) Gower’s sign = put hands down to push themselves up Toe walking - calf hypertrophy Exaggerated lumbar lordosis ```
60
Investigations for DMD
Screen looking for raised creatinine kinase | Genetic testing to confirm
61
Management for DMD
No curative treatment - usually disabled by 10, die in 20s Steroids may delay progression Physiotherapy
62
What is Spinal Muscular Atrophy?
Autosomal Recessive disorder that causes loss of anterior horn cells in spinal cord Usually a deficiency in SMN1 gene which causes motor neuron loss
63
Presentation of Spinal Muscular Atrophy
Floppy and weak baby - hypotonia and muscle weakness | Respiratory failure is resp. Muscles are affected
64
Management of Spinal Muscular Atrophy
Treatment using similar SMN2 gene which prevents essential exon7 being spliced out Prevents progression but doesn’t stop whats already happened
65
Most common causes of meningitis
``` Streptococcus pneumonia Neisseria Miningitidis (meningococcus) ```
66
Describe Streptococcus Pneumonia with regards to meningitis
``` Most common type of meningitis Alpa Haemolytic Gram positive cocci in chains High risk of developing with diabetes, cochlear implants or skull fractures There is a vaccine ```
67
Describe Neisseria Meningitidis with regards to meningitis
Gram negative cocci in pairs Symptoms due to endotoxin More common in young children and adults 12 capsular groups and theres a vaccine for ACWY
68
Treatment for Bacterial Meningitis
Ceftriaxone IV 2g bd (chloramphenicol is penicillin allergy) and Dexamethasone If listeria suspected (anyone >60 or immunocompromised) add amoxicillin
69
Most common cause of encephalitis in UK
Herpes Simplex Virus
70
Presentation of encephalitis
Personality and behavioural changes Confusion, reduced consciousness, coma Speech disturbance Seizures
71
Treatment for Encephalitis
Suspected HSV or VZV then acyclovir IV immediately | Long-term complications are common including memory impairment, personality change, epilepsy
72
Absense seizure
Loss of awareness and vacant facial expression <10secs Maybe slight eye flutterings but no motor symptoms Patient may be unaware
73
Myoclonic Seizure
Jerk movements
74
Tonic seizure
Stiffening of the body. No jerking
75
Atonic seizure
Sudden collapse with loss of muscle tone and consciousness
76
Tonic clonic seizure
Tonic stiffening followed by clonic jerking phase Possible incontinence after convulsions Slow return to consciousness followed by drowsiness, confusion and headaches
77
Management of Epilepsy
1st line for tonic clonic, tonic or atonic seizures = Sodium Valproate (or lamotrigine) 1st line for myoclonic = Sodium Valporate (or levetiracetam) Sodium Valporate is teratogenic so avoid in women of child-bearing age Many AEDs can make contraceptives ineffective
78
In spinal cord, where is the white and grey matter?
Grey matter is in the middle with anterior and dorsal horns | White matter around the outside containing the ascending and descending tracts
79
Describe nigrostriatal dopamine pathway
Pars compacta in substantia nigra of the midbrain Controls movement More dopamine = more movement
80
Describe mesocorticolimbic dopamine pathway
Travels from VTA of midbrain to prefrontal cortex then to nucleus accumbens Controls mood/reward More dopamine = higher mood
81
Describe tuberoinfundibular dopamine pathway
From hypothalamus to pituitary Controls prolactin release More dopamine = less prolactin
82
What foramina does CN I pass through?
Olfactory | Cribiform plate
83
What foramina does CN II pass through?
Optic Nerve | Optic Canal
84
What foramina does CN III pass through?
Oculomotor Nerve | Superior Orbital Fissure
85
What foramina does CN IV pass through?
Trochlear | Superior Orbital Fissure
86
What foramina does CN V pass through?
Trigeminal V1 = SOF V2 = Foramen rotundum V3 = Foramen ovale
87
Wht foramina does CN VI pass through?
Abducens | Superior orbital fissure
88
What foramina does CN VII pass through?
Facial Nerve | Internal auditory meatus then stylomastoid foramen
89
What foramina does CN VIII pass through?
Vestibulocochlear | Internal auditory meatus
90
What foramina does CN IX pass through?
Glossopharyngeal | Jugular Foramen
91
What foramina does CN X pass through?
Vagus Nerve | Jugular Foramen
92
What foramina does CN XI pass through?
Accessory Nerve | Jugular foramen
93
What foramina does CN XII pass through?
Hypoglossal | Hypoglossal Canal
94
Describe what CN III does and signs of a CN III palsy
Eye movements (MR, SR, IR, IO), pupil constriction, accomodation, eyelid opening Palsy = Ptosis, ‘down and out’ eye, dilated, fixed pupil
95
Describe what CN IV does and signs of a palsy
Superior oblique eye movement Palsy = down and in gaze, vertical diplopia
96
Describe what CN VI does and signs of a palsy
Lateral rectus eye movement Palsy = Eye cant move outwards, horizontal diplopia
97
If there is a CN X palsy, which way will the uvula deviate?
Away from the site of the lesion
98
If there is a CN XII palsy, which way will the tongue deviate?
Towards the side of the lesion
99
Which cranial nerve nuclei are located in the medulla oblongata?
``` 9, 10, 11 and 12 Glossopharyngeal Vagus Accessory Hypoglossal ```
100
Which cranial nerve nuclei are located in the posterior part of the pons?
``` 5, 6, 7 and 8 Trigeminal Abducens Facial Vestibulocochlear ```
101
Which cranial nerve nuclei are located in the central part of midbrain?
3 and 4 Oculomotor Trochlear
102
Which blood vessel lies deep to the pterion?
Middle meningeal artery
103
Biceps reflex, which nerve?
C5 (6)
104
Triceps reflex, which nerve?
C7
105
Supinator/brachioradialis reflex, which nerve?
C6
106
Patellar reflex, which nerve?
L4
107
Ankle reflex, which nerve?
S1
108
Describe neurofibromatosis
Type 1 and 2. 1 is more common (90%) Autosomal dominant Chromosome 17 (type 1), 22 is type 2 Neurofibromas, cafe-au-lait spots and freckling, learning disability
109
Treatment for status ellipticus
IV lorazepam IM midazolam (can also do buccal or nasal) Can add phenytoin IV If not working, can add phenobarbitone

Year 3 (10 decks)

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