Neurology Flashcards

(53 cards)

1
Q

Motor neuron disease
Symptoms/signs
Management
Complications

A

a combination of upper motor neuron (UMN) and lower motor neuron (LMN) findings.

No sensory or bladder/bowel deficits!!!

Limb weakness 
Poor gait/balance 
Painful muscle spasms 
Head drop/poor posture 
Hyperreflexia 
Progressive dysphagia, dysarthria 
Emotional incontinence 
May present with frontotemporal dementia 

Clincal diagnosis, consider EMG

Riluzole + treatment of symptoms

Respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Brain tumor symptoms?

A

headaches
seizures (fits)
persistently feeling sick (nausea), being sick (vomiting) and drowsiness
mental or behavioural changes, such as memory problems or changes in personality
progressive weakness or paralysis on one side of the body
vision or speech problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
Multiple sclerosis 
Symptoms/signs 
Investigations 
Management 
Complications
A

Classically presents in white women, aged between 20 and 40 years, with temporary visual or sensory loss.

Visual disturbance - pain, blurring, loss of colour discrimination

Sensory phenomenon - patch of wetness/burning/tingling/numbness, hemibody sensory loss , Lhermitte’s sign(tingling may occur in the limbs on neck flexion), trigeminal neuralgia. symptoms may worsen in heat or with exercise

Cerebellar dysfunction signs - ataxia, nystagmus, intention tremor
Weakness e.g. in legs, foot dragging, spasticity, cramping, paraplegia
Urinary frequency, bowel dysfunction
Optic neuritis

MRI brain and spinal cord = 1st line = periventricular plaques MRI brain, demyelinating lesions in the spinal cord, particularly the cervical spinal cord
lumbar puncture (oligoclonal IgG bands)

acute attack = IV steroids - methylprednisolone
Prevention of future attacks = disease-modifying therapies(B interferon)
spasticity = baclofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

State 3 causes of raised ICP

Symptoms, ivestigations?

A
Too much cerebrospinal fluid 
Bleeding into the brain, Swelling in the brain
Aneurysm
Brain or head injury, Brain tumor
Infections such as encephalitis or meningitis
Hydrocephalus
High blood pressure
Stroke

Headache
Blurred vision
Weakness, vomiting

LP, MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
Myasthenia gravis 
Symptoms/signs 
Investigations 
Management 
Complications
A

Antibodies to the POST-SYNAPTIC
ACh receptor at the neuromuscular junction in skeletal muscle

muscle weakness that worsens with continued activity and improves on rest.

Ptosis, diplopia
Bulbar symptoms - dysphagia, dysarthria 
Proximal limb weakness 
Facial paresis 
Dyspnea - resp involvement 

Serum AchR antibody analysis = 1st line

Acetylcholinesterase inhibitor = pyridostigmine

70% patients have thymic hyperplasia
10% have a thymoma
No ocular involvement if anti Musk antibodies present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Idiopathic intracranial hypertension/ pseudomotor cerebri

Symptoms/signs
Investigations
Management

A

mainly in overweight women of childbearing years

  • Visual field loss, decreased visual acuity, transient visual obscurations, retrobulbar pain, photophobia, diplopia
  • Ocular motility defects - cranial nerve 6 paresis
  • Optic disc swelling/papilloedema
  • Headaches
  • Tinnitus

eliminating causal factors, such as drugs - vitamin A, danazol, tetracyclines
Weight reduction
acetazolamide when indicated
Refractive cases = CSF shunt
Optic nerve sheath fenestration for visual loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cauda equina syndrome
Symptoms
Management

A

Compression of spinal roots L2 and below often due to intervertebral disc herniation or tumour

Loss of bladder and anal sphincter control - finding it hard to start peeing/cant pee, cant control when you poo
Saddle anesthesia - numbness around genitals or anus
Weakness or numbness in both legs that is severe/getting worse
Bilateral Sciatica

Surgery

  • Cauda equina compression causes flaccid paralysis with loss of reflexes. Cord compression usually causes spastic paralysis with brisk reflexes. Both cause sensory and power loss.*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is syringomelia?

Symptoms?

A

Development of fluid filled cyst (syrinx) within your spinal cord.
Bilateral loss of sensitvity to pain and temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is brown sequard syndrome?

A

Hemisection of the spinal cord
Weakness of paralysis on one side of the body
Loss of sensation on the other side - read up more on condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

WERNICKE’S ENCEPHALOPATHY
Symptoms/signs
Management

A

Classic triad = confusion, ophthalmoplegia, ataxia

Causes by b1 deficiency. Therefore other signs may be seen e.g peripheral neuropathy (dry beri beri) high output cardiac failure (wet beri beri) and koraskoff syndrome

Oculomotor findings - gaze palsies, sixth nerve palsies, and impaired vestibulo-ocular reflexes

Acute = Thiamine + magnesium + multivitamins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bells Palsy
Symptoms/signs
Management

A

Unilateral facial palsy
Abscence of constitutional symptoms
Deviation of mout to normal side

Upper motor neurone lesion like stroke is forehead sparing! Bell’s palsy is not

  • dry eye, hyperacusis and dysgeusia can also occur!!

High-dose corticosteroids/prednisolone!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Migraine

Symptoms + managament

A

nausea/vomiting
Photophobia, phonophobia
Unilateral, pulsatile, aura

Acute = NSAIDs, Triptans if severe
anti-CGRP(e.g erenumab) in disabling cases

Prophylaxis = topiramate, propranolol, amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Parkinsons disease
Symptoms
Management

A

Bradykinesia, resting tremor
Masked facies, micrographia
MPTP in illegal drugs = RF

Levodopa = FIRST line control of motor symptoms

MAO-B inhibitor (rasagiline, selegiline), dopamine agonists(pramipexole, ropinirole), amantadine to increase dopamine availability, carbidopa/levodopa, amantadine,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tension headache

Management

A

Acute = analgesia. Chronic = TCAs (e.g. amitriptyline, doxepin), CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Subarachnoid hemorrhage
Symptoms/signs
Investigations
Management

A

Depressed levels of consciousness

Neck stiffness, muscle aches and other signs of meningismus

Photophobia, nausea, vomiting

Rfs: age, HTN, alcohol, smoking, connective tissue disease, cocaine use, family history, ADPKD

Urgent non-contrast CT - hyperdense areas in the subarachnoid space/basal cisterns
If CT is negative with high suspicion = LP = bloody CSF (xanthochromia

Nimodipine + analgesia
Consider endovascular coiling/surgical clipping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Subdural hemorrhage
Symptoms
Investigations
Management

A

RFS: age>65, trauma, anticoagulant use/coagulopathy,
Headache, nausea/vomiting, confusion

Non contrast CT - crescent shaped hemorrhage. Hypodense on CT if chronic

Acute hematoma of small size = monitoring + prophylactic antiepileptics
Acute of large size = surgery + anti-epileptics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Extradural hemorrhage
Symptoms/signs
Investigation
Management

A

Transient loss of consciousness followed by recovery period then rapid deterioration
Scalp hematoma

Non-contrast CT - hyper dense blood collection that doesn’t cross suture lines

Management - craniotomy

Caused by rupture of middle meningeal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Axillary nerve lesion results in?

A

Flattened deltoid
Loss of arm abduction at shoulder
(Loss of sensatoon over deltoid and lateral arm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Musculocutaneous nerve lesion results in?

A

Weakness of forearm flexion

Loss of sensation over lateral forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Radial nerve lesion results in?

A
Wrist drop(loss of extension) 
(Loss of sensation over posterior arm, forearm and dorsal hand)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Median nerve lesion results in?

A

Loss of wrist flexion, flexion of lateral 3.5 fingers(POPES blessing when you try and make a fist), thumb opposition(APES hand), lateral lumbricals

Loss of sensation thenar eminence and lateral 3.5 digits

(M) edian nerve affects thu(M)b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ulnar nerve lesion results in?

A

Ulnar claw on digit extension

Loss of sensation medial 1.5 fingers & hypothenar eminence

Loss of wrist flexion, flexion of medial fingers, abduction and adduction/interossei, medial 2 lumbricals

u(L)nar (L)ittle finger

23
Q

Erbs palsy affects which muscles?

How does it present?

A
  • deltoid, infraspinatus, biceps brachii

- arm hangs by side, medially rotated, pronated

24
Q

Klumpke palsy

Presentation?

A

Total claw hand
Infants - upward force on arm during delivery
Adults - grabbing a tree branch to break a fall

25
Thoracic outlet syndrome presentation
Vascular compromise to arm- pain, pallor, edema, ischemia Due to extra cervical rib or pancoast tumour
26
Winged scapula results from a lesion to?
Long thoracic nerve - serrattus anterior affected
27
Clawing occurs with _ lesions of median and ulnar nerves
Distal
28
Iliohypogastric nerve lesion Presentation? Cause?
Burning/tingling radiating to inguinal and suprapubic region Abdominal surgery
29
Genitofemoral nerve lesion Presentation? Cause?
Decrease in upper medial thigh and anterior thigh sensation Absent cremasteric reflex Laparoscopic surgery
30
Lateral femoral cutaneous nerve lesion Presentation Cause
Decrease in thigh sensation anterior and Lateral Tight clothing, obesity, pregnancy, pelvic procedures
31
Obturator neve lesion Presentation Cause
Decrease in medial thigh sensation and adduction | Pelvic surgery
32
Femoral nerve lesion presentation
Decreased leg extension | Decreased sensarion to anterior thigh, medial leg
33
Common peroneal nerve lesion presentation?
Foot drop
34
Tibial nerve lesion Presentation Cause
Loss of sensation on sole Foot everted at rest Cant stand on tip toes Knew trauma, tarsal tunnel syndrome
35
Superior gluteal nerve lesion presentation
Trendelenburgs sign injury during IM injection
36
Inferior gluteal nerve lesion presentation | Cause
Difficulty climbing stairs, rising from seated position, loss of hip extension Posterior hip dislocation
37
Pudendal nerve lesion presentation | Cause
Decrease in sensation in perieum Fecal/urinary incontinence Stretch injury during childbirth Prolonged cycling Horseback riding
38
L4 radiculopathy results in?
weakness of knee extension, decrease in patellar reflex
39
L5 radiculopathy results in?
weakness of dorsiflexion, difficulty in heel walking, pain down lateral leg
40
S1 radiculopathy results in?
weakness of plantar flexion, difficulty in toe walking, decreased achilles reflex, pain down back of leg
41
Alzheimers investigations | Management
CT/MRI - may show atrophy especially in temporal and parietal lobes, enlarged ventricles, senile plaques, neurofibrillary tangles Mild = cholinesterase inhibitors e.g. donepezil, galantamine, and rivastigmine 2nd line/ severe = memantine (NMDA receptor antagonist)
42
Vascular dementia Symptoms Investigations Management
Focal neurological signs - UMN signs Symptom onset that was Abrupt, stepwise or related to stroke Signs of frontal cognitive syndrome CT/MRI - white matter hypodensities, evidence of old infarcts Antiplatelets, lifestyle changes, control of other comorbidities e.g. hypertension with medication
43
Fronto-temporal dementia Symptoms Investigations Management
Disinhibition and significant changes in behavior and personality early in the disease Loss of language fluency and comprehension - primary progressive subtype - progresses to mutism or agnosia Memory impairment, disorientation, apraxias - later on CT/MRI - Atrophy of frontal AND temporal lobes symptomatic treatment e.g. agitation with benzodiazepines
44
Lewy Body Dementia Symptoms Investigations Management
Physical: parkinsonism symptoms: bradykinesia, rigidity, tremor Cognitive: attention, memory, etc Psychiatric symptoms e.g. hallucinations, delusions REM sleep disturbances Rule out other types of dementia with CT/MRI Differentials - PSP/Steele Richardson(would have limited upgaze), Parkinson’s Symptomatic management
45
Normal pressure hydrocephalus Symptoms Investigations Management
Triad of dementia, gait apraxia(magnetic with feet glued to the floor) and urinary incontinence. Gait apraxia does not respond to levodopa. CT/MRI shows ventricular enlargement out of proportion to sulcal atrophy LP - normal CSF pressures LP or continuous lumbar CSF drainage for several days may cause improvement if this fails = surgical ventriculo-peritoneal shunting
46
CREUTZFELDT-JAKOB DISEASE Symptoms Investigations Management
Subacute dementia, ataxia and or startle-induced myoclonic jerks Psychiatric symptoms - depression may occur Visual changes may occur Parkinsonism symptoms my occur EEG may show periodic sharp wave complexes
47
Diabetic neuropathy management
Without pain = glycemic control and supportive measures With pain = Pregabalin or gabapentin and or duloxetine + glycemic control
48
Siezure investigations?
1st line = EEG HOWEVER If a patient has a seizure and does not recover to baseline/fluctuating consciousness or has focal neurological deficits, then a CT BRAIN should be performed to rule out structural lesions/ pathology!!!
49
Essential tremor Symptoms Investigations Management
``` a progressive tremor of the upper extremities. Usually absent at rest and present during posture and intentional movements No other associated symptoms Gradual onset over years Symmetrical Problems with fine motor tasks ``` Clinical diagnosis- rule out aneamia and hypothyroidism Propranolol or primidone = 1st line. Deep brain stimulation = 2nd
50
Trigeminal neuralgia Symptoms Management
sharp pain running from the mouth to the jaw or less commonly as pain from the upper lip to the orbit. Symptoms in an exclusively ophthalmia (V1) distribution typically referred to as headache. Management - in order of escalation = anticonvulsants -> baclofen -> microvascular decompression/ surgical ablation
51
1st line treatment for delirium?
haloperidol 0.5mg PO lorazepam 0.5mg PO if patient has parkinsons or lewy body dementia avoid IV treatment
52
What are the different types of epilepsy? Epilepsy treatment Side effects of epilepsy drugs? How do you treat status epilepticus?
1. Generalised: this includes tonic-clonic, myoclonic, tonic, atonic, and absence. 2. partial/focal seizures (in simple focal siezures patient is conscious but may experience twitching in muscle group, changes in sensation such as smell, hallucinations. in complex focal seizures, impaired consciousness occurs. - >Generalised seizures 1st line = sodium valproate. give lamotrigine to women of childbearing age!! - >Focal seizures 1st line = carbamazepine/ lamotrigine(always give in young women) Side effect of lamotrigine = SJS Side effects of carbamezapine = neutropenia and osteoporosis Treat in community with buccal midazolam or rectal diazepam. IV lorazepam in hospital
53
Guillain barré cause? Symptoms? Investigations?
usually triggered by infections like URTI, Gastroenteritis(usually due to campylobacter jejuni). 2-3 weeks after infection it causes peripheral neuropathy (ascending paresthesias and bilateral limb weakness, HYPOREFLEXIA, back or leg pain and respiratory distress may occur). Do nerve conduction studies