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Phase 2a Knowledge > Neurology > Flashcards

Neurology Flashcards

(124 cards)

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1
Q

Stroke definition

A

Syndrome of rapid onset of cerebral deficit lasting >24 hours or leading to death

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2
Q

Aetiology ischaemic stroke

A

Thrombus, large artery stenosis, small vessel disease, atherosclerosis

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3
Q

Ischaemic stroke RF

A 
HTN
Smoking 
Alcohol 
Obesity
Cholesterol 
DM
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4
Q

Ischaemic stroke investigations

A

NCCT = will demonstrate haemorrhage immediately
MRI
Brachial BP

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5
Q

Ischaemic stroke acute treatment

A
  • Thrombolysis is within 4.5 hrs onset

- IV alteplase

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6
Q

Ischaemic stroke long term management

A
  • Anti HTN therapy
  • Antiplatelet therapy = aspirin, clopidogrel
  • Statin
  • Surgery
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7
Q

Haemorrhagic stroke aetiology

A 
HTN
Aneurysm rupture 
AV malformations 
Anticoagulants 
Trauma
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8
Q

Haemorrhagic stroke Ix

A

Urgent head CT

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9
Q

Management haemorrhagic stroke

A
  • Stop anticoagulant immediately
  • IV prothrombin complex and vitamin K
  • IV mannitol to reduce ICP
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10
Q

SAH aetiology and RF

A

Berry aneurysm rupture
Smoking
HTN
Alcohol misuse

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11
Q

SAH S+S

A 
Thunderclap headache 
Vomiting 
Seizures
Coma/drowsiness
Photophobia 
Neck stiffness
Kernig's sign Brudzinski's sign
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12
Q

SAH Ix

A

CT = star shaped lesion

LP if doubt after CT

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13
Q

SAH Mx

A

Nimodipine = Ca antagonist = reduces vasospasm and morbidity from cerebral ischaemia
Dexamethasone
Endovascular coiling

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14
Q

Extradural haemorrhage RF

A

Trauma = classic after head injury with brief duration of unconsciousness

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15
Q

Extradural haemorrhage pathophysiology

A

Fractured temporal or parietal bone causing MMA laceration

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16
Q

Extradural haemorrhage S+S

A

Lucid pattern then rapid deterioration
Increasingly severe headache
Vomiting, seizures
Ipsilateral pupil dilation

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17
Q

Extradural Ix

A
  • CT = lens/lemon shaped

Skull XR

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18
Q

Extradural Mx

A

Neurosurgery = clot evacuation or ligation
AP stopped
IV mannitol

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19
Q

Subdural RF

A

Falls
Anticoagulation
Age
Large latent interval

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20
Q

Subdural S+S

A 
Fluctuating consciousness 
Headache 
Unsteadiness 
Confusion 
Seizures
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21
Q

Subdural Ix

A

CT = crescent/banana

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22
Q

Subdural Mx

A

Irrigation/evacuation
AC/AP cessation
IV mannitol
IV prothrombin and Vit K

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23
Q

TIA definition

A

Ischaemic neurological event with symptoms lasting <24 hrs

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24
Q

TIA RF/aet

A 
Atherothromboembolism 
AF
Valve disease 
Stenosis 
HTN
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25
TIA S+S
``` Sudden loss of function Carotid 90% - Amourosis fugax - Aphasia - Hemiparesis Vertebrobasilar - Diplopia, vertigo, vomiting - CHoking - Ataxia ```
26
Ix TIA
CT or diffuse weighted MRI
27
Mx TIA
Immediate = loading dose aspirin | Antiplatelet therapy
28
Epilepsy clinical definition
- At least 2 unprovoked seizures >24 hrs apart - 1 unprovoked seizure and probability of further seizures - Diagnosis of an epilepsy syndrome
29
Epilepsy medical definition
Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of brain, manifesting in seizures
30
Definition of priamry generalised seizure
Simultaneous electrical discharge throughout the whole cortex, with no features tht suggest localisation to only 1 hemisphere/lobe - Bilateral and symmetrical motor manifestations
31
Types of primary generalised seizure
``` Tonic Clonic Tonic clonic Myoclonic Atonic Absence ```
32
Tonic seizure
High tone - stiff rigid limbs
33
Clonic seizure
Rhythmic muscle jerking
34
Tonic clonic
Combination of tonic stiffness and clonic jerking
35
Myoclonic seizure
Isolated jerking of a limb/face/trunk
36
Atonic seizure
Loss of muscle tone = floppy
37
Absence seizure
- Common in childhood | - Pale and stare blankly
38
Definition of partial (focal) seizure
Focal can be referable to a single lobe, as electrical discharge limited to one lobe
39
Simple partial (focal) seizure
- No affect to consciousness or memory - No post ictal sx - Focal motor, sensory or autonomic sx depending on lobe
40
Complex partial (focal) seizure
- Memory affected before, during or immediately after | - Most common temporal
41
Temporal lobe Sx
- Aura - Anxiety, out of body - Automatisms = lip smacking - Temporal = memory, understanding, speech
42
Frontal lobe Sx
- Motor features - Jacksonian march = seizures march up and down motor homunculus - Post ictal todds palsy - Frontal = motor, thought processing
43
Focal Seizure Mx
Carbamazepine or Lamotrigine
44
Generalised tonic clonic Mx
SV or lamotrigine
45
Absence Mx
SV or ethosuximide
46
Myoclonic Mx
SV or levetiracetam
47
Tonic Mx
SV or lamotrigine
48
Status epilepticus
A seizure that lasts more than 5 minutes, or more than 1 seizure in 5 minute period
49
Status epilepticus Mx
- Buccal midazolam in community or rectal diazepam | - IV lorazepam
50
Parkinsons definition
Progressive neurodegenerative movement disorder due to decreased DA in SN, causing triad or tremor, rigidity and bradykinesia
51
PD pathophysiology
Decreased dopamine levels --> mitochondrial dysfunction and oxidative stress on SN --> degeneration of dopaminergic neurones of SN --> decreased DA synthesis in striatum --> decreased thalamus activity --> decreased movement
52
PD Sx
- Bradykinesia plus one of tremor, postural instability - Brady = buttons, writing, slowness of involuntary movement - Hypokinesia = poverty of movement - Tremor = unilateral, rest
53
PD Mx
- Levodopa with dopa decarboxylase inhibitor like co-beneldopa - MAOB inhibitors
54
Sx of migraine without aura
``` At least 2 of: - Unilateral pain (4-72hrs) - Throbbing - Moderate>severe intensity - Motion sensitivity Plus at least 1 of - N+V - Photophobia/phonophobia ```
55
Sx of migraine with aura
- One or more typically fully reversible aura Sx At least 3 of - at least 1 aura Sx spreads gradually over 5 mins - 2 or more aura sx in succession - 5-60 minute duration of aura sx At least 2 aura sx unilateral - At least 1 aura sx positive - aura accompanies or followed in 1 hr by headache
56
Migraine Mx
- NSAIDS or analgesics - Triptans - Frequent = BB
57
Sx cluster headache
- Unilateral orbital, retro-orbital, temporal or mandibular headache with rapid onset - Lacrimation - Swollen eyelid - Facial flushing - Rhinorrhoea - Miosis - Ptosis
58
Mx cluster headache
- Acute = oxygen and sumatriptan - Prevention = CCB, prednisolone - Smoking cessation
59
MS definition
Inflammatory demyelinating disease characterised by presence of episodic neurological dysfunction in at least 2 areas of CNS disseminated in time and space
60
MS Pathophysiology
- Inflammatory plaques demyelination in CNS - Demyelination heals poorly --> axonal loss - Demyelination disrupts axonal support --> destabilisation of axonal membrane potentials
61
MS S+S
- Optic neuritis - Spasticity - Lhermittes sign - Bladder dysfunction - UMN signs - Uhthoff = heat worse
62
MS IX
- MRI = sensitive but not specific for plaque detection
63
MS Mx
- Disease modifying drugs = dimethyl fumarate in mild RR - Monoclonal abs - Methylprednisolone for acute relapses Relapse = oral pred, IV hydrocortisone
64
UMN signs
- Hypertonia - Hyperreflexia - Spasticity - +ve babinski - Clonus
65
LMN signs
- Hypotonia - Hyporeflexia - Flaccid weakness - Fasciculations - Muscle atrophy
66
Anterior circulation stroke Sx
- Aphasia/dysphasia - Hemiparesis - Sensory loss - Amaurosis fugax
67
Posterior circulation sx
- Diplopia, vertigo, vomiting - Swallowing difficulty - Hemianopic visual loss - Sensory loss - Transient global amnesia
68
MCA stroke Sx
Contralateral - Hemiparesis - Hemiplegia - Facial weakness - Hemianopia - Aphasia
69
ACA stroke Sx
Contralateral weak leg +/- shoulder
70
Anterior circulation stroke sx
- Aphasia/dysphasia - Hemiparesis - Amaurosis fugax - Sensory loss - Hemianopia vision loss
71
Posterior circulation stroke Sx
- Diplopia, vertigo, vomiting - Swallowing difficulty - Hemianopia - Sensory loss - Transient global amnesia - Tetraparesis
72
MCA stroke Sx
- Weak arm and face, contralateral - Hemianopia - Aphasia - Hemiplegia - Visuospatial - Hemiparesis
73
Genetics of Huntington's
- Autosomal dominant neurodegenerative disorder - Expanded CAG repeat - 100% penetrance
74
Pathophysiology of HD
- CAG repeat generated elongated polyglutamine tail on huntingtin protein - Extended glutamine translation in H gene - Progressive cerebral atrophy - Progressive degeneration of GABAnergic and cholinergic neurones of corpus striatum - Therefore decreased GABA and Ach synthesis in striatum - Decreased inhibition of DA release, so increased DA release and increased thalamus activity - THerefore increased movement
75
Chorea definition
- Excessive irregular movements flitting from 1 part of body to another
76
HD clinical S+S
- Change in personality and psych issues - Restlessness - Chorea - Dystonia - Incoordination - Dysarthria
77
HD Ix
- CAG genetic testing - Head MRI = caudate nucleus atrophy - MRI/CT = loss of striatal volume
78
HD Mx
- Drugs don't affect progression - Benzos for chorea - Treat psych issues
79
MG definition
Autoimmune disease mediated by antibodies to ACH receptors
80
MG Pathophysiology
- Autoantibodies to ACH receptors form - ACHR lost on postsynaptic membrane of NMJ - Result in decrease in receptors --> endplate potential decrease in amplitude and failure to trigger muscle action potential
81
MG Presenting features
- Ocular - Limb weakness - Generalised muscle weakness - Dysphagia, dysarthria and dysphonia - Jaw and neck weakness
82
MG S+S
- Increasing muscular fatigue, top down - Proximal and asymmetrical - Diplopia - Snarl - Deterioration of voice count to 50 - Reflexes normal
83
MG Ix
- Tensilon test - Anti ACHR test - CT thymus - thymoma - Nerve conduction
84
MG Mx
- Anticholinesterase = pyridostigmine - Prednisolone CRISIS - Plasmanephrines or IV Ig
85
Amyotrophic lateral sclerosis
- Form of MND - UMN signs and LMN wasting - Asymmetric onset - Tongue fasciculations - Most common - Progressive focal muscle weakness and wasting
86
Progressive bulbar pasly
- Form of MND - 1st affected muscles = talking, swallowing, chewing - Present with palsy of tongue, difficulty swallowing and pasly of facial muscles
87
MND Mx
- Antiglutamatergic drugs = riluzole
88
Bacterial meningitis - Neonates - <2yo - up to 50 - Over 50
- Neonates = Group B Strep = S agalactiae - <2 = S. Pneumoniae - up to 50 = N Men and S. Pneumoniae - >50 = S pneumoniae
89
Early meningitis S+S
- Headache - Fever - Leg pains - Cold hands and feet - Abnormal skin colour
90
Meningitis S+S
``` Fever Headache Neck stiffness Photophobia N+V Kernig's sign Can progress to confusion, delirium, coma Petechial non blanching rash ```
91
Meningitis Ix
- Full bloods - Cultures - Lumbar puncture after CT
92
CSF if bacterial
- Cloudy purulent - Elevated cell count - Increased granulocytes - High lactate and protein - Decreased glucose - Positive cultures
93
CSF if viral
- Clear fluid - Variable cell count with Increased lymphocytes - Normal or low lactate - Normal protein and glucose - No organisms
94
Meningitis Mx
- Primary care, if NB rash = 1.2mg benzylpenicillin IM - MRI head, LP 1st line Abx before LP or after CT = ceftriaxone or cefotaxime <55, amoxicillin >60
95
Mx meningitis with typical rash
- IV benzylpenicillin or cefotaxime
96
Mx meningitis without typical rash
- Iv cefotaxime plus IV vancomycin
97
Encephalitis S+S
- Triad of fever, headache and altered mental status
98
Encephalitis Ix
- LP Cultures FBC (leucocytosis) Brain high contrast CT
99
Encephalitis Mx
- Empirical IV acyclovir ASAP | - Benzylpenicillin
100
GBS definition
- Acute inflammatory demyelinating neuropathy
101
GBS causes
- Campylobacter | - EBV, CMV
102
GBS pathophysiology
- Antibodies to preceding pathogen are autoantibodies for Schwann cells - Autoimmune demyelination of Schwann cells
103
GBS S+S
- Toes to nose weakness = symmetrical ascending - Weakness, paraesthesia and hyporeflexia - Autonomic nervous system involvement - Back and leg pain - Proximal muscles more affected
104
GBS Ix
- Nerve conduction studies - L4 LP = raised protein, Normal WCC - Spirometry
105
GBS Mx
- Vital capacity and ECG monitored - Ventilation - Iv Ig for 5 days - Corticosteroids make worse
106
Causes of cauda equina
- Central lumbrosacral disc protrusion - Vertebral body metastasis - Trauma - Spina bifida
107
Cauda equina S+S
- Bilateral leg pain or sensory disturbance - Perianal, perineal or sensory disturbance - Urinary +/- faecal incontinence - Low back pain - Sexual dysfunction - Bilateral motor and reflex deficits - Decreased sphincter tone
108
Cauda equina Ix
- Spine MRI - Femoral stretch - Knee flexion - Straight leg raise - Plantar flexion
109
Cauda equina Mx
- Surgery! decompression
110
Brain tumours metastasise from?
- Bronchus - Breast - Stomach - Prostate - Thyroid - Kidney
111
Clinical effects of tumours
- Headache - Progressive neurological deficit - Cognitive and behavioural changes - Seizures - Raised ICP
112
Red flag tumour
- Headache with features of raised IC pressure - Headache with focal neurology - New onset focal seizure - Rapidly progressive focal neurology - Past Hx Cancer
113
NEAD features
- Gradual onset - Prolonged duration - Abrupt termination - Resistance to eye opening - Fluctuating motor activity - Hx childhood abuse - Triggered by stress
114
GCA pathophysiology
- Immune mediated vasculitis | - Granulomatous inflammation in wall of medium and large arteries
115
S+S GCA
- Headache - Temporal artery and scalp tenderness - Jaw claudication - Sudden blindness 1 eye - Dyspnoea, morning stiffness, weak pulses Need 3 of - >50 - TA abnormality - Abnormal TA biopsy - Elevated ESR >50mm/hr - New headache
116
GCA Mx
- Prednisolone immediately | - Tocilizumab
117
Shingles (HZ) definition
- Viral infection of an individual nerve and the dermatome | - Reactivation of varicella zoster
118
HZ pathophysiology
- VZ remains latent in sensory dorsal root ganglia - Reactivates due to decline in cell mediated immunity - Travels down sensory afferent neurones to infect dermatomes
119
HZ S+S
- Localised dermatome pain - Vesicular rash in dermatomal distribution - Fluid filled blisters - Itching - systemic Sx
120
Definition of dementia
Acquired loss of higher mental function, affecting 2 or more cognitive domains - Episodic memory - Language function - Frontal executive function - Visuospatial function - Apraxia
121
Alzheimer's pathology
- Generalised cortical atrophy - Deposits of amyloid A4 protein in cortex with neuritic plaques - Neurofibrillary tangles contain tau
122
Normal Pressure hydrocephalus triad
- Gait instability - Urinary incontinence - Cognitive impairment
123
Peripheral Neuropathy sensory symptoms
- Loss of touch, proprioception, temperature/pain, sensation, paraesthesia - Numbness, tingling,, burning - +ve Romberg
124
Peripheral neuropathy motor symptoms
- Distal weakness - Proximal weakness - Muscle wasting - Fasciculations - Absent tendon reflexes

Phase 2a Knowledge (3 decks)

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