Neurology Flashcards
(388 cards)
1
Q
What is a transient ischemic attack?
A
Ischemia, without infarction which resolves within 24 hours
2
Q
Which artery supplies the anterior circulation and which the posterior of the brain?
A
- Anterior = internal carotid
- Posterior = vertebral arteries
3
Q
Which circulation do the majority (90%) of TIAs affect?
A
Anterior circulation (embolism travels through internal carotid)
4
Q
What are some risk factors for stroke (8)?
A
- Old
- Smoking
- T2DM
- Hypertension
- Obesity
- Hypercholestrolaemia
- AF
- VSD + other heart defects
5
Q
What deficit is seen in an occluded anterior cerebral artery?
A
Weak/ numb contralateral leg
6
Q
What deficits are seen in an occluded middle cerebral artery (2)?
A
- Weakness/ numbness contralateral body/ face
- Dysphasia (can’t speak properly -temporal)
7
Q
What deficits are seen in an occluded posterior cerebral artery (1)?
A
Contralateral visual changes
8
Q
What part of the vision is often spared and why during a PCA occlusion?
A
Macular sparring - macular is represented at the occipital pole and can receive collateral blood flow from middle cerebral artery
9
Q
What deficits are seen in an occluded vertebral artery (2)?
A
- Cranial nerve lesions (3-12)
- Limb ataxia (clumsiness)
10
Q
What is amaurosis fugax?
A
Transient vision loss in one or both eyes
11
Q
When would amaurosis fugax occur (3)?
A
- Vascular origin (ophthalmic artery blocked - comes off internal carotid)
- Occular origin
- Neurological origin (nerve lesion)
12
Q
How is a TIA investigated?
A
- Clinically by symptoms, usually quite obvious, resolves within 10-15 minutes (can’t differentiate from stroke till after recovery)
- CT head - rule out haemorrhagic stroke
13
Q
How is TIA treated?
A
- Acutely = aspirin 300mg
- Long term prophylaxis = clopidogrel + atorvastatin
14
Q
What is a stroke?
A
Focal neurological deficit lasting 24+ hours with infarction
15
Q
What percentage of strokes are ischemic?
A
85%
16
Q
Which “brain bleeds” are considered strokes?
A
- Intracererbal
- Subarachnoid
(Sub/epi dural not considered strokes)
17
Q
What are some risk factors for an ischemic stroke (9)?
A
- Old
- Smoking
- T2DM
- Hypertension
- Obesity
- Hypercholestrolaemia
- AF
- VSD + other heart defects
- TIA
18
Q
What are the symptoms of a stroke?
A
Same as TIA
19
Q
What is a lacunar stroke?
A
Block in arteries that supply deep brain structures e.g. thalamus, pons
20
Q
What are the symptoms of a lacunar stroke (1)?
A
Weakness/ lack of coordination on one side of body
21
Q
How is an ischemic stroke diagnosed?
A
- CT head
22
Q
How is an ischemic stroke treated?
A
- If within 4.5 hours –> thrombolytic
- Aspirin for 2 weeks
- Prophylactic clopidogrel + atorvastatin
23
Q
What thrombolytic is given for ischmemic strokes?
A
Alteplase
24
Q
How does alteplase break down clots?
A
Tissue plasminogen activator (activates plasminogen to plasmin)
25
What are some risk factors for intracerebral bleeds (5)?
* Trauma
* Hypertension
* Aneurisms
* Tumours
* Anticoagulants (e.g. warfarin)
26
How is a haemorrhagic stroke investigated generally (2)?
* CT head - midline shift, high ICP
* Lumbar puncture - if CT negative
27
What are some signs/ symptoms of intracerebral bleed (4)?
* Seizures
* Weakness
* Vomiting
* Reduced consciousness
28
What scale accesses conciseness?
Glasgow coma scale (3-15)
29
How is intracererbal haemorrhage treated?
Neuro referal - usually surgery
30
What are the layers of the skull and brain?
Skin --> periosteum --> cranium --> dura --> arachnoid --> pia
31
Where is CSF located in the meninges?
Sub-arachnoid space
32
Which vessels lie in the subarachnoid space?
Circle of willis
33
What is a berry aneurysm?
Round out pouching of an artery at the base of the brain (in the circle of willis)
34
What is the most common site for a berry aneurysm?
Anterior communicating artery
35
What are some risk factors for subarachnoid haemorrhages (7)?
* Marfans/ EDS
* Hypertension
* PKD
* Trauma
* Older
* Family history
* Alcohol/ cocaine
36
What are the signs/ symptoms of subarachnoid headache (5)?
* Thunderclap headache (sudden occipital)
* Meningism
* N + V
* Reduced GCS
* CN 3/6 palsies
37
What sometimes occurs before a subarachnoid haemorrhage?
Sentinel headache - days/ weeks before rupture
38
How is subarachnoid haemorrhage investigated (3)?
* CT head - shows bleed
* Lumbar puncture
* CT angiogram - localise point of bleeding
39
What shape is a subarachnoid haemorrhage?
Spider web in centre of brain
40
What is performed if the CT head is negative for bleeding in a SAH?
Lumbar puncture
41
What would a lumbar puncture show if there was a subarachnoid haemorrhage (2)?
* Xanthochromia (bilirubin in CSF due to breakdown of RBCs)
* Raised RBC count
42
How is a subarachnoid haemorrhage treated?
Neurosurgey
43
What is a common surgical treatment for subarachnoid haemorrhage?
Endovascular coiling (catheter through arterial system)
44
What medication is used to prevent vasospasm in subarachnoid haemorrhage?
Nimodipine (CCB)
45
The rupture of which vessel is the most common cause of subdural haemorrhage?
Bridging veins
46
What are 2 risk factors/ causes of subdural haemorrhage?
* Trauma
* Atrophy of brain - e.g. in dementia (weakens vessels and widens subdural space)
47
What are the signs/ symptoms of subdural haemorrhage (4)?
* Headache that keeps getting worse
* N + V
* Lower GCS
* High ICP symptoms
48
Is a subdural haemorrhage fast or slow onset and why?
Slower because bridging vein is lower pressure than arteries
49
What are some symptoms/ signs of high ICP (3)?
* Cushings triad
* Papilloedema
* CN3/6 palsy
50
What are the three parts of Cushing's triad?
* Bradycardia
* Increased pulse pressure
* Irregular breathing
51
What shape is a subdural haemorrhage on a CT?
Banana shape
52
How can you tell on CT if a subdural haemorrhage is acute, subacute or chronic?
* Acute = hyperdense
* Subacute = isodense (same colour as brain tissue)
* Chronic = hypodense
53
How is subdural haemorrhage treated?
Surgery (craniotomy/ burr hole) to allow swelling
54
What medication is used to treat high ICP?
Mannitol
55
Rupture of which vessel often causes extradural haemorrhage?
Middle meningeal artery
56
What age does extradural haemorrhage typically affect?
Younger adults (20-30)
*dura more firmly adhered in older people*
57
Why does risk of extradural haemorrhage decrease as you age?
Dura more firmly adhered to the skull
58
What is the cause of most extradural haemorrhage?
Trauma
59
What are some signs/ symptoms of extradural haemorrhage?
* Headache that keeps getting worse
* N + V
* Lower GCS
* High ICP symptoms
60
What is a typical presentation after trauma for people who develop extradural haemorrhage?
They feel fine --> then ICP builds up and they feel acutely unwell
61
How does a haematoma result in increased ICP?
Clot haemolysed --> becomes osmotically active --> water moves into brain + swells
62
How can high ICP lead to respiratory arrest?
Cerebellar tonsil herniation --> compression of respiratory centre in PONS
63
What shape does an extradural haemorrhage form on a CT?
Lemon shaped (biconvex)
64
How is an extradural haemorrhage treated (2)?
* Surgery
* Mannitol
65
Give 3 types of primary headaches?
* Tension
* Migraine
* Cluster
66
Give 6 causes of secondary headaches?
* Giant cell arteritis
* Infection
* Sub-arachnoid haemorrhage
* Trauma
* Cerebrovascular diseases (e.g. strokes, aneurysms)
* ENT problems
67
What is the most common type of **recurrent** headache?
Migraine
68
Which gender is most commonly affected by migraines?
Females
69
What age range is most commonly affected by migraines?
< 40
70
What are the 3 stages in the development of a migraine?
Prodrome --> Aura --> Throbbing headache
71
What is prodrome in the development of a migraine?
Change in mood before attack
72
What is an aura in the development of a migraine?
Visual/ sensory changes minutes before an attack
73
What are some symptoms of migraines (5)?
* Unilateral moderate-severe throbbing pain
* Motion sickness
* N + V
* Photophobia/ phonophobia
* Facial weakness
74
As well as presence of symptoms, what is also important to be done for a diagnosis of migraine?
Negative neurological examination
75
How are migraines treated acutely (2)?
* Triptan (serotonin receptor agonists)
* Other analgesics
76
How are migraines treated prophylactically (2)?
* Propanolol (topiramate in asthmatics)
* TCA e.g. amitriptyline = 2nd line
77
What is important to check in women of child bearing age with migraines?
Take them off oral contraceptive pill (increases risk of stroke)
78
Give some examples of triggers for migraines (5)?
* Over/under sleeping
* Caffeine
* Alcohol
* Dehydration
* Bright lights
79
What are some risk factors for cluster headaches (3)?
* Male
* Smoking
* Genetics/ family history
80
What sort of pain and where is it felt in a cluster headache?
Unilateral excruciating periorbital (around eye) pain
81
What are some other features of a cluster headache?
* Ptosis
* Red swollen watering eye
* Rinorrhoea (watery nose)
82
How frequently do cluster headaches attack and how long do they last, typically?
* 15 min - 3 hours
* 3-4 attacks a day then pain free period
83
How many cluster headache attacks are often required for diagnosis?
5 or more
84
How are cluster headaches treated?
* Acutely = triptan (serotonin receptor agonist)
* Prophylaxis = verapamil
85
What class of drug is verapamil?
CCB
86
What is the most common primary headache disorder?
Tension headache
87
What are 2 triggers for tension headaches?
* Stress
* Stagnant head/ neck position
88
What pain is felt in tension headaches?
**Bilateral, tight, band** like pain around **forehead**, **temples** and back of head/neck
89
Are other symptoms such as motion sickness and N+V present in those with tension headaches?
NOOOOOO
90
How are tension headaches treated?
Analgesics
91
What cause shooting/ stabbing pain in the face?
Trigeminal neuralgia
92
What are three risk factors for trigeminal neuralgia?
* Multiple sclerosis
* Older age
* Female
93
Where can trigeminal neuralgia affect?
Any combination of trigeminal nerve branches: ophthalmic (V1), mandibular (V3), maxillary (V2)
94
What medication is used to treat trigeminal neuralgia?
Carbamazepine (anticonvulsant)
95
What is another treatment for trigeminal neuralgia?
Surgery (decompression)
96
What type of disease is giant cell arteritis?
Large vessel vasculitis
97
What are some signs/ symptoms of giant cell arteritis (3)?
* Unilateral tender scalp/ temples
* Intermittent jaw claudication
* Amaurosis fugax
98
What features would be present in a biopsy positive for giant cell arteritis?
Granulomatous non-caseating inflammation of media + intima with skip lesions
99
What blood findings are common in those with GCA?
* Anaemia (normocytic, normochromic)
* High ESR/ CRP
100
How is GCA treated?
PREDNISOLONE
101
What is a seizure?
Transient episode of abnormal electrical activity in the brain?
102
What are 9 causes for seizures?
* **V**ascular
* **I**nfection
* **T**rauma
* **A**utoimmune - e.g. SLE
* **M**etabolic
* **I**diopathic
* **N**eoplasms
* **D**ementia/ drugs
* **E**clampsia (pre-eclampsia + seizures)
103
What specific type of seizure is classed as epilepsy?
Idiopathic seizure
104
What is required for a diagnosis of epilepsy to be made?
2 seizures < 24 hours apart (without a cause)
105
What are two risk factors for epilepsy?
* Family history
* Dementia
106
What are three ways an epileptic seizure can be differentiated from a non-epileptic seizure?
*In epileptic seizures...*
* Eyes are often open
* Synchronous movements
* Happen at night
107
What is thought may be the cause of epilepsy?
Imbalances between GABA (inhibitory) and glutamate (stimulatory) - increased glutamate compared to GABA
108
How long does an epileptic seizure typically last?
< 2 minutes
109
What are the 4 phases of epileptic seizures?
Prodrome --> Aura --> Ictal event --> Post-ictal period
110
How does an aura before an epileptic fit often present (2)?
* Deja vu
* Lip smacking (automatism)
111
How are epileptic seizures classified depending on the part of the brain affected?
* Generalised - bilateral + loss of consciousness
* Focal - features confined to one region
112
What are 5 types of generalised epileptic seizures?
* Tonic-clonic (grand mal)
* Absence (petit mal)
* Tonic
* Myoclonic
* Atonic
113
What are the features of a tonic-clonic seizure (3)?
* Tonic phase (1st) = rigidity, fall to floor
* Clonic phase (2nd) = jerking of limbs
+ incontinence, tongue bitten
114
What is the main feature of an absence seizure?
Moment of staring off into space (seconds to minutes)
115
What age do absence seizures most commonly affect?
Children
116
What feature is seen on an EEG in absence seizures?
3 Hz spike
117
What is the main feature of tonic seizures?
Rigid body
118
What is the main feature of myoclonic seizures?
Just jerking limbs
119
What is the main feature of atonic seizures?
Sudden floppy limbs + muscles
120
What are the two types of focal seizure?
* Simple focal
* Complex focal
121
What is the difference between simple and complex focal seizures?
Simple maintain conciseness, complex loose conciseness
122
What are the symptoms of a focal seizure in each hemisphere of the brain?
* Temporal = aura + dysphasia
* Frontal = repeated muscle twitching/ paralysis
* Parietal = parenthesis in limbs
* Occipital = vision changes
123
What are two neurological phenomena that occur with frontal lobe seizure?
* Jacksonian marching (repeated twitching)
* Todds palsy (paralysis)
124
What extra brain structure is usually involved in complex focal seizures when the patient loses consciousness?
Basal ganglia
125
How is epilepsy investigated?
* MRI (check for structural issues)
* Bloods (check for metabolic/ infection causes)
126
What is the first line drug for generalised seizures?
Sodium valproate
127
What is the first line drug for focal seizures?
Carbamazepine
128
Who must sodium valproate not be given to?
Pregnant women (teratogenic - interferes with folic acid)
129
What epileptic drug is used for those who are pregnant?
Lamotrigine
130
What is a complication of epilepsy?
Status epilepticus
131
What is status epileptics defined as?
* Seizures > 5 minutes
* > 3 seizures in one hour
132
How is status epileptics treated?
* Lorazepam (benzodiazepine)
* If not worked, then phenytoin
133
What is the second most common neurodegenerative condition after dementia?
Parkinsons disease
134
What causes Parkinson's disease?
Loss of **dopaminergic** neurones from the **substantial nigra pars compactica**
135
What are 3 risk factors for Parkinson's disease?
* Family history
* Males
* Older age
136
What is protective against Parkinson's disease?
SMOKING
137
Draw out the direct and indirect pathways in the basal ganglia
Direct: cortex (+) --> striatum (-) --> GPi and SNpr (-) --> thalamus (+) --> cortex
Indirect: cortex (+) --> striatum (-) --> GPe (-) --> STN (+) --> SNpr and GPi (-) --> thalamus (+) --> cortex
138
How does substantial nigra pars compactica affect the indirect/ direct pathways?
* Direct = stimulatory (via D1 neurones)
* Indirect = inhibitory (via D2 neurones)
139
What is the effect of the indirect and direct pathway on muscle movement?
* Direct = stimulator
* Indirect = inhibitory
140
Therefore a lack of dopaminergic neurones will increase or decrease muscle inhibition?
Increase muscle inhibition therefore more difficult to initiate movement
141
What are 4 typical features of parkinsons?
* Bradykinesia
* Unilateral resting tremor
* Rigidity
* Postural instability
142
What are some features of bradykinesia when walking (3)?
* Stooped posture
* Reduced arm swing
* Shuffling gait
143
Does Parkinson's typically affect both or one side?
One side (particularly at the beginning)
144
How is parkinsons diagnosed?
Clinically, by a specialist
145
How is parkinsons treated when moderate-severe?
L-DOPA (levodopa)
146
How is parkinsons treated in more mild disease?
* Da agonist
* Monoamine oxidase - B inhibitors
147
What condition is often confused with parkinsons?
Benign essential tremor
148
What is a significant difference between benign essential tremor and parkinsons (in terms of the tremor)?
Bilateral in benign essential tremor
149
Which dementia often causes Parkinson like symptoms?
Lewy body dementia
150
What are the 4 main types of dementia?
* Alzheimers (60%)
* Vascular
* Lewy body
* Frontotemporal
151
How does Alzheimers cause dementia?
Beta amyloid proteins accumulate as plaques and tau neurofibrillary triangles --> death of brain cells
152
What are two risk factors for Alzheimers?
* Downs syndrome (inevitable due to gene mutation)
* Family history
153
What are some symptoms of Alzheimer's (3)?
*Affects whole brain*
* Agnosia - can't recognise
* Apraxia - can't move
* Aphasia - cant speak
154
How is Alzheimers treated?
Cholinesterase inhibitors (e.g. galantamine)
155
What causes vascular dementia?
Lots of small (or big) infarcts of brain tissue
156
What is the pattern of deterioration in vascular dementia?
Stepwise - as more tissue damaged e.g. by TIA
157
What causes levy body dementia?
Lewy body accumulation in cortex
158
What is the main constituent of Lewy bodies?
Alpha synuclein
159
What are the symptoms of Lewy body dementia (2)?
* Cognitive decline
* Parkinsonism
160
The collection of what protein leads to fronto-temporal dementia?
Tau protein/ pick body
161
What sometimes causes frontotemporal dementia?
Autosomal dominant mutation in tau protein
162
What are the symptoms of frontotemporal dementia (2)?
* Frontal = thinking + memory affected
* Temporal = speech + language affected
163
What tool helps with dementia diagnoses?
Mini mental state exam (normal > 25)
164
What investigation is sometimes done I those with dementia?
MRI head
165
What other conditions can also cause dementia (4)?
* SLE
* Infection
* Neoplasm
* Hydrocephalus
*Many others*
166
What pattern is Huntington's chorea inherited?
Autosomal dominant
167
What gene is affected in Huntington's chorea?
HTT gene on chromosome 4
168
What is the mutation found in people with Huntingtons?
Trinucleotide repeat disorder of CAG
169
How many repeats of CAG are required for a person to develop huntingtons?
35 <
170
What changes in the development of huntingtons disease are seen from generation to generation?
Anticipation - symptoms present:
* Earlier
* More severely
171
How often is the genotype expressed in the phenotype for Huntington's chorea?
100% FULL penetrance
172
What are the signs/ symptoms of Huntington's chorea (5)?
* Chorea (limb jerking)
* Dementia
* Psychiatric issues
* Depression
* Dysphagia + dysarthria (speech problems)
173
How is Huntingtons chorea diagnosed?
* Family history + clinically
* Genetic testing (if wanted)
174
How can chorea be treated in those with huntingtons?
* Valproic acid
* Benzodiazepines (diazepam)
175
How can depression be treated in huntingtons?
SSRIs (fluoxetine)
176
How is psychosis treated in those with huntingtons chorea?
Risperidone
177
What is multiple sclerosis?
Chronic and progressive demyelination of neurones in the CNS
178
What are the two types of myelin producing cells?
* CNS = oligodendrocytes
* PNS = Schwann cells
179
Which type of cell does multiple sclerosis affect and which protein that is produced by this cell?
Oligodendrocytes (myelin basic protein)
180
What sort of hypersensitivity reaction is MS?
Type 4 (cell mediated)
181
What are some risk factors for MS (5)?
* Female
* Other autoimmune diseases
* Family history
* EBV
* 20-40
182
What are the four patterns of MS disease?
* Clinically isolated syndrome
* Relapsing-remitting
* Primary progressive
* Secondary progressive
183
What is the difference between primary and secondary progressive MS?
Secondary were initially presenting as relapsing-remitting at point of diagnosis
184
How are MS lesions/ progression of the disease often described?
Disseminated in time and space
185
What are the symptoms of MS (5)?
* Parasthesia
* Blurred vision
* Eye movement disorder
* Weakness
* Ataxia
186
What are some signs of MS (4)?
* Optic neuritis
* UMN signs
* Lhermittes sign
* Charcot neurological triad
187
What is Lhermittes sign?
Electric shock sensation with neck flexion (in MS)
188
What is Charcot neurological triad?
* Dysarthria
* Nystagmus
* Intention tremor
*For MS*
189
What is usually the first presenting sign/ symptom of MS?
Optic neuritis (blurred vision)
190
What diagnostic criteria is used for MS?
McDonald criteria
191
What investigations are often does for those with MS?
MRIs
192
How are relapses of MS treated?
Methylprednisolone
193
What medications are used for long term prophylaxis for MS?
DMARD/ biologic (e.g. beta interferon)
194
What are UMN lesion signs/ symptoms (4)?
* Hyper-reflexia
* Weakness
* Spasticity/ hypertonia
* Positive Babinski sign
195
What is Babinski sign?
Toes extend when foot stoked
196
What is spasticity?
Muscles rigid with movement
197
What are LMN lesion signs/ symptoms (5)?
* Hypo-reflexia
* Weakness
* Muscle waisting/ hypotonia
* Negative Babinski sign
* Fasciculations
198
What is a fasciculation?
Muscle twitching
199
What is motor neurone disease?
Progressive degeneration of upper and lower motor neurones (with a variety of causes, many unknown)
200
What is the main tract responsible for movement?
Corticospinal tract
201
What part of the brain is responsible for idea of movement?
Association cortexes e.g. premotor cortex
202
Where does activation of the upper motor neurone originate from?
Motor cortex
203
Which parts of the brain modulate motor control (2)?
* Basal ganglia - turn signals on/ off
* Cerebellum - fine control of movement
204
What are some risk factors for MND?
* Family history/ genetics (5-10% inherited)
* Male
205
What gene has been associated with MND?
SOD-1 gene mutation
206
What parts of the body/ functions are never affected by MND (3)?
* Eyes
* Sensory function
* Sphincters
207
What are 4 types of MND?
* ALS - 80% (amyotrophic lateral sclerosis)
* Progressive bulbar palsy
* Progressive muscular atrophy
* Primary lateral sclerosis
208
What are 3 features of amyotrophic lateral sclerosis?
* UMN + LMN lesions
* Can have corticobulbar involvement
* SOD-1 mutation (associated)
209
Which cranial nerves are affected in progressive bulbar palsy?
CN 9-12
(Upper + lower involvement)
210
What are the main symptoms of progressive bulbar palsy?
Breathing/ swallowing/ talking difficulties
211
What neurones are affected in progressive muscular atrophy?
Lower motor neurones - distal muscles affected first
212
Which neurones are affected in primary lateral sclerosis?
Upper motor neurones
213
How is MND diagnosed?
Clinically (electromyography shows fibrillation potentials - in muscles)
214
What medication can be used to slow the progression of motor neurone disease?
Riluzole
215
What is meningitis?
Inflammation of the meninges
216
What action do you need to take as a doctor if a patient has meningitis?
Notify public health England
217
What is the most common class of pathogen in infective meningitis?
Viruses
218
What are 3 viruses that infect the meninges?
* Enteroviruses
* Herpes simplex virus - 2
* Varicella zoster virus
219
What is an example of an enterovirus?
Coxsackie
220
What are 2 bacteria that infect the meninges the most in people over 3 months?
* S. pneumoniae
* N. meningitidus
221
What bacteria often infects the meninges of older (over 60) and younger (under 3 months)?
Listeria
222
What is the most common meningitis causing bacteria in neonates (0-3 months)?
Group B alpha haemolytic strep (s. agalactiae)
223
What 4 bacteria often causes meningitis in neonates?
* E. coli
* S. pneumoniae
* Group B alpha haemolytic strep
* Listeria
224
What bacteria has decreased in the prevalence of meningitis due to vaccinations?
H. influenzae
225
What sort of bacteria is N. meningitidus?
Gram -ve diplococcus
226
What sort of rash does N. meningitidus cause?
Non-blanching purpuric rash
227
What sort of bacteria is S. pneumoniae?
Gram + ve diplococcus in chains
228
What sort of bacteria is group b alpha haemolytic strep?
Gram +ve coccus in chains
229
Why is group b alpha haemolytic strep the most common cause of neonatal meningitis?
It colonises the maternal vagina
230
What sort of bacteria is listeria?
Gram +ve bacillus
231
What are the main 3 symptoms of meningitis?
* Headache
* Neck stiffness
* Photophobia
232
What are 3 signs of meningitis?
* Kernig sign
* Brudzinski sign
* Pyrexia
233
What is kerning sign?
Can't extend knee when hip is flexed
234
What is brudzinski sign?
Knees + hips automatically flex when neck flexed
235
How is meningitis diagnosed?
Lumbar puncture + CSF analysis
236
Where is a lumbar puncture done?
L3/L4
237
When is a lumbar puncture contraindicated?
High ICP
238
What is the appearance of bacterial viral and fungal/TB meningitis?
* Bacterial = cloudy yellow
* Viral = normal
* Fungal/ TB = cloudy fibrous
239
What leukocytes are common in bacterial viral and fungal/TB meningitis?
* Bacterial = neutrophilia
* Viral = lymphocytosis
* Fungal/ TB = lymphocytosis
240
What is the protein levels in bacterial, viral and fungal/TB meningitis?
* Bacterial = high
* Viral = normal
* Fungal/ TB = high
241
Why is protein high in bacterial and fungal/ TB meningitis?
Waste product of those pathogens
242
What are the glucose levels in bacterial, viral and fungal/ TB meningitis?
* Bacterial = low
* Viral = normal
* Fungal/ TB = low
243
How is meningitis treated in hospital?
Ceftriaxone/ cefotaxime + steroids (dexamethasone)
244
What antibiotic is given for meningitis if listeria is suspected?
Amoxicillin
245
What antibiotic is given IM to people in the GP if meningitis is suspected?
Benzylpenicillin
246
What antiviral is used for the treatment of some meningitis?
Aciclovir
247
What prophylactic antibiotic is given to those deemed closed contacts of those diagnosed with meningitis?
Ciprofloxacin
248
What are some complications of meningitis (3)?
* Meningococcal septicaemia (DIC) - causes rash
* Hearing loss
* Adrenal insufficiency
249
What is the most common cause of encephalitis?
Viral infections
250
What are some other less common causes of encephalitis (3)?
* Parasitic
* Autoimmune
* Fungal
*Rarely bacterial*
251
What is a parasite that can cause encephalitis?
Toxoplasma gondii (toxoplasmosis - from CATS 🐱)
252
Who is most at risk of encephalitis?
Immunocompromised + very young/ old
253
What are some symptoms of encephalitis (4)?
* Fever
* Headache
* Focal neuropathy (e.g. aphasia)
* Seizures
254
How is encephalitis investigated (2)?
* Lumbar puncture = lymphocytosis
* MRI head
255
How is the viral cause of encephalitis found?
PCR testing of CSF
256
How is encephalitis treated?
Aciclovir
257
What are 4 types of brain tumour?
* Astrocytoma (90%)
* Oligodendrocytoma
* Meningioma
* Schwannoma
258
Which cancers most commonly metastasise to brain (3)?
* Lung cancers
* Breast cancer
* Melanoma
259
How are astrocytomas graded?
1-4 (by WHO)
260
What is grade 4 astrocytoma known as?
Glioblastoma
261
What is a glioma?
Cancer of glial cells (oligodendrocytes, microglial cells or astrocytes)
262
What are the signs/ symptoms of a brain tumour (5)?
* Cushing's triad (high ICP)
* Seizures
* Lethargy + weight loss
* Focal neurology
* Occipital headaches (due to high ICP)
263
How is a brain tumour diagnosed?
MRI
264
How are brain tumours treated (3)?
* Surgery
* Chemo
* Steroids (reduce tumour size)
265
What are the three types of paralysis and what sort of lesion would cause them??
* Hemiplegia = lesion in the brain (half the body paralysed)
* Paraplegia = lesion in the spinal cord (legs paralysed)
* Quadriplegia = lesion in spinal cord (both legs + arms)
266
Where does the spinal cord end?
L1/2
267
What is found at the end and after the spinal cord (3 anatomical things)?
* Conus medularis
* Cauda equina
* Filum teminale
268
What are the main ascending tracts?
* DCML
* Spinothalamic
* Spinocerebellar
269
What does DCML carry?
* Fine touch
* Vibration
* Proprioception
270
Describe the pathway of the DCML?
* 1st order --> medulla (in gracile (T6 below legs) and cuneatus (arms) fasiculata)
* 2nd order --> decussate --> thalamus
* 3rd order --> sensory cortex
271
What does spinothalamic carry?
* Anterior = crude touch + pressure
* Lateral = pain + temperature
272
Describe the pathway of the spinothalamic tract?
* 1st order --> ipsilateral dorsal horn
* 2nd order --> decussate immediately --> contralateral thalamus
* 3rd order --> sensory cortex
273
What does the spinocerebellar tract carry?
Unconscious proprioception
274
What are the main descending tracts?
* Corticospinal
* Corticobulbar
275
What do the descending tracts carry?
Motor information
276
Describe the path of the corticospinal tract?
* Upper neurones - lateral tract (decussate in medulla); anterior tract (decussate just before point of synapse)
* Lower neurones - travel to muscle
277
What is the difference in terms of the muscles supplied by the lateral and anterior corticospinal tracts?
* Anterior = axial muscles
* Lateral = extremities
278
What is the corticobulbar tract?
The cranial nerves
279
Where does the knee jerk reflex go to in the spinal cord?
L3/4
280
Where does the big toe jerk reflex go to in the spinal cord?
L5
281
Where does the ankle jerk reflex go to in the spinal cord?
S1
282
What is brown squared syndrome?
Hemisection of the spinal cord
283
What are the symptoms of brown sequard syndrome?
* Ipsilateral motor control loss
* Ipsilateral proprioception + 2 point discrimination loss
* Contralateral pain + temp loss
284
What is myelopathy?
Spinal cord compression
285
What are two causes of myelopathy?
* Neoplasms
* Disco prolapse/ herniation
*Lots of other spinal pathologies*
286
What are some signs/symptoms of myelopathy?
* Progressive leg weakness
* UMN signs
* Sensory loss below lesions
287
How are myelopathies investigated?
MRI spine
288
How are myelopathies treated?
Surgery
289
What two surgical procedures are used to treat myelopathies?
* Microdiscectomy (removal of small part of disc)
* Laminectomy (removal of some of vertebral bone)
290
What is cauda equina syndrome?
Compression below conus medularis
291
What can cause cauda equina syndrome (4)?
* Herniated disc
* Tumours
* Trauma
* Abscess
292
What do the nerves of the cauda equina supply?
* Motor/ sensory function of lower limbs
* Parasympathetic to bladder and rectum
293
What are the signs/ symptoms of cauda equina (4)?
* Leg weakness
* LMN signs
* Saddle anaesthesia (perianal numbness)
* Bladder/ bowel dysfunction + sphincter involvement
294
How is cauda equina diagnosed?
MRI cord
295
How is cauda equina treated?
Treat underlying cause, e.g:
* Spinal fixation
* Microdiscectomy
296
What is peripheral neuropathy?
Nerve damage/ pathology outside of the CNS
297
What are the mechanisms that can damage nerves?
* Demyelination
* Axonal damage
* Nerve compression
* Infarction
* Wallerian degeneration
298
What is Wallerian degeneration?
Nerve lesion, dies distally
299
What is mononeuritis multiplex?
Several individual nerves affected
300
What are some causes of mononeuritis multiplex (4)?
* T2DM
* Vasculitis
* RA
* Infections
301
What is carpal tunnel syndrome?
Pressure on median nerve passing through the carpal tunnel
302
What are the nerve roots of the median nerve?
C6 - T1
303
What are some risk factors/ causes of carpal tunnel syndrome (5)?
* Hypothyroidism
* Acromegally
* Obesity
* RA
* Strain
304
What are the symptoms of carpal tunnel (3)?
* Hand weakness
* Thenar eminence waisting
* Parasthesia
305
How is carpal tunnel investigated?
* Tinsel test
* Phalen test
* Electymyography (EMG)
306
What is tinsels test?
Tapping wrist where median nerve is causes pain/ tingling
307
What is Phalens test?
Flexing wrist (wrists opposite of praying) causes numbness/ pain
308
How is carpal tunnel syndrome treated?
* Wrist splint at night (extent wrist)
* Steroid injections
* Surgery decompression
309
What would cause wrist drop?
Radial nerve palsy (C5 - T1)
310
Which muscles does the radial nerve innervate which causes wrist drop?
Extensor muscles
311
What causes claw hand?
Ulna nerve palsy (C8 - T1)
312
How are ulna and radial nerve palsy treated?
Splints
313
What is sciatica?
Irritation/ damage to sciatic nerve
314
What are the sciatic nerve roots?
L4 - S3
315
What can cause sciatica (4)?
* IV disc herniation/ prolapse
* Piriformis syndrome
* Tumours
* Trauma
316
What is piriformis syndrome?
Muscle in buttock spasms and irritates sciatic nerve
317
What are the symptoms/ signs of sciatica (2)?
*Shooting pain down from buttock to lateral leg
* Weakness in leg + foot
318
How is sciatica investigated?
* Clinically - can't do strait leg raise
* MRI - check for possible causes
319
How is sciatica treated (3)?
* Analgesia + steroids
* Amitriptyline
* Surgery
320
Where do polyneuropathies typically affect?
Peripheries (glove and stocking distribution)
321
What causes a mostly motor polyneuropathy?
Guillain barre syndrome
322
What causes a mostly sensory polyneuropathy?
Diabetic neuropathy
323
What bacteria is a common cause of guillain barre syndrome?
Campylobacter jejuni
324
What is thought to cause diabetic neuropathy (2)?
* Microvascular disease
* Oxygen free radicals
325
What are some other causes of polyneuropathies (2)?
* Vasculitis
* Vitamin B12 deficiency (damage myelin sheaf)
*GBS and diabetes on previous cards*
326
What would a CN3 lesion present as (3)?
* Ptosis
* Down + out eye position
* Fixed dilated pupil
327
What would a CN4 lesion present as (1)?
Can't look down (and inwards)
*Rare, due to trauma*
328
What would a CN5 lesion present as (3)?
* Jaw deviates towards affected side
* Loss of corneal reflex
* Trigeminal neuralgia
329
What would a CN6 lesion present as (1)?
Can't abduct eye
*Sign of high ICP*
330
What would CN7 lesion present as (1)?
Drooping of one side of face (no forehead sparing)
331
What may cause a CN7 lesion?
Bells palsy
332
What would a CN8 lesion present as (2)?
* Hearing loss
* Loss of balance
333
What often causes a CN8 lesion?
Skull change - compression of internal acoustic meatus
334
What would a CN 9+10 lesion present as (2)?
* Impaired gag reflex
* Uvula deviation
335
What would CN11 lesion present as (1)?
Can't shrug shoulders/ turn head against resistance
336
What would CN12 lesion present as (1)?
Tongue deviation towards side of lesion
337
What is myasthenia gravis?
Autoimmune response at neuro-muscular junction against post synaptic receptor
338
What type of hypersensitivity reaction is myasthenia gravis?
Type 2
339
Who is most commonly affected by myasthenia gravis (2 groups)?
* Women under 40
* Men over 60
340
What has myasthenia gravis been connected to?
Thyoma (thymus tumour) - stimulate production of auto-antibodies
341
What two types of antibodies are found in those with myasthenia gravis?
* Anti nicotinic Ach-R antibodies
* Anti MuSK (muscle specific kinase) antibodies
342
How do Anti Ach-R antibodies cause pathology in myasthenia gravis (2)?
* Competitively bind to Ach nicotinic receptors
* Activate compliment system --> receptor destruction
343
How do Anti MuSK antibodies cause pathology in myasthenia gravis?
* Activate compliment system --> receptor destruction
* MuSK helps synthesise Ach-R --> less Ach-R expression
344
When is myasthenia gravis worse in the day?
At the end of the day (worse with exertion - as more Ab binding)
345
Where do symptoms of myasthenia gravis usually begin?
Head and neck --> lower body
346
What are some signs/ symtpoms of myasthenia gravis (4)?
* Diplopia (due to eye muscle weakness)
* Ptosis
* Swallowing + speech difficulties
* Lopsided smile
347
How is myasthenia gravis diagnosed (2)?
* Serology (Ab presence detected)
* Edrophonium (tensilon) test
348
What is the edrophonium (tensilon) test - how does it work?
Edrophonium administered --> inhibits breakdown Ach-ase --> more Ach available --> weakness relieved
349
How is myasthenia gravis treated (2)?
* Ach-ase inhibitors (neostigmine)
* Immunosurpression (steroids)
350
What is an example of an ACH-ase inhibitor?
Neostigmine
*pyridostigmine*
351
What is a complication of myasthenia gravis?
Myasthenia crisis - muscle weakness --> resp failure
352
How is myasthenic crisis treated (2)?
* Plasma exchange
* IV Ig
*both remove harmful Abs from circulation*
353
What is a differential diagnosis of myasthenia gravis?
Lambert eaton syndrome
354
What are the differences between Lambert eaton syndrome and myasthenia gravis (3)?
Lambert eaton ...
* Pre-synaptic Ca++ channel autoimmune pathology
* Improves with exertion
* Start at extremities
355
What is the treatment for Lambert eaton syndrome?
Similar treatment (steroids + immunosuppression)
356
What is Guillain barre syndrome?
Destruction of Schwann cells in PNS (basically MS in PNS)
357
What pathogens commonly cause GBS?
* Campylobacter jejuni (MOST common)
* CMV
* EBV
358
How does infection cause GBS?
Molecular mimicry (organism and schwann cell antigens similar)
359
What is the presentation of GBS (2)?
* Ascending symmetrical muscle weakness
* Reduced reflexes
360
What is a dangerous complication of GBS?
Respiratory failure
361
How is GBS investigated?
* Nerve conduction studies - reduced impulses
* CSF analysis
362
What is found in CSF analysis in GBS (2)?
* High protein levels (=inflammation)
* No WBC
363
How is GBS managed (3)?
* IV Ig (target schwann cell Abs)
* Plasma exchange
* Intubation if difficulty breathing
364
What is wernickes encephalopathy?
Lesions in the CNS caused by vitamin B1 (thiamine) deficiency
365
What causes wernickes encephalopathy?
High alcohol consumption
366
What are 3 classical symtpoms of wernickes encephalopathy?
* Ataxia
* Confusion
* Opthalmoplegia (lesions in eye movement nerves)
367
How is wernickes encephalopathy diagnosed (2)?
* Clinically
* Supported by microcytic anaemia + deranged LFTs
368
How is wernickes encephalopathy treated?
Pabrinex (vit B1 + others)
369
What is a complication of wernickes encephalopathy?
Korsakoff syndrome (irreversible damage - memory disorder)
370
How is duchennes muscular dystrophy inherited?
X-linked recessive
*Pystrophin gene*
371
What is the pathophysiology of DMD?
Muscle replaced with adipose tissue
372
Who is affected by DMD?
Almost exclusively boys
373
What are 2 symptoms of DMD?
* Difficulty getting up
* Skeletal deformities
374
How is DMD diagnosed?
Genetic testing (often prenatally)
375
What is charcot marie tooth syndrome?
Inherited autosomal dominant that causes sensory + motor polyneuropathy
376
What gene is affected by Charcot marie tooth syndrome?
Duplicated PUP 22 gene (chromosome 17)
377
What are the symptoms of Charcot Marie tooth syndrome (3)?
* Foot drop + weaknesses
* Thin calves
* Hammer toe!!!
378
How is charcot marie tooth diagnosed?
* Genetic testing
* Nerve biopsy
379
What sort of bacteria is clostridium tetani?
Gram +ve bacilli
380
How can you get tetanus?
Dirty soil + rusty metal
381
How does tetanus cause tetany?
Tetanospasmin toxin produced --> travels retrogradely up axons --> muscle spasms
382
How is tetanus prevented?
Vaccine !!!
383
What virus causes chicken pox?
Varicella zoster virus
384
What causes shingles?
Reactivation of varicella zoster virus (usually in adulthood)
385
What causes sensory defects in shingles?
Dorsal root of peripheral nerves attacked
386
What are the main symptoms of shingles?
* Painful erythromatous blistering rash (confined to dermatome)
* Tingling + pain in area of rash
387
How can shingles/ chicken pox be treated?
Aciclovir
388
What causes creutzfeldt Jakob disease?
Prions (misfiled proteins)
