Neurology Flashcards
1
Q
What is syncope?
A
= term used to describe the event of temporarily losing consciousness due to a disruption of blood flow to the brain, often leading to a fall
2
Q
What a prodrome?
A
= early signs or symptoms of an illness or health problem that appear before the major signs of symptoms start
(e.g., how a patient feels prior to fainting)
3
Q
Primary vs secondary syncope
A
Primary syncope: no apparent cause, aka simple fainting
Secondary syncope: underlying cause, not including vasovagal syncope
4
Q
Microscopic features associated with Alzheimer’s disease (2)
(the brain)
A
- beta-amyloid plaques
- intraneuronal neurofibrillary tangles
5
Q
Macroscopic features associated with Alzheimer’s disease
+ particularly which areas of the brain affected?
A
= widespread cerebral atrophy
Particularly cortex + hippocampus
6
Q
What is nominal dysphasia?
A
= inability to recall names of people or objects that are correctly perceived
7
Q
Donepezil, Galantamine + Rivastigmine are all types of?
What are they used to manage?
A
= acetylcholinesterase inhibitors
Used for managing mild to moderate Alzheimer’s disease
8
Q
First-line pharmacological treatment for Alzheimer’s disease
A
= acetylcholinesterase (AChE) inhibitors
9
Q
Second-line pharmacological treatment in Alzheimer’s?
A
= Memantine
10
Q
First-line sedative used in delirium?
A
= Haloperidol
11
Q
Most common type of dementia?
A
= Alzheimer’s disease
12
Q
Contraindications in Parkinson’s disease (2)
A
- typical antipsychotics
- anti-dopaminergic antiemetic e.g., Metoclopramide + Domperidone
13
Q
What is the 2nd most common form of dementia?
A
= vascular dementia
14
Q
What is vascular dementia?
A
= group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia, or haemorrhage secondary to cardiovascular disease
15
Q
What is CADASIL?
A
= rare, inherited type of vascular disease (a disease of the blood vessels such as arteries and veins) that can cause dementia
(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
16
Q
3 subtypes of vascular dementia
A
- stroke-related VD (multi/single-infarct dementia)
- subcortical VD (caused by small vessel disease)
- mixed dementia (presence of both VD + Alzheimer’s disease)
17
Q
Which type of dementia is associated with a stepwise deterioration?
A
= vascular dementia
18
Q
What is NINDS-AIREN criteria used for?
A
= diagnostic criteria for vascular dementia
19
Q
Management for vascular dementia?
A
- mainly symptomatic treatment
- detect + address CV risk
20
Q
When may AChE inhibitors, or Memantine be used for treatment of vascular dementia? (3)
A
If they have suspected co-morbid:
- Alzheimer’s disease
- Parkinson’s disease
- Lewy body dementia
21
Q
What are alpha-synuclein cytoplasmic inclusions also known as, and what are they associated with?
A
= Lewy bodies
Associated with Lewy body dementia
22
Q
True or false: early impairments in attention and executive function can be seen in those with Lewy body dementia rather than just memory loss (as seen in Alzheimer’s)
A
= true
23
Q
What is used to diagnose Lewy body dementia?
A
= SPECT (single-photon emission computed tomography)
I‑FP‑CIT SPECT
24
Q
Which type of dementia is associated with visual hallucinations?
A
= Lewy body dementia
25
Clinical features associated with Lewy body dementia? (3)
- progressive cognitive impairment
- Parkinsonism
- visual hallucinations (other features such as delusions + non-visual hallucinations may also be seen)
26
What should be avoided in patients with Lewy body dementia?
= neuroleptics (anti-psychotics)
27
What is Parkinson'd disease?
= a condition where there is a progressive reduction of dopamine in the basal ganglia of the brain, leading to disorders of movement
28
Symptoms seen in Parkinson's are typically:
- symmetrical
- asymmetrical
- asymmetrical
29
Classic triad of symptoms seen in Parkinson's disease?
- resting tremor
- rigidity
- bradykinesia
30
Which part of the brain is affected in Parkinson's disease?
= substantia nigra (part of the basal ganglia)
31
Where is dopamine produced?
= substantia nigra
32
Clinical features associated with Parkinson's disease (8)
- unilateral tremor, 'pill-rolling tremor'
- cogwheel rigidity
- bradykinesia (movements get slower and smaller)
Other features:
- depression
- sleep disturbance + insomnia
- loss of sense of smell
- cognitive impairment
- memory problems
33
Tremor associated Parkinson's disease is
- symmetrical
- asymmetrical
- asymmetrical
34
Tremor associated with Parkinson's disease is
- 4-6 hertz
- 5-8 hertz
- 4-6 hertz
35
Tremor associated with Parkinson's disease is
- worse at rest
- improves at rest
- worse at rest
36
Tremor associated with Parkinson's disease
- worsens with intentional movement
- improves with intentional movement
- improves with intentional movement
37
Tremor associated with Parkinson's disease
- improves with alcohol
- does not change with alcohol
- does not change with alcohol
38
How is Parkinson's disease diagnosed?
= by a specialist, based on symptoms + examination
39
What is Levodopa?
= synthetic dopamine (given orally), to boost levels
(used in Parkinson's disease)
40
Levodopa is usually combined with peripheral decarboxylase inhibitors. Why?
= stops it being broken down in the body before it gets the chance to reach the brain
41
Cardbidopa, Benserazide - are examples of:
- peripheral decarboxylase inhibitors
- COMT inhibitors
- Dopamine agonists
- Monoamine Oxidase-B inhibitors
- peripheral decarboxylase inhibitors
42
Most effective treatment for managing symptoms in Parkinson's disease?
= Levodopa
43
Main side-effect associated with Levodopa
= dyskinesias (abnormal movements associated with excessive motor activity)
44
What is dystonia?
= excessive muscle contraction which leads to abnormal postures or exaggerated movements
45
What is chorea?
= abnormal involuntary movements that can be jerking and random
46
What is athetosis?
= involuntary twisting or writhing movements usually in the fingers, hands, and feet
47
Entacapone is an example of,
- peripheral decarboxylase inhibitor
- COMT inhibitor
- Dopamine agonist
- Monoamine Oxidase-B inhibitor
- COMT inhibitor
48
Bromocryptine, Peroglide, Carbergoline - are examples of,
- peripheral decarboxylase inhibitors
- COMT inhibitors
- Dopamine agonists
- Monoamine Oxidase-B inhibitors
- Dopamine agonists
49
Selegiline, Rasagiline - are examples of,
- peripheral decarboxylase inhibitors
- COMT inhibitors
- Dopamine agonists
- Monoamine Oxidase-B inhibitors
- Monoamine Oxidase-B inhibitors
50
COMT inhibitors effect on Levodopa?
= inhibits an enzyme which metabolises Levodopa therefore, extending it's effective duration
51
Side-effect associated with prolonged use of dopamine agonists?
= pulmonary fibrosis
52
Which of the following enzyme is specific to dopamine, and does not act on serotonin or adrenaline?
- monoamine oxidase-A enzyme
- monoamine oxidase-B enzyme
- monoamine oxidase-C enzyme
- monoamine oxidase-B enzyme
53
What is Huntington's Chorea?
= autosomal dominant genetic condition that causes a progressive deterioration in the nervous system
54
A 'trinucleotide repeat disorder' the involves a genetic mutation in the HTT gene on chromosome 4 is associated with which condition?
= Huntington's chorea
55
What is genetic anticipation?
= a phenomenon in which the signs and symptoms of genetic conditions become more severe and/or appear at an earlier age, as they are passed from one generation to the next
56
What are the consequences of Huntington's chorea displaying genetic anticipation? (2)
- earlier age of onset
- increased severity of disease
57
Which kind of 'movement disorder' is strongly associated with Huntington's?
= chorea
(involuntary, abnormal movements)
58
How is Huntington's chorea diagnosed?
= genetic testing for faulty gene
59
Life expectancy in Huntington's disease?
= 15-20 years
60
In Huntington's disease, what is death most often caused by?
= respiratory disease
(suicide more common cause than in the general population)
61
What is Guillain-Barré syndrome?
= 'acute paralytic polyneuropathy' which affects peripheral nervous system
62
What is Guillain-Barré syndrome typically caused by?
= usually triggered by an infection
63
Which types of organisms are particularly associated with the development of Guillain-Barre Syndrome? (3)
HINT: CJ, CMV, EBV
- campylobacter jejuni
- cytomegalovirus
- epstein-barr virus
64
Describe the pathophysiology of Guillain-Barre syndrome
Thought to occur due to a process called molecular mimicry. B-cells create antibodies which match proteins on the nerve cells. This causes nerve damage
65
What kind of weakness is seen in Guillain-Barré syndrome?
= symmetrical ascending weakness (starting at feet + moving up the body)
66
Guillain-Barré syndrome: symptoms usually start within
- 1 week preceding infection
- 2-3 weeks preceding infection
- 4 weeks preceding infection
- 1 year preceding infection
- 4 weeks preceding infection
67
Guillain-Barré syndrome: symptoms PEAK within
- 1 week
- 2-4 weeks
- 1 year
- 2-4 weeks
68
Guillain-Barré syndrome: recovery period can last
- days to weeks
- weeks to months
- months to years
- months to years
69
Which of the following criteria can be used for diagnosing Guillain-Barré syndrome?
- Blatchford score
- Brighton criteria
- Eddington criteria
- Love heart criteria
- Brighton criteria
70
Leading cause of death in Guillain-Barre syndrome?
= PE
71
Management for Guillain-Barré syndrome (3)
- IV immunoglobulins
- supportive care
- VTE prophylaxis
72
What can be used as an alternative to IV immunoglobulins to treat Guillain-Barré syndrome?
= plasma exchange
73
Guillain-Barré syndrome: What % of patients fully recover?
- 80%
- 50%
- 15%
- 5%
- 80%
74
What is dementia?
= syndrome associated with a decline in 2 or more cognitive domains, severe enough to disrupt ADLs, occupation or lifestyle
75
What is pseudo dementia?
= cognitive and functional impairment imitating neurodegenerative disorders caused secondary to neuropsychiatric symptoms
76
Description of a tension headache
= classically produces a mild ache across the forehead and in a band-like pattern around the head
77
Treatment of a tension headache (4)
- reassurance
- basic analgesia
- relaxation techniques
- hot towels to local area
78
What is a secondary headache?
= headache caused by another condition
79
What causes hormonal headaches?
= related to oestrogen. Tends to be related to low oestrogen
80
What can be used to help improve hormone headaches?
= oral contraceptive pill
81
Does trigeminal neuralgia most commonly present with unilateral or bilateral pain?
= unilateral (in 90% of cases)
82
What condition is associated with trigeminal neuralgia?
= multiple sclerosis
(around 5-10% of people with MS have trigeminal neuralgia)
83
What is the pain associated with trigeminal neuralgia usually described as?
= electricity-like shooting pain
84
First-line pharmacological treatment for trigeminal neuralgia?
= carbamazepine
85
What is multiple sclerosis (MS)?
= a chronic progressive condition that involves demyelination of myelinated neurons in the CNS
86
Which of the following cells wrap around axons in the CNS:
- Schwann cells
- oligodendrocytes
- oligodendrocytes
87
Which of the following cells wrap around axons in the peripheral nervous system:
- Schwann cells
- oligodendrocytes
- Schwann cells
88
How are the lesions in MS described as?
= disseminated in time and space
89
Most common presentation of MS?
= optic neuritis (demyelination of optic nerve + loss of vision in 1 eye)
90
What is conjugate lateral gaze disorder?
= when looking laterally in direction of affected eye, affected eye won’t be able to abduct
91
What is internuclear ophthalmoplegia internuclear + conjugate lateral gaze disorder associated with?
= multiple sclerosis (MS)
92
What is 'ophthalmoplegia'?
= means problem with muscles around the eye
93
What is Lhermitte’s sign?
= electric shock sensation that travels down the spine into limbs when flexing the neck
94
What is Lhermitte’s sign associated with?
= Multiple sclerosis (MS)
95
What is 'ataxia'?
= problem with coordinated movement
96
MS disease patterns: what is clinically isolated syndrome?
= describes the first episode of demyelination, and neurological signs + symptoms
97
MS disease patterns: what is relapsing-remitting pattern described as?
= characterised by episodes of disease + neurological symptoms followed by recovery
98
MS: what is the most common pattern at initial diagnosis?
- clinically isolated syndrome
- relapsing-remitting
- secondary progressive
- primary progressive
- relapsing-remitting
99
MS disease patterns: what is secondary progressive pattern described as?
= there was relapsing-remitting disease at first, but now there is progressive worsening of symptoms with incomplete remissions
100
MS disease patterns: what is primary progressive pattern described as?
= worsening of disease + neurological symptoms from point of diagnosis without initial relapses + remissions
101
Investigations used to support diagnosis of multiple sclerosis (MS)? (2)
- MRI (to demonstrate lesions)
- lumbar puncture (to detect oligoclonal bands in CSF)
102
What is motor neurone disease?
= progressive, ultimately fatal condition where the motor neurones stop functioning
103
Most common and well-known specific motor neurone disease?
= ALS (amyotrophic lateral sclerosis)
104
Second most common form of motor neurone disease?
= progressive bulbar palsy
105
Signs of lower motor neurone disease (4)
- Muscle wasting
- Reduced tone
- Fasciculations (twitches in the muscles)
- Reduced reflexes
106
Signs of upper motor neurone disease (3)
- Increased tone or spasticity
- Brisk reflexes
- Upgoing plantar responses
107
What is Riluzole used in?
= used in motor neurone disease, can slow the progression of disease and extend survival by a few months in ALS
108
What non-pharmacological management can be used to support breathing at night in those with motor neurone disease?
= non-invasive ventilation (NIV)
109
What is myasthenia gravis?
= autoimmune condition that causes muscle weakness that gets progressively worse with activity and improves with rest
110
Myasthenia gravis has a strong link with what other condition?
= thymoma (tumours of the thymus gland)
111
Pathophysiology of myasthenia gravis
= in 85% of patients, acetylcholine receptor antibodies are produced. Preventing ACh from being able to stimulate receptor + trigger muscle contraction
Antibodies also trigger complement system within NMJ, leading to damage of cells in postsynaptic membrane
In the other 15% - there are antibodies against MuSK + LRP4
112
Do symptoms in myasthenia gravis typically get worse or better at the end of the day?
= worse
As weakness gets worse with muscle use + improves with test
113
What is does the Edrophonium test involve? and what is it used for?
= give IV dose of edrophonium chloride (or neostigmine)
Normally, cholinesterase enzymes in neuromuscular junction breakdown Ach. Edrophonium block these enzymes and stop the breakdown of Ach
As a result, Ach at neuromuscular junction increases. Briefly and temporarily relieves the weakness
This helps establishes a diagnosis of myasthenia gravis
114
Treatment options for myasthenia gravis? (2)
- reversible acetylcholinesterase inhibitors (e.g., Pyridostigmine or Neostigmine)
- monoclonal antibodies (e.g., Rituximab)
115
What is Lambert-Eaton Myasthenia Syndrome?
= rare autoimmune disorder of the neuromuscular junction
Causes progressive muscle weakness with increased use as a result of damage to the NMJ
116
Which condition is Lambert-Eaton Myasthenia Syndrome closely associated with?
= small-cell lung cancer
117
Differences between Myasthenia Gravis and Lambert-Eaton Myasthenia Syndrome (LEMS)?
In LEMS - defect of transmission is in the presynaptic terminals (damage to
118
What is a transient ischaemic attack (TIA)?
= transient neurological dysfunction secondary to ischaemia without infarction
119
What is a crescendo TIA?
= where there is 2 or more TIAs within a week
(carries high risk of developing into a stroke)
120
What is the FAST Tool used for? And what does it stand for?
= used for identifying stroke in the community
F - face
A - arm
S - speech
T - time (act fast, call 999)
121
What is the ROSIER Tool used for?
= recognising stroke in the ED
122
What imaging is used first-line to diagnose a stroke?
= CT head
123
Gold standard imaging technique in stroke?
= diffusion-weighted MRI
124
What is used in secondary prevention of stroke (2)?
= Clopidogrel 75mg once daily + Atorvastatin 80mg should be started but NOT immediately
125
Key feature in presentation of intracranial bleed?
= headache
126
Which of the following are more frequently seen in elderly or alcoholic patients?
- subdural haemorrhage
- extradural haemorrhage
- intracerebral haemorrhage
- subarachnoid haemorrhage
- subdural haemorrhage
127
Which of the following is typically seen as a cresent shape on CT scan?
- subdural haemorrhage
- extradural haemorrhage
- intracerebral haemorrhage
- subarachnoid haemorrhage
- subdural haemorrhage
128
Which of the following is associated with fracture of the temporal bone?
- subdural haemorrhage
- extradural haemorrhage
- intracerebral haemorrhage
- subarachnoid haemorrhage
- extradural haemorrhage
129
Which of the following is typically bi-convex (or lentiform) in shape on CT scan?
- subdural haemorrhage
- extradural haemorrhage
- intracerebral haemorrhage
- subarachnoid haemorrhage
- extradural haemorrhage
130
Which of the following is more commonly associated with young patient who has had a traumatic head injury and has an ongoing headache?
- subdural haemorrhage
- extradural haemorrhage
- extradural haemorrhage
131
Which of the following is associated with a sudden onset occipital headache that occurs during strenuous activity such as weight-lifting or sex?
- subdural haemorrhage
- extradural haemorrhage
- intracerebral haemorrhage
- subarachnoid haemorrhage
- subarachnoid haemorrhage
132
Which of the following is particularly associated with cocaine + sickle cell anaemia?
- subdural haemorrhage
- extradural haemorrhage
- intracerebral haemorrhage
- subarachnoid haemorrhage
- subarachnoid haemorrhage
133
What is a sudden onset occipital headache also called? And what is it a sign of?
= known as a thunderclap headache, seen in subarachnoid haemorrhage
134
First-line investigation for subarachnoid haemorrhage?
= CT head
135
What is xanthochromia?
= presence of bilirubin in the cerebrospinal fluid (appears yellow in colour)
136
What is Nimodipine? And what is it used for?
= calcium channel blocker, used to prevent vasospasm - common complication that can result in brain ischaemia following a subarachnoid haemorrhage
137
What is xanthochromia a sign of?
= may be a sign of subarachnoid haemorrhage
138
What is a breakthrough seizure?
= happens when you have a seizure after not having one for 12 months - often due to not taking your medication, but other things can also trigger it
139
What is a seizure?
= transient episode of abnormal electrical activity in the brain
140
Investigations in suspected epilepsy (2)
Electroencephalogram (EEG) - can show typical patterns in different forms of epilepsy to support diagnosis
MRI brain - used to visualise structural problems which may be associated with seizures
Others: ECG (exclude heart problems)
141
Describe a 'generalised tonic-clonic seizure'
There is a loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes
There may be associated tongue biting, incontinence, groaning and irregular breathing
After seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or depressed
142
First-line pharmacological management for a generalised tonic-clonic seizure?
= Sodium Valproate
143
Where do focal seizures start?
= temporal lobe
144
Describe a focal seizure
There are various ways that focal seizures can present:
- Hallucinations
- Memory flashbacks
- Déjà vu
- Doing strange things on autopilot
145
First-line pharmacological treatment for a focal seizure
= Carbamazepine or Lamotrigine
146
Describe an absent seizure
Patient becomes blank, stares into space and then abruptly returns to normal
During episode they are unaware of their surroundings + won’t respond
147
How long do absent seizures typically last?
= 10-20 seconds
148
First-line pharmacological treatment for absent seizures?
= Sodium Valproate or Ethosuximide
149
Describe an atonic seizure
Also known as ‘drop attacks’. Characterised by brief lapses in muscle tone
150
Describe myoclonic seizures
Present as sudden brief muscle contractions, like a sudden ‘jump’. Patient usually remains awake during the episode
151
First-line pharmacological treatment for atonic OR, myoclonic seizures?
= Sodium Valproate
152
Which of the following epilepsy maintenance medications SEs include Stevens-Johnson syndrome (a life threatening skin rash)?
- Sodium Valproate
- Carbamazepine
- Phenytoin
- Ethosuzimide
- Lamotrigine
- Lamotrigine
153
Which of the following epilepsy maintenance medications SEs include agranulocytosis?
- Sodium Valproate
- Carbamazepine
- Phenytoin
- Ethosuzimide
- Lamotrigine
- Carbamazepine
154
What is status epilepticus?
= defined as seizures lasting more than 5 minutes or more than 3 seizures in 1 hour
(MEDICAL EMERGENCY)
155
What is given to treat status epilepticus in hospital?
= IV Lorazepam 4mg
156
If IV Lorazepam 4mg does not stop seizure in patient with status epilepticus - what is the next step?
= repeat after 10 minutes
157
Medical option for status epilepticus in the community?
= buccal Midazolam OR, rectal Diazepam
158
What diagnosis would you suspect if a patient presents with the following clinical features:
- high foot arches
- distal muscle wasting ('inverted champagne bottle legs')
- weakness in lower legs
- weakness in hands
- peripheral sensory loss
= Charcot-Marie-Tooth Disease
159
What is Charcot-Marie-Tooth Disease?
= an inherited disease that affects peripheral motor and sensory nerves
Causes dysfunction in the myelin or axons
160
Causes of peripheral neuropathy (5)
HINT: ABCDE
A - alcohol
B - B12 deficiency
C - cancer + CKD
D - diabetes + drugs (e.g., Isoniazid, Amiodarone + Cisplatin)
E - every vasculitis
161
Management of Charcot-Marie-Tooth Disease
= no treatment to alter underlying disease or prevent progression
Management purely supportive involving input from various members of MDT
162
How can you tell if a facial nerve palsy if due to a UMN or, LMN lesion?
UMN lesion - forehead spared, patient can move forehead on suspected side
LMN - forehead will NOT be spared
163
Classical presentation of patient with a facial nerve palsy?
= unilateral facial weakness
164
What is Bell's palsy?
= unilateral LMN facial nerve palsy. Relatively common
165
Cause of Bell's palsy?
= idiopathic (unknown)
166
Treatment of Bell's palsy?
= Prednisolone
- 50mg for 10 days OR,
- 60mg for 5 days, followed by 5-day reducing regime of 10mg a day
+ lubricating eye drops
167
What is Ramsay-Hunt Syndrome caused by?
= varicella zoster virus (VZV)
168
Apart from unilateral facial weakness, what other clinical feature may suggest this is Ramsay-Hunt syndrome?
= painful, tender vesicular rash in ear canal, pinna + around ear of affected side
(rash can extend to anterior 2/3 of tongue + hard palate)
169
Treatment for Ramsay-Hunt Syndrome (2)
= Prednisolone + Acyclovir
(recommended to be initiated within 72 hours)
May require lubricating eye drops too
170
What is neurofibromatosis?
= genetic condition that causes nerve tumours (neuromas) to develop throughout the nervous system
171
Is neurofibromatosis type 1 or type 2 more common?
= neurofibromatosis type 1
172
Diagnosis criteria for neurofibromatosis type 1
HINT: CRABBING
C - cafe-au-lait spots
R - relative with NF1
A - axillary or inguinal frexkles
BB - bony dysphasia
I - iris hamartomas (Lisch nodules)
N - neurofibromas
G - glioma of optic nerve
173
What are Lisch nodules (Irish hamartomas) associated with?
= neurofibromatosis type 1
174
Which of the following is most associated with acoustic neuromas
- neurofibromatosis type 1
- neurofibromatosis type 2
- neurofibromatosis type 2
175
Is patient presents with bilateral acoustic neuromas, what does this almost certainly indicate?
= neurofibromatosis type 2
176
Most common cancers that metastasise to the brain (4)
- lung
- breast
- renal cell carcinoma (RCC)
- melanoma
177
Pharmacological management of idiopathic intracranial hypertension?
= Acetazolamide
(carbonic anhydrase inhibitors)
178
Clinically how can you differentiate myasthenia gravis from, Lambert-Eaton myasthenic syndrome?
= Lambert-Eaton myasthenic syndrome is classically associated with fatigue that improves with repeated use, while patients with myasthenia gravis experience greater fatigue with continuous use
179
What is cataplexy?
= describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened
180
She has not been able to read the newspaper recently, despite wearing her usual glasses and has trouble walking down the stairs. She has a past medical history of poorly controlled type two diabetes and hypertension.
An eye examination shows visual acuity 6/6 in both eyes with her glasses on, normal colour vision, intact central and peripheral fields, defective downward gaze and vertical diplopia.
Lesion to what cranial nerve is most likely to be causing her symptoms?
= 4th nerve palsy (Trochlear)
181
What is sarcopenia?
= age-related progressive loss of muscle mass and strength
182
What is 'long lie'?
= term for when a person has fallen and spends a long time on the floor, waiting for assistanc
183
183
What is Todd paresis?
= a syndrome associated with weakness or paralysis of part or all of the body as soon as the ictal discharge (seizure) has ended
184
What is a secondary cause of dementia seen in elderly patients which is thought to be secondary to reduced CSF absorption at the arachnoid villi known as?
= normal pressure hydrocephalus
185
Classical triad of features seen in normal pressure hydrocephalus?
- urinary incontinence
- dementia + bradyphrenia ('slow mind')
- gait abnormality (similar to Parkinson's)
186
Management of normal pressure hydrocephalus?
= ventriculoperitoneal shunting
187
Hydrocephalus with enlarged fourth ventricle and, ventriculomegaly is indicative of?
= normal pressure hydrocephalus
188
Which of the following is the strongest risk factor for developing Bell's palsy?
- smoking
- combined oral contraceptive pill
- asthma
- sarcoidosis
- pregnancy
- pregnancy
189
What is a quick and easy bedside test to perform to confirm that fluid coming out a patient's nose is CSF?
= check for glucose
190
What is uhthoff phenomenon?
= transient worsening of neurological function lasting less than 24 hours that can occur in multiple sclerosis patients due to increases in core body temperature
191
In which condition is uhthoff phenomenon seen in?
= MS
192
What is Ihermitte sign, and what disease is it seen in?
= a sudden brief pain or electrical buzzing sensation. It runs down your neck into your spine and might then spread into your arms or legs. It can be triggered when you bend your neck forward, or after a cough or sneeze
Seen in MS
193
Which kind of ischaemic stroke commonly occurs due to a variety of factors including damage to the aorta?
= anterior spinal artery infarct
194
Imaging of choice in diagnosing anterior spinal artery infarct?
= MRI scanning
(hyperintense signals on T2-weighted images in the anterior 2/3rds of the spinal cord)
195
Is dorsal column function preserved in patients with anterior spinal artery infarct?
= yes
196
Which nerve roots make up the brachial plexus? (5)
= C5-C8 + T1
197
2 types of brachial plexus injuries?
- Erb's palsy
- Klumpke's palsy
198
Which type of brachial plexus injury involves damage to C5-C6 nerve roots?
- Erb's palsy
- Klumpke's palsy
- Erb's palsy
199
Which type of brachial plexus injury involves damage to C8-T1 nerve roots?
- Erb's palsy
- Klumpke's palsy
- Klumpke's palsy
200
Which type of brachial plexus injury is more commonly assocaited with traumatic childbirth?
- Erb's palsy
- Klumpke's palsy
- Erb's palsy
201
Major causes of brachial plexus injuries (3)
- trauma (childbirth)
- high-impact accidents
- axillary radiotherapy (for breast cancer)
202
‘Waiter’s tip’ sign: characterised by shoulder adduction, elbow extension, forearm pronation, and wrist flexion - is associated with which type of brachial plexus injury?
- Erb's palsy
- Klumpke's palsy
- Erb's palsy
203
What investigation can be used to help confirm diagnosis of brachial plexus injury?
= electrodiagnostic studies (EMG + nerve conduction studies)
204
Medication which can be used to manage pain associated with brachial plexus injury?
= NSAIDs
205
Surgery options in brachial plexus injury if no improvement, or injury is severe?
= nerve grafts or transfers
206
Which type of brachial plexus injury involves weakness of intrinsic muscles of the hand?
- Erb's palsy
- Klumpke's palsy
- Klumpke's palsy
207
What is Brown-Sequard Syndrome?
= characterised by anatomical disruption of nerve fibre tracts in one half of the spinal cord
208
Clinical features of brown-sequard syndrome? (3)
(inc. proprioception, pain + temp sensation, paralysis)
- ipsilateral hemiplegia
- ipsilateral loss of proprioception + vibration
- contralateral loss of pain + temperature sensation
209
Does bulbar palsy refer to a LMN or UMN lesion subtype?
= LMN lesion
210
Which cranial nerves are affected in bulbar palsy? (3)
- CN 9 (glossopharyngeal)
- CN 10 (Vagus)
- CN 12 (hypoglossal)
211
Main resultant impairments associated with bulbar palsy? (2)
- dysarthria (speech problems)
- dysphagia (swallowing problems)
212
Clinical manifestations of bulbar palsy (4)
- absent or normal jaw jerk reflex
- absent gag reflex
- flaccid, fasiculating tongue
- nasal speech, described as 'quiet'
213
What is encephalitis?
= pathological condition characterised by inflammation of the brain parenchyma, aka the ‘encephalon’
214
Most common pathogen in encephalitis?
= herpes simplex virus type 1 (HSV-1)
215
Primary clinical feature of encephliatis?
= altered mental status
216
In encephalitis, which lobes does HSV typically affect?
= temporal lobes
(and bilateral multifocal haemorrhage is typical)
217
Management of encephalitis (2)
Involves broad-spectrum antimicrobial cover with:
- 2g IV Ceftriaxone BD
- 10mg/kg Acyclovir TDS for 2 weeks
218
What is cerebellar syndrome?
= refers to a cluster of clinical manifestations resulting from impaired function of the cerebellum, which is responsible for maintaining balance and coordination of movements
219
Signs and symptoms of cerebellar syndrome?
Mneumonic 'DANISH'
D - dysdiadochokinesia (=inability to perform rapid alternating hand movements)
A - ataxia (=broad-based, unsteady gait)
N - nystagmus
I - intention tremor (observed during 'finger to nose test')
S - slurred speech
H - hypotonia
220
Cerebellar syndrome: Lesions in the cerebellar vermis leads to
- ipsilateral limb symptoms
- truncal ataxia and gait instability
- truncal ataxia and gait instability
221
Cerebellar syndrome: Lesions in the cerebellar hemisphere leads to
- ipsilateral limb symptoms
- truncal ataxia and gait instability
- ipsilateral limb symptoms
222
Cranial nerve affected in Bell's palsy?
= facial nerve (7th CN)
223
What is diplopia?
= refers to the perception of 2 images from a single object
224
Common causes of diplopia? (3)
- 3rd nerve palsy
- 4th nerve palsy
- 6th nerve palsy
225
Resting eye position in a 3rd nerve palsy is?
- down and in
- down and out
- upward and inwards
- upward and outwards
- medially deviated
- down and out
226
Resting eye position in a 4th nerve palsy is?
- down and in
- down and out
- upward and inwards
- upward and outwards
- medially deviated
- upward and inwards
227
Resting eye position in a 6th nerve palsy is?
- down and in
- down and out
- upward and inwards
- upward and outwards
- medially deviated
- medially deviated
228
In a patient with a 4th nerve palsy, the double vision is usually worse in
- the vertical plane
- the horizontal plane
- the diagonal plane
- the vertical plane
229
In a patient with a 6th nerve palsy, the double vision is usually worse in
- the vertical plane
- the horizontal plane
- the diagonal plane
- the horizontal plane
230
What is horner's syndrome?
= a condition characterised by a set of signs and symptoms that occur due to a disruption in the sympathetic nerve supply to the eye
231
3 common features associated with Horner's syndrome
- ptosis (=drooping of eyelid)
- miosis (=constriction of pupil)
- anhidrosis (=absence of sweating on affected side of face)
232
Causes of horner's syndrome (4)
- pancoast tumour
- stroke
- carotid artery dissection
Additional causes: neck trauma, surgeries or trauma affecting the sympathetic chain
233
Horner's syndrome: heterochromia is suggestive of?
= congenital Horner's syndrome
234
What is neuromyelitis optica (Devic's disease)?
= neurological disorder that primarily affects the optic nerves and the spinal cord
235
Is neuromyelitis optica (Devic's disease) more common in males of females?
= has a clear female preponderance
236
Classic triad of Devic's disease (neuromyelitis optica)
- optic neuritis
- transverse myelitis
- antibodies to Aquaporin 4 (AQA4) found in serum of patient
237
MRI head & spine reveals demyelinating lesions which, unlike in MS, affect both peripheral white matter tracts and central components of the spinal cord
What is the likely diagnosis?
= neuromyelitis optica (Devic's disease)
238
What is meningitis?
= inflammation of the meninges, which are composed of 3 layers: dura mater, arachnoid mater, and pia mater
This inflammation may arise from both infective and non-infective aetiologies
239
Most common type of meningitis
- viral
- bacterial
- fungal
- viral
(however, usually least severe)
240
Cardinal features of meningitis (8)
- headache
- fever
- neck stiffness
- photophobia
- nausea & vomiting
- focal neurology
- seizures
- reduced conscious level
241
Meningitis: What is Kernig's sign?
= patient lying on back with hip and knee flexed at 90 degrees. Examiner attempts to extend the patient’s knee. If patient experiences pain & resistance, especially when straightening the leg – positive Kernig’s sign
This is suggestive of meningeal irritation or inflammation
242
Meningitis: What is Brudzinski's sign?
= passive neck flexion, where examiner gently flexes the patient’s neck forward towards the chest while the patient is lying on their back. If patient involuntary flexes their hips and knees in response to neck flexion – considered positive
243
Management of meningitis (2)
[bacteria & viral]
Bacterial:
- 2g of IV ceftriaxone twice daily
- with IV amoxicillin added in patients at age extremes for listeria coverage
Viral:
- IV acyclovir
244
What is Cushings reflex?
= physiological nervous system response to acute elevations of intracranial pressure (ICP)
245
Cushing triad (3)
- widening pulse pressure (high systolic, low diastolic)
- bradycardia
- irregular respirations (Cheyne-Stokes respiration)
