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3rd yr clinical > Neurology > Flashcards

Neurology Flashcards

1
Q

What is degenerative cervical myelopathy

A

Loss of fine motor function in both upper limbs

Main risk factor smoking, genetics and occupation

Pain in neck and limbs
Loss of motor function - issues with doing up buttons etc
Loss of sensory function

Hoffman’s sign: Flick one finger on hand and there will be reflex twitching on other hands

MRI cervical spine= gold standard
Need decompressive surgery

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2
Q

What is the difference between an absence seizure and a focal onset impaired awareness seziure

A

Absence seizure- usually in childhood

Focal onset impaired awareness seizure- may start with an aura (focal aware seizure) then they will loose awareness- will do repetitive movements and stare blankly - can be in adults

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3
Q

What are the features of MS

A

Usually young women
Optic neuritis
Pins and needles/ numbness, trigeminal neuralgia

Numbness on neck flexion
Lower limb spasticity/ weakness

For diagnosis :
Need to see demyelinated lesions that are separated in space and time

Olgiocloncal bands in CSF

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4
Q

What is the management of epilepsy

A

Antiepileptics after a second epileptic seizure

To drive need to be 12 months seizure free and can’t drive for 6 months after a seizure

Be careful if on warfarin as antiepileptics can inhibit p450

Sodium val in men / post menopausal women

Lamotrigine used in child baring women

Focal seizures - carbamazepine second line

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5
Q

What is the treatment for Cluster headaches

A

Acute- oxygen and subcutaneous triptan

Prophylaxis - Verapamil -

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6
Q

What are the features of Guillain Barre syndrome

A

Immune demyelination after an infection usually campylobacter jejuni

Weakness is ascending from legs first - few sensory symptoms

Lumbar puncture will show rise in protein with a normal WCC

Nerve conduction studies will show decreased motor nerve conduction (demyelination)

Signs will show LMN signs
Hypotonia, flaccid paralysis, arreflexia

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7
Q

What is the difference between Broca and Wernick’s aphasia and what artery is usually affected in stroke of this area

A

Wernicke’s = what? - the patient can’t understand your command
Inferior division of the left MCA- W is lower than B so inferior

Broca’s = broken - the patient has broken word flow
Superior division of the left MCA

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8
Q

What is conduction aphasia

A

Speech is fluent and comprehension is normal but repetition is poor

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9
Q

What are the features of encephalitis

A

Fever, headache, psychiatric symptoms, seizures, vomiting, mental state change
Aphasia

HSV-1 is responsible for most cases and usually affects temporal and inferior and frontal lobes

Think of a history of a recent viral illness

investigate cerebrospinal fluid - PCR for HSV, VZV and eneterovirus

Neuroimaging and EEG

Manage with IV aciclovir

Bilateral medial temporal lobe involvement

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10
Q

What is pituitary apoplexy

A

Sudden enlargement of a pituitary tumour due to infarction or haemorrhage

Sudden onset headache, vomiting, neck stiffness, bitemporal hemianopia

MRI diagnostic

Urgent steroid replacement due to loss of ACTH
Fluid balance
Surgery

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11
Q

What are some of the posterior stroke syndromes

A

Locked in syndrome- basilar artery occlusion - quadriparesis with preserved consciousness and ocular movements

Wallenberg’s syndrome (lateral medullary syndrome) - Ipsilateral (same side) Horner’s syndrome, ipsilateral loss of pain and temperature on face, contralateral loss of pain and temperature of the body

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12
Q

What is jugular foramen syndrome

A

Symptoms involving CN 9,10,11 that pass through the jugular foramen
Can be caused by tumours, infections, granulomatous disease

Signs
Same side weakness of trapezius and sternocleidomastoid
Uvula deviation to the opposite side
Dysphasia and voice change
Loss of gag reflex

Surgical intervention or radiation for tumours

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13
Q

What are the features of an extradural haemorrhage

A

Between duramater and skull
Head injury to pterion and tearing of middle meningeal artery
Severe headache and oppossite side hemiplegia

Biconvex haematoma limited to the skull

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14
Q

What are the features of a frontal lobe seizure

A

Jacksonian march (works its way up from arms), head and leg movements
Post ictal weakness

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14
Q

What are the features of a subdural haemorrhage

A

Between the dura mater and the arachnoid mater of the meninges

More gradual symptoms than extradural
Alcoholism and anticoag use= risk factors
Fluctuating consciousness

Crescent shape on CT - along side of skull

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15
Q

What are the features of a subarachnoid haemorrhage

A

Occipital headache, seziures, LOC

Trauma, spontaneous rupture of aneurysm in circle of willis

On CT, white area in centre of brain expands bilaterally

IF CT is negative do a lumbar puncture which will have blood in CSF or yellow CSF from haemolysis

Blood is white on CT

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16
Q

What medications and criteria are used for MS

A

McDonald Criteria

Acute management
1g IV methylprednisolone every 24 hrs for 3 days

If unresponsive to this give plasma exchange

Chronic management
Relapsing remitting MS
1st line- Injections - Beta interferon and galtiramer
Oral agents - teeriflunomide
Biologics- alentuzumab

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17
Q

What are the features of myasthenia Gravis

A

Autoimmune disorder antibodies against acetylcholine on muscle fibres

Features
Limb muscle weakness- worse on activity
Facial muscle weakness
Bulbar muscle weakness- issues with speech and swallow

Some drugs can make myasthenia gravis worse
Beta blockers
Lithium
Penicillamine
Gent
Phenytoin

strong link with thymus gland tumours

AcHR antibodies

Treatment
Pyridostigimine- cholinesterase inhibitor
Immunosupression

18
Q

What are the features of Intracranial venous thombosis

A

Strokes in younger people
Headache, confusion, Nausea/vom, papilloedema

Non-contrast CT will show hyperdensity in the affected sinus

Most common dural venous thrombosis affects the superior saggital sinus

Management is with LMWH

19
Q

What are the features of a third cranial nerve palsy

A

Oculomotor nerve paralysis
Down and out eye
Double vision
ptosis, proptosis, fixed pupil dilation

Causes
Surgical: Posterior communicating artery aneurysm

Medical: MS, Vascular (DM or HTN, Vasculitis)

20
Q

What are the features of a 4th CN palsy

A

Paralysis of trochlear nerve
Controls the superior oblique which usually pulls eye down and in

Patient have double vision worse on the verticle plane (looking up)
Eye will point up and in at rest - patient may tilt head to compensate with trouble going down stairs etc

Ocular trauma and diabetes are two most common causes

21
Q

What are the features of a 6th CN palsy

A

Abducens nerve- controls lateral rectus - abduct eye horizontally away from midline

Double vision in horizontal plane
Can be compromised in raised ICP
Diabetic neuropathy, stroke, infection an trauma

22
Q

What is the management of a TIA

A

Lifestyle modification and control of risk factors
Intiation of antiplatelet therapy (aspirin/ clopidogrel)

Can give endartectomy or stenting if
50-70% stenosis of carotid artery

23
Q

What is the management of a stroke

A

Rule out Haemorrhage - CT brain

Aspirin 300mg daily for 2 weeks

Thrombolysis with alteplase given within 4.5 hrs onset

Thrombectomy within 24 hrs with IV thrombolysis

In ischaemic stroke- lowering BP can make things worse

In haemorrhagic stroke- treat BP aggressively

24
Q

What is internuclear opthalmoplegia

A

Lesion in the medial longitudinal fasiculus - where nerve fibres connect all CNs that affect the eye 3,4,6 - impaired adduction on same side as lesion and nystagmus on opposite side

25
Q

How are MS relapses treated

A

500MG steroids orally for 5 days
or
1g IV daily for 3-5 days

26
Q

What are the different types of motor neurone disease

A

MND can give UMNL and LMWL signs

ALS- amylotrophic lateral sclerosis - asymmetric limb weakness, muscle wasting and fasiculations

Progressive Bulbar palsy- affects muscles of talking and swallowing

MND - older man, insidious onset, weakness in upper limbs first, clumsy, slurred speech
LMND signs
- Lower- affects older people

Treatment - no real treatment
Rilizole - slows progression

No sensory symptoms, no cerebellar symptoms, eye movements spared,

27
Q

What are the features of parkinsons

A

Reduced dopamine in basal ganglia
Resting tremour, 4-6Hz rigidity, bradykinesia, asymmetrical tremor

Treat with Levodopa and carbidopa (stops levodopa being metabolised before the brain) - can lead to side effects- Chorea, abnormal movements, excessive motor activity

COMT inhibitors can be used when levodopa effectiveness needs extended

Dopamine agonists can also be used to delay levodopa use but cause pulmonary fibrosis

Monoamine oxidase inhibitors- used to delay end dose symptom worsening with levodopa

28
Q

What are the features of Bell’s palsy

A

Unilateral lower motor neurone facial palsy- forehead not spared

Presents within 72 hrs symptoms- prednisolone 50mg for 10 dats
or
60mg for 5 days followed by a 5 day reducing regime of 10mg per day

29
Q

What are the features of an acoutsic neuroma

A

Tumour of scwann cells around auditory nerve
Vestibular scwannomas

30-60
Unilateral sensorineural hearing loss
Unilateral tinnitus
Dizzy/imbalance
Fullness in ear
Facial nerve palsy

30
Q

What are the features of Huntingtons chorea

A

Triple nucleotide repeat
Anticipation- gets worse down gens

Chorea, dystonia, rigidity, personality change, dysphagia

No treatment

31
Q

What is the treatment for myasthenic crisis

A

worsening of symptoms due to illness
IV immunoglobulins/ plasmapheresis

32
Q

What are the features of Lambert Eaton Myasthenic syndrome

A

Autoimmune condition similar to myasthenia gravis

Associated with paraneoplastic syndrome - SCLC

Less pronounced more insidious symptos
Proximal muscle weakness, autonomic dysfunction

Absent reflexes when rested but present immediately after muscle contraction

Treat underlying malignancy and same treatment as MG

33
Q

What are the features of Charot Marie Tooth Disease

A

Affects peripheral and sensory neurones
Autosomal dominant inherited
Before 10 or in 40s

Distal muscle wasting -champagne legs
Lower leg weakness
Hand weakness reduced muscle tone

No cure - physios, OT etc

34
Q

What are the symptoms of Guillian Barre syndrome

A

Affects peripheral NS after Infection- camplylobacter
Symmetrical ascending weakness
Starts within 4 weeks of infection

Autonomic dysfunction too

Diagnosis with brighton criteria, nerve conduction studies through spinal nerves, lumbar puncture

Management
VTE
IV immunoglobulins
Plasmapheresis

35
Q

What are the features of neurofibromatosis

A

Type 1 gene 17 - autosomal dominant
Cafe au lait spots, bony dysplasia, yellow brown spots on iris, neurofibromas, glioma of optic pathway
Two or more neurofibromas on skin- signficiant

Neurofibromatosis 2
Chr 22
Associated with acoustic neuromas

36
Q

What are the features of tuberous sclerosis

A

Autosomal dominant
Development of harmtomas

TSC1- Chr 9
TSC2- Chr 16

Ash leaf spots, shagreen patches (thick dimpled), angiofibromas (papules over nose and cheeks), ungual fibromas (painless lumps), poliosis ( patch of white hair)

Can cause epilpesy, learning disability, brain tumour

Rhabdomyomas in heart, retinal hamatomas

37
Q

What is syringomyelia

A

Collection of cerebrospinal fluid in the spinal cord

Spinothalamic - P and T- pain and temperature

Only loss of temperature sensation
affecting the neck shoulders and arms

Spastic weakness in lower limbs
Neuropathic pain, upping planters and scoliosis over years

38
Q

What are the features of amaurosis fugax

A

A stroke that affects the retinal/ opthalamic artery

A painless curtain coming down vertically into the vision of one eye

Will be in the same side eye as the stroke

39
Q

What is Cushing’s triad in raised ICP

A
  1. Widening pulse pressure
  2. Bradycardia
  3. Irregular breathing

These are attempts to maintain cerebral perfusion pressure

Indicates brain herniation

40
Q

What are some of the causes and features of idiopathic intracranial hypertension

A

Causes
Tetracyclines, steroids, COCP, retinoids, lithium
Obesity, female sex and pregnancy

Features
Headache, blurred vision, papilloedema, enlarged blind spot, 6th nerve palsy

Management
Weight loss
Toprimarate
Carbonic anhydrase inhibitors

41
Q

What are the features of a temporal lobe seizure

A

Can be aware or non aware
Aura- rising epigastric sensation, deja vu or smell, hearing hallucinations

automatisms- lip smacking etc

42
Q

What is neuroleptic malignant syndrome

A

In patients taking antipsychotics
Pyrexia, muscle rigidity/ cramps
Hypertension, tachycardia, tachypnoea
Delirium with confusion

Raised CK and leukocytosis (raised WCC)

Stop antipsychotic

3rd yr clinical (22 decks)

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