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3rd yr clinical > Neurology > Flashcards

Neurology Flashcards

(43 cards)

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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

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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

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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

Study These Flashcards
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

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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

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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

Study These Flashcards
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

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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
What is internuclear opthalmoplegia
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
How are MS relapses treated
500MG steroids orally for 5 days or 1g IV daily for 3-5 days
26
What are the different types of motor neurone disease
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
What are the features of parkinsons
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
What are the features of Bell's palsy
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
What are the features of an acoutsic neuroma
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
What are the features of Huntingtons chorea
Triple nucleotide repeat Anticipation- gets worse down gens Chorea, dystonia, rigidity, personality change, dysphagia No treatment
31
What is the treatment for myasthenic crisis
worsening of symptoms due to illness IV immunoglobulins/ plasmapheresis
32
What are the features of Lambert Eaton Myasthenic syndrome
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
What are the features of Charot Marie Tooth Disease
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
What are the symptoms of Guillian Barre syndrome
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
What are the features of neurofibromatosis
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
What are the features of tuberous sclerosis
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
What is syringomyelia
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
What are the features of amaurosis fugax
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
What is Cushing's triad in raised ICP
1. Widening pulse pressure 2. Bradycardia 3. Irregular breathing These are attempts to maintain cerebral perfusion pressure Indicates brain herniation
40
What are some of the causes and features of idiopathic intracranial hypertension
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
What are the features of a temporal lobe seizure
Can be aware or non aware Aura- rising epigastric sensation, deja vu or smell, hearing hallucinations automatisms- lip smacking etc
42
What is neuroleptic malignant syndrome
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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