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Neurology Flashcards

1
Q

Define MS

A
  1. Chronic autoimmune disease
  2. Involves CNS
  3. Degeneration of myelin in brain and spinal cord
  4. Leads to eventual demyelination and axonal loss
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2
Q

Sx of MS

A
  1. Patchy paraesthesia
  2. Optic neuritis - loss of central vision
  3. Internuclear opthalmoplegia
  4. Subacute cerebellar ataxia
  5. Spastic paraparesis
    • Lhermitte’s sign (bend neck down they get Sx)
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3
Q

State the 3 classifications of MS

A
  1. Relapsing - remitting (80%)
  2. Primary progressive (<10%)
  3. Progressive-relapsing (10%)
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4
Q

Dx of MS

A
  1. +ve clinical Hx/exam
  2. MRI
  3. CSF
    • Oligoclonal bands in CSF
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5
Q

Name the criteria used to diagnose MS

A

McDonald criteria

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6
Q

Tx of MS

A
  1. Acute
    • 1g IV methylpred
  2. Chronic
    • Disease modifying therapies (DMTs)
      • beta-interferon
      • Dimethyl fumarate
    • Symptomatic therapies
      • Physio
      • Modafinil for fatigue
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7
Q

Summarise Wilson’s disease

A
  1. Autosomal recessive impaired Cu metabolism
    -> Leads to accumulation of Cu in liver + brain
  2. Akinetic rigid syndrome, tremor, ataxia
  3. Ix - Serum caeruloplasmin (low = +ve)
  4. Tx - Chelators (Trientine)
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8
Q

Summarise Wernicke’s encephalopathy

A
  1. Thiamine deficiency (B1)
  2. Sx: Triad of Sx
    • Ataxia
    • Confusion
    • Ocular abnormalities (nystagmus)
  3. Ix
    • Neuro exam
    • MRI head
    • Bloods (low thiamine)
  4. Tx
    • High dose IV thiamine
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9
Q

Summarise visual field loss

A
  1. Monocular vision loss (vision loss one eye)
    • Optic nerve
  2. Bitemporal hemianopia
    • Optic chiasm
  3. Homonymous heminopia
    • Optic radiation
  4. Quadrantanopias
    • Optic radiation
  5. Macular sparing in occipital lobe lesions (central vision spared)
    • Occipital lobe
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10
Q

Summarise vertigo

A
  1. Perception of false sensation of movement or spinning
  2. Ax:
    • Peripheral cause: BPPV, labyrinthitis
    • Central cause: Migraine, MS
  3. Tx:
    • Brandt-daroff exercises (BPPV)
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11
Q

Define Vascular dementia (VaD)

A
  1. Umbrella term
  2. Collection of cognitive impairment syndromes
  3. Cerebrovascular disease (ischaemic or haemorrhagic)
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12
Q

Sx of VaD

A
  1. Progressive stepwise deterioration in cognition
  2. Visual disturbance
  3. Seizures
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13
Q

Ddx of VaD

A
  1. Alzheimer’s
    • Memory impairment
    • Slow and continuous
  2. Lewy body dementia
    • Flux in cognition
    • Visual hallucination
    • Parkinsonism
  3. Frontotemporal dementia
    • Personality + behaviour changes
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14
Q

Ix of VaD

A
  1. Cognition screening
  2. Med review to exclude meds induced
  3. B12 deficiency, hypothyroidism
  4. MRI head (extensive white matter change)
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15
Q

Tx of VaD

A
  1. Address cardio rf
  2. Sx Tx
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16
Q

Trigeminal neuralgia

A
  1. Chronic pain
  2. Severe, sudden and brief bouts
  3. Shooting/stabbing pain
  4. Distribution of one or more divisions of trigem
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17
Q

Ax of trigeminal neuralgia

A
  1. Malignancy
  2. MS
  3. Sarcoidosis
  4. Lyme disease
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18
Q

Tx of trigeminal neuralgia

A
  1. Carbamazepine
  2. Phenytoin
  3. Gabapentin
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19
Q

Define TIA

A
  1. Sudden onset
  2. Focal neuro deficit
  3. Vascular aetiology
  4. Resolving Sx within 1h
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20
Q

Sx of TIA

A

Sudden onset of focal neuro deficits
- Dysphasia (speech)
- Arm or leg weakness
- Sensory changes
- Ataxia, vertigo
- Visual disturbance

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21
Q

Ix of TIA

A
  1. MRI
  2. Carotid USS
  3. ECHO
  4. 24h tape
  5. Bloods (glucose, lipid, clotting)
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22
Q

Tx of TIA

A
  1. Lifestyle mods
  2. Control vasc. rf
  3. Aspirin + clopidogrel
  4. Stenting
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23
Q

Summarise Status epilepticus

A
  1. Seizure >5 minutes OR multiple seizures over 5 minutes without returning to full level of consciousness
  2. Tx
    • Premonitory stage (0-10mins)
      • Diazepam 10-20mg
    • Early status (0-30mins)
      • Buccal/rectal Diazepam (community)
      • 0.1mg/kg Lorazepam (IV)
    • Established status (0-60mins)
      • Phenytoin
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24
Q

State caveat to hypo management (glucose) in alcohol abuse pt

A

IV pabrinex PRIOR to glucose
- Avoid precipitation of Wernicke’s encephalopathy (B1 deficiency)

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25
Define SDH
1. Accumulation of blood 2. Between dura mater and arachnoid mater
26
Ax of SDH
1. Trauma 2. Bleeding disorder 3. Anticoag therapy 4. Chronic alcohol
27
Sx of SDH
1. Headache 2. N+V 3. Confusion 4. Diminished eye, verbal or motor response 5. Focal neuro signs 6. Sub-acute presentation (3d ->3w) 7. Chronic presentation (>3w)
28
Ix of SDH
1. Hyperacute phase (<1h) - Isodense clot + cerebellar oedema 2. Acute phase (<3d) - Crescent shaped hyperdense collection 3. Sub-acute phase (3d -> 3w) - Need contrast enhanced CT/MRI 4. Chronic phase (>3w) - Hypodense haemotoma
29
Tx of SDH
1. Acute - craniotomy 2. Chronic - burr holes
30
Define SAH
1. Bleed in subarachnoid space 2. Beneath arachnoid mater
31
Rf for SAH
1. Hypertension 2. Adult polycystic kidney disease 3. Xs EtOH 4. Smoking
32
Sx of SAH
1. Sudden onset severe headache 2. Hx of physical exertion or coitus prior to onset 3. Loss of consciousness 4. Previous sentinel headache (similar but not severe) 5. Meningism (stiff neck)
33
Ix of SAH
1. CT head 2. CSF if CT not definitive (CSF for xanthochromia) 3. CT angiogram next line
34
Tx of SAH
1. Medical - Nimodipine (prevent vasospasm) 2. Radio + surgical - Coiling or stenting
35
Define EDH
1. Bleed between dura mater and inner surface of skull 2. Almost always trauma induced
36
Sx of EDH
1. Brief loss of consciousness post initial trauma, regain then subsequent deterioration 2. Headache 3. N+V 4. Seizures
36
Ix for EDH
1. ECG - exclude heart block 2. BM - exclude hypo 3. CT head 4. Bloods - Anaemia from blood loss - U&Es and LFTs if GA needed - Coag screen - Group + save
37
Summarise Sub-acute combined degeneration of the cord (SCDC)
1. Neuro disorder from B12 deficiency 2. Degen of dorsal columns 3. Symmetrical distal sensory Sx, mixed UMN and LMN signs 4. MRI + nerve conduction studies 5. B12 replacement therapy
37
Tx of EDH
1. Conservative + A->E 2. Anticonvulsants 3. Burr hole craniotomy
38
Summarise Spinal cord compression (SCC)
1. Medical emergency 2. Sx include: - Weakness + sensory disturbance below level of compression - Deep back pain - Bladder and bowel involvement - UMN signs 3. Ax include: - Trauma - Malignancy - Disc prolapse 4. Ix - MRI spine 5. Tx - high dose steroids + neurosurgery
39
UMN lesion signs
1. Disuse atrophy 2. Increased tone 3. Hyperreflexia 4. Babinski sign (upgoing plantars)
40
LMN lesion signs
1. Marked atrophy 2. Reduced tone 3. Fasiculations (involuntary twitches) 4. Downgoing plantars
41
Sx of spastic hemiparesis
1. Unilateral spastic hypertonia 2. Hyper-reflexia 3. Ankle clonus 4. Upgoing plantar 5. Pyramidal weakness
42
Describe spastic hemiparesis
1. Arm in flexion (upper limb flexor stronger than extensor) 2. Lower limb in extension (vice versa)
43
Ax of spastic hemiparesis
1. Lesion in contralateral cerebral hemisphere 2. MS
44
Sx of sensory peripheral neuropathy
1. Weakness, numbness, pain 2. Glove + stockings presentation
45
Ax of sensory peripheral neuropathy
1. Alcohol toxicity 2. B12 deficiency 3. Chronic renal failure 4. DM 5. Vasculitis
46
Summarise Parkinsonism
1. Bradykinesia + at least one of: - Rigidity - Tremor - Postural instability 2. Non motor features - Autonomic dysfunction (constipation) - Olfactory loss - Psych features
47
Summarise Parkinson's
1. Neurodegen disorder adults >65 2. Asymmetric tremor, bradykinesia, rigidity 3. Lewy body formation + neuronal death in dopaminergic cells of substantia nigra 3. Clinical Dx 4. Tx - Levodopa
48
Summarise optic neuritis
1. Inflammation of optic nerve 2. Adult women 3. Sx include: - Visual loss - Periocular pain - Loss of colour vision 4. Ax include: - Demyelinating lesions (MS) - Autoimmune 5. Ix include: - Visual assessment - MRI 6. Tx include: - Methylpred
49
Summarise normal pressure hydrocephalus (NPH)
1. Triad of Sx: - Dementia - Magnetic gait (feet stuck to floor) - Incontinence 2. Ix include: - CT/MRI (dilated lateral ventricles) 3. Tx include: - Therapeutic LP
50
Summarise the Glasgow Coma Scale
1. Eye response - 4/4 = open spontaneously - 3/4 = open to voice - 2/4 = open to pain - 1/4 = do not open 2. Verbal response - 5/5 = oriented - 4/5 = confused - 3/5 = inappropriate words - 2/5 = incomprehensible sounds - 1/5 = no sounds 3. Motor response - 6/6 = obey command - 5/6 = localises to pain - 4/6 = withdraws to pain - 3/6 = abnormal flexion to pain - 2/6 = extension to pain - 1/6 = no movement THRESHOLD FOR INTUBATION: GCS 8
51
Summarise myasthenia gravis
1. Autoimmune disease 2. Antibodies against nicotinic ACh receptors on muscle fibres -> muscle weakness 3. Sx include: - Fatigable muscle - Weakness - Bilateral ptosis 4. Ix include: - Bloods: serum ACh receptor antibody - CT chest 5. Tx include: - Immunosuppressive therapy - AChesterase inhibitors
52
Summarise MND
1. Protein misfolding 2. UMN + LMN signs 3. Resp complications usual cause of death
53
Summarise migraine
1. Recurrent, unilateral throbbing headache 2. Preceded by aura 3. 4-72h, photophobia, phonophobia, N+V 4. Tx: Propranolol, amitriptyline (prophylaxis)
54
Define meningitis
Inflammation of meninges (dura mater, arachnoid mater and pia mater)
55
Ax of meningitis
1. bacterial - Strep. pneumoniae - N. meningitidis - H. influenzae 2. Viral - Enteroviruses 3. Fungal - Cryptococcus neoformans 4. Parasitic - Amoeba - Toxoplasma
56
Sx of meningitis
1. Headache 2. Fever 3. Neck stiffness 4. Photophobia 5. N+V 6. NON BLANCHING PETECHIAL RASH
57
Signs of meningitis
1. Kernig's - Lie flat - Hip + knee 90 degree flex - Extend patient knee - Resistance = +ve 2. Brudzinski's - Lay flat, passive flex neck towards chest - Flexion of hip and knee by pt = +ve
58
Ix of meningitis
1. LB for CSF 2. Bloods - FBC - U+Es - Clotting - Glucose - Cultures - ABG 3. Bact. throat swab 4. PCR (viral) 5. HIV
59
Summarise CSF interpretation for meningitis
1. Bacterial meningitis - Clear/turbid - Neutrophils - Culture +ve - Protein ^ - Glucose = reduced 2. Viral - Clear/turbid - Lymphocytes - Culture -ve - Protein ^ - Glucose = normal 3. Tuberculous - Clear - Turbid - +/- fibrin web - Lymphocytes + neutrophils - -ve stain; acid-fast bacilli +ve - Protein ^ - Glucose = reduced
60
Tx of meningitis
1. Bacterial - IV ceftriaxone (suspected) - Dexamethasone (strongly suspected) 2. Viral - Aciclovir
61
Summarise Lyme disease
1. Ixodes tickes 2. Stage 1 (localised disease, several weeks) Sx include: - Tick bite - Flu Sx - Regional lymphadenopathy 3. Stage 2 (early disseminated disease, weeks - months after bite) - Continued flue like Sx - Neuroborreliosis (facial nerve) - Early painful arthiritis 4. Stage 3 (late disseminated disease, months to years post bite) - Arthritis - Late neuro disorders 5. Tx includes: - Doxy
62
Summarise Lambert-Eaton Myasthenic Syndrome (LEMS)
1. Autoimmune disorder 2. Affects neuromuscular transmission 3. Antibodies against pre-synaptic voltage gated Ca2+ channels 4. ASSOCIATED WITH SCLC 5. Sx: autonomic features + weakness
63
Summarise TACI
Total Anterior Circulation Infarct (TACI) - Anterior AND middle cerebral arteries on affected side - Contralateral hemiplegia (complete paralysis or hemiparesis (partial paralysis) - AND contralateral homonymous heminopia - AND higher cerebral dysfunction (aphasia)
64
Summarise PACI
Partial Anterior Circulation Infarct - Anterior OR middle cerebral artery - 2 of the TACI presentation - OR higher cerebral dysfunction alone
65
Summarise LACI
Lacunar Circulation Infarct with 1 out of: - Pure motor stroke - Pure sensory stroke - Sensorimotor stroke - Ataxic hemiparesis - Dysarthia
66
Summarise POCI
Posterior Circulation Infarct - Vertebrobasilar arteries (supplying cerebellum, brain stem, occipital lobe) - Cerebellar dysfunction - OR conjugate eye movement disorder - OR bilateral motor/sensory deficit
67
Tx of ischaemic stroke
1. CT head to rule out haemorrhagic stroke 2. CT angio for large vessel occlusion 3. Thrombolysis with ALTEPLASE if within 4.5h of Sx onset + no contraindication of: - trauma - recent surgery - SBP > 185 - Oral anticoag 4. Mechanical thrombectomy
68
Summarise spinal claudication
1. Degenerative disease of lumbar spine with narrowing of spinal canal 2. Sx include: - Insidious onset back pain - Leg pain + weakness + numbness - Activity related - Relieved from stooped posture/bend over 3. Dx - MRI 4. Tx - Physio, pain Mx, decompression surgery
69
Summarise Huntingdon's disease
1. Autosomal dominant neurodegen 2. Choreoathetosis + dementia 3. Dx - Genetic testing 4. Tx - MDT Sx relief (Tetrabenazine for chorea) + pt support
70
Summarise Horner's syndrome
1. Collection of signs and Sx from impairment to sympathetic nerve supply to eye 2. Sx include: - Ptosis - Miosis (constriction of pupil) - Anhidrosis (lack of sweating) on affected side 3. Ix include: - CT head for tumours or vasc. abnormalities - Bloods: DM or autoimmune causes 4. Tx: Manage/ treat underlying cause
71
Summarise GBS
1. Acute inflammatory demyelinating polyneuropathy 2. Rapid, progressive, ascending symmetrical weakness, often preceded by infection 3. Dx: Clinical + LP and nerve conduction studies 4. Tx: Supportive + IVIG (IV immunoglobulins)
72
Summarise typical absence seizures
1. Petit mal 2. Brief episodes 3-20s 3. Staring with impairment of awareness and responsiveness 4. Usually begins 4-14 yrs, resolve by 18 5. Provoked by hyperventilation 6. EEG: 3 Hz spike-wave discharge 7. Back to normal straight after
73
Summarise atypical absence seizures
1. 5-30s 2. Not provoked by hyperventilation 3. Reduction in responsiveness incomplete 4. Usually children with global cogn. impairment therefore hard to distinguish 5. Persist into adulthood
74
Summarise tonic-clonic seizures
1. Grand mal/ convulsive 2. Loss of consciousness 3. Initial tonic phase: - Stiffening with a cry evoked by air forced through contracted vocal cords - Legs extended + arms extended/flexed 4. Subsequent clonic phase: - Jerking of extremities - Gradual increase in amplitude + decrease in frequency 5. 30-120s 6. Drooling or foaming 7. Tongue, cheek or lip biting 8. Incontinence 9. Postictal lethargy 10. Postictal lethargy + confusion
75
Which nerve is involved in facial nerve palsy?
CN7 (facial nerve)
76
Summarise Creutzfeldt-Jakob disease
1. Rapidly progressive 2. Universally fatal 3. Neurodegen disorder 4. Sx include: - Rapidly progressive dementia - Psych disturbance - Myoclonus 5. Tx: Palliative
77
Summarise seizure and DVLA rules
1. One off seizure = reapply in 6m 2. >1 = reapply in 12m 3. Seizure following change in antileptic meds = last seizure 6m ago
78
Summarise focal seizures
1. Complex - With impaired consciousness - Temporal lobe - Post-ictal Sx common (confusion) 2. Simple - Without impaired consciousness - Post-ictal Sx absent
79
Management of seizures
1. Focal seizures: Lamotrigine 2. Absence seizures: Ethosuximide 3. Carbamazepine may WORSEN myoclonic seizures
80
Summarise diabetic peripheral neuropathy (DPN)
1. Distal symmetrical sensory neuropathy 2. Small fibre predominant neuropathy (loss of pain/temp change sensation) 3. Charcot arthropathy
81
Cause of diplopia
1. CN3 = occulomotor 2. CN4 = trochlear 3. CN6 = abducens
82
Tx for cluster headaches
1. Sumatriptan 2. Steroids 3. Greater occipital nerve blocks 4. Li (prophylaxis)
83
Sx of cerebellar syndromes
1. Dysdiadochokinesia - hand roti 2. Ataxia - unsteady gait 3. Nystagmus - involuntary eye movements 4. Intention tremor (finger-nose test: tremor as they approach target) 5. Slurred speech
84
Which nerves bulbar palsy?
CN 9, 10, 12
85
Summarise Brown-sequard syndrome (BSS)
1. Damage to one side of spinal cord 2. Sx include: - Ipsilateral hemiplegia - Loss of proprioception + vibration - Loss of pain and temperature sensation 3. Most common cause = trauma, disk herniation
86
Summarise Bell's palsy
1. LMN facial weakness 2. Altered taste + dry eyes/mouth 3. Tx: corticosteroids
87
Summarise Alzheimer's
1. Progressive neurodegen disorder 2. Cogn. decline, memory impairment 3. Amyloid plaques 4. Tau tangles 5. Neuronal loss + brain atrophy 6. Neurotransmitter imbalance 7. Inflammatory response
88

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