Neurology Flashcards

Question

carotid artery assessment post TIA or stroke ?

Answer 1

Carotid endarterectomy - if stenosis >70% - consider angioplasty / stenting

Answer 2

- warfarin / DOAC - start immediately in TIA - wait 2wks in acute stroke

Answer 3

Fluids - assess hydration - oral hydration, IV saline (no dextrose) Glycaemic control - monitor BMs - aim for 4-11 - IV insulin / glucose infusions for diabetics BP Mx - use anti-HTN if hypertensive emergency - IV labetalol, nicardipine.... Feeding - screen for safe swallow - NG feed - nasal bridle tube / gastrostomy - assess meds for NG feed - nutritional support Disability - Barthel index to measure functional decline

Answer 4

- transient episode of neurological dysfunction caused by focal brain/spinal cord/retinal ischaemia, without acute infarction

Answer 5

2+ TIAs in 1wk - high risk of stroke

Answer 6

- Typically resolve in 1hr - Unilateral weakness / sensory loss - Aphasia / dysarthria - Ataxia, vertigo, loss of balance - Visual problems, amaurosis fugax, diplopia, homonymous hemianopia

Answer 7

- CT - MRI, inc diffusion-weighted / blood-sensitive - Carotid imaging - doppler, CT/MR

Answer 8

- aspirin 300mg - don't drive until seen by specialist - clopidogrel / aspirin + dipyridamole - carotid artery endarterectomy if stenosis >70% - atorvastatin 80mg Specialist review - If >1 TIA / suspected cardioembolic source / severe carotid stenosis - ?admission / observation with stroke specialist - Suspected TIA in last 7d – specialist review in 24hrs - Suspected TIA >7d ago – specialist review asap within 7d

Answer 9

- blood between skull + dura - trauma, fracture to temporal/parietal bone, rupture of middle meningeal artery

Answer 10

- head trauma - initial LOC / drowsiness - lucid interval, later low GCS - headache, N+V, confusion, seizures, focal neurology, fixed dilated pupil, deep coma

Answer 11

response to acutely raised ICP: - bradycardia - irregular respirations - HTN / increase in pulse pressure (systolic up, diastolic down)

Answer 12

- bloods, inc G/S - non-contrast CT head - biconvex (lemon) hyperdense collection +/- mass effect

Answer 13

- A-E Neuroprotection - 30deg tilt head up - oxygenation, loosen collars - intubate + ventilate - normostasis - normotension, normoglycaemia - hyperventilate if coning - IV mannitol - hypertonic saline (3%) - levetiracetam - seizures Neurosurgery - ICP bolt / EVD - burr hole / open craniotomy

Answer 14

- blood between dura + arachnoid layers - acute / subacute / chronic

Answer 15

- rupture of bridging veins between cortex + sinus - infants (NAI), elderly/alcoholics (cerebral atrophy) - bleed forms haematoma - when this breaks down, proteins become soluble - haematoma expands, ICP rises

Answer 16

- Head injury - Lucid interval - can be days/wks/months - Personality change, sleepiness, unsteadiness - Fluctuation in consciousness, memory loss, cognitive impairment - Focal neuro deficit - Seizure, headache, coma, vomiting - Fixed dilated pupil

Answer 17

- non-contrast CT head - hyperdense crescent (sickle) shaped collection - bloods etc

Answer 18

- A-E - neuroprotection Neurosurgery - Burr hole / open craniotomy, clot evacuation

Answer 19

bleed into subarachnoid space - between arachnoid / pia (where CSF is)

Answer 20

Traumatic - most common cause of SAH Spont - Berry aneurysm - 85% spont cases - HTN, PKD, EDS, coarc aorta - AV malformation - pituitary apoplexy - mycotic aneurysms

Answer 21

- 45-70yo, F, black, HTN, smoking, alcohol, FHx, cocaine, SCA, Marfan's, EDH, PKD

Answer 22

- sentinel headache - less severe in wks before px - sudden onset occipital headache - thunderclap - N+V - photophobia, neck stiffness, Kernig's, Brudzinski's - coma - seizures - papilloedema, fixed dilated pupil, Cushing's - maybe ST elevation

Answer 23

Non-contrast CT head - bright star-shaped lesions - if CT head <6hrs of sx onset + normal - LP not indicated - CT less reliable >6hrs - so if normal - consider LP LP - >12hrs after sx onset - xanthrochromia - raised opening pressure - raised red cell count CT intracranial angiogram +/- catheter angiogram

Answer 24

- nimodipine Neurosurgery - endovascular coiling - neurosurgical clipping - intracranial stents / balloons

Answer 25

- rebleed - 20% - cerebral ischaemia - hydrocephalus - VP shunt / EVD - hyponatraemia (SIADH) - fluid restriction

Answer 26

- bleed in brain tissue - spontaneous / secondary to ischaemic stroke, tumours, aneurysm rupture Px - similar to SAH - stroke, focal neurology, reduced GCS Ix - non-contrast CT head - hyperdensity in substance of brain

Answer 27

CT head <1hr if any of: - GCS 12 or lower on initial assessment - GCS <15 2hrs after injury - ?open / depressed skull fracture - Signs of basal skull fracture – haemotympanum, panda eyes, CSF oto/rhinorrhoea, Battle’s sign - Seizure - Focal neurology - 1+ episodes vomiting If none of the above, do CT head <8hrs of injury if there is LOC / amnesia, and any of: - >65yo - Bleeding / clotting disorders - Dangerous MOI - >30 mins retrograde amnesia of events just before injury If no RFs of any category above, CT head <8hrs of injury if anticoagulated: - Warfarin, DOACs, heparin, clopidogrel

Answer 28

- irreversible, progressive decline of higher brain function - cognitive/behavioural sx - memory loss, reasoning/communication problems, change in personality, reduction in ADLs

Answer 29

- older, mild cognitive impairment, genetics, Parkinson's, CVA, smoking, DM, sedentary, obesity

Answer 30

- type of dementia (50-75%) - amyloid plaques / tau proteins in brain - reduce transmission, brain cell death - widespread cerebral atrophy, esp cortex / hippocampus

Answer 31

- Steady decline - Memory loss - Loss of executive function / dysphasia - Aphasia, apraxia, agnosia - Changes in planning, reasoning, speech, orientation

Answer 32

- wellbeing activities, cognitive stimulation therapy, group reminiscence therapy, cognitive rehab - 1st - AChE inhibitors - donepezil, galantamine, rivastigmine - 2nd - NMDA receptor antagonist - memantine - antipsychotics - if risk of harming themselves

Answer 33

- type of dementia (<20%) - Group of syndromes of cognitive impairment caused by ischaemia / haemorrhage secondary to cerebrovascular disease - affects white matter of cerebral hemispheres, grey nuclei, thalamus, striatum Types - stroke-related - multi/single-infarct - subcortical - small vessel disease - mixed dementia - VD + Alzheimer's

Answer 34

- previous stroke/TIA, older, AF, DM, lipids, smoking

Answer 35

- Stepwise progression - stability + acute decline - Cognitive impairment - Mood disturbance - psychosis, delusions, hallucinations, paranoia - Gait, speech, emotional, memory disturbance - Seizures - Focal neurolog

Answer 36

- screen for depression, psychomotor retardation - formal cognitive screen - MRI - infarcts, white matter changes - Dx with NINDS-AIREN criteria

Answer 37

- cognitive stimulation syndromes, multisensory stimulation, music/art therapy, animal therapy - address pain, avoid overcrowding, clear communication

Answer 38

- type of dementia (10-15%), >50yo - lewy body proteins deposited in brain - SN, paralimbic, neocortical areas

Answer 39

- progressive cognitive impairment - may fluctuate, early impairments to attention, executive function - sleep disorder - visual hallucinations - Parkinson's like sx - bradykinesia, resting tremor, rigidity

Answer 40

- AChE - donepezil, rivastigmine - avoid neuroleptics (may develop Parkinsonism)

Answer 41

- type of dementia (2%), <65yo - neuron damage/death at frontal/temporal lobes, atrophy due to tau protein deposition

Answer 42

Behavioural - Change in behaviour / personality, eg disinhibited, impulsive, decline in social skills.. Semantic - Lack of understanding word meanings, difficulty in name retrieval… Non-fluent - Breakdown in speech, apraxia, decline in literac

Answer 43

- maybe SSRIs / trazadone for behavioural sx

Answer 44

Cognitive impairment - Memory loss, difficulty with reasoning / communication / decisions, dysphasia, coordinating movements, not orientated Behavioural and psychological sx of dementia (BPSD) - Psychosis – delusions / hallucinations, agitation / emotional lability, depression / anxiety, motor disturbance, sleep disturbance Difficulties with ADLs - Household tasks, toileting eating, walking

Answer 45

- CJD - HIV-related cognitive impairment / dementia - depression - normal pressure hydrocephalus - mild cognitive impairment - delirium - reversible causes - hypothyroid, Addison's, B12, folate, thiamine, syphilis, tumour, SDH, drugs,

Answer 46

- cognitive screen - bloods: - Exclude reversible causes (eg hypothyroid) – FBC, U/E, LFTs, Ca, glucose, ESR/CRP, TFTs, vit B12, folate - Maybe urine MC+S, CXR, ECG, syphilis serology, HIV testing Imaging - CT / MRI head - consider SPECT scan, PET scan

Answer 47

NICE recommended - 10-CS - 6CIT - 6-item screener - memory impairment screen - mini-cog - Test your memory Not NICE recommended - AMTS - GPCOG - MMSE

Answer 48

- TLOC - mechanical fall - geriatric fall - visual impairment - BPPV - drugs, polypharmacy

Answer 49

- syncope - seizure - hypoglycaemia - head injury - narcolepsy - stroke

Answer 50

- transient LOC due to cerebral hypoperfusion - low BP after fall in CO / SVR

Answer 51

- fall in BP >20/10 on standing - blood pools in legs with gravity, reduced venous return, reduced preload/EDV/SV/CO (normally compensated for by sympathetic increase in HR/SVR - Primary autonomic failure - older, Parkinson's, Lewy Body, MSA - secondary - DM, adrenal insufficiency, hypothyroid - drugs - anti-HTN, diuretics, alcohol - hypovolaemia - D+V, diuresis, haemorrhage

Answer 52

- structural - MI, valvular heart disease, cardiomyopathy - Arrhythmias - tachy/brady

Answer 53

- increase in vagal tone - vasovagal - pain/emotions - carotid sinus hypersensitivity - situational syncope - micturition, defecation, cough

Answer 54

Leg weakness, vision problems, balance / gait disturbance, polypharmacy, incontinence, >65yo, depression, arthritis, psychoactive drugs, cognitive impairment

Answer 55

Meds that cause postural hypotension - Nitrates, diuretics, anticholinergics, antidepressants, BBs, levodopa, ACEi Meds that cause falls by other mechanisms - Benzos, antipsychotics, opiates, anti-epileptics, codeine, digoxin, sedatives

Answer 56

- Hx - before, during, after, any LOC, injuries, anticoags, collateral hx, seizure sx, what were they doing at the time, ?self-mobilised, DHx, SHx... - A-E - Full cardio, resp, GI, neuro exams - Check c-spine, pelvis, hips (?SLR), - Obs, BMs, urine dip, ECG - FBC, U/E, LFTs, bone profile, Mg, CRP, CK if long lie, coag, haematinics, vit D, TFTs - XR of injured limbs - CT head - ECHO - Lying standing BP - Turn 180 tests / timed up and go test - Tilt table test - measure HR / BP as table with pt on tilts - for postural hypotension

Answer 57

- tx cause - adjust meds - IV fluids - Cardiology referral if needed - Maybe neuro obs - Vasovagal / situational - reassure - Inpatient – 1-1 nursing, non-slip socks, low rise beds / mattresses on floor - Walking aids - OT/PT review - Package of care if going home

Answer 58

- Tx cause, review meds, ensure hydrated - Fludrocortisone - Midodrine – alpha agonist – for true autonomic dysfunction

Answer 59

- chronic condition of demyelination in the CNS - plaques of demyelination in brain + spinal cord - autoimmune inflammatory response - new myelin is less efficient - genetics, EBV, low vit D, smoking, obesity

Answer 60

- clinically isolated - relapsing remitting - secondary progressive - primary progressive

Answer 61

- First episode of demyelination - May never have another episode, or go on to develop MS

Answer 62

- 85% - Acute attacks (1-2mo), periods of remission

Answer 63

- Deterioration after relapsing-remitting – neuro signs between relapses - 65% with relapsing-remitting go on to develop secondary progressive within 15yrs of dx

Answer 64

- 10% pts - Progressive deterioration from onset - More common in older pts

Answer 65

- sx can progress over >24hrs, last days-wks, then improve Visual - optic neuritis - unilateral reduced vision, central scotoma, pain with eye movt, impaired colour vision, RAPD - optic atrophy - Uhthoff's - vision worse with warm body temp - internuclear ophthalmoplegia - impaired adduction ipsilaterally, nystagmus contralaterally, conjugate lateral gaze disorder Sensory - paraesthesia, numbness, trigeminal neuralgia, Lhermitte's syndrome Motor - spastic weakness - legs Cerebellar - ataxia - sensory / cerebellar - tremor Others - urinary incontinence - sexual dysfunction - intellectual dysfunction - transverse myelitis

Answer 66

- 2+ relapses of different parts of CNS - disseminated in space and time - Or objective clinical evidence of one lesion + reasonable hx evidence of previous relapse

Answer 67

- exclude ddx - FBC, CRP/ESR, U/E, LFTs, glucose, HIV, auto-ABs, Ca, vit B12 - MRI - high-signal T2 lesions, periventricular plaques, Dawson fingers - LP - oligoclonal bands - electrophysiology - visual evoked potential studies delayed

Answer 68

Acute relapses - high dose oral / IV steroids - methyl/prednisolone Disease-modifying therapies - natalizumab, ocrelizumab, fingolimod... Symptomatic tx - fatigue - amantadine, mindfulness, CBT - spasticity - baclofen/gabapentin, diazepam, physio - bladder dysfunction - USS, ISC, anticholinergics (solifenacin) - oscillopsia - gabapentin/memantin

Answer 69

- progressive destruction of motor neurons - cause unknown, 5% have SOD1 mutation - possibly mitochondrial dysfunction - oxidative stress, ROS damages stuff - Frontotemporal dementia in 25%

Answer 70

- amyotrophic lateral sclerosis (ALS) - progressive bulbar palsy (PBP) - progressive muscular atrophy (PMA) - Primary lateral sclerosis (PLS)

Answer 71

- <80% - most common - Loss of motor neurons in motor cortex and anterior horn of cord – UMN + LMN

Answer 72

- 10-20% - CN9-12 – LMN - Affects muscles of talking + swallowing, tongue also

Answer 73

- <10% - Anterior horn lesion – LMN - Affects distal muscle groups before proximal

Answer 74

- Loss of bets cells in motor cortex – UMN - Marked spastic leg weakness, pseudobulbar palsy, no cognitive decline

Answer 75

- Insidious, progressive weakness – often first in upper limbs - Fatigue when exercising - Clumsiness, dropping things - Dysarthria – slurred speech - dysphagia, fluid regurg, choking LMN signs - Muscle wasting - Reduced tone – flaccid paralysis - Fasciculations - Reduced reflexes UMN signs - Increased tone – spastic paralysis - Brisk reflexes - Upgoing plantar reflex

Answer 76

- Muscle wasting - Reduced tone – flaccid paralysis - Fasciculations - Reduced reflexes

Answer 77

- Increased tone – spastic paralysis - Brisk reflexes - Upgoing plantar reflex

Answer 78

- clinical dx - NCS - normal - EMG - reduced no of APs, increased amplitude - MRI - exclude myelopathy etc

Answer 79

- riluzole - NIV - resp support - baclofen - PEG - benzos - advanced directives

Answer 80

- immune mediated demyelination of PNS - triggered by infection - C jejuni - ABs against infection attack Schwann cells -> demyelination

Answer 81

- hx of GE - sx peak in 2-4wks, recovery years - back/leg pain - progressive, symmetrical weakness of limbs - ascending, reflexes reduced, mild paraesthesia, neuropathic pain, hypotonia - CNs - diplopia, bl facial nerve palsy, oropharyngeal weakness - resp muscle weakness - autonomic - diarrhoea, urinary retention

Answer 82

- LP - raised protein, normal WCC - NCS - decreased velocity - spirometry - monitor FVC

Answer 83

- FVC <80% - mechanical ventilation - IV Ig 1st line - plasma exchange - VTE prophylaxis

Answer 84

- autoimmune disorder with ABs against AChR in NMJ - ABs block receptors, prevent ACh stimulation, - thymoma link - autoimmune link - thyroid, pernicious anaemia, RA, SLE, thymic hyperplasia

Answer 85

- muscle weakness - worse with activity, improves with rest - extraocular - diplopia - proximal muscle weakness - face, neck, limb girdle - ptosis - dysphagia - slurred speech, jaw fatigue

Answer 86

Tests to elicit fatigability - Count to 50, voice quietens - Prolonged upward gazing exacerbates diplopia - Repeated blinking -> ptosis - Repeated abduction of one arm 20x -> unilateral weakness on that side

Answer 87

- ABs - AChR, MuSK, LRP4 - CK normal - CT / MRI thorax - thymus - Single fibre electromyography

Answer 88

- AChE inhibitors - pyridostigmine - immunosuppression - prednisolone, azathioprine, cyclosporin, mycophenolate - thymectomy - rituximab

Answer 89

- life-threatening cx of MG - acute worsening of sx - often triggered by illness - eg resp infection - monitor FVC - resp failure - NIV / mechanical ventilation Mx - IV Ig - plasmapheresis

Answer 90

- Inherited neurodegenerative disorder which causes chorea - jerky, semi-purposeful movements - autosomal dominant - CAG repeats, may see anticipation - lack of GABA + ACh, decreased inhibition of dopamine release -> excessive movts

Answer 91

- Sx develop >35yo - Starts with mild psychotic / behavioural sx - cognitive, psych, mood problems - Chorea - random, irregular, abnormal body movts - Personality changes - irritable, apathy, depression, intellectual impairment - Dystonia - Rigidity - Speech / swallowing difficulties - Saccadic eye movts

Answer 92

- genetic testing, genetic counselling

Answer 93

- MDT, physio, SALT - chorea - benzos, tetrabenazine, sulpiride - antidepressants - advanced directives

Answer 94

- Progressive degenerative movt disorder caused by degeneration of dopaminergic neurons in substantia nigra (in basal ganglia) - dementia, depression associations - from mitochondrial dysfunction / oxidative stress

Answer 95

Tremor - worse at rest, 4-6Hz - worse stressed/tired - improves on voluntary movt - pill-rolling Bradykinesia - hypokinesia/poverty of movt - short, shuffling steps, reduced arm swinging - difficulty initiating movt - micrographia / monotonous hypophonic speech Rigidity - increased tone in limbs/trunk - lead pipe - throughout ROM - cogwheel - superimposed tremor

Answer 96

- hypomimia - reduced facial movts - flexed posture - saliva drooling - psych - depression, dementia, psychosis, sleep disturbance, cognitive impairment, memory problems - anosmia - REM sleep behaviour disorder - fatigue - postural hypotension

Answer 97

Causes of Parkinsonism - Parkinson's disease, drug induced (antipsychotics, metoclopramide, domperidone), PSP, MSA, Wilson's, CO poisoning Drug-induced parkinsonism - rapid onset motor sx, bilateral - rigidity/resting tremor uncommon Benign essential tremor - symmetrical, 6-12Hz, improves at rest, worse with voluntary movts, improves with alcohol

Answer 98

- clinical dx - CT / MRI head - Use UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria - SPECT scan

Answer 99

First line - if motor sx affecting QoL - levodopa - if not - dopamine agonist / levodopa / MAO-B Neuropsych sx - anti-depressants, anti-psychotics Anti-muscarinics - block cholinergic receptors - drug-induced Parkinsonism - procyclidine

Answer 100

- synthetic dopamine, less effective over time - add decarboxylase inhibitor - prevent peripheral metabolism - co-beneldopa (Madopa) - co-careldopa (Sinemet) - S/Es - dyskinesia (amantadine to tx), on-off effect, end-of-dose wearing off, postural hypotension, arrhythmias, N+V, psychosis

Answer 101

- bromocriptine, cabergoline, pergolide - mimic dopamine action - S/Es - pulm/cardiac fibrosis, impulse control disorders

Answer 102

- selegiline, rasagiline - inhibit MAO-B - break down dopamine, serotonin, adrenaline - can use with levodopa to reduce end of dose sx worsening

Answer 103

- entacapone - inhibits enzyme that breaks down levodopa - take with levodopa to slow its breakdown

Answer 104

- group of neurodegenerative diseases with classical sx of Parkinson's + additional features Multiple system atrophy (MSA) - neurons of brain degenerate, inc basal ganglia - Parkinsonism, autonomic dysfunction, cerebellar dysfunction Progressive supranuclear palsy (PSP) - postural instability, falls, impairment of vertical gaze - parkinsonism, cognitive impairment Corticobasal degeneration (CBD) Dementia with Lewy bodies (DLB) Frontotemporal dementia (Pick's disease)

Answer 105

neurological condition characterised by recurrent seizures

Answer 106

Disordered electrical activity in the brain leading to clinical manifestationsexcessive, abnormal electrical activity in the brain

Answer 107

- epilepsy - febrile convulsions - alcohol withdrawal - non-epileptic - idiopathic - stroke, haemorrhage - head injury - Alzheimer's, dementia - tumour - metabolic disturbance - electrolytes

Answer 108

- Situational - Longer - Closed eyes / mouth during tonic clonic - No incontinence / tongue biting - May have psychological cause - Don't occur during sleep - Preserved consciousness - Purposeful movements - Pelvic thrusting - crying afterwards

Answer 109

Focal (partial) seizures - one hemisphere, specific area - simple - no LOC - complex - impaired awareness - secondary generalised - evolve into bl, convulsive seizure Generalised seizure - widespread, both hemispheres, LOC - Tonic-clonic - muscle tensing + muscle jerking - Absence - blank/unresponsive for 10-20s - Myoclonic - rapid, brief muscle jerks - Atonic - sudden loss of muscle tone

Answer 110

- infantile spasms / West syndrome - tx with ACTH / vigabatrin - Lennox-Gastaut syndrome - Benign rolandic epilepsy - Juvenile myoclonic epilepsy

Answer 111

Tonic clonic - Tonic clonic - LOC - Tongue biting - Incontinence - Groaning Focal - Motor – Jacksonian march - Sensory – déjà vu, jamais vu, strange smells / tastes / sight / sound Absence - Stop activity, vacant, 20-30s, carries on Myoclonic - Sudden isolated jerk of muscle Tonic seizure - Sudden increased tone, intense stiffness, no jerking - Characteristic cry / grunt Atonic - Loss of muscle tone, fall

Answer 112

- Pt aware - Strange gut feeling, déjà vu, strange smells, flashing lights - Implies focal seizure, but not necessarily in temporal lobe

Answer 113

- Confused, tired, irritable, low - Todd’s paralysis – temporary weakness after seizure - May have dysphasia – from focal seizure in temporal lobe

Answer 114

Temporal lobe (memory, emotion, speech understanding) - Rising epigastric sensation - Aura – déjà vu, jamais vu, auditory hallucinations, funny smells, fear - Anxiety, out-of-body experience, automatisms – eg lip smacking, chewing, fiddling

Answer 115

Frontal lobe (motor and thought processing) - Motor features – posturing, peddling movts of leg - Jacksonian march (seizure ‘marches’ up/down motor homunculus starting in face/thumb) - Post-ictal Todd’s paralysis – paralysis of limbs involved in seizure

Answer 116

Parietal lobe (interprets sensations) - Paraesthesia

Answer 117

Occipital lobe (vision) - Visual phenomena – spots, lines, flashes

Answer 118

Vasovagal syncope. Cardiac syncope. Non-epileptic attacks. Intermittent hydrocephalus (rare). Migraine (if no loss of awareness).

Answer 119

clinical dx = >2 unprovoked seizures >24hrs apart Bloods - FBC, U/E, bone profile, Mg, LFTs, glucose ECG ?infective cause - blood/urine cultures, LP, CXR CT / MRI head EEG - support dx

Answer 120

- most neurologists start AEDs after 2nd seizure - start after 1st seizure if - neuro deficit, structural abnormality, EEG unequivocal of epilepsy, family find further seizure unacceptable - prescribe by brand (not generic)

Answer 121

M - sodium valproate F - lamotrigine / levetiracetam

Answer 122

1st - lamotrigine / levetiracetam 2nd - carbamazepine

Answer 123

1st - ethosuximide 2nd - M - sodium valproate - F - lamotrigine / levetiracetam

Answer 124

M - sodium valproate F - levetiracetam

Answer 125

M - sodium valproate F - lamotrigine

Answer 126

- folic acid 5mg OD - carbamazepine is least teratogenic - Breastfeeding is safe for mothers on antiepileptics Phenytoin = cleft palate, give vit K in last month of pregnancy also Lamotrigine = congenital malformation rate low Sodium valproate - significant risk of neurodevelopmental delay

Answer 127

on levetiracetam? can use all contraceptive types on lamotrigine? UKMEC 3: cocp. UKMEC 1; POP, implant, depo, IUD, IUS on phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxycarbazepine? UKMEC 3: cocp. UKMEC 2: implant. UKMEC1: depo, IUD, IUS

Answer 128

- aspiration pneumonia - sudden unexpected death in epilepsy (SUDEP)

Answer 129

- seizure > 5mins - or multiple seizures without regaining consciousness in between

Answer 130

- A-E - Check pupils - BMs - VBG, seizure bloods - ?Toxins - Check for focal neurology, meningism, temp, tongue biting, incontinence etc - ?CT head - ?LP - EEG – and to check seizures controlled after mx

Answer 131

- Secure airway - NPA, adjuncts etc - Recovery position - 15L O2 - Get IV access (or IO) At 5 mins – benzodiazepine - Buccal midazolam 10mg - Rectal diazepam 10mg - IV lorazepam 4mg At 10 mins – benzodiazepine At 15 mins – IV phenytoin / levetiracetam, call ITU At 20 mins – RSI

Answer 132

Primary - no underlying cause - tension, migraine, cluster Secondary - underlying cause - eg GCA, glaucoma, haemorrhage, meds

Answer 133

- Fever, photophobia, neck stiffness - meningitis, encephalitis, brain abscess - Focal neurology - New cognitive disturbance - Impaired GCS - Visual disturbance - eg GCA, glaucoma, tumour - Red eye - glaucoma - Sudden-onset headache - 'thunderclap' - Worse on coughing, straining - Postural, worse standing / lying / bending over - Vomiting - Hx of trauma - Hx of malignancy - Pregnancy - pre-eclampsia - Immunocompromised - HIV, immunosuppressants - <20yo and hx of malignancy - Seizures

Answer 134

- common primary headache - most common cause of primary headache in adults - infrequent/frequent episodic, chronic Causes - eg stress, depression, alcohol, skipping meals, dehydration

Answer 135

- Episodic, 30 mins - 7d - Like tight band around head - No aura, N+V, not aggravated by routine physical activity - May have photophobia / phonophobia

Answer 136

- Episodic, 30 mins - 7d - Like tight band around head - No aura, N+V, not aggravated by routine physical activity - May have photophobia / phonophobia

Answer 137

- paracetamol, NSAIDs, aspirin - limit analgesia to <6d/mo - acupuncture - physio, exercise, CBT, relaxation - trial of amitriptyline

Answer 138

- Complex neuro condition causing episodes of headaches + associated sx - most common type in paeds/teenagers Types - migraine +/- aura - silent migraine - aura, no headache - hemiplegic migraine

Answer 139

- likely combination of structural, functional, chemical, vascular, inflammatory factors Triggers - CHOCOLATE - Chocolate - Hangovers - Orgasms - Cheese, caffeine - Oral contraceptives - Lie-ins - Alcohol - Tumult – loud noise (also bright lights) - Exercise

Answer 140

Prodrome - Can begin several days before - Yawning, fatigue, mood change Headache - 4-72hrs - Unilateral - Throbbing / pounding - Aggravated by routine physical activity - Photophobia - Phonophobia - N+V Aura - <60mins - Vision – lines, loss of visual fields (eg scotoma) - Sensation – tingling, numbness - Language - dysphasia Resolution stage - Headache may fade away / relieved abruptly by vomiting / sleeping Postdromal / recovery phase

Answer 141

A - at least 5 attacks fulfilling criteria B-D B - last 4-72hrs C - at least 2 of: - Unilateral - Pulsating - Moderate / severe pain - Aggravated by routine activity D - during headache, at least 1 of: - N +/- V - Photophobia, phonophobia E - no other cause

Answer 142

- Unilateral limb weakness - Ataxia - Impaired consciousness - Mimic stroke / TIA

Answer 143

- Unilateral limb weakness - Ataxia - Impaired consciousness - Mimic stroke / TIA

Answer 144

Acute - NSAIDs, paracetamol - triptans - sumatriptan - stimulate serotonin receptors - antiemetics - prochlorperazine / metoclopramide - no opiates

Answer 145

avoid triggers - propranolol - topiramate - amitriptyline - specialist - candesartan, valproate, MAbs - menstrual migraines - prophylactic triptans, mefenamic acid, aspirin

Answer 146

avoid triggers - propranolol - topiramate - amitriptyline - specialist - candesartan, valproate, MAbs - menstrual migraines - prophylactic triptans, mefenamic acid, aspirin

Answer 147

Pregnancy - paracetamol - NSAIDs 1st/2nd trim - no aspirin/opioids

Answer 148

Pregnancy - paracetamol - NSAIDs 1st/2nd trim - no aspirin/opioids

Answer 149

- most disabling type of primary headache - potential triggers - alcohol, strong smells, exercise

Answer 150

- Occur in clusters which last several weeks, occur once a year - Intense sharp, stabbing pain / headache around one eye - Occurs 1-2 times/day, episode lasts 15mins-2hrs - Restless during attack - Redness, lacrimation, lid swelling, swelling - Nasal stuffiness - Miosis / ptosis in minority

Answer 151

- MRI with gadolinium contrast

Answer 152

- neurology referral Acute - 15L O2 - S/C triptan (or intranasal) Prophylaxis - verapamil - occipital nerve block, prednisolone, lithium

Answer 153

- Present for >15d per month - Developed/worsened whilst taking regular symptomatic medication - Pts using opioids and triptans at most risk - May be psychiatric comorbidity

Answer 154

- withdraw simple analgesics + triptans abruptly (may worsen headache initially) - gradually withdraw opioids Withdrawal sx - Vomiting, hypotension, tachycardia, restlessness, sleep disturbance, anxiety

Answer 155

- due to leak of CSF after dural puncture Px - 24-48hrs after LP, can be <1wk later - Can last several days - Worsens when upright, improves with recumbent position

Answer 156

- supportive - analgesia, rest - if pain >72hrs, tx to prevent SDH - blood patch / epidural saline / IV caffeine

Answer 157

- Inflammation of paranasal sinuses in face - Pain / pressure after viral URTI - May have swelling / tenderness of affected areas - Most resolve in 2-3wks - >10d - steroid nasal spray, abx (phenoxymethylpenicillin

Answer 158

- Caused by degenerative changes in c-spine - Neck pain, worse on movt, often also headaches

Answer 159

- low oestrogen - similar to migraines - unilateral, pulsatile headache, nausea - eg 2d before and first 3d of menstrual period / early pregnancy / perimenopause - triptans / NSAIDs (mefenamic acid) to tx

Answer 160

- primary / secondary (10x more common)

Answer 161

- can be benign/malignant, high/low grade Primary - adults - majority supratentorial, children infratentorial Secondary - NSCLC - most common - SCLC - breast - melanoma - renal cell - GI - SOL, CSF lost to compensate, eventually no more CSF, ICP rises acutely -> worsening in sx, eventually coning, death

Answer 162

Progressive focal neurology - location dependent - eg personality change - frontal lobe - sensory loss, motor change, speech changes, visual field defects, DANISH for cerebellar Raised ICP - Papilloedema - Headache, worse lying down / waking / at night / coughing - Vomiting - CN3/6 palsies - Unilateral ptosis - Drowsiness Seizures - focal seizures more common

Answer 163

- CT with contrast - MRI brain - Biopsy - during surgery - LP CI'd (raised ICP)

Answer 164

- surgery - chemo / radio - dexamethasone - levetiracetam - palliative care

Answer 165

- inflammation of meninges - viral most common, presume bacterial until otherwise, also fungal, non-infective

Answer 166

bacterial infection spreads to bloodstream - non-blanching rash

Answer 167

0-3mo - GBS, E coli, listeria 3mo-6yo - N meningitidis, S pneumoniae, H influenzae 6-60yo - N meningiditis, S pneumoniae >60yo - S pneumoniae, N meningiditis, Listeria Immuno - listeria

Answer 168

- coxsackie, HSV, VZV, CMV, HIV, measles, mumps

Answer 169

- malignancy, chemicals, meds, sarcoidosis, SLE

Answer 170

- fever - neck stiffness - vomiting - headache - photophobia - altered consciousness - seizures - non-blanching rash - Kernig's - Brudzinski's

Answer 171

Position the patients supine with their hips flexed to 90°. This test is positive if there is pain on passive extension of the knee

Answer 172

Position the patients supine and passively flex their neck. This test is positive if this manoeuvre causes reflex flexion of the hip and knee

Answer 173

- cloudy - high protein - low glucose - high WCC (neutrophils) - culture growth

Answer 174

- clear - mildly high protein - normal glucose - high WCC (lymphocytes) - negative culture

Answer 175

- slightly cloudy - low glucose - high protein - PCR to dx

Answer 176

- LP - bloods - cultures, meningococcal PCR, FBC, U/E, glucose, lactate, coag, VBG - maybe throat swab - CT not normally indicated

Answer 177

- IM benzylpenicillin

Answer 178

- <3mo – IV cefotaxime + amoxicillin - 3mo-50yo – IV cefotaxime / ceftriaxone - >50yo – cefotaxime / ceftriaxone + amoxicillin NB Vancomycin added if risk of penicillin resistant pneumococcal infection e.g. recent foreign travel or prolonged antibiotic exposure Steroids used in bacterial meningitis to reduce the frequency and severity of hearing loss and neurological damage - dexamethasone QDS for 4 days if >3m

Answer 179

Mx of contacts - close contact <7d sx onset - oral ciprofloxacin single dose, rifampicin 2nd line - offer meningococcal vaccination/booster

Answer 180

- Sensorineural hearing loss - most common - Seizures - Focal neuro deficit - Cognitive impairment - Sepsis, cerebral abscess - Brain herniation, hydrocephalus - With meningococcal meningitis - Waterhouse-Friderichsen syndrome - adrenal insufficiency secondary to adrenal haemorrhage

Answer 181

- infection / inflammation of brain parenchyma - mostly viral - typically temporal / inferior frontal lobes

Answer 182

Viral - HSV1 (cold sores), HSV2 (genital herpes), VZV, CMV, EBV, HIV, mumps, measles - HSV encephalitis - tends to affect temporal lobes Non-viral - bacterial, TB, malaria, polio, mumps, rubella, measles

Answer 183

- Fever - Headache - Psych sx, unusual behaviour - Altered cognition, consciousness - Seizures, often focal - Vomiting - Focal neurology, eg aphasia

Answer 184

- LP - high lymphocytes/protein, send for PCR, CI if low GCS, unstable, seizing - CT (contrast enhanced) / MRI - petechial haemorrhages in medial temporal/inferior frontal lobes - EEG - lateralised periodic discharges at 2Hz - HIV testing, swabs elsewhere

Answer 185

- IV acyclovir

Answer 186

- dysfunction of facial nerve -> unilateral facial weakness - each side of forehead has UMN innervation from both sides of brain

Answer 187

- forehead spared - strokes, tumours - bilateral - MND, pseudobulbar palsies

Answer 188

- forehead not spared (paralysed) - Bell's, Ramsay Hunt, OM, OE, HIV....

Answer 189

- acute, unilateral idiopathic facial nerve paralysis - cause unknown, maybe HSV involvement

Answer 190

- Unilateral facial muscle weakness, forehead affected (LMN facial palsy) - Rapid onset <72hrs - Post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis (sounds seem louder), eye not closing, drooling

Answer 191

- dx made when no other cause for paralysis found

Answer 192

- oral prednisolone within 72hrs - eye care - drops, tape closed at night - refer if atypical sx / worsening / no improvement

Answer 193

- reactivation of VZV in geniculate ganglion of CN7 Px - auricular pain - facial nerve palsy - vesicular rash around ear - vertigo, tinnitus Mx - oral acyclovir - corticosteroids

Answer 194

- pus-filled swelling in brain Causes - from middle ear / sinuses - trauma - surgery to scalp - penetrating head injuries - emboli from IE

Answer 195

- headache - dull, persistent - fever - focal neurology - site dependent - raised ICP - nausea, papilloedema, seizures

Answer 196

- surgery - craniotomy, debride - IV abx - ceftriaxone + metronidazole - dexamethasone

Answer 197

- hereditary peripheral neuropathy - predominantly motor - majority autosomal dominant Px - Hx of frequently sprained ankles - Foot drop - High-arched feet (pes cavus) - Hammer toes - Distal muscle weakness / atrophy – inverted champagne bottle legs - Hyporeflexia - Stork leg deformity - Peripheral sensory loss Mx - OT/PT, podiatry

Answer 198

- alcohol - B12 deficiency - cancer (myeloma), CKD - diabetes, drugs (amiodarone, isoniazid, nitrofurantoin, metronidazole) - vasculitis

Answer 199

- autosomal dominant condition - tremor usually affecting upper limbs/hands

Answer 200

- postural tremor (worse on movt) 6-12Hz - symmetrical - improved with alcohol/rest - worse when tired, stressed, caffeine - absent during sleep - titubation - head tremor

Answer 201

- propranalol - primidone

Answer 202

- build up of pressure around brain RFs - female, obese, pregnancy, drugs

Answer 203

- headache, worse in morning/coughing/straining - nausea - blurred vision - papilloedema - enlarged blind spot - sixth nerve palsy

Answer 204

- assess neurology, eyes, vision - CT / MRI - LP

Answer 205

- wt loss - acetazolamide / topiramate - act as diuretics - repeated LP - surgery - eg shunt / optic nerve sheath decompression

Answer 206

- long term brain condition causing pt to fall asleep suddenly at inappropriate times - low levels orexin (hypocretin)

Answer 207

- Onset in teenage years - Hypersomnolence - sleepy during day, difficult to stay awake - Sleep attacks - fall asleep suddenly / w/o warning - Cataplexy - sudden loss of muscle tone triggered by emotion - Sleep paralysis - Vivid hallucinations on going to sleep / waking up

Answer 208

- multiple sleep latency EEG - CSF orexin levels - low

Answer 209

- Daytime stimulants - modafinil - Night time - sodium oxybate

Answer 210

- pain syndrome - severe unilateral pain in face - affects any branch of trigeminal nerve - ophthalmic, maxillary, mandibular - idiopathic / nerve compression - possible triggers - light touch, cold weather, spicy food, caffeine, citrus

Answer 211

- intense facial pain, seconds-hrs - electricity-like - attacks worsen over time

Answer 212

- Sensory changes - Deafness, ear problems - Skin / oral lesions - Pain only in ophthalmic division, or bilaterally - Optic neuritis - MS FHx - <40yo

Answer 213

- carbamazepine - neurology referral if atypical features, eg <50yo - surgery to decompress/intentionally damage nerve

Answer 214

- genetic condition that causes nerve tumours (neuromas) to develop throughout nervous system - tumours benign, but cause neuro/structural problems - NF1>NF2

Answer 215

- gene on c17 - codes for neurofibromin - autosomal dominant Dx - need 2/7 - CRABBING C – café-au-lait spots (>6), >5mm in children or >15mm in adults R – relative with NF1 A – axillary / inguinal freckles BB – bony dysplasia (eg Bowing of long bone or sphenoid wing dysplasia) I – Iris hamartomas (Lisch nodules) (>2) – yellow brown spots on iris N – neurofibromas (>2) or 1 plexiform neurofibroma G – glioma of optic nerve Ix - clinical dx - genetic testing - XR - bone lesions - CT / MRI Mx - no tx - mx sx / tx cx

Answer 216

- gene on c22 - codes for merlin - lack of leads to Schwannomas - autosomal dominant Px - acoustic neuromas - hearing loss, tinnitus, balance issues - schwannoma Mx - surgery to resect

Answer 217

- excessive volume of CSF in ventricular system in brain - production/absorption imbalance Obstructive - tumours, haemorrhage, aqueduct stenosis Non-obstructive - choroid plexus tumour, reabsorption failure, normal pressure hydrocephalus

Answer 218

- raised ICP sx - headache - worse in morning, lying down, Valsalva - N+V - papilloedema - coma - infants increased head circumference

Answer 219

Ix - CT head - MRI - LP - drain CSF, measure opening pressure (do not use in obstructive causes) Mx - external ventricular drain (EVD) - ventriculoperitoneal shunt (VP shunt) - surgical tx for obstructive pathology

Answer 220

- reversible cause of dementia in elderly - reduced CSF absorption at arachnoid villi / head injury / SAH / meningitis

Answer 221

- urinary incontinence - dementia, bradyphrenia (slowed thinking) - gait abnormality - sx develop over a few months

Answer 222

- CT head - hydrocephalus, ventriculomegaly, no sulcal enlargement

Answer 223

- VP shunt

Answer 224

- receptive - Lesion of superior temporal gyrus, typically supplied by inferior division of left MCA - Forms speech before sending it to Broca’s - Sentences make no sense, word substitution, neologisms, but speech fluent (word salad) - Comprehension impaired

Answer 225

- expressive - Lesion of inferior frontal gyrus, superior division of left MCA - Speech non-fluent, laboured, halting, repetition impaired - Comprehension normal

Answer 226

- From stroke affecting arcuate fasciculus – connection between Wernicke’s and Broca’s - Speech fluent, repetition poor - Comprehension norma

Answer 227

- spontaneous, continuous lower limb movts, associated with paraesthesia Causes - FHx, IDA, uraemia, DM, pregnancy

Answer 228

- Akathisia - uncontrollable urge to move legs - worse at night initially, then progresses to during day, sx worse at rest - Crawling / throbbing sensations - Noted in sleep by partner - periodic limb movts of sleeps (PLMS

Answer 229

- Clinical dx - Ferritin - r/o iron deficiency anaemia

Answer 230

- Walking, stretching, massaging - Iron - Dopamine agonist 1st line - pramipexole, ropinirole - Benzos - Gabapentin

Answer 231

- Severe progressive encephalopathy affecting children - Associated with fatty infiltration of liver, kidneys, pancreas - Known association with aspirin, ?viral cause also Px - Preceding viral illness - Confusion, seizures, cerebral oedema, coma - Fatty infiltration of liver, kidneys, pancreas - Hypoglycaemia Mx - Supportive

Answer 232

- paraneoplastic syndrome of reduced ACh release at NMJ - SCLC, breast, ovarian, also autoimmune - AB against presynaptic voltage-gated Ca channels in PNS

Answer 233

- limb girdle weakness (lower limbs first) - hyporeflexia - exercise improves sx - autonomic - dry mouth, impotence, difficulty peeing - no ptosis (MG)

Answer 234

- EMG - incremental response to repetitive electrical stimulation

Answer 235

- tx cancer - immunosuppression - prednisolone / azathioprine - amifampridine / 3,4-diaminopyridine - pyridostigmine - IVIg, plasma exchange

Answer 236

- pain which arises following damage/disruption to nervous system Px - burning, tingling, pins/needles, electric shocks, loss of sensation to touch Ix - DN4 questionnaire Mx - amitriptyline / duloxetine / gabapentin / pregabalin - tramadol for exacerbations - topical capsaicin - pain clinic - physiotherapy

Answer 237

- Areas are affected by abnormal nerve functioning -> neuropathic pain, abnormal sensations - Usually one limb, often triggered by injury to area - Painful, hypersensitive (even to clothing), swell, change colour/temp, flush, sweat - Tx as neuropathic - pain specialist

Answer 238

- acoustic neuroma - 90% cerebellopontine angle tumours - Bl in NF2

Answer 239

- CN8 – vertigo, unilateral sensorineural hearing loss, unilateral tinnitus - CN5 – absent corneal reflex - CN7 – facial palsy

Answer 240

Ix - Urgent ENT referral - MRI of cerebellopontine angle - Audiometry Mx - Surgery - Radiotherapy - Watch and wait

Answer 241

- sudden enlargement of pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage/infarction - eg HTN, pregnancy, trauma, anticoags Ix - MRI Mx - steroid replacement (loss of ACTH) - monitor fluid balance - surgery

Answer 242

collection of CSF in spinal cord - syringobulbia - fluid-filled cavity in medulla Causes - chiari malformation - trauma - tumours - idiopathic

Answer 243

- full spine MRI with contrast - brain MRI (exclude chiari) - tx cause - shunt if persistent

Answer 244

- clinical syndrome with spinal cord injury at/above T6 - Afferent signals (most commonly from faecal impaction / urinary retention) cause sympathetic spinal reflex via thoracolumbar outflow - The usual centrally-mediated parasympathetic response prevented by cord lesion - Results in unbalanced physiological response – extreme HTN, flushing, sweating above level of cord lesion, agitation, haemorrhagic stroke Mx - Remove / control stimulus - Tx HTN +/- bradycardia

Answer 245

- Left homonymous hemianopia means visual field defect to left, ie lesion of right optic tract - Homonymous quadrantanopias – PITS - Congruous defect – complete / symmetrical visual field loss. Incongruous – incomplete / asymmetric - Incongruous defects – optic tract lesion, congruous defects – optic radiation lesion / occipital cortex

Answer 246

- Incongruous – optic tract lesion - Congruous – optic radiation / occipital cortex - Macula sparing – occipital cortex

Answer 247

- Superior – lesion of inferior optic radiations, temporal lobe, Meyer’s loop - Inferior – superior optic radiations, parietal lobe, Baum’s

Answer 248

- Lesion of optic chiasm - Upper quadrant > lower – inferior chiasmal compression – pituitary tumour - Lower > upper – superior compression - craniopharyngioma

Answer 249

- Downward displacement / herniation of cerebellar tonsils through foramen magnum – congenital / acquired through trauma Px - Hydrocephalus from obstruction of CSF outflow - Headache - Syringomyelia

Answer 250

- Damage to C5,6 - From excessive lateral flexion of neck – trauma / birth injury Px - Sensory loss in C5,6 dermatomes - Weak elbow flexion, wrist extension, arm abduction + external rotation -> flexed wrist, extended forearm, internally rotated + adducted arm (waiter’s tip posture) - Asymmetric moro reflex in infants

Answer 251

- Damage to lower trunk of brachial plexus – T1 (C8-T1) - Due to hyperabduction of arm – trauma / birth injury, or compression – Pancoast tumour / rib Px - Sensory loss in C8, T1 dermatomes - Weakness of intrinsic hand muscles -> total claw hand - Absent grasp reflex in infants

Answer 252

Causes - Anterior shoulder dislocation - Fracture surgical neck of humerus Motor - Deltoid – impaired abduction, atrophy - Teres minor – impaired external rotation Sensory - Lateral shoulder

Answer 253

Causes - Trauma, Erb’s Motor - Impaired elbow flexion – brachialis / coracobrachialis - Impaired forearm supination – biceps brachii Sensory - Lateral forearm, elbow to base of thumb

Answer 254

Causes - Proximal – supracondylar humerus fracture - Distal – carpal tunnel syndrome, wrist lac Motor - Supplies LOAF – lateral 2 lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis - Median claw, ape hand - Can’t make OK sign - Thenar muscle atrophy - Proximal damage – unable to pronate, weak wrist flexion, wrist ulnar deviation Sensory - Palmar thumb, index, middle fingers, lateral ring finger

Answer 255

Causes - Axilla – crutch, Saturday night palsy - Midshaft fracture of humerus - Wrist fracture, tight bracelets Motor - Impaired elbow extension - Wrist drop – impaired extension Sensory - Dorsal thumb, index, middle, and lateral ring finger

Answer 256

Causes - Proximal – fracture of medial epicondyle of humerus - Distal – ulnar tunnel syndrome, cycling, hook of hamate fracture Motor - Motor to medial 2 lumbricals, adductor pollicis, interossei, hypothenar, flexor carpi ulnaris - Ulnar claw – hyperextension of MCPJ, flexion at distal and proximal IPJ of 4/5th digits - Wasting + paralysis of intrinsic hand muscles (except lateral two lumbricals) - Wasting + paralysis of hypothenar muscles - Damage at elbow – as above + radial deviation of wrist Sensory - Medial half of ring finger, little finger, dorsal and palmar

Answer 257

Causes - IM injection Motor - Paralysis of glut medius / minimus – impaired hip abduction. Positive Trendelenburg (lateral pelvic tilt towards opposite side)

Answer 258

Causes - Posterior hip dislocation Motor - Paralysis of glut maximus – impaired thigh extension – difficulty standing up, climbing stairs

Answer 259

Causes - Trauma, prolonged pressure Motor - Impaired hip flexion, knee extension Sensory - Anteromedial thigh (anterior cutaneous branches), medial lower leg/edge of foot (saphenous nerve lesion)

Answer 260

Causes - Pelvic ring fracture, obturator hernia Motor - Paralysis of hip adductors Sensory - Medial thigh

Answer 261

Causes - Iatrogenic, IM injection - Trauma, hip dislocation, total hip arthroplasty Motor - Impaired knee flexion (hamstrings), motor deficits of tibial nerve and common peroneal Sensory - Lower leg + foot

Answer 262

Causes - Tibial fracture, tarsal tunnel syndrome Motor - Impaired foot inversion / plantarflexion – can’t walk on toes, cannot invert foot (TIPPED) Sensory - Sole of foot

Answer 263

Causes - Fracture of fibular head Motor - Deep peroneal nerve – paralysis of dorsiflexors – foot drop, high-stepping gait - Superficial nerve – impaired pronation / eversion of foot (TIPPED) Sensory - Deep – flip-flop zone between first and second toes - Superficial – lateral lower leg, dorsum of foot

Answer 264

Palsy – change in smell

Answer 265

Palsy – change in sight

Answer 266

- All eye muscles except LR and SO. Pupil constriction, accommodation, eyelid opening - Palsy – ptosis, down + out eye, fixed dilated pupi

Answer 267

- Superior oblique - Palsy – defective downward gaze – vertical diplopia – noticed when looking down – head tilt to compensate

Answer 268

- Facial sensation, mastication - Palsy – trigeminal neuralgia, loss of corneal reflex (afferent), loss of facial sensation, paralysis of mastication muscles, deviation to jaw to weak side

Answer 269

- Lateral rectus - Palsy – defective abduction – horizontal diplopia

Answer 270

- Facial movt, taste anterior 2/3 tongue, lacrimation, salivation - Palsy – flaccid paralysis of upper + lower face, loss of corneal reflex (efferent), loss of taste, hyperacusis

Answer 271

- Hearing, balance - Palsy – hearing loss, vertigo, nystagmus. Acoustic neuromas – Schwann cell tumours of cochlear nerve

Answer 272

- Taste posterior 1/3 tongue. Salivation, swallowing, mediates input from carotid body + sinus - Palsy – hypersensitive carotid sinus reflex, loss of gag reflex (afferent)

Answer 273

- Phonation, swallowing, innervates viscera - Palsy – uvula deviates away from site of lesion, loss of gag reflex (efferent)

Answer 274

- Head + shoulder movt - Palsy – weakness turning head to contralateral side, weakness shrugging shoulder

Answer 275

- Tongue movt - Palsy – tongue deviates towards side of lesion

Answer 276

Affects anterior horns - LMN signs

Answer 277

- Hemi-section of spinal cord Lateral corticospinal tract – ipsilateral spastic paresis below lesion - Decussates at medulla DCML – ipsilateral loss of proprioception and vibration, fine touch - Decussates at medulla Lateral spinothalamic – contralateral loss pain and temp sensation - Decussates almost immediately in spinal cord (1-2 levels below lesion)

Answer 278

- Other features of cerebellar disease as well as ataxia - eg intention tremor

Answer 279

- Eg from anterior spinal artery occlusion, flexion/extension - Lateral corticospinal tracts – bilateral spastic paresis - Lateral spinothalamic tracts – bilateral loss of pain + temp sensation

Answer 280

- Eg from hyperextension - Small lesions - spinothalamic. Large lesions - spinothalamic, DCML, corticospinal - Weakness and numbness - more so in upper limbs than lower limbs - cape-like distribution

Answer 281

- Eg from B12 deficiency, MS, tumour compression, neck hyperextension, posterior spinal artery infarct - DCML – loss of fine touch, vibration, proprioception - Wide steppage gait – sensory ataxia. Positive Romberg’s

Answer 282

- B12 deficiency, and E - Dorsal columns and lateral corticospinal tracts affected - Joint position + vibration lost first, then distal paraesthesia - UMN signs in legs – upgoing plantars, brisk knee, absent ankle jerk - If untreated – stiffness + weakness persist

Answer 283

- thrombosis in brain's venous sinuses - prevents blood draining - 50% isolated sagittal sinus - also cavernous sinus thrombosis / lateral sinus

Answer 284

- sudden headache - N+V - reduced GCS

Answer 285

- MRI venography, CT alternative - D dimer elevated maybe Mx - anticoagulation - LMWH, then warfarin

Answer 286

- stenosis of c-spine leading to spinal cord compression, neurology - age-related osteoarthritis

Answer 287

- subtle early sx, progressive - pain - neck, upper/lower limbs - loss of motor function - dexterity, impaired gait - loss of sensory function - numbness - autonomic - urinary/faecal incontinence, impotence - Hoffman's sign positive

Answer 288

MRI c spine - refer for spinal services assessment - decompressive surgery

Answer 289

- Common peroneal nerve lesion - eg fracture of fibular head, compression - L5 radiculopathy - would also show weakness of hip abduction - Sciatic nerve lesion - Superficial / deep peroneal nerve lesion - Central nerve lesions, eg stroke - other features would be present

Answer 290

- inherited myopathy, sx develop ~20-30yo, affects skeletal, cardiac, smooth muscle - autosomal dominant trinucleotide repeat disorder, DM1/2 types - distal/proximal weakness more prominent Px - Myotonic facies – long, haggard appearance - Frontal balding - Bilateral ptosis - Cataracts - Dysarthria - Myotonia (tonic spasm) - Weakness of arms + legs, distal initially - Mild mental impairment - DM - Testicular atrophy - Cardiac – HB, cardiomyopathy - Dysphagia

Answer 291

- rapidly progressive neuro condition - prion proteins - induce formation of amyloid folds - sporadic / new variant Px - dementia - rapid onset - myoclonus Ix - CSF - normal - EEG – biphasic, high amplitude sharp waves (only in sporadic CJD) - MRI – hyperintense signals in basal ganglia and thalamus

Answer 292

- Frameshift mutation – one/both binding sites lost – more severe form Px - Progressive proximal muscle weakness from 5yo - Calf pseudohypertrophy - Gower’s sign – child uses arms to stand from squatting - 30% - LD

Answer 293

- Non-frameshift insertion – both binding sites preserved – milder form Px - After 10yo - Intellectual impairment much less common

Answer 294

- Sudden / transient loss of muscular tone caused by strong emotion – eg laughter, being frightened. 2/3 pts who have narcolepsy have cataplexy

Answer 295

- Compression of brachial plexus, subclavian artery, or vein at site of thoracic outlet (space between clavicle and first rib)

Answer 296

- S1-2 - ankle - L3-4 - knee - C5-6 - biceps - C7-8 - triceps - S1,2 tie shoe, L3,4 kick the door, C5,6 pick up sticks, C7,8 shut gate

Answer 297

- compression of nerve root / LMN - eg pinched nerve - degenerative disc disease, OA, facet joint degeneration, spondylosis - radicular pain, weakness in limbs, numbness / paraesthesia - MRI, maybe EMG - neuropathic pain meds, tx cause, surgery

Answer 298

pathological process affecting nerve(s)

Answer 299

- single nerve affected - eg CTS

Answer 300

Several individual nerves affected Systemic causes - WARDS PLC - Wegener's granulomatosis - AIDs/amyloid - RA - DM - Sarcoidosis - PAN (polyarteritis nodosa) - Leprosy - Carcinoma

Answer 301

- many nerves affected - diffuse, symmetrical - Can be motor, sensory, sensorimotor, autonomic - Demyelination / axonal degeneration - Often distal – glove + stocking Mostly motor - GBS - Porphyria - Lead poisoning - Hereditary sensorimotor neuropathies (HSMN) – Charcot-Marie-Tooth - Chronic inflammatory demyelinating polyneuropathy (CIDP) - Diphtheria Mostly sensory - Diabetes - Uraemia - Leprosy - Alcoholism - B12 deficiency - subacute combined degeneration of spinal cord - Amyloidosis Px - Sensory deficit - Weakness, muscle cramps, fasciculations, atrophy - Poor balance, ataxia Mx - Tx cause - Neuropathic pain meds if needed