Neurology Flashcards
(87 cards)
1
Q
What HLA is narcolepsy associated with?
A
HLA-DR2
2
Q
What is Ondansetron?
A
Anti-emetic - 5-HT3 receptor inhibitor
3
Q
Side-effects of Ondansetron?
A
Prolonged QT-interval + constipation
4
Q
Essential Tremor first-line treatment?
A
Propanolol (primidone is sometimes used)
5
Q
Features of Essential Tremor?
A
Postural tremor worse when arms outstretched + relieved by rest and alcohol + titubation (head tremor)
6
Q
Mode of inheritance of Essential Tremor?
A
Autosomal dominant
7
Q
Cavernous sinus thrombosis features?
A
- Periorbital erythema and edema
- Ophtalmoplegia (6th nerve first, then 3 and 4)
- Facial hyperesthaesia (upper face and eye pain) if trigeminal nerve involved
8
Q
Sagittal sinus thrombosis features?
A
- Seizures and hemiplegia
- Parasagittal biparietal or bifrontal haemorrhagic infarctions
- ‘Empty delta sign’ seen on venography
9
Q
Lateral sinus thrombosis features?
A
6th and 7th cranial nerve palsies
10
Q
Diplopia + 6/3/4th nerve palsy + no proptosis +/- facial involvement, where is the lesion?
A
Cavernous sinus
11
Q
Generalised tonic-clonic seizures treatment?
A
Males: Sodium valproate
Females: Lamotrigine or Levetiracetam
12
Q
Focal seizure treatment?
A
First line: Lamotrigine or Levetiracetam
Second line: Carbamazepine, oxcarbazepine, zonisamide
13
Q
Myoclonic seizures treatment?
A
Males: Sodium Valproate
Females: Levetiracetam
14
Q
Tonic or atonic seizures treatment?
A
Males: Sodium valproate
Females: Lamotrigine
15
Q
Absence seizures treatment?
A
- First-line: Ethosuximide
- Second-line:
Male: sodium valproate
Female: Lamotrigine or levetiracetam
CARBAMAZEPINE CAN WORSEN ABSENCE SEIZURES
16
Q
Fluctuating confusion/consciousness?
A
Consider subdural haematoma
17
Q
Upper + lower motor neurone symtoms with no sensory involvement + muscle wasting + fasciculations=?
A
Motor neurone disease
18
Q
Management of Motor Neurone Disease?
A
- Treatment is only supportive: Baclofen for spasticity, AntiMuscarinic for excessive salivation, Benzodiazepines for breathlessness exacerbated by anxiety
- Riluzole in ALS can offer a couple month of survival
19
Q
Management of restless leg syndrome?
A
- Walking, stretching
- Iron deficiency anaemia if present
- Dopamine agonists : Ropinirole, Pramipexole
-Benzodiazepines, Gabapentin
20
Q
Localisation of lesion in alexia without dysgraphia?
A
Corpus callosum (through infarction of left posterior cerebral artery LPCA)
21
Q
Which lobe is implicated in Wernicke’s aphasia?
A
Temporal lobe
22
Q
What are effects of temporal lobe lesions?
A
- Wernicke’s aphasia
- Superior homonymous quadrantanopia
- Auditory agnosia
- Prosopagnosia (difficulty recognising faces)
23
Q
What are effects of frontal lobe lesions?
A
- Expressive (Broca’s) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus. Speech is non-fluent, laboured, and halting
- Disinhibition
- Perseveration
- Anosmia
- Inability to generate a list
24
Q
What are effects of occipital lobe lesions?
A
- Homonymous hemianopia (with macula sparing)
- Cortical blindness
- Visual agnosia
25
What are effects of parietal lobe lesions?
- Sensory inattention
- Apraxias
- Astereognosis (tactile agnosia)
- Inferior homonymous quadrantanopia
- Gerstmann's syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation
26
What are effects of cerebellum lesions?
- Midline lesions: gait and truncal ataxia
- Hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus
27
Lesion in subthalamic nucleus of the basal ganglia gives?
Hemiballism
28
Lesion in Striatum (caudate nucleus) of the basal ganglia gives?
Huntington chorea
29
Lesion in the amygdala gives?
Kluver-Bucy syndrome (hypersexuality, hyperorality, hyperphagia, visual agnosia)
30
Lesion in the Medial thalamus and mammillary bodies of the hypothalamus gives?
Wernicke and Korsakoff syndrome
31
Lesion in Substantia nigra of the basal ganglia gives?
Parkinson's disease
32
What is Lateral medullary syndrome ?
Posterior inferior cerebellar artery occlusion (Wallenberg's syndrome) causing cerebellar and brainstem Sx =>
Cerebellar features:
- Ataxia and nystagmus
Brainstem features:
- Ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
- Contralateral: limb sensory loss
33
Fluent speech + normal comprehension =
Conduction aphasia (stroke affecting the arcuate fasiculus - the connection between Wernicke's and Broca's area)
34
Fluent speech + impaired comprehension =
Wernicke's aphasia (Due to a lesion of the superior temporal gyrus, supplied by the inferior division of the left MCA)
35
Impaired speech and comprehension =
Global aphasia
36
Impaired speech + normal comprehension =
Broca's aphasia (lesion of the inferior frontal gyrus, supplied by the superior division of the left MCA)
37
What are the features of Bell's palsy?
Lower motor neurone facial nerve palsy (forehead affected)
Hyperacusis - altered taste - dry eyes - post-auricular pain
38
Management of Bell's palsy?
Oral prednisolone in the 72h - if no improvement after 3 weeks => urgent referral to ENT
39
Features of drug-induced Parkinsonism
40
Mx of cluster headache attack?
Subcutaneous sumatriptan + 100% oxygen
41
Prevention of cluster headache?
Verapamil - Prednisolone
42
What antibody is associated with Guillain-Barré syndrome?
Anti-GB1
43
What antibody is associated with Miller Fisher syndrome?
Anti-GQ1b
Miller Fisher syndrome is descending Guillain-Barré with areflexia, ataxia, ophthalmoplegia
44
Dementia + gait abnormality + urinary/faecal incontinence =
Normal pressure hydrocephalus
45
Management of normal pressure hydrocephalus?
Ventriculoperitoneal shunt (10% risk of seizure, infection, cerebral haemorrhage)
46
What is Von Hippel Lindau syndrome?
Autosomal dominant, due to a mutation in the VHL tumour suppressor gene situated on chromosome 3 which predisposes to visceral cysts and tumours
47
Features of Von Hippel Lindau syndrome?
- Cerebellar haemangiomas=>subarachnoid haemorrhages
- Retinal haemangiomas=>vitreous haemorrhage
- Renal cysts (premalignant)
- Phaeochromocytoma
- Extra-renal cysts: epididymal, pancreatic, hepatic
- Endolymphatic sac tumours
- Clear-cell renal cell carcinoma
48
Localised myoclonic jerk + absence seizures +/- tonic clonic in a teenager, hours within waking up =
Juvenile Myoclonic Epilepsy (Janz syndrome)
49
Management of Juvenile Myoclonic Epilepsy (Janz syndrome)?
Responds well to sodium valproate
50
Features and management of infantile spasms (West's syndrome)?
Brief spasms in the first few months of life, poor prognosis
- Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2 secs, repeat up to 50 times
- Progressive mental handicap
- EEG: Hypsarrythmia
- Vigabatrin and steroids - poor prognosis
51
What is benign rolandic epilepsy?
Unilateral paresthesia of the face upon waking up, more common in males children
52
Features and management of Lennox-Gastaut syndrome?
- Extension of West's syndrome into early childhood (1-5 years)
- Atypical absences, falls, jerks
- 90% moderate-severe mental handicap
- EEG: slow spike
- Ketogenic diet might help
53
Cause of upbeat nystagmus?
Cerebellar vermis lesion
54
Sensorineural (bone>air) hearing loss + absent corneal reflex =
Neurofibromatosis type 2 - Loss of corneal reflex => think vestibular schwanommas
55
Features of vestibular schwanommas?
Vertigo, hearing loss, tinnitus, absent corneal reflex
56
Muscle weakness + ptosis + glycosuria + cataracts (loss of red reflex) in a young woman =
Muscular dystrophy
57
Cause of downbeat nystagmus?
Arnold-Chiari malformation (herniation of cerebellar tissue through foramen magnum into spinal canal, which compresses the vestibulocerebellum and brainstem structures responsible for vertical gaze control.)
58
6 hours of symptom onset + acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation
Thrombectomy + IV thrombolysis
59
Last known to be well between 6-24h previously (including wake-up strokes) +
confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA + potential to salvage brain tissue =
Thrombectomy
60
What are side effects of phenytoin?
Peripheral neuropathy (glove and stocking) + gingival hypertrophy + hirsutism + coarsening of facial features + megaloblastic anaemia/aplastic + lymphadenopathy
Associated with cleft palate and congenital heart disease
61
How to monitor phenytoin?
No monitoring needed, but trough levels should be obtained before dose if suspicion of toxicity, non-adherence or adjusment of dose
62
Adverse effects of Lamotrigine?
- Stevens-Johnson syndrome
- Lamotrigine is a sodium channel blocker
63
Which psychiatric condition is most commonly seen in Parkinson's disease?
Depression first (up to 50% of patients, precedes motor Sx and impairs life), dementia in later stages
64
First-line treatment of muscle spasticity in Multiple Sclerosis?
Baclofen and gabapentin
Physiotherapy is important
Cannabis and botox undergoing evaluation
65
Management of fatigue in Multiple Sclerosis?
A trial of Amantadine after excluding other causes of fatigue (anaemia, thyroid, depression)
66
What is the management of bladder dysfunction in Multiple Sclerosis?
Ultrasound first to assess bladder emptying, then:
- Significant post-residual volume => intermittent self-catheterisation
- Insignificant PRV => anticholinergics
67
What is the medication to reduce risk of relapse in Multiple Sclerosis?
- IV Natalizumab (a recombinant monoclonal antibody that antagonises alpha-4 beta-1-integrin, inhibit migration of leucocytes across the endothelium across the blood-brain barrier) or Ocrelizumab (humanized anti-CD20 monoclonal antibody)
- Fingolimod
68
What is Gertsmann syndrome?
Lesion of dominant parietal lobe (opposite of dominant hand) causing: alexia, acalculia, finger agnosia and right-left disorientation
69
What is a major side-effect of Natalizumab, used to prevent relapses in MS?
Causes immunodeficieny leading to reactivation of JC virus and causing Progressive Multifocal Leukoencephalopathy
70
What is the DVLA stance on driving after a first seizure with normal EEG and MRI?
No driving for 6 months following a first unprovoked seizure (seiXure) (2nd seizure = 2x seiXure = 12 months)
71
Bilateral conductive hearing loss + onset 20-40yo + family history + tinnitus =
Otosclerosis
72
What is otosclerosis?
Autosomal dominant disease where normal bone is replaced by spongy vascular bone causing bilateral conduction deafness
73
Management of brain abcess?
IV 3rd generation cephalosporin + metronidazole
74
Causes of axonal damage in peripheral neuropathy?
- Alcohol
- Vit B12 deficiency,
- Charcot-Marie-Tooth 2 (Hereditary sensorimotr neuropathies 2),
- Diabetes
- Vasculitis
75
Features of seizure due to frontal lobe activity?
- Can occur with or without impairment of consciousness
- Aura + rising epigastric sensation + psychic or experiential phenomena (déjà vu, jamais vu) +/- auditory/olfactory/gustatory hallucinations
- Seizures last around 1 minute - automatisms (lip-smacking-grabbing-plucking)
76
What is Foster-Kennedy syndrome?
Frontal lobe tumour causing ipsilateral optic atrophy and controlateral papilloedema
77
Treatment of acute Meniere's attack?
Buccal or intramuscular prochlorperazine
78
Meniere's disease prevention?
Betahistine and vestibular rehabilitation exercises may be of benefit
79
Features of Tuberous Sclerosis Complex?
- Skin: Ash leaf spots, Shagreen patches, adenoma sebaceum, subungual fibromata
- Brain: Gliohamartomas, subependymal nodules, Sub Ependymal Giant Astrocytoma -> Epilepsy
- Eye : RETINAL hamartomas
- Kidney: Angiomyolipomas
80
Weakness improving with repeated movement?
Lambert-Eaton syndrome
81
What is the mechanism of Lambert-Eaton syndrome?
Voltage-gated Ca2+ channels antibody
82
What antiepileptic can precipitate acute myopia and acute angle closure glaucoma?
Topiramate
83
Features of ataxia telangiectasia?
- Cerebellar ataxia, especially mouth and throat coordination => aspiration pneumonia
- IgA deficiency => immunodeficiency
- Telangiectasia
- 10% risk of developing cancers
84
Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg's positive =?
Subacute combined degeneration of the spinal cord
85
What structure is damaged in Chorea?
Basal ganglia, especially the caudate nucleus
86
First-line treatment in Trigeminal Neuralgia?
Carbamazepine
87
