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Year 5 Notes > Neurology > Flashcards

Flashcards in Neurology Deck (80):
1

Cord compression:
Management

Malignant cause - dexamethasone 4mg/IV, then treatment
Epidural abcess - surgically decompressed and ABx

2

Carotid sinus syncope

Hypersensitive barorecptors, eg turning head, shaving

3

Stokes-Adams attack

Transient arrhythmia/bradycardia
Collapses with slow/absent pulse, pulse speeds up and regains consciousness

4

Causes of cord compression

Disc prolapse
Haematoma
Tumor
Atlanto-axial subluxations

MRI definitive Ix

5

CN I Palsy

Can't smell

6

CNII Palsy

Optic
Blind

7

CNIII Palsy

Oculomotor
Ptosis
Down and out
Dilated fixed pupil

8

CNIV Palsy

Trochlear
Vertical diplopia

9

CNV Palsy

Trigeminal
Neuralgia
Loss of corneal reflex
Loss of facial sensation
Paralysis of mastication muscles
Deviation of jaw to weak side

10

CNVI Palsy

Horizontal diplopia (defective abduction)

11

CNVII Palsy

Flaccid paralysis of face
Loss of corneal reflex (efferent)
Loss of taste
Hyperascusis

12

CNVIII Palsy

Vesticulocochlear
Hearing loss
Vertigo nystagmus

13

CNIX

Glossopharyngeal
Loss of gag reflex

14

CNX Palsy

Vagus
Uvula deviates away from site of patient
Loss of gag

15

CNXI Palsy

Can't shrug

16

CNXII palsy

Hypoglossal
Tongue deviates towards side of lesion

17

Temporal lobe lesion visual field defect

Homonymous hemianopia with macula sparing

18

Wernickes encephalopathy

Thiamine deficiency
Nystagmus
Opthalmoplegia
Ataxia
Confusion
Peripheral sensory

19

Subclavian Steal Syndrome

Stenosis proximal to vertebral artery
When you use arm it steals blood from vertebral artery causing LOC, dizziness
Suspect if BP difference in arms >20

20

Giant cell arteritis

Tender, thickened pulseless temporal
Jaw claudication
ESR >40
Prompt steroids

21

Medication overuse headache

From mixing, eg paracetamol + codiene/opiates, ergos, triptans
Can use analgesia/naproxen for rebound

22

Cluster headache

Rapid onset
Excruciating on eye
Watery, bloodshot, lacrimal ion, flushing, rhinorrhea, miosis, ptosis
Often nocturnal
Give 02 and sumatriptan

23

Trigeminal neuralgia

Sharp stabbing pain over trigeminal nerve
Unilateral
Triggered by eating, washing, shaving
Can be from nerve compression so needs MRI

24

Migraine

Unilateral, throbbing, with aura
Nausea, vom, allodynia, photophobia
Can have produce for dats before

25

Acute migraine treatment

NSAID
triptan
Ergot as it starts

26

Migraine prevention

Propanalol
Amytriptiline

27

Conus medullaris

Mixed UMN/LMN
Let weakness, urinary retention, constipation, back pain, altered sensation

28

Cauda Equina

Back pain
Shooting leg pain
Asymmetrical areflexic
Atrophi. Paralysis
LMN only

29

Spastic gait

Stiff
Circumducting legs
Scuffing toes

30

Extrapyramidal gait

Flexed posture
Shuffling feet
Slow to start
Postural instability
Eg Parkinson's

31

Apraxia gait

Wide based
Unsteady gait
Tendency to fall
E.g normal pressure hydrocephalus

32

Ataxic gait

Wide based
Can't heel to toe
Falls worse with eyes closed
Eg cerebellae lesion

33

Myopathic gait

Can't stand from sit
Waddle gait from hip girdle weakness

34

Chorea

Jerky purposeless
Eg huntingtons

35

Athetosis

Slow confluent
Eg Cerebral palsy

36

Tics

Brief repeated stereotyped
Eg Tourette's

37

Myoclonus

Focal involuntary jerk

38

Tardive dyskinesia

Eg chewing grimacing
From chronic dopamine use

39

Immediate stroke management

Pulse, ECG - AF
Only treat low BP
BM 4-11
Urgent CT/MRI only if
: considering thrombolysis, cerebellae stroke or unusual presentation
Thrombolysis if

40

When can you thrombolyse in stroke?

Less than 1.7)
Facilitates and doctors available
Refer for urgent tPa eg late please
CT 24hr after thrombolysis

41

Prevention of next stroke

Reduce risk factors
Clopidogrel (2nd line aspirin+dipyridamole)
If any AF start warfarin only 2weeks after

42

Later Ix for stroke

CXR - heart failure
ECG - AF
Echo - ideally TOE for thrombus
Carotid Doppler

43

SAH typical presentation

Sign of berry aneurysm
Devastating headache
Collapse, seizure, coma, stiff neck, focal neuro

44

SAH management

CT (invades into fissures). If negative
LP >12h shows bloody/yellow CSF
Aim for BP >160 to maintain perfusion
Nimodipine

45

SDH typical presentation

From trauma, even minor, up to months ago
Elderly more common
Fluctuating consciousness
ICP gradually increases and structures shift to one side
Sleepy headache, gradual slowing
Personality change or unsteadiness
Seizures local Neuro

46

SDH management

CT/MRI shows clot +- midline shift, crescent shift
Irrigate and evacuate

47

EDH typical presentation

Lucid interval
From fractured temporal or parietal bone causing tear of middle meningeal
Increasing ICP
Headache vom, confusion, UMNL
Limb weakness, resp depression, blown pupil

48

EDH management

CT - lens/circle shaped
X-RAYS could be fracture
NO LP!!!
Evacuate and ligamen
Good prognosis if found early

49

Lewy body dementia

Fluctuating cognitive impairment
Detailed visual hallucination
Late parkisonism

50

Fronts-temporal dementia

Behavioral/personality changes
Disinhibition
Emotional unconcern

51

Alzheimers presentation

Progressive global impairment (other dementias affect one at a time)
Role of b amyloid
Some family history

52

Alzheimer's treatment

Acetycholinesterase inhibitors
Antigultaminergics
Folic acid and vit b supplements
Shows beta amyloid senilie plaques on CT

53

Parkinsonism triad

Tremor
Rigidity
Bradykinesia

54

Parkisonism features

Resting/pill roll tremor
Increased tone/rigidity - lead pipe/cogwheel
Poor supination and pronation
Bradykinesia - slow to initiate, montonic quiet speech
Micrographics
Reduced arm swing
Festinance
Freezing
Hypomimia (mask face)

55

Parkinson's management

MDT
Asses cognition and disability
Incurable and progressive but responds well to other measures
Discuss benefits in delaying treatment and wearing off
Complications: depression, dementia, psychosis

56

Parkinson's meds

Levodopa - cause dyskinesia, psychosis, delay alap
Dopamine agonists - mono therapy to avoid above
Apomorphine - rescue pen for freezing
Anticholinergics - for tremor
MAOB inhibitors - alternative to dopamine ags in early PD
COMT - lessen off time

57

MS pathology

Demyelination plaques throughout CNS
Relapsing remitting pattern, but repeated relapse leads to progressive atonal loss
More common in women and vit D deficiency

58

MS typical presentation

Unilateral optic neuritis
Numbness/tingling
Diplopia, dystaxia
Stress/heart induced
Women 30ish
Diagnosis made on McDonald's criteria

59

MS management

MRI - plaques
LP - igG oligoclonal
Steroids - for relapses but not prognosis
Interferon - reduces relapse rate
Monoclonal antibodies
Azothiaprine

60

Parkisonism Plus Syndromes

1) progressive supranuclear palsy
2) multiple systems atrophy
3) Lewy body dementia
4) corticobasal degeneration
5) vascular Parkinsonism

More severe and Les responsive to PD drugs

61

Progressive supranuclear palsy

Early postural instability
Loss of vertical gaze
Rigid trunk>limbs
Symmetrical
Speech and swallowing problems
Not much tremor

62

Multiple systems atrophy

Early autonomic features e,g impotence, incontinence
Postural hypotension
Cerebellar and pyramidal signs
Rigidity>tremor

63

Lewy body dementia

Fluctuating cognition
early dementia
Visual hallucination

64

Corticobasal degeneration

Rigidity in one limb
Cortical sensory loss (higher sensory function)
Apraxia
Alien limb

65

Vascular Parkinsonism

Pyramidal
Gait
Ataxia

66

Carpal tunnel

Aching pain and tingling in hand worse at night
Relieving hanging over bed/shaking
Sensory loss
Thumb middle index
Weakness of abductor pollis brevis- wasting of thenar eminence
Ax w/ RA preg
Phalens/tinels
Tx: - splint, steroids, surgery

67

Motor neurons disease

Loss of upper and lower motor neurons
No sensory loss
4 types: ALS, PBP, PMA, PLS
Awful prognosis

68

Pseudobulbar palsy

UMNL
More common than bulbar palsy
Same slow movement but increased jaw jerk, pharyngeal/palatial reflexes

69

Cervical spondylosis

Can compress cord causing spastic paraparesis
Painful limited neck movement, crepitus
Lhermittes - neck flexion causes tingling down spine
Radiculopathy: pain, electrical tingling down fingers at levels, dull reflexes, sensory disturbance, UMN signs below weakness level
Needs laminectimy

70

Myasthenia gravis

Autoimmune from anti acetylcholine
Sx: increasing muscle fatigue, ptosis, diplopia, myasthenic snarl, fading voice
Ax w/ thymus pathology

71

Myasthenia gravis management

Test for anti aCH antibodies, MUSK
CT thymus
Tx: anticholinesterases, steroids, thymectomy
If mysasthenic crisis: vent support, plasmophoresis, IV Ig

72

Lambert Eaton syndrome

Not enough pre synaptic relapse of ACH
Paraneoplastic eg SCLC or autoimmune
Gait difficulty followed by eyes signs ( unlike MG), autonomic involvement, hyporeflexia
Do CT in case of cancer

73

Syringomyelia

Cyst of CSF in spinal cord
From tumor, infection, blocked CSF
Loss of pain and temp but other ok, at level of syrinx
Wasting/weakness of hand, claw
Syringobulbia is brain stem so involves tongue atrophy, nystagmus

74

Neurofibromatosis type 1

Autosomal dominant
Cafe au lait
Freckling in skin folds
Lisch nodes - in eye slit lamp
Learning disability

75

Neurfibromatosis type 2

Autosomal dominant/de novo
Lass cafe au lait
Bilateral vestibular schwannomas

76

Tuberous sclerosis

Ash leaf spots
Shagreen patches on lumbar sound
Developmental delay
Epilepsy
Intellectual impairment

77

Myotonic dystrophy

20-30
Balding
Ptosis
Myotonic facies
Cataracts
Dysarthria

78

Subacute combined degeneration of the cord

From low b12
Triad: extensor plantar + absent knee jerk + absent ankle jerk
Fine touch/proprioception+motor (dorsal +corticospinal)
Ataxia, decreasing vision, bilateral spastic paresis

79

Brown-sequard syndrome

Damage to spinal cord cussing loss of proprioception and paralysis on ipsilateral side with loss of pain and temp on contra lateral side

80

Charcot Marie tooth

Inherited peripheral neuropathy
Distal Muscle wasting and sensory loss
Autosomal dominant (but can be others)
4 types
Wasting of intrinsic muscles of hands and feet
Pets cavys, hammer toes, pets planus, spinal deformities
Tremors, cramp, acrocyanosis
Inverted champagne bottle sign