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Year 5 Notes > Neurology > Flashcards

Neurology Flashcards

1
Q

Cord compression:

Management

A

Malignant cause - dexamethasone 4mg/IV, then treatment

Epidural abcess - surgically decompressed and ABx

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2
Q

Carotid sinus syncope

A

Hypersensitive barorecptors, eg turning head, shaving

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3
Q

Stokes-Adams attack

A

Transient arrhythmia/bradycardia

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

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4
Q

Causes of cord compression

A

Disc prolapse
Haematoma
Tumor
Atlanto-axial subluxations

MRI definitive Ix

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5
Q

CN I Palsy

A

Can’t smell

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6
Q

CNII Palsy

A

Optic

Blind

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7
Q

CNIII Palsy

A

Oculomotor
Ptosis
Down and out
Dilated fixed pupil

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8
Q

CNIV Palsy

A

Trochlear

Vertical diplopia

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9
Q

CNV Palsy

A 
Trigeminal
Neuralgia
Loss of corneal reflex
Loss of facial sensation
Paralysis of mastication muscles
Deviation of jaw to weak side
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10
Q

CNVI Palsy

A

Horizontal diplopia (defective abduction)

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11
Q

CNVII Palsy

A

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

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12
Q

CNVIII Palsy

A

Vesticulocochlear
Hearing loss
Vertigo nystagmus

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13
Q

CNIX

A

Glossopharyngeal

Loss of gag reflex

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14
Q

CNX Palsy

A

Vagus
Uvula deviates away from site of patient
Loss of gag

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15
Q

CNXI Palsy

A

Can’t shrug

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16
Q

CNXII palsy

A

Hypoglossal

Tongue deviates towards side of lesion

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17
Q

Temporal lobe lesion visual field defect

A

Homonymous hemianopia with macula sparing

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18
Q

Wernickes encephalopathy

A 
Thiamine deficiency
Nystagmus
Opthalmoplegia
Ataxia
Confusion
Peripheral sensory
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19
Q

Subclavian Steal Syndrome

A

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

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20
Q

Giant cell arteritis

A

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

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21
Q

Medication overuse headache

A

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

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22
Q

Cluster headache

A 
Rapid onset
Excruciating on eye 
Watery, bloodshot, lacrimal ion, flushing, rhinorrhea, miosis, ptosis
Often nocturnal 
Give 02 and sumatriptan
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23
Q

Trigeminal neuralgia

A

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

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24
Q

Migraine

A

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

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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 ```

Year 5 Notes (19 decks)

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