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Neurology Flashcards

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1
Q

What test can you do to confirm a diagnosis of subarachnoid haemorrhage?

A

Lumbar puncture 12hrs from onset of symptoms

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2
Q

Most common cause of subarachnoid haemorrhage?

A

Berry aneurysm - 85%
Av malformations
Trauma
Tumours

The 12hrs lets the xanthochromia to develop.

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3
Q

What drugs is used prophylactically for migraines?

A

Propanalol

Or topiramate

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4
Q

Which symptoms can help you distinguish between a ischaemic and haemorrhagic stroke?

A

Haemorragic : decreased consciousness, headache, nausea vomiting and seizures.

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5
Q

What is the best assessment tool for differentiating between stroke and stroke mimics?

A

ROSIER - recognition of stroke in the emergency room

Abcd2- risk of stroke after tia
Nihss- impairment caused
Cha2ds2vasc - risk of stroke secondary to AF

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6
Q

What is neuroleptic malignant syndrome? Has is it treated?

A

Following anti-psychotic meds. Has pyrexia, ridgitiy and tachycardia.

Rx- stop antipsychotic, fluids, dantrolene, bromocriptine

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7
Q

What are the clinical features in cluster headaches?

A

Unilateral intention pain around eye,
Redness, lacriamation and lid swelling of eye
Nasal stuffiness

(Males and smokers more common)

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8
Q

Managaement of cluster headaches
. Acute
. Prophylaxis

A

Acute- 100% oxygen, and Triptan (nasal or subcut)

Prophylaxis- veraparimil, prednisilone

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9
Q

DVLA and epilepsy. What length of time must you be seizure free to drive?

A

12month

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10
Q

DVLA and stroke. What length of time must you be wait before driving?

A

1 month

Multiple Tia’s- 3 months off

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11
Q

The presence of which 3 symptoms helps to classify location of strokes?

A

1) unilateral hemiparesis and or sensory loss of face arm and leg.
2) homonymous hemianopia
3) Higher. Cognitive dysfunction eg dysphasia

All three- total anterior circulation infarct
2/3- partial anterior circulation infarct

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12
Q

How do lacunae infarcts present?

A

1 of these:

1) unilateral weakness
2) pure sensory stroke
3) ataxia hemiparesis

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13
Q

How do posterior infarcts present?

A

1 of the following:

1) cerebellar or brain stem syndromes
2) loss of consciousness
3) isolated homoymous hemianopia

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14
Q

What is Webers syndrome?

A

Ipsilatetal 3rd nerve palsy
ContralaterL weakness

Type of stroke

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15
Q

What is wallenbergs syndrome?

A

Aka lateral medullary syndrome (posterior inferior cerebellar artery stroke)
Ipsilateral - ataxia, nystagmus, dysphasia, facial numbness
Contralateral- limb sensory loss

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16
Q

What is the difference between partial seizures which are simple or complex?

A

Simple- no disturbance of consciousness or awareness
Complex- consciousness disturbed

Temporal lobe - aura, deja vu, Jamais vu;
motor - Jacksonian

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17
Q

What features are present in progressive supranuclear palsy?

A

A Parkinson’s plus disorder so has Parkinsonism (TRAP)

With VERTICAL gaze palsy and dysarthria (speech sound problems)

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18
Q

What are the Parkinson’s plus syndromes? (VIVID)

A

V - vertical gaze and dysarthria = progressive supranuclear palsy

I- impotence/ incontinence, postural hypotension, cerebellAr signs = multiple system atrophy

V- visual hallucinations and early dementia = lewy body dementia

I- interfering activity by ‘alien limb’ = cortico-basal degeneration

D- diabetic/hypertensive patient who falls and pyramidal signs = vascular Parkinsonism

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19
Q

What is assessed in the ROSIER score for stroke?

A 
LOC (-1)
Seizure (-1)
Asymmetrical face weakness  (1)
Asymmetrical arm weakness (1)
Asymmetric leg weakness (1)
Speech (1)
Visual field defect (1)

Score >0 stroke is likely.

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20
Q

What is lambert-eaton syndrome?

A

Rare, autoimmune syndrome antibodies to calcium channels - many have lung cancer (small cell).

Causes proximal muscle weakness which is relived by movement.

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21
Q

What are the side effects of triptans (migraine meds)?

A

Tingling, heat, chest or throat tightness, heaviness and pressure.

Contraindicated in people with history of is hmic heart disease, or cerebrovascular disease.

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22
Q

How do you distinguish between neurofibromatosis and tuberous scleriosis?

A

Both- autosomal dominant, neurocutaneous and ocular hamartomas

TS- depigmented ash leaf spots, shagreen patches (rough skin on lumbar area), angiofibromas, subungual fibromata (beneath nails) // epilepsy, learning difficulties

NF- axillary/groom freckles, pheochromocytoma, nf2: acoustic neuromas, Irish hamartomas.

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23
Q

What does the ABCD2 scoring system mean and how many point for each?

A

Tia to predict stroke risk.

A age>60 (1 point)
B be >140/90 (1 point)
C clinical features: unilateral weakness (2 points), speech w/o weakness (1 point)
D duration : >1 hour (2 points), 10-59mins (1 point)
D diabetes (1 point)

> 6 strongly predicts stroke, >4 see specialist within 24hs, all Tia’s see within 7 days.

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24
Q

What is cataplexy?

A

Sudden and transient loss of muscle tone or collapse due to strong emotion eg laughing or being frightened.

2/3 of those with narcolepsy also have cataplexy

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25
What is the presentation of trigeminal neuralgia?
Episodes of severe shocks to one side of the face. Can be triggered by touch Rx- carbamazepine
26
What's the treatment for trigeminal neuralgia?
Carbimazipine (Effective in about 80%)
27
What are the features of multiple system atrophy?
Parkinsonism Cerebellar dysfunction Autonomic nervous system dysfunction (postural hypotension, urinary incontinence, impotence, constipation, dry mouth, sweating deficiency.) Due to cell loss, gliosis or a proliferation of astrocytes, --> glial scar (Papp-lantos bodies)
28
What the the symptoms of progressive supranuclear palsy?
``` Parkinson plus syndrome Parkinsonism Vertical gaze problems Postural instability Dementia ```
29
Following a stoke at what level cholesterol would you commence a station?
>3.5mmol/L
30
What are the absolute contraindications to thrombolysis following a ischemic stroke?
``` Previous intracranial bleed Seizure at onset of stroke Intracranial neoplasm Suspected subarachnoid haemorrhage Stroke/TBI in previous 3 months Lumbar puncture in previous 7 days GI haemorrhage in preceding 3 weeks. Active bleeding Pregnancy Oesophageal varies Uncontrolled hypertension ```
31
What does the CSF analysis show in bacterial, viral and TB meningitis?
Bacterial, cloudy, low glucose, high protein, polymorph cells Viral, clear/cloudy, 60-80% glucose, protein normal or raised, lymphocytes TB, slightly cloudy/ fibrin web, low glucose, high protein, lymphocytes
32
When should epilepsy treatment be considered if someone has only had seizure?
If they have neurological deficit Brain imaging shows a structural abnormality EEG shows unequivocal epileptic activity Risk of another seizure is unacceptable
33
Tubersclerosis vs neurofibromatosis in someone with epilepsy?
Tuberous sclerosis
34
What's the most common pattern in motor neurone disease?
Amyotrophic lateral sclerosis (50%) | LMN in arms and UMN in legs
35
What is the first line treatment for Wilson's disease?
Penicillamine (chelates copper) traditionally Others : trientine hydrochloride Neurological and liver disease, kasyer-fliesher rings on presentation
36
Medical Management in subarachnoid haemorrhage?
Give nimodipine
37
What is the protocol for assessing tia?
Do the ABCD2 criteria >4 specialist review within 24 hrs. Give aspirin 300mg immediately (Consider clopidogrel) >3 specialist assessment within 1 week. If uncertain refer for brain imaging
38
Risk factors for idiopathic intracranial hypertension?
Obese Female Pregnancy Drugs - vit a, copc, steroid
39
What is lhermittes syndrome?
Parasthesia in limbs on neck flexion
40
What is the first line treatment for MS spasticity?
Baclofen or gabapentin
41
What's the first line management for MS fatigue?
Exclude other problems | 1' amantidine
42
What's the first line treatment for MS oscillolopia?
Gabapentine
43
What is the classic infection that triggers Guillain-Barré syndrome?
Campylobacter jejuni (gastroenteritis) Progressive weakness, demyelination, proximal more affected than distal, ascending eg legs before arms
44
Which anti-emetic should be given to Parkinson's patients to reduce nausea?
Domperidone | No cross blood brain barrier, no extra-pyramidal side effects
45
What is syringomyelia?
Fluid fluid cavity in the spinal cord, leads to destruction over time... Loss of pain and temperature sensation Wasting/weakness of arms Loss of reflexes
46
When can anti-epileptic drugs be stopped?
Over 2 years seizure free. Reducing drugs over 2-3months
47
What are the guidelines for neuropathic pain?
1st line: amitriptyline, duloxitine, gabapentin, or pregabalin Tramadol as a rescue therapy
48
Which drugs can precipitate a myasthenic crisis?
``` Penicillamine, Quinidine, Beta. Blockers Lithium Phenytoin Abx (gentamicin, macrolides, quinolones, tetracyclines) ```
49
Which nerve innovates the muscles of dorsiflexion in the foot?
Perineal nerve
50
Which lesion 'spares' the forehead?
UMN (eg stroke)
51
What is the first line treatment for essential tremor?
Propranolol Helped by alcohol and rest.
52
Restless leg syndrome management?
Dopamine agonist eg pramipexole or ropinirole
53
Which drug has survival benefit in MND?
Riluzole
54
What is the predominant blood cell type if CSF of bacterial, vs TB meningitis?
Bacterial - PMN (neutrophils) 80% TB - L (macrophages) 80%
55
Difference between a arterial and a neuropathic ulcer?
Arterial - pain shin discoloured and hair loss Neuropathic - painless sole of foot (trauma/prsssure)
56
Reversible Causes of memory problems?
``` Infection: HIV, HSV, PML, Toxo Vascular: chronic subdural Inflammation: SLE, sarcoidosis Neoplasia Nutrition: thiamine, b12 and folate, pellagra (B3) Hypothyroid HypoAdrenilsm Hypercalcaemia Hydrocephalus ```
57
Presentation of venous sinus thrombosis?
Sagittal: headache, vomiting, seizures, loss of vision, papilloedma Transverse: headache +/- mastoid pain, focal CNS signs, seizures, papillodema
58
Features of cortical vein thrombosis?
Thunderclap headache Stroke like focal symptoms Focal seizures
59
Features of trigeminal neuralgia?
Unilateral intense stabbing pain, usaully over V2/V3 areas. Triggered by touch. Males >50 Needs an MRI to exclude secondary causes (CN V compression, MS, Zoster, chairi malformation) Rx: carbemazipine, lamotrigine, gabapentin Surg: microvascular decompression
60
Features of GCA?
Unilateral temple pain and tenderness Thickened and pulseless temporal artery. Associated with: jaw claudication, amaurosis fugax, sudden blindness, PMR (50%)
61
Tests is GCA?
High ESR, high platelets, high ALP, low HB, Temporal artery biopsy Rx: steroids (pred)
62
How to diagnose migraine?
``` Aura + headache Or > 5 headaches lasting 4-72hours with either n&v, or photo/phonophabia AND >2 of: - unilateral - pulsating - interferes with normal life - worsened by routine activity ```
63
Medical treatment for paroxysmal hemicrania?
Indomethacin
64
What are the absolute contraindications for thrombolysis in stroke?
``` Previous intercranial haemorrhage Seizure at stroke/ suspected SAH Intercranial neoplasm Stroke or brain injury in past 3 months Lumber puncture in last 7 days Pregnancy Uncontrolled hypertension >200/120 Active bleeding Oesophageal varices/ GI bleed in last 3 weeks ```
65
What Are the contraindications to lumbar puncture?
Try LP Unless ContraINDicated ``` Thrombocytopenia Lateness (delay in ABX) Pressure (signs of raised ICP) Unstable (cardio resp) Coagulation disorder Infection at LP site Neurology (focal) ```
66
Types of aphasia?
Receptive (wernickes) - superior temporal gurus - fluent, abnormal speech, Expressive (brocas) - inferior frontal gyrus - non-fluent, normal speech Associative (conduction from W to B,) - arcuate fasciculus - fluent abnormal poor repetition

Neurology (9 decks)

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