Neurology Flashcards Preview

CP3 Medicine > Neurology > Flashcards

Flashcards in Neurology Deck (126):
1

List the advantage of MRI head over CT head
List the CIs of MRI

No ionising radiation in MRI

Any metal containing implants / bullets + shrapnel
Claustrophobic

2

What are the CSF findings seen in MS? (3)

Lymphocytes upto 50
Protein - moderately raised (<1g)
Oligoclonal IgG bands on electrophoresis

3

List the Irreversible (6) + Reversible (9) RFs for ischaemic stroke

Age/Gender
PMH/FH
Hypercoagulable state / AF

Poor diet / exercise
Smoking / alcohol
HTN / Hyperchol
DM / Obese
COC

4

List some rarer RFs for ischaemic stroke (6)

Endocarditis / Vasculitis
Migraine / Polycythaemia
Antiphospholipid syndrome / Amyloidosis

5

List some RFs for haemorrhagic stroke (5)

FH
Vascular abns (aneurysm / AVM / HHT)
Uncontrolled HTN
Coagulopathies / anticoags
Heavy recent alcohol intake

6

What are the 3 diff types of cerebral ischaemia

Regional (affects cortical areas)
Lacunar (subcortical - from microinfarcts/small vessel disease)
Global ischaemia (post-arrest: can reverse/transient sx but risk reperfusion injury // severe can cause cortical laminar necrosis = vegetative)

7

What are the 3 zones in cerebral ischaemia called?

Infarct core - defo will die
Oligaemic periphery - survives from collaterals
Ischaemic penumbra - uncertain outcome

8

List the main clinical features of an ischaemic stroke (4)

Contralateral mm weakness / hemiplegia
Facial weakness
Higher dysfunction
Visual disturbance
Rare - epileptic fit

9

List some examples of higher dysfunction (6)

Agnosia
Asterognosis
Receptive aphasia
Expressive aphasia
Apraxia
Inattention (neglect)

10

Describe the practical management of ?Stroke coming onto the ward

Quick focussed Hx / NIHSS score
Assess for CIs (fam/GP/Notis)
IV access + baselines (FBC, clotting, Glucose, UEs)
Weight (estimate)
Catheterise (if required)
Consultant review + urgent CT / thrombolysis

11

Post-thrombolysis, what features would indicate complications/haemorrhage?

What aspects of management should be delayed during thrombolysis infusion?

Acute HTN
Severe headache
Nausea/vomiting
-> discontinue infusion + urgent CT

During 1st 24hrs/ during infusion:
Avoid catherisation
Avoid NG
Avoid aspirin

12

What are the secondary prevention measures post-stroke? (5)

Antihypertensive therapy
Statin
Antiplatelet therapy
Identify/tackle RFs
Manage co-morbidities e.g. AF/DM

13

What are the laws regarding driving after a stroke?

Cannot drive for 4wks post stroke
After 4wks if clinical improvement satisfactory, may return to driving w/o having to inform DVLA

14

List some post-stroke complications (8)

Post-stroke pain
Incontinence
Pressure sores
Depression

DVT/PE
Aspiration/hydrostatic pneumonia

Malignant MCA syndrome
Seizure

15

What is malignant MCA syndrome and its features / Tx

Neuro deterioration due to cerebral oedema following middle cerebral aa stroke

Variable but:
Increased agitation
Reducing GCS
Haemodynamic / thermal instability
Signs of raised ICP

Decompressive hemicraniectomy

16

What are some high-risk features of a further stroke post-TIA?

Recurrent TIAs in short period
TIA on anticoag / AF
ABCDD score of ≥4

Age >60
BP at presentation (>140/90)
Clinical features - unilateral weakness (2) / speech disturbance w/o weakness (1)
Duration of Sx - 60mins+ (2) / <60mins (1)
Diabetes - pre-existing (1)

17

How are high-risk and low-risk TIAs managed?

High-risk:
Statin (e.g. simva 40mg)
300mg aspirin (unless CI)
Arrange 24hr urgent clinic
Advise don't drive until seen specialist

Low risk:
Same but less urgent clinic referral (1wk)

18

What further Ix / prophylactic interventions can be done after TIAs (1+2)

Carotid USS in specialist clinic

Carotid endarterectomy if stenosed >50%
OR
Percutaneous luminal angioplasty ± stenting

19

List the RFs for venous sinus thrombosis (7)

Pro-thrombotic state (85%):
Pregnancy / puerperium
Oral contraceptive
Malignancy
Genetic thrombophilia

Head injury
Recent LP
Infection

20

What are the clinical features for cortical (5) / dural (5) / sagittal lateral (5) venous sinus thrombosis

Cortical:
Thunderclap headache
Fever
Focal signs
Seizures
Encephalopathy

Dural: (ophthal signs + fever)
Proptosis/chemosis
Ocular pain
Ophthalmoplegia
Papilloedema
Fever

Sagittal lateral: (raised ICP signs)
Headache
Vomiting
Fever
Papilloedema
Seizures

21

What are the diff types of intra-cerebral haemorrhage?

Deep intra-cerebral: subcortical
from micro aneurysms (Charcot-Bouchard) and degen of small penetrating aa's

Lobar intra-cerebral: in cerebral cortex
Normotensive / >60

22

Describe the immediate management for intra-cerebral haemorrhage

Reverse anticoag
Lower BP to <140/90 within 1hr (IV betolol)
Neurosurgical intervention possibly

23

What are the presenting features of a SAH? (5 + 3)

Thunderclap headache (after transient HTN)
Vomiting
Photophobia
Drowsiness / coma
Focal signs

Neck stiffness
+ve Kernig's
Papilloedema

24

What are the predisposing abnormalities causing SAH? (3)

Berry (saccular) aneurysm (70%)
AVM (10%)
No lesion found (20%)

25

What are the RFs for berry aneurysm development?
What is the most common site of berry aneurysm?

Polycystic kidney disease
FH
HTN
Smoking
Ehlers-Danlos / Marfans

Commonest site is anterior communicating aa

26

What are some complications of SAH (4)

Death (30% immediate)
Rebleed
Hydrocephalus (from CSF pathway fibrosis)
Cerebral vasospasm (poss -> ischaemic damage)

27

What investigations are done in SAH? (4)

Bloods: FBC, clotting, UEs, LFTs, ESR
CT*
LP if CT normal
CT angio - for all pts fit for surgery

28

How is SAH managed? (7)

4wks bed rest
HTN control
Nimodipine - prevents vasospasm
IV fluids - prevents further vasospasm
Analgesia
Stool-softeners (prevent straining)
Neurosurgical referral/discussion

29

What pt groups are subdural haemorrhages seen in?

Acute: major trauma pts

Subacute/Chronic:
Elderly
Coagulopathy
Alcoholics (clotting)

30

How do subacute/chronic subdurals present? (4)

S/O raised ICP 3wks post-insult:
Headache
Drowsy/confusion
Focal neuro signs
Stupor/coma (late: coning)

31

How do acute / chronic subdurals look on CT?

Acute:
Crescenteric
White (increased density)
Midline shift
Ventricular compression

Subacute: isodensity

Chronic:
Lentiform shape (convex lens)
Darker (radiolucent)

32

How are subdurals managed?

Serial CT imaging
Neurosurgery
Chronics may self-resolve

33

How does an extradural (epidural) haemorrhage present?

Young pt minor injury (sports/assault)
Blow to side → middle meningeal aa tear
Brief unconsciousness → lucid recovery period

Over mins-hrs:
Progressive hemiparesis / stupor
Ipsilateral dilated pupil → then bilateral
Resp arrest (untreated)

34

What is seen on CT in extradural haemorrhage?

How is it managed?

Lentiform shape
Midline shift
Ventricular compression

Urgent neurosurgery – burr hole (release pressure)
If v. minor – conservative/monitoring

35

What are the 3 cardinal features of Parkinsonism

Resting tremor
Bradykinesia
Rigidity

36

List some detailed features of the tremor in Parkinsonism

4-7Hz pill rolling
Increases in: rest / anxiety / clenching opposite
Decreases in: movement / finger-nose

37

List some other detailed features of Parkinsonism

+ve Glabellar tap reflex
↓ Spontaneous blinking

'Lead pipe' rigidity
'Cog wheeling' effect

Hypersalivation
Hypomimia

Micrographia
'Walking' thumb along fingers

38

List the Parkinson plus syndromes + how they are different

Progressive supranuclear palsy:
Early dementia / Early speech probs
Postural instability
Vertical gaze palsy
VS PD - symmetrical / no tremor

Multisystem atrophy:
Autonomic / Cerebellar / Pyramidal

Cortico-basal degen:
Akinetic rigid 1 limb
Cortical sensory loss e.g. astereognosis

Vascular: BG strokes
Pyramidal / Legs worse

LBD:
Early dementia / Visual hallucinations
Symmetrical motor signs later

39

List features of Parkinsons DISEASE (other than Parkinsonism) (14)

Characteristic stoop
Fixed flexed joints (all except PIP/DIP)
Dysphagia
Constipation
Urological
Sweating
Shuffling (festinant) gait
Slurring/monotonous (eventually anarthria)
No arm swing
Unsteady turning
Depression (1/3rd)
Dementia/cognition problems (later)
Insomnia (later)
REM behavioural sleep

40

What are the SEs of levodopa?(4+3)

N+V (→ domperidone alleviates)
Confusion
Visual hallucinations (→ atypicals alleviate)
Chorea

Later SEs (2-5yrs):
Motor fluctuations (akinesia switching on/off)
Dyskinesia
Dystonia

41

List other Parkinsons drugs/Tx used (5) (give examples of drug names)

D-r agonists: bromocriptine / cabergoline / ropinirole
MOA-B inhibs: selegeline / rasagiline
COMT inhibs: entacapone
Anticholinergics: procyclidine
Surgery: thalotomy / deep brain stimulation

42

List the diff patterns of MND (4)

Amylotrophic lateral sclerosis**
Progressive muscular atrophy
Primary lateral sclerosis (rare)
Bulbar presentation

43

Which areas are affected in MS? (+ what effects does it have)

Optic nn → optic neuritis
CST → hemi/mono/para-paresis
DST → paraesthesia/proprioceptive loss
Cerebellar peduncles → cerebellar signs inc. vertigo
Brainstem → bladder/bowel/sexual
Cognition → (late) IQ/language

44

List the classifications of MS (3)

Primary progressive (10-20%)
Relapsing/remitting (80-90%) (to 2o progressive)
Fulminant (<10%)

45

List the diagnostic tools for MS (5)

Clinical Dx (2+ characteristic episodes)
Bloods before neuro referral:
FBC/UE/LFT/TFT / B12 / Ca / Gluc / ESR / HIV

MRI confirms Dx
CSF: raised WCC/protein / oligoclonal IgG
VER (visual evoked responses) – prev optic nn lesion

46

List the DDx for MS:
Relapsing-remitting (3)
Primary progressive (3)

Relapsing-remitting:
TIA
SLE w. neuro involvement
CNS sarcoidosis

Primary progressive:
MND
CNS mass
Spinal/cerebellar degen e.g. Alz/Hunt/Park

47

Outline the general management of MS (6)

MDT
Annual R/V
Lifestyle (exercise/smoking)
Pt education (prompt recog sx / tx)
Manage comps
Modifying therapy (dimethyl fumarate / teriflunomide / natalizumab for severe)

48

List the complications of MS (9)

Mental health
Fatigue
Mobility issues
Pressure sores
Constipation
Bladder dysfunc
Sexual dysfunc
Ataxia
Spasticity

49

What are good/poor prognostic factors in MS?

Good: sensory onset
Poor: older at presentation / early cerebellar / cognition

50

How does ALS present?

Progressive spastic tetra-paresis
± Bulbar/pseudo-bulbar
Fronto-temporal dementia

LMN signs: hands → arms + down
UMN signs: legs → up

51

How does progressive muscular atrophy present?

Painless wasting in small hand mm's + spreads
(Just spinal LMNs)

52

How does primary lateral sclerosis present?

Progressive tetraparesis
(Just cortical UMNs)

53

List the diagnostic tools for MND (4)

Clinical (mixed UMN/LMN)
Bloods: exclude DDx
MRI: exclude myelopathy/radiculopathy
Dx – EMG: denervation

54

Outline the general management of MND (5)

MDT
Nutritional support / gastrostomy
Resp support (NIPPV)
Manage comps (as per MS)
Modifying therapy: Riluzole

55

List possible causes for Dementia (surgical sieve)

V: Multi-infarct / Cerebral infarcts / Binswangers / Lupus
I: HIV / syphillis / CJD / Cryptococcus
T: major head / repetitives
Toxins: Alc / Drugs / heavy metals inc. Wilsons
M: B1/B12/Fol defc / Uraemia / Liver failure / Hypothyroid
Mechanical: Hydroceph (inc. NPH) / Haematomas
N: primary/secondarys
D: Alz (62%) / LBD (4%) / FTD (2%) / PD+ (2%) / Hunt's

56

List + describe the diff types of vascular dementia (4)

Post-stroke (25% stroke pts within 1yr)
Multi-infarct (cortical): stepwise decline
Subcortical: h/o HTN
Mixed cortical/subcortical

57

List the features of LBD (3+5)

Core:
Fluctuating cognition
Visual hallucinations
Parkinsonism

Supporting:
Syncope
Autonomic e.g. post hypo
Falls
Neuroleptic sensitivity
REM sleep behaviour

58

List the early features of FTD (7)

Emotional blunting / loss inhibition
Personal hygiene
Hyperorality
Word finding difficulties / less speech
Echolalia / aphasia
Loss insight
Primitive reflexes e.g. grasp

59

What are the features of CJD? (3)
How is it Dx?

Middle aged dementia
UMN signs limbs
Visual disturbances

Dx; EEG

60

What are the features of Huntington's? (2)

Middle aged dementia
Progressive chorea

61

List the DDx of peripheral neuropathy

V: vasculitic
I: HIV/syphillis / CIDP / GBS
Toxins: Alc / Lead / Chronic liver disease
A: RA / CTDs / Myxoedema
M: DM / B12+Folate / Thiamine defc / Uraemia
I: amio / statins / pheny / hydralazine / abx
N: paraprot (myeloma) paraneoplastic
C: Charcot-Marie Tooth / Friedrich's ataxia

62

List the causes of peripheral neuropathy with predominately motor loss (6)

Guillain-Barre syndrome
Porphyria
Lead poisoning
Charcot-Marie-Tooth
Chronic inflamm demyelinating polyneuropathy (CIDP)
Diphtheria

63

List the causes of peripheral neuropathy with predominately sensory loss (6)

DM
Alcohol
B12 defc
Uraemia
Amyloidosis
Leprosy

64

Describe the difference b/wn demye + axonal neuropathy

List some other nerve damage patterns + what happens

Demyelination: only schwanns / immune-med / regrow
↓ Conduction velocity

Axonal: neuronal bodies degen from axon / can't regrow
↓ Amplitude

Wallerian: post-section / microinfarction
Compression: focal demye
Infiltration: malignancy / granulomatous

65

What are the features of GBS? (4)

1-3wks post trivial infection (campylo/CMV)
Ascending paralysis
Loss tendon reflexes
Proximal mm involvement (20%) - Resp/CN

NB sensory loss uncommon

66

List some complications of GBS

LRTI
Pressure sores
VTE
BP instability / arrhythmia (autonomic involvement)
Residual weakness post-recovery (10-20%)
Mortality (10% in acute phase)

67

How is GBS managed?

HDU nursing
Monitor FVC ± Ventilation
SC heparin / TEDS
Prevent complications
High-dose IVIG within 2wks (NB steroids useless)

68

Describe the presentation/progression of shingles

Pain/paraesthesia (days)
Erythema / vesicles / burning / itching / dermatomal
2-3d later become pustular

69

List poss complications of shingles

Post-herpetic neuralgia (10%)
Corneal scarring / uveitis / panophthalmitis
Facial palsy / sensorineural loss / CN5,9,10 neuropathy

70

How is shingles managed?

5-7d oral aciclovir
Paracetamol / amitriptyline

71

How is post-herpetic neuralgia managed?

Amitriptyline
Topical capsaicin

(Gradual recovery over 2yrs)

72

What are the possible features of MG (4)

Weakness/fatiguability of:
Extra-ocular
Proximal mm (limb/face/neck)
→ Ptosis
→ Dysphagia
→ Speech difficulties / chewing (facial exp mm)
→ Proximal mm weakness (arms >legs)

73

List some conditions assoc w. MG (5)

Pernicious
Autoimm thyroid
SLE
Rheumatoid
Thyroid hyperplasia / thymoma

74

What Ix can be done if suspecting MG? (4)

Anti-ACh-R IgG autoAbs
EMG
TFTs / CT thorax (exclude thymoma)

75

Describe the management of MG (3+3)

Long-term:
Initial immunosupp – oral pred
Long-acting anticholinesterases e.g. neo/pyridostigmine
Thymectomy

Relapses:
Corticosteroid/Azathioprine
FVC monitoring ± ventilation
Severe: Plasmaphoresis/IVIG

76

Describe the pathology behind:
1. Duchenne's
2. Becker's
3. Myotonic dystrophy

1. Duchenne's: X-linked recessive dystrophin gene mutation
2. Becker's: partially func dystrophin
3. MD: autosom dom Cl- channelopathy

77

What is the difference b/wn:
Muscular dystrophies
Myopathues
Neurogenic disease

Muscular dystrophy: genetic progressive deterioration

Myopathies: predominant effect on mm

Neurogenic: peripheral nn / LMNs → SkM atrophy

78

What Ix can be done for a suspected myopathy? (3)

CK (serum mm enzyme):
Raised in – dystrophy / inflamm mm disorder
Normal in – MG

EMG – classic traces in:
Myopathy / denervation / myotonic discharge / MG

Mm biopsy: ddx b/wn denervation + mm disease

79

List the management options for spasticity related motor problems (Con/Med/Surg) (3/4/4)

Conservative:
Physio
Gait retraining
Remove exac stim e.g. constipation

Medical:
Baclofen / Dantrolene / BZDs / Botox

Surg:
Tendon lengthening
Fixed deformity release
Electrostim
Orthopaedic referral for contractures

80

What is the pathological difference b/wn bulbar palsy + pseudo-bulbar palsy?

What neuro disease may present with a mix?

Bulbar: LMN weakness from medullary CNs (9/10/12)

Pseudobulbar: bilateral UMN weakness from medullary CNs (9/10/12)

MND: mixed bulbar/pseudo

81

What are the features of a bulbar palsy? (6)

LMN tongue (wasted/fascic/flaccid)
Speech: quiet/nasal
Poor soft palate elevation (ahh)
Jaw jerk absent
Gag absent
Dysphagia

82

What are the features of a pseudo bulbar palsy? (6)

UMN tongue (stiff/spastic/not wasted)
Speech: donald duck/high-pitched/slurred (dysarthria)
Normal soft palate elevation (ahh)
Jaw jerk exaggerated
Gag present
Dysphagia

83

What are the main causes for bulbar/pseudobulbar palsy? (2)

What are some rarer causes? (4+2)

V: Stroke
D: MND

BULBAR:
GBS
Botulism
Brainstem tumours
Congenital

PSEUDO:
Trauma
MS

84

What features may be present in a cerebral lesion in:
1. Frontal (5)
2. Temp-Par L (dom) (3)
3. Temp-Par R (2)
4. Occipital (1)

Frontal:
Intellect / personality / Urinary / hemiparesis / Broca's

L T-P (dom): Contralat neglect / Wernicke's / Agraphia
R T-P: Contralat neglect / Agnosia

Occipital: Visual field/spatial defects

85

What are features of a cerebellar lesion? (6)

+ of a midline cerebellar lesion? (4)

Disdiadokinesia / Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred staccato speech
Hypotonia

Broad gait
Romberg's (unsteady when close eyes)
sUpport needed (sit/standing)
Vertigo/vom (sitting forward + arms across chest)

86

List some causes of unilateral (3) + bilateral (4) cerebellar dysfunc

Unilateral:
Stroke
MS
Tumour (acoustic neuroma, meningioma)

Bilateral:
Alcohol
Anti-epileptics
Severe hypothyroid
Paraneoplastic degen (breast, small cell lung)

87

What is the func of the BG?
What are the BG structures? (7)

Modulates cortical motor activity

Corpus striatum: caudate / globus pallidum / putamen
Subthalamic nucleus
Substantia nigra
Parts of thalamus

88

What are the features of BG dysfunction? (7)

Bradykinesia (→ akinesia)
Mm rigidity
Tremor
Dystonia (spasms)
Athetosis (writhing)
Chorea
Hemiballismus (violent invol prox arm mm)

89

Where does the lesion lie in:
Central scotoma
Monocular loss of vision
Bitemporal hemi/quadrantanopia (superficial + inferior)
Homomymous hemianopia
Homonymous quadrantanopia (superficial + inferior)

Central scotoma → macular
Monocular → ipsilateral optic nn

Bitemp hemi/quad:
Superfic = pituitary tumour (below chiasm)
Inf = craniopharyngioma, meningioma, carotid aneurysm

Homonymous hemi = contralateral optic tract
Homonymous quad:
Superfic = Temporal contralat optic tract
Inf = Parietal

90

What is the difference b/wn Broca's + Wernicke's aphasia? How does each manifest

What are some other types of aphasia? (2)

Broca's = motor speech; expressive
Non-fluent / good comprehension / poor repetition

Wernicke's = understanding speech; receptive
Fluent / poor comprehension / poor repetition

Global = both
Nominal = word finding difficulty

91

List the different causes of DYSARTHRIA + their different manifestations in speech (5)

Bulbar = high-pitched, nasal
Pseudobulbar = donald duck 'gravelly' (UMN)

MG = speech fatigues / dies away

Extrapyramidal = soft / indistinct / monotonous
Cerebellar = slow / staccato / slurred

92

What are the features of Horner's?

MioSIS (unilateral constriction)
PtoSIS (partial) - just Mullers mm
AnhidroSIS

93

List the 1st / 2nd / 3rd order causes of Horner's?
How are they differentiated clinically?

1st order: BRAINSTEM stroke / syphilis / MS / tumour

2nd order:
INTRATHORACIC pancoast / cervical rib / TB
NECK lymphadenopathy / trauma / thyroid surg

3rd order: ICA aneurysm / transient migraine / idiopathic

94

List the DDx for pathology of a LMN lesion (4)

Ventral horn: MND / Post-polio
Peripheral nn: neuropathy
NMJ: MG
Muscular

95

List the DDx for a UMN lesion (6)

V: stroke / AVM / haemorrhage
I: post-meningitis
T: traumatic brain injury
A: MS / MND
I: drugs
N: SOL
D: Parkinson's

96

How would a unilateral cord lesion (hemisection) present? (3)
What is the Eponymous name for it?
List some possible causes (3)

Ipsilateral weakness (CST)
Ipsilateral loss vibration/proprio (DC)
Contralateral loss pain/temp/light (STT)

Brown-Sequard

RTA
Penetrating injury
Facet dislocation

97

How would a dorsal column lesion present? (3)
What is the Eponymous name for it?

Clumsiness
Electric-shock like sensations / tingling / numbness
Sensory ataxia (loss 2-point discrimination)

98

List the indications for LP (5)

Dx: Meningitis/Encephalitis
Dx: Neurosyph / MS / Behcet's
Dx: SAH (if CT normal)
Intrathecal drugs
Measure CSF pressure ± drain

99

List the contraindications for LP (5)

Local infection
Clotting problems
?Raised ICP (if unconscious → CT first)
Haemodynamically unstable
Congenital e.g. NTD

100

List the complications of LP (5)

Infection
Cerebellar tonsillar coning

Spinal nn damage
Dry tap (not worked)
Spinal tap (post-LP headache: 30%)

101

List the differentials for causes of secondary headaches

V: Raised ICP / IIH / HTN
I: meningitis / sinusitis / SAH
T: post-traumatic
A: giant cell arteritis
M: metabolic disturbances
I: nitrates / vasoactives
N: SOL

102

Describe the classic presentation of tension headaches
How are they treated?

Middle-aged woman
Depression
Band-like (occiput/vertex)
Non-pulsatile
Episodic

OTC analgesia (NB caution overuse)
If >2/wk: low-dose amitriptyline

103

Describe the classic presentation of cluster headaches

Male
After drinking
Wakes from sleep
Mins-hrs
Severe unilateral pain around eye / poss BG pain
Aura (20%)
Autonomics: ptosis / watering / red eye / vom

104

How are cluster headaches managed?
What is the main DDx to exclude

Start of attack – SC/Nasal Triptans
During attack – 12L O2 non-rebreather
Prophylaxis – alc avoidance / verapamil (off-licence)

Main DDx: acute angle closure glaucoma

105

List some common triggers for migraines (6)

Stress / emotional states
Alcohol
Physical exercise

Menstruation
OCP
Specific food groups

106

Outline the management for migraines

Headache diary
Avoid triggers

Acute:
NSAIDs / para / anti-emetics
(Severe) Sumatriptan / nasal triptan if vom

Prophylaxis:
Menses related: mefanamic acid / triptans 2d prior
1st – topiramate / propanolol (for child bearing)
2nd - amitriptyline / carba

107

List some possible features of IIH
How is it treated? (2)

Young obese woman OCP
Headache
Pulsatile tinnitus
Diplopia / CN6 palsy
Visual disturbances
Bilateral papilloedema

Trial corticosteroids
VP shunt (to prevent optic atrophy)

108

How does trigeminal neuralgia typically present?
What is it caused by?
How is it treated?

Sudden severe pain across facial distrib
Sensory trigger

Ageing / Compression / MS

TCAs / Carba

109

What are the 2 diff types of hydrocephalus
Who are the at risk groups for hydrocephalus (3)

Non-communicating (obstructive)
Communication (non-resorptive)

Congenital malformations
Post-insult (trauma/SAH)
Meningitis

110

What are the features of hydrocephalus

Headache
Vomiting
Papilloedema
UMN pyramidal signs
Cognitive disturbance
Ataxia

111

How is hydrocephalus managed?

Acetozolamide ± furosemide
VA/VP shunt
Endoscopic 3rd ventriculostomy
Brain tumour removal

112

What are the 3 features of NPH?
How is it treated?

Dementia
Ataxic gait
Urinary incontinence

LP trials (of improvement) + VP shunt

113

What are the 3 main types of primary brain tumours?
+ their natural progression

Malignant glioma – rapid growth (6m)
Meningioma – slow growth benign
Astrocytoma – slow growth benign

114

List the commonest locations of origin for brain mets (6)

Thyroid
Melanoma
Kidney

Breast
Bronchus
Bum (colon)

115

List 4 paraneoplastic syndromes

Myasthenia Gravis
Lambert-Eaton Myasthenic syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration

116

What types of cancer assoc w. paraneoplastic cerebellar degeneration? (4)

Small cell lung
Hodgkins
Breast
Ovarian

117

List some viral causative organisms of meningitis (4)

Enteroviruses:
Coxsackie A/B
Echoviruses

HIV
HSV

118

What features indicate complications in meningitis (4)

What acute neuro complications could these indicate? (3)
What are some other (systemic) acute complications

Progressive drowsiness / LOC
Lateralising signs
CN lesions
Seizures

Hydrocephalus
Severe cerebral oedema
Venous sinus thrombosis

Sepsis
DIC
Adrenal haemorrhage (Waterhouse-Friderichsen)

119

How does TB meningitis present in contrast to normal?
How is it treated?

More gradual + wt loss
Same as resp (RIPE 12m) + Dexa

120

List necessary Ix for ?Meningitis (6)

Bloods: FBC / UEs / LFTs / Clotting / Glucose / Lactate
LP
CT
Blood cultures
Serum PCR
Throat swabs

121

List possible long-term complications of bacterial meningitis (5)

Brain abscess
Hydrocephalus
Hypotonia
CN palsy (e.g. sensorineural deafness)

122

List some causes of brain abscess (5)

Paranasal sinus infection
Otitis media
BActerial endocarditis
Neurosurg
Trauma

123

What are the meningitis empirical Abx in:
1. Non-blanching rash
2. Immunosupp (inc. DM) / >60
3. Non-immunosupp / <60

1. Ben-pen / PA-cefotaxime (IM + IV)
2. Ceftriax / Amoxi / dexa (IV) (PA-chloramphenicol)
3. Ceftriax / Dexa (IV)

124

List the diff types of syncope (7)

Situational: post-prandial / micturition / defacation
Vasovagal: transient parasymp (heat/noxious)
Neurogenic: TIA/Stroke /subclav steal syndrome
Cardiogenic: structural / arrhythmia
Orthostatic: post hypo
Psychogenic
Endocrine: hypogly / anaemic

125

List the Ix for recurrent syncope

FBC / UE / Gluc
ECG
LSBP
CT head / EEG
ECHO

126

What is subacute combined degeneration of cord (SCDC) due to?
What are the features (4 ± 2)

Due to B12 defc
Can be precipitated by folate

Peripheral sensory neuropathy (vibration/proprio)
UMN signs in legs, classic ∆:
• +ve Babinski
• Brisk knee reflex
• Absent ankle reflex

Plus poss also:
Normal tone/power
Ataxic gait