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Flashcards in Neurology Deck (188)
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1

Where does damage occur between in an UMN lesion?

Damage to motor fibres between pre-central gyrus and anterior horn cells of spinal cord

2

Where does damage occur between in a LMN lesion?

Damage to motor fibres between anterior horn cells of spinal cord and peripheral nerve

3

What is the pattern of involvement/distribution in UMN disease?

Pyramidal (affects corticospinal tract)

4

What is the difference in pattern of sensory loss between UMN and LMN lesions?

UMN: central sensory loss
LMN: glove-stocking/nerve distribution sensory loss

5

What is the difference in pattern of tendon reflexes and tone between UMN and LMN lesions?

UMN: hyper-reflexia, hyper-tonia
LMN: hypo-reflexia, hypo-tonia

6

The anterior cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?

Supplies frontal and medial part of the cerebrum
Weakness and numbness in the contralateral leg + arm symptoms

7

The middle cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?

Supplies lateral hemispheres
Contralateral hemiparesis + hemisensory loss in face and arm
Contralateral homonymous hemianopia
Cognitive change - dysphasia, visuo-spatial disturbance

8

The posterior cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?

Supplies occipital lobe
Contralateral homonymous hemianopia with macular sparing

9

List general causes of headache

Raised ICP
Infections (meningitis)
Giant cell arteritis
Haemorrhage, trauma
Venous sinus thrombosis
Sinusitis
Acute glaucoma

10

List red flags for headache

New onset in over 55 yo
Early morning onset
Known/previous cancer
Immunosuppressed
Exacerbated by Valsalva
Autonomic upset

11

What is the commonest cause of intermittent headache?

Migraine

12

What is the proposed pathophysiology of migraine?

Vascular constriction-dilation, substance P and 5-HT release, trigeminovascular activation, cerebral hyperactivity
All of the above are proposed to play some role

13

What are some risk factors/aetiology for migraine?

Obesity
Excess oestrogen, OCP use
Patent foramen ovale
Genetics
Stress, anxiety
Poor diet
Physical exertion
CHOCOLATE: CHeese, Oral contraceptive, Caffeine, alcohOL, Anxiety, Travel, Exercise

14

What are some prodromal signs of migraine?

Yawning
Food craving
Change in sleep/appetite/mood

15

What are some auras that might occur prior to migraine headache?

Visual - central scomata/fortification/hemianopia
Motor - dysarthria, ataxia, ophthalmoplegia
Sensory - paraesthesiae

16

What is the criteria for diagnosing migraine without aura?

5 or more eps of headache lasting 4-72h
1 of nausea, vomiting, photophobia, phonophobia
2 of unilaterality, pulsating, limiting, worse on activity

17

What is the treatment for acute migraine?

NSAID (aspirin, ibuprofen)
Anti-emetic
Triptan (rizatriptan)

18

What drugs can be used for migraine prophylaxis?

Propranolol
Topiramate
Amitryptilline
Valproate
Gabapentin

19

What are some contraindications to triptan use?

IHD, coronary spasm
Uncontrolled BP
Recent lithium/SSRI use

20

What are trigeminal autonomic cephalgias?

Headaches in a unilateral trigeminal distribution with cranial nerve features

21

List the main trigeminal autonomic cephalgias?

Cluster headache
Trigeminal neuralgia
SUNCT
Paroxysmal hemicrania

22

What causes cluster headache?

Superior temporal artery smooth muscle hyperactivity to 5-HT

23

Describe the presentation of cluster headache, commenting on pain and duration

Rapid onset severe unilateral orbital pain
Watery, bloodshot, oedematous eye with miosis
Lasts 15 mins - 3 hours, occurring once or twice a day
Often nocturnal
Clusters last 4-12 weeks with pain-free periods

24

How is cluster headache treated?

Acute: high-flow O2, sumatriptan
Prophylaxis: verapamil, topiramate, steroid

25

What causes trigeminal neuralgia?

Compression of trigeminal nerve root by e.g. aneurysm, tumour, inflammation
Triggered when pressure applied in trigeminal region

26

Describe the presentation of trigeminal neuralgia, commenting on pain and duration

Paroxysmal intense stabbing pain in V2/V3 region
Facial screwing
Triggered typically by washing, shaving, eating, denchers
Lasts 1 - 90 seconds
Can get up 100 eps a day

27

How is trigeminal neuralgia treated?

Carbamazepine
Lamotrigine
Phenytoin
Gabapentin
Surgical decompression

28

What is SUNCT?

Short Unilateral Neuralgiform headache with Conjunctival infections and Tearing

29

How long does SUNCT typically last?

5 seconds - 2 mins
Occurs in frequent bouts

30

How is SUNCT treated?

Gabapentin