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Final year > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the clinical features of a cluster headache?

A

Unilateral headache associated with tearness and redness of the eye on that side, rhinorhea and miosis (constriction) +/- ptosis. They occur over a period of weeks with pain free breaks of months to years in between.

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2
Q

What is the treatment for cluster headaches?

A

Abortive management of cluster headaches involves the use of 100% oxygen at at least 12 litres per minute via a non-rebreathable mask and/or a subcutaneous or nasal triptan.

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3
Q

What is taken to prevent cluster headaches?

A

Verapamil

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4
Q

In which patients should triptans NOT be prescribed?

A

Patients with a history of IHD or CVD.

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5
Q

How do you treat migraines during pregnancy?

A

Paracetamol first-line and NSAIDs second-line (can be used in first and second trimester).

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6
Q

How do you treat migraines in relation to menstruation?

A

Mefanamic acid, and a combination of aspirin, paracetamol and caffeine. Triptans are recommended in the acute phase.

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7
Q

When is is suitable to come off anti-epileptic medication and how long should it take?

A

They must be seizure free for >2 years and the medication can be tapered off over 2-3 months.

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8
Q

What is the first line treatment for generalised seizures?

A

Sodium valproate

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9
Q

What is the first line treatment for partial seizures?

A

Carbamazepine

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10
Q

Who is 3x more likely to get bell’s palsy?

A

Pregnant women are 3x more likely

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11
Q

What other symptoms might people with bell’s palsy have?

A

post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis (increased sensitivity to sound).

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12
Q

What is the treatment for bell’s palsy?

A

Prednisolone. Eye care is important!! so eye lubricant etc.

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13
Q

What is internuclear opthalmoplegia?

A

Occurs due to a lesion of the medial longitudinal fasciculus (MLF), a tract that allows conjugate eye movement. This results in impairment of adduction of the ipsilateral eye. The contralateral eye abducts, however with nystagmus. Can be caused by MS

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14
Q

What is multi-system atrophy?

A

Combination of features of parkinsonism, autonomic disturbance (postural hypotension, bladder dysfunction) and cerebellar signs.

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15
Q

Which neuro condition is commonly diagnosed as carpal tunnel syndrome in the first instance?

A

Degenerative cervical myelopathy

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16
Q

How do you treat normal pressure hydrocephalus?

A

Ventriculoperitoneal shunting

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17
Q

Side effects of sodium valproate?

A 
gastrointestinal: nausea
increased appetite and weight gain
alopecia: regrowth may be curly
ataxia
tremor
hepatitis
pancreatitis
thromobcytopaenia
teratogenic
hyponatraemia
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18
Q

What are the features of an essential tremor?

A

Postural tremor: worse if arms outstretched
Improved by alcohol and rest
Titubation (nodding of the head)
Often strong family history

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19
Q

In what condition would you see an intention tremor?

A

Cerebellar disease

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20
Q

After you diagnose someone with myasthenia gravis, what should you do next?

A

Chest X-ray to exclude a thymoma (mediastinal widening)

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21
Q

What is myasthenia gravis?

A

Autoantibodies bind to the acetyl choline receptor on the neuromuscular junction. This leads to fatigueability. (chicken wing test)

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22
Q

What % of patients with myasthenia gravis have a thymoma?

A

15%

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23
Q

How do patients with MG usually present?

A

Oculuar manifestations eg drooping of both eye lids causing diplopia

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24
Q

In MG, which muscles are weakest?

A

Proximal muscles.

25
Q

Are there any UMN signs in MG?

A

NO. Tone is normal. Sensation is unimpaired and tendon reflexes are normal. Also there is no muscle wasting or fasciculation (LMN signs).

26
Q

How can you easily differentiate between MS and MG?

A

Hyperreflexia and upgoing plantars are seen in MS and not MG.

27
Q

What is a myasthenic crisis?

A

This is characterised by worsening muscle weakness resulting in respiratory failure that requires intubation and mechanical ventilation. MC is a very important, serious and reversible neurological emergency that affects 20-30% of myasthenic patients, usually within the first year of illness; it may be the first indication of the disease.

28
Q

What test can you do to check if someone is having a myasthenic crisis?

A

Give them edrophonium (readily reversible acetylcholinesterase inhibitor.) and if their symptoms improve this means they have myasthenia gravis. So the acetlycholine in the junction is not broken down and binds to the neuromuscular junction instead improving fatiguability suddenly but temporarily.

29
Q

How can you differentiate between motor neurone disease and MG?

A

Motor neurone disease there are signs of LMN problems like muscle wasting and fasciculation’s.

30
Q

LMN signs V UMN signs

A 
Lower = muscle wasting and fasiculations
Upper = hyperreflexia and hypertonia
31
Q

What is guillean barre?

A

A disorder causing demyelination and axonal degeneration resulting in acute, ascending and progressive neuropathy characterised by paraeathesiae, weakness and hyporeflexia

32
Q

What is miller-fisher syndrome?

A

This is a variant of guillean barre comprising ataxia, opthalmoplegia and hyporeflexia.

33
Q

What four things will cause UMN damaging?

A

Stroke, trauma, MS and a tumour.

34
Q

What is Brown-sequard syndrome?

A

Results from a lesion of one lateral half of the spinal cord, causing ipsilateral hemiplegia with contra-lateral painand temperature deficits. (due to crossing of fibres of the spinal thalamic tract).
There is a total ipsilateral loss of position, light touch and vibration sensation at the level of the lesion.

35
Q

Cauda equina

A

Dont forget to ask about sexual dysfunction!!
Lower back pain with pain in legs (uni or bi) and asymmetrical weakness and loss of reflexes.

NOTE: if reflexes were exaggerated then think spinal involvement and NOT cauda equina

36
Q

What is the most common cause of Cauda equina?

A

Herniation of lumbar disc at L4/L5 or L5/S1.

Can also be caused by tumour, trauma, late stage ank spond, IVC thrombosis, sarcoidosis?

37
Q

Onset of cauda eqiuna?

A

Can be sudden, can be gradual

38
Q

Other symptoms of Cauda equina?

A

Bladder dysfunction, saddle anaesthesia, urinary retention

39
Q

Pathophys of cauda equina….

A

The cauda equina is formed by nerve roots caudal to the level of spinal cord termination. Cauda equina syndrome (CES) is caused by compression of the nerves, causing one or more of the following: bladder and/or bowel dysfunction, reduced sensation in the saddle (perineal) area, and sexual dysfunction, with possible neurological deficit in the lower limb (motor/sensory loss, reflex change).

40
Q

Differential for cauda equina?

A

Conus medullaris (the conus medullaris is located above the cauda equina at T12-L2; nerve root pain is less prominent and the main features are urinary retention and constipation)

41
Q

In what condition would you see a cape-like distribution of loss of pain and temperature sensation.

A

Syringomyelia

42
Q

What causes syringomyelia?

A

A blockage of circulation of CSF- can be present from birth and worsen presenting in early adulthood.
Causes- Arachnoiditis following infection, inflammation, irradiation or bleeding.
Meningeal carcinomatosis.
Space-occupying lesions.

43
Q

Radiculopathy v myelopathy

A

In myelopathy the spinal cord itself is compressed, in radiculopathy there is pinching of the nerve roots as they exit the spinal cord which causes pain and weakness is a radicular pattern, eg pinching at cervial spine causes pain and weakness in arms and shoulders.

44
Q

Advice for patients with cervical spondylosis?

A

Avoid straining of the neck- hyper-extension eg swimming, looking up etc. Lie in a neutral position, avoid lying on ones side at night.

45
Q

Symptoms of cervical spondylosis?

A

Cervical pain, referred pain in between shoulder pains and to upper limbs, vague numbness and poor balance.

46
Q

What is Lhermettes sign?

A

This is when neck flexion causes electric shock like sensation radiating down spine.

47
Q

Tx for cervical spondylosis

A

Life style advice, hard firm pillow, yoga, pilates, pysio, TCAs- low dose amytriptilline

48
Q

Most common cause of spinal canal stenosis?

A

Degenerative arthritis of the spine

49
Q

How is spinal canal stenosis relieved?

A

Bending forward, exacerbated by walking (like in PVD)

50
Q

What must you rule out in spinal canal stenosis?

A

PAD to rule out vascular claudication.

51
Q

LP in MS

A

Oligo-clonal bands in CSF in LP (elevated IgG complex).

52
Q

What is uhthoff’s phenomenon?

A

Nerve cells are sensitive to temperature, so optic neuritis is worse after hot shower (MS).
It is the worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs.

53
Q

NB: Guillean Barre get pain. First muscles affected- are usually the last to regain function.

A

CSF- proteins

54
Q

Tx of Guillean Barre

A

IV immunoglobulins and steroids

55
Q

Investigation’s for Guillean barre

A

Anti-ganglioside antibodies & LP proteins
MRI brain & spine
Nerve conduction studies- slow conduction.

56
Q

In PKD, what investigation should be carried out and what should you do?

A

CT angiogram and if there is an aneurysm <1cm you watch and wait.
If the aneurysm is >1cm clip or embolise

57
Q

How to describe hydrocephalus?

A

Communicating (impaired reabsorption of CSF) or non-communicating (caused by a blockage eg a bleed)

58
Q

RFs for bells palsy?

A

Pregnancy, URTI, diabetes.

Caused by HSV, HZV, CMV, adenovirus

Final year (16 decks)

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