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Neurology Flashcards

1
Q

What is the most common mechanism of stroke?

A

Ischaemic (85%)

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2
Q

What does FAST stand for?

A

Face
Arms
Speech
Time

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3
Q

What are the signs of an ACA stroke?

A

Contralateral weakness

Contralateral sensory loss/sensory inattention

Dysarthria

Dysphasia (receptive, expressive)

Homonymous

Hemianopia/visual inattention

Higher cortical dysfunction

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4
Q

How long should you avoid driving following a TIA?

A

One month - you must inform the DVLA of the TIA

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5
Q

What does the MCA supply?

A

Weakness and sensory loss to arms and face

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6
Q

What are the signs of an ACA stroke?

A

Weakness and sensory loss to feet and legs

Incontinence

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7
Q

List 2 causes of an ischaemic stroke

A
  • Embolic - products, pregnancy (placenta - rare)
  • Atherosclerosis
  • Vasculitis
  • Thrombophillia
  • Shock - watershed
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8
Q

What is the pharmacology of anticoagulants?

A
  • Heparin, LMWH (dalteparin)

Act on the coagulation cascade (involved in the formation of fibrin).
Bind to antithrombin 3, accelerates its action, resulting in blocking 10a and thrombin.

  • NOAC - dabigatran, apixaban
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9
Q

What is the pharamoclogy of antiplatelets?

A
  • Aspirin (COX-1 inhib), clopidogerol (P2Y12)

Prevent platelets from adhering together and therefore prevent clots.

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10
Q

How does aspirin work?

A

COX-1 Inhibitor

Prevent the release of TXA

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11
Q

What score is used to estimate the risk of a stroke after a TIA?

Can you list the

A

ABCD2

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12
Q

What score is used to estimate the risk of a stroke after a TIA?

Can you list the features of this

A

ABCD2

Age
Blood pressure
Clinical features
Duration of symptoms
Diabetic?
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13
Q

What is considered a high risk ABCD2 score?

A

> 6

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14
Q

How would you treat a TIA?

A

Aspirin

Modify risk factors - stop smoking, reduce BP, lower lipid levels

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15
Q

How would you treat an ischaemic stroke?

A
  • Thrombolysis < 4.5 hours. tpA - altepase.
  • Carotid endartectomy
  • Coil
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16
Q

What disease is commonly linked to berry aneurysms?

A

Polycystic kidney disease

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17
Q

What is the most common cause of a subarachnoid haemorrhage?

A

Berry aneurysm rupture

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18
Q

What signs are suggestive of a haemorrhagic stroke over an ischaemic stroke?

A

Headache, meningism, coma

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19
Q

What is a sentinel bleed?

A

Prewarning symptoms to SAH.

Headache, dizziness, orbital pain, visual loss.

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20
Q

How would you treat an SAH?

A

Stop the bleeding - clip / coil, and take off blood thinners.

Stop vasospasm - Ca2+ blocker - nimodipine.

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21
Q

When should you do a lumbar puncture on someone who has had a haemorrhagic stroke?

A

> 12 hours most sensitive

Blood broken down into billirubin - yellow (xanthecromia), therefore you know the result isnt from blood you may have put into the CSF from trauma performing the LP.

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22
Q

What must you NOT give patients who have had a haemorrhagic stroke?

A

Antiplatelets / anticoagulants - increase the bleeding.

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23
Q

How can you tell the difference between a subdrual and extradural haemorrhage?

A

CT

  • E for Eye Shaped
  • B for bannana shaped (subdural)
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24
Q

What is the mechanism behind a subdural stroke?

A

Bridging veins

Common in the elderly, young babies that have been shaken, acceleration injury

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25
What is the mechanism behind an extradural stroke?
Temporal / parietal bone fracture - middle meningeal artery
26
What signs would you see in someone that has had a extradural haemorrhage?
LUCID PERIOD - fluctuating levels of conciousness straight after the accident and then appearing 'fine' and concious. Will rapidly progress to coma as the bleeding continues and continue to increase the pressure inside the skull.
27
What investigation is contraidnicated in patients who have had an extradural haemorrhage and why?
- Lumbar puncture - drop CSF pressure that may speed up / result in brain herniation.
28
Where do most berry aneursyms occur?
Circle of willis
29
Which side of the body would a stroke on the LEFT SIDE of the brain affect?
RIGHT side of the body
30
What are the four cardinal features of horners syndrome?
- Cosntricted pupil - Drooping of the upper eyelid - Absense of sweating on the face - Sunken eye Damage to the SYMPATHETIC nerves on the SAME SIDE as the lesion
31
What would you see in a third nerve palsy?
Out and down
32
What would you see in a forth nerve palsy?
often see turning of the head to compensate Supplies the superior oblique: Up and in
33
What would you see in a sixth nerve palsy?
turns inwards
34
List 3 causes of horners syndrome
- Pancoast tumour (associated with arm, shoulder or hand pain) - MS - Stroke - Herpes zoster infection - Trauma - Syringomyelia - Temporal arteritis
35
What is bells palsy?
Paralysis of one half of the face - Inability to control muscles on the AFFECTED SIDE - FACIAL NERVE - Virus - causes inflammation of the nerve, cutting off the blood supply when it passes through the canal
36
How would you treat bells palsy?
Steroids for inflammation Eye drops to protect the eye from drying up
37
What sensations are conveyed in the spinothalamic tract?
(Ascending tract) Pain and temperature
38
What sensations are conveyed in the spinocerebellar tract?
(Ascending tract) Proprioreception
39
What sensations are conveyed in the dorsal columns?
(Ascending tract) Fine touch proprioreception Vibration
40
What sensations are conveyed in the corticospinal tract?
(Descending tract - pyramidal, i.e. goes through the pyramids of the medulla) VOLUNTARY motor control of muscles, modulate sensory info from the body. Anterior = trunk (same side) Lateral = limbs (opposite side)
41
What sensations are conveyed in the extrapyramidal tracts?
(Descending tract - extra pyramidal) Involuntary and automatic control of muscles - balance, posture, locomtion.
42
List some signs of UMN lesions
EVERYTHING GOES UP. Hypertonia – an increased muscle tone Hyperreflexia – increased muscle reflexes Clonus – involuntary, rhythmic muscle contractions Babinski sign – extension of the hallux in response to blunt stimulation of the sole of the foot Muscle weakness
43
What level does the spinal cord end?
L1-L2
44
What level are lumbar punctures done?
L3-L5
45
What is the pathology of carpal tunnel syndrome?
Mononeuropathy
46
What is the most common radiculopathy seen in patients? And what nerve root does it affect?
SCIATICA - L5
47
List 4 causes of polyneuropathy
- Diabetes - Alcohol - Vit B12/ folate deficiency - Charcot marie tooth disease - Guillian barre syndrome
48
What cells produce myelin?
Schwann cells
49
What is the cause of gullian barre syndrome (GBS)?
Often develops 3 weeks after an infection (resp or gastro) - autoantigens, MOLECULAR MIMICRY - Campylobacter jejuni - mycoplasma pneumonia - CMV
50
How do you diagnose GBS?
- Lumbar puncture - Increase in protein with no | - Nerve conduction studies
51
How do you treat GBS?
- IVIg - dampen the immune response | - Plasmapheresis - plasma filtered to remove the antibodies
52
What is the defect that results in Duchennes / Beckers?
Either no / poorly formed dystrophin --> X linked, dystrophin gene
53
What is the pattern of inheritance of Duchennes / Beckers?
X linked recessive
54
What is a myopathy?
- Affects the muscle without affecting the NMJ or the nerve
55
What is the treatment for trigeminal neuralgia?
Carbamezapine - antiepileptic
56
What cells produce myelin?
Oligodendrocytes
57
Name the trhee autoantibodies associated with mG?
- ACHr - MuSK - LIP4
58
What type of hypersensitivty reaction is MS?
Type 4 --> t cell mediated inflammation
59
What is the pathophysiology of MS?
Plaques in the CNS - scarring of the nerves due to autoimmune damage of the myelin sheath
60
How is MS diagnosed?
- MRI - white matter lesions, dissemination in time - IgG oligoclonal bands in the CSF - Visual evoked potentials
61
What preciputating factors can result in migraines?
``` Chocolate Hungover Oral contraceptive Cheese Orgas, Lie in Alcohol Travel Exercise ```
62
How would you treat a patient suffering from status epilepticus?
- abcde | - buccal medazalam
63
Name 3 associated risk factors with MS
- VIT D DEFICIENCY - EBV - Smoking - Being female - HLA DR2
64
What is the only drug shown to prolong life in MND?
RILUZOLE
65
What is hemiparesis?
Weakness of ONE SIDE of the body
66
What is the CHA2DS2 VASc score and what is it used for?
Estimate the risk of stroke in patients who have AF. Congestive heart failure (or Left ventricular systolic dysfunction) Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) Age ≥75 years Diabetes Mellitus Prior Stroke or TIA or thromboembolism Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) Age 65–74 years Sex
67
What is teh ABCD2 score and waht is it used for?
Predicting the risk of stroke after a TIA ``` Age Blood pressure Clinical symptoms - weakness, speech disturbance Diabetes Duration of symptoms ```
68
What is the method of action of pyridostigmine?
LONG ACTING Achr inhibitor
69
How would you manage a myasthenic crisis?
plasmapheresis intravenous immunoglobulins
70
What is the only drug shown to prolong life in MND?
RILUZOLE - only prolong by 2-3 months.
71
What is the scary thing about MND?
Brain function is completely preserved - person will be aware of what is going on, eventually locked in their own body
72
Common peroneal nerve lesion
weakness of foot dorsiflexion and foot eversion runs round the side of the knee and the back of it common in drunk people
73
What factors are needed to diagnose epilespy?
> 2 unprovoked, unpredictable seizures
74
How does an EEG work?
Performed only to support a diagnosis of epilepsy when the clinical history suggests that the seizure is likely to be epileptic in origin - Can show abnormal results in non-epileptic patients and vice versa. Good to determine if someone is having syncope or a seizure.
75
What is the first line investigation needed for anyone that has blacked out?
ECG
76
essential tremor
Differentiating between this and parkinsons = essential tremor more on movement. treatment with propanolol.
77
Why is temporal arteritis (GCA_ considered a medical emergency?
can cause VISUAL LOSS - need to quickly treat with steroids
78
After having a TIA (in isolation), what are the rules for driving in group 1 and group 2 vehicles?
Group 1 = 1 month. inform DVLA. Group 2 = 1 year. inform DVLA.
79
Name 4 RF associated with having a TIA / ischameic stroke
Hypertension. Smoking. Diabetes mellitus. Heart disease (valvular, ischaemic, atrial fibrillation). Peripheral arterial disease. Polycythaemia vera. Carotid artery occlusion; carotid bruit. Combined oral contraceptive pill. Hyperlipidaemia. Excess alcohol. Clotting disorders.
80
What are the four features of narcolepsy?
- Execissve sleepiness (particularly during the day time) - Cataplexy (+/-) - Hypnogognic hallucinations - Sleep paralysis
81
What is cataplexy?
Weakness of the muscles due to strong sense of emotion.
82
What is a gelastic seizure?
Seizure that results in a burst of energy - laughing, crying, etc.
83
What is the difference between Huntingtons and Parkinsons?
``` Parkinsons = reduced dopamine Huntingtons = increased dopamine ```
84
What would you see on an MRI of someone with Huntingtons?
- Coritical atrophy - Enalrged anterior and lateral ventricles - Reduction in the head of the caudate nuclei
85
What is the triad of symptoms seen in normal pressure hydrocephalus, and what conditons would be a differential?
Adams triad - gait ataxia, memory problems, URINARY INCONTINENCE Parkinsons and dementia
86
How would you treat a normal pressure hydrocepahlus?
SHUNT - peritoneum
87
What are the three different types of Cerebral Palsy?
- Spastic - Dyskinetic - Ataxic
88
How can you tell the difference between parkisnons and essential tremor?
Tremor with parkinsons apparent on REST, essential tremor on initiating movement. Psychogenic tremor may mimic it, but can usuallu distract the indibidual and changes with voluntary movement of the contraleteral limb.
89
Are cranial nerves upper of lower motor neurones?
LOWER
90
What are brocas and wernickes apahasia?
Brocas =Cannot express speech but can understand speeh (in R handed people will result from stroke on the left hand side, ACA area) Wernicke = cant understand speech

Phase 3A (17 decks)

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