Neurology Flashcards by John Darlington

Which muscles are affected in radial palsy?

Extensor Carpi Radialis Longus

Externsor Digit communis

Brachioradialis

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Which muscles are affected in ulnar palsy?

Abductor Digit Minimi

Adductor Pollicis

Flexror Carpi Ulnaris

1st Dorsal Interreous

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What muscles are affected in median nerve palsy?

Lumbricals - I and II

Opponens pollicis

Abductor pollicis

Flexor Pollicis Brevis

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What muscles are affected in anterior interossei branch of the median nerve?

Pronator quadratus

Flexor Pollicis longus

Flexor digitorum Profundus

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List come causes of mononeuritis multiplex:

Diabetes

Vasculitis

INfective

Sarcoidosis

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What is the pathology of Guillain Barre Syndrome? and what are some symptoms?

How is it treated?

Break-down in self tolerance due to post infection

campylobacter
EBV

Symptoms:
Progressive ascending motor weakness

flaccid paralysis

Loss of reflexes

delayed impulses on EMG

Treatment:

immunoglobulins
ventilation

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What is Mysthenia Gravis? what is it related too - and list some symptoms?

Autoimmune condition where antibodies target acetylocholine receptor at post synpatic junction

associated with:

thymic hyperplasia
thyoma

Symptoms:

fluctuating weakness
ptosis
diplopia
dysphasia

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How is Myasthenia Gravis treated?

Pyridostigamine

Steroids

Immunoglobulins

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What are the types of stroke?

Thrombotic stroke
- atheroscleerotic plaque

embolic stroke

Lucunar stroke

Hemorrhagic

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In order to have a Total Anterior circulatory stroke, what symptoms must one have?

What arteries are involved?

anterior and middle cerebral:

Contra- lateral hemiparesis

Contra - lateral homonymous heminopia

HIgher cererbral dysfunction

dysphasia
visual spatial disorder
contralateral hemisensory

**all 3 of these things must be present

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In order to have a partial anterior circulatory stroke, what symptoms must be present?

What arteries are involved?

Middle cerebral:

Contra- lateral hemiparesis

Contra - lateral homonymous heminopia

HIgher cererbral dysfunction

dysphasia
visual spatial disorder
contralateral hemisensory

At least 2/3 out of these
or
Higher dysfunction
- dysphagia etc.

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In order to have a Lucunar Syndrome stroke, What symptoms must be present?

What arteries are involved?

Small perforating arteries?

pure sensory
pure motor
sensori motor stroke
Ataxia hemiparesis

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In order to have Posterior Circulating Syndrome stoke what symptoms must be present?

What arteries are involved?

Posterior cerebral artery
perforating cerebral artereis
cerebellar arteries

cranial nerve palsies
eye movement disorder
pupil disorders
cerebellar dysfunction
vertigo
nystagmus
ataxia

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What is the tissue around the area of ischemia, which can potentially be saved called?

Penumbra tissue

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On arrival at hospital for a stroke, what things much be checked/ done immediately?

take full history
ABCD assessment
Medical history
checking for bleeding disorders

*blood glucose

ECG
AF
IV access
NIL by mouth
Imagingin

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What is the immediate treatment for an ischemic stroke?

*admission to stroke unit

Alteplase
<4.5 hours

*Aspirin

(thromboectomy if available)

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What is secondary treatment of an ischemic stroke?

24 hour CT scan
Aspirin 300mg for 14 days or till discharge

then:
Clopidogrel
or
Dipyridamole + Aspirin

Simvastatin

Anti- hypertensives

*retraining
physio
speech therapy
smoking

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What type of hypersensitivity is MS?

Type IV

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List some causes thought to be responsible for MS

HLA DR2

Environmental

Infections

EBV
HHV-6

Lack of Vit D

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List the types of MS:

Relapsing Remitting
- 70% like this

Secondary Progressive

Primary Progressive

Progressive relapsing

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List some common features of MS:

Optic Neuritis

Parasthesia

Weakness

Clumsiness

Hearing dysfunction

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What is it called when symptoms of MS are made worse when the patient is hot?

UHthoff’s Phenomenon

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What investigations are done in suspicion of MS?

MRI T2 weight
- Gadolinium contrast

Lumbar puncture
- Oligoclonal IgG Bands

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Outwith imaging, what other investigations should be done for MS?

FBC

ESR

B12

ANCA
ANA
- exclude inflammatory conditions

Visual Evoked serology
- subclinical neuritis

Chest x-ray
- sarcoidosis

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To diagnose MS, what criteria must there be?

>2 attacks of demyelination dissemination within space and time.

What is a pseudo-replase in MS?

Reemergence of of a previous symptom in the presence of an infection or increased heat.

What is first line treatment for MS? with brief explanations of how they work?

Steroids for flare ups. - methylprednisolone Interferon Beta - infectable Glatiramer - immune modulator Dimethyl Fumarate - reduces lymphocyte count Teriflunomide - supresses immune system

What is second line treatment?

Fingolimond Natalizumab

What is the 3rd line treatment for MS?

Alemtuzumab

How do you stain for cryptococcus meningitis?

Indian Stain

What are some common syndromes that may develop into MS?

Optic neuritis - 50% develop into MS within 15 years Transverse myelitis - inflammation of spinal cord often present as incontinence in young people Clinically isolated syndromes Radiological isolated syndromes - presents as MS on radiographic findings - usually incientenal

What is a seizure?

Episode of neuronal hyperactivity within the brain, either localised or generalised.

What is it called when there is a seizure, leading to jerking movements over one side of the body, and the patient remains conscious?

Simple focal Seizure

Following a complex focal seizure what a person may be confused and have a set of syndromes following after about 2 minutes, what are these?

Speech arrest Automatism - lip smacking - dystonic limb posturing

What is it called when a person has both hemispheres involved during a seizure which results in loss of consciousness?

Generalised Seizures

What are the subtypes of a generalised seizure?

Typical absence seizure - often associated with masses in the brain Generalised tonic clonic seizures / bi -lateral convulsive - tonic - stiffening - clonic - rapid relaxing and tensing Myoclonic - sudden jerks Tonic seizures - whole body contrats Atonic seizure

What is it called when a seizure lasts for >5 mins/ >30mins (depending on definition) or does not return to normal between 2 seperate seizures?

Status Epilepticus an medical emergency where there is cardiovascular risk along with metabolic changes that can occur in the brain recognised mortality due to these changes

Name some things that can occur following a seizure:

Confusion and fatigue Postictal confusion Todd's paralysis - temporary suppression

What investigations are done following a seizure?

Clinical history - eye witness really important, since patient loses consciousness MRI - establish if any structural problem EEG - hour long test - with photo-stimulation Bloods - Ca2+ levels Glucose level - hypoglycemia can mask ECG - QT interval

when someone arrives in A&E following a seizure, what are the differentials and what can help you establish the cause?

Syncope witnesses how quickly they come round how the felt prior to onset

What is the definition of Epilepsy?

At least two unprovoked episodes of a seizure tendency towards seizures. *must be unprovoked

Whats the life time risk of a seizure?

5-10%

What is a focal seizure?

Area discharge from a irritated part of brain, from an other wise normal brain

What is a bilateral convulsive seizure?

Generalised tonic clonic

What immediate treatment of someone having a seizure?

Recovery position ABCD if no ABCs abnormalities then no need for hospitalisation

What are some features of a focal epilepsy?

History of trauma Aura Post attack confusion Automatisms nocturnal events

What are some features of Generalised seizure?

Photosensitivity age of onset - young lack of aura Myoclonus - especially in morning seizures in the morning family history EEG abnormalities

What things do you get the patient to do during an EEG?

lie at rest hyperventilate Relax and make drowsy Photic stimulation

What is the treatment for focal epilepsy?

Lamotrigrine Carbamazepine Levetiractem

What is the treatment for generalised?

Valproate Levetriactem Lamotrigrine

What are the symptoms of optic neuritis?

Fogging of vision Painful eye movement Central vision loss Colour desaturation Dense central scotoma

What are the clinical findings of optic neuritis?

RAPD optic disc pallor red colour destruction

What are some common symptoms of Intracerebral TB?

Progresses over weeks Palsy of cranials: - 3 - 4 - 6 - 9

What brain disease does JC virus cause?

Multifocal Leuco - encephephalopathy

How is cryptococcal meningitis treated?

Amphotericin B Fluconazole ICP shunt

What is a complication with cryptococcal meningitis patients who have HIV?

Paradoxical worsening with anti- retroviral medication

What nerve palsy is usually first seen in high intra-cranial pressure?

6th nerve

Which nerve palsy will present with a head tilting away?

Trocheal, 4th nerve.

List some symptoms outwith motor, which occur in parkinson's:

Dementia Depression anxiety REM sleep behaviour disorder restless legs Constipation urinary urgency

What investigations are done into parkinson's?

Bloods - thyroid - copper levels MRI - for vascular changes Functional imaging - DAT - SPECT allows the dopaminergic neurons to be seen

What drug is given to stop status epilepticus?

Lorazepam?

What are the stages of parkinson's?

Step 1-2: Medulla/ Pons and Olfactory nucleus pre-symptomatic stage. Loss of sense of smell Step 3-4: Midbrain/ substantia nigra symptoms of movement Step 5-6: Neocortex involvement - Parkinson's associated dementia

Neurology Flashcards

(62 cards)