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Neurology Flashcards

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1
Q

What are the clinical features of internal capsule and corticospinal tract lesions?

A

UMN signs

Contralateral hemiparesis and sensory loss

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2
Q

What are the clinical features of spinal cord lesions?

A

LMN signs at the level of the lesion
UMN signs below the lesion
Sensory level

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3
Q

What do the internal carotid arteries supply?

A

Anterior 2/3 cerebral hemisphere

Basal ganglia

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4
Q

What do the anterior cerebral arteries supply?

A

Front and middle cerebrum

Occlusion - contralateral leg weakness

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5
Q

What do the middle cerebral arteries supply?

A

Lateral part of hemisphere
Occlusion - contralateral hemiparesis and sensory loss
Dominant - homonymous hemianopia
Non-dominant - visuospatial disturbance

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6
Q

What do the posterior cerebral arteries supply?

A

Occipital lobe

Occlusion - contralateral homonymous hemianopia

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7
Q

What are the red flags for headache?

A

Papilloedema, visual field loss
6th nerve palsy, tender temples
Focal neurology
Purpuric rash

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8
Q

What are the treatments for migraine?

A
  1. Triptan + NSAID + paracetamol, anti-emetic

2. Prophylactic topiramate propranolol

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9
Q

What are the treatments for cluster headaches?

A

O2 therapy + nasal triptan

Prophylactic verapamil

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10
Q

What are some contraindications to triptans?

A

IHD, TIA, CVA

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11
Q

What are the criteria for prophylactic migraine treatment?

A 
1 of:
Quality of life severely affected
More than 2 attacks per month 
Does not respond to acute drugs 
Frequent/long/uncomfortable auras
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12
Q

What are the clinical features of extradural haematomas?

A

Arterial bleed - often middle meningeal artery
Lucid interval after initial event
Crescent shaped opacity on scan

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13
Q

What are the clinical features of subdural haematomas?

A

Venous bleed - can occur after trivial injury
Increased risk in elderly and alcoholics
Fluctuating levels of consciousness

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14
Q

What are the clinical features of trigeminal neuralgia?

A

Paroxysms of stabbing pain in trigeminal distribution
Washing, shaving, eating, talking
MRI to exclude secondary cause

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15
Q

What are the clinical features of a subarachnoid haemorrhage?

A

Thunderclap headache
Vomiting, collapse, seizures
Usually due to rupture of berry aneurysm
Urgent CT, if negative do LP

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16
Q

What are the features of temporal lobe seizures?

A 
Automatisms - lip smaking/fiddling 
Dysphagia 
Deja-vu 
Emotional disturbance
Hallucinations
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17
Q

What are the features of frontal seizures?

A

Motor features e.g. posturing

Post-ictal Todd’s palsy

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18
Q

What is the treatment for absence seizures?

A

Sodium valproate

Ethosuximide

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19
Q

What is the treatment for tonic-clonic seizures?

A

Sodium valproate

Lamotrigine

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20
Q

What is the treatment for myoclonic seizures?

A

Sodium valproate

Levetriacetam

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21
Q

What are the clinical features and treatment of Bell’s palsy?

A

Abrupt onset, complete unilateral facial palsy
Prednisolone in within 72 hours onset
Artificial tears, tape eye closed at night

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22
Q

What are the clinical features and treatment of Ramsay Hunt syndrome?

A

Shingles of the geniculate ganglion of the facial nerve
Painful vesicular rash on auditory canal and eardrum
Ipsilateral facial palsy, loss of taste, tinnitus, dry eyes and mouth
Aciclovir and prednisolone

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23
Q

What are the clinical features of carpal tunnel syndrome?

A

Compression of median nerve
Aching pain in arm and hand
Paraesthesiae in thumb, index and middle finger
Wasting of thenar eminence

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24
Q

What are the clinical features of a radial nerve palsy?

A

Compression against mid-shaft of humerus

Wrist drop and finger drop

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25
What are the features of an ulnar nerve palsy?
Vulnerable to elbow trauma Hypothenar wasting Weak 5th digit abduction
26
What are the features of a CPN palsy?
Prolonged knee flexion - winds round fibular head Footdrop Weak dorsiflexion and eversion Sensory loss over dorsum
27
What are the features of a sciatic nerve palsy?
Damaged by pelvic and femoral fractures Footdrop Reduced sensation below knee laterally
28
What are the features of a tibial nerve palsy?
Inability to stand on tiptoes Cannot invert foot or flex toes Sensory loss over sole of foot
29
What are some causes of polyneuropathies?
``` Vascular - RA, GPA Infective - HIV, syphilis, lyme Metabolic - DM, renal failure, hypothyroidism Inflammatory - GBS, sarcoidosis Nutrition - B12, folate, B1 deficiency Drugs - cisplatin, phenytoin, isoniazid ```
30
How does Guillain-barre present?
Acute motor demyelinating neuropathy Follows d+v (campylobacter) Symmetrical ascending muscle weakness Autonomic dysfunction - sweating, tachycardia, arrhythmias
31
What tests should be done for GBS?
LP - cytoalbuminologic dissociation Nerve conduction FVC 4 hourly - if <1.5L call ICU
32
What is the treatment of GBS?
IV immunoglobulins - 0.4g/kg/24hrs for 5 days
33
What causes myasthenia gravis?
Antibodies to nicotinic acetylcholine receptors Check anti-ACLR antibodies Can be due to thyoma - do CT
34
What is the treatment of myasthenia gravis?
Anticholinesterase e.g. pyridostigmine Prednisolone Thymectomy
35
What are the features of motor neurone disease?
Neurodegenerative diseases - selective loss of neurons in motor cortex, cranial nerve nuclei and anterior horn cells Gives a mixture of UMN and LMN signs Does not affect eye movements or sphincters
36
What are the signs of motor neurone disease?
Under 40, stumbling spastic gait, foot drop, proximal myopathy, weak grip, aspiration pneumonia
37
What are the fours types of motor neurone disease?
1. Amyotrophic lateral sclerosis 2. Progressive bulbar palsy 3. Progressive muscular atrophy 4. Primary lateral sclerosis
38
What are myopathies?
Primary disorders of muscle with gradual onset symmetrical weakness Preserved reflexes, no fasisculations
39
What tests should be done for myopathy?
ESR, CK, AST and LDH EMG, muscle biopsy Genetic testing
40
What are the features of Duchenne muscular dystrophy?
``` Under 4 Clumsy walking, difficulty standing, respiratory failure x-linked recessive Gower's sign Increased CK ```
41
What are the features of Becker muscular dystrophy?
Milder symptoms | Later age
42
What are the inflammatory myopathies?
Polymyositis and dermatomyositis Spontaneous pain at rest Local tenderness on palpation
43
What is multiple sclerosis?
Inflammatory plaques of demyelination in the CNS disseminated in time and space
44
How can MS present?
Optic neuritis Gait ataxia UMN signs and sensory disturbance Cerebellar signs
45
What tests should be done for suspected MS?
B12, CRP, ESR HIV, syphilis, hep b and c MR spine and brain CSF - oligoclonal bands of IgG
46
How are relapses of MS treated?
Check for infection | High dose methylprednisolone
47
How are symptoms in MS treated?
Fatigue - TFTs, FBC, vit D, sleep hygiene, amantadine Gait - physiology, fampridine Sensory - gabapentin Spasticity - physiology, baclofen
48
What are some stroke mimics?
Hypo/hyperglycaemia Subdural haemorrhage Hemiplegic migraine Post-ictal
49
What are the criteria for TACS?
1. Unilateral weakness of face, arm and leg 2. Homonymous hemianopia 3. Higher cerebral dysfunction
50
What are the criteria for POCS?
1 of: 1. Cerebellar or brainstem syndrome 2. LOC 3. Homonymous hemianopia
51
What are the criteria for LACS?
1 of: 1. Unilateral face, arm and leg weakness 2. Pure sensory stroke 3. Ataxic hemiparesis
52
What is the acute management of stroke?
1. ABCDE - glucose and MRI 2. CT/MR head within 1 hour 3. NIHSS 4. Aspirin 300mg 5. Thrombolysis if within 4.5 hours 6. Consider thrombectomy 7. Admit to stroke unit
53
What tests should be done following a TIA?
FBC, ESR, UEs, glucose, lipids | ECG, echo, carotid doppler
54
What predicts prognosis following a TIA?
Age over 60 Bp over 140/90 Clinical features - unilateral = 2, speech disturbance = 1 Duration - over 1 hour = 2, 10-59mins = 1 Diabetes Over 4 - specialist review within 24 hours
55
What are the side effects of levodopa?
Dyskinesia, dystonia Hallucinations Nausea and vomiting
56
What are ropinorole and pramipexole?
Dopamine agonists Can be used as monotherapy in early PD SE: drowsiness, compulsive behaviour
57
What are rasagiline and selegiline?
MAO-B inhibitors Can be used as monotherapy in early PD SE: postural hypotension, AF
58
What are entacapone and tolcapone?
COMT inhibitors | Can help motor complications in late PD
59
What are the features of dementia with lewy bodies?
1. Dementia 2. Parkinsonism 3. Visual hallucinations
60
What are the features of multi-system atrophy?
Autonomic features - hypotension, bladder instability | Symmetrical Parkinsonism
61
What are the features of progressive nuclear palsy?
Early falls Truncal rigidity Vertical gaze palsy Reduction in mid brain volume on MRI
62
What are the features of normal pressure hydrocephalus?
1. Dementia 2. Gait disorder 3. Bladder instability
63
What are the features of portico-basal degeneration?
Asymmetrical Parkinsonism Dyspraxia Sensory deficit

FINALS (19 decks)

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