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Neurology Flashcards

1
Q

Unilateral weakness/sensory deficit
Homonymous hemianopia
Higher cerebral dysfunction e.g. dysphasia, neglect

A

Anterior cerebral artery stroke

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2
Q

Patient can understand but not reply following stroke

A

Dominant frontal lobe (Broca’s area) affected

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3
Q

Patient has impaired comprehension but replies fluently with jargon following stroke

A

Dominant temporoparietal lobe (Wernicke’s area) affected

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4
Q
  • Vertigo, vomiting, dysphasia
  • Ipsilateral: ataxia, Horner’s syndrome, V, VI palsy
  • Contralateral: loss of sensation
A

Lateral medullary syndrome

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5
Q

Effects of cerebellar syndrome

A 
Effects: DANISH 
•	Dysdiadochokinesis
•	Dysmetria: past-pointing 
•	Ataxia: limb/truncal 
•	Nystagmus: horizontal = ipsilateral hemisphere 
•	Intenion tremor 
•	Speech: slurred, staccato, scanning dysarthria 
•	Hypotonia
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6
Q

Causes of paraneoplastic syndrome

A 
Causes: PASTRIES 
•	Paraneoplastic 
•	Alcohol: B1 and B12 deficiency
•	Sclerosis 
•	Tumour 
•	Rare: MSA, Freidrich’s, Ataxia Telangiectasia 
•	Iatrogenic: phenytoin 
•	Endo: hypothyroidism 
•	Stroke: vertebrobasilar
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7
Q

Anterior cerebral artery stroke

A
  • Supplies frontal and medial part of cerebrum
  • Contralateral motor/sensory loss in the legs > arms
  • Face is spared
  • Abulia (pathological laziness)
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8
Q

Middle cerebral artery stroke

A
  • Supplies lateral/ external part of hemisphere
  • Contralateral motor/ sensory loss in face and arms > legs
  • Contralateral homonymous hemianopia due to involvement of optic radiation
  • Cognitive changes: dominant (L) aphasia, non-dominant (R): apraxia, neglect
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9
Q

Posterior cerebral artery stroke

A
  • Supplies occipital lobe

- Contralateral homonymous hemianopia with macula sparing

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10
Q

Vertebrobasilar circulation

A
  • Supplies cerebrum, brainstem and occipital lobes
  • Combination of symptoms:
  • Visual: hemianopia and cortical blindness
  • Cerebellar: DANISH
  • CN lesions
  • Hemi-/quadriplegia
  • Uni-/bilateral sensory symptoms
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11
Q

Lateral Medullary Syndrome/ Wallenberg’s Syndrome

A
  • Occlusion of one vertebral artery or PICA
  • Features: DANVAH
  • Dysphagia
  • Ataxia (ipsilateral)
  • Nystagmus (ipsilateral)
  • Vertigo
  • Anaesthesia: ipsilateral facial numbness + absent corneal reflex, contralateral pain loss
  • Horner’s syndrome (ipsilateral)
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12
Q 
Pontine lesions (e.g. infarct) 
6th and 7th nerve palsy + contralateral hemiplegia
A

Millard-Gubler Syndrome: crossed hemiplegia

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13
Q

Causes of locked in syndrome

A
  • Ventral pons infarction: basilar artery

- Central pontine myelinosis: rapid correction of hyponatraemia

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14
Q

Causes of cerebellopontine angle syndrome

A
  • Acoustic neuroma
  • Meningioma
  • Cerebellar astrocytoma
  • Metastasis (e.g. breast)
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15
Q

Guess the syndrome:

  • Ipisilateral CN 5, 6, 7, 8 palsies + cerebellar signs
  • Absent corneal reflex (V1 afferent, VII efferent)
  • LMN facial palsy
  • LR palsy
  • Sensorinerual deafness, vertigo, tinnitus
  • DANISH
A

Cerebellopontine angle syndrome

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16
Q

Guess the syndrome:

  • Syncope/ presyncope or focal neurology on using the arm
  • BP difference of >20mmHg between arms
A

Subclavian Steal syndrome

  • Subclavian artery stenosis proximal to origin of vertebral artery may lead to blood being stolen from this vertebral artery by retrograde flow
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17
Q

Guess the syndrome:

  • Para-/quadriparesis
  • Impaired pain and temperature sensation
  • Preserved touch and proprioception
A

Anterior spinal artery/ Beck’s syndrome

  • Infarction of spinal cord in distribution of anterior spinal artery: ventral 2/3 of cord
  • Caused by aortic aneurysm dissection or repair
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18
Q

Causes of sympathetic under activity/ postural hypotension faint

A

• Sympathetic underactivity = Postural Hypotension (STAND UP)
o Salt deficiency: hypovolaemia, Addison’s
o Toxins
 Cardiac: ACEi, diuretics, nitrates, alpha blockers
 Neurology: TCAs, benzos, antipsychotics, L-DOPA
o Autonomic Neuropathy: DM, Parkinson’s, GBS
o Dialysis
o Unwell: chronic bed-rest
o Pooling, venous: varicose veins prolonged standing
 

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19
Q

Causes of Delirium

A

Causes: DELIRUMS
• Drugs: opioids, sedatives, L-DOPA, steroids
• Eyes, ears and sensory deficits
• Low oxygen states: MI, stroke, PE
• Infection
• Retention of stool or urine
• Ictal
• Under-hydration or nutrition
• Metabolic: DM, post-op, sodium, uraemia, calcium
• Subdural haemorrhage or other intracranial pathology

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20
Q

Total Anterior Circulation Stroke (TACS)

A

All 3 of:

  1. Hemiparesis (contralateral) and/or sensory deficit (>2 of face, arm and leg)
  2. Homonymous hemianopia (contralateral)
  3. Higher cortical dysfunction - dysphasia (dominant hemisphere) or hemispatial neglect

Partial = 2/3 of the above (usually 1 and 3)

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21
Q

Posterior Circulation Stroke (PACS)

A

Any of:

  1. Cerebellar Syndrome
  2. Brainstem Syndrome
  3. Contralateral Homonymous Hemianopia
22
Q

Lacunar Stroke (LACS)

A

Small infarcts in white matter tracts (deep penetrating arteries)
Absence of: higher cortical dysfunction, homonymous hemianopia, drowsiness, brainstem signs

5 syndromes:

  • Pure sensory
  • Pure motor
  • Mixed sensorimotor
  • Dysarthria/ clumsy hand
  • Ataxic hemiparesis: anterior limb of internal capsule
23
Q

Lateral Medullary Syndrome (Wallenberg’s)

A 
PICA or vertebral artery 
DANVAH 
- Dysphagia 
- Ataxia (ipsilateral) 
- Nystagmus (ipsilateral) 
- Vertigo 
- Anaesthesia (ipsilateral facial numbness and contralateral pain) 
- Horner's syndrome (ipsilateral)
24
Q

Side effects of lamotrigine

A

o Skin rash (SJS)

o Diplopia

25
Side effects of valproate
``` • Valproate o Appetite increased o Liver failure o Pancreatitis o Reversible hair loss o Oedema o Ataxia o Teratogen, tremor, thrombocytopaenia o Encephalopathy ```
26
Side effects of carbamazepine
o Leukopenia o Skin reactions o Diplopia o SIADH
27
Side effects of phenytoin
``` o Gingival hypertrophy o Hirsutism o Cerebellar syndrome: ataxia, nystagmus and dysarthria o Peripheral sensory neuropathy o Diplopia o Tremor ```
28
Glasgow Coma Scale
E4 V5 M6 ``` Eyes opening 4 - spontaneous 3 - to speech 2 - to pain 1 - none ``` ``` Verbal 5 - oriented 4 - confused 3 - inappropriate 2 - incomprehensible 1 - none ``` ``` Motor 6 - commands 5 - localises 4 - withdraws 3 - flexion 2 - extension 1 - none ```
29
Imaging: CT head (+ C-spine) guidelines in TBI
``` o Open, depressed or basal skull fracture o Retrograde amnesia >30 minutes o Neurological deficit or seizure o GCS <13 at any time or <15 2 hours after injury o Vomit more than once o LOC or any amnesia + any of:  Dangerous mechanism  Age >65  Coagulopathy including warfarin ```  
30
Management of benign intracranial hypertension
Obese young woman, raised ICP but no mass lesion Mx: weight loss, acetazolamide, loop diuretics, prednisolone, LP shunt
31
Management of raised ICP
1. ABC 2. Treat seizures and correct hypotension 3. Elevated bed to 40 degrees 4. Neuroprotective ventilation (PaO2 >13, PCO2 4.5, sedation with NM blockade) 5. Mannitol or hypertonic saline
32
C5 compression
Weakness Deltoid Supraspinatus Loss of supinator jerk Sensory - numb elbow
33
C6 compression
Motor - Biceps Brachioradialis Lost biceps jerk Sensory - numb thumb and index finger
34
C7 compression
Motor - Triceps Finger extension Lost triceps jerk Sensory - numb middle finger
35
C8 compression
Motor - Finger flexors Intrinsic hand Sensory - numb ring and little fingers
36
L4/5 - L5 Root Compression
• Weak hallux extension +/- foot drop o In foot drop due to L5 radiculopathy, weak inversion (tibialis posterior) helps distinguish from peroneal nerve palsy • Decreased sensation of inner dorsum of foot
37
L5/S1 – S1 Root compression
* Weak foot plantarflexion and eversion * Loss of ankle jerk * Calf pain * Reduced sensation over sole of foot and back of calf
38
Causes of mononeuritis multiplex
Definition: 2 or more peripheral nerves affected Usually systemic cause e.g. DM Others: inflammatory disease, AIDS, Leprosy
39
Median (C6-T1) nerve lesion
Cause: trauma, carpal tunnel Motor: LOAF, thenar wasting Sensory: radial 3.5 fingers and palm, Tinel's and Phalen's +ve
40
Ulnar (C7-T1) nerve lesion
Cause: elbow trauma e.g. supracondylar fracture Motor: claw hand, hypothenar wasting, Froment's +ve Sensory: Ulnar 1.5 fingers
41
Radial (C5-T1) nerve lesion
Cause: wrist, humerus or axilla Motor: finger drop +/- wrist drop +/- triceps paralysis Sensory: snuff box
42
Erb's palsy
Cause: trauma, RT e.g. breast leading to high brachial plexus (C5-6) injury Motor: Waiter's tip Sensory: C5-6 dermatome
43
Klumpke's palsy
Cause: trauma/ RT causing low brachial plexus (C8-T1) palsy Motor: claw hand Sensory: dermatomal
44
Phrenic nerve (C3-5) lesion
Cause: lung cancer, myeloma, thymoma, cervical spondylosis, zoster, HIV, Lyme, TB Motor: orhtopnoea + raised diaphragm
45
Lateral cutaneous nerve of thigh lesion (L2-3)
Cause: entrapment under inguinal ligament Sensory: anterolateral burning thigh pain
46
Sciatic (L4-S3) lesion
Cause: pelvic tumour, pelvic or femoral fracture Motor: hamstrings and all muscles below knee Sensory: bellow knee laterally and foot
47
Common perineal (L4-S1) lesion
Cause: fibular head trauma, sitting cross legged Motor: foot drop, weak ankle dorsiflexion and eversion (inversion intact cf. with L5 radiculopathy)
48
Tibial (L4-S3) nerve lesion
Motor: can't plantar flex, invert foot or flex toes Loss of sensation to sole of foot
49
Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease UMN or LMN?
Most common form of MND, often used synonymously. Combined degeneration of upper and lower motor neurones, producing a mix of UMN and LMN signs.
50
Progressive Muscular Atrophy UMN or LMN?
Only LMN signs, e.g. flail arm or flail foot syndrome. Only affects anterior horn cells. Better prognosis.
51
Progressive Bulbar Palsy UMN or LMN?
Dysarthria and dysphagia with wasted fasciculating tongue (LMN) and brisk jaw jerk (UMN). Only affects cranial nerves 9-12.
52
Neurofibromatosis 1 | Features: CAFÉ NOIR
``` • Café au lait spots o Increase in size and number with age o Adult: >6, >15mm across o DDx: McCune-Albright, Multiple Lentigenes, Urticaria Pigmentosa • Axillary freckling • Fibromas o • Eye o Lisch nodules – brown/ translucent iris hamartomas under slit lamp o Optic nerve glioma • Neoplasia o CNS: meningioma, astrocytoma, ependyoma o Phaeochromocytoma o Chronic or acute myeloid leukaemia • Orthopaedic o Kyphoscoliosis o Sphenoid dysplasia • IQ low + epilepsy • Renal – RAS and HTN ```

Finals (13 decks)

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