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Finals > Neurology > Flashcards

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
Q

Side effects of valproate

A 
•	Valproate 
o	Appetite increased 
o	Liver failure
o	Pancreatitis 
o	Reversible hair loss 
o	Oedema 
o	Ataxia 
o	Teratogen, tremor, thrombocytopaenia 
o	Encephalopathy
26
Q

Side effects of carbamazepine

A

o Leukopenia
o Skin reactions
o Diplopia
o SIADH

27
Q

Side effects of phenytoin

A 
o	Gingival hypertrophy 
o	Hirsutism 
o	Cerebellar syndrome: ataxia, nystagmus and dysarthria 
o	Peripheral sensory neuropathy 
o	Diplopia 
o	Tremor
28
Q

Glasgow Coma Scale

A

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
Q

Imaging: CT head (+ C-spine) guidelines in TBI

A 
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
Q

Management of benign intracranial hypertension

A

Obese young woman, raised ICP but no mass lesion

Mx: weight loss, acetazolamide, loop diuretics, prednisolone, LP shunt

31
Q

Management of raised ICP

A
  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
Q

C5 compression

A

Weakness
Deltoid
Supraspinatus
Loss of supinator jerk

Sensory - numb elbow

33
Q

C6 compression

A

Motor - Biceps
Brachioradialis
Lost biceps jerk

Sensory - numb thumb and index finger

34
Q

C7 compression

A

Motor - Triceps
Finger extension
Lost triceps jerk

Sensory - numb middle finger

35
Q

C8 compression

A

Motor - Finger flexors
Intrinsic hand

Sensory - numb ring and little fingers

36
Q

L4/5 - L5 Root Compression

A

• 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
Q

L5/S1 – S1 Root compression

A
  • Weak foot plantarflexion and eversion
  • Loss of ankle jerk
  • Calf pain
  • Reduced sensation over sole of foot and back of calf
38
Q

Causes of mononeuritis multiplex

A

Definition: 2 or more peripheral nerves affected

Usually systemic cause e.g. DM

Others: inflammatory disease, AIDS, Leprosy

39
Q

Median (C6-T1) nerve lesion

A

Cause: trauma, carpal tunnel

Motor: LOAF, thenar wasting

Sensory: radial 3.5 fingers and palm, Tinel’s and Phalen’s +ve

40
Q

Ulnar (C7-T1) nerve lesion

A

Cause: elbow trauma e.g. supracondylar fracture

Motor: claw hand, hypothenar wasting, Froment’s +ve

Sensory: Ulnar 1.5 fingers

41
Q

Radial (C5-T1) nerve lesion

A

Cause: wrist, humerus or axilla

Motor: finger drop +/- wrist drop +/- triceps paralysis

Sensory: snuff box

42
Q

Erb’s palsy

A

Cause: trauma, RT e.g. breast leading to high brachial plexus (C5-6) injury

Motor: Waiter’s tip

Sensory: C5-6 dermatome

43
Q

Klumpke’s palsy

A

Cause: trauma/ RT causing low brachial plexus (C8-T1) palsy

Motor: claw hand

Sensory: dermatomal

44
Q

Phrenic nerve (C3-5) lesion

A

Cause: lung cancer, myeloma, thymoma, cervical spondylosis, zoster, HIV, Lyme, TB

Motor: orhtopnoea + raised diaphragm

45
Q

Lateral cutaneous nerve of thigh lesion (L2-3)

A

Cause: entrapment under inguinal ligament

Sensory: anterolateral burning thigh pain

46
Q

Sciatic (L4-S3) lesion

A

Cause: pelvic tumour, pelvic or femoral fracture

Motor: hamstrings and all muscles below knee

Sensory: bellow knee laterally and foot

47
Q

Common perineal (L4-S1) lesion

A

Cause: fibular head trauma, sitting cross legged

Motor: foot drop, weak ankle dorsiflexion and eversion (inversion intact cf. with L5 radiculopathy)

48
Q

Tibial (L4-S3) nerve lesion

A

Motor: can’t plantar flex, invert foot or flex toes

Loss of sensation to sole of foot

49
Q

Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease

UMN or LMN?

A

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
Q

Progressive Muscular Atrophy

UMN or LMN?

A

Only LMN signs, e.g. flail arm or flail foot syndrome. Only affects anterior horn cells. Better prognosis.

51
Q

Progressive Bulbar Palsy

UMN or LMN?

A

Dysarthria and dysphagia with wasted fasciculating tongue (LMN) and brisk jaw jerk (UMN). Only affects cranial nerves 9-12.

52
Q

Neurofibromatosis 1

Features: CAFÉ NOIR

A 
•	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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