Neurology Flashcards
(144 cards)
1
Q
What is hemiballismus and what lesion causes it?
A
Uncontrolled flailing of limbs
Subthalamic lesion
2
Q
Features of migraine?
A
Throbbing Unilateral Inner side of eye Worse on movement Light and noise sensitivity \+/- aura (20-60mins)
3
Q
Triggers of migraine + aura?
A
Sleep Diet Hormones Stress Physical exertion
4
Q
How do migraines occur?
A
Stress= change to brain= serotonin release
Blood vessels constrict + chemicals irritate nerves–> pain
5
Q
Acute treatment of migraine?
A
Aspirin or Naproxen or Ibuprofen +/- anti-emetic
Triptans (e.g. rizatriptan, sumatriptan)- 5hT agonist
6
Q
Prophylactic treatment of migraine?
A
3+ attacks/month:
Propranolol
Topiramate (carbonic anhydrase inhibitor)
Amitriptyline
7
Q
Features of tension-type headache?
A
Bilateral, tight band sensation
Pressing/tingling
8
Q
Treatment of tension-type headache?
A
Relaxation
Simple analgesia
Ice packs
9
Q
Features of cluster headaches?
A
Mostly young people Around sleep Unilateral Worse headache ever Retro-orbital pain Tearing Cluster of months then disappear
10
Q
Treatment of cluster headaches?
A
High flow O2
sub/cute Sumatriptan
Steroids
11
Q
Prophylaxis for cluster headaches?
A
Verapamil
12
Q
What is paroxysmal hemicrania?
A
Elderly
Unilateral severe pain + unilateral autonomic symptoms (e.g. headache, nasal congestion etc.)
13
Q
Treatment of paroxysmal hemicrania?
A
ABSOLUTE response to Indomethicin
14
Q
Common presentation of idiopathic intracranial hypertension?
A
Overweight/obese
Headaches
Worse in morning/ lying down
Morning N+V
15
Q
What can idiopathic intracranial hypertension lead to?
A
Papilloedema + blindness/visual defects
16
Q
Investigation of idiopathic intracranial hypertension?
A
MRI brain- normal
Lumbar puncture
Fundoscopy + VFs
17
Q
Treatment of idiopathic intracranial hypertension?
A
Weight loss
Diuretics
Acetazolamide
18
Q
Features of trigeminal neuralgia?
A
Unilateral STABBING pain
Triggered by touch
Usually V2/3
19
Q
Treatment of trigeminal neuralgia?
A
Carbamazepine, Gabapentin, Phenytoin
Nerve ablation
Decompression
20
Q
Presentation of brain tumours?
A
Progressive neurological deficit (correlate to location)
Weakness
Headache- wakes from sleep, valsalva, N+V
Seizures
21
Q
A tumour in the parietal lobe may present with what neurological deficit?
A
Dyspraxia
Neglect (ignore one side)
22
Q
A tumour in the frontal lobe may present with what neurological deficit?
A
Perserveration (stuck on one word)
23
Q
Investigations of brain tumours?
A
CT MRI LP PET Lesion biopsy Angiogram Fundoscopy
24
Q
What is the commonest tumour in the brain?
A
METASTASES
breast, bronchus, kidney, thyroid, colon, melanoma
25
Most common primary tumour in brain?
Glioblastoma multiforme (grade 4 astrocytic tumour)
26
Glioblastoma multiforme can spread via...?
White matter tracking
| CSF pathways
27
Management of glioblastoma multiforme?
Surgery (non-curative)
Chemo
Radiotherapy post-op
28
Where do oligodendroglial tumours occur, and how do they present?
Front lobes
Seizures
29
Pathology of oligodendroglial tumours (to distinguish for astrocytic)
Calcification
Cysts
Haemorrhage in tumour
30
Treatment of oligodendroglial tumours?
Chemotherapy- procarbazine
| Surgery
31
Where do meningiomas arise form and what kind of tumour is it?
Arachnoid meningeal cells (outside brain)
BENIGN
32
Symptoms of meningiomas?
Mostly asymptomatic
| Some headache, CN neuropathies
33
What are meningiomas associated with?
Breast cancer
| Neurofibromatosis type 2
34
Treatment of meningiomas?
Surgery
| Radiotherapy
35
Important role of the hippocampus?
Memory formation
36
Important role of the amygdala?
Regulating fear responses
37
What is the frontal lobe responsible for?
Planning, executive function and personality
38
What is the parietal lobe responsible for?
Sensation + language
39
What is the temporal lobe responsible for?
Speech and language
40
Brain lesions in the frontal lobe will produce what symptoms?
```
Disinhibition, flippant
Short attention span
Personality, mood + insight changes
Urinary incontinence
Paraparesis
Magnetic gait
Expressive dysphagia
Seizures
```
41
Brain lesions in the temporal lobe will produce what symptoms?
```
Memory problems (esp episodic)
Temporal epilepsy- deja vu, strange smells
Headache
Speech/language difficulties
Auditory dysfunction
```
42
Brain lesions in the parietal lobe will produce what symptoms?
```
Loss of temp, proprioception etc.
Agnosia (can't identify objects eyes closed)
Apraxia (gestures + complex motor)
Inattention
Visual field defects
Sensory dysfunction
```
43
Symptoms of spontaneous intracranial hypotension?
```
Orthostatic headache + dizziness
Neck/arm pain
Diplopia
Muffled hearing
Galactorrhoea
Impaired SPHINCTER control
```
44
Side effects of sodium valproate?
```
Weight gain
Hair loss
Fatigue
Teratogenic
REDUCE EFFICACY of oral contraceptive + emergency pill
```
45
Features of non-REM sleep?
Start of night
Decreased HR, BP, tidal volume
For protein synthesis, cell division and growth
46
Features of REM sleep?
```
End of night
Atonic muscles (relaxed)
Dreaming
Fast activity on EEG
Early brain development, consolidates memory and maintains immune system
```
47
What is a circadian rhythm?
Endogenous factor regulates sleep-wake cycle- roughly 25 hours
48
What can interfere with normal circadian rhythm?
Light (esp blue light)
49
Symptoms of sleep deprivation?
```
Irritability
Lethargic
Visual illusions
Suspicion
Microsleeps (2-30 secs)
Concentration lapses
```
50
How much sleep does someone need?
7-7.5 hours acceptable
4 hours NOT enough
15 min nap= 90 mins overnight
51
When do non-REM parasomnias occur, and why?
Between stages of sleep and waking
| Activation of motor, cognitive or autonomic systems
52
Examples of non-REM parasomnias?
```
Confusional arousals
Sleep walking
Sleep terrors/paralysis
Bruxism (teeth grinding)
Restless legs
Complex- shouting, weird movements, vivid dreams etc
```
53
Presentation of narcolepsy? (5)
Daytime sleepiness- esp eating/talking
Cataplexy- loss of muscle tone due to emotion
Hypnagogic hallucinations- at sleep onset
Sleep paralysis
REM sleep Behaviour Disorder (RBD)
54
Investigations of narcolepsy? (COMMON EXAM QUESTION)
Overnight polysomnography
Sleep latency tests
LP- low CSF hypocretin = narcolepsy
55
What do peripheral neuropathies affect?
Nerves outside brain + spinal cord
| LMN + sensory + CN + autonomics
56
Classic presentation of a peripheral neuropathy?
Gloves + stocking distribution (affects hands + feet first then moves up the limb)
Altered sensation and diminished reflexes
57
What is a mononeuropathy?
involvement of a single nerve- focal nerve dysfunction
| usually due to trauma or entrapment
58
What is mononeuritis multiplex?
2 separate nerves affected in different locations- rare
59
What is a radiculopathy?
Affecting nerve roots- dermatomes/myotomes
60
What is a plexopathy?
Affects a whole plexus- rare
| High levels of pain/paralysis
61
How does 90% of peripheral nerve damage occur + name other causes?
Axonal loss- diabetes, metabolic conditions, drugs, alcohol
| Demyelination- Guillan Barre, CIDP etc.
62
Presentation of hereditary neuropathy?
Pure motor, sensory, small fibre + autonomic variants
| Can have muscle wasting + arthropathy
63
If there is a lesion at the cervical spinal cord, what areas are involved?
Arms
| UMN signs if central
64
If there is a lesion at the lumbar spinal cord, what areas are involved?
Legs
| no UMN signs
65
Presentation of lumbar disc prolapse?
Unilateral leg pain
| LMN symptoms + diminished reflexes
66
Management of lumbar disc prolapse?
Conservative
| Rarely needs surgery
67
Investigation of disc prolapse?
MRI
68
Presentation of spinal claudication?
```
Intermittent pain, worse on movement, eases at rest
RELIEVES BY BENDING FORWARD
Ache in back of legs
Altered sensation
Heaviness
```
69
What is cervical myelopathy?
Disc prolapse in the cervical spine
70
Symptoms of cervical myelopathy?
```
Numb, clumsy hands
Finger tip paraesthesia
Hard fine motor tasks
Dropping things
Hoffman's sign- thumb flexion when DIP flexed
```
71
Classification of TACS (total anterior circulation syndrome)?
(3Hs!)
All of:
- Hemi-loss (unilateral) weakness (face, arm + leg) +/- sensory
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
72
Classification of PACS (partial anterior circulation syndrome)?
Two of:
- Hemi-loss (unilateral) weakness (face, arm + leg) +/- sensory
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
73
Classification of POCS (posterior circulation syndrome)?
CN palsies
Bilateral motor/sensory deficit
Cerebellar dysfunction (eg ataxia, nystagmus, vertigo)
Isolated homonymous hemianopia or cortical blindness
74
Features of executive dysfunction?
```
Severe inattention
Can't sustain goal-directed behaviours
Apathy
Personality change
Lack of empathy
Lack of inhibition (distracted, hyperactive, impulsive, hypersexual, over eating etc.)
```
75
A stroke in the middle cerebral artery would cause weakness to where?
Contralateral face + arm
76
A stroke in the anterior cerebral artery would cause weakness to where?
Contralateral leg
77
How can the brain respond to injury?
Rapid necrosis
or
Slow atrophy
78
Acute neuronal injury leads to which pathological sign?
Red neuron (intense eosinophilia/red cytoplasm)
79
What is gliosis?
Indicates CNS injury:
- Astrocyte hyperplasia+hypertrophy
- Enlarged nucleus
- Expanded cytoplasm
80
What does gliotic tissue look like?
Firm and translucent
81
4 causes of brain oedema?
1. Dying cells accumulate water
2. Na in causes gradient
3. Breakdown of BBB
4. Haemorrhagic conversion
82
Most common site of thromboembolic disease in brain?
MCA
83
Signs of hypertensive encephalopathy?
Global cerebral oedema
Tenotorial/tonsillar herniation
Petechiae
84
Where do 70% of paediatric brain tumours occur?
Below tentorium cerebelli
85
Who might get multiple brain abscesses?
IV drug users
86
Symptoms of brain abscess?
Fever
Headache
Focal deficit
Increased ICP symptoms
87
Investigation of brain abscess?
CRP
CT/MRI
Culture of aspirate
88
What can high velocity penetrating trauma lead to?
Cavitation (small bubble formations)
89
How does diffuse axonal injury occur?
Widespread due to shearing/tearing of axons
90
Which toxins can cause demyelination?
Carbon monoxide
Cyanide
Solvents
91
Causes of acute cord compression?
Trauma (mostly C spine)
Infection (epidural abscess)
Prolapse
Haemorrhage
92
Causes of chronic cord compression?
Degenerative disease e.g. spondylosis
Tumours
Rheumatoid arthritis
93
Presentation of central cord compression?
Distal upper limb weakness
94
Cause of central cord compression?
Hyperflexion/extension of already stenotic neck
| Cord pinched + block blood supply to centre
95
Treatment of tremors?
Beta blockers
Anti-convulsants
Anti-epileptics
96
Features of polymyositis?
Symmetrical progressive proximal weakness
Increased CK
Tx- steroids
97
What is dermatomyositis?
Similar to polymyositis + skin lesions (heliotrope rash)
98
Symptoms of myotonic dystrophy?
```
Myotonia
Limb weakness
Facial weakness
Cataracts
Ptosis
Frontal balding
Cardiac defects
```
99
Causes of acute cognitive impairment?
```
Viral encephalitis
Head injury
Stroke
Transient global amnesia
Transient epileptic amnesia
Alcohol
```
100
Features of transient global amnesia?
Antegrade over retrograde amnesia
Always <24hrs
Knows self
101
Causes of transient global amnesia?
Cause unknown-
Emotion?
Change in temperature?
102
Features of transient epileptic amnesia?
Forgetful/repetitive questioning (antegrade)
20-30 mins
Temporal lobe seizures
103
What is functional cognitive impairment?
Subjective impairment- everyday forgetfulness, fluctuation etc.
104
Most common type of Prion disease?
Creutzfeldt-Jakob Disease (CJD)
105
What is prion disease?
Neurodegenerative proteinopathy (prion protein)
106
What pathology does Creutzfeldt-Jakob Disease lead to?
Spongiform changes
| Astrocytosis
107
Symptoms of Creutzfeldt-Jakob Disease (CJD)?
Rapid dementia
Myoclonus
Ataxia
108
Diagnosis of Creutzfeldt-Jakob Disease (CJD)?
EEG
CT
LP
109
Pathology of Alzheimer's disease?
Amyloid plaques + neurofibrillary tangles + Tau protein
| Disrupt cholinergic pathways
110
Risk factors for Alzheimer's disease?
```
Age
Female
FH
Down's Syndrome
Head injuries
```
111
Which part of the brain is affected first in Alzheimer's disease?
Nucleus basalis of Meyner
112
Genetics associated with Alzheimer's disease?
APP or PSEN gene
| ApoE2
113
CT signs of Alzheimer's disease?
Temporal, frontal + parietal
Widespread cortical atrophy
Narrow gyri + wide sulci
Dilation of ventricles to compensate
114
Symptoms of Alzheimer's disease?
Worsening memory- initial forgetfulness, then progressive
| May affect mood, behaviour, and aphasia too- LATE STAGES
115
Investigations of Alzheimer's disease?
MMSE
MRI (atrophy of lobes)
SPECT (reduced metabolism)
CSF
116
Treatment of Alzheimer's disease?
```
Acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine)
Memantine in severe (NMDA blocker)
Trazodone for insomnia
```
117
What is Pick's disease?
Frontotemporal dementia
118
Which protein is involved in frontotemporal dementia?
Tau protein
119
Age of onset of frontotemporal dementia?
Majority <65 (50-60)
120
Symptoms of frontotemporal dementia?
```
Frontal dysfunction (disinhibition, apathy, loss of empathy, compulsive behaviour, hyperorality)
Change in character, social skills, memory, language and intellect
Early LOSS OF INSIGHT
```
121
Pathology of frontotemporal dementia?
Extreme cerebral atrophy (frontal then temporal)
Gliosis
Pick's cells (swollen neurons)
122
Investigation of frontotemporal dementia?
MRI (atrophy)
SPECT (reduced metabolism)
CSF
(not MMSE)
123
Management of frontotemporal dementia?
Trazadone/ anti-psychotics
124
Causes of vascular dementia?
Cerebrovascular disease (strokes)
125
Symptoms of vascular dementia?
>65 years
Slowness, executive dysfunction, inattention,
Focal deficits (from strokes)
STEP-WISE DECLINE
126
Investigation of vascular dementia?
SPECT
| MRI shows infarcts
127
Management of vascular dementia?
Vascular risk factors
+/- cholinesterase inhibitors
128
What is Parkinson's Disease dementia?
Dementia starting more than 1 year AFTER the onset of parkinsonism
129
What is Lewy-Body dementia?
Dementia or cognitive symptoms occurring BEFORE or at the same time as parkinsonism
130
Which protein is involved in Lewy-Body dementia?
Alpha-synuclein
131
Symptoms of Lewy-Body dementia?
```
Progressive cognitive impairment
Recurrent visual hallucinations.
Features of parkinsonism--> FALLS
Fluctuating awareness
REM sleep disorders
```
132
Cause of Lewy-Body dementia?
Degeneration of substantia nigra + Lewy bodies
133
Investigation of Lewy-Body dementia?
DaT scan (dopamine transport imaging)
134
Management of Lewy-Body dementia?
Levodopa (low dose)
| Cholinesterase inhibitors
135
Side effects of opioids?
```
Apnoea
Orthostatic hypotension
N+V
Constipation
Confusion
Euphoria/ hallucinations
Dizziness
```
136
What is progressive multifocal leukoencephalopathy?
Secondary demyelinating disorder caused by viral disease
137
Where will a lesion cause contralateral homonymous hemianopia?
Occipital lobe
138
Where will a lesion cause contralateral sensory deficits?
Parietal lobe
139
Where will a lesion cause contralateral superior quadrantopia?
Temporal lobe
| PITS
140
Where will a lesion cause contralateral inferior quadrantopia?
Parietal lobe
| PITS
141
Where will a lesion cause urinary incontinence?
Frontal lobe
142
Where will a lesion cause contralateral weakness of the face/arm/leg?
Frontal lobe
143
What should be used instead of haloperidol as an anti-psychotic in Parkinson's disease?
Quetiapine
144
What should be used instead of meoclopramide for GI issues in Parkinson's disease?
Domperidone
