neurology Flashcards
(145 cards)
1
Q
what are the clinical features of a TIA?
A
- carotid territory symptoms- amaurosis fugax, aphasia, hemiparesis, hemianopic visual loss
- vertobrobasilar territory symptoms- diplopia, vertigo, vomiting, ataxia, hemisensory loss
2
Q
what are some differential diagnoses of TIA?
A
- hyoglycaemia
- migraine aura
- focal epilepsy
- hyperventilation
- retinal bleeds
3
Q
what is the ABCD2 score?
A
• 6+ strongly predicts a stroke (35.5% in next week) o Age >60yrs old – 1pt o BP >140/90 – 1pt o Clinical features Unilateral weakness – 2pt Speech disturbance without weakness – 1pt o Duration of symptoms >1h – 2pt 10-59min – 1pt o Diabetes – 1pt
4
Q
how would you treat a patient with a TIA?
A
- control CV risk- hypertension, diabetes, smoking cessation
- anti platelet- clopidogrel, high dose aspirin
- warfarin
- carotid endarterectomy
5
Q
what can cause a stroke?
A
- cardiac emboli
- atherothromboembolism
- CNS bleeds
6
Q
how can you diagnose a stroke?
A
- CT/MRI
- CXR- cardiomyopathy
- cardiac source of emboli- ECG for AF
- carotid artery stenosis- carotid doppler ultrasound
7
Q
what is the acute management of a stroke?
A
- protect airway
- check pulse, BP and ECG
- blood glucose
- CT/MRI
- thrombolysis- IV altepase
- anti platelet agents- aspirin
8
Q
what is a subarachnoid haemorrhage?
A
spontaneous bleeding into subarachnoid space
9
Q
what can cause a subarachnoid haemorrhage?
A
- rupture of saccular aneurysms
- AV malformations
- idiopathic
10
Q
where are the common sites for berry aneurysms to occur?
A
- junction of posterior communicating with the internal carotid
- junction of anterior communicating with the anterior cerebral artery
- bifurcation of middle cerebral artery
11
Q
what signs and symptoms would a patient with a subarachnoid haemorrhage present with?
A
symptoms- sudden occipital headache, vomiting, collapse, seizures
signs- neck stiffness, Kernig’s sign, retinal bleeds, focal neurology
12
Q
how would you treat a patient who has suffered a subarachnoid haemorrhage?
A
- nimodipine
- endovascular coiling
maintain cerebral perfusion
13
Q
what is a subdural haemorrhage?
A
Bleeding from bridging veins between cortex and venous sinuses
14
Q
what’s the most common cause of a subdural haemorrhage?
A
trauma
15
Q
how does a subdural haemorrhage present clinically?
A
- symptoms- fluctuating consciousness, sleepiness, headache, personality change
- signs- raised ICP ,seizures
16
Q
how would a subdural haemorrhage appear of a CT scan?
A
crescent-shaped collection of blood over one hemisphere
17
Q
how would you treat a subdural haemorrhage?
A
irrigation/ evacuation- burr hole craniotomy
18
Q
what is an extradural haemorrhage?
A
accumulation of blood between the bone and the dura, caused by laceration of the middle meningeal artery and vein due to a fractured temporal or parietal bone
19
Q
how does the shape of an extradural haemorrhage differ from that of a subdural haemorrhage?
A
extradural appears round, subdural appears sickle shaped
20
Q
how would you treat a subdural haemorrhage?
A
clot evacuation and ligation of the bleeding vessel
21
Q
what is epilepsy?
A
recurrent tendency to spontaneous, intermittent, abnormal electrical activity in a part of the brain- seizures
22
Q
what are the elements of a seizure?
A
- prodrome- precedes seizure
- aura- part of the seizure, feeling of deja vu/ flashing lights/ strange smells
- post-ictal state- after the seizure the patient experiences a headache,e confusion, myalgia and a sore tongue
23
Q
what are some non-epileptic causes of seizures?
A
trauma, stroke, haemorrhage, raised ICP, alcohol withdrawal, metabolic disturbance, liver disease, HIV, meningitis, encephalitis, fever
24
Q
what is a simple partial seizure?
A
- awareness impaired
- focal motor, sensory, autonomic symptoms
- no post-ictal symptoms
25
what is a complex partial seizure`?
- awareness impaired
- possible aura
- arise from temporal lobe
- post ictal confusion
26
what are primary generalised seizures?
simultaneous onset of electrical discharge throughout cortex with no localising features referable to only one hemisphere
27
what are examples of primary generalised seizures?
- absence seizures
- tonic-clonic seizures
- myoclonic seizures
- atonic seizures
- infantile spasms
28
what is an absence seizures?
brief pauses less that 10 seconds- e.g. suddenly stopping mid sentence- occur in childhood
29
what is a tonic-clonic seizure?
- loss of conciousness
- limb stiffen then jerk
- post ictal confusion and drowsiness
30
what is a myoclonic seizure?
a sudden jerk of a limb/ trunk/ face
31
what is an atonic seizure?
sudden loss of muscle tone causing a fall with no loss of consciousness
32
what are some locating features of a temporal lobe seizure?
- automatisms
- abdominal rising sensation or pain
- dysphasia
- deja vu
- auditory hallucinations
- delusional behaviour
33
what are some locating features of a frontal lobe seizure?
- motor- posturing and peddling movements of legs
- Jacksonian march
- motor arrest
34
what are some locating features of a parietal lobe seizure?
- sensory- tingling, numbness, pain
| - motor- spread to pre-central gyrus
35
what are some locating features of an occipital lobe seizure?
visual phenomena- spots/ lines/ flashes
36
how would you treat generalised tonic clonic seizures?
sodium valproate or lamotrigine
37
how would you treat absence seizures?
sodium valproate
38
what is the cardinal triad of symptoms for a patient with Parkinson's disease?
- tremor- worse at rest, pill rolling of thumb over fingers
- rigidity/ increased tone- cogwheel rigidity
- bradykinesia
39
what can cause Parkinson's disease?
- idiopathic
- drugs- e.g. neuroleptics
- also trauma, encephalopathy, post-flu, copper toxicity, HIV
40
what is the pathophysiology behind Parkinson's disease?
Mitochondrial DNA dysfunction causes degeneration of dopaminergic neurons in the substantia nigra pars compacta
41
how can Parkinson's disease be treated?
- weight lifting
- levodopa- start late
- dopamine agonists
- MAO-B inhibitors
- deep brain stimulation
42
what is Huntington's chorea?
an autosomal dominant neurodegenerative disorder that can lead to the progression of chorea and dementia
43
how does a tension headache present clinically?
bilateral, non-pulsatile headache and scalp muscle tenderness with no vomiting or sensitivity to head movement
44
how does a cluster headache present clinically?
- rapid onset excruciating pain around one eye
- unilateral pain
- lasts 15-60 mins
45
how would you treat a cluster headache?
100% O2 for 15 mins via a non-rebreathable mask
46
how does a migraine present clinically?
aura lasting 15-30 mins followed within 1 hour by unilateral, throbbing headache
47
what can trigger a migraine?
chocolate, hangovers, orgasms, cheese, oral contraceptives, alcohol, loud noise
48
what is the treatment for a migraine?
topiramate or propanolol
49
how does giant cell arteritis present clinically?
- headache
- temporal artery and scalp tenderness
- jaw claudication
- amaurosis fugax
50
how is giant cell arteritis diagnosed clinically?
- raised ESR and CRP
- low Hb
- temporal artery biopsy
51
how is GCA treated?
oral prednisolone
52
what are some secondary causes of trigeminal neuralgia?
- compression of trigeminal root by a tumour
- chronic meningeal infection
- MS
- herpes zoster
- skull base malformation
53
how would a patent with trigeminal neuralgia present?
- paroxysms of intense, stabbing pain, lasting seconds
- unilateral
- face screwed up in pain
54
what can trigger trigeminal neuralgia?
washing the affected area, shaving, eating, talking
55
how you treat a patient with trigeminal neuralgia?
carbamazepine or lamotrigine
56
what is the aetiology of spinal cord compression?
- secondary malignancy in spine- breast, lung, prostate, thyroid, kidney
- rarer- epidural abscess, cervical disc prolapse, haematoma, myeloma
57
what are some of the differential diagnoses of spinal cord compression?
transverse myelitis, MS, carcinomatous meningitis, spinal artery thrombosis, trauma, dissecting aneurysm
58
how would you diagnose spinal cord compression?
- MRI
| - CXR to look for secondary malignancy or TB
59
what is cauda equina syndrome?
damage to the spine at or distal to L1 injures the cauda equina
60
what can cause cauda equina syndrome?
congenital lumbar disc disease, lumbrosacral nerve lesions, lumbar disc prolapse
61
what are the key clinical signs a patient with cauda equina syndrome will present with?
back pain, radicular pain down the legs, sensory loss in a root distribution
62
what is the aetiology of MS?
discrete plaques of demyelination occur at multiple CNS sites from a T cell-mediated immune response. this demyelination causes axonal loss and clinically progressive symptoms.
63
how does MS present clinically?
- mono symptomatic
| - can be unilateral optic neuritis, numbness/ tingling in limbs, leg weakness, ataxia
64
what are some systemic signs of MS?
- sensory- paraesthesia
- motor- spastic weakness
- sexual- ED, incontinence
- GI- swallowing disorders
- eye- hemianopia, optic neuritis
- cerebrellum- trunk and limb ataxia
- cognitive and visuospatial decline
65
how is MS diagnosed?
more than 1 CNS lesion disseminated in space and time, with no other attributable cause
- plaques seen on MRI
66
how can you treat a patient with MS?
- vitamin D supplements
- monoclonal antibodies- alemtuzumab
- non-immunosuppressives
- azathioprine
67
what is myasthenia gravis?
an autoimmune disease mediate day antibodies to nicotinic acetylcholine receptors. these interfere with the neuromuscular transmission via depletion of working post-synaptic receptor sites.
68
what is the order that muscle groups are affected in in myasthenia gravis?
extra-ocular, bulbar, face, neck, limb girdle, trunk
69
how can myasthenia gravis be diagnosed?
- voice fades counting to 50
- other causes ruled out
- raised anti- AChR antibodies
- look for ptosis, diplopia and myasthenic snarl on smiling
70
what are some fo the differential diagnoses of myasthenia gravis?
polymyositis, systemic lupus erythematosus, Takayasu's arteritis, botulism
71
how can you treat myasthenia gravis?
- symptomatic control- anticholinesterase
- immunosuppression- prednisolone
- thymectomy
72
what is motor neurone disease?
a cluster of major degenerative diseases characterised by the selective loss of neurons in the motor cortex, cranial nerve nuclei and anterior horn cells
73
what is the aetiology of MND?
- sporadic
| - rare mutations in SOD-1
74
what are the 4 clinical patterns of MND?
- ALS- loss of motor neurones in motor cortex and the anterior horn of the spinal cord
- progressive bulbar palsy- only affects CN- IX-XII, resulting in jaw jerk, hoarse speech and flaccid tongue
- progressive muscular atrophy- anterior horn cell lesion only
- primary lateral sclerosis- loss of betz cells in motor cortex
75
how would you treat a patient with MND?
treat symptoms
76
what can cause Gullian- Barre syndrome?
- Campylobacter jejuni
- CMV
- Mycoplasma zoster
- HIV
- EBV
77
how does Gullian-Barre present clinically?
- advancing muscle weakness
| - progressive phase of 4 weeks followed by recovery
78
how would you treat Gullian-Barre syndrome?
IV immunoglobulin for 5 days
79
how does dementia present clinically?
initial= memory loss over months and years
| later- agitation, agression, apathy, hallucinations
80
what is the aetiology of dementia?
- alzheimers dementia
- vascular dementia
- Lewy body dementia
- fronto-temporal dementia
81
how is dementia treated?
- developing routines
- trazodone
- lorazepam
82
what is the aetiology of Alzheimers disease?
accumulation of beta-amyloid peptide results in progressive neuronal damage and raised numbers of amyloid plaques and a loss of acetylcholine.
83
what are some risk factors of Alzheimers disease?
- first degree relative with the condition
- downs syndrome
- vascular- hypertension, diabetes
- depression
- loneliness
84
how is Alzheimers disease treated?
- acetylcholinesterase inhibitors
| - antiglutamatergic treatment
85
what are some examples of mono neuropathies?
Wegener's, AIDS, rheumatoid, sarcoidosis, leprosy
86
what does a median nerve mononeuropathy present like?
- weakness of abductor policis previs
- sensory loss of radial 3.5 fingers and palm
- weakness of flexion of distal phalanx
87
what are the signs of an ulnar nerve mononeuropathy?
weakness and wasting of the medial wrist flexors, interossi and medial 2 lumbricals- claw hand
88
what is the key sign of radial nerve mononeuropathy?
wrist and finger drop
89
what muscles are involved in a radial nerve mononeuroapthy?
brachioradialis, extensors, supinator, triceps (BEST)
90
what can cause brachial plexus mononeuropathy?
trauma, radiotherapy, cervical rib, prolonged wearing of a heavy rucksack
91
what can cause phrenic nerve mononeuropathy?
lung cancer, myeloma, thymoma, thoracic surgery, HIV, Lyme disease, TB, muscular dystrophy
92
what are the signs of a common peroneal nerve mononeuropathy?
- foot drop
- weak ankle dorsiflexion
- sensory loss over dorsum of foot
93
what are the clinical features of carpel tunnel syndrome?
oAching pain in hand and arm, especially at night
oParaesthesiae in thumb, index and middle fingers
oAll relieved by dangling hand over edge of bed and shaking it – wake and shake
oSensory loss and weakness of abductor pollicis brevis ± wasting of thenar eminence
94
what can cause carpal tunnel syndrome?
- Myxoedema
- Enforced flexion – e.g. Colles’ splint
Diabetic neuropathy
- Idiopathic
- Acromegaly
- Neoplasms e.g. myeloma
- benign Tumours – lipomas, ganglias
- Rheumatoid arthritis
- Amyloidosis
- Pregnancy/premenstrual oedema
- Sarcoidosis
95
how can you diagnose carpel tunnel syndrome?
- Phalen's test- maximal wrist flexion for 1 min
| - Tinel's test- tapping over nerve at wrist induces tingling
96
how can you treat carpel tunnel syndrome?
splinting, local steroid injection or decompression surgery
97
what can cause poly-neuropathies?
- metabolic- diabetes mellitus, renal failure
- malignancy
- Gullian-Barre, sarcoidosis
- infections- HIV, Lyme
- deficiency of B1, B6, B12, E, folate
98
what can cause an olfactory nerve lesion?
trauma, respiratory tract infection, meningitis
99
how would a trigeminal nerve palsy present clinically?
motor palsy on opening mouth
| jaw deviates to side of lesion
100
what would an accessory nerve lesion present as clinically?
patient is unable to:
- shrug shoulders against resistance
- unable to urn head left or right against resistance
101
what are the types of common brain tumour?
- primary malignant- glioma, lymphoma, medulloblastoma
- benign- meningioma, neurofibroma
- metastases- bronchus, breast, stomach, prostate, thyroid, kidney
102
what do the clinical features of a brain tumour result from?
- progressive focal neurological deficit due to mass effect and surrounding oedema
- raised ICP
- focal/ generalised epilepsy
103
what is the differential diagnosis of a brain tumour?
other intracranial mass lesions- cerebral abscess, tuberculoma, subdural haematoma, intracranial haematoma
104
how is a brain tumour treated?
- surgery- removal of mass
- radiotherapy
- oral dexamethasone
- anti-convulsants
105
what can cause meningitis?
- meningococcus
- haemophilus influenza
- listeria monocytogenes
106
how does meningitis present clinically?
- early- headache, leg pains, cold hands
| - later- meningism, decreased consciousness, seizures, non-blanching petechial rash
107
what are some differential diagnoses of meningitis?
malaria, encephalitis, septicaemia, subarachnoid, tetanus
108
how would you treat a patient with meningitis?
- cefotaxime and ampicillin
| - dexamethasone
109
what is encephalitis?
inflammation of the brain parenchyma
110
what are the viral causes of encephalitis?
herpes simplex, CMV, EBV, VZV, HIV, measles, rabies
111
what are non-viral causes of encephalitis?
bacterial meningitis, TB, malaria, listeria, Lyme disease, legionella, typhus, aspergillosis
112
how does encephalitis present clinically?
- confusion
- decreased GCS
- fever
- headache
- seizures
113
how is encephalitis treated?
IV acyclovir
114
what is herpes zoster?
occurs after a previous primary infection with chickenpox- the virus remains dormant in dorsal root ganglia- reactivation of this causes shingles
115
what dermatome distribution does shingles present with?
rash- papules and vesicles
pain and tingling
occurs in lower thoracic dermatomes
116
how is shingles treated?
oral acyclovir/ valaciclovir/ famiciclovir
117
what are some modifiable risk factors of a stroke?
- hypertension
- smoking
- DM
- heart disease
- PVD
- OCP
118
how does a cerebral infarct present clinically?
- contralateral sensory loss
- initially flaccid, becomes spastic
- dysphasia
- homonymous hemianopia
119
how does a brainstem infarct present clinically?
- quadraplegia
- disturbances of gaze and vision
- locked-in syndrome
120
what does a lacunar infarct affect?
basal ganglia, internal capsule, thalamus and pons
121
what are some differential diagnoses of a stroke?
- trauma
- hypo/hypergylcaemia
- subdural haemorrhage
- epilepsy
- intracranial tumour
- CNS lymphoma
122
How can a suspected diagnosis of a subarachnoid haemorrhage be confirmed via a lumbar puncture?
CSF is bloody early on then becomes yellow due to bilirubin- xanthochromia confirms
123
what is amaurosis fugax?
common symptom of a TIA- patient describes visual loss as being 'like a curtain descending'
124
How is a partial seizure treated?
carbamazepine
125
what are some symptoms of Huntington's chorea?
- irritability
- depression
- incoordination
- chorea
- dementia
126
How is a tension headache treated?
- stress relief- massage, tricyclic antidepressants
| - analgesia withdrawl
127
what can cause a secondary headache?
- meningitis
- subarachnoid haemorrhage
- raised ICP
- idiopathic intracranial hypertension
- GCA
- medication over-use
128
how can a medication over-use headache be diagnosed?
- Headache for over 15 days/ month
- Regular use for over 3 months of a symptomatic treatment drug (e.g. ergotamine, triptans, opioids)
- Headache has worsened during drug use
129
how can motor neurone disease be differentiated from myasthenia gravis?
MND never affects eye movements
130
How can sensory polyneuropathy be diagnosed?
- numbness
- pins and needles
- affects extremities first
- difficulty handling small objects
131
how can motor polyneuropathy be diagnosed?
- weak hands
| - difficulty walking and breathing
132
how can cranial nerve polyneuropathy be diagnosed?
- swallowing/ speaking difficulty
| - diplopia
133
how do upper motor nerve lesions present clinically?
- no muscle wasting
- loss of skilled fine finger movements
- spasticity
- hyperreflexia
134
how do lower motor nerve lesions present clinically?
- muscle wasting and fasciculation
- hypotonia
absent reflexes
135
what can an olfactory nerve lesion cause?
anosmia- loss of sense of smell
136
what can an optic nerve lesion cause?
- monocular blindness
- bilateral blindness
- bitemporal hemianopia
- homonymous hemianopia
- optic neuritis
- pailloedema
137
how does a palsy of cranial nerve 3 present clinically?
ptosis, eye pointing down and out
138
how does a palsy of the facial nerve present clinically?
facial droop and weakness
139
how does a palsy of the vestibulocochlear nerve present?
problems with hearing, balance and vertigo
140
how does a palsy of the glossopharyngeal and vagus nerve present clinically?
gag reflex problems
141
how does a hypoglossal nerve palsy present clinically?
Tongue deviates to the side of the lesion
142
what symptoms indicate a medical emergency in a patient with meningitis and what is the treatment offered?
2 of headache, pyrexia, neck stiffness, altered mental state
| - IV benzypenicillin
143
how does a peripheral polyneuropathy present clinically?
ataxia, muscle cramps, weakness, fasciculations, atrophy
144
what is the aetiology of peripheral polyneuropathy?
- infectious- hepatitis, HIV, Lyme
- vasculitis
- porphyria
- toxins
145
how can peripheral polyneuropathy be treated?
symptomatic aim
- pain- amitryptilline
- cramps- quinine
- balance problems- walking aids
