Neurology Flashcards
(212 cards)
1
Q
Where can the motor cortex be found? What is also at this location?
A
Precentral gyrus in frontal lobe - also has Broca’s area
2
Q
Where can the sensory cortex be found?
A
The postcentral gyrus in the parietal lobe
3
Q
Where can Wernicke’s area be found?
A
The dominant temporal lobe.
4
Q
Where does the corticospinal tract cross?
A
At the level of the medulla
5
Q
Where does the spinothalamic tract cross?
A
Crosses at same level of entry of S.C.
6
Q
What does the spinothalamic tract carry?
A
Coarse touch, pain and temperature
7
Q
What happens in syringomyelia?
A
Dilated central canal presses on spinothalamic tract –> impairment of temperature and scars due to burns
8
Q
What info does the dorsal column carry?
A
Fine touch and vibration and position.
9
Q
Where does the dorsal column cross?
A
Medulla
10
Q
When is spectrophotometry used?
A
It is used on CSF to look for blood breakdown products in suspected subarachnoid haemorrhage.
11
Q
What is aphonia?
A
Problem with phonation (sound and volume)
12
Q
What is dysarthria?
A
Problem with articulation of speech
13
Q
What is aphasia?
A
Problem with comprehension and production of language.
14
Q
A patient just has a problem with repeating things. What is this called and what is likely to have been damaged?
A
Conductive aphasia. Usually due to lesion in the arcuate fasciculus.
15
Q
What is the afferent and efferent in the pupillary reflex?
A
Afferent = II Efferent = III
16
Q
Name 3 symptoms of optic neuritis
A
- Visual loss
- Retro-orbital pain
- RAPD
17
Q
What does absent venous pulsation and blurring of optic disc margins suggest?
A
Optic disc swelling
18
Q
How would the optic disc look if it is atrophied?
A
Pale optic disc with sharp edges
19
Q
When nerve innervates the superior oblique muscle?
A
Trochlear nerve (4th)
20
Q
How would the eye look like in a cranial nerve III palsy?
A
Ptosis, down + out, impaired accommodation (CN III is efferent nerve)
21
Q
How would the eye look like in a cranial nerve IV palsy?
A
Incomplete depression in adducted position, vertical diplopia. Tilting head towards opposite shoulder.
22
Q
How would the eye look like in a cranial nerve VI palsy?
A
Horizontally separated double vision on looking to the side, with limitation of abduction of eye
23
Q
What is the afferent and efferent nerves involved in the corneal reflex?
A
Afferent = V1 Efferent = VII (facial)
24
Q
Which nerves are carried in the internal acoustic meatus?
A
VII and VIII
25
What is Bell's phenomenon?
The upward and outward movement of the eye when attempting to close the eye - occurs in a CN VII palsy
26
In terms of the nerves affected, what differentiates bulbar from pseudobulbar palsy?
```
Bulbar = LMN lesion
Pseudobulbar = UMN lesion
```
27
What features can be seen in a pt with bulbar palsy?
Wasted & atrophic tongue w/ fasciculation, depressed jaw reflex, nasal speech
28
What features can be seen in a pt with pseudobulbar palsy?
Small, slow-moving spastic tongue. Brisk jaw reflex, spastic, slurring speech, emotional lability, increased gag reflex
29
What would happen to the uvula in a vagus lesion?
The uvula deviates away from the side of the lesion (away to Vegas)
30
What are the afferent and efferent nerves involved in the gag reflex?
```
Afferent = CN IX (Glossopharyngeal)
Efferent = CN X (Vagus)
```
31
What happens to the tongue in a hypoglossal nerve lesion?
Unilateral wasting and fasciculation of tongue - deviates towards the side of the lesion
32
How would acute labyrinthitis present?
Sudden onset rotatory vertigo, vomiting and loss of balance
33
How does Meniere's disease present?
Deafness, tinnitus, episodic vertigo, vomiting
34
A patient struggles to turn their head to the right - lesion of what cranial nerve could have caused this?
Lesion of the left CN XI has lead to weakness of the left SCM
35
What is Jugular foramen syndrome?
Unilateral lower CNs palsy --> deviation of uvula, weakness in twisting head and shrugging shoulders
36
How does Horner's syndrome present?
Unilateral ptosis, small pupil, enopthalmos (posterior displacement of eye in orbit), lack of sweating
37
What happens in internuclear ophthalmoplegia?
When a patient looks to right/left, there is ataxic nystagmus in abducted eye + failure to adduct other eye.
38
What causes internuclear ophthalmoplegia?
Due to lesion in medial longitudinal fasciculus (connects CN III nucleus to 1 side to CN VI nucleus on other side)
39
What is pseudoathetosis? What causes it?
Continuous involuntary movements of outstretched hands and fingers when eyes are closed
Caused by failure of proprioception
40
How does someone with Friedreich's ataxia body look like?
Pes cavus (claw foot), absent ankle jerks, upgoing planters, scoliosis
41
What would you find when doing an CSF analysis for someone with demyelinating neuropathy?
High protein
42
What nerve has been lesioned in a pt with claw hand?
Ulnar nerve
43
How does a common peroneal nerve lesion present?
- Weakness in dorsiflexion of ankle and big toe
- Eversion of foot
- Foot drop --> high steppage gait
- Possible decrease in pinprick sensation over lateral calf and dorsum of foot
44
What happens to ankle jerk in a common peroneal nerve lesion?
It is preserved
45
How does a L5 root lesion present?
- Foot drop
- Inversion of ankle
- Usually painful
46
How does sciatic nerve lesion present?
- Foot drop
- Weakness of toe plantarflexion
- Loss of ankle jerk
47
Which type of headache is typically described as a "tight band" around the head?
Tension headache
48
What is the main treatment used in tension headaches?
Amitriptyline
49
What treatment options can be used for acute migraine attacks?
Simple analgesics, +/- antiemetics, triptans
50
What treatment options are available to prevent migraines in patients?
- Propanolol
- Amitriptyline
- Pizotifen
- Topiramate
- Botox injections
51
What medication can be introduced to those suffering from medication overuse headaches?
Amitriptyline
52
At what point during the day do cluster headaches occur?
Mainly at night, same time of the day usually.
53
Other than excruciating pain around the eye, what are the other symptoms of cluster headaches?
Watering and redness of the eye and nasal blockage.
| Occasionally Horner's syndrome.
54
What are the 2 treatment options for acute cluster headaches?
Sumatriptan subcut injection or high-flow oxygen
55
What are the treatment options to prevent cluster headaches?
Pizotifen, verapamil, topiramate and steroids
56
Where is the pain felt in trigeminal neuralgia?
Pain is felt over area supplied by 1 branch of CN 5.
57
What is the first line treatment for trigeminal neuralgia and what other treatments are available?
1st line = Carbamazepine
Others: Phenytoin, Lamotrigine, Gabapentin
Surgery - glycerol injection of 5th nerve and microvascular decompression.
58
How does concussion syndrome present?
Lack of concentration, struggling to stay awake, poor memory, dizziness, vomiting. persistent headache
59
What is the treatment for concussion syndrome?
Amitriptyline
60
What must be excluded in patients presenting with suspect IIH and how would you do this?
Must exclude cerebral venous sinus thrombosis - would do CTV/MRV to exclude this.
61
Which lobe is most commonly involved in a partial seizure?
Temporal lobe
62
How does a temporal lobe seizure present?
Epigastric sensation rises up the throat
63
How does a frontal lobe seizure present?
Deviation of head and eyes to 1 side. Jerking of arm. Paralysis of arm (Todd's paralysis).
64
How does a parietal lobe seizure present?
Sensory symptoms
65
What happens during the tonic phase of a seizure?
Pt goes rigid, froth, lasts for seconds
66
What happens during the clonic phase of a seizure?
Rhythmic jerking, tongue biting, urinary incontinence, lasts for minutes.
67
How do myoclonic seizures present?
Sudden, brief jerks that affect the upper limb. May precede a generalised tonic-clonic seizure. Often occur in the morning, and in late childhood.
68
In whom do psychogenic attacks tend to occur in and how do they look?
Females, starts in early adolescence/adulthood. Linked with emotional trauma. Pt falls down with coarse alternating movements and pelvic thrusting.
69
Define status epilepticus
A single epileptic seizure lasting over 5 minutes or 2 or more seizures within a 5 minute period without the person returning to normal between them.
70
What are the general side effects associated with taking anticonvulsants?
Nausea, sedation, irritability, headache and depression.
71
What is the first line medication used for partial-onset seizures?
Carbamazepine (Tegretol)
72
What is the 1st line medications used for generalised epilepsy?
Sodium valproate
73
What 2 seizure types is Carbamazepine (Tegretol) NOT used in?
Absence and myoclonic seizures
74
Name 2 side effects specific to Carbamazepine (Tegretol)
Skin rash and hyponatraemia
75
Name some side effects specific to sodium valproate
Tremor, weight gain,, hair loss, amenorrhoea
76
Phenytoin is an anticonvulsant drug that requires monitoring of its blood levels. Name a few of its side effects.
Rash, hepatotoxicity, blood dyscrasias, drowsiness, tremor, gum hyperplasia, ataxia.
77
In what type of epilepsy is Ethosuximide only used in?
Only used in children with absence seizures
78
Which anticonvulsant is an enzyme inducer?
Carbamazepine
79
Which anticonvulsant is an enzyme inhibitor?
Sodium valproate
80
When can you consider stopping anticonvulsants in someone?
If they have been seizure free for at least 2 years
81
What is the treatment of status epilepticus?
lorazepam as IV bolus, IV phenytoin infusion
82
A pt with a history of epilepsy wants to know how long it will take before they are allowed to drive their family car - what do you tell them?
they have to be seizure free for at least 1 year or had attacks only during their sleep for 3 years
83
A lorry driver with epilepsy asks how long it will take before he is allowed to drive his lorry again - what do you tell him?
He would have to be seizure free for 10 years without taking AEDs
84
A patient has experienced their first seizure. They want to know how long it will be until they are allowed to drive again - what do you tell her?
6 months
85
what should women on anti-epileptic drugs be taking during their pregnancy?
5mg folic acid daily
86
Are women on anti-epileptic drugs allowed to breastfeed?
Yes as the amount of AEDs in breastmilk is v small
87
What should be given to babies born to women taking anti-epileptic drugs and why?
1 mg of vitamin K IM @ birth to reduced the risk of haemorrhagic disease of newborn.
88
A tremor affects the arms, head and voice - diagnosis?
Essential tremor
89
What form of parkinsonism tends to present with early gait changes?
Vascular parkinsonism
90
How does progressive supranuclear palsy present?
Limitation in their gaze, especially downwards. Axial and symmetrical rigidity w/ v little tremor - they develop dementia and falls early
91
How does a patient with multiple system atrophy look like?
In a wheelchair, urinary bladder issues, impotence, brisk reflexes, upgoing planters, rigidity
92
What time of imaging can be used to diagnose parkinsonism?
SPECT (CT) assesses dopamine transporter availability PD less bright on scan.
93
What drugs may make up the treatment for someone with PD?
- L-DOPA
- Decarboxylase inhibitor (e.g. Benserazide)
- COMT inhibitors (e.g. Entacapone, opicapone)
- MAO-B inhibitors (e.g. Selegiline, Rasagiline)
- Dopamine agonists (Ropinirole, Pramipexole)
94
List some side effects and effectiveness problems with Levodopa
N&V, efficacy decreases with time
Long term: Dyskinesias, painful dystonias, unpredictable 'off' freezing, pronounced end-of-dose reduced response, psychosis, visual hallucinations
95
List some side effects of dopamine agonists
Drowsy, nausea, hallucinations, compulsive behaviour (gambling, hyper-sexuality)
96
What medication can be used for drug-induced dyskinesias in late PD?
Amantadine
97
Name 2 side effects of MAO-B inhibitors?
Postural hypotension and AF
98
In a patient with PD - what will you give them to treat their symptoms of cognitive impairment?
Rivastigmine - an acetylcholinesterase inhibitor used to treat dementia
99
In a patient with PD - what will you give them to treat their symptoms of hallucinations and psychosis?
Modify anti-PD drugs and Quetiapine (atypical antipsychotics)
100
In a patient with PD - what will you give them to treat their symptoms of lack of sleep/XS sleepiness/ parasomnias (bad dreams)?
Clonazepam (a benzo)
101
In a patient with PD - what will you give them to treat their symptoms of orthostatic/ postural hypotension?
Fludrocortisone (steroid)
102
Which part of the circulation may be affected in a patient with diplopia/ cortical blindness (due to damage to occipital cortex)?
Posterior (vertebrobasilar) circulation ischaemia
103
How would a subarachnoid haemorrhage present?
Sudden onset severe headache that peaks in seconds, with vomiting and neck stiffness
104
What is the most common cause of subarachnoid haemorrhages? How can they be treated surgically?
Rupture of intracranial (Berry) aneurysm on the Circle of Willis. Coil/surgical clipping.
105
What 3 main investigations should you do for a patient with subarachnoid haemorrhages?
Brain CT then LP (look for xanthochromia and do spectrophotometry to confirm), CTA/MRA or cerebral angiogram
106
What are the complications of subarachnoid haemorrhages? How can you reduced these risks?
Rebleeding, secondary ischaemia due to vasospasm - give nimodipine and IV fluids to reduce this risk.
107
What should you do if you suspect a cardiac source of emboli is involved in an ischaemic stroke?
TTE/TOE & 24 hour ECG
108
What should you do if a patient with a suspected ischaemic stroke presents within 4 and half hours from onset of symptoms?
Urgent brain CT, Thrombolysis w/ IV alteplase
109
What should you do if a patient with a suspected ischaemic stroke presents over 4 and half hours from onset of symptoms?
Brain CT ASAP then 300mg of aspirin
110
How may cerebral venous sinus thrombosis present?
headache, seizure, focal neuro signs, maybe papilledema
111
What may cerebral venous sinus thrombosis be linked to?
Pregnancy and OCP
| Otitis media and mastoiditis.
112
What investigation must you do to exclude hypercoagulability disorders in a patient with cerebral venous sinus thrombosis?
Full thrombophilia screen
113
What imaging should you do in a patient with suspected cerebral venous sinus thrombosis?
Brain CT - may identify venous infarction
| CTV/MRV is diagnostic
114
What is the main treatment for a patient with cerebral venous sinus thrombosis?
Anticoagulation
115
How does optic neuritis present?
Pain worse on moving eyes and visual impairment. Central scotoma. Loss of colour vision. RAPD.
116
What are the 2 types of optic neuritis? In which type does the optic disc look abnormal?
- Retrobulbar (posterior): common, optic disc looks normal
| - Papillitis (anterior): less common, optic disc is usually red and swollen w/ exudates and haemorrhages
117
Name the 4 types of MS
Relapsing-remitting (most common)
Primary progressive
Secondary progressive
Progressive-relapsing
118
Name 2 things you can find on investigations of someone to diagnose them with MS
1) Lesions which are disseminated in time and place on brain MRI
2) Oligoclonal bands that are positive in CSF but not in the blood (indicates intrathecal Ig synthesis)
119
What 2 medications can you give to a patient with MS who is suffering from spasticity?
1) Baclofen (a CNS depressant and skeletal muscle relaxant)
| 2) Tizanidine (Central a z adrenergic agonist)
120
Name 2 medications you can offer someone with MS who is in pain?
Amitriptyline or gabapentin
121
When might you recommend anticholinergics (e.g. oxybutynin) to someone with MS?
If they have bladder instability
122
What medication is used to treat the relapses of MS?
IV methylprednisolone (1g daily for 3 days) to shorten the duration of relapses (NB: They have NO influence on long-term outcome)
123
What would show up on a Brain MRI of someone with neuromyelitis optica?
Normal!
124
What would show up on a spinal MRI of someone with neuromyelitis optica?
Demyelination lesions over 3 or more vertebral segments
125
Would oligoclonal bands be present in someone with neuromyelitis optica?
No
126
Which antibodies may be discovered in someone with neuromyelitis optica?
Aquaporin antibodies
127
What is the treatment for someone with neuromyelitis optica?
IV Methylprednisolone, IV antibodies, immunosuppression
128
What is acute disseminated encephalomyelitis and who is it most common in?
Severe and sudden onset demyelinating syndrome
| More common in children (after immunisation)
129
How might acute disseminated encephalomyelitis present?
Seizures, meningism, features of myelitis
130
What would a brain and spinal MRI show in someone with acute disseminated encephalomyelitis?
Demyelination lesions would be present in both the brain and spinal MRI.
131
Would you see oligoclonal bands in someone with acute disseminated encephalomyelitis?
Oligoclonal bands are present in a third of patients with acute disseminated encephalomyelitis
132
What is the treatment for acute disseminated encephalomyelitis?
IV methylprednisolone +/- IV Abs
133
What is the most common cause of acute flaccid paralysis?
GBS
134
Describe the paralysis patients with GBS would get
Rapidly progressive ascending paralysis
| Tetraparesis more marked distally
135
What happens to reflexes in GBS?
Reflexes are absent
136
Name 2 neurology features commonly associated with GBS
LMN lesion of 7th nerve and bulbar involvement
137
What may precede GBS?
URTI or diarrhoea
138
What type of neuropathy is GBS? Consequently, what might you find in the CSF of a patient with GBS?
Demyelinating - High protein in CSF
139
What is the main treatment for GBS?
| What prophylactic medicine must you also give?
IV immunoglobulins
| Low dose subcutaneous heparin to prevent a DVT
140
Name 3 things you must monitor in a patient with GBS and why?
- FVC (as patient is at risk of respiratory failure)
| - BP and heart rhythm as patient is at risk of autonomic neuropathy
141
What are the autoantibodies in myasthenia gravis against?
They are acetylcholine receptor antibodies - block the post-synaptic receptors
142
Which muscles tend to be affected in MG?
Mainly proximal muscles
| Facial and neck weakness
143
Other than limb and facial weakness, how does MG present?
Double vision, ptosis, speech and swallowing difficulties, respiratory muscles may get affected (--> breathing difficulties)
144
What would show up on an electromyograph of someone with MG?
Decrement on repetitive stimulation
145
What was the ice pack used for? What did it show?
Used to be used to diagnose MG
| The cold improves neuromuscular transmission, so would see an improvement in symptoms
146
What was the Edrophonium (Tensilon) test used for and how did it work?
Used to be used to diagnose MG
| Inject acetylcholinesterase inhibitor IV --> would see a big improvement in patient's weakness for 3-5 minutes
147
Once the diagnosis of MG is confirmed, what extra imaging should then be undertaken?
CT/MRI of thorax to check for thymic hyperplasia or thymoma
148
What is the main treatment for MG? How does it work?
Pyridostigmine - it is a acetylcholinesterase inhibitor that increase Ach availability at the neuromuscular junction.
149
What is a side effect of Pyridostigmine and how can you treat this?
Abdo cramps and diarrhoea - can treat this by giving antimuscarinic drugs e.g. propantheline
150
Other than pyridostigmine, what other treatment options are available for MG? What must you warn patients about one of the available treatments?
- Immune TX to suppress production of the abnormal antibodies e.g. prednisolone (warn patients that their condition may deteriorate initially - 'Steroid dip')
- Azathioprine can be used as a steroid-sparing treatment
- If severe, treat with IV immunoglobulins or plasmapheresis
151
How does amyotrophic lateral sclerosis present?
Weakness (mainly in hands) with UMN signs (brisk reflexes) and LMN signs (wasted muscles and fasciculations)
152
How does progressive bulbar palsy present?
Progressive dysarthrtia, then swallowing difficulties. Wasted muscles and fasciculations.
153
How does progressive muscular atrophy present?
LMN type weakness
154
How is the bladder involved in motor neurone disease?
NO bladder involvement
155
What investigation would you do to confirm the diagnosis of motor neurone disease?
NCS/EMG would show denervation and fasciculation in both wasted and normal muscles
156
Name the medication used as disease modifying treatment in motor neurone disease? How does it work?
Riluzole (glutamate antagonist) - may increase survival by a few months
157
What do patients with motor neurone disease die off?
Respiratory failure
158
Name 3 organisms that most commonly cause acute bacterial meningitis?
- Streptococcus pneumoniae
- Neisseria meningitidis
- Haemophilus influenzae
159
Name a common cause of viral meningitis
Enteroviruses
160
How would viral meningitis present?
Headache and fever with no impairment of consciousness
161
What is Kernig's sign?
Thigh is flexed at hip and knee at 90 degree angles - subsequent extension of the knee is painful
162
What is Brudzinski's sign?
Forced flexion of neck elicits a reflex flexion of hips
163
What would show on a brain CT of someone with meningitis?
Normal!
164
How would a cerebral abscess appear on CT? What investigation would you do if you noticed one?
On CT, a cerebral abscess will be a ring-enhancing lesion with surrounding oedema.
Can do PCR of CSF to identify organism
165
A CSF sample is taken. There is a high WCC, with mainly polymorphs - diagnosis?
Bacterial meningitis
166
CSF sample results:
- Slightly raised protein
- High WCC (up to 500/mm3)
- Normal glucose level
Diagnosis?
Herpes simplex encephalitis
167
A CSF sample is taken - there is low glucose (<50% of blood glucose!) - Diagnosis?
Tuberculosis meningitis
168
```
CSF sample results:
- Slightly raised protein levels
- High WCC (<200/mm3) Mainly lymphocytes
- Normal glucose levels
Diagnosis?
```
Viral meningitis
169
What is the specific treatment for viral meningitis?
No specific treatment as it is self-limiting
170
What is the management of bacterial meningitis?
Broad-spectrum IV Abx: 3rd generation cephalosporin e.g. ceftriaxone ASAP
IV dexamethasone for 4 days
171
What is the treatment for cryptocccal meningitis?
Antifungal treatment e.g. fluconazole or amphotericin B ASAP
172
What does a grade IV glioma mean?
It is very malignant
173
What is an acoustic neuroma?
A benign tumour from 8th CN @ cerebellopontine angle
174
Name a medication used to treat prolactinomas
Cabergoline (a dopamine agonist)
175
What is the pathophysiology of Huntington's disease?
CAG repeats on chromosome 4
176
How does Huntington's disease present?
Chorea, dementia, psych problems
177
Is myotonic dystrophy recessive or dominant?
Dominant
178
How does myotonic dystrophy present?
Frontal baldness, ptosis, wasting of masseter and temporalis muscles, bilateral facial weakness
Other symptoms: cataract, cardiac conduction defects. diabetes, testicular atrophy, impairment of intellectual function
179
What are 2 simple tests you can do with someone suffering from myotonia?
1) Get the patient to make a fist and release it - there is a delay in relaxing the hand
2) Percussion myotonia: Strike thenar eminence with a tendon hammer - will take a long time for dimple to return to normal
180
What is the treatment for myotonic dystrophy? What monitoring needs to be done?
No specific treatment.
Do cardiac monitoring with regular ECG (increased risk of cardiac conduction defects) and regularly check blood sugar (at an increased risk of diabetes)
181
What is the cause of subacute combined degeneration of cord?
Vitamin B12 deficiency
182
Which neural pathways get disturbed in subacute combined degeneration of cord?
- Dorsal column dysfunction: impairment of vibration and position sense
- Corticospinal tract dysfunction: motor weakness
183
What would you find on examination of someone with subacute combined degeneration of cord?
Sensory ataxia
Spastic legs
W/ absent ankle reflexes
Upgoing plantars
184
What is the most common form of muscle disease in those over 50 years old? Which parts of the body get involved early?
Inclusion body myositis
| Early involvement of finger flexors, foot extensors and quadriceps
185
Is Charcot-Marie Tooth Disease dominant or recessive?
Dominant
186
How does Charcot-Marie Tooth Disease present?
Bilateral distal weakness
Bilateral foot drop
Pes Cavus (high arch)
Absent ankle and knee jerks
187
What type of neuropathy is Charcot-Marie Tooth Disease?
Both - demyelinating and axonal!
188
What is the pathophysiology behind syringomyelias?
| What is it linked to/what causes it?
Abnormal fluid collection (syrinx) within several segments of SC
Linked to Chiari's malformation (medulla and lower cerebellum descending below foramen magnum)
Can be caused by tumour/ trauma
189
How does syringomyelias present?
Loss of pain and temperature --> burn marks in upper limbs
| Wasting, weakness and loss of reflexes in upper limbs. Spastic limbs
190
Name 2 drugs used to treat narcolepsy?
Modafinil and dexamphetamine (CNS stimulants)
191
Consciousness depends on which part of the brainstem being intact?
Reticular activating system
192
Describe the scoring system for GCS
Eye opening ( /4)
Verbal ( /5)
Motor ( /6)
193
How do you diagnose syringomyelia?
Do MRI of the spine
194
What happens to a patient's consciousness level when they are having a subdural haemorrhage?
Conscious level fluctuates, "evolving stroke"
195
Name 3 risk factors for subdural haemorrhages?
Anticoagulants, old age, falls
196
What is the pathophysiology of subdural haemorrhages?
Bleeding from bridging veins between cortex and venous sinuses - this leads to a haematoma between the dura and arachnoid which increases ICP and shifts midline structures
197
What may happen if subdural haemorrhages are not treated?
Tentorial herniation and coning
198
What fruit does a subdural haemorrhage look like lol?
Banana
199
How long may the lucid interval in a patient with an extradural haemorrhage last?
Lucid interval may last hours-days before GCS drops due to increased ICP
200
How do extradural haemorrhages present?
Increasingly severe headache, vomiting, confusion and seizures +/- hemiparesis with brisk reflexes and upgoing planters
201
What are some of the late signs of extradural haemorrhages?
If bleeding continues --> ipsilateral pupil dilates, coma deepens, bilateral limb weakness, breathing deep and irregular (brainstem compression)
202
What fruit does an extradural haemorrhage look like on imaging?
A lemon
203
How does a subarachnoid haemorrhage present?
With an acute headache
204
What does anosognosia and agnosia mean? When might a patient present with these symptoms?
Anosognisia = Lack of insight
Agnosia = Cannot recognise self
May be seen in patients with AD
205
What is the pathophysiology behind Lambert Eaton Myasthenic Syndrome?
Antibodies against voltage-gated Ca 2+ channels on pre-synaptic membrane
206
How does Lambert Eaton Myasthenic Syndrome present?
Gait difficulty, autonomic involvement (dry mouth, constipation and impotence), hyporeflexia and weakness
207
When would the weakness associated with Lambert Eaton Myasthenic Syndrome improve?
After exercise
208
What are the treatment options for Lambert Eaton Myasthenic Syndrome?
- Pyridostigmine (is a acetylcholinesterase inhibitor)
- 3,4- diaminopyridine
- IV Igs
209
Which malignancy is Lambert Eaton Myasthenic Syndrome linked to?
Small-cell lung cancer
210
What regular imaging must you do for a patient with Lambert Eaton Myasthenic Syndrome, and why?
Regular CXR/HRCT as symptoms may precede cancer
211
What would happen if you give Edrophonium to someone in cholinergic crisis?
It will worsen their muscle weakness by inducing depolarizing block.
212
What sort of respiratory failure would neuromuscular disease cause?
Type 2 respiratory failure
