Neurology Flashcards
1
Q
How does a CN1 lesion present?
A
- Anosia (uni or bilateral) aka loss of smell
2
Q
What are the common causes of CN1 lesion? (4)
A
- Trauma
- Respiratory tract infection
- Meningitis
- Frontal lobe tumour
3
Q
How does a CN2 lesion present?
A
- Low acuity/visual field defect
- optic disc problems
4
Q
What can cause a CN2 lesion?
A
- MS
- giant cell arteritis
- diabetes
- optic chiasm compression
- glaucoma
5
Q
How does a CN3 lesion present?
A
- Eyes go ‘down and out’ due to unopposed action of CN4 and 6
6
Q
What can cause CN3 lesion?
A
- MS
- DM
- Giant cell arteritis
- Posterior communicating arterty aneurysm
7
Q
How does a CN4 lesion present?
A
- Diplopia on looking down
8
Q
What can cause CN4 lesion?
A
- usually due to trauma to orbit
- rare
9
Q
How does a CN6 lesion present?
A
- Horizontal diplopia on looking out
10
Q
What causes CN6 lesion?
A
- MS
- Pontine stroke
11
Q
How does a CN5 lesion present?
A
- Motor = open jaw deviating to side of lesion
- Sensory = V1/2/3 pathology/ diminished corneal reflex
12
Q
What can cause a CN5 lesion?
A
- Motor = rare but stroke
- Sensory = trigeminal neuralgia or herpes zoster
13
Q
How would a CN7 lesion present?
A
- Droop and weakness
- Loss of taste in anterior 2/3 tongue
14
Q
What can cause a CN7 lesion?
A
- Bell’s Palsy
- Otitis media
- Skull fracture
- stroke
15
Q
What is Bell’s Palsy?
A
- Paralysis of facial nerve which causes muscular weakness on one side of the face
16
Q
What can cause Bell’s Palsy?
A
- TB
- HIV
- Polio
- Sarcoid
17
Q
What can happen to eyes and ears in Bell’s palsy?
A
- Eyes rotate up and out when try to close
- Ears hypersensitive
18
Q
What is a dermatome?
A
An area of skin supplied by a single spinal nerve
19
Q
What is a myotome?
A
A volume of muscle supplied by a single spinal nerve
20
Q
Describe the common carotid artery.
A
- R = arises from brachiocephalic trunk
- L = arises from aortic arch
- No branches
- Bifurcate at approx. C3-4
21
Q
What are the 4 lobes of the cortex?
A
- Frontal
- Parietal
- Occipital
- Temporal
22
Q
What are the two “feeder” arteries into the Circle of Willis?
A
- Internal carotid
- Vertebral arteries
23
Q
What is the role of the frontal lobe?
A
- Voluntary movement on opposite side of body
- Controls speech and writing
- Thought processes, reasoning and memory
24
Q
What is the role of the parietal lobe?
A
- Receives and interprets sensations e.g. pain, pressure, size and body awareness
25
What is the role of the temporal lobe?
- Understanding spoken word
| - Memory and emotion
26
What is the role of the occipital lobe?
- Understanding visual images and meaning of written words
27
What is the role of the cerebellum?
- Co-ordinates movement and balance
28
What would injury to the cerebellum lead to? (5)
- Movements that are slow and uncordinated
- Asynergia = loss of coordination
- Intention tremor = movement tremor
- Hypotonia = weak muscles
- Nystagmus = abnormal eye movement
29
What is the function of the brainstem?
- Special senses
- regulates consciousness
- autonomic regulation of body
30
What is schizophrenia?
- Described as type of psychosis
- Positive and negative symptoms
- Mental health disorder
31
What are some symptoms of schizophrenia?
- Positive include delusions, thought disorder, hallucinations
- Negative include withdrawn, unemotional, unable to carry on with everyday activities
32
What are the 6 muscles that move the eyeball?
- Lateral rectus
- Medial rectus
- Superior rectus
- Inferior rectus
- Superior oblique
- Inferior oblique
33
What is the role of the levator palpebrae superioris?
- Lifts the upper eyelid
| - Loss of function gives ptosis
34
What is the function of the 4 rectus muscles?
- Lateral = pulls laterally (abduction)
- Medial = pulls medially (adduction)
- Superior = pulls up and medially and rotates
- Inferior = pulls down and medially and rotates
35
Describe the semi-circular canals.
- Accelerometers
- sit in the petrous part of temporal bone
- the fluid present in the canal stays where it is
36
What is defective outer or middle ear loss called?
- Conductive hearing loss
37
What is defective inner ear hearing loss called?
- Sensorineural hearing loss
38
What are the two types of stress?
- Eustress = good. Positive which is beneficial and motivating
- Distress = bad. Negative which is damaging and harmful
39
What is the difference in acute and chronic stress?
- Acute = response to novel situation experience as danger. Examples include illness, noise, short-term danger
- Chronic = repeated exposure. Examples include physical illness, unemployment, poverty
40
Describe the HPA axis.
- Perceived danger
- Hypothalamus
- Pituitary
- Adrenal cortex
- Stress response
41
What are physiological examples of stress responses
- Breathing rapidly, increasing oxygen
- Blood flow increase
- Increase HR and BP
- Sweating
42
What are the symptoms of PTSD?
- Flashbacks/nightmares
- Sweating
- Nausea
- Insomnia
- Impaired concentration
43
What is allostatic load?
- Refers to cumulative exposure to stressors, leads to 'wearing out'
44
What is the difference between acute and chronic pain?
- Acute = pain less than 12 weeks
| - Chronic = continuous pain over 12 weeks
45
What is nociceptive pain?
- Arises from actual or threatened damage and is due to activation of nociceptors
46
Describe the spinothalamic tract
- Sensory carries pain, temperature and crude touch from the body
47
Describe the trigemino-thalamic tract
- Sensory pathway carrying pain, temperature and touch from the face/neck/head
- Contributions from trigeminal, facial, vagus and CNVI
48
Describe the insular cortex. (2)
- Plays a role in perception, motor control and self-awareness
- Degree of pain is judged here
49
Describe the cingulate cortex. (2)
- Linked with limbic system, so associated with emotion formation and processing
- Maintains connections with pain processing areas
50
What are some examples of symptoms of depression?
- Low mood, anhedonia, low energy
| - Cognitive symptoms include guilt, hopelessness and suicidal thoughts
51
What is the function of the amygdala? (3)
- Receives highly processed information
- Emotional memory
- Mediates fear response
52
What are the types of head injury?
- Non-missile (blunt)
| - Missile, where penetration of skull or brain
53
What are examples of focal damage through a blunt head trauma?
- Scalp laceration
- Skull fracture
-
54
What would a skull fracture lead to?
- Increased risk of haematoma
- Infection
- Aerocele (air getting in)
55
What type of surfaces cause linear fractures?
- Flat surfaces
| - One fracture line will not cross a pre-existing fracture line
56
What is an extradural haematoma? (4)
- Between inner surface of skull and dura
- Associated with skull fracture
- Occurs slowly over hours
- Classified with how deep into the brain meninges it is
57
Which artery is at danger in a skull fracture?
- Middle meningeal artery as it is slow bleeding
58
What is a subdural haematoma? (3)
- Between dura mater and arachnoid mater
- usually due to tears in bridging veins
- Slow constant bleed, which can be acute or chronic
59
What are causes of a subarachnoid haematoma? (3)
- Contusion/lacerations
- Base of skull fracture
- Vertebral artery rupture
60
What are superficial cerebral and cerebellar haemorrhages due to?
- Severe contusion
| - leaves 'bruising'
61
What are deep cerebral and cerebellar haemorrhages due to?
- Diffuse axonal injury or vascular injury
62
What are infections in the brain due to?
- Skull fracture
63
What is the damage mechanism for accelerated or decelerated damage?
- Force to head causes DIFFERENTIAL MOVEMENT
- contusion
- traction on bridging veins can cause subdural haemorrhage
64
What is the difference between "coup" and "contre coup"?
- Coup is at the site of impact
| - Contre coup is away from the site of impact. If you bouncem the brain goes backwards
65
What is a contusion?
- Superficial "bruise" of the brain
66
What is a laceration?
- When contusion is severe enough that it tears the pia mater
67
What is a diffuse axonal injury?
- Syndrome of widespread axonal damage
| - can be caused by a variety of processes
68
What is a traumatic axonal injury?
- involves acceleration and deceleration of the head
- If mild, will recover but with variable severity
- If severe, unconscious from impact and can be severely disabled
69
What is a diffuse vascular injury?
- Results in near immediate death
| - generally the more important vessels and axons
70
What is brain swelling?
- Occurs in 75% patients
| - Leads to increased intracranial pressure
71
What can herniation be due to?
- Bleeding
| - Brain swelling
72
What is hypoxia-ischaemia?
- Insufficient blood flow
- Can cause infarction and ischaemic damage
- Heart finds it heart to keep BP up
- Can be widespread or confined
73
What is chronic traumatic encephalopathy?
- type of dementia associated with repeated blows to the head and recurrent episodes of concussion
74
What is meningitis?
- Inflammation of the meninges
75
How can the meningitis infection enter the head?
- Extracranial infection e.g. nasal carriage, otitis media, sinusitis
- Via bloodstream
- Neurosurgical complications = trauma, post-op etc
76
Describe the pathophysiology of meningitis. (4)
- bacteria enters CSF, which then replicates
- blood vessels become leaky
- WBCs enter CSF, meninges and brain
- causes brain swelling
77
What are the symptoms of meningitis?
- Fever
- Headache
- Neck stiffness = meningism
78
What are the 1st line antibiotics for meningitis?
- Ceftriaxone or cefotaxime
79
If suspected meningitis, what are the steps to do at hospital?
- Assess GCS
- Blood cultures
- Broad spectrum antibiotics
- Steroids (IV dexamethasone)
- Lumbar puncture
80
What is the definitive investigation to diagnose meningitis?
- Lumbar puncture
81
What are the most common bacteria in meningitis?
- Neisseria meningitidis (gram -ve cocci)
| - Strep. pneumoniae (gram +ve cocci)
82
What are the most common viral infections in meningitis?
- Enterovirus
- HSV
- Varicella Zoster virus
83
After meningitis has been diagnosed, what should you do?
- Call Public Health England
| - Identify close contacts - give antibiotic prophylaxis e.g. rifampicin
84
What is encephalitis?
- Inflammation of the brain
85
What are the causes of encephalitis?
- Usually viral
- Herpes simplex
- Varicella Zoster
- TRAVEL e.g. Japanese, tick-borne, rabies
86
What are the symptoms of encephalitis?
- "Flu-like" illness
- THEN
- Altered GCS, fever, seizures, memory loss
87
How do you investigate encephalitis?
- MRI
- Lumbar puncture
- HIV test
88
What is the treatment for encephalitis?
- Mostly supportive in neuro rehabilitiation
| - If HSV or VSV = aciclovir
89
What is tetanus?
- Inoculation through skin with C. tetani spores
| - eg. dirty wounds, stepping on a nail
90
How do you manage tetanus?
- PREVENTION = vaccine
| - If symptoms = supportive with muscle relaxants and metronidazole for residual bacteria
91
What is rabies?
- Inoculation through skin with saliva of rapid animal
| - if reaches CNS, gives paralytic presentation
92
What is Alzheimer's Disease?
- Chronic neurodegenerative disease
| - Gradual onset and progressive
93
What is the criteria for AD?
- Gradual and progressive changes in memory function over 6 months
- Amnestic syndrome of hippocampal type
94
What is the pathology for AD?
- Decreased A beta 1-42, with increase T/P-tau in CSF
| - Increased amyloid PET
95
What are the symptoms and features for AD?
- Sudden onset
- Early occurence of gait disturbances and behavioural changes
- Early hallucinations
- Cognitive fluctuations
96
What are the key features of Multiple Sclerosis?
- Inflammatory, demyelinating disease
- Specific to CNS
- Progressive disability over time
- usually between 20-40 years
97
Where are the common sites for plaque distribution in MS?
- Cerebral hemispheres
- Spinal cord
- Optic nerve
98
What are the typical symptoms in MS?
- Optic neuritis (impaired vision and eye pain)
- Spasticity
- Sensory symptoms and signs
- Nystagmus, double vision
- Bladder and sexual dysfunction
99
How would you diagnose MS?
- Essential diagnostic criteria for MS includes 2 or more lesions
- Exclusion of conditions giving a similar picture
100
What is the treatment for mild MS?
- Oral medications e.g. baclofen, diazepan
| - Tremor = propanol, phenobarbitone
101
What is the treatment for severe MS?
- Disabiling spasticity = phenol
| - Severe = intrathecal baclofen
102
What are the characteristics of an epileptic seizure?
- Duration = 30-120s
| - Stereotypical seizures
103
What are the characteristics of a non-epileptic seizure?
- Situational
- Duration = 1-20 mins
- dramatic motor phenomena or prolonged atonia
- Eyes closed
104
What commonly made mistakes are made with diagnosing epilepsy?
- Incomplete history
- Misinterpretation syncopal, myoclonic jerks
- Misinterpretation of EEG changes
105
What is focal epilepsy?
- Associated with focal brain abnormality
- Can start at any age
- Types of seizures are partial with or without loss of consciousness
106
What is the first line treatment for focal epilepsy?
- Carbamazepine or Iamotrigine
107
What is idiopathic generalised epilepsy?
- No associated brain abnormality
- Usually <30 years
- Types of seizures include absence, myoclonic or tonic clonic
108
Which epilepsy types give absence seizures?
- Childhood absence
| - Juvenile absence
109
What is treatment for primary generalised epilepsy?
- Emergency = IV lorazepam
| - Valproate or Iamotrigine
110
What is ischaemic stroke?
- A blood vessel in the brain that is blocked
111
What is the differential diagnosis of a stroke?
- Hypoglycaemia
- Labyrinthine disorders
- Migrainous aura
- Mass lesions
112
What is an embolic stroke?
- Death of cell bodies in the cortex
| - No recovery
113
What is ataxia?
- Will movements are clumsy, ill-directioned or uncontrolled
114
What are the clinical features of upper motor neurone pathology?
- Muscle tone INCREASED
- tendon reflexes
- Upper limb extensors WEAKER than flexors
- Lower limb flexors WEAKER than extensors
- Emotional lability
115
What are common causes for upper motor neuron pathology?
- Vascular disease
- Inflammatory e.g. MS
- Spondylosis
- Neurodegenerative disease
116
How would you investigate UMN problems?
- MRI
- Bloods = metabolic disorders
- CSF examination
117
What is a glioma?
- Most common primary brain tumour of glial cells
| - Divided into WHO grades
118
Describe low-grade gliomas (WHO2).
- Slow growing but can undergo transformation
| - Median age = 35yrs
119
Describe high-grade gliomas (HGG)
- 85% of all new cases of malignant primary brain tumours
- Median age onset 45-60
- Majority - no cause
120
What are some symptoms of brain tumours?
- Depends on type and site
- headache
- seizures
- focal neurological symptoms
121
What are the different focal and non-focal symptoms that patients can get?
- Focal = weakness, sensory loss, visual/speech disturbance, ataxia
- Non-focal = personality change, memory disturbance, confusion
122
How would you investigate a brain tumour?
- CT and MRI
| - brain biopsy
123
What is the treatment for brain cancer?
- Non-curative generally
| - Depends
124
What is the treatment for HGG tumour?
- Steroids - reduce oedema
- Surgery - resection
- radio and chemo
125
What is the treatment for LGG tumour?
- Surgery - early resection
| - radiotherapy - delay disease transformation
126
What is Parkinson's Disease?
- A condition in which parts of the brain become progressively damaged over many years
127
What are the symptoms of Parkinson's Disease?
- Brady/akinesia
- Tremor (may be unilateral)
- Rigidity (pain)
128
What is the pathology related to PD?
- Substantia nigra has reduced
| - Lewy bodies are present
129
What can cause cell loss in substantia nigra?
- Inherited factors = susceptibility factors and Parkinson genes
- Environmental factors = risk factor and toxin induced
130
What is the treatment for PD?
- No cure or disease-modifying treatment
- L-Dopa
- Dopamine agonists
- COMT/MAO-B inhibitors
131
What are the side effects of anti-cholinergics?
- Cognition
- Confusion
- Systemic
132
What are the side effects of L-dopa?
- The higher the dose, the greater the risk
| - READ
133
What is the 1st line treatment in younger PD patients?
- DA agonists e.g. ropinirole
134
What are the side effects in DA agonists?
- Tiredness
- Gambling
- Hypersexuality
135
What other problems are associated with PD?
- Depression (20-40%)
- Phobias, anxiety
- Dementia
- Autonomic problems
136
What is essential tremor?
- A nerve disorder characterized by uncontrollable shaking in different parts and on different sides of the body
137
What are the symptoms of essential tremor?
- Uncontrollable shaking
- Shaking voice
- Nodding head
- Worsen during stress
- Lessen with rest
138
What is the treatment for essential tremor?
- Beta-blockers
| - Primidone
139
What is contraindicated in beta-blockers for essential tremor?
- Asthma
| - Diabetes
140
What is Huntington's Disease?
- Inherited disorder which results in death of brain cells
141
What are the symptoms in HD?
- Involuntary movements like jerking
- rigidity
- muscle contracting (dystonia)
- dementia
- psychiatric problems e.g. personality change or depression
142
What is the treatment for HD?
- Chorea = sulpiride
- Depression = SSRIs
- Psychosis = haloperidol
143
What is dystonia?
- Movement disorder where the muscles contract uncontrollably
144
What are symptoms of cerebellar dysfunction?
- Slurring of speech
- Swallowing difficulties
- Blurred vision (not common)
- Clumsiness
- Tremor
145
What are signs of cerebellar dysfunction?
- Dysarthria (speech)
- Nystagmus
- Limb ataxia
146
What can help in the diagnostic history for cerebellar dysfunction?
- Congenital vs onset
- Rate of progression
- Episodic
- Speech affected early
147
What is the most common cause of progressive ataxia?
- Sporadic (80%)
148
What are types of primary headache?
- Migraine
- Cluster
- Tension type
149
What are types of secondary headache?
- Meningitis
- Subarachnoid haemorrhage
- Medication overuse headache
150
In a pt history, what should you think about if considering further investigation of headaches?
- 50+
- History of HIV, cancer, or trauma
- Change in personlity
- Vomiting without other obvious cause
151
In a pt exam, what should you think about if considering further investigation of headaches?
- Fever
- Altered consciousness
- Neck stiffness
- Other abnormal neurological exam
152
If someone describes their headache as 'thunderclap', what is it?
- Subarachnoid haemorrhage
153
If someone presents with a red eye(s) and headache, what is suspected?
- Acute glaucoma
154
What is a migraine without aura?
- The headache occurs without the specific signs
155
What are the criteria for a migraine without aura?
- 5 attacks
- Attacks last 4-72 hours
- Two of unilateral, pulsing and moderate
- Have nausea and/or vomiting and photophobia
- not attributed to another disorder
156
What is the preventive treatment of migraine?
- Topiramate or propranolol
- Riboflavin may be effective
- Botulinum toxin type A for chronic migraine
157
How would you investigate SAH?
- CT scan 95% sensitive
- LP
- Angiography
158
What is the management for SAH?
- Resuscitation
- Nimodipine
- Early intervention to prevent re-bleeding
159
What is papilloedema?
- Optic disc swelling caused by increased ICP
- Bilateral
- Can occur over hours-weeks
160
What is idiopathic intracranial hypertension?
- Build-up of pressure around the brain
161
What is the symptoms of IIH?
- constant throbbing headache
- blurred or double vision
- temporary loss of vision
162
What is the management of IIH?
- Modify risk factors (obesity and drug use)
| - Drugs = acetazolamide, topiramate, diuretics
163
What is Giant Cell Arteritis?
- 50+
- New headache
- Temporal tenderness and decreased pulsation
- ESR elevated
- Jaw claudication
164
What would a ACA stroke lead to?
- Leg weakness
- Sensory disturbance in legs
- Gait apraxia
165
What would a MCA stroke lead to?
- Contralateral arm and leg weakness
- Contralateral sensory loss
- Hemianopia
- Dysphasia
- Facial droop
166
What would a PCA stroke lead to?
- Contralateral hemianopia
- Cortical blindness
- Dyslexia, anomic aphasia
- Unilateral headache
167
What is a transient ischaemic attack (TIA)?
- Focal, sudden onset lasting less than 24hrs
| - Complete clinical recovery
168
What is the investigation for TIA?
- ABCD2 = risk score of a stroke
169
What is the treatment for TIA?
- Modify risk factors
- Aspirin
- Clopidogrel
- Statin e.g. simvastatin
170
What is the pathology behind migraines?
- Changes in brainstem blood flow
- Unstable trigeminal nerve in basal thalamus
- Release of CGRP and substance P
- Vasodilatation
171
What is trigeminal neuralgia?
- Unilateral pain confined to one or more divisions of the trigeminal nerve
172
What are triggers of trigeminal neuralgia?
- Washing affected area
- Shaving
- Eating
- Dental prostheses
- talking
173
What is the medication for trigeminal neuralgia?
- 1st = carbamazepine (anti-convulsant)
| - 2nd = phenytoin or gabapentin
174
What is the investigation for GCA?
- Temporal artery biopsy
| - Bloods for raised inflammatory markers
175
What is the treatment for GCA?
- Prednisolone (steroid)
- aspirin
- PPI (omeprazole)
176
For chronic MS, what is the treatment?
- 1st = beta interferon
- 2nd = alemtuzumab
- symptom management
177
What is spinal cord compression?
- Results in UN signs and specific symptoms depending on where compression is
178
What is radiculopathy?
- Compression of nerve root at LMN
179
What is polyneuropathy?
- Multiple/systemic
| - diabetes, MS, Guillian Barre
180
What is Guillian Barre syndrome?
- Demyelinating polyneuropathy in the PNS
- Progressive ascending muscle weakness
- Varies from mild-severe
181
What is the treatment for Guillian Barre syndrome?
- IV Ig
