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Neurology Flashcards

1
Q

Gullain Barre Syndrome:

What are some common causes of it?

How does it present?

What investigations should you do?

What is the treatment?

A

Causes:

Campylobacter Jejunum

Mycoplasma Pneumonia

EBV

Hep E - Genotype 3

**molecular mimicary

Presentation:

Symmetrical Weakness, proximal muslces affected.
- 20% devleop resipratory distress

Sensory changes

  • Pain
  • Distal Parasthesia

Weakness:

  • Loss of reflexes
  • Diploia
  • Dysphasia

Autonomic dysfuncton

  • postural hypotension
  • Constipation

Investigations:

Nerve conduction studies

Peak Flow - to assess respiratory function - every 4 hrly.

Lumbar puncture:

  • raised Protein
  • Normal White cells

*if detioration admitt to ITU

Treatment:

IV immunoglobulins

Plasma Exchange

Respiratory Support

Pain management

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2
Q

Bell’s Palsy:

A

Lower Motor Neuron lesion of the fascial nerve.

Unkown eitology but thought to be associated with:

  • latent HSV

*more common in pregnancy x3
*more common in DM x5

Clinical Features:

  • abrupt onset - over night
  • complete unilateral weakness
  • ipsilateral pain around ear
  • reduced taste (ageusia)
  • hypersensitivity of sounds (stapedius palsy)

Differentials:

  • Ramsay Hunt syndrome (VZV reactivation)
  • Mengitits
  • Braimstem lesions
  • Cerebellopontine angle tumours - accoustic
  • lymm disease (Borrelia)

Investigations:

To rule out other causes:

  • VZV antibodies
  • Borrelia antibodies
  • ESR
  • Glucose

*CT/MRI (tumours)

Mangagement:

within 72 hours - predisilone 60mg.

+72 hours - steroids but the evidence is not clear

**protection of th eye:

  • dark glasses
  • artificial tears
  • use of tape on the eyes
  • surgical eye closure if severe

Prognosis:

incomplete paralysis make full recover
- in a few weeks

complete paralysis - 80%

Myesthenia Crisis:

*Plasmaphresis

*Immunoglobulins

*ventilatory support

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3
Q

Myasthenia Gravis:

What can make this worse?

What is it associated with?

What investigations should be done?

How is it treated?

A

Autoimmune disease
-antibodies against nictonic receptor

Augmentors:

*climte change

* pregnancy

*hypokalamia

*gentamicin

*opiods

*Beta Blockers

Differentials:

Lambert- Eaton Syndrome

Polymyositis

Takayasu’s arteritis

botulism

Associations:

  • SLE
  • RA

Investigations:

  • Anti- AChR antibodies
  • Muscle Specific Tyrosine Kinase / MUSK antibodies
  • Low density lipolipoprotein receptor related protein
  • EMG studies
  • CT for thyoma (as associated)
  • Tensilon test (dangerous)

Treatment:

  • Anti-cholinesterase (pyridostigamine)
  • Immunosupression - steroids
  • Thyectomy
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4
Q

Lambort Eaton Syndrome?

Compare and contrast with MG:

A

Neuromuscular disease that prevents the release of neurotransmitters on the pre-synptic membrane

  • due to antibodies against the Ca2+ channel.

*associated with cancers
- small cell lung cancer

Clinical Features:

gait changes - this is well before changes to the muscles of the eye

Autonomic dysfunction

  • dry eyes
  • constipation

**weakness improves with exercise
this is contrasted with MG, which gets worse.

Treatment:

* cure underlying condition

* pyridostigamine

*Diaminopyridine
- this blocks K+ allowing Ca2+ to stay open for longer

*Immunoglobulins

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5
Q

Define Delierium:

A

A distrubanc of consciousness with reduced ability to focus, substain or shift attention.

It develops acutely (over hours to days) and tends to fluctate in its severity over that time

Evidence of a physiological cause induced by illness, trauma, medication or pyschological distress

Types:

* hypoactive

*hyperative

*mixed

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6
Q

What are some differentials to delierum?

And what are some common risk factors?

A

Dementia

Anxiety

Non- convulsive Status epilepticus

Primary mental illness - schizophrenia

Risk Factors:

>65 years old

Dementia

Hip fracture

Acute illness

Pyschological agitation (pain)

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7
Q

What is the management for Delerious patients?

A

Assessment:

*History
- any clues to underlying causes

*Examination

*Cognitive Assessment

  • AMT
  • MMSE

*Investigations

Investigations:

FBC

U&Es

Blood Glucose

ABG

Bone profile
- Ca2+

CRP

Spetic Screen

  • urine dipstick
  • CXR
  • Blood cultures
  • CT/ EEG
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8
Q

What is the management for delierum?

A

_**Resolve the causative factor_

_**Review medications_

_**Avoid constipation_

Reorientate the patient as best as possible

  • clocks
  • Calenders

Calm the patient with reassurance

Encourage physical movement

Maintain fluids

Sedation:

used only when patient is a risk to themselves and others:

1st line: Haloperidol

*avoid in parkinson’s

2nd line: Lorazepam

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9
Q

What is the Imaging investgiations can be done into Parkinson’s?

A

DAT SPECT scan

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10
Q

What is the treatment for cluster headaches?

A

100% oxgen. The to 80% as pain decreases
+
Triptans

Prophylaxis:

  • verapmil
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11
Q

During a GCS assessment, the supraorbital is squeezed and the patient moves their arm to below their clavical, what does this count as?

A

M4 - normal flexition

it does not count as localisation as it is not above clavical

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12
Q

What are the treatment options for generalised seizures?

A

1st line:

  • Sodium valporate

2nd line:

  • Lamotrigrine
    or
  • Carbamazepine
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13
Q

What are the treatment options for focal seizures?

A

1st line:

  • Carbamezepine
  • Lamotrigrine
  • *2nd Line:**
  • Sodium valporate
  • Levetiracetum
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14
Q

What type of seizure is most associatted with Automatisms?

A

Complex focal seizure of temporal lobe

Automatisms include:

  • lip smacking
  • Dystonic limb movement
  • undressing
  • walking in circles
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15
Q

What are some typical features of a generalised seizure?

A

Photosensitivity - some people sensitivity to certain light frequency.

Usually with genetic in nature

Tend not to have the build up

Usually in early hours of the days

No Aura

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16
Q

If an EMG shows diminished respone to continual stimulation what is a likely diagnosis?

A

Mysthenia Gravis

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17
Q

How are migraines treated acutely?

A

1st line:

  • Triptans
  • NSAIDs - high dose aspirin

2nd line:

  • Metaclopramide
  • Non- oral NSAIDs
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18
Q

What is the propholyatic treatment for migraines?

A

Avoid triggers:
- caffiene
- Cholocate
- Hangovers
etc

1st:
- propranolol
or
- Topiramate

2nd:
- accupuncture - 10 courses

3rd:

  • botulism injections
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19
Q

What is the diagnostic criteria for migraines?

A

Without aura:

>2 of the following:

  • unilateral
  • Pulsating
  • Mod pain
  • Aggrevated by activity

>5 attacks

Lasting 4-72 hours

N&V or Photophobia

With Aura:

>2 attacks

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20
Q

What are the antibodies investigated for in mysthenia gravis?

A

Acetlycholine Receptor

Muscle Specific Kinase - MuSK

Low Density Lipolipoproteins receptor related 4 - LRP4

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21
Q

How is Msythenia Gravis offocially diagnosed?

A

Autoantibodies

Edrophonium test

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22
Q

What type of ventilation is used in mysthenia gravis crisis?

A

BiPAP

or

Intubation

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23
Q

What are the most common causes of Guillian Barre syndrome?

A

Campylobacter

EBV

CMV

Hep E type 3

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24
Q

What is the criteria used for diagnosis of Guillian Barre syndrome?

and what additional tests can be done to support the diagnosis?

A

Brighton Criteria

  • EMG studies - reduced signals
  • LP rasied proteins
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25
What is the management for Guillian Barre syndrome?
IV immunoglobulins Plasma Exchange Supportive care VTE prophylaxis +/- Intubuation / ITU admission
26
What is the prognosis of Guillian Barre syndrome?
80% recover 15% have permenant neurological deficit 5% die
27
What is the investigation of choice into Cervical Spondylosis? and what is the treatment?
\*MRI of Spine * *_Radiculopathy:_** - NSAIDs - Physiotherpay - Spinal Decompression **_Myelopathy:_** - Laminectomy
28
What is the genetic risk factor for developing MS?
HLA DR2
29
What are the types of MS?
Relasping Remitting Secondary Progressive Primary Progressive Progressive Relasping
30
What are some syndromes that may progress into MS?
Optic Neuritis Transvermylitis Clinically Isolated Syndromes Acute Disseminated Encephalomyelitis
31
What is the name of the electric shocks felt across the body related to MS?
Lhermitte's Sign
32
What other things can cause optic neuritis?
DM SLE Sarcoidosis Syphilus
33
What are some core investigatiosn into MS?
MRI T2 - galadonium LP - Oligolonal bands Visual Evoked Potentials - slowed Vitamin D levels
34
What are some differentials to MS?
B12 deficiency Motor Neuron Myelopathy due to Cervical Neuropathy Sarcoidosis
35
How are relaspes treated in MS?
Methylprednisolone
36
What is the mangement for MS?
**_MDT_** - neurologist - MS nurse - physiotherapist - Occupational therapist **_Drugs:_** drugs consist of disease modifying agents and new biologics. _1st line:_ - Interferon Beta - Dimethyl fumerate _2nd Line:_ - Natalizumab _3rd Line:_ - Alemtuzumab * *_Flares:_** - Methylprednisolone
37
What are the causes of coma?
**_Metabolic:_** - drugs, poisoning - Hypoglycaemia - Hypoxia - septicaemia - hepatic encephalopathy (Conn Score) **_Neurological:_** - Trauma - infection - Vascular - Epilepsy
38
What type of CT should be done into a suspected stroke?
Non - contrast CT
39
What is the most commonly survived brainstem stroke and what are the symptoms and which artery is typically involved?
Lateral Medullary Syndrome Facial loss of pain and contralateral loss of pain on body + Nystagmus + Ataxia Right Posterior Inferior Cerebrallar Artery
40
How long following a diagnosis of epilepsy can a person return to driving?
1 year for normal drivers \*6 months for non - epileptic seizure 10 years for public drivers
41
If a person experiences a seizure with Jacksonian movements, where is the likely source of the seizure?
Frontal lobe - focal seizure
42
Which drugs can exacerbate Myasthenia gravis?
Beta Blockers Penicilliamine (Wilson's disease drug) Antibiotics - Gentamcin - Macrolides - quinolones - Tetracyclines Phentyonin
43
What is the immediate management and long term management of cluster headaches?
Subcutaneous Triptans + 100% high flow O2 Prevention: - verapamil
44
Why must levodopa not be stopped acutely?
Can cause neuroleptic malignant syndrome
45
Which hormone may be elevated following a true seizure?
Prolactin
46
Which clinical test can be done to assess for cervical myelopathy?
Hoffman's Test Lhermitte's sign - flexion of neck causes tingling down spine
47
What is the most likely diagnosis following Parkinson's and how does it present?
Progressive Supranuclear Palsy - affects occular nerves and thus these should always be investigated following parkinsons. - Impaired upward gaze - Falls \*always suspect if a person diagnosed with Parkison's falls over shortly afterwards
48
How is Status epilepticus managed?
ABCDE - Take bloods for electrolyte, glucose causes **_1st line:_** - Lorazepam (or diazepam or midazolam buccal) x repeat 3-5 mins \*if evidence of hyoglycaemia - 100ml Glucose 20% \*if evidence of Alcohol Give thiamine * *_2nd Line - within 30mins:_** - Phenytoin **_3rd Line - \>30 mins_** GA Monitor EEG
49
What are the clinical signs of parkinson's disease?
Pill Rolling Tremor Bradykinesia Cog-wheeling Low Blink Rate Drooling Postural Instability Masked Face Shuffling Gait Stooped Posture Conjugate Gaze Disorders (either jerky pursuit or falling short of intended target) Hypophonia (↓volume of speech) Hypokinetic Dysarthria (mumbling)
50
What may a patients family member tell you if they suspect parkinsons?
Change in writing - micrographie Change in walking Difficultly turning unsteady Nightmares
51
What are some differentials to Parkinsons? and what are some risk factors?
Lewy Body dementia Brain tumours Vascular Parkinson's Parkinson's plus syndromes Head Injury
52
What drugs are associatted with developing Parkinson's disease?
Metaclopramide Anti-psychotics
53
54
What are some of the complications following a stroke and their treatments?
**Chest infections** **-Keep NIL by mouth** **-Semi erect** **-NG tube** **Seizures** **- Maintain cerebral oxygenation** **- Avoid metabolic disturbances** **Venous thrombosis** **- Hydration** **- Stocking** **- Enoxaparin** **Pressure sores** **- Frequent turning** **- Avoid urination on skin** **Constipation** **- Diet** **- Movement** **Depression and anxiety** **- CBT** **- Antidepressants**
55
What other important investigations should be done the following day after a stroke?
Second head CT to assess for a rebleed.
56
List some modifiable risk factors for a stroke
Hypertension Smoking Diabetes AF Vavular disease Lipids Alcohol use Cotting abnormalities
57
What are the clinical features of cervivical spondlylosis?
Cervical radiculopathy Cervical Myelopathy Neck pain
58
What is the treatment for cervical myleopathy?
Anterior disectomy Laminectomy
59
What are the secondary drugs given for stroke following the 14 days of aspirin:
Clopidogrel or Aspirin + Dipyridamole These are for life.
60
In the setting of a stroke due to AF, when should anti-coagulation take place?
14 days, following the aspirin
61
What is the defintive best management for a patient who has had a stroke?
Thrombolysis + thromboectomy \*thromboectomy is usually done within 6 hours
62
What is the absolute contraindications to thrombolysis?
Previous Intracranial haemorrhage Seizure at onset of stroke Intracranial neoplasm SAH Stroke in last 3 months LP in last 7 days G.I haemorrhage in last 3 weeks Active bleeding Pregnancy Variceal ulcers Uncontrolled hypertension BP \>200/120mmHg
63
What are the symptoms of myasthenia Gravis?
Ptosis Diplopia Dysphagia Slurred speach Jaw fatigue Weakness of proximal muscles - neck muscles
64
How can you examin someone with MG? - what things can you do to elicit symptoms?
Repeated blinking Upward gazing - diplopia Repeated abduction of one arm - will cause unilateral weakness
65
What are the indications for an endartectomy following a stroke or TIA?
Ischemic stroke within the distruption of the internal carotid \>70% stenosis
66
What scoring system can be used to stratify which patients are at highr isk of having a stroke following a TIA, and should be referred?
ABCD2 \>4 is severe and patients should be admitted and assessed by specialist within 24 hours
67
What does an ischemic stroke appear like on CT?
Low desnity area - black on the scan with surrounding white area owing to oedema
68
What question do you want to ask when someone has collasped/ fainted?
What were the doing before the epidosde? - standing, watching TV Palpatations? Loss of consciouness? How long did the episode last? Any shaking? Injuries? - tongue biting Loss of continecne? Confusion afterwards? - how did they person come about
69
Following a seizure, how long are you band from driving, and how does this change if there is EEG of epilepsy?
Seizure: 6 months Epilepsy: 1 year
70
List several causes to a seizure:
Genetic Alcohol withdrawal Stroke Withdrawal of Benzo's Tumour Fever Head injury Hypoglycaemia and other metabolic abnormalites Infection
71
What is the most useful investgiation to confirm epilepsy and what can be done to increase chance of detecting epileptic activity?
EEG - EEG during sleep - Hyperventilating patient - Photic light stimulation
72
What test should be order into someone with seizures for the first time?
Bloods: - FBC - Coagulation - U&Es - LFTs - Glucose +/- Toxicology +/- Anticonvulsant levels
73
What advice/ intervetions should be offerred to woman who are pregnant and have epilepsy?
To maintain and control seizure activity, as the risk of falling is dangerous to baby. Switch from sodium valporate to a less tetraogenic agent. Offer: - folic acid supplements - Alpha fetal protein screening - 20 week scan for abnormalities
74
If amourosis fagux takes place, which artery has been occluded?
Retinal artery
75
What are some cardiac causes of a stroke?
AF Patent Foramen ovale Infective endocarditis Prosthetic valves - metalic Acute M.I with left venticular wall motion
76
What kind of drug is given alongside LDOPA?
DOPA decarboxylase inhibitor \*remember the DOPA part
77
If patient has a ABCD2 score of \>4, what should happen?
Admitted Seen at TIA clinic with 24 hours and assessment and treatment within 2 weeks. **_Investigatiosn include:_** - Doppler of carotids - ECG - CT angiography of brain
78
What are the cardiovascular causes to a stroke?
AF Patent foramen ovale Prosthetic valves - metalic Infective Endocartitis MI. with large ventricular wall dilation causing thrombous
79
What are the risk factors for Stroke?
Hypertension smoking DM Alcohol Previous TIA AF Family history Sleep apnea
80
What are the differentials to a stroke?
Migraine Seizure Alcohol withdrawal - Wernicke's TIA Tumour Hypoglycaemia
81
In Status epilepticus what immediate investigations should be ordered?
Blood glucose ABG U&Es Ca2+ levels **Consider:** - Anti-convulsant levels - Toxicology - LP - Blood cultures
82
Where is the lesion in RAPD?
Anterior to the optic chiasm
83
What immediate things do you want to give to a patient in status?
Anticonvulsants - Lorazepam IV glucose
84
What are UMN signs?
Spasticity Brisk Reflexes Clonus Hoffman's sign Up going plantars No muscle wasting
85
What is the surgical intervention into Slipepd disc? and what are some of the complications?
Disectomy - CSF leak - Bleeding - Infection
86
What investigations are done into CSF when mengitis is suspected?
WCC White cell differentiation Glucose to plasma Protein Cultures Visual inspection
87
What assessment is used for muscle strength and what are the scores?
**MRC score** 0 - no muscle contraction 1 - muscle contraction but no limb movement 2 - Active movement but not against gravity 3 - active movement against gravity 4 - active movement against some resistance 5 - normal power
88
If a patient has a GCS of \<8 what is one of the immediate things that should be done prior to any imaging?
Anaethetist and Intubation - airway is unsecure at GCS 8
89
How will an old bleed on the brain present? and what is likely bleed?
HYPOdense - Black \*usually a subdural bleed
90
If a person has ataxic gait without limb ataxia where is the lesion likely to be?
Cerebella Vermis
91
What is the wide based gait with loss of heel to toe action called?
Ataxic gait
92
What is the typical type of aura seen in migraines?
Jagged cresecent scotoma
93
What are some common myotomes?
**_Lower Limb:_** S1-S2 button my shoe - ankle flexion L3-L4 kick the door - knee extension **_Upper Limb:_** C5- Arm flexion C6: wrist extension C7: Finger extension C8: Finger flexion T1: finger abduction
94
What is a defining feature of neurofibromatosis type 1?
Freckles in the axillla
95
What are the symptoms of cervical spondylosis?
* *_Radicuopathy:_** - Neck pain - Headaches - Paraesthesia - Dermatomal Pain \*\*loss of dexterity and fine movement control in the hands - Reduced reflexes\*\* **_Myelopathy:_** - loss of dexterity - Painful dermatomal - Spascicity in lower limbs - Gait changes - Autonomic dysfunction \*\*positive hoffman's sign
96
What occular dysfunction won't be seen with a 3rd nerve palsy?
Miosis - this is excessive constriction of pupil. This will not be present
97
List some causes of peripheral neuropathy?
* *_Predominant motor loss:_** - Guillian Barre syndrome - Charcot Marie tooth disease * *_Predominant sensory Loss:_** - Diabetes - Uraemia - B12 - Alcohol
98
What is the pneumonic that can help with the visual field defect seen with temporal or parietal lobe lesions?
PITS Parietal - Inferior quad loss Temporal - Superior quad loss \*\*both will be homologous heminopia
99
What is first line for trigeminal neuralgia?
Carbamezapine
100
Define syncope:
Global cerebral hypoperfusion resulting in loss of conciouness
101
What are some common causes of carpel tunnel syndrome?
Hypothyroidism Pregnancy Rheumatoid disease Polymyalgia rheumatica Amyloidosis
102
What are some differentials to Guillian Barre Syndrome?
MG Botulism Spinal cord compression
103
What investigations should be done into peripheral neuropathy?
**_Bloods:_** - FBC - ESR - U&Es - TFTs - Glucose - B12 - Protein Electrophresis * *_Orifices:_** - electrophresis (Bence Jones) * *_X-rays:_** - CXR * *_Special Test:_** - EMG - Lumbar puncture
104
What are the risk factors for cluster headaches?
Male Smoking Alcohol can trigger
105
What are the differentials for SAH?
Migraine Mengitis Cerebral Venous Sinus Thrombosis Cavernous Sinus Thrombosis
106
What are the clinical findings in SAH?
Kernigs sign - Pain and resistance when knee is extended when hip is flexed Meningisim Terson's sign Diffuse T wave inversion Lowered GCS / Coma Photophobia Irritated
107
What is the grading system used for the radiological findings of SAH?
Fisher's grading
108
As soon as a bleed is confirmed via CT, what investigation next investigation should be done into SAH?
CT angiogram - to confrim the cause (berry aneurysm/ AVM) - to allow for thearaputic intervention
109
What is the management of SAH?
**_Surgerical:_** Neurosurgery Coil to plug the Aneurysm Clipping **_Medical:_** Bed rest - avoid straining Fluid resuscitation Nimodipine - avoid intracerebral vasospasm VTE Controlled blood pressure Analgesia +/- Ventricular stent - off load hydrocephalus
110
What are the different types of MND?
ALS - UMN - LMN Progressive bulblar Pasly - Cranials IX- XII Progressive muscle atrophy - LMN Primary Lateral Sclerosis - UMN
111
What is the diagnostic criteria for MND?
Revised El Escorial Diagnostic criteria - UMN signs + LMN in \>3 regions \*\*less than this is probable
112
What investigations do you want to do into peripheral neuropathy?
**_Bloods:_** - FBC - Glucose - U&Es - B12 - Electrophresis - ANCA - ANA Orfices: - Urine electrophresis - Glucose **_Special Tests:_** - EMG * *_Consider looking for specifcs:_** - Lead - Antiganglioside antibodies
113
What are some of the causes of Carpel tunnel syndrome?
Myoxoedma - Hypothyroidism Acromegaly Pregnancy Sarcoidosis Excessive dialysis RA Polymyalgia Rheumatica
114
What two examination tests can be done into carpel tunnel syndrome?
Phalen's test Tinnel's test
115
Which muscles are implicated in Carpel tunnel syndrome?
Lumbricals Oppensens policis Abductor Pollicis Brevis Flexor Pollicis Brevis LOAF

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