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Neurology Flashcards

1
Q

Difference between simple partial and complex partial seizure

A

Simple: awareness unimpaired
Complex: awareness impaired and post ictal confusion

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2
Q

Tonic clonic vs myoclonic seizures

A

Tonic clonic: limbs stiffen and jerk

Myoclonic: limbs just jerk

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3
Q

Causes of seziures

A 
2/3rd idiopathic
Space occupying lesion/stroke
Trauma/haemorrhage/increased ICP
Fever
Infection
Drugs
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4
Q

Things to ask in seizure history

A 
Length of time/tongue biting/incontinence
Prodrome
Post ictal changes
Triggers
Previous seizures or first one?
Family history
Drug use
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5
Q

Differential diagnosis for transient loss of consciousness

A

Vasovagal syncope
Orthostatic
Cardiac abnormality/arrhythmia
Hypoglycaemia

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6
Q

Investigations for seizures

A 
FBC, glucose, Ca, electrolytes, Creatinine, LFTs
Urine toxocology screen
CXR
Consider LP
CT head
EEG/MRI in certain patients
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7
Q

Non pharmacological management of seizures

A 
Avoid triggers
Avoid driving for 1 year seizure free
Avoid swimming, heights, heavy machinery
Refer to first seizure clinic
Epilepsy nurse specialist
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8
Q

Pharmacological management of seizures

A

Usually commenced by neurologist after 2nd seziure
Generalised: sodium valproate, lamotrigine
Partial: carbamazepine, levertiracetam
Pregnant or breastfeeding: Lamotrigine
Neurosurgical resection if clear epileptogenic focus

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9
Q

Distinguishing features of motor neurone disease

A

No sensory loss
Upper and lower motor neurons affected
Eye movements never affected

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10
Q

Name the 4 types of motor neurone disease

A

Amyotrophic lateral sclerosis: most common, upper and lower motor neuron signs, bladder spared
Progressive bulbar palsy: only affects cranial nerves 9-12
can be bulbar or corticobulbar
Progressive muscular atrophy: only LMN signs
Primary lateral sclerosis: Predominately UMN signs and no cognitive decline

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11
Q

Differentials for motor neuron disease

A 
Peripheral neuropathy
Myopathies
Post polio syndrome
Myasthenia gravis
Brain or spinal cord lesion
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12
Q

Investigations for motor neuron disease

A

MRI

Nerve conduction studies

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13
Q

Management of MND

A 
Poor prognosis-multi disciplinary approach
Antiglutamatergic drugs (riluzole)
Amitriptylline for drooling
Consider NG/PEG
Baclofen/diazepam for spasticity
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14
Q

Pathogenesis of MS

A

Plaques of demylination caused by a T cell mediated immune response
Primarily clinical diagnosis but can use MRI and oligonal bands on LP

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15
Q

Presentation of MS

A

Solo Neurological deficit which comes then goes, eg. weakness in a leg, optic neuritis, ataxia, parasthesia
Family history of MS

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16
Q

What are you looking for on examination for MS

A 
Spastic paraparesis
Sensory loss
Nystagmus
Impaired co-ordination
Ataxic gait
Failure of rhomburg test
Ophthalmoplegia
Decreased visual acuity
Lhermitte's sign
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17
Q

Investigations for MS

A

MRI
Evoked response testing of nerves
CSF (oligoclonal IgG bands on electrophoresis)

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18
Q

Management of MS

A

Symptomatic management
Interferons decrease relapse frequency
Steroids in acute relapses
Methotrexate and aziothioprine can be trialled

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19
Q

Pathogenesis of Myasthenia gravis

A

Autoimmune disease against acetylcholine receptors on post synaptic membranes which inhibits muscle contraction

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20
Q

Presentation to ask about with myasthenia gravis

A

Drooping eyelids
Difficulty chewing/swallowing
Proximal muscle weakness
Ask about other autoimmune diseases

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21
Q

Things to check on examination for myasthenia gravis

A 
Ptosis
peek sign
Sustained upward gaze
Thymectomy scar
Weakness of neck flexion
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22
Q

Investigations for myasthenia gravis

A

Acetylcholine esterase antibodies
Electromyogram
Thymoma investigation (cxr or thoracic CT)
Respiratory function tests

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23
Q

Management of myasthenia gravis

A

Pyrodostigmine (causes increased drooling and crying)
Sudden worsening respiratory symptoms can be life threatening
Relapses treated with prednisone-often needed long term so give osteoporosis prophylaxis
If steroids fail give immunosuppresion with methotrexate or azathioprine
Thymectomy

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24
Q

Key signs of parkinson’s

A

Tremor
Rigidity
Akinesia/bradykinesia
Postural instability

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25
Pathogenesis of parkinson's
Depletion of dopaminergic cells in pars compacta in substantia nigra
26
Name some prodromal premotor symptoms of parkinson's
``` Anosmia Depression Insomnia Autonomic effects Dribbling ```
27
Extra tests for parkinson's on examination
``` Glabellar tap Occular movements Lying and standing BP Undo buttons write name ```
28
What are the parkinson's plus syndromes
Progressive supranuclear palsy: early postural instability and vertical gaze palsy Multisystem atrophy: Cerebellar signs Lewy body dementia: hallucinations Cortico-basal degeneration: akinetic rigidity affecting one limb
29
Which drugs can induce parkinsonism
Haloperidol and lithium | Wilson's disease
30
Investigations for parkinsonism
MRI to exclude brain lesion | Levodopa challenge
31
Management of parkinsonism
Multidiscip Levodopa (can cause pychosis) Dopamine agonists (ropinerole) Anticholinergics help with tremor (but cause confusion, dry mouth and urinary retention) Deep brain stimulation Surgical ablation of overactive basal ganglia
32
What causes a TIA?
Atherothromboembolism Cardioembolism Hyperviscosity
33
Investigations for TIA
``` FBC, ESR, U+E's, glucose, lipids CXR Carotid ultrasound CT ?Echo ECG ```
34
How do we calculate stroke risk score after TIA?
``` ABCD2 Age >60 Blood pressure >140/90 Clinical features (unilateral weakness/speech disturbance) Duration of symptoms >1 hour Diabetes ```
35
Management of TIA
Avoid driving for a month Diet and exercise Control CV risk factors Aspirin 300mg daily and clopidogrel 75mg daily Consider carotid endarterectomy if >70% stenosed
36
How do the causes differ for the two types of stroke?
Ischaemic: artherosclerosis and thromboemboli Haemorrhagic: hypertension, berry aneurysm, av malformation
37
Exam findings in a stroke caused by internal carotid artery
Hemiparesis on opposite side of the body and homonymous hemianopia Dysphasia
38
Exam findings in a stroke caused by anterior cerebral artery
Hemiparesis in legs sensory loss in legs change in personality/mood/behaviour
39
Exam findings in a stroke caused by middle cerebral artery
Weakness on opposite side of the lower face and arms, can have aphasia
40
Exam findings in a stroke caused by posterior cerebral artery
Homonymous hemianopia problems with spatial skills and recognition problems with memory and mood
41
Exam findings in a stroke caused by midbrain
cranial nerve 3 and 4 deficits on SAME SIDE plus weakness and sensory loss on opposite side
42
Exam findings in a stroke caused by medulla
cranial nerve 5 and 6 deficits on SAME SIDE plus weakness and sensory loss on opposite side
43
Exam findings in a stroke caused by cerebellum
``` DASHING Dysdiadochokinesia Ataxia Slurred speech Hypotonia Intention tremor Nystagmus Gait abnormality ```
44
Investigations for stroke
``` FBC, electrolytes, creatinine, glucose, lipids, coag screen Blood cultures if febrile ECG ?AF CT Carotid USS Echo if young and ?cause ```
45
Management of acute ischemic stroke on discharge
``` Protect airway- exclude haemorrhagic stroke Give IV alteplase if within 4.5 hours Clopidogrel 75mg Consider heparin DVT prophylaxis Driving restriction Statins Consider carotid endartectomy ```
46
Management of acute haemorrhagic stroke
Stop antithrombotics Reverse anticoagulation Neurosurgical referral
47
What are some key causes of polyneuropathy
``` Diabetes Renal failure Low B12 and B1 Isoniazid/phenytoin Guillan barre syndrome HIV/Syphilis ```
48
key things to ask in polyneuropathy history
``` Time course Preceding events Travel Drugs Sexual infections Family history ```
49
How to differentiate between sensory, motor and autonomic neuropathy
Sensory: numbness, burning, tingling, glove and stocking Motor: progressive, weakness, wasting, reduced reflexes Autonomic: ED, decreased sweating, urinary retention, homes adie pupil (dilated and unresponsive to light)
50
Investigations for polyneuropathy
``` FBC, ESR, glucose, TSH, b12/folate, ANA, ANCA CXR Consider LP Urinalysis Nerve conduction studies ```
51
management of polyneuropathy
Treat underlying cause foot care Amitryptilline/gabapentin for neuropathic pain
52
Guillan barre syndrome pathogenesis
Acute inflammatory demyelinating polyneuropathy, often caused by campylobacter or EBV Symptoms progress for 4 weeks then resolve
53
Presentation of Guillan barre symptoms
``` Progressive muscle weakness over days Areflexia Pain Speech Facial droop Autonomic dysfunction ```
54
Investigations for guillan barre
``` Nerve conduction studies LP Bloods (check campylobacter serology) Spirometry MRI spinal cord ```
55
Diagnostic criteria for guillan barre
Progressive muscle weakness in limbs Areflexia Progressive sensory change over 2-4 weeks
56
Treatment for guillan barre
``` IV IG Plasma exchange Ventilate if severe respiratory involvement DVT prophylaxis Monitor vitals Follow every 4-6 weeks for 6 months ```
57
Prognosis/complications for guillan barre
85% good recovery but 20% mortality if ventilated | Can have respiratory failure, Ileus and bladder issues
58
What are the three most common muscular dystrophies?
Duchenne's muscular dystrophy Fascioscapulo humeral muscular dystophy Becker's muscular dystrophy
59
What is the most common myotonic disorder?
``` Dystrophia myotonica Distal onset weakness facial weakness/wasting Diabetes Male frontal baldness Most patients die in middle age ```
60
Work up of code stroke
``` ?symptoms worst at onset ?sudden onset How long since last seen well ?anticoagulants ?malignancy ?pregnancy ?prior stroke ?haemorrhage Take BP and determine NIHSS CT head CT angiography CT perfusion ```

Long Case (11 decks)

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