Neurology Flashcards
(88 cards)
1
Q
Two facts about OCCIPITAL AREA
A
- Responsible for Vision
- Contains Primary Vision Cortex
2
Q
Parietal Lobe
A
- Responsible for SENSATION of the opposite side of the body
- Responsible for SPATIAL AWARENESS
SOMATOSENSORY CORTEX-
- Located in ANTERIOR CORTEX
- Processes PAIN, PRESSURE and TOUCH
3
Q
Frontal Lobe
A
- Responsible for MOTOR control of the opposite side of the body
- Controls EMOTIONS and INSIGHT
- DOMINANT HEMISPHERE responsible for speech output (BROCA’s AREA)
4
Q
Where is the Broca’s Area located?
A
FRONTAL LOBE- superior to the LATERAL FISSURE
5
Q
Primary motor cortex location and function
A
Location- Posterior part of FRONTAL LOBE
Function- plans and executes MOTION
6
Q
Temporal Lobe
A
- Responsible for MEMORY and EMOTION
- DOMINANT HEMISPHERE responsible for COMPREHENSION of speech (WERNICKE’s AREA)
7
Q
Where is the Wernicke’s Area located?
A
TEMPROAL LOBE- posterior to SUPERIOR TEMPORAL GYRUS
8
Q
Primary auditory complex location and function
A
Location- BILATERALLY within TEMPORAL LOBE
9
Q
3 parts of CEREBELLUM
A
PAELAEOCEREBELLUM- maintains gait
NEOCEREBELLUM- maintains postural tone and is responsible for coordination of FINE MOTOR SKILLS
ARCHICEREBELLUM- maintains balance
10
Q
BASAL GANGLIA 4 deep nuclei
A
Putamen and Globus Pallidus (together they form LENTIFORM NUCLEUS)
Caudate nucleus
Substantia nigra
Subthalamic nucleus
11
Q
The 12 cranial nerves
A
1- Olfactory
2- Optic
3- Oculomotor
4- Trochlear
5- Trigeminal
6- Abducens
7- Facial
8- Vestibulocohlear
9- Glossopharangeal
10- Vagus
11- Accessory
12- Hypoglosseal
12
Q
Function and Lesion of OLFACTORY (1) NERVE
A
Function- Sense of smell
Lesion- ANOSMIA (loss of smell)
13
Q
Function and Lesion of OPTIC (2) NERVE
A
Function- Sight
Lesion- Different visual field losses- BASED ON LOCATION OF LESION
14
Q
Function and Lesion of OCULOMOTOR (3) NERVE
4 innervations
A
Function-
- Innervates SUPERIOR, MEDIAL and INFERIOR RECTUS muscles
- Innervates LEVATOR PALPEBRAE SUPERIORIS
- Innervates INFERIOR OBLIQUE
- INNERVATES SPHINCTER PUPILLAE
Lesion-
- Eye movements DOWN and OUT (as superior oblique and lateral rectus would pull when the others fail)
- PTOSIS- DROOPING EYELID
- MYDRIASIS- DILATED PUPIL
15
Q
Function and Lesion of TROCHLEAR (4) NERVE
A
Function- Innervates SUPERIOR OBLIQUE
Lesion-
- DIPLOPIA
- Eyes move DOWN and IN
16
Q
Function and Lesion of TRIGEMINAL (5) NERVE
A
Function- Sensation of the face and innervation of the muscles of MASTICATION
(test corneal reflex)
Lesion-
- DECREASED facial sensation
- JAW WEAKNESS
17
Q
Function and Lesion of ABDUCENS (6) NERVE
A
Function- Innervation of LATERAL RECTUS
Lesion-
- Eyes deviate MEDIALLY
18
Q
Functions of FACIAL (7) NERVE
7 things
A
Innervates-
- Muscles of FACIAL EXPRESSION
- STEPDIUS
- Posterior belly of DIGASTRIC MUSCLE
- STYLOHYOID
- ANTERIOR 2/3 of TONGUE (taste)
- LACRIMAL GLANDS
- SALIVARY GLANDS
19
Q
Lesions of FACIAL (7) NERVE
A
UPPER MOTOR NEURONE-
- Asymmetry of LOWER FACE with forehead sparing
LOWER MOTOR NEURONE-
- Asymmetry of UPPER and LOWER FACE
- LOSS of taste
- Eye irritation due to DECREASED LACRIMATION
20
Q
Function and Lesion of VESTIBULOCOCHLEAR (8) NERVE
A
Function- Sense of SOUND and BALANCE
Lesion- DEAFNESS and VERTIGO
21
Q
Function and Lesion of GLOSSOPHARYNGEAL (9) NERVE
A
Function-
- Posterior 1/3 of tongue (taste)
- Innervates PAROTID GLANDS
- STYLOPHARYNGEUS
LESION-
- Decreased GAG REFLEX
- Uvular deviation away from lesion
22
Q
Function and Lesion of VAGUS (10) NERVE
A
Function- Innervates-
- LARYNGEAL and PHARYNGEAL muscles (NOT STYLOPHARYNGEUS)
- Parasympathetic supply to THORACIC and ABDOMINAL VISCERA
Lesion-
- DYSPHAGIA
- RECURRENT LARYNGEAL NERVE PALSIES (loss of voice/ hoarse voice)
- PSEUDOBULBAR PALSIES (inability to control muscles i face)
23
Q
Function and Lesion of ACCESSORY (11) NERVE
A
Function- Innervates-
- TRAPEZIUS
- STERNOCLEIDOMASTOID
Lesion-
- Patient can NOT SHRUG
- Patient displays weak hand movement
24
Q
Function and Lesion of HYPOGLOSSAL (12) NERVE
A
Function- Innervates-
- MUSCLES of the TONGUE (apart from PALATOGLOSSEAL (supplied by VAGUS))
Lesion-
- Tongue deviates TOWARDS the side of weakness during protrusion
25
Dorsal column (Fasciculus gracilis and Fasciculus cuneatus) responsible for-
Proprioception
Fine touch
26
DORSAL and VENTRAL SPINOCEREBELLAR TRACT (Ascendinf tracts) responsible for
Posture
Coordination
27
SPINOTHALMIC TRACT (Ascending tract)responsible for
PAIN
PRESSURE
Non-discriminative touch
28
Lateral Corticospinal and Ventral Corticospinal Tract (Descending Tracts) responsible for
VOLUNTARY skilled movements at DISTAL part of the LIMBS
Lateral (80%) and Ventral (20%)
29
Rubrospinal (Descending Pathway) function
Control of LIMB FLEXOR muscles
30
Medullary Reticulospinal (Descending) Tract responsible-
REFLEXES
Control of BREATHING
Control of ALPHA and GAMMA NEURONES
31
Lateral Vestibulospinal (Descending) Tract responsible for-
Extensor muscle tone posture
32
Tectospinal (Descending) Tract responsible for-
Reflective movements of HEAD
| - In response to VISUAL/ AUDITORY stimuli
33
Signs and symptoms of STROKE
FAST
Face- unilateral drooping
Arms- may be weak and numb- patient may be unable to lift them
Speech- Slurring of speech
Time- Time to call 999
Patients may describe AMAUROSIS FUGAX (curtains descending)
TIA- symptoms<24h
34
Causes of STROKE
CR CASE
Haemorrhagic causes-
- CNS bleeds from trauma
- Ruptured aneurysm
Ischaemic causes-
- Cardiac emboli
- Atherothromboembolism
- Small vessel occlusion
- Emboli secondary to ATRIAL FIBRILLATION
35
Risk factors for STROKE
- ---> Cocaine
- --> Oral contraceptive pill
- Diabetes
- ---> ATRIAL FIBRILLATION
+ classic risk factors for clotting
36
Investigations in STROKE
Bloods-
- ---> PTT
- + other classic blood tests
Other-
- ----> ECG for ATRIAL FIBRILLATION
- ECHO for structural abnormalities
----> CT IF INDICATION OF STROKE- differentiate between HAEMORRHAGIC and ISCHAEMIC strokes as DIFFERENT TREATMENTS
37
Assessing risk of STROKE in TIA patients
ABCD2
- 1 point for each >6 is high risk, <4 is low risk
Age>60
Blood pressure>140/90
---> Clinical features- unilateral weakness (2 points), isolated speech disturbances (1 point)
Duration of symptoms- >60 min (2 points), 10-59 mins (1 point)
Diabetes (1 point)
38
Treatment for TIA patients
ASPIRIN
39
Treatment for Ischaemic stroke patients WITHOUT haemorrhage
Thrombolysis with ALTEPLASE within 3 hours
Start ASPIRIN unless contraindicated
40
Treatment for HAEMORRHAGIC STROKE patients
PROTHROMBIN COMPLEX CONCENTRATE
INTRAVENOUS VITAMIN K
41
Surgical treatment for stroke
ACUTE intracerebral haemorrhage
Decompressive HEMICRANIECTOMY
42
Complications of STROKE
- Hydrocephalus
- APHASIA (impairment of language)
- DYSPHAGIA
- Decreased muscle movement
- Amnesia
- DEPRESSION
43
9 Risk factors of Alzheimer's
- Down's Syndrome due to HIGH APP gene load
- Familial gene associations
- APP
- Presenilin 1
- Presenilin 2
- Apoliopoprotein E4 (ApoE4)
- HYPOTHYROIDISM
- Previous head trauma
- Family history of Alzheimer's
44
The 5A's of Alzheimer's
Amnesia
Aphasia (language impairment)
---> Apraxia (inability to perform learned movements on command)
Agnosia (inability to recognise things)
Lexical ANOMIA (unable to provide NAMES of object)
45
INVESTIGATIONS in ALZHEIMER's and VASCULAR DEMENTIA
And 3 ALZHEIMER SPECIFIC tests
MSE
Addenbrooke's Cognition Examination (ACE-III)
Bloods:
- Normal ones
- Calcium
- Magnesium
- Phosphate
VDRL (test for syphilis)
HIV Serology
B12 and Folate
LUMBAR PUNCTURE
CT
Blood culture
ECG
ALZHEIMER's TESTS (BAT)
- Beta Amyloid Plaques
- Acetylcholine LOW
- Neurofibrillary TRIANGLES
46
The 3 Treatments for ALZHEIMER's
MEMANTINE- inhibits GLUTAMATE by BLOCKING NMDA receptors
DONEPAZIL- ACETYLCHOLINESTERASE inhibitor
RIVASTAGMINE-- ACETYLCHOLINESTERASE inhibitor
47
Complications of ALZHEIMER's
Dysphagia
Increased risk of falls
Urinary incontinence
Amnesia
48
Causes of VASCULAR DEMENTIA
Infarcts of small and medium sized vessels
Gene association with CADASIL
CADASIL= Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy
49
Signs of Vascular Dementia
Signs of UPPER MOTOR NEURONE LESIONS- BRISK REFLEXES
Disorientation
Seizures
Changes in personality
50
3 Types of VASCULAR DEMENTIA
Vascular Dementia- following stroke
Multi-infarct Dementia- following multiple strokes
---> Binswanger Disease- following microvascular infarcts
51
Treatment of VASCULAR DEMENTIA
Treat Diabetes and Hypertension
ASPIRIN
52
Complications of Vascular Dementia
Cardiovascular and Renal Disease
53
Dementia with LEWY BODIES causes
Associated with PARKINSON's DISEASE
- so avoid ANTIPSYCHOTICS
54
3 symptoms of Dementia with LEWY BODIES
Parkinsonism (bradykinesia and gait disorder)
Hallucinations (visual predominantly- usually of ANIMALS and PEOPLE)
Disease process following a fluctuating course
55
Investigations in LEWY BODY DEMENTIA
MSE
ACE-III
ApoE (like Alzheimer's)
Lewy bodies
--> UBIQUITIN proteins and ALPHA SYNUCLEIN found on histology
56
Treatment for Dementia with LEWY BODIES
AVOID ANTIPSYCHOTICS
Levodopa- may be used to treat Parkinson's but WORSENS psychotic symptoms
57
Causes of FRONTOTEMPORAL DEMENTIA (Pick's disease)
Association with Chromosome 17 and TAU 3 gene
58
Symptoms of Frontotemporal Dementia
MUTISM- inability to speak
ECHOLALIA- pointless repetition of another person's words
OVEREATING
Parkinsonism
59
Investigations in Frontotemporal Dementia
and 3 SUBTYPES
MSE
ACE-III
Histology depends on SUBTYPE-
- Microvacuolar Type- MICROVACUOLATION
- Pick Type- NO MICROVACUOLATION and GLIOSIS
- Motor Neurone Disease
60
Treatment for Frontotemporal Dementia
Currently none, only SUPPORTIVE
61
Causes of Huntington's Dementia
Complication of Huntington's Disease
| - Causes abnormal CHOREIFORM (Jerky/ Involuntary movements) and DEMENTIA
62
Symptoms of Huntington's Dementia
Uncontrollable CHOREIFORM movements
----->Obsessive compulsive behaviour
63
Treatment of Huntington's Dementia
For CHOREA- an ATYPICAL ANTIPSYCHOTIC AGENT
For Obsessive Compulsive Thoughts and Irritability- SSRIs
64
Dysphagia is a complication of which two Dementias?
(as well as STROKE)
and which nerve lesion causes this?
Alzheimer's and Huntington's
VAGUS LESION
65
Causes of Creutzfeldt-Jakob Disease (CJD)
PRIONS (misfolded proteins that transfer their shape on to normal proteins)
66
Symptoms of CJD
Ataxia (lack of muscle control/ voluntary control)
67
Investigations in CJD
EEG- TRIPHASIC SPIKES SEEN
LUMBAR PUNCTURE for 14-3-3 protein
68
Complications of CJD
Increased risk of infection
Coma
Heart and Resp failure
69
OTHER CAUSES of DEMENTIA
HIV
---> B12 deficiency
---> Wilson's Disease
Syphilis
Dementia Pugilistica (seen in boxers and people who have suffered multiple concussions)
70
Partial Epileptic Seizure
Seizures that occur in ONE DISCRETE PART of the brain
Simple- no change in consciousness
Complex- alteration in consciousness
71
Generalised Epileptic Seizure
The FIVE TYPES
Affect the brain GLOBALLY, consciousness in ALWAYS ALTERED
-ABSENCE SEIZURES- usually children- 'stare into space'- lasts SECONDS
---> TONIC-CLONIC SEIZURES- convulsions and muscle rigidity- lasts MINUTES
- ATONIC SEIZURES- involves loss of muscle tone
- MYOTONIC- involves jerky muscle movements
- SECONDARY GENERALISED- this is a generalised seizure that originates from a PARTIAL SEIZURE
72
Causes of Epileptic Seizures
VINDICATE
- Vascular- history of STROKE
- ---> Infection- history of MENIGITIS or MALARIA
- Neoplasms- BRAIN TUMOR
- Drugs- Alcohol and drug use
- Iatrogenic- DRUG WITHDRAWAL
- Congenital- Family History
- Autoimmune- VASCULITIS
- Trauma- brain damage
- ---> Endocrine (LOW Na/ Ca/ Glucose or HIGH Glucose)
73
Signs and symptoms of Frontal Lobe Epileptic Seizure
JAM
- JACKSONIAN march (type of simple partial seizure)
- pAlsy (postical TODD's PALSY)
- Motor features
74
Signs and symptoms of Temporal Lobe Epileptic Seizure
ADD FAT
- Aura that the epileptic attack will occur
- Deja vu
- Delusional behaviour
- Fear/ panic (HIPPOCAMPAL involvement)
- Automatisms (actions without thought or consequences)
- Taste/ smell (UNCAL involvement)
75
Signs and Symptoms of Parietal and Occipital Lobe Epileptic Seizure
VISUAL and SENSORY DISTURBANCES (as parietal associated with sensation and occipital associated with vision)
76
Investigations in Epileptic Seizures
LUMBAR PUNCTURE
---> Glucose and Calcium levels (cos low amounts can cause epilepsy, and high amount of glucose and low amounts of sodium also)
77
Treatment for Epileptic Seizures
- Inform DVLA
- Anticonvulsant therapy
Surgery-
- Anterior temporal lobe resection
- Corpus CALLOSOTOMY
- Tumor removal
78
Risk factors of Parkinson's Disease
Male
Genetic component
Exposure to insecticides/ pesticides/ herbicides
79
Pathophysiology of Parkinson's
- LOW DOPAMINE producing cells in PARS COMPACTA of SUBSTANTIA NIGRA in MIDBRAIN
- Dopamine produced is secreted to PUTAMEN and CAUDATE NUCLEUS
- HIGH Lewy Bodies in SUBSTANTIA NIGRA
80
Signs and Symptoms of Parkinson's
Facial TRAPS
```
Facial- expressionless face
Tremor- pill-rolling tremor
Rigidity- cog wheel rigidity
---> Akinesia- loss or impairment of VOLUNTARY movement
---> Posture (stooped)
---> Shuffling gait
```
81
Investigations in Parkinson's
ioflupane DATSCAN- measure BASAL GANGLIA dopaminergic function
82
Treatment of Parkinson's
LEVODOPA- crosses BBB and is converted to dopamine
CARBIDOPA- given with LEVODOPA to prevent peripheral effects of LEVODOPA
SELEGILINE- inhibits MAO B (which usually breaks down DOPAMINE)
AMANTIDINE- dopamine agonist- DECEASES PARKINSONIAN SYMPTOMS
83
Risk Factors of MULTIPLE SCLEROSIS
- ---> Viruses- like EBV
- Smoking
- --> People who live FURTHER away from the equator
- Type 4 T cell mediated immune response
84
Pathophysiology of Multiple Sclerosis
Plaques of DEMYELINATION, disseminated in time and space, interfere with neuronal transmission
Often patients enter remission and relapse as demyelinated neurones do not heal fully
85
Signs and Symptoms of Multiple Sclerosis
DOTS
- Diplopia, DYSAETHESIA (an abnormal unpleasant sensation felt when touched)
- OPTIC NEURITIS- often presenting symptom- patients present with DIPLOPIA
- TRIGEMINAL NEURALGIA, Trunk and limb ATAXIA
- SENSATION of VIBRATION decreased
Symptoms worse in HOT CONDITIONS
86
Investigations in Multiple Sclerosis
LUMBAR PUNCTURE- some proteins are altered- like OLIGOCLONAL BANDS
MRI- shows regions affected by inflammation and scarring
87
Treatment of Multiple Sclerosis
6 medicines
McDonald DIAGNOSTIC CRITERIA
Medical-
- Methylprednisolone- corticosteroid
- Glatiramer acetate- immunomodulator
- Natalizumab- monoclonal antibody
- Alemtuzumab- monoclonal antibody
- Azathioprine- purine analogue (immunosuppressant)
- Mitoxantrone (doxorubicin analogue)
88
Complications of Multiple Sclerosis
URINARY and BOWEL INCONTINENCE
Depression
EPILEPSY
Paralysis
