Neurology Flashcards
(95 cards)
1
Q
Name 5 causes of cerebellar lesions
A
VITAMIN C Vascular Inflammatory - MS Trauma Alcohol Metabolic Iatrogenic - Phenytoin and carbamazepine Neoplastic Congenital - Friedrichs ataxia
2
Q
What is Fredrich’s ataxia
A
AR trinucleotide repeat disorder
GAA - chromosome 9
3
Q
Name 3 presentations of Fredrich’s ataxia
A
kyphoscoliosis Spinocerebellar tract degeneration HOCM DM Cerebellar ataxia optic atrophy High arched palette
4
Q
How does a lesion of the cerebellar vermis present
A
Truncal ataxia
gait instability
5
Q
How does a lesion of cerebellar hemisphere present
A
Ipsilateral limb signs
6
Q
Name 5 risk factors for an ischaemic stroke
A
Male FHx of stroke - < 60 Old age smoking AF Hypercholesterolaemia DM Alcohol
7
Q
Name 4 causes of ischaemic stroke
A
Cardiac emboli - AF / IE
Atherothromboembolism - Carotid artery
Systemic hypoperfusion - cardiac arrest
8
Q
Describe the investigations in an acute suspected stroke
A
1st line - CT scan
Others
- MRI with DWI
- Carotid artery USS
- Echo
- ECG +/- 72 hr tape
- Bloods
9
Q
Describe the management of acute stroke <4.5 hours
A
< 4.5 hours
IV Alteplase
repeat CT 24 hrs after
300 mg Aspirin
10
Q
Describe the management of acute stroke > 4.5 hrs
A
> 4.5 hrs 300mg Aspirin (2 weeks) 75 mg Clopidogrel (lifelong)
11
Q
When is mechanical thrombectomy offered
A
Patient with Anterior circulation stroke within 6hrs
12
Q
Name 4 CI to IV alteplase in stroke
A
Haemorrhagic stroke Unstable BP INR - High Recent head trauma GI bleed Recent surgery Platelet count
13
Q
Describe secondary prevention for strokes
A
HALTSS
HTN - Anti-hypertensives
Antiplatelet - Clopidogrel 75mg
Lipids - Atorvastatin
Tobacco - smoking cessation
Sugar - DM screen
Surgery - >50% Ipsilateral carotid artery stenosis –> carotid endarterectomy
14
Q
How should a patient diagnosed with AF following a stroke be treated differently in secondary prevention
A
HALTSS - A is different
Initiate Warfarin or DOAC 2 weeks post stroke
15
Q
STROKE PRESENTATION
TACI
A
ACA + MCA
ALL 3 REQUIRED
contralateral weakness +/- sensory deficits of face / arm / legs \+ contralateral homonymous hemianopia \+ Higher cerebral dysfunction - aphasia - neglect
16
Q
STROKE PRESENTATION
PACI
A
ACA OR MCA
2 REQUIRED
contralateral weakness +/- sensory deficits of face / arm / legs
+
contralateral homonymous hemianopia
OR - This alone
Higher cerebral dysfunction alone
17
Q
STROKE PRESENTATION
Lacunar stroke
A
Pure: - motor - sensory - sensorimotor OR Ataxic hemiparesis
18
Q
STROKE PRESENTATION
Posterior circulation infarct
A
Cerebellar dysfunction OR Conjugate eye movement disorder OR Bilateral motor/sensory deficit OR Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit OR Cortical blindness/isolated hemianopia.
19
Q
What are the rules following a stroke and driving
A
No driving for 1 month
Don’t have to inform DVLA
20
Q
HAEMORRHAGIC STROKE
Name 4 risk factors
A
older age FHx Malignancy Anti-coagulants cocaine Haemophilia vasculitis
21
Q
HAEMORRHAGIC STROKE
Name 3 causes of a haemorrhagic stroke
A
ruptured cerebral artery
trauma
AV malformation
reperfusion injury - ischaemic stroke
22
Q
HAEMORRHAGIC STROKE
Describe the management
A
conservative
- BP
- lifestyle advice
Medical
- Stop anti-coag and anti-platelet
- Factor 7 concentrate
- Antihypertensive (Beta blocker / CCB)
- Nimodipine (vasospasm)
Surgical
- Clipping
- Coiling
23
Q
HAEMORRHAGIC STROKE
Name the reversal agents for
- warfarin
- heparin
- LMWH
- Apixaban
A
warfarin
- Beri plex
- vitamin K
Heparin
- protamine
LMWH
- Protamine
Apixaban
- Beri plex
24
Q
Describe the ABCD2 risk score
A
A > 60
B - BP >140/80
Clinical features
Unilateral weakness(2)
speech impairment without weakness (1)
Duration
> 60 mins (2)
<59 mins (1)
D - Diabetes (1)
25
Describe how raised ICP presents
```
Headache - worse on lying down/bending/coughing
papilledema
seizures
reduced consciousness - GCS
N+V - relieves headache
Cushigs triad
```
26
What is Cushing's triad and what presentation is it commonly found in
Raised ICP
Raised BP
Reduced HR
Irregular breathing
27
Name 2 causes of raised ICP
Meningitis
haemorrhages
SOL
Hydrocephalus
28
What is the management of raised ICP
Bed rest and head elevation
IV mannitol
29
Name 4 risk factors for SAH
```
Family hx
previous aneurysmal SAH
Smoking
alcohol
PCKD
Increased BP
```
30
Name 4 causes of a SAH
Aneurysmal
- ADPCK
- Rupture of berry aneurysm
- atherosclerosis
- HTN
Non aneurysmal
- Trauma
- AVM
- Coagulopathies
31
How does a SAH present
```
Thunderclap headache
N+V
Reduced GCS
Double vision
Meningism - photophobia / neck stiffness / pain on flexion
Seizure
Kernig's sign
3rd CN palsy - PCA aneurysm
```
32
Describe the investigations for a SAH
Non contrast CT head
Serial LP - If CT -ve but clinical signs present
- 12 hrs post sx onset
- Xanthochromia
33
Name 4 SAH complications
```
re-bleeding
hydrocephalus
Vasospasm
Hyponatraemia
seizures
```
34
What is the management of a SAH
ABCDE
Analgesia and anti-emetics
Nimodipine
Clipping / coiling
35
Describe the flow of CSF
```
Lateral ventricles
Foramen of monro
3rd ventricle
cerebral aqueduct
4th ventricle
- central spinal canal
- SA cisterns
```
36
GCS
Describe the scoring system for eye opening
Spontaneous - 4
To sound - 3
To pain - 2
No response - 1
Not testable
37
GCS
Describe the scoring system for verbal response
Can you tell me your name
Do you know where you are
Do you know the date today
Orientated response - 5
confused conversation- 4
Inappropriate / random words - 3
Incomprehensible - 2
No response - 1
38
GCS
Describe the scoring system for motor response
Obeys commands- 6
- 2 part command
Localises to pain - 5
- trapezius squeeze
- supraorbital notch
Withdraws to pain - 4
- flexion response
Abnormal flexion response to pain - 3
- decorticate posturing
Abnormal extension response - 2
- Decerebrate posturing
No response - 1
39
GCS
Describe decorticate posturing
Adduction of arm + Internal rotation of shoulder + pronation of the forearm + wrist flexion
40
GCS
Describe decerebrate posturing
Head extended + arms and legs extended and internally rotated
41
Name 4 differentials for transient LOC
Seizure
NEAD
Hypoglycaemia
Postural hypotension
42
What is cardiogenic syncope
L.V outflow obstruction leading to to syncope on exertion
43
Name 5 causes of cardiogenic syncope
Aortic stenosis
| HCOM
44
Name 5 causes of orthostatic hypotension
Drugs
- Antihypertensive
- TCA
Hypovolaemia
Primary autonomic failure
- Parkinson's
Secondary autonomic failure
- Diabetes
-
45
Hydrocephalus - Name 3 causes of a communicating hydrocephalus
Damage to arachnoid granulations
- Intracranial haemorrhage
- Meningitis
- Venous thrombosis
46
Name the 3 different categories of syncope
Vasovagal
- reflex bradycardia and peripheral vasodilation
Situational - Post:
- cough
- micturition
carotid hypersensitivity
- tight collar / shaving
47
Name 8 causes of a seizure
Children
- inherited syndromes
- Birth hypoxia
- Infections (meningitis)
Metabolic
- Hypoglycaemia
- Hyponatraemia
- Hypoxia
- Delirium tremens
Other
- Head trauma
- stroke
48
Name 4 factors that reduce seizure threshold
```
Alcohol
Anti-depressants
SOL
Lack of sleep
Hyponatraemia
Stroke
```
49
How do you diagnose epilepsy
2 unprovoked seizures occuring >24 hours apart
OR
1 unprovoked seizure and a >60% probability of increased predisposition to further seizures In next 10 years
(eg: MRI - SOL/ Stroke or on EEG)
50
Name and describe the 4 stages of a seizure
Prodrome - not part of seizure
- change in mood
Aura
- deja-vu
- strange smells
Ictal phase
Post ictal
- headache
- confusion
51
Name investigations required following a seizure
Bloods - glucose / Ca2+ / Na+
ECG - R/O other conditions
EEG
CT/MRI
52
Name the 5 classifications of a generalised seizure
GTC
- tongue biting
- incontinence
- eyes closed
- confusion
Tonic
Atonic
- No LOC
- Falls to floor
Absence
- 3Hz spike in EEG
Myoclonic
- thrown to floor
53
Name the 5 classifications of a generalised seizure
GTC
- tongue biting
- incontinence
- eyes closed
- confusion
Tonic
Atonic
- No LOC
- Falls to floor
Absence
- 3Hz spike in EEG
Myoclonic
- thrown to floor
54
What is the management of generalised seizure
1st - sodium valproate
2nd - Carbamazepine / Lamotrigine
55
Describe the differences between a simple and complex focal seizure
Simple
- No LOC
- No post ictal confusion
Complex
- LOC
- Post ictal confusion
- common from temporal and frontal lobes
56
Describe the presentation of a frontal lobe focal seizure
```
pedalling leg movements
posturing changes
jacksonian march
motor arrest
post ictal - Todd's palsy
```
57
Describe the presentation of a temporal lobe focal seizure
Deja - vu
hallucination - smell / taste / sound
Automatisms - lip smacking / pulling
58
Describe the presentation of a parietal and occipital lobe focal seizure
Parietal
- sensory changes (tingling / paresthesia)
Occipital
- Visual disturbance
59
What is the management in status epilepticus
1st line - IV 4mg lorazepam
Buccal midazolam
rectal diazepam
2nd line - Repeat if no response after 10 mins
3rd line - IV phenytoin
60
What are the risks / complications if status epilepticus is not managed
death
rhabdomyolysis
AKI
Metabolic acidosis
61
What are the driving requirements following a seizure and in epilpesy
Must inform DVLA
- Can't drive for 6m following a seizure
- If established epilepsy must be seizure free for 1 year
62
What is required when administering phenytoin
cardiac monitoring - risk of arrhythmias
63
Name 4 side effects of sodium valporate
teratogenic
weight gain
hair loss
pancreatitis
64
name 4 side effects of lamogitrine
rashes
aggression
steven-johnson syndrome
65
Name 4 side effects of carbamazepine
Teratogenic
Hyponatraemia - SIADH
Rashes
Agranulocytosis
66
Name 4 side effects of phenytoin
gum hypertrophy
cerebellar atrophy
arrhythmias
67
What is the driving advice following a NEAD
No driving unless seizure free for 3m
68
Describe NEAD
Physical manifestation of trauma
- Common after childhood sexual abuse
- no EEG changes
Presents with other MUS
- IBS / Fibromyalgia / chronic fatigue
Mx - Psychotherapy and explanation
69
Describe the presentation of Wernicke's syndrome
```
Triad:
- ataxia
- encephalopathy
- Ocular abnormalities
Ophthalmoplegia
gaze paresis
ptosis
nystagmus
```
Peripheral neuropathy
70
Name 3 causes of Wernicke's syndrome
Hyperemesis
Alcohol dependence
Malnutrition / Anorexia
71
Where is vitamin B1 - thiamine absorbed and stored
Absorbed - duodenum
stored - liver
72
What is the Mx of wernicke's syndrome
IV Pabrinex
IV glucose - prevent metabolic acidosis
73
How does Korsakoff syndrome present
Sx of Wernicke's +
- Anterograde and retrograde amnesia
- Confandibulation
74
What is the pathophysiology behind Korsakoff syndrome
Chronic lack of thiamine damages mamillary bodies in limbic system - Degradation visible on MRI
75
CLUSTER
- Timings
- RF
- Causes
- Presentation
- Mx
- Prophylaxis
5 - 180 mins
Smoking is a risk factor
Alcohol
```
Unilateral orbital pain
- rhinorrhoea
- lacrimation
- bloodshot
- ptosis
Vomiting
```
Mx - 100 O2 + Sumatriptan
Prophylaxis - Verapamil
76
TRIGEMINAL NEURALGIA
- Timings
- RF
- Causes
- Presentation
- Ix
- Mx
Seconds
> 55 year old female
Compression of trigeminal nerve - Aggravated by: Shaving / smiling / talking / wind
Unilateral - electryfying stabbing pain
Ix - MRI to R/O other conditions
Mx:
Medical
- 1st: Carbamazepine
- 2nd: Phenytoin / Gabapentin
Surgical
- Surgical decompression
77
What drugs commonly cause medication overuse headache
opioids
triptans
NSAIDs
78
Name 3 risk factors for GCA
Female
PMR
Family hx
79
What is found on temporal artery biopsy in GCA
Multinucleated giant cells
80
Name the investigations required in GCA
Bloods
- ESR
- ALP - raised
- CRP
- FBC - normochromic normocytic anaemia
Duplez USS - hypoechoic halo sign
81
What is the presentation of GCA
```
Unilateral temporal headache
scalp tenderness
jaw claudication
blurred / double vision
vision loss
fever
weight loss
fatigue
```
82
What is the management of GCA
Prednisolone - 40/60mg
Decrease stroke and vison loss risk
75mg Aspirin
Gastric protection whilst on steroids
PPI
Bisphosphonates + Coleclacifarol
83
Name 2 risk factors for glaucoma
family hx
| High BP
84
Describe the pathophysiology in Glaucoma
Increased intraocular pressure damages optic nerve
85
Describe the presentation of glaucoma
Unilateral orbital pain
swollen eye
visual blurring
Halos in vision
86
What investigations are required in glaucoma
Vision testing
Measure IO pressure - Tonometer
87
What is the medical and surgical management of glaucoma
Medical
- Iatanoprost (PG analgoues)
Surgical
- Trabeculoplasty
- Trabeulotomy
88
Name 4 causes meningitis
```
Strep pneumonia
Neisseria meningitidis
H.influenza
Strep agalactiae
Listeria monocytogenes
```
89
What is the prophylaxis for menignitis for close contacts
Oral ciprofloxacin
90
Name 3 causes of encephalitis
HSV - 1
VZV
CMV
EBV
91
Describe the presentation of encephalitis
```
Sudden onset behavioural change
Headache
New onset seizures
Decreased GCS
Confusion
Focal neurology
Fever
```
92
Describe the investigations required in suspected encephalitis
1st line - Bloods and blood culture
- Viral PCR
2nd line - LP
- Viral PCR
Contrast enhanced CT scan / MRI scan
- Bitemporal and inferior changes
93
What is the infectivity period of shingles
infective 1/2 days before rash onset and 5 days post rash
94
Name 2 complications of shingles
Ramsey hunt syndrome
Post herpetic neuralgia
- burning intractable pain
- poor response to analgesics
95
What is the management of post herpetic neuralgia
Amitriptyline
