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Flashcards in Neurology & Neurosurgery Deck (36):

What are the sinister causes of headache it is important to rule out?

Vascular - SAH, haematoma (subdural or extradural), cerebral venous thrombosis, infarct

Infection - Meningitis or encephalitis

Vision-threatening - Temporal arteritis, acute glaucoma, pituitary apoplexy, posterior leucoencephalopathy

Intracranial pressure - SOL, cerebral oedema, hydrocephalus

Dissection - Carotid dissection


What are the headache red flags?

Decreased level of consciousness

Head injury

Sudden onset/worst headache ever

Seizures/focal neurological deficit

Reduced visual acuity

Persistent headache (worse when lying down or progressive)

Constitutional symptoms - Weight loss, night sweats, fever


What are the main causes of SAH?

Rupture of an arterial aneurysm (usually a berry aneurysm)


Arterioveanous malformations


How do TCA overdoses present?

They present with both sympathetic and parasympathetic symptoms

Dilated pupils, sinus tachycardia, brisk reflexes, urine retention
BUT also dry mouth and drowsiness


What are the types of epileptic seizures?

Generalised seizures
- Tonic-clonic
- Absence
- Atonic
- Tonic
- Clonic
- Myoclonic

Partial seizures
- Unimpaired and impaired
- Or by area affected


Describe a tonic-clonic seizures

Patients are initially rigid (tonic phase) and then convulse, making rhythmical muscular contractions (clonic phase)


Describe an absence seizure

Usually in children, the patient loses consciousness and appears vacant and unresponsive to observers for up to 30 seconds


Describe an atonic seizure

A brief loss of muscle tone, causing the patient to fall to the ground


Describe a myoclonic seizure

An extremely brief muscle contraction


What are the means of categorising partial seizures?

Can be divided into those where consciousness is unimpaired (simple) and those where it is impaired (complex).

Alternatively they may be classified by the brain area affected


What is the classic presentation of Parkinson's disease?

Tremor, rigidity and hypokinesia


How can CSF sampling being used to diagnose the causative organism type in meningitis?

High cell count, mainly neutrophils, high protein => bacterial

Lymphocytes and high glucose => viral

Lymphocytes and low glucose => fungal and TB


What is the most commonest causative organism of bacterial meningitis?

How will it appear in culture?


Gram positive diplococci


What are the causes of viral meningitis?

- Enteroviruses
- HSV type II
- VZV and other herpesviruses (EBV, CMV, HHV-6)

Less common:
- Mmps
- Measles
- Lymphocytic choriomeningitis virus


How can HSV encephalitis present?

Which HSV strain is usually implicated?

What is the treatment?

Usually affects the temporal lobe (opening and closing of mouth)

Presents with altered conscious level, confusion and seizures

Treated with acyclovir


What characteristic positioning of the limbs is associated with brain herniation?

Elbows, wrists and fingers flexed with legs extended and rotated inwards


What are the features of generalised epilepsy?

Myoclonic seizures
Generalised EEG


What are the features of focal epilepsy?



What is Sturge-Weber syndrome?

Vascular abnormalities leading to dystrophic calcification of vessels in cortex


What is lissencephaly

How does it present?

Literally mean smooth brain

Rare brain formation disorder caused by defective neuronal migration during 12th to 24th weeks of gestation

Affected children display psychomotor retardation, failure to thrive, seizures, and muscle spasticity or hypotonia


What is nodular gray matter heterotopia?

Neurological condition caused by clumps of gray matter being in the wrong place

Usually causes some degree of epilepsy or recurring seizures


What is polymicrogyria?

Multiple small gyri create excessive folding of the brain leading to an abnormally thickened cortex

May affect one or multiple regions of the brain


What is tuberous sclerosis?

What has been implicated?

A rare multisystem genetic disease that causes benign tumours to grow in the brain and on other vital organs

Combo of symptoms including seizures, intellectual disability, developmental delay, lung and kidney disease etc.

PI3K-mTOR implicated in cell growth of tubers


What is ulegyria?

What are its signs and symptoms?

"Mushroom-shaped" gyri, in which scarring causes shrinkage and atrophy in the deep sulcal regions

Mental retardation, cerebral palsy, and seizures


What are the causes of subarachnoid haemorrhage?

85% - Rupture of saccular aneurysm in cerebral vasculature (berry aneurysm)

Arterial dissection
Arteriovenous malformation
Cocaine abuse
Septic aneurysm


What are the risk factors for chronic subdural haemotoma?

Chronic alcoholism
Anti-coagulant therapy


How can neurological assessment be used in cauda equina syndrome to localise the lesion

Level - Sensory deficit - Motor deficit - Effect on reflexes
L2 - Antero-lateral thigh - Hip flexion - N/A
L3 - Medial thigh and knee - Quad and knee extension - Knee
L4 - Medial calf and malleolus - Knee extension - Knee
L5 - Dorsum and lateral calf - EHL - Ankle
S1-S2 - Lateral foot - Plantar flexion - Ankle
S3-S4 - Saddle region - Sphincters - Anal


What are the most common locations of disk herniation?

L4-5 and L5-S1


Erb's palsy?

This is caused by an injury to C5,6 often during excessive downward traction on the upper limb during a difficult delivery

Shoulder abduction, elbow flexion and supination of the forearm are all affected => waiter's tip sign


Klumpke's palsy?

Caused by injury to T1, often due to hyperabduction of the shoulder (eg in a breach delivery)

Leads to wasting of the small muscles in the hand


What is the cause of a winged scapula?

Injury to the long thoracic nerve that lead to paralysis of serratus anterior

Can occur during axillary clearance (eg for breast carcinoma)


What is important about the path of the common fibula nerve?

What might happen if it is injured?

It wraps around the proximal end of the femur, superficially

Therefore vulnerable to trauma => foot drop


What is Bell's Palsy?

An inflammatory disease of unknown origin in which all the facial muscles on one side are paralysed

The site of pathology is within the facial canal, just above the stylomastoid foramen


What is torticollis?

What are the possible causes?

AKA wryneck = excessive contraction of sternocleidomastoid and trapezius leading to the neck to be pulled to the ipsilateral side and the face rotated contralaterally

Inflammation of the spinal root of the accessory nerve, injury to the nerve during lymph node biopsy or sternocleidomastoid injury during birth


What is thoracic outlet syndrome?

Compression of the neurovasucular structures in the area above the first rib and behind the clavicle

Structures are the lower trunk of the brachial plexus, the subclavian vein and the subclavian artery

Clinical signs and symptoms include ischaemia, swelling, pain , paraesthesia of the hand, and wasting of the small muscles of the hand


What is Horner's syndrome?

Ptosis (levator palp embrace superioris), miosis (constricted pupil), anhydrosis of the affected side and flushing of the face due to loss of vasoconstriction

Due to compression of the cervical superficial chain, often by a Pancoast tumour