Neurology MSRA passmed Flashcards
Jacksonian movement (clonic movements travelling proximally
Frontal lobe seizures
seizures with sensory abnormalities?
PArietal lobe
seziures with aura - lip smacking/ clothes plucking, rising epigastric sensation?
Temporal lobe seizures
Absolute CI to thrombolysis in stroke?
ICH, seizures, cancer sus, SAH, stroke/ injury in 3 months before, LP 7 days before, GI bleed 3 weeks before, Oesophageal varices, HTN>200/120mmHg
Relative CI to thrombolysis?
- Pregnancy
- Concurrent anticoagulation (INR >1.7)
- Haemorrhagic diathesis
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in the preceding 2 weeks
Lacunar stroke features?
purely motor/
purely sensory
ataxic hemiparesis
ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit
dysarthria-clumsy hand syndrome
affect: internal capsule, thalamus and basal ganglia.
Bilateral median N Dysfunction and twitches in elderly “fibrillation” think?/ hx of carpal tunne/ new imbalance/ sensnory/motor dysfunction
Degenerative cervical myelopathy.
MRI: gold standardL
fever, headache, malaise focal neurology, seizures, immunocompromised. what does CT show? dx?
CT: temporal lobe/ frontal changes (hypodensities). CSF: lymphocytosis and raised protein.
HSV encephalitis
asymmetric limb weakness, fasciculations, tibialis anterior wasting, small hand muscle wasting
ALS MND. risk frontotemporal dementia
Features of tuberus sclerosis?
AD, epilepsy, retinal haematoma, ash leaf spots, shagreen patches, sublingual fibromata, adenoma sebaceum, angiofibromas, poliosis
Neurofibromatosis features?
CRABBing?
Risks?
lisch nodules, AD, cafe au lait spots, phaechromocytomas, axillary/ groinfreckles,
CRABBING: cafe au lait, renal A stensosi (HTN/ relative), axillary nodules/ inguinal, Bone dysplasia/ bowing scapula, iris nodules, neurpfibroma, glioma eyes
NF2: acoustic neuroma, cns tumours
pyramidal tract lesions?
Upper limb - flexors>extensors
lower: extensores >flexors
pronator drift
acute;y flaccid paralysis then becoming spastic and increased tone over weeks with clonus/ brisk reflexes
Variation of gbs with descending demyelination?
miller fischer syndrome
ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
Anti GQ1B antibodies present
32 year-old female 3 day history of altered sensation of her left foot and right forearm. She had an episode of visual loss/ nystagmus?
Multiple sclerosos. ON with female <50 YO.
60 YO male with clumsy hand, dropping cups, struggles to use phone, worse over months?
degenerative cervical meylopathy (UMN signs with loss of dexterity, hoffman’s)
trigeminal neuralgia tx?
carbemazepine. if fail to respond and atypical features eg <50 - refer to neuro. preceded by pain in ear
red flag features of trigeminal neuralgia?
Sensory changes
Deafness or other ear problems
History of skin or oral lesions that could spread perineurally
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
Optic neuritis
A family history of multiple sclerosis
Age of onset before 40 years
Migraine tx?
menstrual migraine tx?
acute: triptan + nsaid/ paracetamol
child@ nasal triptan,
Others: non oral metoclopramide, domperidone
proph: propanolol/ topiramatee (teratogenic)/ amitryptiline/ riboflavin (for some),
predictable menstrual migraine: frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of ‘mini-prophylaxis’
differentiate between PD and essential tremour?
SPECT
features: essential: improves with alcohol, worse with intention, symmetrical
Parkinson’s symptoms?
tx?
features: resting tremour, bradykinesia, rigidity, shuffling gait, arm swinging, stooped,
tx: levodopa with peripheral decarboxylase inhibitors Co-beneldopa (levodopa and benserazide), with the trade name Madopa
Co-careldopa (levodopa and carbidopa), with the trade name Sinemet
parkinson plus syndome?
Multiple system atrophy: autonomic dysfunction (sweating, ED, postural hypotension), ataxia
Normal pressure hydrocephalus (wet, wobbly, wacky - incontinence, falls, dementia)
Lewy body dementia
progressive supranuclear palsy (virtical gaze palsy, speech/ swallowing issues)
levodopa SE?
dyskinesia :excessive motor activity, chorea, dystonia, athetosis.
MX: amantadine
PD drugs:
COMT inhibitors?
dop agonists?
MOBI?monoamine oxidase-B enzymes
COMT - entacapone, slows breakdown to levodopa in brain
dopamine agonist: bromocriptine/ cabergoline/ pergolide. SE: pulmonary fibrosis. less effective but delays need for levodopa and then combined to reduce necessary dose
MOBi: selegiline, rasagiline
(slow breakdown)
cx of brain abscess?
extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries and embolic events from endocarditis
15 min headache 5 weeks men, smoker, alcohol, crying around eye. tx?
cluster headache. get advice from specialist, imaging and acute: 02, sc triptan, prophylaxis: verapamil
features favouring epileptic seziure?
tongue biting, raised serum prolactin
wernicke’s encephalopathy triad?
Confusion, gait ataxia, nystagmus + opthalmoplegia. thiamine deficinecy
32 YO, F, altered sensation left foot and right forearm. B/L clonus in legs, and hyperreflexia in all limbs.
Multiple sclerosis
carbemazepine se?
dizziness, ataxia, and diplopiap
phenytoin se?
peripheral neuropathy, (numbness and reduced sensation in a glove-and-stocking distribution). gingival hyperplasia, bleeding gums, osteomalacia, p450 inducer, megaloblastic anaemia, Lymphadenopathy. check trough level (before dose) if dose change/ tox suspicion/ compliance doubt
lumbar spondylosis and chronic back pain presents with gradually worsening bilateral upper limb paraesthesias and leg stiffness
degenerative cervical myelopathy. do MRI c spine
Huntington’s disease features?
35 +, chromosome 4 (H, 4 arms), chorea
personality changes (e.g. irritability, apathy, depression) and intellectual impairment
dystonia
saccadic eye movements
stroke of: Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
stroke: ipsilateral facial paralysis and deafness?
anterior inferior cerebellar artery
stroke: Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
site of lacunar stroke?
isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
AF: hypertension
common sites: basal ganglia, thalamus and internal capsule
Cushing triad?
bradycardia, irregular breathing, wide pulse pressure, systolic HTN (response to raised ICP). also dilated poorly reactive pupils, gcs low, CN6 palsy, pappiloedema
Tx of stroke?
CT, if ischaemic stroke - give aspirin 300mg 2/52 then lifelong chlopi
-TIA: aspirin 75mg +chlopi 75mg 3 weeks, then lifelong chlopi.
-if PACS and <4.5hrs do both thrombolysis and thrombectomy (ensure BP 185/110)
thrombolysis if within 4.5 - 9 hrs or 9 hrs of mid point sleep in wake up stroke
- thrombectomy if within 6 hrs. 6-24 hrs if salvagable brain tissue evidence
- clopidogrel and MR dipyramdioleafter aspirin.
- carotid endartectomy wihtin 7 days if 50% + stenosis
-statin if cholesterol 3.5+ (usually delayed 48 hrs due to risk of haemorrhagic transformation)
(CN8)vertigo, hearing loss, tinnitus and an absent corneal reflex (CN5)? and facial nerve palsy (CN7)
acoustic neuroma/ vestibular schwannoma
seratonin syndrome?
NMS?
presents hours rather than days, sweating, myoclonus, diarrhoea and hyperreflexia. TX: chlorpromazine, cryptoheptadine
NMS: pyrexia
muscle rigidity, reduced reflexes, HTN, hgih HR/ RR, delerium, raised CK/ WCC. over days. TX: dantrolene