Year 3: Neurology Flashcards
Everything you need to know to pass for Neurology in Dundee Medical School (345 cards)
1
Q
Prosencephalon becomes
A
Telencephalon > Cerebrum Diencephalon > Thalamus and Hypothalamus
2
Q
Mesencephalon becomes
A
Midbrain
3
Q
Rhombencephalon
A
Metencephalon > Pons and Cerebellum
Myelencephalon > Medulla
4
Q
Ascending Pathways are
A
Somatosensory
5
Q
2 Ascending pathways
A
- Spinothalamic Tract
- Dorsal Column Medial Leminiscus (DCML)
6
Q
Spinothalamic Tract is responsible for
A
Pain and Temperature
7
Q
Spinothalamic fibres decussate at
A
Spinal cord
8
Q
A lesion in the spinothalamic tract would cause
A
Contralateral loss of pain and temperature
9
Q
Spinothalamic tract is
A
Anterior
10
Q
DCML Pathway is responsible for
A
Fine touch, pressure and vibration
11
Q
DCML fibres decussate in
A
the medulla
12
Q
A lesion in the DCML pathway would cause
A
ipsilateral loss of fine touch, pressure and vibration sensations
13
Q
DCML pathway is
A
Posterior
14
Q
DCML is split into
A
- Fasciculus cuneatus: Upper limbs and trunk
- Fasciculus gracilis: Lower limbs and trunk
“You stand with grace”
15
Q
Fasiculus Cuneatus ends at
A
T6
16
Q
Descending pathways are
A
Somatomotor
17
Q
2 main descending pathways
A
- Pyrimidal (Corticospinal, Corticobulbar)
- Extrapyrimidal (Reticulospinal, Rubrospinal)
18
Q
Pyramidal Tracts are
A
Anterior
19
Q
Extrapyramidal tracts are
A
Anterior
20
Q
Corticospinal tract is split into
A
- Lateral corticopsinal tract
- Anterior corticospinal tract
21
Q
Lateral Corticospinal tract is responsible for
A
Voluntary motor control of the limbs and digits
22
Q
Lateral corticospinal fibres decussate in the
A
Medulla (pyramidal decussation)
23
Q
A lesion in the lateral corticospinal tract would cause
A
Weakness in ipsilateral limbs and digits
24
Q
Anterior corticospinal tract is responsible for
A
Voluntary motor control of the trunk (maintains posture)
25
Corticobulbar tract is responsible for
Motor control of the muscles of the face, head and neck
26
Corticobulbar tract is associated with
Cranial Nerves
27
Rubrospinal tract
controls flexion in the upper limbs
"RuBROspinal as they are bicep curling"
28
Origin of rubrospinal tract is in the
red nucleus (in the midbrain)
29
Reticulospinal tract
excites extensor muscles
30
Decerebrate posture
* Extension of all upper and lower limbs
* Pronation of the wrist
* Damage to brain, including midbrain
"You De-celebrate because they are dead, or look like it"
31
Decorticate
* Flexion of upper limbs
* Extension of the lower limbs
* Damage to brain, excluding midbrain (rubrospinal is intact)
"Your arms are flexed to your deCOREticate"
32
* Ipsilateral loss of touch, pressure, vibration
* Ipsilateral loss of motor strength
* Contralateral loss of pain and temperature
Brown Sequards Syndrome
"Hemi-section of the cord"
33
Bilateral loss of touch, pressure and vibration
Posterior Cord Syndrome
34
* Bilateral loss of pain and temperature in a cape-like pattern
* Bilateral weakness in proximal upper limbs
Central Cord Syndrome
35
* Bilateral loss of motor strength
* Bilateral loss of pain and temperature sensation
Anterior Cord Syndrome
36
* Bilateral loss of touch, pressure and vibration
* Bilateral loss of pain and temperature
* Bilateral loss of motor strength
Complete Cord Sydnrome
37
Muscle weakness is a sign of
Upper and lower motor neuron lesion
38
Muscle atrophy is
LMN lesion
"Loss of muscle = Lower"
39
Hyperreflexia is
UMN lesion
40
Hyporeflexia is
LMN lesion
41
Increased tone
UMN lesion
42
Decreased tone
LMN lesion
43
Fasciculations
LMN lesion
44
Babinski sign is positive
UMN lesion
45
Types of Motor Neurone Disease (MND)
* Amyotrophic Lateral Sclerosis (ALS)
* Primary Lateral Sclerosis (PLS)
* Progressive Muscular Atrophy (PMS)
* Spinal Muscular Atrophy (SMA)
46
ALS
UMN and LMN lesions
47
At the beginning ALS involves
upper limbs (starts distally)
48
Frontotemporal Dementia is seen in
ALS
49
The gene that links FTD and ALS is
C9ORF gene
50
Treatment to improve survival in ALS
Riluzole
51
Treatment to improve spasticity in ALS
Baclofen
52
Treatment to reduce the viscosity of sputum in ALS
Carbocisteine
53
Primary Lateral Sclerosis presents with
UMN symptoms
54
Progressive Muscular Atrophy presents with
LMN symptoms
55
Spinal Muscular Atrophy presents with
LMN symptoms
"Floppy Baby Syndrome" - hypotonia
56
Gene for SMA
SMN 1 gene
57
Cyst in spinal cord
Syringomyelia
58
* Sensory loss (pain and temperature) in the upper limps and "cape" area
* Paralysis
* Muscle weakness
* Neck pain
* Bladder problems
Syringomyelia
59
* Sciatica
* Lower back pain
* Lower Limb/buttocks loss of sensation/ tingling
Lumbar stenosis
60
Compression of the spinal cord
Spinal Stenosis
61
Pain relieved on sitting forward or walking uphill
Lumbar stenosis
62
Spinal cord stops at
L1/2
63
Lumbar punctures are taken at
L3/4
64
Intervertebral disc prolapse causing Cauda Equina Syndrome usually happens at
L4/5
65
* Lower limb weakness/ pain/ loss in sensation
* Saddle area anaesthesia
* Bladder/bowel incontinence
Cauda Equina Syndrome
66
* Unliateral mydriasis (dilated pupil)
* Down and out eye
* Ptosis (drooping eye lid)
Third Nerve Palsy
67
* Facial drooping
* Loss of forehead wrinkles
* Inability to close eye
* Inability to produce tear film (dry eyes)
* Hyperacusis (stapedius)
Bell's Palsy (Facial Nerve palsy)
68
Treatment for Bell's Palsy
Steroids
69
* Miosis (constricted pupil)
* Partial ptosis
* Enophthalmos (sinking of the eyeball in socket)
* Ipsilateral anhidrosis
Horner's Syndrome
70
Horner's Syndrome is due to
Sympathetic nerve problem/damage
71
* Damage to C5/C6
Erb's Palsy
72
* Internally rotated arm
* Pronated forearm
* Flexed wrist
"Waiters tip posture"
Erb's Palsy
73
Damage to C8 and T1
Klumpke's Palsy
74
"Claw hand"
Klumpke's Palsy
75
* Muscle fatigue at the end of the day
* Diplopia, ptosis, heavy head
Myasthenia Gravis
76
Myasthenia Gravis pathophysiology
* Autoimmune neuromuscular junction disorder (B-cell mediated)
* Auto-antibodies attack post-synaptic Acetylcholine receptors
77
Myasthenia Gravis Antobodies
Anti Acetylcholine receptor antibodies (AChR)
| (Produced in thymus)
78
1st line Treatment for Myasthenia Gravis
Pyridostigmine (Acetylcholinesterase inhibitor)
79
2nd line for myasthenia gravis
Thymectomy
80
Side effect of Pyridostigmine
Can cause a cholinergic crisis
Tx: Plasmapheresis and Ig
81
* Distal proximal weakness in arms and legs
* Pins and needles in hands and feet
* Recent GI campylobacter infection
Guillain-Barré Syndrome
82
Guillain-Barré Syndrome
Autoimmune destruction of peripheral nerves and their myelin insulation
83
Guillain-Barré Syndrome Antibodies
Anti-ganglioside antibodies
84
Treatment for Guillain-Barré Syndrome
Immunoglobins
85
* "Wine bottle legs/stork like legs"- like a saber tooth
* "Claw hand"
* "Hammer toe"
* Foot drop
Charcot-Marie-Tooth Disease
86
Pathophysiology of Charcot-Marie-Tooth disease
Motor and sensory neuropathies of the peripheral nervous system with associated muscle loss
87
Lambert-Eaton Myasthenis Syndrome
Muscle weakness to the limbs due to autoimmune antibodies attacking presynaptic Ca2+ channels, interfering with cell signals from nerve cells
88
Voltage gate calcium channel antibodies (VGCC)
Lambert-Eaton Myasthenic Syndrome
89
Lambert-Eaton Myasthenic Syndrome is associated with
Small cell carcinoma (lung cancer)
90
Treatment for Lambert Eaton Syndrome
* 3,4-Diaminopyridine +Steroids
* Pyridostigmine
91
* Optic neuritis
* Incontinence
* Ataxia
* Weakness
* Spasticity
* Pyramidal Dysfunction (Weakness in UL extensors, weakness in LL flexors)
Symptoms separated in space and time
Increasing frequency of symptoms
Relapsing and remitting disease
Multiple Sclerosis (MS)
92
Pathophysiology of MS
* Inflammatory process of demyelination of CNS
* Deposition of plaques around lateral ventricles "dawson's fingers"
- Acute: Pink
- Chronic: Pearl grey
*
93
Lhermitte's Sign
Movement of neck sends electric shock pain down spine
Present in MS
94
Investigations for MS
* MRI: lesions will be seen
* LP: Oligoclonal Bands seen in CSF
Raised Lymphocytes in CSF
95
Acute treatment of MS
High dose steroids (methylprednisolone)
96
1st line Treatment for MS
* Beta-interferon (Avonex, Extavia)
* or sometimes Copaxone
97
2nd line for MS
* Natalizomab (Monoclonal antibody)
* or sometimes Fingolimod
98
MS treatment for fatigue
Amantidine
99
MS treatment for increased sleepiness
Modafinil
100
MS treatment for spasticity
Baclofen, botox
101
Type types of Seizure
* General (all of the brain)
* Focal (partial bits of the brain)
102
Types of generalised seizures
* Tonic-clonic
* Myoclonic
* Myotonic
* Atonic
* Absence
103
Tonic-Clonic Seizure
* Tonic: Muscles tense up
* Clonic: Convulsions and shaky movements
Often bite tongue
104
Myotonic seizure
Muscles tense up
105
Myoclonic Seizure
Clonic jerks: Shaky movements
Common in kids, often happen in the morning
106
Atonic seizure
All muscles lose tone
They fall to the floor like in Toy Story
107
Absence seizure
Motionless stare for 15-30s
108
Types of Focal/Partial Seizures
* Simple: Remains consciousness
* Complex: Loss of consciousness + Aura
109
Classifications of Focal/Partial Seizures
* Frontal
* Temporal
* Parietal
* Occipital
110
Frontal Seizure
**Motor signs**: Twitching movements, stiffness
111
Temporal Seizure
* Deja Vu feeling
* Weird smell / taste
* Lip smacking
* Feeling of impending doom
112
Parietal Seizure
Loss of sensation in distal limbs
Burning / tingling sensation
113
Occipital Seizure
Visual problems
114
Todd's Paralysis
A period of temporary paralysis following a seizure
Can last up to 24hrs
115
Investigation for someone having a seizure
ECG
116
1st line treatment of Generalised Seizures
Sodium Valproate
117
2nd line treatment for Generalised Seizures
Lamotrigine
Myoclonic: Levetiracetam
Absence: Ethosuximide
118
1st line treatment for Focal/Partial Seizures
Carbamazepine
119
2nd line treatment for Focal/Partial Seizures
Lamotrigine
or sometimes Levetiracetam
120
Contraindications for sodium valproate
* Teratogenic (don't use in pregnancy), but can use in breastfeeding
* Weight gain
* Hair loss
* Fatigue
121
Contraindications of carbamazepine
Makes general seizures worse
122
Side effects of Lamotrigine
Dizziness and a rash
123
Contraceptive contraindications of Epileptic medications
* POP won't work
* Increase dosage of COC
* Take 5mg Folic Acid for pregnancy
124
Status Epilepticus
* Single epileptic seizure lasting more than five minutes
* Two or more seizures within a five-minute period without the person returning to normal between them
125
Acute treatment of Status Epilepticus
1st: Rectal Diazepam, IV Lorazepam
2nd: Phenytoin
126
Single seizure patient can't drive for
6 months
127
Single Seizure patient who drives heavy goods vehicles can't drive for
5 years
128
Epilepsy patient without seizures has to wait
1 year of being seizure free to drive again
129
Epilepsy patient who drives a heavy goods vehicle has to wait
10 years seizure free while off of their medication
130
4 main types of Dementia
* Alzheimer's
* Frontotemporal "Picks disease"
* Vascular
* Lewy Body's
131
Criteria for dementia
2 or more of:
* Forgetfulness
* Memory loss
* Confusion
* Poor reason
* Personality changes
* Decreased concentration
* Visual perceptions
132
Tools for diagnosing Dementia
* 4AT
* MMSE
* MOCA
133
Frontal lobe is responsible for
Sequencing, fluency and behaviour
134
Parietal lobe is responsible for
* Language- Left side
* Spacial awareness- Right side
135
Temporal lobe is responsible for
Memory and speech
136
Alzheimer's criteria
a decline in function in 2+ areas
137
Pathophysiology of Alzheimer's Dementia
* Deposition of amyloid plaques (alphabeta) that are neurotoxic and cause an inflammatory response when broken down
* Deposition of Tau protein which is also neurotoxic
138
Alzheimer's effects
Frontal, temporal and parietal lobes first
Starts in nucleus basalis of meynert
139
Amyloid plaques and Tau Protein cause
* Decrease in ACh which leads to less serotonin
* Decrease in GABA which leads to less NorA
140
Pathological changes to the brain in Alzheimer's
* Huge sulci
* Narrowed gyri
* Cortical atrophy
* Thin brain
* Dilated ventricles
141
Genes associated with Alzheimer's
* PSE1/2 is found in early onset dementia
* APP is found in Trisomy 21
142
Treatment for Alzheimer's Dementia
* ACh inhibitor (Donepezil, Rivastigmine, Galantamine)
* Memantine (NMDA receptor antagonist)
143
Pathophysiology of Frontotemporal Dementia
* Deposition of Tau proteins- silver staining "Pick Bodies"
* Frontal lobe atrophy
* Gyral atrophy with knife-blade appearance
144
Do not offer
ACh receptor antagonists or memantine in Frontotemporal dementia
145
Presentation of Frontal temporal dementia
* Early insidious onset
* Personality changes
* Preserved memory
146
Lewy Body Dementia is caused by
* Deposition of Lewy bodies (alpha-synuclein)
147
Ubiquitin detects
Lewy bodies when stained
148
Lewy Body Dementia is associated with
Parkinson's Disease
149
To have DWLB (Dementia with Lewy Bodies) and not Parkinson's you must have
Onset of dementia symptoms within 1 year of onset of Parkinson's symptoms
150
Presentation of DWLB
* Parkinson's symptoms
* Visual Hallucinations
* REM Sleep disorder
151
Investigations for DWLB
Positive DAT (Dopamine active transporter) scan
152
Treatment for DWLB
ACh inhibitor (Donepezil, Rivastigmine, Galantamine)
153
Vascular Dementia pathology
* Multiple lacunar infarcts in small vessels in brain
154
Vascular Disease is found in
CHD/stroke patients
155
Vascular Dementia has a
Step wize progression
156
Dementia Pugilistica is found in
Boxers
Due to repeated trauma
157
Pathophysiology of Parkinson's Disease
* Lewy bodies also aggregate in the brain and destroy the substantia nigra (produces dopamine)
* Decrease in dopamine leads to the inhibition of the thalamus (motor cortex) which in turn inhibits motor movement
158
Core features of Parkinson's Disease
* Bradykinesia (causes shuffling gait)
* Resting Tremor
* Rigidity (cogwheeling limbs)
159
Other associated features with Parkinsonism
* Quiet speech
* Decreased facial expressions
* Decreased sense of smell
* Bladder dysfunction
160
Genes associated with Parkinson's
* LRRK2 gene
* PRKN gene
161
Investigations for Parkinson's
* Positive DAT scan
* Treatment with Levodopa will work- diagnostic
162
1st line treatment for Parkinson's
**Levodopa**
(Carbidopa is prescribed alongside to prevent Levodopa from being broken down before it reaches the brain)
163
2nd line treatment for Parkinson's
* Monoamine Oxidase Inhibitors (MAOIs): Selegiline, rasagiline
* Dopamine agonist (D2 receptor agonists): Pramipexole, Ropinirole, Bromocriptine
* COMT inhibitor: Entacapone
164
1st line treatment for Parkinson's tremor
Anticholinergics
165
Parkinsons Plus
Parkinson's plus additional neurodegenerative features
166
Parkinson's Plus features
* Multi-system atrophy: Decreased BP, Ataxia
* Progressive supranuclear palsy: Vertical gaze, Hummingbird sign
* Cortical Basil Degeneration: Alien hand syndrome
167
Huntington's disease
Progressive degeneration of striatium, basal ganglia, and cerebral cortex due
168
Huntington's Genetics
Autosomal dominant
\>38 glutamine (CAG repeats)
Chromosome 4
* The more repeats, the earlier the onset
* CAG repeats get longer in men, shorter in women
169
Huntington's Presentation
* Middle aged
* Chorea
* Progressive dementia
170
Treatment for Huntington's
Tetrabenazine (monoamine depletor) to help with chorea
171
Wilson's Disease
Autosomal recessive disease that causes deposition of copper in your brain and other organs
172
Symptoms of Wilson's Disease
* "Wing beating" tremor
* Keiser-fleischer rings
173
Tourette's Syndrome
Autosomal dominant neurodevelopmental disorder with onset in childhood, characterized by multiple motor tics and at least one vocal (phonic) tic
174
Treatment for Tourette's
* 1st: CBT
* 2nd: Clonidine (alpha agonist)
* 3rd: Tetrabenazine (monoamine depletor)
175
Dystonia
Neurological movement disorder syndrome in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures
176
Treatment for Dystonia
* Levodopa
* Botox
177
Narcolepsy
* Patient goes from being awake to being straight into REM sleep
* Often have daytime sleepiness
* Can be triggered by emotion: Cataplexy
178
Investigations for Narcolepsy
* Overnight polysomnography
* Multiple Sleep Latency Test
179
Treatment for Narcolepsy
* Modafinil- stimulant
* SSRIs for cataplexy
180
Two classifications of strokes
* Ischaemic (85%)
* Haemorrhagic (15%)
181
Ischaemic strokes
* Artheroembolic: Arterial (white thrombus)
* Cardioembolic: Venous (red thrombus)
182
Haemorrhagic strokes
Due to:
* HTN
* Abnormalities (e.g. aneurysm)
* Cerebral amyloid angiopathy
* Warfarin etc
183
Which score do you use on A&E admission to distinguish between a stroke and a stroke mimic
Rosier score
\>0 = Stroke
184
4 types of strokes
* Total Anterior Circulation Stroke (TACS)
* Partial Anterior Circulation Stroke (PACS)
* Lacunar Anterior Circulation Stroke (LACS)
* Posterior Circulation Stroke (POCS)
185
Oxford Stroke Classification has 3 criteria
1. Unilateral motor loss and/or sensory loss of face/ arm/ leg
2. Homonymous hemianopia
3. Higher cognitive dysfunction (e.g. dysphagia)
186
TACS affects
Anterior and middle cerebral arteries
187
TACS presents with
3/3 from Oxford's Stroke Classification (OSC)
188
PACS involves
Smaller arteries of anterior and middle cerebral circulation
189
PACS presents with
2/3 features of OSC
190
LACS involves
Arteries around the internal capsule, thalamus and basal ganglia
191
LACS presents with
* Unilateral weakness/sensory loss in face/arms/legs
* Pure sensory stroke
* Ataxic hemiparesis
192
POCS involves
Vertebrobasilar arteries
193
POCs presents with
* Isolated homonymous hemianopia
* Cerebellar/Brainstem syndromes (CNs)
* Loss of consciousness
194
* Decrease in consciousness
* Vomiting/Nausea
* Headaches
* Seizures
are more common in haemorrhagic strokes
195
Treatment for Ischaemic Stroke
\<4.5 hours since onset of symptoms and haemorrhage is excluded:
* Thrombolysis: Alteplase + Aspirin (300mg)
\>4.5 hours since onset of symptoms
* Surgical removal of clot
196
Alteplase is a
Tissue plasminogen activator
197
Prophylaxis treatment commenced post ischaemic stroke
A: Antiplatelets (Aspirin)
B: Blood pressure control (amlodipine if \>65, ACE i if \<65)
C: Cholesterol management (Statins) if \>3.5
D: Diabetes management (if needed)
198
Treatment for haemorrhagic stroke
* Opiates and antiemetics for nausea and pain
* Increase fluids (IV drip) and blood (transfusion) to support brain
* Calcium channel blockers to cause vasodilation to maintain cerebral perfusion
* Neurosurgery
199
3 types of brain haemorrhages
* Subarachnoid
* Extradural (Epidural) Haematoma
* Subdural Haematoma
200
Subarachnoid Headache effects
Arteries in the circle of Willis
Often caused by a berry aneurysm
201
Subarachnoid haemorrhage bleeds into
the subarachnoid space and so can be seen in the eyes as a vitreous haemorrhage
202
Subarachnoid haemorrhage presents with
* Acute loss of consciousness
* "Thunderclap" occipital headache (extremely painful)
* Meningism: (Neck pain, Brudzinski's sign positive)
203
Brudzinski's Sign
Flexion of the knees/hips on flexion of the neck in meningism
204
Treatment for Subarachnoid Haemorrhage
Nimodipine (Calcium channel blocker)
205
Extradural (Epidural) Haematoma effects
* Middle meningeal artery (often due to pterion fracture in head trauma)
* Tear in the dura
"MMA fighters get head trauma"
206
Extradural (Epidural) Haematoma can cause a
Contra-coup injury
(Injury on the contralateral side of primary injury)
207
Extradural Haematoma appear as
Unilateral hyperdense biconvex lesions on CT
208
Extradural Haematoma Present with
* Trauma (e.g. sports head injury"
* Lucid interval followed by loss in consciousness
209
Subdural Haematoma effects
Bridging veins (tear)
Venous
210
Subdural Haematoma appear as
Hypodense crescent-shaped haemorrhage
211
Subdural Haematoma present as
* Low impact trauma (e.g. elderly, alcoholic fall- due to decreased clotting factors)
* Progressive headache and confusion since trauma
212
Treatment for Subdural Haematoma
Burr hold drainage
213
Racoon Eyes (peri-ocular) bruising
Anterior Cranial Fossa Fracture
214
"Battle sign" mastoid bruising
Middle cranial fossa fracture
215
* Trouble opening jaw
* Diplopia
Zygoma fracture
216
* Ophthalmoplegia (weakness in eye muscles)
* Ataxia
* Confusion
Wernicke Encephalopathy
217
Korsakoff's Syndrome
* Impaired memory
* Confabulation
* Confusion
* Personality changes
218
Wernicke Encephalopathy and Korsakoff's Syndrome are seen in
**Alcoholics** (and sometimes other malnourished people)
Due to deficiency of thiamine (B1)
219
Broca's area is responsible for
Production of speech
220
Patient's with Broca's aphasia
* Can't find words to say (non-fluent)
* Have trouble producing speech
* Are aware of disability
221
Broca's area is found
* Left side of brain
* More anterior than Wernicke's area
* Inferior frontal lobe
222
Wernicke's area is responsible for
Speech comprehension
223
Patients with Wernicke's aphasia
* Cannot comprehend their own speech
* Cannot comprehend other people's speech
* Are not aware of their disability
Can produce fluent sentences, however, they do not make sense
224
Types and causes of Headaches
* Migraine
* Trigeminal Autonomic Cephalopathies
- Cluster
- Paroxysmal Hemicrania
- SUNCTs
* Tension
* Sinusitis
* Idiopathic Intracranial Hypertension (IIH)
* Temporal Arteritis
* Trigeminal Neuralgia
* Acute Glaucoma
225
Headache Red Flags
* New onset \>55
* Previous Malignancy
* Immunosuppressed
* Early morning (wakes them up)
* Exacerbation by valsalva maneouvre
226
IHS Criteria for a Migraine
2/3 of:
* Debilitating
* Unilateral
* Throbbing
+ nausea/ photophobia/ phonophobia
+ aura
227
Migraine's usually last for
4-72hrs
228
You only treat migraines if they are happening
3 times per month
229
Acute Migraine treatment
* During aura (pre-pain): Triptan
* During pain: NSAID and antiemetic
230
Migraine prophylaxis
* Propranolol
* Topiramate
* Amitriptyline
231
Trigeminal Autonomic Cepholopathies (TACs) consist of
* Cluster
* Paroxysmal Hemicrania
* SUNCTs
232
Cluster headaches last for
45-90mins
233
Cluster headaches presentation
* 30 year old
* Unilateral supraorbital pain
* 1-8 headaches per day for many weeks
234
Acute treatment of cluster headache
* High flow O2
* Steroids
* Triptans
235
Prophylaxis for Cluster headaches
Verapamil (Calcium channel blocker)
236
Paroxysmal Hemicranias last for
2-30mins
237
Presentation of Paroxysmal Hemicrania
* Elderly patient
* Severe unilateral pain
* 1-40 headaches per day
* Horner's Syndrome
238
Treatment for Paroxysmal Hemicrania
Indomethacin
239
SUNCT stands for
* Short-lived
* Unilateral
* Neuralgiform
* Conjunctival infection
* Tearing
240
Treatment for SUNCTs
Antiepileptics
* Lamotrigine
* Gabapentin
241
Tension headaches last for
30mins - 7 days
242
Presentation of a tension headache
* Tight band
* Non-pulsatile
* Stressed patient
243
Treatment for Tension headache
* Antidepressant for 3 months
* Stress relief
244
Presentation of a sinus headache
* Recent viral infection
* Worse when leaning forward
245
Presentation of Idiopathic Intracranial Hypertension
* Young and overweight patients
* Increased CSF (papilloedema)
* Morning vomiting/ nausea
246
Treatment for Idiopathic Intracranial Hypertension
* Lose weight
* Acetazolamide
* Ventricular shunt
247
Side effects of ventricular shunts
Can cause infection
Can cause low-pressure headache
248
Trigeminal Neuralgia Presentation
* Female patient in 60s
* V2/V3 pain on touching
* Gone in seconds
249
Treatment for Trigeminal neuralgia
* Gabapentin
* Carbamazepine
* Pregabalin
250
Temporal arteritis presentation
* Temple pain
* Scalp tenderness
* Associated with jaw claudication
251
Investigation for Temporal arteritis
Temporal artery biopsy
252
Treatment for Temporal arteritis
Steroids
253
Acute Primary Angle Closure Glaucoma Presentation
* Severe eye pain
* Vomiting and nausea
* Blurred vision
* See's lights around halos
* Tearing
254
Treatment for Acute angle closure glaucoma
* Admit to hospital
* Pilocarpine eye drops
* Acetazolamide
* Pain relief
255
3 Types of Meningitis
* Bacterial
* Viral
* Fungal
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Most common type of meningitis
Viral
257
Presentation of Meningitis
* Meningism
* Fever
* Rash (non-blanching purpuric)
* Headache
* Photophobia
* Decreased GCS
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Organisms that affect Neonates
* Listeria
* Group B Strep
* E. coli
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Organism that affect children
H. Influenzae
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Organism that affect teens (10-21)
* Neisseria Meningitidis
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Organisms that affect adult population (21+)
* Strep pneumoniae
* Neisseria meningitidis
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Organisms that affect elderly \>65
* Listeria
* Strep pneumoniae
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Gram-positive bacillus found in deli foods
Listeria
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Gram-negative bacillus
H Influenzae
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Gram-positive cocci found in nasopharynx
Strep pneumoniae
Most common cause of bacterial meningitis (51%)
266
Gram-negative cocci, found intracellularly
Neisseria Meningitidis
Second most common cause of bacterial meningitis (37%)
267
Most likely organisms to cause meningitis due to a head fracture
* Staph aureus (gram-positive cocci)
* H influenza
268
Most likely organisms to cause bacterial meningitis due to a cribriform plate fracture
* Strep pneumoniae
* H influenza
269
Most likely organism to cause bacterial meningitis from a CSF shunt
Staph epidermidis
270
Viral meningitis is usually caused by
Enterovirus (Echovirus)
Common in Autumn
271
Fungal meningitis is most usually caused by
Cryptococcal neoformans
Common in immunosuppressed people
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Investigations for Meningitis
LP
| (Don't do if increased CSF pressure)
273
Bacterial meningitis will show
* High WBC (neutrophils)
* High protein
* Low glucose
* High opening pressure
* Cloudy CSF
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Viral meningitis will show
* High WBC (lymphocytes)
* Normal protein
* Normal glucose
* Clear CSF
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TB meningitis will show
* High WBC (lymphocytes)
* High protein
* Low glucose
* Yellow CSF
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If someone has meningitis then
notify public health within 24hrs
277
1st line treatment in bacterial meningitis (adults)
**Dexamethasone + Ceftriaxone**
"Adults do triathlons"
Give steroids to reduce inflammation from damaging bacterial debris.
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Treatment for bacterial meningitis for children
**Dexamethasone + Cefotaxime**
"Because kids don't pay taxes"
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Treatment for listeria infection in adult/children meningitis
Normal 1st line treatment **+ amoxicillin**
If resistant to amoxicillin: Vancomycin + rifampicin
280
Treatment for Penicillin Allergy Bacterial Meningitis
**Dexamethasone + Chloramphenicol + Vancomycin**
281
Treatment for Listeria Penicillin Allergy Meningitis
Normal treatment **+ Co-trimoxazole**
282
Do not give steroids in meningitis in
Cases that involve
* Immunocompromised patients
* Post-surgical patients
* Septic patients
As they will make them more immunosuppressed
283
Treatment for Viral meningitis
Aciclovir
284
Treatment for Fungal Meningitis
**IV Amphotericin B + Fluconazole**
285
Normal CSF production
* 0.35ml/min
* 500ml per day
286
CSF is produced in
Choroid plexus
and 25% in the interstitial fluid
287
CSF if absorbed in
arachnoid granulations
288
Hydrocephalus presents with
* In neonates: Bulging fontanelle
* Nausea/vomiting (especially in morning)
* Bilateral Headache (wakes you up)
* Sunsetting of the eyes (fixed downward eyes)
* Seizure
* No aura
289
Treatment of Hydrocephalus
* Ventricular shunt
* Acetazolamide
290
Argyl-Robertson pupils
"Prostitutes sign" - as they accommodate but don't react
Neurosyphilis
291
Sunsetting sign and vertical gaze palsy
Perinaud's Syndrome
292
Cranial nerves that come out above the pons
CN I, II, III, IV
293
Cranial nerves that come out of the pons
CN V, VI, VII, VIII
294
Cranial nerves that come out below the pons
CN IX, X, XI, XII
295
3 types of brain herniation
* Subfalcine
* Transtentorial
* Tonsilar
296
Subfalcine Herniation
Cingulate gyrus us pushed under the falx cerebri
297
Transtentorial "Uncal" Herniation
Temporal lobe herniates under the edge of the tentorium cerebelli
298
Transtentorial herniation will cause
Blown pupil "dilated" due to CN III compression
299
Tonsillar Herniation
Cerebellar tonsils are forced through the foramen magnum
this is known as "coning"
300
Tonsilar herniation will cause
* HTN
* Bradycardia
* Respiratory arrest
* Eventually death
301
A primary cause for tonsillar herniation
Chiari Malformation
302
A secondary cause for tonsillar herniation
* SOL in brain
* Doing a LP in a patient with increased CSF
303
Brain pathology often presents with
Hydrocephalus symptoms
Mostly in Non-gliomas types as they are not in the brain tissue and cause mass effect
304
Most common brain cancer is
Metastatic (Secondary)
305
Metastatic brain cancer is most commons spread from the
* Lung
* Breast
* Melanoma (skin)
* Colon
* Kidneys
306
2 classifications of primary brain cancer
* Glioma
- Astrocytoma
- Ologodendroglioma
* Non-Glioma
- Meningiomas
- Pituitary
- Schwannomas
- Pineal gland tumours
307
Gliomas in kids occur
Infratentorial
308
Gliomas in adults occur
Supratentorial
309
Astrocytomas occur
at any age
310
Astrocytoma grade I
Local benign lesion
Vomiting and reduced appetite
* Pilocytic in kids (optic gliomas)
* Pleomorphic xanthoastroma in children-teens
Tx: Surgical removal
311
Optic gliomas are associated with
Neurofibromatosis Type 1
312
Astrocytoma grade II
Low grade, pre-malignant
Frontal, temporal and parietal
* Fibrillary (firm consistency)
Tx: Chemo/radiation + surgery
313
Astrocytoma Grade III
Anaplastic astrocytoma
2 years prognosis
314
Astrocytoma Type IV
Glioblastoma Multiforme
"Patchy enhancement"
1 year prognosis
Tx: Surgery + radiotherapy + temozolomide (MGMT+)
315
Oligodendroglial tumours occur in
Middle-aged adults
316
* Calcifications on MRI "toothpaste like"
* Frontal lobe involvement
* Seizures
Oligodendroglial
317
Treatment for Oligodendroglial tumours
* Radio
* Chemo
318
Meningiomas occur in
\>40s
319
Types of Meningiomas
CCRAP
C: Clear cell
C: Choroid
R: Rhabdoid
A: Atypical
P: Pupillary
320
Meningiomas
* Dural tail
* Often due to previous radiation
* Blush effect on angiography
* Increased bone lesions around the area
In subtypes can be :
* Meningioma en plaque (Carpet sheet-like lesion, infiltration of dura and bone)
Tx: Surgery
321
Pituitary Tumours
Cause:
* Cushing's syndrome
* Bitemporal hemianopia
Prolactinoma: increased prolactin
322
Schwannoma
Acoustic neuroma:
* Hearing loss
* Vertigo
* Tinnitus
others affect: CN V, VII, VIII
323
3 main types of pineal gland tumour
* Choriocarcinoma
* Yolk sac
* Germinoma
324
Increased B-hCG pineal gland tumour
Choriocarcinoma
325
Increased AFP Pineal tumour
Yolk sac (massively raised)
Teratoma
326
Increased PLAP Pineal tumour
Placental Alkaline Phosphotase
Germinoma
327
Symptoms of Pineal tumours
* Commonly obstruct CSF flow and cause non-communicating hydrocephalus
* Vertical gaze palsy (CN IV)
328
Chemo treatment for Brain tumours
"PCV"
## Footnote
**Procarbazine, CCNU (Lomustine), Vincristine**
329
Schwann cells produce myelin in
PNS
330
Oligodendrocytes produce myelin in the
CNS
331
Astrocytes make up the
Blood brain barrier
332
Ependymal cells are responsible for
CSF regulation
333
Microglia are
Phagocytes
334
Alpha/Beta/Delta receptors are
* Thinly myelinated
* Sharp pain= first response
335
C fibres are
* Not myelinated
* Throbbing pain= secondary response
336
A-Alpha receptors
Proprioception
337
A-beta
Mechanoreceptors
338
A-delta
Pain (nociceptors) and temperature
339
Types of mechanoreceptors
* Meissner's corpuscles
* Merkel discs
* Ruffini endings
* Pacinian corpuscles
340
Meissner's corpuscles
Light touch
341
Merkel discs
Pressure
342
Ruffini endings
Stretch sensation
343
Pacinian corpuscle
Vibration
344
Lateral geniculate nucleus
Optic fields
345
Medial geniculate nucleus
Auditory
