What % of sub arachnoid haemorrhages are seen on CT?
95%
Where is SAH seen in CT?
Centrally between ventricles
What other investigations could be in suspected SAH, except CT?
Lumbar puncture after 12 hours to look for xanthanchrcomia
What is the cause of most SAH?
Berry aneurysms
Which infection commonly precedes guillan barre?
Campylobactor jejuni - diarrhoea
Other - CMV and EBV
Where does GBS typically begin?
In the legs, proximal muscles first
What happens to reflexes in GBS?
May be present at first but disappear as weakness progresses
Where are the antibodies directed in myasthenia gravis?
At the acetylcholine receptor
What is the cardinal symptom of myasthenia gravis?
Fatiguable muscle weakness
What is the most common type of MND?
ALS
What type of MND has the worst prognosis?
Progressive bulbar palsy
What type of MND has the best prognosis?
Progressive muscular atrophy.
ALS - UMN or LMN?
UMN - signs
LMN - wasting
Progressive muscular atrophy - LMN or UMN?
LMN
Primary lateral sclerosis - UMN or LMN?
UMN
Which nerves does progressive bulbar palsy typically affect?
Cranial nerves IX - XII
When should you give give Aspirin 300mg in a stroke?
After a haemorrhage stroke has been ruled out
What is the triad of normal pressure hydrocephalus?
Gait disturbance, sphincter dysfunction and dementia
What radiological sign is seen on normal pressure hydrocephalus?
Dilated ventricles
Features of alcoholic neuropathy?
Symmetrical motor and sensory symptoms
Deranged liver enzymes
3 causes of normal pressure hydrocephalus?
Head injury, meningitis, SAH
GBS - motor or sensory peripheral neuropathy?
motor
Diabetes - motor or sensory peripheral neuropathy?
Sensory
Alcoholic neuropathy - motor or sensory?
Sensory
Position of eye in 3rd nerve palsy?
Down and out + ptosis
Pneumonic for orbital muscles?
LR6 SO4 AO3
Clinical signs in intranuclear ophthalmoplegia?
Impairment of adduction of ipsilateral eye, and nystagmus on abduction of contralateral eye.
What is intranuclear ophthalmoplegia?
Lesion on the medial longitudinal fasiculus
Causes of INO?
MS and vascular disease
What is mononeuritis multiplex?
Sensory and motor loss in individual non contiguous nerves
What are the 3 branches of the trigeminal nerve?
V1 - Ophthalmic
V2 - Maxillary
V3 - Mandibular
What is the main treatment for trigeminal neuralgia?
Carbemazepine - titrate up
What are the 5 branches of the facial nerve?
Temporal Zygomatic Buccal Mandibular (marginal) Cervical
What are the features of the CH2DS2VAS score and what is it used for?
C - CHF - 1 H - HTN -1 A2 - Age>75 - 2 D - diabetes - 1 S2 - Stroke, TIA, DVT -2 V - vascular disease -2 Age - 65-74 -1 S - Female - 1 To calculate AF risk of stroke and management
What are the features of the ABCD2 score and what is it used for?
A - Age >60 - 1 B - HTN - 1 C - Weakness -2, Speech 1 D2 - Duration >60mins 2, 10-59 -1 D2 - Diabetes - 1 Risk of stroke in people with a previous TIA
What is the NIHSS score used for?
To quantify impairment caused by stroke
What is the ROSIER score used for?
To differentiate between stroke and mimics
3 Drug causes of idiopathic intracranial hypertension?
Isotretonin (vit a derivatives)
Tetracyclines
Oral contraceptive
What condition is fasciculation typical of?
Motor neuron disease
Which signs are absent in motor neurone disease?
Sensory signs
When should thrombolysis be given in a ischaemic stroke?
Within 4.5 hours
When aspirin regime should be followed in ischaemic stroke?
300mg OD for 14 days (clopidogrel if intolerant)
When should Warfarin be given in new diagnosis AF causing a stroke?
After 14 days of aspirin
What is the management of idiopathic intracranial hypertension?
Therapeutic lumbar punctures and Acetalzolomide
What drugs cause neuroleptic malignant syndrome?
Typical anti psychotics, can also occur with atypical
When does neuroleptic malignant syndrome usually present?
Within 10 days of treatment starting
What are 3 signs of Neuroleptic malignant syndrome?
Pyrexia, rigidity and tachycardia
Management of neuroleptic malignant syndrome?
Stop antipsychotic, IV fluids to prevent renal failure, bromocriptine
Folic acid dose in pregnancy - normal vs epilepsy
Normal - 400mcg
Epilepsy - 5mg
In central cord syndrome which limbs are most weak?
Lower limbs
Which nerve is at risk from a fibular fracture or compression from cast? and what signs would this cause?
Common peroneal
Foot drop
What type of protein is seen in CJD?
Proteinaceous beta sheets
Definition of status epilepticus?
Single or serial seizures lasting more than 5 minutes, o 2 of more seizures without a return to consciousness between
First line and second treatment of status in in-patients?
Lorazepam IV
2nd - Midazoloam bucally
What other drug should be given within 30 minutes of status if not responding to benzodiazepines?
Phenytoin
First and 2nd line treatment of status in the community?
Midazolam bucally
2nd diazepam PR
Which vessels are affected in TACS?
Middle and anterior cerebral arteries
Which vessels are affected in PACS?
Smaller arteries of anterior circulation
Which vessels are affects in LACS?
Perforating arteries around the internal capsule, thalamus and basal ganglia
Which vessels are affected POCS?
Vertebrobasillar arteries
What 2 drugs are used for status epilepticus in the community?
Bucal midazolam
PR diazepam
What are the 3 options in treating status epilepticus?
- Lorazepam IV
- Midazolam - buccal
- Diazepam - IV
Repeat dose after 5 mins if no response
Dorsal column - modalities, decusates, ascending or descending?
Ascending
Fine touch and proprioception
Decusates in the medulla
Spinothalamic trace - modalities, decusates, ascending or descending?
Pain temp and deep pressure
Decussates segmentally
Ascending
Corticospinal (pyramidal tract) modalities, decusates, ascending or descending?
fine movement
85% cross at pyramid, 15% segmentally
Descending
Function of tectospinal tract?
Mediates reflex of head and neck movement
Features of brown sequard syndrome?
Ipsilateral paralysis
Ipsilateral loss of fine touch and proprioception
Contralateral loss of pain and them
Ipsilateral hyperreflexia
Myelin producing cells, CNS and PNS??
CNS - oligodendrocytes
PNS - Schwann cells
3 layers of the meninges?
Dura, arachnoid, pia
Where is CSF absorbed?
By arachnoid granulations
4 drug classes in Parkinson’s management?
Levodopa - increases dopamine
Decarboxylase inhibitor (benserazide)
Dopamine agonists - bromocriptine
Catechol - o - methyltransferase inhibitor
4 types of MND?
Amyotrophic lateral sclerosis - UMN and LMN
Progressive bulbar palsy -
Progressive muscular atrophy - LMN signs
Primary lateral sclerosis - UMN
Benign essential tremor , mode of inheritance?
Autosomal dominant
First line treatment of benign essential tremor?
Bisoprolol
What two special tests are positive in carpal tunnel syndrome?
Tinnels - tapping causing parasthesia
Phalens - flexion of wrist causes symptoms
What is the surgical option for carpal tunnel syndrome?
Flexor retinaculum division
Triad of normal pressure hydrocephalus?
Gait disturbance, urinary incontinence, dementia
What is wernickes encephalopathy?
Thiamine deficiency (B1), ophthalmoplegia, ataxia and confusion. Reversible with thiamine - IV (pabrinex) then oral -
What is korsakoffs?
Decreased ability for form new memories and confabulating - as a result of wernickes - irreversible
What is Picks disease?
Frontotemporal dementia
Broca and wernickes area - expressive or receptive dysphasia?
broca - expressive
wernicke - receptive
Management of focal seizures?
Carbemazepine or lamotrigine
Management of absence seizures?
Ethosuximide or sodium valproate
Management of tonic clonic seizures?
- Sodium valproate
2. Lamotrigine
Management of myoclonic seizures?
- Sodium valproate
2. Levetricitam
Management of atone seizures?
sodium valproate
When should treatment be commenced in Parkinson disease?
At the onset of disabling symptoms
What type of intra cerebral haemorrhage had a lucid interval?
Extra dural haematoma
How long much an epileptic patient remain fit free before they can drive?
12 months
How long must you wait to drive after a new seizure?
6 month
Features of TACS?
All 3 of
- Unilateral hemiparesis andor hemisensory loss of face, arm or leg
- Homonymous hemianopia
- Higher cognitive function loss e.g. dysphasia
Features of PACS?
2 of
- Unilateral hemiparesis andor hemisensory loss of face, arm or leg
- Homonymous hemianopia
- Higher cognitive function loss e.g. dysphasia
Features of a lacunar stroke?
1 of the following 1. Unilateral weakness 2. Pure sensory stroke 3. ataxic hemiparesis Can be pure motor or sensory
Features of POCS?
1 of following
- Cerebellar or brainstem symptoms
- Loss of consciousness
- Isolated homonymous hemianopia
What is the difference between simple partial seizures and complex partial seizures?
Simple - no loss of awareness
Complex - loss of awareness
2 features of progressive supranuclear palsy?
Dysarthria and vertical gaze palsy
What effect does exertion have in Lambert eaton myasthenia syndrome?
Improves the weakness
What heart condition are triptans contraindicated in?
IHD
2 features of tuberous sclerosis?
Ash leaf spots, subungual fibromas
What is cataplexy?
Loss of muscle tone caused by strong emotion
What may happen to the hearing in bells palsy?
Hyeracusis
What is syringiomyelia?
Fluid filled cavities in spinal cord, loss of pain and temp sensation are lost
3 features of multi system atrophy?
Parkinsonism
Autonomic disturbance
Cerebellar signs
What is levodopa usually combined with?
Decarboxylase inhibitor (carbidopa)
Acute drugs for migraine?
Triptan, NSAID and paracetamol
Prohpylactic drugs for migraine?
Topiramate and propanolol
Drug to give in SAH?
Nimodipine
How quickly should a patient be seen with a TIA?
Withint 24 hours
What to give for spascicity in MS?
Baclofen
Investigation for myasthenia gravis?
Nerve conduction studies
What nerve might be injured during childbirth or pregnancy?
Lateral femoral cutaneous nerve
Indian ink?
HIV meningitis
How is Huntington’s inherited?
Autosomal dominant
What nerve is affected in carpal tunnel syndrome?
Median