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Flashcards in Deck 2 - neuro Deck (28)
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1
Q

Q. What type of stroke is the most common?

A

A. 85% are embolic (10% are haemorrhagic, 5% have rarer causes)

2
Q

Q. In what layer do the a) meningeal vessels, b)bridging veins, c) circle of wilis lie?

A

A. Meningeal vessels: extradural space

B. Bridging veins: cross the subdural space

C. Circle of wilis: subarachnoid space

D. There are no vessels deep to the pia – the pia forms part of the BBB

3
Q
  1. Q. What causes an extradural haemorrhage?
A

A. Traumatic – fractured skull

B. Causes bleeding from the meningeal arteries

C. There is a lucid period then a rapid rise in inter-cranial pressure – - coning and

death if not treated!

4
Q

Q. What occurs in a subdural haemorrhage, who is this most likely to occur in?

A

A. Bleeding from the bridging veins – these are low pressure so bleed soon stops,

days or weeks later the haematoma starts to autolyse. There is a massive

increase in osmotic and oncotic pressure which sucks water into the haematoma

B. Gradual rise in ICP over many weeks

C. Commonly occurs in pts with small brains (alcoholics, elderly with dementia),

also occurs in “shaken babies”

5
Q

Q. What occurs in a subarachnoid haemorrhage? Name three features of clinical

presentation

A

A. Rupture of the arteries forming the circle of willis (often due to berry enurysms)

B. Thunderclap headache: sudden onset of severe headache, photophobia and

reduced consciousness, rapidly fatal

6
Q

Q. Describe the management of a subarachnoid haemorrhage

A

(CT, LP, angiography), resuscitation, nimodipine, early intervention to prevent re- bleeding, monitor

7
Q

Q. Where is a traumatic blow to the pterion likely to rupture?

A

Anterior division of the middle meningeal artery causing an extradural (aka epidural) haematoma. The pterion may also be fractured indirectly by high force blows to the top or back of the head.

8
Q

Q. Name 3 forms of primary headache and 3 forms of secondary headache

A

A. Primary: tension, cluster, migraine

B. Secondary: meningitis, subarachnoid haemorrhage, GCA, idiopathic intracranial

HTN, medication overuse headache

9
Q

Q. Name five features that require urgent investigation due to increased brain tumour risk (red)

A

A. New headache with Hx cancer, cluster headache, seizure, significantly altered

consciousness, memory, confusion, coordination, papilledema, other abnormal

neuro exam or symptom

10
Q

Q. Name five features that require monitoring due to mod brain tumour risk

(orange)

A

New headache where diagnostic pattern not emerged after 8 weeks,

exacerbated by exercise or Valsalva (e.g. coughing, laughing, straining), headache

associated with vomiting, headache increasing in frequency, new headache if

> 50yrs, headache that wakes pt from sleep, confusion

11
Q

Q. Name four features of headache examination

A

Any fever? altered consciousness, neck stiffness (Kernigs sign), focal neurological

signs (fundoscopy)

12
Q

Q. Describe the features of migraine without aura

A

A. 5 attacks with the following:

B. Attacks last 4-72 hours

C. Two of the following: unilateral, pulsing, mod/severe, aggravation by routine

physical activity

D. During headache at least one of: Nausea/vomiting, photophobia and

phonophobia

E. Not attributed to another disorder

13
Q

Q. Describe the features of infrequent tension type headache

A

A. ≥ 10 attacks occurring < 1 day/moth (<12 days/year) and fulfilling B-D

B. Headache lasting from 30 minutes to 7 days

C. Headache has two of the following characteristics:

  1. Bilateral
  2. Pressing/tightening (non pulsating) quality
  3. Mild or moderate intensity
  4. Not aggravated by routine physical activity (e.g. walking or climbing stairs)

D. Both of the following: 1. No nausea or vomiting (anorexia may occur) 2. No more

than one of photophobia and phonophobia

E. Not attributed to another disorder

14
Q
  1. Q. Describe the features of cluster type headache
A

A. At least five headache attacks fulfilling criteria B-D

B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting

15-180 minutes if untreated

C. Headache is accompanied by ipsilateral cranial autonomic features and/or a sense

of restlessness or agitation

D. Attacks have a frequency from 1 every other day to 8 per day

E. Not attributed to another disorder

15
Q
  1. What is the difference between episodic and chronic cluster headache?
A

A. Episodic ≥ 2 cluster periods lasting 7 days to 1 year separated by pain free periods lasting ≥1 month

Chronic attacks occur for more than 1 year without remission or with remission lasting

16
Q

Describe the features of Classical Trigeminal Neuralgia

A

A. At least three attacks unilateral facial pain fulfilling B and C

B. Occurring in one or more distributions of the trigeminal nerve, with no radiation

beyond the trigeminal distribution

C. Pain has at least three of the following four characteristics:

  1. Reoccuring in paroxysmal attacks from a fraction of a second to 2 minutes
  2. Severe intensity
  3. Electric shock like, shooting, stabbing or sharp
  4. Precipitated by innoculous stimuli to the affected side of the face

D. No clinically evidence of neurological deficit

E. Not better attributed to another diagnosis

17
Q

Q. Three abortive treatments of migraine

A

A. Oral triptan and an NSAID, aspirin, paracetamol

B. Anti-emetic as an additional tx for migraine

18
Q

Q. Three preventative treatments for migraine

A

A. Topiramate or propranolol, acupuncture, gabapentin

B. Riboflavin, Bot tox A for prophylaxis of chronic migraine

19
Q

Q. Name 4 possible features of raised intracranial pressure

A

A. Worse on waking, worse on coughing, sneezing, straining, worse when lying

down, nausea & vomiting, +- papilloedema (+- focal signs)

20
Q

Q. Name 5 features that could be suggestive of meningitis

A

A. Headache with: pyraxial, photophobia, neck stiffness, +- Kernig’s sign, pyrexia, rash, reduced GCS, Brudzinski’s sign

21
Q

Q. Who is at a higher risk of idiopathic intracranial hypertension?

A

A. Obesity, certain drugs e.g. tetracycline

B. headache of raised intracranial pressure, visual disturbances (acuity, fields),

papilloedema

C. Ix: CT, high LP opening pressure

D. Mx: modify RF, monitor visual fields, drugs (Acetazolamide/topiramate/diuretics)

22
Q

Q. Name 3 presenting features associated with giant cell arteritis

A

A. New headache or type of localized pain, tenderness/decreased pulsation of

temporal artery (age>50, elevated ESR, abnormal biopsy)

B. Jaw claudication, visual symptoms, associated with PMR

C. Start high dose steroids – refer for biopsy

23
Q

Q. What two features would be seen in the eye of a patient with a 3 rd nerve palsy?

Give a medical cause and a surgical cause

A

A. Depressed and abducted (down and out) – because CN3 damaged so only 2&6

functions left

B. Fixed dilated pupil

Medical: microinfarction (acute onset)

Surgical: brain tumor – longer onset

24
Q

Q. What may be seen in lateral medullary syndrome?

A

A. Ipsilateral side: Horner’s syndrome (ptosis, droopy eyelid), hypohydrosis (reduced

sweating), meiosis, limb ataxia, loss of pain and temp sensation on face, reduced

corneal reflex, dysarthria, dysphagia

B. Contralateral: loss of pain and temp sensation

25
Q

Q. What is a slow nerve conduction study suggestive of? What is a small nerve

conduction study suggestive of?

A

A. Small – axon loss

B. Slow – demyelination (MS?)

26
Q

Q. What may slow/big motor units on electromyography be suggestive of?

A

A. Big motor units = nerve or motor neuron pathology

B. Small motor units = muscle pathology e.g. entrapments, axonal neuropathy etc

Myopathy = NCS normal, EMG shows small waves (multiple nerves show the bigger

picture)

27
Q

Q. How may Myasthenia Gravis be seen on EMG?

A

A. Jitters – the time between two muscle fibers contracting varies

28
Q

Q. What investigation can be used evaluate the spinal cord and optic nerves?

A

A. Somatosensory evoked potentials

Slow – MS, also used for pt monitoring in spinal cord surgery

B. Visual evoked potentials, transcranial magnetic stimulation