Neurology

Hydrocephalus & Headaches

100

List 4 red flags for a serious headache

Any 4 of:

Sudden onset, thunderclap character

RICP headache - morning with nausea, worse lying down/sneezing/coughing

Hx of malignancy, immunosuppression

A/w systemic symptoms - fever, rash, meningism, B symptoms

Focal neurological signs

200

List 6 drugs that can be used to treat an acute attack of migraine

PANTOP

Paracetamol

Antinauseants

NSAIDs

Triptans

Opioids

Paracetamol + antinauseant (e.g. metochlorpramide)

300

Give examples of primary and secondary headaches.

Can you describe the characteristics?

Primary: migraines (throbbing, pulsatile, aura), tension (band-like tightness usually worse at end of day), cluster, trigeminal neuralgia

Secondary: haemorrhage, cerebral venous thrombosis, reversible cerebral vasoconstriction syndrome, toxins, infection (meningitis/abscess), extracranial

400

What are the 2 main types of hydrocephalus?

Obstructive (non-communicating) most common type due to blockage of CSF pathway from ventricles to subarachnoid space

Communicating (non-obstructive) due to impaired reabsorption of CSF at arachnoid villi along dural venous sinus, usually due to SAH or infection

500

What are the features of normal pressure hydrocephalus? How is it treated?

Gait apraxia/magnetic gait

Dementia

Urinary incontinence

Place a ventriculoperitoneal shunt to drain excess CSF from ventricles into systemic circulation through peritoneum

Trauma

100

Where are the bridging veins located? If ruptured, where would the haematoma be?

Subdural haemorrhage

200

What are cerebral contusions and the subtypes?

A primary, focal injury to the CNS causing the brain to move and be crushed by violent contact with the skull or dura membranes

COUP LESIONS = contusions occurring at the site of impact (same side of impact)

CONTRECOUP LESIONS = contusions occurring opposite to the site of impact (other side of head)

300

What is an epidural haemorrhage? How do they present? How does it occur?

Rupture of middle meningeal artery in epidural space

Initial loss of consciousness immediately after head injury

Regain consciousness and return to baseline

Then rapidly decline

Commonly due to skull fracture

400

Clinical features of a patient with trauma to the corticospinal tract? What would they report below the level of the lesion?

Ipsilateral weakness below the level of the lesion

Corticospinal tract runs from cortex, decussates in medulla, then descends down spinal cord to LMN innervating the limbs. Since it decussates in the brainstem, the symptoms will be on the ipsilateral side to the lesion.

500

What are 4 types of brain herniation?

Cingulate (subfalcine) under falx cerebri

Transtentorial (central)

Uncal

Cerebellar tonsillar herniation into foramen magnum

Anatomy

100

Where are the Broca's and Wernicke's areas located? What do they control?

Broca's in frontal lobe - expressive speech and fluency

Wernicke's in temporal lobe - comprehension

200

Describe the flow of CSF

Lateral ventricle (cerebral hemispheres)

Interventricular foramina

3rd ventricle (diencephalon)

Cerebral aqueduct

4th ventricle (dorsal to pons)

Lateral (2) and median (1) apertures

Subarachnoid space

Reabsorbed into venous circulation through dural venous sinuses through the arachnoid granulations

300

What does the middle cerebral artery supply and how might someone with an MCA stroke present?

Lateral cortex - frontal (motor, Broca), parietal (sensory), temporal (Wernicke)

Weakness upper limbs > lower, contralateral

Contralateral hemisensory loss

Broca or Wernicke in DOMINANT only

400

What cranial nerves are involved in the following:

Pupil light reflex

Jaw jerk

Gag reflex

Pupil light reflex - CN II afferent, CN III efferent

Jaw jerk - CN V3 afferent and efferent

Gag - CN IX afferent, CN X efferent

500

Describe the blood supply to the brain.

Anterior circulation arises from ICA - MCA (lateral cortex), ACA (medial cortex) with lenticulostriate branches

Posterior circulation arises from vertebral artery

Vertebral gives off meningeal, spinal, PICA, basilar, pontine, superior cerebellar, PCA

Pathology

100

Which tumour is histologically described as a 'fried egg with chickenwire capillaries'

Oligodendroglioma

200

What is a LMN lesion? How do they present compared to an UMN lesion?

LMN signs - hyporeflexia, hypotonia, paralysis/paresis, muscle atrophy

UMN signs - hyperreflexia, hypertonia, clonus, paralysis/paresis, Babinski

300

What is a lacunar infarction? How does it occur?

Hyaline arteriolosclerosis of lenticulostriate arteries supplying the basal ganglia, internal capsule, thalamus 

A/w hypertension and diabetes

Pure sensory (thalamus)

Pure motor (internal capsule)

Sensorimotor (mixed)

400

Glioblastoma - derivative, location, spread?

Derived from astrocytes

Usually in cerebral hemispheres

Can cross the corpus callosum = 'butterfly tumour' but does not metastasise outside nervous system

Clinical

100

When testing reflexes, what myotome is involved in knee, ankle, and plantar (Babinski) reflexes?

Knee - L3, L4

Ankle - S1, S2

Plantar - L5, S1, S2

200

Clinical features of raised intracranial pressure?

Cushing triad = HTN, bradycardia, irregular breathing

Altered consciousness

Headache

Nausea, vomiting

Papilloedema

300

What is lymphocytic meningitis? Describe the typical course of disease and CSF findings.

Self-limiting, benign disease

Fever, meningism (headache, neck stiffness, photophobia), altered mental state

CSF - clear, normal glucose, mildly elevated protein, lymphocytes +++