Comprehensive Neurology Review – Flashcards

A set of high-yield Q&A flashcards covering neuro-anatomy, motor and sensory pathways, neurological examination, movement disorders, cerebrovascular disease, epilepsy, neuromuscular junction disorders, peripheral neuropathies, intracranial pressure, CNS infections, headaches and tumours – designed for efficient exam revision.

Which two main parts constitute the Central Nervous System (CNS)?

Brain (intracranial) and spinal cord (inter-vertebral).

Name the four lobes of each cerebral hemisphere and one major function of each.

Frontal – voluntary motor control; Parietal – somatic sensation; Temporal – hearing; Occipital – vision.

What structure connects the two cerebral hemispheres?

Corpus callosum.

Which cranial nerves have motor nuclei in the midbrain?

Cranial nerves III and IV.

Which cranial nerves have motor nuclei in the pons?

Cranial nerves V, VI and VII.

Which cranial nerves have motor nuclei in the medulla?

Cranial nerves IX, X, XI and XII.

How many spinal cord segments are there in total?

31 segments (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal).

Where does the pyramidal (corticospinal) tract decussate?

In the lower medulla (pyramidal decussation).

Which tract carries pain and temperature sensation?

Lateral spinothalamic tract.

Which ascending tract carries vibration and position sense?

Dorsal columns (gracile and cuneate fasciculi).

Give two distinguishing clinical features of an Upper Motor Neuron lesion.

Hypertonia (spasticity) and hyperreflexia with possible Babinski sign.

Give two distinguishing clinical features of a Lower Motor Neuron lesion.

Flaccid weakness with fasciculations and hyporeflexia/areflexia.

What does a positive Hoffmann reflex indicate?

Upper motor neuron lesion above C7 level.

What combination of signs suggests a mixed UMN + LMN lesion?

Extensor plantar response with absent ankle reflex (e.g., in subacute combined degeneration).

List four functions of the cerebellum.

Coordination of voluntary movement, maintenance of equilibrium, regulation of muscle tone, and learning of motor skills.

Differentiate sensory vs cerebellar ataxia using the Romberg test.

Sensory ataxia worsens with eyes closed (positive Romberg); cerebellar ataxia is present with eyes open or closed.

What are the three orders of neurons in any somatic sensory pathway?

First-order cell in dorsal root ganglion, second-order cell in spinal cord/medulla, third-order cell in contralateral thalamus.

Define hemiplegia.

Paralysis of one side of the body due to pyramidal tract lesion from cortex to C5.

Give two common vascular causes of hemiplegia.

Thrombosis/embolism of cerebral arteries and intracerebral haemorrhage.

What is Brown-Séquard syndrome?

Hemisection of the spinal cord causing ipsilateral UMN weakness & dorsal column loss, with contralateral pain/temperature loss below lesion.

Name four types of tremor and the system each implies.

Resting (basal ganglia), intention/kinetic (cerebellum), postural (nonspecific/physiologic), flapping asterixis (metabolic encephalopathy).

Describe the typical Parkinsonian gait.

Festinating, shuffling steps with reduced arm swing and flexed posture.

What triad defines Parkinson's disease?

Bradykinesia, rigidity, resting tremor.

Which neurotransmitter is deficient in Parkinson’s disease?

Dopamine in the substantia nigra/basal ganglia.

Why is levodopa combined with carbidopa or benserazide?

To inhibit peripheral decarboxylation, increasing CNS availability and reducing side-effects.

What is the first-line drug for acute migraine attack?

NSAID (e.g., ibuprofen) ± anti-emetic; sumatriptan for severe attacks.

List one prophylactic drug class for frequent migraine.

β-blockers (e.g., propranolol) or valproate, amitriptyline, topiramate, etc.

Define epilepsy.

Disorder of recurrent unprovoked seizures due to abnormal cortical electrical discharges.

What distinguishes simple from complex partial seizures?

Consciousness is preserved in simple partial; impaired in complex partial.

Which antiepileptic is preferred for absence (petit-mal) seizures?

Ethosuximide (or valproate).

Outline first-line management steps in status epilepticus.

Airway/oxygen, IV lorazepam or diazepam; if persists give IV phenytoin/fosphenytoin; escalate to phenobarbital or anaesthesia if refractory.

What autoantibody is typical in myasthenia gravis?

Anti-acetylcholine receptor antibody (AchR-Ab).

Which bedside test gives rapid confirmation of myasthenia gravis?

Edrophonium (Tensilon) test showing transient improvement in strength.

Name two drugs that worsen myasthenia gravis and should be avoided.

Aminoglycosides (e.g., gentamicin) and propranolol (also quinine, ciprofloxacin, etc.).

What is Guillain-Barré syndrome?

Acute autoimmune demyelinating polyneuropathy causing ascending flaccid paralysis.

Which antecedent infection is most often linked to Guillain-Barré syndrome?

Campylobacter jejuni gastroenteritis.

What classic CSF finding supports GBS diagnosis?

Albuminocytologic dissociation – high protein with normal/low cell count.

State two indications for plasma exchange or IVIG in GBS.

Rapid progression with weakness <4 weeks, or respiratory compromise/bulbar involvement.

Which motor neuron disease shows combined UMN and LMN signs?

Amyotrophic lateral sclerosis (ALS).

In ALS, which functions are usually spared until late?

Sensory modalities, ocular movements, and bowel/bladder control.

List three common causes of peripheral polyneuropathy.

Diabetes mellitus, chronic alcohol misuse, vitamin B12 deficiency (also CRF, drugs, toxins).

What sensory pattern is typical for peripheral polyneuropathy?

Symmetrical glove-and-stocking sensory loss, distal > proximal.

How does cerebellar tumour often present in children?

Truncal ataxia, nystagmus, headache and vomiting due to posterior fossa mass (e.g., medulloblastoma).

Give four general clinical signs of raised intracranial pressure.

Morning headache, projectile vomiting, papilloedema, bradycardia with hypertension (Cushing response).

Which herniation syndrome causes dilated, fixed ipsilateral pupil?

Uncal (transtentorial) herniation compressing cranial nerve III.

What is the most sensitive initial imaging test for suspected acute intracerebral haemorrhage?

Non-contrast CT head.

List two absolute contraindications to lumbar puncture.

Signs of raised ICP/mass lesion with papilloedema or focal deficit; uncorrected coagulopathy/platelets <40 000.

Give normal CSF values for opening pressure, cells and protein.

Pressure 60-150 mm H₂O; cells <5 lymphocytes/mm³; protein 0.2-0.4 g/L.

How does bacterial CSF differ from viral CSF?

Bacterial: turbid, neutrophils >1000, low glucose, very high protein; Viral: clear, lymphocytes, normal glucose, mild ↑protein.

What organism most commonly causes bacterial meningitis in adults?

Streptococcus pneumoniae.

First empirical antibiotics for suspected adult bacterial meningitis?

IV 3rd-generation cephalosporin (e.g., ceftriaxone) plus vancomycin (± ampicillin for Listeria coverage).

Why is dexamethasone given before or with first antibiotic dose in meningitis?

Reduces inflammatory response, lowering risk of deafness and neurologic sequelae.

Describe classic ‘thunderclap’ headache and its principal cause.

Sudden severe worst-ever headache peaking within seconds; characteristic of subarachnoid haemorrhage due to ruptured berry aneurysm.

Which vessel is most often involved in berry aneurysm rupture?

Anterior communicating artery junction.

Name three major complications after subarachnoid haemorrhage.

Re-bleeding, cerebral vasospasm/ischemia, hydrocephalus (also seizures, hyponatremia).

What medication is routinely given to reduce vasospasm after SAH?

Nimodipine (calcium-channel blocker).

What visual field defect results from pituitary macroadenoma?

Bitemporal hemianopia (upper quadrants first in intrasellar, lower in suprasellar lesions).

Which tumour is most common in the cerebellopontine angle?

Acoustic (vestibular) schwannoma.

Give three presenting features of vestibular schwannoma.

Unilateral sensorineural hearing loss, tinnitus, and ipsilateral cerebellar signs (e.g., ataxia) ± facial numbness.

What are the diagnostic criteria for benign intracranial hypertension (pseudotumor cerebri)?

Raised ICP symptoms, normal consciousness, no focal signs except VI palsy, normal imaging (no mass/hydrocephalus), CSF high opening pressure with normal composition.

First-line treatment for benign intracranial hypertension.

Weight loss and acetazolamide; serial LP or shunting if vision threatened.

Differentiate cluster from migraine headache by key features.

Cluster: severe periorbital pain, male, autonomic signs, short (15-90 min) recurrent in clusters; Migraine: throbbing hemi-cranial pain, photophobia, hours-long, often with aura, female predominant.

What drug can abort an acute cluster headache?

High-flow 100 % oxygen and/or subcutaneous sumatriptan.

Define trigeminal neuralgia.

Brief paroxysms of lancinating facial pain along trigeminal branches, triggered by light touch or movement.

First-line medical therapy for trigeminal neuralgia.

Carbamazepine (alternatives: oxcarbazepine, gabapentin).

Which organism is associated with Waterhouse-Friderichsen syndrome?

Neisseria meningitidis causing fulminant meningococcal septicaemia with adrenal haemorrhage.

What CSF pattern is typical for tuberculous meningitis?

Clear/slightly cloudy, lymphocytic pleocytosis, markedly ↑protein, ↓glucose, forms cobweb clot on standing.

List four essential components of first-line antituberculous therapy.

Isoniazid, rifampicin, pyrazinamide, ethambutol (plus corticosteroids for TB meningitis).

Name two inherited peripheral neuropathies.

Charcot-Marie-Tooth disease and Friedreich’s ataxia.

What cardiac arrhythmia is an important source of embolic stroke?

Atrial fibrillation.

Define a Transient Ischemic Attack (TIA).

Focal neurological deficit due to vascular cause resolving completely within 24 hours (usually <1 hour).

Recommended antiplatelet therapy after non-cardioembolic ischemic stroke.

Aspirin 300 mg then 75-100 mg daily (or clopidogrel 75 mg if aspirin-intolerant).

When is carotid endarterectomy indicated after TIA/stroke?

Symptomatic internal carotid stenosis >70 % (50-69 % in selected cases).

What does the ‘on-off’ phenomenon refer to in Parkinson’s therapy?

Sudden fluctuations between mobility and akinesia related to levodopa dosing in advanced disease.

Which movement disorder presents with rapid, purposeless, dance-like movements?

Chorea (e.g., Huntington disease, rheumatic chorea).

What is pseudobulbar palsy and one key distinguishing sign from bulbar palsy?

Bilateral UMN lesion of corticobulbar tracts; exaggerated jaw jerk present, whereas it is absent in LMN bulbar palsy.