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BioMed S2 > 14. Nervous System II - Pathologies > Flashcards

14. Nervous System II - Pathologies Flashcards

1
Q

Raised Intracranial Pressure: definition

A

Increase in pressure within the cranial cavity

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2
Q

Raised Intracranial Pressure: pathophysiology

A

Compression of blood vessels leads to reduced oxygen perfusion to the brain

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3
Q

Raised Intracranial Pressure: aetiology

A
  • Tumours - gliomas (primary), metastases
  • Haemorrhage - subdural (venous, slow), subarachnoid (arterial, rapid)
  • Hydrocephalus - excess CSF
  • Meningitis - inflammation of meninges
  • Encephalitis - inflammation of brain tissue
  • Intracranial abscess
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4
Q

Raised Intracranial Pressure: signs and symptoms

A

Headache - worse on awakening*, when coughing or moving head
Vomiting - often without nausea
Visual disturbance - if damage to optic nerve
Pupil fixed/dilated in one eye
Impaired mental state
Altered speech
Seizures
Papilloedema - bulging of the optic disc
Elevated blood pressure, slow irregular pulse, slow breathing

*CSF at daily peak

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5
Q

Hydrocephalus: definition

A

Abnormal accumulation of CSF in the cerebral ventricles and subarachnoid space

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6
Q

Hydrocephalus: pathophysiology

A

Impaired absorption or excessive secretion
Results in ventricular dilation
CSF permeates through the ependymal lining into the surrounding white matter

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7
Q

Hydrocephalus: aetiology - young children

A

Infection or congenital malformation

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8
Q

Hydrocephalus: aetiology - older children/adults

A

Tumour
Trauma
Meningitis

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9
Q

Hydrocephalus: signs and symptoms

A

Headache - worse on awakening - CSF doesn’t drain well whilst lying down
Infants - increase in head circumference and dliated scalp veins
Vomiting, nausea
Blurred or double vision
Neck pain

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10
Q

Hydrocephalus: allopathic treatment

A

Diuretics - inhibit CSF secretion
Shunt, ventricular drain, lumbar puncture

Emergency - to prevent white matter scarring/brain damage/death

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11
Q

Meningitis: definition

A

Infection or inflammation of the meninges

Can be life-threatening if leads to intracranial pressure

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12
Q

Meningitis: aetiology

A

Viral meningitis (herpes simplex) - most common cause (90%). Less severe
Bacterial infection - more serious
Fungal/parasitic micro-organisms
Non-infective - brain tumour

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13
Q

Meningitis: signs and symptoms

A

Can initially resemble flu:
~~~
Fever
Sudden onset of severe headache
Neck stiffness
Photophobia
Vomiting
~~~

Petechiae - small purple/red spots on skin as result of tiny haemorrhages that don’t disappear under pressure (non-blanching)

Kernigs sign - pain resistance to knee extension when lying with the hips fully flexed

Brudzinski sign - neck flexion causes flexion of hip and knee

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14
Q

Meningitis: diagnostics

A

Lumbar puncture: withdraw CSF between L4-L5

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15
Q

Meningitis: complications

A

Swelling
Raised ICP*
Septicaemia
Seizures

*Intracranial pressure

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16
Q

Meningitis: allopathic treatment

A

Antibiotics, antivirals, corticosteroids
Analgesics, antipyretics (to lower temperature)
Intravenous fluids

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17
Q

Concussion: definition

A

Temporary loss of neuronal function

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18
Q

Concussion: aetiology

A

Significant blow to the head

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19
Q

Concussion: signs and symptoms

A

Loss of consciousness
Memory loss of events surrounding the injury
Headache
Disorientation
Nausea/vomiting

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20
Q

Concussion: allopathic treatment

A

Rest
If any consciousness lost, avoid any vigorous activity for 3 months

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21
Q

Cerebral Contusion: definition

A

Traumatic brain injury that causes bruising of the brain with ruptured blood vessels and oedema

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22
Q

Cerebral Contusion: aetiology

A

Blunt blow to the head

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23
Q

Cerebral Contusion: signs and symptoms

A 
Headache
Confusion
Dizziness
Loss of consciousness
Nausea
Vomiting
Seizures
Difficulty with co-ordination/movement
Impaired memory, vision, speech, hearing
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24
Q

Cerebral Contusion: allopathic treatment

A

Medical emergency

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25
Q

Coup injury: definition

A

Injury to the site of primary impact

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26
Q

Contrecoup injury: definition

A

Damage to the brain at a site contra-lateral to the site of trauma

The skull acts to stop acceleration of the brain away from the site of impact, causing damage to the opposite side

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27
Q

Headaches: aetiology

A
  • Dehydration
  • Cervicogenic (from the neck)
  • TMJ* - jaw headache (structural)
  • Tension (muscular)
  • Congested sinuses
  • Hypoglycaemia
  • Migraine/cluster (Trigeminal nerve)
  • Medication - e.g. paracetamol
  • Intra-cranial - e.g. brain tumour, haemorrhage
  • Organ referral

*Temporomandibular joint

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28
Q

Cervicogenic headache:

location, duration, severity, pain character

A

Occipital to frontal/temporal
1 hr to weeks
Moderate to severe
Non-throbbing pain, dull and deep

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29
Q

Tension headache:

location, duration, severity, pain character

A

Diffuse (bilateral)
Hours to days
Mild to moderate
Dull pain

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30
Q

Migraine headache:

location, duration, severity, pain character

A

Retro-orbital (behind eyes)
4-72 hrs
Moderate to severe
Throbbing, pulsating

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31
Q

Cervicogenic headache: aetiology

A

Neck movement, sustained postures

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32
Q

Cervicogenic headache: signs and symptoms

A

Reduced neck range of movement (ROM)

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33
Q

Cervicogenic headache: allopathic treatment

A

Stretching
Supporting neck
Massage

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34
Q

Tension headache: aetiology

A

Stress
Muscle tension

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35
Q

Tension headache: signs and symptoms

A

Reduced appetite
Photophobia

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36
Q

Tension headache: allopathic treatment

A

Rest
Massage
Relaxation

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37
Q

Migraine headache: definition

A

Neurological condition that results in recurrent, severe headaches

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38
Q

Migraine headache: aetiology

A

Strong links with genetics - more common in women
Food allergies
Food additives - tyramine, nitrates, MSG, aspartame, histamine, alcohol
Emotions - stress
Hormonal changes
Poor sleep
Low levels of serotonin (link with digestive function)

Complex series of intracranial vascular changes - vasoconstriction (aura) and subsequent vasodilation (headache)
Induced by cerebral depolarisation - this secretes vasodilators and pain mediators

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39
Q

Migraine headache: signs and symptoms

A

Aura - occurs hours to days before headache (tingling, changes in vision, smell)
Unilateral, pulsating headache (retro-orbital)
Moderate to severe intensity, worsened by movements
Photophobia
Phonophobia
Nausea, vomiting (which can improve symptoms)

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40
Q

Migraine headache: allopathic treatment

A

Analgesics - ibuprofen
5-HT agonists*

Bind to and activate 5-HT (serotonin) receptors in the brain.

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41
Q

Headaches: red flags

A

First onset of headache over 50 yrs old

Thunderclap headache (subarachnoid haemorrhage)

Signs of intracranial pressure:
Worsening morning headaches, uneven pupils, double vision, tunnel vision, papilloedema, vomiting but no nausea

Signs of meningitis:
Headache, neck stiffness, non-blanching rash, positive Kernig/Brudzinski tests

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42
Q

Epilepsy: definition

A

Sudden, hyper-excitable and uncontrolled neuronal activity in the brain

43
Q

Epilepsy: aetiology

A 
Idiopathic
Brain tumour
Cerebral infarction/haemorrhage
Congenital malformation
Head trauma
CNS infections - meningitis
Degenerative brain disease
Some drugs
Chemical imbalances - hypoglycaemia/calcaemia
44
Q

Epilepsy: triggers

A 
Flickering lights
Stress
Drugs/alcohol
Dehydration
Sleep deprivation
Fever
Hypoglycaemia
Pesticides
45
Q

Epilepsy: signs and symptoms

A

Petit mal seizure - non convulsive
Grand mal seizure - convulsive

46
Q

Epilepsy: allopathic treatment

A

Anti-epileptic drugs - gabapentin, sodium valproate (adverse effects)

47
Q

Petit mal seizure: definition

A

Non-convulsive seizure
‘Absence’ seizure
Lasts 10-30 seconds
Mainly in children
Usually no lingering confusion

48
Q

Grand mal seizure: definition

A

‘Tonic-clonic’, convulsive seizure

Tonic phase - contraction of all body muscles, causing patient to fall if sitting or standing

Clonic phase - rapid contraction and relaxation of muscles causing convulsions. Ranging from exaggerated twitches to violent shaking
Usually lasts around 1 min
Followed by physical and nervous exhaustion

49
Q

Spina Bifida: definition

A

Incomplete closure of the embryonic neural tube

Results in failure of the spinal column to fully enclose the spinal cord

50
Q

At what junction does spina bifida usually occur?

A

Lumbosacral junction - L5/S1

51
Q

What are the two types of spina bifida?

A

Spina bifida occulta - overlying skin intact
Spina bifida cystica - visible cystic mass

52
Q

Spina Bifida: risk factors

A

Lack of folate (vit B9) during and before pregnancy
Sodium valproate link

53
Q

Spina Bifida: complications

A

Meningitis*
Hydrocephalus
Reduced bowel and bladder function

*Especially in Spina bifida cystica because openings for bacteria

54
Q

Disc Herniation: definition

A

The nucleus pulposus of the intervertebral disc leaks out into the annulus fibrosus, often compressing the spinal nerves

55
Q

At which junctions are disc herniations likely to affect?

A

Tends to affect discs with the highest fluid content, most commonly L5, S1 (sacrum), then the cervical spine (C1-7)

56
Q

What age group is more likely to be affected by a disc herniation?

A

30-40 yrs old

Discs are most hydrated at this stage

57
Q

Disc Herniation: signs and symptoms

A

Radiating pain (sharp and linear)
Worse in the extremity
Aggravated by coughing/sneezing
Positive straight leg raise test*

*Reproduces the symptoms

58
Q

Disc Herniation: allopathic treatment

A

Manual therapy
Muscle strengthening

59
Q

Sciatica: definition

A

Compression or irritation of the sciatic nerve

60
Q

Sciatica: aetiology

A

Disc herniation at L4/5 or L5/S1
Compression against piriformis muscle
Tumours in spinal canal or pelvis

61
Q

Sciatica: signs and symptoms

A 
Pain in lower back and buttock
Pain radiating down posterior leg - usually unilateral
Pins and needles, numbness
Weak calf muscles and 'foot drop'
Often absent ankle jerk reflex
62
Q

Sciatica: diagnostics

A

Straight leg raise test
Loss of sensation in sciatic nerve dermatome
Absent ankle jerk reflex

63
Q

Sciatica: allopathic treatment

A

Physiology
Steroid injection
Surgery

64
Q

What is the SLRT (straight leg raise test) used to diagnose?

A

Nerve tethering in the lower lumbar spine
A positive SLRT is generally suggestive
of a disc herniation

65
Q

What does a positive straight leg raise test generally suggest?

A

Disc herniation

66
Q

What does a positive straight leg raise test show?

A

Reproduced pain/symptoms in the buttock and posterior leg*

*Sciatic nerve distribution

67
Q

How is a straight leg raise test performed?

A
  1. Patient lies supine
  2. Practitioner raises one leg at a time
  3. Symptoms usually experienced at 45 degrees
68
Q

What is aspartame?

A

A non-carbohydrate artificial sweetener

69
Q

How much sweeter than sugar is aspartame?

A

200 times

70
Q

How many foods and drinks contain aspartame?

A

Approx 6000

71
Q

Why is aspartame considered harmful?

A

Aspartame is a neurotoxin
It has neuroexcitatory properties (excitotoxin)

72
Q

What sort of damage can aspartame cause?

A

Widespread neurological damage
MS
Parkinson’s disease
Balance problems

73
Q

What does a neurological examination test for?

A

Abnormal neurological function

74
Q

What might a neurological examination include?

A

Signs - tremor, rigidity
Motor (power) testing
Cranial nerve exam
Dorsal column testing - light touch, vibration, proprioception
Spinothalamic tract testing - pin prick, temperature
Gait analysis/Romberg’s - proprioception
Cutaneous (i.e. foot) and deep tendon reflexes

75
Q

What does the Romberg’s test assess?

A

Proprioception

76
Q

How is Romberg’s test performed?

A

Ask patient to stand with feet together
Ask patient to close eyes
Maintain position for 20-30s

77
Q

What is a positive Romberg’s test?

A

If patient sways after closing eyes

78
Q

What does a positive Romberg’s test indicate?

A

A problem with the
proprioceptive system
* Damage of dorsal columns in spinal cord
* B12 deficiency

79
Q

What does a knee jerk test assess?

A

Deep tendon reflexes

80
Q

How is a knee jerk test performed?

A

Tap the patellar tendon

81
Q

What can an absent knee jerk indicate?

A

Disc herniation
Peripheral nerve compression
Hypothyroidism

82
Q

What can an exaggerated knee jerk indicate?

A

CNS dysfunction e.g. spinal cord,
MND
Hyperthyroidism

83
Q

What does an ankle jerk test assess?

A

Deep tendon reflexes

84
Q

How is an ankle jerk test performed?

A

Tap the Achilles tendon whilst foot is dorsiflexed

85
Q

What does a knee jerk test simulate?

A

Contraction of the quadriceps muscle

86
Q

What does an ankle jerk test simulate?

A

Plantar flexion of the foot

87
Q

What can an absent ankle jerk indicate?

A

Nerve damage - peripheral neuropathy, sciatic nerve compression
Hypothyroidism

88
Q

What can an exaggerated ankle jerk indicate?

A

CNS dysfunction e.g. spinal cord
MND
Hyperthyroidism

89
Q

How is a plantar response/Babinski sign performed?

A

Stroke the lateral margin of the sole of the foot

90
Q

What is a normal plantar response/Babinski sign?

A

Plantar flexed* toes

*Curled toes

91
Q

What is the Babinski sign?

A

Big toe extending (dorsiflexing) while other toes fan out

Considered normal only below 2years of age, pathological afterwards

92
Q

What does an abnormal plantar response indicate?

A

Corticospinal tract damage
MS
MND

93
Q

How is an abdominal reflex performed?

A

Patient should be supine and relaxed
Practitioner strokes medially across the upper and lower quadrant of abdomen towards the belly button

94
Q

What should happen in an abdominal reflex?

A

Brisk contraction of abdominal muscles

95
Q

What does an absent abdominal reflex indicate?

A

Corticospinal tract damage
MS
MND

96
Q

Who is more likely to be affected by meningitis?

A

Immuno-compromised populations - elderly, HIV, organ transplants, cancer patients

97
Q

Hydrocephalus: diagnostics

A

CT scans
MRI

98
Q

Migraine headache: natural treatment

A
  • Avoid allergens / food intolerances
  • Low GL diet
  • Avoid amine-containing foods (vasodilators) (tyramine, histamine)
  • Magnesium + B6
  • Herbs (e.g. feverfew)
  • Acupuncture, osteopathy.
  • Homeopathy.
99
Q

Brain tumour: pathophysiology

A

Often secondary malignant tumours
Can be primary (originate within the brain).
Gliomas (most common type is astrocytoma).
Meningiomas and pituitary tumours (less aggressive)

100
Q

Brain tumour: signs and symptoms

A
  • Morning headaches, increasing in frequency
  • Nausea and vomiting
  • Uneven pupils and double vision
  • Papilloedema
101
Q

Epilepsy: natural treatment

A

Ketogenic diet (increases GABA that surpresses the excessive electrical activity)
Dietary and supplements: EFAs,
magnesium.
Smoking cessation.
Acupuncture,
Sleep hygiene, stress management. Homeopathy.

102
Q

Disc Herniation: natural treatments

A

Anti-inflammatory
diet
Supplements (bromalaine, tumeric, ginger, boswellia, magnesium, epsom salts, serrapeptase*)
Homeopathy
Herbs
acupuncture.

*proteolytic enzyme, natural anti-inflammatory

103
Q

Sciatica: natural treatment

A

Magnesium, epsom salts (if related to muscle contraction)
Manual therapies
Herbs for pain, nerve support
Acupuncture
Homeotherapy

BioMed S2 (34 decks)

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