2. Intro to neurology

Question 1

Diagnosing neurological problems

Answer 1

Signs and symptoms to characterise underlying anatomy and characterise syndrome
Mode of onset to determine aetiology/ pathological cause

Question 2

Infarct and haemorrhage as causes of stroke

Answer 2

80% blockage of a vessel (infarct)

20% haemorrhage

Question 3

How does stroke affect the brain?

Answer 3

Can affect any part of brain

Tends to cause problems on the side of brain lesion

Question 4

Risks/ causes of stroke

Answer 4

Infarcts often caused by clot from carotid arteries or heart
Haemorrhage often related to high BP
Smokers, diabetics and alcoholics are at higher risk

Question 5

Consequences of stroke

Answer 5

If spinal cord/ brain damaged leads to upper motor neurone weakness
Bent arm and stiff leg
Symptoms relate to which artery in brain is affected
Left side of brain responsible for language so strokes on left can cause aphasia

Question 6

Stroke affecting middle cerebral artery

Answer 6

Results in weakness (mostly in arms but also legs)

Loss of sensation on the other side (contralateral)

Question 7

Stroke affecting posterior cerebral artery

Answer 7

affect occipital lobe-result in visual loss on the contralateral side in both eyes
(e.g. Right sided stroke results in loss of vision of left side in both eyes)

Question 8

Stroke affecting anterior cerebral artery

Answer 8

Contralateral leg weakness

Question 9

Stroke affecting brainstem

Answer 9

Cause problems with balance, eye movements, speech and swallowing (Cranial Nerves), breathing

Question 10

Stroke treatment

Answer 10

Acute:
IV Thrombolysis: dissolve the clot 
Intra-arterial Thrombectomy: remove clot 
Treat Complications:
Surgery for haemorrhage or dangerously high pressure 
Prevent Further Stroke:
Thin blood with aspirin 
Treat Diabetes and high Cholesterol 
Treat narrow Carotid Arteries

Question 11

Parkinson’s Disease

Answer 11

Slowly progressive degenerative disease affecting the basal ganglia
Loss of neurones from substantia nigra to the caudate and putamen
Asymmetric

Question 12

Main clinical features of Parkinson’s disease

Answer 12

Rigidity (stiffness)
Tremor (shaking)
Bradykinesia (reduced movement)

Question 13

What neurotransmitter is associated with Parkinsons? Why?

Answer 13

Dopamine

Dopaminergic neurones are dying

Question 14

What drug is used to treat Parkinsons?

Answer 14

Levodopa

Dopamine does not cross blood brain barrier but levodopa crosses BBB and is converted into dopamine

Question 15

Causes of Spastic Paraparesis

Answer 15

Trauma 
Inflammatory/Autoimmune (eg MS) 
Neoplastic (e.g. Spinal Cord Tumour) 
Degenerative (MND) 
Vitamin Deficiency (B12) 
Infection (e.g. Syphilis, Viral) 
Vascular (Anterior Spinal Artery Thrombosis)

Question 16

Causes of Acute Polyneuropathy

Answer 16

Infections eg. Diphtheria
Autoimmune (eg Guillain Barre Syndrome)
Drugs (Chemotherapy)
Exposure to toxins (organophosphate insecticides)

Question 17

Investigations for neurological problems

Answer 17

Brain Scans: CT, MRI
Cerebrospinal fluid (CSF): Lumbar puncture
Nerve Conduction Studies and Electromyography (EMG)
Electroencephalogram (EEG) and Evoked Potentials
Brain pathology: damage to cells or larger structures