20 cards Flashcards
What is autonomic dysreflexia
Medical emergency caused by SNS stimulation –> HTN -> blockage of PNS below spinal cord injury
Management of autonomic dysreflexia
- Raise head, lower legs, remove restricitve clothing
- GTN patch
red flags for HA
SAINT POISON
Severe
Affected personality
I - eyes - visual changes
Neurological deficit - consciousness, focal, cognition
Triggers - cough, valsalva, postural change, sneeze
Pregnant
Older
Injury
Secondary RFs
Onset sudden
New symptoms/ change in characteristics of the symptoms
common association with myasthenia gravis
Thymomas in 15%
Autoimmune disorders: pernicious anamenia, AI thyroid disorders, rheumatoid, SLE
Thymic hyperplasia 50-70%
Pathophysiology of myasthenia gravis
Autoantibodies against post synaptic anticholinergic receptors
Clin F of myasthenia gravis
Muscle fatigability - get progressively weaker during periods of avtivity and slowly improve after rest:
- extraocular muscle weakness: diplopia
- proximal muscle weakness: face, neck, limb girdle
- Ptosis
- dysphagia
What would the EMG findings be if a patient had neuropathy
increased action potential duration
increased action potential amplitude
What would the EMG findings be if a patient had myopathy
decreased action potential duration
decreased action potential amplitude
Differentials/ causes of ‘tremor’
Parkinsonism pill rolling tremor
Essential tremor
Anxiety
Thyrotoxicosis
Hepatic encephalopathy
Carbon dioxide retention
Cerebellar disease
Trigeminal neuralgia features
Short lived, lightning shock pain in the facial region or jaw
Regular pain and lasts between 1-5 minutes and ends spontaneously
Not associated with autonomic symptoms like lacrimation or rhinorrhea
Triggered by movement of the face- chewing food, yawning or shaving
Cluster headache features
Unilateral HA or eye pain occurring intermittently
Symptom free interval which can last for weeks or moths - then present with attacks of HAs at a rate of 20-30 in a day for 2-3 days
Association with autonomic symptoms - lacrimation, rhinorrhea and Horner’s syndrome
Giant cell arteritis features
Elderly population
Universal pulsatile HA associated with tenderness in the temporal region, elevated ESR and CRP
Tension HA features
Occur due to stressful situations- occur throughout hte day and worsen with exercise
Bilateral pain radiating to the neck or a tension band wrapped around their head
Migraine HA features
Unilateral, pulsatile pain that lasts between 24-48 hours
Associated with photophobia, nausea, vomiting\
Triggered by coffee, chocolates, menstural cycle
When would a carotid endarterectomy be appropriate to perform
Evidence of high grade stenosis 70-99% with a hx of TIA, stoke- strongest benefit if performed within 2 weeks
It is not suitable for complete occulsion
Which nerve is likely to be injured in a humeral shaft fracture
Radial nerve
Features of radial nerve injury
Weak wrist and finger extension (wrist drop)
Reduced sensation over the dorsal aspect of the hand
Def of cauda equina syndrome
Spinal cord compression below l2 vertebral level
Features of cauda equina syndrome
progressive development of saddle anaesthesia, bladder dysfunciton, decreased anal tone
Reduced lower limb refleces, back pain radiating ot lower limbs which is associated with spinal canal stenosis
Features of conus meduallaris syndrome
Sudden onset of LBP radiating to the lower limbs, distal sensory loss, urinary incontinence, perianal numbness
Presents with perianal paraestheis but does not cause saddle anasthesia
Def of conus medullaris syndrome
Damage to SC at T12 to L2
Def central cord syndrome
involving injury to the central region of the spinal cord, affecting both the corticospinal and spinothalamic tracts. Hyperextension injury is the most common cause of this injury, usually from a car crash, but other aetiologies such as syringomyelia and spinal cord compression can contribute to this condition as well.
Clin f of central cord syndrome
bilateral paresis where the upper limbs are more affected than the lower limbs,
Def Brown-Sequard syndrome, or hemisection syndrome
hemisection of the cord with a lesion at the right or left half of the spinal cord. It is commonly caused by trauma (penetrating/crush injuries) but can also be caused by disc herniation, spinal epidural haematoma, or a tumour.
features of brown sequard syndrome
ipsilateral loss of all sensation at the level of the lesion, ipsilateral loss of proprioception below the level of the lesion, and contralateral loss of pain and temperature sensation one or two levels below the lesion.
def anterior spinal cord syndrome
Reduced BF to the anterior segment of the spinal cord via the anterior spinal artery, resulting in ischemic injury to the corticospinal and spinothalamic tracts.
Features of anterior spinal cord syndrome
bilateral loss of motor function and decreased pain and temperature sensation below the level of the lesion
