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DPD 2019 > Acute neurological complaints > Flashcards

Acute neurological complaints Flashcards

1
Q

T/F the brain is insensate

A

T

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2
Q

What structures in the head can cause headache, given that the brain iteself is insensate

A

Traction or dilatation of intracranial vessels

Traction of large extra cranial veins

Compression, traction or inflammation of cranial and spinal nerves

Meningeal irritation and raised intracranial pressure

Spasm or trauma to cranial or cervical muscles

Disturbance of serotonergic projections

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3
Q

Primary headaches

A

Migraine
Tension Type
Cluster Headache
Other primary head aches

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4
Q

Secondary headaches causes

A 
Head or neck trauma
Vascular disorder
CNS Infection
Intracranial Pressure disorder
Metabolic disorders
Drug withdrawal disorders
Headache psychiatric disorder
Dental, ENT or ocular problem
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5
Q

What examinations and investigations would you do for headache

A 
Full neuro exam
Fundoscopy
Miningism
Systemic exam
Temperature
Blood pressure

Imaging and tests

CT, MRI
ESR bloods
LP

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6
Q

Red flags for headache

A

Age of onset middle aged to elderly (>50)

Abrupt and severe onset (thunderclap)

Progressively severe or increasing frequency

Significant change in headache pattern or new headahce

Meningism, focal signs, confusion, altered LOC

Abnormal examnation, fever, weight loss

Posture, valsalvar, coughing exertion

Systemic disease, cancer, HIV, 3rd trimester, pregnancy postpartum, recent head injury

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7
Q

What is the third type of headache classification after primary and secondary

A

Cranial neuralgias

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8
Q

….

A

…

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9
Q

……….

A

…….

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10
Q

………

A

………

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11
Q

………

A

…….

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12
Q

…….

A

……..

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13
Q

What position makes ICP higher

A

Lying down

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14
Q

What proportion of those with SAH present with acute onset severe headache as the only symptom

A

1/3 present with acute onset severe headache as the only symptom

5-11% misdiagnosed commonly as migraine

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15
Q

Describe headache onset with SAH

A

Abrupt, sudden, acute, thunderclap (over seconds or minutes)

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16
Q

What is the sensitivity of SAH on CT scan

A

At 12hrs- 98%

3 days 80%

1 week 50%

After 3 weeks 0%

Even if done 12 hours from headache onset 2% will have SAH with normal scan.

17
Q

What else should be done if you expect SAH other than CT scan

A

LP should be carried out 12 hours from symptom onset for detection of xanthochromia

From 12 hours up to 2 weeks xanthochromia is reliable for the presence of SAH using Spectrophotometry

18
Q

Other causes of thunderclap headache other than SAH

A

IC infection:
Meningitis

CSF pressure related:

  • 3rd ventricle colloid cyst
  • Spontaneous intracranial hypotension

Vascular:

  • Ischaemic and haemorrhagic stroke
  • Cerebrovenous thrombosis
  • Cervical arterial dissection
  • Pituitary apoplexy

Acute hypertensive crisis

19
Q

For what time period is xanthochromia reliable for detecting presence of SAH?

A

From 12 hrs to 2 weeks!……………

20
Q

What are the parts of the peripheral vs the central vestibular system

A

Peripheral:
Semicircle canals
Vestibular nerve

Central:
Brainstem
Cerebellum

21
Q

Peripheral causes of vertigo

A

BPPV
Meniere’s
Vestibular Neuritis

22
Q

Central cuases of vertigo

Would you be worried about isolate nystagmus?

A

Other CNS deficits

But 4% of isolated nystagmus is caused by stroke

23
Q

Why is it important to establish whether double vision is horizontal or vertical

A

Most common causes of horizontal diplopia are VIth nerve palsy and internuclear ophthalmoplegia (in MS).

Horizontal diplopia that appears only after a prolonged near vision is highly pointing towards a convergence insufficiency (most common in patients with Parkinson’s disease).

Vertical diplopia may be a sign of thyroid eye disease, cranial nerve palsy, skew deviation, or Browns syndrome

24
Q

What would you find on examination of 3rd nerve palsy

A
  • Ptosis (70% of L paplebrae by Parasympathetic III fibres) – may be complete
  • Mydriasis with decreased direct and consensual constriction
  • Inferio-lateral deviation of eye in primary position
  • Diplopia on upwards and inwards gaze
  • Loss of accomodation
25
Q

List the components of the UMN and the LMN

A

UMN:
Brain
Brain stem
Spinal Cord

LMN:
Lower motor neurone
Neuro-muscular junction
Muscle

26
Q

Where is the lesion if the eye can look up at the start but then fatigues

A

Fatigability - myasthenia gravis

This is a problem at the NMJ

27
Q

What is intra-nuclear opthalmoplegia, and what are the differentials for a young and old patient

A

Most nystagmuses are biocular unless in a medial pontine stroke, where the unilateral medial longitudinal fasciculus is affected. Patient will present with contralateral internuclear opthalmoplegia (INO). If the right medial longitudinal fasciculus is damaged, and patient is instructed to look to the left, the right eye will not look to the left (fails to adduct) while the left eye has horizontal nystagmus.

This is because the medial longitudinal fasciculus function is for concurrence contraction of medial rectus muscle and lateral rectus muscle on adduction gaze. Any lesion that damages the unilateral medial longitudinal fasciculus can produce INO.

In young patients with bilateral INO, multiple sclerosis is often the cause. In older patients with one-sided lesions a stroke is a distinct possibility. Other causes are possible

NOTE THAT THEY GET HORIZONTAL DIPLOPIA TOO WHEN THEIR EYES DO NOT COORDINATE., BUT ACCOMMODATION IS MAINTAINED

28
Q

What are the symptoms in horners syndrome

A

Mild ptosis
Moisis
Anhdrosis
Enophalmos

29
Q

The forehead is spared in which type of lesion

A

In the UMN lesion, there is still bihemispheric innovation of of the frontalis muscle

But if LMN then there is one sided paralysis which doesn’‘t spare one side of the face

30
Q

What is bright on CT scan and what is dark

A 
Bright: 
Blood
Contrast
Bone
Calcium
Metal

Dark:
Aiqr
CSF/H20
Oedema

31
Q

Intra-cerebral haemorrhage why is it an issue

A 
Pressure of increasing amounts of blood 
Blood itself (blood is irritating to the brain tissue, causing it to swell)
32
Q

Causes of intracerebral haemorrhage

A 
Hypertension 
Rupture of an aneurysm or AVM 
Haemorrhagic necrosis (eg tumour, infection) 
Venous outflow obstruction (CVT)
Trauma 
Altered haemostasis
33
Q

How could infection lead to the appearance of a haemorrhage

A

Can lead to abscess

34
Q

Which maneuvre can be used to test for BPPV

A

Hallpike

DPD 2019 (30 decks)

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