Common neurological disorders Flashcards
what are some common neurological disorders?
- Epilepsy
- Multiple sclerosis
- Parkinson’s disease
- Sciatica
- Cerebral palsy
- Down’s syndrome
- Stroke and TIA
- Dementia
- Retinal degeneration
- Neoplasm
What are the impacts of neurological diseases?
- Abnormal sensory function
- Abormal motor function
- Abnormal co ordination
- Abnormal organic function
- Abnormal cognitions
Is carpal tunnel syndrome more common in men or women?
women
What is the carpal tunnel?
it is where the median nerve passes in the wrist
What forms the carpal tunnel?
It is formed by a ring of bones and tough tendon
What is the significance of the Median nerve?
provides motor (movement) functions to the forearm, wrist, and hand.
It also sends touch, pain, and temperature sensations from the lower arm and hand to the brain.
what does a pinched median nerve cause?
carpal tunnel syndrome
What happens in carpal tunnel syndrome
Swelling at the carpal tunnel leading to the compression of the median nerve
When might the carpal tunnel be swollen?
- Pregnancy
- Obesity
- Structural damage to the wrist
What is sciatica?
It is where the sciatic nerve, which runs from your lower back to your feet, is irritated or compressed causing symptoms.
What is the sciatic nerve?
The largest nerve arising from the spinal cord
What are the symptoms of sciatica?
-Mild backache =minor nerve compression)
-Severe pain shooting down the leg which may be accompanied by numbness and loss of motor power (major nerve compression)
What are the impacts of neurological diseases?
- Abnormal sensory function
- Abnormal motor function
- Abnormal co ordination
- Abnormal organic function
- Abnormal cognitions
What is sciatica commonly caused by?
caused by the compression of one or more of the 6-6 nerve roots arising from the distal end of the spinal cord
Most commonly due to prolapsed intervertebral disk (slip disk)
how is sciatica managed ?
by Rest or
Surgical decompression
what is a seizure?
temporary abnormal electrical activity in a group of brain cells that may spread to involve other parts of the brain causing stiffness or jerking of arms/legs
another term for a seizure is>
convulsion
What is a seizure characterised by
Range of clinical features
Duration of a few seconds or minutes
What can seizures be broadly divided into?
Epilepsy
2. Other seizures
define epilepsy?
A group of disorders with many different causes all of which are characterised by a tendency to have recurring unprovoked seizures
Name the different types of epilepsy
A
Active epilepsy
Refractory epilepsy
Status epilepticus
Other
Define active epilepsy
An Occurrence of an epileptic seizure in the last 2 years
Or
Where a patient is taking medication to prevent further epileptic seizures
Define refractory epilepsy
Inadequate control of seizures despite optimal treatment
What is status epilepticus
a rare but serious condition where epileptic seizures continue either constant or repeatedly over a period of 30 mins or more
When are we all susceptible to seizures?
If the brain is subjected to certain stressful situations eg
Fever
Hypoglycaemia
Withdrawal of alcohol in alcohol dependency
How common is active epilepsy?
1 in 200 people have it in the uk
350,000 people
How common is refractory epilepsy?
1 in 700 people in the uk
100,000 people
How is epilepsy classified?
1) Partial epileptic seizures
2. Generalised epileptic seizures
What are partial epileptic seizures
When Abnormal electrical activity is restricted to a focal area of the brain
What can partial epileptic seizures be further classified into?
1)
Temporal lobes epilepsy
2. Occipital lobe epilepsy
What can temporal lobe epilepsy result in
Abnormalities of taste or smell, psychic disturbances including deja vu
What can occipital love epilepsy result in
Abnormal visual perceptions such as balls of light or coloured patterns
What can happen to partial epileptic seizures if they are untreated?
Around half of partial seizures subsequently become generalised
How do some partial seizures become generalised?
The abnormal electrical activity spread from a focal area to involve both cerebral hemispheres
What will happen if a partial seizure doesn’t become generalised?
Patient will either have:
No impairment of consciousness
Impaired consciousness but not loss
What do generalised epileptic seizures reflect?
abnormal electrical activity throughout the cerebral hemispheres
What can generalised epileptic seizures develop from?
A
Partial seizures
Or
A Discrete event without a focal onset
Name the most common form of generalised seizures
Grand mal epilepsy /Tonic clonic epilepsy or seizures
List the defined stages of tonic clonics
Prodrome
Aura
Tonic phase
Clonic phase
Post-ictal phase
Describe the prodrome stage of tonic clonic
It precedes the main symptoms where it is characterised by typically vague features such as unease, irritability or non specific malaise that may last hours or day
What is the aura stage of tonic clonic seizures ?
it can occur in patients who experience a partial seizure that subsequently becomes generalised
The symptoms depend on the anatomical site of the partial seizure and may include disturbances of one or more sensory modalities
What is the tonic phase of tonic clonics?
Lasts only a few seconds usually and is characterised by unconsciousness, inability to maintain a normal posture which usually results in the patient falling
Absence of breathing as the best walk muscles have gone into spasms and patient may cry of grunt as it happens
Increased thoracic pressure can result in deoxygenated blood pooling in facial tissues
Tongue busting
Drooling
Urinalysis and faecal incontinence may occur as well
Name the first clear indication of tonic clonic seizures
tonic phase
What is the clonic phase
Last seconds or minutes and is characterised by generalised rhythmic muscular movements which may be violent and the tongue may be bitten
Patient remains unconscious
What does ictus mean?
Means seizures but is usually reserved for the description of the period after a tonic clonic seizure
Describe the post-ictal phase
Last several minutes to hours and reflects a period of recovery
Initially the patient is unconscious or confused but full consciousness has usually been regained in 15-60 mins
What can the post-ictal phase be associated with
Generalised muscular aches, a sore tongue and headache, strong desire to sleep
What can epilepsy be caused by
Genetic and congenital causes
or Acquired diseased
List some acquired Illnesses that may lead to epilepsy
Cerebrovascular disease
Cerebral neoplasms
Alcohol related brain damage
Post traumatic brain damage
When is a diagnosis of epilepsy made?
When a patient has 2 or more unprovoked seizures
What is the impact of a diagnosis of epilepsy
Driving affected
Employment and earning potential
Child may have learning difficulties
4 memory loss
How can driving be affected if a patient has epilepsy?
Patient must refrain from driving for one year from the date of the attack
What employment options are restricted for a patient with epilepsy?
Control of a vehicle or aircraft
Positions in the police, armed forces or fire brigade
Merchant seaman
What are the aims of epilepsy management?
to Prevent seizures without causing unacceptable side effects due to medication or other interventions
and Optimise the patients quality of life
What to drugs for epilepsy management aim to do?
Drugs aims to raise the seizure threshold and so prevent seizure initiation
What does management of epilepsy include?
Identification and where possible, correction or underlying conditions that promote seizure initiation
Avoidance of situations that precipitate seizures
Active intervention to reduce seizure frequency
List some medication used to manage epilepsy
Carbamazepine
Sodium valproate
Phenytoin
Lamotrigine
Gabapentin
What influences our decision when choosing which drug to prescribe to manage epilepsy?
Seizure type
Age
Learning difficulties
Complexity of the situation
What is the standardised mortality rate for epilepsy
2-3 times greater risk of dying compared to matched individuals without epilepsy
What is the death risk for a patient with refractory epilepsy
1 in 200
What can the outcome following an initial seizure be?
Can be predicted to some degree:
Patients with underlying structural abnormalities are least likely to remit
Many patient s without an obvious cause for their epilepsy have a better change of ultimately coming off mediation
Patient s who have had 2 unprovoked seizures 65% will expedite further seizures within 4 years
What is multiple sclerosis
MS Is an inflammatory demyelinating disease of the CNS that is disseminated in time and space
What does dissemination in time mean
That clinics attacks occur at different points in time
What does dissemination in space mean?
lesions occur at different neuro anatomical sites
How common is multiple sclerosis?
1 in 750 (90,000 people)
Is multiple sclerosis more common in men or women?
Women 2x as much
What is the pathology of MS?
Where and why does multiple sclerosis plaque form
Forms in the CNS as a consequence of inappropriate lymphocyte induced and macrophage mediated inflammation
What does macrophage mediated inflammation result in?
Results in demyelination of t the nerve axons
This impairs nerve conduction
What is MS thought to arise due to
A combination of genetic predisposition and an environmental trigger such as viral infections
Describe the clinical features of MS?
A
They are highly variable and change with time depending on where the plaque is and if sensory or motor nerves are affected
List some common symptoms of MS
Weakness
Optic neuritis
Paraesthesia (numbness of tingling)
Diplopia (double vision)
Trouble passing urine (micturation disturbances)
Vertigo
Fatigue
Mood disturbances
List some sensory symptoms of MS
1)
Dysaesthesias including off sensations
2. Neuropathic pain
List some motor symptoms of MS
1)
Spasticity
2. Ataxia of the limbs
What is spasticity
Spinal cord lesions result in limb stiffness
Flexor spasms
Cramps
Clonus
When is a diagnosis of MS made?
Diagnosis not made until a patient has experienced clinical attacks at more than one neuroanatomical site at different times
A diagnosis of MS is made after?
One clinical attack if an MRI scan of the brain and spinal cord after the first attack identify new plaque
Why is an accurate diagnosis of MS important?
To prevent:
A patient being given an inappropriate MS label
Delayed diagnosis
What are the aims of MS management?
Communication of accurate information
Optimise support
Optimise physical impairment and function
Optimise control of pain
Limit progression
How can we carry out symptomatic treatment of chronic problems?
Spasticity
Oxybutynin
Tricyclic antidepressants
Systemic corticosteroids
Interferon
Cannabinoids
the different subtypes of MS?
Initially, illness is categorized by acute attacks
Primary progressive MS
Benign MS
What is primary progressive MS?
it is characterised by a lack of remissions and rapid progression of impairment and disability
What is benign MS?
Characterised by a lack of significant impairment and disability 10 years after diagnosis
What is death in MS patients usually due to?
suicide - 2 to 7 times more common in MS Pts
What is Parkinsonism?
It is a descriptive term for a clinical state with the main clinical features of:
Bradykinesia
Rigidity
Resting tremor
What is Bradykinesua?
slow movement
What can Parkinsonism caused by?
Parkinson’s disease
Anti- psychotic disease
Head injury
Recreational drugs
Cerebral atherosclerosis
Carbon monoxide poisoning
What is Parkinson’s disease
?
A common neurodegenerative disorder categorised by degeneration of dopamine producing cells in the substantia nigra which results in bradykinesia, rigidity etc
In whom is Parkinson’s most common in?
Middle and later life
Where is dopamine made?
in the substantia nigra -a small area in the midbrain
What is the significance of dopamine?
It is a neurotransmitter essential to the normal working of motor pathways in the midbrain and in particular the function of the corpus striatum
What is the significance of the corpus striatum?
It receives information about the position and movement of the body from several different parts of the brain
What happens to dopamine production as you get older
falls after age 35
What happens as dopamine levels fall?
The substantia nigra starts to degenerate (also due to finished Lewy bodies)
What are Lewy bodies?
They are abnormal aggregates of protein inside the dying nerve cells
What are the clinical features of Parkinson’s disease?
1)
One side of the body is affected more than the other
2. Only one side of the body may be affected
What is bradykinesia characterised by?
Finished performance of repot ice movements undertaken at a pace determined by the patient
Do all Parkinson’s patients have a tremor
no
Describe the classic form of tremor in Parkinson’s patients
A pill rolling tremor as though the patient is trying to roll an object between the thumb and first finger when the arms are at red
List some other features of Parkinson’s disease
Loss of postural reflexes
Changes in facial expression
Changes in speech
Altered position
Changes to walk (gait)
Dementia
Depression.
Burning mouth syndrome
What are the aims of Parkinson’s disease management
A
Communication of accurate information
Optimise support
Optimise psychical impairments and unctions
Limit progression
What are the principles of Parkinson’s disease management
Accurate communication of information
Support mechanisms
Drug treatment
Surgery
Emergency therapies
What drugs can we use to treat / manage Parkinson’s?
Levodopa
Dopamine agonists
MAOIs and COMTs
Anti-muscarinic drugs
Anti depressants and anti psychotic agents
What is levodopa?
A prodrug that is decarboxylated to dopamine by surging neurons
Levodopa is in a class of medications called dopamine agonists. Levodopa works by mimicking the action of dopamine, a natural substance in the brain that is lacking in patients with PD.
Name the main alternative to levodopa?
Dopamine agonists
What to MAOIs do?
Reduce catabolism of dopamine in the CNS
What do COMTs do?
They reduce the catabolism of levodopa in the peripheral circulation
Q
What drugs can be used to control tremors and rigidity?
Anti muscarinic drugs
What are the problems with anti muscarinic drugs?
Adverse drug reactions common and include:
Urinary frequency
Blurring of vision
Xerostomia
