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Ls Neuro > Core Conditions > Flashcards

Core Conditions Flashcards

1
Q

How many people have a stroke a year

A

110,000

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2
Q

define a stroke and a tia

A

A stroke occurs when a blocked blood vessel in the brain causes lack of blood flow and oxygen starvation. This differs from a tia which lasts less than 24 hours and resolves itself whereas a stroke lasts longer than 24 hours

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3
Q

How does a stroke present

A 
Face dropping 
Arm weakness one sided 
Slurred speech 
Time 
Visual changes 
 Confusion
Abnormal gait 
Nausea vomiting 
Diplopia 
Vertigo
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4
Q

Causes

A

Thrombosis

Embolism

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5
Q

Three pathological features

A

Ischaemia
Reduction in blood flow
Cellular necrosis

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6
Q

Risk factors

A

Increased blood
Pressure

Diabetes

Smoking

Alcohol

Ocp

FH

Hyperlipidemia

Previous stroke

Age over 60

Trhomvophilia
Af

Heart disease

Increased clotting and reduced anti thrombin

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7
Q

Four things to give afew a stroke

A

Anti platelet aspirin or clopedigrel
Anti hypertensive
Anti coagulant such as warfarin and DNOC
Statin

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8
Q

How do you assess someone with a tia is having a stroke or likeliness

A

Abcd^2

Age - over 60 
Blood pressure over 140/90
Change in speech (1) one sided weakness (2)
Diabetes 
Duration over one hour (1)
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9
Q

Acute management

A

Oxygen
Fluids
Reassurance
Monitor obs

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10
Q

Investigations for a stroke

A

Monitor blood glucose
Bloods fbc
Ct scan
ECG and X-ray

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11
Q

How common is a subarachnoid haemorrhage

A

9 in 100/000 people

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12
Q

What is it

A

A spontaneous bleed in the subarachnoid space

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13
Q

Signs

A 
Sudden onset of an excruitiating  headache - thunderclap 
Vomiting 
Collapse 
Seizure 
Coma 
Neck stiffness
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14
Q

What sign can be seen

A

Kernig sign
This is when you flex at the hip And then knee to make right angle
On lowering there is pain which indicates meningeal irritation

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15
Q

Risk factors

A 
Smoking 
Alcohol 
Precious sah
Family history 
Hypertension 
Polycysric kidneys 
Aortic coarsctation 
Ehler danios syndrome
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16
Q

Cause main one

A

Berry aneurysm

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17
Q

Diagnostic

A

90% picked up within an hour if ct done

It ct is neg do lumbar puncture to obtain xanthochronic fluid sample

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18
Q

Management

A 
Refer to neurosurgery asap 
Keep hydrated 
Given nimpdipine a CAlcuim antagonist 
Endocascular  coiling 
Intracranial stent
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19
Q

Complications

A

Rebleedinf
Ischemia
Hydrocephalus
Hyponatremia

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20
Q

what is a peripheral neuropathy

A

damage to or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected.
mono - affecting one nerve group
poly- affect multiple nerve groups
this can include system disease or trauma directly related to site of nerve endings.

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21
Q

causes

A 
diabetes
renal failure
hypothyroidism 
hiv
hypoglyemia 
chacot marie tooth 
porphyria  
syphilis 
leprosy
lyme disease 
sarcoidosis
gullian barre syndrome
lead 
alcohol
phenytoin 
decreased b12, b6, b1 E
WEGNERS GRANDULOMATOSIS
RHEUMATOID ARTHRITIS 
POLYARTERITIS NODSA 
metronidazole
nitrofurantoin 
vcsplatin
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22
Q

symptoms

A 
tingling sensation, shooting pain, weakness muscle group, pins and needles
muscle weakness, muscle paralaysis
involuntary movement 
muscle twitching 
fassiculations 
abnormal gait 
numbeness 
reduced reflexes 
crawling sensation
porstural hypotension
sweating
impotence 
D and C and bloating 
incontinence/loss of bladder control
tremors
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23
Q

additional symptoms

A 
median nerve c6-t1     carpal tunnel syndrome
ulnar nere c8 -t1   claw hand 
radial nerve c5-t1   wrist drop
brachial plexus 
phrenic nerve c3-c5
sciatirc nerve 
tibal nerve

gullian barre syndrome-loss or impaired lower motor function

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24
Q

signs on examinations

A

see symptoms above.

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25
Q

investifations

A

bloods- glucose, b12, lft, u and e, esrp , ana/anca
mri/ct
nerve conduction studies
neuro exam

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26
Q

management

A

treat cause e.g. diabetes, b12 defciciency
physiotherapy
iv imunglobins for GB syndrome
neuropathic pain meds - duloxetine, amitrypllyine, pregabalin.

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27
Q

define a seizure

A

an abnormally excessive and hyper-synchronous activity of neurones located predominantly in the cerebral cortex causing twitching and convulsions in muscles

28
Q

classification

A

generalised- both hemispheres

partial- 1 hemisphere

29
Q

subtypes

A 
myoclonic - jerking movement
atonic- falls to floor, no tone
tonic- falls to floor, stuff
tonic-clonic-falls to floor, jerking movement 
absence- staring and blinking no falling
30
Q

status epilepticus

A

life-threatening condition -> brain is in constant persistent seizure
more than 30 minutes
medical emergency

31
Q

epilepsy

A

spontenous 2 or more episodes of unprovoked seizure

32
Q

causes

A 
2/3 idiopathic
trauma/injury to cerebral cortex
stroke
brain tumour 
congenital brain defects 
SLE
sarcoidosis 
raised ICPP 
benzodiazepine withdrawal 
liver disease
33
Q

signs and symptoms

A 
pre-event signs 
-flashing lights
dizziness 
gut feeling
metallic taste in mouth
myalgia 
confusion 
dysphagia 
change in behaviour
34
Q

differentials

A

movement disorder
syncope
stroke

35
Q

investigations

A

EEG
full blood count
prolactin test
drug level for compliance with anti-epileptics

36
Q

treatment

A 
focal/partial - lamo, carba
tonic clonic -na valoprate, lamo
absence- na valoprate
myoclonic na valoprate
tonic and atonic - na valoprate
37
Q

which type do you avoid carbamazepines in?

A

myoclonic

38
Q

what is meningitis

A

inflammation of the meninges surrounding the brain

39
Q

what can it be confused with

A

encephalitis, dengue, malaria, septicaemia

40
Q

causes in neonates, infants, adults and elderly

A

neonates: listeria, E.coli, STREP B
infants, nisseria menigitides, h.influenza,
adults -nisseria menigitdies, influenza, s.pneumoniae
elderly - TB, s.pneumoniae

can also be caused by HSV, CMV, HZv, enteroviruses

41
Q

signs and symptoms

A 
headache
fever
cold hands and feet
dyspnoea 
confusion/altered mental state
low GCS
irritability
lack of appetite
meningism - photophobia, neck stiffness, positive kernig sign or brudzski sign 
muscle aches
non blanching petiache rash
42
Q

what is brudzski sign

and kernig sign

A

kernig- hip and knee flexed at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance). This may indicate subarachnoid hemorrhage or meningitis.

brudzski - Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

43
Q

investigations

A

full blood count - LFT, UandE, GLUCOSE
lumbar puncture
examination - kernigs, brudzski
CXR

44
Q

treatment

A

benzylpencillin
cefataxomine
if ampicillin - listeria
acyclovir - encephalitis

45
Q

what can be given when meningism is present?

A

dexamethasone

46
Q

what is a migraine?

A

a unilateral throbbing headache seen in 2% of the population
it is often associated in individuals with a family history

47
Q

causes

A 
chocolate - caffeine 
Hang over 
orgasm 
Cheese
Ocp
Lie in
Alcohol
Trauma/tumulent 
Exercise
Stress
coffee 
high Bp
obesity
female : male (2:1)
48
Q

signs and symptoms

A 
headache -unilateral
photophobia
nausea and vomiting 
sleep changes
yawning and craving 
fatigue 
dizziness

cranial tenderness
horner syndrome
irregular pulse BP

49
Q

DD

A

TIA
cluster tension headache
sinusitis
cervical spondylosis

50
Q

investigations

A

ct if reccurent
based on history
exclude any differentials

51
Q

treatment

prevention too

A

triptan and naproxen
can give parcetamol

prevention- propanol, botox, amitrylline

52
Q

who is parkinsons disease commonly seen in

A

M > F 3:2
65 year old
Caucasian

53
Q

triad of symptoms (used a basis for diagnosis)

A

rigidity cogwheel, increased tone
tremor - pin rolling
bradykinesia- difficulty initating movement, shuffling gait, reduced blinking, reduced arm swinging

54
Q

other symptoms and signs

A 
mood changes
sleep disturbance 
anosmia 
dysphagia 
dystonia
depression
dementia
55
Q

diagnosis

A

clinical

trial dopernegic agents

56
Q

management

A

assess and monitor memory, mood
physiotherapy, occ health and speech and language therapy

medications include
LDOPA
dopamine agonists- ropinierole
MOAB-I - rasagiline 
COMT-I  Entacapone
57
Q

pathophysiology

A

degeneration of dopaminergic neuron in substantia nigran - reduced dopamine for movement

58
Q

what Is MS?

A

demyelination of the CNS caused by T cell mediated response

heals incompletely, therefore remitting and relapsing condition

59
Q

who does MS affect?

A

30 years of age
3;1 female to male ratio
42 per 100,000 in the UK
rare in African Caribbean community

60
Q

associated with

A

lack of early exposure to vitamin D and sun light

vitamin D and sunlight has been found to prevent and improve symptoms

61
Q

signs

A

Lhermitte sign is when you have sharp electric shock down back and to limbs when you bend your neck forward
optic neuritis - reduced central vision and pain on movement
loss of thermoregulation - excess sweating, hypothermia and pyrexia

62
Q

symptoms

A 
headache
trunk and limb ataxia 
dyarrthia speech
intention tremor 
nystagmus 
urine retention
erectile dysfunction
numbness and tingling in limb 
spastic weakness 
amnesia
leg weakness
63
Q

what can worsen symptoms

A

exercise

heat

64
Q

investigatioons

A 
electrophysiology - visual provoked protential 
MRI
CSF
Bloods- FBC, lft, tft
neuroligcal examination
65
Q

treatment

A

disease modifiying drug - dimethyl fumarate -monoclonal antibody - alemtuzumab
relapsing - methylprednisolone (doesn’t alter prognosis)

fatigue - amantadine
spactitiy-baclofen
tremor- botulin A
urgency/frequency -tolterosone and self catherisation

66
Q

criteria for MS

A

McDonald

Ls Neuro (5 decks)

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