Deck 5a - neuro Flashcards
Q. What does the Glasgow Coma scale access?
A. Level of consciousness
B. Motor response (obeys commands, localises pain, flexors to pain, extends to
pain, none), Sensory response to pain, Best eye opening response – brain stem
(not accurate in first one hour)
Q. Name 3 ways a patient’s neurological state can be tested?
A. Glasgow coma scale, pupil reactivity (fixed dilated pupil?), lateralising signs –
response to pain stimuli – (obeys commands, localises pain, flexes to pain,
extends to pain, none)
B. (Other vital signs – BP, RR, oxy sat, temp, pulse)
Q. How do subdural/extradural haematoma appear on imaging?
A. Concave – subdural
B. Convex - epidural
- Who is at a greater risk of suffering from chronic subdural haematoma?
A. The elderly and alcoholics – smaller brain – following small head injury there is a
low pressure bleed, the blood sucks in fluid and forms a mass
B. Days-weeks later pt is confused, falls
C. Tx: surgery – decompression – drill hole in skull
Q. Define a) disability/limitation of activity b) Handicap/participation
A. Disability/ Limitation of activity: Any restriction or lack of ability to perform an
activity in manner or within the range considered as normal
B. Handicap/ Participation: A disadvantage for a given individual resulting from an
impairment or disability that limits or prevents the fulfilment of a role that is
normal for that individual
Q. Name 3 different treatments/ways to manage the symptoms of MS e.g.
spasticity
A. Physiotherapy – special seating, moving and handling, stretching
B. Drugs – anti-spasticity drugs e.g. baclofen
C. Surgery
D. Botulinum Toxin
E. Psych, nurses, social workers
Q. Name 6 symptoms of raised ICP (tumour)
A. Headache, reduced consciousness level, nausea and vomiting, may also present
with progressive neurological deficit, or epilepsy
B. Stage 1: no symptoms
C. Stage 2: headache, confusion, drowsiness
D. Stage 3: coma
E. Stage 4: death
Q. Name two features of raised ICP headache
A. Worst on waking from sleep in the morning, increased by coughing, straining,
bending forwards
Q. Name a cardinal physical sign of raised ICP – name 4 features seen
A. The cardinal physical sign: is papilloedema – due to obstruction of venous return
from the retina - Loss of crisp optic nerve head margins, Venous enlargement,
Retinal oedema, Haemorrhages
- Q. What neurological deficits may be seen due to ICP?
A. Wide range – motor, sensory, speech, visual deficit, deafness, deteriorating memory, personality change
Q. What features of epilepsy are suggestive of raised ICP/brain tumour?
Recent onset – focal seizures (motor, sensory, temporal lobe pattern – often
associated with olfactory aura, or deja vue, funny feeling in gut/stomach)
Q. Where do most secondary brain tumours originate?
A. 24% non-small cell lung cancer, 15% small-cell lung cancer, 17% breast,
11% melanoma, 6% renal cell, 6% GI, unknown primary 5%
B. Surgery + RT
Q. What cell origin are the majority of primary brain tumours?
Glial cell in origin: 85-90% are astrocytoma, 5% are oligodendroglioma
(favourable prognosis, eventual transformation into WHO III, can transform into
GBM WHO IV – genetic defect in chromosomes 1 and 19)\
Q. What are the 4 WHO grades of glioma? Which are most common?
A. Grade I (pilocytic astrocytoma) is a ‘paediatric’ tumour
B. Grade II (‘benign’) is a premalignant tumour – not benign (!)
C. Grade III is called ‘anaplastic astrocytoma’ = Cancer
D. Grade IV = GLIOBLASTOMA MULTIFORME (GBM) - THE MOST COMMON
PHENOTYPE (necrosis seen within tumour – histologically)
Q. What are the two common pathways to malignant glioma?
Common – genetic error of glucose glycolysis – mutation of isocitrate
dehydrogenase 1 (IHD-1) results in excessive build up of 2-hydroxyglutarate,
which triggers genetic instability in glial cells and subsequent inappropriate
mitosis
B. No IDH mutation – catastrophic genetic mutations – very poor prognosis
