Dementia, seizures and blood supply Flashcards
Presentation of dementia
Memory loss
Altered personality
Disinhibition
Incontinence
Anomic aphasia (difficulty word-finding)
Apraxia (difficulty performing learned purposeful movements)
Can’t identify visuospatial relationships
Investigations for dementia
Collateral history Mini mental state exam CAM score Neurological exam Blood test for organic causes e.g TFTs and vitamin B12 Memory clinic Head CT/MRI to rule out SOL
Criteria for confusion assessment method
Acute
Inattention (can’t count back from 20)
Decreased consciousness
Disorganised thinking
Pattern of cognitive decline in each type of dementia
AD: linear
Vascular: stepwise relating to vascular accident
Lewy body: fluctuates but general decline
Describe Lewy body dementia
Lewy bodies deposited in substantia nigra and cortex
Parkinsonism
Visual hallucinations, acting out dreams, frequent falls
Types of frontotemporal dementia
Picks disease
Taupathies
Describe frontotemporal dementia
Altered personality and behaviour
Impaired judgment
Speech output decreases, eventual mutism
Management of dementia
Assessment of risk and capacity
Memory aids
Pharmacological: cholinesterase inhibitors, memantine
Definition of seizure
Sudden irregular discharge of electrical activity in brain causing a physical manifestation
Increased glutamate or decreased GABA
Definition of convulsion
Uncontrolled shaking movements due to rapid contraction and relaxation of muscles
Definition of aura
Perceptual disturbance some people experience prior to a seizure (usually partial)
Definition of epilepsy
Neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness or convulsions associated with abnormal electrical activity in brain
Definition of status ellipticus
Epileptic seizures occurring continuously without recovery of consciousness
A medical emergency, should get medical assistance if seizure >5 mins
Broad classes of seizures
Partial
Generalised
Classification of partial seizures
Simple - no loss of consciousness
Complex - impaired consciousness
Classification of generalised seizures
Tonic clonic - muscles tense, then have convulsion Absence - 'daydreaming' Status epilepticus Myoclonic- muscle jerking Atonic - 'drop attack'
Describe examples of partial seizures in order of more to less common
Temporal lobe epilepsy - usually have auditory aura, common in 1st or 2nd decade due to early brain injury
Frontal lobe epilepsy - usually have contralateral abnormal movements
Investigations for epilepsy
Collateral history
EEG to assess risk of recurrence
MRI to exclude SOL
What to find out from collateral history in suspected epilepsy
Before: PMH, FH, aura, triggers
During: duration, description of seizure, how it ended
After: incontinence, memory loss, post ictal
Problems with using EEG for investigating epilepsy
May induce seizure as need to hyperventilate while having photic stimulation
Shouldn’t use unless history suggests epilepsy most likely explanation for symptoms
What provides the anterior circulation of brain
ICA
What provides the posterior circulation of brain
Vertebral artery
Arteries making up anterior circulation of brain
Anterior cerebral
Middle cerebral
Anterior and posterior communicating
Arteries making up posterior circulation of brain
Posterior cerebral
Basilar (pontine branches)
Vertebral (anterior spinal branches)
Cerebellar - superior, ant inferior, post inferior
What do cerebellar arteries supply
Brainstem
Cerebellum
What does the anterior cerebral artery supply
Medial frontal and parietal lobes
Corpus collosum
What does the middle cerebral artery supply
Lateral surface of hemispheres Most of temporal lobe Basal ganglia Internal capsule Lentiform nucleus
What does the posterior cerebral artery supply
Inferior temporal lobe
Occipital lobe
Thalamus
