Disturbances of Cortical Function: Epilepsy and Dementias Flashcards
What is dementia?
A progressive decline in higher cortical function, leading to a global impairment of memory, intellect and personality
What are 3 potentially reversible causes of dementia?
Vitamin Deficiency
Thyroid Disoders
Alcohol Excess
Name 2 types of dementia
Alzheimer’s Disease
Dementia with Lewy-Bodies
Fronto-Temporal Dementia
Vascular Dementia
Rare: Creutzfeldt-Jacob Disease
Which lobe of the brain is responsible for personality, mood and behaviour?
Frontal Lobe
Within which lobe of the brain is the Broca’s area found?
Frontal Lobe
Within which lobe of the brain is Wernicke’s area found?
Temporal Lobe
Name 3 symptoms a patient with dementia may present with
Memory Deficit
Altered Behaviour
Aphasic
What is apraxia and why can this cause problems for patients with dementia?
difficulty with motor planning > therefore unable to perform learned purposeful movements
patient’s are unable to carry out their normal ADL’s such as washing/eating/dressing
What is delirium and what score can be used to help identify this condition?
“acute confusional state”
characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course
Confusion Assessment Method (CAM) Score
How does the rate and pattern of cognitive decline differ between Alzheimer’s Disease, Vascular Dementia and Dementia with Lewy-Bodies?
Vascular Dementia
rapid decline followed by period of stability - due to repeated vascular attacks (strokes)
Alzehimer’s Disease
gradual decline over prolonged period of time
Lewy Body
general downward trend with periods of improvement
What macroscopic pathology is seen in Alzheimer’s Disease?
loss of cortical and subcortical grey & white matter
narrow gyri and wide sulci
dilatation of the ventricular system
What microscopic features are seen in the brains of patients with Alzheimer’s disease?
Amyloid-Beta Plaques
Neurofibrillary Tangles
(composed of hyperphosphorylated Tau Protein)
(caused by abnormal cleavage of protein from amyloid precursor protein, APP)
How do the lewy bodies found in parkinson’s disease differ from those found in dementia with lewy bodies?
both are abnormal aggregates of protein
Parkinson’s Disease
isoalted to substantia nigra region of brainstem
Dementia with Lewy Bodies
proteins in substantia nigra and wide spread throughout the cortex
How may a patient present with dementia with Lewy Bodies?
fluctuations in degree of cognitive impairment
parkinson’s symptoms
visual hallucinations
What is the underlying pathology in vascular dementia?
diffuse small vessel disease causing reduced blood supply to specfic parts of the brain
How can the progression of vascular dementia be slowed?
reduce cardiovascular risk factors
e.g. treat high cholesterol / hypertension
How may a patient with frontotemporal dementia present?
altered social behaviour and personality
(e.g. aggitation, depression)
impaired judgement and insight
(e.g. gamling, taking off clothes)
reduced speech until possibly mutism
What social care requirements need to be considered for patients with dementia?
risk assessments
(e.g. fire hazard)
care needs
mental capacity act / lasting power of attorney
What medications could be tried in a small population of patients suffering from Alzheimer’s disease?
cholinesterase inhibitors
(to increase the amount of acetylcholine available)
memantine
(blocks the effects of glutamate that is released from damaged neruones)
What is a seizure?
a sudden irregular discharge of electrical activity causing physical manifestiations such as sensory disturbances, unconsciousness or convulsions
What is a convulsion?
uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles
(can occur as a result of a seizure, but note a seizure has a different definition)
What is an aura?
a perceptual disturbance experienced by a person prior to a seizure
e.g. unpleasant smeel, strange light, confusing thoughts
What is epilepsy?
a neurological disorder marked by sudden recurent episodes of sensory disturbance, altered conscious level or convulsions, associated with abnormal activity in the brain
What is status epilepticus?
MEDICAL EMERGENCY
epileptic seizures occuring without recovery of consciousness between
What is the difference between simple partial and simple complex seizures?
Simple Partial
part of the brain affected, with no change in LOC
Simple Complex
part of the brain affected, with altered LOC
Epilepsy involving which lobe is often assoicated with auras such as auditory hallucinations?
Temporal Lobe
Name 5 types of generalised epilepsy
Tonic-Clonic
Myoclonic
Tonic
Abscence
Atonic
How does a patinet with tonic-clonic seizures present?
increased muscle tone
followed by jerking movments
How does a patinet with myoclonic seizures present?
sudden, short-lasting jerks that affect some or all of the body
How would a patient with absence epilepsy seizures?
cause lapses in awareness
mistaken for daydreaming
patients may be unaware of their absence
How may a patinet present with atonic seizures?
loss of tone
(can cause head to fall backwards)
How may a patient present with a tonic seizure?
increase in tone
How are patients stimulated during a EEG to help ilicit a response?
photic stimulation
hyperventilation
(± sleep deprivation)
Why do patients with a first presentation of seizure often undergo MRI brain imaging?
exclude other casuses
How would you manage an epileptic seizure?
ABCDE Approach
Benzodiazepines
(PR, Buccal, IV)
What may be potential differential diagnoses following a seizure?
- Vascular: Stroke
- Infection: Abscess, Meningitis
- Trauma: Intracerebral haemorrhage
- Autoimmune: SLE
- Metabolic: Hypoxia, Hypoglycaemia
- Iatrogenic: Drugs, Alcohol Withdrawal
- Neoplastic: Intracerebral mass
What are the general rules around epilepsy and driving?
need to be seizure free for 1 year for licence back
(if seizures when awake)
isolated seizure - apply at 6 months to get licence back
noctural seizures only - DVLA assessment
