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Semester 4 - Neuroanatomy & Neuropsychiatry > Disturbances of Cortical Function: Epilepsy and Dementias > Flashcards

Disturbances of Cortical Function: Epilepsy and Dementias Flashcards

1
Q

What is dementia?

A

A progressive decline in higher cortical function, leading to a global impairment of memory, intellect and personality

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2
Q

What are 3 potentially reversible causes of dementia?

A

Vitamin Deficiency

Thyroid Disoders

Alcohol Excess

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3
Q

Name 2 types of dementia

A

Alzheimer’s Disease

Dementia with Lewy-Bodies

Fronto-Temporal Dementia

Vascular Dementia

Rare: Creutzfeldt-Jacob Disease

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4
Q

Which lobe of the brain is responsible for personality, mood and behaviour?

A

Frontal Lobe

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5
Q

Within which lobe of the brain is the Broca’s area found?

A

Frontal Lobe

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6
Q

Within which lobe of the brain is Wernicke’s area found?

A

Temporal Lobe

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7
Q

Name 3 symptoms a patient with dementia may present with

A

Memory Deficit

Altered Behaviour

Aphasic

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8
Q

What is apraxia and why can this cause problems for patients with dementia?

A

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

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9
Q

What is delirium and what score can be used to help identify this condition?

A

“acute confusional state”

characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course

Confusion Assessment Method (CAM) Score

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10
Q

How does the rate and pattern of cognitive decline differ between Alzheimer’s Disease, Vascular Dementia and Dementia with Lewy-Bodies?

A

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

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11
Q

What macroscopic pathology is seen in Alzheimer’s Disease?

A

loss of cortical and subcortical grey & white matter

narrow gyri and wide sulci

dilatation of the ventricular system

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12
Q

What microscopic features are seen in the brains of patients with Alzheimer’s disease?

A

Amyloid-Beta Plaques

Neurofibrillary Tangles
(composed of hyperphosphorylated Tau Protein)

(caused by abnormal cleavage of protein from amyloid precursor protein, APP)

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13
Q

How do the lewy bodies found in parkinson’s disease differ from those found in dementia with lewy bodies?

A

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

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14
Q

How may a patient present with dementia with Lewy Bodies?

A

fluctuations in degree of cognitive impairment

parkinson’s symptoms

visual hallucinations

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15
Q

What is the underlying pathology in vascular dementia?

A

diffuse small vessel disease causing reduced blood supply to specfic parts of the brain

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16
Q

How can the progression of vascular dementia be slowed?

A

reduce cardiovascular risk factors

e.g. treat high cholesterol / hypertension

17
Q

How may a patient with frontotemporal dementia present?

A

altered social behaviour and personality
(e.g. aggitation, depression)

impaired judgement and insight
(e.g. gamling, taking off clothes)

reduced speech until possibly mutism

18
Q

What social care requirements need to be considered for patients with dementia?

A

risk assessments
(e.g. fire hazard)

care needs

mental capacity act / lasting power of attorney

19
Q

What medications could be tried in a small population of patients suffering from Alzheimer’s disease?

A

cholinesterase inhibitors

(to increase the amount of acetylcholine available)

memantine

(blocks the effects of glutamate that is released from damaged neruones)

20
Q

What is a seizure?

A

a sudden irregular discharge of electrical activity causing physical manifestiations such as sensory disturbances, unconsciousness or convulsions

21
Q

What is a convulsion?

A

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)

22
Q

What is an aura?

A

a perceptual disturbance experienced by a person prior to a seizure

e.g. unpleasant smeel, strange light, confusing thoughts

23
Q

What is epilepsy?

A

a neurological disorder marked by sudden recurent episodes of sensory disturbance, altered conscious level or convulsions, associated with abnormal activity in the brain

24
Q

What is status epilepticus?

A

MEDICAL EMERGENCY

epileptic seizures occuring without recovery of consciousness between

25
Q

What is the difference between simple partial and simple complex seizures?

A

Simple Partial

part of the brain affected, with no change in LOC

Simple Complex

part of the brain affected, with altered LOC

26
Q

Epilepsy involving which lobe is often assoicated with auras such as auditory hallucinations?

A

Temporal Lobe

27
Q

Name 5 types of generalised epilepsy

A

Tonic-Clonic

Myoclonic

Tonic

Abscence

Atonic

28
Q

How does a patinet with tonic-clonic seizures present?

A

increased muscle tone

followed by jerking movments

29
Q

How does a patinet with myoclonic seizures present?

A

sudden, short-lasting jerks that affect some or all of the body

30
Q

How would a patient with absence epilepsy seizures?

A

cause lapses in awareness

mistaken for daydreaming

patients may be unaware of their absence

31
Q

How may a patinet present with atonic seizures?

A

loss of tone

(can cause head to fall backwards)

32
Q

How may a patient present with a tonic seizure?

A

increase in tone

33
Q

How are patients stimulated during a EEG to help ilicit a response?

A

photic stimulation

hyperventilation

(± sleep deprivation)

34
Q

Why do patients with a first presentation of seizure often undergo MRI brain imaging?

A

exclude other casuses

35
Q

How would you manage an epileptic seizure?

A

ABCDE Approach

Benzodiazepines
(PR, Buccal, IV)

36
Q

What may be potential differential diagnoses following a seizure?

A
  • Vascular: Stroke
  • Infection: Abscess, Meningitis
  • Trauma: Intracerebral haemorrhage
  • Autoimmune: SLE
  • Metabolic: Hypoxia, Hypoglycaemia
  • Iatrogenic: Drugs, Alcohol Withdrawal
  • Neoplastic: Intracerebral mass
37
Q

What are the general rules around epilepsy and driving?

A

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

Semester 4 - Neuroanatomy & Neuropsychiatry (19 decks)

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