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1
Q

What changes does chronic alcahol consumption cause in the CNS?

A

Enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors

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2
Q

What changes does alcahol withdrawal cause in the CNS?

A

Decreased inhibitory GABA and increased NMDA glutamate transmission

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3
Q

Symptoms of alcohol withdrawal syndrome

A

> 

tremor, sweating, tachycardia, anxiety at 6-12 hours
seizures at 36 hours
delirium tremens is at 48-72 hours
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4
Q

What are the initial (early) symptoms of alcohol withdrawal syndrome?

A

Tremor, sweating, tachycardia, anxiety at 6-12 hours

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5
Q

When do seizures occur in alcohol withdrawal syndrome

A

36 hours

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6
Q

When does delirium start in alcohol withdrawal syndrome

A

48-72 hours

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7
Q

When does the initial early symptoms of alcohol withdrawal syndrome start?

A

6-12 hours

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8
Q

Management of alcohol withdrawal syndrome

A
  1. first-line: long-acting benzodiazepines e.g diazepam
    > Lorazepam may be preferable in patients with hepatic failure.
  2. carbamazepine also effective in treatment of alcohol withdrawal
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9
Q

What benzodiazepines are used in the management of alcohol withdrawal syndrome?

A

Long acting benzodiazepines e.g. diazepam

Lorazepam may be preferable in patients with hepatic failure.

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10
Q

Brown Sequard syndrome

A

Rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

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11
Q

Features of right-sided Brown Sequard syndrome

A

Right sided (ipsilateral) proprioception/vibration loss & weakness but would cause contralateral (left-sided) loss of pain and temperature.

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12
Q

Features of left-sided Brown Sequard syndrome

A

Left sided (ipsilateral) proprioception/vibration loss & weakness but would cause contralateral (right-sided) loss of pain and temperature.

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13
Q

Tuberous sclerosis

A

A rare autosomal dominant condition that causes mainly non-cancerous (benign) tumours to develop in different parts of the body.

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14
Q

Tuberous sclerosis mode of inheritance

A

autosomal dominant

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15
Q

What are the cutaneous features of Tuberous sclerosis

A
  • Depigmented ‘ash-leaf’ spots
  • Shagreen patches
  • Adenoma sebaceum
  • subungual fibromata
  • Café-au-lait spots
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16
Q

What are shagreen patches

A

Roughened patches of skin over lumbar spine

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17
Q

Subungual fibromata

A

Painless, slow-growing tumor seen in the nail apparatus. They can be spherical or oval in shape and firm or elastic in consistency.

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18
Q

What are the neurological features of Tuberous sclerosis

A
  • developmental delay
  • epilepsy (infantile spasms or partial)
  • intellectual impairment
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19
Q

Retinal hamartomas

A

Dense white areas on retina (phakomata)

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20
Q

Lymphangioleiomyomatosis

A

Multiple lung cysts

A lung disease caused by the abnormal growth of smooth muscle cells, especially in the lungs and lymphatic system. This abnormal growth leads to the formation of holes or cysts in the lung.

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21
Q

Left homonymous hemianopia

A

Left visual field defect, i.e. Lesion of right optic tract

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22
Q

Right homonymous hemianopia

A

Right visual field defect, i.e. Lesion of Left optic tract

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23
Q

Homonymous superior quadrantanopia

A

Lesion of the Inferior optic radiations in the temporal lobe

Is a loss of vision in the same upper quadrant of visual field in both eyes

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24
Q

Homonymous superior quadrantanopia

A

Lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)

Is a loss of vision in the same lower quadrant of visual field in both eyes

Correct card

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25
Homonymous quadrantanopia
PITS (Parietal-Inferior, Temporal-Superior)
26
Congruous defect of visual field: causes
Simply means complete or symmetrical visual field loss Causes - optic radiation lesion or occipital cortex
27
Incongruous defects of visual field: causes
Usually optic tract lesions Is incomplete or asymmetric visual field loss
28
Bitemporal hemianopia
Lesion of the optic chiasm
29
What causes an inferior chiasmal compression and thus bitemporal hemianopia?
Commonly a pituitary tumour
30
What causes a superior chiasmal compression and thus bitemporal hemianopia?
Commonly a craniopharyngioma
31
5-HT3 antagonists examples
Ondansetron | Granisetron
32
5-HT3 antagonists mechanism of action
Antiemetics used mainly in management of chemotherapy-related nausea. Act in the chemoreceptor trigger zone area of the medulla oblongata.
33
5-HT3 antagonists adverse effects
Constipation is common | Prolonged QT interval
34
Absence seizure features
> Absences last a few seconds > quick recovery > Provoked by hyperventilation or stress > Usually unaware of seizure > May occur many times a day > EEG: bilateral, symmetrical 3Hz spike and wave pattern
35
Global aphasia
Large lesion affecting the inferior frontal gyrus, superior temporal gyrus and the arcuate fasiculus resulting in severe expressive and receptive aphasia May still be able to communicate using gestures
36
Conduction aphasia
Classically due to a stroke affecting the arcuate fasiculus - the connection between Wernicke's and Broca's area Speech is fluent but repetition is poor. Aware of the errors they are making -- Comprehension is normal
37
Wernicke's (receptive) aphasia
Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA This area 'forms' the speech before 'sending it' to Broca's area. Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - 'word salad' Comprehension is impaired
38
Broca's aphasia
Due to a lesion of the inferior frontal gyrus. It is typically supplied by the superior division of the left MCA Speech is non-fluent, laboured, and halting. Repetition is impaired Comprehension is normal
39
Arnold-Chiari malformation
Describes the downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum. Malformations may be congenital or acquired through trauma.
40
Features of Arnold-Chiari malformation
> non-communicating hydrocephalus may develop as a result of obstruction of CSF outflow > headache > syrinomyelia
41
Ataxia causes
Cerebellar hemisphere lesions cause peripheral ('finger-nose ataxia') Cerebellar vermis lesions cause gait ataxia
42
Ataxia telangiectasia
Autosomal recessive disorder caused by a defect in the ATM gene which encodes for DNA repair enzymes. It typically presents in early childhood with abnormal movements.
43
Features of Ataxia telangiectasia
> cerebellar ataxia > telangiectasia (spider angiomas) > IgA deficiency - recurrent chest infections > 10% risk of developing malignancy, lymphoma or leukaemia, but also non-lymphoid tumours
44
Erb-Duchenne paralysis
damage to C5,6 roots winged scapula may be caused by a breech presentation
45
Klumpke's paralysis
damage to T1 loss of intrinsic hand muscles due to traction
46
Causes of brain abscess
> extension of sepsis from middle ear/ sinuses > trauma or surgery to the scalp > penetrating head injuries > embolic events from endocarditis
47
Investigations of brain abscess
CT scanning
48
Management of brain abscess
Craniotomy is performed and the abscess cavity debrided IV antibiotics: IV 3rd-generation cephalosporin + metronidazole Intracranial pressure management: e.g. dexamethasone
49
Carbamazepine mechanism of action
Binds to sodium channels increases their refractory period
50
Cataplexy
Sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened). Features range from buckling knees to collapse.
51
Cavernous sinuses
Are paired and are situated on the body of the sphenoid bone. It runs from the superior orbital fissure to the petrous temporal bone.
52
The cerebral perfusion pressure (CPP)
Is defined as being the net pressure gradient causing blood flow to the brain. The CPP is tightly autoregulated to maximise cerebral perfusion.
53
Charcot-Marie-Tooth Disease
Charcot-Marie-Tooth Disease is the most common hereditary peripheral neuropathy. Results in a predominantly motor loss. There is no cure, and management is focused on physical and occupational therapy.
54
Most common hereditary peripheral neuropathy
Charcot-Marie-Tooth Disease
55
Charcot-Marie-Tooth Disease features
``` History of frequently sprained ankles Foot drop High-arched feet (pes cavus) Hammer toes Distal muscle weakness Distal muscle atrophy Hyporeflexia Stork leg deformity ```
56
Common peroneal nerve lesion
The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula Most characteristic feature is foot drop.
57
Complex regional pain syndrome
Umbrella term for a number of conditions such as reflex sympathetic dystrophy and causalgia. It describes a number of neurological and related symptoms which typically occur following surgery or a minor injury. CRPS is 3 times more common in women.
58
Types of Complex regional pain syndrome
Type I (most common): there is no demonstrable lesion to a major nerve Type II: there is a lesion to a major nerve (causalgia) Reflex sympathetic ?
59
Features of Complex regional pain syndrome
``` progressive, disproportionate symptoms to the original injury/surgery allodynia temperature and skin colour changes oedema and sweating motor dysfunction ```
60
Drugs causing a peripheral neuropathy
``` amiodarone isoniazid vincristine nitrofurantoin metronidazole ```
61
EMG characteristics for neuropathy
Increased action potential duration | Increased action potential amplitude
62
EMG characteristics for myopathy
Decreased action potential duration | Decreased action potential amplitude
63
Essential tremor
A neurological disorder that causes your hands, head, trunk, voice or legs to shake rhythmically. It is often confused with Parkinson's disease. Essential tremor is the most common trembling disorder.
64
Features of Essential tremor
postural tremor: worse if arms outstretched improved by alcohol and rest most common cause of titubation (head tremor)
65
Essential tremor management
propranolol is first-line | primidone is sometimes used
66
Sagittal sinus thrombosis
may present with seizures and hemiplegia | parasagittal biparietal or bifrontal haemorrhagic infarctions are sometimes seen
67
Lateral sinus thrombosis
6th and 7th cranial nerve palsies
68
Lateral medullary syndrome
Also known as Wallenberg's syndrome, occurs following occlusion of the posterior inferior cerebellar artery. Affects glossopharyngeal and vagus nerves
69
Features of Lateral medullary syndrome
ataxia & nystagmus Brainstem features: ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss
70
Refeeding syndrome
``` Describes the metabolic abnormalities which occur on feeding a person following a period of starvation. The metabolic consequences include: Hypophosphataemia Hypokalaemia Hypomagnesaemia Abnormal fluid balance ```
71
Pituitary apoplexy
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction.
72
Features of Pituitary apoplexy
sudden onset headache similar to that seen in subarachnoid haemorrhage vomiting neck stiffness visual field defects: classically bitemporal superior quadrantic defect extraocular nerve palsies features of pituitary insufficiency e.g. hypotension/hyponatraemia secondary to hypoadrenalism
73
Pituitary apoplexy management
urgent steroid replacement due to loss of ACTH careful fluid balance surgery
74
Pituitary apoplexy investigations
MRI
75
Post-lumbar puncture headache
usually develops within 24-48 hours following LP but may occur up to one week later may last several days worsens with upright position improves with recumbent position
76
Factors favouring pseudoseizures
``` pelvic thrusting family member with epilepsy much more common in females crying after seizure don't occur when alone gradual onset ```
77
Factors favouring true epileptic seizures over pseudoseizures
tongue biting | raised serum prolactin*
78
Reye's syndrome
A severe, progressive encephalopathy affecting children that is accompanied by fatty infiltration of the liver, kidneys and pancreas. Aetiology is not fully understood although there is a known association with aspirin use and a viral cause has been postulated
79
Spontaneous intracranial hypotension
A very rare cause of headaches that results from a CSF leak. The leak is typically from the thoracic nerve root sleeves.
80
Features of Spontaneous intracranial hypotension
Strong postural relationship with the headache generally much worse when upright. Patients may, therefore, be bed-bound
81
Spontaneous intracranial hypotension investigations
MRI with gadolinium: typically shows pachymeningeal enhancement
82
Syringomyelia
Describes a collection of fluid filled cysts within the spinal cord.
83
Syringobulbia
Syringobulbia in which there is a fluid-filled cavity within the medulla of the brainstem. This is often an extension of the syringomyelia but in rare cases can be an isolated finding.
84
Causes of Syringomyelia
A Chiari malformation: strong association trauma tumours idiopathic
85
Investigations of Syringomyelia
full spine MRI with contrast to exclude a tumour or tethered cord a brain MRI is also needed to exclude a Chiari malformation
86
Features of Syringomyelia
a ‘cape-like’ (neck, shoulders and arms) loss of sensation to temperature but the preservation of light touch, proprioception and vibration classic examples are of patients who accidentally burn their hands without realising this is due to the crossing spinothalamic tracts in the anterior commissure of the spinal cord being the first tracts to be affected spastic weakness (predominantly of the lower limbs) neuropathic pain upgoing plantars
87
Wernicke's encephalopathy
A neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics.

Neurology Year 3 (22 decks)

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