interactive cases iv Flashcards
What are the possible areas affected in neuro?
Brain
Spinal cord
Nerve roots Peripheral nerves Neuromuscular junction
What are the possible causes of pathology in neuro?
V ascular
I nfection
I nflammation/autoimmune
T oxic/metabolic
T umour/malignancy
Hereditary/congenital
Degenerative
Compare UMN and LMN lesions
UMN - tone increased (spasticity) - power decreased - reflexes increased, plantar up LMN - tone decreased (flaccid) - power decreased - reflexes decreased/normal
Name cerebellar signs
Ataxia Nystagmus Dysdiadochokinesia Speech: slurred, scanning Intention tremor
What abnormal sensation would you expect for pathology in the following areas: a) cerebral cortex, b) spinal cord, c) nerve roots, d) mononeuropathy, e) polyneuropathy?
a) Hemisensory loss b) Level, i.e. umbilicus c) Dermatomal d) Specific area e) Glove + stockings distribution
What drug can be used to treat neuropathic pain?
Duloxetine
What are possible causes of peripheral neuropathy?
Drugs (hx)
Alcohol (hx, raised GGT/MCV)
B12 deficiency (anaemia, raised MCV)
Diabetes (hx, glucose/HbA1c)
Hypothyroidism (TFTs)
Uraemia (U&Es)
Amyloidosis (hx of myeloma or chronic infection/inflammation, i.e. RA)
Infection (HIV)
Inflammation/autoimmune (vasculitis, inflam. demyelinating neuropathy)
Tumour (paraneoplastic, paraproteinaemia)
Hereditary sensory motor neuropathy
What sx would you see with papillits?
Optic nerve affected: - blurred optic disc margins - blurred vision - pain on eye movement
What sx indicate MS?
Two lesions Separated in time/space
How is meralagia paraesthetica managed?
Compression of the lateral femoral cutaneous nerve - reassure not serious - avoid tight clothing - lose weight - if persistent pain, start on carbamazepine/gapapentin
What is radiculopathy, including sx and causes?
Disease of the nerve roots Sx include: pain in buttock, radiating down leg below knee (sciatica) Causes include compression by disc herniation or spinal canal stenosis
Describe the sx of the following conditions: a) Parkinson’s, b) PSP (Steele-Richardson syndrome), c) Lew body dementia?
a) Tremor, rigidity, bradykinesia b) Parkinsonian features, upgaze abnormality c) Features of Alzheimer’s disease, Parkinson’s and hallucinations
Possible ddx for apparent confusion/low AMTS
Post-ictal - hx of seizures Dysphasia (receptive/expressive) - features of stroke/TIA Dementia (vascular, alcohol, Alzheimer’s, inherited: HD) - hx of IHD/PVD, signs of excess ETOH, features of HD Depressive pseudodementia - elderly, withdrawn, poor eye contact, precipitating factor
Possible ddx of confusion/low consciousness
Hypoglycaemia
Vascular
- bleed: headache, collapse
- subdural haematoma: fall, fluctuating consciousness
Infection - temperature, intracranial, extra-cranial?
Inflammation
Malignancy
Metabolic/toxic - Drugs, U&E, LFTs, vit. defi., endocrinopathies
How to assess GCS
Eyes (4) 4 = Spontaneous 3 = Opens in response to voice 2 = Opens in response to painful stimuli 1 = Does not open Verbal response (5) 5 = Oriented 4 = Confused 3 = Words 2 = Sounds 1 = No sounds Motor response (6) 6 = Obeys commands 5 = Localizes pain 4 = Withdraws to painful stimuli 3 = Abnormal flexion 2 = Extension 1 = No movements
How to assess AMTS
Start by telling them an address to remember then ask the following: 1. DOB 2. Age 3. Time 4. Year 5. Place 6. Recall (West Register Street) 7. Recognise doctor/nurse 8. Prime Minister 9. Second WW 10. Count backwards from 20 to 1
Possible ddx of headaches
Meningitis - fever, neck stiffness, Kernig’s sign
Subarachnoid haemorrhage - sudden onset, CT, LP (xanthochromia)
Migraine - throbbing, vomiting, aura, photo/phonophobia, FHx
Giant cell arteritis - polymyalgia rheumatica, shoulder girdle pain, stiffness, constitutional upset - >50 y.o - ESR, steroids, Bx
How would you manage a stroke?
<4.5 hours - CT: no haemorrhage - Thrombolysis (if no contraindications) >4.5 hours - CT head (exclude haemorrhage) - Aspirin (300mg) - Swallow assessment - Maintain hydration, oxygenation, monitor glucose
How would you manage a TIA?
Aspirin Don’t treat BP acutely (unless >220/120 or other indication) ECG, echocardiogram Carotid doppler Risk factor modification
What is the most likely diagnosis? - 40 year old - Backacke - LMN weakness - admitted to HDU - regular FVC monitoring - cardiac monitor - IVIG
Guillain-Barre syndrome - immune system produces harmful antibodies that attack the nerves - IVIG is a treatment made from donated blood that contains healthy antibodies (intravenous immunoglobulin)
