Intro to neurology Flashcards
Distinguish between a neurologist and neurology
Neurology: problems of the brain, spinal cord and nerves, neuromuscular junction etc.
Neurologist: diagnoses and treats disorders of the nervous system
Describe the incidence of neurology in general practice
Stroke Carpal Tunnel Syndrome Epilepsy Bells Palsy Tremor Parkinson’s Disease Brain Tumour Multiple Sclerosis
Describe the prevalence of neurology in the community
Migraine Stroke Alzheimer’s Disease Epilepsy Tremor Multiple Sclerosis Chronic Fatigue Syndrome Parkinson’s Disease Unexplained Symptom
Outline an approach for diagnosing neurological problems
Use the presenting signs and symptoms to identify the underlying anatomy and characterise the syndrome
• Use the mode of onset to determine the most likely underlying aetiology (or pathological cause)
Describe the speed of onset of different neurological problems from fast to slow
Traumatic • Vascular • Toxic/Metabolic • Infectious • Inflammatory/Autoimmune • Genetic-congenital • Neoplastic • Degenerativ
Describe history
• Nature of symptoms • Onset of symptoms • Previous medical problems • Family history • Social history • Other symptoms
Where could the problem be
• Muscle • Neuromuscular Junction • Peripheral Nerve • Spinal Cord • Brain
Summarise stroke
• 80 % are blockage of a blood vessel (infarct) • 20 % bleeding (haemorrhage) • Can affect any part of brain (including brainstem) • Tend to cause problems on the other side to the brain lesion (Contralateral)
Describe the different causes of stroke
• Infarcts often caused by clot from arteries in neck (carotid arteries) • Haemorrhage often related to high blood pressure • People who smoke or have family history are at higher risk • Other risk factors include diabetes and excess alcohol
What do the symptoms of stroke relate to
- Symptoms related to which artery in the brain is affected
- Left side of brain responsible for language so strokes on the left side can cause aphasia
How can strokes affecting different arteries cause different syndromes
• Middle cerebral artery most commonly affected-often results in weakness and loss of sensation on the other side (contralateral) • Posterior cerebral artery strokes often affect occipital lobe-result in visual loss on the contralateral side • Anterior cerebral artery strokes often cause contralateral leg weakness
Describe strokes affecting the brainstem
Strokes affecting brainstem may cause problems with balance, eye movements, speech and swallowing (Cranial Nerves), breathing
• Recovery is very variable and can take up to 2 years
Describe stroke treatment
Acute – Intravenous Thrombolysis-dissolve the clot – Intra-arterial Thrombectomy-remove clot • Treat Complications – Neurosurgery for haemorrhage or dangerously high pressure • Prevent Further Stroke – Thin blood with aspirin – Treat Diabetes and high Cholesterol – Treat dangerously narrow Carotid Arteries
What does the neurological examination consist of
- Cognitive/thinking abilities: ‘Mini Mental State Examination’
- Cranial Nerves-Smell, Vision, Eye movements, Facial sensation and movements
- Limbs-Power, Coordination, Reflexes and Sensation
What is Parkinson’s disease
Slowly progressive degenerative disease affecting the basal gangli
Describe the clinical features of Parkinson’s
The main clinical features are rigidity (stiffness), tremor (shaking) and bradykinesia (reduced movement)
• There is loss of neurones from the substantia nigra to the caudate and putamen (parts of the basal ganglia)
Describe the treatment for Parkinson’s
• The neurotransmitter associated with this is dopamine
• Patients are treated with levodopa
• (Dopamine does not cross blood brain barrier but levodopa crosses blood brain barrier and is converted into dopamine)
Can also be treated with electrodes implanted deep into the brain.
What are the causes of spastic paraparesis
Trauma • Inflammatory/Autoimmune (eg Multiple Sclerosis) • Neoplastic (e.g. Spinal Cord Tumour, Metastatic Tumour) • Degenerative (Motor Neurone Disease) • Vitamin Deficiency (B12) • Infection (e.g. Syphilis, Viral) • Vascular (Anterior Spinal Artery Thrombosis)
What is multiple myeloma
Tumour of plasma cells
• Treated with radiotherapy and chemotherapy
Describe the causes of acute polyneuropathy
Infections eg. Diphtheria • Autoimmune (eg Guillain Barre Syndrome or Acute Inflammatory Demyelinating Polyneuropathy) • Drugs (Chemotherapy) • Exposure to toxins (organophosphate insecticides
GBS/AIDP
Common cause of acute neuromuscular weakness • Clinical Diagnosis • Progressive ascending sensorimotor paralysis with areflexia, affecting 1 or more limbs and reaching nadir within 4 weeks • Patients may progress to almost complete paralysis and require ventilation
Describe the treatment for GBS/AIDP
- ‘Immunotherapy’-Plasma exchange or intravenous immunoglobulin
- Supportive including ventilation if necessary
- Cardiac monitoring
- Anticoagulation to prevent leg clots (and subsequent pulmonary emboli)
Describe the investigations for diagnosing neurological conditions
- Brain Scans- CT and MRI
- Cerebrospinal fluid (CSF) - Lumbar puncture
- Nerve Conduction Studies and Electromyography (EMG)
- Electroencephalogram (EEG) and Evoked Potentials
- Brain pathology – damage to cells or larger structures
