Introduction to neurology Flashcards
What is neurology?
diseases of brain, spinal cord, peripheral nerves and muscle
use patients’ symptoms, history and examination to help guide diagnosis
What is syndrome?
signs and symptoms people present with - CHECK HISTORY
damage to NS causes a collection of symptoms
gives idea of underlying anatomy
Speed/mode of onset indicated?
determines most likely underlying aetiology
traumatic –> vascular –> toxin –> infection –> inflammatory autoimmune –> genetic –> neoplasia –> degenerative
What is stroke?
clinical syndrome
- loss of vision
- paralysis on one side
- weakness on one side
- difficulty with speech
What is typically affected with high BP, smoker, cannot move one side of body?
brain due to stroke
muscle unlikely to affect one side only
Types of stroke?
80% infarct (blocked vessel) due to clot from arteries in neck typically (carotid arteries)
20% haemorrhage (bleeding) due to high BP often
smokers/family history/diabetes/excess alcohol at higher risk
What problems are caused by stroke?
can affect any part of brain (also brainstem)
tend to cause problems on other side of lesion (contralateral)
How to assess stroke?
MRI - see whether infarct/haemorrhage
Syndrome for middle cerebral artery stroke?
most commonly affected
weakness and loss of sensation contralaterally
Syndrome for posterior cerebral artery?
in occipital lobe
visual loss contralaterally
Syndrome for anterior cerebral artery?
contralateral leg weakness
Syndrome for brainstem?
problems with balance, eye movements, speech and swallowing (cranial nerves), breathing
Recovery for brainstem stroke?
very variable
up to 2 years
Treatment for stroke?
IV thrombolysis dissolve clot, thrombectomy to remove clot
neurosurgery for haemorrhage or dangerously high pressure
Preventative measure for further stroke?
thin blood with aspirin
treat diabetes and high cholesterol
treat very narrow carotid arteries
How to diagnose neurological problems?
cognitive/thinking abilities using mini mental state examination
cranial nerves (smell, vision, eye movements, facial sensation and movements)
limbs - power, coordination, reflexes and sensation
What are the symptoms of parkinson’s?
akinetic rigid syndrome - parkinsonism
main features are rigidity (stiffness), tremor (shaking) and bradykinesia
What is Parkinson’s disease?
slowly progressive degenerative disease of dopamine neurones of substantia nigra of basal nigra (loss of neurones to caudate and putamen - parts of basal ganglia)
What drug is used to treat Parkinson’s?
levadopa - can cross blood brain barrier
electrodes implanted deep into brain to improve movement
Where would be affected with weak and stiff lower limbs (increased tone) and brisk reflexes (upper motor neurone)?
Spinal cord
not brain - no cranial nerves affected
no muscle - rest of body working fine
What is the cause of stiff legs, over 4 months?
spastic paraparesis
trauma
inflammatory/autommune (MS)
degenerative (MND)
Vitamin deficiency (B12)
neoplastic (spinal cord tumour, metastatic)
Infection (viral, syphilis)
vascular (anterior spinal artery thrombosis)
Cause of spastic paraperesis?
tumour of plasma cells - multiple myeloma
treat with radio/chemotherapy quite quickly
Cause of paraesthasiae (ascending pins and needles), 3 days, cannot walk
Peripheral nerves - acute polyneuropathy
normal cognition and cranial nerves
Causes of acute polyneuropathy?
infection (diphtheria)
autoimmune (AIDP, GBS)
drugs (chemo)
exposure to toxins
What are GBS/AIDP?
common causes of acute neuromuscular weakness
progressive ascending sensorimotor paralysis with areflexia (reach nadir in 4wks, affect 1 or more limbs)
can cause complete paralysis, need ventilation
Treatment of GBS/AIDP?
Caused by antibodies binding to myelin causing demyelination
plasma exchange to wash out toxic antibody or IV Ig
supportive (ventilation) whilst treated/cardiac monitoring
anticoagulation - minimal movement so prone to clots
Methods for diagnosis of neurological problems?
lumbar puncture (CSF) to look for infection, tumour, inflammation, signs of Alzheimers at L1/2 where no spinal cord
EEG - spikes in epilepsy (spike all at one time)
Nerve conduction studies - check how quickly nerves work, how many axons died
Visual evoked potentials - record speed of signal due to loss of myelin
Histology - stain for amlyoid plaques in Alzheimer’s
