Lecture 2 NS - Clinical Neurology Flashcards
What is neurology?
Diseases of brain, spinal cord, peripheral nerves and muscle
Which neurological diseases have high incidence in GP?
Stroke, carpal tunnel syndrome, epilepsy, bell’s palsy, tremor, parkinson’s disease, brain tumour, multiple sclerosis
Which neurological diseases have a high prevalence in the community?
Migrainse, stroke, alzheimer’s disease, epilepsy, tremor, MS, chronic fatigue, parkinson’s disease, unexplained symptoms
What are the different types of stimuli which can cause neurological problems in order of speed of onset?
Traumatic, vascular, toxic/metabolic, infectious, inflammatory/autoimmune, genetic/congenital, neoplastic, degenerative
How do you take a history?
Nature of symptoms, onset of symptoms, previous medical problems, family history, social history, other symptoms
What are the causes of stroke?
80% due to blockage of blood vessel, 20% due to bleeding - usually due to clot formed in carotid arteries
What does stroke affect?
Any part of the brain (but cerebrum), and tends to cause problems on contralateral side to brain lesion
What are some risk factors for stroke?
Haemorrhage often due to high blood pressue - smoking, family history, diabetes, excess alcohol
What are the symptoms of stroke?
Related to which artery in the brain is affected - aphasia, hemiparetic,
What does a middle cerebral artery stroke result in?
Mot commonly affected - results in weakness, loss of sensation on contralateral side
What does a posterior cerebral artery stroke result in?
Affect occipital lobe, so result in vision loss on contralateral side (in both eyes)
What does an anterior cerebral artery stroke result in?
Cause contralateral leg weakness
What occurs if a stroke affects the brainstem?
Cause problems with balance, eye movements, speech and swallowing, breathing
How long can recovery from stroke take?
Variable and can take up to 2 years
What are the 3 types of stroke treatment?
Acute, treat complications, prevent further stroke
How is the stroke acutely treated?
Intravenous thrombolysis or intra-arterial thrombectomy
How are the complications from stroke treated?
Neurosurgery for haemorrhage/dangerously high pressure
How are further clots prevented?
Thin blood with aspirin, treat diabetes and high cholesterol, treat dangerously narrow carotid arteries
How are neurological problems examined?
Cognitive/thinking abilities, cranial nerves (smell, vision, eye movement, facial sensation and movements), limbs-power/coordination/reflexes/sensation
What is Parkinson’s disease?
Slowly progressive degenerative disease affecting basal ganglia
What are the main clinical features of Parkinson’s?
Rigidity, tremor and bradykinesia - loss of neurones from substantia nigra to the caudate and putamen
How is Parkinson’s treated?
With levodopa or with electrodes implanted deeps into brain
What is Spastic Paraparesis and what is its cause?
Stiff and weakness in limbs -due to: trauma, Autoimmune/inflammatory, neoplastic, degenerative, infection, vit deficiency, vascular
What are the areas affected by stroke, multiple myeloma and acute polyneuropathy?
A) stroke
B) MM
C)APN
What are the causes of acute polyneuropathy?
Infections, autoimmune, drugs, exposure to toxins
What are the symptoms of Acute inflammatory demyelinating polyneuropathy/Guillain-Barre Syndrome?
Common cause of acute neuromuscular weakness - progressive ascending sensorimotor paralysis with areflexia, affecting 1 or more limbs - patients may progress to almost complete paralysis and require ventilation
How is Guilllain-Barre syndrome treated?
Immunotherapy, supportive inc. ventilation, cardiac monitoring, anticoagulation to prevent blood clots
How are neurological problems investigated?
Brain scans - CT/MRI, CSF (Lumbar puncture), Nerve conduction studies and EMG, EEG and evoked potentials, brain pathology (damage to cells/larger structures
Where is a lumbar puncture carried out?
L3-L4 or L4-5
