more brain stuff Flashcards
Mostly nerve disorders.
risk factors for giant cell arteritis
polymyalgia
rheumatica
age
pathology of giant cell arteritis
inflammation of temporal artery due to granulomatous build up
symptoms of giant cell arteritis
claudication of jaw scalp sensitivity temple pain sudden unilateral blindness headache
complications of giant cell arteritis
blindness
diagnosis of giant cell arteritis
temporal artery biopsy
ESR and CRP up
ACE up
treatment of giant cell arteritis
high dose steroid (prednisolone)
risk factors for spinal cord compression
osteoporosis
malignancy
slipped disc
treatment of spinal cord compression
treat underlying cause
compression relief surgery
diagnosis of spinal cord compression
emergency MRI
biopsy
serum electrophoresis
CXR to check for lung cancer
symptoms of a trapped nerve
patient feels pain in the distribution of that nerve because the axon spontaneously fires when irritated
lower motor neuron lesion signs
signs at the level of the lesion
upper motor neuron signs
signs below the level of the lesion
causes of cauda equina syndrome
malignancy
disc herniation
signs of cauda equina syndrome
mixed UMN and LMN signs
leg weakness
early urinary retention
symptoms of cauda equina syndrome
low back pain
pain that radiates down leg
numbness around anus
loss of bowel or bladder control
complications of cauda equina syndrome
ongoing bladder/sexual dysfunction
diagnosis of cauda equina syndrome
CT/MRI
treatment of cauda equina syndrome
surgical relief
laminectomy
risk factors for Brown-Sequard syndrome
trauma
septic emboli
pathology of Brown-Sequard syndrome
damage to one half of the spinal cord
signs of Brown-Sequard syndrome
loss of two point discrimination
ipsilateral UMN weakness
ataxia
ipsilateral Babinski sign
symptoms of Brown-Sequard syndrome
ipsilateral paralysis and loss of proprioception
contralateral loss of pain and temperature sensation
diagnosis of Brown-Sequard syndrome
MRI
risk factors for accessory nerve disorder
medical procedures to neck - e.g. cervical lymph node biopsy
pathology of accessory nerve disorder
palsy of accessory nerve, leading to sternocleidomastoid and trapezius function loss
signs of accessory nerve disorder
loss of muscle mass
fasciculations
partial paralysis
winged scapula
symptoms of accessory nerve disorder
muscular weakness in trapezius and sternocleidomastoid
treatment of accessory nerve disorder
surgical repositioning of muscles
preservation of C2-4
risk factors for Bell’s palsy
diabetes
pregnancy
pathology of Bell’s palsy
CN7 palsy, often as a result of a viral infection
signs of Bell’s palsy
unilateral facial weakness numbness/pain around the ear ageusia (loss of taste) sagging of mouth speech difficulty unable to wrinkle forehead
complications of Bell’s palsy
crocodile tears - unilateral lacrimal stimulation
diagnosis of Bell’s palsy
rule out brainstem lesion, stroke, tumour
bloods - increased Borrelia antibodies in Lyme disease
treatment of Bell’s palsy
prednisolone (give quickly)
symptoms of third nerve palsy
pupils down and out
ptosis
diplopia
what is the most common mononeuropathy?
carpal tunnel syndrome
symptoms of carpal tunnel syndrome
aching in hand and arm (esp. at night)
paraesthesia in thumb, index, and middle finger
relieved by dangling arm over the bed
diagnosis of carpal tunnel syndrome
maximal wrist flexion for one minute can induce symptoms
tapping over the nerve can cause tingling
treatment of carpal tunnel syndrome
splinting
local steroid injection
decompression surgery
what percentage of patients over 40 with myasthenia gravis have thyme hyperplasia?
70%
what percentage of patients with myasthenia gravis have a thymic tumour?
10%
they may have antibodies to striated muscle
pathology of myasthenia gravis
autoimmune disease and B and T cell mediation
antibodies to nicotinic acetylcholine receptors at neuromuscular junctions
some pts have anti-MuSK instead (against tyrosine kinase)
signs of myasthenia gravis
ptosis
diplopia
myasthenia snarl
symptoms worse at end of day
order of muscle fatigue in myasthenia gravis
extraoccular bulbar face neck limb girdle trunk
complications of myasthenia gravis
myasthenia crisis - weakness of respiratory muscle
diagnosis of myasthenia gravis
anti-AChR antibodies in 90%
EMG - decreasing muscular response to repetitive nerve stimulation
single fibre EMG - block and jitter of orbiculares occuli
CT to exclude thymoma
tensilon test
treatment of myasthenia gravis
anti cholinesterase (pyridostigmine) immunosuppresion (prednisolone) plasma pharesis IV immunoglobulin thymectomy
risk factors for peripheral neuropathies
infection ischaemia toxins (e.g. vitamin B6 excess) inflammatory disease hereditary
characteristics of sensorimotor neuropathy
symmetrical
length dependent
characteristics of sensory neuropathy
asymmetrical
symptoms of peripheral neuropathy
loss of perception of temperature and pressure
loss of balance (ataxia - worse in the dark)
muscle cramps
muscle weakness
fasciculations
muscle atrophy
what should you always check for in patients presenting with asymmetrical sensorimotor neuropathy?
vasculitis
treatment of peripheral neuropathies
amitriptyline, pregabalin, or gabapentin for pain
quinine for cramps
physiotherapy and walking aids to help with balance
risk factors for Guillain-Barre syndrome
Campylobacter infection
signs of Guillain-Barre syndrome
rapid ascending paralysis and sensory deficits
GI infection might precede the disease
treatment of Guillain-Barre syndrome
IVIG - plasma exchange - do immediately
ITU
