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Year 3 Neuro > Nerve injuries > Flashcards

Nerve injuries Flashcards

1
Q

Define Bell’s palsy

A

Acute, unilateral, idiopathic facial nerve paralysis

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2
Q

What are the features of bell’s palsy?

A

Lower motor neurone facial nerve palsy - forehead affected
Post-auricular pain
Altered taste
Dry eyes

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3
Q

What is the difference between upper and lower motor neurone facial lesions?

A

Upper = forehead sparing

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4
Q

How is Bell’s palsy diagnosed?

A

Clinical diagnosis of exclusion

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5
Q

What are some RFs for Bell’s Palsy?

A

Intranasal flu vaccine

Pregnancy

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6
Q

What is the management for Bell’s palsy?

A

Corticosteroid
e.g. Prednisolone reduces time for full recovery
Usually within 3-4 months

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7
Q

What are the features of third nerve palsy?

A

Down and out eye

Ptosis

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8
Q

What is ptosis?

A

Drooping or downward displacement of the upper eyelid

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9
Q

What are some differentials for ptosis?

A

Thyroid eye disease
Stroke
Orbital tumours
Involutional changes as a result of squinting

Uncommonly - MS, Myasthenia gravis, giant cell arteritis, horner’s, third nerve palsy

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10
Q

What is multiple sclerosis?

A

Demyelinating CNS conditions

2 separate episodes of neuro dysfunction in different anatomy

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11
Q

Who is a typical MS pt?

A

White women
20-40 years
Temporary visual and sensory weakness

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12
Q

What are some presenting features of MS?

A 
Visual disturbance in one eye
Peculiar sensory phenomena e.g. numbness, trigeminal neuralgia
Increased muscle tone
Increased reflexes 
Imbalance
Spastic weakness
Tremor
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13
Q

What are the investigations for MS?

A

MRI brain - periventricular plaques

Visual evoked potentials

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14
Q

What are the different forms of MS?

A

Relapsing-remitting
Secondary progressive disease
Primary progressive disease

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15
Q

What is the treatment for an acute MS relapse?

A

High dose steroids e.g. methylprednisolone

Hastens recovery

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16
Q

What are some disease modifying drugs used in MS?

A

Beta-interferon reduces relapse rate up-to 30%

Monoclonal ABs e.g. natalizumab

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17
Q

What can be used to treat spasticity?

A

Gabapentin
Diazepam
Physio

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18
Q

Define trigeminal neuralgia

A

Unilateral disorder characterised by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve

19
Q

What evokes pain in trigeminal neuralgia?

A

Light touch e.g. washing, shaving, smoking, talking , brushing teeth

20
Q

What is first-line treatment for trigeminal neuralgia?

A

Carbamazepine

21
Q

What comprises the term paraesthesia?

A

Tingling
Prickling
Pins and needles
Burning

22
Q

What are some differentials for paraesthesia?

A 
Carpal tunnel (3 digit weakness) 
Spinal cord compression
MS
DM
Peripheral vascular disease
23
Q

What are the main symptoms of peripheral neuropathy?

A 
Pain
Tingling 
Loss of sensation
Loss of balance or weakness
Poor healing wounds/lcers
24
Q

What cases peripheral neuropathy?

A

Viral infection e.g. shingles
Alcohol excess
Medications
Diabetes

25
Q

What is the initial management for neuropathic pain?

A 
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
One at a time
26
Q

What conditions can case tremor?

A 
Parkinsons
Anxiety
Essential tremor
Thyrotoxicosis
Hepatic encephalopathy 
CO2 retention
Cerebellar disease
27
Q

Define tremor

A

involuntary rhythmic oscillation of ≥1 body parts, mediated by alternating contractions of reciprocally acting muscles

28
Q

Define essential tremor

A

progressive tremor of the upper extremities, present in posture and action, without other neurological signs or symptoms

postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)

29
Q

How do you diagnose essential tremor?

A

Clinically

bilateral tremor with normal muscle tone and speed of movement; negative history and examination for Parkinson’s disease, hyperthyroidism, medications, and alcohol use

30
Q

When is medical treatment considered for essential tremor?

A

Dysfunction or embarrassment

31
Q

What are the treatment options for essential tremor?

A

Propanolol

32
Q

Define ALS

A

Amyotrophic lateral sclerosis
Neurodegenerative disorder
Progressive muscle weakness and disability
Usually death from respiratory failure

33
Q

What are some presenting feature of ALS?

A 
Upper extremity weakness
Stiffness
Poor coordination and balance
Painful muscle spasms
Foot drop
Muscle atrophy
Hyper-reflexia
Dyspnoea
Slow speech
34
Q

How is ALS diagnosed?

A

Clinically
presence of upper and lower motor neuron signs, disease progression, and absence of any other explanation for the presentation

35
Q

What is the first line treatment for ALS?

A 
Riluzole - Prolongs survival 
Supportive care
NIV
Counselling regarding prognosis 
Advance directives
36
Q

What are the types of motor neurone disease?

A

AML - 50%
Primary lateral sclerosis - UMN signs only
Progressive muscular atrophy - LMN signs only
Progressive bulbar palsy

37
Q

What are the features of progressive bulbar palsy?

A

palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
carries worst prognosis

38
Q

What can cause spinal cord compression?

A 
Spine trauma
Vertebral compression fracture
Intervertebral disc herniation
Primary or metastatic spinal tumour 
Infection
39
Q

What can be presenting features of spinal cord compression?

A 
Back pain 
Numbness
Weakness or paralysis 
Bladder/bowel dysfunction
Hyper-relflexia
40
Q

What is the investigation for spinal cord decompression?

A

MRI Spine

41
Q

What is the management for acute spinal cord injury?

A

Immobilisation e.g. cervical collar, backboard

Decompressive/stabilisation surgery

42
Q

What is the management for cauda equina syndrome?

A

Decompressive laminectomy

43
Q

What is the management for malignant spinal cord compression?

A

Corticosteroids - oral dexamethasone
Surgery - decompression laminectomy
Radiation therapy

Year 3 Neuro (17 decks)

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