Neuro Flashcards

1
Q

Causes of TIA

A

Cardioembolism from valve disease, prosthetic valve, post-MI, AF etc
Hyperviscosity e.g. polycythaemia, sickle cell anaemia, VERY HIGH WBC, myeloma
Artherothromboembolism

ALSO, hypoperfusion (important to think abt in young people)
e.g. cardiac dysrhythmia, postural hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define a TIA

A

Acute loss of cerebral/ocular function lasting < 24 hours
Complete clinical recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RF TIA

A

Same as IHD
M > F
Black ethnicity have ↑ risk (bc ↑ risk of HTN, atherosclerosis etc)
Age
HTN, Smoking, Heart disease
Peripheral arterial disease

ALSO, combined oral contraceptive pill (bc ↑ risk of clots)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Key presentation of TIA

A

Sudden loss of function with complete recovery
FAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What part of the circulation is more commonly affected?

A

Anterior circulation (90%) - carotid artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe some signs/symptoms if the anterior circulation (carotid artery) is occluded in TIA

A

Weak, numb contralateral leg and/or similar but milder arm symptoms
Hemiparesis
Hemi-sensory disturbance
Amaurosis Fugax
Dysphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe some signs/symptoms if the posterior circulation (vertebrobasilar artery) is occluded in TIA

A

Diplopia, vertigo
Vomiting
Choking and dysarthria
Ataxia
Hemi-sensory loss
Tetraparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

WHat do oligodendrocytes do?

A

Myelinate axons in brain (CNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do Schwann cells do?

A

Myelinate axons in the rest of the body (PNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does white matter contain?

A

Myelinated axons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does grey matter contain?

A

Cell bodies, no myelin sheaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are afferents?

A

Axons which take info towards CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are efferents?

A

Axons which take info from CNS to rest of body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Function of frontal lobe

A

Voluntary movement on opposite side of body
Frontal lobe of dom hemisphere controls speech (Broca’s!) and writing
Also, intellectual function, thinking, reasoning and memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Function of parietal lobe

A

Receives/interprets sensations
e.g. pain, touch, pressure, body-part awareness (proprioception)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Temporal lobe function

A

Understanding the spoken word (Wernicke’s), and sounds, memory and emotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Occipital lobe function

A

Understanding visual images and meaning of written words

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is CSF produced by?

A

Mostly by ependymal cells in the choroid plexuses of lateral ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DDx

A

Hypoglycaemia!!
Intracranial lesion
Migrainous aura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

1st line Ix TIA

A

ROSIER scale - in emergency department

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the ROSIER scale

A

ABCD2 score - risk score of strokes (max = 7)]

A - Age ≥ 60 (1)
B - Blood pressure (at presentation), 140/90 or more (1)
C - Clinical features
Unilateral weakness (2)
Speech disturbance without weakness (1)
D - Duration, 60 mins or longer (2), 10 - 59 mins (1) D - Presence of diabetes (1)
—-
High risk :
- ABCD2 score of 4 or more
- AF
- More than TIA in one week
- TIA whilst on anti-coagulation

Low risk :
- None of the above
- Present more than a week after their last symptoms have resolved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the signs/symptoms if the Anterior cerebral artery (ACA) is occluded in stroke

A

DCLIT

Drowsiness
Contralateral leg weakness and sensory loss (more leg than arm bc ACA)
Logical thinking and personality affected
Incontinence
Truncal/gait ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the signs/symptoms if the middle cerebral artery (MCA) is occluded in stroke

A

Contralateral motor weakness/sensory loss (BOTH arms and legs)
Hemiplegia
Aphasia - Wernicke’s and Broca’s
Facial droop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the signs/symptoms if the posterior cerebral artery (PCA) is occluded in stroke

A

Contralateral homonymous hemianopia
Disorders of perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Describe the signs/symptoms if the posterior circulation (vertobrobasilar artery) is occluded in stroke
(More catastrophic bc wider region supplied) Balance and coordination impaired
26
Describe the signs/symptoms if there is a brainstem infarction
Sudden vomiting, vertigo, ipsilateral Horner's syndrome
27
Ix Ischaemic Stroke
**URGENT non-enhanced CT head!!!** (BEFORE Tx) to differentiate between ischaemic and haemorrhagic -- Diffusion weighted MRI - more sensitive, confirms diagnosis Bloods - to check BG and for polycythaemia etc Pulse, BP and ECG - check for AF ESR - vasculitis U&Es - cholesterol INR - if on warfarin
28
Tx Ischaemic stroke
Immediate loading dose of aspirin and refer to specialist !!
29
Tx Ischaemic stroke
**Immediate loading dose (300mg) of aspirin** and refer to specialist !! Continue aspirin for 2 weeks **THROMBOLYSIS WITH IV ALTEPLASE** WITHIN 4.5 hours of symptom onset Thrombectomy Within 6 hours of symptom onset Also : maximise reversible ischaemic tissue w/ hydration, keep O2 sats > 95%
30
Contraindications of thrombolysis w/ IV alteplase
Hx of stroke in diabetes patients Severe stroke Stroke in last 3 months Active malignancy
31
When is thrombectomy indicated?
In severe stroke if large artery affected
32
Long term management for Ischaemic stroke
SALT support Rehab After 2 weeks of aspirin, switch to 75mg Clopidogrel
33
What is a lacunar infarct?
Small perforating artery occlusion Supplies subcortical area (i.e. internal capsule, basal ganglia, thalamus, pons)
34
Why do you have to be careful about treating BP with an ischaemic stroke?
bc even 20% fall will compromise cerebral perfusion
35
Hx of SAH
Hx of trauma Skull fracture Lucid interval, follows by unconciousness
36
What is Cushing's triad?
Bradycardia Wide pulse pressure Irregular respirations
37
What is an intracerebral haemorrhage?
Sudden bleeding into brain tissue due to rupture of blood vessels ∴ infarction bc O2 deprivation
38
Cause of intracerebral haemorrhage
**Uncontrolled HTN** is almost always cause 2° to ischaemic stroke - bleeding after reperfusion Head trauma AV malformation Vasculitis Brain tumour Cerebral amyloid angiopathy - amyloid beta deposits in small/medium vessles Carotid artery dissection
39
RF Intracerebral haemorrhage
HTN Age Smoking Alcohol DM Anticoagulation/Thrombolysis
40
How does HTN cause intracerebral haemorrhage?
Causes stiff, brittle vessels Prone to rupture, microaneurysms
41
Key presentation of intracerebral haemorrhage
Same as ischaemic stroke BUT more likely to lose consciousness or sudden headache
42
Tx intracerebral haemorrhage
**STOP anticoagulants immediately!** Reverse with clotting factor replacement if needed (Beriplex and vit K if on warfarin) **Control BP** - rapid BP lowering if < 6 hours before onset + systolic BP is between 150-220 mmHg AIM : below 140 mmHg **Reduce ICP** IV mannitol Mechanical ventilation if needed **Neurosurgical** - Decompression/shunting may be req
43
When might be lowering BP be contraindicated when treating intracerebral haemorrhage?
Underlying structural cause GCS below 6 Early neurosurgery Poor prognosis
44
Prognosis of SAH
High mortality! ~ 50% die straight away High chance of rebleeding Most survivors left with severe disability
45
What are some signs of ↑ ICP?
N+V Seizures ↑ BP
46
If a Px has meningococcal disease, what must you do?
Notify Public Health England !!!!!!!!!!
47
What is supratentorial herniation?
When the cerebrum is pushed against the skull or tentorium
48
What is infratentorial herniation?
When the cerebellum is pushed against the brainstem
49
If someone has a skull fracture, what must you do? Why?
Urgent CT To check if there's an extradural haemorrhage
50
What is an extradural haemorrhage also known as?
Epidural haemorrhage
51
Cause of extradural haemorrhage
Traumatic head injury - usually to temple, usually at pterion Ruptures middle meningeal artery
52
With a subdural haemorrhage, focal neurology signs/symptoms occurs when?
Mean = ~ 63 days after injury Can be days, weeks or months
53
What is meningitis?
Inflammation of the 2 inner layers of meninges - the leptomeninges (pia mater + arachnoid mater)
54
What age does meningitis most commonly occur?
Can occur at any age but mostly in infants, young children and elderly
55
Causes of meningitis
_Adults and children :_ Neisseria meningitidis Streptococcus Pneumoniae (H. Inuenzae - less common now bc vaccine) _Pregnant women/elderly :_ Listeria monocytogenes _Neonates :_ Escheria coli Group B haemolytic streptococcus (agalactiae and pyogenes) _Immunocompromised :_ CMV Cryptococcus neoformans (fungi) TB - mycobacterium tuberculosis HIV Herpes simplex virus
56
Why are pregnant women told to avoid cheese?
Listeria monocytogenes is found in cheese Risk to pregnant women
57
If Neisseria meningitidis is in the blood with meningitis, what happens?
Meningococcal septicaemia - endotoxin in blood leads to inflammatory cascade Non-blanching purpuric rash/petechial rash, necrosis, signs of meningitis High mortality
58
Key presentation meningitis
Fever Headache Neck stiffness !!!!!!!
59
How to test whether a rash if blanching or non-blanching
Glass test
60
Describe viral meningitis
Benign, self-limiting lasting ~ 4-10days usually
61
Describe the pathophysiology behind papilloedema
Swelling of the optic disc on fundoscopy Usually bilateral
62
Ix meningitis
Immediately assess GCS and take blood cultures - dont wait for results to start treating!! If in community, give IM benzylpenicillin **Lumbar puncture**
63
Tx meningitis
**1. Broad spectrum Abx** - cefotaxime OR ceftriaxone If immunonocompromised, ↑ Listeria risk ∴ add high dose of amoxicillin **2. Specific Abx** -- **Other stuff** If severe penicillin allergy, then = chloramphenicol If recent travel, then = IV vancomycin If viral (enterovirus) = nothing If viral (HSV or vZv) = acylovir **Prophylaxis!** If in contact w meningitis Px for 7+ days (i.e. living together) = one-off dose of ciprofloxacin or rifampicin asap rifampicin - CI if pregnant **Corticosteroids** Oral dexamethasone to ↓ cerebral oedema and complications (e.g. hearing loss) 4x daily for 4 days to children over 3 months
64
Describe the findings of CSF in a meningitis patient
**Bacteria** - turbid colour! Cells - polymorphs (neutrophils) Protein = ↑ Glucose = ↓ **Virus** - clear Cells - lymphocytes Protein = ↑ but not as high Glucose = normal **TB** - fibrin web Cells - lymphocytes Protein = ↑ Glucose = ↓ or normal **Cryptococcal** - fibrin web High opening pressure!
65
RF bacterial meningitis
Students Travel Immunosuppressed
66
RF viral meningitis
Small children Immunosuppressed
67
RF TB meningitis
TB contact Immunosuppressed
68
RF Cryptococcal meningitis
HIV Immunosuppressed
69
Should you give penicillin to a meningitis patient with a penicillin allergy?
Yes unless it's anaphylaxis or severe! If it's just a rash or something, not that deep Meningitis is the bigger threat
70
Complications of meningitis
Hearing loss Seizures/epilepsy Cognitive disability Memory loss Focal neurological deficits
71
How do neonates/children present with meningitis?
Hypotonia Poor feeding Lethargy Hypothermia Bulging fontanelle
72
Why do children/neonates have a low threshold for lumbar punctures? Describe these thresholds
Because meningitis presents w non-specific symptoms < 1 month old with fever 1 - 3 months with fever and are unwell < 1 year w/ unexplained fever and other features of serious illness
73
In patients who present with meningitis, what are some indications that you should perform a CT BEFORE a lumbar puncture?
> 60 years Immunocompromised History of CNS disease New onset/recent seizures Losing consciousness Papilloedema
74
Bacterial Meningitis - If severe anaphylaxis w penicillin, what can you give instead?
IV Chloramphenicol
75
What is encephalitis?
Infection and inflammation of brain parenchyma
76
Encephalitis viral causes
Viral is most common! **HSV VZV, EBV, CMV, HIV, measles, mumps, arbovirus (in West Nile)
77
Encephalitis Non-viral causes
Bacteria - TB, mycoplasma, rickettsia, listeria, neisserria Fungal - Cryptococcus, histoplasmosis Parasitic - malaria, toxoplasmosis, schistosomiasis
78
Non-Infectious causes of Encephalitis
Paraneoplastic Post-infectious Autoimmune
79
Key presentation Encephalitis
Hours - days before = flu-like illness then TRIAD of : 1. Altered GCS 2. Fever 3. Headache
80
Other signs/symptoms of encephalitis
Seizures Memory loss Behavioural changes (common early on) with/without Hx of meningitis (bc it can progress to encephalitis)
81
Ix Encephalitis
MRI head - shows swelling/inflammation with/without midline shifting ECG - periodic sharp and slow waves **Lumbar puncture** (after) - ↑ lymphocytes in CSF, viral PCR May be normal for first 48 hours
82
DDx encephalitis
Anything that causes behavioural changes - DKA Hypoglycaemia Hepatic encephalopathy Thiamine deficiency Meningitis Stroke Drug overdose Brain tumour
83
What is thiamine deficiency also known as?
Beri-beri
84
In encephalitis, what does HSV typically affect?
Temporal lobes of brain
85
Tx Encephalitis
If suspected, start IV Acyclovir until results If HSV or ZVZ - immediate IV Acyclovir VZV - can use Ganciclovir Immunocomp patients - use combination antiviral therapy For seizures - anticonvulsants e.g. Primidone, Carbamazepine
86
Complications of encephalitis
Permanent neurological deficits e.g. epilepsy, movement disorder, personality change, cognitive impairment
87
Prognosis of encephalitis
Mortality = 10-30% even w/ optimum treatment
88
Define seizure
Spontaneous, intermittent, uncontrolled electrical brain activity
89
Define Epilepsy
Recurrent tendency to have seizures, chronic disorder (minimum = 2)
90
Define prodrome
Non-specific symptoms that precede an epileptic attack
91
Describe aura
Sensory disturbance that precedes an attack, usually be minutes. More specific
92
Cause Shingles
Reactivation of varicella zoster virus (chickenpox), usually within dorsal root ganglia Patient has chicken pox, then virus is latent in dorsal root ganglia
93
What age do shingles present?
Any age but usually elderly
94
Route of transmission Shingles
CANNOT be caught from contact w person w chickenpox Patients with rash are infectious until lesions dry
95
RF Shingles
↑ Age Immunocomp HIV Hodgkin's lymphoma BM transplant Low Vit D
96
Presentation Shingles
Pain and paraesthesia in area (side of face or body) then rash. **Restricted to same dermatome** Also : malaise, myalgia, headache, fever
97
Tx Shingles
Oral antivirals within 72 hours of rash onset e.g. Oral aciclovir x5 daily OR oral valicilovir x2 daily OR oral famciclovir x2 daily + Analgesia for pain
98
Shingles complications
Damage to opthalmic branch of trigeminal nerve - affect sight! Post herpetic neuralgia - pain for more than 4 months AFTER shingles
99
How do you treat post herpetic neuralgia?
Tricyclic antidepressant e.g. oral amitriptyline Anti-epileptic e.g. oral gabapentin Anti-convulsant e.g. oral carbamazapine
100
Define Multiple Sclerosis
Chronic autoimmune disease. T-cell mediated inflammatory disease of CNS, multiple plaques of demyelination within brain and spinal cord **EPISODES MUST BE DISSEMINATED BY TIME AND SPACE**
101
How is MS classified?
Pattern 1 - macrophage mediated Pattern 2 - antibody mediated. lots of inflammation Pattern 3 - distal oligodendrogliopathy (virus induced) Pattern 4 - 1º oligodendroglia degeneration (metabolic defect)
102
RF MS
FEMALE ! (2:1 F:M) 20 - 40 years More common the further from equator More common in caucasian HLA-DR2 Exposure to EBV early in childhood Age of migration
103
Types of MS progression
Relapsing/Remitting MS - most common 1º progressive 2º progressive Progressive/relapsing (sucky) Draw graph!!
104
Describe relapsing-remitting MS progression
Clearly defined relapses w/ full or partial recovery and residual deficits! Between bouts, no progression in disability
105
Describe 1º progression of MS
Disease progresses continuously Maybe plateaus and minor improvements but no relapses/remission
106
Describe 2º progression of MS
Initially relapsing-remitting then progresses continuously
107
Describe progressive-remitting progression of MS
Progressive disease w/ clear acute relapses. Periods between relapses are still progressive
108
What type of hypersensitivity reaction is MS?
Type 4 (cell-mediated)
109
What is Charcot's triad?
Intention tremor Nystagmus Dysarthria (Scanning/staccato speech)
110
What's Lhermitte's sign?
When bend neck down, electrical shock runs down back and to limbs
111
Key presentation of MS
Charcot's triad Lhermitte's sign
112
What is MS exacerbated by?
HEAT! e.g. showers, hot weather, sauna Uhthoff's phenomenon
113
Other signs/symptoms of MS
**LOSS NB** **L**hermitte's sign **O**ptic neuritis **S**pasticity **S**ensory symptoms/signs **N**ystagmus, double vision and vertigo **B**ladder and sexual dysfunction
114
What visual signs/symptoms does MS cause?
Optic neuritis - loss of colour discrmination Internuclear ophthalmoplegia! Relative afferent pupillary defect (RAPD)
115
Ix MS
**MRI WITH CONTRAST** - active lesions white, in the periventricular regions **Lumbar puncture w/ CSF electrophoresis** - oligoclonal IgG bands = CNS inflammation (sensitive, not specific), ↑ lymphocytes Other : Aevoked potentials - tests how long impulses take to travel, longer w demyelination
116
What cells are targeted in MS?
OLIGODENDROCYTES ! - CNS Not Schwann cells
117
What specific CNS sites are targeted in MS?
Perivenular, everywhere in CNS but especially : Optic nerves Around ventricles of brain Corpus callosum Brainstem and cerebellar connections Cervical cord
118
How does unilateral optic neuritis present?
Pain in one eye upon eye movement Reduced central vision
119
Tx Acute attacks of MS e.g. relapsing-remitting
Corticosteroids - IV methylprednisolone (1g od for 3 days)
120
Tx Chronic MS i.e. frequent relapse
**1st :** SC beta interferon and glatiramer acetate **2nd :** IV alemtuzumab or IV natalizumab
121
S/E of Beta-Interferon
Flu-like symptoms Mild intermittent lymphopenia Mild-moderate rise in liver enzymes
122
Pathophysiology of IV alemtuzab
CD52 monoclonal antibody, targets T cells
123
Pathophysiology of IV natalizumab
Reduces immune cells that can cross BBB
124
Tx for symptom management of MS
Tremors - beta blockers Muscle spasticity - baclofen, gabapentin General - removal of triggers, physio
125
What do ALL anti-spasticity medications cause?
Weakness
126
Pathophysiology of Baclofen
GABA analogue, reduces Ca2+ influx ∴ surpasses release of excitatory neurotransmitters
127
Prognosis of MS
5-10 years below average Often die from aspiration pneumonia due to dysphagia
128
Define Guillain-Barre syndrome
Acute, inflammatory, demyelinating polyneuropathy Progressive, ascending loss of sensation
129
What age does Guillain-Barre syndrome present in?
2 peaks 15-35 years and 50-75 years
130
Cause of Guillain-Barre syndrome
Usually preceded by resp/GI infection 1-3 weeks before Bacterial : Campylobacter jejuni, Mycoplasma pneumoniae Viral : CMV, EBV, ZVZ, HIV
131
RF
Hx of resp/GI infections a couple weeks before Vaccinations might be implicated ! Post-pregnancy has higher risk (during pregnancy tho has lower incidence)
132
Types of Guillain-Barre syndrome
Demyelinating Axonal Axonal sensorimotor Miller Fisher syndrome - very rare
133
What does Miller Fisher syndrome affect?
Cranial nerves to eye muscles
134
Key presentation of Guillain-Barre syndrome
1. Symmetric, ascending limb weakness 2. Reduced/absent tendon reflexes 3. Reduced sensation
135
What cells are affected in Guillain-Barre syndrome?
Schwann cells! Condition of the PNS
136
Other signs/symptoms of Guillain-Barre syndrome
Cranial nerves - diplopia, dysarthria Resp - affects diaphragm (death) Reflexes are lost early on !!! Back/limb pain Autonomic features - sweating, ↑ pulse, postural hypotension
137
Ix Guillain-Barre syndrome
**Electromyography (EMG)** **Nerve conduction studies** - slow conduction **LP** (done at L4) - CSF = **↑ protein but normal WBC!** also : can check lung function w/ spirometry
138
Tx Guillain-Barre syndrome
IV immunoglobulins Plasmapheresis
139
When using IVIG to treat Guillain-Barre syndrome, what does it do?
Decreases duration and severity of paralysis
140
When is IVIG contraindicated?
If IgE deficient bc can cause severe allergic reaction
141
When using plasmapheresis to treat Guillain-Barre syndrome, what does it do?
Eliminates harmful antibodies
142
How can you reduce venous thrombosis in Guillain-Barre syndrome?
LMWH e.g. SC enoxaparin + compression stockings
143
Prognosis of Guillain-Barre syndrome
Disease progresses for 2 weeks then plateaus for 2-4 weeks then recovery! takes several months to regrow myelin sheath
144
What is the peak age of onset with Parkinson's?
55 - 65 years But can be diagnosed early (40)
145
What happens in Parkinson's disease?
Degeneration of dopamine-producing neurons in substantia nigra
146
Key presentation of Parkinson's disease
**TRAP** **T**remor (resting, pin-rolling) **R**igidity (cogwheel) **A**kinesia **P**ostural instability NO WEAKNESS
147
Other signs/symptoms of Parkinson's disease
Shuffling gait! Mask-like face Depression Autonomic problems - constipation! ↑urinary freq
147
Other signs/symptoms of Parkinson's disease
Shuffling gait! Mask-like face Depression Constipation
148
What medication, used to treat a neurological disease, causes constipation?
Levadopa - Parkinson's
149
What can cause foot drop? What is the difference in presentation with these two causes?
Common peroneal nerve palsy - causes eversion L5 Radiculopathy - causes inversion
150
Key presentation of Cauda Equina syndrome
Saddle anaesthesia Loss of sensation in bladder and rectum - not knowing when full Urinary retention / incontinence Faecal incontinence Bilateral sciatica Bilateral or severe motor weakness in legs Reduced anal tone
151
Causes of Cauda Equina
*Herniated disc Tumours - mets Spondylolisthesis Abscess infection Trauma
152
Ix Cauda Equina
Medical emergency!! - immediate neurosurgery for lumbar decompression surgery Emergency MRI scan to confirm !
153
Tx Cauda Equina
Surgical decompression ASAP Immobilise spine Anti-inflammatory agents Chemo if mets Abx if infection
154
What is Bell's palsy?
LMN weakness of CN 7 (facial nerve) Results in peripheral facial palsy
155
Presentation of Bell's palsy
Rapid onset (< 72 hours) of unilateral facial weakness Loss of taste Post-auricular/ear pain Difficulty chewing Drooling Tingling in cheek/mouth Ocular dryness Drooping of eyebrow
156
Define epilepsy
Recurrent tendency of spontaneous, intermittent, abnormal electrical activity in brain that results in seizures
157
Name of post-ictal symptoms
Headache Confusion Myalgia Sore tongue
158
What is Todd's palsy?
Temporary weakness/paralysis after focal seizure, usually resolves after 2 days