neuro Flashcards
discuss some broad features of peripheral nueropathy
weakness– distal
early muscle wasting
reduced or absent reflexes
sensory/autonomic can be involved.
EMG will give neurogenic picture
CK may be elevated
discuss polymyositis
chronic inflam of the muscle endomysial layer.
similar to dermatomyositis
S+S: weakness + loss of muscle mass in prox muscles (inc neck) +/- pain.
hip extensors often significantly affected- sit to stand is difficult.
dysphagia, foot drop, low grade fever and enlarged lymph nodes.
associated with interstitial lung disease + cancers.
cytotoxic T cell mediated, unknown antigen.
Ix: need 4 things for diagnosis
history + examination in keeping, inc creatine kinase, EMG alteration, +ve muscle biopsy.
Rx: steds
discuss a drug induced myopathy
steroids- >10mg a day for 30 days can induce myopathy (inhailed also)
proximal lower limb muscle loss, gradual, insidious- often alongside other side effects.
can get a severe one if on ICU in high dose dex, betamathasone, triamcinolone.
discuss bells palsy
sudden (within 72 hours) unilateral upper and lower facial paralysis.
unknown cause- but infection considered likely (HSV, VZV)
20-30ppl per 100 000
15-45- age range
forehead involvement is key differential vs stroke.
Ix: clinical but may investigate due to red flag style symptoms.
Rx: pred if caught early- 50mg daily 10/7 Or 60mg 5/7 then reduce 10mg a day.
lubricate eye- ointment at night
refer if no resolution in 3/12, no improvement in 3/52 of treatment.
brain abscess
a suppertive collection of microbes (bact, fung, para) within a gliotic capsule.
prog related to neuro status at presentation.
RF: sinusitis, ititis media, dental issues, meningitis, head/neck/neurosurg, endocarditis
S+S: headache, nerve palsy, kernig/ brudzinski, fever.
Ix: MRI with contrast- ring enhancing lesions.
bloods, inflam markers etc.
Rx: abx 1st line- vanc (15mg/kg 12hrly) + met (500mg 6hr) + CEF (2g 12hrly)—- all IV
surgical evac if neurodecompenstaion OR greater than 2.5cm.
brain metastases
lung, breast, melanome are most likely to met to brain.
- small cell gets brain irradiation due to high likelyhood.
mets more common than primary brain tumour.
S+S: headaches, bluury vis, nausea, hearing loss, papilledema.
Ix: fine slice MRI with contrast. - gold standard
CT is good for quick.
Rx: manage brain edema first – steds (consider 10mg IV + 4 IV 6hrly)
if fit, good current neuro status– surgical resection + whole brain radiotherapy
sterotactic radiotherapy if not surg candidate.
discuss carpal tunnel syndrome
most common entrapment neuropathy
1 in 25
40-60 female highest risk
S+S: numbness/ tingling in medial nerve area, worse at night, gradual onset, weakness of thenar muscles.
RF: age, bmi, female, prev #, diabetes, preg.
Ix: electrogyography- slowing of conduction
Rx: splints at night 1/12.
2nd line- sted injection- methlypred- 20-80mg or dex 4mg.
falied injection- surgical release.
discuss cerebellar disorders
coordination, balance and gait. slurred speech.
S+S: ataxia, imbalance, dysarthria, nystagmus, vertigo, dyspraxia.
stroke more common in over 45, genetic ususally diagnosed in childhood.
clinical signs gaze test- change head but fix gaze, nystagmus is indicative.
scanning speech, coord test issues.
rebaound phenomenum
gait, heel shin etc etc.
Ix: broad range of things that can cause, consider imaging, labs, LP etc
Rx: the underlying causes.
things that cause bilateral/ uni cerebellar dysfunction
MS, PCA stroke, paraneoplastic syndromes, toxins, metabloic (thyroid, b12, wilson), infections, inflammation (GBS) hereditary
unilateral: space occupying lesion, vascular lesions, multipel system atrophy.
cerebral palsy definition, causes and types.
umberella term for non progressive neurological disease. results in movement disorders and posture disorders.
causes:
antenatal: TORCH, prematurity, multiple birth, maternal illness (thryoid)–> 70-80% of CP cases.
perinatal: asphyxiation (instrumental), birth trauma, placental abruption,
Post natal: neonate sepsis, resp distress, early-onset meningitis, head injuries.
there are multiple subtypes
spastic
dyskinetic
ataxic
mixed.
investigation, management of CP
Ix: mri brain
Rx: PTOT,
consider orthoses
consider injectables (botox)
consider surgery
consider adaptive equipment.
dystonia- consider levodopa
discuss chronic fatigue
a chronic debilitating disorder characterised by post exertional fatigue
need to be observed/ monitored for 3 months (NICE) to start treatment. 6 months for diagnostic criteria to be met in adults, 3 in children.
sudden or gradual onset, persistent disabiling fatigue.
cognitive dysfunction
Ix: depaul symptom questionaire, FBC with WBC, ESR, CRP.
Rx: lifestyle changes, pacing, rest intervals, improve sleep quality.
discuss encephalitis
pathological state of brain parenchymal dynsfunction + inflammation– leads to altered function / consiousness
noninfective (autoimmune, hepatic dysnfunction etc) and infective causes(Herpes, west nile, meningitedies).
Rf: under one, over 65.
immunodef
post-infection
transplantation, body fluid exposure.
S+S: altered consiousness, seizures, personality change, CN palsy, speech, motor or sensory problems.
headache, blur vis, somnolence.
Ix: FBC (inc wcc indicated infective cause)
MRI>CT- hyperintense lesions on T2.
Rx:
suspected viral –> acyclovir 10mg/kg 8 hrly.
if autoimmune–> steds
if no cause–> supportive mgt–> may requiere ICU.
Prog: may die
discuss essential tremor
progressive tremor in upper extremites present in posture and action without other neuro signs or symptoms.
gen mild.
prelevance inc with age
symmetrical, rythmic, involuntary oscillation. absent at rest.
RF: age, FH, white, toxins.
Ix: clinical diagnosis after ruling out other causes (use MRI if other signs present)
Rx: if functional dysfunction or embaressment
propanolol- 10mg/day (between 2-4 doses) up to a max of 320
Or
primidone
2’- gabapentin
2nd line treatment- deep brain stim.
discuss febrile seziures
a seziure occuring in a febrile child (38 or more) between the ages of 6 - 60 months.
– no intercranial infection
– metabolic disturbance
– history or other seziure
classified as complex or simple, depending on clinical features.
patho: individual reaches a threshold temperature. induced by a viral pathogen usually.
simple: less than 15 mins, resolve and dont recurr (24hr)
complex: focal onset/ features, longer than 15 mins, recurrence within 24hr. 9-35% 1st seziures are complex.
