Neuro 2 Flashcards
Cerebellar disorders:
- Function of cerebellum
- Causes
- Symptoms
Cerebellar disorders:
- Function of cerebellum: controls sequence of movements with each hemisphere controlling ipsitlat side
- Causes: VITAMINC: vascular stroke, infection lymes, trauma, alc, iatrogenic phenytoin/carbamaz, neoplastic, congen cataracts
- Symptoms: Dysdiadocokinesia, Ataxia, Nyastagmus horizontal, Intention tremor, Slurred speech, Hypotonia . hemisphere lesions cause peripheral (finger nose ataxia) whereas vermis lesions cause gait ataxia
Horner’s syndrome:
- Definition
- Symptoms
- Cause: central lesions, pre-gang, post-gang lesions
- Investigations
Horner’s syndrome:
- Definition : interuption of sympathetic chain of which postgang fibres synapse at sup cervical ganglion. one runs with ext carotids to sweat glands and other with int carotid to pupillae dilator and sm component of LPS (retracts eyelid)
- Symptoms : ipsilat partial ptosis, miosis, anhidrosis
- Cause: central lesions, pre-gang, post-gang lesions
central (anhidrosis body): stroke, syringomyelia, swelling/tumour/ MS
pre-gang (an face): thyroid dysf, trauma, tumour (pancoast)
post gang: carotid aneurysm/dissection (only painful cause), cs thrombosis, clustrer headache - Investigations: apraclonidine drops (alpha adren agonist) will cause dilatation in horners (but constricts in normal eye), cocaine eye drops (stops na reuptake so dilates in normal pupil but not in horners bc no na released)
Creutzfeldt- jakob disease:
- Definition + types
- Symptoms
- Investigations
Creutzfeldt- jakob disease:
- Definition + types: sporadic >65 or autodom or acquired infection of bovine spongiform encephalopathy. Prion proteins cause amyloid folds which build up into beta pleated sheats which can cause death within few years
- Symptoms : rapid onset dementia, myoclonus, incont, aphasia, anxiety in new variant sporadic
- Investigations : lp (normal or 14 3 3 protein), eeg (biphasic high amp sharp waves), mri (hyperintense signals in basal gang and thymus + cortical ribboning)
Wernicke’s encephalopathy:
- Definition
- Complication
- Symptoms (triad)
- Management
Wernicke’s encephalopathy:
- Definition: neuropsych disorder due thiamine deficiency (b1) which causes neuronal injury in brain where haemorrhage in thalamic nuclei/bstem nuclei and cerebellum
- Causes: alcoholics, persistent vomiting (hyperemesis), anorexia, stomach cancer, diet def
- Complication : korsakoffs (amnesia, confusion, confabulation)
- Symptoms (triad): delirium/confusion, ataxia, ocular dysfunction (nystag,ophthalmoplegia)
- ix: dec red cell transketolase, mri
- Management : iv pabrinex 5 days then oral (+ glucose after if hypoglycemia)
Cavernous sinus syndromes:
- What is the CS + what passes through it
- Causes
- Symptoms
Cavernous sinus syndromes:
- What is the CS + what passes through it : dural venous sinuses - cn3/4/5a/b/6, int carotids, ophthalmic veins
- Causes : cs tumours, pit adenoma, cs thrombosis, cs venous fistula, ica aneurysm
- Symptoms: headache, photophobia, diplopia (cn3), sensory loss v1/v2, facial pain, ipsilat horners
Intracranial venous thrombosis:
- symptoms
- ix
- mx
Intracranial venous thrombosis
- symptoms: headache sudden onset, n+v, reduced conciousness
- types: sagittal sinus (seziures, hemiplegia - delta sign)), CS (periorbital erythema/oedema, trigeminal nerve involved causing eye/face pain, central vein thrombosis, cn6 nerve damage - big risk if antiphospholipid syndrome, inflammatory cond, thrombophilia), lateral sinus (cn6/7 palsies)
- ix: mri venography, d dimers inc, abx also if cs
- mx: lmwh acutely, warfarin long term
Normal pressure hydrocephalus:
- definition
- symptoms
- ix
- mx
Normal pressure hydrocephalus:
- definition: rev cause of dementia. Due to reduced csf absorption at arachnoid villi
- symptoms: urin incont, dementia, gait abnorm
- ix: CT: hydroceph w ventriculomegaly
- mx : ventriculoperitoneal shunting (seizures, infection, haemorrhages)
Aphasia
- wernickes
- brocas
- conduction
- global
Aphasia
- wernickes: receptive, can’t comprehend so word salad. Lesion in superior temporal gyrus (inferior left MCA)
- brocas: expressive, can understand but speech non fluent. Lesion in inferior frontal gyrus (sup left MCA)
- conduction: speech fluent, can’t repeat, comprehends, stroke in arcuate fasiculus
- global: affects all areas
Duchennes muscular dystrophy:
- definition
- symptoms
- signs
- ix
- mx
- complications
- DD
Duchennes muscular dystrophy:
- Definition: defective gene for dystrophin on X chromo which holds muscles together (part of cytoskeleton in cells) and needed for stability/muscle contraction. X linked recessive hence more common in boys. Is progressive disease with 25-35 years life expectancy
- Symptoms: 3-5yr old muscle weakness around pelvis (gower’s sign), shoulders + arms held back when walking + difficulty lifting things (proximal muscle weakness), sway back, calf pseudohypertrophy (degenerated muscle replaced by fat), protruding belly (weak belly muscles), poor balance /clumsy, walks on toes (tight heel cord is contracture), delayed milestones, faltering growth, fatigue, intellectual impairment
- Signs: flat feet, waddling gait, toe walking
- Investigations: CK raised, genetic testing, muscle biopsy
- Management: oral steroids slow progression, creatine supplement can help muscle strength, genetic counselling
- Complications: usually die of resp failure, dilated cardiomyopathy
- DD: spinal muscular atrophy, limb girdle muscular dystrophy (later onset, auto dom)
-
Extra facts:
CHECK CK IF CAN’T WALK BY 18 MONTHS
Syncope:
- causes: reflex, postural orthostatic, cardiac
- mx
reflex: vasovagal fainting, situational (pee, gi, cough), carotid sinus syncope
postural: parkinsons, dehyd, drugs
cardiogenic: arrhythmias, valve disease, long qt, homc
mx: cvs ex, ecg, lying + standing bp
3rd nerve palsy
- function
- symptoms
- causes
3rd nerve palsy
- oculomotor: motor component of lps retracts eyelid, psns sphincter pupillae constricts pupil, extraocular muscles
- symptoms: eye down and out (as LR + SO still ok), ptosis, dilated/aniscoria (if this is spared means microvasc cause like diab/htn/isch and not compressive)
- causes: diab, gca, sle, inc icp causing herniation hence compressiom, post communicating art aneurysm, cs thrombosis, webers syndrome (w contralat hemiplegia)
tuberous sclerosis vs neurofibromatosis
tuberous: auto dom. Dev delay/epilepsy/intellectual impairment. Depigmentation spots, shagreen patches on lumbar spine, angiofibromas butterfly rash over nose, fibromata beneath nails. Also retinal hamartomas
neurofibromatosis: auto dom. phaeochromocytomas, axillary/groin freckles, cafe au lait spots, iris hamartomas, acoustic neuromas
cn4 + 6 palsy
lr6so4
4: trochlear
superior oblique - depresses, abducts, intorts - so eye inwards + elevated - diplopia on vertical gaze (walking downstairs, reading)
6: abducens
lateral rectus: abducts - so eye inwards - diplopia on horizontal gaze
Argyll robertson pupil:
- definition
- causes
- mx
Argyll robertson pupil:
- definition: pupils don’t constrict in response to light but do constrict to focus on nearby object
- causes: tertiary neurosyphilis, diabetes, ms (damage to EWN)
- mx: syph: 3x benzylpenicillin (G) + oral probenecid, diabetes: antidep + antiepil, ms: steroids + glativamer acetate
