Neuro Flashcards
Definition of trigeminal neuralgia
- Facial nerve pain that occurs in one or more of the divisions of the trigeminal nerve - maxillary, opthalmic or mandibular
- Characterised by sharp intense stabbing pain lasting up to 2 minutes and/or constant component of facial pain without neurological pain.
Aetiology of trigeminal neuralgia
- Compression, demyelination or brain stem lesion
Risk factors of trigeminal neuralgia
- Smoking, MS, increasing age, women and hypertension
Presentation of trigeminal neuralgia
- Knife like pain
Investigations of trigeminal neuralgia
- Clinical picture
Management of trigeminal neuralgia
- Carbamazepine
- Gabapentin
Definition of cluster headache
- Painful, unilateral headache
- Men, common and between 20 to 50.
Aetiology and risk factors of cluster headache
- Unknown but risk factors include male, family history, head injury, smoking and heavy drinking
Presentation of cluster headache
- Pain around the eye or temple, extruciating pain.
Investigations of cluster headache
- Rule out of red flags and use of MRI/CT
Management of cluster headache
- Acute attacks with triptans.
Definition of migraine
- Recurrent headaches with visual and GI disturbances
- Chronic and usually occur in patients with genetic predisposition
- Women
- Common
- Mostly commonly before the age of 40
Aetiology of migraine
- No known cause but due to genetic and abnormal brain activity
Presentation of migraine
- Triggers - CHOCOLATE
- Unilateral throbbing or pulsative headache with moderate to severe pain, usually lasting around 4 to 72 hours.
- With or without aura including visual, sensory, motor or speech that lasts 5 to 60 minutes and is reversible
Investigations of migraine
- Clinical
Management of migraine
- Acute attacks = triptans with NSAIDs/paracetomol
- Prophylaxis = beta blockers or anti epileptic medications
- Remove triggers - ie OCP
- Hot/cold compresses, sleep, dark rooms or acupuncture
Definition of tension type headaches
- Chronic or episodic
- Most common type of headache and rarely disabling
Aetiology and risk factors of tension type headaches
- Usually triggered by emotion or stress
- Females, 20 - 40, fatigue or analgesic overuse
Presentation of tension type headaches
- Mild to moderate ‘band like’ headache
- Bilateral and non pulsitile
- Can be with or without scalp muscle tenderness
Investigations of tension type headaches
- Clinical picture
- Can classify episodic or chronic - less than 15 days a month is considered episodic where as more than 15 days a month for 3 month is chronic
Management of tension type headaches
- Over the counter analgesics such as NSAIDs or paracetomol
- Accupuncture?
Definition of meningitis
- Inflammation of the meninges
- Epidemiology varies due to widespread vaccination programme.
Aetiology of meningitis
- Bacteria: N.meningitidis, S. penumonia
- Viral: Enterovirus
- Chronic: Myobacterium tuberculousis, syphilis
- Neonates usually Listeria
Presentation of meningitis
- Classically acute bacterial meningitis can present with fever, headache, neck stiffness - usually occurs over minutes and hours.
- Viral meningitis - self limiting usually around 4 to 10 days.
Investigations of meningitis
- Bacterial meningitis is a medical emergency.
- Glasgow Coma Score
- Blood cultures - as soon as possible
- Lumbar puncture
Management of meningitis
- Broad spectrum antibiotics such as Certifixone
- Steroids such as IV dexamethasone
- Contact tracing
Definition of ataxia
- A neurological syndrome characterised by clumsy and uncoordinated movement of the limbs, trunk and cranial muscles.
Presentation of ataxia or cerebellar disease
- It can affect any motor function - this includes slurring speech, difficulty swallowing, blurred vision, clumsiness due to loss of precision of movement, tremor, unsteadiness when walking, falls and cognitive movement
Investigations of ataxia or cerebellar disease
- MRI
Definition of muscular dystrophies
- Progressive, generalised disease of muscle.
- Most often caused by a defective or specifically absent glycoprotein (Dystrophin)
- Characterised by ongoing degeneration and regeneration of muscle fibres
- Examples include Duchenne and Becker’s: X linked, most common males, rarely females but can be carriers
Presentation of muscular dystrophies
- Duchenne presents in childhood usually around 18 month, with proximal muscle weakness.
- The patient has hip and knee flexor and ankle planter flexers being stronger than the hip and knee extensors and ankle dorsiflexors.
- Calf hypertrophy
- Diminished muscle tone and deep tendon reflexes
Investigations of muscular dystrophies
- Increased serum creatine kinase levels
- Muscle biopsies
- Genetics - Xp21
Management of muscular dystrophies
- No cure
- Steroids delay progression