Neuro Flashcards
What is the treatment for TIA
- Aspirin 300mg
- TIA clinic within 24 hrs
- Clopidogrel 75mg
Describe the Aetiology of Stroke (3)
- Ischaemic (80%)
- Haemorrhagic (17%)
How might someone with an anterior cerebral artery stroke present (5)
- Contralateral leg weakness/numbness
- Difficulty speaking
- Decreased consciousness
- Ataxia
- Incontinence
How might someone with a middle cerebral artery stroke present (4)
- Contralateral leg AND arm weakness/numbness
- Visual loss in ONE eye
- Difficulty understanding words
- Facial drooping
How might someone with a posterior cerebral artery stroke present (4)
- Vision loss
- Difficulty interpreting vision
- Generalised weakness
- Headache
What tests would you run for stroke
- URGENT HEAD CT
How would you treat a stroke acutely (3)
- Oxygen and fluids
- If ischaemic
- Thrombolysis within 4.5 hours
- iv alteplase followed by clopidogrel 24 hours after - If Haemorrhagic
- iv Mannitol (decrease ICP)
- Surgery
How might someone with SAH present (5)
- Thunderclap headache
- Nausea, vomiting, seizure, coma
- Decreased consciousness
- Vision loss/double vision
- Neck stiffness
What tests would you do for SAH
Head CT
- Diagnostic
How would you treat SAH
- iv mannitol
- Stabilise patients
- Neurosurgery
- Endovascular stent
How might someone with a SDH present (6)
- Decreasing cognition
- Personality change
- Headache
- Nausea and Vomiting
- Decreasing conscouisness
- Focal Neurology (late)
What tests would you do for SDH
- Head CT
- Sickle shaped bleed
How do you treat SDH (3)
- Stabilise patient
- Iv Mannitol
- Neurosurgery- drain
How might someone with an EDH present (5)
- Head trauma then unconsciousness
- Often followed by lucid period
- Severe headache
- Nausea, vomiting, seizure, coma
- Decreased consciousness
What tests would you do for EDH
- Head CT
- Lemon shaped bleed
What are the partial triggers of migraine
Chocolate Hangover Orgasm Cheese Oral contraception Lie in Alcohol Tunus (loud noise) Exercise
How does migraine present (4)
- With/without aura
- 30 mins - 72 hours
- At least 3/4
1) Unilateral
2) Pulsing
3) Moderate/severe pain
4) Worse with movement - At least 1/2
1) Nausea/vomiting
2) Photophobia/phonophobia
How do you treat Migraine
Acute - Sumatriptan - NSAIDs (Naproxen) avoid ibuprofen/paracetamol - Anti-emetics Prevention - Avoid triggers (headache diary) - Beta blockers - Topiramate
How might someone with Tension Headache present (5)
- Mins to days
- Bilateral
- Pressing
- Mild/moderate
- Scalp tenderness
How do you treat tension headache (4)
- Paracetamol/Aspirin/Ibuprofen
- Use sparingly to avoid medication overuse headache
- Avoid opiates
- Amitriptyline if severe
How might someone with cluster headache present (5)
- Sudden onset debilitating unilateral pain
- Localised to one eye or temple or forehead
- Clusters of attacks followed by remission
- Can be chronic
How do you treat cluster headache (3)
Acute attack - Sumatriptan - Oxygen Prevention - CCB (verapamil) 1st line prevention - Prednisolone + alcohol avoidance during cluster
What is the aetiology of trigeminal neuralgia (2)
- Usually trigeminal compression due to loop of artery or vein
- May be caused by a tumour or aneurysm
How might someone with trigeminal neuralgia present (2)
- At least 3/4
1) Attacks last 1 sec to 2 mins
2) Severe
3) electric shock/stabbing like pain
4) Brought on by innocuous stimuli eg. shaving - At least 3 attacks for diagnosis
How do you treat trigeminal neuralgia (3)
- Anti-convulsant (carbamazepine)
- Surgery to relieve compression
- Surgery to remove tumour/clip aneurysm if present
What can cause epilepsy (5)
- Idiopathic (2/3)
- Tumour
- Stroke
- Dementia
- Cortical scarring
What are the 2 general categories of epileptic seizure
- Primary Generalised (40%)
- Electrical activity throughout entire cortex
- Simultaneous, bilateral motor onset
- Associated with loss of awareness/consciousness - Partial/Focal (57%)
- Focal onset, may later become generalised
- Often seen with underlying structural disease
What are the types of Primary generalised seizure (5)
- Generalised tonic clonic seizure
- Loss of consciousness (eyes remain open)
- Rigidity (fall) followed by jerking (may be
incontince) - Post-ictal confusion/drowsiness
- Absence seizure
- Stop activity and pale/stare, then resume
- Unaware they have had seizure
- Myoclonic seizure
- Sudden jerking of limb
- Tonic seizure
- Sudden onset rigidity plus associated grunt
- Atonic seizure
- Sudden loss of muscle tone/movement
How might Partial/Focal seizure present (4)
- Temporal
- Aura and out of body experience or anxiety - Frontal
- Motor movements eg. peddling legs - Parietal
- Tingling/numbness - Occipital
- Spots/lines/flashes
How would you diagnose epilepsy
- 2 seizures more than 24 hours apart
- EEG (supports diagnosis)
How do you treat epilepsy (4)
- Diazepam (rectally during seizure)
- Carbamezapine (Not in abscence)
- Sodium Volproate
- Educate patients eg. don’t swim alone
How might frontotemporal (picks) dementia present
- Middle aged onset
- Personality change - decreased inhibitions, inappropriate behaviour
- Picks - Pricks
How might someone with alzheimers present (4)
- Slow progressive onset
- Usually short term memory loss first noticed
- Progressive decline in cognition/motor skills
- Personality change
How might someone with Vascular dementia present (2)
- Stepwise deterioration
- Signs of vascular disease eg. high B.P or stroke
How might someone with Lewy-bodies dementia present (4)
- Fluctuation in cognition/skills
- Hallucinations
- Often associated with Parkinsons
- Lowered inhibitions
How might you diagnose dementia (2)
- History and assess cognitive function
- Mini metal state examination
- > 25 = normal
- 18-24 = mild/moderate impairment
- <17 = severe impairment
How do you treat dementia (5)
- Encourage healthy lifestyle
- Inform/educate friends and family
- Nurse at home/care home
- Acetylcholinerase inhibitors (rivastigimine)
- B.P control in vascular dementia
Define parkinsons disease
- A degenerative movement disorder caused by a lack of dopamine in the substantia nigra
- Triad of
- Bradykinesia
- Rigidity
- Resting tremor
Describe the pathophysiology of parkinsons
- Destruction of dopaminergic neurones in substantia nigra
- Decreased dopamine to striatum so decreased stimulation of thalamus leading to decreased movemnet
How might someone with parkinsons present (4)
- Asymmetrical and progressive
- Bradykinesia
- Shuffling walk/narrow stance
- Decreased arm swing
- Drags one leg
- Resting tremor (vs active in BET, asymmetrical)
- Difficulty with fine motor skills eg. doing
buttons/writing
- Difficulty with fine motor skills eg. doing
- Rigidity
- Pain rolling over in bed
How do you diagnose parkinsons
- Clinical diagnosis based on examination
- Confirmed by medication response
How do you treat parkinsons (2)
- Dopamine agonist used initially to delay use of L-Dopa due to side effects (ropinirole)
- Levo-Dopa combined with decarboxylase inhibitor to reduce peripheral conversion to dopamine
- Careldopa
What is huntingtons chorea
- A progressive neurodegenerative disorder caused by lack of GABA (inhibitory NT) that causes chorea
- Chorea is involuntary jerking movements that cease during sleep
Describe the pathophysiology of huntingtons
- CAG repeat mutation on huntingtin gene on chromsome 4
- Leads to progressive cerebral atrophy especially in the striatum
- This leads to decreased GABA synthesis causing decreased inhibition of the thalamus causing increased movement
How might someone with huntingtons present (6)
- Progressive involuntary, jerky, explosive movements
- Ceases when alseep
- Can’t sit still
- Increased aggression
- Depression
- Unclear speech
How do you diagnose huntingtons (3)
- Mostly clinical diagnosis
- Genetic testing (CAG repeats)
- Head CT
How do you treat huntingtons (3)
- Diazepam (increases GABA binding)
- Antidepressants eg. SSRI
- Tertrabenazine (dopamine deleting agent)
How might someone with MS present (8)
- Usually monosymptomatic to start
- Usually relapsing and remitting
- Trigeminal neuralgia
- Limb parasthesiae
- Worse on exercise and heat
- Optic neuritis (unilateral)
- Ataxia
- Leg weakness
How do you diagnose MS (2)
- At least 2 attacks in different CNS areas
- MRI is diagnostic if supported by clinical history
What is the treatment for MS (3)
- Acute attack give iv Methylprednisolone
- Disease modifying agents
- iv alemtuzumab
- iv natalizumab
- Stem cell transplant
Describe the pathophysiology of myasthenia gravis
- Anti-AchR antibodies block and destroy nicotinic Ach receptors on neuromuscular post-synaptic junction
- This leads to decreased muscle excitation
How might myasthenia gravis present (6)
- Progressive muscle weakness
- Uusally affects facial/eye, limb and speech muscles
- Ptosis (upper eyelid droop)
- Double vision
- Ask patient to count to 50, voice becomes less audible
- Ask patient to watch raised finger without moving head, they cannot for more than a few seconds
How would you diagnose myasthenia gravis (2)
- Serum anti-AchR
- EMG and NCS
How do you treat myasthenia gravis
- Acetylcholinerase inhibitors (Rivastigimine)
- Immunosuppression (prednisolone +/- Azathioprine)
How might MND present (5)
- UMN and LMN signs with NO SENSORY LOSS
- Weakness, hyper-reflexia, wasting and fasciculations
- Wrist and foot drop
- Over 40
- Dementia in 25%
How do you diagnose MND (5)
- LMN + UMN in 3+ sites is definite
- LMN + UMN in 2 sites is probable
- LMN + UMN in 1 site is possible
- UMN or LMN in 1+ site is suspected
- Confirmed by EMG
How do you treat MND (4)
- Antiglutaminergic drugs (riluzole)
- Nasogastric tube
- Mechanical ventilation
- Analgesia (NSAIDs and opiates)
Describe the pathophysiology of Guillan-Barre syndrome
- Mostly post infection
- Thought that the pathogens share antigens with schwann cells
- This leads to autoimmune mediated demyelination of PNS neurones causing polyneuropathy
How might Guillan-Barre present (4)
- 1-3 weeks post infection acute ascending muscle weakness that may result in paralysis
- Proximal muscles affected the most
- May be paraesthesiae/pain or no sensory signs
- May be autonomic signs eg. raised B.P or sweating
What is the treatment for Guillan-Barre syndrome (3)
- Ventilation if respiratory arrest
- IV immunoglobulins for 5 days
- LMW heparin (enoxaparin)/stockings
What is the epidemiology of brain tumours (5)
- Secondary more common
- 16th most common in adults
- 2nd most common in children
- Most common are gliomas
- Astrocytomas most common overall
How might someone with a brain tumour present (4)
- 4 Cardinal signs
1) Signs of raised ICP- Progressive headache
- Drowsiness
- Vomiting
- Papilloedema
2) Seizures
3) Progressive neurology
4) Lethargy and tiredness
How might you diagnose a brain tumour (2)
- CT/MRI
- Biopsy
What is the epidemiology of encephalitis (3)
- Mostly viral cause
- Mostly seen in elderly and infants
- More common in imunocompromised
How might encephalitis present (5)
- Triad of headache, fever and altered mental state
- Starts with headache/fever/myalgia
- Progresses to Dec. consciousness/confusion
- Focal neurology
- Seizure
How do you diagnose encephalitis (3)
- MRI
- Inflammation of brain tissue
- EEG
- Lumbar puncture
How do you treat encephalitis
- Anti-virals (aciclovir)
What is the epidemiology of shingles (herpes zoster) (3)
- Re-activation of chicken pox virus
- Can occur at all ages but mostly seen in elderly
- Incidence and severity increases with age
How might someone with shingles present
- Pain and paraesthesiae in one dermatome
- Painful red rash on one dermatome
- May be headache/malaise/myalgia
How do you treat shingles
- Anti-virals (aciclovir) x5 daily
- Analgesia for pain eg. NSAIDs
How might a median nerve palsy present
- Numbness/parasthesiae of palm, thumb and first two fingers + 1/2 of third
- Weakness of thumb (thenar wasting)
How might an ulnar nerve palsy present
- Loss of wrist flexion
- Can’t cross fingers
- Loss of sensation on back of hand
How might a radial nerve palsy present
- Wrist and finger drop (extension of wrist)
- Loss of sensation of anatomical snuff box
How might a CN 3 palsy present
- Ptosis
- Down and out eye
- Pupil dilation
How might a CN 4 palsy present
- Diplopia when looking down (eg. stairs)
- Head tilted to correct
How might a CN 5 palsy present
- Sensory loss of face
- Jaw deviation to side of lesion
- Loss of mastication muscles
How might a CN 6 palsy present
- Adducted eye/weakness of abduction
How might a CN 7 palsy present
- Facial droop/weakness
- Associated with Bells palsy- caused by HSV, treat with prednisolone
How might a CN 8 palsy present
- Vertigo/balance difficulty
- Hearing loss
How might a CN 9 palsy present
- Dysphagia
- Palate and tongue sensation impairment
How might a CN 10 palsy present
- Uvula deviation away from lesion
- Dysphagia
- Hoarse/nasal voice
How might a CN 11 palsy present
- Diminished SCM/weakness
How might a CN 12 palsy present
- Tongue weakness/paralysis
- Deviation towards lesion
What is neurofibromatosis
Type 1 - Causes tumours to grow on nerves - Cafe au lait spots - Abnormal clusters of freckles Type 2 - Associated with acoustic neuromas
What is tubular sclerosis
- Predisposes to tumours most often affect the brain, skin, kidneys, heart, eyes and lungs.
- epilepsy
- learning disabilities
- behavioural problems – such as hyperactivity or an autistic spectrum disorder
- skin abnormalities – such as patches of light-coloured or thickened skin or red acne-like spots on the face
