neuro Flashcards
what is epilepsy
the tendency to have recurrent seizures
What are some causes of seizures that are not epilepsy
- eclampsia
- alcohol/benzo withdrawal
- hypoglycaemia
- space occupying lesion
- post-trauma
What are the three time-periods in a seizure
- pre-seizure
- seizure
- post-ictal
What might a patient report happening before the seizure?
mood/behaviour change in the hours/days before the seizure
What is common in the post-ictal period
- drowsiness
- nausea
- Todd’s paralysis
What are differentials for a seizure (it might not be a seizure)
- syncope
- transient ischaemic attack
- migraine
What investigations should you order for a seizure
- blood - fbc, BM, U&Es, LFTs, calcium
- ECG
- MRI
- EEG
What general advice should you give after a seizure
- avoid dangerous things like taking baths and swimming
- occupational advice
- inform DVLA
What is a partial seizure
one that affects a specific part of the brain
What is a generalised seizure
one that affects both hemispheres of the brain
In generalised seizures, patients always (lose consciousness/retain consciousness)
Patients always lose consciousness
What is the most common type of generalise seizure
tonic-clonic
Is this really a seizure? Which symptoms would be convincing of a seizure
tongue biting and slow recovery
Which area of the brain is probably affected if Todd’s paralysis is present in the post-ictal period?
The motor cortex
Which area of the brain is probably affected if dysphasia is present in the post-ictal period
temporal lobe
What is an aura pre-seizure
part of the seizure the patient is aware of
What might the patient experience during an aura
- deja vu
- strange smells
- flashing lights
What type of seizure is aura indicative of
partial seizure
What are some anti-epileptic drugs
- carbamazepine
- valproic acid
- lamotrigine
Which anti-epileptic is highly teratogenic
valproic acid
What is status epilepticus
seizure that goes on for >30 minutes or recurring seizures with no recovery of consciousness between
What is the treatment of status epilepticus
- secure the airway
- lorazepam
- valproic acid
- give thiamine if alcohol withdrawal, glucose if hypoglycaemic, call obstetrics if eclampsic
What is a TIA
transient ischaemic attack
* sudden-onset neurologic deficit that lasts less than 24 hours and patient returns completely to normal
What are the causes of ischaemic stroke
- thrombus
- embolism
- hypoxia
What are the types of haemorrhagic stroke
- intra-cerebral
* subarachnoid
What are the classes of Bamford’s stroke classification
- TACS
- PACS
- LACS
- POCS
What is a TACS stroke? Which vessels are involved?
- anterior and middle ceberal arteries
- these vessels are blocked
- must have all of these three:
(1) homonomous hemianopia
(2) higher cortical dysfunction (eg dysphasia)
(3) hemiplegia and/or hemiparesis
What is a PACS stroke?
- affects either anterior or middle cerebral artery
- has two or more of the following:
(1) homonymous hemianopia
(2) higher cortical dysfunction (dysphasia, visuospatial disorder)
(3) hemiparesis +/- hemiplegia
What is a POCS stroke?
- posterior circulation stroke
- affecting the occipital lobe, cerebellum or brainstem
- must have one of the following:
(1) cranial nerve palsy and motor/sensory deficit
(2) isolated homonymous hemianopia
(3) conjugate eye movement disorder
(4) cerebellar dysfunction
What kind of cerebella dysfunction might you expect following a POCS stroke?
- ataxia
- vertigo
- nystagmus
What is a LACS stroke
- lacunar stroke
- stroke of small vessels
- one of the following must be present:
(1) pure sensory stroke
(2) pure motor stroke
(3) sensori-motor stroke
(4) ataxic hemiparesis
What is the treatment for an ischaemic stroke
- confirm with CT
- aspirin/ticagrelor
- thrombolysis is an option
- warfarin post-stroke
What must you rule out before you give antiplatelets/thromblysis/warfarin for an ischaemic stroke?
haemorrhagic stroke
What are the complications of a haemorrhagic stroke
- rebleeding
- hydrocephalus
- ischaemia
What are the main primary headache syndromes
- migraine
- tension
- cluster
What is a rebound headache
analgesia overuse headache common in chronic migraine/tension patients
What are some secondary headache causes?
- space occupying lesion
- meningitis/encephalitis
- subarachnoid haemorrhage
What is the most common cause of secondary headache
infection
What symptoms are suggestive of meningitis/encephalitis
- headache with neck stiffness and photophobia/phonophobia
What examination signs might be positive in meningitis
- Kernig’s sign
* Brudzkinsi’s sign
What is Kernig’s sign
lie patient flat, bend the knee and if extension of the knee is painful then Kernig’s postive
What is Brudzinski’s sign
lie patient flat, passively flex neck and knees will bend if positive
What headache is reported in SAH
thunderclap headache
Describe a migraine
- severe, unilateral throbbing pain
- photophobia common
- aura may be present
- nausea and vomiting common
What medications can you give in acute migrain
- NSAIDs
- triptans
- ergotamines
- metoclopramide
What medications can you give for prophylaxis in migraine
- antiepileptics
- tricyclics
- beta-blockers
What medication is contraindicated in patients with migraine who get auras
OCP
- risk of stroke
What is a cluster headache
- occurs behind the eye every day at the same time for about 8 weeks
- patient may report tearing, ptosis, myosis, running nose on the affected side
- patients will be restless and pacing
Which sex do cluster headaches preferentially affect
males
What is the main treatment for cluster headaches
oxygen
What kind of headache is described with raised intracranial pressure
- worse after waking up
- bending forward makes it worse
- associated symptoms eg vomiting, seizures, odd behaviour
What causes subarachnoid haemorrhage
- spontaneous bleeding into the subarachnoid space
What is the most common type of subarachnoid haemorrhage
berry aneurysm
What is the main symptom of a subarachnoid haemorrhage
sudden blow to the back the head- ‘thunderclap headache’
Signs of ____ will appear 3-12 hours after SAH
meningism
* Kernig’s sign, nuchal rigidity
What investigations should be done for an SAH
- CT head
* LP
What treatment is required for SAH
surgery
What are the main complications of SAH
- rebleeding
- ischaemia
- hydrocephalus
what is multiple sclerosis
an autoimmune condition causing demyelination of the CNS
What is a common primary presentation of MS
optic neuritis
What type of diagnosis is MS
clinical diagnosis - plaques may be seen on MRI but not diagnostic alone
MS lesions must be _____ in ___ and ___
MS lesions must be disseminated in space and time
What is Lhermitte’s sign
an electric shock running down the back and legs when neck is bent forward
What condition is Lhermitte’s sign associated with
MS
What is the typical age presentation for MS
20-40
What are the main types of MS
- relapsing-remitting
- secondary progressive
- primary progressive
- progressive-relapsing
What imaging modality might MS lesions be visible on?
plaques may be visible on MRI
What treatment can be given for ms
- methylprednisolone
- interferons
- monoclonal antibodies (alemtuzumab)
- azathioprine
What causes parkinson’s disease
loss of dopaminergic cells in the substantia nigra
What is the triad of parkinsons’
- bradykinesia
- resting tremor
- rigidity/increased tone
What other symptoms might be associated with parkinson’s
- postural instability
- hypomimia
- micrgraphia
- fatiguing of repetitive movement
Give an example of a parkinson’s plus disorder
Lew-body dementia
Parkinson’s symptoms are (symmetrical/asymmetrical)
Parkinson’s symptoms are asymmetrical
What kind of tremor is seen in Parkinson’s
resting tremor
pill-rolling
What gait is seen in PD
stooped, shuffling gait with increasingly smaller steps and difficulty turning
What neuropsychiatric symptoms are common in parkinsons
- depression
- dementia
- psychosis
What is the medical treatment of PD
- levodopa + carbidopa/mardopar
- dopamine agonists
- anticholinergic drugs
- COMT-inhibitors
- MAO-b inhibitors
What is carbidopa?
a dopa-decarboxylase inhibitor
Name some dopamine agonists
bromocriptine, cabergoline, ropinorole
Name a COMT-inhibitors
entecapone
Name a MAO-B inhibitor
selegiline
rasagiline
What is cervical spondylosis
reduction of the spinal canal caused by annulus fibrosis degradation and osteophyte formation
- wear and tear -
What are symptoms of cervical spondylosis
- neck pain (especially on turning)
- crepitus
- Lhermitte’s sign
- wrist/forearm pain
What are symptoms of cervical spondylosis with cord compression
- foot drop
- leg weakness
- numb hands
- incontinence
What is treatment of cervical spondylosis
- anti-inflammatories
- cervical collar
- physio
- surgical cord decompression
What is myasthenia gravis
Antibodies for the postsynaptic Ach receptors
What are symptoms of myasthenia gravis
- muscle fatiguability
- ptosis, diplopia, myasthenic snarl
- increased muscle weakness at end of day
- reflexes intact
What is a myasthenic crisis
acute relapse of MG causing weakness of respiratory muscles
- medical emergency
What might precipitate a myasthenic crisis
infection, medication
What is treatment of myasthenic gravis
- anticholinesterase
- immunosuppressants (prednisolone, methotrexate, azathioprine)
- surgical thymectomy
Is surgical thymectomy effecting in MG patients who don’t have a thymoma?
Yes sometimes
Name an anticholinesterase used in myasthenia gravis
pyridostigmine
What is motor neurone disease
a group of disorders caused by progressive degeneration of motor neurones in the motor cortex, cranial nerves, or anterior horns of the spinal cord
What are the types of motor neurone disease
- ALS
- progressive bulbar palsy
- progressive muscular atrophy
- progressive lateral sclerosis
What is the most common type of MND
ALS
What type of motor neurones are affected in ALS
upper and lower
What is affected in progressive bulbar palsy
cranial nerves IX-XII
What is affected in progressive muscular atrophy
mainly LMN
What is affected in primary lateral sclerosis
mainly UMN
What distribution is typical of peripheral neuropathy? why?
glove and stocking
length-dependent axonal injury
Upper limb neuropathy before lower limb is indicative of what?
demyelination instead of axonal injury
What are sensory symptoms of neuropathy
- numbness
- parasthesia
- difficulty with small objects (eg buttons)
- signs of trauma/ joint deformity
What are symptoms of motor neuropathy
- weak hands
- difficulty walking
- difficulty breathing
What are symptoms of autonomic neuropathy
- erectile dysfunction
- incontinence
- urine retention
- postural hypotension
What are causes of motor neuropathy
- lead poisoning
- Charcot-Marie-Tooth
- Guillain-Barre
What are causes of sensory neuropathy
- DM
* renal failure
