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Year 3 > Neuro conditions > Flashcards

Neuro conditions Flashcards

1
Q

What is epilepsy?

A

Recurrent seizures

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2
Q

What symptoms will someone with epilepsy classically present with?

A

Seizures
Fits/ convulsions
Staring blankly into space
Lack of awareness of surroundings

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3
Q

What investigations should you do if you suspect someone has epilepsy?

A

Refer them to a specialist

They will do an EEG and and ECG

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4
Q

What are the causes of epilepsy?

A

Not known but could be genetic

Could be due to brain damage eg trauma, stroke, tumor etc

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5
Q

What is the first line treatment for someone with epilepsy who has tonic/atonic seizures?

A

Sodium valproate

If not appropriate then lamotrigine

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6
Q

What is the first line treatment for someone with epilepsy who has myoclonic seizures?

A

Sodium valproate

If not appropriate then levitiracetam

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7
Q

What is the first line treatment for someone with epilepsy who has generalised tonic clonic seizures?

A

Sodium valproate

If not appropriate then lamotrigine

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8
Q

What is the first line treatment for someone with epilepsy who has focal seizures?

A

First line carbamepazine or lamotrigine

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9
Q

What is the first line treatment for someone with epilepsy who has absence seizures?

A

Sodium valproate

If not appropriate then ethosuximide

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10
Q

What is the most important thing to remember when prescribing medication for epilepsy?

A

Sodium valproate cannot be prescribed to women and girls with child bearing potential and who want to have kids

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11
Q

What are absence seizures?

A

Seizures wherein the patient will stop doing activity or responding for a while (usually 5-10 seconds). Usually there is no aura, it may be preceded by hyperventilation etc

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12
Q

What are focal seizures?

A

Seizures that originate in one part of the brain, the patients may be aware for the episode and if they are not aware they may have memory loss for the duration of the seizure

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13
Q

What are generalised tonic clonic seizures?

A

Seizures that usually start in both sides of the brain. They last 1-3 mins and in the tonic phase the patient will go still, the muscles will stiffen etc and in the clonic phase there will be jerking of the limbs etc. They may loose continence and usually are not aware during the seizure

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14
Q

What is status epilepticus?

A

When a tonic clonic seizure lasts longer than 5 mins or there are 3 or more seizures in a row without a patient coming to in between them. It is a medical emergency and the patient must be immediately taken to hospital

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15
Q

What is another name for generalised tonic clonic seizures?

A

Grand mal seizures

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16
Q

What are myoclonic seizures?

A

Quick rapid jerking of a muscle or group of muscles. Patients are usually awake and able to think clearly during them

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17
Q

What is a tonic seizure?

A

A seizure wherein the person stiffens up and cannot move and may fall

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18
Q

What is an atonic seizure?

A

A seizure wherein the patient looses muscle tone and falls limp

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19
Q

If you suspect someone has epilepsy, what characteristics about their episodes of blackout will encourage the diagnosis?

A

The episodes of balckout/ seizures are stereotpyed
The patient experiences confusion after the episodes
Recovery from each episode is not quick

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20
Q

What are some causes of spinal cord compression?

A 
Tumor
Slipped disc
Trauma 
Disc herniation
Infection
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21
Q

What are symptoms of spinal cord compression?

A 
Incontinence
Loss of sensation
Paralysis 
Weakness of limbs
UMN lesion symptoms 
Back pain
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22
Q

What is the first line investigation when spinal cord compression is suspected?

A

MRI spine

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23
Q

How is spinal cord compression managed?

A

Sometimes it will resolve itself eg a slipped disc
Manage incontinence with catheter
If you suspect its due to a tumor the start corticosteroids
May be beneficial to tell them to lie still with intermittent movement to prevent bed sores and minimise damage to nerves in the spine

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24
Q

What is multiple sclerosis?

A

An inflammatory demyelinating disease which results in episodic neurological degeneration separated by time and space, and affects at least 2 neurological areas (brain, spinal cord, peripheral nerves)

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25
Q

What symptoms will someone with multiple sclerosis classically present with?

A

Visual problems (stop seeing the colour red, double vision, painful eye movements, nystagmus, graying/blurring of vision)
Sensory impairment (feeling of wet or burning patches, shooting pain down their spine when they bend their head forwards)
Problems with balance
Dizziness

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26
Q

What pattern do symptoms of MS follow?

A

Relapsing remitting ie they occur in episodes and then the patient gets better

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27
Q

Who is more likely to get MS?

A

White people
Women
Those between the ages 20-40

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28
Q

What are the first line investigations you should do when you suspect someone has MS?

A 
Full bloods (to rule out anything else): FBC, CRP, ESR, thyroid function, LFTs, B12, calcium, glucose
If you have ruled out everything, refer to a specialist who will likely to a brain MRI, spine MRI etc
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29
Q

How is MS managed?

A

Lifestyle advice eg exercise, stop smoking
Manage symptoms as they present and individually:
Medications to reduce spasticity
Anticonvulsants
Antidepressants
Catheter (if theres incontinence)
Mobility assistance (walking aids etc)

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30
Q

What are complications of MS?

A 
Spasticity
Mobility issues 
Incontinence 
UTI
Erectile dysfunction
Visual impairment 
Cognitive dysfunction
Depression
Osteopenia/osteoporosis
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31
Q

What does the suffix paresis mean?

A

Weaknes

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32
Q

What does the suffix plegia mean?

A

Complete paralysis

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33
Q

What does the prefix mono mean?

A

One limb

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34
Q

What does the prefix tetra or quadra mean?

A

All 4 limbs

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35
Q

What does the prefix hemi mean?

A

Half of the body

36
Q

What does the prefix para mean?

A

Lower limbs

37
Q

What is full body hemiparesis?

A

Weakness on one side of the body

38
Q

Where may a lesion be located is someone has full body hemiparesis?

A

Contralateral motor cortex, corona radiata, pons

39
Q

Where may a lesion be located if someone has limb hemiparesis?

A

Contralateral motor cortex, corona radiata, pons

Ipsilateral spinal motor tract

40
Q

Where may a lesion be located is someone has isolated limb weakness?

A

Ipsilateral peripheral nerve, nerve root etc

Contralateral cerebral motor cortex

41
Q

Where may a lesion be located if someone has paraparesis?

A

Cauda equina
Bilateral cerebral motor cortex
Bilateral spinal motor tracts

42
Q

Where may a lesion be located if someone has tetraplegia?

A 
Bilateral cerebral motor cortex 
Peripheral nerves (systemic demyelinating disease)
43
Q

Where may a lesion be located if someone has proximal muscle weakness?

A

Neuromuscular junction

Muscles

44
Q

What is paraparesis?

A

Weakness of the lower limbs

45
Q

What is tetraplegia?

A

Complete paralysis of all 4 limbs

46
Q

What is motor neurone disease?

A

Progressive degeneration of motor neurones resulting in muscle wastage

47
Q

What symptoms will someone with motor neurone disease classically present with?

A

Usually some form of muscle weakness eg loss of dexterity, tripping, falling
UMN and LMN symptoms
Problems swallowing
Tongue fasciculations
Neurological symptoms eg behaviour changes, mood lability, frontotemporal dementia)
Breathing problems
Poor sleep/fatigue as a result of other symptoms

48
Q

What investigations should you do if you suspect motor neurone disease?

A

None, refer to a specialist, usually diagnosis is clinical

49
Q

How is motor neurone disease managed?

A

Riluzole should be offered first line
Manage symptoms individually, this may involve:
Ventilation support
Medication for excess saliva production
Quinine for muscle spasticity/ increased tone
Opiods to relieve breathlessness
Cough augmentation techniques
Discuss gastrostomy at start of treatment (early reduces chances of complications

50
Q

What causes motor neurone disease and how is it cured?

A

Cause is unknown, it may be due to glutamate toxicity, protein misfolding, oxidative stress etc
It cannot be cured- it causes progressive disability which will eventually lead to death (usually from respiratory failure)

51
Q

What is another name for motor neurone disease?

A

Amyotrophic lateral sclerosis (ALS)

52
Q

What are the different onsets of motor neurone disease?

A

Limb (limb muscle weakness) or bulbar (problems with speech/swallowing/tongue fasciculations)
It may also start with only neurological symtptoms

53
Q

Who is more likely to get motor neurone disease?

A

Onset is usually at an older age eg post 55 years

Those with family history of frontotemporal dementia

54
Q

What is myasthenia gravis?

A

An autoimmune disorder wherein antibodies to the post synaptic membranes of nicotinic acetylcholine receptors reduce neuromuscular transmission

55
Q

What symptoms will someone with myasthenia gravis classically present with?

A 
Muscle weakness that is worse with exercise and better with rest 
Diplopia
Ptosis
Dysarthria
Problems swallowing
56
Q

What type of muscle weakness is present in myasthenia gravis?

A

Weakness that gets better with rest and is worse after exercise

57
Q

How is more likely to get myasthenia gravis?

A

Women

58
Q

How is myasthenia gravis managed?

A

Anticholinesterase eg pyridostigmine
Prednisolone/ corticosteroids if other medication doesn’t work
In a crisis the patient should be intubated and plasma exchange or IV immunoglobulins should be given

59
Q

What investigations are done for myasthenia gravis?

A

Serum nicotinic acetylcholine receptor antibody

Muscle specific tyrosine kinase antibody

60
Q

What is a myasthenic crisis?

A

When the respiratory muscles are affected so badly that ventilation is impaired and a patient has be to hospitalised

61
Q

What is Parkinson’s disease

A

A neurodegenerative disorder where there is degeneration of dopaminergic neurones in the substantia nigra and deposition of Lewy bodies in the brain

62
Q

What symptoms will someone with Parkinson’s disease present

A

Bradykinesia (slowing of movements)
Rigidity
Resting tremor
Gait problems/ postural instability

63
Q

Who is more likely to get Parkinsons?

A

Older people

Men

64
Q

What is the first line investigation when you think someone has Parkinsons?

A

None- the diagnosis is clinical

Can do PET if essential tremor is not Parkinsons

65
Q

How is Parkinsons managed?

A

Levodopa first line (is converted to dopamine)
Otherwise give dopamine agonists
Treat symptoms eg antidepressants, cholinesterase inhibitors
Refer to physiotherapists, dieticians, speech therapist etc

66
Q

What is the mechanism of action of levodopa?

A

It is converted into dopamine

67
Q

What are complications of Parkinsons

A 
Levodopa induced dyskinesia (excessive movements)
Dementia 
Depression
Anxiety 
Constipation
68
Q

What is epistaxis?

A

Nosebleed

69
Q

What is the first line investigation for epistaxis?

A

None are needed unless the bleeding is persistent- if this is the case then can do a nasoendoscopy

70
Q

How is epistaxis managed?

A

Tell the patient to lean forward but remain upright and pinch their nostrils closed for 10 mins (if a child have them sit on their parents lap etc)
If bleeding is persistent, identify the bleeding point and cauterise it

71
Q

What is essential tremor?

A

Bilateral involuntary oscillatory movements of the upper extremities on movement

72
Q

What is the difference between resting tremor and essential tremor? What are they associated with?

A

Resting tremor is associated with Parkinson’s and is present when the patient isn’t doing anything, it will usually disappear when they go to write something down/ pick up a cup etc

Essential tremor is a stand alone condition where the tremor occurs on movement. It is usually bilateral as is not accompanied by any other neurological symptoms

73
Q

Who is more likely to get essential tremor?

A

White ancestry
Advanced age
Those with family history
Those who were exposed to environmental toxins

74
Q

What is the first line investigation for essential tremor?

A

None- diagnosis is clinical and MRI head/ other imaging only needs to be done if there is another focal neurological symptom and if an alternate diagnosis is suspected

75
Q

How is essential tremor managed?

A

No pharmacological treatment is required if there isn’t severe disruption to everyday life or embarrassment
If treatment is needed give propanolol first line or primidine

76
Q

What is Meniere’s disease?

A

Episodic vertigo with low grade hearing loss and tinnitus (usually unilateral in regards to hearing loss and tinnitus)

77
Q

What symptoms will someone with Meniere’s disease classically present with?

A

Episodes of vertigo (associated with nausea and vomiting)
Low grade hearing loss
Roaring tinnitus

78
Q

What is the first line investigation for Menieres disease?

A

There isn’t one, diagnosis is clinical

Pure tone audiometry can be done if other causes of hearing loss are suspected

79
Q

How is Meniere’s disease managed?

A

Reassure the patient that episodes usually resolve within 24 hours
Give anti vertigo, anti emetics etc if needed (prochlorperazine)
In acute episodes hospitalise and give IV labyrinthine sedatives
Advise low salt low caffeine/ alcohol intake diet

80
Q

What are some risk factors for Meniere’s disease?

A

Family history
Having an autoimmune condition
Recent viral infection

81
Q

What are the guidelines for confirming vertigo is characteristic of Meniere’s disease?

A

2 episodes of vertigo that were 20 mins-12 hours

82
Q

What is the difference between Meniere’s disease vs syndrome?

A 
Disease= idiopathic ie no cause
Syndrome= secondary to something
83
Q

If webber’s test lateralises to the left ear what are the 2 types of hearing loss the patient may have and say what ear they will be in?

A

Conductive hearing loss of the left ear

Sensorineural hearing loss of the right ear

84
Q

How do you interpret rhinne’s test?

A

Air conduction should be better than bone conduction

If it was louder in the air outside the ear there is conductive hearing loss in that ear

85
Q

How do you interpret webber’s test?

A

Sound lateralises to one ear:
Conductive hearing loss in that ear
Sensorineural hearing loss in the other ear

Year 3 (104 decks)

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