Neuro Conditions Flashcards
What is the pathology of a stroke?
Occlusion of an intracranial vessel
Infarction - 85%
Haemorrhage - 15%
What are the causes of stroke?
Diabetes mellitus Hypertension Smoking Hypercholesteraemia Family history Age Valvular lesions Hypercoaguable state
What are the symptoms of stroke?
Sudden onset One-sided Weakness of limbs Facial weakness Speech disturbance Vision changes
What is a transient-ischaemic attack?
Symptoms of a stroke that resolve within 24hrs
What investigations would be done if a stroke was suspected?
FBC, U&Es, lipids, ESR, CRP, glucose
CT/MRI
How are strokes managed?
Stroke unit
Aspirin within 48hrs
Thrombolysis within 3hrs
Secondary prevention - clopidogrel, atorvastatin
What is the pathology of a subarachnoid haemorrhage?
Blood in the subarachnoid space (between pia and arachnoid)
What are the causes of SAH?
Berry aneurysm
Rupture
Encephalitis
What are the risk factors for SAH?
Hypertension
Smoking
Excessive alcohol
Cocaine
What are the symptoms of SAH?
Thunderclap headache Neck stiffness Photophobia Vomiting Collapse
What investigations would be done if SAH was suspected?
CT head
LP if CT negative
Angiography
How is SAH managed?
Surgery - end-vascular coiling/clipping
What are the complications of a SAH?
Permanent CNS deficits
Hydrocephalus
What is the pathology of a subdural haemorrhage?
Bleeding from bridging veins between the dura and arachnoid
What are the risk factors for a subdural haemorrhage?
Elderly
Alcoholics
Trauma 9 months ago
What are the symptoms of subdural haemorrhage?
Fluctuating level of consciousness Sleepiness Headache Personality change Increased ICP symptoms
What investigations would be done if subdural haemorrhage was suspected?
CT head - shows clot, midline shift
How is subdural haemorrhage treated?
Reverse clotting abnormality
Surgery depends on size of clot
What is the pathology of an extradural haemorrhage?
Bleeding between the dura and bone
Typically a rupture of the middle cerebral artery
What are the causes of extradural haemorrhage?
Suspect in anyone after a traumatic head injury
What are the symptoms of extradural haemorrhage?
Increasingly severe headache Vomiting Confusion Seizures Decreased GCS Increased ICP symptoms
What investigations would be done if extradural haemorrhage was suspected?
CT - lens shaped bi-convex shape
How are extradural haemorrhages managed?
Transfer to neurosurgical unit
Clot evacuation and ligation of vessels
What are the causes of cerebellar syndrome?
Vascular lesion Alcohol Demyelination Tumours Hypothyroidism
What are the symptoms of cerebellar syndrome?
DANISH: Dysdiadochokinesis Ataxia Nystagmus Intention tremor Scanning speech (dysarthria) Hypotonia Hyporeflexia
How is cerebellar syndrome treated?
Based on cause
What is the pathology of myasthenia gravis?
Autoimmune condition
B cells make antibodies that bind to nicotinic acetylcholine receptors on the muscle cell blocking ACh so there is no signal for muscle contraction
What are the symptoms of myasthenia gravis?
Weakness - gets worse with muscle use and improves with rest, typically affects proximal muscles and small muscles of the head and neck
Ptosis
Diplopia
Myasthenia snarl on smiling
Dysphagia
Tired chewing
Can potentially lead to myasthenia crisis - weakening of respiratory muscles
What investigations would be done if myasthenia gravis was suspected?
Increased ACh antibodies
Electromyography (EMG)
CT chest - look for underlying thyoma
How is myasthenia gravis treated?
Anticholinesterase - pyridostigmine
Prednisolone
Thymectomy
What is the pathology of Parkinson’s?
Degeneration of the dopaminergic neurones of the substantial nigra
What are the symptoms of Parkinson’s?
Triad of - resting tremor, rigidity, bradykinesia (slow to initiate movements)
Worse at rest
Postural instability
Diagnosed clinically
How is Parkinson’s treated?
Levodopa - synthetic dopamine
COMT inhibitor - entacapone
MAOB inhibitor - selegine
Timing of these drug is critical - should be taken at the same time daily
What are the complications of Parkinson’s?
Drug ones include excessive motor activity
What is the pathology of multiple sclerosis?
Inflammatory plaques of demyelination disseminated in space and time
Chronic and progressive condition
What are the types of multiple sclerosis?
Primary progression
Secondary progression
Relapsing-remitting
What are the symptoms of multiple sclerosis?
Optic neuritis
Corticospinal tract and bladder involvement common
Sensory - dysaesthesia, pins and needles, vibration sense, trigeminal neuralgia
Motor - spastic weakness, myelitis
Erectile dysfunction
Urine retention
Urine incontinence
How is multiple sclerosis investigated?
Clinical picture important for diagnosis
MRI
LP - increased protein, oligoclonal bands
How is multiple sclerosis treated?
MDT
Disease modifying drugs - dimethyl fumarate
Relapses - methylprednisolone
Symptomatic treatment
What is the pathology of guillain-barre syndrome?
Autoimmune response causing demyelination
Usually follows on from infection - campylobacter jejune, CMV, EBV
What are the symptoms of guillain-barre syndrome?
Starts at feet Progressive ascending weakness Sensory loss Paraesthesia Pain Dysphagia Dysarthria Hypotonia/hyporeflexia
What investigations would be done if guillain-barre syndrome was suspected?
LP - increased protein
Nerve conduction studies
Antibody screen
ECG
How is guillain-barre syndrome managed>
IV immunoglobulins
Plasmapheresis
80% fully recover, 15% left with neurological disability, 5% die
What is the pathology of motor neurone disease?
Degeneration of upper and lower motor neurones
NO SENSORY SYMPTOMS
What are the signs of an upper motor neurone deficit?
Weakness
Increased reflexes
Increased tone
Babinski present
What are the signs of a lower motor neurone deficit?
Weakness Atrophy Fasciculations Decreased reflexes Decreased tone Absent babinski
What investigations would be done if motor neurone disease was suspected?
Clinical diagnosis
Exclude other causes
How is motor neurone disease treated?
Riluzole - glutamate antagonist
Symptomatic
What are the causes of raised ICP?
Brain tumour Intracranial haemorrhage Idiopathic intracranial hypertension Abscess Infection
What are the symptoms of raised ICP?
Headache Nausea/vomiting Diplopia Somnolence Cognitive impairment Altered consciousness Papilloedema CN III and IV palsies
What are common cancers that metastasise to the brain?
Lung
Breast
Colorectal
Prostate
What are the different types of brain tumours?
Glioma - glioblastoma multiforme most common
Meningioma - commonly benign
Pituitary tumours - can secrete things, bilateral hemianopia
Acoustic neuroma - tumour of schwann cells surrounding auditory nerve
How are brain tumours managed?
Depends on grade Surgery Chemotherapy Radiotherapy Palliative
What are the causes of cauda equine syndrome?
Vertebral metastases Abscess Disc prolapse Cord tumour Trauma
What are the symptoms of cauda equine syndrome?
Triad of: Saddle anaesthesia Bilateral leg weakness Bladder and bowel dysfunction Other - back pain, LMN signs
How is cauda equine syndrome managed?
Depends on cause
Surgical decompression
Dexamethasone
Hydrocephalus
Excess CSF
Communicating - production > reabsorption
Non-communicating - physical obstruction
Wet, wobbly, wacky - increased ICP
Treatment - shunt, external ventricular drain
What are the symptoms of a migraine?
Headache - throbbing, unilateral, lasts 4-24hrs
Nausea/vomiting
Photophobia, phonophobia
With/without aura
How are migraines managed?
Abortive - aspirin, paracetamol, triptans (sumatriptan)
Prophylaxis - propranolol, topiramate, amitriptyline
