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1st/2nd Year Revision > Neuro Conditions > Flashcards

Neuro Conditions Flashcards

1
Q

What is the pathology of a stroke?

A

Occlusion of an intracranial vessel
Infarction - 85%
Haemorrhage - 15%

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2
Q

What are the causes of stroke?

A 
Diabetes mellitus
Hypertension
Smoking
Hypercholesteraemia
Family history
Age
Valvular lesions
Hypercoaguable state
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3
Q

What are the symptoms of stroke?

A 
Sudden onset
One-sided
Weakness of limbs
Facial weakness
Speech disturbance
Vision changes
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4
Q

What is a transient-ischaemic attack?

A

Symptoms of a stroke that resolve within 24hrs

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5
Q

What investigations would be done if a stroke was suspected?

A

FBC, U&Es, lipids, ESR, CRP, glucose

CT/MRI

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6
Q

How are strokes managed?

A

Stroke unit
Aspirin within 48hrs
Thrombolysis within 3hrs
Secondary prevention - clopidogrel, atorvastatin

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7
Q

What is the pathology of a subarachnoid haemorrhage?

A

Blood in the subarachnoid space (between pia and arachnoid)

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8
Q

What are the causes of SAH?

A

Berry aneurysm
Rupture
Encephalitis

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9
Q

What are the risk factors for SAH?

A

Hypertension
Smoking
Excessive alcohol
Cocaine

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10
Q

What are the symptoms of SAH?

A 
Thunderclap headache
Neck stiffness
Photophobia
Vomiting
Collapse
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11
Q

What investigations would be done if SAH was suspected?

A

CT head
LP if CT negative
Angiography

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12
Q

How is SAH managed?

A

Surgery - end-vascular coiling/clipping

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13
Q

What are the complications of a SAH?

A

Permanent CNS deficits

Hydrocephalus

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14
Q

What is the pathology of a subdural haemorrhage?

A

Bleeding from bridging veins between the dura and arachnoid

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15
Q

What are the risk factors for a subdural haemorrhage?

A

Elderly
Alcoholics
Trauma 9 months ago

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16
Q

What are the symptoms of subdural haemorrhage?

A 
Fluctuating level of consciousness
Sleepiness
Headache
Personality change
Increased ICP symptoms
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17
Q

What investigations would be done if subdural haemorrhage was suspected?

A

CT head - shows clot, midline shift

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18
Q

How is subdural haemorrhage treated?

A

Reverse clotting abnormality

Surgery depends on size of clot

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19
Q

What is the pathology of an extradural haemorrhage?

A

Bleeding between the dura and bone

Typically a rupture of the middle cerebral artery

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20
Q

What are the causes of extradural haemorrhage?

A

Suspect in anyone after a traumatic head injury

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21
Q

What are the symptoms of extradural haemorrhage?

A 
Increasingly severe headache
Vomiting
Confusion
Seizures
Decreased GCS
Increased ICP symptoms
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22
Q

What investigations would be done if extradural haemorrhage was suspected?

A

CT - lens shaped bi-convex shape

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23
Q

How are extradural haemorrhages managed?

A

Transfer to neurosurgical unit

Clot evacuation and ligation of vessels

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24
Q

What are the causes of cerebellar syndrome?

A 
Vascular lesion
Alcohol
Demyelination
Tumours
Hypothyroidism
25
Q

What are the symptoms of cerebellar syndrome?

A 
DANISH:
Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning speech (dysarthria)
Hypotonia
Hyporeflexia
26
Q

How is cerebellar syndrome treated?

A

Based on cause

27
Q

What is the pathology of myasthenia gravis?

A

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

28
Q

What are the symptoms of myasthenia gravis?

A

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

29
Q

What investigations would be done if myasthenia gravis was suspected?

A

Increased ACh antibodies
Electromyography (EMG)
CT chest - look for underlying thyoma

30
Q

How is myasthenia gravis treated?

A

Anticholinesterase - pyridostigmine
Prednisolone
Thymectomy

31
Q

What is the pathology of Parkinson’s?

A

Degeneration of the dopaminergic neurones of the substantial nigra

32
Q

What are the symptoms of Parkinson’s?

A

Triad of - resting tremor, rigidity, bradykinesia (slow to initiate movements)
Worse at rest
Postural instability
Diagnosed clinically

33
Q

How is Parkinson’s treated?

A

Levodopa - synthetic dopamine
COMT inhibitor - entacapone
MAOB inhibitor - selegine
Timing of these drug is critical - should be taken at the same time daily

34
Q

What are the complications of Parkinson’s?

A

Drug ones include excessive motor activity

35
Q

What is the pathology of multiple sclerosis?

A

Inflammatory plaques of demyelination disseminated in space and time
Chronic and progressive condition

36
Q

What are the types of multiple sclerosis?

A

Primary progression
Secondary progression
Relapsing-remitting

37
Q

What are the symptoms of multiple sclerosis?

A

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

38
Q

How is multiple sclerosis investigated?

A

Clinical picture important for diagnosis
MRI
LP - increased protein, oligoclonal bands

39
Q

How is multiple sclerosis treated?

A

MDT
Disease modifying drugs - dimethyl fumarate
Relapses - methylprednisolone
Symptomatic treatment

40
Q

What is the pathology of guillain-barre syndrome?

A

Autoimmune response causing demyelination

Usually follows on from infection - campylobacter jejune, CMV, EBV

41
Q

What are the symptoms of guillain-barre syndrome?

A 
Starts at feet
Progressive ascending weakness
Sensory loss
Paraesthesia
Pain
Dysphagia
Dysarthria
Hypotonia/hyporeflexia
42
Q

What investigations would be done if guillain-barre syndrome was suspected?

A

LP - increased protein
Nerve conduction studies
Antibody screen
ECG

43
Q

How is guillain-barre syndrome managed>

A

IV immunoglobulins
Plasmapheresis
80% fully recover, 15% left with neurological disability, 5% die

44
Q

What is the pathology of motor neurone disease?

A

Degeneration of upper and lower motor neurones

NO SENSORY SYMPTOMS

45
Q

What are the signs of an upper motor neurone deficit?

A

Weakness
Increased reflexes
Increased tone
Babinski present

46
Q

What are the signs of a lower motor neurone deficit?

A 
Weakness
Atrophy
Fasciculations
Decreased reflexes
Decreased tone
Absent babinski
47
Q

What investigations would be done if motor neurone disease was suspected?

A

Clinical diagnosis

Exclude other causes

48
Q

How is motor neurone disease treated?

A

Riluzole - glutamate antagonist

Symptomatic

49
Q

What are the causes of raised ICP?

A 
Brain tumour
Intracranial haemorrhage
Idiopathic intracranial hypertension
Abscess
Infection
50
Q

What are the symptoms of raised ICP?

A 
Headache
Nausea/vomiting
Diplopia
Somnolence
Cognitive impairment
Altered consciousness
Papilloedema
CN III and IV palsies
51
Q

What are common cancers that metastasise to the brain?

A

Lung
Breast
Colorectal
Prostate

52
Q

What are the different types of brain tumours?

A

Glioma - glioblastoma multiforme most common
Meningioma - commonly benign
Pituitary tumours - can secrete things, bilateral hemianopia
Acoustic neuroma - tumour of schwann cells surrounding auditory nerve

53
Q

How are brain tumours managed?

A 
Depends on grade
Surgery
Chemotherapy
Radiotherapy
Palliative
54
Q

What are the causes of cauda equine syndrome?

A 
Vertebral metastases
Abscess
Disc prolapse
Cord tumour
Trauma
55
Q

What are the symptoms of cauda equine syndrome?

A 
Triad of:
Saddle anaesthesia
Bilateral leg weakness
Bladder and bowel dysfunction
Other - back pain, LMN signs
56
Q

How is cauda equine syndrome managed?

A

Depends on cause
Surgical decompression
Dexamethasone

57
Q

Hydrocephalus

A

Excess CSF
Communicating - production > reabsorption
Non-communicating - physical obstruction
Wet, wobbly, wacky - increased ICP
Treatment - shunt, external ventricular drain

58
Q

What are the symptoms of a migraine?

A

Headache - throbbing, unilateral, lasts 4-24hrs
Nausea/vomiting
Photophobia, phonophobia
With/without aura

59
Q

How are migraines managed?

A

Abortive - aspirin, paracetamol, triptans (sumatriptan)

Prophylaxis - propranolol, topiramate, amitriptyline

1st/2nd Year Revision (15 decks)

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