Neuro Diseases Flashcards
1
Q
What is Brown-Séquard syndrome?
A
Brown-Séquard syndrome is an incomplete spinal cord lesion often in the cervical cord region.
Contralateral loss ofpain and temperature and crude touch, Ipsilateralweakness, ipsilateral loss of vibration, proprioception andfine touch. CAUSED BY TRAUMA
2
Q
What causes Brown-Séquard?
A
Most of the cases are caused by trauma
If there is no history of trauma, you should consider MS, Stroke, spinal cord compression and spinal tumors
3
Q
What is Myasthenia gravis?
A
- Myasthenia gravis is a rare long-term condition that causes muscle weakness that comes and goes.
- It most commonly affects the muscles that control the eyes and eyelids, facial expressions, chewing, swallowing and speaking. But it can affect most parts of the body.
It can cause double vision
4
Q
What is the science of drooping eyelid?
A
5
Q
What is the pathophysiology of Myathenia gravis (85% of them)?
A
- 85% of Mg people produce Ach receptor antibodies that can bind to the postsynaptic Ach receptors and they block the receptors.
- prevents Ach from stimulating the receptor and trigger muscle contraction.
- more activity means more receptors become blocked and this leads to less effective stimulation of the muscle.
- -Therefore with rest myasthenia gravis can be improved.
6
Q
What is the pathophysiology of Myathenia gravis (15% of them)?
A
15% of people with Mg produce 2 different antibodies.
Muscle specific kinase (MuSK) and low density lipoprotein receptor related protein 4 (LRP4).
MUSK and LRP4 are important proteins In the creation and production of Ach receptor. Destruction of these proteins leads to inadequate Ach receptors being created and organised.
7
Q
What is Parkinsons?
A
Parkinson’s disease is a condition in which parts of the brain become progressively damaged over many years due to the lack of dopamine being produced
8
Q
Symptoms of Parkinsons
A
1) Tremor
2) Slowness of movement
3) Muscle stiffness
9
Q
How does Parkinsons develop?
A
- Parkinson’s disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.
- Nerve cells in this part of the brain are responsible for producing dopamine.
- If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement can’t work as well as normal.
- The loss of nerve cells is a slow process. The symptoms of Parkinson’s disease usually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost.
10
Q
Is Parkinsons Genetic or Environmental?
A
Parkinson’s disease can run in families as a result of faulty genes being passed to a child by their parents. However, it’s rare for the disease to be inherited this way.
It’s also been suggested that pesticides and herbicides used in farming and traffic or industrial pollution may contribute to the condition.
11
Q
Pathophysiology of Parkinsons?
A
- Reduced release of dopamine
- therefore there is an excessive inhibitory input to thalamus due to D1 and D2 receptors not recieving dopmaine.
- as result there is a demyelination of substantia nigra
12
Q
What is another name for Wallenberg’s syndrome?
A
PICA/Lateral medullary syndrome
13
Q
What is Wallenberg’s?
A
Wallenberg syndrome is a rare condition in which an infarction, or stroke, occurs in the lateral medulla. Specifically at the posterior inferior cerebellar arteries
The lateral medulla is a part of the brain stem. Oxygenated blood doesn’t get to this part of the brain when the arteries that lead to it are blocked.
14
Q
Causes of Wallenburgs
A
- The most common underlying cause of Wallenberg syndrome is a brain stem stroke in the vertebral or posterior inferior cerebellar arteries (PICA) of the brain stem
- Mechanical trauma to the vertebral artery in the neck
- Vertebral arteritis
- Metastatic cancer
- Hematoma aneurysm
15
Q
What tracts/nuclei are affected in Wallenbergs?
A
16
Q
What goes wrong in a subdural hematoma?
A
- Small veins run into the dural venous sinuses from brain tissue
- they tear where they enter the dural sinuses between the dura and arachnoid
- Causing blood to collect between dura and arachnoid
17
Q
What is an aneurysm?
A
- An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches.
- As blood passes through the weakened blood vessel, the blood pressure causes a small area to bulge outwards like a balloon.
- eventually this can burst and cause a hemorrhage
18
Q
What is Strabismus?
A
Strabismus, also called crossed eyes/lazy eye, is a condition in which the eyes do not properly align with each other when looking at an object. The eye which is focused on an object can alternate. The condition may be present occasionally or constantly
19
Q
What are the two types of Strabismus?
A
- Syndromic strabismus
- Isolated strabismus
20
Q
What are the causes for Strabismus?
A
- Genetics is a possible cause for Strabismus,
- inappropriate development of the “fusion center” of the brain
- problems with the controlled centre of the brain,
- injuries to muscles or nerves or other problems involving the muscles or nerves.
- Surprisingly, most cases of strabismus are not a result of a muscle problem, but are due to the brain
21
Q
What is encephalitis?
A
Encephalitis is an uncommon but serious condition in which the brain becomes inflamed (swollen).
It can be life-threatening and requires urgent treatment in hospital. Anyone can be affected, but the very young and very old are most at risk
22
Q
What is the cause of encephalitis?
A
Viral infections – several common viruses can spread to the brain and cause encephalitis in rare cases, including the herpes simplex virus and the chickenpox virus.
- Problem with the immune system – It mistakenly attacks the brain causing inflammation
- Bacterial or fungal infections - rare
- Encephalitis is not contagious
23
Q
Examples of Gradual loss of vision?
A
Glaucoma,
Cataracts,
Diabetic retinopathy,
Macula degeneration
24
Q
What is Glaucoma?
A
- High pressure inside eye damaging optic nerve, causes vision loss gradually. Lose peripheral vision but retain central vision.
Outflowof fluid is blocked->buildup ofpressure in the eye-> damage to the optic nerve->gradual loss of visual field and optic nerve change
25
What is age related macular degeneration?
Degeneration of the macula (dry - common) (haemorrhage/wet - bleed) Lose central vision, but maintain peripheral vision. Usually is more common in women than men
26
What is cataracts?
- loss of transparency of the lens, removable by operation. Cataracts sometimes start to develop in a person's lens as they get older, stopping some of the light from reaching the back of the eye.
Accumulation of clumps of protein or yellowpigments-\> lens becomes cloudy-\> reducestransmission of ligh
27
What is the diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated
1) leaks out of blood vessels interfering with light transmission
2) Ischaemia - reduced circulation
28
Examples of Rapid loss of vision?
Retinal vein/artery occlusion,
Ischemic optic neuropathy
29
What is retinal vein occlusion?
- It is a blockage of the small veins that carry blood away from the retina.
30
What is Retinal artery occlusion
You lose whatever part of the retina that that artery supplies
31
What is Ischaemic optic neuropathy
- Ischemic optic neuropathy (ION) is when blood does not flow properly to your eye’s optic nerve, eventually causing lasting damage to this nerve. With Ischaemic optic neuropathy, you suddenly lose your vision in one or both of your eyes.
32
What is Vitreous haemorrhage
Vitreous haemorrhage is bleeding into the jelly-like filling of the back part of your eye. This substance is the vitreous humour
- Vitreous should be clear on a normal day.
33
What is Retinal detachment
- Retina peels away, Macula still attached so you lose peripheral vision, keep central vision
34
What is Acute glaucoma
Acute angle-closure glaucoma is a serious eye condition that occurs when the fluid pressure inside your eye rises quickly.
- rapid damage to the optic nerve
35
What is syringomyelia?
Syringomyelia is a rare disorder in which a cyst/cavity forms within your spinal cord/brainstem. As this fluid-filled cyst, or syrinx, expands and lengthens over time, it compresses and damages part of your spinal cord from its center outward. It also blocks the CSF.
36
Which tracts are affected in the syringomyelia?
spinothalamic tract neurons decussating in the anterior white commissure
NOT dorsal column/medial leminscus
37
What are the causes of Syringomyelia
Most cases of syringomyelia are caused by a **malformation of the brain known as a Chiari type 1 malformation.**
- A CM1 occurs where the brain joins the spinal cord.
- In this malformation, the brainstem lies lower than normal. Located at the back of the brainstem is the cerebellum.
- Often the bases of each lobe of the cerebellum, or the cerebellar tonsils, protrude from the skull and into the spinal canal.
- Syringomyelia can also occur due to trauma, meningitis, hemorrhage, a tumor or arachnoiditis
38
What is a hematoma?
- A hematoma is a collection of blood outside of a blood vessel
39
What is Epidural Hematoma?
Bleeding accumulates outside dura and under skull. Result of an arterial bleed associated with the MCA.
40
What is a subdural hematoma?
blood collect between the dura and arachnoid. Result of shearing of the cortical veins that kind of bridge between the dura and arachnoid.
41
42
What is meningitis?
- Meningitis is an infection/inflammation of the protective membranes that surround the brain and spinal cord (meninges – dura, arachnoid, pia.)
43
Causes of Meningitis?
Bacterial Meningitis
Viral Meningitis:
Fungal meningitis:
Non infective meningitis:
44
Examples of Bacterial and Viral meningitis?
Bacteria: Neisseria Meningitidis and streptococcus pneumoniae
Viral: Enteroviruses and herpes simplex viruses
45
What is Foot Drop
- Foot drop is a muscular weakness or paralysis that makes it difficult to lift the front part of your foot and toes.
- It's also sometimes called drop foot, and can cause you to drag your foot on the ground when you walk.
- Foot drop usually only affects one foot, but both feet may be affected, depending on the cause. It can be temporary or permanent.
46
What are the causes of foot drop?
Muscle weakness of the tibialis anterior muscle.
Peripheral nerve problems or neuropathy
Brain and spinal cord disorders
47
What is Amyotrophic lateralsclerosis (ALS)
- Amyotrophic lateral sclerosis (ALS) is a rare group of neurological diseases that is to do with degenration of motor neurones controlling voluntary muscle movement.
The disease is progressive, meaning the symptoms get worse over time so you will have difficulty walking speaking and breathing.
48
What is Huntingtons
Affecting neurons of the neostriatum
•Caused by triplet expanse mutation in the Huntingtin gene on chromosome 4
-Autsomal dominant
49
What is Guillain Barre syndrome?
Guillain-Barré syndrome is a rare but serious autoimmune disorder in which the immune system attacks healthy nerve cells in your peripheral nervous system. This leads to weakness, numbness, and tingling. It can eventually cause paralysis
50
Pathophysiology of Guillain Barre syndrome?
In Guillain Barre syndrome (GBS) you have damaged myelin coating around the nerves and that stops the nerves from being delivered properly. Weakness or tingling of your legs is the first sign for this. Progressive GBS results in the spread of numbness and weakness. This can affect your facial muscles and breathing.
51
Causes of Guillian Barre syndrome?
Infections
- Surgery
- An injury
- Medical procedures – such as a bone marrow transplant
52
What is Guillain Barre syndrome often referred to as?
AIDP = Acute inflammatory demyelinating polyneuropath
53
Polyneuropathy
= degeneration of the peripheral nerves that spreads towards the centre of the body
54
What is Motor Neurone disease (ALS inclusive)
Motor neurone disease occurs when specialist nerve cells in the brain and spinal cord called motor neurones stop working properly. This is known as neurodegeneration. As the condition progresses, people with motor neurone disease will find some or all of gripping, walking, speaking, swallowing and breathing increasingly difficult. Eventually, they may become impossible
55
Causes of Motor neurone disease?
- In most cases, a person with motor neurone disease won't have a family history of the condition. This is known as **sporadic motor neurone disease.**
- About 5% of people with motor neurone disease have a close family relative with the condition or a related condition known as frontotemporal dementia.
- This is called **familial motor neurone disease** which can be hereditary or linked to a problem with genes that can cause problems at a younger age
56
What is a stroke?
When the brain does not get enough oxygen. This is often when a blood clot gets trapped where the blood vessel is getting narrowed. This results in oxygen not getting into the brain tissue and that tissue gets to quickly starts to die off. Blood flow will be stopped/reduced. (lasting more than 24 hours)
57
What are the different types of strokes?
Ischaemic stroke
Large vessel Ischaemic stroke:
Small vessel Ischaemic stroke
Haemorrhage stroke
58
What is Ischaemic Stroke?
plaque formation in the **internal carotid artery.** This can lead to a stroke or the plaque can rupture and lead to thrombus and that leads to an embolism (traveling mass eg blood clot). The emboli goes up to the brain to the circle of willis and go to the **middle cerebral artery** because the internal carotid is mainly formed form the middle cerebral artery. The emboli gets stuck here.
59
What is Haemorrhage stroke?
this is the rupturing of vessels and blood spilling everywhere. The middle cerebral artery will have a ruptured vessel because it might have had an aneurysm. As it grows it will rupture the vessel. Haemorrhagic stroke usually occurs in the **anterior cerebral communicating arteries, posterior cerebral communicating arteries and branches of the middle cerebral and basilar artery.**
60
Causes/Risk Factors of Stroke
Smoking/Excessive alcohol
- High blood pressure (hypertension)
- Obesity
- High cholesterol levels/Diabetes
61
What is apraxia?
•Inability to perform or select the correct movement
62
What is mutifocal neuropathy?
Multifocal motor neuropathy (MMN) is a disease that affects your body's motor nerves.
- The condition makes it hard for them to send the electrical signals that move your body, which makes your hands and arms feel weak.
- They’ll also twitch and cramp.
63
Causes of mutifocal neuropathy
- Unknown cause
- It’s an autoimmune disease, meaning your immune system mistakenly attacks your nerve cells as if they were invaders.
- Researchers are studying the disease to try to find out why it happens.
64
WHat is double vision?
Double vision (diplopia) is seeing two images of a single object. The two images may be one on top of the other, side by side, or a mix of both. Double vision may be constant, it may come and go, or it may only occur when you're looking in a particular direction
65
What causes binocular double vision?
- Each eye creates its own slightly different image because the two eyes are physically located in different positions.
- However, you usually only see one image.
- This is because your brain joins the images produced by each eye together into a single image in a process known as fusion.
- If your eye muscles or nerves are damaged, the muscles may not be able to control your eyes properly and you may develop double vision
66
What causes monocular double vision?
- Double vision in one eye is known as monocular double vision.
- You should be able to see normally if the affected eye is covered, but double vision continues when the unaffected eye is covered.
- In cases of monocular double vision, the two images are often only slightly separated.
- Causes can include:
- Refractive errors
– such as shortsightedness or long-sightedness
- Corneal disease
- Cataracts
67
What is thyroid eye disease
- Graves ophthalmopathy (thyroid eye disease), is potentially sight-threatening, it generally occurs in patients with hyperthyroidism or a history of hyperthyroidism due to Graves' disease; can occur in patients with euthyroid or hypothyroid chronic autoimmune thyroiditis.
- Thyroid eye disease is an eye condition in which the eye muscles, fatty tissue behind the eye and white part of they eye become inflamed. This can cause the eyes to be pushed forward (bulging) and the eyes and eyelids to become swollen and red
68
What are the disorders of the inner ear?
Acoustic Trauma
Meniere’s diseases (endolymphatic hydrops)
Presbyacusis
Ototoxicity
69
Disorders of the middle ear:
Congenital: Abnomalies of the ossicles
Trauma: TM perforation: H.L + pain + bleeding, Haemotympanum: H.L
Inflammation: •Acute otitis media, Chronic otitis media (suppurative/non suppurative), Tumours
Cholesteatoma •Sac like structure lined with Keratinizing Squamous epithelium •Migration of epithelium Vs Retraction pocket. •Bone destruction ( pressure necrosis) and hearing loss
70
Disorders of the outer ear:
Congenital: Atresia
Trauma: Foreign bodies
Inflammation: Bacterial (Furunclosis) (Otitis Externa) or Fungal (Otomycosis) Tumours & Impacted wax
Otitis Externa: •Non-infective, Allergic (Eczema), Acute: Severe itching, marked oedema, redness and watery discharge, Chronic: mainly itching, Dermatitis: Contact, Sebrrhhoeic
Fungal: Otomycosis Hot, humid conditions, Prolonged use of AB. C/P: itching, pain and hearing loss Skin of EAC inflamed and fungal mass (hyphae and spores).
71
What is Schizoprenia?
Schizophrenia is a psychotic disorder that affects around 1% of the populations. Sufferers are not always able to distinguish between their own thoughts and ideas from reality
72
Causes of Schizophrenia:
Psychological: Double blind, Schizophrenogenic mother
Influenza: Increased association in Spring births
Genetics: Risk if x has schizophrenia (identical twin = 48%) (a parent = 17%) (fraternal twin = 17%)
- However the actual gene for schizophrenia has never been identified
- Vulnerability model: A mixture of environmental challenges with genetic vulnerability
73
What are the changes to brain on a schizophrenic person
Larger than normal lateral ventricles
- Cortical atrophy
- Reduced grey matter
74
What is depression?
- Many types of depression and many names and innumerable causes
- Apparently common 5% incidence and 20% lifetime prevalence for unipolar depression
- Depression is more than simply feeling unhappy or fed up for a few days.
- Most people go through periods of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.
75
What is a tension headache?
Bilateral, pressing or tightening in quality, mild to moderate intensity, no nausea
76
What is a migraine?
Unilateral, pulsating, +/- nausea and vomiting, sensitivity to light and sound. Aggravated by physical activity, usually has a family history, comes on slowly
77
What is Cluster headache?
trigeminal autonomic cephalalgia (facial pain), comes on quickly
78
What is a primary headache?
* Cluster headaches
* Migraine
* Tension headache
* No pathology associated
79
What is Secondary Headache?
* Neoplastic (Raised ICP)
* CNS infection (meningitis)
* Drug induced
* Vascular (SAH)
* Trauma
* A secondary headache is attributed to an underlying patholog
80
What are the red flags for headaches?
Rarely headache can be a symptom of a condition such as a stroke, meningitis or brain tumour.
1. It occurs suddenly and is very severe – often described as a blinding pain
2. It doesn't go away and gets worse over time
3. It occurs after a severe head injury
4. It's triggered suddenly by coughing, laughing, sneezing, changes in posture, or physical exertion
5. You have a NS problem (eg: neck)
81
What are the causes of aphasia?
* Stroke/TIA
* Neurodegenerative disorders —\> Focal lobar atrophy (Picks disease) \> Alzheimer's disease
* Viral Encephalitis
* MS (extremely unusual)
82
What is cauda equina?
Bladder incontinence, Sciatica, SaddleAnesthesia. CAUSED BY DISC HERNIATION
83
What is Myopia?
Nearsightedness ( near object clear, far awayis blurry).Light focuses in front of the retina (eyeballgets longer, cornea or lens is too curved)
84
What is Hypermetropia?
Farsightedness ( near object blurry,far away is clear).Light focuses behind the retina(eyeball gets shorter , cornea or lens is too flat).
85
What are the types of strokes?
86
Causes of Ischaemic Stroke?
* Large artery atherosclerosis
* Cardiac-aortic embolism
* Small vessel occlusion
87
What is a subdural CT shape?
banana
88
What is a subarachnoif harmorrhage shape on CT?
Spider
star
89
What is a seizure?
Seizure is a sudden change in behaviour caused by
electrical hypersynchronization of neuronal networks
in the cerebral cortex
90
What is the classification of seizure?
91
What is lambert eaton syndrome?
Reduced acetylcholine (ACh) release from the presynaptic
nerve terminals, despite normal ACh vesicle number, normal
ACh presynaptic concentration, and normal postsynaptic ACh
receptors
92
What are the signs for meningitis?
93
