Neuro - Preading Flashcards
What areas / questions are covered in a neurological systems review?
- Headaches
- Fits / falls / LOC
- Memory problems
- Balance / coordination problems
- Vision problems
- Photophobia & neck stiffness
- Hearing difficulties
- Speech problem
- Swalling problem
- Weakness
- Numbness / tingling / paresthesia
- Incontinence or erecticle dysfunction
What are some features of Cluster headaches?
Features:
- Pattern - high frequency over a period of weeks –> then months of symptom free (i.e. clustering)
- occur at night (characteristically)
- Duration - 15 mins - 3 hours
- Better or worse? - unable to stay still during
- Other symptoms?
- Eye involvement (unilateral autonomic dysfunction); red eye, eye watering, nasal congestion
What are some features of migraine headaches?
Features:
- Pattern - spread out over the year
- Duration - hours to days
- Better or worse?
- lying down in dark room
- multiple triggers
- Other symptoms:
- Aura symptoms
- Nausea / vomiting
- Photophobia
- Phonophobia
What condition is most associated with “Sudden onset, excruciating headache”?
Subarachnoid haemorrhage
What condition is best associated with “Facial tenderness and rhinorrhoea”?
Sinusitus
What condition is best associated with “Pain around eye, blurred vision with halos around lights”?
Acute glaucoma
What condition is best associated with “20 minute unilateral, debilitating episodes of retro-orbital pain with red eye and eye watering”?
Cluster headaches
What condition is best associated with “headache triggered by changes in position or exertion. Changes in vision with leaning forward”?
Increased intracranial pressure
List as many headache ‘Red-Flags’ as you can. (10 total)
- Sudden-onset headache reaching max intensity < 5 mins (subarachnoid haemorrhage)
- Headache with fever (meningitis)
- New onset neurological deficit
- New onset cognitive dysfunction
- Change in personality
- Impaired level of consciousness
- Recent head trauma (< 3 months)
- Headache triggered by cough, valsalva, sneeze, exercise or change in posture (↑ ICP)
- Headache + jaw claudication and scalp tenderness (GCA)
- Headache + halos around lights or headaches that get worse in the dark (acute narrow-angle glaucoma)
What TLOC condition is best associated with “Chest pain, brteathlessness and collapse on exertion”?
Aortioc stenosis
What TLOC condition is best associated with “palpitations or chest pain beforehand, family history of sudden exaplained death”?
Arrhythmia / cardiogenic syncope
What TLOC condition is best associated with “triggered by; fear, pain, micturition or prolonged standing. Preceded by pallor, nausea or sweating. No confusion afterwards”?
Vasovagal syncope
What TLOC condition is best associated with “Collapse on shaving or turning the head”?
Carotid sinus hypersensitivity
What TLOC condition is best associated with “triggered by vigorous exercise in a young person”?
Hypertrophic cardiomyopathy (HOCM) / cardiogenic syncope
What TLOC condition is best associated with “Being told off by teachers for seemingly daydreaming”?
Absence seizures
What TLOC condition is best associated with “Pale and sweaty beforeheand, jerking of limbs, eyes rolled back, short duration of episode, no confusion afterwards”?
Vasovagal syncope
What TLOC condition is best associated with “Twitching and jerking in the morning”?
Early morning myoclonus
- Often presents as feature of ‘juvenile myoclonic epilepsy’
- More likely to occur if; sleep deprived or alcohol excess
- Can present with infrequenct GTCS (generalised tonic-clonic seizures)
What TLOC condition is best associated with “Crying out, falling to floor, period of stiffness followed by rhythmic jerking that gradually decreases in amplitude and frequency, period of confusion for 30 mins afterwards”?
Generalised tonic-clonic seizures
What TLOC condition is best associated with “Violent shaking, head moving side to side, arching back, episodes of stillness before starting again. Forced eye closure”?
Psychogenic non-epileptic seizure (PNES)
also called non-epileptic attack disorder (NEAD)
Seizures can be ‘provoked’ or ‘unprovoked’, give some examples of things that can provoke seizures.
- Alcohol - withdrawal / excess
- Cocaine
- MDMA (ecstacy)
- Amphetamines
- Opiods e.g. tramadol
A tool to distinguish between syncope and seizure is to asses the presyncopal symptoms, this can be remembered as PPP - what does this stand for?
Vasovagal syncope features:
-
Position
- Should only happen when upright
-
Provocation
- pain, dehydration, emotional shock
-
Prodrome
- light headeded, dizziness, blurred vision, ears ringing
Absence of these = consider cardiogenic syncope + cardiac opinion
What is the difference between pyramidal and extra-pyramidal tracts?
Both pyramidal + extrapyramidal are descending motor tracts
-
Pyramidal tracts:
- Path = carry motor fibres from cortex –> brainstem + spinal cord
- Role = voluntary control of muscles
-
Extra-pyramidal tracts:
- Path = carry fibres from brainstem –> spinal cord
- Role = involuntary / automatic control of muscles e.g. tone, balance, posture, locomotion
On which sides of the body will a brainstem lesion show 1) limb signs 2) cranial nerve signs?
Brainstem lesion:
- Limb signs = contralateral
- Cranial nerve signs = ipsilateral
What is the name of the condition which involves damage to one hemi-section of the spinal cord?
Brown-Séquard syndrome
- Cause: dmg to one half of the spinal cord
- Features:
- Ipsilateral spastic paralysis below level of lesion + flaccid paralysis at level of lesion (as LMN is affected at level of lesion)
- Ipsilateral loss of vibration + proprioception (dorsal column)
- Contralateral loss of pain + temperature (spinothalamic)
