Neuro slides Flashcards
Apraxia
Unable to perform learned motor movements
Eg. Cant use tools - dominant parietal lobe
Agnosia
Failure to recognize familiar objects
Aphasia
Loss of ability to produce/understand written or spoken language
Gerstmann Syndrome
Tetrad:
- right left orientation
- finger agnosia (own or anothers fingers)
- dysgraphia (loss of ability to express thoughts in writing)
- acalculia
-lesions in posterior left hemisphere
UMN features
- spasticity (increased tone - clasp knife)
- increased DTR (deep tendon reflexes)
- no atrophy
- babinski, Hoffmann
LMN features
- absent reflexes
- decreased tone
- atrophy (early)
- fasciculations
Coma
Reduction in arousability and awareness
Sleep
Normal physiologic state of no awareness but arousable
Stupor
State of deep sleep, where mental and physical activity are at minimum
-difficult to arouse
Obtundation
Varying degrees of decreased alertness
-Loss of interest and responsiveness to stimuli
Coma
Unarousable for at least one hour
-lack of awareness, wakefulness, movement, closed eyes
Persistent vegetative state
No awareness of self or environment
- no evidence of sustained or reproducible behavioral responses
- no language comprehension or expression
- wakeful unconsciousness diagnosed 1 month after coma onset
Mannitol
IV osmotic diuretic for elevated ICP
Propofol
Sedation in elevated ICP - to reduce metabolic demand
Seizure
Paroxysmal electrical disturbance of neurons that disrupt the motor system, sensory system, behavior, consciousness and autonomic function.
Myoclonus
Sudden jerking of muscles, usually sufficient to move a joint
Epilepsy
At least 2 seizures that are unprovoked more than 24h apart
Status epilepticus
A single seizure which lasts more than 30mins
OR
A series of epileptic seizures during which function is not regained between ictal events in a 30 minute period
Management of seizures
Airway, breathing, circulation
Determine status + etiology if possible
Test glucose, give 50ml 50% dextrose with thiamine 100mg IV
1st drug status epilepticus
Lorazepam 4mg IVI at 2mg/min
OR
Diazepam 10mg IVI at 2mg/min
2nd drug status epilepticus
Phenytoin 18mg/kg in 200ml saline at 50mg/min
THEN
Phenytoin 10-12mg/kg in 200ml saline at 50mg/min
3rd drug status epilepticus
Sodium valproate 25mg/kg IVI at 5mg/kg/min
THEN
Sodium valproate 15mg/kg IVI at 5mg/kg/min
If drugs fail in status epilepticus
Intubate
THEN
Phenobarbital / midazolam / propofol
CADASIL
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
-multiples small holes (infarction) subcortical
GANS
Granulomatous angiitis of the nervous system
-chronic inflammation with giant cells
Cavernous sinus syndrome
CN3,4,6 with V1 & V2 involvement
Horner syndrome
Affected side of face has pupil constriction partial ptosis and anhidrosis
-lesion in lateral medulla oblongata (affects sympathetic chain)
Seizure
Transient occurrence of signs/symptoms due to excessive or synchronous neuronal activity in the brain
Epilepsy
Enduring predisposition to generate seizures with neurobiological, cognitive, psychological, & social consequences
To diagnose epilepsy
>2 unprovoked/reflex seizures >24h apart OR 1 unprovoked/reflex seizure + probability (>60%) of further seizures over the next 10y OR Diagnosis of epilepsy syndrome
Parasomnia
Unusual experience / behavior during sleep
- sleep terror disorder
- sleepwalking
- nightmare disorder
Dyssomnia
Abnormality in amount, quality or timing of sleep
- primary insomnia
- hypersomnia
- narcolepsy
- sleep apnea
- circadian rhythm sleep disorder
Narcolepsy
- Excessive daytime sleepiness
- cataplexy (loss of muscle tone with emotional stimulus)
- hypnagogic hallucinations
- sleep paralysis
Obstructive sleep apnea
5-15 pauses per hour in breathing each lasting >10s
-associated with sleepiness or difficulty concentrating, unrefreshing nocturnal sleep or nocturia
Dysarthria
A group of speech disorders resulting from disturbances in muscular control - weakness, slowness or incoordination of the speech mechanism due to damage of the CNS or PNS or both
Aphasia Screening
- Spontaneous speech
- Reading
- Writing
- Comprehension (verbal and written)
- Repetition
- Naming
Basal ganglia
Striatum: caudate nucleus and putamen (inhibitory) Globus pallidus (inhibitory) Subthalamic nucleus (excitatory) Sunstantia nigra (inhibitory)
Athetosis
Continuous, slow, writhing movements (in children)
Akinesia
Difficulty initiating movement
Extrapyramidal system
Controls automated / involuntary movements, modulates muscle tone and movement, and regulates posture
ROLE:
-selective activation of movements and suppression of others
-initiation of movements
-setting rate and force of movements
-coordinating movements
DAMAGE RESULTS IN DISKINESIAS - eg. Parkinsons
Features of Parkinsons
TRAP -Tremor (resting) -Rigidity -Akinesia (bradykinesia) -Postural instability NB IN TEST - PHARMS
Parkinson’s - other features
- Monotonous speech
- Blurred vision, impaired upward gaze
- cognitive impairment, depression, sleep disturbances, anxiety, psychosis, hallucinations
- shuffling gait with decreased arm swing, freezing
Parkinson’s Protective Factors
- Smoking (nicotine - neuroprotective)
- Coffee (caffeine)
- Moderate exercise
- Low dose ibuprofen
Warning signs in Paeds headaches
- very severe
- wakes from sleep, or worse upon waking then gets better
- chronic progressive (chronic is 3-4h/day for >15 days per month for 3 months)
- increasing frequency and severity
- worsened by coughing/sneezing, going to toilet
- change in personality
- history of convulsions
- relieved by effortless vomiting
- neurological deficit
- signs of meningeal irritation
Causes of Delirium
-medical condition / medication eg. UTI, aspiration pneumonia, hyponatremia, sleep deprivation VITAMIN -Vascular (stroke, aneurism) -infectious (encephalitis, meningitis, UTI) -Tumor -Alcohol (and other substances) -Metabolic and deficiency diseases (B12) -Iatrogenic (medications) -Non-organic
Amnestic syndrome
The “ETERNAL PRESENT TENSE” - Bourne identity
Impaired recent memory (anterograde, retrograde)
Global amnesia, disoriented, confabulation (make up words)
Procedural, immediate, remote memory spared
-posterior circulation bilateral stroke, head injury
Transient Global amnesia
Sudden loss of short term memory - ask repetitive questions
Dementia - aka Major Neurocognitive Disorder
Significant cognitive decline from previous level of performance where deficits interfere with independence in everyday activities, where deficits aren’t explained by another mental disorder
Dementia can be due to:
-the FLAPP V(5) - five birds
Frontotemporal lobar degeneration Lewy body disease Alzheimer'z disease Prion disease Parkinson's disease
Vascular disease
Motor Neuron Disease
Synonym for ALS (amyotrophic lateral sclerosis)
-Progressive motor syndrome with UMN + LMN features (half die within 14mo), with weak limbs or bulbar regions
Progressive bulbar palsy (speech, swallowing)
Progressive muscular atrophy (LMN)
Primary lateral sclerosis (UMN)
WHO Tumor grading (anat path)
Grade 1: Polycystic pleocytoma
Grade 2: diffuse fibrillary astrocytoma
Grade 3: Anaplastic astrocytoma
Grade 4: Glioblastoma, medulloblastoma
Contraindications of an LP
Increased ICP Local infection on skin / abscess Obstruction to CSF flow Coagulopathy / thrombocytopenia Sepsis, HT
Myasthenia gravis
Acquired autoimmune disease of neuromuscular junction - targeting postsynaptic Ach receptors
-usually eye muscles are affected
Differential: botulism, Lambert-Eaton
Myasthenia gravis diagnosis
Fatigability testing (esp of eyes) - muscles get weaker with exertion
Edrophonium test - inhibit the enzyme that breaks down Ach
Antibodies against ACh receptors
Repetitive nerve stimulation - the action response fatigues
Myathenia gravis treatment
ACh esterase inhibitor (pyridostigmine) - symptomatic treatment
Immune treatment: steroids
Methotrexate - reduces production of inflammatory cells
Myaesthenic crisis: Plasmaphresis and infusion of IV immunoglobulin
Dysmetria
Inaccuracy of movement so desired target is either under-reached or over-reached
Dysdiadochokinesia
Irregularity of rhythm and amplitude of rapid alternating movements
Cerebellar signs (Pillay)
VARNISHDDT Vertigo Ataxia Rebound test Nystagmus Intention tremor Speech Hypotonia Dysmetria Dysdiadochokinesis Titubation
Muscle disorders Picture
LMN picture
Cause proximal weakness (neuropathies cause distal)
CK levels elevated (creatine kinase)
