Neurological Flashcards
What is the 3rd most common cause of death in the UK?
Stroke
Fraction of Ischaemic Vs Hemorrhagic
87% Ischaemic
2 types of Ischaemic Stroke
2 types of Haemorrhagic Stoke
Thrombotic and Embolic
Intracerebral and SAH
Carotid Symptoms
Amaruosis Fugax and Hemisensory loss, transient loss of vision
Vertebrobasilar symptoms
Diplopia, Vertigo, Vomiting, Dysarthria, Ataxia and Visual loss
Treatment for Ischaemic and Haemorrhagic
Ischaemic = Altepase withing 4.5 hrs, mechanical clot clearance Haemorrhagic = Reverse anticoagulation with prothrombin concentrate and possible surgical intervention
Risk factors for SAH
50 yrs old, Female, afro-carribbean, smoking, HTN, cocaine and alcohol
Most common site of SAH
Berry Aneurysm in circle of willis
Symptoms of SAH
Thunderclap headache, may be sentinel bleeds - small leaks from aneurysm gives some symptoms but resolve themselves
Decreases level of consciousness, neck stiffness, loss of pupillary light reflex
Investigations of SAH
CT head and the LP if negative
Treatment of SAH
Prevent further bleeding/ re-bleeding
70% die before leaving hospital
Define Epilepsy
Transient occurrence of signs and symptoms due to abnormal electrical activity in the brain
When is a diagnosis of epilepsy made?
1) > 1 unprovoked seizure > 24 hrs apart
2) 1 unprovoked seizure + 60% probability of another
3) Diagnosis of an epilepsy syndrome
Focal/Partial Seizures
Activity is limited to one part of one brain hemisphere -
Generalised
Widespread seizure activity with many different subtypes
Absence
Activity throughout the whole brain - causes unconsciousness without convulsions - 2 to 10 seconds
Tonic-clonic
1 to 3 minutes, loss of consciousness. Tonic phase of muscle stiffness, incontinence and tongue biting. Clonic phase - extremities jerk rhythmically with breathing irregularities. Usually followed by post-ictal phase of reduced consciousness.
What is the leading cause of early childhood death in the UK?
Bacterial Meningitis
What is inflammed in Meningitis?
Leptomeninges and CSF
Bacterial vs Viral
Bacterial is less common but more severe
Risk factors of meningitis
Low birth weight, CSF shunts or dural defects
Causative organisms
Infants - GBstrep, Listeria Monocytogenes, E.coli, H.flu, N.men
Adults - S. pneu, H.flu, N.men + gram neg bacilli
Who is given prophylactic antibiotics
Pregnant women at risk of GBstrep
What is aseptic meningitis?
Cells in CSF but no gram stain or culture
Symptoms of meningitis
Fever, headache, neck stiffness, LoC, Non-blanching rash, Kernigs and Brudzinski’s sign
Investigations of meningitis
Lumbar Pucture and CT head if neuro signs
Meningitis Treatment
Benzylpenicillin for meningococcal septicaemia
Blind therapy = Ceftriaxone n+/- Amoxicillin
Corticosteroids and Dexamethasone
Is migraine more common in men or women?
3x more common in women
What classifies a chronic migraine?
Having a migraine at least every other day
Different Types of migraine (3)
1) Headache with aura
2) Headache without aura
3) Aura but no headache1
Symptoms of migraine
Paroxysmal, severe, unilateral headache
30% have premonitory phase (Vomiting/visual loss)
Treatment of migraine - mild, severe and prophylaxis.
Mild = Analgesia, Anti-emetics, fluid and rest
Severe = Triptans (Serotonin agonists)
Prophylaxis if > 2 attacks / month and unresponsive to treatment once they begin - Pizotifen/ B-blockers
Is parkinsons more common in men or women?
1.5 x more common in men
Parkinsonism vs Parkinson’s Disease
Parkinsonism = Syndrome involving bradykinesia, rigidity, tremor and postural immobility
Parkinson’s Disease = Most common cause of Parkinsonism
Pathophysiology of Parkinson’s Disease
Depletion of dopamine secreting cells in the substantia nigra
Symptoms of parkinsons
Unilateral to begin with and become bilateral
Bradykinesia, Tremor, slow shuffling gait, trouble turning and initiating movement, depression, anxiety
Treatment of parkinsons
L-dopa - can cross the BBB but dopamine can’t
Dopamine agonists - Ropinorole or Pramipexole
What is the most common form of chronic recurring head pain?
Tension headache
Who are tension headaches most common in?
Females, young adults
Presentation of tension headaches
Featureless, generalised headache - tightness around head
Gradual onset and less severe, non-pulsatile
Episodic vs Chronic TH
Episodic = Occur on less than 15 days of a month Chronic = More than 15 days of a month
TH Treatment
Episodic = Analgesia, lifestyle modification, acupuncture, massage Chronic = The above + antidepressants (Amitriptyline)
