Neurological Flashcards
What fraction of Strokes/TIAs occur in over 65 yr olds?
2/3
What are the two main types of stroke and which is most common?
Ischaemic (most common - 87%)
Haemorrhagic
What can cause a ischaemic stroke?
Thrombosis, Embolism, Shock
What can cause a haemorrhagic stroke?
Intracerbral bleed, Subarchnoid bleed
Definition of TIA
Symptoms appear and last less than 24 hours
Stroke/TIA Risk Factors
High BP, Smoking, Obesity, Cholesterol, Diabetes, AF
Stroke/TIA Presentation
Hemiplegia, Apraxia, Altered smell/taste/vision, Spasticity, Hyperreflexia, Aphasia
What symptoms are more common in haemorrhagic stroke?
Loss of consciousness, Thunderclap headache, Vomiting, Neck stiffness, Seizure
Stroke/TIA Investigations
CT/MRI, ECG, Bloods, USS, Angiogram
Stroke/TIA Treatment
Aspirin, Statins, Thrombolysis, Surgery
Who is subarachnoid haemorrhage more common in?
Elderly Females
What is usually the cause of a spontaneous subarachnoid haemorrhage?
Ruptured aneurysm in Circle of Willis
Subarachnoid haemorrhage Risk Factors
High BP, Smoking, Family Hx, Alcohol/Cocaine, Blood thinners
What does a lumbar puncture show in subarachnoid haemorrhage?
Elevated RBCs
Subarachnoid haemorrhage Treatment
Surgery, Labetolol, CCBs (prevent vasospasm), Benzodiazepines, Antiemetics
Most common cause of Peripheral Neuropathy?
Diabetes
Causes of Peripheral Neuropathy?
Systemic disease, Vitamin deficiency, Medication, Trauma, Genetic, Idiopathic
What medication can cause Peripheral Neuropathy?
Chemotherapy, Metronidazole, Fluoroquinolones
Peripheral Neuropathy Presentation
Motor = Balance, Weakness
Sensory = Numbness, Tingling
Autonomic = Poor bladder control, Sweating
Peripheral Neuropathy Investigations
EMG, Bloods (FBC, B12, TSH, Metabolic panel)
Peripheral Neuropathy Treatment
Cause, TCAs, SSRIs, Antiepileptics, Topical capsaicin
How many cases of Epilepsy occur in the developing world?
80%
What is Epileptogenesis?
When epilepsy occurs due to brain injury (stroke/infection etc.)
Epilepsy Risk Factors
Family Hx, Toxins (lithium), Metabolic disturbance, Infection, Degenerative disorders
What are the two main categories of seizure?
Focal and Generalised
What are the types of Generalised Seizure?
Tonic-Clonic, Tonic, Clonic, Myoclonic, Atonic, Absense
What are the types of Focal seizure?
Simple, Complex, Secondary Generalised
Epilepsy Presentation
Aura, Jerking, Muscle contraction, Loss of consciousness, Loss of bladder control
Epilepsy Investigations
EEG, CT/MRI, Blood prolactin
Epilepsy Treatment
Acute = IV lorazepam and then Phenytoin
Chronic = Phenytoin, Carbamazepine, Sodium Valproate, Ketogenic diet
What Bacteria most commonly cause Meningitis in different age groups?
Babies = Group B Strep
Children = Neisseria meningitis, Strep pneumoniae, Haemophilus Influenzae)
Adults = Neisseria meningitis, Strep pneumoniae
What viruses can cause Meningitis?
Enterovirus, HSV (type 2), VZV, Mumps, HIV, LCMV
Most common fungal cause of Meningitis?
Cryptococcus neoformans
Meningitis Presentation
Headache, Fever, Stiff neck, Vomiting, Photophobia, Confusion, Non-blanching rash
Meningitis Investigations
Bloods (CRP, FBC, Cultures), Lumbar puncture, CT/MRI
Meningitis Treatment
Immediate empiric antibiotics (usually cephalosporin)
IV fluids, Ventilation, Anticonvulsants
(Viral = supportive / Fungal = Antifungals)
What is the most common type of Headache?
Tension Headache
Migraine Risk Factors
Food, Drink, Exercise, Medication, Stress, Bright lights, Hunger
Tension Headache Risk Factors
Stress, Sleep deprivation, Hunger, Eyestrain
Migraine Presentation
One half of head, Pulsating, Nausea/Vomiting, Sensitivity to light/sound/smell
4 Stages of a Migraine
Prodrome, Aura, Pain, Postdrome
Tension Headache Presentation
Constant pressure pain, Both sides of head
Migraine Treatment
Analgesics, Triptans/Ergotamines
Prevention = Metoprolol, Valproate, Topiramate
Tension Headache Treatment
Water, OTCs, Amitriptyline
Who is most likely to get Parkinson’s?
Males, Over 60yrs
Cause of Parkinson’s?
Cell death in Basal ganglia and presence of Lewy Bodies in remaining neurons
Parkinson’s Risk Factors
Pesticides, Trauma, Never smoked/Drank caffeine, Low urate
Parkinson’s Presentation
Motor = Tremor, Bradykinesia, Rigidity, Postural instability
Many Non-motor
What Imaging is not used in Parkinson’s?
CT
Parkinson’s Investigations
Neurological exam, MRI, PET/SPECT
Parkinson’s Treatment
Levodopa, COMT inhibitors, Dopamine agonists, MAO-B inhibitors, Surgery, Rehabilitation
Proximal Myopathy Presentation
Symmetrical weakness of Upper and/or Lower Limbs
Proximal Myopathy Causes
Drugs, Alcohol, Thyroid disease, Osteomalacia, Myopathies, Malignancy, Infection, Sarcoidosis
Proximal Myopathy Investigations
Ca/K/Mg, ESR, Creatinine, TFTs, Vitamin D, Muscle imaging and biopsy
What is Multiple Sclerosis?
Demyelinating disease = disrupts communication in the nervous system
Who is most likely to get Multiple Sclerosis?
Women, 20-50yrs
Multiple Sclerosis Presentation
Double vision, Muscle weakness, Trouble with Sensation and Coordination
Multiple Sclerosis Investigations
Neuro-imaging, Lumbar puncture, Biopsy
Multiple Sclerosis Treatment
Acute = IV Corticosteroids
Long term = Rituximab