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Y3 Core Conditions > Neurological > Flashcards

Neurological Flashcards

1
Q

Stroke aka Cerebral Vascular Accident

A

Sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain causing cerebral dysfunctions lasting for more than 24 hours or death

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2
Q

Types of Stroke

A

Ischaemic (85%)

Haemorrhage (15%)

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3
Q

How common are Strokes

A

> 50yo
M>F
Higher rates amongst Asians, Africans and Hispanics

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4
Q

Pathophysiology of Ischaemic Strokes

A

Arterial thrombus present in carotid, vertebral or cerebral arteries. Vessel obstruction leads to brain ischaemia causing infarct. Infarcted area will become swollen and lack normal function.

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5
Q

Pathophysiology of Haemorrhagic Strokes

A

Arterial aneurysm becomes ruptured causing catastrophic bleeding. The area swells as pressure increases leading to further damage of neighbouring structures.

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6
Q

Risk factors for Strokes

A

HTN, Smoking, Male, AF
Diabetes, Heart Disease, Peripheral Vascular Disease, Alcohol, Syphillis, Clotting Disorder, Hyperlipidaemia, Hormone Replacement Therapy

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7
Q

Symptoms and Signs of Strokes

A

Neck stiffness, visual changes - hemianopia, photophobia, headache, weakness, sensory loss, aphasia, dysarthria, ataxia

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8
Q

Symptoms of Cerebral Hemisphere Infarct

A
  1. Contralateral hemiplegia
  2. Contralateral sensory loss
  3. Homonymous hemianoia
  4. Dysphasia
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9
Q

Symptoms of Brainstem Infarct

A
  1. Quadriplegia
  2. Vision disturbances
  3. Locked-in Syndrome
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10
Q

Symptoms of Lacunar Infarct (small infarcts in basal ganglia, internal capsule, thalamus and pons)

A
  1. Pure motor or sensory symptoms
  2. Ataxia
  3. Intact cognition and consciousness
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11
Q

Differentials for Stroke

A 
CNS tumour
Subdural Haemorrhage
Drug Overdose
Hemiplegic migraine
Hepatic encephalopathy
Hypoglycaemia
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12
Q

Investigations for Stroke

A 
CT scan of head: Bright
MRI angiography
ECG
Carotid doppler- scans for occlusions
Intracerebral Haemorrhage Score (ICH)
FBC, Clotting, ECG, LFTs
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13
Q

Management of Stroke Patients

A

EMERGENCY
1. Admit to stroke unit
2. Airway, O2 by mask, BP, assess emboli sources
3. Thrombolysis
4. Brain imaging
Assess whether stroke is ischaemic or haemorrhagic

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14
Q

Treatment for Stroke Patients

A
  1. Anti-hypertensives: ACEi, Beta blockers, CCB,
  2. Diuretics
  3. Anti-coagulants: heparin and warfarin
  4. Surgery
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15
Q

Complications of Stroke

A 
DVT/PE
Infection
Seizures
Delirium
Aspiration pneumonia
Hydrocephalus (accumulation of CSF)
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16
Q

Transient Ischaemic Attack (TIA)

A

Neurological Deficit due to cerebral or retinal ischaemia lasting <24 hours

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17
Q

ABCD2 Score

A

Used to predict the risk of stroke following a TIA
Age > 60 years
BP > 140/90
Unilateral weakness (2) or speech impairment (1)
Duration <10mis, 10-59mins, > 60mins
Diabetes

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18
Q

How common are TIAs

A

M>F
Increases with age >50
Less common with Asians

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19
Q

Causes of a TIA

A
  1. Micro-emboli from heart or atheromatous plaques
  2. Fal in cerebral perfusion due to cardiac dysrhythmia, postural hypotension, decreased flow due to atheroma
  3. Stenosis of blood vessels in the brain
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20
Q

Pathophysiology of TIAs

A

Cerebral blood flow is regulate to maintain flow of >50ml/100g/minute
If decreased to 20-50ml, the brain compensates.
<20ml neurological deficits occur
<15ml neuronal death occurs causing oedema

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21
Q

Risk factors for TIAs

A

HTN, smoking, DM, Heart Disease esp AF, valvular disease, carotid stenosis, congestive heart failure, alcohol , syphillis, clotting disorder, hyperlipidaemia

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22
Q

Symptoms and signs of TIAs

A

Unilateral weakness or sensory loss, aphasia, ataxia, cranial nerve defects, incoordination
Anterior circulation: Aphasia, Amarausis Fugax
Posterior circulation: Ataxia, Diplopia, Vertigo, Bilateral symptoms
Either: Hemianopia, hemiparesis, hemisensory loss

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23
Q

Amarausis Fugax

A

Painless temporary loss of vision in one or both eyes

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24
Q

Investigations for TIA

A 
FBC, U&amp;Es, ESR, glucose
Prothrombin time, INR and APTT
ECG
MRI or CT
Fasting lipid profileT
Telemetry
Carotid doppler
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25
Q

TIA mimics

A

Migraine, Seizure, Syncope

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26
Q

Differentials for TIA

A 
Hypoglycaemia
Seizure
Todd's Paralysis: seizure followed by paralysis
Migraine
Haemorrhage, abscess or mass
Conversion Disorder
Benign Paroxysmal Positional Vertigo (BPPV)
MS
Bells Palsy: Facial Paralysis
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27
Q

Treatment for TIAs

A

Antiplatelet therapy: Aspirin, clopidogrel
Cardioembolic TIA: Warfarin, dabigatran, apixaban
Lipid-Loweing agent
Antihypertensives: ACEi, ARBs, CCB
Carotid Endarterectomy

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28
Q

Complications of TIAs

A

Stroke

Myocardial Infarction

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29
Q

Peripheral Neuropathy

A

Damage to peripheral nerves. Types:
Mononeuropathy
Mononeuritis Multiplex
Polyneuropathy

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30
Q

Myelopathy

A

Disease affecting the spinal cord

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31
Q

Radiculopathy

A

Disease affecting nerve roots and plexuses

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32
Q

Causes of Peripheral Neuropathy

A
  1. Demyelination by
  2. Axonal damage caused by HIV, MS
  3. Wallerian Degeneration
  4. Compression eg Carpal Tunnel Syndrome
  5. Infiltration of inflammatory cells e.g. Leprosy, Sarcoidosis, Neoplastic Granulomas
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33
Q

Symptoms and signs of Peripheral Neuropathy

A

Sensory: Numbness, tremor, gait abnormality, pain, itching and crawling, pins and needles

Motor: Weakness and tiredness, heaviness hyporeflexia, cramps, myalgia, tremor, fasciculations

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34
Q

Differentials for Peripheral neuropathy

A 
Diabetes
Post-Herpes Neuralgia
Malnutrition- B12 and alcohol 
Hypothyroidism 
Guillain-Barre Syndrome 
Myasthenia Gravis
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35
Q

Investigations for Peripheral Neuropathy

A 
Peripheral neuro examination 
Electromyography
Nerve conduction studies
Blood tests
Fasting blood glucose, HBA1C, B12, lipid profile
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36
Q

Treatment for Peripheral Neuropathy

A

Amitriptyline, Pregabalin or Gabapentin

Glycaemic control if Diabetic Neuropathy

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37
Q

Complications of Peripheral Neuropathy

A

Wounds and ulcers, infections, gangrene, amputation, silent MI, death, depression

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38
Q

Epilepsy and Seizures

A

Recurrent and intermittent abnormal electrical activity in the brain manifesting as seizures.

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39
Q

Types of Seizures

A

Generalised seizure is onset of electrical discharge throughout the cortex involving 1 hemisphere.

Partial seizures are focal onset features relating to a specific part of one hemisphere

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40
Q

Causes of Seizures

A

Trauma, Head injury, tumour, stroke, hippocampal sclerosis, sarcoidosis and SLE, Polyarteritis Nodosa, Alcohol or benzodiazepine withdrawal, Metabolic: hypoxia, hypo/hyper natraemia/glycaemia, hepatic encephalopathy, infection, drugs

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41
Q

Symptoms and signs of Seizures

A

Prodrome: symptoms preceding by hours/ days e.g. change in mood or behaviour
Aura: symptoms experienced during seizures e.g. flashing lights, strange smells, gut feeling
Post-ictally: symptoms experienced after seizures e.g. headache, confusion, aching limbs and headache

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42
Q

Define Myoclonic, Atonic, Absence and Tonic-Clonic of Generalise Seizures

A

Myoclonic: Short muscle twitch without conscious impairment
Atonic: loss of tone and relaxed with conscious impairment
Absence: Quick onset and offset of jerking
Tonic: Stiff and flex
Clonic: violent muscle contractions/ convulsions

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43
Q

Signs of Toni-Clonic Seizures

A 
Sudden fall
Stiff limbs
Jerking
Loss of consciousness Tongue biting
Incontinence
44
Q

Differentials for Epilepsy and Seizures

A 
Syncope
Cardiac Arrhythmias
TIA
Migraine
Benign Paroxysmal Vertigo
Acute Encephalopathy
Narcolepsy
Panic Attacks
45
Q

Treatment for Seizures

A

Sodium Valporate or Lamotrigine, Carbamazepine

If seizing, record time, protect them from injury, recovery position when sizure has stopped
Inform DVLA

46
Q

Complications of Epilepsy

A

Sudden Unexpected Death in Epilepsy (SUDEP)
Status Epilepticus: Seizure lasting for more than 5 mins
Depression and Anxiety
Injuries

47
Q

Meningitis

A

Inflammation of meninges and the under lying subarachnoid CSF

48
Q

Causes of Meningitis: Bacterial

A

Neisseria Meningitidis
Streptococcus Pneumoniae
Haemophilus Influenzae

49
Q

Causes of Meningitis: Viral

A 
Enterovirus
Herpes Simplex
Varicella Zoster
Mumps
HIV
50
Q

How common is Meningitis

A

Common for < 2 months and >60yo

Decreasing incidence due to vaccinations

51
Q

Risk factors for Meningitis

A 
<5 or >65yo 
Non-immunised infants
Immunodeficiency
Cancer
No spleen
52
Q

Symptoms and signs of Meningitis

A

Stiff neck and photophobia, fever, headache, altered mental status, confusion, vomiting, seizures, rash

Infants: hypothermia, irritability, lethargy, poor feeding, apnoea, bulging fontanelle

53
Q

Kernig’s Sign

A

Patient supine, thigh flexed, hip and knee at 90degrees, attempts to straighten the leg are resisted and painful. Can indicate subarachnoid haemorrhage or meningitis

54
Q

Brudzinski’s Sign

A

Flexion of the neck causes involuntary flexion of the knees and hips. Indicative of meningitis

55
Q

Differentials for Meningitis

A 
Subarachnoid Haemorrhage
Encephalitis
Pyrexia and severe infection 
Intracranial abscess
Septicaemia
56
Q

Investigations for Meningitis

A
  1. Lumbar Puncture: CONTRAINDICATED in patients with raised ICP. CSF will have low glucose, high WCC< elevated protein.
  2. Bloods: FBS, U&Es, glucose and coagulation
  3. Blood culture, Throat Swabs, Stool Culture
  4. CT Scan
57
Q

Treatment for Meningitis

A
  1. Vancomycin AND Ceftriaxone

2. Dexamethasone

58
Q

Treatment for Herpes Simplex Meningitis

A

Acyclovir

59
Q

Prophylaxis for Meningitis

A

Rifampicin or Ciprofloxacin

60
Q

How many days will it take for Viral Meningitis to resolve

A

4-10 days

61
Q

Complications of Meningitis

A 
Sepsis
Septic Arthritis
Raised ICP
Pericardial Effusion
Haemolytic Anaemia
Subdural Effusions
Seizures
62
Q

Migraine

A

Neurological disorder characterised by recurrent moderate-severe headaches. Features with nausea, photophobia and headache.

63
Q

Types of Migraines

A

Migraine without aura (common migraine 75%)
Migraine with aura (classic migraine 25%)
Childhood periodic syndromes
Retinal Migraine
Probable Migraine

64
Q

How common are Migraines

A

F >M

Common around puberty and menopause

65
Q

Causes of Migraines

A
  1. Changes to cerebral blood vessels

2. Primary brain disorder: Altered modulation of normal stimuli and trigeminal nerve dysfunction

66
Q

Risk Factors for Migraines

A 
CHOCOLATE
Chocolate
Orgasms
Cheese
Oral Contraceptives
Lie-ins
Alcohol
Tumult (loud noise and crowds)
Exercise
67
Q

Symptoms and signs of Migraine

A 
Unilateral throbbing headache
Nausea and vomiting
Photophobia
Phonophobia (fear of loud sounds)
Allodynia: stimuli producing pain which normally didn't
68
Q

Differentials for Migraines

A 
SAH or meningitis
TIA
Sensory epilepsy
Cluster Headaches (severe pain around 1 eye, attacks last less than 3 hours)
Tension Headaches (generalised throughout head, bilateral pressure, non-throbbing)
Cervical Spondylosis
HTN
Raised ICP
Ischaemic Stroke
69
Q

Treatment for Migraines

A
  1. NSAIDS
  2. Triptans - to treat migraines
  3. Ergot Alkaloids - to treat migraines
  4. Prophylaxis
    1st line: Propranolol, Amitriptyline
    2nd line: Sodium Valporate, Pizotifen, Gabapentin and Pregabalin
70
Q

Complications for Migraines

A 
Depression
Status migrainosus: lasting >24 hours
Migrainous infarction: aura lasting >1 hour 
Migraine-triggered seizures
Chronic Migraine
71
Q

Symptoms of Migraine with aura (aka Classic Migraine)

A

Migraine with flashing lights, visual loss, scotoma, numbness, tingling, aphasia, dysphagia, paralysis, slurred speech and opthalmoplegia

72
Q

Prognosis of Migraines

A

Children’s migraines normally seize when entering adulthood

73
Q

Tension Headache

A

Diffused generalised pain throughout the head described as a ‘tight band.’ Can be either episodic or chronic.

74
Q

How common are Tension Headaches

A

F>M
Most common type of headache
Onset 20-39yo
Prevalence decreases with age

75
Q

Causes of Tension Headaches

A

Release and activation of inflammatory agents lead to sensitisation of trigeminal afferents and in hypersensitivity. Musculature is affected here, unlike migraine where it’s blood vessels and meningeal nociceptors.

76
Q

Risk factors for Tension Headaches

A 
Sleep deprivation 
Stress
Eye Strain 
Depression 
Tumult
77
Q

Symptoms and Signs of Tension Headaches

A 
Bilateral Headache (mild-moderate)
'Tight band around head'
Pain radiating to neck
Pressure behind eyes
Non-pulsatile 
Often frontal or occipital regions
Neck tenderness
78
Q

Differentials for Tension Headaches

A 
Migraine
Raised ICP
Cluster headache
Sinusitis
Giant Cell Disorder
TMJ Disorder
79
Q

Treatment for Tension Headaches

A
  1. Ibuprofen
  2. Diclofenac
  3. Naproxen
  4. Paracetamol
  5. Relaxation therapies, physiotherapy, acupuncture and osteopathy
  6. Antidepressants: Amitriptyline
80
Q

Parkinson’s Disease and Parkinson’s Triad

A

A movement disorder caused by degeneration of the CNS

Triad: asymmetric resting tremor, cogwheel rigidity and bradykinesia

81
Q

How common is Parkinson’s Disease

A

Most common neurological disorder

0.3% in general population and 1% in people older than 60

82
Q

Pathophysiology of Parkinsons Disease

A

Dopamine producing neurons in the Substance nigra pars compacta (SNc) degenerate. Lack of dopamine causing hypokinesia, rigidity and tremor

83
Q

Causes of Parkinsons Disease

A

Mutation in PINK1, PARKIN, ALPHA SYNUCLEIN genes
DRugs that block dopamine receptors
Wilson’s Disease (Manganese and copper toxicity)
Encephalopahty
Trauma/ Boxing
HIV

84
Q

Risk factors to Parkinsons

A 
Increasing age
FHx of Parkinsons
Mutation in GBA genee
MPTP exposure
Chronic exposure to metals
Head trauma
85
Q

Symptoms and signs of Parkinsons

A 
Bradykniesia
Resting tremor
Rigidity
Postural instability
Dysdiadokinesis
Hypomimesis (expressionless face)
Hypophonia (soft speech)
Shuffling gait
Depression
Demenetia
86
Q

Differentials for Parkinsons

A 
Progressive supranuclear palsy
Lewy body dementia
Alzheimer's disease with parkinsonism 
Drug-induced Parkinsonism
Normal pressure hydrocephalus
Huntington's
Wilson's Disease
87
Q

Treatment for Parkinsons

A
  1. Levodopa- dopamine pre-cursor (tyrosine is the amino acid precursor of levodopa) with Carbidopa (prevents metabolism of Levodopa into dopamine)
  2. Benzotropine - controls tremor
  3. Dopamine - used in early stage of Parkinsons
  4. Apomorphine - potent dopamine agonist
  5. Anti-cholinergic - help tremor
  6. MOI-alternative to dopamine agonists in early PD
  7. Dopamine agonists: Bromocriptime, Pramipexole, Ropinirole
  8. Catechol-O-methyl transferase (COMT) Inhibitors - palliative drug
88
Q

Management of Parkinsons

A

Assess disability and cognition regularly
Postural exercises
Drugs
Respite Care
Deep-brain stimulation - to stimulate dopamine responsive tissue
Surgical ablation of overactive basal ganglia circuits

89
Q

Prognosis of Parkinsons

A

Progressive with duration of 15 years
Earlier onset = shorter lifespan
Unilateral symptoms become bilateral

90
Q

Complications of Parkinsons

A 
Levodopa-induced dyskinesia (excess dopmine causing excessive movements)
Dementia
Depression
Aspiration Pneumonia
Bed Sores
Falls
91
Q

Proximal Myopathy

A

Symmetrical weakness of proximal upper and/lower limbs

92
Q

Causes of Myopathy

A 
Drugs: statins and steroids
Alcohol
Thyroid Disease, 
Osteomalacia
Malignancy
Infections: HIV, Hepatitis, CMV, EBV
Connective Tissue Disease: SLE, Sarcoidosis, Vasculitis
93
Q

Symptoms and signs of Myopathy

A

Tone, reflexes and sensation will be normal
Symmetrical muscle weakness so power will be reduced
Malaise and fatigue
Muscle atrophy and tenderness (rare)
Waddling Gait
Fever (inflammatory cause)

94
Q

Differentials for Myopathy

A 
Motor Neuron Disease
Gullian-Barre Syndrome
Myasthenia Gravis
Polymyalgia Rheumatica
Fibromyalgia
95
Q

Investigations for Myopathy

A
  1. Urinalysis -> myoglobinuria
  2. Blood - raised CK
  3. MRI- muscle inflammation
96
Q

Treatment for Myopathy

A

Depends on severity of disease

Drug therapy e.g immunosuppressives, physical therapy, bracing to support weakened muscles, and surgery

97
Q

Complications of Myopathy

A

Respiratory failure
Aspiration pneumonia
Rhabdomyolysis
Chest, spine or joint deformities

98
Q

Multiple Sclerosis

A

Autoimmune condition resulting in demyelination of axons at multiple CNS sites

99
Q

How common is Multiple Sclerosis

A

Common in young adults

F>M

100
Q

Causes of Multiple Sclerosis

A

HLA genes
Toxins, viral exposures- EBV , sunlight exposure
Postnatal hormonal changes

101
Q

Risk factors for Multiple Sclerosis

A 
Female
Aged 20-40
Genetics
Smoking 
Vitamin D Deficiency
Autoimmune disease
102
Q

Symptoms and signs of Multiple Sclerosis

A 
Visual disturbance in 1 eye
Unilateral optic neuritis
Numbness or tingling in the limbs 
Leg weakness/ Foot dragging
Brain stem or cerebellar symptoms
Bell's Palsy
Relapses and Remission
Imbalance/ Incoordination 
Spasticity/ increased muscle tone
103
Q

Differentials for Multiple Sclerosis

A 
Spinal Cord Neoplasms
Acute Encephalomyelitis
Sarcoidosis
Transverse Myelitis
Vasculitis
Fibromyalgia
Guillain-Barre Syndrome
Amyotrophic Lateral Sclerosis (ALS)
SLE
104
Q

Treatment for Multiple Sclerosis

A
  1. Interferon Beta
  2. Non-immunosuppressive
  3. Monoclonal antibodies
  4. Methylprednisolone for acute relapses
105
Q

Complications for Multiple Sclerosis

A 
UTIs
Osteopenia and osteoporosis
Depression
 Visual Impairment
Erectile Dysfunction
Cognitive impairment 
Impaired mobility

Y3 Core Conditions (13 decks)

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