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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
TIA mimics
Migraine, Seizure, Syncope
26
Differentials for TIA
``` 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 ```
27
Treatment for TIAs
Antiplatelet therapy: Aspirin, clopidogrel Cardioembolic TIA: Warfarin, dabigatran, apixaban Lipid-Loweing agent Antihypertensives: ACEi, ARBs, CCB Carotid Endarterectomy
28
Complications of TIAs
Stroke | Myocardial Infarction
29
Peripheral Neuropathy
Damage to peripheral nerves. Types: Mononeuropathy Mononeuritis Multiplex Polyneuropathy
30
Myelopathy
Disease affecting the spinal cord
31
Radiculopathy
Disease affecting nerve roots and plexuses
32
Causes of Peripheral Neuropathy
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
33
Symptoms and signs of Peripheral Neuropathy
Sensory: Numbness, tremor, gait abnormality, pain, itching and crawling, pins and needles Motor: Weakness and tiredness, heaviness hyporeflexia, cramps, myalgia, tremor, fasciculations
34
Differentials for Peripheral neuropathy
``` Diabetes Post-Herpes Neuralgia Malnutrition- B12 and alcohol Hypothyroidism Guillain-Barre Syndrome Myasthenia Gravis ```
35
Investigations for Peripheral Neuropathy
``` Peripheral neuro examination Electromyography Nerve conduction studies Blood tests Fasting blood glucose, HBA1C, B12, lipid profile ```
36
Treatment for Peripheral Neuropathy
Amitriptyline, Pregabalin or Gabapentin | Glycaemic control if Diabetic Neuropathy
37
Complications of Peripheral Neuropathy
Wounds and ulcers, infections, gangrene, amputation, silent MI, death, depression
38
Epilepsy and Seizures
Recurrent and intermittent abnormal electrical activity in the brain manifesting as seizures.
39
Types of Seizures
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
40
Causes of Seizures
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
41
Symptoms and signs of Seizures
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
42
Define Myoclonic, Atonic, Absence and Tonic-Clonic of Generalise Seizures
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
43
Signs of Toni-Clonic Seizures
``` Sudden fall Stiff limbs Jerking Loss of consciousness Tongue biting Incontinence ```
44
Differentials for Epilepsy and Seizures
``` Syncope Cardiac Arrhythmias TIA Migraine Benign Paroxysmal Vertigo Acute Encephalopathy Narcolepsy Panic Attacks ```
45
Treatment for Seizures
Sodium Valporate or Lamotrigine, Carbamazepine If seizing, record time, protect them from injury, recovery position when sizure has stopped Inform DVLA
46
Complications of Epilepsy
Sudden Unexpected Death in Epilepsy (SUDEP) Status Epilepticus: Seizure lasting for more than 5 mins Depression and Anxiety Injuries
47
Meningitis
Inflammation of meninges and the under lying subarachnoid CSF
48
Causes of Meningitis: Bacterial
Neisseria Meningitidis Streptococcus Pneumoniae Haemophilus Influenzae
49
Causes of Meningitis: Viral
``` Enterovirus Herpes Simplex Varicella Zoster Mumps HIV ```
50
How common is Meningitis
Common for < 2 months and >60yo | Decreasing incidence due to vaccinations
51
Risk factors for Meningitis
``` <5 or >65yo Non-immunised infants Immunodeficiency Cancer No spleen ```
52
Symptoms and signs of Meningitis
Stiff neck and photophobia, fever, headache, altered mental status, confusion, vomiting, seizures, rash Infants: hypothermia, irritability, lethargy, poor feeding, apnoea, bulging fontanelle
53
Kernig's Sign
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
Brudzinski's Sign
Flexion of the neck causes involuntary flexion of the knees and hips. Indicative of meningitis
55
Differentials for Meningitis
``` Subarachnoid Haemorrhage Encephalitis Pyrexia and severe infection Intracranial abscess Septicaemia ```
56
Investigations for Meningitis
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
Treatment for Meningitis
1. Vancomycin AND Ceftriaxone | 2. Dexamethasone
58
Treatment for Herpes Simplex Meningitis
Acyclovir
59
Prophylaxis for Meningitis
Rifampicin or Ciprofloxacin
60
How many days will it take for Viral Meningitis to resolve
4-10 days
61
Complications of Meningitis
``` Sepsis Septic Arthritis Raised ICP Pericardial Effusion Haemolytic Anaemia Subdural Effusions Seizures ```
62
Migraine
Neurological disorder characterised by recurrent moderate-severe headaches. Features with nausea, photophobia and headache.
63
Types of Migraines
Migraine without aura (common migraine 75%) Migraine with aura (classic migraine 25%) Childhood periodic syndromes Retinal Migraine Probable Migraine
64
How common are Migraines
F >M | Common around puberty and menopause
65
Causes of Migraines
1. Changes to cerebral blood vessels | 2. Primary brain disorder: Altered modulation of normal stimuli and trigeminal nerve dysfunction
66
Risk Factors for Migraines
``` CHOCOLATE Chocolate Orgasms Cheese Oral Contraceptives Lie-ins Alcohol Tumult (loud noise and crowds) Exercise ```
67
Symptoms and signs of Migraine
``` Unilateral throbbing headache Nausea and vomiting Photophobia Phonophobia (fear of loud sounds) Allodynia: stimuli producing pain which normally didn't ```
68
Differentials for Migraines
``` 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
Treatment for Migraines
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
Complications for Migraines
``` Depression Status migrainosus: lasting >24 hours Migrainous infarction: aura lasting >1 hour Migraine-triggered seizures Chronic Migraine ```
71
Symptoms of Migraine with aura (aka Classic Migraine)
Migraine with flashing lights, visual loss, scotoma, numbness, tingling, aphasia, dysphagia, paralysis, slurred speech and opthalmoplegia
72
Prognosis of Migraines
Children's migraines normally seize when entering adulthood
73
Tension Headache
Diffused generalised pain throughout the head described as a 'tight band.' Can be either episodic or chronic.
74
How common are Tension Headaches
F>M Most common type of headache Onset 20-39yo Prevalence decreases with age
75
Causes of Tension Headaches
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
Risk factors for Tension Headaches
``` Sleep deprivation Stress Eye Strain Depression Tumult ```
77
Symptoms and Signs of Tension Headaches
``` 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
Differentials for Tension Headaches
``` Migraine Raised ICP Cluster headache Sinusitis Giant Cell Disorder TMJ Disorder ```
79
Treatment for Tension Headaches
1. Ibuprofen 2. Diclofenac 3. Naproxen 4. Paracetamol 5. Relaxation therapies, physiotherapy, acupuncture and osteopathy 6. Antidepressants: Amitriptyline
80
Parkinson's Disease and Parkinson's Triad
A movement disorder caused by degeneration of the CNS | Triad: asymmetric resting tremor, cogwheel rigidity and bradykinesia
81
How common is Parkinson's Disease
Most common neurological disorder | 0.3% in general population and 1% in people older than 60
82
Pathophysiology of Parkinsons Disease
Dopamine producing neurons in the Substance nigra pars compacta (SNc) degenerate. Lack of dopamine causing hypokinesia, rigidity and tremor
83
Causes of Parkinsons Disease
Mutation in PINK1, PARKIN, ALPHA SYNUCLEIN genes DRugs that block dopamine receptors Wilson's Disease (Manganese and copper toxicity) Encephalopahty Trauma/ Boxing HIV
84
Risk factors to Parkinsons
``` Increasing age FHx of Parkinsons Mutation in GBA genee MPTP exposure Chronic exposure to metals Head trauma ```
85
Symptoms and signs of Parkinsons
``` Bradykniesia Resting tremor Rigidity Postural instability Dysdiadokinesis Hypomimesis (expressionless face) Hypophonia (soft speech) Shuffling gait Depression Demenetia ```
86
Differentials for Parkinsons
``` Progressive supranuclear palsy Lewy body dementia Alzheimer's disease with parkinsonism Drug-induced Parkinsonism Normal pressure hydrocephalus Huntington's Wilson's Disease ```
87
Treatment for Parkinsons
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
Management of Parkinsons
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
Prognosis of Parkinsons
Progressive with duration of 15 years Earlier onset = shorter lifespan Unilateral symptoms become bilateral
90
Complications of Parkinsons
``` Levodopa-induced dyskinesia (excess dopmine causing excessive movements) Dementia Depression Aspiration Pneumonia Bed Sores Falls ```
91
Proximal Myopathy
Symmetrical weakness of proximal upper and/lower limbs
92
Causes of Myopathy
``` Drugs: statins and steroids Alcohol Thyroid Disease, Osteomalacia Malignancy Infections: HIV, Hepatitis, CMV, EBV Connective Tissue Disease: SLE, Sarcoidosis, Vasculitis ```
93
Symptoms and signs of Myopathy
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
Differentials for Myopathy
``` Motor Neuron Disease Gullian-Barre Syndrome Myasthenia Gravis Polymyalgia Rheumatica Fibromyalgia ```
95
Investigations for Myopathy
1. Urinalysis -> myoglobinuria 2. Blood - raised CK 3. MRI- muscle inflammation
96
Treatment for Myopathy
Depends on severity of disease | Drug therapy e.g immunosuppressives, physical therapy, bracing to support weakened muscles, and surgery
97
Complications of Myopathy
Respiratory failure Aspiration pneumonia Rhabdomyolysis Chest, spine or joint deformities
98
Multiple Sclerosis
Autoimmune condition resulting in demyelination of axons at multiple CNS sites
99
How common is Multiple Sclerosis
Common in young adults | F>M
100
Causes of Multiple Sclerosis
HLA genes Toxins, viral exposures- EBV , sunlight exposure Postnatal hormonal changes
101
Risk factors for Multiple Sclerosis
``` Female Aged 20-40 Genetics Smoking Vitamin D Deficiency Autoimmune disease ```
102
Symptoms and signs of Multiple Sclerosis
``` 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
Differentials for Multiple Sclerosis
``` Spinal Cord Neoplasms Acute Encephalomyelitis Sarcoidosis Transverse Myelitis Vasculitis Fibromyalgia Guillain-Barre Syndrome Amyotrophic Lateral Sclerosis (ALS) SLE ```
104
Treatment for Multiple Sclerosis
1. Interferon Beta 2. Non-immunosuppressive 3. Monoclonal antibodies 4. Methylprednisolone for acute relapses
105
Complications for Multiple Sclerosis
``` UTIs Osteopenia and osteoporosis Depression Visual Impairment Erectile Dysfunction Cognitive impairment Impaired mobility ```

Y3 Core Conditions (13 decks)

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