Neurological Cases in Medicine AS Flashcards
HOW DO YOU ASSESS GCS?
EYES 4
VERBAL RESPONSE 5
MOTOR RESPONSE 6
MINIMUM IS 3
LIST THE COMPONENTS OF THE AMTS test for confusion.
- DOB
- AGE
- TIME
- YEAR
- PLACE
- RECALL (WEST REGISTER STREET)
- RECOGNISE DOCTOR/NURSE
- PRIME MINISTER
- SECOND WW
- COUNT BACKWARDS FROM 20 TO 1
What are the UMN signs?
Increased tone/spasticity and reflexes
Upgoing plantars
Decreased power
What are the LMN signs?
Decreased tone(flaccid) and reflexes
Decreased power
What anatomy must you consider in neurological diagnosis?
Brain + spinal cord
Nerve roots
Peripheral nerves
NMJ
What are the general causes of neurological pathology?
- Vascular
- Infection
- Inflammation/autoimmune
- Toxic/metabolic
- Tumour/malignancy
- Hereditary/congenital
- Degenerative
Describe these visual field defects.
Describe these visual field defects.
- III, IV, VI - diplopia
- IX, X - slurred speech and dysphagia
- This is a problem affecting NMJ
- This is a LOWER MOTOR NEURONE LESION
Botulism - when addict run out of venous sites for injection they innject under skin. This man needed . Dx: myasthenia gravis (but no lesions).
Not brain - no hemiparesis. Affecting extraocular muscles as well as speech and swallowing.
Describe the disribution of these lesions:
- Cerebral cortex
- Spinal cord
- Nerve roots (radiculopathy)
- Mononeuropathy
- Polyneuropathy
- hemisensory loss
- level (e.g. umbilicus)
- dermatomes
- specific area
- glove and stocking districbution
What is hydroxocobalamin?
Vit B12a - dietary supplement
What would you say in front of patient… HIV? Ca?
HIV - “retroviral disease”
Cancer = “mitotic disease”
What would you prescribe?
Codeine/duloxetine/hydroxocobalamin/paracetamol/morphine
duloxetine
What are the causes of peripheral neuropathy?
(Less likely vascular)
Infection
Inflammation/autoimmune
Toxin/metabolic
Tumour/malignancy
What are the toxic/metabolic causes of peripheral neuropathy?
Young woman - lesion likely in spinal cord
Blurred margins of optic disc - papilloedema or papillitis…
- Might also complain of pain - papillitis (reduced visual acuity, blurred vision, pain)
- Less likely papilloedema because she is young - and doesn’t reduce visual acuity
Two lesions
- Optic nerve - optic neuritis (papillitis) - blurred dic margins/vision, pain on eye movement
- Spinal cord - corticospinal/spinothalamic tracts - spastic paraparesis - vascular/infection/inflammation (demyelination e.g. transverse myelitis), toxic/metabolic, tumour/malignancy
What is TB affecting spinal cord called?
Pott disease
What characterises MS?
Two lesions
Separated in time/space
Lose weight
Describe meralgia paraesthetica. How do you treat it?
Describe innervation of the hand.
What is radiculopathy? Use lumbosacral as an example.
Disease of nerve roots
E.g. lumbosacral - pain in buttock, radiating down leg below the knee = “sciatica”
What is the cause of radiculopathy?(2)
Compression
- Disc herniation
- Spinal canal stenosis
A
List 3 features of Parkinson’s diseae.
Tremor rigidity and bradykinesia
(affects dopaminergic neurones, substantia niagra)
Name 2 features of PSP.
Parkinsonian features, upgaze abnormality
What is the general cause?
Toxic/metabolic -recently moved house e.g. CO poisoning
Name some differentials for apparent confusion/reduced AMTS.
What test should you do first when investigating metabolic/toxic causes? What others?
Glucose
Drugs
U&Es
LFTs
Vitamin deficiencies
Endocrinopathies
What are the most common causes of headache in ED? How do you differentiate between them?
Should you treat BP acutely in TIA?
No, unless it is over 220/120
How do you manage stroke?
How do you manage TIA?
A- if FVC keeps dropping then PT needs to be sent to ITU
What are the 2 main causes of collapse?
What are the different classes of antibiotics?
What areas of the cell do each of the antibiotic classes affect?
