Neurological Conditions Flashcards
List some neurological conditions due to trauma.
Head injury
Spinal cord injury
Disc prolapse
Peripheral nerve trauma
What is concussion?
Transient disturbance of neurological function caused by trauma to the head
May or may not be loss of consciousness
May cause intracranial bleeding
Extradural haematoma
Neurosurgical emergency
Acute bleeding - blood collection between skull and dura mater
Middle meningeal artery
Lucid interval after head trauma followed by rapid deterioration over minutes
Decompression treatment is needed
Subdural Haematoma
Follows after trivial injury to head
Venous bleed in subdural space
Common in elderly people
How does a subdural haematoma present?
Hours after the injury (chronic = more than a month after the injury)
- gradual loss of consciousness occurring within hours after the injury
- severe headache
- weakness on one side of body
- seizures
- changes in vision or speech
What is the presentation of a chronic subdural haematoma?
Subtle symptoms similar to dementia or stroke
May continue for more than a month before diagnosis is made
- mild headache
- nausea/vomiting
- change in personality
- memory loss
- loss of balance or difficulty walking
- double vision
- weakness, numbness or tingling in arms/legs
What is a spinal cord injury?
May be due to compression, laceration or contusion
Sudden blow or laceration to the spine
What are the symptoms of a spinal cord injury?
Paralysis (loss of voluntary control and movement of muscles) and loss of sensation/reflex function below the point of injury (including autonomic activity e.g. breathing and bladder/bowel control)
What is disc prolapse?
Nucleus pulposus of the intervertebral disc (a gel-like substance) bulges from the disc causing severe pain
An event often causes this pain
Most cases heal within a few weeks, only some require surgery
One cause of the neurosurgical emergency cauda equina syndrome
What are the symptoms of disc prolapse?
Burning stinging pain that may radiate
Cause of radiculopathy (damage to nerve root/s) causing weakness of sensation changes
May develop to myelopathy (damage to spinal cord)
Peripheral Nerve Trauma
Compression, laceration or contusion
Symptoms depend on nerve affected
Important to assess motor and sensory function following a traumatic event
Herpes Zoster (Shingles) - what causes this?
Reactivation of the Varicella zoster virus (VZV)
Initial infection occurs as varicella (chickenpox)
After initial infection, VZV resides in dormant state in cranial nerve and dorsal-root ganglia
If VZV is reactivated, it travels from the cell bodies of the neurons to their nerve terminals in the skin
= causes local inflammation and pain followed by distinctive shingles rash with vesicles (blisters)
VZV in blisters is infectious to anyone who does not have immunity
What are the symptoms of herpes zoster (shingles) and who does it affect?
Pain followed by the development of a vesicular (blistered) rash
Rash is unilateral and typically affects one dermatome
More common over the age of 60
What is a frequent complication of herpes zoster (shingles)?
Post-herpetic neuralgia is common - pain persists for months/years after the rash has resolved
What happens in cauda equina syndrome?
Lesion affecting cauda equina (horses tail of nerve roots that exit the spinal cord)
What are symptoms of cauda equina syndrome and its causes?
Sphincter disturbance (urinary retention and faecal overflow incontinence), lower motor neurone leg weakness, gait disturbance, reduced sensation in saddle distribution (perineum and buttocks)
Causes - disc prolapse and tumours
What is peripheral neuropathy?
Disease of peripheral nerves
What is polyneuropathy?
Diffuse involvement of peripheral nerves - distal weakness and sensory disturbance in a glove and stocking distribution
Begins in feet and toes and spreads proximally
Then involves fingers, hands, arms
List the causes of polyneuropathy?
Metabolic disorders (diabetic neuropathy)
Nutritional disorders (vit B12 deficiency)
Medication (statins, chemo, antibiotics)
Infection (leprosy)
Autoimmune disease (Guillian Barre)
What is mononeuropathy?
Disease of a single nerve e.g. nerve entrapments = carpal tunnel syndrome
What is carpal tunnel syndrome?
Nerve entrapment of upper limb
Median nerve is pressed in carpal tunnel of wrist
Comes on gradually
What are the symptoms of carpal tunnel?
Paraesthesia in distribution of median nerve
Often complain of pins and needles in whole hand (unaware that little finger and part of ring finger is unaffected)
Woken at night with pins and needles/pain in median nerve distribution
Tends to occur after prolonged use of hands
What is carpal tunnel syndrome associated with?
Pregnancy - this causes peripheral oedema
Endocrine conditions - acromegaly, diabetes mellitus, hypothyroidism
What is cubital tunnel syndrome?
Ulna nerve compression at elbow
Symptoms are chronic and slow progressive
What are the symptoms of cubital tunnel syndrome?
Altered sensation in little and ring fingers
May develop hand weakness with clumsiness with the hand (ulnar nerve is principle motor supply to intrinsic muscles of the hand)
Sensory loss is usually the first thing patients notice
Condition progresses = atrophy of small muscles of hand and ulnar sided muscles of forearm
What is cubital tunnel syndrome associated with?
Diabetes mellitus
More common in people who spend long periods with elbow flexed (e.g. prolonged use of computer mouse)
May occur following trauma to elbow
Guillian-Barre Syndrome
Rapidly progressive (but treatable)
Early diagnosis is crucial as respiratory paralysis may cause death
Segmental demyelination of peripheral nerves and nerve roots
Starts with a motor neuropathy causing limb weakness starting peripherally and moving proximally
Can progress to cause quadriparesis and respiratory paralysis within weeks
Bells Palsy
Unilateral paralysis of facial muscles due to lower motor neurone lesion affecting facial nerve
What are the symptoms of bells palsy?
Sound is louder on affected side (hyperacusis)
Ear pain on affected side
Smooth forehead and mouth droop on affected side
Cannot raise their eyebrow on affected side
What causes Bells Palsy?
Autoimmune origin - viral infection
Trigeminal neuralgia
Causes facial pain in the distribution of the trigeminal nerve
Usually maxillary and mandibular divisions of the side of the nerve affected
Over age of 50
Associated with MS
What are the symptoms of trigeminal neuralgia?
Brief paroxysms of severe burning, knifelike searing pain
Frequency of pain is variable and it lasts seconds to minutes
Precipitated by chewing or touching trigger areas on the face when shaving or washing
Name conditions affecting the peripheral nerves.
Herpes zoster (shingles) Cauda equina syndrome Peripheral neuropathy Carpal tunnel syndrome Cubital tunnel syndrome Guillian Barre syndrome
Name conditions affecting the cranial nerves.
Bells palsy - cranial nerve 7
Trigeminal neuralgia - 5
Herpes zoster
Name conditions causing seizure.
Epilepsy
What is epilepsy?
Diagnosed when at least two seizures have occurred at least 24 hours apart
Focal or generalized
Genetic or focal lesions (brain tumours)
Name conditions causing vascular disease.
Cerebrovascular disease Stroke SAH TIA Amaurosis fugax
What does cerebrovascular disease usually present as?
Stroke
can also present as vascular dementia
Name the two main types of stroke.
Ischaemic - blockage of cerebral blood vessel by thrombus or embolus
Haemorrhagic - often due to a bleed caused by HTN or anticoagulant therapy
What are the symptoms of stroke?
Hemiparesis Sensory deficits Diplopia (doubled vision) Dysarthria (disturbed speech articulation) Facial droop
Posterior circulatory strokes = sudden onset of ataxia and vertigo
Haemorrhagic stroke = nausea, vomiting, headache, blurred/double vision (raised ICP)
What causes SAH?
Haemorrhage from aneurysm situated in Circle of Willis
Causes bleeding into subarachnoid space
Very sudden headache, neck stiffness, collapse with loss of consciousness or sudden death
TIA
Temporary vascular blockage
Symptoms are similar to stroke, but are transient and must recover within 24 horus
Amaurosis fugax
Fleeting loss of vision due to impaired blood flow in ophthalmic of retinal artery, analogus to TIA
List conditions causing vertigo.
Benign paroxysmal positional vertigo
Menieres syndrome
Benign paroxysmal positional vertigo
Acute onset vertigo
Benign - dislodged otoliths in semi-circular canals of the inner ear
Paroxysmal - symptoms occurring repeatedly
Related to change in position (e.g. turning over in bed is a common precipitant)
Causes vertigo - spinning sensation
Diagnosed and treated with positional manoeurves
Menieres Syndrome
Attacks last 30min to several hours
Commonest in age 30-50 years
Caused by buildup of endolymph
Vertigo, tinnitus, nausea and vomiting, sweating and pallor, sensorineural deafness
List conditions causing primary headache.
Migraine
Tension headache
Medication overuse headache
What are the symptoms of migraine?
- aura preceded or accompanied with visual symptoms e.g. zig-zag lines or areas of scrotoma (visual loss within visual field)
- Usually starts on one side (unilateral) and is aching/throbbing pain
- associated with nausea, vomiting and photophobia
How long does it take for a migraine headache to occur?
15-20min onset
Resolves within a day or up to 3 days maximum
Episodic migraine
Less than 15 headache days per month
Chronic migraine
More than 15 headache days per month over a three month period
More than 8 are migrainous in the absence of medication overuse
Symptoms of a tension headache.
Generalized pressure or tightness like a band around the head (can originate in the back of the neck)
- bilateral pain of mild to moderate intensity
- pressing/tightening pain, not aggravated by routine activities
- duration of 30 min to continuous
- no significant additional symptoms (nausea may be present)
- tend to develop later in the day
Who is susceptible to a medication overuse headache?
Patients with history of migraine
Female
Symptoms of medication overuse headache
Present upon awakening, may increase after physical exertion
In which circumstances should a medication overuse headache be suspected?
In patients using:
- simple analgesics on > 15 days per month
- opioids > 10 days per month
- triptans > 10 days per month
List conditions causing secondary headache.
Intracranial tumour
Encephalitis
Meningitis
What are intrinsic tumours?
Primary - mostly glioma
Secondary - metastasis from distant cancer
Where may extrinsic tumours arise from?
Meninges - meningioma
Cranial or spinal nerves - schwannoma
Meningitis
Headache, fever, neck stiffness = simple triad
Onset: minutes to hours
Symptoms of infection and CNS dysfunction
Encephalitis
Inflammation of brain parenchyma
Usually caused by virus e.g. herpes simplex virus
Headache and flu-like illness
What non-neurological conditions may cause headache?
Sinusitis
Temporal arteritis
Conditions causing hearing loss
Sensorineural loss
Conduction loss
Sinusitis
Bacterial infection of paranasal sinuses
Headache, purulent discharge, facial pain, fever
Temporal arteritis
Inflammatory condition (in association with polymyalgia rheumatica)
Rare under age of 50
Severe headache, scalp tenderness, jaw claudication when eating and tenderness of temporal or occipital arteries
Early diagnosis is essential = may cause permanent blindess
Sensorineuronal hearing loss
Problem in inner ear affecting cochlear and associated structures of vestibulocochlear nerve
Conductive hearing loss
Problem affecting ear canal or middle ear
Obstruction of ear canal due to ear wax
Trauma to middle ear
Infection causing otitis media with an effusion in the middle ear
Condition causing visual loss
Optic neuritis
Optic neuritis
Inflammation of optic nerve
Most common type is idiopathic, some are autoimmune (may be first presentation of MS)
Reduction or loss of vision in at least one eye (blurred, dim or faded vision)
Comes over a course of a few days
Usually only affects vision in one eye
Commonly affects the central area vision = reading and face recognition difficult
Flashing or flickering lights
Colour vision is affected
Discomfort or pain around the eye, worse with eye movement
Multiple sclerosis
Focal demyelinated plaques in CNS with inflammation, gliosis and neurodegeneration
Lesions in brain or spinal cord
Optic nerves = common site (optic neuritis)
Has periods of relapse and remission
Benign essential tremor
Hereditary and autosomal dominant
Begins in early adult life in hands
Made worse by anxiety or carrying out tasks e.g. handwriting/holding a cup of tea
Relieved by alcohol
Triad of features: positive family history, tremor present with little in way of disability, normal gait
PD
Unknown Aetiology, small genetic component
Bradykinesia, resting tremor, rigidity (cogwheel or leadpipe)
Gait of PD
Slower than expected for age Festinating (strides are quicker and shorter than normal) Jerky Reduced arm movement Frequent falls Freezing episodes
Motor Neuron Disease
LMN weakness of limbs and LMN weakness of cranial nerves: 9, 10, 11 and 12
Incurable, die within 3-5 years of diagnosis
Weakness, muscle atrophy, altered gait, dysphagia, dysarthria, muscle pain
AD
Memory and cognitive dysfunction
Difficulties with day to day activities
Amyloid plaques and neurofibrillary tangles
Diagnosis of exclusion
