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