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3 - Clinical Skills > Neurological Conditions > Flashcards

Neurological Conditions Flashcards

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1
Q

List some neurological conditions due to trauma.

A

Head injury
Spinal cord injury
Disc prolapse
Peripheral nerve trauma

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2
Q

What is concussion?

A

Transient disturbance of neurological function caused by trauma to the head
May or may not be loss of consciousness
May cause intracranial bleeding

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3
Q

Extradural haematoma

A

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

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4
Q

Subdural Haematoma

A

Follows after trivial injury to head
Venous bleed in subdural space
Common in elderly people

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5
Q

How does a subdural haematoma present?

A

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
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6
Q

What is the presentation of a chronic subdural haematoma?

A

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

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7
Q

What is a spinal cord injury?

A

May be due to compression, laceration or contusion

Sudden blow or laceration to the spine

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8
Q

What are the symptoms of a spinal cord injury?

A

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)

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9
Q

What is disc prolapse?

A

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

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10
Q

What are the symptoms of disc prolapse?

A

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)

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11
Q

Peripheral Nerve Trauma

A

Compression, laceration or contusion
Symptoms depend on nerve affected
Important to assess motor and sensory function following a traumatic event

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12
Q

Herpes Zoster (Shingles) - what causes this?

A

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

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13
Q

What are the symptoms of herpes zoster (shingles) and who does it affect?

A

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

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14
Q

What is a frequent complication of herpes zoster (shingles)?

A

Post-herpetic neuralgia is common - pain persists for months/years after the rash has resolved

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15
Q

What happens in cauda equina syndrome?

A

Lesion affecting cauda equina (horses tail of nerve roots that exit the spinal cord)

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16
Q

What are symptoms of cauda equina syndrome and its causes?

A

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

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17
Q

What is peripheral neuropathy?

A

Disease of peripheral nerves

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18
Q

What is polyneuropathy?

A

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

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19
Q

List the causes of polyneuropathy?

A

Metabolic disorders (diabetic neuropathy)
Nutritional disorders (vit B12 deficiency)
Medication (statins, chemo, antibiotics)
Infection (leprosy)
Autoimmune disease (Guillian Barre)

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20
Q

What is mononeuropathy?

A

Disease of a single nerve e.g. nerve entrapments = carpal tunnel syndrome

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21
Q

What is carpal tunnel syndrome?

A

Nerve entrapment of upper limb
Median nerve is pressed in carpal tunnel of wrist
Comes on gradually

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22
Q

What are the symptoms of carpal tunnel?

A

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

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23
Q

What is carpal tunnel syndrome associated with?

A

Pregnancy - this causes peripheral oedema

Endocrine conditions - acromegaly, diabetes mellitus, hypothyroidism

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24
Q

What is cubital tunnel syndrome?

A

Ulna nerve compression at elbow

Symptoms are chronic and slow progressive

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25
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
26
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
27
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
28
Bells Palsy
Unilateral paralysis of facial muscles due to lower motor neurone lesion affecting facial nerve
29
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
30
What causes Bells Palsy?
Autoimmune origin - viral infection
31
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
32
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
33
Name conditions affecting the peripheral nerves.
``` Herpes zoster (shingles) Cauda equina syndrome Peripheral neuropathy Carpal tunnel syndrome Cubital tunnel syndrome Guillian Barre syndrome ```
34
Name conditions affecting the cranial nerves.
Bells palsy - cranial nerve 7 Trigeminal neuralgia - 5 Herpes zoster
35
Name conditions causing seizure.
Epilepsy
36
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)
37
Name conditions causing vascular disease.
``` Cerebrovascular disease Stroke SAH TIA Amaurosis fugax ```
38
What does cerebrovascular disease usually present as?
Stroke | can also present as vascular dementia
39
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
40
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)
41
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
42
TIA
Temporary vascular blockage | Symptoms are similar to stroke, but are transient and must recover within 24 horus
43
Amaurosis fugax
Fleeting loss of vision due to impaired blood flow in ophthalmic of retinal artery, analogus to TIA
44
List conditions causing vertigo.
Benign paroxysmal positional vertigo | Menieres syndrome
45
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
46
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
47
List conditions causing primary headache.
Migraine Tension headache Medication overuse headache
48
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
49
How long does it take for a migraine headache to occur?
15-20min onset | Resolves within a day or up to 3 days maximum
50
Episodic migraine
Less than 15 headache days per month
51
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
52
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
53
Who is susceptible to a medication overuse headache?
Patients with history of migraine | Female
54
Symptoms of medication overuse headache
Present upon awakening, may increase after physical exertion
55
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
56
List conditions causing secondary headache.
Intracranial tumour Encephalitis Meningitis
57
What are intrinsic tumours?
Primary - mostly glioma | Secondary - metastasis from distant cancer
58
Where may extrinsic tumours arise from?
Meninges - meningioma | Cranial or spinal nerves - schwannoma
59
Meningitis
Headache, fever, neck stiffness = simple triad Onset: minutes to hours Symptoms of infection and CNS dysfunction
60
Encephalitis
Inflammation of brain parenchyma Usually caused by virus e.g. herpes simplex virus Headache and flu-like illness
61
What non-neurological conditions may cause headache?
Sinusitis | Temporal arteritis
62
Conditions causing hearing loss
Sensorineural loss | Conduction loss
63
Sinusitis
Bacterial infection of paranasal sinuses | Headache, purulent discharge, facial pain, fever
64
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
65
Sensorineuronal hearing loss
Problem in inner ear affecting cochlear and associated structures of vestibulocochlear nerve
66
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
67
Condition causing visual loss
Optic neuritis
68
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
69
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
70
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
71
PD
Unknown Aetiology, small genetic component | Bradykinesia, resting tremor, rigidity (cogwheel or leadpipe)
72
Gait of PD
``` Slower than expected for age Festinating (strides are quicker and shorter than normal) Jerky Reduced arm movement Frequent falls Freezing episodes ```
73
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
74
AD
Memory and cognitive dysfunction Difficulties with day to day activities Amyloid plaques and neurofibrillary tangles Diagnosis of exclusion

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