Neurological conditions Flashcards
What symptoms are seen for infarcts of the various areas of the brain?
Cerebral hemisphere (50%): contralateral hemiplegia initially flaccid then spastic, contralateral sensory loss, homonymous hemianopia, dysphasia Brainstem: quadaplegia, disturbance of vision, locked-in syndrome Lacunar (25%): pure motor/sensory or mixed signs, ataxia, intact cognition/consciousness
What test needs to be required out immediately for a stroke brought to hospital?
Brain CT to determine if ischaemic/haemorrhagic but often normal in ischaemic for first few hours, very sensitive for haemorrhagic in acute stages. MRI more accurate but contraindicated in some.
How do patients describe their headache if they have a SAH?
Sudden severe thunderclap headache, typically occipital
What is the most common mononeuropathy caused by nerve compression?
Carpal tunnel syndrome
What are some sensory symptoms seen in peripheral neuropathy?
Negative: numbness, tremor, gait abnormality
Postitive: Tingling, pain, itching, crawling, pins and needles
What are some motor symptoms seen in peripheral neuropathy?
Negative: weakness, tiredness, heaviness, gait abnormalities, reduced reflexes
Positive: cramps/myalgia, tremor, fasciculations
Causes of seizures?
2/3 are idiopathic
Structural: cortical scarring (from previous injury), developmental, space-occupying lesion, stroke, hippocampal sclerosis, sarcoidosis, SLE, polyarteritis nodusa
Non-epileptic causes of seizure: trauma, stroke, haemorrhage, raised ICP, alcohol/benzodiazepine withdrawal, metabolic disturbances, liver disease, infection, drugs
What are the different types of seizure?
Absence: brief pauses mid sentence (presents in childhood)
Tonic-clonic: loss of consciousness, limbs stiffen then jerk
Myoclonic: sudden jerks
Atonic: sudden loss of muscle tone
Simple partial: unimpaired awareness and focal symptoms
Complex partial: impaired awareness, focal symptoms
Partial with secondary generalisation: combination of above
When should an electroencephalograph be offered to patients?
After their 2nd not 1st seizure
1st could just be a one-off
Management of seizure/epilepsy?
Drugs not offered after only 1 seizure due to high impact on life (can’t drive/operate machinery)
Generalised tonic-clonic: sodium valproate or lamotrigine
Absence: sodium valproate, lamotrigine or ethosuximide
Tonic, atonic and myoclonic: same as generalied tonic-clonic but avoid carbamazepine as makes seizures worse
Partial with 2o generalisation: Carbamazepine, sodium valproate or lamortrigine
What bacteria tend to cause meningitis?
Neisseria meningitides, strep pneumoniae, S.aureus, H.influenza type B
Symptoms of meningitis?
Early: headache, leg pains, cold hands+feet, abnormal skin colour
Later: meningism (stiff neck, photophobia, Kernig’s sign), reduced conscious level, coma, seizures, non-blanching petechial rash
Most viral meningitises tend to be self limiting, which virus requires active anti-microbial treatement and what should be given?
Herpes simplex meningitis - give aciclovir
How are tension headaches classified into benign or chronic?
Benign: present for <15 days/month
Chronic: present for >15 days/month
Symptoms of tension headache?
Bilateral, non-pulsatile headache, scalp muscle tenderness, spreads to neck, “feels like tight band around head”, pressure behind eyes, no vomiting or sensitivity to head movements
Name some partial triggers for migraines?
C - Chocolate H - Hangovers O - Orgasms C - Cheese O - Oral contraceptives L - Lie-ins A - Alcohol T - Tumult (loud noise) E - Exercise
Symptoms of migraine?
Prodrome (hours to days before): yawning, craving, modd change
Aura (minutes before): chaotic cascading, distortion, hemianopia, parasthesiae, dysarthria, ataxia
During: unilateral throbbing headache, N+V, photophobia, phonophobia, allodynia
Management of migraines?
Avoid triggers, NSAIDs, triptans, ergot alkaloids.
Prophylaxis in some: Firstly - propanolol/amitriptylline. Secondly, sodium valproate/pizitofen/gabapentin
Define Parkinson’s disease?
A degenerative disorder of the CNS characterised by resting tremor, rigidity and bradkinesia
Pathology behind Parkinson’s?
Mitochondrial DNA dysfunction causes degeneration of dopaminergic neurons in substantia nigra pars compacta.
Can be brought on by drugs (neuroleptics/metaclopramide), trauma, encephalopathy, copper toxicity, HIV
Symptoms of Parkinson’s?
Resting tremor (pill rolling of thumb & finger), cogwheel rigidity, bradykinesia, postural instability, shuffling gait, reduced arm swing, freezing at obstacles, expressionless face
Pathology behind Multiple Sclerosis?
Cell mediated autoimmune condition. Discrete plaques of demyelination occur at multiple CNS sites, demyelination heals poorly causing relapsing and remitting symptoms. Prolonged demyelination casues axonal loss and progressive symptoms.
Symptoms of MS?
Unilateral optic neuritis, numbness/tingling of limbs, leg weakness, brainstem/cerebellar symptoms, Bell’s palsy
Management of MS?
Early exposure to sunlight & vit D helps reduce symptoms. Encourage happy/stress free life.
Steroids for acute relapses
Immunomodulators can help
