Neurological conditions

Question 1

What symptoms are seen for infarcts of the various areas of the brain?

Answer 1

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

Question 2

What test needs to be required out immediately for a stroke brought to hospital?

Answer 2

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.

Question 3

How do patients describe their headache if they have a SAH?

Answer 3

Sudden severe thunderclap headache, typically occipital

Question 4

What is the most common mononeuropathy caused by nerve compression?

Answer 4

Carpal tunnel syndrome

Question 5

What are some sensory symptoms seen in peripheral neuropathy?

Answer 5

Negative: numbness, tremor, gait abnormality
Postitive: Tingling, pain, itching, crawling, pins and needles

Question 6

What are some motor symptoms seen in peripheral neuropathy?

Answer 6

Negative: weakness, tiredness, heaviness, gait abnormalities, reduced reflexes
Positive: cramps/myalgia, tremor, fasciculations

Question 7

Causes of seizures?

Answer 7

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

Question 8

What are the different types of seizure?

Answer 8

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

Question 9

When should an electroencephalograph be offered to patients?

Answer 9

After their 2nd not 1st seizure

1st could just be a one-off

Question 10

Management of seizure/epilepsy?

Answer 10

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

Question 11

What bacteria tend to cause meningitis?

Answer 11

Neisseria meningitides, strep pneumoniae, S.aureus, H.influenza type B

Question 12

Symptoms of meningitis?

Answer 12

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

Question 13

Most viral meningitises tend to be self limiting, which virus requires active anti-microbial treatement and what should be given?

Answer 13

Herpes simplex meningitis - give aciclovir

Question 14

How are tension headaches classified into benign or chronic?

Answer 14

Benign: present for <15 days/month
Chronic: present for >15 days/month

Question 15

Symptoms of tension headache?

Answer 15

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

Question 16

Name some partial triggers for migraines?

Answer 16

C - Chocolate
H - Hangovers
O - Orgasms
C - Cheese
O - Oral contraceptives
L - Lie-ins
A - Alcohol
T - Tumult (loud noise)
E - Exercise

Question 17

Symptoms of migraine?

Answer 17

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

Question 18

Management of migraines?

Answer 18

Avoid triggers, NSAIDs, triptans, ergot alkaloids.

Prophylaxis in some: Firstly - propanolol/amitriptylline. Secondly, sodium valproate/pizitofen/gabapentin

Question 19

Define Parkinson’s disease?

Answer 19

A degenerative disorder of the CNS characterised by resting tremor, rigidity and bradkinesia

Question 20

Pathology behind Parkinson’s?

Answer 20

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

Question 21

Symptoms of Parkinson’s?

Answer 21

Resting tremor (pill rolling of thumb & finger), cogwheel rigidity, bradykinesia, postural instability, shuffling gait, reduced arm swing, freezing at obstacles, expressionless face

Question 22

Pathology behind Multiple Sclerosis?

Answer 22

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.

Question 23

Symptoms of MS?

Answer 23

Unilateral optic neuritis, numbness/tingling of limbs, leg weakness, brainstem/cerebellar symptoms, Bell’s palsy

Question 24

Management of MS?

Answer 24

Early exposure to sunlight & vit D helps reduce symptoms. Encourage happy/stress free life.
Steroids for acute relapses
Immunomodulators can help