Neurological Disorders Flashcards
Features tension type headache
Symmetrical
Gradual Onset
Band or pressure tightness
No associated symptoms
Features migraine
Episodes lasting 1-72 hours Commonly bilateral Pulsatile Over temporal or frontal area GI disturbance Photophobia Phonophobia Aggravated by activity Relived by sleep
Features migraine aura
Visual, sensory, or motor
Most commonly visual
Negative phenomena .e.g. hemianopia or scotoma
Positive phenomena .e.g. fortification spectra
Migraine triggers
Disturbance of biorhythm .e.g. late nights
Stress
Certain foods .e.g. cheese, chocolate, caffeine
Menstruation and OCP
Uncommon forms of migraine
Familial hemiplegic migraine (calcium channel defect)
Sporadic hemiplegic migraine
Basilar type migraine- vomiting with nystagmus
Periodic syndromes .e.g. cyclical vomiting, benign paroxysmal vertigo
Features space occupying lesion
Visual field defects .e.g. craniopharyngioma Cranial nerve abnormality Abnormal gait Torticollis (tilting of the head) Growth failure Papillodema Cranial bruit Early/late puberty
Features Raised intracranial pressure
Worse lying down
Morning vomiting
Night-time waking
Change in mood, personality, and educational performance
Mx Migraine- rescue treatments
Analgesia: paracetamol and NSAIDs Antiemetics .e.g. prochlorperazine, cyclazine Triptans .e.g. sumatriptan (nasal prep) Warm pads Cold compresses Topical forhead balms
Mx Migraine- prophylactic
Indicated with frequent and intrusive headaches
Sodium channel blockers .e.g. topiramate, valproate
Beta-blockers .e.g. propranolol (not in asthma)
Tricyclics .e.g. pizotifen (causes weight gain and sleepiness), amitriptyline
Acupuncture
Features febrile seizure
Epileptic seizure in the presence of fever and absence of intracranial infection
Typically children aged 6m to 6y
Occurs with viral infection and rapid rise of temp
Brief generalised tonic-clonic
Features complex febrile seizures
Focal
Prolonged (>15-30m)
Repeated within same illness
Mx febrile convulsion
Admission for first seizure of complex seizure
Reassurance of parent/career
Antipyretics have no effect on seizure
In prolonged seizures: rescue therapy by buccal midazolam
Causes of paroxysmal disorders
Ble breath holding spells Reflex asystolic syncope (trauma, cold, fright, fever) Syncope Migraine Benign paroxysmal vertigo Cardiac arrhythmia Tics, daydreaming, night terrors Self-gratification Non-epileptic seizures Pseudoseizures Fabricated Induced illness Paroxsymal movement disorders
Generalised epileptic seizures types
Absence seizures (may be precipitated by hyperventilation) Myoclonic seizures Tonic seizures Tonic-clonic seizures Atonic seizures
Generalised epileptic seizures features
Onset in both hemispheres Loss of consciousness No warning Symmetrical seizure Bilateral synchronous discharge on EEG
Features focal epileptic seizures
Originate in small group of dysfunctional neurones
Heralded by an aura
Can evolve to tonic-clonic
Focal seizures brain areas
Frontal- motor phenomena .e.g. Jacksonian march
Temporal lobe- auditory or sensory, lip-smacking, plucking at clothing, non-purposeful walking (spread to pre-motor)
Occipital- visual
Parietal- contralateral altered sensation
Ix Epileptic seizures
ECG, esp convulsive seizures
EEG: ictal, inter-ictal, sleep-deprived, 24hr or 5day video-telemetry
Brain imaging
Features Infantile spasms (West syndrome)
3-12m Violent spasms of head, trunk and limbs Extension of arms Lasts 1-2s Mulitple bursts of 20-30 On waking or multiple times a day EEG- hypsarrythmia (chaotic background of slow wave activity) Similar to colic
Mx Infantile spasms
Vigabatrin Corticosteroids 60-70% response Relapse common Most lose skills and develop learning disability
Features Lennox-Gastaut syndrome
1-3 y Mostly atypical, atonic absences Tonic seizures in sleep Neurodevelopmental arrest or regression EEG- slow generalised spike and wave (1-3Hz) Poor prognosis
Features Childhood Absence Epilepsy
4-12y
Momentary unresponsive stare with motor arrest
Sudden onset
Lasts a few seconds
Poor recall
Normal development, may interfere with schooling
Common in females
Induced by hyperventilation
EEG- generalised spike and wave discharges (3-4Hz)
Features Benign Rolandic Epilepsy
Tonic-clonic seizures in sleep or simple focal seizures
Abnormal feeling in tongue and distortion of face
EEG- sharp focal waves from rolandic area
Benign
Remits in adolescence
Features Panayiotopoulus Syndrome
1-5y
Autonomic features .e.g. vomiting, unresponsive staring, eye deviation
EEG- posterior focal sharp waves and occipital charges
Remits in childhood
Features Juvenile Absence epilepsy
10-20y Absences and generalised tonic-clonic seizures Photosensitivity EEG- 4-6Hz atypical spike Remission unlikely
Feature Juvenile Myoclonic Epilepsy
10-20y Myoclonic seizures, generalised tonic-clonic, abscences Typical Hx throwing drinks or cereal Occurs in morning Remission unlikely
Anti-epileptic drugs
Tonic-clonic: valproate
Abscence: valproate
Myoclonic: valproate
Focal: carbamezapine
S/E Anti-epileptic drugs
Valproate- weight gain, hair loss, teratogenic, idiosyncratic liver failure
Carbamazepine- rash, hyponatraemia, ataxia, live enzyme induction
Lamotrigine- rash, insomnia, ataxia
Ethosuximide- nausea and vomiting
Levetiracetam- irritability
Gabapentin- insomnia
Topiramate- weight loss, depression, paraesthesia
Vigabatrin- irritability, restriction of visual fields
Non-medication Mx Epilepsy
Ketogenic diet (low carb, fat based)
Vagal nerve stimulation
Epilepsy surgery (concordance between ictal EEG, MRI and functional imaging)
-temporal lobectomy in medial temporal sclerosis
-hemispherectomy (disconnection of the hemisphere)
Safety netting Epilepsy
Avoiding deep baths No swimming unsupervised Driving (1y seizure free) Avoidance of heights No pregnancy with some medications
Definition status epilepticus
Epileptic seizure lasting 30 minutes or repeated epileptic seizures for 30m without recovery
Corticospinal tract disorders
Cerebral dysgenesis Global hypoxia-ichaemia Arterial ischaemic stroke Cerebral tumour Acute disseminated encephalomyeltitis Postictal paralysis Hemiplegic Migraine
Basal Ganglia Disorders
Acquired brain injury -Acute and profound hypoxia-ischaemia -Carboin monoxide posioning -Post-cardiopulmonary bypass chorea Post-strep chorea (Rheumatic fever) Mitochondrial cytopathies Wilson Disease Vit E deficiency Pontocerebellar hypoplasia
Cerebellar Disorders
Acute- medication and drugs
Post viral esp. varicella
Posterior fossa lesion/tumour
Genetic and degenerative .e.g. Friedreich
Features Cerebellar disorders
Past pointing
Poor alternating movements
Wide based ataxic gait
Nystagmus
Features Basal Ganglia disorder
Difficulty initiating movement
Jerky movements
Fluctuating increased tone
Features Corticospinal tract disorders
Weakness in pattern: -adduction at shoulder -flexion at elbow -adduction and internal rotation at hip -flexion at hip and knee -plantar flexion at ankle Brink hyperreflexia Extensor plantar reflexes Loss of fine finger movement
Features Neuromuscular disorders
Hypotonia
Delayed motor milestones
Muscle weakness- may be progressive or static
Unsteady/abnormal gait
Fatiguability
Muscle cramps (suggest metabolic myopathy)
Define Gower’s Sign
Need to turn prone to rise to standing from a supine position
Normal until 3y
Very weak- climb legs with hands to gain standing position
Sign of proximal muscle weakness
