Neurological - Lecture 11 Flashcards
Name the 5 common presenting complaints
Memory loss Loss of consciousness HA Numbness Weakness
Name the 4 main causes memory loss
Age related changes (slower recall, cognition not impaired)
Mild cognitive impairment (learning slower)
Dementia
Depression
Discuss Age related Memory Loss
Increased risk with age Storage and recall takes longer learning is more difficult forgetfulness at times No impaired cognition
Discuss Mild Cognitive impairment Memory Loss
Actual memory loss
Short term memory suffers first, with working and long term memory preserved
mild impairment does not affect daily function, but can lead to dementia
Discuss Dementia Memory Loss
-name 4 x cognitive changes
Dx requires evidence of memory loss plus cognitive or behavioural dysfunction
Daily function impaired
Cognitive change:
-Aphaxia (language difficulty)
-Apraxia (decrease in fxn of prev learned motor activities)
-Agnosia (difficulty identifying objects)
-Impaired executive function (planning/organising)
Discuss Depression memory loss
Can mimic dementia (pseudo-dimentia)
patients have other signs of depression- sleep disturbance, loss appetite or slow movements
memory loss may correlate to mood disturbance
Discuss loss of consciousness (LOC)
3x main categories and differentiation between them
-Seizure disorders (++incontinence, ++lat tongue biting, ++jerking)
-Cardiovascular syncope (pallor, prodrome, orthostatic situational, incontinece, brief jerking, ++nausea)
-Non-epileptic attacks -Psychogenic seizures (pseudo seizures) (situational stress, incontinence, prolonged jerking +++, pelvic thrusting +++, Gaze aversion +++)
Others less common inc: TIAs, Poor diabetes control
LOC caused by age
before 2- fever, birth development defects, birth injuries, metabolic disorders
age 2-14- idiopathic seizure disorder
adults: cerebral trauma, alcohol withdrawal, tumour, strokes, unknown 50%
elderly: tumours, strokes
HA red flags
- Neurologic symptoms or signs (alt. mental state, weakness, diploplia, papilledema, focal neuro deficit)
- Immunosuppression or cancer
- Meningitis
- Onset over 50
- Thunderclap HA (severe within seconds)
- signs Giant Cell Arteritis )visual disturbance, jaw claudication, fever, weight loss, temp. aa tender, proximal myalgia)
- systemic symptoms (fever, weightloss)
- progressivle worsening
- red eye and halo around lights
Numbness
-7x causes and examples
- Ishemia (brain or spinal cord infarction, vasculitis)
- Demylenating disorders (MS, Guilain-Barre syndrome)
- Mechanical N comp. (tumours, herniated disc, carpal tunnel)
- Infections (HIV, Leprosy)
- Toxins or drugs (heavy metals, certain chemo)
- Metabolic disorders (diabetes, chron Kidney D, vit 12 def.)
- Immune mediated disorders (post-infec inflammation-transverse myelitis)
- Degenerative disorders (hered. neuropathies)
Numbness patterns and cause
- Part of one limb (pns lesion)
- unilateral numbness of both limbs (brain lesion)
- Bilat numbness below specific dermatomal (spinal cord lesion)
- Bilateral numbness not corresponding to specific dermatome (polyneuropathy, multiple mononeuropathy, patchy spinal cord or brain disorder)
Specific numbness patterns and cause
- Stocking glove & minimal motor sign dsyfxn (axonal polyneurop) or with weakness & spasticity (myelopathy, demyelinating polyneurop, or spinal cord lesion)
- Single dermatomal distribution (N root lesion-radiculopathy)
- Single extremity with more than one nerve or nerve root affected (plexus lesion)
- multiple related or unrelated peripheral nn (multiple neuropathy)
- saddle area (cuada equina)
- crossed face-body distribution (lower brain stem lesion)
- ipsilateral face and body (up. brain stem, thalamic, cortical lesion)
Red flags Numbness
- Sudden onset (within min to hrs)
- Sudden or rapid onset of weakness dyspnea
- signs cauda equina or connus medullaris (saddle anasth, incontinence, loss of anal wink reflex)
Weakness causes & symptoms
distinguish from fatigue or fxn limitation= use myotome testing
- UMN (corticospinal, corticobulbar tract lesion)- spasticity & hyperreflexia
- LMN- hypo reflexia & decreased M tone/atrophy (periph polyneurop-distal weakness with sensory symptoms)( ant. horn lesion-asymmetrical, common cran NN symps)
- neuromuscular junction (myasthenia gravis)- weakness with activity and improves with rest, common Cran NN symptoms
- Muscle (myopathies)- proximal
- Radiculopathy- asymmetrical, bladder dysfunction, sensory symptoms pain
- Spinal cord- pyramidal, common to have bladder and sensory-never cranial NN)
- brain stem & cerebral cortex- pyramidal, common crane NN and sensory sumps
Amytrophic lateral Sclerosis (ALS or Lou Gehrigs Disease) Cruetzfeldt-Jakob Disease (CJD) Epilepsy Gulain-Barre syndrome (GBS) Huntingtons Disease Parkinsons disease (PD) Multiple sclerosis (MS) Traumatic Brain Injury Alzheimers Disease
review individually
