neurological_conditions_20180310144626 Flashcards
Aetiologies?
IdiopathicAssociated with disease of the thymus
Pathology?
Autoantibodies vs AchR at NMJ Leads to failure of muscles to contract and relax properly
Symptoms and signs?
Muscle weakness increasing with activity, begins with extraocular and descends with timePtosis, peek sign, snarl, mastication weakness –> dysarthria, dyspnoea, limb weakness and fatigueNO LOSS OF REFLEXES Symptoms worsen during stress and over treatment
Investigations and findings?
Tensilon test - diagnostic Autoantibodies - positive EMGCT chest - may reveal thyme disease
Management?
Anticholinesterases Immunosuppression Thymectomy if associated thymus disease
Epidemiology?
More common in males over 50 and women under 50
Aetiologies?
Post infective disease Causitive organisms: Camylobacter jejuni, EBV, Mycoplasma pneumonia
Pathology?
Autoantibodies vs infective agents also acting on myelin sheath Leads to acute demyelinating polyneuropathy
Signs and Symptoms?
Bilateral ascending muscle weaknessPain Reduced/absent reflexesSensory lossAutonomic signs Respiratory distress
Investigations and Findings?
Nerve conduction study - slow conductionLumbar puncture - high protein in CSF
Management?
Resuscitation IV immunoglobulin Plasma exchange
Complications?
Permanent paralysis in ~10%
Epidemiology?
More common in males 15-30 and 50-75
Aetiologies?
IdiopathicViralFamilial
Pathology?
Progressive destruction of the UMN and LMN in the motor cortex, spinal cord and peripheral nerves
Signs and symptoms?
Four main patterns:ALS - lateral cortocospinal tract and anterior horn signsHand small muscle wastingBulbar/psuedobulbar palsies Primary lateral sclerosis - purely UMN signs
Investigations and findings?
Careful history and examination MRI excludatory
Management?
Palliative - MDT basedSodium channel blocker prolongs life slightly
Complications?
Prognosis bleak
Epidemiology?
M > F, 3:2
Aetiologies?
TraumaNeoplasiaIschaemia Degenerative diseaseDemyelinating diseaseInfection
Pathology?
Partial/full hemisection causing a combination dorsal column, spinothalamic tract and corticospinal tract lesions
Signs and symptoms?
Ipsilateral UMN signs in lower sectionsIpsilateral proprioception/vibration loss in lower sections Contralateral pain/temperature loss
Investigations and Findings?
MRI/CT - will show area and extent of trauma, ischaemia, neoplasia
Management?
Treatment of infection if applicable Removal of causative agent if applicable
Aetiologies?
Risk factors - cardiovascular disease risk factors
Pathology?
Ischaemia of spinal cord portion due to occlusion of a supplying blood vessel
Signs and symptoms?
Anything spinal cord related, depends on area of lossUMN signsSensory lossSphincter tone loss
Investigations and Findings?
MRI can diagnose - areas of ischaemia seen
Management?
Early management vital Surgical repair is an option
Complications?
Many will not recover
Aetiologies?
Dietary deficiency or lack of gastric intrinsic factor
Pathology?
Demyelination
Signs and symptoms?
Insidious onset where symptoms begin peripherally and move centrally Spinal cord involvement indicated by UMN signs
Investigations and Findings?
B12 serum tests - deficient Intrinsic factor - deficient
Management?
B12 supplementation
Aetiologies?
Maternal folic acid deficiency
Pathology?
Failure of neural tube to fuse during embryogenesis –> spaces in vertebral column
Signs and symptoms?
Varying degrees from asymptomatic to complete paralysis Depends on how much of the spinal cord and its coverings protrude through
Investigations and Findings?
Severe disease obvious on physical examination Oculta seen incidentally on x-ray later in life Cyst on the back in the midline
Management?
Surgical repair ASAP
Complications?
Treatment not always successful Quality of life impaired
Aetiologies?
Part of MSRarely - sinusitus and other infections
Pathology?
Inflammation of the optic nerve +/- optic disc
Signs and symptoms?
Visual and colour vision loss Optic pain
Investigations and Findings?
Ophthalmoscopy Test for MS
Management?
Refer to specialist Corticosteroids
Complications?
Progression into MS
Aetiologies?
TraumaInfectionInfarctionTumourDiabetic neuropathy Aneurysm Raised ICP
Pathology?
Compression or section of the ophthalmic nerve
Signs and Symptoms?
Permanent dilatation of eyePainless loss of adduction, extortion and elevation Ptosis
Investigations?
Examination
Aetiologies?
TraumaInfectionTumourInfarctionDiabetic NeuropathyAneurysmRaised ICP
Pathology?
Compression/section of trochlear nerve
Signs and symptoms?
Difficulty depressing eyeDiplopia once eye depressed
Investigations?
Examination
Aetiologies?
TraumaInfectionInfarctionTumourDiabetic NeuropathyAneurysmRaised ICP
Pathology?
Compression or section of abducens nerve
Signs and Symptoms?
Inability to abduct eye
Investigation?
Examination
Aetiologies?
TumourInfectionTraumaInfarction MS
Pathology?
Demyelination or compression from adjacent structures of trigeminal nerve
Signs and Symptoms?
Unilateral sharp, severe bursts of pain in face after a certain trigger
Investigations?
History and examination
Management?
Carbemazepine Analgesics don’t work
Aetiologies?
Trauma InfectionTumourInfarction
Pathology?
Compression/section of trigeminal nerve or its branches
Signs and Symptoms?
Sensory loss in one or more of the six areas in the face Trouble chewing if UMNLMN causes flaccid paralysis of the affected side of the jaw –> deviation
Investigations?
Examination
Aetiologies?
MNDGuillean - Barre syndrome PolioMyasthenia gravis Brainstem tumours
Pathology?
Damage to the CN IX-XII nuclei which causes impairment to the innervation of the bulbar targets LMN lesion
Signs and Symptoms?
LMN signs of the tongue and the muscles of talking and swallowing Tongue fasciculation, jaw jerk absence Quiet/hoarse/nasal speech
Investigations?
Examination