Neurology Flashcards
What is the definition of an Ischaemic stroke?
Sustained occlusion of a cerebral artery leads to ischaemic necrosis of the territory of the brain supplied by the affected artery
What is the definition of a haemorrhagic stroke
Rupture of a Charcot-Bouchard aneurysm
What is the clinical presentation of a stroke?
o Anterior cerebral artery: lower limb weakness and loss of sensation, gait apraxia, incontinence, drowsiness, decrease in spontaneous speech
o Middle cerebral artery: upper limb weakness and loss of sensation, hemianopia, aphasia, dysphasia, facial drop
o Posterior cerebral artery: visual field defects, cortical blindness, visual agnosia, prosopagnosia, dyslexia, unilateral headache
What are the investigations of a stroke?
CT scan
What is the treatment of a stroke?
o Ischaemic: thrombolysis (IV alteplase), aspirin for 2 weeks, then clopidogrel
o Haemorrhagic: control BP, nimodipine (prevent cerebral artery spasm)
o Long-term: physiotherapy and occupation therapy
What is the definition of a transient ischaemic attack ?
An ischaemic, usually embolic, neurological event with symptoms lasting
< 24 hours and resulting in complete clinical recovery
What is the aetiology of a transient ischaemic attack ?
Atherothromboembolism, cardioembolism, hyperviscosity, vasculitis
What is the clinical presentation of a transient ischaemic attack ?
Amaurosis fugax (unilateral progressive vision loss, like a curtain descending)
What is the treatment of a transient ischaemic attack ?
Control CV risk factors, aspirin for 2 weeks, then clopidogrel, anti-coagulation (if cardiac source of emboli), carotid endarterectomy
What score assesses the risk of having a stroke within the next 7 days after a TIA?
ABCD2 assess the risk of a stroke occurring within 7 days (Age > 60 (1), Blood pressure > 140/90 (1), Character unilateral weakness (2), speech disturbances (1), Duration 10-60 minutes (1), > 60 minutes (2), Diabetes (1))
What is the definition of a subarachnoid haemorrhage?
A spontaneous, non-traumatic bleed into the subarachnoid space
What is the aetiology of a subarachnoid haemorrhage?
Rupture of a berry aneurysm, arteriovenous malformation, encephalitis, vasculitis, tumour invading blood vessels
What is the clinical presentation of a subarachnoid haemorrhage?
Sudden onset thunderclap headache, vomiting, collapse, seizure, neck stiffness, photophobia, reduced consciousness
What are the investigations of a subarachnoid haemorrhage?
o CT scan
o Cerebral angiography
What is the treatment of a subarachnoid haemorrhage?
Hydration (maintain perfusion), nimodipine (prevent cerebral vasospasm), mannitol (reduce ICP), surgery (endovascular coiling, surgical clipping)
What is the definition of a subdural haemorrhage?
Bleeding from bridging veins between cortex and venous sinuses
What is the aetiology of a subdural haemorrhage?
Minor trauma, dural metastases
What is the clinical presentation of a subdural haemorrhage?
Fluctuating levels of consciousness, raised ICP, seizures
What are the investigations of a subdural haemorrhage?
o CT: crescent-shaped collection of blood over one hemisphere
What is the treatment of a subdural haemorrhage?
IV mannitol (reduce ICP), surgery
What is the definition of an extradural haemorrhage?
Bleeding from middle meningeal artery with a characteristic lucid period
What is the aetiology of an extradural haemorrhage?
Fracture of the squamous temporal bone
What is the clinical presentation of a extradural haemorrhage?
Rapid deterioration several hours later, severe headache, vomiting, confusion, seizure, ipsilateral pupil dilates
What are the investigations of an extradural haemorrhage?
o CT: biconvex (lemon-shaped), hyperdense haematoma
o X-ray: skull fracture
What is the treatment of an extradural haemorrhage?
Clot evacuation, IV mannitol (reduce ICP)
What is the definition of a epilepsy?
Recurrent tendency to spontaneous episodes of abnormal electrical activity within the brain which manifests as seizures
What is the clinical presentation of epilepsy?
Seizure (30-120 seconds), tongue biting, head turning, muscle pain
What are the investigations of epilepsy?
o EEG
o MRI: may show structural lesions
What is the treatment of epilepsy?
o Focal epilepsy: carbamazepine
o Generalised epilepsy: sodium valporate
What is the definition of vascular dementia?
Disease characterised clinically by dementia and histologically by injury to the brain parenchyma
What is the aetiology of vascular dementia?
Multiple infarcts cause diffuse white matter injury
What is the clinical presentation of vascular dementia?
Impairment of executive function and slowing of mental processing
What is the definition of dementia with Lewy Bodies?
Neurodegenerative disease characterised clinically by dementia and histologically by the presence of Lewy bodies in cortical and subcortical neurones
What is the pathophysiology of dementia with Lewy Bodies?
Accumulation of Lewy bodies within neurons leads to damage and cellular loss
What is the clinical presentation of dementia with Lewy Bodies?
Progressively worsening, fluctuating levels of cognition, recurrent visual hallucinations
What are the investigations of dementia with Lewy Bodies?
Histopathology: intracytoplasmic inclusions (Lewy bodies) within neurone of cortical grey matter and subcortical nuclei
What is the definition of Alzheimer’s disease?
Neurogenerative disease characterised clinically by dementia and histologically by neuron loss in the cerebral cortex and numerous amyloid plaques
What is the pathophysiology of Alzheimer’s disease?
Abnormal accumulation of beta-amyloid and tau protein in the temporal lobe
What is the clinical presentation of Alzheimer’s disease?
Memory loss, agnosia, delusions, loss of motor skills, apraxia
What are the investigations of Alzheimer’s disease?
o Macroscopy: cortical atrophy
o Microscopy: abundant amyloid and tau plaques
What is the treatment of Alzheimer’s disease?
Acetylcholine esterase inhibitors (galantamine, rivastigmine), behavioural treatment (memantine)
What is the definition of Parkinson’s disease?
Neurodegenerative hypokinetic movement disorder characterised clinically by parkinsonism and histologically by neuronal loss and Lewy bodies concentrated in the substantia nigra
What is the aetiology of Parkinson’s disease?
Loss of dopaminergic neurons in the substantia nigra
What is the clinical presentation of Parkinson’s disease?
Bradykinesia, rigidity, resting tremor, postural instability, depression, psychiatric problems, dementia
What are the investigations of Parkinson’s disease?
MRI: atrophy of the substantia nigra
What is the treatment of Parkinson’s disease?
Levodopa, dopamine agonists (cabergoline), COMT/MAO inhibitor (selegiline)
What is the definition of Huntington’s Chorea?
Autosomal dominant inherited neurodegenerative disorder
What is the pathophysiology of Huntington’s Chorea?
Atrophy and neuronal loss of the striatum and cortex
What is the clinical presentation of Huntington’s Chorea?
Chorea
What is the treatment of Huntington’s Chorea?
Antipsychotics (risperidone, dopamine receptor antagonist)
What is the definition of a migraine?
Recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision
What are the triggers of a migraine?
Chocolate, hangovers, orgasms, caffeine, cheese, OCP, alcohol, travel, exercise, anxiety
What is the clinical presentation of a migraine?
Unilateral throbbing headache which is associated with photophobia, phonophobia, nausea and vomiting, 4-72 hours
What is the treatment of a migraine?
Avoid triggers, abortive therapy (triptan, NSAIDs), prophylactic treatment (propranolol, acupuncture, amitriptyline)
What is the aetiology of a tension headache?
Missed meals, conflict, stress, clenched jaw, overexertion, lack of sleep, depression
What is the clinical presentation of a tension headache?
Bilateral, tight/pressing headache 30 minutes-7 days
What is the clinical presentation of a cluster headache?
Unilateral, severe pain around the eye and temporal area which may be associated with cranial autonomic features
What is the treatment of a cluster headache?
o Acute attack: oxygen, sumatriptan
o Prevention: avoid triggers, verapamil, short term corticosteroids
What are the triggers of trigeminal neuralgia?
Washing, eating, shaving, talking
What is the clinical presentation of trigeminal neuralgia?
Unilateral face pain, in the V3 distribution, which is intense, sharp, and stabbing and lasts for a couple of seconds
What are the investigations of trigeminal neuralgia?
MRI: exclude secondary causes
What is the treatment of trigeminal neuralgia?
Carbamazepine, surgery
What is the aetiology of spinal cord compression?
Secondary malignancy, infection, cervical disc prolapse
What is the clinical presentation of spinal cord compression?
Bilateral leg weakness, preceding back pain, bladder and anal sphincter involvement
What are the investigations of spinal cord compression?
MRI
What is the treatment of spinal cord compression?
Immobilisation, dexamethasone, analgesia
What is the definition of cauda equina syndrome?
Spinal cord compression at the site of the cauda equina (L1)
What is the aetiology of cauda equina syndrome?
Secondary malignancy, infection, cervical disc prolapse
What is the clinical presentation of cauda equina syndrome?
Bilateral sciatica, saddle anaesthesia, bladder/bowel dysfunction, erectile dysfunction, variable leg weakness
What is the investigations of cauda equina syndrome?
MRI
What is the treatment of cauda equina syndrome?
Immobilisation, dexamethasone, analgesia
What is the definition of multiple sclerosis?
A relapsing and remitting and demyelinating disease of the CNS
What is the clinical presentation of multiple sclerosis?
Spasticity, nystagmus and double vision, optic neuritis, weakness, sensory symptoms, paraesthesia, bladder and sexual dysfunction
What are the investigations of multiple sclerosis?
o MRI: plaques around blood vessels
o CSF: oligoclonal IgG bands
What is the treatment of multiple sclerosis?
Lifestyle modifications, natalizumab, stem cell transplant, muscle relaxants, IV methylprednisolone in acute attacks
What is the definition of Myasthenia Gravis?
Autoimmune disease caused by autoantibodies against antigens of the neuromuscular junction (Anti-AChR and MuSK (tyrosine kinase)
What is the clinical presentation of Myasthenia Gravis?
Muscle fatigability (extraocular bulbar face neck limb girdle trunk)
What are the investigations of Myasthenia Gravis?
o Autoantibodies: Anti-AChR or Anti-MuSK
o EMG: decreased muscle response
o Tensilon Test
What is the treatment of Myasthenia Gravis?
Acetylcholine esterase inhibitors (pyridostigmine), immunosuppression
What is Lambert-Eaton syndrome?
Autoantibodies against voltage-gated calcium channels on presynaptic neurons.
Gait difficulty develops before eye signs, autonomic involvement (dry mouth, constipation, impotence), hyporeflex and weakness which improves after exercise
What is the definition of motor neurone disease?
A group of neurodegenerative diseases characterised by selective loss of motor neurones
What is the clinical presentation of motor neurone disease?
o Muscular atrophy (anterior horn): fasciculations, wasting, weakness
o Amyotrophic lateral sclerosis (motor cortex and anterior horn): progressive spastic tetraparesis
o Progressive bulbar palsy (destruction of Cn 9-12): dysarthria, dysphagia, wasting and fasciculations of the tongue
What is the treatment of motor neurone disease?
Riluzole (inhibit glutamate release), ventilatory support, PEG feeding
What is the definition of Guillain-Barre syndrome?
Acute demyelinating polyneuropathy following an upper respiratory tract or GI infections
What is the aetiology of Guillain-Barre syndrome?
C.jejuni, CMV, EBV
What is the pathophysiology of Guillain-Barre syndrome?
Immune response mounted to an antigen on a pathogen cross-reacts with components of the peripheral nerve, particularly myelin
What is the clinical presentation of Guillain-Barre syndrome?
Ascending muscle weakness, reduced or absent reflexes, changes in sensation and pain
What are the investigations of Guillain-Barre syndrome?
Nerve conduction studies: slowing of motor conduction
What is the treatment of Guillain-Barre syndrome?
IV immunoglobulin, plasma exchange, ventilatory support if diaphragm involvement
What is the definition of meningitis?
Infection of the subarachnoid space which leads to inflammation of the meninges
What is the aetiology of meningitis?
o Bacterial: S. pneumoniae, N. meningitidis, L. monocytogenes
o Viral: enterovirus, herpesvirus
What is the clinical presentation of meningitis?
Headache, fever, neck stiffness, photophobia, non-blanching purpura rash (N. meningitidis), papilledema
What are the investigations of meningitis?
o Blood culture
o Lumbar puncture and CSF analysis
o Neuroimaging (if lumbar puncture is contraindicated)
What is the treatment of meningitis?
o Bacterial: antibiotics, dexamethasone
o Viral: usually life-limiting, supportive, acyclovir (HSV)
What is the definition of encephalitis?
Infection and inflammation of the brain parenchyma
What is the aetiology of encephalitis?
Herpes simplex virus (HSV)
What is the clinical presentation of encephalitis?
: Precedes with flu-like symptoms, confusion, behavioural changes, altered consciousness, seizures
What are the investigations of encephalitis?
Lumbar puncture and CSF: PCR for HSV
What is the treatment of encephalitis?
Acyclovir
What is the aetiology of shingles?
Varicella zoster virus
What is the pathophysiology of shingles?
Reactivation of virus in sensory ganglia
What is the clinical presentation of shingles?
Band-like vesicular eruption along the distribution of the sensory nerve
What are the investigations of shingles?
Viral PCR
What is the treatment of shingles?
Acyclovir
Mononeuropathy: Ulnar nerve (C7-T1)
Sensory loss of medial 1.5 fingers
Mononeuropathy: Radial nerve (C5-T1)
Wrist and finger drop
Mononeuropathy: Brachial plexus
Pain/paraesthesia and weakness in affected arm
Mononeuropathy: Sciatic nerve (L4-5)
Foot drop and loss of sensation below the knee
Mononeuropathy: Common perineal nerve (L4-S1)
Foot drop, weak ankle, sensory loss of foot
Mononeuropathy: Tibial nerve (L4-S3)
Inability to stand on tiptoe, invert foot or flex toes
