Neurology Flashcards
What is epilepsy?
Common neurological condition characterised by recurrent seizures
Epilepsy is not the only reason people have seizures
What are febrile convulsions?
Typically occur in children between the ages of 6 months and 5 years
Around 3% will have at least one febrile convulsion
Usually occur early in a viral infection as the temperature rises rapidly
Seizures are typically brief and generalised tonic/tonic clonic in nature
What are alcohol withdrawal seizures?
Occur in pts with a hx of alcohol excess who suddenly stop drinking ie
Chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzos) and inhibits NMDA type glutamate receptors
Alcohol withdrawal leads to the opposite
Peak incidence of seizures is around 36 hrs following cessation of drinking
Pts are often given ben os following cessation of drinking to reduce the risk
What are psychogenic non epileptic seizures?
Previously termed pseudoseizures, this term describes ots who present with epileptic like seizures but do not have characteristic electrical discharges
Pts may have hx of mental health problems or a personality disorder
What are focal seizures?
Previously termed partial seizures
These start in a specific area, on one side of the brain
The level of awareness can vary in focal seizures
Focal aware of focal impaired
Further to this, focal seizures can be classified as being motor, non motor or having other features such as aura
What happens in generalized seizures and what are the specific types?
Consciousness is lost immediately
The level of awareness classification is not needed
All patients lose consciousness
They can be subdivided into motor eg: tonic clonic and non motor (absence)
Specific types;
Tonic clonic (grand mal) Tonic Clonic Typical absence (petit mal) Myoclonic- brief, rapid muscle jerks Atonic
What are infantile spasms (wests syndrome)?
Brief spasms beginning in the first few months of life
You get flexion of head, trunk, limbs —> extension of arms (salaam attack); last 1-3 secs, repeat up to 50 times
Progressive mental handicap
EEG; hypsarrythmia
Usually 2nd to serious neurological abnormality
Poor prognosis
What is lennox gastaut syndrome?
May be extension of infantile spasms (50% have hx)
Onset 1-5 years
Atypical absences, falls, jerks
90% have moderate to severe mental handicap
EEG shows slow spike
Ketogenic diet may help
What is juvenile myoclonic epilepsy?
Typical onset in the teens, more common in girls
1. Infrequent generalized seizures, often in morning
2. Daytime absences
3. Sudden, shock like myoclonic seizure
usually good response to sodium valproate
What are the symptoms and signs of epilepsy?
Generalised seizures may bite their tongue and experience incontinence of urine
Asking about such features can be useful way of detecting epileptic seizures when taking a hx from a patient who presents with blackout or collapse
Following a seizure, pts typically have a postictal phase where they feel drowsy and tired for around 15 mins
What IX do you do for seizures?
EEG and neuroimaging (MRI)
How do you treat epilepsy?
Most neurologists now start antiepileptics following a second epileptic seizure…
As a general rule
Sodium valproate is used first line for pts with generalised seizures
Carbamazepine is used first line for pts with focal seizures
What is the acute management of seizures?
Most seizures terminate spontaneously
When seizures don’t terminate after 5-10 mins then it is appropriate to administer medication to terminate the seizures
Benzodiazepines such as: diazepam are typically used and they may be administered rectally or intranasally/under the tongue
What are the causes of UMN lesions?
Stroke
Tumour
Raised ICP
MS
What is MS?
Multiple sclerosis (MS) is a chronic and progressive condition that involves demyelination of the myelinated neurones in the central nervous system. This is caused by an inflammatory process involving the activation of immune cells against the myelin.
MS typically presents in young adults (under 50 years) and is more common in women. Symptoms tend to improve in pregnancy and in the postpartum period.
What is charcots marie tooth?
Inherited disease that affects the peripheral motor and sensory nerves
They cause dysfunction in the myelin of the axons
Autosomal dominant
What should you do with blood pressure in stroke?
Should not be lowered in the acute phase unless there are complications- hypertensive encephalopathy
What should you do with regards to atrial fibrillation and anticoagulants in regards to stroke?
with regards to atrial fibrillation, the RCP state: ‘anticoagulants should not be started until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke’
What is haemorrhagic transformation and what are the symptoms?
It is where an ischaemic stroke transforms into haemorrhagic stroke around 2 weeks after a stroke
The symptoms= confusion, one sided facial weakness and headache
When should you start a statin after stroke?
if the cholesterol is > 3.5 mmol/l patients should be commenced on a statin. Many physicians will delay treatment until after at least 48 hours due to the risk of haemorrhagic transformation
What are Cerebrovascular accidents?
Ischaemia or infarction of brain tissue secondary to inadequate blood supply
Intracranial haemorrhage
What can cause a stroke?
Thrombus/embolus formation in patients with AF
Atherosclerosis
Shock
Vasculitis
What is TIA?
Transient ischaemic attacks often precede a full stroke. A crescendo TIA is where there are two or more TIAs within a week. This carries a high risk of developing in to a stroke.
What is the presentation of stroke?
In neurology, suspect a vascular cause where there is a sudden onset of neurological symptoms.
Stoke symptoms are typically asymmetrical:
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss