Neurology Flashcards
What are they main types of spina bifida?
Spina bifia occulta- mild and most common. 1 or more posterior spinal arches missing - small gap in the spine
Meningiocoele - meninges protrude through the defect of the spinal arches. CSF filled.
Myelomeningeocoele - the spinal cord and its covering herniates through the defect. Severe and causes neurological problems - If above L3 affected may be non-ambulant
What is cerebral palsy?
A permanent neurological condition that occurs due to damage of the brain around the time of birth. Esp hypoxic-ischaemic-encephalopathy
‘A dynamic and changing disorder of posture and movement due to a NON-progressive lesion to a developing brain’
How might a child with cerebral palsy present?
- Not meeting milestones e.g. not sitting by 8 months and not walking by 18 months
- Inc or dec tone generalised or in specific limbs
- Hand preference before 18 months *
- Walking on tip toes
- Problems with coordination, speech or walking
- Problems with swallowing or feeding
- LD
What is Muscular dystropy?
Umbrella term for genetic conditions causing gradual weakness and wasting of muscles.
Duchennes and beckers - both X-linked mutations in the dystrophin gene
What is myotonic dystrophy and what are some features?
Mutation to DMPK. Presents in adulthood
Muscle weakness
*Prolonged contraction
Cataracts, cardiac arrythmias
What is the normal ICP?
0-10mmHg
What are some causes of hydrocephalus?
Congenital - congenital arachnoid cyst, arnold chairi malformation, spina bifida, aqueduct stenosis
Acquired - infection, haemorrhage, tumour
What is a febrile convulsion?
A seizure occurring in a child with a high fever
~6m-5y
What is a simple febrile convulsion?
A generalised tonic clonic convulsion, lasting < 15min, with only a single seizure in that febrile period
What is a complex febrile convulsion?
A partial or focal seizure lasting >15min, with multiple per febrile episode
What is a tonic clonic seziure?
Loss of consciousness with muscles tensing then jerking. Associated with incontinence, tongue biting, irregular breathing.
Prolonged post-ictal period where they may feel irritable, low or confused.
1st - Na valproate
What is a focal seizure?
Usually starts in the temporal lobe. Associated with memory, hearing, speech or emotions. E.gs. hallucinations, deja vu, flashbacks (e.g. a smell)
1st - Lamotrigine or carbamazepine
What are absence seizures?
Usually in childhood. Go blank and stare into space. Abruptly goes back to normal. During episode they are unaware of environment and will no respond.
1at - Na valproate
What is an atonic seizure?
‘Drop attack’, brief lapses in muscle tone. Last <3min. Associated with Lennox-Gastaut syndrome??
1st - Na valproate
What is a myoclonic seizure?
A sudden brief muscle contraction, like a ‘jump’. Patient remains awake. Common in juvenile myoclonic epilepsy
1st - Na valproate
What is a stroke?
Rapid onset cerebral deficit (usually focal) lasting >24hours or leading to death
What is a TIA?
A transient episode of neurological dysfunction due to a temporary focal cerebral ischaemia without infarction, lasting <24 hours with complete recovery
Triaged by ABCD2
Where is broca’s area?
Left inferior posterior frontal gyrus
Where is wernicke’s area?
Left superior-posterior temporal gyrus
What are the causes of an ischaemic stroke?
Primary thrombosis - In the vessel itself
Secondary to an embolic - MI, AF
How do you manage an ischaemic stroke?
Onset within 4.5hr - Thrombolysis (IV alteplase)
>4.5h - 300mg Aspirin immediately
Within 6h - Endovascular surgery to remove the clot
What is a hemiplegic gait?
Where there is circumduction of the leg to prevent dragging the foot
Due to a CNS lesion, unilateral weakness and spasticity.
Spastic flexion of upper limb and extension of lower
What is a diplegic gait?
Like hemiplegic but bilateral.
Hips and knees flexed and abducted with ankles extended and IR. Knees forced together causing overlap and so circumduction of both legs - scissoring
What is a parkinsonians gait?
Slow or hesitant INITIATION STEP LENGTH is reduced and may get smaller as they attempt to retain balance (shuffling) Reduced ARM SWING Flexed neck and trunk - stooping POSTURE RESTING TREMOR Impaired balance on TURNING
What is an ataxic gait?
Cerebellar, vestibular or loss of proprioception
- Broad based gait
- Staggering, slow and unsteady
- Difficulty turning
What is a neuropathic/ high stepping gait?
Due to weak dorsiflexion of foot. Hips and knee flex excessively to compensate for foot drop - high step
Common peroneal injury?
What is a neurodegenerative disease?
Progressive and selective loss of neurones/ dysfunction due to depositions of pathologically altered protein causing functional and clinical symptoms
When tau becomes hyperphosphorylated it can become an insoluble neurofibrillary tangle, what conditions may arise?
Alzheimers dementia Frontotemporat dementia Progressive supranuclear palsy Corticobasilar degneration Chronic truamtic encephalopathy
What may been seen on MRI in progressive supranuclear palsy?
Atrophy of the midbrain
Dementia, vertical gaze palsy, falls
When alpha synuclein gets misfolded, it forms lewy bodies, what pathology has lewy bodies?
Multiple systems atrophy (parkinsonism + cerebellar/autonomic features)
Parkinsons
Lewy body dementia
Where in the spinal cord do the sympathetic neurones run?
T1-L2
Where in the spinal cord do the parasympathetic neurones run?
Brainstem (CN 3,7,9,10)
S2-S4
What signs might indicate FTD?
Frontal release signs - ‘release’ of primitive reflexes that are normally inhibited - palmomental reflex, grasp relfex, glabellar tap, snout and rooting relfexes
What things are seen histologically in FTD?
Picks bodies
How would you treat an acute attack of migraine and what would you use as preventative?
Acute - Triptans + NSAIDs or Triptans + paracetmaol
Preventative - Topiramate or propranolol
