Neurology Flashcards
What is syncope?
How does it present?
Temporary loss of consciousness due to hypoperfusion of the brain.
Causes can be primary or secondary.
Primary- Dehydration, missed meals, standing for extended period of time in warm environment, response to stimuli i.e. scare, surprise etc.
Secondary- Dehydration, hypoglycaemia, arrhythmias, anaemia, infection, valvular heart disease etc.
Patients will remember the prodrome: Sweating Dizzy Vision blurring Headache Heavy Hot and clammy
How is syncope investigated?
How is it managed?
Need to take a thorough history to understand what happened before and after the fall (won’t have post-ictal confusion although may be groggy). Take a collateral to see what happened after the fall.
Examination; pulse, arrhythmias, neurological changes, head injury etc.
Investigations: FBC (anaemia), glucose (hypoglycaemia) electrolytes (seizures, arrhythmias), ECG (arrhythmias), ECG-24hr tape (paroxysmal arrhythmias), echocardiogram (structural heart disease).
Management:
Rule out any potential harmful diagnosis i.e. seizures.
Reassurance and prevention- don’t miss meals, stay hydrated, if feel prodrome then sit/lie down eat/drink until feeling better.
What is epilepsy?
What are the different types of seizures?
Transient episodes of abnormal electrical activity within the brain.
Generalised tonic-clonic:
LOC, tonic first then clonic, can have tongue biting, incontinence, irregular breathing. Post-ictal period of confusion and irritation.
1st- Sodium valproate. 2nd- Carbamazepine/Lamotrigine.
Focal seizures:
Of the temporal lobe therefore affecting hearing, speech, memories. Can present as hallucinations, Deja vu, memory flashbacks.
1st- Lamotrigine/Carbamazepine. 2nd- Sodium valproate.
Absent seizures:
In children, blank face, lasting 20-30 seconds. Usually resolves by adulthood.
1st- Sodium valproate.
Atonic seizures:
‘Drop attacks’. Brief loss of muscle tone, lasting up to 3 mins. Typically begin in childhood.
1st- Sodium valproate. 2nd- Lamotrigine
Myoclonic-
Brief muscle spasms, whilst retaining consciousness.
1st- Sodium valproate
How is epilepsy investigated?
How is it managed?
Diagnosed based on observation of the seizure i.e. recording.
Need to collect a good Hx including collateral.
EEG- If second episode of simple tonic-clonic seizure.
MRI is indicated to look for structural brain issues including tumour if; focal seizure OR not responding to first line anti-epileptic OR the first seizure in under 2yr old.
Advice the patient to minimise the dangers of a seizure. I.e. stay away from traffic, stay away from heights, don’t go swimming, no driving, take showers instead of bath, be cautious with lifting heavy objects etc.
In the event of a seizure:
Cushion the head, clear the surrounding space, put patient onto a carpet, place in the recovery position where possible, time the seizure, call the ambulance if >5mins.
How is status epilepticus managed?
Seizure >5 mins or 2 seizures without any rest in between.
A-E assessment:
Secure airway, give O2, IV access, check blood glucose.
Give dose of IV lorazepam.
If still not controlled- IV phenytoin + notify ITU.
What are febrile convulsions?
How is it diagnosed?
How is it managed?
Seizure as a result of a high fever, usually underlying viral/bacterial cause. Exclusively occurring in 6 months to 5yrs old.
Simple- generalised tonic-clonic lasting up to 15 minutes.
Complex- either focal/partial seizure lasting >15 mins OR >1 episode in the same febrile illness.
Diagnosis is made by excluding diagnoses of meningitis, encephalitis, epilepsy, SOL, electrolyte imbalance, trauma etc.
Should attend hospital after first seizure for diagnosis.
Simple seizures require reassurance. Complex seizures may need more investigating.
Ensure parents educated on seizure practice i.e. place child on soft medium, clear surrounding, achieve recovery positiuon, call ambulance if >5 mins etc.
Management involves treating the underlying condition and managing the fever with simple analgesia i.e. paracetamol or ibuprofen.
What are breath holding spells?
How are they managed?
Episodes where the baby involuntarily holds their breath in response to being frightened tor upset. Occurs in 6-18 months old and usually resolves by age 4-5yrs.
2 types.
Cyanotic breath spells:
Child upset and crying, lets out a last long cry then stop breathing. Become cyanotic, lose consciousness, regains consciousness after min then starts breathing again, child tired after this episode.
Reflex anoxic seizures:
Child scared, causes vagus nerve to send signal stopping the heart from beating. Become pale, lose consciousness and may develop muscle twitching. After 30 seconds heart starts beating again and baby breathing.
Management:
Rule out more sinister causes. Educate and reassure parents.
May have associations with iron deficiency anaemia, treat where appropriate.
What are tension headaches? (RECAP)
Headache in band like distribution across the head.
May be due to poor oral intake, dehydration, stress or infection.
In children usually resolve within 30 minutes.
Manage with analgesia and fluids, avoid skipping meals/dehydration and reduce stress.
What are migraines?
Several types; migraine with aura, migraine w/o aura, silent migraine (migraine with aura but no headache), hemiplegic migraine and abdominal migraine (occurs in childhood increase likelihood of developing migraines).
Signs: Unilateral, severe, throbbing, longer to resolve.
Associated with: Nausea, vomiting, photophobia, phonophobia, visual aura.
Management- Fluids, rest, low stimulus environment. Medications: Paracetamol, ibuprofen, sumatriptan and anti-emetics.
If recurrent or causing disruption to daily life start prophylaxis; propranolol (avoid in asthmatics), topimarate (avoid in girls of child bearing age).
What is cerebral palsy?
What are the causes?
Permanent neurological damage affecting the brain.
Antenatal:
Maternal infection
Trauma
Perinatal:
Birth asphyxia
Pre-term birth
Post natal-
Severe neonatal jaundice
Meningitis
Head injury
What are the types of cerebral palsy?
What are the patterns of spastic CP?
Spastic- Hypertonia and reduced function. Caused by damage to UMN.
Dyskinetic- Problems with hyper and hypotonia, athetoid movements (fingers, hands, toes, feet wiggling) and oromotor dysfunction. Caused by damage to the basal ganglia.
Ataxic- Problems with co-ordinated movements. Caused by damage to the cerebellum.
Mixed- Mix of spastic and Dyskinetic +/- ataxic.
Patterns of Spastic CP:
Monoplegia- One limb affected.
Hemiplegia- One half of the body affected.
Diplegia- All four limbs affected, legs more than arms.
Quadriplegia- All four limbs affected, severe, with seizures and other disturbances (i.e. speech).
How does cerebral palsy present?
Need to keep an eye on babies with increased risk i.e. hypoxic-ischaemic encephalopathy: Failure to meet milestones Difficulty with speech Poor co-ordination Change in muscle tone Hand preference before 18 months old Swallowing issues Learning difficulties
O/E hypertonia, slightly reduced power, brisk reflexes, di/hemiplegia, may also have athetoid movements. Ensure to examine for co-ordination.
How is cerebral palsy managed?
What are the complications?
Incurable and permanent.
MDT:
Physiotherapy for muscle stretches to manage hypertonia and reduce likelihood of contractures
Occupational therapist- Help at home, if wheelchair bound make at home arrangements
Paediatrician- Baclofen (spasticity and contractures), glycopyrronioum bromide (drooling), anti-epileptic (seizures)
SALT- Speech and swallow. If poor swallow and can’t meet nutritional needs need either NG tube or PEG.
Dietician- To help meet nutritional needs
Social worker
Charities/voluntary organisations- providing access to others with CP
Orthopaedic surgeons- Procedures to release contractures.
Complications: Muscle contractures Epilepsy Learning disability Kyphoscoliosis GORD
What is strabismus?
What are the causes?
How is it managed?
(RECAP)
Misalignment of the eyes.
Usually idiopathic but can be due to hydrocephalus, cerebral palsy, trauma, SOL.
Examination by testing VF, fundoscopy (rule out retinoblastoma, cataract etc), VA, cover test.
Management is co-ordinated with a ophthalmologist; need to treat before VF have developed (8yrs old). Can manage with patching good eye or pilocarpine drops to blur the good eye- thus forcing the bad eye to align and work better.
What is hydrocephalus?
Usually CSF produced by the walls of the cerebral ventricles to cushion and protect the brain. It is then drained and reabsorbed.
Hydrocephalus refers to too much CSF, either from XS production, poor drainage or poor resorption.
Causes:
- Most commonly congenital aqueductal stenosis. The cerebral aqueduct, draining between the third and fourth ventricle is stenosed, therefore build up of CSF within the lateral and third ventricle
- Subarachnoid cyst- If large enough can block the drainage
- Arnold-Chiari malformation- cerebellum herniation into the foramen magnum can compress drainage system
- Chromosomal abnormalities
