Neurology Flashcards
What is the difference between Conus Medullaris Syndrome and Cauda Equina?
Conus Medullaris- Upper Motor Neurone signs- Hyperreflexia and Hypertonia
Cauda Equina- Lower Motor Neurone signs- Hyporeflexia and Hypotonia
What are the 4 causes of Cauda Equina?
Lumbar Disc Herniation
Trauma (Fall)
Spinal Tumour
Lumbar Spine Stenosis (narrowing of the spinal canal)
What are the 5 signs of Cauda Equina?
Lower Back pain and Sciatica (Back and Leg Pain)
Saddle Anaesthesia- numbness in the Peri-anal Region, Groin and Inner Thighs
Urinary Retention and Incontinence (Palpable Bladder due to Urinary Retention)
Leg Weakness and Difficulty Walking
Erectile Dysfunction
What 2 investigations should be done if Cauda Equina is suspected?
Urgent MRI of the Spine
CT Myelography if an MRI is not possible
What is the management of Cauda Equina?
Emergency Decompressive Laminectomy Surgery
What are Cluster Headaches and what is their pahtophysiology?
They are Unilateral, Periorbital Headaches with Autonomic Dysfunction that presents with (4) Conjunctival Infection, Lacrimation, Rhinorrhoea and Nasal Congestion
They are a form of Trigeminal Autonomic Cephalgia that occur due to the Hypersensitivity of the Trigeminal Autonomic Reflex Arc- they consist of Vascular Dilation and Trigeminal Nerve Stimulation
What are the 3 main forms of Trigeminal Autonomic Cephalgia?
Cluster Headaches
Paroxysmal Hemicranial
Short-lived Unilateral Neuralgiform Headaches with Conjunctival Injection and Tearing (SUNCT)
What are the 8 signs of Cluster Headaches?
Clusters of Headaches that occur due to certain precipitants (Alcohol, Volatile smells, Warm temperatures, Sleep)
Unilateral, Periorbital or Temporal headaches that last between 15 mins to 3 hours
Ipsilateral Autonomic Symptoms (6)
- Lacrimation
- Conjunctival Infection
- Nasal Congestion
- Rhinorrhoea
- Ptosis
- Miosis
What investigation should be conducted if a Cluster Headache is suspected?
ESR- to rule out Giant Cell Arteritis
What is the management of Cluster Headaches? (3)
What 4 things should be avoided? (4)
Triptans for Symptomatic Relief
High flow Oxygen
Verapamil for Prophylaxis
Avoid
- Paracetamol
- NSAIDs
- Opioids
- Oral Triptans
What is the most common cause of Encephalitis?
Herpes Simplex Virus 1
causing Frontal and Temporal Lobe Encephalitis
What is the main risk factor for Encephalitis?
Being Immunocompromised (HIV, being Very Old or Very Young, Medication)
What are the 6 signs of Encephalitis?
Reduced GCS
Fever
Headache (Excruciating)
Confusion
Focal Neurological Deficit (3)
- Aphasia
- Hemiparesis
- Cerebellar signs
Behavioural Changes (3)
- Memory disturbances
- Psychotic behaviour
- Withdrawal or changes in personality
What 3 investigations should be ordered if Encephalitis is suspected?
MRI- would show inflammation of Frontal and Temporal Lobes in Herpes Simplex Virus 1
Cerebrospinal Fluid- Lymphocytosis with Raised Protein in Viral Aetiology
EEG- Periodic Lateralised Discharges at 2Hz
What is the 3 step management plan for Encephalitis?
Aciclovir
Ganciclovir- If it is a Herpes Virus that is Not HSV1
Ganciclovir and Foscarnet- If it is Cytomegalovirus
What is the pathophysiology of Guillain-Barre Syndrome?
It is an autoimmune demyelinating condition of the Peripheral Nervous System- triggered by an Infection
- This is due to a pathogenic antigen being very similar to Myelin Gangliosides in the Peripheral Nervous System
- So the Myelin Sheath is attacked by the Immune System
What are the 2 types of Guillain-Barre Syndrome and what are some facts about them?
Acute-Inflammatory Demyelinating Polyneuropathy (ADIP) is the most common
Miller-Fischer Syndrome (3)
- Ataxia, Areflexia and Opthalmoplegia
- In this form, the Eyes are affected first- not the Legs like Normal
- It is a Descending Paralysis
What are the two main risk factors for Guillain-Barre Syndrome?
Malignancies- Lymphoma may increase risk of Guillain-Barre Syndrome
Respiratory or Gastrointestinal Infections-
Bacterial (2)
- Campylobacter Jejuni
- Mycoplasma Pneumoniae
Viral (4)
- Zika virus
- Influenza
- Epstein-Barr Virus
- Cytomegalovirus
What are the 6 signs of Guillain-Barre Syndrome
Symmetrical Muscle weakness affecting the Legs first and then the Arms (Ascending Weakness)
Tingling in hands and feet which is followed by muscle weakness
Unsteady when Walking- Ataxia with Hyporeflexia or Areflexia in Affected Limb
Back and Leg Pain
Shortness of Breath- due to weakness of Respiratory Muscles
Facial Weakness and Speech Problems- Cranial Nerve Involvement and Bulbar Dysfunction (Diplopia or Facial Droop)
What 6 investigations should be conducted if Guillain-Barre Syndrome is suspected?
Progressive Weakness and Areflexia (hyporeflexia) typically means Guillain-Barre Syndrome
Check B12 and Folate as their deficiencies are associated with Neurological Features
TFTs- to exclude Hypothyroidism as a cause of Weakness
LFTS- elevation of Hepatic Enzymes is associated with a more Severe Disease
Anti-Ganglioside Antibodies- as AntiGQ1b is associated with Miller-Fisher Syndrome
Lumbar Puncture- shows Raised Protein with Normal WBC Count (However a Normal Protein Level does NOT Exclude Guillain-Barre Syndrome)
What is the 5 step management for Guillain-Barre Syndrome?
IV Immunoglobulins
Plasma Exchange
Thromboprophylaxis to Prevent Venous Thromboembolisms
Physiotherapy
Intensive Care Support
What are the 3 complications of Guillain-Barre Syndrome?
Type 2 Respiratory Failure
Pulmonary Complications (such as infections due to Intubation or Pulmonary Emboli due to immobility and a pro-inflammatory state
Autonomic Dysfunction of Bowel (ileus) and Bladder (retention)
What are the 8 red flags for a Headache?
Recent Head Trauma (within past 3 months)- check for Subdural Haematoma
Headache worse when standing- check for a CSF leak
Headache worse when lying down- check for a raised ICP (such as due to a Space-Occupying Lesion)
Household contact has similar symptoms (check for CO poisoning)
Headache with a Fever or a Change in Consciousness (check for Meningitis or Encephalitis)
Headache with Visual Disturbance (check for Acute Closed Glaucoma)
Headache with Vomiting (check for a Space-occupying Lesion, Abscess or CO Poisoning)
Headache during Pregnancy (check for Pre-Eclampsia)
What 4 conditions can a Lumbar Puncture help diagnose?
Multiple Sclerosis
Guillain-Barre Syndrome
Sub-Arachnoid Haemorrhage
Meningitis