Neurology

Question 1

What makes up the central nervous system?

Answer 1

Spinal cord and brain

Question 2

What does the cerebellum control?

Answer 2

Co-ordination, balance and posture

Question 3

What does the frontal lobe do?

Answer 3

Higher level functions, speech etc…

Question 4

What are primary headaches?

Answer 4

They are tension type headaches or severe shortlisting headaches (cluster), which occur spontaneously.

They occur in response to a life long condition

Question 5

What are secondary headaches?

Answer 5

Secondary to illness or injury and are pathological in origin

E.g. head trauma, infective origin, intracranial haemorrhage or vascular

Question 6

What are the causes of primary headaches?
I.e. migraines, tension type and cluster

Answer 6

Migraines are thought to be caused by changes in blood vessel sizes within the brain

Tension type are thought to be caused by residual muscle contraction, which is why pain tends to be bilateral

Cluster headaches are though again to be a vascular type of pain

Question 7

What are potential warning signs for a migraine?

Answer 7

Flashing lights, stiffness in neck/shoulders/limbs, occasionally limb weakness/altered sensations

Question 8

What are the characteristics of tension type headaches?

Answer 8

May feel like a constant ache that affects both sides of the head and is often frontal. Patients may also complain of pain in their neck as muscles tightening and feeling a pressure behind the eyes

Can feel like a tight band wrapped around the head

Can last 1-6 hours

Question 9

Is a tension type headache caused by medication overuse/withdrawal a primary or secondary headache?

Answer 9

Secondary

Question 10

What are cluster headaches?

Answer 10

Excruciating attacks in one side of the head, often felt behind the eye

Begin unexpectedly and are the most painful type

Usually get 1-3 attacks every day

Can be caused by alcohol or infection to CSF/meninges

Question 11

What are the characteristics of a subarachnoid haemorrhage?

Answer 11

Common characteristic is a sudden headache lasting a few seconds or a fraction if a second

Can sometimes look around and cause someone of hitting them in the back of the head

Dominant feature is often the severity rather than the suddenness

Vomiting may occur

Question 12

Medication overuse headaches are suspected when the following drugs are taken:

Answer 12

Tristan’s

Opioids

Ergots

Question 13

Can develop headaches after not taking painkillers if the painkiller has been taken for more than 15 days per month or more. Why is this?

Answer 13

The body gets used to the painkillers, a rebound headache develops when a painkiller hasn’t been taken.

Patients believe they are suffering further tension headaches and take further doses

When painkillers wears off, another rebound headache and cycle continues

Question 14

What is an ischaemic stroke?

Answer 14

It is known as a cerebral infarction - caused by a clot formation which leads to interruption of blood flow in a cerebral artery

Causes decreased blood flow distal to the clot

Causes hypoxia and affected area of brain tissue can die if not treated correctly

Question 15

What is a haemorrhaging stroke?

Answer 15

Generally caused by a rupture of an aneurysm within brains bloods vessels

More severe with higher associated risk of dying within 3 months

Question 16

What is a TIA?

Answer 16

TIA is a transient ischaemic attack

Generalised term for stroke symptoms lasting less than 24 hours

Must be transferred due to high risk of further stroke

Question 17

What are symptoms of a stroke?

Answer 17

Face, arms, speech (FAST test)

Visual disturbances, dizziness, unsteady gait, confusion, altered GCS, vomiting, seizure, vomiting, altered RR, arrhythmias

Question 18

What are a few head injury tools or guidelines to safeguard patients with head injuries?

Answer 18

NICE guidelines
New Orleans criteria
Canadian CT rule
Major trauma (local)

Question 19

What is Alzheimer’s disease?

Answer 19

Neurodegenerative disordered characterised by learning and memory impairments

Associated with a lack of AcH in certain regions of brain

Question 20

What is depression?

Answer 20

Caused by depletion of norepinephrine, serotonin and dopamine in the CNS

Pharmacological treatment aims to increase the concentrations of these at neurotransmitters

Question 21

What is schizophrenia?

Answer 21

Severe mental illness, shown to involve excessive amounts of dopamine in frontal lobes, leading to psychotic episodes

Question 22

What is Parkinson’s disease?

Answer 22

Destruction of substantial nigra leads to destruction of the only CNS source of dopamine

Dopamine depletion leads to uncontrollable tremors, seen in patients suffering from Parkinson’s

Question 23

What is epilepsy?

Answer 23

Seizure condition caused by the lack of inhibitory neurotransmitters
Such as GABA, or an increase in the excitatory neurotransmitters such as glutamate

Question 24

What is huntingtons disease?

Answer 24

It is an inherited disease related to DNA abnormality, reduced ability to take up GABA.

Beside epilepsy, chronic condition of GABA in the brain can lead to this

Question 25

What is myasthenia gravis?

Answer 25

Rare, chronic autoimmune condition characterised by the impairment of synaptic transmission of acetylcholine at neuromuscular junctions, leading to fatigue and muscular weakness without atrophy

Question 26

What is a tonic clinic seizure

Answer 26

Tonic colonic seizure/known as grand mal seizures

Most common type of seizures

Involuntary muscle contractions

Question 27

What is PNES

Answer 27

Phsychogenic non-epileptic Seizures

Onset after 15 years old, history of PTSD, recurrent status epileptics

It is a psychological response to stress - connected to trauma and abuse

Question 28

Signs and symptoms of a tonic clinic seizures

Answer 28

Stiffening of whole body = tonic phase
Vigorous shaking = clonic phase
Eyes and mouth open
Arm and leg movement synchronised/symmetrical
Tongue biting common
Abnormal breathing
Normally self terminates
If the patient is still conscious = focal seizure

Question 29

Signs and symptoms of PNES?

Answer 29

Fluctuating intensity
Brief pauses
Arms and legs not symmetrical
Eyes often shut
Purposeful movement
Crying during

Question 30

Post ictal phase of tonic clonic seizures

Answer 30

Gradual slowing of convulsion
Gradual post-ictal phase
Noisy laboured breathing
Confusion
Tachycardia

Question 31

Post ictal phase of PNES

Answer 31

Rapid end to convulsion
Rapid post-ictal phase
No confusion
Upset post event

Question 32

What is meningitis?

Answer 32

Infection of the protective membranes that surround the brain and spinal cord (meninges)

Causes inflammation of subarachnoid space

Most common in babies, children, teens and young adults

Can cause life threatening septicaemia

Question 33

Signs and symptoms of meningitis?

Answer 33

Pyrexia, vomiting, headache, non-blanching rash, stiff neck, reduced GCS, drowsiness, tachy, sepsis symptoms

Question 34

What is Kernig sign and brudzinski sign

Answer 34

They are physical ways to check for symptoms of meningitis

Kernig sign = knee is flexed 90 degrees, hip is flexed 90 degrees, extension of the knee is painful or limited

Brudzinski sign = passive flex ion of the neck elicits hip and knee flexion

Question 35

What is encephalitis?

Answer 35

It is acute swelling of the brain tissue due to a response to viral illness or in response to the body attaching its own tissue

Question 36

Symptoms of encephalitis?

Answer 36

Fever, photophobia, headaches, stiff neck, hallucination, memory loss, generalised weakness, vomiting, seizure and coma

Question 37

Symptoms of encephalitis in children?

Answer 37

Main signs may be bulging fontanel, inconsolability, irritability and vomiting

Question 38

What is hydrocephalus?

Answer 38

Build up of fluid in the ventricles of the brain