Neurology Flashcards
What makes up the central nervous system?
Spinal cord and brain
What does the cerebellum control?
Co-ordination, balance and posture
What does the frontal lobe do?
Higher level functions, speech etc…
What are primary headaches?
They are tension type headaches or severe shortlisting headaches (cluster), which occur spontaneously.
They occur in response to a life long condition
What are secondary headaches?
Secondary to illness or injury and are pathological in origin
E.g. head trauma, infective origin, intracranial haemorrhage or vascular
What are the causes of primary headaches?
I.e. migraines, tension type and cluster
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
What are potential warning signs for a migraine?
Flashing lights, stiffness in neck/shoulders/limbs, occasionally limb weakness/altered sensations
What are the characteristics of tension type headaches?
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
Is a tension type headache caused by medication overuse/withdrawal a primary or secondary headache?
Secondary
What are cluster headaches?
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
What are the characteristics of a subarachnoid haemorrhage?
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
Medication overuse headaches are suspected when the following drugs are taken:
Tristan’s
Opioids
Ergots
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?
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
What is an ischaemic stroke?
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
What is a haemorrhaging stroke?
Generally caused by a rupture of an aneurysm within brains bloods vessels
More severe with higher associated risk of dying within 3 months
What is a TIA?
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
What are symptoms of a stroke?
Face, arms, speech (FAST test)
Visual disturbances, dizziness, unsteady gait, confusion, altered GCS, vomiting, seizure, vomiting, altered RR, arrhythmias
What are a few head injury tools or guidelines to safeguard patients with head injuries?
NICE guidelines
New Orleans criteria
Canadian CT rule
Major trauma (local)
What is Alzheimer’s disease?
Neurodegenerative disordered characterised by learning and memory impairments
Associated with a lack of AcH in certain regions of brain
What is depression?
Caused by depletion of norepinephrine, serotonin and dopamine in the CNS
Pharmacological treatment aims to increase the concentrations of these at neurotransmitters
What is schizophrenia?
Severe mental illness, shown to involve excessive amounts of dopamine in frontal lobes, leading to psychotic episodes
What is Parkinson’s disease?
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
What is epilepsy?
Seizure condition caused by the lack of inhibitory neurotransmitters
Such as GABA, or an increase in the excitatory neurotransmitters such as glutamate
What is huntingtons disease?
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
What is myasthenia gravis?
Rare, chronic autoimmune condition characterised by the impairment of synaptic transmission of acetylcholine at neuromuscular junctions, leading to fatigue and muscular weakness without atrophy
What is a tonic clinic seizure
Tonic colonic seizure/known as grand mal seizures
Most common type of seizures
Involuntary muscle contractions
What is PNES
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
Signs and symptoms of a tonic clinic seizures
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
Signs and symptoms of PNES?
Fluctuating intensity
Brief pauses
Arms and legs not symmetrical
Eyes often shut
Purposeful movement
Crying during
Post ictal phase of tonic clonic seizures
Gradual slowing of convulsion
Gradual post-ictal phase
Noisy laboured breathing
Confusion
Tachycardia
Post ictal phase of PNES
Rapid end to convulsion
Rapid post-ictal phase
No confusion
Upset post event
What is meningitis?
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
Signs and symptoms of meningitis?
Pyrexia, vomiting, headache, non-blanching rash, stiff neck, reduced GCS, drowsiness, tachy, sepsis symptoms
What is Kernig sign and brudzinski sign
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
What is encephalitis?
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
Symptoms of encephalitis?
Fever, photophobia, headaches, stiff neck, hallucination, memory loss, generalised weakness, vomiting, seizure and coma
Symptoms of encephalitis in children?
Main signs may be bulging fontanel, inconsolability, irritability and vomiting
What is hydrocephalus?
Build up of fluid in the ventricles of the brain
