Neurology Flashcards
WEBERS SYNDROME
Mid brain stroke and hemiplegia
eyes go down and out and also hemiparesis (half of the body is paralysed)
eyes go down and out and there is oculomotor nerve palsy
this is caused by?
diabetes
effects of temporal lobe epilepsy
partial seizure
effects of occipital lobe seizure
visual hallucinations
What is trigeminal neuralgia
Very severe headache disorder but does NOT cause photophobia and vomiting
What is tension headache
Will happen over the head
What are cluster headaches
Frequent short lasting headaches that causes lacrimation
Why do you get Biconcave shaped haemotoma on CT
Extradural haemorrhage
Risks, arterial bleed
When do you get crescent shaped haemotoma on CT
Subdural haemorrhage
When do you see global atrophy
Seen in Alzheimer’s
Shrinking of the brain
Autonomic neuropathy
Complication if poorly controlled diabetes
Can cause postural hypotension and sensation of being full too soon
What are absence seizures
Brief pauses several times a day
what is the Gillian barre syndrome
when the immune system attacks the nerve cells
difficulty breathing, swallowing and blurred vision
- weakness in the lower limbs and then it spreads
- post infection
-camlybactor jejuni
what is a non-motor seizure called
absence seizure
what type of seizure is this?
long onset >30 mins
jerking of arms and legs
satus epilepticus
best management for tonic clonic seizure?
lorazepam IV
what is mevalgia paraesthetica
numbness of the anterior thigh due to compression of the lateral femoral cutaneous nerve
what is a TIA and side effects
can cause transient loss of vision that is one sided and goes away after a few days
medical term: Amaurosis Fugax
multiple sclerosis - what is it
demyelination of the nerves
neural impulses get slowed down and gaps in the myelin sheath causes gaps in the neural path
- affects the parasympathetic supply to the bladder which can cause urinary retention - urge to go but cannot pass
- this can cause urinary symptoms and TIA
- urinary retention
- more common in younger people
- people who have lived away from the equator
Stroke - what is it
not enough blood reaching the brain
- subdivided into ischaemic stroke - vascular stenosis
and haemorrhagic stroke - vascular rupture
anterior, middle and posterior cerebral artery supply blood to the brain
anterior -
middle - face and arms and speech to be effected
posterior - occipital lobe and inferior part of temporal lobe, so visual problems
do head CT within 1 hour
ischaemic stroke and haemorrgagic stroke on CT
- ischaemic - looks dark
- heamorrhagic - looks white
ischaemic stroke management
- check breathing
- endotracheal intubation
if stroke is confirmed and within 4.5 hours: alteplase (dissolve blood clot) and anti platelet agent
after 4.5 hours
supportive care
thrombectomy and anti platelet agent
thrombolysis window for ishcaemic stroke
4.5 hours
give IV aleteplase
mechanical thrombectomy
long term secondary prevention - aspirin 300mg for 2 weeks and then clopidrogrel long term
hemorrhagic stroke management
manage airway
neurosurgery and fix ruptured artery
confirmed hemorrhagic stroke management
supportive care
anticoagulant
venous thromboembolism
TIA
sudden onset neurological deficit
resolves completely in 24 hours
suspected TIA - give aspiring 300 mg loading dose
confirmed TIA - clopidogrel
middle medullary syndrome - what is it
stroke that affects the medulla
due to the occlusion of the basilar artery
causes: deviation of the tongue
limb weakness
person is not able to move their limbs
what is used to detect carotid stenosis
diffusion weighted MRI brain
when is a MRI done in stroke patients?
after the CT head that is done within 1 hour - when the CT comes back normal
3 meninges of the brain
dura mater
arachnoid - it doesn’t receive any innervation
under this is where the CSF is
pia - very vascularised
they provide a supportive framework for the cerebral arteries
protect the CSF inside
epidural haemorrhage
between the skull and dura mater
due to trauma to the pterion (temple)
damages the middle mengineal artery
contralateral hemiplegia
rapid deterioration then lucid (normal period)
BI CONVEX OR LENTIFORM SHAPE ON CT
subdural haemorrhage
between dura and arachnoid mater
increasing headache and confusion
- older patients
gradual
CRESECENT SHAPED HAEMATOMA
subarachnoid haemorrhage
under the arachnoid
severe headache and sudden
‘blow to to the back of their head’ ‘thunderclap headache’
decrease in consciousness
CT - WHITE AREA IN CENTRE OF BRAIN THAT IS EXPANDING
red or yellowing of the CSF
when is lumbar puncture contraindicated
raised intracranial pressure - as it can cause a release in this pressure and pull the brain down
basal skull fracture can cause?
leaking of the CSF from the nose
bacterial meningitis
inflammation of meninges
lumbar puncture
antibiotics are started immediately
meningitis symptoms
fever
photophobia
rash
confusion
neck stiffness
headache
management of meningitis
IM benzylpenniclin
in hospital - IV dexamethasone within 1 hour
ceftriaxone
vancomycin
amoxicillin (if immunocompromised)
viral meningitis management
acicilovir
encephalitis
inflammation of the brain iteself
caused by herpes simplex virus
altered state of consciousness
fever
headache
ataxia
cranial nerve deficits
myasthenia gravis
blocks acetyl coline the post synaptic cleft
muscle weakness
acetyl choline asters is given so acetyl choline is not broken down
ptosis
dysphagia
test for the antibodies that bind to the acetyl choline receptors
Lambert eaton myasthenic syndrome
inhibits calcium current in the neurosynapse
limbs go weak to strong
dry mouth
Lambert eaton myasthenic syndrome
inhibits calcium current in the neurosynapse
limbs go weak to strong
dry mouth
Gillian barre syndrome
inflammatory demyelinating polyneuropathy
typical post infection from camplyobacter jejuni
limb weakness
respiratory muscle weakness
cranial nerve palsies eg facial droop
reflexes are absent
polymyositis
bilateral proximal muscle weakness
myalgia
tenderness
management with: corticosteroids
physio
methotrexate
dermatomyositis
myositis and skin changes
heliotrope rash - purple rash on eyelids
gottrons papules - red papule on dorsal finger joints
shawl rash - erythema across upper back and shoulders
management:
oral corticosteroids
carpal tunnel syndrome
median nerve entrapment
tingling in the first 3 digits
worse at night
relived by shaking
management
splinting
steroid injections
cauda equina syndrome
compression of cauda equina
- nerve roots at the L1 level which get compressed
lower back pain
anaesthesia
bladder and bowel disturbance
mangement - surgery to decompress
bells palsy - forhead
NOT SPARED
stroke - forehead
IS SPARED
what is an intracerebral haemorrhage
bleeding into the brain
- can be due to hypertension
gradual onset
can be due to amyloid deposit - this can weaken blood vessels which can then bleed
subarachnoid haemorrhage
bleeding around the brain
can be the bleed of the ruptured aneurysms
- can be anywhere in the brain
THUNDERCLAP HEADACHE
very painful
what is xanthochromia
yellow staining of the CSF
- this is due to an increase content of bilirubin in the CSF
- this indicates that there is a bleed somewhere in the brain
intracranial bleeds risk factors
head injury
hypertension
aneurysms
- sudden onset headache
seizures
weakness
vomiting
subdural bleed
bleed in the veins
- crescent shaped
- gradual onset
extradural bleed
bleed in the arteries
fast onset
post trauma
lucid interval
biconcave shaped
what is spastic paraparesis
strong family history of gait disturbances
hyper-reflexia of the limbs
caused by:
what is an atonic seizure
this is when the patient becomes all limp and have no tone
myoclonic seizure
this is sudden increase in muscle tone which causes sudden jerking of the upper and lower limbs
idiopathic intracranial hypertension
raised pressure in the cranial cavity
most common in obese women
those who are on the contraceptive pill
causes blurred vision, headache and is worse in the morning or when lying down
when can a lumbar puncture be performed after a subarachnoid haemorrhage
only after 12 hours
myasthenia gravis - what is it
autoimmune disorder - immune system attacks the acetyl choline receptor, so these signals don’t transmit
POST SYNAPTIC
reduced nerve transmission
- so muscle weakness
- rapid fatigue of voluntary muscles
IgG attacks these receptors
- worse with movement
- tendon reflexes are preserved
associated with thymic hyperplasia -
management of myasthenia gravis
acetylcholinesterase inhibitors (e.g., pyridostigmine), immunosuppressants (e.g., prednisone, azathioprine, mycophenolate)
What is LEMS
It is an autoimmune condition which attacks the presynaptic calcium voltage gated channels causes muscle weakness, which gets better on use and is associated with small cell lung cancer. Other symptoms include dry mouth.
This causes a decrease in calcium
gets better with use
What investigation do you do for GBS
Bedside/country to check for forced FVC
and anti-ganglioside antibodies
management of epilepsy in the community during seizure
- diazepam rectally x2 15 mins apart
OR
midazolam 10mg orally
management of epliepsy with IV access
- IV lorazepam x2 (10-20mins apart)
- IV phentoynin
raised intracranial pressure - what is it
- headaches worse in the morning
- worse on bending over
- gets better on vomiting
- and lying down
do CT
what is idiopathic intercranial hypertension
- worse in the morning and on bending forwards
common in obese women
visual disturbances
visual darkening and bilateral papilooedma seen on fundoscopy
COCP can be a cause
steroids
weight loss is the only intervention
what is trigeminal neuralgia
recurrent short episodes of stabbing pain
affects one side of the face
may be triggered by eating etc
do MRI
management with carbemezapine
most common cause of encephalitis
herpes simplex virus
presentation of encephalitis and investigation
- fever
- altered mental status
-headache - seizures
- CSF and Viral PCR
management of encephalitis
- IV acyclovir
investigations for subarachnoid haemorrhage
- CT scan - to identify bleed
- if bleed isn’t picked up in this then - Lumbar puncture
CSF might show blood in CSF or
Xanthochromia - yellow coloured CSF which means previous bleed and haemolysis
management of extradural haemorrhage
Ligation of the damaged blood vessel
Management of subdural haemorrhage is?
Burr hole craniotomy
Management of subarachnoid haemorrhage
Nimodipine
end-vascular coiling
and then clipping
upper motor neurone disease symptoms
hyperreflexia /brisk reflexes
spasticity
pyramidal distribution
lower motor neurone disease symptoms
fascicultations - twitching
atrophy - wastage of muscles
where is wernickes area situated
in the superior temporal lobe
Where is broca’s area situated
in the inferior frontal gyrus
what is bulbar palsy
lower motor neurone condition affecting the cranial nerves 7,9,10,12
tonic-clonic and atonic seizures managemnt
sodium valproate or lamortigine (are first line)
pregnant women - give lamotrogine
absence seizures management
sodium valproate
or ethosoximide
do not give CARBAMEZEPINE
myoclonic seizure management
sodium valproate
women - topiramate or leviterasitam
side effects of sodium valproate
weight gain
hair loss
oedema
ataxia
tremor
what is hemiballism
Hemiballism results in involuntary, sudden, jerking movements which occur contralateral to the side of the lesion
basal ganglia
what are the features of temporal lobe seizure
epileptiform and is preceded by deja vu.
presentation of temporal lobe lesions
- mixing up words and saying words that don’t make sense
Parietal lobe, lesions presentation
Lesions in the parietal lobe can cause apraxia.
Occipital lobe lesion presentation
Lesions in the occipital lobe can cause changes to vision.
frontal lobe lesion presentation
Lesions in the frontal lobe can cause speech to become non-fluent.
cerebellum lesion presentation
Lesions in the cerebellum can cause ataxia, an intention tremor and dysdiadochokinesia.
what is the first line treatment for myasthenia gravis
Pyridostigmine is a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of myasthenia gravis
it increases the amount of acetylcholine reaching the post-synaptic receptors
what is Brown-Sequard syndrome
below the level of wound - ipsilateral loss of proprioception and vibration, and contralateral loss of pain and temperature sensation
at the lesion level
acute cord compression symptoms
severe back pain
numbness
and incontinence
side effects of sodium valproate
hepatic dysfunction with raised AST and ALT
what is Plummer Vinson syndrome
characterised by
Dysphagia: Difficulty swallowing due to the presence of webs or strictures in the upper esophagus. This can lead to malnutrition and weight loss.
Iron deficiency anemia: A type of anemia caused by insufficient iron levels in the body, which can lead to fatigue, weakness, and other symptoms.
]Glossitis: An inflammation of the tongue, which can cause soreness, pain, and difficulty speaking or swallowing.
increases chance of squamous cell carcinoma of the oesophageas
