Neurology Flashcards
Syncope
Black outs - loss of consciousness
Common causes of blackouts
Vasovagal “faint”
Postural hypotension
Cardiac arrhythmia
Epileptic seizure
Hypoglycaemia
Vasovagal “faint”
Brought on by fear, emotion, heat, prolonged standing, hunger.
Prodrome: feeling faint, nausea, visual fields closing in
Due to low BP and low heart rate
Recover within 2 mins
Management: lie flat and elevate legs to increase venous return
Postural hypotension
A drop in blood pressure when you stand up after lying or sitting down.
Commonly drugs are a common cause of PH
Haemorrhage
Bleed on the brain
Subdural haematoma
Ventricle is compressed and midline is shifted
Bleed underneath the dura
Extradural haematoma
Bleed outside the dura
Impaired consciousness
A state where consciousness has been affected by damage to the brain e.g head injury, stroke, tumour.
Impaired conscious level can be due to any organ system disfunction as well as a primary brain problem.
Often can have more than one cause
The Glasgow Coma Scale (GCS)
Measures the severity of a coma
Generally, comas are classified as: severe, with GCS ≤8, moderate, GCS 9–12, and minor, GCS ≥13
NEWS score - AVPCU scale
Alert
Verbal
Pain
C new confusion
Unresponsive
Metabolic causes of impaired conciousness
Hypoglycaemia - where the level of sugar in your blood (glucose) drops too low
Hypoxia - low levels of oxygen in body tissues
Hypercapnia - too much CO2 in the blood
Hyponatraemia - concentration of sodium in the blood is abnormally low
Hyperglycaemia - calcium level in your blood is too high
Hypothyroidism - underactive thyroid
Impaired consciousness caused by infections
Brain - encephalitis, meningitis, cerebral abscess
Any other severe bacterial infection causing sepsis - pneumonia
Impaired consciousness caused by drugs and toxins
Alcohol
Opiates
Recreational drugs
Overdose of prescribed medication
ABCDE approach
Airway
Breathing
Circulation
Disability
Exposure
Epilepsy
Excessive electrical discharges in brain
Focal (partial) seizures
Presentation depends on part of brain affected
Generalised seizures
Whole brain affected - whole body presentation
How do you investigate epilepsy
Blood tests
Brain imaging - MRI
Electroencephalogram - EEG
Tonic phase of a seizure
causes a sudden stiffness or tension in the muscles of the arms, legs or trunk
Clonic phase of a seizure
repeated jerking movements of the arms and legs on one or both sides of the body, sometimes with numbness or tingling
Emergency treatment of seizure >5 minutes or repeated seizures
High flow oxygen
Midazolam oromucosal solution 10mg buccally
999 if needed
Primary headache disorders
tension headache
migraine
cluster headache
medication overuse headache
trigeminal neuralgia
Tension headache
feels like a “tight band” around the head
often stress related
symmetrical
treatment for tension headaches
conventional analgesia
tricyclic antidepressants for prophylaxis
Migraine
prolonged reduction in cerebral blood flow following a brief spell of increased flow
treatment for a migraine
conventional analgesia (paracetamol, aspirin, ibuprofen)
metoclopramide
serotonin agonists e.g. sumatriptan, zolmitriptan
cluster headaches
severe pain around eye
watery, blood shot, lid swelling, runny nose
treatment for cluster headache
sumatriptan, oxygen
trigeminal neuralgia headache
intense stabbing pain 10/10 severity
treatment for trigeminal neuralgia headache
carbamazepine
sometimes surgery
secondary headache disorders
head injury
CNS tumours
CNS infections
intracerebral or subarachnoid bleeds
giant cell arteritis
glaucoma
giant cell arteritis
inflammatory condition affecting the arteries in the temple
glaucoma
a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged.
CNS infections - bacterial meningitis
Bacteria that enter the bloodstream and travel to the brain and spinal cord.
CNS infections - encephalitis
inflammation of brain parenchyma
diagnosis of bacterial meningitis
lumbar puncture
blood cultures
CT or MRI brain
diagnosis of encephalitis
lumbar puncture
EEG
MRI
what is a stroke?
an acute compromise of blood supply to the brain
what are the 2 types of strokes and likeliness percentage?
cerebral infarction (90%)
cerebral haemorrhage (10%)
cerebral infarction
disrupted blood flow to the brain due to problems with the vessels that supply it. common cause of strokes
cerebral haemorrhage
bleeding in the surrounding tissues of the brain
subarachnoid haemorrhage
blood in subarachnoid space
diagnosis of subarachnoid haemorrhage
CT scan
Angiography to identify aneurysms
lumbar puncture
intracerebral haemorrhage
bleed directly into the brain tissue
what is a thrombectomy?
innovative surgical procedure used to remove blood clots from arteries and veins
what is the FAST campaign
Face
Arms
Speech
Time
when a stroke arises act fast
what are the 2 main movement disorders
parkinson’s disease
essential tremor
what is parkinson’s disease
a degeneration of the dopaminergic neurones in the basal ganglia
what are the main clinical features of parkinson’s disease?
bradykinesia - slowness and reduced movement
rigidity - inability to bend
tremor
treatment for parkinson’s disease
dopaminergic drugs - levodopa (co - careldopa, co - beneldopa). dopamine receptor agonists (ropinirole, rotigotine, pramipexole)
rehab/supportive care - physio and occupational therapy
surgical - deep brain stimulation
what causes parkinson’s disease
when cells in the substantia nigra stop working and die off, leaving the body to lack dopamine.
The brain uses dopamine to send messages to help control movement.
the reason this happens is undetermined
essential tremor
a nervous system (neurological) disorder that causes involuntary and rhythmic shaking
what is multiple sclerosis (MS)?
auto immune destruction of myelin sheath of neurones in CNS
is MS more common in men or women
women
what are the two forms of MS?
relapsing/remitting
chronic progressive
diagnosis of MS
Clinical
lumbar puncture
MRI
treatment for MS
High dose steroids in acute relapse
drugs to reduce relapse and progression of disability in relapsing remitting disease (betaferon, glatiramer)
rehab and supportive care
what is Motor Neurone Disease (MND)
The destruction of motor neurones
is MND more common in male or female
male
diagnosis of MND
clinical
neurophysiology
treatment for MND
medication
mainly supportive e.g. feeding tubes, wheelchair, NIV, communication aids etc
prognosis of MND
usually < 5 yrs
what is peripheral neuropathy
Peripheral neuropathy develops when nerves in the body’s extremities, such as the hands, feet and arms, are damaged. The symptoms depend on which nerves are affected.
What is bell’s palsy?
a condition that causes sudden weakness in the muscles on one side of the face
