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Neurology Flashcards

1
Q

What is the pathophysiology of an ischaemic stroke?

A

Stenosis or occlusion of a cerebral artery, often associated with prothrombotic states.

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2
Q

What are the three pathophysiologies of ischaemic stroke?

A
  • Primary vascular pathology (directly reduce cerebral perfusion)
  • Cardiac pathologies (cerebral artery occlusion)
  • Haematological pathologies (cerebrovascular thrombus)
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3
Q

What are the risk factors for an ischaemic stroke?

A
  • Age
  • Family history
  • Hypertension
  • Smoking
  • Diabetes mellitus
  • Atrial fibrillation
  • Comorbid cardiac condition
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4
Q

What are the signs and symptoms of an ischaemic stroke?

A
  • Vision loss/field defect
  • Muscle weakness
  • Aphasia
  • Ataxia
  • Sensory loss
  • Headache
  • Diplopia
  • Dysarthria (slurred words)
  • Gaze paresis
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5
Q

How is an ischaemic stroke diagnosed?

A

Non-contrast CT head

  • Hypoattenuation of brain parenchyma
  • Loss of grey matter-white matter differentiation
  • Hyperattentuation in an artery
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6
Q

What are the differentials for an ischaemic stroke?

A
  • Intracerebral haemorrhage
  • Epileptic seizure
  • Space occupying lesion
  • Infection
  • MS
  • FND
  • Migraine
  • Metabolic changes (eg. alcohol/drugs)
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7
Q

How is an ischaemic stroke managed?

A
  • Mechanical thrombectomy
  • Thrombolysis
  • Aspirin
  • Statins 48 hours after
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8
Q

What are the possible complications of an ischaemic stroke?

A
  • DVT
  • Haemorrhagic transformation
  • Depression
  • Aspiration pneumonia
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9
Q

What is the pathophysiology of a haemorrhagic stroke?

A

Vascular rupture → bleeding into brain parenchyma → primary mechanical injury to brain

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10
Q

What are the risk factors for haemorrhagic stroke?

A
  • Hypertension
  • Old age
  • Male sex
  • Asain/black/hispanic
  • Alcohol use
  • Sympathomimetic drugs
  • FHx
  • Anticoagulation
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11
Q

What are the signs and symptoms of haemorrhagic stroke?

A
  • Unilateral weakness
  • Sensory loss
  • Dysphasia/dysarthria
  • Photophobia
  • Headache
  • Confusion
  • N+V
  • Decreased consciousness
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12
Q

How is haemorrhagic stroke diagnosed?

A

Non-contrast CT head
- Hyperattenuation suggesting acute blood
- Surrounding hypoattenuation due to oedema

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13
Q

What are the differentials for haemorrhagic stroke?

A
  • Ischaemic stroke
  • Hypersensitivity encephalopathy
  • Hypoglycaemia
  • Complicated migraine
  • Seizure disorder
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14
Q

How are haemorrhagic strokes managed?

A
  • Manage comorbidities
  • Craniotomy
  • Drugs to relieve pressure (eg. manitol)
  • Stereotactic aspiration

Management depends on type of stroke

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15
Q

What are the complications of haemorrhagic strokes?

A
  • Infection
  • DVT/PE
  • Seizures
  • Delirium
  • Aspiration pneumonia
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16
Q

What is a transient ischaemic attack?

A

A transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia.

No acute infarction, sudden onset and usually lasts between 1 and 24 hours.

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17
Q

What is the pathophysiology of a TIA?

A

Severity depends on a combination of:
- Degree of obstruction
- Area and function of tissue supplied by the vessel
- Length of time thrombus obstructs the vessel
- Ability of collateral circulation to provide supplemental perfusion

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18
Q

What are the causes of TIA?

A
  • Stenosis or unstable atherosclerotic plaques
  • Cardioembolic events (impaired ejection fraction)
  • Microatheromas, fibrinoid necrosis etc
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19
Q

What are the risk factors for a TIA?

A
  • CVD
  • Diabetes mellitus
  • Hyperlipidaemia
  • Smoking
  • Alcohol
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20
Q

What are the signs and symptoms of a TIA?

A
  • Sudden onset and brief duration
  • Focal neurological deficit
  • Unilateral weakness
  • Dysphasia
  • Ataxia, vertigo/loss of balance
  • Homonymous hemianopia/diplopia
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21
Q

How is a TIA diagnosed?

A

Clinical diagnosis

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22
Q

What are the differentials for TIA?

A
  • Stroke
  • Hypoglycaemia
  • Post-seizure paralysis
  • Complex migraine
  • Conversion disorder
  • MS
  • Peripheral neuropathy
  • Labyrinthine disorders
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23
Q

What is the management of a TIA?

A

Aspirin and clopidogrel

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24
Q

What are the possible complications of a TIA?

A
  • Stroke
  • MI
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25
What is the pathophysiology of a subarachnoid haemorrhage?
- Usually caused by cerebral aneurysms - Bifurcation of major arteries that form the circle of Willis
26
What factors increase the risk of aneurysm rupture?
- Size - Location - Presence of symptoms - Multiple aneurysms - History of ruptured aneurysms
27
What are the risk factors for subarachnoid haemorrhage?
- Age - Female sex - Smoking - Hypertension - Alcohol misuse - FHx - Acute cocaine use - Adrenergic/seretonergic drugs
28
What are the signs and symptoms of subarachnoid haemorrhage?
- Severe sudden-onset headache - Depressed/loss of consciousness - Neck stiffness and muscle aches - Photophobia - N+V - Confusion
29
How are subarachnoid haemorrhages diagnosed?
- Non-contrast CT scan (hyperdense areas in subarachnoid space) - LP after 24 hours
30
What are the differentials for subarachnoid haemorrhage?
- Aortic dissection - Cerebral arteriovenous malformation - Dural arteriovenous fistulae - Vasculitis - Cardiac myxoma - Cocaine abuse - Sickle cell disease
31
What is the management of a subarachnoid haemorrhage?
- Nimodipine (prevents ischemia) - Neurosurgery to secure aneurysm - Observe for signs of deterioration
32
What are the possible complications of subarachnoid haemorrhage?
- Neuropsychiatric problems - Chronic hydrocephalus
33
What is the pathophysiology of a subdural haemorrhage?
The result of torsional or sheer forces → disruption of bridging cortical veins → empty into dural venous sinuses
34
What are the causes of subdural haemorrhage?
- Trauma (most common) - Increased intracranial pressure - Mets
35
What are the risk factors for subdural haemorrhage?
- Alcoholism - Aspirin/blood thinners - Age
36
What are the signs and symptoms of a subdural haemorrhage?
- Drowsiness - Consciousness fluctuation - Personality change - Increased ICP - Seizures - Focal neurological signs (unequal pupils)
37
How are subdural haemorrhages diagnosed?
CT/MRI - Concave crescent of blood around the edge of the brain - Midline shift of brain structures
38
What are the differentials for subdural haemorrhage?
- Stroke - Dementia - Mass lesion
39
What is the management of subdural haemorrhage?
- Irrigation/evacuation/burr hole craniostomy - Craniotomy - Identify cause
40
What are the possible complications of a subdural haemorrhage?
- Neurological deficits - Coma - Stroke - Epilepsy
41
What is intracerebral haemorrhage?
Rapidly developing clinical signs of neurological dysfunction attributable to a focal collection of blood within the brain parenchyma or ventricular system
42
What are the symptoms of posterior circulation strokes?
- Unsteadiness - Visual disturbance - Slurred speech - Headache - Vomiting
43
What is the pathophysiology of an extradural haemorrhage?
Usually a bleed from the middle meningeal artery and/or vein, normally due to trauma around the eye (fracture of temporal/parietal bone).
44
What is the presentation of extradural haemorrhage?
- Drowsiness - Pupil asymmetry - Impaired consciousness/coma - Severe headache - Vomiting - Seizures - Hemiparesis
45
How is an extradural haemorrhage diagnosed?
CT or MRI Convex lesion
46
What are the differentials for extradural haemorrhages?
- Subdural haemorrhage - Meningioma
47
How is an extradural haemorrhage managed?
1. Surgery - 1st line - Evacuation of blood - Bleeding lesion ligation 2. Decompression if required 3. Sit up in bed
48
What is epilepsy?
The tendency to have seizures (not a true condition, more a symptom). Diagnosed after a minimum of 2 seizures.
49
What is the pathophysiology of epilepsy?
- Abnormal synchronised discharge of neurones (usually glutamate and GABA neurones) - Failure of inhibitory mechanisms
50
What does 'seizure threshold' mean?
The level of excitability at which cells will discharge uncontrollably, in epilepsy this is lowered (neurones are hyperexcitable).
51
What triggers can push neurones past the seizure threshold?
- Sleep deprivation - Alcohol - Drug misuse - Physical/mental exhaustion - Flickering lights - Infection/metabolic disturbance
52
What are the causes of epilepsy?
- Genetic - Developmental abnormalities - Trauma/surgery - Hypoxia - Pyrexia - Mass lesion in the skull - Drugs - CNS infection
53
What are the risk factors for epilepsy?
- Age - FHx - Head injury - Stroke (vascular diseases) - Dementia - Brain infection
54
What are the signs and symptoms of a simple partial seizure?
- Remains consciousness - Isolated limb jerking - Isolated head turning - Isolates paraesthesia - Weakness of limbs follows
55
What are the signs and symptoms of a complex partial seizure?
- May impair consciousness - Deja vu - Vertigo - Hallucinations - Lip-smacking (other motor disturbances) - Tachycardia - Post-ictal confusion and drowsiness
56
What are the signs and symptoms of absence seizures?
- Unresponsive to stimuli but still conscious - Stares/pallor - Muscle jerking - Multiple episodes in one day - Normal function quickly resumes post episode
57
What are the signs and symptoms of Tonic-Clonic seizures? §
1. Aura prior to the episode 2. Tonic phase - Rigidity - Epileptic cry - Tongue biting - Incontinence - Hypoxia 3. Clonic phase - Convulsions - Eye rolling - Tachycardia - Random or uncontrolled breaths
58
What are the features of generalised epilepsy?
- Absence seizures - Tonic-Clonic seizures - Tonic only seizures - Atonic seizures (presents similar to syncope) - Myoclonic seizures
59
What are the features of focal epilepsy?
- Simple partial seizure - Complex partial seizure
60
What are the signs and symptoms of status epilepticus?
Seizure >30 minutes OR Multiple seizures without regaining consciousness lasting >30 minutes The brain swells and can cause herniation due to electrolyte imbalance
61
How is epilepsy diagnosed?
- EEG - CT/MRI (focal lesions) - PET scan - Bloods (CK)
62
What are the differentials for epilepsy?
- Other causes of falls - Pseudoseizures
63
How is epilepsy managed?
- Avoid triggering factors - Focal seizures - carbamazepine - Generalised TC - Sodium valproate - Surgery
64
How is status epilepticus managed?
Benzodiazepines.
65
What is meningitis?
Inflammation of the meninges. Notifiable disease.
66
What is the pathophysiology of infective meningitis?
1. Haematogenous spread - Binding to surface receptors - Vulnerable spots/areas of damage 2. Direct spread - Anatomical - Through the nose - Through overlaying skin
67
What are the causes of bacterial meningitis? §
- Neisseria meningitides (gram-negative diplococci) - Strep pneumoniae or pneumococcus - Haemophilus influenzae - Listeria monocytogenes (pregnant women) - E. coli (neonates) - TB
68
What are the causes of viral meningitis?
- HSV - VZV - Enteroviruses
69
What are the causes of fungal meningitis?
Cryptococcus neoformans
70
What are the causes of parasitic meningitis?
P. Falciparum
71
What are the risk factors for infective meningitis?
- Elderly - Pregnant - Bacterial endocarditis - Crowding - Diabetes - Malignancy - IV drugs
72
What is the clinical presentation of infective meningitis?
Classic triad: - Headache - Fever - Neck stiffness
73
What are the early signs of meningitis?
- Headache - Fever - Leg pain - Cold hands and legs - Abnormal skin colour
74
What are the chronic signs of meningitis?
- Meningism - Papilloedema - Impaired consciousness - Petechial rash (non-blanching) - Seizures
75
What is meningism?
Positive Kernig's and Brudzinski's sign - Neck stiffness - Photophobia
76
How is infective meningitis diagnosed?
Lumbar puncture Bacteria: - Appears cloudy - High protein - High WCC - Neutrophil polymorphs Virus: - Appears normal - Normal protein and glucose - High WCC - Lymphocytes
77
What are the differentials for meningitis?
- Malaria - Encephalitis - Sepsis - Subarachnoid haemorrhage - Dengue fever - Tetanus
78
What is the management of meningitis?
- Benzylpenicillin - Cefotaxime (in hospital)
79
What are the possible complications of meningitis?
- Hearing or vision loss - Epilepsy - Memory and concentration problems - Coordination, movement and balance problems - Learning difficulties - Loss of limbs
80
What is Guillain-Barre syndrome?
Acute inflammatory demyelinating polyneuropathy. Usually follows a GI/URT infection or HIV.
81
What is the pathophysiology of Guillain-Barre syndrome?
The viral infection causes the production of auto-immune antibodies against peripheral nerves, damaging myelin, reducing/blocking transmission.
82
What are the risk factors for Guillan-Barre syndrome?
Preceding viral/bacterial infection.
83
What is the clinical manifestation of Guillan-Barre syndrome? (most common)
- Muscle weakness - Respiratory distress - Speech problems - Paraesthesia - Facial weakness - Areflexia/hyporeflexia - Facial droop
84
How is Guillain-Barre syndrome diagnosed?
- Lumbar puncture (raised protein) - Slowed nerve conduction
85
What are the differentials for Guillain-Barre syndrome?
- Transverse myelitis - Myasthenia gravis - Botulism - Lambert-Eaton myasthenic syndrome - Vasculitic neuropathy
86
How is Guillain-Barre syndrome managed?
- Intravenous immunoglobulin - Plasma exchange - Supportive treatment
87
What are the possible complications of Guillain-Barre syndrome?
- Respiratory failure - Bladder areflexia - Adynamic ileus - Paralysis - Fatigue - Immobilisation hypercalcaemia - DVT
88
What is the pathophysiology of Parkinson's disease?
- Progressive loss of dopaminergic neurones in the basal ganglia - Lewy bodies accumulate in surviving neurones - Slowly progressive with no remission - Symptoms at 20-40% loss
89
What are the risk factors for Parkinson's disease?
- Age - Hereditary - Male sex - Exposure to toxins (herbicides/pesticides)
90
What are the clinical features of Parkinson's disease?
- Tremor (usually in hands) - Bradykinesia - Rigidity (no sensory deficit) - Slow shuffling gait - Stooped posture - Slow and monotonous speech - Depression - Dementia
91
How is Parkinson's disease diagnosed?
Usually completely clinical.
92
What are the differentials for Parkinson's disease?
VODKA: - Vascular events (stroke/MI) - Orthostatic hypotension with atonic bladder - Dementia with vertical gaze paralysis - Kayser-Fleisher rings - Apraxic gait
93
How is Parkinson's disease managed?
Exercise and physiotherapy can improve mobility. L-DOPA
94
What is Huntington's disease?
- Autosomal dominant disease - Causes degeneration of neurones in the brain
95
What is the clinical presentation of Huntington's disease?
- Personality change - Irritability and impulsivity - Chorea - Twitching and restlessness - Loss of coordination - Dementia and seizures
96
How is Huntington's disease diagnosed?
Clinical diagnosis.
97
How is Huntington's disease managed?
Management is supportive - no cure.
98
What are the complications of Huntington's disease?
- Weight loss - Dysphasia - Falls - Suicide risk - Incontinence
99
What can trigger a migraine?
CHOCOLATE: - CHocolate - Oral contraceptive - Caffeine - AlcohOL - Travel - Exercise
100
What are the risk factors for migraines?
- Family history - Age - Female sex - Hormonal changes (menstruation, pregnancy, menopause)
101
What is the clinical presentation of a migraine?
- Visual aura - Throbbing/pulsing sensation - Photophobia - Unilateral pain - Nausea and vomiting - Hyperalgesia - Onset in morning
102
How are migraines diagnosed?
Clinical diagnosis
103
How are migraines managed?
- Aspirin/NSAIDs - Antiemetic - Triptans (serotonin receptor agonists)
104
What are the causes of tension headaches?
- Stress - Noise - Concentrated visual effort - Fumes/smells
105
What are the signs and symptoms of a tension headache?
- Bilateral headache - Tight band sensation - Pressure behind the eyes - Frequent occurence - Not sensitive to head movement - No N+V or neurological signs
106
How is a tension headache diagnosed?
Clinical diagnosis
107
How are tension headaches managed?
Analgesia - Avoid strong analgesics (risk of medication overuse headache)
108
What are the risk factors for cluster headaches?
- Male sex - Age - Smoking - Alcohol use - FHx
109
What are the clinical features of cluster headaches?
- Episodic, intense unilateral pain - Onset early in the morning - Can have multiple episodes in one day - Unilateral lacrimation and rhinorrhoea - Miosis and ptosis - No N+V
110
How are cluster headaches diagnosed?
Clinical diagnosis
111
How are cluster headaches managed?
- 100% O2 - Subcut sumatriptan - Analgesia not effective
112
What is Mulitple Sclerosis?
Chronic inflammation of the CNS - Demyelination and axonal loss of nerves - Peripheral nerves are spared
113
What is the pathophysiology of Multiple Sclerosis?
- Demyelination condition with axonal loss - Autoimmune reaction (CD4 cells attack oligodendrocytes) - Macrophages can cross BBB
114
Describe the progression of Multiple Sclerosis.
Relapse-remission disease - Relapse - local inflammation and damage to myelin/oligodendrocytes/conduction block - Remission - inflammation subsides, remyelination of damaged areas
115
What are the risk factors for Multiple Sclerosis?
- Age (20-40) - Female sex - FHx - Certain infections (eg. EBV) - White people - Colder climates - Smoking
116
What are the clinical features of Multiple Sclerosis?
Any neurological sign can be present in MS, episodes don't always present with the same S+S
117
How is Multiple Sclerosis diagnosed?
MRI - presence of plaques
118
What are the differentials for Multiple Sclerosis?
- Migraine - Cerebral neoplasms - Nutritional deficiencies (B12 and copper) - Infections (HIV) - MND - Psychiatric disease - Vascular causes
119
What is the management of Multiple Sclerosis?
- No cure - Smoking cessation - Steroids for relapse (methylprednisolone) - Glatiramer (may prevent relapse)
120
What are the complications of Multiple Sclerosis?
- UTI - Osteoporosis - Depression - Visual/cognitive impairment - Erectile dysfunction
121
What is motor neurone disease?
General term for several types of motor neurone degeneration: - Amyotrophic lateral sclerosis (ALS) - Progressive bulbar palsy (PBP) - Progressive muscular atrophy (PMA) - Spinal muscular atrophy (SMA)
122
What is the pathophysiology of MND?
Degeneration of motor neurones in the motor cortex and spinal cord (never causes sensory issues) - Oxidative neuronal damage - Abnormally large amounts of protein inside cells - Glutamate problems - Apoptosis
123
What are the risk factors for MND?
- Inherited - Age (40-60) - Male sex (up to 65, then equal) - Genetics
124
What are the clinical features of MND?
- Symmetrical weakness and wasting - Bulbar and pseudobulbar features - Reflex problems - Does NOT affect eye movement - Dementia
125
How is MND diagnosed?
- Normally clinical - EMG may be used (shows denervation) - Needs both UMN and LMN and no sensory signs with a progressive pattern
126
What are the differentials for MND?
- Motor neuropathy - Spinal muscular atrophy - Kennedy's syndrome - Hyperthyroidism and hyperparathyroidism - Pseudobulbar palsy - Spinal tumours
127
What is the management for MND?
- Na channel blocker (riluzole) - GABA agonist (Baclofen) No remission, death is usually due to bronchopneumonia.
128
What is myasthenia gravis?
- Acquired autoimmune condition - Affects NMJ - Antibodies against ACh receptors - Results in weakness of the muscles
129
What is the pathophysiology of myasthenia gravis?
- B and T cell-mediated IgG (attack post-synaptic AChR) - Antibodies block the receptor, stopping ACh from binding - nerve signal is not fully transmitted
130
What are the risk factors for Myasthenia Gravis?
- FHx of autoimmune disorders - Genetic markers - Cancer-targeted therapy
131
What is the clinical manifestation of myasthenia gravis?
- Pattern of remission and crises - All muscles are affected, most notably ocular, bulbar, proximal, and axial muscles - Fatigability of muscles - Symptoms better in morning, worse throughout the day - Rarely muscle wasting
132
How is Myasthenia Gravis diagnosed?
Serum AChR antibody analysis = positive
133
What are the differentials for Myasthenia Gravis?
- Lambert-Eaton myasthenic syndrome - Botulism - Penicillamine-induced myasthenia gravis - Primary myopathies
134
How is myasthenia gravis managed?
- Pyridostigmine - Corticosteroid (prednisolone) as adjunct
135
What are the complications of Myasthenia Gravis?
- Respiratory failure - Impaired swallowing - Acute aspiration - Secondary pneumonia
136
What is encephalitis?
Inflammation of brain parenchyma, usually caused by infection (normally viral).
137
What is the pathophysiology of encephalitis?
Intracranial infection causes inflammatory response. Inflammation of cortex, white matter, basal ganglia and brain stem.
138
What are the risk factors for encephalitis?
- Extremes of age - Immunodeficiency - Viral infections - Body fluid exposure - Organ transplantation - Location/season
139
What are the clinical features of encephalitis?
- Normally mild self-limiting illness - Headache - Drowsiness - Pyrexia - Malaise - Meningism symptoms - Parenchymal signs
140
How is encephalitis diagnosed?
Lumbar puncture: - Viral PCR - MCS - Glucose (raised in bacterial) - Protein (raised in bacterial) - Cloudy if bacterial
141
What are the differentials for encephalitis?
- Diabetic ketoacidosis - Hepatic encephalopathy - Hypoglycaemia - Drug overdose - SLE - Hypoxia
142
How is encephalitis managed?
- IV anciclovir if HSV - Dexamethasone treats high ICP
143
What are the possible complications of encephalitis?
- Death - Hypothalamic and autonomic dysfunction - Ischaemic stroke - Seizures - Cerebral haemorrhage - Cerebral vasculitis
144
What are gliomas?
Tumour of glial cells in the brain or spinal cord
145
What are the three types of gliomas?
- Astrocytoma - Oligodendroglioma - Ependymoma
146
What are meningiomas?
Grow from arachnoid, normally benign but can cause raised ICP and neurological signs.
147
What are pituitary tumours?
May cause hormone deficiencies or excess hormone production leading to: - Acromegaly - Hyperprolactinaemia - Cushing's disease - Thyrotoxicosis Tend to be benign.
148
What are hemangioblastomas?
Tumours with blood vessel origin
149
What are acoustic neuromas?
AKA vestibular schwannoma Schwann cell tumour of the auditory nerve that innervates the ear
150
What are the classic symptoms of acoustic neuromas?
- Hearing loss - Tinnitus - Balance problems
151
What are the risk factors for primary brain tumours?
- Affluent groups - Ionising radiation - Vinyl chloride - Immunosuppression - FHx
152
What are the clinical manifestations of primary brain tumours?
- Tend to be asymptomatic while small - Focal neurological symptoms - Signs and symptoms usually associated with raised ICP
153
What are the signs and symptoms associated with raised ICP?
- Headache - Vomiting - Altered medical state - Visual field defects - Seizures - Unilateral ptosis - 3rd and 6th nerve palsies
154
How are primary brain tumours diagnosed?
- CT/MRI (lesions) - Tissue biopsy to identify gradec§
155
What are the differentials for brain tumours?
- Aneurysm - Abscess - Cyst - Haemorrhage - Idiopathic intracranial hypertension
156
How are primary brain tumours managed?
- Steroids - Surgery - Chemotherapy - Radiotherapy - Palliative care
157
What are the possible complications of primary brain tumours?
- Hydrocephalus - Midline shift and herniations through foramen magnum
158
What are the common causes of secondary brain tumours?
- Lung - Breast - Melanoma - Renal - GI
159
What are the clinical manifestations of secondary brain tumours?
- Headache - Focal neurological symptoms - Ataxia - Seizures - Nausea + vomiting - Papilloedema
160
How are secondary brain tumours diagnosed?
CT/MRI
161
How are secondary brain tumours diagnosed?
- Steroids (eg. dexamethasone) - Radiotherapy - Chemotherapy - Surgery - Palliative care
162
What are the causes of spinal cord compression?
- Degenerative disc lesions - Degenerative vertebral lesions - TB - Epidural abscess - Vertebral neoplasm - Epidural haemorrhage
163
What are the risk factors for spinal cord compression?
- History of trauma - High risk occupation - High risk sports activity
164
What are the clinical manifestations of spinal cord compression?
- Back pain - Numbness/paraesthasia - Weakness/paralysis - Bladder/bowel dysfunction - Hyperreflexia - Sensory loss - Loss of tone below suspected injury - Neurogenic shock
165
How is spinal cord compression diagnosed?
- MRI spine - Plain spine X-ray - CT spine - CT myelography
166
What are the differentials for spinal cord injury?
- Transverse myelitis - Guillain-Barre syndrome - HIV-related myelopathy - ALS - MS - Diabetic/peripheral neuropathy
167
How is spinal cord compression treated?
- Treat underlying cause - Surgery - Antibiotics - Steroids - Radiotherapy
168
What are the possible complications of spinal cord compression?
- Pressure ulcers - Cardiovascular dysfunction - DVT - PE - MRSA infection
169
What are the causes of cauda equina syndrome?
- Lumbar disc herniation - Trauma - Spinal tumour - Epidural abscess/haematoma
170
What is the clinical manifestation of cauda equina syndrome?
- Bilateral lower limb weakness - Decreased/absent lower limb reflexes - Reduced perianal sensation and anal tone - Lower back pain and sciatica - Bladder and bowel dysfunction - Leg weakness/paralysis
171
How is cauda equina syndrome diagnosed?
MRI
172
What are the differential diagnoses for cauda equina syndrome?
- Conus medullaris syndrome - Vertebral fracture - Peripheral neuropathy - Mechanical lower back pain
173
How is cauda equina syndrome managed?
- Surgery - Antibiotics - Corticosteroids
174
What are the possible complications for cauda equina syndrome?
- Permanent leg weakness - Sexual/urinary dysfunction - Chronic pain - DVT

Phase 2a (11 decks)

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