Neurology Flashcards
What is Alzheimer’s disease
it is the most common cause of dementia in the uk
has a slowly progressive memory loss and other cognitive decline
Some signs and symptoms of Alzheimer’s
progressive memory loss
inattention
sundowning - symptoms worse at night
language difficulties
inability to solve problems of daily life through abstract reasoning
how is Alzheimer’s diagnosed
clinically diagnosed by history and ruling out other potential causes
its also important to look at other reversible causes of the dementia
what types of medication should be avoided in Alzheimer’s disease
Sedatives
what medication is used to manage Alzheimer
acetylcholinesterase inhibitor
what are some non pharmacological treatment options for Alzheimer’s
caregiver education and support
maximizing treatment for other health problems
memory clinic
physical and occupational therapy
What is ALS
is a progressive neurodegenerative disease that attacks both the upper and lower motor neurons resulting in muscle weakness and atrophy
Who are at risk from suffering from blow-induced dementia
football players -heading the ball
boxers
domestic violence survivors with repeated head trauma
what is one key difference in how stroke and bells palsy present
stroke only affects eyebrows down but in bells palsy it will affect forehead aswell
Risk factor for bells palsy
diabetes and pregnancy
SS for bells palsy
facial muscle weakness over days -weeks
decreased taste or lacrimation, hyperacusis
facial tingling or pain near ear
treatment for bell’s palsy
steroids + acyclovir if pt presents early
symptom control- eye patch and pain control
2 causative pathogen for bacterial meningitis
S.pneumoniae and N.menigitidis
SS for bacterial meningitis
rapidly developing fever
stiff neck
headache
altered mental status
Seizures
Photophobia
Non blanching rash - late sign
Ix for bacterial meningitis
Lumbar puncture
FBC
Blood culture
Finding of ix in bacterial meningitis
Low glucose, high protein
WBC>5 mm3
Management for bacterial meningitis
get blood cultures and start IV antibiotics immediately - usually ceftriaxone
add ampicillin in patients older than 65
steroids - IV dexamethasone
What type of headache is cluster headache
primary headache
what group of headaches do cluster headache fall into
trigeminal autonomic cephalalgias
RF for cluster headaches
common in males
common in 30s to 40s
genetics
name some triggers for cluster headache
alcohol
smoking
histamine
nitrate- containing food
smell of volatile substance like petrol, paint nail varnish
Diagnostic criteria for cluster headache
at least 5 attacks of severe or very severe unilateral orbital, supraorbital and/ or temporal pain lasting 15 minutes to 3 hours and either or both of the following:
- one of: conjunctival injection, rhinorrhoea, eyelid swelling, forehead/ facial sweating , fullness in ear
- sense of restlessness or agitation
Ix for cluster headache
if first time and presenting with signs of Horner’s syndrome then do angiogram
Management for acute cluster headache
Oxygen
subcut sumatriptan
Preventative management for cluster headaches
verapamil - after ecg
greater occipital nerve block
prednisolone
Topiramate or sodium valproate
Lithium but rarely used
GammaCore - non -invasive vagal nerve stimulation
What is cauda equina syndrome
radiculopathy in which the cauda equina is compressed
surgical emergency
SS of cauda equina syndrome
saddle anaesthesia
associated with loss of bowel or bladder control
severe back pain
bilateral sciatica
what are some causes of cauda equina
Lumbar disc herniation
spinal vertebral fractures
Malignancy
Spinal infection
Iatrogenic
examination finding in cauda equina
lower limb neuro exam :
- hypotonia
- weakness
-areflexia
-abnormal sensory changes
Rectal exam:
- recued sensation and anal tone
Abdo: palpable bladder
Ix for cauda equina
MRI spine
Management for cauda equina
ABCDE approach, then once stable:
Analgesia
Urinary retention- catheter
surgery to fix any reversible cause of decompression
what is Creutzfeldt- Jakob disease
rare, progressive and fatal cause of dementia
it is caused by prions which are mis-shaped proteins
what are the 2 types of Creutzfeldt-Jakob Disease
sporadic and variant
Variant CJD is caused by eating meat infected by bovine spongiform encephalopathy through eating infected cattle meat
symptoms of Creutzfeldt-Jakob disease
may not have symptoms for a while but once symptoms starts showing then pt will only have few years left
the symptoms are abnormalities in almost every area of the neurologic system
Ix for Creutzfeldt-Jakob disease
tissue biopsy
EEG
MRI
Lumbar puncture
Management for Creutzfeldt-Jakob disease
none. Symptomatic, supportive and psychological care for patient and family.
what neurotransmitter is known to be involved in delirium
acetylcholine
Risk factors for delirium
advanced age
serious illness
dehydration
polypharmacy
pre-existing dementia
electrolyte imbalance
sleep deprivation
infection -very common cause
Signs and symptoms of delirium
reduced awareness of the environment t
drowsy or lethargic
distractable
new memory impairment
hallucination
delusions
Ix for delirium
Look for signs of infection
neuro exam
FBC, U&E, Renal and kidney functions
urinalysis
CXR
ECG
ct/mri
Management for delirium
treat the cause
what is diabetic peripheral neuropathy
a prevalent complication of diabetes
Ss of diabetic peripheral neuropathy
pain, loss of sensation
Ix for diabetic neuropathy
clinical diagnosis
fasting glucose
HbA1C
nerve conduction studies
What is extradural haemorrhage
collection of blood between the outer dura mater and the inner surface of the skull
which artery tear us commonly associated in an extradural haemorrhage
middle meningeal artery
presentation of an extradural haemorrhage
brief LOC
subsequent deterioration of consciousness and headache
Ix and findings for an extradural haemorrhage
CT head
“lens” or “balloon” shaped mass over surface of brain
usually has a mass effect with midline shift
Management for an extradural haemorrhage
evacuation of the blood by a neurosurgeon
if unable to do neurosurgery then may attempt burr holes
ss for essential tremor
noticeable tremor when arms are outstretched
difficulty in writing, eating, and holding objects and doing fine motor tasks
but do not have bradykinesia, rigidity, balance difficulties or cog impairment
non medical, medical and surgical management for essential tremor
behavioural techniques and physical therapy
propranolol, primidone, topiramate
deep brain stimulation, focused ultrasound thalamotomy
what is epilepsy
umbrella term for a condition where there is a tendency to have seizures.
seizures are transient episodes of abnormal electrical activity in the brain
ix for epilepsy
eeg
mri
what is generalised tonic clonic seizures
loss of consciousness
tonic (muscle tensing )
clonic (muscle jerking)
may have tongue biting, incontinence, groaning
after the seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or depressed
management for tonic clonic seizures
sodium valproate
what is focal seizures
start in temporal lobes
affect hearing, speech, memory and emotions
some ways focal seizures can present
hallucination
memory flashbacks
deja vu
doing strange things on autopilot
Management for focal seizures
carbamazepine or lamotrigine
what is absence seizures
typically happen in children
becomes blank, stares into space and then abruptly returns to normal
typically last 10-20 seconds
Management for absence seizures
sodium valproate
ethosuximide
what is atonic seizures
aka drop attacks
brief lapses in muscle tone
don’t usually last more than 3 minutes
Management for atonic seizures
sodium valproate
what is myoclonic seizures
present as sudden brief muscle contractions like sudden “jump”
usually remains awake during the episode
Management for myoclonic seizures
sodium valproate
what is infantile spasm
aka west syndrome
starts in infancy around 6 months of age
clusters of full body spasms
poor prognosis
Management for infantile spasm
prednisolone or vigabatrin
what is status epilepticus
medical emergency
defined by seizures lasting more than 5 minutes or more than 3 seizures in one hour
management of status epilepticus
ABCDE approach
IV lorazepam
what is encephalitis
inflammation of the encephalon
ss of encephalitis
altered mental status
fever
flu-like prodromal illness
early seizure
common virus that cause encephalitis
herpes simplex virus type 1
IX for encephalitis
Routine blood test, blood cultures, viral PCR, CSF
CNS imaging
Treatment fir encephalitis
iv ceftriaxone and iv acyclovir
other supportive management
what does frontotemporal dementia cause
causes extreme disinhibition and markedly inappropriate behaviour which quickly alienates family, spouses, co workers and can lead to arrest by police for inappropriate activities
key motor findings in foot drop
weakness or paralysis of dorsiflexion and eversion
what does gullian barre syndrome often present after
often presents after a URTI or gastroenteritis
what is guillain barre sydnrome
demyelination of peripheral nerves
what pathogen is commonly associated with Guillain barre syndrome
campylobacter jejuni
SS of guillain barre syndrome
progressive weakness in arms and legs
areflexia
elevated CSF proteins
symmetrical symptoms
progression of symptoms over days to weeks
Ix for guillain barre syndrome
FBC
LP
EMG/NCV
Management for guillian barre syndrome
IV immunoglobulin
pain control
physical therapy
what are the triad for Huntington’s disease
Dominant inheritance
choreoathetosis
dementia
Ix for Huntington’s and what it shows
MRI and CT scans in moderate to severe disease can show loss of striatal volume and increased size of the frontal horns of the lateral ventricles.
Genetic testing is required to make a diagnosis and genetic counselling in a specialist unit is required.
Management for Huntington’s
chorea - managed with a number of med e.g tetrabenazine
depression treated with SSRI
psychosis- antipsychotics
management for meningitis in GP and second line
benzylpenicillin
second line -chloramphenicol
glucose and protein levels in viral meningitis
glucose - normal
proteins - normal/high
some complication of meningitis
septic shock
DIC
coma
Seizures
hearing loss
hydrocephalus
death
common causative agent in viral meningitis
enteroviruses such as echoviruses, coxsackie viruses A&B , polio virus
some causes of non-infective meningitis
Malignancy
chemical meningitis
DRUGS ( NSAIDS and Trimethoprim)
Sarcoidosis
SLE
Behcet’s disease
what is migraine
complex neuro condition that cause headaches and other associated symptoms
name the 4 types of migraine
migraine without aura
migraine with aura
silent migraine
hemiplegic migraine
what are the typical headaches symptoms
pounding/throbbing
usually unilateral
discomfort with light(photophobia)
discomfort with loud noises
with or without aura
nausea and vomiting
how long can migraine headaches last between
4 to 72 hours
what does aura mean and name some examples of how it presents
term used to describe visual changes associated with migraine
sparks in vision
blurring vision
line across vision
loss of of different visual fields
what is hemiplegic migraine
can mimic stroke
symptoms of hemiplegic migraine
typical migraine symptoms
sudden or gradual onset
unilateral weakness of the limbs
ataxia
change in consciousness
some triggers for migraine
stress
bright lights
strong smells
certain foods
dehydration
menstruation
abnormal sleep patterns
trauma
5 stages of migraine
prodromal
aura
headache
resolution
postdrome
acute management for migraines
paracetamol
triptans
NSAIDS
Antiemetics
Medication used for migraine
Tripatans
Migraine prophylaxis
headache diary
avoid triggers
propranolol
topiramate
amitriptyline
injectable preventative for migraine
greater occipital nerve blocks for HFEM or CM
Botulinum toxin therapy for chronic migraine
Buzzword for multiple sclerosis
separated in time and space
what is the leading cause of multiple sclerosis
EBV
pathophysiology of multiple sclerosis
autoimmune destruction of the CNS myelin sheath causing demyelination in the CNS white
RF for multiple sclerosis
smoking
ebv
low vit D
Genetics
