Neurology Flashcards
What is a tonic-clonic seizure
Generalised tonic contractions followed by clonic contractions
Begins with tonic contractions of all four limbs
Ketogenic diet
high fat
low fat
controlled high proteins
Used for epilepsy that is resistent to usual AED
Generlised tonic clonic management
1st line - Sodium valproate
2nd line - Lamotrigine
Sodium valproate side effects
Nausea
Vomiting
Abdominal pain
Liver function abnormalities
Oxcarbazine side effects
Sedation
Rash
Lamotrigine side effect
Rash
Carbmazepine side effect
Ataxia
Sedation
Leukopenia
Thrombocytopenia
Rash
Typical Absence and atypical absence treatment
1st line - Ethosuximide
2nd line - sodium valproate
Ethosuximide side effect
GI disturbance
Rash
Myoclonic seizures treatment
1st line - sodium valproate
Adjunctive - keppra or topiramate
Carbamazepine affect on myoclonic seizure?
Worsens it
Tonic or atonic seizure treatment
1st line - sodium valproate
2nd line - lamotrigine
Adjunctive - rufinamide or topiramate
Topiramate side effect
Sedation
weight loss
Paraesthesia
What is required for seizures
-Population of pathologically excitable neurones
- Increase in excitatory glutamatinergic activity through recurrent connections to spread discharge
- Reduction in normal activity of inhibitory gama-aminobutyric acid-ergic projections
Functions of CSF
- Protect brain from impact
- Remove waste and toxins
- Help regulates intracerebral blood pressure
Where is CSF produced?
Produce in choroid plexus by ependymal cells
Route of CSF
Choroid plexus in lateral ventricles
Foreman of munro
Third ventricle
Aqueduct of sylvius
Fourth ventricle
Spinal cord and cerebral hemispheres
What reabsorbs CSF
Arachnoid villi
What is Communicating hydrocephalus
No obstruction between ventricles and subarachnoid space
Causes of communicating hydrocephalus
Increase excretion of CSF - choroid plexus tumour
Failure to reabsorb it - blockage of arachnid granulations by debris after meningitis or haemorrhage
What is non-communicating hydrocephalus
Physical obstruction between ventricles and subarachnoid space
Causes of non-communicating hydrocephalus
Congenital malformation - aqueduct estenosis, Arnold -Chiari malformation
Acquired obstruction - brain tumour
CSF results in bacterial meningitis
wBC 100 -10,000
Lymphocytes <100
Protein >1
Glucose <0.4
CSF in viral meningitis
WBC <100
Lympocytes 0 10 - 1000
Protein 0.4 - 1
Glucose - normal
TB meningitis
WBC <100
Lympocytes 50 - 1000
protein - 1-5
glucose <0.3
What nerve is affected In Bell’s palsy
7th cranial nerve
7th cranial nerve branches
temporal branch
zygomatic branch
buccal branch
marginal mandibular branch
cervical branch
Sensory branch - anterior 2/3 of tongue
What pharyngeal pouch is 7th cranial nerve dervived from?
2nd
layers of brain
Cerebral cortex
Pia mater
Subarachnoid space (filled with CSF)
Arachnoid mater
Dua mater
Skull
Scalp
Where is Subdural space
Dua mater and the arachnoid mater meninges
Subdural haemorrhage
Causes by traumatic head injury
Subarachnoid haemorrahage
Thunder clap headache
Extradural haemorrhage
Between skull and dural mater
Lucid period
What are EEG findings of focal seizure with partial awareness?
Centrotemporal spikes
What happens in a partial (focal) seizure?
Small area of brain has unusual electrical acitivity and does not affect awareness
Congenital malformations of brain that lead to partial / focal seizures
Sturge-Weber syndrome
tuberous sclerosis
focal cortical dysplasia
Focal Brian lesions that cause partial / focal seizures
Congenital malformations
Brain tumours
Benign idiopathic epilepsy syndromes
Clinical symptoms of seizures in occipital lobe
Simple visual hallucinations
Clinical symptoms of seizures in parietal lobe
Focal sensations
Clinical symptoms of seizures in frontal lobe
Generalised difficult to characterise sensation
Clinical symptoms of seizures in temporal lobe
complex visual hallucinations
Benign childhood epilepsy with centrotemporal spikes
Type of focal seziures
Occur at night
Start with buccal and throat tingling followed by tonic / clonic contractions down one side of face and drooling and inability to speak
Consciousness and comprehension preserved
Partial / focal seizure treatment
Oxcarbamazepine
Leveitiracetam
West syndrome features on EEG
Hypsarrhythmia
Absence seizures features on EEG
3 hertz spike and slow wave discharges
Lennox-gastaut features on EEG
1 to 2 hertz interictal slow spike waves
Lennox-gastuat
Mutliple seizure types
Developemental delay
Juvenile myoclonic seizures features on EEG
4 to 5 hertz poly spike and slow wave discharge
Cause of Rett syndrome
sporadic mutation in MECP 2
X linked dominant inheritance
Clinical presentation of Rett syndrome
Aerophagia - abdominal extension and difficulty respiratory
Apraxia
Aphasia
Drooling
Abnormal breathing pattern
Spinal deformity
Hand sterotypes
Epilepsy
What nerve is damaged to cause foot drop? (Weakness in dorsiflexion and eversion)
Common perineal nerve
Inability to plantar flex ankle and toe and invert foot - which nerve is affected?
Tibial nerve
How is Friedreich’s Ataxia inherited?
Autosomal recessive
Most patients have repeat GAA expansion of flaxtaxin gene(defect in FXN gene)
What does Friedrich Ataxias include?
Spinocerebellar tracts
Dorsal spinal column
Pyramidal tracts
cerebellum
medulla
Presentation of Friedreich’s ataxia
Progressive ataxia
Absence of deep tendon reflex - no achilles reflex
Spasticity
Peripheral neuropathy
Dysarthria
MSK - pes cavus, hammer toe
Heart - cardiac hypertrophy, myocardial fibrosis, heart failure
Diabetes
Hearing loss
Optic atrophy
Investigations for Friedreich’s ataxia
Nerve conduction studies - absent sensory action potentials
Genetic analysis
ECG - ventricular hypertrophy with t wave inversion
MRi of brain and spinal cord
Treatment of friedreich’s ataxia
symptomatic and supportive
PT’s
SALT
Annual review of systems
Types of cells that line choroid plexus
simple columnar cells (Ependymal cells)
What is syringemyelia?
Cysts/ syrinx form on spinal cord
As they widen, they compress anterior horn cells and causes fasiculations
Ass. Arnold-chaira malformations and spina bifida
How to differientiate between neonatal hypotonia having central or peripheral cause?
weakness
Presentation of Central cause of neonatal hypotonia
Irritiable
Microcephaly
Encephalopathy
normal strength
Normal deep tendon reflexes
CNS caused of neonatal hypotonia
Genetics - Trisomy 21, Prader-Willi syndrome, Zellweger syndrome
Cerebral malformations
Hypoxic ischeamia encephalopathy
PNS causes of neonatal hypotonia
Anterior cell horn - spinal muscular atrophy
NMJ - congenital myasthenia gravis
Muscles- congenital myotonic dystrophy
Congenital myotonic dystrophy
Developmental delay
Polyhydramnios and premature
Baby is week - may need ventilatory support
Decrease in facial expressions
Decrease in reflexes and strength
SMA
Normal facial expressions
Generalised weakness
Which branch of cranial 5th never has motor and sensory
mandibular
Where does inflammation of facial nerve cause bells palsy the most
Through the temporal bone
