Neurology Flashcards
1
Q
what are the types of stroke?
A
ischemic 85%
haemorragic 15%
transient ischemic attack
2
Q
what is Transient Ischemic Attack (TIA)?
A
- “mini-stroke”
- stroke symptoms but temporary, last minutes to hours
- importan warning sign to developing future strokes
- preventative measures need to be established eg antiplatelets/anticoagulants, managing BP etc.
3
Q
what techinque is used to diagnose/differentiate strokes?
A
MRI/CT
4
Q
what can cause an ischaemic stroke?
A
Interruption of cerebral blood supply:
Embolism
Thrombosis
Systemic hypoperfusion
5
Q
what is the Oxford Community Stroke Project (OCSP) Classification (Bamford et al)?
A
classification of stroke
- Anterior Circulation Infarction - Partial (PACI), Total (TACI)
- Posterior Circulation Infarction (POCI)
- Lacunar Infarction (LACI)
6
Q
what are signs of Anterior Circulation Infarction?
A
(middle/anterior cereberal arteries)
Contralateral weakness
Contralateral sensory loss/sensory inattention
Dysarthria
Dysphasia (receptive, expressive)
Homonymous Hemianopia/visual inattention
Higher cortical dysfunction
7
Q
what are signs of Posterior Circulation Infarction ?
A
- cranial nerve damage
- cerebellar dysfunction
- Conjugate eye movement disorder (e.g. horizontal gaze palsy)
- Isolated homonymous hemianopia
8
Q
what is Lacunar Infarction ?
A
- Occlusion of deep penetrating arteries
- affects small volume of subcortical white matter
- doesn not present with cortical features eg dysphasia, visual field loss
- pure sensory/motor stroke
9
Q
what tests investigations are required for stroke?
A
- CT head
- bloods - BM, LFTs, CRP
- BP - if over 180 thrombolysis not given due to bleeding risk
- Carotid Doppler USS (carotid stenosis)
- echo/ECG - endocarditis/thrombus
- NIHSS - severity of stroke
10
Q
what are modfifiable risk factors for stroke?
A
- high BP
- smoking
- diabetes
- high cholesterol levels
- heavy alcohol consumption
- obesity
- physical inactivity.
11
Q
what are non-modifiable risk factors for stroke?
A
- Age
- family history
- race (African Americans)
- sex (men)
12
Q
what are symptoms of a stroke?
A
- numbness/weakness in face, arm, leg, often one-sided
- Confusion, trouble speaking, or difficulty understanding speech.
- Trouble seeing in one or both eyes
- Difficulty walking, dizziness, loss of balance, or lack of coordination.
- Severe headache
13
Q
what is Alberta Stroke Program Early CT Score?
A
- segments brain into parts and score based on areas affected
- 10 is normal - going down
14
Q
what is given if ischaemic stroke is suspected?
A
thrombolysis
15
Q
what is the definition of a stroke?
A
- rapidly developing clinical signs of focal disturbance of cerebral function
- lasting more than 24 hours or leading to death
- no apparent cause other than a vascular origin
16
Q
what is another treatment for stroke other than medication?
A
- Mechanical Thrombectomy - catheter that removes blood clot
17
Q
what is Ischaemic Penumbra?
A
- reverisble area of damage around the core (irreverable damage)
18
Q
what is the management of a stroke?
A
- preventing complication (infection, pressure sores, depression etc.)
- secondary prevention - lifestyle etc.
- rehabilitation - physio, occupational therapy, speech/language
19
Q
what is the ABCD2 score for stroke?
A
Estimates the risk of stroke after a suspected transient ischemic attack (TIA)
A - age over 60
B - over 140/90
C - clinical features - speach/weakness
D - duration ie over 60 mins
D - diabetes
20
Q
what are Pathological subtypes of ischaemic stroke ?
A
- Large vessel disease (50%)
- Small vessel disease (25%)
- Cardioembolic (20%)
- Unknown (cryptogenic) (3%)
- Rare causes (2%) e.g. dissection, CVST, vasculitis
21
Q
what are secondary preventative measures for stroke?
A
- antiplatelets - aspirin/clopidogrel
- anticoagulation
- hypertension management
- cholesterol management - statins
22
Q
what is the surgical management for stroke?
A
- Carotid endarterectomy (CEA) or carotid artery stenting - for Carotid Stenosis - prevetative
- Decompressive hemicraniectomy - part of skull removed if stroke is very large/swelling
23
Q
what are the risks of Posterior circulation infarction?
A
- hydrocephalus
- treated with EVD/posterior fossa decompression
24
Q
how are brain tumours graded?
A
- WHO classification – histology (cell type), molecular markers and genetic factors (not tumour-node-metastasis)
- 1 = non-malignant
- 2 = cytological atypia
- 3 = anaplasia and mitotic activity
- 4 = Anaplasia, mitotic activity with microvascular proliferation, and/or necrosis - v aggressive malignant
25
what are prognostic factors of brain tumours?
Histology type
Age *
Size of tumour *
Rate of growth
Location *
Cross midline
Presenting features
Performance status
26
what are the main types of gliomas?
- Astrocytomas - Glioblastoma (GBM) v aggressive
- Oligodendrogliomas - more responsive to treatment
- Ependymomas - easier to surgicallly remove
- mixed
27
what are symptoms of brain tumour?
- headache
- seziures
- motor loss
- confusion/weakness/memory loss
28
what are the presentations of a headache with brain tumours?
Woken by headache,
worse in the morning,
worse lying down,
associated with N&V,
exacerbated by coughing, sneezing, drowsiness
29
what are causes/risk factors of brain tumours?
mostly no causes found
risk factors/association
- ionising radiation exposure
- family history
- Immunosuppression (CNS lymphoma)
30
what is Papilloedema?
- swelling of the optic disc due to elevated intracranial pressure (ICP)
- seen with brain tumours
31
what are signs of raised intracranial pressure?
- VIth nerve palsy - hearing loss one sided
- papilloedema
32
what are the investigations for brain tumours?
- CT/MRI
- brain biopsy
33
what is the treatment of high grade glioma?
- Steroids – reduce oedema
- surgery - to relieve IC, survival prolongation
- chemo/radio
(non curative but prolongs survival)
34
what is the treatment of low grade glioma?
Surgery – early resection (Awake craniotomy)
radio/chemo
35
what are types of brain tumours?
- gliomas
- meningomas
- Schwannomas
- pituitary tumours
- Secondary (Metastatic) Brain Tumors
36
what are the types of traumatic head injury?
- blunt vs penetarting
- focal vs diffuse
- primary vs secondary eg due to poor care
37
what are diffuse axonal injuries?
- white matter lesions on grey/white margins
- loss of consciousness
- little haemmorage - better seen on MRI not CT
- in high impact/shaking incidents
38
what are tbi contusions?
- brain tissue injured due to brain/skull collision
39
what are the types of intracranial bleeds?
- extradural (lemon shaped)
- subdural (banana shaped) - more gradual
- subarachnoid - from aneurysm/trauma
- intracerebral/intraventrcular
40
what is the management of a head injury?
- CT/MRI
- control seziures if present
- surgical treatment (rarely)
- prophylaxis - due to meningitis risk
41
what is the glasgow coma scale?
scale for head injury
- includes assesment of eye, verbal and motor response
- low=more severe, coma likely
- 9-12 moderate
42
what are potenital complications after TBI?
- endocrinopathy - hormone deficiencies etc.
- Post-traumatic epilepsy
- infections
- gi - peptic ulcers, dysphagia
- heterotopic ossification
- congnative changes - memory/personality
43
what are the typical causes of different bleeds?
Extradural Hematoma - arterial bleeding - skull fracture
Subdural Hematoma - vein rupture - rotational injury
Subarachnoid Hemorrhage - rupture of an aneurysm or trauma
Intracerebral Hemorrhage - trauma, hypertension, vascular malformations
44
what is characteristic of chronic traumatic encephalopathy?
p-tau aggregates
45
what causes parkinsons disease?
- loss of dopamine producing neurones
- in substantia nigra
- lewy bodies detected
46
what are symptoms of parkinsons?
**- bradykinesia (shuffeling gait, hypomimia)
- resting tremor - asymmetrical
- rigidity**
- Postural instability
- sleep disturbances
- Mood/cognitive symptoms
47
what are types of tremor?
rest
action - postrual, kinetic - intention
essential - inherited
dystonic
cerebellar
functional
48
how is parkinsons diagnosed?
- clinical - classical motor symptoms
- Datscan
- tests for infections/electrolystes, thyroid
49
what is the treatment of parkinsons?
- L-dopa
taken with carbidopa to reduce metabolism
- MOA-B inhibitors stop breakdown of dopamine
(time sensative medication_
50
what is a complication of stopping parkinsons medication?
- freezing
- neuroleptic malignant syndrome
51
what conditions are associated with parkinsons?
- depression/anxiety/psychosis
- dementia
- orthostatic hypotension
52
how are essential tremors treated?
primidone
beta-blockers
53
what are the non-infective causes of meningitis
- neoplastic - cancers
- drug induced- NSAIDS
- autoimmune/systemic - SLE
54
what are symptoms of meningitis?
- fever
- headache
- neck stiffness
- photophobia
55
what are permenant complications from meningitis?
- skin scars
- amputation
- hearing loss
- seziures
- Hydrocephalus
- motor deficit
56
investigations for meninigitis
- GCS
- vital signs/glucose levels
- blood culture
- lumbar puncture - definitive
57
treatment of meningitis
- benzylpenicillin
- supportive treatment - fluids, analgesia
(notify public health)
58
what are contraidications of lumbar puncture?
- platelet count less than 20,000 mm3or heparin use within 24hr
- vertebral trauma
- infection at LP site
- raised intracranial pressure
59
what bacteria cuases meningitis?
-ve bacteria
- neisseria meningitidis - young adults
- haemophilis influenza B
- e.coli
+ve bacteria
step.pneumonia
- listeria spp.
- group B step
chronic:
- TB
- syphilis
60
meningococcal septicaemia symptoms/signs?
- rash: non-blanching, red/brown pin-prick rash then large purple
- nausea/vomiting
- hypotension
- fever
- septic shock
61
what are differential diagnosis of meningitis?
- subarachnoid haemorrhage - trauma, thunderclap
- flu
- sinusitis
- malaria
- brain abscess
62
what is encephalitis?
inflammation of brain
63
what are the symptoms of encephalitis (different to meningitis)?
- confusion
- behaviour changes
- memory loss
- seziures
64
# types of viruses ect.
what are causes of encephalitis?
- herpes simplex
- varicella zoster
- if travelling - ticks, rabies, etc.
- Enteroviruses
- measels
65
what are investigations for encephalitis?
- MRI
- LP - CSF, viral PCR
66
what are the main symptoms of huntingtons disease?
- chorea - Uncontrolled movements, poor coordination, speech
- dementia
- psychiatric problems - depression/anxiety/OCD
only start to appear at ages 30-50, then patient starts to deteriorate
67
what gene is affected in huntingtons disease?
HTT
68
what is the treatment of huntingtons disease?
- Neuroleptics:
Sulpiride for chorea
haloparidol for psychosis
- SSRIs for depression
- Risperidone for aggression
- therapy eg speech, physical, occupational
69
what is Cerebellar ataxia?
- lack of muscle coordination and control
- originates from the cerebellum
70
what causes Cerebellar ataxia?
- Genetic disorders: Friedreich's ataxia, spinocerebellar ataxia
- damage to cerebellum from stroke, MS, tumors, alcohol, infections
- inflammation of cerebllum from autoimmune conditions
- toxins
- E/B12 deficiency
71
what is Generalized dystonia?
- movement disorder
- twisting, muscle contraction, repetitive movement, abnormal posture
- starts in one limb then effects body
72
what causes Generalized dystonia?
- genetic: DYT1 dystonia - mutation in TOR1A gene
- secondary: Wilson's disease, cerebral palsy, brain injury, medication
73
how is generalised dystonia treated?
- muscle relaxants, anticholinergic drugs
- Botulinum toxin injections for muscle spams
- physical/speech therapy
74
what are primary headaches?
Migraine, Cluster,
Tension Type - most common
75
what causes secondary headaches?
Meningitis, Subarachnoid Haemorrhage, GCA, Idiopathic Intracranial Hypertension
Medication Overuse Headache
76
what features suggest secondary headache?
- sudden thunderclap headache
- infection - meningitis (neck stiffness, photophobia)
- Red eye - acute glaucoma
- Papilloedema
- seziures
77
what can cause transient loss of consciousness other than epilepsy?
- low bp/heart conditions
- syncope
78
types of epilepsy
- Genetic generalised epilepsy
- Unclassifiable epilepsy
- Structural / metabolic epilepsy
79
what is epilepsy
- Primary disturbance of brain function - excessive hypersynchronous neuronal firing
- changes of behaviour, sensation and cognition
80
how long do eplieptic seizures commonly last?
30 - 120 seconds
81
types of seizures?
- focal
- generalised
- eplieptic
- Convulsive status epilepticus
82
what is Convulsive status epilepticus
prolonged convulsive seizure lasting for 5 minutes or longer, or recurrent seizures one after the other without recovery in between
83
what does tonic clonic seizure mean
stiffening & jerking
84
what is Functional / dissociative seizure
- caused by mental processes triggered by internal/external stimuli
- eg from PTSD
85
what presentations are more common in epilepsy rather than syncope
- tongue biting
- head turning
- muscle pain
- loss of conciousness over 5 min
86
symptoms that indicate syncope not epilepsy
- sweating prior
- prolonged upright position
- nausea
- pallor
87
presentations indicating Functional / Dissociative Seizures (FDS) rather than epilepsy
- pre anxiety, crying etc.
- long duration
- closed eyes/mouth
- Surprisingly rapid or slow postictal recovery
- no cyanosis - blue fingers
88
what are types of epilepsy
- focal (Structural / metabolic) - with/without impairment of consciousness/Secondary generalised seizures
- Genetic (idiopathic) generalised epilepsy - Absence/Myoclonic/Primary generalised tonic clonic seizures
89
first line treatment of Structural / metabolic (focal) epilepsy
Lamotrigine / carbamazepine / levetiracetam
90
neuropathic finding in focal epilepsy
Hippocampal sclerosis especially temporal lobe seziures
91
first line treatment of Genetic (idiopathic) generalised epilepsy
Lamotrigine / levetiracetam / valproate
92
treatment if drugs not effective for epilepsy
- surgery - Hemispherectomy
- vagus nerve Electrostimulation - less effective
93
what causes ataxia
cerebellar degeneration
purkinje cell loss
94
autosmall recessive ataxia
Friedreich’s ataxia
95
autosomal dominant ataxia
- spinocerebellar ataxias
SCA 6
- episodic ataxias
EA 2
96
what drug can cause ataxia
lithium
97
immmune mediated ataxia
- paraneoplastic
cerebellar
degeneration
- gluten related
98
degenerative ataxia
multi-system atrophy cerebellar variant
(MSA-C)
99
Symptoms of cerebellar dysfunction
* dizzy – unsteady / wobbly / clumsy
* falls, stumbles
* difficulty focusing / double vision / ‘oscillopsia’
* slurred speech
* problems with swallowing
* tremor
* problems with dexterity / fine motor skills
100
clinical signs of ataxia
- nystagmus - uncontrolled eye movement
- intention tremor
- heel - shin ataxia
- gait
- Dysarthria - speech disorder
101
ataxia investiagtions
- MRI brain
- blood tests - gluten serology, HLA DQ8, autoimmune screen, CRP etc.
102
cause of motor neurone disease
degeneration and loss of upper and lower motor neurons
103
motor neurone disease risk factors
age 50-70
male
genetic
104
signs/symptoms of motor neurone disease
- muscle weakness/wasting (LMN)
- Fasciculations (LMN)
- spascicity, hyperreflexia (UMN)
- Dysarthria, dysphagia
- emotional lability - Inappropriate laughing or crying
- respiratory failure
105
motor neurone disease investigations
- Electromyography (EMG) and Nerve Conduction Studies (NCS)
- MRI - rule out lesions
- blood tests - exlude other
106
motor neurone disease treatment
- Riluzole: An antiglutamatergic drug (glutamate stims neurones)
- Baclofen or tizanidine for spasticity (GABA (cns inhibitor) agonist)
- Non-invasive ventilation
- Multi-disciplinary specialist care
107
cell body location of motor neurones
brain/spinal cord
108
main type of motor neurone disease
- ALS (amyotrophic lateral sclerosis)
109
motor neuone disease alternate diagnosis
- FTD
- Parkinson’s disease
- Myasthenia gravis
- Muscular dystrophies
- Spinomuscular atrophy
- Polio
110
gene mutations associated with motor neurone disease
- C9orf72
- SOD1 (Superoxide Dismutase 1)
- TDP-43
111
what does primary lateral sclerosis effect
upper motor neurones
112
what does primary muscular atrophy effect
lower motor neurones
113
what does Amyotrophic lateral sclerosis effect
upper and lower motor neurones - 90% of MND
114
what are bulbar symptoms of MND
- Dysarthria
- dysphagia
- Bulbar pseudobulbar affect - inappropriate emotions
- facial/tongue weakness
- jaw jerk reflex test UMN
115
what nucleus are not affected by MND
oculomotor
onuf
(MND do not lose continance)
116
histological features of Alzheimer’s dementia
amyloid plaques
neurofibrillary tangles
117
types of dementia in order of prevelance
Alzheimer’s dementia
Vascular dementia
Lewy body dementia
Frontotemporal dementia (including Pick’s disease)
118
risk factor for vascular dementia
stroke
119
Vascular dementia presentation
stepwise fashion - stability then decline then stability
- Mood disturbances - depression
- cognative impairment
120
lewy body presentation
- visual hallucinations
- cognative problems - less memory
- sleep disorders
- death within 7 years
121
treatment of alzheimers
- Acetylcholinesterase (AChE) inhibitors
- Memantine - NMDA antagonist regulates glutamate
- Cognitive rehabilitation
- Cognitive stimulation therapy
122
alzheimers disease prevention
- reduce CVD risk - smoking, diet etc.
- treat depression
- no loneliness or social isolation
- staying mentally active
123
what tests assess memory/cognative function in alzheimers
Mini-Mental State Examination (MMSE)
Montreal Cognitive Assessment (MoCA)
124
imaging for alzheimers
- Positron Emission Tomography (PET) Scans - show amyloid-beta plaque
- CT/MRI scan - atrophy, tumours, stroke
125
gene mutations in alzheimers
APP, PSEN1, PSEN2
126
CSF analysis in alzheimers
- Total Tau (t-Tau) - elevated = dementia etc.
- Phosphorylated Tau (p-Tau) - elevated = AD
- Beta-Amyloid (Aβ) Peptides - low Aβ42
127
what asseses power/strength
The Medical Research Council (MRC) Scale of
Muscle Strength
0 - no mevement
5 - (full movement against full resistance)
128
lesions and pulmonary compliactions
high thoracic T2-T4 - vital capacity of 30-50%
T11 - strong cough, minimal dysfunction
129
lesions causing neurogenic shock
high thoracic
cervical
130
what is spinal shock
loss of motor, sensory, autonomic and reflex function at or below the level of injury
131
Brown-Sequard presentations
- UMN signs - lesion side
- weakness/paralysis, proprioceptive deficits on lesion side
- loss of pain and temperature sensation on the contralateral side
132
Non Compressive Myelopathy types
- inflammatory: MS, NMO, acute disseminated encephalomyelitis (ADEM)
- infectious: syphilis, Lyme, HIV, HSV, EBV, enteroviruses
- infarction: blockage in blood supply or spinal arteriovenous malformations (AVMs)
133
inflammation of spinal cord CSF analysis
- pleocytosis (WBCs)
- elevated igG
- gadolinium enhancement (on MRI_
134
Transverse Myelitis signs/symptoms
- numbness, tingling, or pain,weakness - normally bilateral
- Clearly defined sensory level
- Bowel and Bladder Dysfunction
- Autonomic Dysregulation
- rapid onset
135
causes of Transverse Myelitis
- infections
- autoimmune eg SLE, MS, NMOS
- idiopathic
136
Transverse Myelitis on MRI
- **Gadolinium Enhancement** (more in acute)
- Hyperintense lesions on T2-weighted images - large area of cords **cross-section**
- Spinal Cord **Swelling**/expanded
- **Longitudinally Extensive** - 3 or more vertabrae
- **thoracic** spinal cord most common
137
transverse myelitis treatment
- high-dose corticosteroids - Methyl Prednisolone
- plasma exchagne, IVIg
- bowel/bladder care
- rehab
138
Diagnostic Criteria for Neuromyelitis Optica
- Optic neuritis
- Acute myelitis
- And at least two of:
1. Contiguous spinal cord MRI lesion extends over 3 vertebral
segments.
2. Brain MRI not multiple
sclerosis.
3. AGP4-IgG
139
Conus Medullaris Syndrome (CMS) and Cauda Equina Syndrome (CES) comparison
- impotence = CMS
- reflexes: CMS dimished at level, brisk below, CES absent
- symetrical = CMS
- asymetrical = CES
- pain: CES - severe radicular pain, CMS - back pain
- saddle anesthesia - both
140
what is Syringomyelia
- fluid filled cysts - syrinx in spinal cord
- most commonly due to obstruction of CSF
- eg Chiari malformation
141
nitrous oxide-induced subacute combined degeneration causes and treatment
- n2o effects b12 metabolism and cuases demyelination
- Hydroxocobalamin as b12 supplement
- c3-c5 most commonly affected, axial slices show inverted V
142
what can cuase loss of light touch, vibration and joint position
copper/b12 deficiency
143
compensatory mechanism for increased intracranial pressure
- increased CNS drainage via ventricular system
- increased venous drainage via dural venous sinuses
144
what is Monro-Kellie Doctrine
relationship between the contents of the cranium and intracranial pressure.
145
intracranial volume and distribution
- 1700ml total
- CSF 150ml
- blood 150ml
- brain parenchyma 1400ml
146
normal value for intracranial pressure
5-15mmHg
147
what is herniation due to a tumour
- tumour growing caused raised intracranial pressure
- parenchyma shift in position and become displaced
- Uncal herniation - temporal lobe displaced
- Tonsillar herniation - cereballar tonsils displaced - compression on brainsetm
148
what brain tumours have/not IDH mutation
IDH mutation:
- Astrocytoma
- Oligodendroglioma + 1p/19q-codeleted
No IDH mutation:
- Glioblastoma - aggresive, grade 4 gliomas
149
what is dissociation?
involutary disruption in the normal integration of identity, sensation, perception, affacts, thoughts, memories, control of body
- feeling of being disconnected from one/world
150
what is mild/common dissociation
daydreaming
151
what are the symptom groups of functional neurological disorders
sensory
motor
seizures
cognative - memory, concentration, fatigue
152
what is functional neurological disorders likely cause
traumatic events
insoluble/intolerable problems
disturbed relationships
153
what is hoovers signs
voluntary and automatic movement inconsitency
- seen in functional neurological disorders
154
what are some presenations of functional neurological disorders
whack a mole sign - tremor moves when stopped
dystonia
falling towards support
exessive exabaration eg huffing and puffing
155
treatment of functional neurological disorders
- managing physical symptoms eg headaches
- physio/OT/SALT
- therapy, CBT
- hypnosis - some evidence
156
Myasthenia gravis symptoms
- Ptosis: Drooping of one or both eyelids.
- Diplopia: Double vision
- facial weakness - difficulty speaking/swallowing etc.
- generalised weakness - proximal muscles of the limbs
157
most common antibody in MG
Acetylcholine Receptor (AChR) Antibodies
- affect nicotinic acetylcholine receptors (AChRs) at the neuromuscular junction of skeletal muscles
158
investigation for MG
- antibody test
- A CT or MRI of the thymus gland is used to look for a thymoma.
- Edrophonium Test - improves muscle strength = +ve
159
what tumours is MG associated with?
thyomas
160
other MG antibodies
Muscle-specific kinase (MuSK) antibodies
Low-density lipoprotein receptor-related protein 4 (LRP4) antibodies
161
ways to elicit fatiguability in the muscles
Repeated blinking will exacerbate ptosis
Prolonged upward gazing will exacerbate diplopia on further testing
Repeated abduction of one arm 20 times will result in unilateral weakness when comparing both sides
162
treatment of MG
- Pyridostigmine - cholinesterase inhibitor - prolongs acetylcholine
- Immunosuppression (e.g., prednisolone or azathioprine)
- Thymectomy can improve symptoms, even in patients without a thymoma
- Rituximab
163
treatment of Myasthenic Crisis
- non-invasive ventilation or mechanical ventilation
- IV immunoglobulins
- plasmapheresis
164
Guillain-Barré syndrome trigger
infection eg
Campylobacter jejuni, cytomegalovirus (CMV) and Epstein-Barr virus (EBV).
165
Guillain-Barré pathophysiology
molecular mimicry
- B cells produce antibodies against pathogen
- also attack myelin sheath or the nerve axon itself
166
Guillain-Barré syndrome symptoms
- Symmetrical ascending weakness
- Reduced reflexes
- loss of sensation
- pain
167
Guillain-Barré syndrome investiagtion
- CSF - raised protein, normal glucose & cell count
- Nerve conduction studies - reduced signals
168
Guillain-Barré syndrome treatment
- Supportive care
- VTE prophylaxis (pulmonary embolism is a leading cause of death)
- IV immunoglobulins (IVIG) first-line
- Plasmapheresis
169
what is multiple sclerosis
- autoimmune
- causes demylination
- affects the central nervous system (the oligodendrocytes)
170
potential causes of MS
Multiple genes
Epstein–Barr virus (EBV)
Low vitamin D
Smoking
Obesity
171
optic neuritis in MS
Central scotoma (an enlarged central blind spot)
Pain with eye movement
Impaired colour vision
Relative afferent pupillary defect - pupils react differently
172
focal symptoms/signs in MS
Incontinence
Horner syndrome - ptosis, anhidrosis and miosis
Facial nerve palsy
Limb paralysis
Trigeminal neuralgia - severe facial pain
Numbness
Paraesthesia (pins and needles)
Lhermitte’s sign - electric shock sensation
173
types of symptoms in MS
- optic
- focal
- ataxia
174
diagnosis of MS
- MRI scans -typical lesions
- Lumbar puncture - oligoclonal bands in CSF
175
MS treatment
- steroids in relapse
- physio/OT
- treat depression, pain, fatigue etc.
176
causes of compressive myelopathy
- herniated disc
- spinal stenosis
- Spondylolisthesis - displacement vertabrae
- tumours
- infection - abscesses - potts disease
- osteoartheritis
177
symptoms of sciatica and spinal nerves
- unilateral pain: worse with movement, burning/jolt
- Numbness or Tingling in leg/foot
- weakness (leg)
(from spinal nerves L4 – S3)
178
sciatica investigation
MRI - shows herniations or bulges, stenosis etc.
179
what is Bilateral sciatica a red flag for?
cauda equina syndrome
