Neurology Flashcards
- Functions of the brain stem?
- Affects on the brain stem during stroke?
- BP, breathing, HR, swallowing
- Dysphasia, vertigo, insomnia, difficulty organising/ understanding the environment, inability to coordinate balance and movement
- Functions of the cerebellum?
- Effects on the cerebellum during stroke?
- Balance and coordination, fine muscle control
- Inability to coordinate fine movements, walk, grab/ reach out to objects, make rapid movements, vertigo/ tremors, slurred speech,
- Occipital lobe functions?
- Effects on the occipital lobe during stroke?
- Vision
- Colour and movement agnosia, difficulty reading/ writing, VF defects, difficulty locating objects, hallucinations, inability to recognise words and seeing objects inaccurately
- Parietal lobe functions?
- Effects on the parietal lobe during a stroke?
- Language, reading, coordination, sensation, intelligence, reading
- Anomia, agraphia, alexia, dyscalculia, apraxia, inability to focus visual attention
- Temporal lobe functions?
- Effects on the temporal lobe during a stroke?
- Speech, behaviour, memory, emotions, vision, hearing
- Wernicke’s aphasia, difficulty IDing and naming objects, aggressive behaviour, short-term memory loss, hypersexuality,
- Functions of the frontal lobe?
- Effects on the frontal lobe during a stroke?
- Locomotion, mood, intelligence, judgment, logic, decision-making, behaviour, personality, planning, inhibition, memory
- Loss of simple body movements, Broca’s aphasia, loss of flexible thinking, sequencing, interaction, inability to focus, problem-solving difficulties, changes in mood, behaviour, personality
Essential problem with ischaemic VS haemorrhagic strokes?
What is the % proportion for each?
Ischaemic: Blockage in the blood vessel stops blood flow- 85%
Haemorrhagic: Blood vessel bursts leading to reduction in blood flow- 15%
Subtypes for ischaemic/ haemorrhagic stroke?
Ischaemic:
Thrombotic (thrombus from large vessel- carotids)
Embolic (blood clot, fat, air or clumps of bacteria)
AF
Haemorrhagic:
Intracerebral haemorrhage (bleeding within brain)
Subarachnoid haemorrhage (bleeding on surface of brain)
Risk factors for ischaemic/ haemorrhagic stroke?
Ischaemic:
General risk factors for cardiovascular disease
age
hypertension
smoking
hyperlipidaemia
diabetes mellitus
Haemorrhagic:
age
hypertension
arteriovenous malformation
anticoagulation therapy
Contraindications for thrombolysis?
Previous intracranial haemorrhage
Seizure at onset of stroke
Intracranial neoplasm
Suspected SAH
Stroke or traumatic brain injury in preceding 3 months
Lumbar puncture in preceding 7 days
Gastrointestinal haemorrhage in preceding 3 weeks
Active bleeding
Oesophageal varices
Uncontrolled hypertension >200/120mmHg
Management for meningitis in adults?
- IV Ceftriaxone (amoxicillin should be given as well if immunocompromised, elderly, neonate)
Chloramphenicol if severe penicillin allergy
- IV Dexamethasone given to all >3 months
Management for meningitis in children?
Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
Steroids: >3 months
Fluids
Cerebral monitoring
Public health notification
Management for cluster headache?
Acute:
-100% oxygen (80% response rate within 15 minutes)
-subcutaneous triptan (75% response rate within 15 minutes)
Prophylaxis:
-verapamil is the drug of choice
Headaches red flags?
-compromised immunity, caused, for example, by HIV or immunosuppressive drugs
-age under 20 years and a history of malignancy
a history of malignancy known to metastasise to the brain
-vomiting without other obvious cause
worsening headache with fever
-sudden-onset headache reaching maximum intensity within 5 minutes - ‘thunderclap’
-new-onset neurological deficit
-new-onset cognitive dysfunction
(change in personality, impaired level of consciousness)
-recent (typically within the past 3 months) head trauma
-headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked), sneeze or exercise
-orthostatic headache (headache that changes with posture)
-symptoms suggestive of giant cell arteritis or acute narrow-angle glaucoma
-a substantial change in the characteristics of their headache
- How does peripheral neuropathy caused by diabetes present?
- Management for peripheral neuropathy?
- Sensory loss in a ‘glove and stocking’ distribution affecting lower legs first
- First-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
If the first-line drug treatment does not work, try one of the other 3 drugs
Tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
topical capsaicin may be used for localised neuropathic pain
Pain management clinics may be useful in patients with resistant problems
What additional investigations can be done in a young person with a stroke?
‘Young’ stroke blood tests include thrombophilia and autoimmune screening - performed in those under 55 with no obvious cause of a stroke
ANA
APL
ACL
LA
ESR
Syphilis serology
Symptoms of carpal tunnel?
Examination for carpal tunnel?
Causes?
Management?
History
-pain/pins and needles in thumb, index, middle finger
-unusually the symptoms may ‘ascend’ proximally
-weakness of thumb abduction
-wasting of thenar eminence (NOT hypothenar)
-Tinel’s sign: tapping causes paraesthesia
-Phalen’s sign: flexion of wrist causes symptoms
Causes
idiopathic
pregnancy
oedema- heart failure
lunate fracture
rheumatoid arthritis
Management:
trial of wrist splint +/- steroid injections
if fails -> surgical decompression
Management for lower back pain?
Lower back pain without sciatic symptoms:
NSAIDs +/- PPIs
If sx persist for 4-6 weeks -> referral for MRI
What is the definition of Parkinson’s?
Classical triad of sx?
Neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra.
The reduction in dopaminergic output results in a classical triad of features:
Bradykinesia-> poverty of movement, shuffling gait, difficulty in initiating movement
Tremor-> mostly at rest, pill-rolling tremor, worse when stressed or tired
Rigidity- lead-pipe and cogwheel rigidity
Other characteristic features of Parkinson’s?
Other characteristic features:
mask-like facies
flexed posture
micrographia
drooling of saliva
psychiatric features: depression is the most common feature (affects about 40%); dementia, psychosis and sleep disturbances may also occur
impaired olfaction
REM sleep behaviour disorder
fatigue
autonomic dysfunction:
postural hypotension
- What is Myasthenia Gravis?
-Autoimmune condition resulting in insufficient functioning acetylcholine receptors.
-Antibodies to acetylcholine receptors are seen in 85-90% of cases. (MuSK, LRP4)
-Abs bind ACh-recepotors and blocks these receptors and prevents ACh from stimulating and triggering muscle contraction
-Associated with Thymoma (thymus cancer)
Women <40
Men >60
Muscle weakness-> affects proximal muscles
Worse with activity
Improves with rest
Myasthenia Gravis symptoms?
How to elicit symptoms?
-extraocular muscle weakness: diplopia
-proximal muscle weakness: face, neck, limb girdle
-ptosis
-dysphagia
-fatigue in jaw
-slurred speech
Repeated blinking -> ptosis
Upward gazing -> diplopia
Repeated abduction-> unilateral weakness
Thymectomy scar following thymoma treatment
Investigations for Myasthenia Gravis?
single fibre electromyography: high sensitivity (92-100%)
Abs:
ACh-Abs
MuSK-Abs
LRP4-Abs
CT/ MRI thorax of thymus gland-> check for thymoma
Tensilon test: IV edrophonium
Management for Myasthenia Gravis?
ACh-inhibitors: pyridostigmine is first-line
Immunosuppression is usually not started at diagnosis, but the majority of patients eventually require it in addition to long-acting acetylcholinesterase inhibitors:
prednisolone initially
azathioprine, cyclosporine, mycophenolate mofetil may also be used
Thymectomy
