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Phase 2a > Neurology 2 > Flashcards

Neurology 2 Flashcards

1
Q

What is a sudden onset headache likely to be?

A

SAH - sudden onset worst ever thunderclap occipital headache and neck stiffness

Migraine - more gradual onset, history of migraines

Venous sinus thrombosis

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2
Q

What is a subdural haematoma?

A

Bleeding between the arachnoid and dura mater

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3
Q

What are the risk factors of subdural haematoma?

A

More common in patients with smaller brains e.g. alcoholics, elderly

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4
Q

What causes a subdural haematoma?

A

Often head injury – can be minor/from a long time ago, sometimes the patient doesn’t remember/notice the injury

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5
Q

What is the site of the bleed in a subdural haematoma?

A

Bridging veins between the dura and arachnoid mater

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6
Q

How does a subdural haematoma present?

A

Confusion/drowsiness
Fluctuating consciousness
Signs of raised ICP
Focal neurological signs e.g. hemiparesis.

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7
Q

What is the difference in presentation between an acute and chronic subdural haematoma?

A

Acute presents like an extradural, chronic presents more gradually with fluctuating consciousness

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8
Q

How do you investigate subdural and extradural haematomas?

A

1st line = IMMEDIATE CT HEAD – remember blood is white on CT

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9
Q

What is an extradural haematoma?

A

Bleeding between the dura mater and skull bone

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10
Q

What causes an extradural haematoma?

A

Traumatic head injury! Usually associated with skull fracture

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11
Q

Where is the site of the bleed in an extradural haematoma?

A

Middle meningeal artery

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12
Q

How does an extradural haematoma present?

A
  1. Head injury
  2. Brief loss of consciousness/drowsiness
  3. Lucid period
  4. Rapid decline in consciousness as it compresses other structures.
  5. Signs of raised ICP.
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13
Q

How do you treat subdural and extradural haematomas?

A

Surgery
Craniotomy/decompressive craniectomy/burr hole
IV mannitol to reduce ICP

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14
Q

What can happen if a haematoma keeps growing?

A

Compress local structures + raises ICP > cerebellar herniation/coning + brainstem death

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15
Q

What are the signs of a growing haematoma?

A 
Severe headache
N+V
Confusion
Seizures
Papilloedema
Eventually start to get signs of brainstem compression (RAISED ICP)
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16
Q

What is the body’s response to raised ICP?

A

Cushing’s triad > bradycardia + HTN + deep irregular breathing

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17
Q

What are the common causes of raised ICP?

A

Haemorrhages
Tumours
Hydrocephalus

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18
Q

What are the less common causes of raised ICP?

A

Infections e.g abscess

Metabolic stuff – hypercalcaemia, hyponatraemia

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19
Q

What does a subdural haematoma look like on a CT scan?

A

Crescent shaped haematoma in 1 hemisphere
On CT blood gets darker over time so chronic ones are usually hypodense (dark)
Look for midline shift

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20
Q

What does an extradural haematoma look like on a CT scan?

A

Biconvex/lemon shaped haematoma adjacent to skull

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21
Q

What is an intracerebral haemorrhage?

A

Bleeding into the brain tissue

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22
Q

What causes an intracerebral haemorrhage?

A

HTN

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23
Q

Where is the site of bleeding in an intracerebral haemorrhage?

A

Can be anywhere - intraventricular, cerebellar, lobar

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24
Q

What is the most common site of an intracerebral bleed?

A

Basal ganglia

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25
Q

How does an intracerebral haemorrhage present?

A

Signs of raised ICP, rapid loss of consciousness, focal neurological signs

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26
Q

How do you investigate an intracerebral haemorrhage?

A

CT head - shows irregularly shaped, high density area

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27
Q

How do you manage an intracerebral haemorrhage?

A

Clot evacuation

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28
Q

What can cause loss of consciousness?

A

Epileptic seizure
Syncope
Psychogenic non-epileptic seizure

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29
Q

What are the 2 types of syncope?

A

Vasovagal and cardiogenic

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30
Q

What causes cardiogenic syncope?

A

Due to an arrhythmia

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31
Q

What is the cause of blackouts during exercise until proven otherwise?

A

Cardiogenic syncope

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32
Q

What are the key investigations after loss of consciousness?

A

Vital signs including BP
Bloods - glucose, FBC, U+Es
Same day ECG then 24hr ECG
EEG if they have another event

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33
Q

How does a non-epileptic seizure present?

A

Often stay a normal colour/normal vital signs
Eyes closed
Retained consciousness - may be able to respond
Pelvic thrusting, arching back, erratic movements

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34
Q

How are non-epileptic seizures treated?

A

No treatment

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35
Q

How does timing of seizures compare with syncope?

A

Seizures - anytime, commonly during activity

Syncope - day or after prolonged standing

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36
Q

How does prodome of seizures compare with syncope?

A

Seizures - brief (twitching, hallucinations)

Syncope - longer (light-headedness, dizziness, confusion, tunnel vision, vertigo, N+V, headache, sweating, palpitations)

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37
Q

How does the duration of seizures compare with syncope?

A

Seizures - variable

Syncope - <5 mins

38
Q

How do tonic-clonic movements of seizures compare with syncope?

A

Seizures - common with tongue biting and head turning

Syncope - rare

39
Q

How does colour change in seizures compare with syncope?

A

Seizures - may be cyanosed

Syncope - pallor

40
Q

How does injury in seizures compare with syncope?

A

Seizures - common

Syncope - rare

41
Q

How does urine incontinence in seizures compare with syncope?

A

Seizures - common

Syncope - rare

42
Q

How does recovery from seizures compare with syncope?

A

Seizures - post-ictal symptoms: drowsiness, confusion, headache, myalgia, sore tongue

Syncope - quick

43
Q

How many seizures are required for an epilepsy diagnosis?

A

At least 2 unprovoked seizures >24 hours apart

44
Q

What are the stages of an epileptic seizure?

A
  1. Prodome
  2. Aura
  3. Ictus
  4. Post-ictal period
45
Q

How long do seizures normally last?

A

30-120 seconds

46
Q

What happens in the prodome stage of an epileptic seizure?

A

Change of mood/behaviour before attack

47
Q

What happens in the aura stage of an epileptic seizure?

A

Part of the seizure where the patient is aware, symptoms just before attack e.g. déjà vu

48
Q

What happens in the ictus stage of an epileptic seizure?

A

Attack itself, usually positive symptoms e.g. jerking

49
Q

What happens in the post-ictal stage of an epileptic seizure?

A

Negative symptoms e.g. weakness, drowsiness, myalgia

50
Q

What are the different types of epilepsy?

A

Primary generalised

Partial/focal seizures

51
Q

What is the pathology of primary generalised epilepsy?

A

Electrical discharge throughout whole cortex

52
Q

What are the features of primary generalised epilepsy?

A

No localising features
Bilateral symmetrical manifestations
Loss of consciousness/awareness

53
Q

What is the pathology of partial/focal seizures?

A

Features restricted to limited part of the cortex of one hemisphere

54
Q

What are the features of partial/focal seizures?

A

May remain conscious

May later become generalised + spread to both hemispheres (secondary generalised tonic-clonic seizure)

55
Q

What are the different types of primary generalised seizures?

A

Generalised tonic clonic (grand mal)
Absence (petit mal)
Myotonic
Atonic

56
Q

What are the classic features of a generalised tonic clonic seizure?

A 
Epileptic cry at onset
Tonic then clonic phase
Eyes remain open
Lose consciousness
May be cyanosed
Post-ictal drowsiness/confusion
57
Q

What happens in the tonic phase of a seizure?

A

Sudden rigid limbs

58
Q

What happens in the clonic phase of a seizure?

A

Bilateral muscle jerking +/- tongue biting, incontinence

59
Q

What are the classic features of an absence seizure?

A

Sudden cessation of activity
No aura
No post-ictal period

60
Q

Who is commonly affected by absence seizures?

A

Usually in children, likely to develop tonic-clonics as an adult

61
Q

How does a patient appear when they are having an absence seizure?

A

Often stop talking mid-sentence and stare blankly/pale for a few seconds/stay still then continue where they left off and don’t realise it happened

62
Q

How long do absence seizures last?

A

<30 seconds

63
Q

What are the classical features of a myoclonic seizure?

A

Repetitive but isolated shock-like symmetrical jerks of limb/face/trunk

64
Q

What are the classical features of an atonic seizure?

A

Sudden loss of muscle tone > drop attack (fall to ground). Usually remain conscious

65
Q

What are the 2 types of focal seizures?

A

Simple and complex

66
Q

What is a simple focal seizure?

A

Does not affect consciousness / memory
No post-ictal signs
Motor, sensory, autonomic, psychic signs

67
Q

How long do simple focal seizures last?

A

10-20 seconds

68
Q

What are complex focal seizures?

A

Memory affected before during or after

Temporal lobe so post-ictal confusion + automatisms common

69
Q

Where do complex focal seizures usually occur?

A

Temporal lobe

70
Q

How do seizures in the temporal lobe present?

A

Aura
Automatisms
Post-ictal confusion & headache

71
Q

What symptoms are experienced in the aura phase of a seizure?

A

Déjà vu, auditory hallucinations, strange smells, fear, vertigo

72
Q

Give some examples of automatisms.

A

Lip smacking, chewing, fiddling etc.

73
Q

What is the main cause of temporal lobe epilepsy?

A

Hippocampal sclerosis

74
Q

How does a parietal lobe seizure present?

A

Sensory disturbances e.g. tingling, skin crawling

75
Q

How does an occipital lobe seizure present?

A

Visual phenomena

76
Q

How does a frontal lobe seizure present?

A

Motor features - posturing/peddling legs
Jacksonian march
Post-ictal Todd’s paralysis
No post-ictal confusion

77
Q

What is Jacksonian march?

A

Motor symptoms spread from distal limb to face on ipsilateral side

78
Q

What is post-ictal Todd’s paralysis?

A

Paralysis of limbs involved for a few hours

79
Q

How is a diagnosis of epilepsy made?

A

Clinically with description of attacks - eyewitnesses

80
Q

What investigations are done for epilepsy?

A

EEG during next seizure, almost always abnormal during epilepsy
MRI/CT to exclude underlying cause e.g. space occupying lesion
Bloods
ECG

81
Q

What is classed as an emergency in epileptic patients?

A

Seizure lasting >3 mins

82
Q

How is an epileptic emergency treated?

A

ABCDE management + IV diazepam/lorazepam. Repeat twice until it stops. IV phenytoin if still fitting after this.

83
Q

What is the long-term management of epilepsy?

A

Primary generalised - sodium valproate (CI in pregnancy - use lamotrigine)
Partial seizure - carbamazepine
Inform DVLA - can’t drive until seizure free for >1 year

84
Q

When should drugs be prescribed for epilepsy?

A

After 2nd seizure of after 1st if high risk of recurrence

85
Q

What is the main complication of epilepsy?

A

Status epilepticus

86
Q

What is status epilepticus?

A

Continuous seizure (>30 mins or 2+ seizures without recovery)

87
Q

How is status epilepticus managed?

A

2 doses of benzodiazepine e.g. lorazepam then anti-epileptic drugs e.g. IV valproate
Find and treat underlying cause

88
Q

What could be the underlying cause to status epilepticus?

A

Non-adherence to medication, alcohol, acute brain problem

89
Q

What is the risk posed by status epilepticus?

A

Hypoxic brain injury

90
Q

What should you aim for when treating epilepsy?

A

Monotherapy

Phase 2a (25 decks)

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