Neurology 2

Question 1

what neurological signs and symptoms present In sensory functions ?

Answer 1

changes in special senses:
sigh smell taste hearing and balance

Changes in sensation
- Numbness - anaesthesia
- Reduced sensation - paraesthesia
- Tingling/pins and needles - dysaesthesia

Question 2

what neurological signs and symptoms present in motor functions ?

Answer 2

Power
Tone
Reflexes
Coordination
Tremor

Question 3

how do we check for resting tone?

Answer 3

if we move a pts arm and there’s no resistant - lack of tone
- If resistance = increase in tone = nervous system injury

Question 4

what’s a reduced reflex ?

Answer 4

injury in peripheral nerves

Question 5

whats an increased reflex ?

Answer 5

CNS injury

Question 6

what is a tremor?

Answer 6

shake
we all have low altitude
parkinsons = high tremor

Question 7

what neurological signs and symptoms present in cerebral functions ?

Answer 7

• speech (forming words and choosing words and understanding words
• thoughts
• memories

Question 8

what are central nerves ?

Answer 8

brain and spinal cord

• damaged central nerves do not recover

Question 9

what are peripheral nerves ?

Answer 9

nerves connected to central nerves
axon of peripheral nerves may recover

Question 10

give eg of peripheral nerve injuries

Answer 10

IDN, lingual nerve injury
Trigeminal neuralgia
Carpal tunnel syndrome
Sciatica

Question 11

what is trigeminal neuralgia ?

Answer 11

• disorder of trigemnial nerve
• damage to the schwan cells which insulate the nerve causing pain as there’s constant sensation
• sharp pain - electric shock
• trigger point = face washing
• last few seconds but u can get several attacks in a minute

Question 12

what divisions does trigeminal neuralgia affect ?

Answer 12

1 = ophthalmic
2 = maxillary
3 = mandibular - doesn’t cross midline

Question 13

how do we diagnose trigeminal neuralgia ?

Answer 13

clinical diagnosis
pt cannot move
history of it
MRI confirms it - will show inflammation around trigmainal nerve or pulse in artery - refer to neurosurgeon
rule of MS in children
older pt - idiopathic neuralgia

Question 14

how do we treat trigeminal neuralgia

Answer 14

-Carbamazepine (medical)

Surgical
- Cryotherapy (freezing specific nerve, damage, lasts 6-12 months)
- Radiofrequency ablation (damage with heat)
- Radiotherapy (gamma knife) (damage specific dose, effect ganglion)

Question 15

what is carpal tunnel syndrome?

Answer 15

The median nerve is compressed at the wrist

The ‘carpal tunnel’ is a narrow passageway of ligament and bone housing the median nerve as it passes through
the wrist

Question 16

what are the results of carpel tunnel?

Answer 16

Results in sensory and motor
supplies sensation to index middle thumb and half of ring finger
May impact on a person’s ability to grip a toothbrush
May impact you ability to hold a drill (safely)

can get wasting of thumbs see in next card

diagnosis - clinical
can be associated with diabetes

Question 17

how do we manage carpal tunnel?

Answer 17

Rest - splints
Exercises
Drugs - NSAIDs, steroids
Surgical decompression

Question 18

what is sciatica?

Answer 18

Very common
Is a symptom not a diagnosis
Can range from mild to severe pain and sometimes loss of motor function
Commonly due to IV disc disease (compression of nerve due to cancer/trauma)

Question 19

dermatomes in sciatica

Answer 19

pain and numbness
altered sensation in dermatome

Question 20

management of sciatica in practice

Answer 20

• refer to gp as can rapidly deteriorate if in S1 S2 S3 S4 -Numbness around perineum, genitalia, incontinence is a
  neurological emergency!
• always ask about distribution of numbness

Question 21

how can seizures present?

Answer 21

Loss of consciousness
Staring (absence)
Confusion
Strange sensation/emotion (aura)
Sudden fall

Question 22

what are the causes of epilepsy?

Answer 22

Genetic
Trauma
Stroke
Tumour
Infection

Question 23

Epilepsy vs seizures

Answer 23

One or two seizures is not epilepsy
Epilepsy is characterized by repeated seizures

Question 24

what are the stages of seizures ?

Answer 24

Prodrome- feeling before seizure
Aura- before seizure
Tonic phase- muscle tightening
Clonic phase- shake, usually self limiting
Post-ictal- distressed and sleepy

Question 25

what to do to manage seizures ?

Answer 25

• making sure pt is safe
• cushion head
• don’t restrain them
• talk to them
• time seizure

Question 26

drugs for eplisepy

Answer 26

Largely pharmaceutical
Carbamazepine (Tegretol)
Levetiracetam (Keppra)
Sodium Valproate
Phenytoin
Gabapentin
Pregabalin

Question 27

what is MS?

Answer 27

Aggressive auto-inflammatory disease of the CNS
Demyelination of nerves
Occasionally may effect peripheral nerves but mainly central

Question 28

what are the symptoms of MS?

Answer 28

numbness weakness coordination speech etc

Question 29

what are the different types of MS?

Answer 29

Only 15% have primary progressive MS

So most people with MS will have variable symptoms
and disability.

Question 30

how do we manage MS?

Answer 30

Holistic
May end up wheelchair-bound
Need for carers
Pharmaceutical
Inflammatory mediators
Steroids
special monoclonal antibodies

Question 31

what is the incidence of MS?

Answer 31

Incidence: more common further from the equator

Question 32

what affected in Parkinson’s and Huntingtons ?

Answer 32

Base ganglia
- hub of the brain with communications going in and out

Question 33

whats the function of the basal ganglia ?

Answer 33

Communication hub with other parts of the CNS.
Major function is CONTROL of movement. - how fast how far
Automatic functions (posture, balance

Question 34

what does disease of basal ganglia lead to?

Answer 34

Difficulty controlling movements
Difficulty starting movements
Difficulty stopping movements

Question 35

Prevalence and aetiology of Parkinson’s

Answer 35

Approx 1% >80 years

Complex aetiology:
Genetic
Environmental

Question 36

what is the impact of Parkinson ?

Answer 36

Loss of dopaminergic neurons (dopimergic cells) in nigrostriatal tract - used in treatment
Difficulty initiating movement and stopping
Tremor
Also emotional changes

Question 37

what are some signs of parkinsons?

Answer 37

Question 38

what is Huntingtons disease?

Answer 38

AKA Huntingtons chorea
disease of the basal ganglia
Corpus striatum and cerebral cortex
purely genetic
autosmal dominat
50% chance if one parent has it

Question 39

what are symptoms of Huntingtons

Answer 39

Uncontrollable movements
Depression
Dementia
- incurable

Question 40

what are pyramidal tracts?

Answer 40

• Connect cerebral cortex to medulla and spinal column.
• Basal ganglia: extra-pyramidal, control of movement, balance, suppression of tremor etc.
• Lots of drugs affect extra-pyramidal cells: anti-cholinergics, anti-psychotics, MAOIs, etc.
• Extra-pyramidal effects: similar to some signs/symptoms of Parkinsons/Huntingtonds
• Tremor, uncontrolled movement of head and neck

Question 41

what is pseudo Parkinsonism ?

Answer 41

impacts of extra pyramidal effect

Question 42

what is acute dystonia ?

Answer 42

impacts of extra pyramidal effect

Question 43

what is akathisia?

Answer 43

impacts of extrapyramidal effect

Question 44

what is tardive dyskinesia ?

Answer 44

impacts of extrapyramidal effects

Question 45

dentistry and neurodisease

Answer 45

ASK THE PATIENT
Be aware of potential impact on oral hygiene and work around it. (comes up in exams)
Be aware of drug interactions
Involve carers early
Look after your fingers and instruments in seizures!
These are chronic illnesses - be flexible