Neurology 2 Flashcards
what neurological signs and symptoms present In sensory functions ?
changes in special senses:
sigh smell taste hearing and balance
Changes in sensation
- Numbness - anaesthesia
- Reduced sensation - paraesthesia
- Tingling/pins and needles - dysaesthesia
what neurological signs and symptoms present in motor functions ?
Power
Tone
Reflexes
Coordination
Tremor
how do we check for resting tone?
if we move a pts arm and there’s no resistant - lack of tone
- If resistance = increase in tone = nervous system injury
what’s a reduced reflex ?
injury in peripheral nerves
whats an increased reflex ?
CNS injury
what is a tremor?
shake
we all have low altitude
parkinsons = high tremor
what neurological signs and symptoms present in cerebral functions ?
- speech (forming words and choosing words and understanding words
- thoughts
- memories
what are central nerves ?
brain and spinal cord
- damaged central nerves do not recover
what are peripheral nerves ?
nerves connected to central nerves
axon of peripheral nerves may recover
give eg of peripheral nerve injuries
IDN, lingual nerve injury
Trigeminal neuralgia
Carpal tunnel syndrome
Sciatica
what is trigeminal neuralgia ?
- 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
what divisions does trigeminal neuralgia affect ?
1 = ophthalmic
2 = maxillary
3 = mandibular - doesn’t cross midline
how do we diagnose trigeminal neuralgia ?
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
how do we treat trigeminal neuralgia
-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)
what is carpal tunnel syndrome?
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
what are the results of carpel tunnel?
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
how do we manage carpal tunnel?
Rest - splints
Exercises
Drugs - NSAIDs, steroids
Surgical decompression
what is sciatica?
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)
dermatomes in sciatica
pain and numbness
altered sensation in dermatome
management of sciatica in practice
- 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
how can seizures present?
Loss of consciousness
Staring (absence)
Confusion
Strange sensation/emotion (aura)
Sudden fall
what are the causes of epilepsy?
Genetic
Trauma
Stroke
Tumour
Infection
Epilepsy vs seizures
One or two seizures is not epilepsy
Epilepsy is characterized by repeated seizures
what are the stages of seizures ?
Prodrome- feeling before seizure
Aura- before seizure
Tonic phase- muscle tightening
Clonic phase- shake, usually self limiting
Post-ictal- distressed and sleepy
what to do to manage seizures ?
- making sure pt is safe
- cushion head
- don’t restrain them
- talk to them
- time seizure
drugs for eplisepy
Largely pharmaceutical
Carbamazepine (Tegretol)
Levetiracetam (Keppra)
Sodium Valproate
Phenytoin
Gabapentin
Pregabalin
what is MS?
Aggressive auto-inflammatory disease of the CNS
Demyelination of nerves
Occasionally may effect peripheral nerves but mainly central
what are the symptoms of MS?
numbness weakness coordination speech etc
what are the different types of MS?
Only 15% have primary progressive MS
So most people with MS will have variable symptoms
and disability.
how do we manage MS?
Holistic
May end up wheelchair-bound
Need for carers
Pharmaceutical
Inflammatory mediators
Steroids
special monoclonal antibodies
what is the incidence of MS?
Incidence: more common further from the equator
what affected in Parkinson’s and Huntingtons ?
Base ganglia
- hub of the brain with communications going in and out
whats the function of the basal ganglia ?
Communication hub with other parts of the CNS.
Major function is CONTROL of movement. - how fast how far
Automatic functions (posture, balance
what does disease of basal ganglia lead to?
Difficulty controlling movements
Difficulty starting movements
Difficulty stopping movements
Prevalence and aetiology of Parkinson’s
Approx 1% >80 years
Complex aetiology:
Genetic
Environmental
what is the impact of Parkinson ?
Loss of dopaminergic neurons (dopimergic cells) in nigrostriatal tract - used in treatment
Difficulty initiating movement and stopping
Tremor
Also emotional changes
what are some signs of parkinsons?
what is Huntingtons disease?
AKA Huntingtons chorea
disease of the basal ganglia
Corpus striatum and cerebral cortex
purely genetic
autosmal dominat
50% chance if one parent has it
what are symptoms of Huntingtons
Uncontrollable movements
Depression
Dementia
- incurable
what are pyramidal tracts?
- 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
what is pseudo Parkinsonism ?
impacts of extra pyramidal effect
what is acute dystonia ?
impacts of extra pyramidal effect
what is akathisia?
impacts of extrapyramidal effect
what is tardive dyskinesia ?
impacts of extrapyramidal effects
dentistry and neurodisease
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
