Neurology 2.0 Flashcards
Nystagmus is associated with a lesion of what cranial nerve and why?
CN VIII Things like vertigo or an vestibular defect can cause nystagmus
- pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
- Typically last 4-12 weeks
- intense sharp, stabbing pain around one eye (recurrent attacks ‘always’ affect same side)
- patient is restless and agitated during an attack
What is this and what else is a telling symptoms
Cluster Headaches
- accompanied by redness, lacrimation, lid swelling
- nasal stuffiness
- miosis and ptosis in a minority
Treatment for a cluster Headache Attack.
Prophylaxis?
Acutely
- 100% Oxygen
- Triptan
Prophylactically
- Verapamil
What things are risk factors for cluster headaches
Being male, smoking, another family member, alcohol can exacerbate
Chronic paroxysmal hemicrania?
Multiple (5+) short (5-10min) headaches that are centered around the eye (VI)
*CH are usually longer >15min and more common in men
What is the first line treatment for Chronic paroxysmal hemicrania
Indomethacin
What are you ‘red flags’ for headaches?
- sudden onset
- severe and debilitatin pain
- fever
- vomiting
- disturbed consciousnes
- max in the morning
- worse with bending/cough/sneezing
- neuro symptoms and signs
- “new” in elderly
- you obese female
Probable cause of an acute headache?
Respiratory tract infection
Probable cause of chronic headaches?
Tension-type
Combination
Migraine
Transformed migraine
Describe a tension-type headache
- Symmetrical tightness
- episodic or chronic
- Last for hours and recurr each day
What is the mnemonic to remember cerebellar disease symptoms and what are they?
D ysdiodochokinesia: This is this inability to perform rapid alternating movements
A taxia
Nystagmus
Intention tremor
Slurred staccato speech
Hypotonia
How to remember glascow coma score?
654 MoVE
Motor (6 points) Verbal (5 points) Eye opening (4 points).
Motor response
- Obeys commands
- Localises to pain
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
Verbal response
- Orientated
- Confused
- Words
- Sounds
- None
Eye opening
- Spontaneous
- To speech
- To pain
- None
ABCD2
used to assess a patient’s stroke risk after a transient ischaemic attack.
CHA2DS2VASC
- CHF hx +1
- Hypertension +1
- Age >75 +2
- Diabetic +1
- Stroke/TIA +2
- Vascular disease Hx +1
- Age 64-75 +1
scoring tool used to assess the risk of stroke in patients with atrial fibrillation
Features of a subdural haemorrage?
What vessels are impacted?
- fluctuating consciousness
- raised ICP
- headache
- commonly seen in trauma eg; oldperson/alcohol and falling over
- damage too the bridging vessels between cortex and venous sinuses
What is an Acoustic neuroma
what will you see with big ones?
more correctly called vestibular schwannomas
noncancerous growth that develops on the eighth cranial nerve.
cranial nerve VIII: hearing loss, vertigo, tinnitus
If a large tumour other CN may be involved:
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
When you are investigating a potentially acoustic neuroma/vestibular schwanomma, what imaging do you want to be doing?
MRI of cereballar-pontine angle
OR intracranial
Three main subtypes of Ischaemic Stoke, what should you be thinking about with each
- Embolic Strokes: AF
- ECG → telemetry → Holter moniter
- Thrombotic Stroke: Carotid stenosis
- US
- Hypoperfusion Stroke: Low CO
- Shock?
What stroke is NOT associated with Carotid stenosis
POCS- Posterior Circulation Stroke Syndrome
As it impacts the posterior aspect of the circle of willis
What ELSE would you see wil POCS apart from 2 of the classical stroke signs?
- Cerebellar signs:
- Vestibular signs: vertigo
- Brainstem signs: Change in HR, BP, RR
What type of ischaemic stroke is associated with HTN?
Lacunar stroke
If someone has a homonymous quadrantopia, where will the lesion be?
PITS
Parietal: inferior
Temporal: Superior
Always contralateral to the site!
What do you prescribe for suspected Bell’s Palsy?
Prednisolone and lubricating Eye drops
patients may not be able to close their eyes and may also need eye tapes!
A 61-year-old man presents with a two-week history of a sharp, stabbing pain over his right cheekbone. He describes the pain as ‘very severe’ and ‘coming in spasms’. It typical lasts for around one minute before subsiding. The pain can be triggered by shaving and eating. Examination of his eyes, cranial nerves and mouth is unremarkable. What is the most likely diagnosis?
Trigeminal neuralgia
Unilateral pain commonly evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth (trigger factors), and frequently occurs spontaneously
What is Guillian Barre?
What are the main initial symptoms?
An immune-mediated demyelination of the PNS, often triggered by an infection.
- Progressive weakness “tingling/numbness → flaccid paralysis” of all four limbs: ascending, hands +feet first.
- Mild sensory involvement
- Back pain
- areflexia
- Resp depression
- diplopia
- autonomic involvement; eg urinary incontinence
What bacteria commonly triggers guillian barre?
Campylobacter
so look out for previous gastro symptoms in the Hx!!
How quickly does Gullian Barre progress?
hours to weeks.
Symptoms usually peak ~2-4weeks
How is it that a campylobacter, CMV or EBV can cause Gullian Barre?
They all have capsules that contain antigens have similar structures to the axons of myelocytes
and when the body creates an antibody response both the virus and muscle cells are attackes
“molecular mimicry”
How do you diagnose Gullian Barre?
Bilateral weakness
Areflexia (absent reflexes)
LP shows high protein + low WBC in CSF
EMG may show decrease muscle velocity
How do you treat Guillain Barre
Plasmapheresis
Immunoglobulins
??resp support??
Corticosteriods are AVOIDED
What is the triad you will see with normal pressure hydrocephalus?
- Urinary incontinence
- Dementia + bradyphrenia (slow thought)
- Gait abnormality
These symtpoms will develop over a few months
What will you see on imaging with Normal Pressure Hydrocephalus?
- Hydrocephalus + an enlarged 4th ventricle
Normal pressure hydrocephalus is a common cause of _____ in the elderly, and is due to what?
Common cause of dementia in the elderly
Due to inadequant CSF absorption by arachnoid villi
What are the commonly known side effects of electroconvulsive therapy
- Nausea
- Short term memory impairment
- Headaches
- Cardiac arrhythmias
What do you use blood test wise to distinguish between a true seizure and a pseudo seizure
Measure prolactin (increased after real seizures)
What are the 2 important causes of status epilepticus to rule out first?
Hypoxia and hypoglycaemia
