Neurology Flashcards
Define impaired consciousness.
the loss of normal level of awareness
what is the spectrum of impaired consciousness? from ? to ?
mild confusion to unrousable coma
what does GCS stand for?
glasgow coma scale
what is the minimum and maximum scores on the GCS?
3 - 15
what are the 3 subsections in the GCS?
- movement
- speech
- eye opening
how many points can you get in movement in GCS?
6
how many points can you get in speech in GCS?
5
how many points can you get in eye opening in GCS?
4
The lower the GCS score, the…
less conscious (the greater the impaired consciousness)
what does AVPU stand for?
Alert
Verbal
Pain
Unresponsive
give the 2 broad causes of impaired consciousness.
- structural damage
- global failure
what are the 2 types of structural damage? causing impaired c
- external (head injury)
2. internal (stroke, tumour, abscess etc)
what are the 4 types of global damage? causing impaired c
- metabolism
- infection
- seizure
- drugs & toxins
name 3 types of infections affecting the brain.
- meningitis
- malaria
- encephalitis
name 3 other severe infections that could affect the brain.
- urine
- GI
- pneumonia
Examples of drugs that can cause impaired conscious are..
- alcohol
- opiates
- ‘recreational drugs’
- anti-depressants
- anti-epileptics
- tranquilliser
- benzodiazepines
the 3 stages of treatment for impaired consciousness are..
1 - ABCDE
2 - Identify causes
3 - treat cause
define epilepsy
excessive electrical discharge in the brain
what are the 2 clinical features of epilepsy?
- focal (partial) seizures
- generalised seizures
what are the 2 types of focal seizure?
- simple and complex
indications of a simple focal seizure?
shaking down one side
indications of a complex focal seizure?
1st an aura
2nd odd behaviour (lip smacking, staring, odd posture, “out of it”)
name 4 generalised seizures?
- tonic/clonic
- petit mal
- myoclonic
- atonic
what is a petit mal seizure and who do they effect?
absence seizure in children (staring into space for 10 sec)
what happens during a myoclonic seizure?
limbs jerking and collapse
what happens in a atonic seizure?
limbs collapse
what are some causes of epilepsy?
primary - hereditary
secondary
- structural damage
- metabolic damage
3 ways to investigate epilepsy?
- blood tests
- brain imaging
- EEG
2 ways to treat epilepsy
- drugs
2. surgery
name 4 drugs that can be given to treat epilepsy?
- phenytoin
- carbamazepine
- sodium valproate
- lamatorigine
what are 2 surgery options that can help some kinds of epilepsy?
- tumour removal
- arteriovenous malformation
when to avoid dental treatment with an epileptic patient?
if not well controlled
what are the red flags that indicate secondary headache disorders? (8)
- sudden onset
- severe pain
- features of raised intracranial pressure signs are
- worse on change in position
- present on walking
- nausea and vomiting - focal neurology (CNS deficit = weakness in limbs)
- impaired consciousness/confusion
- fever - meningitis?
- associated history ie cancer/HIV
- visual changes
name 5 types of primary headache disorders.
- tension headache
- migraine
- cluster headache
- medication overuse headache
- trigeminal neuralgia
symptoms of a tension headache are…
- gradual onset (chronic)
- symetrical
- ‘tight band’ feeling
- worse towards end of the day
what is the cause of tension headache?
stress related
what are the 2 treatment options for tension headache?
- conventional analgesic
- tricyclic anti depressants for prophylaxis
define a migraine.
the temporary reduction in blood flow, followed by compensatory increase in blood flow
what is the incidence of migraines?
common
8% more in females
what are common triggers of migraines?
- often none
- wine, cheese, chocolate, fasting
- OCP, premenstrual
- anxiety, sleep deprivation
how long does the pre headache ‘aura’ typically last for?
15 mins
what are 3 symptoms of a migraine?
- one sided throbbing pain
- nausea and vomiting
- photophobia
what are the 3 treatment options for acute migraines?
- conventional analgesics
- metoclopramide - to prevent nausea
- serotonin agonists (sumatriptan)
what are the 3 types of drugs that can be given in chronic migraines? what else can be done - other than drugs
- anti-epilptics
- amitriptyline
- beta blockers
- avoidance of triggers
define cluster headaches.
the dilation of superficial temporal artery
cluster headaches are more common in men or women?
men
what are the symptoms of cluster headache?
severe pain around the eye
- watery
- blood shot
- lid swelling
- running nose
what is the onset and duration of cluster headaches?
- rapid onset
- lasting
name two drug groups that give the greatest risk of medication overuse heachache?
- opiates
- triptans (serotonin receptor agonists)
how to manage medication overuse headaches?
- medication withdrawal
what brings about pain from trigeminal neuralgia?
- touch ( shaving, washing, talking )
or - spontaneous
management of trigeminal neuralgia is
- rule out other causes
- carbamazepine
give 5 causes of secondary headache disorders
- head injury
- infection (eg meningitis)
- non-traumatic bleeds
- giant cell arteritis (temporal arteritis)
- glaucoma (increased pressure in eyeball)
what is hydrocephalus?
a drainage problem that can follow - head injury - tumour - infection or can be idiopathic
4 causes of raised intracranial pressure are…
- tumour
- bleeds (either head injury or non-traumatic)
- hydrocephalus
- abscess
how can raised intracranial pressure be diagnosed?
CT scan
name the 3 types of bacterial meningitis.
- meningococcus
- pneumococcus
- haemophilus
who is affected by meningococcus meningitis? how is it spread?
- infants
- adolescents
- young adults
spread through contact
who is affected by pneumococcus meningitis?
- babies
- elderly
who is affected by haemophilus meningitis?
- babies
- infants
what are the 5 common symptoms of meningitis?
- impaired consciousness
- meningism = neck stiffness
- drowsy
- photophobia
- +/- rash with meningococcus
2 ways that meningitis can be diagnosed are…
- lumbar puncture = spinal fluid collected
2. blood clutures
management of meningitis?
- urgent hospitalisation
- empirical antibiotics
- prophylaxis for contacts
define encephalitis
Inflammation of the brain parenchyma
what is the cause of encephalitis?
viral infections
- herpes simplex
- varicella zoster
- rabies
associated features of encephalitis are… 4 things
- impaired consciousness
- personality changes
- menigism (neck stiffness)
- seizures
2 ways to diagnose encephalitis…
- lumbar puncture
2. EEG
2 ways to mange encephalitis?
- hospitalisation
- anti-virals
the most common cerebral abscess is caused by what?
streptococci or staphlococci infections from
- otits mitus
- mastoiditis
- sinusitis
- dental infections
what is otitus mitus?
inflammation of the middle ear
what is mastoiditis?
inflammation of the mastoid process
what is sinusitis?
inflammation of the nasal sinus
name the 3 types of infections causing secondary headache disorders are?
- meningitis
- encephalitis
- cerebral abscess
symptoms of cerebral abscess are?
- increased intracranial pressure
- focal neurology
2 ways that cerebral abscess can be diagnosed are?
- CT scan (MRI better)
- biopsy/surgery sample
what is the 2 ways to manage a cerebral abscess
- antibiotics
2. drainage
name the 2 types of non-traumatic cerebral bleed?
- sub-arachnoid haemorrhage (SAH)
2. intracerebral haemorrhage (ICH)
where in the brain is affected by a SAH?
the subarachnoid space
where in the brain is affected by ICH?
bleed is directly into the brain tissue
in 70% of SAH what happens and why?
rupture due to congenital berry aneurysm
in one 15% of SAH what happens? and the other 15%?
15% = no cause 15% = rupture due to arterovenous malformation
what is ICH associated with?
hypertension
what can ICH also be called?
charcot-bochard aneurysms
what is the incidence of SAH?
35-65 year olds
15 in 100,000
4 symptoms of SAH?
- sudden severe headache (often occipital area)
- drowsy
- vomiting
- collapse
true or false
ICH is always accompanied by a headache.
False
what 2 additional symptoms (from SAH) are present with ICH?
- focal neurology
- raised intracrainal pressure
how would you diagnose ICH?
imaging
how would you diagnose SAH? 2 things
- CT scan +/- angiogram
- lumbar puncture
how common is re-bleeding in SAH? what %
30% re-bleeding
what are the two treatment options?
- surgery (clipping)
- coils - probs preferred option
what is giant cell arteritis?
where the medium and large arteries in the neck become inflamed
who is most likely to be affected by giant cell arteritis?
over 55
what are the 3 main concerns with someone who had giant cell arteritis?
risk of
- blindness
- stroke
- death
what are the 3 main clinical features of giant cell arteritis/
- scalp tenderness (esp at the temporal area)
- jaw claudication - pain when chewing
- loss of vision
what are the 2 investigations into giant cell arteritis?
- blood samples - ESR/PV
2. Temporal artery biopsy
what is the treatment for giant cell arteritis?
HIGH dose IMMEDIATE prednisolone
symptoms of glaucoma are?
- constant ache around 1 eye
- reduced vision
- watery eye, blood shot red
- dilated and non reactive pupils
- nausea and vomiting
