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Phase 2A Med Concise > Neurology > Flashcards

Neurology Flashcards

1
Q

Transient ischaemic attack (TIA) - Pathophysiology

A

Focal, sudden onset, neurological deficit lasting <24hrs, with complete clinical recovery
Ischaemia, without infarction

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2
Q

Transient ischaemic attack - Causes

A

Thromboembolism (from carotids)

Cardioembolism

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3
Q

Transient ischaemic attack - Symptoms

A

Weakness in left arm
Slurred speech
Left sided facial droop

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4
Q

Transient ischaemic attack - Risk factors

A

Smoking
Alcohol
Obesity - exercise/diet

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5
Q

Transient ischaemic attack - Investigations

A 
ABCD2 - Stroke risk score
Carotid doppler (stenosis)
CT angiography (stenosis)
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6
Q

Transient ischaemic attack - Treatment

A

Aspirin
Clopidogrel
Simvastatin
B-blocker (Atenolol)

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7
Q

Stroke - Pathophysiology

A

Rapid onset of neurological deficit caused by focal, cerebral, spinal or retinal infarction
If untreated within 24hrs leads to death

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8
Q

Stroke - Signs and symptoms

A

ACA (Anterior cerebral artery) - Frontal lobe - Drowsiness, logical thinking, personality
MCA (Middle cerebral artery) - Motor weakness, hemiplegia (paralysis of one side of body), sensory disturbances, aphasia (affected speech)
PCA (Posterior cerebral artery) - Contralateral hemianopia (blindness over half field of vision)

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9
Q

Stroke - Investigation

A

CT scan - check whether ischaemic or haemorrhagic

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10
Q

Stroke - Treatment

A

Ischaemic stroke - Aspirin/clopidogrel, IV altepase (thrombolysis)
Haemorrhagic - B-blocker (control BP), beriplex (if warfarin related), surgery
Rehab - Physio, OT
Lifestyle

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11
Q

Haemorrhage - Types

A

Extradural - Middle meningeal artery
Subdural - Bridging veins
Subarachnoid - Circle of Willis

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12
Q

Subarachnoid haemorrhage - Pathophysiology

A

Circle of Willis (subarachnoid)

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13
Q

Subarachnoid haemorrhage - Cause

A

Berry aneurysm causes spontaneous bleed in subarachnoid space

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14
Q

Subarachnoid haemorrhage - Symptoms

A

Sudden sharp pain in back of head
Neck stiffness
Systemically fine
Lower consciousness (raised ICP (intracranial pressure) due to artery rupture)

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15
Q

Subarachnoid haemorrhage - Investigations

A

CT

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16
Q

Subarachnoid haemorrhage - Treatment

A

Neurosurgery

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17
Q

Subdural haemorrhage - Pathophysiology

A

Rupture of bridging veins

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18
Q

Subdural haemorrhage - Cause

A

Head injury

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19
Q

Subdural haemorrhage - Symptoms

A

Fluctuating consciousness and headache due to raised ICP

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20
Q

Subdural haemorrhage - Investigations

A

CT - Crescent shaped collection of blood

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21
Q

Subdural haemorrhage - Treatment

A 
Neurosurgery - Irrigation
IV mannitol (reduce ICP)
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22
Q

Extradural haemorrhage - Pathophysiology/Cause

A

1) Head injury
2) Fracture in temporal/parietal bone
3) Rupture of middle meningeal artery
4) Rapid collection of blood in extradural space

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23
Q

Extradural haemorrhage - Symptoms

A

Decreased consciousness due to raised ICP

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24
Q

Extradural haemorrhage - Investgations

A

CT - Biconvex, hypodense haematoma

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25
Extradural haemorrhage - Treatment
``` Neurosurgery - Irrigation IV mannitol (Reduce ICP) ```
26
Epilepsy - Pathophysiology
2 or more unprovoked seizures with 24hrs apart Seizure - Recurrent tendency of spontaneous, abnormal electrical activity in part of the brain due to excessive hypersynchronous neuronal discharges
27
Epilepsy - 2 Types
Generalised - Whole cortex | Partial/focal - Lobe
28
Generalised epilepsy - Symptoms
1) Rigidity/sitffening 2) Rhythmic muscle jerking 3) Drowsiness, confusion and coma
29
Partial/focal epilepsy - Symptoms
``` Frontal lobe (motor) - Jacksonian march (seizure 'marches' up/down motor homonculus), limb paralysis Parietal lobe (sensory) - Numbness, tingling Temporal lobe (memory, emotion) - Hallucinations, out of body experience - fiddling ```
30
Differences between epilepsy and syncope
Seizure - Sudden onset, any position, falls backwards | Syncope - Sitting or standing, falls forwards
31
Epilepsy - Investgations
EEG (Electroencephalogram)
32
Epilepsy - Treatment
Emergency - IV lorazepam Generalised - Sodium valporate Partial/focal - Carbamezapine
33
Dementia - 4 Types (AVLF)
Alzheimer's Vascular Lewy body Fronto-temporal
34
Alzheimer's - Onset
Gradual
35
Alzheimer's - Signs and symptoms (4As)
Aphasia (speech) Agnosia (sensation, recognition) Apraxia (motor) Amnesia (memory)
36
Alzheimer's - Pathology
Degeneration of cerebral cortex with cortical atrophy
37
Vascular - Onset
Gradual or abrupt
38
Vascular - Signs and symptoms
Deterioration
39
Vascular - Pathology
Brain damage from cerebrovascular disease
40
Lewy body - Onset
Gradual
41
Lewy body - Signs and symptoms
Fluctuating cognition | Visuospatial impairment
42
Lewy body - Pathology
Deposition of abnormal proteins associated with parkinson's disease
43
Fronto-temporal - Onset
Rapid progression
44
Fronto-temporal - Signs and symptoms
Behavioural and personality changes
45
Fronto-temporal - Pathology
Atrophy of fronto-temporal lobes
46
Dementia - Pathophysiology
A syndrome that causes memory loss, difficulties thinking, problem-solving, language
47
Dementia - Investigation
Clinical diagnosis | Mini-mental state exam (MMSE) - <17/30 = Serious cognitive impairment
48
Dementia - Treatment
Lifestyle Social support Rivastigmine (acetylcholinesterase inhibitor) Control CV risk factors
49
Differences between dementia and delirium
Delirium - Acute, fluctuating, altered consciousness, caused by stroke or infection Dementia - Gradual, progressive, normal consciousness, caused by disorder
50
Headaches - 2 Types
Primary - Migraine, cluster, tension-type, trigeminal neuralgia Secondary - GCA, meningitis, drug overuse
51
Migraine - Symptoms
Unilateral more commonly (can be bilateral) Pulsating/throbbing Lasts 4-72hrs Moderate to severe pain
52
Migraine - Causes (CHOCOLATE)
``` Chocolate Hangovers Orgasms Cheese Oral contraceptive pill Lie-ins Alcohol Tummult (loud noises) Exercise ```
53
Migraine - Pathophysiology
1) Changes in brainstem blood flow 2) Unstable trigeminal nerve nucleus/nuclei in basal thalamus 3) Release of vasoactive neuropeptides (substance P) 4) Neurogenic inflammation, vasodilation
54
Migraine - Types
Migraine with aura | Migraine without aura
55
Migraine - Without aura - Symptoms
``` >5 Attacks Lasting between 4-72 hours Unilateral, pulsating, moderate/severe pain N&V Photophobia, phonophobia ```
56
Migraine - With aura - Symptoms
``` >2 Attacks Each aura symptom lasts up to an hour Visual abnormalities (zigzags, spots) Unilateral sensory (tingling, numbness) Aphasia Motor weakness Followed by headache ```
57
Migraine - Treatment
Avoid triggers | Sumatriptan (Triptan)
58
Prophylaxis definition
Preventative treatment
59
Tension headache - Symptoms
``` Lasts 30mins-7days Bilateral band around forehead Tight/pressing Lasts mins-days Mild/moderate pain Photophobia, phonophobia (only one, not both!) No N&V ```
60
Tension headache - Pathophysiology
Neurovascular irritation which refers to scalp muscles and soft tissues
61
Tension headache - Causes (MC SCOLD)
``` Missed meals Conflict Stress Clenched jaw Overexertion Lack of sleep Depression ```
62
Tension headache - Treatment
Amitriptyline (antidep)
63
Cluster headache - Symptoms
``` Unilateral Orbital, supraorbital or temporal pain Lasts 15mins-3hrs Severe pain Night/morning hours ```
64
Cluster headache - Treatment
Sumatriptan
65
Trigeminal neuralgia - Symptoms
Unilateral facial pain confined to divisions of the trigeminal nerve Electrifying/stabbing/lightning pain (very severe) Lasts few seconds-few mins No neurological deficit
66
Trigeminal neuralgia - Cause
Compression of trigeminal nerve by intracranial vessels or a tumour, or other abnormal prominence
67
Trigeminal neuralgia - Treatments
``` Neuropathic analgesic (Gabapentin) Surgical ```
68
Giant cell arteritis - Symptoms
``` Headache Jaw claudication Fever Weight loss Depression ```
69
Giant cell arteritis - Signs
Palpable, tender and reduced pulsation of temporal arteries
70
Giant cell arteritis - Investigations
Temporal artery biopsy | Bloods - Raised ESR/CRP
71
Giant cell arteritis - Treatment
Prednisolone Aspirin PPI (Omeprazole)
72
Secondary headaches
Raised ICP
73
Parkinsonism - Pathophysiology
Syndrome consisting of bradykinesia, resting tremor, rigidity
74
Parkinsonism - Cause
Infections (encephalitis) Drug induced Vascular parkinsonism
75
Parkinson's disease - Cause
No known cause
76
Parkinson's disease - Pathophysiology
Neurodegenerative loss of dopamine secreting cells from the substantia nigra Lack of dopamine causes alteration in neural circuits within basal ganglia that regulates movement
77
Parkinson's disease - Symptoms
Bradykinesia (problems with daily activities) Tremor (unilateral) Rigidity (stooped posture) Gait (shuffling, reduced arm swing, slow to start) Postural instability (impaired balance, more so when turning) Depression Dementia Hallucinations
78
Parkinson's disease - Investigations
CT/MRI head - Atrophy of substantia nigra
79
Parkinson's disease - Treatment
No cure! Co-careldopa (carbidopa/levodopa) - dopamine precursors Ropinirole (Dopamine receptor agonist) Amantadine (anticholinergic) - tremor
80
Huntington's disease - Pathophysiology
Autosomal dominant 1) >36 triplet repeats in huntington gene 2) Faulty huntington protein builds up in striatum causing cell death and loss of GABA-nergic neurons 3) Less GABA causes less regulation of dopamine to striatum causing increased dopamine levels and so increased movement
81
Huntington's disease - Symptoms
Purposeless, dance-like movements) Dementia Rigidity
82
Huntington's disease - Investigations
``` Genetic testing (<36 triplet repeats in huntington gene) MRI - Atrophy of striatum (caudate/putamen) ```
83
Huntington's disease - Treatment
No cure! Risperidone (Dopamine receptor antagonist) - chorea/aggressive behaviour Sertraline (SSRI) - depression
84
Multiple sclerosis - Pathophysiology
Chronic autoimmune T-cell mediated demyelination of the CNS
85
Multiple sclerosis - Risk factors
Young (20-40) F>M Further from equator (VitD link)
86
Multiple sclerosis - Signs and symptoms
Motor weakness Slurred talking Numbness Tremor
87
Multiple sclerosis - Investigations
MRI (Demyelination plaques) | Lumbar puncture/CSF - CNS inflammation
88
Multiple sclerosis - Treatment
``` No cure! IV methylprednisolone (steroid) - acute attacks Beta interferon (chronic) B-blocker (tremor) Baclofen (spacicity) Gabapentin (neuropathic pain) ```
89
Motor neuron disease - Pathophysiology
Destruction of motor neurons in: Motor cortex (UMN signs) Anterior horn cells (LMN signs) Cranial nerve nuclei (Mixed UMN/LMN signs)
90
Motor neuron disease - Lesions (symptoms)
UMN lesion - Weakness, increased reflexes, increased tone | LMN lesion - Weakness, atrophy, decreased reflexes, decreased tone
91
Motor neuron disease - Symptoms
``` Stiffness Muscle wasting in hands Tripping/stumbling gait Foot drop Slurred speech Overall muscle atrophy and spasticity ```
92
Motor neuron disease - Investigations
Bloods - Raised CK (creatinine kinase) due to muscle destruction Electromyography - Denervation of muscles Nerve conduction studies - R/O Motor neuropathies Lumbar puncture - R/O inflammatory causes MRI - R/O lesions
93
Differences between motor neuron disease and multiple sclerosis
MND - No sensory loss | MS - Sensory loss
94
Motor neuron disease - Treatment
``` No cure Riluzole (Anti-glutaminergic sodium channel blocker) MDT approach PEG tube (dysphagia) Baclofen (spasticity) Analgesic ladder (joint pain) ```
95
Brain tumours - Pathophysiology
Progressive focal neurological deficit
96
Brain tumours - Symptoms
Raised ICP - Headaches, vomiting Epilepsy - focal or generalised seizures Weight loss Malaise
97
Brain tumour - Types (GMAS)
Glioma Meningioma Acoustic neuroma Secondary
98
Spinal cord compression - Pathophysiology
Myelopathy | Compression of spinal cord resulting in upper neuron signs and symptoms dependent on where compression is
99
Spinal cord compression - Causes
Osteophytes (bony projection when cartilage wears) Disc prolapse Tumour
100
Spinal cord compression - Symptoms
UMN signs (everything increased)
101
Spinal cord compression - Investigations
MRI urgently
102
Spinal cord compression - Treatment
Surgical decompression
103
Brown-sequard syndrome - Sign
Spinal nerve lesions | Level of lesion - Ipsilateral spinothalamic dysfunction (local sign)
104
Radiculopathy - Pathophysiology
Compression of nerve root (LMN)
105
Mononeuropathy - Pathophysiology
1 nerve
106
Polyneuropathy - Pathophysiology
Multiple/systemic
107
Peripheral neuropathy - Causes
``` Compression Infarction Demyelination Infection Drugs ```
108
Carpal tunnel syndrome - Risk factors
``` Pregnancy Obesity Hypothyroidism Rheumatoid arthritis Gout Acromegaly ```
109
Carpal tunnel syndrome - Symptoms
``` Hand pain Hand parathesia Worse at night Loss of sensation in palms (radial) Wasting of abductor pollicis brevis ```
110
Carpal tunnel syndrome - Investigations
Phalens and tinents
111
Carpal tunnel syndrome - Treatment
Pain relief Hydrocortisone injection Surgical decompression
112
Sciatica - Pathophysiology
Nerve lesion of S1 nerve root (compression)
113
Sciatica - Symptoms
Sensory loss | Pain in back of thigh/leg/lateral aspect of little toe (sciatic nerve distribution)
114
Sciatica - Causes
Disc prolapse | Osteoarthritis
115
Sciatica - Investigation
MRI urgently
116
Cauda equina nerve lesion - Pathophysiology
Lesion at or below L1 (Bundle of spinal nerves - horses tail)
117
Cauda equina nerve lesion - Causes
Tumours Disc herniation Trauma
118
Cauda equina nerve lesion - Symptoms/signs
``` Lumbosacral pain Bladder problems Bowel problems Urinary retention Erectile dysfunction ```
119
Cauda equina nerve lesion - Investigation
MRI spine
120
Cauda equina nerve lesion - Treatment
Surgical decompression | Dexamethasone
121
3rd cranial nerve palsy - Pathophysiology
Tramps palsy - Down and out
122
7th cranial nerve palsy - Pathophysiology
Bell's palsy - Muscles of facial expression droop (Forehead and lip) In a stroke just lip droops with forehead sparing, but bell's palsy includes forehead too
123
7th cranial nerve palsy - Treatment
Steroid (infection)
124
1st cranial nerve lesion - Pathophysiology
Anosmia (olfactory)
125
5th cranial nerve lesion - Pathophysiology
Facial sensation and muscles of mastication (trigeminal)
126
8th cranial nerve lesion - Pathophysiology
Hearing and balance (vestibulococlear)
127
9th/10th cranial nerves lesions - Pathophysiology
Swallow, gag, cough (glossopharyngeal, vagus)
128
11th cranial nerve lesion - Pathophysiology
Sternocleidomastoid and trapezius - Shrug shoulder and shake head (accessory)
129
12th cranial nerve lesion - Pathophysiology
Tongue deviates towards side of lesion (hypoglossal)
130
Raised ICP - Symptoms
``` Headache Vomiting Pupillary changes Seizures Worse in morning ```
131
Raised ICP - Investigation
CT head | Ophthalmology review
132
Raised ICP - Investigation
Mannitol Surgical (shunt/decompression) Dexamethasone (tremor)
133
Myasthenia gravis - Pathophysiology
Autoimmune IgG autoantibodies attach to receptors at NMJ
134
Myasthenia gravis - Symptoms
``` Muscle weakness and fatigability Ptosis (upper eyelid drooping) Talking and chewing problems Swallowing Any muscle can be affected variably ```
135
Myasthenia gravis - Investigations
Anti-MuSK antibodies Electromyography CT/MRI - thyoma (thymus hyperplasia)
136
Myasthenia gravis - Treatment
Pyridostigmine (acetylcholinesterase inhibitor) Prednisolone (immunosuppression) Methotrexate/cyclosporine Thymectomy
137
Duchenne muscular dystrophy - Pathophysiology
X-linked recessive Only males (young) Muscle degeneration and eventually premature death
138
Duchenne muscular dystrophy - Symptoms
Awkward manner of running Frequent falls Easily fatigued
139
Meningitis - Pathophysiology
Inflammation of the meninges
140
Meningitis - Symptoms
``` Neck stiffness Headache Photophobia Fever Non-blanching rash (meningococcal septicaemia) ```
141
Meningitis - Causes
Viral - Herpes simplex, mumps | Bacterial - Strep pneumoniae, neisseria meningitis, listeria monocytogene
142
Meningitis - Investigation
CSF analysis - protein, colour, glucose CT head Bloods - FBC, culture
143
Meningitis - Treatment
GP - IM benzylpenicillin Hospital - IV cefotaxime Contacts - Rifampicin, men C vaccine
144
Encephalitis - Pathophysiology
Infection of brain parenchyma | Unlike meningitis, cerebral function is altered
145
Encephalitis - Causes
Viral | Bacterial
146
Encephalitis - Symptoms
``` Fever Headache Behavioural change Seizures Coma ```
147
Encephalitis - Investigations
Lumbar puncture - Raised lymphocytes Bloods - culture (Viral PCR) CT head
148
Encephalitis - Treatment
Immediate high dose IV acyclovir
149
Herpes zoster - Pathophysiology
Initial infection - Chicken pox Reactivation - Shingles Varicella lies dormant in dorsal root ganglion
150
Herpes zoster - Risk factors (reactivation)
Elderly | Immunocompromised
151
Herpes zoster - Symptoms
Dermatomal distribution of rash and pain
152
Herpes zoster - Treatment
Oral acyclovir
153
Gullian-barre syndrome - Pathophysiology
Inflammation Demyelinating Polyneuropathy in PNS
154
Gullian-barre syndrome - Causes
Campylobacter jejuni
155
Gullian-barre syndrome - Symptoms
Progressive distal to proximal muscle weakness Motor and sensory Loss of reflexes Resp depression
156
Gullian-barre syndrome - Investigations
Lumbar puncture - Increased protein in CSF Nerve conduction studies Vital capacity (resp depression suspicion)
157
Gullian-barre syndrome - Treatment
IV Ig Ventilation No steroids!
158
CJD (Creutzfeldt-jakob disease) - Pathophysiology
Neurodegenerative disease | Apoptosis of neurons leads to cysts and plaques forming in brain giving it a sponge-like appearance
159
CJD - Symptoms
``` Ataxia Poor memory Behavioural changes Muscle weakness Dementia ```
160
Stroke risk score
ABCD2

Phase 2A Med Concise (18 decks)

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