Neurology Flashcards
What are the 10 components in an Abbreviated Mental state examination?
- Age
- Location
- Date
- Identify two people (nurse and doctor)
- Address
- Current Monarch
- Time
- Dates of WW2
- Count backwards from 20
Give 3 causes of a Spontaneous non-traumatic intraparenchymal haemorrhage?
What would you see on MRI scans?
- Hypertension
- Amyloid Deposits
- Anticoagulation
Hyperdense ellipital mass
Give 4 neurological emergencies:
- Sudden onset thunderclap headache
- Sudden loss of power (GBS)
- Generalised respiratory failure (GBS and MG)
- Status Epilepticus
- Loss of bladder function: spinal cord compression
Give 4 causes of a coma:
- Drugs: amphetamines or poisoning
- Brain haemorrhage
- Brain Injury
- DKA
- Mass lesions (tumours)
What are 3 complications of amphetamines;
- Seizures
- Psychosis
- Ischaemic stroke/ Intracranial haemorrhage
What are 3 complications of cocaine?
- Seizures
Anxiety. confusion
Psychosis
What is the definition of status epilepticus?
What are the 3 stages of management:
- Continuation of seizing for more than 5 minutes without a break.
1. Benzo
2. Lamotrigine
3. Ventilate
Bimodal common in old and young
What are 3 causes of Status E?
- Alcohol withdrawal
Anoxia
Hypotension
Cerebrovascular disease
3 complications of GBS:
- Respiratory Distress
- Autonomic instability: sudden severe hypotension and cardiac arrythmias
- Long term numbness
What are the 7 components of the motor pathway?
- Motor Cortex (tumor, stroke or MS)
- Medulla (tumor, stroke or MS)
- Spinal Cord
- Anterior Horn
- Motor Neurons
- Neuromuscular Junctions
- Muscles
What are 3 symptoms of PN?
- Numbness and Tingling
- Reduced Sensation
- Burning sensation
What is the ROSIER scoring system?
It is a scoring system and stands for Recognition of Stroke in the Emergency Room.
- Any loss of consciousness
- Any seizure activity
- Any new onset of FAST or stroke like symptoms
What is the 4 step management of a TIA?
- Start Aspirin
- Treat BP
- Order CT
- Do ABCD2
What is ABCD2?
It is a risk assessment tool that looks into the patient’’s risk of a TIA after a stroke:
- Low risk 0-3
- Medium Risk 4-5
- High Risk 6-7
High risk start on aspirin and change this to clopidogrel after 2 weeks
What are 3 causes of transient loss of consciousness?
- NEAD
- Syncope
- Epileptic seizure
What is epilepsy?
An overfiring of the neurones. Leading to a tendency to seize.
What is Transient Global Cerebral Hypoperfusion?
This is basically syncope
Give 3 causes of syncope?
- Reflex or Vaso-Vagal Syncope
- Cardiogenic: i.e aortic stenosis, Heart attack or bradyarrhythmia
- Orthostatic hypotension: drugs or autonomic failure
Always do an ECG on unexplained Syncope
If someone always collapses when doing exercise what would you think?
- There is a reduced output blood flow i.e. aortic stenosis or hypertrophic cardiomyopathy.
- Brain can not be perfused enough
- As such fainting when exercise is said to be cardiogenic until proven otherwise.
What 4 investigations may you want to do on a patient with syncope?
- ECG
- EEG
- CT head
- Blood Glucose
- 24 hour blood pressure monitoring
What could a possible cause of sudden hemiparesis be?
- Parenchymal bleed in the internal capsule
2. Possible cause: hypertension
Give 4 conditions that mimick a stroke?
- Hypoglycaemia
- Todd’s Paralysis
- Migraine
- Brain Cancer
Give 4 Headache Red Flags:
- Waking up with Headache
- Headache that causes vomiting
- Seizures
- Local neuro deficits: blurred vision, weakness and tingling
If you damage your extrapyramidal tracts what symptoms may you get?
Cog Wheel rigidity
Clasp Knife
Bradykinesia
What is the diagnosis:
- Stange burns around body
- Loss of sensation in cape like distribution
- Loss of sensation in hands?
- Syringomyelitis
- Fluid filled cysts along the spinal cord
what type of myopathic disorder is more common?
Proximal
Give 4 causes of myopathic disorders?
- Genetic
- Corticosteroids
- Chemotherapy
- Immunosuppression
Would someone with a myopathy or NMJ disease struggle more with hills?
Myopathic disease struggles more with hills
What syndrome can paraneoplastic syndrome lead to? What is this? Give 3 symptoms
I.e. lung cancer =paraneoplastic Leads to Lambert Eaton syndrome - Generalised weakness - Ptosis - Constipation - Aching muscles
What are 3 signs of NF-1 ?
Cafe-au-lait spots
Freckling in armpits and groin
Short stature and large head
What can happen in NF-2 ?
Benign growths in the ears. Which leads to hearing loss.
What is Schwannomatosis?
Tumours that develop in the cranial, spinal and peripheral nerves. Leads to chronic pain, numbness and weakness of muscles
What is radiculopathy? What does C6 do? What does C7 do? What does L5 do? What does S1 do?
Compression of spinal root
C6: leads to biceps (6 letters) hitchhikers thumb
C7: triceps (7 letters) elbow extension and middle finger
L5: dorsiflexion. Big tow and dorsum
S1: plantar flexion. Small tow and sole. Unable to stand on tows
3 signs of raised ICP:
Headaches
Vomiting
Visual Disturbances
What is normal pressure hydrocephalus?
What are 3 causes of NPH?
What are the 3 main symptoms?
What will be seen in the clinical signs?
What investigations would you like to do?
What are 2 ways to manage the condition?
- Dilation of the ventricles in the absence of a raised CSF
- SAH, Meningitis and Head Injury
- Incontinence, Gait disturbance and Dementia (distortion of the limbic system leads to memory loss and inattention)
- UMN signs like brisk reflexes and papilloedema may be present
- Investigations: MRI/CT and lumbar puncture
- Treatment: carbonic anhydrase inhibitor and repeated lumbar punctures alongside insertion of a CSF shunt
What is Bulbar Palsy?
What two components makeup speech?
What are 3 causes of BP?
What are 4 clinical signs of bulbar palsy?
- A disease of the CN IX-XII in the medulla. All of which are required for speech
- Phonation (production of sounds (vocal cords)) and articulation (a contraction of structural muscles).
- MND, MS and a stroke
- Fascinating tongue, drooling, quiet speech, dysarthria and jaw jerk is absent
What is Pseudo-Bulbar Palsy is it more common than Bulbar Palsy?
What are 3 causes
What are the clinical signs
It is more common than bulbar palsy
It is an UMN lesion and has a bilateral lesion in the mid pons
- Causes: MND, MS and stroke
- Drooling, dysarthria and quiet speech. Increased jaw jerk
AND INCONGRUENT mood: giggling or sobbing.
What is the definition of NEAD?
Non epileptic Attack Disorder refers to paroxysmal events that are not due to epilepsy. There are 2 categories:
- Physiological: like syncope, TIA and non-toxic organic hallucinations
- Psychogenic: dissociative and involuntary. Most commonly due to panic attacks. Also can be due to Munhausen Syndrome
Who is NEAD common in?
How does a patient present?
3 DDx:
How to diagnose?
Females and those who have suffered abuse or PTSD
- Eyes closed, pelvic thrusting, no incontinence, no postictal symptoms
- Generally, don’t injure themselves.
DDX: syncope, TIAs and migraines
Diagnosis: > 2 24 hours apart. Need to do CT/MRI/ EEG and Blood Glucose. Alongside a full psychiatric assessment
What is the definition of a stroke?
What are the two types of stroke that you get what is more common?
A stroke is a rapid onset neurological deficit: caused by focal, cerebral, spinal or retinal infarction. IT leads to global disturbance lasting for more than 24 hours or deat.
Haemorrhagic or Ischaemic. Ischaemic is more common
What are 3 causes of an ischaemic stroke?
What are 3 causes of haemorrhagic strokes?
- Cardio Emboli (AF, endocarditis, valve disease or fat emboli)
- Hyperviscosity, hypoperfusion or vasculitis
- Large artery stenosis
- Trauma
- SAH
- Warfarin
- Venous sinus thrombus
Give 5 RF for a stroke:
- Age
- Gender (male)
- Diabetes
- Smoking
- Ethnicity (black and asian more prevalent)
- Previous TIA
How would an ACA stroke present?
How would a MCA stroke present?
How would a PCA stroke present?
How would a posterior circulation stroke present as?
ACA: leg weakness, sensory disturbance of legs, gait apraxia and truncal ataxia
MCA: leg/arm weakness, sensory disturbance of legs/arms, hemianopia, aphasia and dysphasia
PCA: contralateral homonymous hemianopia, cortical blindness, visual agnosia, prosopagnosia and unilateral headache
Posterior circulation territory: vertigo, nausea and vomiting, visual disturbance and locked-in syndrome
What is a lacunar stroke? What does it lead to?
Small subcortical strokes (midbrain or internal capsule) One of: - Unilateral weakness - Pure sensory loss - Ataxic hemiparesis
How do you diagnose a stroke?
How do you treat a stroke?
Urgent CT/MRI
BP, Pulse and ECG to check for HTN and AF
Bloods for FBC and blood glucose
Management:
- ALL hydrate and get on O2
- Ischaemic: within 4.5 hrs start on IV ateplase. Then Clopidogrel after 24 hrs
- Haemorrhagic: Vit K and Bereplex to reverse warfarin .
IV mannitol may be needed
Post stroke:
- Aspirin and clopidogrel
- Statins
- AF give warfarin or NOAC like apixaban
What are the 4 cardinal symptoms of brain cancer?
How is it Diagnosed:
- Papilloedema
- Raised ICP: headache worse on the morning, made better with vomiting, often wakes up patient, worse with coughing straining etc
- Vomiting
- Drowsiness
Other ones include seizures and focal neurological signs.
Diagnosis: CT/MRI brain and biopsy
How do you treat Brain cancer?
What are 5 common metastatic sites for Brain cancer?
- Surgical excision
- Chemotherapy and Radiotherapy
- Give Dexometasone
Common ones are:
- NSCLC
- SCLC
- Renal
- Melanoma
- GI
Motor Neurone Disease: give a definition
Who is it more prevalent in. What is the LE?
What gene is it associated with?
MND: this is a condition where there is major degeneration and selective loss of MN in the cortex, CN nuclei and anterior horn cells
Males. LE of 2-4 years
Associated with the SOD-1 gene
Motor Neurone Disease:
Where does it affect?
Main difference between MND and MG and MS
What CNs can it involve? What is this called?
The CN nuclei, anterior spinal cord and motor cortex
MG: affects the eye movements
MS: affects sphincter control
CNs it can involve are: 9,10,11 and 12 leading to bulbar palsy
Motor Neurone Disease: What is the most common form?
Does it affect UMN or LMN?
What are the Symptoms?
Amyotrophic Lateral Sclerosis (ALS)
UMN and LMN
It causes muscle wasting, fasciculations, hyper reflexia and babinski sign. Also can lead to foot and wrist drop
Motor Neurone Disease: What does progressive muscular atrphy affect ?
Give 3 symptoms?
- Affects the LMN
- Leads to the patient to have hypotonia, hyporeflexia, muscle wasting, fasciculations
What is Progressive Bulbar Palsy?
What does it lead to?
A LMN palsy of CN 9 10 11 and 12
Leads to dysarthria, dysphagia and nasal regurg
Tongue with be flaccid and fasiculating and speech with be quiet
What is Primary Lateral Sclerosis?
What does it cause a loss of?
UMN lesion
Loss of Betz cells
Causes spastic leg weakness, progressive tetraparesis and pseudobulbar palsy
What 2 tasks to patients with MND struggle with?
They struggle with: brushing teeth and hair
They struggle walking and going up stairs
To diagnose MND. What do you do/need?
What is the treatment:
CT/MRI to exclude focal pathology
EMG will show denervation of muscles
You need at least 3 LMN and UMN in different regions
Treatment: anti-glutamatergic drugs like Riluzole
Baclofen for spasms and for drooling give amitriptyline. Give NG feed or PEG
What dementia is common in MND?
What is Rigidity?
What is Spasticity?
Fronto-Temporal Dementia
Rigidity: This is when there is the same resistance in all directions not velocity dependent.
Spasticity: caused by a UMN. More tone initially. Velocity dependent.
What is Horner’s Syndrome?
What is the clinical presentation?
A rare condition that happens due to disruption to the sympathetic nerves that supply the eyes
Clinical Presentation:
- Ptosis
- Miosis
- Hemifacial anhidrosis
- Facial Flushing
- Orbital pain/headache
What is the aetiology of Horner’s Syndrome?
First, Second and Third Order
- First Order (CVS accidents)
- Second-Order (preganglionic) Pancoast tumours and lower brachial plexus tumours
- Third Order (postganglionic): cluster headache, Herpes Zoster virus or carotid artery dissection
What investigations might you want to do for Horner’s Syndrome?
- MRI/CT to exclude CVS accident
- CT angiography: to exclude Carotid Artery Dissection
What is a TIA?
Who is it more common in?
What are 4 main causes of a TIA?
A TIA is a brief episode of neurological dysfunction leading to temporal focal cerebral dysfunction. Resolves within 24 hours
IT is more common in men, those who smoke, have Diabtes or HTN or of a black ethnic minority
4 main causes: hyperviscosity, hypoperfusion, Cardiac embolism or small vessel occulsion
What artery is commonly affected in a TIA?
The ACA is most commonly affected It can lead to symptoms such as: - Motor and sensory loss in the arms and legs - Dysphasia - Incontinence - Amaurosis Fugax
What can happen if the posterior circulation is involved in a TIA?
You can get a headache, fainting, ataxia, diplopia and hemianopia vision loss
What 4 investigations would you do for a TIA?
- ECG
- CT/MRI
- FBC, ESR and Glucose
Carotid artery doppler
What is involved in the treatment of a stroke?
- CT/MRI head
- ABCD2 >6 urgent refer, >4 within 24 hrs, less is within 7 days
- Start patient on aspirin, clopidogrel, warfarin and simvastatin, ramipril and changes to lifestyle
What does the ABCD2 tool look at?
Age >60 Blood Pressure >140/90 C: unilateral weakness, speech disturbance D: duration (more than an hour) D : diabetes
What is MS?
What is the epidemiology of MS?
This is an autoimmune condition that happens when the body’s T cells start to attack the oligodendrocytes of the CNS. Leading to multiple plaques of demyelination. Generally, you get perivenular and around the ventricles, corpus callosum and brainstem. The myelin can regenerate but is less effective such as in higher heat.
It affects more women. And normally in their 30-50s. Associated with people further from the equator and low Vit D and sunlight.
What are the 3 types of MS:
Give 5 symptoms of MS:
Relapsing and Remitting: has periods of being good
Primary Progressive
Secondary Progressive
Fatigue
Bladder dysfunction
Optic neuritis (i.e. eye pain)
Pins and needles and numbness in hands and feet
Muscle weakness particularly in the legs
Sexual dysfunction
If it affects the cerebellar you can also get: ataxia, balance, coordination and speech problems or diplopia
How do you diagnose MS?
You diagnose MS by having 2 or more signs isolated in time and space.
MRI plaques will be seen in the brain and spine
Lumbar puncture will show Oligoclonal B bands
How do you treat MS:
Have a Stress Free life
Encourage sunlight exposure and Vit D tablets
- Management: Give interferon IB and IA and dimethylfumarate
Relapse:
- Methyl Prednisolone
Spasticity: baclofen
Botox injection for incontience
Cerebellar Disorders: what are the 3 main structures of the cerebellum?
Vermis
Flocculonodular
Lingula
Cerebellar Disorders:
What is it’s 2 functions?
What is it’s most important layer?
Sensory and Motor Function
Purkinjie layer
Cerebellar Disorders: What are 5 aetiological causes of cerebellar disorders?
- Metabolic/Immune
- Vascular
- Infection
- MS
- Trauma
Cerebellar Disorders: Give 5 symptoms of it
Dysdiadokinesia Nystagmus Ataxia (limb and gait) Intention tremor Clumsiness of arms and legs Cognitive Issues
Cerebellar Disorders: Give an example of an autosomal recessive and autosomal dominant condition
What 3 investigations would you like to perform?
AR: Fredricj’s Ataxia: affects gait and limbs. Increased risk of diabetes and cardiomyopathy
AD: SCA-6. Most common disorder. Starts in 40s and causes dysarthria, dysphagia and nystagmus
MRI, Bloods and EEG
What is Cerebral Palsy?
What are 3 Risk Factors for it?
Give 3 causes of it?
Is a non progressive lesion or abnormality that is pernamnet and non-changing. It affects movement, motor function and the commonest form is bilateral spastic cerebral palsy
3 RF:
- Low Birth Weight and Premature Labour
- Maternal Infection and a complicated/prolonged birth
- Multiple Babies
Causes:
- Mostly antenatal and due to lack of oxygen to the baby generally caused by reduced oxygen supply by vascular occlusion
- Other causes include: congenital infection, trauma and NAI
What are the 3 classifications of Cerebral Palsy?
Spastic: damage to the UMN. Increased tone, reflexed and gait appears like scissoring affects the legs more than the arms.
Dyskinetic: Where the basal ganglia are affected. Causing irregular movements and coordination to be affected. Chorea and Dystonia happen in particular
Ataxic: loss of muscular co-ordination so that movements are of an abnormal force. Normally due to a genetic cause or an acquired brain injury.
How do people with cerebral palsy present?
Generally before the age of 2.5 yrs. Due to an inability to reach developmental milestones and problems with posture, head holding, early hand preference and feeding and speaking problems
They have associated learning difficulties and fatigue, swallowing and drinking problems
What investigations may you want to do on someone with suspected Cerebral Palsy?
How would you manage patients
Sequential US
MRI
CT and EEG
Mobility aids
Spasticity: give baclofen
Pain: diazepam or amitryptyline
Botox can be given as a last resort
Spinal Stenosis:
- What is it?
- What causes it?
- Who is it common in?
This is when there is a narrowing of the spinal canal causing there to be root ischaemia and neurogenic claudication
Normally caused by loss of disc space and osteophytes
Caused by generally degenerative changes. Common in older people
Spinal Stenosis:
What symptoms do you get with it
Well it’s common in the cervical and lumbar regions
You get pain in the neck or back, you get altered sensations in the arms and legs, loss of power, instability, you get reduced ROM and Urinary incontinence
Spinal Stenosis: how is it diagnosed?
How is it managed?
Back X-Ray and the MRI
Managed with: NSAIDs, physio and steroid injections
LAST resort is surgery
What is myopathy?
What is the most common type?
A disease of the muscle fibres causing them not to function well
Most commonly an inherited condition. Such as Duchenne’s Muscular Dystrophy
What are 4 causes of myopathies?
Inherited: Duchennes or Beckers Infectious: Polio Toxic: steroids, alcohol Non inflammatory: thyroid or Cushings Immunological: SLE or rheumatoid arthritis
What 5 symptoms do you get with myopathies?
IF a patient has fluctuating weakness what is it?
IF a patient has fatigabiluty what is it?
WHat 4 tests would you like to do on your patient?
- Muscle Weakness (primarily in shoulders and pelvic girdle) Myalgia and Fatigue Waddling gait Cramps and myalgia with exercise Problems climbing stairs
Muscle Biopsy
EMG
MRI
Blood Tests: creatine kinase, serum myoglobin, FBC and ESR
How do you treat hypokalemia?
How do you treat Hyperkalemia?
Hypo: will present with U waves, wide WRS and PR interval
Hypokalemia: spironolactone and IV potassium
Hyperkalemia: glucose, carb loading and insulin
How does a brain abscess form?
What are 3 causes?
What are 3 symptoms?
What are 2 management plans?
Happens when the brain inflames it then leads to cerebral oedema and subsequently there can be a necrotic brain. Leading to encapsulating of material
Trauma
Infective endocarditis
Sinusitis or osteomyelitis
Fever Malaise Headache Personality change Drowsiness
Drain fluid under a guided CT and start Abx
What is the cause of Anterior Cord Syndrome?
What symptoms will you get?
What investigations would you do?
Compression of the anterior spinal artery leading to anterior cord ischaemia. Normally secondary to trauma or fractures
You will get inability for motor, pain and temperature
However, proprioception, vibration and light touch will remain
X-Ray and CT
Management: Methylprednisolone and surgical correction or fracture site
What are two complications of anterior cord syndrome?
- Spinal Shock: this happens when there is a severe spinal injury the body gets areflexia and flaccid quadriplegia and eventual full paralysis
- Neurogenic Shock:
- Vasomotor instability leading to loss of sympathetic tone, hypotensive and bradycardic.
What is GBS? Who is it common in? What causes it to occur? What is the pathophysiology? What is the diagnostic Method used? What is the management?
- GBS is an acute inflammatory demyelinating ascending polyneuropathy. Commonly occurring after a URTI or GI infection
- It is common in people at the extremes of age: the young and old
- Caused by Campylobacter jejuni, CMV or EBV
- Works by molecular mimicry. The pathogen’s antigens are similar to the patient’s cells antigens
- Diagnosis is via NCS, may want to do an LP shows increased protein or spirometry
- Management: LMWH, IV immunoglobulin and if FVC <80% ventilate on ITU
What are 4 symptoms of GBS?
Ascending symmetrical muscle weakness
Happens 1-4 weeks post-infection
Autonomic symptoms like sweating, raised pulse, raised BP may occur.
Reflexes are absent early on
Is paraesthesia common or uncommon in GBS?
UNCOMMON
What is Uhthoff’s Phenomenon?
What is L Hermitte’s Phenomenon?
MS symptoms are worse with heat
Sudden electric shock sensation felt from the back of the neck down the legs/arms
What is a Marcus Gunn Pupil?
Relative Afferent Pupillary Defect: observed on swinging flashlight test.
Whereupon the patient’s pupils constrict less when light is shone on them.
Happens because of an optic nerve lesion
Name 3 vascular causes of unilateral vision loss?
3 other causes:
Amaurosis Fugax: central retinal artery
Central retinal vein occlusion: cotton wool spots
Anterior Ischaemic Optic Neuropathy: ischaemia or choroidal artery
Optic neuritis
Retinal detachment
Acute angle closure glaucoma: painful red eye and N and V
What tests should you do on optic neuritis?
Visual Evoked Potentials
Tonometry
MRI head
NOTE: dyschromatopsia: colour vision is affected but visual acuity is ok
Give the 3 different types of squint
Exotropia: points out
Esotropia: points in
Pseudo squint: looks like a squint but is due to prominent epicanthic folds
Other two categories are non-paralytic and paralytic squints
What types of squints are more common in Older and Younger People?
Non-Paralytic: common in younger people. With esotropia being more common in younger children.
Paralytic: common in older people
What are two ways to diagnose a squint?
- Cover Test
2. Corneal reflection (asymmetrical if a squint is there)
What are the 3 Os of managing a squint?
- Optical: get right refractive state
- Orthoptic: patching of good eye
- Operation: to realign the eye or use of Botox
What are 2 causes and 3 symptoms of a 3rd nerve palsy
Cause: brain mass (tumor) or a PCA aneurysm
Symptoms: Eye goes down and out, fixed pupil and ptsosis
What are 2 causes of a 4th nerve palsy and what are symptoms
Causes: diabetes and trauma
symptoms: head tilted and they have an eye that is up and abducted. Affects the SO
What does these muscles do? LR MR SR IR SO IO
LR: abducts the eye MR: adducts the eye SR: elevates and intorts IR: depression and extort SO: depression and intorsion IO: elevation and extorsion
What is a frontal lobe disorder characterised by?
What are 3 causes?
- Personality and behavioural change
- Impaired talking
- Impaired memory
- Lack of attention and lack of spontaneous activity
- Trauma
- Stroke
- Dementia
In a spinal cord compression: what signs do you get at the site of the compression?
Explain the aetiology:
- site of the compression you at LMN signs
Below this site you get UMN signs
Aetiology:
- Tumours secondary to breast, lung and prostate cancer
- Infection and vascular causes
- You can get disc herniation or disc prolapse. Each irritate the nerve root causing pain.
What symptoms do you get in a spinal cord compression?
How do you diagnose a spinal cord compression?
Treatment: 2 ways
- Pain
- Numbness and Pins and Needles
- Arm or Leg Weakness
- Sphincter damage leading to painless retention
- Sensory loss below the level of the lesion.
- You will also get the symptoms of a UMN lesion!!!
Diagnosis:
- MRI
Treatment:
Surgical Decompression and IV dexamethasone
What is a mononeuropathy?
What are two causes of them?
What is a mononeuritis Multiplex? give the possible types
- lesion of only one nerve
- trauma and entrapment (can be secondary to a tumor)
- Mononeuritis multiplex is when a person has multiple mononeuropathies around their body. Causes include:
W: wegners
A: amyloidosis
R: rheumatoid
D: diabetes
S: sarcoid
P: polyarteritis nodose
L: leprosy
C: cancer
What is Carpal Tunnel Syndrome?
Who is prone to it?
How do you diagnose it?
How do you treat it?
Entrapment of the Median Nerve C6-T1
More common in women, diabetics and obese. Acromegaly, pregnancy and Rheumatoid are other causes
Symptoms: Worse at night and appear gradually. You get pins and needles of the median distribution thumb to half of ring finger. Loss of sensation and weakness to thumb abductors.
Diagnosis: tinels and phalens signs. Look at EMG
Management:
- Splints at night and eventually do surgical decompression.
What is the distribution of the Ulnar Nerve
Where does it get compressed
What symptoms does it cause?
How can you treat it?
C7-T1
At the epicondylar groove of the elbow
Weakness and wasting of the wrist flexors, interossei (no good luck sign) and medial 2 lumbricals.
Treatment is a splint or surgery
What muscles does the radial nerve supply?
BEST Brachioradial Extensors Supinator Triceps
The radial nerve basically helps to open the wrist!
What can damage the brachial plexus?
Backpack wearing
Trauma
Radiotherapy (secondary to breast carcinoma)
What are 6 reasons why nerves can malfunction?
- Demyelination
- axonal degeneration
- Compression
- Infarction
- Infiltration: leprosy or sarcoid
- Wallerian degeneration: when a nerve fibre is crushed or cut
What type of nerve condition is GBS?
Acute demyelinating ascending polyneuropathy
What is cauda equina syndrome? Is it a medical emergency? Who is at risk? How does it present? What are the investigations? What are the treatments you should do?
Compression of the nerve root distal to termination of the spinal cord
YES IT IS
trauma. malignancy and herniation of the lumbar discs
Saddle paraesthesia, bilateral sciatica, sphincter incompetence, leg weakness and erectile dysfunction.
SIGNS include: LMN so areflexic and flaccid
Investigations: urgent MRI
Management: urgent decompressive surgery and dexamethasone
What is epilepsy?
What is the epidemiology?
What else can cause epilepsy
Epilepsy is the tendency to seize. It is an unprovoked event caused by an excessive hypersynchronous neuronal discharge in the brain.
To be said to be epilepsy there must be at least 2 attacks separated by 24 hours.
Epidemiology: common in the very young and old. Liked with FH.
Other causes include:
- Alcohol withdrawal
- Low oxygen
- Brain tumors
What is Narcolepsy?
What is Cataplexy?
Who is it more common in?
What are triggers?
- Is a sleep disorder causing an abnormality in the brain neurotransmitter hypocretin
- Is a sudden loss of muscle tone and power in response to strong emotion. It can only occur with narcolepsy not on its own
It is more common in males and adolescence
Triggers include: lack of sleep , stress and infection
What is the Pathophysiology of Narcolepsy?
What criteria do you use to diagnose Narcolepsy?
What are the points in the criteria?
Give 3 autonomic symptoms:
Give 3 treatments:
The patient is having as much sleep as a normal patient. However, it is fragmented. With night time sleep loss and daytime naps.
Epworth Sleepiness Scale:
- Excessive daytime sleepiness
- Cataplexy
- Hypogogic hallucinations: when falling asleep or waking up
- Sleep Paralysis
You can also get autonomic symptoms like night sweats, pupillary changes and erectile dysfunction.
Treatment: good sleep hygiene, lots of exercise and Narcolepsy: Modafinil and Cateplexy: Anti-Depressants
What is Bell's Palsy? Who is it common in? What happens in the pathophysiology? What are the 2 viral causes? Give 5 clinical presentations: Give 2 diagnostic tests: What is the management?
Bell’s palsy is a condition when you get compression of the facial nerve leading to inflammation
Common in pregnancy and diabetic patients
2 viral causes include: HSV and VZV
Clinical Presentation:
- loss of sensation unilateral
- Speech difficulty
- Hypersensitivity to noise
- Lop sided smile and Decreased taste and hypersensitivity to noise
Routine bloods, serology for lyme disease and MRI of head
Management: give steroids in 72 hours of presentation and protect the eye. As it is unable to close
What is an extra Dural haematoma? Who is it common in How does it occur? Name 4 symptoms of an extra dural haematoma? Give 2 diagnostic methods? Give 2 treatments?
- Fracture of the temporal bone leading to laceration of the middle meningeal artery.
- Common in Old People (anyone who has head trauma)
- 4 symptoms: initially loss of consciousness for a couple of seconds. regains consciousness and then lucid until another decrease in consciousness.
Nausea, Vomiting, altered consciousness, confusion and seizures are common. - 2 diagnostic methods: CT head and Skull X ray
- management: IV mannitol and evacuation
What is a sub dural haematoma?
Who are they common in?
What is the aetiology?
What is the clinical presentation?
This is a build up of blood in the space between the dura and the arachnoid.
- Old people and babies (small brains) and alcoholics
- Rupture of the bridging veins. you get an original excess blood loss and this then autolyses and oedema occurs putting more pressure in the skull
The patient will lose consciousness and then symptoms develop weeks to months later. altered consciousness, change in personality, headache, seizures and raised ICP (headaches, nausea and vomiting)
What is a SAH?
What is the most common cause? Where do these commonly happen?
What are 3 RF for this condition?
Give 6 clinical symptoms:
Is a saccular aneurysm that bleeds into the space between the arachnoid and the pia mater.
Berry aneurysm. Commonly saccular aneurysms occur between the posterior communicating artery and the middle cerebral and the anterior cerebral and anterior communicating artery.
3RF: artrio-venous malformation, PKD and Ehlers Danlos
CF: sentinel headache the day before. Thunderclap headache in the occipital region, loss of consciousness, Nausea, Vomiting, Irritates the meninges so you can get neck stiffness and visual disturbance
Remember you want to give patient Ca2+ blocker like nifedipine
What is trigeminal neuralgia?
Who is it common in?
What are 3 causes?
What are 3 RF?
What is the symptoms?
What do you need to know to give a diagnosis?
Chronic pain in the trigeminal distribution. Lasts for a couple of seconds.
Common in females aged 50-60.
Normally caused by compressed loop of artery or vein. Normally aneurysm, tumors or meningeal inflammation.
Leads to nerve demyelination
3 RF: infection, high BP or incocuous triggers (shaving, brushing hair)
Parosysmal attacks lasting a few seconds. Severe intensity. Electric shock. Precipated by incocuous stimuli
At least 3 attacks.
Has to meet the diagnostic criteria
MRI to exclude other causes
Treatment:
- Give the patient: oral anti-convulsants like carbamazepine
- Not worl? give a gamma knife surgery
What is the definition of Meningitis?
Who does it occur in?
What are two causative organisms in neonates, adults and the immunocompromised?
What is the pathophysiology?
- Inflammation of the meninges of the brain normally secondary to a bacterial infection.
- It occurs in the very young and old
- Neonates: GABHS and E.coli
- Adults: N. meningitides, Strep pneumoniae and H influenza
- immunocompromised: TB, HIV and CMV
- Pathophysiology: crosses the BBB and causes inflammation of the meninges and done by droplet infection. Also releases endotoxins that lead to septicaemia that is petechial rash and septic signs
What are the classic symptoms of Meningitis?
What will the LP tests for viral, bacterial and TB show?
- Headache
- Neck Stiffness
- Fever
- Photophobia
- Nausea and Vomiting
- Loss of consciousness
- Seizures may also get focal CNS signs
Viral: lots of lymphocytes
Bacterial: lots of neutrophils and low glucose. TURBID colour
TB: lots of lymphocytes, protein and low glucose
What are the Diagnostic Tests for meningitis?
What are the two clinical signs for meningitis?
What is the treatment:
- Community
- Hospital
- For exposed members
- Blood Culture
- Lumbar Puncture
- Blood tests or throat swabs
Clinical signs:
- Kernigs: hip flexed and straighten knee can not be done
- Brudzinki’s Signs: lift neck and passive flexion of knees
What is the treatment:
- Community: benzylpenicillin
- Hospital: IV cefotaxime
- For exposed members: rifampicin
What is encephalitis? What are 3 organisms that normally cause it? What are 4 symptoms of it? How do you diagnose it? How do you treat it?
Inflammation of the brain parenchyma. Normally caused by a viral infection - HSV, CMV, EBV and VZV - Fever, headache, confusion - Also can get myalgia and fatigue alongside seizures Diagnosis: - With a brain MRI and EEG. - LP will show high lymphocyte counts Treatment: - IV acyclovir - May need seizure medication too
What is Myasthenia Gravis?
Who is it more common in?
What is the common cause in males and females?
What is the pathophysiology of myasthenia gravis?
What are 4 symptoms of the condition?
How is it diagnosed?
How is the condition managed?
- Autoimmune condition against the Ach receptors in the muscles
- More common in females when younger and males when older.
- Males: thymic tumors
- Females: thymic hyperplasia, SLE and Rheumatoid Arthritis
- There are antibodies against the nicotinic ACh antibodies. Blocks the excitatory effects of ACh resulting in muscle weakness
Symptoms: - Muscle fatiguability
- Speech and facial muscle issues
- Eye muscles
- Respiratory depression can occur
Diagnosed: - Anti-MUSK antibodies and anti-AChR
- EMG and NCS
- CT of thymus
Management: - Anti-choliesterase like Pyridostigmine and prednisolone.
What should you do in a myasthenia crisis?
Check FVC regularly. Respiratory depression is common
GIve patient plasmapheresis and IV immunoglobulin.
What is Wernicke’s Encephalopathy?
What are the symptoms?
What is the pathophysiology?
What are the management?
This is a neurological disease that is a result of thiamine deficiency. Normally secondary to alcoholism Symptoms: - Nystagmus, ophthalmoplegia and ataxia - Acute confusional state Pathophysiology: - Haemorrhages and secondary gliosis in the periventricular and peri-aqueductal grey matter Management: - Thiamine
What happens in Korsaakoff’s psychosis?
What symptoms will you get?
Thiamine deficiency. Progression of Wernicke’s.
Haemorrhages and secondary gliosis in the periaqueductal grey matter
You will get the same as in Wernicke’s.
But you can also get confabulation (retrograde amnesia inability to lay down new memories)
Seizures
What is the medical treatment of epilepsy?
Partial seizures: Carbamazepine, Sodium Valproate
Grand mal: Sodium Valproate, Lamotrigine
Absence Seizures: Sodium Valproate and Lamotrigone
Can only drive after being seizure-free for a year.
What epileptic symptoms will you get if:
- Focus is in Frontal Lobe
- Temporal Lobe
- Parietal Lobe
Frontal Lobe: motor area, posture would be affected. Jacksonian march and Postictal Todd’s palsy
Temporal: lip-smacking, hallucinations and smells
Parietal: sensory and tingling
What is a focal vs generalised seizure?
Focal Seizure: set area of the brain affected. Consciousness is maintained. Not incontient to urine or faeces
Generalised Seizures: the whole brain is affected.
What are a few triggers of epilepsy?
Stress Lack of Sleep Infection Bright flashing lights Alcohol withdrawal.
In status epilepticus what do you need to give?
- Rectal Benzodiazepine
- IV pheyltoin
What happens in the prodrome, aura and post ictal of a seizure
Prodrome: patient doesn’t feel theirselves. They have change in mood/behaviour
Aura: part of the seizure when the patient is aware. Patient may get hallucinations, smell weird things or have a bad stomach
Post itcal: this is after the seizure. People generally feel very tired and just want to sleep. Muscles/jaw may hurt. May have a biten tongue and be confused
May have Todd’s Palsy if Frontal lobe was affected.
2 causes of a decreased GCS:
Infection
Cerebral Vascular Event
What symptoms do you get if the following arteries are affected?
- Anterior Cerebral Artery
- Middle Cerebral Artery
- Posterior Cerebral Artery
- Anterior Cerebral Artery: Leg weakness Gait apraxia Truncal ataxia Incontinent Drowsiness
- Middle Cerebral Artery Contralateral leg and arm weakness and sensory loss Hemianopia Aphasia Dysphasia
- Posterior Cerebral Artery Cortical blindness Visual Agnosia Contralateral homonymous hemianopia Prosopagnosia Unilateral headache
What are some primary and secondary causes of headaches?
Primary: - no underlying cause - migraine Secondary: - Haematoma - Encephalitis - Menigitis - SAH
What is a migraine? Give 5 triggers? What is the presentation Investigations? Treatment?
Recurrent throbbing headache preceded by aura and is associated with N and V and visual changes. Can be with or without aura.
5 triggers:
- Chocolate
- Hangovers
- Alcohol
- Sex
- Cheese
- Oral Contraceptives
