Neurology Flashcards
Bell’s palsy
Facial muscle weakness and resulting facial asymmetry
- unilateral (rarely bilateral)
- No constitutional sx
- keratoconjunctivitis sicca - leads to crocodile tears
Classification with House Brackmann scale - Grade IV and above (unable to properly blink) are at risk of Ulcerative Keratitis
Benign Intracranial Hypertension
Risks
- FHX
- Obese women
- Wt gain
- Sleep apnoea
- medications - retinoids, NSAIDs, Nitrofurantoin, OCPs
- conditions - SLE, Uraemia, Fe Def and Sarcoid
Sx
- Headache
- Pulse synchronous tinnitus
- Transient visual changes/vision loss
- Neck/back pain
- Diplopia
Signs
- papilloedema
- 6th nerve palsy (impaired outward gaze)
- enlarged blind spot
- inferonasal visual field defect
BPPV
Risks
- increasing age
- trauma
- female
- vestibular neuronitis/labyrinthitis
- meniere’s
Hx
- vertigo - short duration associated head movements
- Sudden, severe, brief attacks
- No neurological sx
Examination
- Dix-Hallpike
- Supine lateral head turn
- normal otological ex
- normal neuro ex
Central Sleep Apnoea
Risks
- Age >/=60
- Male
- HF
- End-stage renal disease
- opioid use
- AF
- stroke
- brainstem lesions
Hx
- difficulty maintaining sleep - midnight waking and difficulty returning
- Witnessed apnoeas, snoring
- waking breathless or getting breathless when falling asleep
- morning headaches
- daytime sleepiness
- Cheyenne-Stokes breathing - uncommon but hallmark
Acoustic Neuroma
Unilateral sensorineural hearing loss Dizziness/balance issues Facial numbness Tinnitus Difficulty localising sound
Temporal Lobe epilepsy (Complex partial seizure or Focal impaired awareness seizure)
Feats
- may present with aura - fear, epigastric sensation, deja vu, jamais vu
- Automatisms - lip smacking, picking at clothes, fumbling
- movement of one side of body or one limb
- No recollection of automatisms
- sudden staring and loss of contact
Concussion
History * presence of risk factors * direct blow to the head or deceleration of the head from an impulsive force (Symptoms) * headache * feeling foggy/slow * dizziness/balance problems * memory difficulties * vomiting/nausea Exam Signs * normal physical neurological examination * abnormalities on neuropsychological testing
Corticobasal Degeneration (CBS)
Asymmetric motor and cerebral cortical dysfunction
Varying combinations of: Motor impairment - Limb rigidity Bradykinesia or clumsy limb Postural instability Falls Abnormal gait Hyperreflexia Axial rigidity Tremor Limb dystonia Myoclonus
Cortical dysfunction - Cognitive impairment Behavioral changes Limb apraxia Aphasia Depression Cortical sensory loss Alien limb
Diagnostic criteria
asymmetric presentation and at least two of: a) limb rigidity or akinesia, b) limb dystonia, c) limb myoclonus, plus two of: d) orobuccal or limb apraxia, e) cortical sensory deficit, f) alien limb phenomena (more than simple levitation)
Epidural Abscess
RF: *intravenous drug use *recent spinal surgery or trauma *concomitant local infection *immunosuppression *diabetes mellitus *chronic renal disease Key Features * presence of risk factors (common) * fever (common) * spinal pain or tenderness (common) * weakness of extremities * paralysis * sensory disturbance * abnormal reflexes * Isolated sphincter dysfunction
Extradural haematoma
Head trauma, especially to the temporal or occipital region
Key Features Hx/Exam: usual red flags of raised intracranial pressure: loss of consciousness altered mental status Severe headache Vomiting Seizure
Lucid interval for minutes up to several hours followed by deterioration GCS
Lateralizing signs (anisocoria “blown pupil”, hemiparesis, hemiplegia) and Cushing triad (hypertension, bradycardia, respiratory depression) are late findings that indicate cerebral herniation
Focal Dystonia
RF: FHx of condition Birth injury and delayed development in childhood Exposure to antidopaminergic agents Ashkenazi Jewish ethnicity Parkinsonian syndrome
Key Features History/Exam
- simultaneous contraction of agonist and antagonist muscles
- muscle pain
- worsening with action
Guillain Barre syndrome
RF: *preceding viral illness *preceding bacterial infection *preceding mosquito-borne viral infection Key Features History/Exam * Progressive symmetrical muscle weakness usually affecting lower extremities before upper extremities and proximal muscles before distal muscles *paraesthesias in the feet and hands * respiratory distress * speech problems * back/leg pain * areflexia/hyporeflexia * facial weakness * bulbar dysfunction causing oropharyngeal weakness * extra-ocular muscle weakness * facial droop * diplopia * dysarthria * dysphagia
Meniere’s Disease
RF : Family history of condition, recent viral illness
Key features : sudden onset of vertigo + sensorineural hearing loss (usually unilateral) +tinnitus, others: aural fullness and drop attacks.
Tests : positive rhomberg’s test, Fakuda’s stepping test
Bacterial Meningitis
RF: -≤5 years of age -≥60 years of age -male gender -low socio-economic status -crowding -non-immunised infants -immunosuppression -asplenia -cranial anatomical defects -cochlear implants -sickle cell disease Clinical findings: -headache -neck stiffness -fever -altered mental status -confusion -photophobia -vomiting -seizures
Migraine
RF: Family history of condition, childhood motion sickness, caffeine intake, female sex, obesity, menstruation, Lack of sleep
Clinical findings:
Headache that lasts 4 to 72 hours if untreated
Nausea
Decreased ability to function
Headache worse with activity
Photophobia
Sensitivity to noise
Aura - positive phenomena (visual sparkles, flashing lights) and negative phenomena (visual loss or scotoma). Sensory aura (numbness, tingling), and aura with aphasia/dysphagia may occur
Unilateral (bilateral in more than 40%)
Throbbing sensation (50%)
