Neurology Flashcards
what is Gower sign and how to conduct it
Lay child supine and ask child to stand
- shows proximal muscle weakness - first turn prone then “walk up” legs with the hands
types and causes of tremors
- essential (initiation and maintenance of posture): AD inheritance or thyrotoxicosis, phaeochromocytoma, wilson
- intention (end of mvt): wilson
- static (at rest, disappears with mvt): wilson, parkinson, huntington
what is myoclonus
- causes
- Brief, sudden muscle contractions
* Seen in seizure disorders, metabolic disorders, brain infections, brain injury and degenerative conditions
what is chorea
- causes
- Random rapid movements
- Seen most commonly in cerebral palsy, Sydenham’s chorea, Wilson’s and Huntington’s disease
- Due to damage to the corpus striatum
what is athetosis
- causes
- Slow writhing movements
- Seen in cerebral palsy and Wilson’s disease
- Due to damage to the putamen
what is dystonia
- causes
- Sustained disturbed muscle contraction causing abnormal posturing
- Seen with certain drugs (anticonvulsants), trauma, infections, and vascular, metabolic and degenerative pathologies
what is hemiballismus
- causes
- Random gross proximal limb flailing
* Due to contralateral subthalamic brain damage
what is tics
- causes
• Spasmodic stereotypic involuntary repetitive movements, typically of the facial movements
• Gilles de la Tourette is an inherited form
Associated vocal tics, obsessive-compulsive disorder and attention deficit hyperactivity disorder
how does CN 4 palsy present
- dipopia when looking down and in
- difficulty when walking downstairs
signs of cerebellar dysfunction
Truncal ataxia, dysarthric speech, horizontal nystagmus, intention tremor, dysdiadokinesia, dysmetria
secondary causes of headache
- trauma
- vascular malformation
- non vasc intracranial malformation
- substances and withdrawal
- infection
- metabolic disorder
- facial pain (cranium, neck, eyes, ears, nose, sinus, teeth, mouth)
- cranial neuralgia
triad of hypertensive encephalopathy
- headache
- seizures
- visual impairment
cushing triad
raised ICP
- hypertension
- bradycardia
- irregular breathing
seen in the terminal stages of acute head injury and may indicate imminent brain herniation
warning signs for headache
First and worst headache Signs and symptoms of raised intracranial pressure Aggravation by valsalva maneouvre Abnormal neurological findings Papilloedema Chronic progressive headache, with change in behaviour and deteriorating academic performance Early morning vomiting Headache waking up patient from sleep Immunosuppressed patients Neurocutaneous syndromes Age < 4 years
what is seen on CT for headaches from sinusitis
and what is the tx
Total opacification, mucosal thickening and air-fluid levels are seen on CT/MRI
Treat with prolonged antibiotics, short-term decongestants and surgical drainage of sinuses – rarely
Precipitiating causes of migraines
anxiety, fatigue, mild head trauma, stress, exercise, excitement, travel, menses, some dietary factors and illness.
what are childhood periodic syndromes
early life expression of genes later expressed as migraine
- cyclical vomitting syndrome
- abdominal migraine
- benign paroxysmal vertigo of childhood
- benign paroxysmal torticolis
Mgx of migraine
Non pharm Reassurance Elimination of trigger factors Stress relief/stress management Regular diet Sufficient sleep Biofeedback Relaxation techniques Counseling
Pharm - abortive
Single analgesic – NSAIDs, ergotamine compounds, triptans
Adjunctive – anti-emetics
Pharm - prophylactic Cyproheptadine Beta-blockers – propranolol Valproate Amitriptyline Flunarizine
When to consider migraine prophylaxis
Considered if headaches occur more than four times per month and require substantial medication for relief.
Medical problems associated with seizures
Neurocutaneous syndromes (NF-1, TS, S-W)
Cerebral palsy
Neurodegenerative syndromes (Rett’s, Lennox-Gastaut)
Past hx of organic brain disease: brain tumour, head trauma, meningitis/encephalitis/brain abscess
Inborn errors of metabolism
What is epilepsy
Epilepsy is recurrent seizures (>2 more than 24 hours apart) unrelated to fever or acute cerebral insult
causes of seizures
- Birth or gestational insults
- Congenital malformations
- CNS infections
- Metabolic disorders
- Trauma and bleeding
- Degenerative diseases
- Neoplasms
- Toxins
what are some epilepsy syndromes you know
- infantile spasms
- lennox-gastaut syndrome
- childhood absence epilepsy
- juvenile myoclonic epilepsy
- benign rolandic epilepsy
Infantile spasm
- age range
- EEG features
- associations
- tx
4-6 months onset, boys>girls
EEG: hypsarrhythmias
associated with: tuberous sclerosis; metabolic disease, birth injury e.g. IVH, HIE; postnatal injury e.g. trauma, infections
tx: vigabatrin or steroids
What is west syndrome
triad of: (i) infantile spasms; (ii) hypsarrhythmias; and (iii) mental retardation
What is Lennox -gastaut syndrome
electroclinical syndrome:
- multiple seizure types
- EEG showing slow spike and wave
Childhood absence epilepsy
- onset age
- triggers
- tx
onset 3-10 years, girls>boys
induced by hyperventilation, emotion, hunger
tx: valproate, carbamazepine, lamotrigine
What is juvenile myoclonic epilepsy
- onset
- EEG
- tx
12-16 years, girls>boys
myoclonic jerks, worse in the morning, no loss of consciousness
EEG: shows normal background, 4-6 per sec irregular polyspike and wave discharge pattern. Photosensitivity is a feature
Tx: valproate, lamotrigine
Benign rolandic epilepsy
- prognosis
- onset
- features
- EEG
- tx
GOOD prognosis, will spontaneously resolve in mid teens
onset 2-14 years
features: drooling, abnormal sensations in the mouth; secondary generalisations. 75% occur in sleep, 25% occur on waking
EEG: repetitive spike focus in the Rolandic area (centrotemporal)
Tx: may not need treatment due to spontaneous resolution; carbamazepine may help
First aid advice for seizure
(i) Lie the child on the side.
(ii) Do not put things in the child’s mouth.
(iii) Move away any nearby objects to avoid hurting himself or herself.
(iv) Have a time plan: if a seizure lasts longer than 5mins, call an ambulance.
SE of
- carbamazepine
- valproate
(i) Carbamazepine – neutropaenia (screen FBC), nystagmus, ataxia
(ii) Valproate – thrombocytopaenia (screen FBC), hepatitis (screen LFT)
Causes of status epilepticus
Sudden withdrawal of anticonvulsants in a known epileptic
Bad epileptic syndrome e.g. West, Lennox-Gastaut Sudden withdrawal of anticonvulsants
Acute infection (CNS or systemic)
Acute insult to the brain
Brain tumour
Medications for status epilepticus
IV glucose and IV thiamine if hypoglycaemic
IV benzodiazepine (diazepam or lorazepam): 0.25mg/kg at 1mg/min up to 10mg (up to 0.3mg/kg)
OR
Rectal valium if no IV access (<10kg –2.5mg; >10kg – 5mg)
IV Phenytoin 20mg/kg at 1mg/kg/min (up to 30mg/kg)
IV phenobarbital 20mg/kg
if still persist:
GA/ barbiturate coma with EEG monitoring
Complications of status epilepticus
Tissue anoxia – cerebral anoxia Brain oedema Circulatory shock with renal failure Respiratory failure Acute rhabdomyolysis Severe acidosis Hyperpyrexia Permanent neurological damage (20-50%) Death (8-33%)
