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Phase 3A Flashcards > Neurology > Flashcards

Neurology Flashcards

1
Q

what are 5 common causes of abnormal gait?

A
  1. stroke
  2. childhood hip disorders
  3. parkinson’s disease
  4. cerebral palsy
  5. multiple sclerosis
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2
Q

what are 4 uncommon causes of abnormal gait?

A
  1. cerebellar disorder
  2. peripheral neuropathy
  3. myopathies
  4. guillain-barré syndrome
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3
Q

what 2 clinical signs does difficulty rising from a chair point to?

A
  1. proximal weakness

2. difficulty initiating movements

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4
Q

what clinical sign does a shuffling gait point to?

A

parkinsonism

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5
Q

what 2 gait-related clinical signs other than a shuffling gait can point towards parkinsonism?

A
  1. postural sway

2. increased rate of walking

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6
Q

what is a steppage gait?

A

the affected leg is lifted higher on walking and toes scrape the ground?

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7
Q

what is the most common cause of a steppage gait?

A

foot drop

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8
Q

what are 4 causes of foot drop?

A
  1. multiple sclerosis
  2. GBS
  3. peroneal nerve injury
  4. prolapsed intervertebral disc
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9
Q

what are 2 conditions that can cause difficulty turning?

A
  1. cerebral defect

2. basal ganglia defect

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10
Q

what does a widened base whilst walking suggest?

A

ataxia

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11
Q

what is frontal ataxia?

A

a gait apraxia involving difficulty initiating movements despite normal power and co-ordination. gait is slow, shuffling and wide with hesitation and poor control

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12
Q

what are 4 causes of frontal gait disorder/ ataxia?

A
  1. cerebral tumours
  2. subdural haematoma
  3. normal pressure hydrocephalus
  4. multiple lacunar infarcts
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13
Q

what is the most common cause of a hemiparetic/ hemiplegic gait?

A

stroke/ CVA

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14
Q

what is a hemiparetic/ hemiplegic gait?

A

asymmetry with flexors and extensors, affected side often shows increased flexion in upper limb and increased extension in lower limb. EG person walks with arm curled up and on one tiptoe

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15
Q

what is the most common cause of scissor gait?

A

spastic cerebral palsy

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16
Q

what is a scissor gait?

A

rigidity with excessive adduction of the legs when walking

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17
Q

what is a trendelenburg gait?

A

the affected hip drops when the associated leg is raised from the ground

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18
Q

what are 2 common causes of trendelenburg gait?

A
  1. L5 radiculopathy

2. hip abductor weakness/pain possibly due to superior gluteal nerve

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19
Q

what is the most common cause of waddling gait?

A

proximal muscle weakness in the pelvic girdle

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20
Q

what are three causes of proximal muscle weakness in the pelvic girdle?

A
  1. congenital hip dysplasia
  2. spinal muscular atrophy
  3. muscular dystrophies
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21
Q

what are 2 common causes of disordered cognition/ deterioration of intellect?

A
  1. acute confusional state/ delirium

2. dementia

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22
Q

what are 4 uncommon causes of disordered cognition/ deterioration of intellect?

A
  1. AIDS
  2. normal pressure hydrocephalus
  3. huntington’s disease
  4. vitamin deficiency
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23
Q

what are 4 common causes of a coma?

A
  1. transient losses of consciousness (epilepsy/ syncope)
  2. primary cerebral conditions (haemorrhage, infection, trauma, tumours)
  3. hypoxia
  4. alcohol
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24
Q

what 3 bits of information are important to find out with someone in a coma?

A
  1. immunosuppression
  2. recent travel
  3. past medical history
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25
Q

what are 5 components of an examination of someone in a coma?

A
  1. normal obs
  2. response to stimuli
  3. survey of skin and mucous membranes
  4. resp/abdo/cardiac/neuro exam
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26
Q

what does unilateral pupil dilation with no light response suggest?

A

uncal herniation of the temporal lobe trapping the 3rd nerve

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27
Q

what does fixed mid position pupils with a lack of response to light suggest?

A

midbrain lesion

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28
Q

what does small pupils with a response to light suggest?

A

pontine lesion

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29
Q

what is horner’s syndrome?

A

usually unilateral meiosis, ptosis and anhydrosis

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30
Q

what does horner’s syndrome suggest?

A

lesion in hypothalamus or brain stem, or an apical lung tumour (damage to sympathetic chain)

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31
Q

what do small pupils with a brisk response to light suggest?

A

metabolic cause

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32
Q

what are 6 common causes of dizziness?

A
  1. benign positional vertigo
  2. meniere’s disease
  3. vestibular neuronitis
  4. brain stem stroke
  5. TIA
  6. postural hypotension
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33
Q

what are 2 uncommon causes of dizziness?

A
  1. arrhythmia

2. multiple sclerosis

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34
Q

what is the pathophysiology of benign positional vertigo?

A

detached otoliths (calcite particles in the membrane of the inner ear) moving after the head has stopped moving, causing dizziness and vertigo

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35
Q

what are 3 causes of benign positional vertigo?

A
  1. idiopathic
  2. spontaneous labyrinth degeneration
  3. chronic middle ear disease
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36
Q

what are 3 risk factors for benign positional vertigo?

A
  1. women
  2. older age
  3. meniere’s disease
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37
Q

what is the clinical presentation of benign positional vertigo?

A

vertigo worse on head movement and usually one side, sudden onset attacks for 20-30 seconds. nausea is common and often worse symptoms in the morning. hearing is not affected

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38
Q

what are 4 red flags in the examination of benign positional vertigo?

A
  1. unilateral hearing loss
  2. new onset headache
  3. focal neurological signs
  4. nystagmus
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39
Q

what is the management of benign positional vertigo?

A
  1. reassurance

2. epley’s manoeuvre

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40
Q

what is the pathophysiology of meniere’s disease?

A

change in fluid volume in the labyrinth causing vertigo

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41
Q

what are 4 risk factors for meniere’s disease?

A
  1. allergy
  2. autoimmunity
  3. metabolic disturbance of sodium and potassium
  4. viral infection
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42
Q

what are the 4 core symptoms of meniere’s disease?

A
  1. vertigo
  2. tinnitus
  3. fluctuating hearing loss
  4. aural pressure
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43
Q

how long do attacks of meniere’s disease last and what is their pattern of occurence?

A

2-3 hours, and usually occur in clusters

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44
Q

what do you examine for meniere’s disease?

A

no diagnostic signs so do a cranial nerve, ear, c-spine exam and hallpike manoeuvre

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45
Q

what is the hallpike manoeuvre?

A
  1. with the patient sitting up, turn head to 45 degrees
  2. lie patient down with head overhanging the bead keeping the rotation and look for nystagmus
  3. repeat on contralateral side, can be a sign of bpv
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46
Q

what is the medical treatment for vertigo attacks?

A
  1. prochlorperazine, can also be used for nausea related to a migraine
  2. local steroid injections
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47
Q

what is the pathophysiological of vestibular neuritis?

A

inflammation of the labyrinth and damage to vestibular and auditory end organs

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48
Q

what are 3 causes of vestibular neuritis?

A
  1. reactivated herpes simplex type 1
  2. autoimmune
  3. microvascular ischaemic insults
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49
Q

what are 3 causes of cochlear trauma?

A
  1. meniere’s disease
  2. meningitis
  3. vertebrobasilar ischaemia
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50
Q

what is the clinical presentation of vestibular neuritis?

A

sudden incapacitating vertigo, not triggered by movement but worsened with movement. hearing loss can occur with labyrinthitis

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51
Q

what are 3 conditions to rule out with vestibular neuritis?

A
  1. stroke
  2. TIA
  3. brain tumour
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52
Q

what are 7 important things to examine with vestibular neuritis?

A
  1. cranial nerves
  2. ear
  3. gait
  4. mastoid tenderness
  5. weber’s sign
  6. head-impulse test
  7. nystagmus type
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53
Q

what are 6 common causes of a headache?

A
  1. non-organic pain syndromes
  2. sinusitis
  3. migraine
  4. meningitis
  5. subarachnoid haemorrhage
  6. raised ICP
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54
Q

what is an uncommon cause of a headache?

A

encephalitis

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55
Q

what 5 things should a headache examination include?

A
  1. optic fundi
  2. blood pressure
  3. temporal artery palpation (>50)
  4. neuro exam
  5. cognitive level
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56
Q

what is the 1st line treatment for acute tension headaches?

A

ibuprofen

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57
Q

what is the 1st line treatment for chronic tension headaches?

A

amitriptyline

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58
Q

what are 4 headache red flags?

A
  1. papilloedema
  2. new seizure
  3. abnormal neurological signs
  4. new onset cluster headache
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59
Q

how do you manage migraines?

A
  1. simple analgesics like NSAIDs
  2. prochlorperazine for nausea
  3. triptans
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60
Q

what is the 1st line prophylactic treatment for migraines?

A
  1. beta blocker

2. amitriptyline

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61
Q

what is the 2nd line prophylactic treatment for migraines?

A

sodium valproate

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62
Q

how do you treat a cluster migraine attack?

A
  1. subcutaneous sumatriptan

2. oxygen

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63
Q

what is the 1st line prophylactic treatment for cluster headaches?

A

verapamil calcium channel blocker (2 weekly ECG monitoring necessary)

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64
Q

what is the 2nd line prophylactic treatment for cluster headaches?

A

lithium

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65
Q

what is the treatment for subarachnoid haemorrhage?

A
  1. coiling or clipping
  2. nimodipine to prevent cerebral ischaemia due to vasospasm
  3. intubation and ventilation may be required
  4. antiemetics and analgesia for conscious patients
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66
Q

what examination should be done for subarachnoid haemorrhage?

A
  1. consciousness level
  2. ophthalmoscopy
  3. neck stiffness
  4. full neuro exam
  5. marked increase in BP
  6. head CT
  7. ECG
  8. lumbar puncture if head CT is negative but symptoms suggest SAH
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67
Q

what are 4 common causes of movement disorder/ tremor?

A
  1. parkinson’s
  2. benign essential tremor
  3. drug induced (alcohol, neuroleptics, beta agonists)
  4. thyrotoxicosis
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68
Q

what are 4 uncommon causes of movement disorder/ tremor?

A
  1. huntington’s
  2. chorea
  3. liver failure
  4. wilson’s disease
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69
Q

what is the first line treatment for benign essential tremor?

A

beta blocker (propranolol)

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70
Q

what are 4 neurological features of wilson’s disease?

A
  1. tremor (asymmetrical and variable)
  2. difficulty speaking
  3. excess salivation
  4. ataxia
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71
Q

what are 6 causes of altered sensation?

A
  1. peripheral neuropathy
  2. CNS disorders (stroke, MS)
  3. nerve root lesions
  4. spinal cord compression
  5. hyperventilation
  6. circulatory disturbance (raynaud’s, PVD, embolic disease)
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72
Q

what are 2 common causes of visual problems?

A
  1. optic neuritis

2. papilloedema

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73
Q

what is optic neuritis and what is the triad of symptoms?

A

inflammation of the optic nerve presenting with eye pain, reduced vision and reduced colour vision

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74
Q

what is the clinical presentation of optic neuritis?

A

visual development over a period of hours to days that gets worse with a hot bath. presents with eye pain on movement, reduced vision and colour vision, and often light flashes and fatigue

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75
Q

what are 2 signs of optic neuritis?

A
  1. decreased pupillary light reflex

2. papillitis in 1/3 of cases

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76
Q

how do you treat optic neuritis?

A

if the cause is demyelination, methylprednisolone can speed up acute recovery and interferon beta is considered

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77
Q

what tests should you do for optic neuritis?

A
  1. fundoscopy
  2. MRI
  3. CXR if atypical for sarcoidosis
  4. LP can be useful
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78
Q

what pathological phenomena causes papilloedema?

A

raised intracranial pressure

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79
Q

what are 3 causes of papilloedema?

A
  1. non-arteritic anterior ischaemic optic neuropathy
  2. optic neuritis
  3. intracranial pathology
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80
Q

what are 3 common causes of unilateral papilloedema/

A
  1. optic neuropathy
  2. retinal vein occlusion
  3. diabetic papillopathy
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81
Q

what are 2 common causes of bilateral papilloedema?

A
  1. toxic optic neuropathy

2. malignant hypertension

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82
Q

what are 5 intracranial causes of papilloedema?

A
  1. tumour
  2. haemorrhage
  3. trauma
  4. infection/ abscess
  5. respiratory failure
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83
Q

what is the clinical presentation of papilloedema caused by intracranial pathology?

A

increases over a period of hours to weeks, and can proceed to blind spot enlargement, blurred vision and vision obscurations

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84
Q

how do you treat papilloedema?

A

treat the underlying cause, iv mannitol can reduce intracranial pressure

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85
Q

what are 7 common causes of weakness?

A
  1. upper/lower motor neurone lesions
  2. hypocalcaemia
  3. hypokalaemia
  4. anaemia
  5. post-viral syndrome
  6. malignancy
  7. guillain-barre
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86
Q

what are 3 uncommon causes of weakness?

A
  1. myasthenia gravis
  2. inflammatory myopathy
  3. proximal myopathy (thyroid, cushing’s, addison’s)
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87
Q

what 2 disorders causing weakness can raise creatine kinase in the blood?

A
  1. inflammatory myopathies

2. anterior horn cell disease

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88
Q

what is dysarthria?

A

a speech disorder caused by disturbance of muscle control

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89
Q

what is dysphagia?

A

impairment of language

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90
Q

what are 2 causes of dysarthria?

A
  1. UMN lesions of cerebral hemispheres

2. LMN lesions of the brainstem

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91
Q

what are features of pseudobulbar palsy related to speech?

A

slurred and weak articulation, weak voice

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92
Q

what are features of cerebellar lesions related to speech?

A

slurred, staccato (stopping and starting through words) speech

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93
Q

what are features of parkinson’s disease related to voice?

A

dysrhythmic, dysphonic (hoarseness) and monotonous voice

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94
Q

what are features of motor neurone disease related to voice?

A

indistinct articulation and hyper-nasality

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95
Q

what are 4 causes of dysarthria?

A
  1. pseudobulbar palsy
  2. cerebellar lesions
  3. parkinson’s disease
  4. motor neurone disease
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96
Q

what are 3 causes of dysphasia?

A
  1. stroke
  2. dementia
  3. head injury

generally caused by a lesion of the dominant hemisphere that affects broca’s area or wernicke’s area

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97
Q

what is receptive dysphasia and where in the brain is damaged?

A

language that is fluent in rhythm and articulation but does not make sense. wernicke’s area

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98
Q

what is expressive dysphasia and where in the brain is damaged?

A

language that is NOT fluent in rhythm and articulation but the person understands what is being said. broca’s area

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99
Q

what causes conduction dysphasia?

A

lesions in the arcuate fasciculus, posterior parietal and temoporal areas

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100
Q

what is conduction dysphasia?

A

speech that is quite fluent but words can be jumbled, speech is spontaneous and can be repetitive

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101
Q

what is the arcuate fasciculus?

A

a curved bundle of axons that connects broca’s and wernicke’s area. affected in conduction dysphasia

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102
Q

what are 4 neuro causes of incontinence?

A
  1. stroke
  2. multiple sclerosis
  3. spinal cord injury
  4. epileptic seizures
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103
Q

what are 7 causes of raised intracranial pressure?

A
  1. localised mass lesions
  2. neoplasm
  3. abscesses
  4. focal oedema secondary to infection or trauma
  5. disturbance of CSF circulation
  6. obstructed venous sinuses
  7. idiopathic intracranial hypertension
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104
Q

what is the clinical presentation of raised intracranial pressure?

A
  1. typically presents with headache, papilloedema and vomiting
  2. headache worrying when nocturnal, early morning, or worse on coughing or moving the head
  3. mental state changes early on can be tiredness, slow decision making, irritability, abnormal behaviour
  4. other symptoms can include pupil changes, unilateral ptosis, hemiparesis, hypertension, slow irregular pulse
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105
Q

what investigations should be included in raised intracranial pressure?

A
  1. CT/MRI
  2. blood glucose
  3. renal function
  4. electrolytes
  5. osmolality
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106
Q

in what 3 instances is ICP monitoring used?

A
  1. severe head injury
  2. abnormal CT
  3. GCS 3-8
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107
Q

what are 2 treatment priorities for raised ICP?

A
  1. maintaining arterial oxygen tension

2. maintaining normal vascular volume

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108
Q

what are some first line management strategies for raised ICP?

A
  1. avoid pyrexia
  2. manage seizures
  3. CSF drainage
  4. head off bed elevation
  5. morphine for analgesia
  6. IV propofol for sedation
  7. neuromuscular blockade
  8. iv mannitol to reduce cerebral hypertension
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109
Q

what is the last line strategy for raised ICP?

A

decompressive craniectomy

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110
Q

what is hydrocephalus?

A

increase in volume of CSF in the cerebral ventricles usually do to impaired absorption or increased secretion

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111
Q

what is the danger of hydrocephalus?

A

increased volume of CSF causes ventricular dilation, raised ICP and the CSF permeates periventricular white matter and can cause damage

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112
Q

what is non-communicative/obstructive hydrocephalus?

A

increases volume of CSF in the ventricles because there is obstruction to flow

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113
Q

what is hydrocephalus ex vacuo?

A

ventricular expansion secondary to brain atrophy

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114
Q

what are 4 causes of congenital hydrocephalus?

A
  1. absence of antenatal care
  2. maternal hypertension
  3. pre-eclampsia
  4. foetal alcohol use
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115
Q

what are 3 causes of acquired obstructive hydrocephalus?

A
  1. supratentorial masses
  2. intra-ventricular haematoma
  3. tumours
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116
Q

what are 2 causes of communicating hydrocephalus?

A
  1. thickening of the leptomeninges

2. increase in CSF viscosity

117
Q

what are 2 signs of hydrocephalus in infants?

A
  1. rapid increase in head circumference

2. increased limb tone

118
Q

what are 4 signs of hydrocephalus in adults?

A
  1. headache
  2. vomiting
  3. papilloedema
  4. impaired upward gaze
119
Q

what are 5 signs of gradual onset hydrocephalus?

A
  1. cognitive deterioration
  2. neck pain
  3. nausea and vomiting
  4. double vision
  5. incontinence
120
Q

how do you diagnose hydrocephalus?

A

CT scan with dilated ventricles

121
Q

what does an abnormal 4th ventricle with regards to hydrocephalus mean in a CT scan?

A

posterior fossa mass

122
Q

what does a normal 4th ventricle with regards to hydrocephalus mean in a CT scan?

A

aqueduct stenosis

123
Q

what type of hydrocephalus is safe to use lumbar puncture?

A

communicating hydrocephalus

124
Q

what is the common treatment for hydrocephalus?

A

insertion of a ventriculo-peritoneal shunt or an external ventricular drain

125
Q

what is normal pressure hydrocephalus?

A

ventricular dilation in absence of CSF change

126
Q

what are 3 symptoms of normal pressure hydrocephalus?

A
  1. gait abnormality
  2. urinary incontinence
  3. dementia
  4. pyramidal signs can be present and reflexes can be brisk
127
Q

how do you diagnose normal pressure hydrocephalus?

A
  1. MRI/CT shows ventricular enlargement
  2. large volume LP shows normal CSF pressure
  3. no papilloedema
128
Q

how do you treat normal pressure hydrocephalus?

A

acetazolamide (carbonic anhydrase inhibitor) and ventriculo-peritoneal shunt insertion

129
Q

what is a simple focal seizure?

A

motor or sensory disturbance with retained awareness

130
Q

what is a complex focal seizure?

A

motor or sensory disturbance with impaired awareness

131
Q

what are the 6 types of generalised seizures?

A
  1. absence
  2. tonic clonic
  3. myoclonic
  4. clonic
  5. tonic
  6. atonic
132
Q

what are 5 non-idiopathic causes of epilepsy?

A
  1. cerebrovascular disease
  2. head injury
  3. brain surgery
  4. CNS infection
  5. neurodegenerative disease
133
Q

what are common features of the post-ictal phase?

A
  1. drowsiness

2. headache

134
Q

what is the clinical presentation of a generalised tonic clonic seizure

A
  1. tonic and clonic phases
  2. loss of consciousness
  3. tongue biting
  4. incontinence
  5. usually last 1-3 minutes
135
Q

what are 3 things that can cause a tonic clonic seizure?

A
  1. sleep deprivation
  2. alcohol
  3. early morning seizures
136
Q

what are 4 broad features of focal seizures?

A
  1. motor (automatisms, lip smacking, plucking at clothes)
  2. sensory (parasthesiae)
  3. autonomic (epigastric sensation, nausea, abnormal taste)
  4. psychiatric (deja vu, fear)
137
Q

how do you diagnose epilepsy?

A
  1. 2 seizures that are more than 24 hours apart
  2. EEG abnormalities
  3. MRI/CT
  4. bloods
  5. genetic testing
138
Q

how often is epilepsy resistant to drug therapy?

A

1/3 of patients

139
Q

how do you treat epilepsy?

A
  1. tonic clonic- sodium valproate or lamotrigine
  2. absence- ethosuximide or sodium valproate
  3. tonic/atonic/myoclonic- avoid carbamazepine
  4. focal seizures and focal seizures with secondary generalisation- carbamazepine 1st line, lamotrigine and sodium valproate 2nd line
  5. try and treat with 1 drug and 1 main doctor
140
Q

what is status epilepticus?

A

convulsive seizures that last for longer than 5 minutes, or convulsive seizures that occur one after another with no remission

141
Q

what are 5 things that can cause status epilepticus?

A
  1. drug withdrawal
  2. intercurrent illness (disease occurring during current disease)
  3. metabolic disturbance
  4. alcohol intoxication
  5. cerebrovascular accident
142
Q

how do you treat status epilepticus?

A
  1. protect the head and maintain the airway
  2. IV lorazepam (0.1mg/kg) or buccal midazolam (10mg people over 10y/o, 7.5mg 5-10, 5mg 0-5)
  3. IV phenytoin if necessary (1g if 60kg, 1.5g if 80kg, max 2g) do not use if bradycardic
  4. IV diazepam if necessary
  5. general anaesthesia if still refractory
143
Q

what is the initial hospital management of a head injury?

A
  1. involve neurosurgeons at an early stage
  2. examine CNS, pulse, blood pressure, temperature, respirations and pupils every 15 minutes
  3. assess anterograde and retrograde amnesia
144
Q

what is the pre-hospital management for a head injury?

A
  1. ABC

2. immobilisation of the cervical spine if indicated

145
Q

when is cervical spine immobilisation indicated in a head injury?

A
  1. neck pain
  2. focal neurological deficit
  3. paraesthesia
146
Q

what are the indications for A+E referral with a head injury?

A
  1. high energy head injury
  2. loss of consciousness
  3. amnesia
  4. persistent headache
  5. focal neurological signs
  6. vomiting
  7. seizures
  8. visible trauma
  9. suspected skull fracture
  10. age over 65
  11. history of bleeding
  12. anticoagulation
  13. drug or alcohol intoxication
  14. suspicion of a non-accidental injury
147
Q

what is the primary investigation for a head injury?

A

CT head

148
Q

what are the indications for a CT head with a head injury?

A
  1. gcs < 13 at any time
  2. focal neurological signs
  3. suspected open or depressed skull fracture (panda eyes, csf leak)
  4. post-traumatic seizure
  5. vomiting more than once
  6. loss of consciousness COMBINED WITH-
    age >65, coagulopathy, dangerous mechanism of injury, or anterograde amnesia of >30 minutes

basically anyone who needs to go to A+E also needs a head CT

149
Q

what are the indications for a C-spine CT with a head injury?

A
  1. GCS< 13
  2. plain X-ray abnormal
  3. patient intubated
  4. suspicion
150
Q

how can you treat a head injury in A+E?

A
  1. high dose mannitol
  2. prophylactic AED
  3. early nutritional support

all depending on clinical signs

151
Q

what is the immediate management plan for head injury in order?

A
  1. ABC
  2. oxygen with sats lower than 92% or hypoxia
  3. stop blood loss, support circulation, if req treat for shock
  4. treat seizures with lorazepam or phenytoin
  5. assess level of consciousness and amnesia
  6. rapid examination survey
  7. investigations- u+e,, glucose, fbc, blood alcohol, toxicology, abg and clotting
  8. neuro examination
  9. brief history- when, where, how, had a fit, lucid interval, alcohol
  10. evaluate face or scalp lacerations
  11. check for csf leak from nose or ear and blood behind ear drum
  12. palpate posterior neck for tenderness and deformity
  13. radiology
152
Q

what are 3 early common complications of head injuries?

A
  1. extradural haemorrhage
  2. subdural haemorrhage
  3. seizures
153
Q

what are 5 late onset complications of head injuries?

A
  1. subdural haemorrhage
  2. seizure
  3. diabetes insipidus
  4. parkinsonism
  5. dementia
154
Q

what is the clinical presentation of an extradural haemorrhage?

A
  1. trauma that causes a loss of consciousness
  2. headache
  3. nausea and vomiting
  4. seizures
155
Q

what are some clinical signs of an extradural haemorrhage?

A
  1. CSF otorrhoea/ rhinorrhoea
  2. decrease in GCS
  3. facial nerve injury
  4. weakness of limbs
  5. visual field defects
156
Q

what is the clinical presentation of a haematoma in the spinal cord?

A
  1. numbness
  2. paraesthesia
  3. alteration in reflexes
  4. urinary incontinence
157
Q

how do you treat an extradural haemorrhage?

A
  1. maintain airway and perform a trauma assessment
  2. treat with IV mannitol (osmotic diuretic) if ICP is raised
  3. surgery might be needed to evacuate haematoma
158
Q

what is the mortality rate for extradural haemorrhage?

A

30%

159
Q

what are the 3 types of subdural haemorrhage?

A
  1. acute
  2. subacute (3-7 days)
  3. chronic (2-3 weeks after injury)
160
Q

what causes a subdural haemorrhage?

A

tearing of the bridging veins of the venous sinuses or bleeding from a damaged cortical artery. usually caused by blunt head trauma or aggressive shaking

161
Q

what is the clinical presentation of a subdural haemorrhage?

A
  1. presents shortly after a moderate-severe head injury and can involve a loss of consciousness
  2. if it is chronic there is progressive anorexia, nausea, vomiting, and focal neurological deficit. can also manifest with sleepiness, headache, unsteadiness
  3. fluctuating levels of consciousness are seen in 35% of cases
  4. seizures may occur
162
Q

what are four components of the examination for a subdural haemorrhage?

A
  1. GCS evaluation
  2. vital signs
  3. neuro exam
  4. external trauma exam
163
Q

what investigations should be done for a subdural haemorrhage?

A
  1. FBC, U+E, LFT, coagulation screen

2. CT head

164
Q

what is the emergency management for subdural haemorrhage in severe trauma?

A
  1. immobilise the cervical spine
  2. assess ABC
  3. intubate and ventilate
  4. refer to neurosurgical team
  5. IV mannitol if signs of raised ICP
  6. treat coagulopathy
  7. emergency craniotomy and clot evacuation
165
Q

what are 5 complications fo a subdural haemorrhage?

A
  1. cerebral oedema
  2. raised ICP
  3. recurrent haematoma
  4. seizures
  5. permanent neurological deficit
166
Q

what are 4 causes of ischaemic stroke?

A
  1. hypoperfusion
  2. thrombus
  3. embolus
  4. cerebral venous sinus thrombosis
167
Q

what are the two types of haemorrhagic stroke?

A
  1. cerebral haemorrhage

2. subarachnoid haemorrhage

168
Q

what are 4 causes of haemorrhagic stroke?

A
  1. cerebral amyloid angiopathy
  2. cerebral AV malformation
  3. intracranial aneurysm
169
Q

what are three classic features of a stroke?

A
  1. facial weakness
  2. arm drift
  3. abnormal speech
170
Q

what are 7 features of a stroke that involves the spinothalamic, corticospinal and dorsal columns?

A
  1. hemiplegia
  2. facial weakness
  3. numbness
  4. reduced sensation
  5. reduced muscle tone leading to spasticity
  6. hyperreflexia
  7. tongue and sternocleidomastoid weakness
171
Q

what nerves does a brainstem stroke affect?

A

the cranial nerves

172
Q

what are 5 features of a stroke than involves the cerebral cortex?

A
  1. aphasia
  2. dysarthria
  3. apraxia
  4. visual field defect
  5. memory loss
173
Q

what are 3 features of a stroke that involved the cerebellum?

A
  1. ataxia
  2. co-ordination problems
  3. vertigo
174
Q

what vessels are mostly affected in the brain with large vessel disease?

A
  1. common/ internal carotid arteries
  2. vertebral arteries
  3. circle of willis
175
Q

what vessels are mostly affected in the brain with small vessel disease

A
  1. middle cerebral artery
  2. basilar artery
  3. distal vertebral artery
176
Q

what are two factors that can cause cerebral hypoperfusion?

A
  1. cardiac arrest

2. arrhythmias

177
Q

how does cerebral venous sinus thrombosis cause stroke

A

venous pressure will exceed arterial pressure so blood vessels break and leak blood into brain tissues

178
Q

how do you diagnose a stroke?

A

history, examination and CT/MRI of the head

179
Q

what investigations help you to determine the cause of a stroke?

A
  1. ECG
  2. ultrasound
  3. angiogram
  4. routine bloods
180
Q

what are two procedures that remove atherosclerosis?

A
  1. carotid angioplasty

2. carotid endarterectomy

181
Q

what medicine can reduce the risk of future ischaemic strokes?

A

aspirin

182
Q

what medicine can be given within 4.5 hours of the start of a stroke?

A

alteplase

183
Q

how do you treat a venous stroke

A

LMW heparin and then warfarin, with oxygen if sats are less than 95%

184
Q

what type of stroke might require a decompressive hemicraniectomy?

A

a middle cerebral artery stroke

185
Q

what is the most common cause of a subarachnoid haemorrhage?

A

rupture of a berry aneurysm

186
Q

what 3 genetic conditions have links to subarachnoid haemorrhage?

A
  1. neurofibromatosis type 1
  2. Marfan’s
  3. Ehlers-Danlos
187
Q

where do 85% of berry aneurysms occur?

A

the circle of willis

188
Q

what is the clinical presentation of a subarachnoid haemorrhage?

A
  1. sudden explosive headache that may last for a few seconds
  2. nausea and vomiting may occur
  3. seizures may occur
  4. meningism can present 6 hours after (headache, neck stiffness, photophobia)
  5. following a head injury it causes headache, decreased consciousness and hemiparesis
189
Q

what are symptoms of sentinel bleeds of a subarachnoid haemorrhage?

A
  1. headache
  2. diplopia
  3. dizziness
  4. orbital pain

often 3 weeks before subarachnoid haemorrhage

190
Q

what should the examination for subarachnoid haemorrhage include?

A
  1. consciousness level
  2. ophthalmoscopy
  3. neck stiffness
  4. full neuro exam
  5. marked increase in blood pressure
191
Q

what does a subarachnoid haemorrhage in someone who has had seizures suggest?

A

arteriovenous malformation

192
Q

how do you diagnose subarachnoid haemorrhage?

A
  1. CT scan followed by an angiography
  2. if CT is negative but symptoms are suggestive do a lumbar puncture and look for xanthochromia
  3. ECG should be done
193
Q

how do you treat cerebral ischaemia due to vasospasm in subarachnoid haemorrhage?

A

nimodipine

194
Q

what treatments may be required for subarachnoid haemorrhage?

A
  1. clipping/ obliteration
  2. nimodipine
  3. ventricular drainage or LP for hydrocephalus
  4. intubation, ventilation and nasogastric feeding
  5. analgesia and antiemetics
  6. nitroprusside can be used for hypertension
195
Q

what are 7 symptoms of meningitis?

A
  1. severe headache
  2. nuchal rigidity (inability to flex the neck forward)
  3. sudden high fever
  4. sudden altered mental status
  5. photophobia
  6. phonophobia
  7. petechial rash
196
Q

what is kernig’s sign?

A

pain prevents passive extension of the knee

197
Q

what is brudzinski’s sign?

A

flexion of the neck causes involuntary flexion of the knee

198
Q

what are 5 early complications of meningitis?

A
  1. sepsis
  2. DIC
  3. gangrene
  4. focal seizures
  5. cranial nerve abnormality
199
Q

what are 4 common viral causes of meningitis?

A
  1. herpes simplex
  2. varicella zoster
  3. HIV
  4. mumps
200
Q

what are 3 non-infectious causes of meningitis?

A
  1. sarcoidosis
  2. SLE
  3. malignant meningitis
201
Q

what deficiency is common bacterial meningitis?

A

hyponatraemia

202
Q

what are 3 prophylactic drugs for close contacts of people with meningitis?

A
  1. rifampicin
  2. ciprofloxacin
  3. ceftriaxone
203
Q

what antibiotic is given for meningococcal meningitis in primary care?

A

benzylpenicillin

204
Q

what is the standard antibiotic given for meningitis?

A

cefotaxime (3rd generation cephalosporins)

205
Q

what is given in paediatric H.influenzae meningitis?

A

corticosteroids

206
Q

what is given in viral meningitis?

A

acyclovir

207
Q

what is given in fungal meningitis?

A

amphotericin B

208
Q

what is encephalitis?

A

sudden onset inflammation of the brain

209
Q

what are 5 symptoms of encephalitis?

A
  1. acute onset fever
  2. headache
  3. confusion
  4. seizures
  5. younger children may be irritable, feverish and have a poor appetite
210
Q

what are 4 viral causes of encephalitis?

A
  1. rabies
  2. herpes simplex
  3. polio
  4. measles
211
Q

what does an MRI of encephalitis show?

A

T2 hypersensitivity in median temporal lobes

212
Q

what should investigations for encephalitis include?

A

MRI, EEG, LP, bloods, urinalysis

213
Q

why are steroids used in encephalitis?

A

to reduce brain swelling

214
Q

what are the symptoms of a frontal lobe tumour?

A
  1. poor reasoning
  2. personality change
  3. inappropriate behaviour
  4. poor planning
  5. decreased speech production
215
Q

what are the symptoms of a temporal lobe tumour?

A
  1. loss of memory
  2. loss of hearing
  3. difficulties in language and comprehension
216
Q

what are the symptoms of a parietal lobe tumour?

A
  1. poor language interpretation
  2. decreased sense of pain
  3. poor visuospatial perception
217
Q

what are the symptoms of an occipital lobe tumour?

A

poor vision or loss of vision

218
Q

what are the symptoms of a cerebellar tumour?

A
  1. poor balance
  2. muscle movement
  3. poor posture
219
Q

what are the symptoms of a brain stem tumour?

A
  1. altered blood pressure
  2. swallowing difficulties
  3. altered heartbeat
220
Q

what is diagnostic for gliomas, meningiomas and brain mets and is seen on a CT/MRI?

A

disruption of the blood brain barrier

221
Q

are meningiomas benign or malignant?

A

benign

222
Q

what are the 5 most common original tumours to cause brain mets?

A
  1. lung cancer
  2. breast cancer
  3. malignant melanoma
  4. kidney cancer
  5. colon cancer
223
Q

what are 3 types of brain tumour and what are their prognoses?

A
  1. medulloblastoma- good prognosis
  2. glioblastoma- worse prognosis
  3. oligodendroglioma- incurable and slowly progressive
224
Q

what causes symptoms in parkinson’s disease?

A

reduced dopamine in the pars compacta of the substantia nigra

225
Q

what other abnormal body is found in the brain of someone with parkinson’s disease?

A

lewy bodies

226
Q

what are lewy bodies?

A

alpha-synuclein bound to ubiquitin in damaged cells

227
Q

what are 3 genes that cause parkinson’s disease?

A

PARK 1, 4, 5

228
Q

what is the classic parkinsonian triad?

A
  1. rigidity
  2. bradykinesia
  3. resting tremor
229
Q

what are some other symptoms of parkinson’s disease that are not the triad?

A
  1. postural instability
  2. shuffling gait
  3. hallucinations
  4. depression
  5. sleep disturbance
  6. cognitive dysfunction
  7. reduced facial expressions
230
Q

what is characteristic of the arms in a parkinsonian shuffling gait?

A

asymmetrical reduced arm swing

231
Q

how do you diagnose parkinson’s disease?

A
  1. medical history and examination

2. patients can be given levodopa to see improvement which is diagnostic

232
Q

how do you treat parkinson’s disease medically?

A
  1. dopamine analogue- levodopa
  2. dopamine agonist- ropinirole
  3. MAO inhibitors- selegiline
  4. COMT inhibitors- entacopone

MAO and COM-T are enzymes that break down dopamine

233
Q

what are some side-effects of dopamine agonists?

A
  1. drowsiness
  2. hallucinations
  3. insomnia
  4. nausea
234
Q

what are some environmental causes of multiple sclerosis?

A
  1. smoking
  2. stress
  3. toxins
  4. diet
235
Q

what is the pathophysiology of multiple sclerosis?

A

autoimmune disorder causing CNS plaques, inflammation and destruction of myelin sheaths. loss of oligodendrocytes

236
Q

where in the central nervous system is white matter affected by lesions in multiple sclerosis?

A
  1. basal ganglia
  2. spinal cord
  3. brainstem
  4. optic nerve
237
Q

what are 8 symptoms of multiple sclerosis?

A
  1. loss of sensation
  2. muscle weakness
  3. blurred vision
  4. hyperreflexia
  5. muscle spasms
  6. ataxia
  7. dysarthria
  8. depression
238
Q

what of Uhthoff’s phenomenon?

A

the worsening of multiple sclerosis symptoms in hot temperatures

239
Q

what is Lhermitte’s sign?

A

electrical sensation down back when bending the neck

240
Q

how do you diagnose multiple sclerosis?

A
  1. McDonald criteria
  2. CT/MRI-periventricular lesions
  3. LP- oligoclonal IgG bands
241
Q

what are the 4 types of multiple sclerosis?

A
  1. relapsing-remitting
  2. primary progressive
  3. secondary progressive
  4. progressive-remitting
242
Q

how do you treat multiple sclerosis medically?

A
  1. treatment of relapses- methylprednisolone (steroid)
  2. reduction of relapses- interferons and monoclonal antibodies (natalizumab)
  3. fatigue- amantadine
  4. spasticity- baclofen
  5. emotional lability- amitriptyline
243
Q

what are the three cause classification of spinal cord injury?

A
  1. mechanical force
  2. toxic
  3. ischaemic
244
Q

how is the level of injury defined in spinal cord injury?

A

the lowest level of full sensation and function

245
Q

what is the clinical presentation of central cord syndrome?

A
  1. weakness of arms
  2. sparing in legs and spared sensation in areas supplied by sacral segments
  3. loss of pain sensation, light touch and pressure below injury
246
Q

what are the most common causes of central cord syndrome?

A
  1. trauma to the neck due to mechanical injury

2. neck hyperextension in the elderly due to spinal stenosis

247
Q

what is the clinical presentation of anterior cord syndrome?

A

lost motor sensation, pain and temperature sensation below the level of the injury

248
Q

what are the most common causes of anterior cord syndrome?

A
  1. compression of the anterior spinal artery

2. compression of the anterior spinal cord

249
Q

what is the clinical presentation of posterior cord syndrome?

A

loss of proprioception and sense of vibration below the level of injury

250
Q

what is the clinical presentation of brown sequard syndrome?

A

hemisection of the spinal cord causing loss of motor function, proprioception and vibration on the ipsilateral side and pain and temperature contralaterally

251
Q

what is the clinical presentation of cauda equina syndrome?

A
  1. leg weakness
  2. saddle anaesthesia
  3. back pain
  4. sensory loss
  5. decreased sphincter tone
252
Q

what is guillain-barre syndrome?

A

autoimmune destruction of the peripheral nerve system, can be demyelinating or axonal

253
Q

what typically causes guillain-barre syndrome?

A

gastroenteritis or respiratory tract infection

254
Q

what are 5 viruses and bacteria that can cause guillain-barre syndrome?

A
  1. campylobacter jejuni
  2. influenza
  3. epstein-barr virus
  4. cytomegalovirus
  5. varicella zoster
255
Q

what is the clinical presentation of guillain-barre syndrome?

A
  1. initial numbness, tingling and pain
  2. progressive weakness of arms and legs (half a day to two weeks to reach maximum severity)
  3. proximal muscles are more affected- trunk, respiratory, cranial nerves
  4. BP fluctuations and arrhythmia
256
Q

what are 3 complications of guillain-barre syndrome?

A
  1. pneumonia
  2. thrombosis
  3. GI bleeding
257
Q

how do you diagnose guillain-barre syndrome?

A
  1. nerve conduction studies show slow conduction
  2. increased protein in CSF
  3. weakness and hyporeflexia on examination
  4. CT/MRI
258
Q

what is a potentially fatal symptom of guillain-barre syndrome?

A

respiratory muscle involvement causing respiratory distress

259
Q

how do you treat guillain-barre syndrome?

A
  1. plasmapheresis
  2. IV immunoglobulins
  3. mechanical ventilation
260
Q

what is a radiculopathy?

A

damage to a spinal nerve root

261
Q

what is the clinical presentation of radiculopathy?

A
  1. sharp, shooting pain within the distribution of the nerve
  2. weakness
  3. loss of sensation
262
Q

what is the clinical presentation of a proximal myopathy?

A
  1. proximal weakness

2. stairs, hair and chairs- difficulty climbing stairs, brushing hair and rising from a chair

263
Q

what are common causes of proximal myopathy?

A
  1. steroids- in transplant, chemotherapy or severe respiratory disease
  2. duchenne muscular dystrophy
264
Q

what is the most common mononeuropathy?

A

carpal tunnel syndrome

265
Q

what is the clinical presentation of carpal tunnel syndrome?

A
  1. pain
  2. numbness
  3. paraesthesia
  4. affects the thumb and first two fingers and can radiate up to the forearm
266
Q

what never is compressed in carpal tunnel syndrome?

A

median nerve

267
Q

how do you treat carpal tunnel syndrome?

A

carpal tunnel release surgery

268
Q

what is the clinical presentation of peripheral neuropathy?

A
  1. burning pain in feet
  2. decreased vibration sensation
  3. weakness
  4. paraesthesia
  5. numbness
  6. all occurs in the peripheries
  7. discordance between vibration and sensation
269
Q

what is myasthenia gravis?

A

binding of autoantibodies to acetylcholine receptors that interfere with neuromuscular transmission (autoimmune destruction of post-synaptic acetylcholine receptors)

270
Q

what is the clinical presentation of myasthenia gravis?

A
  1. increased muscular fatigue
  2. ptosis, diplopia and myasthenic snarl
  3. voice fading on repeated talking
  4. weakness
  5. tone, reflexes and sensation are all normal
271
Q

what are the common causes of myasthenia gravis?

A
  1. other autoimmune diseases EG rheumatoid arthritis, SLE

2. thymic hyperplasia/ atrophy/ tumour

272
Q

what is a myasthenic crisis?

A

worsening muscle weakness causing respiratory failure that required intubation and mechanical ventiliation, affecting 20-30% of patients within the first year

273
Q

what 3 medications can aggravate myasthenia gravis symptoms?

A
  1. antibiotics
  2. anti-arrhythmics
  3. beta-blockers
274
Q

how do you diagnose myasthenia gravis?

A
  1. anti-achR antibodies or MuSK antibodies
  2. neurophysiological tests
  3. clinical features and examination
  4. thyroid function
  5. MRI/CT head
  6. Thymus CT
  7. tensilon test
275
Q

what is the tensilon test for myasthenia gravis?

A

giving the patient IV acetylcholinesterase inhibitor and observing muscle strength

276
Q

how do you treat myasthenia gravis?

A
  1. acetylcholinesterase inhibitor- pyridostigmine
  2. immunosuppressants- prednisolone
  3. thymectomy
  4. IV Ig can be useful
277
Q

what is the emergency management protocol for a coma?

A
  1. ABC of life support
  2. IV access
  3. stabilise cervical spine
  4. blood glucose fingerprick
  5. control seizures
  6. treat potential causes (EG IV glucose, thiamine, naloxone)
  7. brief collateral history and examination
  8. ABG, FBC, U+E, LFT, ESR, CRP, ethanol, toxicity, drug levels, blood cultures, urine cultures, malaria?
  9. CXR, CT head
  10. reassess situation
278
Q

what are some common causes of acute confusional state?

A
  1. PINCH ME- pain, infection (pneumonia, UTI, IV lines, encephalitis, meningitis), nutrition, constipation, hydration, medication (opiates, anticonvulsants, levodopa), environment
  2. non-convulsive status epilepticus
  3. head injury
279
Q

what investigations should/could be done on a patient with acute confusional state?

A
  1. FBC, U+E, LFT, glucose, ABG, septic screen, ECG, LP, EEG, CT/MRI
280
Q

how do you treat acute confusional state?

A
  1. reduce distress and prevent accidents
  2. treat suspected cause
  3. remove catheters if you can
  4. augment self care
  5. minimise medication, consider sedation if agitated and disruptive
281
Q

what are 10 red flag symptoms for acute new headache?

A
  1. first and worst headache
  2. thunderclap headache
  3. unilateral headache with eye pain
  4. unilateral headache and ipsilateral symptoms
  5. cough-initiated headache
  6. worse in the morning or bending forward
  7. persisting headache with scalp tenderness over 50
  8. headache with fever or neck stiffness
  9. change in pattern of usual headache
  10. decreased consciousness
282
Q

what is a first and worst, thunderclap headache likely to be?

A

subarachnoid haemorrhage

283
Q

what 2 things is a unilateral headache with eye pain likely to be?

A
  1. cluster headache

2. acute glaucoma

284
Q

what 3 things is a unilateral headache with ipsilateral symptoms likely to be?

A
  1. migraine
  2. tumour
  3. vascular
285
Q

what 2 things are a headache that worsens on coughing, waking up and leaning forward likely to be?

A
  1. raised ICP

2. venous thrombosis

286
Q

what is a persistent headache and scalp tenderness in someone over 50 likely to be?

A

giant cell arteritis

287
Q

what is a headache with fever or neck stiffness likely to be?

A

meningitis

288
Q

what 6 things is a headache with decreased consciousness or localising signs likely to be?

A
  1. stroke
  2. encephalitis/ meningitis
  3. cerebral abscess
  4. subarachnoid haemorrhage
  5. tumour
  6. subdural haemorrhage
289
Q

what 5 things can cause papilloedema with a headache?

A
  1. tumour
  2. venous sinus occlusion
  3. malignant hypertension
  4. idiopathic intracranial hypertension
  5. prolonged CNS infection

Phase 3A Flashcards (6 decks)

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