Neurology Flashcards
What are the differential diagnoses for a collapse?
Epileptic seizure
Syncope - vasovagal, postural, cardiogenic
Physiological - hypoglycaemia, sleep disorder, TIA
Psychological - non-epileptic attack/pseudo-seizure, panic attack
Give 3 features of the history to ask about for seizure
History from eyewitness Provoking factors Preceding symptoms Description of episode Recovery from episode
What risk factors may be present in the history for seizures?
Previous/family history
Birth injury, febrile convulsions, meningitis
Brain injury - stroke, surgery
History of myoclonic jerks
Give a provoking factor for seizure
Alcohol
Drugs
Sleeping tablets
Sleep deprivation
Give 2 provoking factors for syncope
HTN medication Undergoing painful medical procedure Hot environment Standing up too quickly Prolonged standing
What preceding symptoms might there be for a seizure?
Generalised - none
Focal - aura (smell, taste, deja vu, fear, unusual feeling, sensory changes)
What preceding symptoms might there be for syncope?
Darkening of vision Seeing spots Ringing in ears Hot flush Feeling dizzy Palpitations
Give 3 features of a focal seizure
Automatisms - lip smacking, stroking Head and eye deviation Limb stiffening and jerking Reduced interaction/responsiveness Frontal lobe 10-20 secs; temporal lobe 2-4 mins
Give 3 features of a generalised seizure
Body stiffening/rigidity May let out scream Rhythmical limb jerking Colour change (blue/purple) Open rolled back eyes 1-2 mins duration Heavy breathing and snoring after
Give 3 features of a vasovagal or postural episode
Fade to black Flop to ground Pale/sweaty/ashen Slow pulse Short duration Rapid recovery
What is the recovery period like after a seizure?
Non-responsive for some time Post-ictal confusion Dysphasia Todd's paresis May not recall events Headache Malaise Sleepy
What is Todd’s paresis?
Focal weakness in a part or all of the body after a seizure; usually subsides within 48 hours
What is convulsive syncope?
Common variant of syncope
May have rigidity and rhythmic jerking
May be incontinent and be briefly confused
Give 4 features of non-epileptic attack
RFs - sexual/physical abuse, anxiety, depression
Prodrome - inability to move, fear, breathlessness, dizzy
Description - prolonged, wax and wane, thrashing/flailing, back arching, tremor all over, resisting eye opening
After - confused, rapid recovery, tearful, awareness, injuries
What examinations may be considered for collapse?
Standing/lying BP
Auscultation of heart
Focused neurological exam
Fundoscopy
What investigations may be considered for collapse?
ECG
Bloods - FBC, U&Es, glucose, calcium, phosphate, magnesium
Syncope - tilt table, monitoring, echo
Seizure - MRI, EEG, video telemetry
Define seizure
Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
When is a diagnosis of epilepsy no longer applicable?
Patient with age dependent epilepsy syndrome who is past the applicable age
A patient who has remained seizure free for >10 years off medication
What is meant by a focal seizure?
Seizure originating within networks limited to a single hemisphere; may be localised or distributed
What is meant by a generalised seizure?
Seizure originating at some point and rapidly engaging bilaterally distributed networks; may not necessarily involve the entire cortex
What is Dravet syndrome?
Epilepsy syndrome with genetic cause
Onset in first year of life with febrile seizures, prolonged clonic seizures, often precipitated by hyperthermia
Give 3 types of non-epileptic seizures/events
Syncope Psychological/behavioural events Sleep related problems Paroxysmal movement disorders Migraine and related disorders Miscellaneous neurological and non-neurological events
Define syncope
A transient loss of consciousness resulting from an insufficient supply of oxygen to the brain
What are anoxic seizures?
The collapse, stiffening, +/- jerking that can occur as a result
of neurogenic syncope or breath holding, often due to unpleasant event/crying (children)
Give 2 clinical features used to differentiate syncope and seizure
Lateral tongue biting
Unpleasant circumstances preceding event
Define cataplexy
Sudden, brief loss of voluntary muscle tone triggered by strong emotions such as laughter
What is a TIA?
Focal neurological symptoms of acute onset which resolve within 24 hours, typically within minutes, due to underlying cerebral ischaemia
What is the ABCD2 score?
Risk factors for stroke
A- age >60 years (1)
B - BP elevation (1)
C - clinical features - unilateral weakness (2) or speech disturbance without weakness (1)
D - duration of symptoms - >60 mins (2), 10-59 mins (1)
D - diabetes (1)
Define stroke
Rapidly developing clinical signs of disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin
Give 2 signs/symptoms of stroke
Weakness - limb/face/arm/hemiparesis
Dysphasia
Visual disturbance (right homonymous hemianopia)
Light-headedness
What artery is likely to have been affected in a stroke where weakness has occurred in the leg only?
Anterior cerebral artery
What artery is likely to have been affected in a stroke where weakness has occurred in the face and arm?
Middle cerebral artery
What artery supplies Wernicke’s and Broca’s speech areas?
Middle cerebral artery
A stroke involving which artery could result in cerebellar signs?
Posterior inferior cerebral artery
Give 2 causes of ischaemic stroke
Cryptogenic (unknown)
Cardiac embolism
Small vessel disease
Atherosclerotic cerebrovasular disease
What does TACS stand for, what symptoms occur and where is the occlusion?
Total anterior circulation syndrome
Hemiperesis, higher cortical dysfunction and hemianopia
Proximal middle cerebral artery or internal carotid artery
What does PACS stand for, what symptoms occur and where is the occlusion?
Partial anterior circulation syndrome
Higher cortical dysfunction alone OR 2 of hemiparesis, HCD, hemianopia
Branch of middle cerebral artery
What does POCS stand for, what symptoms occur and where is the occlusion?
Posterior circulation syndrome
Hemianopia OR brainstem syndrome alone
Perforating arteries, posterior communicating artery or cerebellar arteries