Neurology e lecture Flashcards
Dorsal column vs spinothalamic pathway
4 categories of causes of coma
- metabolic
- diffuse intracranial (injury to the brain itself)
- space occupying lesions
- brainstem injury
Metabolic causes of coma
- hypoglycaemia
- hypercalcaemia
- diabetes mellitus
- drug overdose
- “the failures”
Diffuse intracranial causes of coma
- meningitis
- encephalitis
- SAH
- trauma
- epilepsy
Examples of hemispheric lesions causing coma
- cerebral infarct
- cerebral haemorrghage
- subdural hematoma
- extradural hematoma
- abscess
- tumour
Brainstem causes of coma
- brainstem infarct
- tumour
- abscess
- cerebellar haemorrghage
- cerebellar infarct
Concepts of consicousness
Vegetative state: brainstem is intact but there’s vast damage to the rest of the cortex.
Locked in syndrome: brainstem is largely intact. Patient can’t MOVE.
Definition of seizure
Paradoxical discharge of cerebral neurones which is apparent to an external observer (eg generalised seziure) or as an abnormal perceptual experience by the subject
i.e. it’s the physical manifestation of sudden changes in electrical activity in the brain
Symptoms:
- abnormal perceptual exprience by subject
- paradoxical cerebral discharge
- body stiffening
- TACHYCARDIA
- breathing may be absent in a tonic-clonic seizure
Definition of epilepsy
A RECURRING tendency to have seizures
(diff from a seizure- seizure is a one off event whereas epilepsy is recurrent seizures)
Two broad categories of seizures in epilepsy
- generalised- affects diff parts of the brain
- partial- affects a localised area of the brain
Types of generalised seizures in epilepsy
(All of these are generalised seizures, affecting different parts of the brain simultaneously. Tonic-clonic is the most common type)
Types of partial seizures in epilepsy
Status epilepticus
How do patients with LIS communicate?
Vertical eye movements and blinking
Coma vs vegetative state vs LIS vs minimally conscious state
Coma: patients may have reflexes and postural movements
Vegetative state: may be purposeful movement and withdrawal from noxious stimuli
MCS: may reach for objects and localise noxious stimuli
LIS: quadriplegia
Broadly what is the mechanism for headaches?
The brain doesn’t have pain receptors but the meninges and blood vessels do.
Pains are referred back into trigeminal nerves and C2 root (occipital nerve)
Causes of acute single headaches
Causes of recurrent headaches
Causes of a triggered headache
Causes of dull headache with increasing severity
Causes of dull headache, unchanegd over time
Broad mechanisms of syncope
Anything that reduces perfusion of the brain.
- Things affecting HR
- Things affecting stroke volume: acute and chronic
- Other
Causes of syncope: things affecting Heart rate
- bradycardia
- complete heart block
- tachycardia
- ventriuclar tachycardia
Causes of syncope: things that affect stroke volume
Acute vs chronic
Causes of syncope: things affecting peripheral resistance
Definitino of stroke
Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or more, with no apparent cause other than that of vascular origin.
Symptoms of stroke in anterior circulation of the brian
- contralateral hemiparesis
- aphasia
- apraxia
- visual neglect
Symptoms of stroke in posterior circulation of the brain
4Ds + Ataxia
Dysphagia
Diplopia
Dysarthria (slurred speech)
Dizziness (vertigo)
Ataxia
Define TIA
Acute episodes of focal disturbance of cerebral or visual function, lasting less than 24h, due to inadequate blood supply
Symptoms of PICA
Ipsilateral cerebellar ataxia
Symptoms of posterior cerebral artery stroke
Symptoms of middle cerebral artery stroke
Which artery is affected in LIS?
Basilar artery
Important brain infections
- meningitis- affects the meninges
- encephalitis- within the substance of the brian (often affects temporal lobe)
Organisms that can cause meningitis
Definition of PD
Symptoms of PD on the face
Symptoms of PD: gait
Tremor in PD
Rigidity in PD
Main drug for PD
L-DOPA
Precursor of dopamine, able to cross the BBB unlike dopamine.
eg Sinamet, Madopar
L-Dopa side-effects
What happens in MS?
Which areas are commonly affected by MS?
Examples of sensory and motor neuropathies
Classification of polyneuropathies
What causes radial nerve palsy?
AKA saturday night palsy.
Caused byd raping the arm over back of chair for hours
Type of neuropathy in renal disease
Progressive sensorimotor neuropathy
Type of neuropathy in connective tissue disease
Mononeuritis multiplex
Type of neuropathy in Alcoholic neuropathy
Progressing numbness, burning pains, distal muscle weakness
Type of neuropathy in AIP
Motor neuropathy and abdominal pain
