Neurology (other) Flashcards
What is another name for shingles ? what pathogen causes this ? what else does this pathogen cause ?
shingles/ herpes zoster
- Caused by VZV
- Same as chicken pox (primary infection)
what is shingles characterised by ?
characterised by nerve damage + painful skin rash
Explain the pathophysiology of shingles ? where does virus start from (location) ?
after primary infection (chicken pox), virus lies dormant in sensory ganglia (dorsal root ganglia) of spin/cranial nerves (inactive)
- when immunity weakens => chance for reactivation to occur => infection spreads along path of infected nerve => dermatomal pain (unilateral)
what are you more likely to get singles ?
the immunity weakens
- Aging
- Stress
- Infected with other diseases
What are the 3 phases to the shingles disease course ?
- Pain
- Painful skin rash
- Rashing healing
Describe the pain associated with shingles ?
First phase
- Stabbing, burning, tingling, numbness
- sensitive to touch
describe the skin rash associated with singles ?
Painful skin rash (second phase)
- small dots => fluid filled (vesicular) blisters (dermatomal)
- unilateral
What is the management of shingles ?
no cure, self limited condition
- Aciclovir: speed up recovery + decrease risk of complications
what are some complications of shingles ? (2)
- Post hepetic neuralgia (PHN): considerable pain post rash healing
- Vision/hearing loss (possible if there were blisters on head)
Describe the infectivity of shingles ? how spread?
- shingles can’t be passed on
- but Px with shingles can pass on chicken pox to those who have not had it yet
What is giant cell arteritis ? also known as ? what vessels ?
temporal arteritis
- systemic vasculitis affecting medium + large vessels
with what other condition does GCA have a strong link with ?
strong link with polymylagia rheumatica
What is a key complication of GCA ?
painless vision loss (irreversible)
GCA presentation ? (5)
- headache: severe unilateral around temporal area
- scalp tenderness
- jaw claudication
- visual changes: double vision, loss of vision
- systemic sx: fevere, muscle aches, fatigue, peripheral oedema
GCA Ix ? diagnostic ?
- clinical presentation
- ESR (>50mm/hr) - important
- definitive: temporal artery biopsy (skip lesions so need a couple biopsies)
what would be seen on biopsy of temporal artery in GCA ?
definitive Ix
- multinucleate giant cells
GCA Mx ?
do not wait for confirm diagnosis (so reduce risk of vision loss)
- high dose steroids: prednisone, meythlprednisolone
GCA complications ?
- vision loss
- steroids SE
- stroke
describe what controls pupil constriction ? what nerve ? para/sym ? what muscles ?
parasympathetic nerve fibres travel along CN3 => make circular muscles of iris contract => pupil constriction
What are the causes of a dilated pupil ? (4)
- 3 rde nerve palsy
- trauma
- stimulants
- anticholingeric meds
What are the causes of miosis ?
constricted pupil
- horners syndrome
- cluster headache
- opiates
How does third nerve palsy present (3)
- Ptosis (drooping upper eyelid)
- dilated non-reactive pupil
- eye fixed down and out
describe the eye direction associated with third nerve palsy ? why is it like this ?
fixed down and out
- Because only lateral rectus (out) and superior oblique (down) work
- because those 2 are not controls by CNIII
What could cause a third nerve palsy ? (3)
- idiopathic
- diabetes (microvascular cause)
- compression of nerve (tumour, trauma, PCA aneurysm)
What is Horner syndrome presentation ? (3)
- ptosis
- miosis
- anhidrosis
what causes Horner syndrome ?
damage to sympathy NS supplying face
- either central, preganglionic or postganglionic
What is muscular dystrophy ?
umbrella term for various genetic conditions that cause gradual weakening + wasting of muscles
Name 2 types of muscular dystrophy ?
- duchesses muscular dystophy
- Beckers muscular dystrophy
What is gowers sign? describe ? what is it associated with ?
technique children with proximal weakness use to stand up
- on hands and knees and then walk hands up body to stand up
- associated with muchness muscular dystrophy
5 yo with vague symptoms of muscle weakness + use hands on legs to stand up. what diagnosis ?
duchesses muscle dystrophy
what inheritance is duchesses muscular dystrophy ?
x linked recessive
duchesses managment ?
oral steroids may help
no way to treat
patient unable to let fo after shaking some hand. what is this most likely ?
beckers muscular dystrophy
What is acoustic neuroma ? Affecting what nerve ? affecting what cells ?
benign tumours of the Schwann cells surrounding auditory nerve (vestibulocochlea nerve) that innervates inner ear
Where is acoustic neuroma usually located ?
cerebellar pontine angle (usually unilateral)
with what other condition is acoustic neuroma associated ?
associated with neurofibromatosis type II
typical Patient presentation of acoustic neuroma ?
40-50 yrs
- gradual onset unilateral sensoneural hearing los, tints, dizzinessac
acoustic neuroma Ix ?
- audiometry (to assess hearing loss)
- MRI/CT
What is caudal equine syndrome ?
surgical emergency
- nerve roots of caudal equine are compressed
what is the caudal equine ?
collection of nerve roots that travel throughout spinal canal after spinal cord terminates (L2/3)
describe the sensation, motor and parasymapthic supply of caudal equina ?
- sensation (lower limb, peritoneum, rectum)
- Motor (lower limb, anal + urethral sphincters)
- para (bladder and rectum)
(controls faecal + urinary continence
cause equina causes ? (4)
(compression of nerve roots)
- herniated disc (most common)
- tumours (metastesis)
- Abscess
- Trauma
Red flags for caudal equina presentation ?
- saddle anaesthesia
- loss of sensation of bladder/rectum (not knowing when full)
- Urinary retention or incontinence
- faecal incontinence
- sciatica
cauda equina Mx ?
need emergency decompression surgery to prevent permanent neurodysfunction
- hospital admision
- Emergency MRI
- Neurosurgery
cauda equina complicaitons ?
- bladder, bowel or sexual dysfunction
what is metastatic spinal cord compression ? where
when metastiacti lesion compresses spinal cord (before end of spinal cord)
how dies metasticit spinal cord compression present (MSCC) ? similar to what ?
similar to caudal equina (back pain, Motor + sensory signs)
- but also has back pain that is worse on coughing/straining
metastatic spinal cord compression Mx ?
oncolocial emergency
- high dose dexamethasone
- analgesia
- surgery
- chemo
- radiotherapy
What is meniere’s disease
long term inner ear disorder => recurrent vertigo eps
meniere’s disease triad ?
- hearing loss
- Vertigo
- Tinitus
meniere’s disease pathophys ?
excessive buildup of endolymph in labyrinth of inner ear => increase pressure => disrupt sensory signals
what’s the increased pressure in meniere’s disease called ?
end-lymphatic hydrops
meniere’s disease presentation ?
unilateral vertigo, hearing loss, tinitus
- fullness in ear
describe the vertigo in meniere’s disease ?
lasts around 20 mins + not triggered by movement
meniere’s disease Dx
clinical diagnosis
meniere’s disease Mx ?
- Attacks: prchloperazine
- Prophylaxis: betahistine
What is malaria ? causative organism ?
infectious disease caused by members of plasmodium family (protozoan parasites)
most common malaria subtype ?
plasmodium falciparum (80%)
how is malaria spread ?
spread thought bites form female anopheles mosquitoes (usually associated with travel)
describe the life cycle of malaria ? mosquitoes ? to where in body ?
- Feeding mosquito suck up infected blood, parasite reprove in mosquito => sporozoites (malaria spores)
- mosquito bite => inject sporozoites => travel to liver => sporozoites mater to nerzoites => reproductive in RBC => rupture + release (haemolytic anaemia)
how often do RBC rupture in malaria ?
every 48 hrs
(fever spike every 48 hrs)
malaria Px ? (5)
travelled to area where malaria present (1-4 week, lie dormant for yrs)
- Fever (up to 41, spikes every 48 hrs)
- Fatiue
- myalgia
- headahce
- vomiting
malaria Dx ?
malaria blood fom
- 3 consecutive samples over 3 consecutive days (due to release into blood every 48 hrs)
malaria Mx ? drugs (2)
admit patients with plasmodium falciparum
- artesunate
- quinine
malaria complication ? (6)
- cerebral malaria
- siezures
- DIC
- AKI
- PE
- Death
malaria prophylaxis ?
no single method is 100% effective so use multiple
- mosquito nets
- antimalarials
What is normal pressure hydrocephalus ? due to what ?
excessive build up of CSF within the brain: reversible cause of dementia (elderly)
- Pressure on LP expected to increase but is normal
- Due to reduced CSG absorption at the arachnoid villi (maybe)
Causes of normal pressure hydrocephalus (5)
- Idiopathic (50%)
- SAH
- Meningitis
- Head injury
- Malignancy
normal pressure hydrocephalus triad Px ? how quick to sx present ?
- urinary incontinence
- dementai
- gait abnormality
(symptoms develop over a few months)
normal pressure hydrocephalus Ix ? what would this show ?
CT - ventral enlargement
LP - CSF pressure normal
Normal pressure hydrocephalus Mx ?
surgical insertion of a CSF shunt
what could cause a brain abscess ? (4)
- extension of sepsis (from middle ear/sinuses)
- trauma/surgery
- penetrating head inury
- embolic events from endocarditisb
brain abscess px ? (4)
- headache (dull, persistent)
- fever
- focal neurology
- signs of raised ICP (nausea, papilloedema, seizures)
brain abscess Ix ? Mx ?
CT
craniotomy + abscess debridement
- IV Abx: IV 3rd gen cephalosproin + metronidazole
- dexamethasone (to reduce ICP)
What is bulbar palsy ? associated with function of which CN ?
sx linked to impaired function of lower cranial nerves (CNIX - CNXII)
- can be progressive or non prgoressive
bulbar palsy causes ? (4)
- brainstem strokes
- brainstem tumours
- MND
- GBS
bulbar palsy sx ?
- dysphagia
- absent gag reflex
- dysphonia
- drooling
- difficulty chewing
What is diabetic neuropathy ? affect sensory/motor ? what distribution ?
typically causes sensory loss (glove and stocking distribution) + not motor loss
where affected first in diabetic neuropathy ? why ?
lower legs affected first de to tenth of sensory nerves
diabetic neuropathy pain Mx ? same as what ?
managed in same way as other neuropathic pain
- 1st line: amitriptyline, duloxetine, gabapentin
What is myelopathy ?
injury to the spinal cord due to severe compression
What is myopathy ?
any disease that affects the muscles that control voluntary movement
What is radiculopathy ?
pinching of nerve roots as they exit spinal cord or cross intervertebral disc (rather than compression of cord itself => myelopathy)
what types of myelopathy are there ? most common ?
- cervical (most common)
- thoracic
- lumbar
causes of myelopathy ? (5)
typically developed slowly as result of gradual degeneration of spine
- spinal stenosis (narrowing of spinal canal)
- central disc herniations
- RA
- spinal tumours
- spinal injury (acute myelopathy)
myelopathy sx ?
- loss of sensation + function
- pain/discomfort
(in area/ below compression point)
what is foot drop a result of ? what muscle ?
result of weakness of foot dorsi flexor
What is chornic fatigue syndrome ? diagnosis ?
diagnosed after >3months of diabling fatigue affecting physical + mental function >50% of time in abscence of any other disease
Chrnoic fatigue syndrome Ix ?
screening blood test to exclude other pathology
chronic fatigue syndrome Mx ? (4)
- CFS referral
- energy managment
- physical activity + exercise
- CBT
