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3a > Neurology (other) > Flashcards

Neurology (other) Flashcards

1
Q

What is another name for shingles ? what pathogen causes this ? what else does this pathogen cause ?

A

shingles/ herpes zoster
- Caused by VZV
- Same as chicken pox (primary infection)

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2
Q

what is shingles characterised by ?

A

characterised by nerve damage + painful skin rash

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3
Q

Explain the pathophysiology of shingles ? where does virus start from (location) ?

A

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)

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4
Q

what are you more likely to get singles ?

A

the immunity weakens
- Aging
- Stress
- Infected with other diseases

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5
Q

What are the 3 phases to the shingles disease course ?

A
  • Pain
  • Painful skin rash
  • Rashing healing
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6
Q

Describe the pain associated with shingles ?

A

First phase
- Stabbing, burning, tingling, numbness
- sensitive to touch

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7
Q

describe the skin rash associated with singles ?

A

Painful skin rash (second phase)
- small dots => fluid filled (vesicular) blisters (dermatomal)
- unilateral

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8
Q

What is the management of shingles ?

A

no cure, self limited condition
- Aciclovir: speed up recovery + decrease risk of complications

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9
Q

what are some complications of shingles ? (2)

A
  • Post hepetic neuralgia (PHN): considerable pain post rash healing
  • Vision/hearing loss (possible if there were blisters on head)
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10
Q

Describe the infectivity of shingles ? how spread?

A
  • shingles can’t be passed on
  • but Px with shingles can pass on chicken pox to those who have not had it yet
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11
Q

What is giant cell arteritis ? also known as ? what vessels ?

A

temporal arteritis
- systemic vasculitis affecting medium + large vessels

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12
Q

with what other condition does GCA have a strong link with ?

A

strong link with polymylagia rheumatica

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13
Q

What is a key complication of GCA ?

A

painless vision loss (irreversible)

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14
Q

GCA presentation ? (5)

A
  • 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
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15
Q

GCA Ix ? diagnostic ?

A
  • clinical presentation
  • ESR (>50mm/hr) - important
  • definitive: temporal artery biopsy (skip lesions so need a couple biopsies)
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16
Q

what would be seen on biopsy of temporal artery in GCA ?

A

definitive Ix
- multinucleate giant cells

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17
Q

GCA Mx ?

A

do not wait for confirm diagnosis (so reduce risk of vision loss)
- high dose steroids: prednisone, meythlprednisolone

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18
Q

GCA complications ?

A
  • vision loss
  • steroids SE
  • stroke
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19
Q

describe what controls pupil constriction ? what nerve ? para/sym ? what muscles ?

A

parasympathetic nerve fibres travel along CN3 => make circular muscles of iris contract => pupil constriction

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20
Q

What are the causes of a dilated pupil ? (4)

A
  • 3 rde nerve palsy
  • trauma
  • stimulants
  • anticholingeric meds
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21
Q

What are the causes of miosis ?

A

constricted pupil
- horners syndrome
- cluster headache
- opiates

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22
Q

How does third nerve palsy present (3)

A
  • Ptosis (drooping upper eyelid)
  • dilated non-reactive pupil
  • eye fixed down and out
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23
Q

describe the eye direction associated with third nerve palsy ? why is it like this ?

A

fixed down and out
- Because only lateral rectus (out) and superior oblique (down) work
- because those 2 are not controls by CNIII

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24
Q

What could cause a third nerve palsy ? (3)

A
  • idiopathic
  • diabetes (microvascular cause)
  • compression of nerve (tumour, trauma, PCA aneurysm)
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25
Q

What is Horner syndrome presentation ? (3)

A
  • ptosis
  • miosis
  • anhidrosis
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26
Q

what causes Horner syndrome ?

A

damage to sympathy NS supplying face
- either central, preganglionic or postganglionic

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27
Q

What is muscular dystrophy ?

A

umbrella term for various genetic conditions that cause gradual weakening + wasting of muscles

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28
Q

Name 2 types of muscular dystrophy ?

A
  • duchesses muscular dystophy
  • Beckers muscular dystrophy
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29
Q

What is gowers sign? describe ? what is it associated with ?

A

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

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30
Q

5 yo with vague symptoms of muscle weakness + use hands on legs to stand up. what diagnosis ?

A

duchesses muscle dystrophy

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31
Q

what inheritance is duchesses muscular dystrophy ?

A

x linked recessive

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32
Q

duchesses managment ?

A

oral steroids may help
no way to treat

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33
Q

patient unable to let fo after shaking some hand. what is this most likely ?

A

beckers muscular dystrophy

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34
Q

What is acoustic neuroma ? Affecting what nerve ? affecting what cells ?

A

benign tumours of the Schwann cells surrounding auditory nerve (vestibulocochlea nerve) that innervates inner ear

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35
Q

Where is acoustic neuroma usually located ?

A

cerebellar pontine angle (usually unilateral)

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36
Q

with what other condition is acoustic neuroma associated ?

A

associated with neurofibromatosis type II

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37
Q

typical Patient presentation of acoustic neuroma ?

A

40-50 yrs
- gradual onset unilateral sensoneural hearing los, tints, dizzinessac

38
Q

acoustic neuroma Ix ?

A
  • audiometry (to assess hearing loss)
  • MRI/CT
39
Q

What is caudal equine syndrome ?

A

surgical emergency
- nerve roots of caudal equine are compressed

40
Q

what is the caudal equine ?

A

collection of nerve roots that travel throughout spinal canal after spinal cord terminates (L2/3)

41
Q

describe the sensation, motor and parasymapthic supply of caudal equina ?

A
  • sensation (lower limb, peritoneum, rectum)
  • Motor (lower limb, anal + urethral sphincters)
  • para (bladder and rectum)
    (controls faecal + urinary continence
42
Q

cause equina causes ? (4)

A

(compression of nerve roots)
- herniated disc (most common)
- tumours (metastesis)
- Abscess
- Trauma

43
Q

Red flags for caudal equina presentation ?

A
  • saddle anaesthesia
  • loss of sensation of bladder/rectum (not knowing when full)
  • Urinary retention or incontinence
  • faecal incontinence
  • sciatica
44
Q

cauda equina Mx ?

A

need emergency decompression surgery to prevent permanent neurodysfunction
- hospital admision
- Emergency MRI
- Neurosurgery

45
Q

cauda equina complicaitons ?

A
  • bladder, bowel or sexual dysfunction
46
Q

what is metastatic spinal cord compression ? where

A

when metastiacti lesion compresses spinal cord (before end of spinal cord)

47
Q

how dies metasticit spinal cord compression present (MSCC) ? similar to what ?

A

similar to caudal equina (back pain, Motor + sensory signs)
- but also has back pain that is worse on coughing/straining

48
Q

metastatic spinal cord compression Mx ?

A

oncolocial emergency
- high dose dexamethasone
- analgesia
- surgery
- chemo
- radiotherapy

49
Q

What is meniere’s disease

A

long term inner ear disorder => recurrent vertigo eps

50
Q

meniere’s disease triad ?

A
  • hearing loss
  • Vertigo
  • Tinitus
51
Q

meniere’s disease pathophys ?

A

excessive buildup of endolymph in labyrinth of inner ear => increase pressure => disrupt sensory signals

52
Q

what’s the increased pressure in meniere’s disease called ?

A

end-lymphatic hydrops

53
Q

meniere’s disease presentation ?

A

unilateral vertigo, hearing loss, tinitus
- fullness in ear

54
Q

describe the vertigo in meniere’s disease ?

A

lasts around 20 mins + not triggered by movement

55
Q

meniere’s disease Dx

A

clinical diagnosis

56
Q

meniere’s disease Mx ?

A
  • Attacks: prchloperazine
  • Prophylaxis: betahistine
57
Q

What is malaria ? causative organism ?

A

infectious disease caused by members of plasmodium family (protozoan parasites)

58
Q

most common malaria subtype ?

A

plasmodium falciparum (80%)

59
Q

how is malaria spread ?

A

spread thought bites form female anopheles mosquitoes (usually associated with travel)

60
Q

describe the life cycle of malaria ? mosquitoes ? to where in body ?

A
  • 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)
61
Q

how often do RBC rupture in malaria ?

A

every 48 hrs
(fever spike every 48 hrs)

62
Q

malaria Px ? (5)

A

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

63
Q

malaria Dx ?

A

malaria blood fom
- 3 consecutive samples over 3 consecutive days (due to release into blood every 48 hrs)

64
Q

malaria Mx ? drugs (2)

A

admit patients with plasmodium falciparum
- artesunate
- quinine

65
Q

malaria complication ? (6)

A
  • cerebral malaria
  • siezures
  • DIC
  • AKI
  • PE
  • Death
66
Q

malaria prophylaxis ?

A

no single method is 100% effective so use multiple
- mosquito nets
- antimalarials

67
Q

What is normal pressure hydrocephalus ? due to what ?

A

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)

68
Q

Causes of normal pressure hydrocephalus (5)

A
  • Idiopathic (50%)
  • SAH
  • Meningitis
  • Head injury
  • Malignancy
69
Q

normal pressure hydrocephalus triad Px ? how quick to sx present ?

A
  • urinary incontinence
  • dementai
  • gait abnormality
    (symptoms develop over a few months)
70
Q

normal pressure hydrocephalus Ix ? what would this show ?

A

CT - ventral enlargement
LP - CSF pressure normal

71
Q

Normal pressure hydrocephalus Mx ?

A

surgical insertion of a CSF shunt

72
Q

what could cause a brain abscess ? (4)

A
  • extension of sepsis (from middle ear/sinuses)
  • trauma/surgery
  • penetrating head inury
  • embolic events from endocarditisb
73
Q

brain abscess px ? (4)

A
  • headache (dull, persistent)
  • fever
  • focal neurology
  • signs of raised ICP (nausea, papilloedema, seizures)
74
Q

brain abscess Ix ? Mx ?

A

CT
craniotomy + abscess debridement
- IV Abx: IV 3rd gen cephalosproin + metronidazole
- dexamethasone (to reduce ICP)

75
Q

What is bulbar palsy ? associated with function of which CN ?

A

sx linked to impaired function of lower cranial nerves (CNIX - CNXII)
- can be progressive or non prgoressive

76
Q

bulbar palsy causes ? (4)

A
  • brainstem strokes
  • brainstem tumours
  • MND
  • GBS
77
Q

bulbar palsy sx ?

A
  • dysphagia
  • absent gag reflex
  • dysphonia
  • drooling
  • difficulty chewing
78
Q

What is diabetic neuropathy ? affect sensory/motor ? what distribution ?

A

typically causes sensory loss (glove and stocking distribution) + not motor loss

79
Q

where affected first in diabetic neuropathy ? why ?

A

lower legs affected first de to tenth of sensory nerves

80
Q

diabetic neuropathy pain Mx ? same as what ?

A

managed in same way as other neuropathic pain
- 1st line: amitriptyline, duloxetine, gabapentin

81
Q

What is myelopathy ?

A

injury to the spinal cord due to severe compression

82
Q

What is myopathy ?

A

any disease that affects the muscles that control voluntary movement

83
Q

What is radiculopathy ?

A

pinching of nerve roots as they exit spinal cord or cross intervertebral disc (rather than compression of cord itself => myelopathy)

84
Q

what types of myelopathy are there ? most common ?

A
  • cervical (most common)
  • thoracic
  • lumbar
85
Q

causes of myelopathy ? (5)

A

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)

86
Q

myelopathy sx ?

A
  • loss of sensation + function
  • pain/discomfort
    (in area/ below compression point)
87
Q

what is foot drop a result of ? what muscle ?

A

result of weakness of foot dorsi flexor

88
Q

What is chornic fatigue syndrome ? diagnosis ?

A

diagnosed after >3months of diabling fatigue affecting physical + mental function >50% of time in abscence of any other disease

89
Q

Chrnoic fatigue syndrome Ix ?

A

screening blood test to exclude other pathology

90
Q

chronic fatigue syndrome Mx ? (4)

A
  • CFS referral
  • energy managment
  • physical activity + exercise
  • CBT

3a (43 decks)

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