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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
What is Horner syndrome presentation ? (3)
- ptosis - miosis - anhidrosis
26
what causes Horner syndrome ?
damage to sympathy NS supplying face - either central, preganglionic or postganglionic
27
What is muscular dystrophy ?
umbrella term for various genetic conditions that cause gradual weakening + wasting of muscles
28
Name 2 types of muscular dystrophy ?
- duchesses muscular dystophy - Beckers muscular dystrophy
29
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
30
5 yo with vague symptoms of muscle weakness + use hands on legs to stand up. what diagnosis ?
duchesses muscle dystrophy
31
what inheritance is duchesses muscular dystrophy ?
x linked recessive
32
duchesses managment ?
oral steroids may help no way to treat
33
patient unable to let fo after shaking some hand. what is this most likely ?
beckers muscular dystrophy
34
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
35
Where is acoustic neuroma usually located ?
cerebellar pontine angle (usually unilateral)
36
with what other condition is acoustic neuroma associated ?
associated with neurofibromatosis type II
37
typical Patient presentation of acoustic neuroma ?
40-50 yrs - gradual onset unilateral sensoneural hearing los, tints, dizzinessac
38
acoustic neuroma Ix ?
- audiometry (to assess hearing loss) - MRI/CT
39
What is caudal equine syndrome ?
surgical emergency - nerve roots of caudal equine are compressed
40
what is the caudal equine ?
collection of nerve roots that travel throughout spinal canal after spinal cord terminates (L2/3)
41
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
42
cause equina causes ? (4)
(compression of nerve roots) - herniated disc (most common) - tumours (metastesis) - Abscess - Trauma
43
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
44
cauda equina Mx ?
need emergency decompression surgery to prevent permanent neurodysfunction - hospital admision - Emergency MRI - Neurosurgery
45
cauda equina complicaitons ?
- bladder, bowel or sexual dysfunction
46
what is metastatic spinal cord compression ? where
when metastiacti lesion compresses spinal cord (before end of spinal cord)
47
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
48
metastatic spinal cord compression Mx ?
oncolocial emergency - high dose dexamethasone - analgesia - surgery - chemo - radiotherapy
49
What is meniere's disease
long term inner ear disorder => recurrent vertigo eps
50
meniere's disease triad ?
- hearing loss - Vertigo - Tinitus
51
meniere's disease pathophys ?
excessive buildup of endolymph in labyrinth of inner ear => increase pressure => disrupt sensory signals
52
what's the increased pressure in meniere's disease called ?
end-lymphatic hydrops
53
meniere's disease presentation ?
unilateral vertigo, hearing loss, tinitus - fullness in ear
54
describe the vertigo in meniere's disease ?
lasts around 20 mins + not triggered by movement
55
meniere's disease Dx
clinical diagnosis
56
meniere's disease Mx ?
- Attacks: prchloperazine - Prophylaxis: betahistine
57
What is malaria ? causative organism ?
infectious disease caused by members of plasmodium family (protozoan parasites)
58
most common malaria subtype ?
plasmodium falciparum (80%)
59
how is malaria spread ?
spread thought bites form female anopheles mosquitoes (usually associated with travel)
60
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)
61
how often do RBC rupture in malaria ?
every 48 hrs (fever spike every 48 hrs)
62
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
63
malaria Dx ?
malaria blood fom - 3 consecutive samples over 3 consecutive days (due to release into blood every 48 hrs)
64
malaria Mx ? drugs (2)
admit patients with plasmodium falciparum - artesunate - quinine
65
malaria complication ? (6)
- cerebral malaria - siezures - DIC - AKI - PE - Death
66
malaria prophylaxis ?
no single method is 100% effective so use multiple - mosquito nets - antimalarials
67
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)
68
Causes of normal pressure hydrocephalus (5)
- Idiopathic (50%) - SAH - Meningitis - Head injury - Malignancy
69
normal pressure hydrocephalus triad Px ? how quick to sx present ?
- urinary incontinence - dementai - gait abnormality (symptoms develop over a few months)
70
normal pressure hydrocephalus Ix ? what would this show ?
CT - ventral enlargement LP - CSF pressure normal
71
Normal pressure hydrocephalus Mx ?
surgical insertion of a CSF shunt
72
what could cause a brain abscess ? (4)
- extension of sepsis (from middle ear/sinuses) - trauma/surgery - penetrating head inury - embolic events from endocarditisb
73
brain abscess px ? (4)
- headache (dull, persistent) - fever - focal neurology - signs of raised ICP (nausea, papilloedema, seizures)
74
brain abscess Ix ? Mx ?
CT craniotomy + abscess debridement - IV Abx: IV 3rd gen cephalosproin + metronidazole - dexamethasone (to reduce ICP)
75
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
76
bulbar palsy causes ? (4)
- brainstem strokes - brainstem tumours - MND - GBS
77
bulbar palsy sx ?
- dysphagia - absent gag reflex - dysphonia - drooling - difficulty chewing
78
What is diabetic neuropathy ? affect sensory/motor ? what distribution ?
typically causes sensory loss (glove and stocking distribution) + not motor loss
79
where affected first in diabetic neuropathy ? why ?
lower legs affected first de to tenth of sensory nerves
80
diabetic neuropathy pain Mx ? same as what ?
managed in same way as other neuropathic pain - 1st line: amitriptyline, duloxetine, gabapentin
81
What is myelopathy ?
injury to the spinal cord due to severe compression
82
What is myopathy ?
any disease that affects the muscles that control voluntary movement
83
What is radiculopathy ?
pinching of nerve roots as they exit spinal cord or cross intervertebral disc (rather than compression of cord itself => myelopathy)
84
what types of myelopathy are there ? most common ?
- cervical (most common) - thoracic - lumbar
85
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)
86
myelopathy sx ?
- loss of sensation + function - pain/discomfort (in area/ below compression point)
87
what is foot drop a result of ? what muscle ?
result of weakness of foot dorsi flexor
88
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
89
Chrnoic fatigue syndrome Ix ?
screening blood test to exclude other pathology
90
chronic fatigue syndrome Mx ? (4)
- CFS referral - energy managment - physical activity + exercise - CBT

3a (43 decks)

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