Neurology Peer Teaching Flashcards
Name 3 primary headaches
Migraine
Cluster headache
Tension headache
Name some secondary headaches
Meningitis SAH GCA Medication over use IIH
Name headaches which arent primary or secondary headaches
Trigeminal neuralgia
Painful neuropathies
What is classic migraine
Migraine with aura
What is common migraine
Migraine without aura
Name triggers for migraine
Cheese OCP Caffeine Alcohol Anxiety Travel Ecercise
Give some examples of migraine auras
Reversible visual symptoms (unilateral blindness, flashes, fortification)
Reversible dysphagic sppech disturbances, numbness, tingling
Features of migraine
4-72hrs Unilateral, pulsing Moderate to severe Acitivity = worse N and V Photo/phonophobia
First line management of an acute migraine attack
Aspirin +- metoclopramide
Second line management of an acute attack
Sumatriptan
Prophylaxis of migraine
Propanolol
Features of cluster headaches
Severe, short lived 15mins- 180mins Unilateral eye pain Ipsilateral autonomic features Headaches in clusters Restless during attack
Do migraine patients move around
No
Do cluster headache patients move around
Yes
Treatment of an acute cluster headache attack
SC sumatriptan
100% Oxygen
Cluster headache prophylaxis
Verapamil
Features of tension headache
30 minutes- a week
Bilateral pressing
Not associated with activity or nauseau
Treatment for tension headache
Reassurance that self limiting. Stress is cause. <15 a month, then paracetamol but be wary of MOH
Who more commonly gets cluster headaches
Men
Who gets giant cell arteritis
Over 50s
Associated with polymyalgia rheumatica
Symptoms of GCA
Headaches Scalp tenderness Jaw claudication Unilateral vision loss Temporal artery tenderness
Investigations for GCA
ESR (often v high) Temporal artery biopsy
Treatment of GCA
PO Prednisolone
What can cause a headache of raised intracranial pressure
Space occupying lesion, intracranial tumour or idiopathic intracranial hypertension
Features of a headache of raised intracranial pressue
Generalised ache
Aggravated by bending, coughing or straining.
Worse in morning or after prolonged recumbency
Accompanying symptoms fo headache of raised intracranial pressure
Vomiting
Visual obscurations
Progressive focal neurological signs
Papilloedema, enlarged blind spots, reduced visual acuity
What investigation do you do for suspected headache of raised ICP
Urgent imaging with CT or MRI
Describe idiopathic intracranial hypertension
Fat young women, papilloedema is marked so they might get optic atrophy.
3 cardinal presenting symptoms of brain tumours
Symptoms of raised ICP
Progressive neurological defecity
Focal or generalised epilepsy
Which cancers met to brain
Lung
Breast
RCC
GI
What cells do most brain tumours come from
Glial cells
Which tumour makes up 90% of gliomas
Astrocytoma
Name two gliomas
Astrocytoma
Oligodendroblioma
What can be used to treat cerebral oedema
IV dexamethasone
What can be used to treat raised ICP
IV mannitol
What treats glioblastoma multiforme
Temozolamide
How do you treat brain tumours
IV dexamethasone (for cerebral oedema) IV mannitol (for ICP) Anticonvulsants (epilepsy) Surgical excision Adjuvant chemo-radiotherapy
Features of trigeminal neuralgia
Stabbing sharp pain in CN V distribution
Unilateral
Second to 2mins
Triggers of trigeminal neuralgia
Washing face
Shaving
Eating
Talking
What is the neurological examination like in trigeminal neuralgia
Normal
First line treatment of trigeminal neuralgia
Carbamazepine
What is a subarachnoid haemorrhage
Spontaneous bleeding into the subarachnoid space
What are causes of SAH
Rupture of berry aneurysms
Congenital AVMs
Describe features of SAH
Sudden onset occipital headache
N and V
reduced consciousness
Meningeal irritation signs
Name 3 signs of meningeal irritation
Neck stiffness
Kernigs sign positive
Photophobia
What is kernigs sign positive
Hip flexed to 90 degrees, then patient cant straighten leg
Investigations for SAF
CT head
LP if CT normal
MR angiography
What does LP show in SAH
Xanthochromia (only after 12 hours)
Management of SAH
Bed rest, analgesia, supportive measures.
Nimodipine
What is nimodipine
CCB
Why is a CCB given to SAH patients
Prevents cerebral artery spasm
What is a subdural haematoma
Accumulation of blood in the subdural space following rupture of veins running from hemisphere to sagittal sinus
Who gets subdurals
Head injury
Elderly
Alcoholic
Symptoms of subdural haematoma
Headahc Confusion Fluctuating LOC Personality change Latent period
Gold standard investigation of subdural haematoma and the finding
CT Head
Crescent shaped lesion
Management of subdural
Surgical removal of the haematoma
What is an extradural haematoma
Collection of blood between the dura mater and the skull
What causes an extradural
Rupture of the miffle meningeal artery following head injury, usually ssociated with temproal bone skull dracture
Extradural presentation
Brief LOC, lucid interval of recovery. If severe headache, decreased consciousness and signs of raised ICP
What is the gold standard investigation for extradural and the finding
CT scan
Biconvex haematoma
Treatment of extradural haematoma
Evacuation of the clot through burr holes or open craniotomy
What is multiple sclerosis
Inflammatory demyelinating autoimmune disease of the CNS. Characterised by multiple plaques of demyelination in the brain and spine
What must plaques be for them to be MS
Disseminated both in time and place
Who gets MS
Young adult, women more than men
Which sites are most commonly affected by MS
Periventricular region of the hemispheres
Brainstem, cerebellum
Cervical cord
Optic nerves
Name the 4 types of MS
Benign
Relapsing remitting
Secondary progressive
Primary progressive
Which is the most common type of MS
Relapsing remitting
Define relapsing remitting MS
Clearly defined relapses with full recovery or with some residual deficit upon recovery. There is no disease progression between relapses.
Define secondary progressive MS
When the disease starts with a relapsing-remitting picture, but eventually recovery from each successive relapse becomes less complete
Eye signs in MS
Optic neuritis => optic atrophy
- unilateral visual loss
- painful eye movement
- reduced colour vision
Spinal cord lesion sensory symptoms (MS)
Numbness Tingling Burning Band like sensation Lhermittes Altered temperature sensation
What is Lhermittes symptom
Electric shock like sensation down the limbs on flexion of the neck
When is Lhermittes present
MS
Vit B12 deficiency
Spinal cord lesion motor symptoms (MS)
Weakness
Clumsiness
Tonic spasms
Spinal cord lesion sphincter symptoms (MS)
Urinary
Constipation
Faecal incontinence
Erectile dysfunction
Cerebellum lesion symptoms (MS)
DANISH Dysdiodochokineasia Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
Best investigation for MS
MRI and gadolinium contrast
What does CSF electrophoresis show in MS
Oligoclonal bands of IgG
What do you need for diagnosis of MS
Lesions should be disseminated in time (2 attacks) and space (MRI)
Acute treatment of MS attack
IV methylprednisolone
Chronic treatment of MS
Beta interferon (immune modulation)
mab (natalizumab)
Immunosuppression (azathioprine)
Describe pathophysiology of myasthenia gravis
Autoimmune destruction of Ach receptors at NMJ. Depletes working post synaptic receptor sites.
What is Myasthenia gravis associated with
Thymoma, RA, SLE, T1DM, Addisons, hyperthyroid (AI)
Clinical features of MG
Ptosis, eyelid droop after looking up Diplopia Myasthenic snarl Dysarthria Voice fades Tendon reflexes normal but faitgue Sensory exam normal
Does Myasthenia affect motor or sensory
Only motor
Investigations for myasthenia gravis
Antibodies
CT thorax
Ice test
Tensilon test
What antibodies do you look for in myasthenia
Anti-AChR
MuSK
What are you looking at on CT thorax for myasthenia
Thymus (thymoma common)
What is the tensilon test for myasthenia
Very short acting anti acetylcholinesterase will show improvement in muscle strength
Immediate treatment of myasthenia gravis
Pyridostigmine
Prednisolone
Thymectomy
What type of drug is pyridostigmine
Acetylcholinesterase inhibitor
What is a potential long term consequence of myasthenia
Myasthenic crisis with weakness of respiratory muscles
Name 4 treatable causes of delerium
Vitamin B12 deficiency
Folat deficiency
Neurosyphilis
HIV related
Describe the onset of alzheimers dementia
Gradual, progressive
Vascular dementia onset
Abrupt or gradual
Lewy body dementia onset
Insideous, progressive with fluctuations
Frontotemporal dementia onset
Insidious onset, 50s and 60s, rapid progression
Alzhiemers dementia pathology/ imaging
Generalised atrophy
Beta amyloid plaques
Neurofibrillary tangles
Vascular dementia pathology/ imaging
Strokes
Lacunar infarcts
White matter lesions
Vulnerable to cerebrovascular events
Pathology/ imaging of lewy body dementia
Generalised atrophy
lewy bodies in cortex and midbrain
Pathology/ imaging of frontotemporal dementia
Frontal and temporal atrophy
Pick cells and pick bodies in cortex
Alzhimers disease signs and symptoms
Memory loss Language defecit Rapid forgetting Impaired visuospatial Normal gate and neuro exam Late affective disturbances and behaviour
Vascular dementia signs and symptoms
Focal neurological signs
Signs of vascular disease
Lewy body dementia signs and symptoms
Fluctuating cognition Visual hallucinations Neuroleptic sensitivity Shuffling gait Increased tone Tremors Falls
Frontotemproal dementia signs and symptoms
Disinhibition Socially inappropriate behaviour Poor judgement Apathy Decreased motivation Poor executive function
Dementia vs delerium onset
Delerium acute, dementia insidiouds
Dementia vs delerium consciousness
Delirium altered, dementia normal
Dementia vs delirium course
Dementia progressive deterioration, delirium flucuating
Dementia vs delirium sleep wake cycle
Dementia normal, delirium altered
Dementia vs delirium speech
Delirium incoherent rapid or slow speech. Dementia difficulty finding words
Dementia vs delirium perceptual disturbance
Delirium common, dementia late stage
