Neurology - RF, pathology and symptoms Flashcards

Question

Primary Brain Tumour - Glioblastoma RF Pathology Symptoms

Answer 1

(poor prognosis of 1 year) RF - White, male, history of exposure to ionising radiation, history of neurofibromatosis type 1. Most common primary tumour in adults (non-metastatic). It is a cancer arising in astrocytes (which provide structure and support for the neurons) Sx - Headache (worse with coughing, valsalva maneuvre or lying down due to increased ICP) - Gait abnormality - N+V - Seizure + Basically most of the neuro symptoms

Answer 2

A tumour arising from the meningeal cells of the arachnoid layer. (falx cerebri) RF - Radiotherapy, genetic predisposition Sx - Headache - Neurological deficit - Seizure

Answer 3

A benign tumour arising from the vestibular division of the 8th cranial nerve RF - Neurofibromatosis type 2 (associated with bilateral vestibular schwannoma) (At the cerebellopontine angle) Sx (Affects - CN 5,7 and 8) - Absent corneal reflex - Unilateral hearing loss (that could progressively worsen) - Dizziness - Tinnitus - Facial nerve palsy (due to compressing of neighbouring facial nerve)

Answer 4

An umbrella term referring to a non-progressive disease of the brain originating during antenatal, neonatal or early postnatal period --> resulting in disorders of movement and postural development. RF - Prematurity, low birth weight, meningitis, maternal illness, birth asphyxia - hypoxic ischemic encephalopathy, head trauma Sx - Delayed motor development (usually sit by 6 months and crawl by 9 months) - Abnormal gait - Muscle weakness - Delay in speech development (short sentences by 2 years) (some will have learning difficulties, epilepsy, hearing impairment)

Answer 5

Spastic (70%) - Diplegic (bilateral), hemiplegic (unilateral), quadriplegic (all 4 limbs) - Increased tone. e.g. clasp knife Dyskinetic - Athetoid movements - slow involuntary movements -- writhing (flexed elbow and wrist) - Speaking and swallowing issues Ataxic - Damage to the cerebellum. Problems with balance and coordination.

Answer 6

When the baby's brain does not receive enough oxygen and/or blood flow around the time of birth. Also referred to as birth asphyxia Causes - Issues with blood flow to the placenta - Heart disease - Pre-eclampsia (high BP and signs of organ damage) - Uterine rupture - Cord entanglement or compression Sx - Hyperalert or reduced level of awareness - Floppy or stiff - Unusual movements or seizures - Weak cry - Pauses in breathing (apnoea)

Answer 7

- Junction of the anterior cerebral artery and anterior communicating artery - Junction of the posterior communicating artery and internal carotid artery - Bifurcation of middle cerebral artery

Answer 8

RF - Hypertension, smoking, ADPKD (Chr 16 and 4) Pathology Bleeding in the subarachnoid space due to rupturing of a cerebral aneurysm. (most commonly caused by head injury, then spontaneous cause) -- If painful 3rd nerve palsy - Posterior communicating artery aneurysm Causes: Aneurysm, Trauma, Arteriovenous malformation Symptoms - Occipital thunderclap headache - Meningism- Photophobia and Neck stiffness - Nausea and vomiting - Seizures

Answer 9

RF - Recent trauma, anticoagulant use, advanced age (>65), alcoholism Pathology - Usually occurs due to recent trauma - Rupture of the bridging veins (seen in shaken baby syndrome) Symptoms (GILF) (Possible fall 5 weeks before) - Gradual onset of symptoms (possible slight lucid interval) - increasing progressive confusion - Increased ICP (Cushing's neurological triad - bradycardia, hypertension, irregular respiration - Loss of continence - Fluctuating GCS - range from mild confusion to coma, irritability (Unilateral weakness, aphasia)

Answer 10

RF- Young adults, head trauma at the pterion - fracture of the temporal bone Pathology - Trauma to the side of the head - Rupturing of the middle meningeal artery Symptoms (LIND) - Lucid interval - temporary improvement in patient's condition after which there is rapid deterioration - Increased ICP - cushing's neurologic triad - hypertension, bradycardia, irregular respiration - Nausea and vomiting - Decreased GCS

Answer 11

RF - >50 female (peak in 70s), smoking Pathology - Associated with polymyalgia rheumatica - Granulomatous inflammation of the medium and large sized arteries, leading to narrowing and occlusion of the lumen. Symptoms - Unilateral headache - Scalp tenderness (combing hair) - Jaw claudication (e.g. chewing) - Blurred/double vision (amaurosis fugax) - Aching and morning stiffness (neck, shoulders, hips)

Answer 12

RF/triggers - females, Chocolates, hangover, orgasm, cheese, oral contraceptives, Lie in, alcohol, tumult, exercise stress Pathology Prodromal- mood changes days before Aura - visual disturbances Episode Resolution Symptoms (4-72 hours) - Unilateral throbbing headache - Nausea and/or vomiting - Photophobia and phononphobia

Answer 13

RF - Stress, missing meals, lack of sleep, dehydration Sx - Tight band around the head --> Bilateral constricting pain - (low-moderate intensity with no aura/photophobia)

Answer 14

RF - Male smokers, strong smells, alcohol (Lasts 15 mins - 2 hours) Sx - Intense, intolerable, sharp stabbing pain around one eye. - Red, swollen, watery eye - Ptosis and miosis - Rhinorrhea

Answer 15

RF - Elderly, dementia, polypharmacy, dehydration, visual/hearing disability (lack of sensory input negatively impacts the brain) An acute, fluctuating change in mental status, with inattention, disorganised thinking and altered levels of consciousness. Causes CHIMPS PHONED Constipation Hypoxia Infection (e.g UTI) Metabolic disturbance Pain Sleeplessness Prescription Hypothermia/pyrexia Organ dysfunction Nutrition Environmental changes Drugs 3 subtypes 1) Hyperactive delirium - Patient has heightened arousal, restlessness, agitation, hallucinations and inappropriate behaviour 2) Hypoactive delirium - Lethargic, reduced motor activity, incoherent speech, apathy, excessive sleeping 3) Mixed delirium - Combination of the 2

Answer 16

RF - Old age, Lewy bodies made of alpha synuclein and ubiquitin accumulate in the substantia nigra Symptoms - Visual hallucinations - Memory loss - FLUCTUATING Cognitive issues --> Attention, arousal (unlike other dementias - Parkinsonism - bradykinesia, cogwheel rigidity, resting tremor

Answer 17

RF - 45-65 years Sx - Usually changes in personality and habits precede development of memory impairment - Progressive aphasia (can speak but doesn't make sense) (associated with MND)

Answer 18

PICA - Ipsilateral dysphagia, facial pain/numbness, temperature loss, Horner's syndrome - Contralateral limb/torso pain/sensory loss and temperature loss - Ataxia, nystagmus AICA - Ipsilateral facial paralysis and deafness - Contralateral limb/torso pain and temperature loss

Answer 19

RF - Females, obese, pregnancy, medication (COCP, steroids, tetracycline antibiotics) Sx - Headache - Blurred vision - Papilloedema (usually present)

Answer 20

A unilateral facial pain syndrome in at least 1 of the distributions of the trigeminal nerve. RF - Increased age, multiple sclerosis, female Most common in patients with MS (20x) Triggers: shaving, brushing teeth, talking, touch, (cold) Sx - Unilateral pain that is electric shock like, stabbing, pain - in one of the distributions of the trigeminal nerve. - Triggered generally by facial.oral mechanical stimulation

Answer 21

Stroke, multiple Sclerosis pancoast's Tumour, Trauma Cluster headache, Cavernous sinus thrombosis

Answer 22

C5-T1 Sensory - Most of the skin of the posterior forearm, lateral aspect of the dorsum of the hand and dorsal lateral 3 and a half digits excluding nail bed - median nerve Motor - Triceps brachii and extensor muscles of the forearm (posterior) Pathology - Commonly due to midshaft humerus fracture Sx - Wrist drop - Sensation impaired over innervated area Tx - Wrist splint and simple analgesia

Answer 23

C8-T1 Sensory - Medial one and a half fingers and associated palm and dorsum. Motor - Flexor carpi ulnaris, medial half of FDP and intrinsic muscles of the hand. Pathology - Caused by trauma at the medial epicondyle Symptoms - Claw hand - Sensory impairment in innervated areas

Answer 24

Most commonly caused by fracture of the fibular neck Sx - Footdrop - Loss of sensation over dorsum of the foot and lateral side of the leg

Answer 25

CN3 - Down and out (unopposed superior oblique) - Dilated pupils (sphincter pupillae) - Ptosis (levator palpebrae superioris) CN4 - Up and out (unopposed inferior oblique) - Vertical diplopia CN6 - Forced adduction (unopposed medial rectus)

Answer 26

Jaw is deviated to the affected side Loss of corneal reflex Loss of sensation in specific distributions of the trigeminal nerve (trigeminal neuralgia)

Answer 27

UMN lesion - unilateral facial drooping with forehead spared LMN lesion - unilateral facial drooping affecting the whole face. Parotid inflammation Bell's palsy - drooping eyelid, drooping corner of mouth

Answer 28

Hearing loss Loss of balance Associated with paget's disease of the bone -- due to compression of CN8.

Answer 29

- Speech and swallowing difficulties - Impaired gag reflex

Answer 30

11 - Inability to shrug shoulders or turn head against resistance 12 - Tongue deviates towards side of lesion - Atrophy of the tongue

Answer 31

3rd CN (bleeding on the right side means it affects the right cranial nerve 3)

Answer 32

Complication of diabetes RF - Poorly controlled hyperglycemia, >70, hypertension Sx - Sensory loss in a glove and stocking distribution - (Possible LUTS symptoms) - Painless injuries - Reduced/absent ankle reflex

Answer 33

Refers to the compression of nerve roots as they exit the spinal cord and spinal column, leading to motor and sensory symptoms. Causes - Spinal stenosis - Bone spurs - Disc herniation Sx - Radiating , sharp shooting, limb pain - usually in a dermatomal pattern (Treatment - Sometimes goes away on its own First line - NSAIDS, lifestyle management e.g. weight loss, stretches and exercises Corticosteroids)

Answer 34

Myelopathy - The result of compression of the spinal cord (radiculopathy - compression of nerve roots as they exit the spinal cord) Pathology Most common - metastatic spinal cord compression --> BLTKP Other causes - Disc osteophyte cord compression - Traumatic e.g. vertebral fracture - Disc prolapse - herniation (leads to spinal cord stenosis) Sx - Back pain - earliest and most common symptom - Lower limb weakness (unsteady gait) - Sensory loss and numbness - UMN signs e.g. hyperreflexia, babinski's sign (patient's might say they struggle with keyboard texting, buttoning up shirt, legs not doing as they want) (Red flags - dual incontinence, saddle anaesthesia)

Answer 35

Caused by compression of the lumbosacral nerve roots that extend below the spinal cord. RF - Lumbar disc herniation, spinal surgery/trauma, anticoagulants (Late diagnosis can lead to permanent nerve damage resulting in long term leg weakness and dual incontinence) Most common cause - Central disc prolapse (L4/5 or L5/S1) Sx - Low back pain - Bilateral sciatica - Saddle anaesthesia - Dual Incontinence

Answer 36

Examining below the level of the lesion - Ipsilateral hemiparesis (corticospinal tract) - can test with Hoffmann's sign - Ipsilateral loss of proprioception and vibration sense (DCML) - Contralateral loss of temperature and pain sensation (spinothalamic tract) (methyl prednisolone, occupational therapy, surgery)

Answer 37

Mutation in FXN gene on chromosome 9 (leads to mitochondrial dysfunction) - Bilateral spastic paresis (hypertonia +paralysis) --> Lateral corticospinal tracts - Bilateral loss of proprioception and vibration sense --> DCML - Bilateral limb ataxia --> Spinocerebellar tract Intention tremor Tx - omaveloxolone

Answer 38

The development of a fluid filled cyst within the spinal cord. Congenital Causes - Chiari malformation type 1(causing the cerebellum to push into the spinal canal) Acquired causes - Spinal cord tumours - Spinal cord injuries (Anterior white commissure pathology) Sx - Progressive weakness and muscle atrophy in your arms and legs - but typically affects hands(ventral horns) - Hypotonia (ventral horns - LMN sx) - Loss of pain and temperature sensation (spinothalamic) - cape like, over arms and shoulders (MRI) (Usually observation only if symptoms not bothersome.) Just manage symptoms e.g. pain, physical therapy. Definitive - surgical

Answer 39

Caused by - crushing injury, surgery, atherothrombotic disease, vasculitis Disruption of blood flow through the spinal artery --> spinal cord tissue ischemia and infarction from the level of disruption --> infarction of the corticospinal and spinothalamic pathways. Sx - Bilateral spastic paresis (corticospinal tracts) - Bilateral loss of pain and temperature sensation (spinothalamic tracts) - Bladder/bowel incontinence (MRI)

Answer 40

A disorder of the inner ear. Most likely due to over production or impaired absorption of endolymph leading to increased pressure in the endolymphatic system. RF - 40-50 peak onset, recent viral infection (weak rf) Sx (usually unilateral) (Fluctuating aural sx of the those mentioned below) - Vertigo (may lead to n+v) - Lasts minutes to hours - Tinnitus - Hearing loss (not progressive in contrast to vestibular schwanomma) - Aural fullness (a sensation of clogging of the ear/muffled hearing) (positive romberg's and nystagmus)

Answer 41

Characterised as onset of persistent disabling fatigue, post-exertional malaise, pain, etc for at least 3 months. RF - Female sex, epstein barr infection in adolescents, Covid-19 Sx - Persistent disabling fatigue not alleviated with sleep or rest - Post exertional malaise - poorly tolerating minor levels of physical/mental exertion - Muscle/joint pain - Cognitive dysfunction - inability to think/concentrate, short term memory impairment - Sore throat - Headache

Answer 42

A neuropsychiatric disorder caused by thiamine deficiency (most commonly seen in alcoholics) RF - Alcohol-use disorder, HIV infection and aids, cancer and chemotherapy, malnutrition, GI surgery Sx - Possible recent history of GI surgery - Mental status change e.g. confusion, slowing, impaired concentration, apathy - Nystagmus - CN6 palsy, conjugate eye palsy - Gait ataxia

Answer 43

Wernicke-Korsakoff syndrome - amnesia and confabulation (creating false memories) -Mental status change e.g. confusion, slowing, impaired concentration, apathy - Nystagmus - CN6 palsy, conjugate eye palsy - Gait ataxia

Answer 44

Mononeuropathy refers to pathology affecting a single peripheral nerve resulting in weakness, sensation disturbance and/or pain. Causes include 1) Trauma 2) Compression - Pressure from being in a fixed position for a long time e.g. confined to bed/paralysis 3) Inflammation - e.g. vasculitis --> Blocking transmission of impulses through the nerve Most common - Median nerve in the wrist - CTS - Ulnar nerve in the elbow - Radial nerve in the upper arm - Peroneal nerve below the knee Sx - Loss of feeling in the affected area - Pain/burning/pins and needles - Weakness in the affected area

Answer 45

An assymetrical peripheral neuropathy involving isolated damage to at least 2 separate limb or cranial nerves. (e.g. carpal tunnel and foot drop affecting the median and common peroneal nerves) RF - >50 years, sarcoidosis, vasculitis, hepatitis and HIV infections (recreational drug use) Most frequently results from nerve ischemia secondary to vasculitis. (including infections and malignancy) Sx - Numbness, weakness, pain in affected areas - Rash, livedo reticularis (vasculitis) e.g. polyarteritis nodosa

Answer 46

A chronic autoimmune disorder of the post-synaptic membrane at the NMJ in skeletal muscle - resulting in insufficient functioning acetylcholine receptors. RF - Family history of autoimmune disorders, females, >60 males (thymoma) Pathology Acetylcholine receptor antibodies (85%) bind to acetylcholine receptors at the postsynaptic nmj receptors --> blocking them and preventing Ach from binding and stimulating muscle contraction. (There is more build up with exertion so worse symptoms) Sx Muscle fatiguability - muscles become progressively weaker during periods of activity and slowly improves after periods of rest. Affects small muscles of the head and neck - Diplopia, ptosis, difficulty swallowing, slurred speech/speech fatiguability

Answer 47

An autoimmune disorder at the NMJ RF - Small cell lung cancer, co-existing/family history of autoimmune disorder, smoking, - Paraneoplastic disorder in association with SCLC - Due to antibodies against voltage gated calcium channels in the presynaptic membrane of the NMJ Sx - Proximal Muscle weakness at (usually starting with lower limbs) e.g. difficult to climb stairs, standing from seated position - improves with exertion - Autonomic symptoms: dry mouth, impotence, difficulty micturating.

Answer 48

An autosomal dominant disorder that presents with seizures, particularly in childhood. Seizures mostly occur at night. There may be roughened patches of skin over the lumbar spine (shagreen patch)

Answer 49

It is excess CSF within the ventricular system of the brain Obstructive (non-communicating) hydrocephalus - Blockage of flow of CSF due to tumours, acute haemorrhage and developmental abnormalities e.g. aqueduct stenosis (flor of CSF is blocked along one or more narrow passages connecting the ventricles) Non obstructive hydrocephalus (communicating) - Imbalance of CSF production and absorption. Increased CSF production (choroid plexus tumour) - RARE Failure of reabsorption at the arachnoid granulations (meningitis, post haemorrhagic) - more common - Normal pressure hydrocephalus Sx - Headache typically worse in the morning, when lying down and valsalva maneuvre - N+V - Papilloedema (Coma in severe cases) (In infants, increased ICP can increase their head circumference)

Answer 50

1) 6 months no driving 2) Seizure free for 12 months 3) 1 month off driving - no need to inform DVLA 4) 3 months off driving and inform DVLA

Answer 51

A form of non obstructive hydrocephalus characterised by large ventricles but normal intracranial pressure. RF - >65 years, vascular disease, diabetes Congenital - Arnold chiarimalformation (Secondary cause) Can be due to head trauma, subarachnoid haemorrhage, meningitis - resulting in reduced CSF absorption at the arachnoid villi Sx (develops over months) - Dementia (reversible) - Urinary Incontinence - Abnormal gait

Answer 52

- Spinal cord injury above T6 level Sx (most commonly triggered by faecal impaction/urinary retention) - Extreme hypertension - Flushing and sweating - (Uncomfortable abdomen) Tx - Removal of stimulus and treat hypertension

Answer 53

Normal pressure hydrocephalus

Answer 54

- Distal sensory loss and paraesthesia - Gait abnormalities/Romberg's positive (loss of proprioception and vibration sense with hyper reflexia) - dorsal columns and corticospinal affected (absent ankle jerk) So it is hyperreflexia BUT absent ankle jerk - due to peripheral neuropathy in vitamin B12 deficiency

Answer 55

Wernicke's - Fluent speech, impaired repetition, abnormal sounds Broca's - Non-fluent speech, laboured and halted speech, words make sense

Answer 56

Dexamethasone - for oedema related to tumours Mannitol - Acute management of increased ICP Acetazolamide - inhibits carbonic anhydrase - increases excretion of bicarbonate (idiopathic intracranial hypertension)

Answer 57

Obstructive - Head trauma resulting in haemorrhage - Tumour - Aqueductal stenosis - Complications of surgery Non obstructive - Impaired absorption of CSF (Problem with arachnoid granulations)

Answer 58

Type 1 - Cafe au lait spots - Axillary/groin freckles - pheochromocytoma Type 2 - Cafe au lait spots - Tinnitus, vertigo, hearing loss - Bilateral vestibular schwannoma - Meningioma

Answer 59

Dementia, abnormal gait, incontinence

Answer 60

In patients with coronary artery disease

Answer 61

Dangerous condition seen in patients taking antipsychotics can also occur with parkinsonian drugs (e.g. levodopa) - usually when drug is suddenly stopped or reduced --- occurs due to the reaction to dopamine antagonists rigidity, hyperthermia, autonomic instability (hypotension, tachycardia) and altered mental status (confusion). (Causes muscle damage and neurotoxicity) - CK is extremely high - A known cause of AKI (secondary to rhabdomyolysis) Tx Stop antipsychotics and give IV fluids (Can also use dopamine agonists) - Transdermal dopamine agonist patch