Neurology - RF, pathology and symptoms Flashcards
Alzheimer’s disease
RF
Pathology
Symptoms
RF - >65, family history, down syndrome, lifestyle factors (smoking, alcohol, obesity)
Pathology
MOST COMMON TYPE OF DEMENTIA
(Associated with ApoE-4 allele and down syndrome)
A chronic neurodegenerative disease due to
- Extracellular plaques of beta amyloid
- Intracellular neurofibrillary tangles composed of hyperphosphorylated tau protein.
Sx
- Memory loss
- Agnosia (can’t recognise people/things)
- Apraxia - can’t do basic motor skills
- Nominal dysphasia - difficulty naming things that are correctly perceived
- Disorientation
Parkinson’s disease
RF
Pathology
Symptoms
Unilateral or bilateral?
RF - >60 years male
Pathology
A chronic progressive neurological disorder due to degeneration of dopaminergic neurons in the substantia nigra
Symptoms
4 major
- Bradykinesia
- UNILATERAL Resting tremor (3-5Hz)
- Muscle rigidity (Cogwheel)
- Postural instability
Minor
- Micrographia
- Mask-like facies
- Depression - most common psychiatric feature
- Shuffling gait
Vascular dementia
RF
Pathology
Symptoms
RF- >60, history of stroke/TIA (doubles risk), obesity, hypertension, smoking
Pathology
STEPWISE progression (over several months - years)
Mostly due to cerebrovascular infarcts
Symptoms
- Cognitive - Difficulty concentrating/poor attention
- Memory disturbance
- Mood disorders
- Difficulty walking and keeping balance
Motor neurone disease
RF
Pathology
Symptoms
(Symmetric or assymetric?)
RF - Family history, >40 years, genetic predisposition
Pathology
An umbrella term of slowly progressive diseases affecting ONLY motor nerves.
1) Amyotrophic lateral sclerosis (most common) - both LMN and UMN sx
2) Primary lateral sclerosis - only UMN sx
3) Progressive muscular atrophy - only LMN sx
Sx
- Asymmetric limb weakness
- Wasting of small hand muscles
- Fasciculations
- ABSENCE of sensory signs/symptoms
- Respiratory/breathing issues (muscle weakness can progress to affect respiratory muscles)
Bulbar palsy
Pathology + most common cause
Symptoms
2nd most common MND (worst prognosis)
Most commonly caused by brainstem strokes and tumours
Affects CN 9-12
- Affects muscles of speech and swallowing
Sx - slurred speech, difficulty swallowing
(Treated via feeding tube. Speech and language therapy)
Multiple sclerosis
RF
Pathology
Symptoms
RF - 20-40 Females, family history, personal/family history of autoimmune disease
Pathology
Type 4 hypersensitivity - autoimmune demyelination in the CNS
1) Relapsing remitting –> flare ups of disease with periods of incomplete recovery
2) Primary progressive –> Gradually worsening symptoms and an accumulation of disability
3) Secondary progressive –> Develops from relapsing remitting
Sx (5 main ones)
(Spastic pareparesis)
1) Charcot’s neurologic triad –> Nystagmus, intention tremor, dysarthria
2) Optic neuritis –> painful eye movements + blurred vision + red/green colour blindness
3) Internuclear ophthalmoplegia - inability to adduct the eye
4) Uhthoff’s phenomenon - worsening of MS symptoms due to heat (exercise/fever)
5) Lhermitte’s sign - Paraesthesia in limbs on neck flexion
(Urinary incontinence)
Huntington’s disease
RF
Pathology
Symptoms
RF - Family history, CAG repeat length on huntingtin gene
Pathology
Autosomal dominant –> Causing neurological dysfunction
(Regions affected have decreased GABA and acetylcholine. Increased dopamine)
Due to CAG repeat disorder – Genetic mutation of HTT gene on chromosome 4 (huntingtin protein)
Sx
- Chorea –> Involuntary, random, irregular body movements
- Psychiatry –> irritability, personality change
- Depression
- Saccadic eye movements
Meningitis
RF
Most common cause?
Pathology - 2 ways in which bacterial causes spread
Symptoms
RF - Crowding (e.g. student dorms/training camps), immunocompromised
Pathology
Mainly caused by viruses (but less severe) –> Coxsackie virus, herpes simplex virus
Bacterial causes (more severe)
- Streptococcus pneumoniae (MOST COMMON)
- Neisseria meningitidis (non blanching rash)
- Listeria monocytogenes (most common in elderly and immunocompromised)
Bacteria can spread via
- Haematogenous (more common)
- direct extension from a contiguous site (invade through the wall of an organ to other organs)
Sx
- Meningism –> Neck stiffness, photophobia, headache
- Fever, vomiting
- Rash (only in N.meningitidis)
(most common complication - sensorineural hearing loss)
Encephalitis
- Which lobe is usually affected?
RF
Pathology
Symptoms
RF - Extremes of age, immunocompromised, animal bites (mosquito, bats, cats)
Pathology
Caused by human simplex virus 1 in 95% of cases
Affects temporal lobe (+ inferior frontal lobe)
Symptoms
Fever
Headache
Focal features - Aphasia
Seizures
Vomiting
Guillain Barre Syndrome
RF
Pathology
Symptoms
RF - Preceding viral/bacterial infection
Pathology
Immune mediated demyelination of the peripheral nervous system often triggered by infection (Gastroenteritis, UTI)
- Campylobacter.jejuni
The antigens of the pathogens match the antigens of myelin sheath and axons (molecular mimicry) - Type 2 hypersensitivity
Symptoms
- Progressive ascending symmetrical weakness
- Respiratory distress (SOB)
- Double vision, facial drooping
Cerebellar disorders
Causes
Symptoms
A group of neurological conditions that affect the cerebellum which coordinates and regulates movement.
Causes
- Friedrech’s ataxia (inherited)
- Neoplastic: Cerebellar haemangioma (and paraneoplastic)
- Stroke
- Alcohol
- MS
- Drugs: Phenytoin, lead poisoning
Symptoms
DANISH
Dysdiadochokinesia, dysmetria (past-pointing)
Ataxia (loss of coordination - poor balance and walking
Nystagmus
Intention tremor
Slurred staccato speech (+ scanning dysarthria)
Hypotonia
Bell’s Palsy
RF
Pathology
Symptoms
RF - Pregnancy (3rd trimesters + 1st week post partum), 20-40 years
Pathology
Unilateral, idiopathic, facial nerve paralysis
Symptoms
Lower motor neuron facial nerve palsy –> Forehead is Affected (lesion between nucleus and face)
Upper motor neuron facial nerve palsy –> Forehead is spared (due to forehead receiving bilateral UMN input between motor cortex and nucleus)
(Droopy eyelids, drooling, smile unevenly)
(possible dry eyes - keratoconjunctivitis sicca (due to loss of adequate blink function) and altered taste)
Post auricular pain (behind the ears)
Loss of taste on anterior 2/3 of the tongue
(Check for shingles in the ear)
Epilepsy
RF
Pathology
Symptoms
RF- Head trauma, family history, stroke, (dementia, cerebral palsy)
Pathology
Common neurological condition characterised by recurrent seizures
Symptoms
Absence - stare into space, abruptly return to normal
- Myoclonic - limb jerking
- Atonic - body relaxes, fall forwards
Focal seizures (Consciousness varies)
Temporal - Aura, dysphasia
Frontal - Jacksonian march
Parietal - Paraesthesia
Occipital - Visual changes
List the type of seizures
What are the order of events?
Generalised seizures (consciousness is lost)
- Tonic-clonic (grand mal)
- Tonic - body stiffens, fall backwards
- Absence - stare into space, abruptly return to normal
- Myoclonic - limb jerking
- Atonic - body relaxes, fall forwards
Focal seizures (Consciousness varies)
Temporal - Aura, dysphasia
Frontal - Jacksonian march
Parietal - Paraesthesia
Occipital - Visual changes
Predromal - Mood changes, lightheadedness, visual changes (flashing lights)
During - Tongue biting, incontinence, irregular breathing
Postdromal - confusion, irritable, todd’s paresis - paralysis of arms and legs
Ischemic stroke/TIA
RF
Pathology
Symptoms (generally)
RF - Older age, family history, hypertension, smoking, diabetes, atrial fibrillation
Pathology
Ischemic stroke - A sudden interruption in the vascular supply of the brain due to a blockage of a blood vessel. (Resulting in infarction)
TIA - Transient focal neurological deficit that lasts from a few minutes to 24 hours, without infarction.
Symptoms
- Motor weakness
- Visual issues
- Balance problems
- Speech problems (dysphasia)
Symptoms of a
1) Anterior cerebral artery
2) Middle cerebral artery
3) Posterior cerebral artery
4) Lacunar
Infarct (Stroke)
1)
- Contralateral hemiparesis and sensory loss, lower extremity more affected.
2)
- Contralateral hemiparesis and sensory loss, upper extremity more affected
- Contralateral homonymous hemianopia
- Aphasia
3)
- Contralateral homonymous hemianopia with macular sparing
( Visual agnosia - cannot recognise things/people)
4)
- Either isolated hemiparesis/hemisensory loss/hemiparesis with limb ataxia
Essential tremor
RF
Pattern of inheritance?
Symptoms
RF - Age, family history
(most common cause of head tremor)
Autosomal dominant
Sx
- Postural tremor that is worse with arms outstretched (bilateral upper limb action tremor)
- Improved with alcohol and rest
(Problems with fine motor tasks e.g. writing, eating, dressing)
Muscular dystrophies
RF
Most common muscular dystrophy and pattern of inheritance?
Pathology
Sx
RF - Males, family history
Pathology
Muscular dystrophies are progressive , generalised diseases of muscle most often caused by a defective or absent glycoprotein in the muscle membrane (e.g dystrophin)
Duchenne muscular dystrophy - X linked recessive (mutation in DMD gene encoding for dystrophin)
Sx
- Progressive proximal muscle weakness (from 5 years)
- Calf hypertrophy (due to ongoing regeneration of muscle fibres)
- Gower’s sign
- Difficult to walk without assistance (ambulation difficulties)
Difference between Becker’s and Duchenne muscular dystrophy
- Duchenne is more common, severe and rapidly progressive.
- Duchenne presents in early childhood
- Becker’s usually in later childhood or adolescence
(symptoms generally the same)
Brain abscess
RF
Pathology
Sx
A life threatening condition where there is a suppurative (pus like) collection of microbes (within a gliotic capsule) in the brain parenchyma.
RF - <30yr Men, Sinusitis, otitis media, infective endocarditis, meningitis, dental procedures/infection, penetrating/traumatic head injuries.
Causes as mentioned in RF (basically an infection or injury)+ sepsis extending from previous infections.
Sx
(Recent infection)
- Persistent, dull headache
- Fever
- Increased ICP leading to
+ 3rd/6th cranial nerve palsy
+ Papilloedema
+ nausea
+ Seizures
(Possible motor findings if it affects the motor cortex)
Herpes Zoster
RF
Pathology
Sx
A reactivation of varicella zoster virus acquired during a primary varicella infection.
RF - >50 years female, anything that promotes being immunocompromised (chronic steroid use, HIV, malignancies)
(Characterised by dermatomal pain and papular rash)
Sx
- Burning/stinging/itching pain that is confined to a dermatome
- Erythematous maculopapular rash (bumps)
(pain in affected eye and reduced vision - corneal ulceration)
Malaria
Most common protozoal cause?
RF
Pathology
Sx
Plasmodium falciparum - most common cause overall (most common in africa)
Plasmodium vivax - most common outside africa
RF - Endemic area, pregnancy, immunocompromised + old age (severe disease)
Sx
- Fever
- Headache
- Myalgia
- N+v
2 traits that are protective from malaria
Sickle cell trait (anaemia)
G6PD deficiency
Tumours that commonly spread to the brain
Lung (most common)
Breast
Bowel
Skin
Kidney
Primary Brain Tumour - Glioblastoma
RF
Pathology
Symptoms
(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
Meningioma
Risk factors
Pathology
Symptoms
A tumour arising from the meningeal cells of the arachnoid layer. (falx cerebri)
RF - Radiotherapy, genetic predisposition
Sx
- Headache
- Neurological deficit
- Seizure
Vestibular schwannoma (previously called acoustic neuroma)
Where does it arise from?
Symptoms
Which cranial nerves does it affect?
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)
Cerebral palsy
RF
Pathology
Symptoms
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)
Types of cerebral palsy and which is the most common?
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.
What is hypoxic ischaemic encephalopathy?
Causes?
Symptoms?
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)
Common places for berry aneurysms
- 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
Subarachnoid haemorrhage
What does a painful 3rd nerve palsy indicate?
RF
Pathology
Symptoms
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
Subdural haemorrhage
RF
Pathology
Symptoms
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)
Epidural/extradural haemorrhage
RF
Pathology
Symptoms
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
