Neuroscience Flashcards
What is Bell’s Palsy?
Bell’s palsy is an acute unilateral peripheral facial nerve palsy in patients for whom physical examination and history are otherwise unremarkable, consisting of deficits affecting all facial zones equally that fully evolve within 72 hours.
What are the risk factors for Bell’s Palsy?
> Intranasal influenza vaccine> Pregnancy> URTI> FHx> Diabetes
What are the signs and symptoms of bells palsy?
> Single episode> Unilateral> Involvement of all nerve branches> keratoconjunctivitis sicca> Pain> Synkinesis> Ipsilateral hyperacusis or dysgeusia
What is the epidemiology of bell’s palsy?
The reported incidence is 23 to 32 cases per 100,000 per year.
What investigations would you do for bell’s palsy?
> Clinical diagnosis> electroneuronography or eEMG> EMG (absence of voluntary motor unit potentials)> Serology for Borrelia burgdorferi (neg)
What is the management of Bell’s Palsy?
> Corticosteroids (e.g. prednisolone)> Eye protection> Concurrent antiviral therapy
What are the complications of Bell’s Palsy?
> keratoconjunctivitis sicca, exposure keratopathy, and ulcerative keratitis> Ectropion (saggy eyelid)> Contracture and synkinesis> Gustatory hyperlacrimation
What is the prognosis of Bell’s palsy?
The extent of facial palsy following complete evolution of Bell’s palsy (i.e., within 72 hours of onset) is the parameter most predictive of ultimate recovery outcome. Of those who present with incomplete paralysis on clinical examination, 94% will fully recover, as compared to 61% of those who present with complete paralysis.
What are the types of CNS tumours?
GlioblastomaAstrocytomaPituitary adenomaAcoustic neuromaMeningiomaOligodendrogliomaHaemangioblastomaCNS lymphomaCraniopharyngiomaSpinal cord tumour
What is the most common types of brain tumour?
- Gliomas2. Meningiomas
How do you grade tumours? (WHO grading)
Grade 1- low proliferating, discrete, non invasiveGrade 2- moderately proliferating, partly invasiveGrade 3- Fast proliferating, invasuveGrade 4- Rapidly proliferating, highly invasive
What are the risk factors for braing tumours?
> Age> Male> Exposure to solvent/ pesticide/ oil products/ rubber/ vinyl chloride> FHx> Infections, viruses, allergens (e.g. EBV, CMV)> Electromagnetic fields> Ionizing radiation> Head injury/ seizures> N-nitroso compounds
What are some signs and symptoms of brain tumours?
> Focal deficits e.g. personality, memory changes, loss of balance, vision, speeche changes, lactation> Headache> Nausea and vomiting> Fatigue> Drowsiness> Seizures
What investigations might you do for a brain tumour?
> MRI head/ pituitary MRI (mass with oedema)> CT head> Angiogram> Spinal tap> Biopsy> Bloods- inflammation, tumour markers, hormonal imbalance
What is a cluster headache?
Cluster headache is considered one of the most painful conditions known to humanity.
What are the risk factors for a cluster headache?
> Male> FHx> Head injury> cigarette smoking> heavy drinking
What are the signs and symptoms for a cluster headache?
> Repeated attacks of unilateral pain> Excruciating pain> lacrimation, rhinorrhoea, parital Horner’s syndrome> agitation> Nauseas and vomiting> Photophobia and phonophobia> Migrainous aura
What is the epidemiology of a cluster headache?
This is one of the few primary headaches that affect men predominantly (male-to-female ratio varies between 2.5:1 and 3.5:1).Studies suggest the prevalence of cluster headache is likely to be at least one person per 500
What investigations would you use for a cluster headache?
> Brain CT or MRI (normal)> ESR (normal)> Pituitray function test (normal)
What is encephalitis?
Encephalitis is defined as inflammation of the brain parenchyma associated with neurological dysfunction such as altered state of consciousness, seizures, personality changes, cranial nerve palsies, speech problems, and motor and sensory deficits.
What are the signs and symptoms of encephalitis?
> Fever> Rash> Altered mental state> Focal deficits> Meningismus> cough> GI infection> Seizures
What is the epidemiology of encephalitis?
Around 2500 cases of encephalitis occur in England each year.
What are the risk factors of encephalitis?
> Age <1 or >65> Immunodeficiency> Post inefction> Blood or body fluid exposure> Organ transplantation> Animal or insect bite> Location> Season> Swimming in warm freshwater
What investigations are important for encephalitis?
> Bloods»FBC, U/E, LFTs, cultures (high WBC, hyponatraemia, raised LFTS, systemic bacteria)> Nasopharyngwal aspirate (infection)> Sputum culture (infection)> CXR (infection/ other)> CT/ MRI brain (lesions)> EEG (slow)> CSF analysis/ culutre/ serology/ PCR (High WBC/ protein/ blood/ low glucose- infectious cause)
What is epilepsy?
Epilepsy is considered to be a disease of the brain defined by any of the following conditions:1. At least two unprovoked (or reflex) seizures occurring more than 24 hours apart2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years3. Diagnosis of an epilepsy syndrome.
What are the types of sezures?
General Seizures:Tonic-clonic seizures: loss of consciousness -> muscle stiffening -> jerking/twitching -> deep sleep -> wakes upAbsence seizures: brief staring episodes with behavioural arrestTonic/atonic seizures: sudden muscle stiffening/sudden loss of muscle controlMyoclonic seizures: sudden, brief muscle contractionsStatus epilepticus: > 5 min of continuous seizure activityPartial/ focal SeizuresSimple: retained awareness/consciousness Complex: impaired awareness/consciousness
What are the risk factors for epilepsy?
> Age (young)> FHx> Head injury> Stroke> Brain infection> Dementia> Tumours
What are the treatments for the different types of seizures?
> Tonic clonic/ partial- carbamazepine/ lamotrigine> Absence- ethosuximide> Myoclonic- Levetriacetam/ topiramate> Status epilepticus- diazepam> Valproate- all
What are the signs and symptoms of epilepsy?
Temporary confusion.A staring spell.Uncontrollable jerking movements of the arms and legs.Loss of consciousness or awareness.Psychic symptoms such as fear, anxiety or deja vu
How would you investigate epilepsy?
> EEG> MRI brain> CT brain
What are the complications of epilepsy?
> Learning difficulty> Aspiration pneumonia> Injury> Permanent brain damage> Anti convulsants side effects > Status epilepticus
What is the prognosis of people with epilepsy?
The overall prognosis for people with newly diagnosed epilepsy is good, with 60−70% becoming seizure-free, many of whom doing so in the early course of the condition.
What is the epidemiology of epilepsy?
Prevalence between 2-7% of the populationIncidence increased over the last 30-40 years
What is an extradural haemorrhage?
A hihg pressure haemorrhage from an artery occuring between the sura mater and the skull.
What are the risk factors for an extradural haemorrhage?
> Head injury> Spontaneous haemorrhage> Severe thermal burn
What are the signs and symptoms of an extradural haemorrhage?
> LOC followed by regainig consciousness then loss again (lucid interval)> Headache> confusion> vomiting> parasthesia/ paralysis> seizures
What is the epidemiology of an extradural haemorrhage?
Most common = pterion region over middle meningeal arteryAbout 2 percent of head injuries and 15 percent of fatal head injuries involve an epidural hematoma.
What investigations would you do for an extradural haemorrhage?
> CT> MRI Shows convex mass that is translucent (clotted blood is darker though)
What is Guillain Barre?
Guillain-Barre syndrome (GBS) is a type of acute inflammatory neuropathy.
What are the risk factors for Guillain Barre?
> preceding viral illness> preceding bacterial infection> preceding mosquito-borne viral infection> hepatitis E infection
What are the signs and symptoms of Guillain Barre?
It is a clinically defined syndrome characterised by motor difficulty, absence of deep tendon reflexes, paraesthesias without objective sensory loss, and increased CSF albumin with absence of cellular reaction (albuminocytological dissociation).Motor and sensory difficulty includes:> Weakness, Dysarthria, dysphagia, dysautonomia, diplopia, drooped face, oropharyngeal weakness> Parasthesia, pain
What is the epidemiology of Guillain Barre?
Population-based studies give crude mean annual incidence rates varying from 0.6 to 1.9 per 100,000 population.
What investigations would you do for Guillain Barre?
> Nerve conduction studies (slow)> Lumbar Puncture (elevated protein in CSF/ WBC)> LFTs (high AST/ ALT)> Spirometry (reduced VC and pressure)> Antiganglioside antibodies (Acute neuropathy markers)
What is Horner’s Syndrome?
Unilateral Sympathetic Dysfunction in the face
What are the risk factors for Horner’s Syndrome?
> Pancoast Tumour> Tumours compressing sympathetic outflow> Diseases> Iatrogenic> Repeated minor head trauma> Stroke> Vascular damage (carotids/ jugular/ cluster headaches)
What are the signs and symptoms of Horner’s Syndrome?
> Miosis> Ptosis> Anhidrosis > (enopthalmos)
What is the epidemiology of Horner’s Syndrome?
Rare
What investigations would you do for Horner’s Syndrome?
> Investigations to rule out other causes (e.g. CXR for tumours/ Doppler US/ CT/ MRI)> Using eye drops to dilate the affected eye as compared to the unaffected eye
What is the management of Horner’s syndrome?
> Treatment of underlying cause>
What are the complications of horner’s syndrome?
> Dizziness> Vision problems> Pain> Muscular weaknesses or involuntary movements
What is the prognosis of Horner’s syndrome?
> Being or Fatal depends on cause (e.g. tumours are more likely to lead to death than minor trauma)
What is Huntington’s disease?
Huntington’s disease is a slowly progressive, neurodegenerative disorder characterised by chorea, incoordination, cognitive decline, personality changes, and psychiatric symptoms, culminating in immobility, mutism, and inanition.It is autosomal dominant.
What are the risk factors for Huntington’s disease?
> CAG expansion on huntingtin gene> FHx
What are the signs and symptoms of Huntington’s disease?
> Impaired performance> Personality change> Irritability and impulsivity> Choreic movements> Loss of coordination> Deficit in fine motor coordination> Slowed rapid eye movements> Motor impersistence> Impaired tandem walking
What is the epidemiology of Huntington’s disease?
The prevalence of Huntington’s disease in European populations is estimated at 4 to 8 per 100,000.
What investigations would you do for Huntington’s disease?
No real testsClinical diagnosisCAG repeat testingMRI/ CT- caudate or striatal atrophy
What is Hydrocephalus?
Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain which typically increases pressure inside the brain.
What are the risk factors for Hydrocephalus?
> Congenital- malformations, aqueduct stenosis, neural tube defects etc. > Acquired- infections, meningitis, brain tumours, toxoplasmosis or intracranial haemorrhages
What are the signs and symptoms of Hydrocephalus?
Vomiting.Sleepiness.Irritability.Poor feeding.Seizures.Eyes fixed downward (sunsetting of the eyes)Deficits in muscle tone and strength.Poor responsiveness to touch
What is the epidemiology of Hydrocephalus?
Prevalence estimates for infantile hydrocephalus vary between one and 32 per 10,000 births
What investigations would you do for Hydrocephalus?
MRICTMight show increased CSF or pressure
What are the types of hydrocephalus?
> Communicating (impaired CSF absorption- flow between ventricles and sub arachnoid space)> Non communicating (obstruction)> Normal pressure
What is a lumbar puncture?
A lumbar puncture is where a thin needle is inserted between the bones in your lower spine. It shouldn’t be painful, but you may have a headache and some back pain for a few days.
When would you do a lumbar puncture?
> take a sample of fluid from your spinal cord (cerebrospinal fluid) or measure the fluid’s pressure – to help diagnose a condition> inject medications – such as painkillers, antibiotics or chemotherapy> inject a spinal anaesthetic (epidural) – to numb the lower part of your body before an operation> remove some fluid to reduce pressure in the skull or spine
What are the complications of a lumbar puncture?
> Headaches > Swelling/ lower back pain> Brain herniation> Bleeding> Infection
What is Meningitis?
An inflammation of the meninges caused by bacteria, viruses or fungi.
What are the risk factors of Meningitis?
- young or old (<5, >65)- Crowding> Exposure to pathogens> Students> Non immunised infants> Immunodeficiency> Cancer> Cochlear implants> Anatomical defects
What are the signs and symptoms of Meningitis?
> Headache, neck stiffness, photophobia> Rash> Fever, vomiting > Confusion, altered mental state> Papilloedema> Kernig’s sign> Brudzinski’s sign
What is the epidemiology of Meningitis?
The incidence of bacterial meningitis in Western countries and the US is 0.7 to 0.9 per 100,000 persons per year and has decreased by 3% to 4% in the past 10 to 20 years.
What investigations would you do for Meningitis?
> CSF analysis (high protein, low glucose, positive gram stain and culture)> Blood culture (positive)> Bloods- FBC (anaemia, leukocytosis, thrombocytopenia), CRP (high) , U/E (acidosis, low Ca/Mg, or hyper/hypoglycaemia), Coag profile (evidence of DIC)> CT head (normal or raised ICP)> PCR (pos)
What is the management of Meningitis?
Bacterial> Antibiotics (ampicillin and cefotaxime)> Supportive therapy> DexamethasoneViral> Supportive care> Antiviral therapy
What are the complications of Meningitis?
> Shock> ICP> Hydrocephalus> Focal neural deficits> Subdural effusion> Seizures> Brain abscess> Septic deep vein thrombosis> hearing loss
What is the prognosis of Meningitis?
Untreated bacterial- poorViral- meh
What is Kernig’s sign?
With the patient supine and the thigh flexed to a 90° right angle, attempts to straighten or extend the leg are met with resistance.
What is Brudzinski’s sign?
Flexion of the neck causes involuntary flexion of knees and hips.Alternative sign is passive flexion of the leg on one side causing contralateral flexion of the opposite leg.
What is a Migraine?
Migraine is a chronic, genetically determined, episodic neurological disorder that usually presents in early-to-mid life.
What are the risk factors of a Migraine?
> family history of migraine> high caffeine intake> exposure to change in barometric pressure> female sex> obesity> habitual snoring> stressful life events> overuse of headache medications> lack of sleep
What are the signs and symptoms of a Migraine?
> Prolonged headache> Nausea> Decreased ability to function> hedache worse with acitivy> Sensitivity to light> aura
What is the epidemiology of a Migraine?
Migraine is a highly prevalent condition. Summarising the data from a review of headache and migraine in Europe, on 1-year prevalence, the proportion of adults in Europe reporting migraine is 14% and ‘chronic headache’ (i.e., 15 or more days/month or daily) is 4%
What investigations would you do for a Migraine?
> Clinical diagonsis> Bloods and imaging to rule out other causes
What is the management of a Migraine?
> Antiemetic and analgesia (emergency)> NSAIDs, anti emetics, hydration, paracetamol> Triptan> Trigger avoidance
What are the complications of a Migraine?
> Status migranosus> Migrainous infection> Migraine triggered seizures> Depression> Chronic migraine> Persistent aura without infarction
What is the prognosis of a Migraine?
Most patients with episodic migraine do well with treatment. In population-based surveys the frequency of migraine headaches decreases with age.
What is MND (Also: ALS)?
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder, characterised by progressive muscle weakness that can start in limb, axial, bulbar, or respiratory muscles and then generalises relentlessly, causing progressive disability and ultimately death, usually from respiratory failure.
What are the risk factors of MND?
> Genetic predisposition> Age >40 yrs
What are the signs and symptoms of MND?
> upper extremity weakness> stiffness, with poor co-ordination and balance> spastic, unsteady gait> painful muscle spasms> difficulties in arising from chairs and climbing stairs> foot drop> stiffness and decreased balance with impact on gait> head drop> progressive difficulties in maintaining erect posture, with stooping> muscle atrophy> increased lumbar lordosis and tendency for abdominal protuberance> hyper-reflexia> dyspnoea> coughing and choking on liquids (including secretions) and eventually on food> strained, slow speech> slurred, nasal, and, at times, dysphonic speech
What is the epidemiology of MND?
The incidence of ALS in Europe and the US is about 1.5 to 2.5 per 100,000 per year, with a prevalence of 2.7 to 7.4 per 100,000. The mean age of onset is about 57 years.
What investigations would you do for MND?
> Clinical diagnosis> EMG> MRI brain and spine
What is MS?
Multiple sclerosis (MS) is defined as an inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least two areas of the central nervous system (brain, spinal cord, and optic nerves) separated in time and space.
What are the risk factors of MS?
> Female> Northern Latitude> Smoking> Genes> Vit D def> EBV
What are the signs and symptoms of MS?
> Mono-ocular disturbance in one eye> Peculiar sensory phenomena> Foot drag> Leg cramp> Fatigue> Urinary frequency> Bowel dysfunction> Spasticity > Increased deep tendon reflexes > Imbalance/ co ordination
What is the epidemiology of MS?
There is a significantly skewed sex ratio, with a female to male ratio of around 3:1, and the disparity appears to be increasing.In Europe and North America the estimated prevalence of MS is 1 in 800, and the annual incidence is between 2 and 10 cases per 100,000 population.
What investigations would you do for MS?
> MRI brain and spinal cord- lesions> FBC, metabolic panel, TSH and B12- should all be normal
What is Myasthenia Gravis?
Myasthenia gravis (MG) is a chronic autoimmune disorder of the post-synaptic membrane at the neuromuscular junction (NMJ) in skeletal muscle. Circulating antibodies against the nicotinic acetylcholine receptor (AChR) and associated proteins impair neuromuscular transmission.
What are the signs and symptoms of Myasthenia Gravis?
Characterised by muscle weakness that increases with exercise (fatigue) and improves on rest. Commonly presents with drooping eyelids, double vision, oropharyngeal and/or appendicular weakness, and shortness of breath.Also:> Dysphagia
What are the risk factors of Myasthenia Gravis?
FHx of AI diseaseGenetic markersCancer targeted therapies
What is the epidemiology of Myasthenia Gravis?
Myasthenia gravis (MG) is an uncommon disease with an estimated worldwide prevalence of 100 to 200 per million population.
What investigations would you do for Myasthenia Gravis?
> Serum AChR antibody analysis> muscle specific tyrosine kinase antibodies> Serum pulmonary function tests> Repetitive nerve stimulationResults:Elevated serum acetylcholine receptor antibody titres or muscle-specific tyrosine kinase antibodies are present. Antibodies to 4 new autoantigens, low-density lipoprotein receptor-related protein (LRP4), agrin, collagen Q, and cortactin, located at the neuromuscular junction, have been identified. Clinical electrophysiology shows decremental response on repetitive nerve stimulation or increased jitter on single-fibre study.
What is Neurofibromatosis?
Neurofibromatosis is a genetic disorder of the nervous system. It mainly affects how nerve cells form and grow. It causes tumors to grow on nerves.
What are the signs and symptoms of neurofibromatosis?
> Pain> Compromised vision- optic disc pallor and iris Lisch nodes> Neurological deficits> Skin- cafe au lait spots, axilla freckles, cutaneous juvenile xanthogranulomas, neurofibromas> CNS- hydrocephalus, tumours, cerebellar problem> PNS- Palpable masses> Skeletal- tibial dysplasia, pectus excavatum, genu valgum/ varum, ankle valgus> Vascular- abdo pain, neuro problem> Autism spectrum disorder
What are the risk factors of neurofibromatosis?
> Genetics- parental> Severe Crush trauma
What is the epidemiology of neurofibromatosis?
For all populations studied, the overall frequency of NF1 is about 1 in 2500-3000, with one third of all cases and half of new presenting cases representing new mutations and the remainder being inherited from an affected parent.
What investigations would you do for neurofibromatosis?
> MRI/ CT- shows evidence of tumours or hydrocephalus> PET> Biopsy- tumours> Genetic testing for NF1 mutation
What are the types of Neurofibromatosis?
The three types are neurofibromatosis type I (NF1), neurofibromatosis type II (NF2), and schwannomatosis
Which type is most common?
Neurofibromatosis type 1
What are the signs and symptoms of NF2?
Bilateral vestibular schwannomas, intracranial meningiomas and/or ependymomas, spinal glioma, paraspinal schwannomas, cutaneous schwannomas, posterior subcapsular cataracts, pigmentary retinopathy, absence of typical café au lait spots
What would you find on investigation of NF2?
Identification of a mutation at the NF2 locus in chromosome band 22q11
What is Parkinson’s Disease?
Idiopathic Parkinson’s disease (PD) is a neurodegenerative disorder.
What are the risk factors of parkinsons disease?
> Age> FHx > Mutation in gene encoding glucocerebrosidase> MPTP exposure
What are the signs and symptoms of Parkinsons disease?
> Bradykinesia> Resting tremor> Rigidity> Postural instability> Hypomimic face> Shuffling gait> Depression, anxiety, dementia> Fatigue, constipation, micrographia> Hypokinetic dysarthria> Conjugate gaze disorders
What is the epidemiology of parkinsons disease?
With prevalence of disease increasing with age, PD is one of the most common neurodegenerative disorders. Given various age distributions in study populations, reports of incidence and prevalence vary. The overall age-adjusted prevalence of PD is 1% worldwide and 1.6% in Europe.
What investigations would you do for parkinsons disease?
> Dopaminergic agent trial> MRI brain
What is raised intracranial pressure?
Increased pressure inside the skull
What can cause raised intracranial pressure?
> Traumatic brain injuries> Hydrocephalus> Haematomas> High blood pressure> TUmours> Seizures/ epilepsy> Sstroke> Brain infections> Aneurysms> Swellings (oedema)
What are the signs and symptoms of Raised intracranial pressure?
> Papilloedema> Headache> Fatigue> Nausea or vomiting> Impaired speech> Impaired movement> Muscle weakness> Drowsiness> Confusion
What is the epidemiology of the different causes of raised ICP?
Depends on the cause
What investigations would you do for raised ICP?
> CT scan> MRI scan
What is spinal cord compression?
Spinal cord compression (SCC) results from processes that compress or displace arterial, venous, and cerebrospinal fluid spaces, as well as the cord itself
What are the risk factors of spinal cord compression?
> Age 16-30 AND male> trauma> Tumour> Osteoporosis> High risk occupation> High risk recreational activities
What is the epidemiology of spinal cord compression?
Overall, the leading 5 causes of acute SCI in people ≤65 years of age are as follows, with the highest listed first:Males: automobile accidents, falls, gunshot wounds, diving accidents, motorcycle accidentsFemales: automobile accidents, falls, gunshot wounds, medical/surgical complications, diving accidents.
What are the signs and symptoms of spinal cord compression?
> back pain> numbness or paraesthesias> weakness or paralysis> bladder or bowel dysfunction> hyper-reflexia> sensory loss> muscle weakness or wasting> loss of tone below level of suspected injury (spinal shock)> hypotension and bradycardia (neurogenic shock)> complete cord transection syndrome> cauda equina syndrome> central cord syndrome
What investigations are important for cord compression?
> MRI spine> Gadolinium-enhanced MRI> Plain spine X Ray> CT spine> CT myelographyFindings:- TUmours> Narrowing of the canal> Bone abnormalities
What is cauda equina syndrome?
Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control.
What is Radiculopathy?
Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly.
What are the risk factors of radiculopathy?
> aging> being overweight> poor posture> improper lifting techniques.> repetitive motions.> a family history of degenerative bone conditions
What are the signs and symptoms of radiculopathy?
> Pain> Weakness> Numbness> Neck or Back pain> Absent or diminished reflexes
What is the epidemiology of radiculopathy?
Cervical radiculopathy is less prevalent in the United States than lumbar radiculopathy with an occurrence rate of 83 cases per 100,000
What investigations would you do for radiculopathy?
> MRI/ CT spine> EMG (needle) >
What is a tension headache?
The attacks are generalised throughout the head with a predilection for involving the frontal and occipital regions. The pain is typically expressed as being a ‘tight band’ around the head. It does not worsen with routine physical activity.
What are the risk factors of a tension headache?
> Mental tension> Stress> Missing meals> Fatigue
What is the epidemiology of a tension headache?
Tension-type headaches are probably the most common type of headache. In adults, the mean global prevalence of tension-type headache is 42%.
What are the signs and symptoms of a tension headache?
> generalised head pain> frontal or occipital head pain> non-pulsatile head pain> constricting pain> pericranial tenderness> sternocleidomastoid muscle tenderness> trapezius muscle tenderness> temporalis muscle tenderness> lateral pterygoid muscle tenderness> masseter muscle tenderness
What investigations would you do for a tension headache?
> Clinical diagnosis> CT/MRI/ LP to rule out other causes
What is the management plan for a tension headache?
> Analgesia- aspirin/ paracetamol> Antidepressants e.g. amitriptyline
What are the complications of a tension headache?
> Peptic ulcer
What is the prognosis of a tension headache?
Tension-type headaches are probably the most common type of headache in the general population. They are most common between the ages of 20 to 39 years and then decline. Self-treatment with simple analgesic medicine is usually effective.
What is a TIA?
A transient ischaemic attack (TIA) is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. (Complete resolution in 24 hrs)
What are the risk factors for a TIA?
> AF> Valvular disease> Carotid stenosis> Congestive Heart Failure> Hypertension> Diabetes Mellitus> Cigarette smoking> Alcohol abuse> Advanced Age
What is the epidemiology of a TIA?
Stroke is a major health concern in the UK that accounts for 11% of all deaths in England and Wales. Each year in England 2000 people have a first episode of TIA.
What are the signs and symptoms of a TIA?
> Brief> Extracranial atherosclerosis> Unilateral symptoms> Increased BP on presentation> Focal neurological deficit> Absence of positive symptoms or headache> History of migraine
What investigations do you use for a TIA?
> Bloods» Glucose (rule out hypo)» Chemistry (abnormality may suggest non ischaemic)» FBC (normal)» Clotting profile (normal)> ECG (AF?)> Brain MRI (may have positive diffusion images)> Fasting lipid profile
What is the management of a TIA?
> Antiplatelet therapy (aspirin)> Statin (atorvastatin)> Ezetimibe (if artherosclerotic heart disease)
What are the complications of a TIA?
> Stroke> MI
What is the prognosis of a TIA?
By definition, a patient with a TIA has no residual symptoms from the primary event. The most significant risk to the patient is a second ischaemic event causing permanent disability.
What is trigeminal neuralgia?
Trigeminal neuralgia (TN) is a facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve.
What are the risk factors of trigeminal neuralgia?
> Increased age> MS> Female> HTN
What are the signs and symptoms of trigeminal neuralgia?
> Face pain> Prior oropharyngeal or facial trauma
What is the epidemiology of trigeminal neuralgia?
The incidence of trigeminal neuralgia is generally thought to be from 4 to 13 per 100,000 based on US and UK population studies.
What investigations would you do for trigeminal neuralgia?
None that are diagnosticIntra oral X ray or MRI to rule out other causes
What is Wernicke’s Encephalopathy?
Wernicke’s encephalopathy is a neurological emergency resulting from thiamine deficiency with varied neurocognitive manifestations, typically involving mental status changes and gait and oculomotor dysfunction.
What are the risk factors of wernickes encephalopathy?
> alcohol dependence> AIDS> cancer and treatment with chemotherapeutic agents> malnutrition> Hx of GI surgery
What are the signs and symptoms of wernickes encephalopathy?
> mental slowing, impaired concentration, and apathy> frank confusion> ocular motor findings> Mild irritability> Delirium> Acute psychosis
What is the epidemiology of wernickes encephalopathy?
The prevalence of this condition according to unselected autopsy studies varies throughout the world from 0.8% to 2.8%.
What investigations would you use for wernicke’s encephalopathy?
> therapeutic trial of parenteral thiamine- clinical response> finger-prick glucose (normal)> FBC (normal)> serum electrolytes (abnormal in late disease)> renal function (abnormal in late disease)> LFTs (elevated)> urinary and serum drug screen (negative)> serum ammonia (normal unless decompensation of ALD)> blood alcohol level> blood thiamine (low) and its metabolites> serum magnesium (May be low)
