New Neurology Flashcards
What is presbycusis?
Age related sensorineural hearing loss
What is Otosclerosis?
autosomal dominant replacement of normal bone with spongy vascular bone.
What is menieres disease?
Recurrent episodes of vertigo, tinnitus and sensorineural hearing loss, lasting mins-hours. Vertigo main complaint!
Middle aged adults
Feeling of aural fullness/pressure
Nystagmus/positive romberg test
Investigations in Meniere’s disease
Menieres triad
- Otoscopy - Normal ear drum
- Audiometry - Sensorineural hearing loss
- Tympanometry - normal
Pharmacological mx of menieres
Prochlorperazine (acute vertigo and nausea) [Acute attacks]
Betahistine medication (H1 agonist that acts as a Vestibular sedative) [Prevention]
Intratympanic gentamicin injection if surgical
What is Acoustic Neuroma?
AKA vestibular schwanomma. Tumour arising from schwann cells myelinating CN8. Usually presents between 40-60yo.
Associated with type 2 neurofibromatosis
Presents similar to menieres (vertigo, tinnitus, S hearing loss) BUT also has absent corneal reflex and possible facial paralysis
Affected cranial nerves:
- Men. symptoms (VIII)
- Absent corneal reflex (V)
How can acoustic neuroma present?
Depends on cranial nerves affected
- CN5: Absent corneal relfex
- CN7: Facial palsy
- CN8: Unilateral sensorineural hearing loss and tinnitus, vertigo.
Ix of Acoustic Neuroma
Audiogram and examination show sensorineural hearing loss.
MRI Gold standard imaging for diagnosis and tumour tracking.
Mx and comps of acoustic neuroma
Conservative or
Tumour excision or
Radiotherapy
Permanent hearing loss (CN8), permanent facial weakness (CN7)
What is an essential tremor, give features and management?
Autosomal dominant condition usually affecting both arms.
Postural tremor: worse when arms stretched out
Improved by alcohol and rest
Most common cause of titubation (head tremor)
Managed with propanolol, or primidone second line
Define Extradural Haemorrhage with its main cause and epidemiology
Cranial bleeding above the dura mater.
Usually caused by trauma to pterion of skull, causing rupture of middle meningeal artery in temporo-parietal region. Can associate with temporal bone fracture.
Usually found in young adults
Blood doesnt cross suture lines
Why can extradural stroke present slowly at first before becoming more severe?
If bleeding is slow, symptom onset is slower (lucid interval) before there is a sudden, rapid decline when intracranial pressure increases enough to compress brain
Describe non contrast ct appearance in extradural haemorrhage (3)
Biconvex, hyperdense haematoma
Blood doesnt cross suture lines
Shows midline shift (increased pressure can cause cause brain shifting/herniation)
What are the 2 main herniation complications of haemorrhagic stroke?
Supratentorial herniation (cerebrum against skull, compressing arteries and causing ischaemic stroke)
Infratentorial herniation (Cerebellum pushed against brainstem, compressing area that controls consciousness, respiration, heart rate)
What is cushings triad and how is it treated?
Body’s response to increased intracranial pressure, signifies severe lack of oxygen in brain tissue
- Bradycardia
- Irregular respirations
- Widened pulse pressures (increased systolic, decreased diastolic)
Treated with IV mannitol to reduce ICP
Define Subdural haemorrhage with its main cause and epidemiology
Bleeding below dura mater, caused by bridging vein rupture.
Usually occur in elderly/alcoholic patients but can occur in babies (shaken baby syndrome)
causes of bridging vein rupture
Brain atrophy; with age. Stretches bridging veins, meaning they stretch over gaps unsupported.
Alcohol abuse: Causes walls of vein to thin
Trauma
Falls
Shaken baby syndrome
Acceleration/deceleration injury
non contrast ct appearance of subdural haemorrhage
Bleeding between the dura mater and arachnoid
- Follows contours of brain and crosses suture lines, forming a crescent shape
Acute (hyperdense mass)
Chronic (Hypodense mass)
Acute on Chronic (both)
what gcs requires intubation
8 or below
specific surgery in subdural haemorrhage
Burrhole washout if haemorrhage small
Craniotomy if large haemorrhage
define subarachnoid haemorrhage with main cause
Bleeding below the arachnoid layer, where CSF is located.
Main cause is a ruptured saccular (or Berry) aneurysm, with majority located between anterior communicating artery and anterior cerebral artery
RF for subarachnoid haemorrhage (7)
PKD (Associated with berry aneurysm)
Connective tissue disorders (Ehlers-Danlos, Marfans)
Family history
Increasing age
HTN
Smoking
Alcohol
typical presentation of subarachnoid haemorrhage
Sudden onset occipital “thunderclap” headache, following strenuous activity, with associated neck stiffness and photophobia. Smaller, “Sentinel” headache may have preceded thunderclap
Black, female, 45-70
signs/symptoms of subarachnoid haemorrhage
Thunderclap headache
Meningism (Headache, photophobia + neck stiffness)
Fixed dilated pupil (third nerve palsy - especially in posterior communicating artery rupture)
6th nerve palsy
Kernigs and Brudzinskis due to meningism also
Nausea/vomiting, weakness, confusion, coma, reduced consciousness, speech reduction