Peripheral Neuropathies, Ischaemic Stroke and Head Injury

Question 1

What are the different types of peripheral receptors?

Answer 1

1) A-a -> Proprioception (M - Large)
2) A-b -> Light touch, pressure and vibration (M - Large)
3) A-d -> Pain and Cold (M - Small)
4) C -> Pain and Warmth (UM - Small)

Question 2

What are the 2 main classifications of peripheral neuropathies?

Answer 2

De-Myelination: Slow conduction with IS and genetic defectors
Axonal: V amplitude of potentials –> Systemic diseases

Question 3

What are some of the pathological symptoms seen with motor dysfunction?

Answer 3

• Arched feet
• Muscle cramps
• Weakness
• Fasciculations
• Atrophy

Question 4

What are the 3 different types of sensory peripheral neuropathies?

Answer 4

1) Symmetrical: Initial sensory –> Sensorimotor
2) Asymmetrical : Patchy distribution –> DRG affected
3) Asymmetrical Sensorimotor: Mononeuritis multiplex

Question 5

What are the main treatments for PN?

Answer 5

1) Pain: Amitriptyline
2) Cramps: Quinine
3) Balance: Physiotherapy

Question 6

How would you determine if someone has an ischaemic stroke?

Answer 6

Conduct a CT Scan

Question 7

What is the treatment for an ischaemic stroke?

Answer 7

Thrombolysis e.g. alteplase

- IV infusion to break up clot

Question 8

What is the timeframe for thrombolysis in an ischaemic stroke?

Answer 8

Up to 4.5 hours post symptom onset

Question 9

What effects will be seen by posterior circulation stroke?

Answer 9

1) Motor Circulation
Dysarthria
Vertigo, Nausea and Vomiting
Visual disturbances
Altered consciousness

Question 10

What is the difference between missile and non-missile head injury?

Answer 10

M: Penetration of skull and brain

N-M: Risks fracture, contusions and lacerations

Question 11

What are the 2 main risks associated with skull fracture?

Answer 11

1) Haematoma

2) Infection

Question 12

How does a non-missile affect both scalp and brain?

Answer 12

Meninges: Haemorrhage and infection
Brain: Contusions, lacerations, infections and haemorrhage (Skull fracture)

Question 13

How do focal and diffuse head injuries differ?

Answer 13

Focal: Contusions, lacerations, fracture and haemorrhage
Diffuse: Hypoxia/Ischaemia and diffuse axonal

Question 14

What is the difference between coup and contrecoup injuries?

Answer 14

Coup: Brain injury at site of contact
Contrecoup: Opposite side of brain from where the impact occurs

Question 15

What is the main mechanism behind acceleration and deceleration damage?

Answer 15

Force to head can cause differential movement of skull and brain –> Shearing, traction and compressive forces –> Risk of axon tear and blood vessel damage

Question 16

How do traumatic axonal and diffuse injuries differ?

Answer 16

Axonal: Accel/decel –> Shearing forces and rotation -> Axons tear
Diffuse: Shown by multiple petechial haemorrhages

Question 17

What is more severe out of traumatic axonal and diffuse?

Answer 17

Diffuse is much more severe –> Can result in near death

Question 18

Define contusion

Answer 18

Superficial “bruises” of the brain

Question 19

Define laceration

Answer 19

Contusion severe enough that pia mater is torn

Question 20

What can raised intracranial pressure cause and what are the main types?

Answer 20

Brain Swelling

i) Congestive Brain Swelling: Vasodilation with increased cerebral blood volume
ii) Vasogenic Oedema: Extravasation from damaged blood vessels
iii) Cytotoxic Oedema: Increased content H2O in neurons and glia