relevant clinical points Flashcards
What is an EDH?
bleed between skull and dura
post head injury
usually meningeal arteries
lens (lemon) shaped on CT
What is a SDH?
- bleed between the dura and the arachnoid
- crescent shape (banana) on CT (acute = bright. chronic = dark)
- due to tearing of bridging veins (vein between sinus & brain)
- chronic in elderly 4-8 weeks following head injury
What is a SAH?
Bleed between arachnoid an pia
berry aneurysm burst
blood sulci near injury
pathognomic thunder clap headache
what is an intracerebral haemorrhage?
rupture of small perforating arteries into the brain parenchyma
internal capsule lenticulostriate artery rupture because of high blood pressure
What is meningitis?
- inflammation of the meninges
- triad = headache, neck stiffness and photophobia
- bacterial and viral
- bacterial associated rash when infection spreads to the blood (this is called meningococcal septicaemia)
what is amaurosis fugax?
- a type of transient ischaemic attack
- blood clot occluding central retinal artery
- causing a curtain like loss of vision
- warning sign of ICA stroke
What is a berry aneurysm?
- bulging of weak points in the cerebral arteries
- progressively enlarge until bleed
- commonly at communicating artery sites
- can have sentinel bleeds - small headaches before big bad boy daddy headache
What is a venous sinus thrombosis?
- clot in the venous drainage
- disease of the cavernous sinus
- causes raised ICP
- headache + seizure
- possible causes include rare complication at childbirth, clotting disorders and ear infection
describe what happens with raised intracranial pressure.
- pressure increase due to extra stuff in the brain - tumour, abscess, bleed or idiopathic raised ICP
- Sx - headache, nausea, vomitting, visual changes, eventually LOC
- sign - papillodema (optic disc swelling)
what happens in vertebral disc herniation?
- Nucleus populous herniates through the annulus fibrosis
- presses on spinal cord
- causes back pain, sensory changes, loss movement
What is cauda equina syndrome?
- compression of the cauda equina (ending of spinal where nerve roots leave L1 - S5)
- loss of sphincter tone, saddle anaesthesia, incontinent of urine and faeces,
- MEDICAL EMERGENCY
What is a radiculopathy?
- spinal Root compression
- vertebral disc herniation
- most commonly C6/7 or L5/S1
What is sciatica?
- compression/irritation of sciatic nerve (L5)
- pain radiating down buttock into calf, weakness in dorsiflexion - foot drop
Where would you do a lumbar puncture and why?
- between L3/4 needle into the intervertebral space
- At this level, the subarachnoid space contains the nerve roots of the cauda equina floating free in the CSF
- check for IRICP + treatment, MS diagnosis, infection, diagnose SAH
What is Bell’s palsy?
- inflammation or irritation of the facial nerve
- paralysis of the muscle of facial expression, behind ear pain, failure to close eye
- absent corneal reflex, hyperaurcusis, loss of taste to anterior 2/3rds of tongue
What is bulbar palsy?
- impairment CN 9/10/11/12 (medulla)
- dyspaghgia (can’t swallow), Slurring of speech, Dysphonia (can’t talk properly), excess slobber
- signs - wasting and fasciculation of tongue, absent GAG
- MND, GBS
What is central pontine myelinosis?
- destruction of myelin in the pons
- caused from the rapid correction of Na+ levels
- confusion, balance loss, dysphagia (can’t swallow), hallucinations, LOC, tremor/weakness
Describe a patient with cerebellar dysfunction?
- DANISH
- dysdiadochokinesia (poor coordination at speed)
- ataxia - poor unbalanced gait
- nystagmus - eye shaking
- Intention tremor
- slurred speech
- hypotonia (floppy)
- balance problems, abnormal gait, wide stance, impaired limb coordination
- caused by stroke, physical trauma, tumours and chronic alcohol excess
What can happen with a limbic system lesion?
- anterograde amnesia
- generation of emotion and emotional responses in the absence of external stimulation
- production of inappropriate emotional response to particular stimuli
- inability to detect emotions of others and regulate own
Describe hydrocephalus
- blockage of CSF flow into ventricles or SAS
- tumours or adhesions following meningitis or trauma
- rise in fluid pressure causing ventricles to swell
- RICP, headache, unsteadiness, mental impairment
- insertion of shunt connecting the ventricular system to the jugular/peritoneum can relieve pressure
Describe Parkinson’s disease
- degeneration of dopaminergic neurons of the pars compacta of the substantia nigra with depletion of striatal dopamine levels
- treated with Levadopa - can minimise symptoms
- cause is usually unknown but some genetically determined forms
- symptoms include: cog-wheel ridigity, pill-rolling tremor (thumb and forefinger), shuffling and fenstinant gait (difficulty starting and stopping), bradykinesia (slowness of movements), loss of facial expression
What are the signs of an upper motor neuron syndrome (lesion of the medullary pyramids damaging the corticospinal tracts)
- spasticity
- hyper reflexes
- loss of ability to perform fine movements
- babinski sign
What is wallenberg syndrome
Blockage of the vertebral artery or posterior inferior cerebellar artery leading to infarction of the lateral medulla
symptoms - a variety of motor, sensory, cognitive, perceptual, speech and language deficits
systems affected may include - vestibulocerebellar, sensory, bulbar, respiratory and autonomic systems
Pituitary tumour
Most commonly adenoma
Cause under- or overproduction of hormones
May lead to bi temporal hemianopia due to pressing on optic chiasum where nerve fibres from both optic nerves cross
