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relevant clinical points Flashcards

1
Q

What is an EDH?

A

bleed between skull and dura
post head injury
usually meningeal arteries
lens (lemon) shaped on CT

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2
Q

What is a SDH?

A
  • 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
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3
Q

What is a SAH?

A

Bleed between arachnoid an pia
berry aneurysm burst
blood sulci near injury
pathognomic thunder clap headache

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4
Q

what is an intracerebral haemorrhage?

A

rupture of small perforating arteries into the brain parenchyma
internal capsule lenticulostriate artery rupture because of high blood pressure

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5
Q

What is meningitis?

A
  • 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)
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6
Q

what is amaurosis fugax?

A
  • a type of transient ischaemic attack
  • blood clot occluding central retinal artery
  • causing a curtain like loss of vision
  • warning sign of ICA stroke
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7
Q

What is a berry aneurysm?

A
  • 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
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8
Q

What is a venous sinus thrombosis?

A
  • 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
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9
Q

describe what happens with raised intracranial pressure.

A
  • 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)
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10
Q

what happens in vertebral disc herniation?

A
  • Nucleus populous herniates through the annulus fibrosis
  • presses on spinal cord
  • causes back pain, sensory changes, loss movement
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11
Q

What is cauda equina syndrome?

A
  • 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
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12
Q

What is a radiculopathy?

A
  • spinal Root compression
  • vertebral disc herniation
  • most commonly C6/7 or L5/S1
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13
Q

What is sciatica?

A
  • compression/irritation of sciatic nerve (L5)

- pain radiating down buttock into calf, weakness in dorsiflexion - foot drop

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14
Q

Where would you do a lumbar puncture and why?

A
  • 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
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15
Q

What is Bell’s palsy?

A
  • 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
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16
Q

What is bulbar palsy?

A
  • 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
17
Q

What is central pontine myelinosis?

A
  • 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
18
Q

Describe a patient with cerebellar dysfunction?

A
  • 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
19
Q

What can happen with a limbic system lesion?

A
  • 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
20
Q

Describe hydrocephalus

A
  • 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
21
Q

Describe Parkinson’s disease

A
  • 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
22
Q

What are the signs of an upper motor neuron syndrome (lesion of the medullary pyramids damaging the corticospinal tracts)

A
  • spasticity
  • hyper reflexes
  • loss of ability to perform fine movements
  • babinski sign
23
Q

What is wallenberg syndrome

A

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

24
Q

Pituitary tumour

A

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

25
Q

Huntington’s disease

A

Autosomal dominant inheritance

symptoms include: chorea, personality change, depression, progressive dementia (due to degeneration of the corpus straitum and cerebral cortex)

26
Q

Lacunar stroke

A

Occlusion of the deep perforating artery

Hypertension, smoking and diabetes are strong risk factors

resultant lesion occur in the deep nuclei, pons or internal capsule

symptoms include: hemiparesis typically of half the face, one arm or leg, ataxic hemiparesis (cerebellar and motor symptoms affecting the leg)

mixed sensorimotor stroke - if the thalamus is also affected, causing hemiparesis with ipsilateral sensory impairment

neuroanatomy (21 decks)

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