Revision notes Flashcards
Causes of hyPERcalcaemia
- Primary hyperparathyroidism
-
Malignancy
- SQUAMOUS CELL LUNG CANCER
- releases Parathyroid Hormone-related Protein (PTH-rP) - paraneoplastic syndrome
- MYELOMA (releases cytokines -> increased osteoclastic resorption)
- Bone METASTESES
- SQUAMOUS CELL LUNG CANCER
- SARCOIDOSIS (granulomatous disease)
- Addison’s disease
- Thiazides
- THYROTOXICOSIS
- Vitamin D intoxication
- Acromegaly
- DEHYDRATION
- Milk-alkali syndrome
Px of subdural haemorrhage
- Acute = Sx within 48 hours of injury - rapid neurological deterioration
- Subacute = over days / weeks
- Chronic = over weeks to months (esp in elderly - may not remember specific trauma)
Typical Hx:
- Head trauma
- Lucid interval
- Gradual decline in consciousness / cognition (esp in chronic SDH)
Oft also, unilateral headache, confusion + lethargy
Which groups of people are particularly at risk of subdural haematomas
Elderly and Alcoholic
- they have brain atrophy -> more fragile / taut bridging veins
Acute vs chronic subdural haematomas on CT
- Acute = hyperdense
- Chronic = hypOdense
Parietal lobe lesion Px
- Sensory inattention
- Apraxia
- Astereognosis (tactile agnosia)
- Inferior homonymous quadrantinopia (if optic radiations affected)
- Grestmann’s syndrome (if dominant parietal lobe affected):
- Alexia (can’t comprehend written language)
- Acalculia
- Finger agnosia
- Right-left disorientation
Occipital lobe lesion Px
- Cortical blindness
- Visual agnosia
- Homonymous hemianopia (oft with macula sparing)
- spacifically from posterior cerebral artery strokes
- The macula is usually spared because the occipital pole (which is where the info from macula is processed) is usually supplied by the middle cerebral artery (tho not always)
Temporal lobe lesion Px
- Wernike’s aphasia
- Superior homonymous hemianopia (if optic radiations affected)
- Auditory agnosia
- Prosopagnosia (difficulty recognising faces)
Frontal lobe lesion Px
- Expressive dysphasia (Broca’s)
- Disinhibition
- Perseveration
- Anosmia
- Inability to generate lists
Which area of the brain in particular is associated with Wernicke Korsakoff
Medial thalamus + mammillary bodies (in hypothalamus)
Posterior cerebral artery stroke Px
- Contralateral homonymous hemianopia with macular sparing
- Visual agnosia
(baso just the occipital cortex)
Middle cerebral artery stroke Px
- Contralateral hemiparesis and sensory loss, upper extremity > lower
- Contralateral homonymous hemianopia
- Aphasia
Anterior cerebral artery stroke
Contralateral hemiparesis and sensory loss, lower extremity > upper
Ipsilateral CN III palsy + Contralateral weakness of upper and lower extremity
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
Posterior inferior cerebellar artery stroke
- Ipsilateral: facial pain and temperature loss
- Contralateral: limb/torso pain and temperature loss
- Ataxia,
- nystagmus
- Sudden onset vertigo + vomiting
- Dysphagia
(AKA lateral medullary syndrome + Wallenberg syndrome)
Anterior inferior cerebellar artery
- Ipsilateral: facial paralysis and deafness
+/- Contralateral: limb/torso pain and temperature loss - Ataxia, nystagmus
- oft associated sudden onsent vertigo + vomiting
(AKA lateral pontine syndrome)
Common sites of lacunar strokes
- Basal ganglia
- Thalamus
- Internal capsule
What pathology is often associated with temporal lobe epilepsy
Sclerosis of hippocampus
What is Jacksonian march
A type of focal epileptic seizure - typically related to lesions of the frontal lobe
Starts with tingling / twitching in small area (Finger, Big toe, Corner of mouth) then spreads (whole hand, foot, face etc)
Also oft associated with:
- Automatisms (licking lips, rhythmic hand movements, touching clothes)
- Head turning
- Eye movement
- MUSCLE CRAMPING
- Numbness
- HALLUCINATIONS
- Drooling
Some link to MS
The typical presentations of common MND types
Amyotrophic Lateral sclerosis (50% of pts)
- typically more UMN signs in legs and more LMN signs in upper body
Primary lateral sclerosis = UMN signs only
Progressive muscular atrophy (has best prognosis)
- LMN signs only
- But characteristically affects DISTALLY before proximally (usually opposite in myopathies)
Progressive bulbar palsey (worst prognosis)
- palsey of tongue, muscles of mastication + swallowing + facial muscles (from loss of function of BRAINSTEM NUCLEI)
- oft presents as part of ALS
ALS Px
Thoracic outlet syndrome
A combination of 3 related syndromes caused by compression of any of the 3 key structures in the thoracic outlet (area between neck + shoulder):
- Brachial plexus (most common)
- Subclavian artery (least common - aneurysm)
- Subclavian vein (blood clot risk)
Causes of thoracic outlet syndrome
- Trauma (e.g. car accident)
- Repetitive injuries from sport / job
- Pregnancy
- Differences in anatomy (e.g. extra rib)
- Poor posture
- Idiopathic
Thoracic outlet syndrome Px
Neurogenic:
- Pain
- Paresthesia
- Arm fatiguing with activity
- Weakening grip
Venous:
- Change in colour (starts with extremities)
- Hand/arm swelling + pain
Arterial:
- Pulsating lump near collar bone
- Cold arm (starting from extremities)
- Hand / arm PAIN
- Colour change
RFx + Prevention of thoracic outlet syndrome
RFx = Female sex + age 20-50 (most common)
- Avoid repetitive movements
- Losing weight if overweight
- Avoid carrying heavy weight (e.g. bags) over shoulder
- Daily stretches / exercise
What is the most common cause of intracerebral haemorrhage
Hypertension
What is the most common site of microaneurysms in the brain and what are the aneurysms called
- Leticulostriatal arteries (small penetrating blood vessels)
- Chracot bouchard aneurysms
Features of unsafe swallow + Mx
Any of the following upon drinking water in upright position:
- Drooling
- Dysphonia / ‘wet’ voice
- > 2 seconds to initiate swallow
- Coughing during / within 1 min of swallowing
Need to make NIL by mouth + need urgent SALT review
