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Year 3 > Week 22 - Brain metastasis, epilepsy, meningitis, migraine > Flashcards

Week 22 - Brain metastasis, epilepsy, meningitis, migraine Flashcards

1
Q

what are the four main types of migraines

A

migraine without aura
migraine with aura
silent migraine
hemiplegic migraine

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2
Q

what are the five stages of a migraine

A

premonitory or prodromal
aura (lasts for up to 60mins)
headache (lasts 4-72hrs)
resolution
postdromal or recovery phase

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3
Q

what may the prodromal phase involve

A

subtle symptoms such as yawning, fatigue or mood change

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4
Q

what are the typical features of a migraine headache

A

usually unilateral
moderate-severe intensity
pounding or throbbing
photophobia
phonophobia
osmophobia
aura (visial changes)
nausea or vomiting

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5
Q

what can migraine aura affect

A

vision, sensation or language

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6
Q

what are the visual symptoms associated with aura

A

sparks in the vision
blurred vision
lines across the vision
loss of visual fields (scotoma)

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7
Q

what do sensation aura changes include

A

tingling or numbnessw

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8
Q

what language aura symptoms may be found in migraine

A

dysphasia - difficulty speaking

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9
Q

what is the main features of hemiplegic migraines

A

hemiplegia - unilateral limb weakness

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10
Q

what other symptoms may be seen in hemiplegic migraines

A

ataxia - loss of coordination
impaired consciousness

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11
Q

what is familial hemiplegic migraine

A

an autosomal genetic condition characterised by hemiplegic migraines that run in families. however, they may occur without any genetic link or family history

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12
Q

what can hemiplegic migraines mimic

A

can mimic a stroke or a TIA - it is essential to exclude a stroke with sudden-onset hemiplegia

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13
Q

what are the common triggers for the onset of migraines

A

Stress
Bright lights
Strong smells
Certain foods (e.g., chocolate, cheese and caffeine)
Dehydration
Menstruation
Disrupted sleep
Trauma

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14
Q

what is the acute medical management of migraines

A

NSAIDs (naproxen or ibuprofen)
paracetamol
triptans - sumatriptan
antiemetics if vomiting occurs

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15
Q

what is NOT used in the treatment of migraines and why

A

opiates are NOT used to treat migraines and may make the condition worse

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16
Q

when are triptans used

A

used to abort migraines when they start to develop.

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17
Q

what is the mechanism of action of triptans

A

They are 5-HT receptor agonists (they bind to and stimulate serotonin receptors), specifically 5-HT1B and 5-HT1D. They have various mechanisms of action, including:
- Cranial vasoconstriction
- Inhibiting the transmission
of pain signals
- Inhibiting the release of inflammatory neuropeptides

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18
Q

what are the main contraindications related to triptans

A

vasoconstriction for example, hypertension, coronary artery disease, or previous stroke, TIA, or MI

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19
Q

what are the usual prophylactic medications used to reduce the frequency and severity of migraine attacks

A

Propranolol (a non-selective beta blocker)
Amitriptyline (a tricyclic antidepressant)
Topiramate (teratogenic and very effective contraception is needed)

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20
Q

give two names of prophylactic triptans

A

frovatriptan or zolmitriptan

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21
Q

when are prophylactic triptans used

A

for menstrual migraines

symptoms tend to occur two days before until three days after the start of menstruation

regular triprans may be used at this time

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22
Q

what are the risks associated with migraines

A

migraines are assoiated with a slightly increased risk of stroke, particularly when associated with aura.

the risk of stroke is further increased with the combined pill, making them a contraindication to the combined pill

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23
Q

what is epilepsy characterised by

A

seizures

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24
Q

what are seizures

A

transient episodes of abnormal electrical activity in the brain

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25
what are the common 5 types of seizures seen in adults
Generalised tonic-clonic seizures Partial seizures (or focal seizures) Myoclonic seizures Tonic seizures Atonic seizures
26
what are the types of seizures more commonly seen in children
absence seizures infantile spasms febrile convulsions
27
what do generalised tonic-clonic seizures involve
tonic (muscle tensing) and clonic (muscle jerking) movements associated with a complete loss of consciousness
28
what are generalised tonic-clonic seizures also called
grand mal seizures
29
what may patients experience before a generalised tonic-clonic seizure
aura, an abnormal sensation that gives a warning that a seizure will occur. there may be tongue biting, incontinence, groaning or irregular breathing
30
what happens after the seizure
there is a prolonged post-ictal period, where the person is confused, tired and irritable or low
31
where do partial seizures/focal seizures occur
in an isolated brain area, often in the temporal lobes
32
what do partial seizures affect
hearing, speech, memory and emotions
33
what is the common state of the patient during a partial seizure
patients remain awake during partial seizures they remain aware during simple partial seizures but lose awareness during complex partial seixures
34
what are the various symptoms associated with partial seizures, depending on the location of the abnormal electrical activity
Déjà vu Strange smells, tastes, sight or sound sensations Unusual emotions Abnormal behaviours
35
how do myoclonic seizures present
with sudden, brief muscle contractions like an abrupt jump or jolt. they remain awake.
36
what do tonic seizures involve
a sudden onset of increased muscle tone, where the entire body stiffens.
37
what do tonic seizures usually result in and how long do they last
usually result in a fall if the patient is standing, usually backwards they last only a few seconds, or at most a few minutes
38
what do atonic seizures involve
sudden loss of muscle tone, often resulting in a fallh
39
how long do atonic seizures last and are patients awake during them?
They last only briefly, and patients are usually aware during the episodes. They often begin in childhood.
40
what kind of syndrome may atonic seizures be indicative of
Lennox-Gastaut Syndrome
41
what are absence seizures and in who are they usually found
usually seen in children. the patient becomes blank, stares into space and then abruptly returns to normal
42
what are infantile spasms also known as
West syndrome
43
when do infantile spasms start
rare, start at around six months of age
44
how does West syndrome present
with clusters of full-body spasms.
45
what is the characteristic ECG finding in West syndrome
Hypsarrhythmia
46
what is the treatment of West syndrome and what is the prognosis like
it is associated with developmental regression and has a very poor prognosis treatment is with ACTH and vigabatrin
47
what are febrile convulsions
tonic-clonic seizures that occur in children due to a high fever
48
are febrile convulsions caused by epilepsy
no. may occur in children between 6 months and 5 years
49
what are the differential diagnoses for epilepsy
Vasovagal syncope (fainting) Pseudoseizures (non-epileptic attacks) Cardiac syncope (e.g., arrhythmias or structural heart disease) Hypoglycaemia Hemiplegic migraine Transient ischaemic attack
50
what will happen with the DVLA regarding epilepsy
the DVLA will remove their driving license until a specific criteria is met - e.g being seizure free for one year
51
what are the safety precautions taken with epilepsy
Taking showers rather than baths (drowning is a major risk in epilepsy) Particular caution with swimming, heights, traffic and dangerous equipment
52
what does epilepsy treatment aim for
aim to be seizure free on the minimum anti-epilelptic medications
53
what is given to men and women who cannot have children with generalised tonic-clonic seizures
sodium valrpoate
54
what is given for generalised tonic-clonic seizures in women able to have children
lamotrigine or levetiracetam
55
what is given for partial/focal seizures in all men and women
lamotrigine or levetracetam
56
what is given for myoclonic and tonic/aclonic seizures in men and women who cannot have children
sodium valporate
57
what is given for myoclonic seizures in women who can have children
Levetiracetam
58
what is given for tonic and aclonic seizures in women who are able to have children
lamotrigine
59
what is given in all men and women with absence seizures
ethosuximide
60
how does sodium valporate work
increasing the activity of the GABA which has a calming effect on the brain
61
what are the notable side effects of sodium valporate
teratogenic liver damage and hepatitis hair loss tremor reduce fertitilty
62
what may sodium valporate cause in pregnancy
cause neural tube defects and developmental delay
63
what is in place to ensure effective contraception and an annual risk acknowledgement form
the Valproate pregnancy prevention programme
64
what is status epilepticus
a medical emergency defined as either: - a seizure lasting more than 5 mins - multiple seizures without regaining consciousness in the interim
65
what does management of status epilepticus involve
an ABCDE approach, including; Securing the airway Giving high-concentration oxygen Checking blood glucose levels Gaining intravenous access (inserting a cannula)
66
what is first line treatment for status epilepticus
a benzodiazepine first line, repeated after 5-10 mins if the seizure continues
67
what are second and third line treatments for status epilepticus
Second-line options (after two doses of benzodiazepine) are IV levetiracetam, phenytoin or sodium valproate Third-line options are phenobarbital or general anaesthesia
68
what are the options for benzodiazepines
Buccal midazolam (10mg) Rectal diazepam (10mg) Intravenous lorazepam (4mg)
69
what is meningitis
inflammation of the meninges due to infection.
70
what are the meninges
are the lining of the brain and spinal cord. CSF is contained within the meninges
71
what are the causes of bacterial meningitis
Neisseria meningitidis Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae Group B streptococcus (GBS) (particularly in neonates as GBS may colonise the vagina) Listeria monocytogenes (particularly in neonates)
72
what is neisseria meningitidis
a gram-negative diplococcus bacteria. they are circular bacteria that occur in pairs commonly known as meningococcus
73
what is meningococcal meningitis
when the bacteria infects the meninges and the CSF.
74
what does meningococcal septicaemia mean
when the meningicoccal bacterial infection is in the blood stream this is what causes the non-blanching rash
75
what are the most common causes of viral meningitis
Enteroviruses (e.g., coxsackievirus) Herpes simplex virus (HSV) Varicella zoster virus (VZV)
76
what is used to treat herpes and varicella
aciclovir
77
what are the typical symptoms of meningitis
Fever Neck stiffness Vomiting Headache Photophobia Altered consciousness Seizures
78
what are the non-specific symptoms that neonates and babies can present with in the case of meningitis
hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle
79
what do the NICE guidelines on sepsis recommend as part of the investigation in children
The NICE guidelines on sepsis recommend lumbar puncture as part of the investigations for children with suspected sepsis who are: - Under 1 month, presenting with fever - 1 to 3 months and are unwell or have a low or high white blood cell count
80
what are the two special tests you can perform to look for meningeal irritation
Kernig's test Brudzinski's test
81
what is involved in Kernig's test
involves lying the patient on their back, flexing one hip and knee at 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees this causes a slight stretch in the meninges. Where there is meningitis, it will produce spinal pain or resistance to movement
82
what does Brudzinski's test involve
lying the patient flat on their back and gently using your hands to lift their head and neck off the bed, flexing their chin to their chest a positive test, indicating meningitis is when this causes the patient to flex their hips and knees involuntarily
83
where is the needle usually inserted for lumbar puncture
L3-L4 or L4/L5 intervertebral space
84
what is the appearance of bacterial and viral CSF
bacterial - cloudy viral - clear
85
what is the protein and glucose in bacterial and viral CSF
bacterial - protein is high and glucose is low viral - protein is mildly raised or normal and the glucose is normal
86
what is the white cell count in bacterial and viral CSF
bacterial - high WCC (neutrophils) viral - high WCC (lymphocytes)
87
what is the culture seen in bacterial and viral CSF
bacterial - bacteria viral - negative
88
TOM TIP: Lumbar puncture interpretation is a common exam question. Think about what will happen with bacteria or viruses living in the CSF rather than rote learning the results. Bacteria swimming in the CSF will release proteins and use up glucose. Viruses may release a small amount of protein and do not use up glucose. The immune system releases more neutrophils with bacteria and lymphocytes with viruses.
89
which type of meningitis is the most serious
bacterial meningitis is the most serious and is a medical emergency
90
what are children seen in primary care given if they have suspected meningitis AND a non-blanching rash
urgent dose of benzylpenicillin (IM or IV) while awaiting transfer to hospital
91
what are the blood tests for bacterial meningitis
Blood tests should include a meningococcal PCR if meningococcus is suspected. This tests for meningococcal DNA. It can give a result faster than blood cultures (depending on local services) and will still be positive after the bacteria has been treated with antibiotics.
92
what is added to treatment of meningitis if viral meningitis is suspected
aciclovir - herpes simple virus
93
when should vancomycin be added to meningitis treatment
if there is a risk of penicillin-resistant pneumococcal infection (e.g., recent foreign travel or prolonged antibiotic exposure).
94
why are steroids used in bacterial meningitis treatment
to reduce the frequency and severity of hearing loss and neurological complications
95
which types of meningitis are notifiable disease to the UK health security agency
Bacterial meningitis and meningococcal infection
96
what is the usual choice for post exposure prophylaxis in the case of meningococcal infection
single dose of ciprofloxacin
97
what are the complications of meningitis
Seizures and epilepsy Cognitive impairment and learning disability Memory loss hearing loss - A KEY COMPLICATION Focal neurological deficits, such as limb weakness or spasticity
98

Year 3 (63 decks)

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