Week 5 Flashcards
Are febrile fits epilepsy risk factors?
Yes
What can opiods, anti-emetics, antibiotics, analgesics (tramadol), amphetamines and aminophylline/theophylline all cause?
Epilepsy
What investigation is mandatory when approaching the fallen?
ECG
What investigation classifies epilespy, confirms non-epileptic attacks, surgical evaluation and confirms non-convulsive status?
EEG - electroencephalogram - recording brain activity
if you have had one seizure how long can you not drive a caqr for?
6 months
What is the definition of epileptic seizures?
Abnormal synchronisation of neuronal activity
In epiletpic seizures - why does abnornal synchronisation of neuronal activity happen?
Too much excitation
Too little inhibition
Changes
What is a partial simple epileptic seizure?
Without impaired consciousness
What is a partial complex epileptic seizure?
With impaired consciousness
What sensory semiology can partial seizures have?
Olfactory, gustatory, visual and auditory
Can generalised seizures start from a focal point?
Yes
What type of epilepsy: most have genetic predisposition, present in childhood and adolescence, generelaised spike wave abnormalities on EEG, tonic clonic, absence, myoclonic, clonic, tonic and atonic?
Generalised epilepsy
Wake up in morning and are stumbling and clumsy, dropping things?
Generalisd seizures
When does primary generalised epilepsy present?
Childhood or teens
What is treatment of choice for primary generalised epilepsy?
Sodium valproate - lamotrigine as alternative
Give a side effect of sodium valproate?
Teratogenic
What is juvenile myoclonic epilepsy an example of?
primary generalised epilepsy
Early morning jerks, generalised seizures, risk factosr are sleep deprivation, flashing lights?
Juvenile myoclonic epilepsy
When is the onset of focal onset epilepsy?
Any age - underlying structural cause
What is treatment for focal onset epilepsy?
Carbamazepine or lamotrigine
What can focal onset epilepsy frequently cause?
Complex partial seizures with hippocampal sclerosis
What do AEDs target?
Presynaptic excitability and neurotransmitter release
What do these drugs inhibit - carbamazepine, lamotrigine, oxcarbazepine, phenytoin?
Voltage gated sodium channels - influx increases excitability
K+ efflux reduces neuronal excitability, what increases channel activity?
Retigabine
What two drugs inhibit Ca2+ channel influx?
Pregablin and gabapentin
What AED binds to SV2A, interfering with synaptic vesicles and inhibiting neurotransmitter release?
Levetiracetam
What AED enhances GABA synthesis?
Sodium valproate
What AEDs target the GABAA receptor, reduce neuronal excitability and increases GABAA receptor activity?
Benzodiazepines, barbiturates, felbamate, topiramate
What drug targets GABA transaminase to stop degradation of GABA?
Vigabatrin (elevates GABA levels)
What does tiagabine target?
GABA transporter, removes GABA from synapse
What two AED should not be prescribed together?
Sodium valproate and lamotrigine
Give the initial treatment for partial seizures?
Carbamazepine
Lamotrigine
What treatment is for generalised seizures (absence)?
- Sodium valproate
2. Ethosuximide
What treatment is for generalised seizures (myoclonic)?
- Sodium valproate
- Levetiracetam
- Clonazepam
What treatment is for generalsied seizures (atonic, tonic, generalised tonic clonic)?
Soidum valproate
What AED causes gum hyperrophy?
Phenytoin
What drug should never bebn given in generalised epilepsy?
Carbamazepine
Give four side effects of sodium valproate?
- Weight gain
- Teratogenic
- Har loss
- Fatigue
What AED is for acute management only, rapid loading possible, enzyme enducer?
Phenytoin
What does levetiracetam cause?
Mood swings
What AED causes sedation, dysphasia and weight loss?
Topiramate
What do carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate all induce?
Hepatic enzymes
COT3P
What do carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate all alter the efficacy of?
Combined oral contraceptive pill
COT3P
What is not adequate if taking enzyme inducing AEDs (COT3P) and dose should be increased?
Morning after pill
What is the term for recurrent epileptic seizures without full recovery of consciousness?
Status epilepticus - continuous seizure activity lasting more than 30 minutes
Epilepsia partialis continua is a type of status epilepticus - what is it?
Continual focal seizures, consciousness preserved
Sudden onset severe headache, collapse, vomiting, neck pain, photophobia?
SAH
What focal neurological deficits are present in SAH?
- dysphasia
- hemiparesis
- 3rd nerve palsy
What investigation is safe in alert patients with no neurological focal deficit and no papilloedema?
Lumbar puncture
SAH lumbar puncture- what does it show?
Blood stained or xanthochromic CSF
What is the gold standard for SAH?
Cerebral angiographt
Give five complications of SAH?
- Re-bleeding
- Delayed ischaemic deficit
- Hydrocephalus
- Hyponatraemia
- Seizures
Delayed ischaemic neurological deficit is a complication of SAH. How is it treated?
Nimodipine - CCB
High fluid intake tripe H therapy
How do you treat hydrocephalus?
CSF drainage- LP, EVD, shunt
How do you treat hyponatraemia caused by SAH?
Fludrocortisone
What is bleeding into brain parenchyma?
Intracerebral haemorrhage
What are 50% of intracerebral haemorrahges due to and what are 30% due to?
50% - hypertension
30% - aneurysm or AV malformation
What shows Charcot Bouchard microaneurysms arising on small perforating arteries and basal ganglia haematoma?
Hypertensive Intracerebral Haemorrhage
What are two investigations ofr ICH?
CT
Angiography
What occurs with rupture of a subarachnoid or intracerebral bleed into a ventricle?
Intraventricular haemorrhage
What can cause intraventricular haemorrhage?
AV malformations - steal syndrome, headache
What gies from motor cortex to anterior grey horn and decussates at medullary level?
Upper motor neurone
What is the anterrior horn cell of corticospinal tract?
Lower motor neurone
Is the corticospinal tract ipsilateral or contralateral?
Ipsilateral
Give four features of Upper Motor Neurone Lesion?
- Increased tone
- Muscle wasting NOT marked
- No fasciculation
- Hyper - reflexia
Give four features of Lower Motor Neurone Lesion?
- Decreased tone
- Muscle wasting
- Fasciculation
- Diminished reflexes
Ipsilateral motor level
Ipsilateral dorsal column sensory level
Contralateral spinothalamic sensory level
Brown sequard syndrome
cord hemisection
What causes central cord syndrome?
Hyperflexion or extension injury to already stenotic neck
What gets weakness in central cord sybndrome?
Distal upper limb weakness - wrists and elbows
Cape like spinothalamic sensory loss?
Central cord syndrome
What colums are preserved in central cord syndrome?
dORSAL
how do you treat spinal cord metastatic tumours?
Dexamethasone
Radiotherapy
Surgery
What part of brain is affected in ataxia?
Cerebellum
In upper motor neuron pattern there is pyramidal/corticospinal patter nof weakness - whjat does it involve?
Weak extensors of arm
Weak flexors of leg
What lobe enables self critisism and trying again?
Frontal lobe
What lobe is affected in brocos dysphasia?
Dominant frontal lobe
Memory dysfunction nad difficulty recognising things?
Temporal lobe lesion
What lobe is affected iun Wernickes disorder?
Temporal
What lobe in congruous upper homonymous quadrantanopia?
Temporal lobe
Visual field defect (congruous lower homonymous quadrantanopia)
parietal lobe
Gerstmann’s syndrome (disease of the dominant angular gyrus, part of the inferior parietal lobe): Dysgraphia, left-right disorientation, finger agnosia, acalculia
Parietal lobe
What lobe in inattention and denial?
Parietal
What condition are COMT inhibitors such as entacapone and tocapone used for?
Parkinsons
The mainstay treatment of PD is levodopa which can lead to what?
Dyskinesias
Visual compromise, stiffness and weakness ?
MS
nAME A Pure upper motor neurone syndrome of MND?
Primary lateral sclerosis
What stroke related syndrome - no visual field defect, pure motor hemiparesis, or pure sensory deficit on one side of body, clumsy hand syndrome?
Lacunar syndromes
Cranial nerve palsy Unilateral or bilateral motor or sensory deficit Disorder of conjugate eye movements Cerebellar dysfunction Homonymous hemianopia Cortical blindness
posterior circulation syndrome
where is stroke lesion?
Hemiplegia and homonymous hemianopia contralateral to the lesion, and
Either aphasia or visuospatial disturbances
+/- sensory deficit contralateral to the lesion
Total anterior circulation syndromes
where is stroke lesion?
One or more of unilateral motor or sensory deficit, aphasia or visuospatial neglect (with or without homonymous hemianopia)
Motor or sensory deficit may be less extensive than in lacunar syndromes
Partial anterior circulation syndromes
What term is given to glove and stocking type peripheral neuropathy with weakness and or loss of sesnation?
Length dependant peripheral neuropathy
Name an acute condition of demyelinating neuropathy?
Guillaine barre syndrome
Name a chronic demyelinating neuropathy?
CIDP
Hereditary sensory motor neuropathy = charcot marie tooth disease
Progressive paraplegia over days, pain common, post infection campylobacter?
Guillain Barre Syndrome
Pure motor, sensory, sensorimotor, small fibre (congenital insensitivity to pain syndrome) and autonomic variants.
Demyelinating and axonal varieties.
Genetic testing available for the most common mutations (eg CMT1a)
Hereditary neuropathy
Treatment of peripheral neuropathy - axonal vasculitic?
Pulsed IV methylprednisolone and cyclophosphamide
Treatment of peripheral neuropathy demyelinating?
IVIg pooled immunoglobulin
Steroids
Azathioprine, mycophenalate and cyclophosphamide
What nerve fibres are damaged in muscle control, touch vibration, position, perception?
Large
What nerve fibres are damaged in cold, perception and pain?
Small
