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Phase 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

Causes of TIA

A

Cardioembolism from valve disease, prosthetic valve, post-MI, AF etc
Hyperviscosity e.g. polycythaemia, sickle cell anaemia, VERY HIGH WBC, myeloma
Artherothromboembolism

ALSO, hypoperfusion (important to think abt in young people)
e.g. cardiac dysrhythmia, postural hypotension

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2
Q

Define a TIA

A

Acute loss of cerebral/ocular function lasting < 24 hours
Complete clinical recovery

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3
Q

RF TIA

A

Same as IHD
M > F
Black ethnicity have ↑ risk (bc ↑ risk of HTN, atherosclerosis etc)
Age
HTN, Smoking, Heart disease
Peripheral arterial disease

ALSO, combined oral contraceptive pill (bc ↑ risk of clots)

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4
Q

Key presentation of TIA

A

Sudden loss of function with complete recovery
FAST

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5
Q

What part of the circulation is more commonly affected?

A

Anterior circulation (90%) - carotid artery

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6
Q

Describe some signs/symptoms if the anterior circulation (carotid artery) is occluded in TIA

A

Weak, numb contralateral leg and/or similar but milder arm symptoms
Hemiparesis
Hemi-sensory disturbance
Amaurosis Fugax
Dysphasia

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7
Q

Describe some signs/symptoms if the posterior circulation (vertebrobasilar artery) is occluded in TIA

A

Diplopia, vertigo
Vomiting
Choking and dysarthria
Ataxia
Hemi-sensory loss
Tetraparesis

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8
Q

WHat do oligodendrocytes do?

A

Myelinate axons in brain (CNS)

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9
Q

What do Schwann cells do?

A

Myelinate axons in the rest of the body (PNS)

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10
Q

What does white matter contain?

A

Myelinated axons

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11
Q

What does grey matter contain?

A

Cell bodies, no myelin sheaths

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12
Q

What are afferents?

A

Axons which take info towards CNS

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13
Q

What are efferents?

A

Axons which take info from CNS to rest of body

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14
Q

Function of frontal lobe

A

Voluntary movement on opposite side of body
Frontal lobe of dom hemisphere controls speech (Broca’s!) and writing
Also, intellectual function, thinking, reasoning and memory

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15
Q

Function of parietal lobe

A

Receives/interprets sensations
e.g. pain, touch, pressure, body-part awareness (proprioception)

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16
Q

Temporal lobe function

A

Understanding the spoken word (Wernicke’s), and sounds, memory and emotions

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17
Q

Occipital lobe function

A

Understanding visual images and meaning of written words

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18
Q

What is CSF produced by?

A

Mostly by ependymal cells in the choroid plexuses of lateral ventricles

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19
Q

DDx

A

Hypoglycaemia!!
Intracranial lesion
Migrainous aura

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20
Q

1st line Ix TIA

A

ROSIER scale - in emergency department

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21
Q

Describe the ROSIER scale

A

ABCD2 score - risk score of strokes (max = 7)]

A - Age ≥ 60 (1)
B - Blood pressure (at presentation), 140/90 or more (1)
C - Clinical features
Unilateral weakness (2)
Speech disturbance without weakness (1)
D - Duration, 60 mins or longer (2), 10 - 59 mins (1) D - Presence of diabetes (1)
—-
High risk :
- ABCD2 score of 4 or more
- AF
- More than TIA in one week
- TIA whilst on anti-coagulation

Low risk :
- None of the above
- Present more than a week after their last symptoms have resolved

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22
Q

Describe the signs/symptoms if the Anterior cerebral artery (ACA) is occluded in stroke

A

DCLIT

Drowsiness
Contralateral leg weakness and sensory loss (more leg than arm bc ACA)
Logical thinking and personality affected
Incontinence
Truncal/gait ataxia

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23
Q

Describe the signs/symptoms if the middle cerebral artery (MCA) is occluded in stroke

A

Contralateral motor weakness/sensory loss (BOTH arms and legs)
Hemiplegia
Aphasia - Wernicke’s and Broca’s
Facial droop

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24
Q

Describe the signs/symptoms if the posterior cerebral artery (PCA) is occluded in stroke

A

Contralateral homonymous hemianopia
Disorders of perception

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25
Q

Describe the signs/symptoms if the posterior circulation (vertobrobasilar artery) is occluded in stroke

A

(More catastrophic bc wider region supplied)
Balance and coordination impaired

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26
Q

Describe the signs/symptoms if there is a brainstem infarction

A

Sudden vomiting, vertigo, ipsilateral Horner’s syndrome

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27
Q

Ix Ischaemic Stroke

A

URGENT non-enhanced CT head!!! (BEFORE Tx)
to differentiate between ischaemic and haemorrhagic
–
Diffusion weighted MRI - more sensitive, confirms diagnosis

Bloods - to check BG and for polycythaemia etc
Pulse, BP and ECG - check for AF
ESR - vasculitis
U&Es - cholesterol
INR - if on warfarin

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28
Q

Tx Ischaemic stroke

A

Immediate loading dose of aspirin and refer to specialist !!

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29
Q

Tx Ischaemic stroke

A

Immediate loading dose (300mg) of aspirin and refer to specialist !!
Continue aspirin for 2 weeks

THROMBOLYSIS WITH IV ALTEPLASE
WITHIN 4.5 hours of symptom onset

Thrombectomy
Within 6 hours of symptom onset

Also : maximise reversible ischaemic tissue
w/ hydration, keep O2 sats > 95%

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30
Q

Contraindications of thrombolysis w/ IV alteplase

A

Hx of stroke in diabetes patients
Severe stroke
Stroke in last 3 months
Active malignancy

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31
Q

When is thrombectomy indicated?

A

In severe stroke if large artery affected

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32
Q

Long term management for Ischaemic stroke

A

SALT support
Rehab
After 2 weeks of aspirin, switch to 75mg Clopidogrel

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33
Q

What is a lacunar infarct?

A

Small perforating artery occlusion
Supplies subcortical area
(i.e. internal capsule, basal ganglia, thalamus, pons)

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34
Q

Why do you have to be careful about treating BP with an ischaemic stroke?

A

bc even 20% fall will compromise cerebral perfusion

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35
Q

Hx of SAH

A

Hx of trauma
Skull fracture
Lucid interval, follows by unconciousness

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36
Q

What is Cushing’s triad?

A

Bradycardia
Wide pulse pressure
Irregular respirations

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37
Q

What is an intracerebral haemorrhage?

A

Sudden bleeding into brain tissue due to rupture of blood vessels
∴ infarction bc O2 deprivation

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38
Q

Cause of intracerebral haemorrhage

A

Uncontrolled HTN is almost always cause
2° to ischaemic stroke - bleeding after reperfusion
Head trauma
AV malformation
Vasculitis
Brain tumour
Cerebral amyloid angiopathy - amyloid beta deposits in small/medium vessles
Carotid artery dissection

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39
Q

RF Intracerebral haemorrhage

A

HTN
Age
Smoking
Alcohol
DM
Anticoagulation/Thrombolysis

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40
Q

How does HTN cause intracerebral haemorrhage?

A

Causes stiff, brittle vessels
Prone to rupture, microaneurysms

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41
Q

Key presentation of intracerebral haemorrhage

A

Same as ischaemic stroke
BUT more likely to lose consciousness or sudden headache

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42
Q

Tx intracerebral haemorrhage

A

STOP anticoagulants immediately!
Reverse with clotting factor replacement if needed (Beriplex and vit K if on warfarin)

Control BP -
rapid BP lowering if < 6 hours before onset + systolic BP is between 150-220 mmHg
AIM : below 140 mmHg

Reduce ICP
IV mannitol
Mechanical ventilation if needed

Neurosurgical - Decompression/shunting may be req

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43
Q

When might be lowering BP be contraindicated when treating intracerebral haemorrhage?

A

Underlying structural cause
GCS below 6
Early neurosurgery
Poor prognosis

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44
Q

Prognosis of SAH

A

High mortality! ~ 50% die straight away
High chance of rebleeding
Most survivors left with severe disability

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45
Q

What are some signs of ↑ ICP?

A

N+V
Seizures
↑ BP

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46
Q

If a Px has meningococcal disease, what must you do?

A

Notify Public Health England !!!!!!!!!!

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47
Q

What is supratentorial herniation?

A

When the cerebrum is pushed against the skull or tentorium

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48
Q

What is infratentorial herniation?

A

When the cerebellum is pushed against the brainstem

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49
Q

If someone has a skull fracture, what must you do? Why?

A

Urgent CT
To check if there’s an extradural haemorrhage

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50
Q

What is an extradural haemorrhage also known as?

A

Epidural haemorrhage

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51
Q

Cause of extradural haemorrhage

A

Traumatic head injury - usually to temple, usually at pterion
Ruptures middle meningeal artery

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52
Q

With a subdural haemorrhage, focal neurology signs/symptoms occurs when?

A

Mean = ~ 63 days after injury
Can be days, weeks or months

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53
Q

What is meningitis?

A

Inflammation of the 2 inner layers of meninges - the leptomeninges (pia mater + arachnoid mater)

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54
Q

What age does meningitis most commonly occur?

A

Can occur at any age but mostly in infants, young children and elderly

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55
Q

Causes of meningitis

A

Adults and children :
Neisseria meningitidis
Streptococcus Pneumoniae
(H. Inuenzae - less common now bc vaccine)

Pregnant women/elderly :
Listeria monocytogenes

Neonates :
Escheria coli
Group B haemolytic streptococcus (agalactiae and pyogenes)

Immunocompromised :
CMV
Cryptococcus neoformans (fungi)
TB - mycobacterium tuberculosis
HIV
Herpes simplex virus

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56
Q

Why are pregnant women told to avoid cheese?

A

Listeria monocytogenes is found in cheese
Risk to pregnant women

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57
Q

If Neisseria meningitidis is in the blood with meningitis, what happens?

A

Meningococcal septicaemia - endotoxin in blood leads to inflammatory cascade
Non-blanching purpuric rash/petechial rash, necrosis, signs of meningitis
High mortality

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58
Q

Key presentation meningitis

A

Fever
Headache
Neck stiffness
!!!!!!!

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59
Q

How to test whether a rash if blanching or non-blanching

A

Glass test

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60
Q

Describe viral meningitis

A

Benign, self-limiting lasting ~ 4-10days usually

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61
Q

Describe the pathophysiology behind papilloedema

A

Swelling of the optic disc on fundoscopy
Usually bilateral

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62
Q

Ix meningitis

A

Immediately assess GCS and take blood cultures - dont wait for results to start treating!!
If in community, give IM benzylpenicillin

Lumbar puncture

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63
Q

Tx meningitis

A

1. Broad spectrum Abx -
cefotaxime OR ceftriaxone
If immunonocompromised, ↑ Listeria risk
∴ add high dose of amoxicillin

Other stuff
If severe penicillin allergy, then = chloramphenicol
If recent travel, then = IV vancomycin
If viral (enterovirus) = nothing
If viral (HSV or vZv) = acylovir

Prophylaxis! If in contact w meningitis Px for 7+ days (i.e. living together) = one-off dose of ciprofloxacin or rifampicin asap
rifampicin - CI if pregnant

Corticosteroids
Oral dexamethasone to ↓ cerebral oedema and complications (e.g. hearing loss)
4x daily for 4 days to children over 3 months

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64
Q

Describe the findings of CSF in a meningitis patient

A

Bacteria - turbid colour!
Cells - polymorphs (neutrophils)
Protein = ↑
Glucose = ↓

Virus - clear
Cells - lymphocytes
Protein = ↑ but not as high
Glucose = normal

TB - fibrin web
Cells - lymphocytes
Protein = ↑
Glucose = ↓ or normal

Cryptococcal - fibrin web
High opening pressure!

65
Q

RF bacterial meningitis

A

Students
Travel
Immunosuppressed

66
Q

RF viral meningitis

A

Small children
Immunosuppressed

67
Q

RF TB meningitis

A

TB contact
Immunosuppressed

68
Q

RF Cryptococcal meningitis

A

HIV
Immunosuppressed

69
Q

Should you give penicillin to a meningitis patient with a penicillin allergy?

A

Yes unless it’s anaphylaxis or severe!
If it’s just a rash or something, not that deep
Meningitis is the bigger threat

70
Q

Complications of meningitis

A

Hearing loss
Seizures/epilepsy
Cognitive disability
Memory loss
Focal neurological deficits

71
Q

How do neonates/children present with meningitis?

A

Hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle

72
Q

Why do children/neonates have a low threshold for lumbar punctures? Describe these thresholds

A

Because meningitis presents w non-specific symptoms

< 1 month old with fever
1 - 3 months with fever and are unwell
< 1 year w/ unexplained fever and other features of serious illness

73
Q

In patients who present with meningitis, what are some indications that you should perform a CT BEFORE a lumbar puncture?

A

> 60 years
Immunocompromised
History of CNS disease
New onset/recent seizures
Losing consciousness
Papilloedema

74
Q

Bacterial Meningitis - If severe anaphylaxis w penicillin, what can you give instead?

A

IV Chloramphenicol

75
Q

What is encephalitis?

A

Infection and inflammation of brain parenchyma

76
Q

Encephalitis viral causes

A

Viral is most common!
**HSV
VZV, EBV, CMV, HIV, measles, mumps, arbovirus (in West Nile)

77
Q

Encephalitis Non-viral causes

A

Bacteria - TB, mycoplasma, rickettsia, listeria, neisserria
Fungal - Cryptococcus, histoplasmosis
Parasitic - malaria, toxoplasmosis, schistosomiasis

78
Q

Non-Infectious causes of Encephalitis

A

Paraneoplastic
Post-infectious
Autoimmune

79
Q

Key presentation Encephalitis

A

Hours - days before = flu-like illness

then TRIAD of :
1. Altered GCS
2. Fever
3. Headache

80
Q

Other signs/symptoms of encephalitis

A

Seizures
Memory loss
Behavioural changes (common early on)

with/without Hx of meningitis (bc it can progress to encephalitis)

81
Q

Ix Encephalitis

A

MRI head - shows swelling/inflammation
with/without midline shifting

ECG - periodic sharp and slow waves

Lumbar puncture (after) - ↑ lymphocytes in CSF, viral PCR
May be normal for first 48 hours

82
Q

DDx encephalitis

A

Anything that causes behavioural changes -

DKA
Hypoglycaemia
Hepatic encephalopathy
Thiamine deficiency
Meningitis
Stroke
Drug overdose
Brain tumour

83
Q

What is thiamine deficiency also known as?

A

Beri-beri

84
Q

In encephalitis, what does HSV typically affect?

A

Temporal lobes of brain

85
Q

Tx Encephalitis

A

If suspected, start IV Acyclovir until results

If HSV or ZVZ - immediate IV Acyclovir
VZV - can use Ganciclovir

Immunocomp patients - use combination antiviral therapy

For seizures - anticonvulsants e.g. Primidone, Carbamazepine

86
Q

Complications of encephalitis

A

Permanent neurological deficits
e.g. epilepsy, movement disorder, personality change, cognitive impairment

87
Q

Prognosis of encephalitis

A

Mortality = 10-30% even w/ optimum treatment

88
Q

Define seizure

A

Spontaneous, intermittent, uncontrolled electrical brain activity

89
Q

Define Epilepsy

A

Recurrent tendency to have seizures, chronic disorder (minimum = 2)

90
Q

Define prodrome

A

Non-specific symptoms that precede an epileptic attack

91
Q

Describe aura

A

Sensory disturbance that precedes an attack, usually be minutes. More specific

92
Q

Cause Shingles

A

Reactivation of varicella zoster virus (chickenpox), usually within dorsal root ganglia

Patient has chicken pox, then virus is latent in dorsal root ganglia

93
Q

What age do shingles present?

A

Any age but usually elderly

94
Q

Route of transmission Shingles

A

CANNOT be caught from contact w person w chickenpox
Patients with rash are infectious until lesions dry

95
Q

RF Shingles

A

↑ Age
Immunocomp
HIV
Hodgkin’s lymphoma
BM transplant
Low Vit D

96
Q

Presentation Shingles

A

Pain and paraesthesia in area (side of face or body) then rash. Restricted to same dermatome

Also : malaise, myalgia, headache, fever

97
Q

Tx Shingles

A

Oral antivirals within 72 hours of rash onset
e.g. Oral aciclovir x5 daily
OR oral valicilovir x2 daily OR oral famciclovir x2 daily

+ Analgesia for pain

98
Q

Shingles complications

A

Damage to opthalmic branch of trigeminal nerve - affect sight!
Post herpetic neuralgia - pain for more than 4 months AFTER shingles

99
Q

How do you treat post herpetic neuralgia?

A

Tricyclic antidepressant e.g. oral amitriptyline
Anti-epileptic e.g. oral gabapentin
Anti-convulsant e.g. oral carbamazapine

100
Q

Define Multiple Sclerosis

A

Chronic autoimmune disease.
T-cell mediated inflammatory disease of CNS, multiple plaques of demyelination within brain and spinal cord

EPISODES MUST BE DISSEMINATED BY TIME AND SPACE

101
Q

How is MS classified?

A

Pattern 1 - macrophage mediated

Pattern 2 - antibody mediated. lots of inflammation

Pattern 3 - distal oligodendrogliopathy (virus induced)

Pattern 4 - 1º oligodendroglia degeneration (metabolic defect)

102
Q

RF MS

A

FEMALE ! (2:1 F:M)
20 - 40 years
More common the further from equator
More common in caucasian

HLA-DR2
Exposure to EBV early in childhood
Age of migration

103
Q

Types of MS progression

A

Relapsing/Remitting MS - most common
1º progressive
2º progressive
Progressive/relapsing (sucky)

Draw graph!!

104
Q

Describe relapsing-remitting MS progression

A

Clearly defined relapses w/ full or partial recovery and residual deficits!
Between bouts, no progression in disability

105
Q

Describe 1º progression of MS

A

Disease progresses continuously
Maybe plateaus and minor improvements but no relapses/remission

106
Q

Describe 2ºprogression of MS

A

Initially relapsing-remitting then progresses continuously

107
Q

Describe progressive-remitting progression of MS

A

Progressive disease w/ clear acute relapses. Periods between relapses are still progressive

108
Q

What type of hypersensitivity reaction is MS?

A

Type 4 (cell-mediated)

109
Q

What is Charcot’s triad?

A

Intention tremor
Nystagmus
Dysarthria (Scanning/staccato speech)

110
Q

What’s Lhermitte’s sign?

A

When bend neck down, electrical shock runs down back and to limbs

111
Q

Key presentation of MS

A

Charcot’s triad
Lhermitte’s sign

112
Q

What is MS exacerbated by?

A

HEAT! e.g. showers, hot weather, sauna
Uhthoff’s phenomenon

113
Q

Other signs/symptoms of MS

A

LOSS NB
Lhermitte’s sign
Optic neuritis
Spasticity
Sensory symptoms/signs

Nystagmus, double vision and vertigo
Bladder and sexual dysfunction

114
Q

What visual signs/symptoms does MS cause?

A

Optic neuritis - loss of colour discrmination
Internuclear ophthalmoplegia!
Relative afferent pupillary defect (RAPD)

115
Q

Ix MS

A

MRI WITH CONTRAST - active lesions white, in the periventricular regions

Lumbar puncture w/ CSF electrophoresis - oligoclonal IgG bands = CNS inflammation (sensitive, not specific), ↑ lymphocytes

Other : Aevoked potentials - tests how long impulses take to travel, longer w demyelination

116
Q

What cells are targeted in MS?

A

OLIGODENDROCYTES ! - CNS
Not Schwann cells

117
Q

What specific CNS sites are targeted in MS?

A

Perivenular, everywhere in CNS but especially :
Optic nerves
Around ventricles of brain
Corpus callosum
Brainstem and cerebellar connections
Cervical cord

118
Q

How does unilateral optic neuritis present?

A

Pain in one eye upon eye movement
Reduced central vision

119
Q

Tx Acute attacks of MS
e.g. relapsing-remitting

A

Corticosteroids - IV methylprednisolone (1g od for 3 days)

120
Q

Tx Chronic MS
i.e. frequent relapse

A

1st :
SC beta interferon and glatiramer acetate

2nd :
IV alemtuzumab or IV natalizumab

121
Q

S/E of Beta-Interferon

A

Flu-like symptoms
Mild intermittent lymphopenia
Mild-moderate rise in liver enzymes

122
Q

Pathophysiology of IV alemtuzab

A

CD52 monoclonal antibody, targets T cells

123
Q

Pathophysiology of IV natalizumab

A

Reduces immune cells that can cross BBB

124
Q

Tx for symptom management of MS

A

Tremors - beta blockers
Muscle spasticity - baclofen, gabapentin
General - removal of triggers, physio

125
Q

What do ALL anti-spasticity medications cause?

A

Weakness

126
Q

Pathophysiology of Baclofen

A

GABA analogue, reduces Ca2+ influx
∴ surpasses release of excitatory neurotransmitters

127
Q

Prognosis of MS

A

5-10 years below average
Often die from aspiration pneumonia due to dysphagia

128
Q

Define Guillain-Barre syndrome

A

Acute, inflammatory, demyelinating polyneuropathy
Progressive, ascending loss of sensation

129
Q

What age does Guillain-Barre syndrome present in?

A

2 peaks
15-35 years and 50-75 years

130
Q

Cause of Guillain-Barre syndrome

A

Usually preceded by resp/GI infection 1-3 weeks before

Bacterial : Campylobacter jejuni, Mycoplasma pneumoniae
Viral : CMV, EBV, ZVZ, HIV

131
Q

RF

A

Hx of resp/GI infections a couple weeks before
Vaccinations might be implicated !
Post-pregnancy has higher risk (during pregnancy tho has lower incidence)

132
Q

Types of Guillain-Barre syndrome

A

Demyelinating
Axonal
Axonal sensorimotor
Miller Fisher syndrome - very rare

133
Q

What does Miller Fisher syndrome affect?

A

Cranial nerves to eye muscles

134
Q

Key presentation of Guillain-Barre syndrome

A
  1. Symmetric, ascending limb weakness
  2. Reduced/absent tendon reflexes
  3. Reduced sensation
135
Q

What cells are affected in Guillain-Barre syndrome?

A

Schwann cells!
Condition of the PNS

136
Q

Other signs/symptoms of Guillain-Barre syndrome

A

Cranial nerves - diplopia, dysarthria
Resp - affects diaphragm (death)
Reflexes are lost early on !!!
Back/limb pain
Autonomic features - sweating, ↑ pulse, postural hypotension

137
Q

Ix Guillain-Barre syndrome

A

Electromyography (EMG)
Nerve conduction studies - slow conduction
LP (done at L4) - CSF = ↑ protein but normal WBC!

also : can check lung function w/ spirometry

138
Q

Tx Guillain-Barre syndrome

A

IV immunoglobulins
Plasmapheresis

139
Q

When using IVIG to treat Guillain-Barre syndrome, what does it do?

A

Decreases duration and severity of paralysis

140
Q

When is IVIG contraindicated?

A

If IgE deficient
bc can cause severe allergic reaction

141
Q

When using plasmapheresis to treat Guillain-Barre syndrome, what does it do?

A

Eliminates harmful antibodies

142
Q

How can you reduce venous thrombosis in Guillain-Barre syndrome?

A

LMWH e.g. SC enoxaparin
+ compression stockings

143
Q

Prognosis of Guillain-Barre syndrome

A

Disease progresses for 2 weeks then plateaus for 2-4 weeks
then recovery! takes several months to regrow myelin sheath

144
Q

What is the peak age of onset with Parkinson’s?

A

55 - 65 years
But can be diagnosed early (40)

145
Q

What happens in Parkinson’s disease?

A

Degeneration of dopamine-producing neurons in substantia nigra

146
Q

Key presentation of Parkinson’s disease

A

TRAP

Tremor (resting, pin-rolling)
Rigidity (cogwheel)
Akinesia
Postural instability

NO WEAKNESS

147
Q

Other signs/symptoms of Parkinson’s disease

A

Shuffling gait!
Mask-like face
Depression
Autonomic problems - constipation! ↑urinary freq

147
Q

Other signs/symptoms of Parkinson’s disease

A

Shuffling gait!
Mask-like face
Depression
Constipation

148
Q

What medication, used to treat a neurological disease, causes constipation?

A

Levadopa - Parkinson’s

149
Q

What can cause foot drop?
What is the difference in presentation with these two causes?

A

Common peroneal nerve palsy - causes eversion
L5 Radiculopathy - causes inversion

150
Q

Key presentation of Cauda Equina syndrome

A

Saddle anaesthesia
Loss of sensation in bladder and rectum - not knowing when full
Urinary retention / incontinence
Faecal incontinence
Bilateral sciatica
Bilateral or severe motor weakness in legs
Reduced anal tone

151
Q

Causes of Cauda Equina

A

*Herniated disc
Tumours - mets
Spondylolisthesis
Abscess infection
Trauma

152
Q

Ix Cauda Equina

A

Medical emergency!! - immediate neurosurgery for lumbar decompression surgery
Emergency MRI scan to confirm !

153
Q

Tx Cauda Equina

A

Surgical decompression ASAP
Immobilise spine
Anti-inflammatory agents
Chemo if mets
Abx if infection

154
Q

What is Bell’s palsy?

A

LMN weakness of CN 7 (facial nerve)
Results in peripheral facial palsy

155
Q

Presentation of Bell’s palsy

A

Rapid onset (< 72 hours) of unilateral facial weakness
Loss of taste
Post-auricular/ear pain
Difficulty chewing
Drooling
Tingling in cheek/mouth
Ocular dryness
Drooping of eyebrow

156
Q

Define epilepsy

A

Recurrent tendency of spontaneous, intermittent, abnormal electrical activity in brain that results in seizures

157
Q

Name of post-ictal symptoms

A

Headache
Confusion
Myalgia
Sore tongue

158
Q

What is Todd’s palsy?

A

Temporary weakness/paralysis after focal seizure, usually resolves after 2 days

Phase 2 (24 decks)

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