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BioMed S2 > 14. Nervous System II - Pathologies > Flashcards

14. Nervous System II - Pathologies Flashcards

(103 cards)

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1
Q

Raised Intracranial Pressure: definition

A

Increase in pressure within the cranial cavity

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2
Q

Raised Intracranial Pressure: pathophysiology

A

Compression of blood vessels leads to reduced oxygen perfusion to the brain

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3
Q

Raised Intracranial Pressure: aetiology

A
  • Tumours - gliomas (primary), metastases
  • Haemorrhage - subdural (venous, slow), subarachnoid (arterial, rapid)
  • Hydrocephalus - excess CSF
  • Meningitis - inflammation of meninges
  • Encephalitis - inflammation of brain tissue
  • Intracranial abscess
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4
Q

Raised Intracranial Pressure: signs and symptoms

A

Headache - worse on awakening*, when coughing or moving head
Vomiting - often without nausea
Visual disturbance - if damage to optic nerve
Pupil fixed/dilated in one eye
Impaired mental state
Altered speech
Seizures
Papilloedema - bulging of the optic disc
Elevated blood pressure, slow irregular pulse, slow breathing

*CSF at daily peak

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5
Q

Hydrocephalus: definition

A

Abnormal accumulation of CSF in the cerebral ventricles and subarachnoid space

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6
Q

Hydrocephalus: pathophysiology

A

Impaired absorption or excessive secretion
Results in ventricular dilation
CSF permeates through the ependymal lining into the surrounding white matter

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7
Q

Hydrocephalus: aetiology - young children

A

Infection or congenital malformation

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8
Q

Hydrocephalus: aetiology - older children/adults

A

Tumour
Trauma
Meningitis

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9
Q

Hydrocephalus: signs and symptoms

A

Headache - worse on awakening - CSF doesn’t drain well whilst lying down
Infants - increase in head circumference and dliated scalp veins
Vomiting, nausea
Blurred or double vision
Neck pain

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10
Q

Hydrocephalus: allopathic treatment

A

Diuretics - inhibit CSF secretion
Shunt, ventricular drain, lumbar puncture

Emergency - to prevent white matter scarring/brain damage/death

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11
Q

Meningitis: definition

A

Infection or inflammation of the meninges

Can be life-threatening if leads to intracranial pressure

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12
Q

Meningitis: aetiology

A

Viral meningitis (herpes simplex) - most common cause (90%). Less severe
Bacterial infection - more serious
Fungal/parasitic micro-organisms
Non-infective - brain tumour

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13
Q

Meningitis: signs and symptoms

A

Can initially resemble flu:

Fever
Sudden onset of severe headache
Neck stiffness
Photophobia
Vomiting

Petechiae - small purple/red spots on skin as result of tiny haemorrhages that don’t disappear under pressure (non-blanching)

Kernigs sign - pain resistance to knee extension when lying with the hips fully flexed

Brudzinski sign - neck flexion causes flexion of hip and knee

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14
Q

Meningitis: diagnostics

A

Lumbar puncture: withdraw CSF between L4-L5

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15
Q

Meningitis: complications

A

Swelling
Raised ICP*
Septicaemia
Seizures

*Intracranial pressure

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16
Q

Meningitis: allopathic treatment

A

Antibiotics, antivirals, corticosteroids
Analgesics, antipyretics (to lower temperature)
Intravenous fluids

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17
Q

Concussion: definition

A

Temporary loss of neuronal function

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18
Q

Concussion: aetiology

A

Significant blow to the head

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19
Q

Concussion: signs and symptoms

A

Loss of consciousness
Memory loss of events surrounding the injury
Headache
Disorientation
Nausea/vomiting

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20
Q

Concussion: allopathic treatment

A

Rest
If any consciousness lost, avoid any vigorous activity for 3 months

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21
Q

Cerebral Contusion: definition

A

Traumatic brain injury that causes bruising of the brain with ruptured blood vessels and oedema

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22
Q

Cerebral Contusion: aetiology

A

Blunt blow to the head

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23
Q

Cerebral Contusion: signs and symptoms

A 
Headache
Confusion
Dizziness
Loss of consciousness
Nausea
Vomiting
Seizures
Difficulty with co-ordination/movement
Impaired memory, vision, speech, hearing
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24
Q

Cerebral Contusion: allopathic treatment

A

Medical emergency

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25
Coup injury: definition
Injury to the site of primary impact
26
Contrecoup injury: definition
Damage to the brain at a site contra-lateral to the site of trauma The skull acts to stop acceleration of the brain away from the site of impact, causing damage to the opposite side
27
Headaches: aetiology
* Dehydration * Cervicogenic (from the neck) * TMJ* - jaw headache (structural) * Tension (muscular) * Congested sinuses * Hypoglycaemia * Migraine/cluster (Trigeminal nerve) * Medication - e.g. paracetamol * Intra-cranial - e.g. brain tumour, haemorrhage * Organ referral | *Temporomandibular joint
28
Cervicogenic headache: | location, duration, severity, pain character
Occipital to frontal/temporal 1 hr to weeks Moderate to severe Non-throbbing pain, dull and deep
29
Tension headache: | location, duration, severity, pain character
Diffuse (bilateral) Hours to days Mild to moderate Dull pain
30
Migraine headache: | location, duration, severity, pain character
Retro-orbital (behind eyes) 4-72 hrs Moderate to severe Throbbing, pulsating
31
Cervicogenic headache: aetiology
Neck movement, sustained postures
32
Cervicogenic headache: signs and symptoms
Reduced neck range of movement (ROM)
33
Cervicogenic headache: allopathic treatment
Stretching Supporting neck Massage
34
Tension headache: aetiology
Stress Muscle tension
35
Tension headache: signs and symptoms
Reduced appetite Photophobia
36
Tension headache: allopathic treatment
Rest Massage Relaxation
37
Migraine headache: definition
Neurological condition that results in recurrent, severe headaches
38
Migraine headache: aetiology
Strong links with genetics - more common in women Food allergies Food additives - tyramine, nitrates, MSG, aspartame, histamine, alcohol Emotions - stress Hormonal changes Poor sleep Low levels of serotonin (link with digestive function) Complex series of intracranial vascular changes - vasoconstriction (aura) and subsequent vasodilation (headache) Induced by cerebral depolarisation - this secretes vasodilators and pain mediators
39
Migraine headache: signs and symptoms
Aura - occurs hours to days before headache (tingling, changes in vision, smell) Unilateral, pulsating headache (retro-orbital) Moderate to severe intensity, worsened by movements Photophobia Phonophobia Nausea, vomiting (which can improve symptoms)
40
Migraine headache: allopathic treatment
Analgesics - ibuprofen 5-HT agonists* | Bind to and activate 5-HT (serotonin) receptors in the brain.
41
Headaches: red flags
**`First onset`** of headache over 50 yrs old **`Thunderclap headache`** (subarachnoid haemorrhage) **`Signs of intracranial pressure:`** Worsening morning headaches, uneven pupils, double vision, tunnel vision, papilloedema, vomiting but no nausea **`Signs of meningitis:`** Headache, neck stiffness, non-blanching rash, positive Kernig/Brudzinski tests
42
Epilepsy: definition
Sudden, hyper-excitable and uncontrolled neuronal activity in the brain
43
Epilepsy: aetiology
``` Idiopathic Brain tumour Cerebral infarction/haemorrhage Congenital malformation Head trauma CNS infections - meningitis Degenerative brain disease Some drugs Chemical imbalances - hypoglycaemia/calcaemia ```
44
Epilepsy: triggers
``` Flickering lights Stress Drugs/alcohol Dehydration Sleep deprivation Fever Hypoglycaemia Pesticides ```
45
Epilepsy: signs and symptoms
Petit mal seizure - non convulsive Grand mal seizure - convulsive
46
Epilepsy: allopathic treatment
Anti-epileptic drugs - gabapentin, sodium valproate (adverse effects)
47
Petit mal seizure: definition
Non-convulsive seizure 'Absence' seizure Lasts 10-30 seconds Mainly in children Usually no lingering confusion
48
Grand mal seizure: definition
'Tonic-clonic', convulsive seizure Tonic phase - contraction of all body muscles, causing patient to fall if sitting or standing Clonic phase - rapid contraction and relaxation of muscles causing convulsions. Ranging from exaggerated twitches to violent shaking Usually lasts around 1 min Followed by physical and nervous exhaustion
49
Spina Bifida: definition
Incomplete closure of the embryonic neural tube | Results in failure of the spinal column to fully enclose the spinal cord
50
At what junction does spina bifida usually occur?
Lumbosacral junction - L5/S1
51
What are the two types of spina bifida?
Spina bifida occulta - overlying skin intact Spina bifida cystica - visible cystic mass
52
Spina Bifida: risk factors
Lack of folate (vit B9) during and before pregnancy Sodium valproate link
53
Spina Bifida: complications
Meningitis* Hydrocephalus Reduced bowel and bladder function | *Especially in Spina bifida cystica because openings for bacteria
54
Disc Herniation: definition
The nucleus pulposus of the intervertebral disc leaks out into the annulus fibrosus, often compressing the spinal nerves
55
At which junctions are disc herniations likely to affect?
Tends to affect discs with the highest fluid content, most commonly L5, S1 (sacrum), then the cervical spine (C1-7)
56
What age group is more likely to be affected by a disc herniation?
30-40 yrs old | Discs are most hydrated at this stage
57
Disc Herniation: signs and symptoms
Radiating pain (sharp and linear) Worse in the extremity Aggravated by coughing/sneezing Positive straight leg raise test* | *Reproduces the symptoms
58
Disc Herniation: allopathic treatment
Manual therapy Muscle strengthening
59
Sciatica: definition
Compression or irritation of the sciatic nerve
60
Sciatica: aetiology
Disc herniation at L4/5 or L5/S1 Compression against piriformis muscle Tumours in spinal canal or pelvis
61
Sciatica: signs and symptoms
``` Pain in lower back and buttock Pain radiating down posterior leg - usually unilateral Pins and needles, numbness Weak calf muscles and 'foot drop' Often absent ankle jerk reflex ```
62
Sciatica: diagnostics
Straight leg raise test Loss of sensation in sciatic nerve dermatome Absent ankle jerk reflex
63
Sciatica: allopathic treatment
Physiology Steroid injection Surgery
64
What is the SLRT (straight leg raise test) used to diagnose?
Nerve tethering in the lower lumbar spine A positive SLRT is generally suggestive of a disc herniation
65
What does a positive straight leg raise test generally suggest?
Disc herniation
66
What does a positive straight leg raise test show?
Reproduced pain/symptoms in the buttock and posterior leg* | *Sciatic nerve distribution
67
How is a straight leg raise test performed?
1. Patient lies supine 2. Practitioner raises one leg at a time 3. Symptoms usually experienced at 45 degrees
68
What is aspartame?
A non-carbohydrate artificial sweetener
69
How much sweeter than sugar is aspartame?
200 times
70
How many foods and drinks contain aspartame?
Approx 6000
71
Why is aspartame considered harmful?
Aspartame is a neurotoxin It has neuroexcitatory properties (excitotoxin)
72
What sort of damage can aspartame cause?
Widespread neurological damage MS Parkinson's disease Balance problems
73
What does a neurological examination test for?
Abnormal neurological function
74
What might a neurological examination include?
Signs - tremor, rigidity Motor (power) testing Cranial nerve exam Dorsal column testing - light touch, vibration, proprioception Spinothalamic tract testing - pin prick, temperature Gait analysis/Romberg's - proprioception Cutaneous (i.e. foot) and deep tendon reflexes
75
What does the Romberg's test assess?
Proprioception
76
How is Romberg's test performed?
Ask patient to stand with feet together Ask patient to close eyes Maintain position for 20-30s
77
What is a positive Romberg's test?
If patient sways after closing eyes
78
What does a positive Romberg's test indicate?
A problem with the proprioceptive system * Damage of dorsal columns in spinal cord * B12 deficiency
79
What does a knee jerk test assess?
Deep tendon reflexes
80
How is a knee jerk test performed?
Tap the patellar tendon
81
What can an absent knee jerk indicate?
Disc herniation Peripheral nerve compression Hypothyroidism
82
What can an exaggerated knee jerk indicate?
CNS dysfunction e.g. spinal cord, MND Hyperthyroidism
83
What does an ankle jerk test assess?
Deep tendon reflexes
84
How is an ankle jerk test performed?
Tap the Achilles tendon whilst foot is dorsiflexed
85
What does a knee jerk test simulate?
Contraction of the quadriceps muscle
86
What does an ankle jerk test simulate?
Plantar flexion of the foot
87
What can an absent ankle jerk indicate?
Nerve damage - peripheral neuropathy, sciatic nerve compression Hypothyroidism
88
What can an exaggerated ankle jerk indicate?
CNS dysfunction e.g. spinal cord MND Hyperthyroidism
89
How is a plantar response/Babinski sign performed?
Stroke the lateral margin of the sole of the foot
90
What is a normal plantar response/Babinski sign?
Plantar flexed* toes | *Curled toes
91
What is the Babinski sign?
Big toe extending (dorsiflexing) while other toes fan out | Considered normal only below 2years of age, pathological afterwards
92
What does an abnormal plantar response indicate?
Corticospinal tract damage MS MND
93
How is an abdominal reflex performed?
Patient should be supine and relaxed Practitioner strokes medially across the upper and lower quadrant of abdomen towards the belly button
94
What should happen in an abdominal reflex?
Brisk contraction of abdominal muscles
95
What does an absent abdominal reflex indicate?
Corticospinal tract damage MS MND
96
Who is more likely to be affected by meningitis?
Immuno-compromised populations - elderly, HIV, organ transplants, cancer patients
97
Hydrocephalus: diagnostics
CT scans MRI
98
Migraine headache: natural treatment
* Avoid allergens / food intolerances * Low GL diet * Avoid amine-containing foods (vasodilators) (tyramine, histamine) * Magnesium + B6 * Herbs (e.g. feverfew) * Acupuncture, osteopathy. * Homeopathy.
99
Brain tumour: pathophysiology
Often secondary malignant tumours Can be primary (originate within the brain). **Gliomas** (most common type is astrocytoma). Meningiomas and pituitary tumours (less aggressive)
100
Brain tumour: signs and symptoms
* Morning headaches, increasing in frequency * Nausea and vomiting * Uneven pupils and double vision * Papilloedema
101
Epilepsy: natural treatment
Ketogenic diet (increases GABA that surpresses the excessive electrical activity) Dietary and supplements: EFAs, magnesium. Smoking cessation. Acupuncture, Sleep hygiene, stress management. Homeopathy.
102
Disc Herniation: natural treatments
Anti-inflammatory diet Supplements (bromalaine, tumeric, ginger, boswellia, magnesium, epsom salts, serrapeptase*) Homeopathy Herbs acupuncture. | *proteolytic enzyme, natural anti-inflammatory
103
Sciatica: natural treatment
Magnesium, epsom salts (if related to muscle contraction) Manual therapies Herbs for pain, nerve support Acupuncture Homeotherapy

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