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Y3 - CS - Neuro > condition 2 > Flashcards

condition 2 Flashcards

1
Q

defintion in epilepsy/ seizures

A

recurrent tendency to spontaneous, intermittent, abnormal electrical activity activity in part of the brain manifesting as seizures

epilepsy is not a diagnosis but a symptom with many underlying causes

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2
Q

what are the different types of seizure

A

generalised - simultaneous onset of electrical discharge throughout cortex with no localising features referable to only one hemisphere, there are other smart subtype within generalised seizures

  • absence seizures - brief pauses
  • tonic-clonic seizures - loss of consciousness, limbs stiffen (tonic), then jerk (clonic)
  • myoclonic - sudden jerk of limb, face or trunk
  • atonic - sudden of muscle tone causing fall

partial - focal onset with features referable to a part of one hemisphere, they are other different type within partial

  • simple partial seizure - awareness is unimpaired with focal motor, autonomic or psychic symptoms
  • awareness is impaired
  • partial seizure with secondary generalisation - electrical disturbance which starts focally spreads widely causing a secondary generalised seizures which is typically convulsive
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3
Q

how common is seizure/epilepsy

A

5-10 cases per 1000 but 5-30% of these are misdiagnosed

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4
Q

causes of seizure or epilepsy

A 
idiopathic (2/3) often familial 
structural 
- cortical (cerebrum) scarring eg head injury years before onset 
- developmental 
- space-occupying lesion 
- stroke
- hippocampal sclerosis
- sarcoidosis 
-SLE 
- polyarteritis nodosa

non-epileptic causes of seizures

  • trauma
  • stroke
  • haemorrhage
  • raised ICP
  • alcohol or benzodiazepine withdrawal
  • metabolic disturbance - hypoxia, hyper/hypo-natraemia/gycaaemia, hypocalcaemia, uraemia
  • liver disease
  • infection
  • drugs
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5
Q

symptoms of seizures/epilepsy

A

prodrome - symptoms preceding the seziure by hours or days such as change in mood or behaviour

aura - part of the seizure of which the patient is aware and may precede its other manifestations eg odd feeling in the gut or flashing lights or strange smells

psot-ictally - heachace, confusion, myalgia, sore tongue, temporary weakness (seizure in the motor cortex)k dysphagia ( seizure in temporal lobe)

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6
Q

what are the specific symptoms for generalised tonic clonic seizures

A 
sudden fall
stiff limbs 
jerking 
loss of consciousness 
tongue biting 
incontinence
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7
Q

differential for seizures

A 
syncope 
cardiac arrhythmias 
TIA
migraine 
benign paroxysmal vertigo 
acute encephalopathy 
panic attacks 
aggressive outburst eg related to learning disability
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8
Q

further invest for seizures

A

EEG - only supportive to diagnosis, should only be performed after the second epileptic seizures, sleep EEG can be more accurate

MRI
bloods - to exclude other causes
ECG

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9
Q

treatment for seizures

A

drugs are not advised following one fit unless there is a high risk of recurrence. drug treatment should only start after 2nd attack and after discussion with patient

tonic-clonic - sodium valproate or lamotrigine (carbamazepine or topiramate - 2nd line)

absence - sodium valproate, lamotrigine or ethosuximide

tonic, atonic and myoclonic - same as generalised tonic clonic but avoiding carbamazepine and oxcarbazepine, topiramate 2 line

DVLA should be notify when epilepsy

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10
Q

what are some complications for epilepsy

A

SUDEP - Sudden Unexplained Death in Epilepsy

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11
Q

definition for meningitis

A

acute inflammation of the meninges and the underlying subarachnoid CSF –> medial emergency

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12
Q

how common is meningitis

A

2500/year bacterial and 5000/year viral

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13
Q

what are the 2 subtype of meningitis

A

infective and non-infective

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14
Q

what are some of the pathogens included in infective meningitis

A

bacterial - neisseria meningitides, strep pneumonia, staph aureus, haemophilius influenze type B (rare in the UK due to vaccine)

viral - enteroviruses, herpes simplex, varicella zoster, Mumps, HIV

fungal - in immunosuppressed

parasitic - eosinophilic meningitis

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15
Q

what are some causes of meningitis in non-infective category

A

malignant cells
intrathecal drugs (durgs injected in the spinal cord)
blood from SAH
sarcoidosis
SLE
Behcet’s disease (a rare immune-mediated small-vessel systemic vasculitis that often presents with mucous membrane ulceration and ocular problems.)

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16
Q

symptoms of meningitis

A

headache, leg pains, cold hands and feet
abnormal skin colour

meningism - stiff neck, photophobia 
seizures 
focal CNS signs 
petechial rash - non-bleeding 
signs of galloping sepsis - slow cap refill, low BP, pyrexia, tachycardia
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17
Q

prognosis of meningitis

A

viral meningitis usually self-limiting and resolves within 4-10 days might leave headache months after

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18
Q

differential for meningitis

A 
SAH
encephalitis 
other causes of pyrexia/severe infection 
intracranial abscess 
septicaemia (blood poisoning)
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19
Q

further investigations for meningitis

A

bloods - FBC, U&Es, LFT, glucose, coagulation
blood culture
throat swab - one for bacterial and one for viral
stool samples - for viral
LP - measure opening pressure - normally 7-18cm, typically 14-30 in meningitis), send samples for MC+S, gram stain, protein estimation, glucose, virology, only do this when not contraindicated (eg inc ICP, focal signs, papilloedema, truma, middle ear pathology, major coagulaopathy)
CT

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20
Q

what are the appearance of CSF for meningitis

A

pyogenic (bacterial only) - cloudy, polymorphs mainly with some lymphocytes, glucose half plasma, inc protein

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21
Q

treatment for meningitis

A

ABCDE assessment, bacterial is fatal if untreated

  • if meningitic signs predominate
    • dexamethasone IV
    • Do LP
    • cefotaxime IV post-LP immediately
    • adjust Ax following MC&S
  • if septicaemic signs predominate then
    • cefotaxime IV
    • do not do LP
    • take to ICU for fluid resuscitation, intubation etc

aciclovir - if herpes simplex meningitis, otherwise, viral meningitis only supportive and analgesia

bacterial meningitis is a notifiable disease

22
Q

definition for migraine

A

chronic neurological disorder characterised by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms

23
Q

what are the different subtype of migraine

A

migraine without aura (common migraine -70%, aura = migraine without neurology signs)

migraine with aura (classic migraine - 20%)

childhood periodic syndromes

retinal migraine

probable migraine

24
Q

how common is migraine

A

6% of men and 18% of women

25
Q

who is affected the most by migraine

A

F:N 2:1
in 90%, symptoms begins <40yrs
common around puberty and menopause

26
Q

causes of migraine

A

mechanism still unclear

27
Q

RF for migraine

A

precipitating factors/partial triggers

CHOCOLATE

Chocolate 
Hangovers 
Orgasms 
Cheese 
Oral contraceptives 
Lie-ins 
Alcohol 
Tumult (loud noise and commotion of large crowd) 
Exercise

in 50%, no triggers were found

28
Q

symptoms of migraine

A

prodrome (before) - yawnings, craving, modd change, sleep chane

aura (just before and during) (can be visual, somatosensory, motor or speech

  • chaotic cascading, distorting, melting and jumbling of dots lines or zigzags
  • hemianopia
  • parastehsiae spreading from fingers to face
  • dysarthria
  • ataxia
  • opthalmoplegia
  • hemiparesis
  • dysphasia/paraphasia

symptoms

  • unilateral throbbing headache
  • nausea and vomiting
  • photophobia
  • phonophobia (scare of loud noises)
  • allodynia - stimuli which normally produce pain cuase pain
29
Q

differenital for migraine

A 
sudden migraine - SAH or meningitis 
Hemiplegic, visual and hemisensory symptoms: thromboembolic TIAs (nb in TIA maximum deficit is present immediately = sudden; headaches = gradual)
unilateral tingling or numbness - sensory epilepsy 
cluster or tension headaches 
cervical spondylosis 
HTN
raised ICP
sinusitis/otitis media
30
Q

management for migraine

A

explanations
avoidance or dietary triggers
brand change if related to oral contraceptive

31
Q

treatment for migraine

A

NSAIDs, triptans, ergot alkaloids

prophylaxis - 1st line - propranolol, amitryptiline, topiramate, 2nd line - sodium valproate, pizitofen, gabapentin

32
Q

definition of tension-type headache

A

a primary benign headache that is either episodic or chronic

33
Q

how common is tension-type headache

A

most common form of chronic recurring head pain, quite common

34
Q

who is affected the most by tension-type headache

A

anyone and everyone
more common in women than man
more common in adult

35
Q

causes of tension type headache

A

most are innocent nature
due to neurovascular irritation and referred to scalp muscles and tissues
there many be obvious precipitating factors - worry, noise, concentrated visual effort, depression

36
Q

symptoms of tension-type heacache

A 
bilateral headache 
feel like tight band around head 
pain into or from neck 
gradual onset 
mild-moderate intensity pain 
non-pulsatile 
not aggravated by routine physical activity 
pressure behind eye
37
Q

signs of tension-type headache

A

tenderness and tension in the neck and scalp muscle

38
Q

differential for tension-type headache

A

migraine, raised ICP, cluster headache, sinusitis

39
Q

management of tension-type headache

A 
stress and trigger management 
ibuprofen - 1st line 
diclofenac - GI side effect 
naproxen - GI side effect 
paracetamol
40
Q

definition for parkinson’s diseaese/Parkinsonism

A

parkinson’s disease - degenerattive disorder of the CNS characterised by resting tremour, rigidity and bradykinesia

parkinsonism - a symptomatic complex whihc shares the symtpoms from Parkinson’s disease but has neumerous underlying causes

41
Q

what are the different types of Parkinson’s Disease

A

primary or idiopathic parkinsonism

42
Q

different types of parkinsonism

A

secondary and atypical parkonsonism or parkinson’s syndrome

43
Q

what is Parkinson’s-plus syndrome

A

neurodegenerative disease featuring the classical features of parkinson’s disease with additional features that distinguish them from primary Parkinson’s disease eg multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration

44
Q

how common is parkinson’s disease or Parkinsonism

A

incidence 0.6% at 60-64 yrs and incidence rises steeply with age

45
Q

pathology of Parkinson;s Disease

A
  • mitochondrial DNA dysfunction
  • causes cell death in substantia nigra pars compacta (thought to be associated with Lewy body)
  • leads to reduced activity of producing cells
  • reduced dopamine in the striatum
  • leads to difficulty initing movement leading to hypokinesia, rigidity and tremor
46
Q

what are the causes of parkinssonism

A

parkinson’s disease - most common cause

drugs - that block dopamine receptors or reduced storage of dopamine

toxins chemicals, Wilson’s disease

encephalopathy

trauma/boxing
HIV
Parkinson’s Plus syndromes

47
Q

RF for parkinsons’s disease

A

Inc age

pesticide exposure

48
Q

symptoms of parkinson’s disease

A 
resting tremor 
oillin-rolling thumb over fingers 
rigidity/dec tone 
cogwheel rigidity felt on rapid pronation and supination 
Bradykinesia/hypokinesia 
postural instability 
festinate/shuffling gait 
decreased arm swing 
freezing at obstacles or doors 
expressionless face
49
Q

differential for Parkinson’s disease

A

benign essential tremor

durg-induced tremor

hungington’s disease -FH

Parkinson’s Plus syndrome

cerebellar tremor - intension tremor

psychogenic tremor - inc on direct observation

50
Q

investigation for Parkinson’s Disease

A

Diagnosis
Bradykinesia plus at least one of the following:
• Muscular rigidity
• Resting tremor (4-6Hz)
• Postural instability not caused by primary visual, vestibular, cerebellar or proprioceptive dysfunction

Supportive prospective positive criteria
3 or more are required for diagnosis of definitie PD:
•	Unilateral onset
•	Rest tremor present
•	Progressive disorder
•	Persistent asymmetry affecting the side of onset most
•	Excellent response (70-100%) to L-dopa
•	Severe L-dopa-induced chorea
•	L-dopa response for five years or more
•	Clinical course of ten years or more
•	Hyposmia
•	Visual hallucinations
51
Q

treatment for Parknson’s Disease

A

Levodopa - key decision is when to start L-dopa as its efficacy decreases over time and requiring larger doses and greater frequency

Y3 - CS - Neuro (2 decks)

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