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Core Conditions > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the causes of primary headaches?

A

Migraine
Tension-type headaches
Cluster headaches

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2
Q

What are the causes of secondary headaches?

A
  1. Mass lesions/tumours
  2. Infections: meningitis, abscess, sinusitis
  3. Trauma: head injury or neck injury
  4. Raised ICP: tumour, intracranial HTN, hydrocephalus
  5. Decreased ICP: CSF leak, post-lumbar puncture
  6. Vascular: SDH, SAH, AVM, stroke, vasculitis, arterial dissection
  7. Metabolic: OSA, thyroid disease, B12 deficiency
  8. Structural abnormalities
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3
Q

What are the pain-sensitive structures in and around the brain?

A
  1. Large arteries at base of brain
  2. Meningeal arteries
  3. Large venous channels
  4. Parts of dura
  5. Cranial nerves V, VII, IX, X
  6. Skin/subcutaneous tissue, muscle, vessels, periosteum
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4
Q

What are the RED FLAGS in a headache history?

A
  1. First and/or worst headache
  2. Abrupt onset
  3. Change or progression of pre-existing headache pattern
  4. Abnormal findings on exam
    - fever, stiff neck, rash
    - alteration in consciousness
    - focal neurological deficits
  5. New headache in patients > 50 years
  6. New headache in pts with cancer, immunosuppression or pregnancy
  7. Headache triggered by exertion, sexual activity, Valsalva
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5
Q

What is the IHS criteria for migraine without aura?

A

A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or successfully treated)
C. Headache has at least 2 of the following:
- Unilateral location
- Pulsating quality
- Moderate or severe intensity
- Exacerbated by movement
D. During headache at least one of the following:
- Nausea and/or vomiting
- Photophobia and phonophobia
E. Not attributed to another disorder

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6
Q

What is a migraine aura?

A

A fully resersible set of neurological symptoms, which develop gradually over >5 minutes and last 5-60 minuts.

  • visual symptoms
  • sensory symptoms (paraesthesia, numbness)
  • dysphasic speech disturbace
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7
Q

What is the IHS criteria for a tension-type headache?

A

A. At least 10 episodes fulfilling criteria B-D
B. Headache lasting from 30 minutes to 7 days
C. Headache has at least 2 of the following:
- Bilateral location
- Pressing/tightening (non-pulsating) quality
- Mild or moderate intensity
- Not exacerbated by movement
D. Both of the following:
- No nausea or vomiting (anorexia may occur)
- No more than one of photophobia or phonophobia
E. Not attributed to another disorder

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8
Q

What is the IHS criteria for a cluster headache?

A

A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated.
C. Headache is accompanied by at least one of the following:
- Ipsilateral conjunctival injection and/or lacrimation
- Ipsilateral nasal congestion and/or rhinorrhoea
- Ipsilateral eyelid oedema
- Ipsilateral forehead and/or facial sweating
- Ipsilateral miosis and/or ptosis
- A sense of restlessness or agitation
D. Attacks have a frequency from 1 every other day to 8 per day
E. Not attributed to another disorder

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9
Q

What are the differentials for acute painless loss of vision?

A 
Central retinal artery occlusion
Central retinal vein occlusion
Temporal arteritis
Retinal detachment
Vitreous haemorrhage
Exudative macular degeneration
Optic neuritis
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10
Q

What is acute angle-closure glaucoma?

A

Acute angle-closure glaucoma is caused by a rapid or sudden increase in intraocular pressure (IOP), the pressure within the eye.

Patients will present with:

  • acute monocular vision loss
  • severe periorbital pain
  • redness
  • nausea and vomiting
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11
Q

What are the causes, presentation, examination findings and treatment for central retinal artery occlusion (CRAO)?

A

Cause: embolic (95%) or GCA (5%)
Presentation: profound loss of vision, instant onset (if offset, amaurosis fugax)
Examination: cloudy swelling with cherry red spot
Treatment:
- CO2 rebreathing to dilate vessel
- Acetazolamide to decrease pressure in eye
- AC paracentesis: drain fluid from eye
- ?clot lysis

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12
Q

What is the presentation, examinating findings and treatment of central retinal vein occlusion (CRVO)?

A

Presentation: sudden, painless vision loss
Risk factors: HTN, diabetes, atherosclerosis, glaucoma, smoking, CVD
Examination: ‘margherita pizza’ appearance; cotton wool spots and haemorrhage
Treatment: no acute interventions - observation + treat risk factors

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13
Q

What is giant cell arteritis (GCA)?

A

Giant cell arteritis (GCA), also called temporal arteritis, is a granulomatous vasculitis of large and medium-sized arteries. It primarily affects branches of the external carotid artery, and it is the most common form of systemic vasculitis in adults. The most common serious consequence of GCA is irreversible loss of vision due to optic nerve ischaemia.

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14
Q

What are the common symptoms of giant cell arteritis (GCA)?

A
  • vision loss
  • polymyalgia rheumatica
  • jaw claudication
  • scalp ache and tenderness
  • fever
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15
Q

What will you find on examination of a patient with giant cell arteritis (GCA)/anterior ischaemic optic neuropathy (AION)?

A
  1. Optic disc oedema (NOT papilloedema) +/- microinfarcts, haemorrahge.
  2. RAPD
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16
Q

What is the treatment of giant cell arteritis (GCA) following presentation of acute vision loss?

A

It is essential to identify GCA early because it is irreversible and vision loss in the other eye is inevitable (often within 3 weeks).

MUST do these three things:

  1. ESR/CRP
  2. Steroids (i/v methylprednisolone or oral prednisolone)
  3. Temporal artery biopsy
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17
Q

What is anterior ischaemia optic neuropathy (AION)?

A

AION is loss of vision, most often caused by giant cell arteritis (GCA)/temporal arteritis.
The optic nerve is damaged due to ischaemia of the posterior ciliary arteries.

18
Q

What are the causes of flashes, floaters or shadows in the vision?

A
  1. Posterior Vitreous Detachment (PVD)
  2. Retinal Detachment (RD)
  3. Vitreous Haemorrhage (VH)
19
Q

What are the causes of vitreous haemorrhage (VH)?

A
  1. Posterior Vitreous Detachment (PVD)
  2. Trauma
  3. Proliferative Diabetic Retinopathy (PDR)
  4. Central Retinal Venous Occlusion (CRVO)
20
Q

What is the common presentation of retinal detachment (RD)?

A
  1. Loss of central vision
  2. Flashes
  3. Floaters
  4. Known PVD
21
Q

What are the two broad categories of seizures?

A
  1. Primarily generalised seizures (idiopathic) - start everywhere in the brain and spread
  2. Focal/partial seizures - start in one region and spread
22
Q

What are the three types of primarily generalised seizures?

A
  1. Absent
  2. Myoclonic
  3. Generalised tonic-clonic
23
Q

What are the two main types of focal seizures?

A
  1. Simple - where consciousness is preserved
  2. Complex - where consciousness is impaired

Note: focal seizures may progress to secondarily generalised seizures.

24
Q

What is a Jacksonian seizure?

A

This is a type of simple partial (focal) seizure that originates in the motor cortex.

It is characterised by:

  1. initial tingling or twitching in finger, toe or corner of mouth
  2. progression to entire hand, foot or facial muscles
  3. other features of automatism:
    - licking lips
    - fumbling with clothing
    - rhythmic hand movements
    - head turning
    - muscle cramping
    - hallucinations
  4. only one side is affected
25
Q

What are the common causes of syncope?

A
  1. Neurocardiogenic (vasovagal, cough, post-micturition)
  2. Orthostatic hypotension (dehydration, drug-induced)
  3. Cardiac (arrhythmias, AMI)
  4. Psychiatric
26
Q

What are the four main clinical syndromes of dizziness?

A
  1. Acute vestibulopathy
  2. Recurrent vestibulopathy
  3. Motion-induced vertigo
  4. Chronic disequilibrium
27
Q

What are the causes of acute vestibulopathy, how do they present and how do you differentiate between them?

A

Vestibular neuronitis is the main cause.

  • This is an acute severe spontaneous isolated vertigo that may be associated with ataxia, nausea and vomiting.
  • Worse with head movement
  • Able to stand, usually unsteady with eyes open
  • Horizontal nystagmus, may be suppressed by fixation
  • Head impulse test (HIT) positive
  • Treat with high dose prenisolone

Cerebellar stroke: rare but you want to exclude this

  • Cannot stand without support and eyes open
  • Head impulse test (HIT) negative
  • Nystagmus is bilateral, no fixation suppression and may be vertical
  • Assocaited with other cerebellar signs: dysarthria, ataxia
  • MRI brain is defnitive
28
Q

What are the causes of recurrent vestibulopathy and how do they present?

A

1, Migrainous vertigo

  • episodic vertigo +/- nausea, vomiting, headache, tinnitus, hearing loss
  • seond most common cause of episodic vertigo
  • may have separate history of headache (must ask)
  • family and past history
  1. Meniere’s disease
    - due oedema of the inner ear (endolymphatic hydrops)
    - associated aural symptoms: tinnitus, aural fullness, subjective hearing loss
    - very uncommon
    - treat with sodium restruction, diuretics (oedema)
29
Q

What is motion-induced vertigo and what are its causes?

A

This is characterised by frequent, brief episodes of motion-induced vertigo.
- does not occur spontaneously at rest

Causes:

  • benign paroxysmal positional vertigo (BPPV) is the most common cause - symptoms when supine, self-limiting
  • uncompensated peripheral vestibule lesion, e.g. post-vestibular neuronitis - marked motion-induced symptoms when upright
30
Q

What are the peripheral and central causes of vertigo?

A

Peripheral:

  • BPPV
  • Vestibular neuronitis
  • Meniere’s disease
  • Trauma

Central:

  • Migrainous vertigo
  • Vascular disease
  • MS
  • Trauma
  • Tumours
31
Q

What are the clinical signs of peripheral vestibular disease?

A

Usually viral cause.

  1. Spontaneous nystagmus - unilateral, away from affected side, can be suppressed
  2. Gait ataxia
  3. Positive Hallpike manoeuvre (if BPPV)
  4. Postive head impulse test
32
Q

What is the Hallpike manoeuvre?

A

This is a test used to diagnose BPPV in patients presenting with vertigo.

  • turn head 45 degrees towards side being tested
  • positive test if nystagmus is elicited when patient is supine
33
Q

What is the head impulse test (HIT)?

A

The HIT is a test used to identify an impaired vestibulo-ocular reflex. This involves rapid rotation of the head while the patient’s eyes are fixed on a target. A positive HIT is when there is a “catch-up” saccade, which indicates peripheral vestiblar hypofunction.

34
Q

What is the scoring system for GCS and in what context is it used?

A

This scoring system is designed for blunt head trauma and is a gross estimate for cerebral function.

Motor:
6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - flexion to pain
2 - extension to pain
1 - no response
Verbal:
5 - orientated
4 - confused
3 - uses inappropriate words
2 - incomprehensible
1 - nil
Eyes:
4 - spontaneous opening
3 - to verbal command
2 - to pain
1 - nil
35
Q

What is the rapid assessment of consciousness and when in what context is it used?

A

A - alert
V - response to verbal stimuli
P - response to painful stimuli
U - unresposive

Used in rapid assessment OR assessment in young children

36
Q

What is Cushing’s triad and what causes it?

A
  1. Hypertension
  2. Bradycardia
  3. Irregular respiration

Caused by raised ICP –> herniation

37
Q

What are the urgent interventions for a patient with coning?

A
  1. Elevate head to improve venous sinus drainage
  2. Mannitol as an osmotic diuretic
  3. Hyperventilation to decrease pCO2 leading to vasoconstriction
38
Q

What is the clinical presentation of meningitis?

A
  • Headache is the major early symptom, usually persistent and severe
  • Classic triad: fever, altered conscious state, neck stiffness
  • Focal neurological signs
  • Seizures
  • Photophobia (not important)
  • Vomiting
  • Preceding or concurrent URTI
39
Q

What changes in the CSF from an LP will you find in a patient with bacterial meningitis?

A
  • elevated WCC >1000
  • 98% polymorphs
  • elevated protein >1g/L
  • low glucose
40
Q

What changes will you see in the CSF of a patient with viral meningitis?

A
  • elevated WCC <500
  • more lymphocytes (may have neutrophils early on)
  • protein <1g/L
  • normal glucose
41
Q

What is the treatment of meningitis?

A
  1. Dexamethasone
  2. Ceftriaxone
  3. Vancomycin
  4. Penicillin
42
Q

What are some of the causative agents of meningitis? (Bacterial or viral)

A 
Bacterial:
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae Group B
Listeria monocytogenes
Group B Streptococcus
E. Coli

Viral:
Enterovirus
HIV (seroconversion)

Core Conditions (13 decks)

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