Basic Neurology Flashcards
(27 cards)
Meningitis
Photophobia Fever Neck stiffness Headache Rash (bacterial) Treatment in hospital ceftriaxone CT head then do lumbar puncture
Migraine
Aura, sense of déjà vu Headache one side of the head Photophobia, noise sensitivity Zig-zagging lines in front of eyes Nausea
Stroke
One sided arm and leg weakness Slurred speech Problems with swallow One sided facial weakness Increased reflexes and tone on one side Lose vision on side of weakness
Raised intracranial pressure
Worse on coughing/bending over/lying down/in the morning
Nausea vomiting
Headache
Possible Papillodeoma - swollen optic discs
Causes: tumour, infection, inflammation
Hepatic encephalopathy
Build up of ammonia in the liver
Causes confusion
Give lactulose
Sub-arachnoid haemorrhage
Most severe thunderclap headache in occipital lobe peaks rapidly
CT head then CT angiogram
CSF: xanthochromia
Linked to polycystic kidneys
Treatment: CCB nimodipine reduce vasospasm then neurosurgery to relieve bleed
Main cause: aneurysm, eg. Berry aneurysm in Circle of Willis
Viral encephalitis
MRI of temporal lobes
Headache
Confusion
Treat with acyclovir
Bell’s palsy
Lower motor neurone
Droop on one side of face
Can be caused by viral
Treat with steroids
Cauda equina syndrome
Neurological emergency Commonest cause is central disc prolapse Compression of central sacral or lumbar roots Sciatica Loss of bladder/bowel control/sexual dysfunction Saddle sensory loss Lower limb weakness Can cause paralysis Urgent MRI and surgical referral
Guillain-Barre Syndome
Autoimmune disease that affects the myelin
60% have infection two weeks before
Ascending loss of limb function
Absence of reflexes
Test their vital capacity, monitor their peak flow
Motor neurone disease
Combination of upper motor neurone and lower motor neurone signs
Absence of sensory symptoms
Wasting/weakness of small muscles in hand
Fasiculations uppers limbs/shoulders
Leg weakness/brisk reflexes/extensor plantars
Multiple sclerosis
Affects young women
Different neurology separated in time and location in body
Inflammatory demyelinating CNS disorder
Relapsing/remitting, secondary progressive, primary progressive
Typical presentation:
Option neuritis - loss of colour vision
Transverse myelitis - altered sensation from umbilicus down
Investigation: brain MRI/LP oligoclonal banding
Treat with steroids: methyl prednisalone
Parkinson’s
Cogwheel rigidity Tremor - pill rolling worse at rest Difficulty getting going - propel themselves forward Loss of facial expression (hypomimia) Bradykinesthia Prone to Lewy-Body dementia Caused by dopamine deficiency Treat with l-dopa but can lead to dystonia
Myasthenia gravis
Autoimmune against acetylcholine receptors
Weakness progressive through the day
Small muscles affected most
Droopy eyes
Difficult to swallow
Serum AChR antibody test
Treat with neostigmine - antiacetylcholineesterase
Find out their peak flow as could get to the lungs
Epidural/extradural haemorrhage
Damage to the middle meningeal artery Limited by the suture lines of the skull Biconvex appearance on CT Often a blow to the temporal region: petrion Lucid interval after injury
Subdural haemorrhage
May be acute or chronic signs may be delayed by up to 2 weeks
Common in alcoholics because of recurrent falls and cerebral atrophy
Is crescent shaped on imaging
Damage to veins that bridge the subdural space
Suspect it in those with evolving strokes and fluctuating levels of consciousness
Subarachnoid haemorrhage
Between arachnoid mater and pia mater
Usually caused by ruptured cerebral aneurysm
Thunderclap severe headache
CT scan
Diffuse axonal injury
Tearing of nerve fibres due to shearing force during injury
Shaken Baby Syndrome
Basal skull fracture
CSF leakage
Accumulates and dribbles through ear, nasopharynx, nose, raccoon eyes, haemotympanum
Duchenne’s Muscular Dystrophy
X-linked recessive
Affects mostly boys, present around age 4 with delayed motor milestones, waddling gait, proximal limb weakness, calf pseudohypertrophy and scoliosis
Gower’s sign positive - walk up legs to stand up
Investigation: raised creatinine kinase
Treat with steroids
Patients die 20-30 from respiratory problems
Wernicke-Korsakoff Syndrome
Wernicke’s encephalopathy
Lack of vitamin B1 - thiamine
Often caused by alcohol dependency
Px: ataxic gait, opthalmaplegia, confusion with IV thymine
Otherwise leads to Korsakoff syndrome - irreversible, can’t make new memories, confabulation
Headache Red Flags
Trauma, thunderclap, focal neurological deficit, vomiting, loss of consciousness/altered consciousness, papilloedema, headache waking up in the morning, jaw claudication, fever, neck stiffness
Cluster headaches
severe unilateral supraorbital +/- temporal pain with ipsilateral eye watering happen every other day up to 8xday more common in men, smokers Treat with sumatriptan SC and oxygen Prophylaxis verapamil
Temporal arteritis (giant cell arteritis)
Over 50, immune mediated vasculitis
Temporal headache, myalgia, malaise
possible visual disturbance, scalp tenderness, acute blindness, jaw claudication
Ix: raised ESR, temporal artery biopsy
Treat with corticosteroids eg prednisolone, low dose aspirin
