interactive cases iv Flashcards
(20 cards)
What are the possible areas affected in neuro?
Brain
Spinal cord
Nerve roots Peripheral nerves Neuromuscular junction
What are the possible causes of pathology in neuro?
V ascular
I nfection
I nflammation/autoimmune
T oxic/metabolic
T umour/malignancy
Hereditary/congenital
Degenerative
Compare UMN and LMN lesions
UMN - tone increased (spasticity) - power decreased - reflexes increased, plantar up LMN - tone decreased (flaccid) - power decreased - reflexes decreased/normal
Name cerebellar signs
Ataxia Nystagmus Dysdiadochokinesia Speech: slurred, scanning Intention tremor
What abnormal sensation would you expect for pathology in the following areas: a) cerebral cortex, b) spinal cord, c) nerve roots, d) mononeuropathy, e) polyneuropathy?
a) Hemisensory loss b) Level, i.e. umbilicus c) Dermatomal d) Specific area e) Glove + stockings distribution
What drug can be used to treat neuropathic pain?
Duloxetine
What are possible causes of peripheral neuropathy?
Drugs (hx)
Alcohol (hx, raised GGT/MCV)
B12 deficiency (anaemia, raised MCV)
Diabetes (hx, glucose/HbA1c)
Hypothyroidism (TFTs)
Uraemia (U&Es)
Amyloidosis (hx of myeloma or chronic infection/inflammation, i.e. RA)
Infection (HIV)
Inflammation/autoimmune (vasculitis, inflam. demyelinating neuropathy)
Tumour (paraneoplastic, paraproteinaemia)
Hereditary sensory motor neuropathy
What sx would you see with papillits?
Optic nerve affected: - blurred optic disc margins - blurred vision - pain on eye movement
What sx indicate MS?
Two lesions Separated in time/space
How is meralagia paraesthetica managed?
Compression of the lateral femoral cutaneous nerve - reassure not serious - avoid tight clothing - lose weight - if persistent pain, start on carbamazepine/gapapentin
What is radiculopathy, including sx and causes?
Disease of the nerve roots Sx include: pain in buttock, radiating down leg below knee (sciatica) Causes include compression by disc herniation or spinal canal stenosis
Describe the sx of the following conditions: a) Parkinson’s, b) PSP (Steele-Richardson syndrome), c) Lew body dementia?
a) Tremor, rigidity, bradykinesia b) Parkinsonian features, upgaze abnormality c) Features of Alzheimer’s disease, Parkinson’s and hallucinations
Possible ddx for apparent confusion/low AMTS
Post-ictal - hx of seizures Dysphasia (receptive/expressive) - features of stroke/TIA Dementia (vascular, alcohol, Alzheimer’s, inherited: HD) - hx of IHD/PVD, signs of excess ETOH, features of HD Depressive pseudodementia - elderly, withdrawn, poor eye contact, precipitating factor
Possible ddx of confusion/low consciousness
Hypoglycaemia
Vascular
- bleed: headache, collapse
- subdural haematoma: fall, fluctuating consciousness
Infection - temperature, intracranial, extra-cranial?
Inflammation
Malignancy
Metabolic/toxic - Drugs, U&E, LFTs, vit. defi., endocrinopathies
How to assess GCS
Eyes (4) 4 = Spontaneous 3 = Opens in response to voice 2 = Opens in response to painful stimuli 1 = Does not open Verbal response (5) 5 = Oriented 4 = Confused 3 = Words 2 = Sounds 1 = No sounds Motor response (6) 6 = Obeys commands 5 = Localizes pain 4 = Withdraws to painful stimuli 3 = Abnormal flexion 2 = Extension 1 = No movements
How to assess AMTS
Start by telling them an address to remember then ask the following: 1. DOB 2. Age 3. Time 4. Year 5. Place 6. Recall (West Register Street) 7. Recognise doctor/nurse 8. Prime Minister 9. Second WW 10. Count backwards from 20 to 1
Possible ddx of headaches
Meningitis - fever, neck stiffness, Kernig’s sign
Subarachnoid haemorrhage - sudden onset, CT, LP (xanthochromia)
Migraine - throbbing, vomiting, aura, photo/phonophobia, FHx
Giant cell arteritis - polymyalgia rheumatica, shoulder girdle pain, stiffness, constitutional upset - >50 y.o - ESR, steroids, Bx
How would you manage a stroke?
<4.5 hours - CT: no haemorrhage - Thrombolysis (if no contraindications) >4.5 hours - CT head (exclude haemorrhage) - Aspirin (300mg) - Swallow assessment - Maintain hydration, oxygenation, monitor glucose
How would you manage a TIA?
Aspirin Don’t treat BP acutely (unless >220/120 or other indication) ECG, echocardiogram Carotid doppler Risk factor modification
What is the most likely diagnosis? - 40 year old - Backacke - LMN weakness - admitted to HDU - regular FVC monitoring - cardiac monitor - IVIG
Guillain-Barre syndrome - immune system produces harmful antibodies that attack the nerves - IVIG is a treatment made from donated blood that contains healthy antibodies (intravenous immunoglobulin)
