Lecture 2 NS - Clinical Neurology

Question 1

What is neurology?

Answer 1

Diseases of brain, spinal cord, peripheral nerves and muscle

Question 2

Which neurological diseases have high incidence in GP?

Answer 2

Stroke, carpal tunnel syndrome, epilepsy, bell’s palsy, tremor, parkinson’s disease, brain tumour, multiple sclerosis

Question 3

Which neurological diseases have a high prevalence in the community?

Answer 3

Migrainse, stroke, alzheimer’s disease, epilepsy, tremor, MS, chronic fatigue, parkinson’s disease, unexplained symptoms

Question 4

What are the different types of stimuli which can cause neurological problems in order of speed of onset?

Answer 4

Traumatic, vascular, toxic/metabolic, infectious, inflammatory/autoimmune, genetic/congenital, neoplastic, degenerative

Question 5

How do you take a history?

Answer 5

Nature of symptoms, onset of symptoms, previous medical problems, family history, social history, other symptoms

Question 6

What are the causes of stroke?

Answer 6

80% due to blockage of blood vessel, 20% due to bleeding - usually due to clot formed in carotid arteries

Question 7

What does stroke affect?

Answer 7

Any part of the brain (but cerebrum), and tends to cause problems on contralateral side to brain lesion

Question 8

What are some risk factors for stroke?

Answer 8

Haemorrhage often due to high blood pressue - smoking, family history, diabetes, excess alcohol

Question 9

What are the symptoms of stroke?

Answer 9

Related to which artery in the brain is affected - aphasia, hemiparetic,

Question 10

What does a middle cerebral artery stroke result in?

Answer 10

Mot commonly affected - results in weakness, loss of sensation on contralateral side

Question 11

What does a posterior cerebral artery stroke result in?

Answer 11

Affect occipital lobe, so result in vision loss on contralateral side (in both eyes)

Question 12

What does an anterior cerebral artery stroke result in?

Answer 12

Cause contralateral leg weakness

Question 13

What occurs if a stroke affects the brainstem?

Answer 13

Cause problems with balance, eye movements, speech and swallowing, breathing

Question 14

How long can recovery from stroke take?

Answer 14

Variable and can take up to 2 years

Question 15

What are the 3 types of stroke treatment?

Answer 15

Acute, treat complications, prevent further stroke

Question 16

How is the stroke acutely treated?

Answer 16

Intravenous thrombolysis or intra-arterial thrombectomy

Question 17

How are the complications from stroke treated?

Answer 17

Neurosurgery for haemorrhage/dangerously high pressure

Question 18

How are further clots prevented?

Answer 18

Thin blood with aspirin, treat diabetes and high cholesterol, treat dangerously narrow carotid arteries

Question 19

How are neurological problems examined?

Answer 19

Cognitive/thinking abilities, cranial nerves (smell, vision, eye movement, facial sensation and movements), limbs-power/coordination/reflexes/sensation

Question 20

What is Parkinson’s disease?

Answer 20

Slowly progressive degenerative disease affecting basal ganglia

Question 21

What are the main clinical features of Parkinson’s?

Answer 21

Rigidity, tremor and bradykinesia - loss of neurones from substantia nigra to the caudate and putamen

Question 22

How is Parkinson’s treated?

Answer 22

With levodopa or with electrodes implanted deeps into brain

Question 23

What is Spastic Paraparesis and what is its cause?

Answer 23

Stiff and weakness in limbs -due to: trauma, Autoimmune/inflammatory, neoplastic, degenerative, infection, vit deficiency, vascular

Question 24

What are the areas affected by stroke, multiple myeloma and acute polyneuropathy?

Answer 24

A) stroke

B) MM

C)APN

Question 25

What are the causes of acute polyneuropathy?

Answer 25

Infections, autoimmune, drugs, exposure to toxins

Question 26

What are the symptoms of Acute inflammatory demyelinating polyneuropathy/Guillain-Barre Syndrome?

Answer 26

Common cause of acute neuromuscular weakness - progressive ascending sensorimotor paralysis with areflexia, affecting 1 or more limbs - patients may progress to almost complete paralysis and require ventilation

Question 27

How is Guilllain-Barre syndrome treated?

Answer 27

Immunotherapy, supportive inc. ventilation, cardiac monitoring, anticoagulation to prevent blood clots

Question 28

How are neurological problems investigated?

Answer 28

Brain scans - CT/MRI, CSF (Lumbar puncture), Nerve conduction studies and EMG, EEG and evoked potentials, brain pathology (damage to cells/larger structures

Question 29

Where is a lumbar puncture carried out?

Answer 29

L3-L4 or L4-5