Nervous System Diseases Flashcards
(257 cards)
1
Q
how is hydrocephalus classified?
A
- communicating hydrocephalus
- non-communicating hydrocephalus
2
Q
what is the pathology behind hydrocephalus?
A
excess CSF in ventricles
3
Q
what is the difference between communicating and non-communicating hydrocephalus?
A
communicating - CSF pathway not affected
non-communicating - obstruction of the CSF pathway
4
Q
what are the physiological processes behind production and absorption of CSF in the brain?
A
production: Na-K ATP-ase activity
absorption: pressure gradient between CSF and venous pressure
5
Q
where is CSF produced?
A
in choroid plexus of ventricles
6
Q
where is CSF reabsorbed from subarachnoid space into the venous sinuses?
A
at arachnoid villi protruding into the sinuses
7
Q
where is CSF drained from the ventricles to the subarachnoid space?
A
through foramina at 4th ventricle
8
Q
what are the names of the foramina in the 4th ventricle through which CSF drains into the subarachnoid space?
A
Laterally: foramen Lushka (x2)
Medially: foramen Magendie (x1)
9
Q
what is usually the pathology behind communicating hydrocephalus?
A
impairment of CSF resorption
10
Q
what are the common causes of communicating hydrocephalus?
A
- infection (eg meningitis)
- subarachnoid haemorrhage
- post-operative
- post-trauma
11
Q
what is a common sign of hydrocephalus in young children? what is the reason for this?
A
enlarged head and failure to thrive - cranial sutures haven’t fused yet, so enlarged ventricles expand the skull
12
Q
what are common symptoms of hydrocephalus in older children and adults?
A
raised ICP symptoms:
- nausea and vomiting
- headache
- papilloedema
- visual disturbance/upgaze difficulty
- balance problems
- cranial nerve palsy
- drowsiness
13
Q
what is the pathology behind non-communicating hydrocephalus?
A
obstruction of CSF pathway
14
Q
what are common causes of non-communicating hydrocephalus?
A
- acqueductal stenosis (most common!)
- tumours
- cysts
- infection
- haemorrhage
- congenital abnormalities
15
Q
what is the imaging investigation and immediate treatment for acute hydrocephalus?
A
imaging: CT head
immediate intervention: external ventricular drain (EVD) - to drain excess CSF
16
Q
what is the gold standard treatment for communicating hydrocephalus?
A
shunt - normally ventriculo-peritoneal
17
Q
what disadvantages are associated with shunts used to treat hydrocephalus?
A
- high failure rate after 1 year
- disconnection/occlusion
- under/overdrainage
- migration
- infection
18
Q
what are treatment options in non-communicating hydrocephalus, other than shunting?
A
- surgical removal of obstruction
- 3rd ventriculostomy
19
Q
what is among the first symptoms a patient will experience if their hydrocephalus-treating shunt fails?
A
headache
20
Q
what measures are used to diagnose hydrocephalus on radiological imaging?
A
- ventricular index (>50%)
- Evans ratio (>30%)
21
Q
how is normal pressure hydrocephalus treated?
A
by using a programmable ventriculo-peritoneal shunt to control the drainage of CSF
22
Q
what is normal pressure hydrocephalus commonly misdiagnosed as?
A
dementia/Alzheimer’s
23
Q
what is the symptom triad for normal pressure hydrocephalus?
A
Wet - urinary incontinence
Wobbly - gait and balance difficulty
Wacky - fast progressive dementia
24
Q
which symptoms of normal pressure hydrocephalus are more or less likely to improve once the hydrocephalus is treated?
A
likely to improve: incontinence, memory and gait
less likely to improve: dementia
25
what is likely to happen to a patient's symptoms if they have normal pressure hydrocephalus and they receive a lumbar puncture?
their symptoms improve
26
why is normal pressure hydrocephalus important?
because it may be the reason for a patient presenting with dementia - can be reversed if treated early
27
what are the indications for a lumbar puncture?
diagnostic: meningitis, meningoencephalitis, cancer, neurological disease, inflammation, subarachnoid haemorrhage, idiopathic ICP
- therapeutic: contrast, intrathecal chemotherapy
28
what are the contraindications for a lumbar puncture?
- raised ICP
- suspicion of intracranial mass
- patient cardiovascular/respiratory unstable
- skin infection over area to puncture
- clotting abnormality
29
why should a lumbar puncture not be carried out on a patient with raised ICP because of a lesion?
because the change in pressure from the puncture could cause coning of the cerebellar tonsils
30
what are the two positions a patient can be in for a lumbar puncture to be carried out? in which cases is each position used?
- decubitus position (most patients)
| - sitting position (obese and infants)
31
which position used for a lumbar puncture also allows to measure the ICP of the CSF? what is the tool used to do this?
decubitus position (by using manometer)
32
at which level should a lumbar puncture be carried out and why?
between L3/4 or L4/5 - because that sits sufficiently below the conus medullaris
33
what layers does a lumbar puncture needle pierce before entering the dural space?
- skin
- subcutaneous tissue
- supraspinous ligament
- interspinous ligament
- ligamentum flavum
- dura mater
34
what piece of equipment should always be attached to the needle when piercing the interspace and coming out of it again during a lumbar puncture?
the stylet
35
why should the bevel of the needle be parallel to the fibres in the cauda equina?
so that the fibers are separated rather than cut through
36
after a lumbar puncture, three samples are sent to labs to test what?
- culture/gram stain
- glucose/proteins
- cell count
37
what are possible complications of a lumbar puncture?
- headache
- back pain
- bleeding from site or into dural space
- nerve damage/irritation
- transient abducens palsy
- coning
38
what are the indications for a paramedian approach in a lumbar puncture?
if there is fibrosis in interspace due to previous LP's, or to avoid site of previous lumbar surgery
39
why is there less incidence of spinal headache with a paramedian approach to a lumbar puncture?
because the needle goes through the erector spinae muscles - CSF can't leak through the muscle, and the holes made by the needle don't overlap because of the angle of insertion
40
what position should patients adopt during a lumbar puncture and why?
ideally decubitus position with back flexed - maximise space between spinous processes of vertebrae
41
what is the purpose of a blood patch in lumbar punctures?
it stops leakage of CSF into the epidural space following a lumbar puncture
42
what are solutions to spinal headaches after lumbar punctures?
- lying flat
- consuming caffeine/IV caffeine
- hydration
- blood patch
43
what immediate steps should be taken if a patient experiences coning following a lumbar puncture?
```
remove needle immediately
raise backrest to 45 degrees
give mannitol/3% saline
intubate/hyperventilate
get urgent neurosurgery consultation
```
44
what is a common cause of an epidermal inclusion cyst after a lumbar puncture?
the use of a needle without a stylet
45
what steps should be taken if a lumbar puncture fails?
ask someone else to try
| guided LP with use of USS, CT or fluoroscopy
46
how can a spinal headache from a lumbar puncture be avoided?
- using smaller diameter needles
- always using the stylet
- ensuring bevel of needle is parallel to nerve roots
47
What are the three main causes of localised cerebrovascular disease?
1. Atheroma/thrombosis
2. Thromboembolism
3. Haemorrhage
48
What are the three factors contributing to cerebrovascular disease? What are they called collectively?
Virchow’s Triad:
- changes in blood vessel wall
- changes in blood flow/pressure
- changes in blood components
49
What is the pathological presentation of an ischaemic stroke on a brain specimen?
Wedge shaped lesion in area supplied by blocked artery
| Tissue loss, yellow discolouration, cyst formation
50
How does a haemorrhagic stroke cause ischaemia?
Distal ischaemia - causes by spasm of ruptured artery in attempt to stop bleeding. Protective mechanism
51
What are the most common regions in the brain for haemorrhagic strokes to occur?
- basal ganglia, around internal capsule
| - circle of Willis, berry aneurysms
52
what are three common presentations of syncope?
- cardiogenic (MI, arrhythmia)
- reflex (vasovagal reaction)
- orthostatic (hypotension, endocrine)
53
with which type of seizure are tongue biting at tip or lateral side of tongue associated respectively?
tip - syncopal seizure
| lateral side - epileptic seizure
54
what are the two main criteria for diagnosing epilepsy?
- at least 2 seizures more than 24hrs apart
| - one seizure with high risk of recurrence
55
what are the two main classifications of seizures?
generalised and partial seizures
56
what do absent seizures, myoclonic seizures and tonic/clonic seizures have in common?
they are all generalised seizures
57
in which age group are absent seizures common?
in children
58
list some of the signs of a tonic/clonic seizure
```
groaning sounds
stiff limbs followed by jerking
foaming at mouth
eyes open/rolling back
drowsy/no recollection afterwards
```
59
list some risk factors for seizures
```
sleep deprivation/fatigue
drug and alcohol use
stress/anxiety
hormone changes
missed medications
```
60
what is status epilepticus?
one continuous seizure or multiple seizures with no recovery time, lasting >30mins
61
how is status epilepticus treated?
benzodiazepines + phenytoin/sodium valproate
62
what is the mortality of status epilepticus due to?
normally due to underlying condition (eg stroke, tumour, trauma)
63
what is the first line treatment for partial seizures, generalised seizures and status epilepticus respectively?
partial seizures - carbamazepine
generalised seizures - sodium valproate
status epilepticus - benzodiazepines
64
what are DVLA regulations for epilepsy in case of one-off seizures and diagnosed epilepsy?
one-off seizure - no driving for 6 months
| epileptic patients - after seizure no driving for 1 year, HGV drivers no driving for 10 years
65
what are some of the reversible causes for dementia-like symptoms?
b12 deficiency
thyrotoxicosis
HIV
tertiary syphilis
66
is frontotemporal dementia normally early or late onset?
early onset
67
list some common forms of dementia
Alzheimer's
vascular dementia
Lewy body dementia
frontotemporal dementia
68
what is the pathogenesis behind vascular dementia?
multiple very small strokes
69
what are common features of Alzheimer's?
loss of skills, speech, memory, executive decision making, visuo-temporal impairment
70
what drugs can help to relieve Alzheimer's symptoms?
```
acetylcholinesterase inhibitors (rivastigmine)
glutamate inhibitors (memantine)
antipsychotics
```
71
list some of the differences between frontotemporal and temporoparietal dementia
- frontotemporal dementia has earlier loss of personality compared to temporoparietal
- frontotemporal retains visuo-spatial awareness until late disease, temporoparietal loses it sooner
- frontotemporal has earlier speech/auditory impairment compared to temporoparietal
72
what is the pathology behind alzheimer's disease?
```
beta amyloid build up
tau protein build up
neurofibrillary tangles
brain tissue shrinkage
enlarged ventricles
```
73
what is the pathology behind parkinson's disease?
dopaminergic cell loss in substantia nigra
74
what are the common symptoms of parkinson's disease?
TRAP - tremor, rigidity, akinesia/bradykinesia, postural instability
urinary frequency/retention
75
list some complications of parkinson's disease
depression
dementia
bowel/bladder problems
speech impediments
76
name some features of parkinsonian gait
shuffling
hunched over
arm swing absent
head down
77
list some of the drug treatments used in parkinson's
levodopa (+ COMT/MAO-B inhibitors)
carboxylase inhibitors - carbidopa, madopar
dopamine agonists
78
if a dementia has fast progression, what underlying cause should be considered?
Creutzfeld-Jakob Disease
79
what is the characteristic of vascular parkinsonianism?
only lower half of body affected
80
name some of the possible aetiologies and risk factors of multiple sclerosis
```
EBV
vitamin D deficiency/temperate climate
genetics (HLA)
autoimmune (MBP)
female
early 20's
caucasian
```
81
name some investigations carried out to diagnose MS
MRI scan
lumbar puncture - oligoclonal IgG bands
bloods - look for infection or other inflammatory cause
visual evoked potentials
82
what are the three management principles for MS
- treat symptoms
- manage relapses
- disease modifying treatments
83
name some common presentations of MS
optic neuritis
limb weakness
sensory disturbance
ataxia/diplopia/vertigo
84
how is neuromyelitis optica treated?
with immunosuppression
85
what is the variant of MS which immunosuppressed patients are more at risk of developing?
progressive multifocal leukencelopathy
86
what are the three main causes of ischaemia in the brain?
- atheroma/thrombosis
- thromboembolus
- ruptured aneurysm
87
in a brain specimen, what would an ischemic stroke caused by thrombosis look like?
wedge shaped area, soft and later cystic
88
name the common point of origin of an thromboembolus causing an ischemic stroke, and where in the brain it's most likely to end up
origin: left atrium
| often gets stuck in middle cerebral artery
89
a wedge shaped area of soft and cystic brain tissue is indicative of what?
ischaemic stroke
90
which two types of ischaemic stroke are likely to cause a wedge shaped area of neuronal damage?
thromboembolic
| thrombotic
91
what is the most common cause of a haemorrhagic stroke?
rupture of aneurysm
92
what causes the hypoxia in haemorrhagic strokes?
distal vasospasm of ruptured artery in attempt to stem bleeding
93
name two common areas in the brain where aneurysms are found, and what kind of aneurysms are likely to form there
circle of willis - berry aneurysms
| basal ganglia - microaneurysms
94
through which three mechanisms could generalised ischaemia in the brain occur?
- reduced oxygen in blood
- reduced blood flow
- reduced ability to use O2 in cells
95
name a few common causes of generalised ischaemia in the brain
cardiac arrest
respiratory arrest
hypotension
haemorrhage
96
what are watershed zones in the brain, and what causes ischaemia in those areas?
junctions between areas of brain tissue supplied by different arteries
ischaemia at these junctions is caused by generalised hypotension, causing adequate perfusion in main arteries but less in peripheral arteries
97
what type of ischaemia pattern is visible in the brain, when the cause of ischaemia is a generalised lack of perfusion?
cortical necrosis
98
what is cortical necrosis in the brain often due to?
generalised hypoxia/lack of perfusion
99
an epidural haematoma is most likely caused by rupture of what?
middle meningeal artery
100
a subdural haematoma is most likely caused by rupture of what?
bridging veins
101
a subarachnoid haemorrhage is most likely caused by rupture of what?
aneurysm (berry or microaneurysm)
102
haemorrhagic and ischaemic strokes are better visualised which which imaging techniques respectively?
haemorrhagic - CT scan
| ischaemic - MRI scan
103
during a stroke, the area of brain affected by ischaemia is divided in two zones. what are they called?
ischaemic core
| ischaemic penumbra
104
what is the radiological appearance of an epidural haematoma?
lens shaped
105
what is the radiological appearance of a subdural haematoma?
crescent shaped
106
what is small vessel lipohyalinosis, what causes it and what can it lead to?
it's thickening and narrowing of small arteries in the brain
| it's often caused by hypertension, and can lead to lacunar strokes
107
what is a stroke of the anterior cerebral artery likely to affect?
lower limbs - motor and sensory input
| gait
108
what is a stroke of the middle cerebral artery likely to affect?
face, arm and leg paralysis/sensation
speech affected - aphasia
vision affected - homonymous hemianopia, gaze paralysis to opposite side
sensation affected - one-sided neglect
109
what is a stroke in the posterior cerebral artery likely to affect?
vision
balance
breathing/HR control
110
name the arteries that supply the basal ganglia, and what artery they are branches of
lenticulostriate arteries, branches of MCA
111
name some contraindications to using thrombolysis for stroke treatment
> 3hrs since onset
any cause of potential bleeding
high blood pressure
glucose too low or too high
112
what are the two main treatments for acute ischaemic stroke?
- tPa (thrombolysis)
| - thrombectomy
113
what percentage of TIA patients go on to have a larger stroke within 2 weeks?
10%
114
name the common investigations carried out to confirm stroke diagnosis
bloods
ECG
CT scan
carotid doppler ultrasound
115
name two common causes for young onset ischaemic stroke
arterial dissection
cardioembolic
arteriovenous malformation
116
what are the signs of an upper motor neuron lesion?
```
muscle weakness
increased reflexes
increased tone
muscle wasting (only if lack of use)
positive Babinski sign
```
117
what are the signs of a lower motor neuron lesion?
decreased reflexes
decreased tone
muscle weakness
fasciculations
118
name some common surgical causes of myelopathy
tumour
vascular abnormalities
trauma
degenerative spine disorders
119
name some common medical causes of myelopathy
spinal cord stroke
demyelination
inflammation
B12 deficiency
120
what is the area of the spinal cord most vulnerable to spinal cord strokes, and why?
thoracic spinal cord
| because it's in a watershed zone between two joining blood supply regions
121
which spinal artery is most commonly affected in a spinal cord stroke?
anterior spinal artery
122
name some symptoms of a spinal cord stroke
```
onset over hours
back pain
increasing limb weakness
increasing sensory loss
urinary retention/incontinence
```
123
name some of the causes of a spinal cord stroke
```
atherosclerosis
thromboembolism
vasculitis/inflammation
hypotension
venous occlusion
hypercoagulability
```
124
how is a spinal cord stroke treated?
same as a normal stroke: address risk factors, anticoagulate, thrombolysis
125
define Brown-Sequard syndrome
myelopathy that only affects one half of the spinal cord
126
which imaging technique is normally used to diagnose a spinal cord lesion?
MRI scan
127
what kind of lesion does MS related spinal cord myelopathy often present as?
transverse myelitis
128
what is the treatment for myelopathy caused by B12 deficiency?
intramuscular B12 injection
129
where is the junction between the UMN and LMN?
when the fibres from the descending tract synapse with a second neuron
130
define myelopathy
injury to spinal cord due to compression causing UMN deficits
131
define radiculopathy
injury to spinal nerve root causing dermatome and myotome LMN deficits
132
what is the management of a disc prolapse?
discectomy
| rehabilitation
133
what are is the classic symptom triad of Cauda Equina Syndrome?
- saddle anesthesia
- bilateral sciatica
- urinary problems
134
how is Cauda Equina Syndrome diagnosed?
```
clinical diagnosis
radiological diagnosis (MRI)
```
135
what is the management of Cauda Equina Syndrome?
emergency discectomy
136
where are the majority of cord-compressing tumours located?
intradural/extramedullary
| extradural
137
what is the triad of symptoms to help diagnose a spinal abscess?
- pyrexia
- focal symptoms
- back pain
138
name two types of degenerative conditions which may require surgery for myelopathy or radiculopathy
cervical spondylosis
| spinal stenosis
139
what characterises lumbar spinal stenosis?
bilateral claudication
140
how is a spinal abscess managed?
- decompression
| - antibiotics
141
how is a spinal abscess diagnosed?
urgent MRI
142
list some risk factors which may contribute to spinal infections
- immunocompromised
- diabetes
- CKD
- alcoholism
143
name three common causes of myelopathy that require surgery, with examples of each type
infection - osteomyelitis, spinal abscess
degenerative - disc prolapse, spondylosis, stenosis
tumour - intra/extradural, intramedullary
144
how is lumbar spinal stenosis treated if it's causing neurological symptoms?
surgical laminectomy
145
how is cervical spondylosis treated if it's causing neurological symptoms?
conservative if mild, decompression surgery if severe
146
how are spinal tumours investigated and treated if causing neurological symptoms?
urgent MRI
| surgical decompression and radiotherapy
147
name three common organisms to cause epidural spinal abscesses
E coli
staph aureus
streptococci
148
what is a common cause of oculomotor (CNIII) palsy and why?
diabetes, microvascular changes affect nerve function
149
how is trigeminal neuralgia treated?
with carbamazepine or surgery
150
how is Bell's palsy treated? what is an important consideration in terms of the eyes?
with steroids
| give eye drops as palsy causes inability to close eye, drying it out and risking damage
151
what causes Horner's syndrome?
damage to sympathetic nerves to the face
152
list the three main symptoms of Horner's syndrome
ptosis
constricted pupil (miosis)
lack of sweating (anhydrosis)
153
describe the main presentation of CNIII (oculomotor) palsy
unilateral dilated pupil
impaired adduction of affected eye - "down and out" gaze
ptosis
154
describe the main presentation of CNVI (abducens) palsy
impaired abduction of affected eye
155
what is a common disorder affecting CNV (trigeminal), what can cause it and how is it treated?
trigeminal neuralgia
can be caused by nerve compression by an artery
treated with carbamazepine
156
what disease presents when the facial nerve (CNVII) be affected? how is it treated?
Bell's palsy
| treated with steroids
157
how can a patient's ability to lift their eyebrows determine whether they have an UMN or LMN lesion?
UMN - forehead spared
| LMN - unilateral forehead paralysis
158
what happens as a result of inflammation to the vestibular nerve?
labyrinthitis/vestibular neuritis
159
what does bulbar refer to?
anything related to the medulla
160
what is bulbar palsy?
damage to LMN in medulla related to CNVIII, CNIX, CNX and CNXI
161
what is pseudobulbar palsy?
bilateral damage to UMN coming from the cortex
162
name some symptoms which can occur in bulbar and pseudobulbar palsy
dysarthria
dysphagia
dysphonia
163
what signs are found in bulbar but not pseudobulbar palsy? why is that?
tongue fasciculations
tongue wasting
LMN lesion signs, fasciculations and wasting not present in UMN lesions
164
which cranial nerves are affected in bulbar palsy?
CNIX (glossopharyngeal), CNX (vagus), CNXII (hypoglossal)
165
in general terms, what does a cranial nerve palsy present with?
impaired function of that nerve
166
name a common disorder affecting the optic nerve (CNII) and what disease it's associated with
optic neuritis, commonly affects patients with multiple sclerosis
167
name a few causes of dilated pupils
```
young age
dark lighting
amphetamines
anxiety
CNIII palsy
coma
```
168
name a few causes of narrowed pupils
old age
bright light
opiates
Horner's syndrome
169
where is the cause of the problem likely to be if CNIII, CNIV and CNVI are all affected?
superior orbital fissure
170
how can a subarachnoid haemorrhage lead to communicating hydrocephalus?
breakdown blood products can block the arachnoid granulations into the venous sinuses
171
what are two commonest organisms causing meningitis?
```
strep pneumoniae (pneumococcus)
neisseria meningitidis (meningococcus)
```
172
what is the first line treatment for meningitis?
ceftriaxone
173
list some features of meningitis
```
meningism (photophobia, stiff neck)
fever
headache
seizures
raised ICP
focal symptoms
cranial nerve palsy
```
174
what investigations are done to diagnose meningitis?
bloods
blood cultures
lumbar puncture: CSF culture (bacterial) and PCR (viral)
175
which viral organisms may be involved in meningitis?
enteroviruses
176
what is the most common organism causing encephalitis?
HSV virus
177
what is the treatment of viral encephalitis?
aciclovir
178
name some organisms which may be involved in encephalitis
HSV
enteroviruses
arboviruses
179
which receptors are affected in auto-immune encephalitis?
NMDA receptors
| VGKC receptors
180
list some common features of encephalitis
```
preceding flu symptoms
headache
seizures
focal signs
raised ICP
```
181
list the investigations done to diagnose encephalitis
```
bloods
blood cultures
LP: CSF cultures (bacterial) and PCR (viral)
CT/MRI
EEG
```
182
what investigations are done for brain abscesses?
bloods
LP
CT/MRI
aspirate biopsy
183
how is a brain abscess/empyema treated?
drainage
| antibiotics - penicillin/ceftriaxone/metronidazole
184
what is the aetiology of Guillain-Barre syndrome?
post-infectious neuropathy - autoimmune reaction to neurons a few weeks after an infection
185
does Guillain-Barre syndrome present with ascending or descending paralysis?
ascending paralysis
186
does botulism present with ascending or descending paralysis?
descending paralysis
187
when should botulism be suspected?
IVDA
dilated pupils
descending paralysis
188
how are diseases like polio, rabies, tetanus and botulism treated?
vaccination
antibodies
antibiotics
189
how does tetanus present, and why?
presents with rigidity and spasticity, due to blockage of NMJ
190
how does botulism present, and why?
presents with flaccid paralysis, stops ACh release at NMJ
191
how is neurosyphilis treated?
with penicillin
192
how is lyme disease treated?
with ceftriaxone and doxicycline
193
what organism is responsible for syphilis?
treponema pallidum
194
what organism is responsible for lyme disease?
borrelia burgdorferi
195
what organism is responsible for leptospirosis?
leptospira interrogans
196
what class of bacteria do the organisms causing lyme disease and syphilis belong to?
spirochaetes
197
what is a common sign found on imaging in patients with variant CJD?
pulvinar sign
198
what causes CJD?
prions (eg misfolded proteins) causing other proteins to misfold
199
when should CJD be borne in mind as a differential?
when a patient presents with rapidly progressing dementia
200
what investigations are done for CJD?
bloods
LP - CSF culture/PCR
MRI
EEG
201
name a few possible types of CJD
sporadic CJD
familiar CJD
variant CJD
202
neurotropic infections from which organisms are more likely to present in immunocompromised patients?
```
toxoplasmosis gandii
cryptococcus neoformans
cytomegalovirus
aseptic meningitis/encephalitis
progressive multifocal leukoencelopathy (PML)
cerebral abscess
```
203
list a few types of skull fracture
```
linear fracture
depressed fracture
mosaic fracture
ring fracture
basal skull fracture
```
204
which types of brain haemorrhage are not associated with skull fractures?
subdural hematoma
| subarachnoid hematoma
205
in subarachnoid, subdural and epidural haemorrhages, which vessels are most likely affected?
subarachnoid - circle of Willis (berry aneurysms)
subdural - bridging veins
epidural - middle meningeal artery
206
why is it important to perform a head CT after an event which may have caused head trauma, even if the patient feels fine?
because the patient might be experiencing a lucid interval, before the haemorrage builds up and causes raised ICP
207
how does a patient present who has diffuse axonal injury (DAI)?
usually comatose
208
explain the term "one punch killer"
it's the term for punches which cause the head to suddenly swing upwards, causing a laceration of the vertebral artery and resulting in a traumatic basal subarachnoid haemorrhage
209
what is a contre-coup brain contusion?
damage to the brain surface caused by trauma to the opposite side of the brain
210
what is normally responsible for scalp lacerations vs incise injuries?
laceration injury - often blunt force trauma
| incise injury - normally sharp object eg knife
211
what is the physiological activity in vegetative state?
brainstem recovery post injury, but no recovery from cortex
212
what can cause "locked-in" syndrome, and what does it result in?
stroke in pons
| causes all nerve activity below CNIII to cease, so no motor or sensory activity
213
what GCS score counts as comatose?
GCS 8 or less
214
what needs to be looked for specifically when someone presents with a coma, to work out a possible differential?
- meningism
| - focal symptoms/lateralising
215
if a comatose patient presents with no meningism or focal symptoms/lateralising, what are some of the likely causes?
hypoxia/hypercapnia
metabolic causes
alcohol/drug intoxication
hypo/hyperthermia
216
if a comatose patient presents with meningism but no focal symptoms/lateralising, what are the likely causes?
meningitis
encephalitis
subarachnoid haemorrhage
217
if a comatose patient presents with focal symptoms and lateralising to one side (with or without meningism), what are the likely causes?
stroke (haemorrhage or infarct)
tumour
cerebral abscess
218
how is brainstem function assessed in comatose patients?
cranial nerve reflexes
219
name a few examples of metabolic causes which may result in a coma
```
hypoglycaemia
diabetic ketoacidosis
hepatic failure
renal failure
sepsis
```
220
what is the system called that determines being awake?
ascending reticular activating system
221
name the three initial neurological assessments carried out if someone presents in a coma
GCS
brainstem function
motor function and reflexes
222
which muscle disease can present with a rash, an what type of condition is it?
dermatomyositis - an inflammatory muscle condition
223
how are inflammatory muscle conditions investigated?
bloods: CK, ESR, AST, LDH levels
electromyography
serology for autoantibodies
muscle biopsy
224
how are inflammatory muscle conditions treated?
with steroids/immunosuppression
225
name two examples of similar NMJ diseases and explain the difference between them
myasthenia gravis
| lambert-eaton syndrome
226
what is the pathophysiology behind myasthenia gravis and lambert-eaton syndrome?
myasthenia gravis - ACh antibodies blocking post-synaptic ACh receptors
lambert-eaton syndrome - Calcium channel antibodies blocking vesicle exocytosis from pre-synaptic terminal
227
how does myasthenia gravis present?
```
fatiguability - symptoms worse as day goes on
ptosis
lid lag
diplopia
slurred speech
swallowing problems
respiratory problems
muscle weakness
```
228
how can lambert-eaton syndrome be differentiated from myasthenia gravis in terms of symptoms?
in lambert-eaton syndrome, symptoms improve after exercise
| in myasthenia gravis, symptoms get worse throughout the day
229
how are NMJ disorders investigated?
serology - autoantibodies
bloods - CK, AST, LDH
muscle biopsy
EMG
230
what imaging test is always done in myasthenia gravis, and why?
CT chest to look for thymus abnormalities - can cause myasthenia gravis-like symptoms
231
what structural abnormality is associated with myasthenia gravis?
thymus hyperplasia or thymoma
232
how is myasthenia gravis treated?
```
acetylcholinesterase inhibitors (pyridostigmine)
immunosuppression
immunoglobulins
plasmapheresis
thymectomy
```
233
name the types of nerve fibres found in a peripheral nerve
```
motor fibres
sensory fibres (pain/temp and touch/pressure./vibration)
autonomic fibres (symp and parasymp)
```
234
list a few common causes of peripheral neuropathy
diabetes
alcohol
drugs
inflammatory (guillain-barre syndrome)
235
what are the two most common pathophysiological processes behind peripheral neuropathy?
axonal damage
| demyelination
236
list some investigations that are done for nerve diseases
```
bloods
genetic testing
nerve conduction tests
nerve biopsy
lumbar puncture
```
237
what characterises motor neuron disease symptoms?
they have both UMN and LMN features
238
list some features of motor neuron disease
```
weakness
increased reflexes
increased tone
fasciculations
muscle wasting
```
239
in which order are motor neurons often affected in motor neurone disease?
limbs first
bulbar next
respiratory last
240
how is MND investigated?
examination - UMN and LMN signs
nerve conduction studies
genetic testing
241
how is MND treated?
supportive and palliative care
242
list some of the types of brain herniation which can occur
```
cingulate
central
uncal
transcalvarial
cerebellotonsillar
```
243
name two common symptoms/signs found in raised intracranial pressure due to a tumour
morning headache + vomiting
| papilloedema
244
name a common malignant brain tumour in children
medulloblastoma
245
why are all glial brain tumours classed as malignant?
because they can cause significant damage even if slow growing
246
what is an unusual characteristic of malignant gliomas?
they can't metastasise outside CNS despite aggressiveness, because they can't cross BBB
247
where are the majority of brain tumours found in adults and children?
adults - cerebrum
| children - cerebellum and brainstem
248
are meningiomas slow or fast growing?
slow growing
249
name a few common tumours which metastasise in the brain
```
breast
lung
melanoma
renal
colorectal
```
250
what is an acoustic neuroma?
shwannoma of CNVIII (vestibulocochlear)
251
why are CNS lymphomas difficult to biopsy?
because they often sit in a deep central area of the brain
252
list some presenting symptoms of brain tumours
```
morning headache
nausea and vomiting
vision problems
drowsiness
reduced conscious level
seizures
focal symptoms
```
253
list some presenting signs of brain tumours
```
papilloedema
CNIII and CNVI palsy
reduced GCS
altered consciousness
focal signs
```
254
what investigations should be done if a brain tumour is suspected
identify lesion: CT/MRI scan
find out if primary or met: chest/abdo or pelvic XR
characterise lesion: biopsy
255
what are the management options for brain tumours?
treat symptoms: mannitol, steroids, antiemetics, anticonvulsants
surgery: remove tumour or debulk
medical: radiotherapy/chemotherapy
256
what drugs are sometimes used to alleviate cluster headaches?
with the use of triptans
257
how is paroxysmal hemicrania treated?
with indomethacin
