neuro Flashcards
1
Q
what is superiorly at the brainstem
A
thalamus n internal capsule
2
Q
what is inferiorly at the brainstem
A
spinal cord
3
Q
what are descending motor tracts
A
pyramidal tracts
4
Q
what are ascending sensory tracts
A
lemnisci
5
Q
what are some tumours affecting brainstem?
A
meningioma
schwannoma
astrocytoma
metastasis
6
Q
what is an inflammatory disorder affecting brainstem
A
MS
7
Q
what is criteria for brainstem death?
A
pupils corneal reflex cough reflex gag reflex respirations response to pain
8
Q
what does peripheral neuropathy refer to?
A
any disorder of the PNS
9
Q
what is diff btwn acute and chronic neuropathies?
A
acute - evolve rapidly, severe enough to make pt seek A&E help
chronic - outpatient setting, can be further classified based on pathology and neurophysiological findings
10
Q
which are the large myelinated fibres?
A
a alpha (proprioception)
a beta (light touch, pressure and vibration)
11
Q
which re the small fibres?
A
a alpha (myelinated) c (unmyelinated)
both transmit signals regarding pain
also a alpha - cold sensation
c - warm sensation
12
Q
what is mononeuropathy
A
problem w/ 1 nerve
13
Q
what is polyneuropathy
A
problem w/ many nerves
14
Q
name some common mononeuropathies
A
carpal tunnel syndrome (median nerve)
ulnar neuropathy (entrapment at cubital tunnel)
peroneal neuropathy (entrapment at fibular head)
15
Q
what is ataxia?
A
poor balance
sensory (loss of proprioception) or cerebellar
when sensory, ataxia gets worse w/ eyes closed or when dark
16
Q
how do peripheral neuropathies present differently?
A
symmetrical (sensorimotor)
asymmetrical (sensory)
asymmetrical (sensorimotor)
17
Q
how do symmetrical peripheral neuropathies present?
A
initially sensory, but eventually sensorimotor
commonest type
18
Q
how does asymmetrical peripheral neuropathies present?
A
patchy distribution of symptoms
dorsal root ganglia affected
uncommon - paraneoplastic, sjogre, gluten sensitivity
19
Q
how do asymmetrical sensorimotor peripheral neuropathies present?
A
mononeuritis multiplex
very uncommon
painful
20
Q
how do u clinically examine peripheral neuropathies?
A
reduced/absent tendon reflexes
sensory deficit
weakness - muscle trophies
21
Q
what is axonal peripheral neuropathy associated with?
A
systemic disease
22
Q
what does chronic mean?
A
develops over at least 6m
23
Q
what does idiopathic mean?
A
no aetiology can be identified despite extensive investigations
24
Q
how do u treat chronic neuropathies?
A
symptomatic treatment
aim to stop disease progression
25
what are the 3 main branches of the aortic arch?
brachiocephalic (R CC & R sub)
L common carotid
L subclavian
26
where does the R CCA arise from?
brachiocephalic artery
27
where does the L CCA arise from??
aortic arch
28
does the CCA have any branches? where do they bifurcate?
no - C3-4
29
what do the CCA split into?
internal and external carotid arteries (At upper border of thyroid cartilage)
30
where is a typical area to see carotid artery dissection?
carotid canal - vulnerability of anatomical dissection bc of
31
what are the 4 "parts" of the internal carotid artery?
cervical
petrous
cavernous
supraclinoid (intradural)
32
what do the sup hypophyseal arteries supply?
pit gland/stalk
hypothalamus
optic chiasm
33
what does the anterior choroidal artery supply?
```
choroid plexus
optic tract
cerebral peduncle
internal capsule
medial temporal lobe
```
34
look at territories supplied by MCA/ACA/PCA
!
middle - outer bits on both sides
anterior - where 2 hemispheres connect
posterior - back of head, post lobe
35
what are the 2 types of head injury?
non-missile - BLUNT (most common)
| missile - PENETRATING (penetration of skull/brain)
36
how can lesions be distributed?
focal
| diffuse brain lesions
37
what is primary vs secondary time course of trauma?
primary - immediate biophysical forces of trauma
secondary - presenting some time after traumatic event
38
what is some focal damage in diff areas after non-missile (blunt) trauma
(scalp, skull, meninges, brain)
scalp - lacerations
skull - fracture
meninges - haemorrhage, infections
brain - confusions, infection etc
39
what is some diffuse brain lesion damage ???? after non missile/blunt trauma
diffuse axonal/vascular injury
hypoxia-ischaemia
swelling
40
what does skull fracture imply? (4)
considerable force
incr risk of haematoma/infection/aerocele
angled/pointed objects - localised fractures, open/depressed
flat surfaces - linear fractures, can extend to skull base
41
what is sig abt fracture lines?
1 fracture line will not cross any other fracture lines ... can deduce order from this
42
what are extradural haematomas like ? (3)
cause? time frame? how can they cause death?
skull fracture
occurs slowly over hrs
can cause death by: brain displacement, herniation, raised ICP
43
what are extradural haematomas?
what are they usually associated with?
collection of blood that forms between the inner surface of the skull and outer layer of the dura (endosteal layer).
usually associated with a history of head trauma and frequently associated skull fracture.
44
what are subdural haematomas like ? (4)
why do they happen?
what is the onset?
what are they usually surrounded by?
what can they cause?
(underneath dura mater)
usually due to tears in bridging veins
can occur slowly ('chronic') in shrunken (old, alcoholic?) brains as well as acutely
usually surrounded by membrane of granulation tissue
cause of cog decline in elderly ! treatable
45
what are some causes of a traumatic subarachnoid haematoma?
punch in the neck - rupture of vertebral artery
laceration
base of skull fracture
IV haemorrhage
46
what is diff btwn superficial and deep cerebral/bellar haemorrhage
superficial: due tos evere contusion (bruise)
deep: related to diffuse axonal injury
47
what is a contusion?
bruise
48
what is a risk for any head injuries in A&E?
meningitis
49
what is a neuro laceration?
when contusion sufficient enough to tear in layer of brain (pia mater)
50
what is diff btwn coup contusion and contre coup?
coup = at site of impact
| contre coup = away from site of impact
51
what is mild traumatic axonal injury?
hurt ur head, have recovery of consciousness ± LT, variable severity deficit
52
what is severe traumatic axonal injury?
hurt ur head, become unconscious from impact & remain so or severe disability
53
what does brain swelling lead to?
increased ICP
54
name 2 causes of brain herniation
bleeding
| brain swelling
55
hypoxia-ischaemia is likely in which patients who've had? (3)
- clinically evident hypoxia
- hypotension w systolic BP <80mmHg for ≥15mins
- raised ICP
56
what is 1 of the LT consequences of head injuries?
chronic traumatic encephalopathy eg Muhammad Ali
57
what happens in chronic traumatic encephalopathy?
repetitive mild traumatic brain injury
initially irritability, aggression, depression, memory loss
then dementia, gait/speech issues, parkinsonism
some have MND-like symptoms
58
what are some infective causes of meningitis?
bacterial
viral
fungal parasitic
59
what is the first line of treatment usually before diagnosis of meningitis?
antimicrobials
60
the syndrome of meningitis must be administered from what?
brain abscesses and encephalitis, other major CNS syndromes
61
what is meningitis?
inflammation of meninges (Pia mater, arachnoid, dura)
62
what are some non-infective causes of meningitis?
paraneoplastic
drug side effects
auto immune eg vasculitis/SLE
63
how does brain infection get in?
neurosurgical complications eg post op, trauma
extracranial infection eg nasopharynx, ear, sinuses
via bloodstream ie bacteraemic
64
what is the pathophysiology of meningitis?
bacteria enters CSF
can be isolated from immune cells due to BBB
replicates
BVs become leaky - WBCs enter CSF/meninges/brain
results in meningeal inflammation ± brain swelling
65
what are 3 classic symptoms of meningitis?
fever
headache
neck stiffness - "meningism"
(can't tolerate bright light)
66
20% of bacterial meningitis patients can have permanent effects. list some
```
skin scars
amputation
hearing loss
seizures
brain damage
```
67
what does GCS (Glasgow coma score) help us determine
how sick pt - lower score = sicker
if they can maintain own airway
if there's any raised ICP
68
what are 4 immediate management steps for someone who has bacterial meningitis?
1. assess GCS
2. blood cultures
3. broad spectrum ABs (ceftriaxone, cefotaxime - both cross BBB)
4. steroids (IV dexamethasone)
69
what is a definitive investigation to diagnose meningitis?
lumbar puncture
70
what are some contraindications to lumbar puncture?
```
abnormal clotting (platelets/coagulation)
petechial rash
raised ICP
```
71
what are some risk factors for bacterial meningitis
students
travel
(immunosuppressed)
72
what are some risk factors for viral meningitis
small children
| immunosuppressed
73
if meningitis is in bloodstream, what do u get?
meningococcal septicaemia
non-blanching purpuric rash, necrosis, high mortality !
74
differential diagnosis for meningitis :
!subarachnoid haemorrhage! - trauma - "thunderclap" onset
also migraines, flu, brain abscess, malaria
75
what is encephalitis?
inflammation of the brain
76
what are causes of encephalitis?
p much always viral - herpes simplex (coldsore)
varicella zoster virus (chickenpox/shingles)
ask abt TRAVEL! eg rabies etc
77
what is the clinical present of encephalitis:
hrs to days: preceding 'flu-like' illness
then: altered GCS (confusion, drowsiness), fever, seizures, memory loss, ± meningism)
78
how do u manage encephalitis
MRI head ± EEG
lumbar puncture
DO A HIV TEST
treat: mostly supportive
recovery can be v long process
79
how does tetanus happen?
inoculation through skin w/ clostridium tetani spores found globally in soil
eg stepping on nail, dirty wounds
80
what happens in tetanus?
tetanospasmin (toxin that bacteria prod) - travels retrogradely along axons
interferes w neurotransmitter release - incr neutron firing - unopposed muscle contraction/spasm
81
how can tetanus be managed?
if at risk injury - vaccinate!
if symptomatic - support (muscle relaxants), IG, AB (metronidazole to clear any residual bacteria that may prod toxins)
82
how does rabies happen?
viral infection
inoculation through skin with saliva of rabid animal eg dogs/cats/foxes eg lick, bite, splash
travels retrogradely along nerves
83
how is rabies managed?
most ppl die
managed with sedatives
prophylaxis is key
84
what is dementia?
a set of symptoms - inc memory loss, problem solving language
gradual onset and progressive
Alzheimer's is the commonest cause of dementia
85
what is Alzheimer's disease a problem w?
storing of memories
86
what makes up the exclusion criteria for Alzheimer's?
sudden onset
| early occurrence of: gait, seizures, major behavioural changes
87
which med cond are severe enough that u can't diagnose Alzheimers?
major depression
| cerebrovascular disease
88
what is pseudodementia?
depressie dementia
89
what is the diff in depression/dementia on onset?
depression - trigger, onset/decline rapid
dementia - vague, insidious onset
90
what is the diff in depression/dementia on memory loss?
depression - aware, complaints of memory loss
dementia - unaware/attempt to hide problems
91
what is mood diff in depression vs dementia
depression - patient unhappy. "don't know" answers
dementia - mood labile. attempts all questions
92
why Is temp lobe important?
```
hearing
language comprehention
semantics
memory
emotional/affecting behaviour
```
93
what happens in dementia with levy bodies (3)
fluctuation cognition
visual hallucinations
spontaneous Parkinsonism
94
why do u do a structural MRI in dementia patients?
to rule out other causes
see atrophy as a biomarker
95
what are the 2 main medications for dementia?
acetylcholine esterase inhibitors
memantine (anti-glutamate)
96
which diagnostic tests can be used for Alzheimer's pathology
non-invasive (amyloid and tau PET ? imaging)
97
what are some key features of MS?
inflammatory, demyelinating tissue
specific to CNS
usually begins 20-40 yrs
progressive disability over time
98
which pops is MS more common in?
caucasian
prevalence can be altered by env change - age of migration is critical
99
what are the 2 types of lesions in MS?
active and inactive
100
what are common sites for plaque distribution in MS?
cerebral hemispheres
spinal cord
optic nerves
medulla/pons
101
what are some typical symptom in MS?
optic neuritis
spasticity
sensory symptoms/signs
bladder/sexual dysfunction
102
what are some atypical symptoms in MS?
aphasia
hemianopia
severe muscle wasting
103
what is the majority of MS patient's course of illness?
in a relapsing/remitting fashion ... full recovery from disease, stable until next attack etc etc cycles !
don't need to recover fully each time
104
what are the 2 essential diagnostic criteria for MS?
2+ CNS lesions disseminated in time/space
exclusion of cond giving a similar clinical picture
105
what are some conditions misdiagnosed as MS?
SLE
lyme disease
syphilis
AIDS
106
what is the gold standard investigation for MS?
imaging !!!!!!!! MRI
107
blackouts can be bc of what?
problem w/ blood circulation (heart/BP)
disturbance of brain function (epilepsy)
108
what are the 2 types of seizures?
epileptic seizures and stress-related (non-epileptic) seizures
109
what are the 3 types of epilepsy - following epileptic seizures
idiopathic generalised epilepsy
unclassifiable epilepsy
focal epilsepsy
110
what is an epileptic seizure?
paroxysmal event in which changes of behaviour/sensation/cog processes are caused by excessive, hypersynchrous neuronal discharges in the brain
111
what is the usual duration of epileptic seizures
30-120s
112
what happens in an epileptic seizure?
"positive" ictal symptoms (seeing/hearing/feeling stuff that aren't there)
may occur from sleep
may be associated with other brain dysfunction
typical seizure phenomena: lateral tongue bite, deja vu etc
113
what is syncope?
paroxysmal event in which changes in behaviour/sensation/cog processes are caused by an INSUFFICIENT BLOOD/OXYGEN SUPPLY to the brain
114
list some syncope characteristics
situational
sitting/standing
rarely from sleep
presyncopal symptoms (seeing stars, distorted noises, dizzy/light headed, blacked out vision)
duration 5-30 seconds
recovery within 30 seconds
115
what is cariogenic syncope like ?
less warning
| history of heart disease
116
define non-epileptic seizure
paroxysmal event in which changes in behaviour/sensation/cog function caused by MENTAL PROCESSES ASSOCIATED W/ PSYCHOSOCIAL DISTRESS
117
what are some characteristics of non-epileptic seizures
situational
duration 1-20 mins
eyes closed
ictal crying/speaking
instead of panic attack ?
surprisingly rapid/slow postictal recovery
history of psych illness esp PTSD
118
what are some factors suggestive of epilepsy
tongue biting
head turning
muscle pain
119
what are some factors suggestive of syncope
prolonged upright position
sweating prior
nausea
presyncopal symptoms
120
what is focal epilepsy?
associated w/ focal brain abnormality, starts at any age
partial seizures w or w/o impairment of consciousness
1st line treatment: carbamazepine
121
what is idiopathic (primary) generalised epilepsy?
no associated brain abnormality, manifestation usually <30 years
absence seizures, myoclonic seizures or primary generalised tonic clonic seizures
1st line treatment:
valproate
122
how do anti-epileptics work?
taget GABA receptor/transporter or GABA transaminase
123
what do u do if anti-epileptics don't work?
alternative mono therapy, combo therapy
consider epilepsy surgery - vagal nerve stimulator
124
what is essential in epilepsy diagnosis?
patient and witness history !
125
what's the diff btwn new and conventional anti-eleptics
not much in terms of effectiveness but fewer side effects
126
define stroke
a clinical syndrome, caused by cerebral infarction/haemorrhage, typified by rapidly developing signs of focal/global disturbance of cerebral functions lasting more than 24h or leading to death
127
define TIA (transient ischaemic attack)
acute loss of cerebral/ocular function with symptoms lasting less than 24h caused by an inadequate cerebral or ocular blood supply as a result of low blood flow, ischaemia, or embolism associated with disease of the BV, heart or blood
128
what are the majority of strokes?
ischaemic (85%)
129
what happens in ischaemic strokes
BV in brain blocked
usually atherosclerotic plaque/clot in larger artery ruptures, travels downstream, gets trapped in narrower artery in brain
embolic strokes are common complications of atrial fib and atherosclerosis of carotid arteries
130
what are the minority of strokes caused by (15%)?
haemorrhage
bleeding from BV in the brain
high BP is main cause of intracerebral haemorrhagic stroke
131
someone presenting w/ an acute onset, ongoing focal near deficit that cannot be explained by hypoglycaemia or other stroke mimics .. suspect what?
stroke
132
obstruction ot MCA can cause what
facial weakness
unilateral weakness of upper/lower limb
unilateral sensory loss of upper/lower limb
speech problems
133
obstruction of PCA can cause what
visual defects
disorders of perception
disorders of balance
co-ordination disorders
134
obstruction of ACA can cause what
unilateral weakness + sensory loss of upper/lower limb
135
what cond does stroke mimic?
migrainous aura
hypoglycaemia
mass lesions eg subdural haematoma, tumour
136
how do u manage a suspected stroke
arrange emergency admission to specialist stroke unit
999 or 1 hr admission
137
what do u do in a TIA?
assess risk of stroke in next 7d using ABCD^2 score
138
how do u assess risk of stroke in next 7d - and how is this scored
ABCD^2 score
A - age (60+) = 1pt
B - BP at pres (140/90+) = 1 pt
C - clinical features (unilateral weakness = 2pt, speech disturbance w/o weakness = 1pt)
D - duration (60min+ = 2pts, 10-59mins = 1pt)
D - diabetes presence = 1pt
139
what is high risk ABCD^2 score
4+
atrial fib
more than 1 TIA in a week
TIA whilst on anticoagulant
140
what do u do for a low risk stroke patient
how does this differ to a high risk?
refer for specialist assessment within 7d of symptom onset
start statin - simvastatin 40mg
antiplatelets - aspirin/clopidogrel 300mg
treat BP if raised
no driving until seen by specialist
HIGH RISK - same as above but within 24H
141
what is primary health care
1st point of contact for healthcare - for new issues inc urgent/emergency and for ongoing issues
eg GP, walk-in, minor injuries, dentist, ?999
142
what is MND aka?
ALS (amyotrophic lateral sclerosis)
143
what does ALS stand for
amyotrophic lateral sclerosis aka MND
144
why are brain tumours sig?
20% of childhood cases !
145
where do the majority of brain tumours occur in adults?
supratentorial
146
where do the majority of brain tumours in children occur?
posterior fossa
147
list some neuroepithelial tumours
```
astrocytic
oligodendroglial
neuronal and neuro-glial
choroid plexus
embryonal etc
```
148
how do brain tumours clinically manifest?
loss function
seizures
raised ICP!
149
what is the most frequent primary brain tumour and who does it occur in?
astrocytic tumours
150
how can astrocytic tumours be classified
diffuse astrocytomas
| other types eg pilocytic
151
what are diffuse astrocytomas like ?
infiltrate diffusely
| propensity to undergo progressive anaplasia
152
what is anaplasia?
condition of cells with poor cellular differentiation, losing the morphological characteristics of mature cells and their orientation with respect to each other and to endothelial cells.
153
how does a pilocytic astrocytoma grade into a glioblastoma? (more severe, worse prognosis)
pilocytic astrocytoma - diffuse astrocytoma - anaplastic astrocytoma - glioblastoma
154
discuss oligodendroglioma
most common 4/5th decades
may have seizures
WHO grade 2
calcification recognised on scan
155
what are the aims with gliomas? to identify?
tumour type
tumour grade
additional prognostic markers
predictive markers
156
discuss pilocytic astrocytomas (WHO grade 1)
```
children!
posterior fossa - cerebellum
also at optic nerves, hypothalamus
often cystic
good prognosis
```
157
what is medulloblastoma like ? (who grade 4)
primitive "small blue cell" tumour of cerebellum
childhood
highly malignant
may respond to exicison/radio/chemo
158
what is a meningioma?
dural based
push into brain
most grade 1, more aggressive variants (2/3) exist
159
what are the most common sites for metastases to the brain?
lung (45%)
breast (25%)
melanoma (12%)
160
discuss 4 point about brain tumours !
unique features associated with CNS env
mass effects are important
graded by WHO scheme, but conventional pathological staging not used
moving towards integrated histo/molec diagnosis for better treatment stratification
161
what are some anatomical effects of a mass lesion? (3)
1. local deformity and shift of structures
2. decreased CSF volume
3. pressure gradients - internal herniation
162
list some examples of inter-cranial haemorrhages
extradural haemorrhage
subdural " "
subarachnoid " "
intracerebral " "
163
what are the 3 layers of meninges, n give. adescription of each
Pia - on surface, cannot be separated from brain
Arachnoid - more adherent to brain
Dura - usually firmly adherent to inside of skull
164
where are meningeal vessels?
in the extradural space
165
where do bridging veins cross
subdural space
166
which space does the circle of willis lie in?
subarachnoid pace
167
are there any vessels deep to the Pia?
no - Pia forms part of BBB
168
list 6 points about extradural haemorrhages
1. traumatic
2. fractured skull
3. bleeding from middle meningeal artery
4. lucid period
5. rapid rise in ICP
6. coning and death if not treated
169
bleeding from MMA can result in which haemorrhage?
extradural
170
list 5 points about subdural haemorrhages
1. bleeding from bridging veins
2. these bridging veins bleed, low pressure so soon stops
3. days/weeks later, haematoma starts to autolyse
4. massive increase in oncotic/osmotic pressure - sucks water into haematoma
5. gradual rise in ICP over many weeks
171
which type of haemorrhage is commonest where the patient has a small brain? and list why someone might have a small brain
subdural haemorrhage
alcoholics, dementia
172
list 5 points about subarachnoid haemorrhages
1. rupture of arteries forming circle of willis
2. often bc of berry aneurysms
3. sudden onset severe headache, photophobia and reduced conciousness
4. 'thunderclap headache'
5. rapidly fatal - commonest source of organs for transplant since seat belts made compulsory
173
bleeding from bridging veins can result in which type of haemorrhage?
subdural
174
berry aneurysms can result in which haemorrhage?
subarachnoid
175
trauma can result in which haemorrhage and why?
extradural - bleeding from MMA
176
is there recovery with embolic strokes?
no
177
is there recovery from haemorrhage strokes?
possibly
178
what happens in an embolic stroke?
death of cell bodies in cortex
'small' well defined territory of loss of motor/sensory function
179
what happens in a haemorrhage stroke?
compression of internal capsule - no death of cells
large territory of loss of motor/sensory function
180
which type of stroke is where cell death occurs?
embolic
181
what is the function of CN I?
olfactory - smell
182
what is the function of CN II?
optic - light pathway, neuronal pathway
183
what is the function of CN III?
oculomotor - bilateral cortical
innervation of nuclei, eye movements
184
what is the function of CN IV?
trochlear - bilateral cortical
| innervation of nuclei, eye movements
185
what is the function of CN V
trigeminal - motor, bilateral;
sensory, contralateral.
sensation face, muscles of mastication
186
what is the function of CN VI
abducens - bilateral cortical
innervation of nuclei, eye movements
187
what is the function of CN VII
motor, bilateral to forehead
motor, contralateral to the rest of the face
sensory, contralateral (taste)
188
what is the function of CN VIII
vestibular, ipsilateral; cochlear, bilateral
hearing, balance
189
what is the function of CN IX
glossopharyngeal
motor, bilateral; sensory, contralateral
sensation back of throat
190
what is the function of CN X
vagus
motor, bilateral; sensory, contralateral
motor pharynx; autonomics complex
191
what is the function of CN XI
spinal accessory
motor, bilateral
shrugging shoulders, turning head
192
what is the function of CN XII
hypoglossal
motor, bilateral
sticking tongue out
193
what proportion of brain tumours are malignant?
over 50%
194
what is the commonest brain tumour?
secondary/metastatic tumour with another primary source eg lung, breast
195
do you use the TNM staging system for brain tumours
no
use WHO classification - histology
196
for brain malignancy what does grade I mean? what does grade IV mean?
grade I - most benign
| grade IV - most malignant
197
what is the most common primary brain tumour
glioma
198
what is a glioma a tumour of?
glial cells: astrocytes, oligodendrocytes, ependymal cells
199
85% of all new cases of malignant primary brain tumour are what?
high grade glioma
200
what are symptoms of brain tumour
variable
headaches
seizures
focal neuro symptoms
201
what is the classic brain tumour symptom?
raised ICP headache
worse in morning/lying down
associated with N&V
exacerbated by cough/sneezing
drowsiness
202
what are signs of a brain tumour?
papilloedema (swelling of optic disc)
focal neuro deficit eg visual field defect, dysphasia
203
what are red flags with headaches?
features of raised ICP
papilloedema
focal neuro
check for field defect
204
if there's a long history of isolated headaches, what is unlikely?
a brain tumour
205
how do low grade brain tumours typically present
w/ seizures
| can be incidental
206
how do high grade brain tumours typically present
rapidly progressive neuro deficit
| symptoms of raised ICP
207
what are investigations for brain tumours
CT w/ contrast
MRI
brain biopsy
208
what is treatment for brain tumours like
non-curative, except for grade I
only 19% survive 5+ years
209
what are some treatments for a high grade glioma?
steroids - reduce oedema
surgery - biopsy/resection
radiotherapy
chemotherapy
210
what are some "hardware" diseases of basal ganglia
parkinson's
| huntington's
211
what are some "software" diseases of the basal ganglia
essential tremor
dystonia
tourette
212
what are the 3 main symptoms in Parkinson's?
brady/akinesia
tremor
rigidity
213
what is brady/akinesia like in Parkinson's?
problems w doing up buttons, keyboards etc
writing smaller
walking deteriorated: small stepped, dragging 1 foot etc
214
what is tremor like in Parkinson's?
at rest
may be unilateral
215
what is rigidity like in Parkinson's?
pain
problems w turning in bed
216
what can u see in the midbrain in Parkinson's disease?
diminished/paler substantial nigra
presence of Lewy bodies?
217
what is the main drug for Parkinson's?
L-Dopa
218
what is L-dopa changed into in the body?
dopamine
219
how can l-dopa action be supported?
dopamine agonists
or monoamine-oxidases (enzyme inhibitors) - red breakdown of naturally occurring dopamine
220
what is the issue with anticholinergics?
many side effects:
- cognition
- confusion
- systemic
221
what are some motor complications of late-stage PD?
med doesn't work as long as before
freezing - unpredictable loss of motility
on and off dyskinesias
222
what else is common in Parkinson's?
depression
other psych problems
dementia
autonomic problems eg constipation, incr urine frequency
223
which symptoms shouldn't be present in Parkinson's?
incontinence
dementia
symmetry
early falls
224
what are the 3 cardinal features of Huntington's disease?
chorea (jerky involuntary movements affecting esp shoulders, hips, n face.
dementia
psychiatric problems
225
what do u find o/e of a Huntington's patient?
abnormal eye movements
chorea
ataxia
often additional "touch of Parkinsonism"
226
define weakness/paresis
impaired ability to move a body part in response to will
227
define paralysis
ability to move a body part in response to will is completely lost
228
define ataxia/incoordinationz
willed movements are clumsy, ill-directioner or uncontrolled
229
what are involuntary movements?
spontaneous movement of a body part, independently of will
230
what is apraxia?
disorder of consciously organised patterns of movement or impaired ability to recall acquired motor skills
231
what are the 5 steps to movement organisation
1. idea - association areas of cortex
2. activation of UMN in precentral gyrus
3. impulses travel to lMN and their motor units via corticospinal (pyramidal) tracts
4. modulating activity of cerebellum n basal ganglia
5. further modification of movement depending on sensory feedback
232
where are LMNs located
anterior horns of SC and in CN nuclei in the brainstem
233
what is the final common pathway by which the CNS controls voluntary movement
LMN --> axon (nerve root and peripheral nerve) --> NMJ --> muscle fibres
234
what is a motor unit?
basic functional unit of muscle activity
LMN + axon + several supplied muscle fibres
235
what are stretch receptors in muscle called
muscle spindles
236
what are stretch receptors in muscle (muscle spindles) innervated by?
gamma motor neurones
237
what are some potential sites of damage along the final common pathway
```
motor nuclei of CN
motor neurones in SC
spinal ventral roots
peripheral nerves
NMJ
muscle
```
238
list 4 clinical features of LMN lesions
muscle tone normal/reduced (flaccid)
muscle wasting
fasciculation - visible
spontaneous contraction of motor units
reflexes depressed/absent
239
what do LMN lesions usually result in?
everything going DOWN
240
how do u investigate LMNs
neurophysiology nerve conduction studies
neuro-imaging - MRI scan head/spine
blood tests eg muscle enzymes, auto-antibodies
lumbar puncture
241
what is the corticospinal tract?
a major descending pathway connecting UMN & LMNs, important in control of voluntary movements
242
what is the corticospinal tract aka
pyramidal tract
243
list some clinical features of UMN pathology
muscle tone increased (spasticity)
tendon reflexes/jaw jerk are brisk
plantar responses extensor (+ Babinski sign)
characteristic pattern of limb muscle weakness, pyramidal pattern
emotional lability may be present
244
what do UMN lesions usually result in?
everything goes UP
245
what are some common causes of UMN pathology
vascular disease
inflammatory eg MS
compression of brain/spine
neurodegenerative disease of UMN ± LMN eg MND
246
how do u investigate UMN issues
neuroimaging - MRI brain/spine
blood tests for metabolic disorders
CSF exam
247
what are the likely levels of UMN
cortex
internal capsule
brainstem
SC
248
what are the likely levels of LMN
LMN
spinal root
peripheral nerve
NMJ
muscle
249
what is prophylaxis?
treatment given or action taken to prevent disease
250
what does the cerebellum do?
contains complete motor/sensory rep of whole body
contains timing/pattern of motor activating during movement
251
what does cerebellar dysfunction cause?
ataxia
252
what are the only output element of cerebellum?
purkinje cells
253
list symptoms of cerebellar dysfunction
slurring of speech (Staccato speech)
swallowing dificulties
clumsiness (arms/legs)
tremor
unsteadiness when walking
stumbles n falls
254
what do u examine for cerebellar dysfunction
```
gait
limb ataxia
eye movements
speech
sensory ataxia
```
255
list some signs of cerebellar dysfunction
nystagmus (other abnormalities of eye movements)
dysarthria
action tremor
truncal ataxia
limb ataxia
256
what is mild ataxia?
mobilising independently or walking with 1 walking aid
257
what is severe ataxia?
predominantly wheelchair dependent
258
what is moderate ataxia?
mobilising with 2 walking aids/walking frame
259
how can ataxias be classified?
congenital
diseases where ataxia is 1 of many features
familial ataxias (presumed genetic) - AD & AR
sproadic (acquired) ataxias
260
what are some history clues to classify ataxia
congenital vs early onset s late
rate of progression
episodic
pure ataxia or ataxia + sensory symptoms/leg stiffness/deafness etc
speech affected early
urinary, postural, nocturnal symptoms
261
what are some investigations for ataxia
MRI will exclude:
- post circ stroke
- tumours
- MS
etc
262
what is the commonest genetic ataxia?
Friedrichs ataxia (FA)
can cause CV issues
263
name some vaccine preventable neurological cond
polio
tetanus
measles
tuberculosis
264
define epidemiology
study of the distribution/determinants of health-related states/events in specified pops; and the application of this study to control health problems
265
define migraine (3)
unilateral pain distribution
premonitory visual disturbance
presence of nausea or vomiting
266
what is MS
multiple areas of demyelination in brain/SC
267
what does myasthenia mean?
muscle weakness
268
what do myasthenia gravis patients have?
antibodies against nicotinic acetyl choline receptors
269
what is the history of myasthenia gravis like?
fluctuating ocular weakness
bulbar (speech n swallow)
limb smyptoms
fatigability
SOB
270
what do u see in a myasthenia gravis exam?
complex ophthalmoplegia: ask look to RHS - left eye should adduct
ptosis (drooping of the upper eyelid)
head drop
limb fatiguability
271
if a patient has complex ophthalmoplegia ... what 3 cones do u think?
myasthenia gravis
thyroid eye disease - graves' disease
mitochondrial disorders
272
what is opthalmoplegia
paralysis of the muscles within or surrounding the eye
273
what is the ice pack test?
if pt has drooping of upper eyelid (ptosis)
put ice pack for 2ish mins
if the eyelid improves - + test
probs myasthenia gravis !
274
what is complete ptosis?
when eyelid covers pupil
275
what imaging do u do on a newly diagnosed MG patient
CT thorax
276
what investigations do u do for myasthenia gravis?
antibodies - AchR
| EMG - repetitive stimulation
277
myasthenia gravis patients can also have issues w what?
thyroid !!!!!!!!
278
treatment of myasthenia gravis
AChE inhibitors
immunosuppressants - prednisolone (SE: Htn, weight gain, glucose intolerance)
steroids
279
what is a positive safety culture
staff have constant n active awareness of potential for things to go wrong
- open n fair culture - encourages ppl to speak up abt mistakes
- shared values n resp
280
how can a headache be classified?
primary
secondary
painful cranial neuropathies, other face pains and other headaches
281
what comes under primary headaches?
migraine
cluster
tension type
282
what comes under secondary headaches?
meningitis
subarachnoid haemorrhage
idiopathic
intracranial
Htn medication overuse
283
what are some reasons for further referral/investigation?
thunderclap headache ?SAH
seizure n new headache
suspected meningitis
suspected encephalitis
red eye ?acute glaucma
284
what do u look at in a headache history?
types/number
time - onset/duration/why not/freq n pattern
pain - severity/quality/site
triggers - aggravating factors/relieving/FHx
285
what are red flags in a headache exam?
fever
altered consciousness
neck stiffness
focal neuro signs
BP
286
what is migraine?
episodic migraine with or without an aura
287
what is the criteria for a migraine disorder?
a) 5 attacks fulfilling B-D
b) attacks last 4-72h
c) 2 of:
- unilateral
- pulsing
- moderate/severe
- aggravation by routine physical activity
d) during headache at least 1 of:
1) nausea and/or vomiting
2) photophobia and phonotobia
3) not attributed to another disorder
288
what are some principles of migraine treatment?
accurate diagnosis, manage expectations
lifestyle modification, trigger management
pharmacological treatments
psych/behavioural treatments
surgical treatments
289
what medication can you use for migraine?
oral triptan and and NSAID/paracetamol
290
headache with
- pyraxial
- photophobia
- neck stiffness + pyrexia
- rash
diagnosis??
treat for meningitis bc suspected
```
bloods
blood cultures
HIV test
CXR
CT head
CSF
```
291
what is a subarachnoid haemorrhage like ?
thunderclap headache
- max severity within seconds
- "worse" ever
292
what do u do if SA haemorrhage suspected
CT
| angiography
293
how do u manage a subarachnoid haemorrhage?
resuscitation
nimodipine (Ca channel blocker)
early intervention to prevent re-bleeding (radiologically/surgically)
monitor for complications
294
what is a raised ICP headache like
worse on waking
worse when coughing, sneezing, straining
postural, worse when lying down
nausea, vomiting
295
what are some risk factors for idiopathic intracranial Htn
obesity
drugs eg tetracycline
296
how long does a chronic daily headache last?
≥ 15 days per month
297
should the WHO analgesic ladder be applied to headache management?
NO
codeine is not a long term treatment option
298
the cognitive, psych, and behavioural sequelae of CNS disorders depends upon: (4)
1. tempo of underlying disorder
2. brain region it affects
3. neurotransmitter systems it involves
4. individual characteristics, such as age/sex/psychosocial background
299
what are acute pathologies caused by
trauma
metabolic issues
drugs/infections
300
what is an example of a chronic pathology?
dementia
301
RH stroke can give rise to what?
mania
302
orbitofrontal cortex is associated with what?
disinhibited behaviour
303
what is anterograde amnesia?
unable learn new info
304
what is retrograde amnesia?
unable to recall events from recent past
305
what does an ACA stroke result in?
leg weakness
sensory disturbance in legs
gait apraxia
incontinence
drowsiness
306
what does a MCA stroke result in?
contralateral arm and leg weakness
contralateral sensory loss
hemianopia
aphasia
dysphasia
307
what happens with a PCA stroke?
contralateral homonymous hemianopia
cortical blindness
visual agnosia
prosopagnosia
308
how is stroke risk managed?
platelet treatments (aspirin/clopidogrel)
cholesterol treatments (statins)
AF treatments (warfarin)
antihypertensives
309
list 5 things that happen with an ACA territory stroke
leg weakness
sensory disturbance in legs
gait apraxia
incontinence
drowsiness
310
list 6 things that happen with a MCA stroke
contralateral arm/leg weakness
contralateral sensory loss
hemianopia
aphasia
dysphasia
facial droop
311
list 5 things that happen with a PCA stroke
contralateral homonymous hemianopia
cortical blindness - bilateral involvement of occipital lobe branches
visual agnosia
prosopagnosia (can't recognise familiar faces)
312
what is agnosia?
inability to interpret sensations and hence to recognize things
313
what happens in visual agnosia?
can see
but
can't interpret visual info
314
what is prosopagnosia
can't recognise familiar faces
315
what is thrombolysis
the dissolution of a blood clot
316
what is a treatment for AF
warfarin
