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Neuro Flashcards

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1
Q

What are the three types of brain haemorrhage we need to know?

A

Subarachnoid
Subdural
Extradural

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2
Q

What is a subarachnoid haemorrhage?

A

Spontaneous arterial bleed into the subarachnoid space

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3
Q

What is the leading cause of subarachnoid haemorrhage?

A

Saccular (‘berry’) aneurysms

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4
Q

Give some risk factors for subarachnoid haemorrhage

A

Hypertension
Smoking
PKD

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5
Q

What is a subdural haemorrhage?

A

Traumatic venous bleed into the subdural space

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6
Q

What is the leading cause of subdural haemorrhage?

A

Head trauma

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7
Q

Give some types of people who are more susceptible to subdural haemorrhage and explain why

A

Elderly and alcoholics

Because prone to accidents/cerebral atrophy means veins are more susceptible to damage and therefore rupture

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8
Q

What is a extradural haemorrhage?

A

Traumatic arterial bleed into the extradural space (from middle meningeal artery)

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9
Q

What is the leading cause of extradural haemorrhage?

A

Head trauma

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10
Q

Describe the investigation of brain haemorrhage

A

CT head:

  • Subarachnoid = white 5 pointed star shape
  • Subdural = white crescent shaped mass
  • Extradural = white lentiform shaped mass

Lumbar puncture for SUBARACHNOID ONLY - performed 12 hours after onset of symptoms, shows xanthochromia (immediately = blood)

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11
Q

Describe the symptoms and signs of brain haemorrhage

A

Symptoms due to raised intracranial pressure:

  • Headache
  • Seizures
  • Nausea and vomiting
  • Loss of consciousness

Signs:
- Papilloedema (due to raised ICP)

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12
Q

Describe the management of brain haemorrhage

A

Neurosurgery

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13
Q

Types of headache and facial pain…

A 
Tension headache
Migraine
Cluster headache
Giant cell arteritis
Trigeminal neuralgia
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14
Q

Compare the clinical presentation of tension headache and migraine

A

Tension headache:

  • Bilateral pain
  • Lasts minutes to days
  • Feeling of tightness/pressure all around the head
  • No associated features to suggest migraine (visual/GI disturbance)

Migraine:

  • Unilateral, throbbing pain
  • Lasts hours to days
  • Headache associated with visual symptoms (e.g. photophobia) and/or GI symptoms (e.g. nausea/vomiting)
  • Migraine may be preceded by a aura, e.g. flashing lights, tingling/numbness
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15
Q

What are the triggers for migraine?

A

CHOCOLATE

C - chocolate
H - hangovers
O - OCP
C - caffeine
O - orgasms
L - lie-ins
A - alcohol
T - travel
E - exercise
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16
Q

What are the triggers for a tension headache?

A

Stress
Concentrated visual effort
Fumes
Loud noise

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17
Q

How are tension headaches/migraines diagnosed?

A

Diagnosis is clinical

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18
Q

Describe the management of tension headaches

A

Conservative:

  • Stress relief
  • Reassurance

Pharmacological:
Short-term analgesia, e.g. paracetamol, ibuprofen (take care not to cause medication overuse headache!)

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19
Q

Describe the management of migraines

A

Conservative
- Avoid triggers

Pharmacological
Acute attacks:
- Mild: NSAID +/- antiemetic
- Severe: Sumatriptan

Prophylaxis:

  • Beta blockers OR
  • Valproate OR
  • Amitriptyline
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20
Q

Describe the clinical presentation of cluster headaches

A
  • Rapid onset, severe, short lived headaches (average 15 mins up to 3 hours)
  • Pain usually starts around one eye/temple (unilateral)
  • Associated symptoms include eye redness/lacrimation, miosis (pupil constriction) and/or ptosis (eyelid drooping) and rhinorrhoea
  • Multiple attacks over period of weeks/months with periods of remission in between
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21
Q

Describe the management of cluster headaches

A

Pharmacological:

  • Acute attacks: sumatriptan (serotonin agonist) and 100% oxygen
  • Prophylaxis: verapamil (CCB)
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22
Q

What is giant cell arteritis?

A

Granulomatous inflammation of blood vessel walls, in particular the extradural arteries

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23
Q

Describe the symptoms of giant cell arteritis

A

Headache
Tender scalp
Jaw claudication
Loss of vision

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24
Q

Describe the investigation of giant cell arteritis

A

Bloods:
ESR/CRP raised

Temporal artery biopsy showing granulomatous inflammation is diagnostic

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25
Describe the management of giant cell arteritis
Immediately start high dose oral steroids (e.g. prednisolone) if GCA is suspected Temporal artery biopsy must be taken within 7 days of starting steroids
26
Describe the symptoms of trigeminal neuralgia Give some triggers for these symptoms
- Sharp, stabbing pain lasting only a few seconds - Unilateral, within distribution of trigeminal nerve (side of face) Triggers: - Washing face - Shaving - Eating - Talking
27
What causes trigeminal neuralgia?
``` Primary = idiopathic Secondary = e.g. compression of trigeminal nerve by intracranial vessels or a tumour, multiple sclerosis ```
28
Describe the investigation of trigeminal neuralgia
MRI to exclude secondary causes
29
Describe the management of trigeminal neuralgia
Pharmacological: | Carbemazepine
30
Brain tumours are classed as being either...
Primary | Secondary
31
What is the most common histopathological type of malignant primary brain tumour?
Glioma
32
Which primary cancers commonly lead to brain metastases?
``` Lung Prostate Breast Thyroid Kidney ```
33
What are the symptoms/signs of a brain tumour?
Symptoms: - Focal neurological deficit - Symptoms of raised ICP (headache, seizure, nausea and vomiting, loss of consciousness) Signs: - Papilloedema (due to raised ICP)
34
Describe the investigation of a brain tumour
CT/MRI head
35
Describe the management of a brain tumour
Neurosurgery to remove mass lesion if possible Radiotherapy IV dexamethasone to reduce cerebral oedema Anti-convulsants (if having seizures)
36
What is the definition of 'transient ischaemic attack'?
- Focal, sudden-onset, neurological deficit lasting less than 24 hours - Complete clinical recovery
37
What are the causes of TIA?
- Thromboembolism from carotid arteries - Cardioembolism, e.g. post-MI, AF - Hyperviscosity, e.g. polycythaemia
38
What visual syndrome is associated with TIA? | Describe its pathophysiology and it symptoms
Amaurosis fugax: - Thromboembolism passes into retinal artery - 'curtain descending over field of vision'
39
Describe the investigation of TIA
- Diagnosis is clinical - Brain imaging: MRI - Carotid artery imaging: carotid doppler and CT angiography (stenosis) - Risk of stroke assessed using ABCD2 score ABCD2: - Age > 60 - BP > 140/90 mmHg (either systolic or diastolic) - Clinical features (unilateral weakness or speech disturbance without weakness) - Duration of symptoms < 10 mins, 10-59 mins, > 1 hour - Diabetes
40
Describe the conservative, pharmacological and interventional management of TIA
Conservative: - Smoking cessation, regular exercise etc. Pharmacological: - Aspirin 300 mg should be started immediately and continued long term (75 mg daily) - Start statin if high cholesterol Interventional: - Carotid endarterectomy to remove plaque build up if stenosis > 70%
41
What types of stroke are there?
Ischaemic | Haemorrhagic
42
What are the causes of ischaemic stroke?
Thromboembolism from carotid arteries Cardioembolism, e.g. post-MI, AF Hyperviscosity, e.g. polycythaemia
43
What are the causes of haemorrhagic stroke?
Chronic HTN (Charcot-Bouchard aneurysms) AV malformations Over-anticoagulation
44
Describe the symptoms of an ischaemic, posterior circulation stroke
- Horner's syndrome = miosis, ptosis, anhydrosis, enophthalmos - Cerebellar syndrome = headache, vomiting, vertigo, ataxia
45
Describe the symptoms of an ischaemic anterior circulation stroke
- Anterior cerebral artery = personality/mood changes - Middle cerebral artery = contralateral loss of motor/sensory function of upper limbs, aphasia - Posterior cerebral artery = contralateral hemianopia
46
Describe the investigation of stroke
CT head to distinguish between ischaemic and haemorrhagic
47
Describe the management of ischaemic stroke
- If patient presents within 4.5 hours = thrombolysis (IV alteplase = tissue plasminogen activator) - 2nd line = aspirin for 2 weeks, then clopidogrel OD
48
Describe the management of haemorrhagic stroke
- Control BP with beta blockers | - Use beriplex if warfarin related bleed
49
What are the contraindications to thrombolysis?
- Time of onset more than 4.5 hours ago/time of onset unknown - Haemorrhage - Low platelet count - Recent major surgery
50
What is meningitis?
Inflammation of the meninges
51
What causes meningitis?
- Infective: bacteria, e.g. strep pneumoniae, neisseria meningitidis; virus, e.g. EBV - Non-infecive, e.g. paraneoplastic, autoimmune (e.g. SLE, vasculitis)
52
Describe the symptoms and signs of meningitis
Symptoms: - Fever - Headache - Nausea and vomiting - Stiff neck - Photophobia Signs: - Non-blanching rash - +ve Kernig's signs (inability to allow full extension of the knee when the hip is flexed 90 degrees)
53
Describe the investigation and management of acute bacterial meningitis
- Immediately administer IM benzylpenicllin - Immediately start patient on cephalosporin, e.g. cefotaxime if suspect meningitis - Bloods/lumbar puncture --> MC+S, use results to direct Abx
54
Who must be notified when there is a case of meningitis?
PHE
55
What is encephalitis?
Inflammation of the brain
56
What causes encephalitis?
- Infective: viral, e.g. herpes simplex virus, varicella zoster virus - Non-infective, e.g. paraneoplastic, autoimmune (e.g. SLE, vasculitis)
57
Describe the investigation of encephalitis
- CSF analysis shows raised lymphocyte count | - Viral serology
58
Describe the management of encephalitis
Aciclovir
59
What is shingles?
Shingles (also known as herpes zoster) is caused by reactivation of varicella zoster virus, the same virus which causes chickenpox (which has been dormant in dorsal root ganglion)
60
Describe the symptoms of shingles
Rash/pain in dermatomal distribution that does not cross midline
61
Describe the management of shingles
Aciclovir
62
Give some causes of epilepsy
- Idiopathic (most cases) | - Structural causes, e.g. brain tumour
63
What is the most common symptom of epilepsy?
Seizure
64
How are seizures classified?
- Generalised seizure | - Partial/focal seizure
65
What is a generalised seizure? Give an example of a type of generalised seizure and describe the symptoms
Generalised seizure = bilateral abnormal electrical activity with bilateral motor manifestations and impaired consciousness Type of generalised seizure: tonic clonic seizure Characterised by: - Loss of consciousness - Limbs suddenly stiffen (tonic) then jerk uncontrollably (clonic) - Common ictal symptoms: tongue biting, urinary incontinence - Common postictal symptoms: drowsiness, confusion
66
What is a partial seizure?
Abnormal electrical activity in one specific area of the brain
67
Describe the diagnosis of epilepsy
Diagnosis is made clinically from detailed description of eye-witness account or from video evidence
68
Describe the management of generalised and partial seziures
``` Generalised = Sodium valproate Partial = carbemazepine ``` Lamotrigine can be used for either as alternative
69
Describe the pathophysiology of Parkinson's disease
- Depletion of dopaminergic neurons in substantia nigra | - Prescence of Lewy bodies
70
What are the three characteristic features of Parkinson's disease?
1. Resting tremor 2. Rigidity (increase in muscle tone in limbs and trunk) 3. Bradykinesia (difficulty initiating movement, slow speech, progressive fatiguing/reduction in amplitude of repetitive movements, dysdiadochokinesa) Other features: - Stoop - Shuffling gait - Reduced arm swing on one side
71
Give some non-motor features of Parkinson's disease
- Neuropsychiatric problems: depression/anxiety/impulsive behaviour - Sleep problems: insomnia - GI/autonomic symptoms: excess saliva, excess sweating, constipation
72
Describe the diagnosis of Parkinson's disease
- Diagnosis is clinical | - CT/MRI head shows atrophy of substantia nigra
73
Describe the management of Parkinson's disease
Pharmacological: 1. Increase the amount of dopamine in the CNS by using a dopamine precursor, e.g. levodopa, co-careldopa 2. Mimic the action of dopamine using dopamine agonists, e.g. ropinirole 3. Inhibit enzymatic breakdown of dopamine 4. Tremor management using an anticholinergic, e.g. amantadine
74
List the causes of peripheral neuropathy
DAVID ``` D -diabetes A - alcohol V - vitamin B12 deficiency I - infective (Guillian Barre) D - drugs (e.g. isoniazid) ```
75
What is multiple sclerosis?
Autoimmune demyelination (T cell mediated) affecting the CNS only
76
Describe the clinical presentation of multiple sclerosis
Relapsing-remitting pattern (at least 2 clinically distinct episodes with period of remission in between) Common presentations: - Optic neuritis (inflammation of optic nerve resulting in blurred vision and unilateral eye pain) - Spinal cord lesions (tingling/numbness) - Other symptoms: spasticity, tremor, urinary incontinence
77
Describe the investigation of MS
- Clinical diagnosis based on symptoms and relapsing remitting pattern - MRI showing plaques disseminated in time and space
78
Describe the management of MS
Pharmacological: - Acute attacks: steroids - Prophylaxis: B interferon - Symptom control: beta blockers for tremor, baclofen for spasticity, oxybutynin for incontinence
79
What is Huntington's chorea? Characteristics, age of onset...?
- Autosomal dominant degenerative CNS condition - Characterised by chorea (abnormal, involuntary movement), dementia and personality/mood changes (e.g. aggression, depression) - Onset 4th/5th decade (although children of affected parents may develop symptoms at an earlier age - this is known as anticipation)
80
Describe the pathophysiology of Huntington's chorea
Loss of GABA and cholinergic neurons
81
Describe the investigation of Huntington's chorea
- Genetic testing (CAG repeat)
82
Describe the management of Huntington's chorea
NO CURE - Mx of chorea: benzodiazepine - Depression: SSRI - Aggression: Risperidone
83
What is myasthenia gravis - describe its pathophysiology
Destruction of ACh postsynaptic receptor sites at NMJ by IgG autoantibodies
84
What are the symptoms of myasthenia gravis
Weakness and fatiguability (worse at end of day)
85
Describe the investigation of myasthenia gravis
- Electromyography shows fatiguability | - CT = thymus gland hyperplasia
86
Describe the management of myasthenia gravis
- Pyridostigmine (acetylcholinesterase inhibitor) and steroids (immunosuppression) - May need ciclosporin, methotrexate etc. in severe disease
87
What is an upper motor neurone? What is a lower motor neurone? What is motor neurone disease (MND)?
- Upper motor neurone: motor neurone which begins in the motor cortex and terminates in the medulla - Lower motor neurone: motor neurone which begins in the spinal cord and terminates at the neuromuscular junction - Motor neurone disease: degeneration of motor neurones in the brain, brainstem and spinal cord; degeneration may affect UMN only, LMN only or both
88
Describe the symptoms that would be present with UMN lesion(s)
- Muscle tone increased (spasicity) - Reflexes brisk - +ve Babinski sign (extensor plantar response) - Pyramidal pattern weakness (upper limbs - extensors weaker than flexors, lower limbs - flexors weaker than extensors)
89
Describe the symptoms that would be present with LMN lesion(s)
- Muscle tone reduced - Reflexes decreased/absent - Muscle wasting - Fasciculation
90
Which type of motor neurone disease is most common? | Does this affect UMNs/LMNs? - and therefore what is the clinical picture?
ALS - amyotrophic lateral sclerosis Affects UMNs and LMNs Mixed clinical picture of UMN and LMN symptoms
91
Describe the investigation of MND
- Clinical diagnosis confirmed by electromyography | - Raised creatinine kinase due to muscle breakdown
92
Describe the management of MND
- Slowing disease progression: Riluzole (Na channel blocker) - Symptom control, e.g. baclofen for spasticity - May need palliative intervention, e.g. tracheostomy, ventilator etc.
93
What is Guillian Barre syndrome?
Acute, demyelinating, inflammatory polyneuropathy affecting peripheral nerves as a result of viral infection
94
Give some examples of viruses which can cause Guillian Barre syndrome
EBV CMV HIV
95
Describe the symptoms of Guillian Barre syndrome
Acute ascending muscle weakness following viral infection
96
Describe the investigation of Guillian Barre syndrome
Lumbar puncture shows raised protein count but normal WCC
97
Describe the management of Guillian Barre syndrome
Usually self-limiting Treat viral infection Supportive therapy in mean time
98
What are the different types of dementia?
- Alzheimer's - Vascular dementia - Lewy body - Frontotemporal
99
What class of drug is used in Alzheimer's disease?
Acetylcholinesterase inhibitor, e.g. donepezil

Phase 2a (16 decks)

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