Neuro Flashcards
(161 cards)
1
Q
What are differential diagnoses for recurrent black outs?
A
Syncope
- Cardiopulmonary- structural (aortic stenosis, PE), arrhythmias
- Vasovagal (reflexive)- postural hypotension, carotid sinus sensitivity, situational (coughs, micturation, postexertional)
Epilepsy
Hypoglycaemia
Pychogenic
- NEAD
- Panic attacks/ hyperventilation
- Narcolepsy
2
Q
What is a Jacksonian March?
A
Simple focal seizure spreads to include more muscles etc.
3
Q
What is a partial/focal seizure?
+ what is simple vs complex partial seizures?
A
Only effects one part of the brain- a set few symptoms
Simple- remains conscious and is usually aware
Complex- unconscious and unaware, doesn’t remember
4
Q
What is a generalised seizure?
Tonic? Atonic? Clonic? Tonic-Clonic? Myoclonic? Absent?
A
- includes the whole brain
Tonic- muscles stiffen
Atonic- muscles all relax
Clonic- muscles spasm
Tonic-Clonic- muscles have periods of spasm and relaxation (grand mal)
Myoclonic- short muscle twitches
Absent- lose consciousness and then regain- “spaced out” (petit mal)
5
Q
What classifies a diagnosis of “epilepsy”?
A
recurring 8 unpredictable seizures
6
Q
What is status epilepticus?
- causes?
How do you manage this?
A
Seizure(s) for >5 minutes without a break.
- usually tonic-clonic
Causes
- stopping epileptic medication (suddenly)
- alcohol/ drug abuse
- infection
MANAGEMENT: ABCDE, Benzodiazepines (Lorazepam, diazepam, phenytoin)
7
Q
What is Todd’s Paralysis?
A
Post-epileptic paralysis, usually in the area where the seizure was
8
Q
How do you investigate recurrent LOC?
A
Bloods
- FBC (anaemia)
- U+E (arrhythmias)
- Glucose (Hypoglycaemia)
- LFTs (alcoholism)
- Calcium
ECG
Imaging: CT, MRI (to exclude other lesions)
- EEG
9
Q
What can causes/risk factors epilepsy?
A
- cerebrovascular accidents
- tumours
- alcohol
- Post traumatic epilepsy
- metabolic disturbances
- previous seizures (e.g. febrile convulsions)
- increasing age
- Family history
10
Q
What is the first line treatment for generalised tonic clonic seizures?
A
Sodium valproate
Lamotrigine
Carbamazepine
11
Q
What is the first line treatment for absence seizures?
A
sodium valproate
12
Q
What is the first line treatment for focal seizures?
A
Lamotrigine
Carbamazepine
Sodium valproate
Neurosurgery !
13
Q
What are the side effects for sodium valproate?
A
weight gain
hair loss
liver damage
14
Q
What are the side effects for Carbamazepine?
A
Rashes, leucopenia, toxic epidermal necrolysis
15
Q
What are the side effects for Lamotrigine?
A
toxic epidermal necrolysis
16
Q
What is non-epileptic attack disorder?
- characteristics
- management
A
Pseudoseizures, usually psychogenic
Characteristics of NEAD:
- flapping
- eyes and mouth open (can tongue bite)
- sometimes responsive
- normal vital signs
- unresponsive to medication
- many external physical and emotional triggers
commonly from shoulders and pelvis
Management
- Psychiatric referral
17
Q
What are causes of acute single episodes of headache?
A
Meningism Subarachnoid haemorrhage Head trauma Sinusitis Low/high pressure headache- CSF leak/ haemorrhage Acute glaucoma Giant cell arteritis
18
Q
What are causes of recurrent headaches?
A
Tension headaches
Migraines
Trigeminal neuralgia
19
Q
What are causes of chronic headaches?
A
Tension
Raised ICP (lesion, haemorrhage)
Medication overuse headache (after stopping)
20
Q
What is the presentation of a tension headache?
A
- bilateral
- non-pulsatile
- scalp tenderness
21
Q
What is the management of a tension headache?
A
- analgaesia
- antidepressants
22
Q
What is the presentation of a migraine?
A
- Aura
- unilateral
- pulsatile
- photophobia
- phonophobia
- worsens on head movement
- vomiting/ nausea
4-72h
23
Q
What is the management of a migraine?
A
Analgaesia: paracetamol, ibuprofen, aspirin
Acute treatment: Sumatriptan, Zolmitriptan
Preventative: Propanolol
24
Q
What is the presentation of trigeminal neuralgia?
- pathophysiology
A
paroxysmal stabbing pain in trigeminal distribution, screws up face
exacerbated by washing/shaving/ eating/ talking
Asian men >50
Pathophys; compression of trigeminal nerve root, causing chronic demyelination
25
What is the management of trigeminal neuralgia?
Carbamazepine
| Lamotrigine
26
What is the presentation of a cluster headache?
+ management
rapid onset, excruciating pain
- around one eye - red, watery
unilateral
15-160min
Management: Subcut sumatriptan+ Oxygen!!
27
What is a stroke?
Brain infarction causing focal CNS signs
28
What are the 2 types of stroke?
Ischaemic (80%)
Haemorrhagic (20%)
29
What are risk factors for ischaemic stroke?
- hypertension +++
- smoking ++
- heart disease, coronary artery stenosis
- poor lifestyle
- AF
- Diabetes
- High cholesterol
- Alcohol intake
- Age, Race (Black),
30
What are risk factors for a haemorrhagic stroke?
- hypertension
- smoking
- lifestyle
- AF
- Obesity
- Age
31
What is a common presentation of a stroke?
ROSIER TOOL- LOC, seizures, asymmetrical arm/leg/face movements, speech and vision defects
Contralateral
- hemiparesis
- hemiplegia
- absent or hyporeflexive
- facial weakness
- hemianopia
- Dysarthria, dysphasia (when dominant lobe)
32
What is a lacunar infarct?
Very localised infarct, usually from deep cerebral arteries
33
What investigations do you do in ?stroke
- MRI
- CT
- ECG
- Bloods- GLUCOSE
- examination- BP, carotid bruit, arrythmias
34
What are the differential diagnoses for stroke?
```
TIA
Head injury
Subdural haemorrhage
tumours
migraine
epilepsy- Todd's palsy
Wernicke's
```
35
What is the management for an acute stroke?
ABCDE
Imaging- urgent head CT to rule out haemorrhagic
ONCE RULED OUT
- Aspirin or clopidegrel
- thrombolysis (alteplase) if onset <4.5h
Haemorrhagic
- supportive
36
What are the contraindications for a thrombolysis?
- Haemorrhagic stroke
- Previous haemorrhagic stroke
- Major surgery or trauma in the last 2 weeks
- active internal bleeding
- prolonged CPR
- Pregnancy or postnatal
- hypertension 200/120
- allergy
- previous ischaemic stroke in <3 months
37
What is the presentation of a TIA?
- Stroke symptoms that resolve within 24h
| - amaurosis fugax
38
What are notable points in the history/ examination of a TIA?
- Cardiac arrhythmias - AF++
- Carotid bruits
- Recent MI/ CVA
- radioradial delay - brachial artery stenosis
39
What is the management of a TIA?
- Stroke protocol if suspected
Investigations:
- ABCD2 score + CT immediate or within a week (<4>)
- Blood pressure
- ECG
- Bloods: FBC, U+E, Glucose, cholesterol
Management:
- Aspirin + continued aspirin/ clopidogrel
- second line: dipyramidole
- htn/ cholesterol management
40
What is the primary prevention of stroke/ TIA?
Reducing risk of stroke in people who have never had a stroke before
- Lifestyle: diet, exercise, smoking, alcohol
- Managing bp and cholesterol
- anticoagulation therapies for those at risk (e.g. AF, rheumatic heart disease)
41
What is the secondary prevention of stroke/ TIA?
Reducing risk of another stroke in people who have had a stroke before
- Lifestyle: diet, exercise, smoking, alcohol
- Managing bp and cholesterol
- Asprin/ warfaring + clopidogrel
42
What is the presentation of cerebellar dysfunction?
Acute:
- nausea/ vomiting
- vertigo
- altered level of consciousness
```
Ataxias:
- gait
- truncal
- limb (heel-shin, fingers) IPSILATERAL
Dysarthria (broken speech)
```
Signs:
- past pointing
- dysdiadochokinesia
- tremor
- nystagmus
43
What is the aetiology of cerebellar dysfunction?
Vascular:
- infarction- posterior cerebellar artery
Other disease:
- MS
- cerebral oedema
- Wilson's disease (excess copper)
- developmental: cerebral palsy, cerebella hypoplasia, Dandy-Walker
Space occupying lesion
Nutritional
- thiamine deficiency (wernicke's)
- vitamin E deficiency
Infection
- meningitis
- encephalitis
- abscess
Toxins
- alcohol
- drugs
- mercury
- CO
44
What is narcolepsy?
management
Brain's inability to regulate sleep
- hypocretin deficiency
managed with psychotherapies and occupational therapies
45
What is cataplexy?
Temporary loss of muscle control as a result of emotions
46
What is shingles?
Reactivation of varicella zoster infection, often during times of immunosuppression
(virus lies dormant in dorsal root ganglia)
47
What is the presentation of shingles?
pain in dermatomal presentation
malaise fever
erythematous swollen plaques, in clusters
neuritic pain
crust over after 7-10 days (no longer infectious)
48
What is the management of shingles?
Acyclovir
analgaesia
Post herpetic pain: amitryptilline
49
What is the role of thiamine (B1) in the body and specifically brain?
Generally:
- glucose metabolism
Brain:
- metabolises carbohydrates and lipids
- maintains levels of neurotransmitters and amino acids
- can help with propagating neural signals
50
What condition is related to thiamine (B1) deficiency?
Wernicke-Korsakoff Syndrome
51
What is the pathophysiology and aetiology of thiamine (B1 deficiency)
thiamine deficiency--> impaired glucose metabolism and brain function (as brain uses so much energy)-->
Alcohol
- prevents thiamine becoming activated
- ethanol also prevents thiamine absorption
- fatty liver/ cirrhosis- stops storage of thiamine
Nutritional
- deficiency- malnutrition/ anorexia
- absorption (stomach cancer, IBD etc.)
Chronic Illness
- HIV/ Aids
- thyrotoxicosis
- vomiting (hyperemesis)
52
What is the presentation of Wernicke's Encephalopathy?
```
Cerebellum
KEY
- opthalmoplegia
- ataxia
- confusion
```
other:
- unsteady gait
- personality change
- coma/ death
53
What is the presentation of Korsakoff's Syndrome
Limbic system
- memory impairment- antero/retrograde amnesia
- confabulation- make up stories
54
How do you diagnose Wernicke- Korsakoff syndrome?
- clinical history
- blood thiamine (B1) levels
- MRI- mammilary body degeneration
55
What investigations would you want to do in ?Wernicke-Korsakoff?
Bloods
- FBC
- U+E- rule out other metabolic disturbances
- LFTs- alcoholism
- Urine (UTI- delirium)
- THIAMINE LEVELS
Imaging
- CT scan if acute- periaqueductal punctate haemorrhages, brain damage
56
What is the management of Wernicke-Korsakoff syndrome?
- thiamine infusion
- Alcohol cessation referral
- dietician input
57
What is Huntington's Disease?
Autosomal Dominant Disease
Neuronal damage due to abnormal HTT gene
Loss of GABAnergic and Cholinergic neurons
58
What is the presentation of Huntington's disease?
| inc. signs
Onset: 35-50yo
```
Chorea- jerky movements
Agitation
Dementia
Seizures
Death
```
Signs:
- squaring off of ventricles on MRI
- cerebral and caudate nucleus atrophy
59
What is the management of Huntington's Disease?
Antipsychotics- haloperidol, chlorpromazine
+ genetic counselling
60
What is the pathology of Parkinson's Disease?
Loss of dopaminergic neurones in substantia nigra (basal ganglia)
Cell loss--> akinesia
Left over aggregates of protein known as Lewy body's- if found all around the brain--> Lewy Body Dementia
61
What is the presentation of Parkinson's Disease?
- Tremor (at rest)
- Rigidity
- Bradykinesia
Gait:
- shuffling gait
- reduced arm swing
- stooped
- frequent falls
Face:
- Masked expression
- Slow speech
Psych:
- Depression
- Hallucination
- Dementia (if cell degeneration occurs in the whole brain)
62
What diseases cause Parkinsonism?
Idiopathic Parkinson's Disease- L-Dopa
Drug induced (e.g. dopamine antagonists- antiemetics)
Progressive supranuclear palsy (Steel-Richardson-Olszewski Syndrome)
Multisystem atrophy (neurodegenerative disease)
Wilson's Disease- Parkinsonism+ liver/renal failure, personality problems. Copper metabolism pathology- deposits in the brain (SN), liver, eyes etc.) Penicillamine
63
What investigations are done for ?Parkinson's disease?
Clinical diagnosis
?MRI for differentials
64
What is the management of Parkinson's disease?
- Levodopa (dopamine precursor) + Carbidopa
| - Ropinirole (dopamine agonist)
65
What are the side effects of L-Dopa and Carbidopa?
- Psychosis/ Hallucinations (due to increased dopamine)
- Risky behaviours
- Vomitting/ nausea
66
What are the risk factors for Alzheimer's Disease?
- Insulin resistance
- cholesterol/ atherosclerosis
- Family history
- Depression
- Hypothyroidism
- Head injury
- HIV
- Parkinson's disease
67
What are the symptoms of dementia?
```
Memory loss (short term ++)
Visuospacial disturbances
Emotional disturbances
Loss of normal social behaviour
Behaviour- aggression, depression, irritable,
Personality changes
```
68
How do you diagnose dementia?
Mini-Mental-State-Exam
+ DSM IV criteria;
One of:
- Aphasia
- Apraxia
- Agnosia
- Reduced executive function (e.g. planning)
And not linked with:
- organic causes
- delirium
- mental health disorder
69
What are the differential diagnoses for dementia?
- Delirium (Infection, Diabetes, Parkinson's, Substance misuse)
- Head injury
- Depression
- Normal reduced cognition with age
70
What investigations would you want to do in ?dementia?
Bloods:
- FBC (anaemia)
- Calcium, U+E (metabolic disturbances)
- CRP (infection)
- Glucose
Urine:
- MC+S (UTI)
CT/MRI in ?SOL (general atrophy)
71
What is the pathogenesis of Alzheimer's disease?
B-amyloid plaque deposits
Atrophy of brain tissue + compensatory ventricle dilation (hydrocephalus)
Cholinergic fibre atrophy + reduction of acetylcholine production
= reduced brain function
72
What is the pathogenesis of vascular dementia?
Multiple small infarcts
73
What is the management of dementia?
Lifestyle: physio and occupational therapy
Advance Care Planning
Report to DVLA
Drugs:
Acetylcholinesterase inhibitors- Donepazil, Galantamine, Rivastigmine (hallucinations)
NDMA receptor antagonists- Memantine
Slows progression. No cure.
74
What is the role of CSF?
- Protects brain from damage
- Provides nutrients
- Removes waste
75
What is hydrocephalus?
Abnormal build up of CSF in the cerebral ventricles
76
What are the mechanisms of damage in hydrocephalus?
Increased secretion OR decreased/ impaired absorption
77
What is normal pressure hydrocephalus?
- presentation
- causes
build up of CSF due to blockage of the spinal cord- build up of pressure
- causes dementia like symptoms +urinary incontinence + instability (wet, whacky and wobbly)
caused by:
Haemorrhages, stroke, tumour, meningitis
78
What are some causes of congenital hydrocephalus?
- Spina bifida
- Congenital malformations: e.g. Dandy-walker
- maternal infections- rubella, mumps, toxoplasmosis
79
How do you manage a hydrocephalus
| - inc investigations
History- acute-ish onset
CT/MRI
- ventriculoperitoneal shunt
- Third Ventriculostomy (put a hole in the third ventricle)
80
What cells are affected in MS?
Oligodendrocytes in the CNS
81
What is the pathophysiology of MS?
Autoimmune attack against the myelin and oligodendrocytes (CNS version of Schwann cells) + subsequent axonal loss
Causes inflammation (plaques of active lesions)- show up on MRI as white blobs
Symptoms as a result of conduction loss
82
What are the types of MS?
1. Primary progressive (linear line)
2. Secondary Progressive (Relapses and then a linear line)
3. Progressive- relapsing ( relapses with linear lines in between)
4. Relapsing-remitting (relapses only, no progression between)
83
What is the presentation of MS?
- Symptoms
- Signs
20-50y/o
Symptoms:
- Vision loss (optic neuritis)
- incontinence
- sexual dysfunction
- weakness
- sensory loss
- fatigue
- Worse in heat
Signs:
- UMN LESIONS!!!!!!
- Spasticity, weakness, hyperreflexive
- Numbness, paraesthesia
- Autonomic: urinary incontinence, constipation, sexual dysfunction
- Cerebellar: ataxia, nystagmus
- Lhermitte's- electric shock down spine when flexes neck
84
What investigations do you do in ?MS ?
MRI
LP: oligoclonal bands
85
What is the management of MS?
For acute attacks: Methylprednisolone
For prevention: INF1a/ INF1b, monoclonal antibodies
Symptomatic relief:
- urinary: catheter
- Sexual: mechanical aids
- Psych: antidepressants
86
What is Guillain Barre Syndrome (GBS)?
Acute inflammatory demyelinating polyneuropathy
87
What is the pathophysiology (inc. aetiology) of GBS?
Aetiology:
- Often post infectious (campylobacter, EBV, CMV) (several weeks after)
Pathophys:
- autoimmune reaction against myelin and peripheral nerves
- resulting in reduced transmission
88
What is the presentation of GBS?
LMN lesions in ascending pattern
- Paralysis (usually symmetrical)
- Numbness
- Areflexia
- Pain
89
What is the management of GBS?
ABCDE (respiratory distress)
IV immunoglobulins
Supportive- can recover by themselves
90
What is Motor Neurone Disease (MND)?
+ most common type?
Relentless degeneration of UMN and anterior cells horns
Given UMN AND LMN signs!!!!!!!!!
ALS- Amylotropic Lateral Sclerosis
91
What is bulbar palsy?
CN 9,10,11,12 impairment
- flaccid paralysis of the pharynx and larynx
Presentation:
- dysphagia
- difficulty chewing
- difficulty speaking- slurring words
- aspiration
- dribbling
- ABSENT GAG REFLEX
- FLACCID TONGUE
Causes:
- Medullary infarct
- GBS
- MND
- Toxins (scorpion/snake venom)
- Botulism
- Malignancy
Management:
- supportive: feeding tubes, ventilation
- management of causes
92
What is pseudobulbar palsy?
UMN lesion
Spastic paralysis of CN 9,10,11,12
Causes: (UMN)
- infarction (stroke)
- malignancy
- MND
- MS
- Parkinsons
Presentation:
- dysphagia
- difficult speech
- drooling
- SMALL STIFF TONGUE
- BRISK JAW REFLEX
- NORMAL, ABSENT OR HYPER GAG REFLEX
Management:
- SSRIs
- Supportive
93
What is the presentation of MND?
- middle aged onset
**NO PAIN, NO SENSORY INVOLVEMENT**
**NO BLADDER INVOLVEMENT**
**NO EYE INVOLVEMENT**
can see, can pee, can feel a tree
Combination of UMN and LMN signs
- Symmetrical weakness and wasting (LMN)
- Fasciculations (LMN)
- Hyperreflexia OR areflexia (in anterior horns)
- ALS (spastic paraperesis + muscle wasting (UMN+LMN))
- Progressive bulbar and pseudobulbar palsy
94
What is the pathology of MND?
Unknown causes (?genetic)
oxidative damage of neurones
protein aggregation inside cells
95
What investigations do you do in ?MND?
EMG (electromyography)- denervation
NCS
Bloods:
Calcium/thyroid bloods (to rule out)
Creatinine kinase (raised)
96
What is the management for MND?
Riluzole (Sodium channel blocker)
ABCDE + feeding
Palliation
97
What is myasthenia gravis?
Autoimmune condition which attack the nicotinic ACh receptors in the NMJ
98
What is the presentation of myasthenia gravis?
- young women (20-35) and older men (60-75)
FATIGABILITY- worse at end of the day, has relapses and remissions
- muscle fatigue and weakness
EYES, SHOULDERS, NECK and TRUNK
Eyes: diplopia, ptosis
Shoulders: and thighs
Neck: bulbar palsy, enlarged thymus!!!!!
Trunk: problems with respiration
*no sensory, normal reflexes*
99
What is the management of Myasthenia Gravis?
Acetylecholinesterase inhibitors- Pyridostigmine
Corticosteroids
Thymectomy
100
What is cerebral palsy?
Non-progressive lesion on motor pathways in the developing brain, leading to abnormalities in movement and posture
101
What is Neurofibromatosis?
- Benign tumours of neurones.
102
What are the types and causes of neurofibromatosis?
2 Types; Both autosomal dominant (50% chance)
1: common, skin or other PNS lesions- linked with cafe au lait spots
2: In the head, most commonly presents with hearing loss (due to bilateral vestibular schwannomas)
103
What is the management of neurofibromatosis?
Surgical removal if necessary/ SOL
Monitor hearing
Genetic counselling
104
What are the causes of meningitis?
Commonly; Meningococcus (neisseria meningitidis) or Pneumococcus (Strep. Pneumoniae)
Less commonly; Haemophilus influenzae, listeria monocytogenes
105
What is the presentation of meningitis?
Symptoms:
- headache
- neck stiffness
- fever
Signs:
- photophobia
- Kernig's (pain on passive extension of knee in flexed hip)
- petechial rash
106
What investigations do you do in meningitis?
Bloods:
- FBC (WCC)
- CRP
- Blood culture
- coagulation screens
- LFT U+E Glucose
LP- raised protein, cloudy if bacterial, reduced glucose , raised white cells (neutrophils in bacterial)
107
What white cells are raised in CSF in bacterial meningitis?
Neutrophils
108
What white cells are raised in CSF in viral meningitis?
Lymphocytes
109
What is the management of meningitis?
IV cefotaxime
110
What is the presentation of encephalitis?
- Fever
- Bizarre behaviour/ confusion
- Headache
- Lowered GCS
- Focal seizures
- History of travel or animal bite
111
What are the common causes of encephalitis?
Viral- HSV 1+2,3,4,5, measles, mumps, rabies
| Non-viral: bacterial meningitis (meningococcus, pneumococcus)
112
What investigations would you do in ?encephalitis?
```
Bloods:
FBC (WCC)
Glucose
Cultures
Viral PCR
```
Swabs/ culture:
Throat + PCR
Urine
CSF culture+ pcr
Imaging: CT head
EEG
LP: raised protein, low glucose
113
What is the management of encephalitis?
IV aciclovir
114
What is Horner's Syndrome?
Ipsilateral damage of sympathetic fibres that supply the eyes
115
What is the presentation of Horner's Syndrome?
Ptosis
Anhydrosis
Miosis (pupil consitriction)
116
What causes Horner's Syndrome?
MS
CVA
Trauma
Brain tumours
Thyroidectomy
Goiter
Thyrocarcinoma
Migraine
Cluster headache
Middle ear infection
117
What investigations do you do for ?Horner's Syndrome?
CT/ CXR/ Carotid angio
COCAINE EYEDROPS- fail to elicit pupil dilation in Horners
Paredrine test to localise lesion to which order neuron
118
What is Bell's Palsy?
Facial nerve palsy (CNVII)
most common mononeuropathy
119
What is the presentation of Bell's Palsy?
Rapid onset unilateral facial paralysis
120
What is the management of Bell's Palsy?
70% self resolve
Prednisolone
Aciclovir
Lubricating eye drops
121
What are the causes of peripheral neuropathy?
```
Diabetes
Alcoholism
Vitamin B12 deficiency
Infection- GBS/ charcot-marie tooth
Drugs- Isoniazid
```
122
How could peripheral neuropathy resolve?
remyelination
axonal regrowth
123
What are the domains assessed in the Glasgow Coma Scale?
1. Eye response (/4)
2. Verbal response (/5)
3. Motor response (/6)
/15
124
What is a myasthenic crisis?
- precipitating factors
+ management
Respiratory failure due to myasthenia gravis
Precipitating factors:
- infection
- pain
- sleep deprivation
- antibiotics
- emotional causes
- perimenstruation
- antiepileptics
Management:
- ABCDE
- IVIg
- Plasma exchange
- antibiotics (Myathenic crisis pt. have increased risk of sepsis)
125
What is a cholinergic crisis?
- Presentation
- Management
Too much cholinergics (often seen in myasthenia gravis pts)
```
Presentation: wet and weak
Nicotinic toxicity:
- muscle weakness
- fasiculations
Muscarinic toxicity:
- Nausea
- Vomitting
- sweating
- tearing
- diarrhoea
```
Management:
ABCDE
atropine
withdraw from anticholinesterases (pyridostigmine)
126
What is cord compression?
Pressure of spinal cord causing neurological symptoms from that level down (e.g. weakness, incontinence)
127
What is the presentation of cord compression?
Commonly:
Leg weakness/ paralysis, loss of sensation
Urinary/ bowel symptoms- incontinence, retention, frequency, constipation, hesitancy etc.
arm paralysis: cervical lesion
***LMN SIGNS AT THE LEVEL
UMN SIGNS BELOW THE LEVEL***
128
What are the causes of cord compression?
- Malignancy (secondary tumour)
- Infection (epidural abscess)
- Disc prolapse
- Haematoma (?warfarin)
- Myeloma
129
What is the presentation of cauda equina syndrome?
Cord compression from L2 onwards
- Mixed UMN and LMN
- Urinary retention and constipation
- back pain/ leg pain
- Saddle paraesthesia
- decreased sphincter tone
130
What are the differential diagnoses for cord compression?
- MS
- MND
- GBS
- Trauma
- Transverse Myelitis
131
What are the investigations for spinal cord compression?
- URGENT IMAGING: CT or MRI (+ biopsy)
PET scan
Bloods:
FBC (WCC)
ESR, CRP (?infection)
cultures
LP:
- culture
Urodynamics
132
What is the management of spinal cord compression?
```
ABCDE
Immobilisation
IV methylprednisolone or dexamethasone (in malignancy)
Surgical correction
ABx if abscess
```
133
What are common mononeuropathies?
- carpal tunnel syndrome
- common peroneal nerve palsy
- axilliary
134
What is the causes of mononeuropathies?
Injury
| Long term pressure (RSI, swelling, kneeling)
135
What is the presentation of carpal tunnel syndrome?
Median nerve entrapment
Pain or tingling in the arm and hand
Paraesthesia in the thumb, index and middle finger
Relieved by hanging arm over bed
Tinel's + Phalen's positive
136
What nerve is effected in carpal tunnel syndrome?
Median nerve
137
What's the management of carpal tunnel syndrome?
- splints
- local steroid injection
- decompression surgery
138
What is the pathology of sciatica?
L4/L5/S1 nerve compression due to bulging disc or herniated disc
This causes back and leg pain and weakness
139
What is a radiculopathy?
+ what can cause it
Nerve root compression causing pain (dorsal root) and weakness (anterior root)
Disc prolapse (weakened anulus fibrous), trauma, heavy lifting, osteoarthritis, spinal stenosis
140
Where are common radiculopathies?
C6/7= median/ radial nerve
L4/5,S1= sciatica
141
What is the presentation of sciatica?
shooting pain down leg/ back + weakness
142
What is the management of radiculopathies?
Conservative: physiotherapy, lifestyle- diet and exercise, stay active, heat pads, cushion between knees
Medical: NSAIDs (ibuprofen or naproxen), analgaesics (cocodamol, codeine)
Surgical: discectomy
143
What is a subarachnoid haemorrhage?
+ presentation
rupture of blood vessel in the circle of willis or connecting
(Berry aneurysm)
thunderclap headache
neck stiffness (chemical meningitis) + Kernig's sign +
altered consciousness
hemiplegia
144
What are the risk factors of subarachnoid haemorrhages?
- raised BP
- smoking
- known aneurysm
- aneurysm causing disease- PKD, ehler-danlos, coarctation of the aorta
- family history
145
What are investigations and management of a subarachnoid haemorrhage?
CT: star shaped lesions (circle of wilis)
LP: (contraindicated in raised ICP)
- billirubin
- xanthochromia
Management:
ABCDE
Neurosurgical referral- drain
146
What is a subdural haemorrhage?
+ presentation
Haemorrhage between the dura and the arachnoid.
Due to damage of the bridging veins, commonly a venous bleed
Drowsiness
LOC
Personality change
focal symptoms: seizures, unequal pupils, hemiparesis (after 2 months)
147
What are the risk factors of a subdural haemorrhage?
- Old age (smaller brain)
- Alcoholism (smaller brain)
- Epilepsy
- Anticoagulant therapy
- Trauma- mild or severe
148
What is the investigations and management of a subdural haemorrhage?
CT: Cresent shape inside skull, midline shift
Management:
- ABCDE
- Burr hole- craniostomy- irrigation or evacuation
- Craniotomy
- Manage cause of falls/ trauma
149
What is a Extradural haemorrhage?
+ presentation
Haemorrage between the cranium and the dura
Often as a result of damage to the middle meningeal artery, commonly arterial bleed
Commonly presents with fracture to parietal or temporal bone (near the eye)
Trauma followed by dull headache and drowsiness, which resolves
THEN neurological signs (drowsiness and headache++, unequal pupils, vomitting, seizures, hemiparesis
150
What are the risk factors of a extradural haemorrhage?
skull trauma
151
What is the investigations and management of a extradural haemorrhage?
CT: convex shaped lesion
Head Xray for fractures
LP IS CONTRAINDICATED
Management:
- ABCDE
- Surgery to remove blood and ligate bleeding vessels
152
What is the management of spinal stenosis?
Conservative: physiotherapy and exercise
Medical: NSAIDs, Steroid injection
Surgical: laminectomy, discectomy, spinal fusion
153
What is anterior cord syndrome?
Interruption of the anterior 2/3 of the spinal cord
154
What is the presentation of anterior cord syndrome?
Complete loss of motor, temp and pain
Retention of vibration and fine touch
155
What is the presentation of Brown Sequard's syndrome?
ipsilateral loss of motor and vibration and fine touch
contralateral loss of temperature and pain after 1-2 levels
156
What is muscular dystrophy?
Genetically caused weakened muscles without any nerve damage
157
What is the aetiology of muscular dystrophy?
X-linked recessive. (More common in boys)
| Missing or damaged Dystrophin gene
158
What is the presentation of muscular dystrophy?
Ataxic gait- waddling, walking later, calf pseudohypertrophy
Later: respiratory distress, cardiac arrhythmias
159
How do you diagnose muscular dystrophy?
High serum creatinine kinase (++++ as creatinine kinase leaves cells)
muscle biopsy staining for dystrophin
Karyotyping
160
What is the management of muscular dystrophy?
Corticosteroids
Physio, occupational therapy
161
What are non-medical managements of epilepsy?
- ketogenic diets
- surgery
- canniboids
