Neuro: Aphasia, Memory + Trauma Flashcards by Sam Donnelly

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Confusion
Ataxia
Nystagmus
Ophthalmoplegia
PEripheral Neuropathy

Wernicke’s Encephalopathy

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Wenicke’s Encephalopathy is caused by

Thiamine (Vit B1) deficiency

- Usually underlying alcoholism

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Investigation findings of Wernicke’s encephalopathy

Decreased Red cell transketolase

MRI: Petechial haemorrhages

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Management of Wernicke’s Encephalopathy

Vitamin B1
IV Pabrinex (Vit B/C)

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If Wernicke’s Encephalopathy is not treated is can become

Korsakoff’s psychosis

non-reversible

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Retrograde amnesia

Confabulation

Korsakoff’s psychosis

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Urinary incontinence
Dementia
Bradyphrenia (slow thought)
Gait abnormality

Normal pressure hydrocephalus
“Wet, wobbly + whaley”

onset: months

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Cause of Normal pressure hydrocephalus

decreased CSF absorption at arachnoid villi

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Imaging: - Enlarged 4th ventricle

- Sulcal atrophy

Normal pressure hydrocephalus

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Management of normal pressure hydrocephalus

Ventriculoperitoneal shunting

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Causes of cerebellar injury

PASTRIES

Posterior fossa tumour
Alcohol
Sclerosis (MS)
Trauma
Rare (Freidrich's ataxia)
Iatrogenic (Epilepsy drugs= Phenytoin)
Endocrine (hypothyroidism)
Stroke

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Disruption and tearing of axons following a deceleration injury

Diffuse axonal injury

best seen on MRI

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Peri-orbital bruising (raccoon eyes)
Post-auricular bruising
Mastoid bruising

Basilar skull fracture (base of skull)

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Double vision (diplopia)
Painful to open mouth (trismus)
Hx of assault

Zygoma fracture

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Difficulty opening mouth

Ramus fracture

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Management for depressed skull fractures

Surgical reduction and debridement

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Displacement of cingulate gyrus under the flax cerebri

Subfalcine herniation

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Herniation occurs when brain is displaced through a defect in the skull (from fracture/ craniotomy)

Transcalvarial herniation

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Displacement of the uncut of temporal lobe under the tentorium cerebelli

ipsilateral fixed + dilated pupil (CNIII)
contralateral paralysis (cerebral peduncle)

Transtentorial (uncal) herniation

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Downwards displacement of the brain

Central herniation

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Displacement of the cerebellar tonsils through the foramen magnum

increased ICP
Cushing’s triad
- Wide pulse pressure
- Resp changes (cheyre-strokes)
- Bradycardia
- HTN

Associated with chiari 1 malformations

Tonsillar herniation (coning)

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Inability to:

write
mathematics
identify fingers (finger agnosia)
identify side of body

Gerstmann syndrome

- lesion of angular gyrus

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Language comprehension + word formation is controlled by

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Wernicke’s area

Word articulation is controlled by

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Broca’s area

Connects Wernicke's area to broca's area

Arcuate fasiculus

Non-fluent aphasias

``` Global aphasia (comprehension impaired) Broca's aphasia (comprehension intact) Transcortical motor aphasia (comprehension intact) ```

Fluent aphasias

``` Wernicke's aphasia (comprehension impaired) Conduction aphasia (comprehension intact) Anomic aphasia (comprehension intact) ```

Large lesion affecting all 3 areas Severe expressive + receptive aphasia Communicates in gestures

Global aphasia - non-fluent - comprehension impaired

``` Lesion of inferior frontal gyrus (supplied by superior left MCA) - laboured speech - halting - impaired repetition ```

Broca's aphasia "Expressive aphasia" - non-fluent - comprehension intact

- laboured speech - halting - strong repetition skills

Transcortical motor aphasia - non-fluent - comprehension intact

- difficulty finding words - generic fillers "things" - many words needed to explain (circumulocution) - repetition good

Anomic aphasia - fluent - comprehension intact

- Aware of errors - Repetition is poor Hx of stroke affecting the arcuate fasiculus

Conduction Aphasia - fluent - comprehension intact

``` Lesion of superior temporal gyrus (supplied by inferior left MCA) Damage in temporal lobe - intact sentence structure - lacking meaning - word salad ```

Wernicke's aphasia "receptive aphasia" - fluent - comprehension impaired

DANISH ``` Dysdiadochokinesia (difficulty repeating movements) Dysmetria (past-pointing) Ataxia Nystagmus Intention tremor Slurred staccato speech Scanning dysarthria (syllables are broken up) Hypotonia ```

Cerebellar injury

Intervertebral disc prolapse is more likely to herniate

laterally due to weaker ligament

Weakness of muscle strength Decreased muscle tone Decreased reflexes Muscle wasting

Lower motor neuron lesion (LMN lesion)

Weakness of muscle strength Increased muscle tone Increased reflexes Muscle mass maintained

Upper motor neuron lesion (UMN lesion)

Causes of upper motor neuron lesion

Stroke | Tumour

Dyskinesia

Dystonia Chorea Athetosis

Involuntary contraction of muscles

Dystonia

Irregular unpredictable movements

Chorea

Involuntary writhing of fingers

Athetosis

``` Impaired balance (prone to falls) Vertical gaze Symmetrical onset Speech difficulties Swallowing difficulties ```

Progressive supranuclear palsy (PSP) - Levodopa can sometimes help

Genetics of Huntington's Disease (Chorea)

Autosomal dominant Tri-nucleotide repeat disorder Anticipation: the younger age of onset the severity in later generations

30 years old Uncontrolled movements Falls Difficulty speaking

Huntington's Disease (Chorea)

``` Symmetrical fine tremor Worsens on intentional movements Disappears on rest Improves with alcohol Can effect vocal cords ```

Benign essential tremor

Management of benign essential tremor

Propranolol | Primidone

A collection of CSF (syrinx cyst) within the spinal cord that causes compression of spinothalamic tract fibres decussating at anterior white commissure of spine

Syringomyelia

``` Cape-like loss of temperature (neck + arms) - accidental burns Upper limb weakness Preserved: - light touch - proprioception - vibration Paraesthesia Neuropathic pain Bowel + bladder dysfunction ```

Syringomyelia - 20-40 years old

Causes of Syringomyelia

Arnold-chiari malformation Trauma Tumours Idiopathic

Investigations for syringomyelia

Full spine + brain MRI

Complications of syringomyelia

Syringobulbia Scoliosis Horner's syndrome

Fluid filled cavity in the medulla

Syringobulbia

Causes of peripheral neuropathy

ABCDE ``` Alcohol B12 Deficiency Cancer CKD Diabetes Drugs (Isoniazid) Every vasculitis ```

Causes of predominantly motor loss

Guillain-Barre syndrome Porphyria Lead poisoning Hereditary Sensorimotor Neuropathies (HSMN) Charcot Marie Tooth Chronic inflammatory demyelinating polyneuropathy Diptheria

Causes of predominantly sensory loss

``` Diabetes "glove and stocking" Uraemia Leprosy Alcoholism Vitamin B12 deficiency Amyloidosis ```

Neuro: Aphasia, Memory + Trauma Flashcards

(56 cards)