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Neuro conditions Flashcards

1
Q

What is epilepsy?

A

Recurrent seizures

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2
Q

What symptoms will someone with epilepsy classically present with?

A

Seizures
Fits/ convulsions
Staring blankly into space
Lack of awareness of surroundings

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3
Q

What investigations should you do if you suspect someone has epilepsy?

A

Refer them to a specialist

They will do an EEG and and ECG

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4
Q

What are the causes of epilepsy?

A

Not known but could be genetic

Could be due to brain damage eg trauma, stroke, tumor etc

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5
Q

What is the first line treatment for someone with epilepsy who has tonic/atonic seizures?

A

Sodium valproate

If not appropriate then lamotrigine

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6
Q

What is the first line treatment for someone with epilepsy who has myoclonic seizures?

A

Sodium valproate

If not appropriate then levitiracetam

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7
Q

What is the first line treatment for someone with epilepsy who has generalised tonic clonic seizures?

A

Sodium valproate

If not appropriate then lamotrigine

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8
Q

What is the first line treatment for someone with epilepsy who has focal seizures?

A

First line carbamepazine or lamotrigine

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9
Q

What is the first line treatment for someone with epilepsy who has absence seizures?

A

Sodium valproate

If not appropriate then ethosuximide

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10
Q

What is the most important thing to remember when prescribing medication for epilepsy?

A

Sodium valproate cannot be prescribed to women and girls with child bearing potential and who want to have kids

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11
Q

What are absence seizures?

A

Seizures wherein the patient will stop doing activity or responding for a while (usually 5-10 seconds). Usually there is no aura, it may be preceded by hyperventilation etc

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12
Q

What are focal seizures?

A

Seizures that originate in one part of the brain, the patients may be aware for the episode and if they are not aware they may have memory loss for the duration of the seizure

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13
Q

What are generalised tonic clonic seizures?

A

Seizures that usually start in both sides of the brain. They last 1-3 mins and in the tonic phase the patient will go still, the muscles will stiffen etc and in the clonic phase there will be jerking of the limbs etc. They may loose continence and usually are not aware during the seizure

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14
Q

What is status epilepticus?

A

When a tonic clonic seizure lasts longer than 5 mins or there are 3 or more seizures in a row without a patient coming to in between them. It is a medical emergency and the patient must be immediately taken to hospital

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15
Q

What is another name for generalised tonic clonic seizures?

A

Grand mal seizures

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16
Q

What are myoclonic seizures?

A

Quick rapid jerking of a muscle or group of muscles. Patients are usually awake and able to think clearly during them

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17
Q

What is a tonic seizure?

A

A seizure wherein the person stiffens up and cannot move and may fall

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18
Q

What is an atonic seizure?

A

A seizure wherein the patient looses muscle tone and falls limp

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19
Q

If you suspect someone has epilepsy, what characteristics about their episodes of blackout will encourage the diagnosis?

A

The episodes of balckout/ seizures are stereotpyed
The patient experiences confusion after the episodes
Recovery from each episode is not quick

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20
Q

What are some causes of spinal cord compression?

A 
Tumor
Slipped disc
Trauma 
Disc herniation
Infection
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21
Q

What are symptoms of spinal cord compression?

A 
Incontinence
Loss of sensation
Paralysis 
Weakness of limbs
UMN lesion symptoms 
Back pain
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22
Q

What is the first line investigation when spinal cord compression is suspected?

A

MRI spine

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23
Q

How is spinal cord compression managed?

A

Sometimes it will resolve itself eg a slipped disc
Manage incontinence with catheter
If you suspect its due to a tumor the start corticosteroids
May be beneficial to tell them to lie still with intermittent movement to prevent bed sores and minimise damage to nerves in the spine

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24
Q

What is multiple sclerosis?

A

An inflammatory demyelinating disease which results in episodic neurological degeneration separated by time and space, and affects at least 2 neurological areas (brain, spinal cord, peripheral nerves)

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25
What symptoms will someone with multiple sclerosis classically present with?
Visual problems (stop seeing the colour red, double vision, painful eye movements, nystagmus, graying/blurring of vision) Sensory impairment (feeling of wet or burning patches, shooting pain down their spine when they bend their head forwards) Problems with balance Dizziness
26
What pattern do symptoms of MS follow?
Relapsing remitting ie they occur in episodes and then the patient gets better
27
Who is more likely to get MS?
White people Women Those between the ages 20-40
28
What are the first line investigations you should do when you suspect someone has MS?
``` Full bloods (to rule out anything else): FBC, CRP, ESR, thyroid function, LFTs, B12, calcium, glucose If you have ruled out everything, refer to a specialist who will likely to a brain MRI, spine MRI etc ```
29
How is MS managed?
Lifestyle advice eg exercise, stop smoking Manage symptoms as they present and individually: Medications to reduce spasticity Anticonvulsants Antidepressants Catheter (if theres incontinence) Mobility assistance (walking aids etc)
30
What are complications of MS?
``` Spasticity Mobility issues Incontinence UTI Erectile dysfunction Visual impairment Cognitive dysfunction Depression Osteopenia/osteoporosis ```
31
What does the suffix paresis mean?
Weaknes
32
What does the suffix plegia mean?
Complete paralysis
33
What does the prefix mono mean?
One limb
34
What does the prefix tetra or quadra mean?
All 4 limbs
35
What does the prefix hemi mean?
Half of the body
36
What does the prefix para mean?
Lower limbs
37
What is full body hemiparesis?
Weakness on one side of the body
38
Where may a lesion be located is someone has full body hemiparesis?
Contralateral motor cortex, corona radiata, pons
39
Where may a lesion be located if someone has limb hemiparesis?
Contralateral motor cortex, corona radiata, pons | Ipsilateral spinal motor tract
40
Where may a lesion be located is someone has isolated limb weakness?
Ipsilateral peripheral nerve, nerve root etc | Contralateral cerebral motor cortex
41
Where may a lesion be located if someone has paraparesis?
Cauda equina Bilateral cerebral motor cortex Bilateral spinal motor tracts
42
Where may a lesion be located if someone has tetraplegia?
``` Bilateral cerebral motor cortex Peripheral nerves (systemic demyelinating disease) ```
43
Where may a lesion be located if someone has proximal muscle weakness?
Neuromuscular junction | Muscles
44
What is paraparesis?
Weakness of the lower limbs
45
What is tetraplegia?
Complete paralysis of all 4 limbs
46
What is motor neurone disease?
Progressive degeneration of motor neurones resulting in muscle wastage
47
What symptoms will someone with motor neurone disease classically present with?
Usually some form of muscle weakness eg loss of dexterity, tripping, falling UMN and LMN symptoms Problems swallowing Tongue fasciculations Neurological symptoms eg behaviour changes, mood lability, frontotemporal dementia) Breathing problems Poor sleep/fatigue as a result of other symptoms
48
What investigations should you do if you suspect motor neurone disease?
None, refer to a specialist, usually diagnosis is clinical
49
How is motor neurone disease managed?
Riluzole should be offered first line Manage symptoms individually, this may involve: Ventilation support Medication for excess saliva production Quinine for muscle spasticity/ increased tone Opiods to relieve breathlessness Cough augmentation techniques Discuss gastrostomy at start of treatment (early reduces chances of complications
50
What causes motor neurone disease and how is it cured?
Cause is unknown, it may be due to glutamate toxicity, protein misfolding, oxidative stress etc It cannot be cured- it causes progressive disability which will eventually lead to death (usually from respiratory failure)
51
What is another name for motor neurone disease?
Amyotrophic lateral sclerosis (ALS)
52
What are the different onsets of motor neurone disease?
Limb (limb muscle weakness) or bulbar (problems with speech/swallowing/tongue fasciculations) It may also start with only neurological symtptoms
53
Who is more likely to get motor neurone disease?
Onset is usually at an older age eg post 55 years | Those with family history of frontotemporal dementia
54
What is myasthenia gravis?
An autoimmune disorder wherein antibodies to the post synaptic membranes of nicotinic acetylcholine receptors reduce neuromuscular transmission
55
What symptoms will someone with myasthenia gravis classically present with?
``` Muscle weakness that is worse with exercise and better with rest Diplopia Ptosis Dysarthria Problems swallowing ```
56
What type of muscle weakness is present in myasthenia gravis?
Weakness that gets better with rest and is worse after exercise
57
How is more likely to get myasthenia gravis?
Women
58
How is myasthenia gravis managed?
Anticholinesterase eg pyridostigmine Prednisolone/ corticosteroids if other medication doesn't work In a crisis the patient should be intubated and plasma exchange or IV immunoglobulins should be given
59
What investigations are done for myasthenia gravis?
Serum nicotinic acetylcholine receptor antibody | Muscle specific tyrosine kinase antibody
60
What is a myasthenic crisis?
When the respiratory muscles are affected so badly that ventilation is impaired and a patient has be to hospitalised
61
What is Parkinson's disease
A neurodegenerative disorder where there is degeneration of dopaminergic neurones in the substantia nigra and deposition of Lewy bodies in the brain
62
What symptoms will someone with Parkinson's disease present
Bradykinesia (slowing of movements) Rigidity Resting tremor Gait problems/ postural instability
63
Who is more likely to get Parkinsons?
Older people | Men
64
What is the first line investigation when you think someone has Parkinsons?
None- the diagnosis is clinical | Can do PET if essential tremor is not Parkinsons
65
How is Parkinsons managed?
Levodopa first line (is converted to dopamine) Otherwise give dopamine agonists Treat symptoms eg antidepressants, cholinesterase inhibitors Refer to physiotherapists, dieticians, speech therapist etc
66
What is the mechanism of action of levodopa?
It is converted into dopamine
67
What are complications of Parkinsons
``` Levodopa induced dyskinesia (excessive movements) Dementia Depression Anxiety Constipation ```
68
What is epistaxis?
Nosebleed
69
What is the first line investigation for epistaxis?
None are needed unless the bleeding is persistent- if this is the case then can do a nasoendoscopy
70
How is epistaxis managed?
Tell the patient to lean forward but remain upright and pinch their nostrils closed for 10 mins (if a child have them sit on their parents lap etc) If bleeding is persistent, identify the bleeding point and cauterise it
71
What is essential tremor?
Bilateral involuntary oscillatory movements of the upper extremities on movement
72
What is the difference between resting tremor and essential tremor? What are they associated with?
Resting tremor is associated with Parkinson's and is present when the patient isn't doing anything, it will usually disappear when they go to write something down/ pick up a cup etc Essential tremor is a stand alone condition where the tremor occurs on movement. It is usually bilateral as is not accompanied by any other neurological symptoms
73
Who is more likely to get essential tremor?
White ancestry Advanced age Those with family history Those who were exposed to environmental toxins
74
What is the first line investigation for essential tremor?
None- diagnosis is clinical and MRI head/ other imaging only needs to be done if there is another focal neurological symptom and if an alternate diagnosis is suspected
75
How is essential tremor managed?
No pharmacological treatment is required if there isn't severe disruption to everyday life or embarrassment If treatment is needed give propanolol first line or primidine
76
What is Meniere's disease?
Episodic vertigo with low grade hearing loss and tinnitus (usually unilateral in regards to hearing loss and tinnitus)
77
What symptoms will someone with Meniere's disease classically present with?
Episodes of vertigo (associated with nausea and vomiting) Low grade hearing loss Roaring tinnitus
78
What is the first line investigation for Menieres disease?
There isn't one, diagnosis is clinical | Pure tone audiometry can be done if other causes of hearing loss are suspected
79
How is Meniere's disease managed?
Reassure the patient that episodes usually resolve within 24 hours Give anti vertigo, anti emetics etc if needed (prochlorperazine) In acute episodes hospitalise and give IV labyrinthine sedatives Advise low salt low caffeine/ alcohol intake diet
80
What are some risk factors for Meniere's disease?
Family history Having an autoimmune condition Recent viral infection
81
What are the guidelines for confirming vertigo is characteristic of Meniere's disease?
2 episodes of vertigo that were 20 mins-12 hours
82
What is the difference between Meniere's disease vs syndrome?
``` Disease= idiopathic ie no cause Syndrome= secondary to something ```
83
If webber's test lateralises to the left ear what are the 2 types of hearing loss the patient may have and say what ear they will be in?
Conductive hearing loss of the left ear | Sensorineural hearing loss of the right ear
84
How do you interpret rhinne's test?
Air conduction should be better than bone conduction | If it was louder in the air outside the ear there is conductive hearing loss in that ear
85
How do you interpret webber's test?
Sound lateralises to one ear: Conductive hearing loss in that ear Sensorineural hearing loss in the other ear

Year 3 (104 decks)

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