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1st/2nd Year Revision > Neuro Conditions > Flashcards

Neuro Conditions Flashcards

1
Q

What is the pathology of a stroke?

A

Occlusion of an intracranial vessel
Infarction - 85%
Haemorrhage - 15%

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2
Q

What are the causes of stroke?

A 
Diabetes mellitus
Hypertension
Smoking
Hypercholesteraemia
Family history
Age
Valvular lesions
Hypercoaguable state
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3
Q

What are the symptoms of stroke?

A 
Sudden onset
One-sided
Weakness of limbs
Facial weakness
Speech disturbance
Vision changes
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4
Q

What is a transient-ischaemic attack?

A

Symptoms of a stroke that resolve within 24hrs

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5
Q

What investigations would be done if a stroke was suspected?

A

FBC, U&Es, lipids, ESR, CRP, glucose

CT/MRI

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6
Q

How are strokes managed?

A

Stroke unit
Aspirin within 48hrs
Thrombolysis within 3hrs
Secondary prevention - clopidogrel, atorvastatin

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7
Q

What is the pathology of a subarachnoid haemorrhage?

A

Blood in the subarachnoid space (between pia and arachnoid)

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8
Q

What are the causes of SAH?

A

Berry aneurysm
Rupture
Encephalitis

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9
Q

What are the risk factors for SAH?

A

Hypertension
Smoking
Excessive alcohol
Cocaine

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10
Q

What are the symptoms of SAH?

A 
Thunderclap headache
Neck stiffness
Photophobia
Vomiting
Collapse
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11
Q

What investigations would be done if SAH was suspected?

A

CT head
LP if CT negative
Angiography

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12
Q

How is SAH managed?

A

Surgery - end-vascular coiling/clipping

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13
Q

What are the complications of a SAH?

A

Permanent CNS deficits

Hydrocephalus

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14
Q

What is the pathology of a subdural haemorrhage?

A

Bleeding from bridging veins between the dura and arachnoid

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15
Q

What are the risk factors for a subdural haemorrhage?

A

Elderly
Alcoholics
Trauma 9 months ago

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16
Q

What are the symptoms of subdural haemorrhage?

A 
Fluctuating level of consciousness
Sleepiness
Headache
Personality change
Increased ICP symptoms
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17
Q

What investigations would be done if subdural haemorrhage was suspected?

A

CT head - shows clot, midline shift

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18
Q

How is subdural haemorrhage treated?

A

Reverse clotting abnormality

Surgery depends on size of clot

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19
Q

What is the pathology of an extradural haemorrhage?

A

Bleeding between the dura and bone

Typically a rupture of the middle cerebral artery

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20
Q

What are the causes of extradural haemorrhage?

A

Suspect in anyone after a traumatic head injury

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21
Q

What are the symptoms of extradural haemorrhage?

A 
Increasingly severe headache
Vomiting
Confusion
Seizures
Decreased GCS
Increased ICP symptoms
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22
Q

What investigations would be done if extradural haemorrhage was suspected?

A

CT - lens shaped bi-convex shape

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23
Q

How are extradural haemorrhages managed?

A

Transfer to neurosurgical unit

Clot evacuation and ligation of vessels

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24
Q

What are the causes of cerebellar syndrome?

A 
Vascular lesion
Alcohol
Demyelination
Tumours
Hypothyroidism
25
What are the symptoms of cerebellar syndrome?
``` DANISH: Dysdiadochokinesis Ataxia Nystagmus Intention tremor Scanning speech (dysarthria) Hypotonia Hyporeflexia ```
26
How is cerebellar syndrome treated?
Based on cause
27
What is the pathology of myasthenia gravis?
Autoimmune condition B cells make antibodies that bind to nicotinic acetylcholine receptors on the muscle cell blocking ACh so there is no signal for muscle contraction
28
What are the symptoms of myasthenia gravis?
Weakness - gets worse with muscle use and improves with rest, typically affects proximal muscles and small muscles of the head and neck Ptosis Diplopia Myasthenia snarl on smiling Dysphagia Tired chewing Can potentially lead to myasthenia crisis - weakening of respiratory muscles
29
What investigations would be done if myasthenia gravis was suspected?
Increased ACh antibodies Electromyography (EMG) CT chest - look for underlying thyoma
30
How is myasthenia gravis treated?
Anticholinesterase - pyridostigmine Prednisolone Thymectomy
31
What is the pathology of Parkinson's?
Degeneration of the dopaminergic neurones of the substantial nigra
32
What are the symptoms of Parkinson's?
Triad of - resting tremor, rigidity, bradykinesia (slow to initiate movements) Worse at rest Postural instability Diagnosed clinically
33
How is Parkinson's treated?
Levodopa - synthetic dopamine COMT inhibitor - entacapone MAOB inhibitor - selegine Timing of these drug is critical - should be taken at the same time daily
34
What are the complications of Parkinson's?
Drug ones include excessive motor activity
35
What is the pathology of multiple sclerosis?
Inflammatory plaques of demyelination disseminated in space and time Chronic and progressive condition
36
What are the types of multiple sclerosis?
Primary progression Secondary progression Relapsing-remitting
37
What are the symptoms of multiple sclerosis?
Optic neuritis Corticospinal tract and bladder involvement common Sensory - dysaesthesia, pins and needles, vibration sense, trigeminal neuralgia Motor - spastic weakness, myelitis Erectile dysfunction Urine retention Urine incontinence
38
How is multiple sclerosis investigated?
Clinical picture important for diagnosis MRI LP - increased protein, oligoclonal bands
39
How is multiple sclerosis treated?
MDT Disease modifying drugs - dimethyl fumarate Relapses - methylprednisolone Symptomatic treatment
40
What is the pathology of guillain-barre syndrome?
Autoimmune response causing demyelination | Usually follows on from infection - campylobacter jejune, CMV, EBV
41
What are the symptoms of guillain-barre syndrome?
``` Starts at feet Progressive ascending weakness Sensory loss Paraesthesia Pain Dysphagia Dysarthria Hypotonia/hyporeflexia ```
42
What investigations would be done if guillain-barre syndrome was suspected?
LP - increased protein Nerve conduction studies Antibody screen ECG
43
How is guillain-barre syndrome managed>
IV immunoglobulins Plasmapheresis 80% fully recover, 15% left with neurological disability, 5% die
44
What is the pathology of motor neurone disease?
Degeneration of upper and lower motor neurones | NO SENSORY SYMPTOMS
45
What are the signs of an upper motor neurone deficit?
Weakness Increased reflexes Increased tone Babinski present
46
What are the signs of a lower motor neurone deficit?
``` Weakness Atrophy Fasciculations Decreased reflexes Decreased tone Absent babinski ```
47
What investigations would be done if motor neurone disease was suspected?
Clinical diagnosis | Exclude other causes
48
How is motor neurone disease treated?
Riluzole - glutamate antagonist | Symptomatic
49
What are the causes of raised ICP?
``` Brain tumour Intracranial haemorrhage Idiopathic intracranial hypertension Abscess Infection ```
50
What are the symptoms of raised ICP?
``` Headache Nausea/vomiting Diplopia Somnolence Cognitive impairment Altered consciousness Papilloedema CN III and IV palsies ```
51
What are common cancers that metastasise to the brain?
Lung Breast Colorectal Prostate
52
What are the different types of brain tumours?
Glioma - glioblastoma multiforme most common Meningioma - commonly benign Pituitary tumours - can secrete things, bilateral hemianopia Acoustic neuroma - tumour of schwann cells surrounding auditory nerve
53
How are brain tumours managed?
``` Depends on grade Surgery Chemotherapy Radiotherapy Palliative ```
54
What are the causes of cauda equine syndrome?
``` Vertebral metastases Abscess Disc prolapse Cord tumour Trauma ```
55
What are the symptoms of cauda equine syndrome?
``` Triad of: Saddle anaesthesia Bilateral leg weakness Bladder and bowel dysfunction Other - back pain, LMN signs ```
56
How is cauda equine syndrome managed?
Depends on cause Surgical decompression Dexamethasone
57
Hydrocephalus
Excess CSF Communicating - production > reabsorption Non-communicating - physical obstruction Wet, wobbly, wacky - increased ICP Treatment - shunt, external ventricular drain
58
What are the symptoms of a migraine?
Headache - throbbing, unilateral, lasts 4-24hrs Nausea/vomiting Photophobia, phonophobia With/without aura
59
How are migraines managed?
Abortive - aspirin, paracetamol, triptans (sumatriptan) | Prophylaxis - propranolol, topiramate, amitriptyline

1st/2nd Year Revision (15 decks)

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