Neuro Table Flashcards

Question

OPTIC/ RETROBULBAR NEURITIS

Answer 1

It is also known as optic papillitis (when the head of the optic nerve is involved) and retrobulbar neuritis (when the posterior part of the nerve is involved). demyelination within the optic nerve "Subacute visual loss monocular visual loss -pain on eye movement -reduced visual acuity -reduced colour vision -Usually resolves over weeks " "Initial swelling optic disc -Optic atrophy seen later" fundoscopy. VEP. Visual evoked response – how the optic nerve is firing. Can pick up issues even if they’ve been asymptomatic.

Answer 2

Demyelination or inflammation within the spinal cord Usually part of multiple sclerosis. Can affect the young "Sensory level often with band of hyperaesthesia -Weakness/ upper motor neurone changes below level -Bladder and bowel involvement (urinary retention) -May be painful, Subacute onset, There may be a history of previous neurological or ophthalmological episodes" Partial or Transverse (complete). pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction MRI, CSF "Supportive Methylprednisolone" "May have a chronic progressive myelopathy 2˚ or 1˚ progressive"

Answer 3

Vascular and neoplastic (malignant or benign tumours) lesions from the optic tract, to visual cortex. (optic radiation) can't see out of lateral aspect of one eye and medial of other. Brain is damaged on opposite side as where you get the lack of vision (lateral of right eye - left side damaged) Left sided lesion – right visual field loss visual field testing

Answer 4

can't see out temporal aspects of both eyes Optic chiasma disrupted in the middle. Can be pituitary tumour. can't see lateral aspects from both eyes visual field testing

Answer 5

An external stye (hordeolum externum), An internal stye (hordeolum internum). a bacterial infection of an oil gland in the eyelid. bacteria a small, painful lump on or inside the eyelid or around the eye, skin may be red, swollen and filled with yellow pus like a pimple, watery eyes but vision should not be affected "common and should clear up on their own within a week or two. Soak a clean flannel in warm water, Hold it against eye for 5 to 10 minutes, Repeat this 3 or 4 times a day. surgical incision and curettage" spread

Answer 6

congenital malformation of the eye causing defects in the lens, iris, or retina. congenital, parts of the eye don't form properly and close up together mild to more severe visual loss depending on what part of the eye is affected keyhole like shape in the pupil "May have other issues: C - coloboma H - heart defects A - atresia of the choanae (problems with the nose passages) R - retarded growth and developments G - genital hypoplasia (undescended testicles) E - ear abnormalities." no treatment. Sunglasses for light sensitivity, glasses for non condition related vision problems (maximise good vision) glaucoma, retinal detachment

Answer 7

formation of a blood clot within the cavernous sinus can develop when an infection in the face or skull spreads to the cavernous sinuses. The blood clot develops to prevent the infection spreading further. Sometimes, clots can develop without infection. Sinusitis, a boil. Head injury, conditions/drugs that increase chances of blood clots. "a sharp and severe headache, particularly around the eye, swelling and bulging of the eyes – this usually starts in one eye and spreads to the other eye soon after, red eyes, eye pain – which can be severe, vision problems – such as double vision or blurred vision, difficulty moving the eyes, ptosis and mydriasis" "a high temperature of 38C or above vomiting seizures (fits) changes in mental state, such as feeling very confused. papilloedema and/or retinal-vein dilatation decreased corneal reflex hypo- or hyper-aesthesia in the distribution of the ophthalmic and maxillary nerves" FBC, blood culture, MRI, CT, possibly lumbar puncture antibiotics, anticoagulants (heparin and further tablets for a few months), corticosteriods, surgical drainage of infection site it can restrict the blood flow from the brain, which can damage the brain, eyes and nerves running between them. Without treatment can go into a coma. Vision loss, further infections, other blood clots. ICA is in the cavernous sinus – can get communication of venous and arterial system.

Answer 8

a traumatic deformity of the orbital floor or medial wall typically resulting from impact of a blunt object larger than the orbital aperture, or eye socket "one eye isn’t moving up. Has to be superior rectus or inferior oblique. But other muscles are ok – so points out its probably not an issue with a nerve. (III). Infraorbital nerve can be affected. Loss of sensation below eye of affected side" "fat or muscles can herniate out and get caught up in the fracture. If on the floor – the inferior muscles will be tethered/caught in the fracture – muscles can’t elevate the eye. " Teardrop sign. (maxillary sinus). On CT

Answer 9

"Is the 3rd nerve palsy pupil sparing or not. If it is – more likely medical cause – like diabetes. If it isn’t – more likely compression – cerebral artery aneurysm?? – immediate investigation. " eye down and out. Ptosis. headaches, sudden onset of double vision

Answer 10

Cant look towards nose – Superior oblique affected.

Answer 11

can't abduct eye

Answer 12

chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1) most commonly caused by alcohol misuse. Can also be associated with AIDS, chronic infections, poor nutrition. Thiamine (vitamin B-1) helps brain cells produce energy from sugar. When levels fall too low, brain cells cannot generate enough energy to function properly. often preceded by an episode of Wernicke encephalopathy, which is an acute brain reaction to severe lack of thiamine. Wernicke encephalopathy is a medical emergency that causes life-threatening brain disruption, confusion, staggering and stumbling, lack of coordination, and abnormal involuntary eye movements. problems learning new information, inability to remember recent events and long-term memory gaps clinical diagnosis oral thiamine, other vitamins and magnesium 25 percent of those who develop Korsakoff syndrome eventually recover, about half improve but don't recover completely, and about 25 percent remain unchanged.

Answer 13

serious inflammatory disease that affects the white outer coating of the eye The disease is often contracted through association with other diseases of the body, such as granulomatosis with polyangiitis or rheumatoid arthritis "Pain++ - Deep gnawing pain – radiates into orbit – can’t sleep. -Redness (deep scleral vessels) " "Nodule (does not move over sclera) -Tender++" Systemic steroids - Need to be admitted – IV prednisolone. Or oral in less severe – but high dose steroid. sight threatening

Answer 14

infection of orbital tissues Sinuses normally the root cause of the infection that then tracts into the orbital tissues. Pain+, Redness, Blurred vision, Diplopia, Malaise, Pyrexia, Proptosis, Reduced eye movement, Chemosis CT Scan "Admit - IV antibiotics - Drainage of pus" Can lead to meningitis, encephalitis, cavernous sinus thrombosis, blind

Answer 15

occulsion of an artery in the eye Embolus from elsewhere in the body. Most common embolus source – the carotid. - Other common place – heart. AF. "Pupil will not constrict in bad eye (no indirect either) – afferent problem - Blood vessels look tatty – segmental. - Retina looks pale and boggy - Fovea looks cherry red. " Retina is ischemic – photoreceptors stop working – no sight "Listen for bruits / send for a duplex scan. - fundoscopy " Must ensure treatment of risk factors – blood thinners, statin. Unless you see px in 30min, then unlikely to do anything to save sight in that eye.

Answer 16

obstruction of vein in the eye Vein usually obstructed as it passes down through the optic cup. vein compression from artery (they share a common sheath) – in hypertensives Bleeding into the retina – affects vision Fluid seeps out and may get fluid at the macula. – black cystic spaces on imaging (OTC) – damaging of photo receptors OTC Treat risk factors – bp control, assess for hyper viscosity syndromes. intravitreal anti Vegf if you leave the fluid there – permanent vision issues.

Answer 17

Inflammatory process of the wall of the blood vessel that thickens the wall. Short posterior ciliary arteries – optic nerve head infarcts. loss of vision, classic headache, sore to brush hair, scalp tenderness, loss of appetite, pain on chewing "tenderness over STAs, raised inflammatory markers - Erythrocyte segmentation rate (ESR) and CRP raised. -Afferent pupillary defect" ESR and CRP. May need to do a temporal artery biopsy, if unsure. High dose systemic steroids, normally IV - If they’ve infarcted one, then the other optic nerve likely

Answer 18

due to non-inflammatory disease of small blood vessels. Smoking can elevate risk" painless, loss of vision

Answer 19

a common condition that affects the middle part of your vision. It usually first affects people in their 50s and 60s. It's been linked to smoking, high blood pressure, being overweight and having a family history of AMD "Progressive loss of central vision -distortion. Condition is bilateral but not necessarily symmetrical" loss of some but not all of vision

Answer 20

distortion on amsler chart. Drusen (yellow or white dots), pigment epithelial changes and photreceptors - will see choroid. OCT "No curative treatment.low vision aids registration"

Answer 21

distortion on amsler chart. Often a gradual deterioration and a sudden loss (a bleed) OCT. Breach of pigment epithelium, neovascular membrane leaked fluid or blood into retina. Flurescein angiography – see leaks "intravitreal antivegf – monthly injection (Topical anaesthetic – only feel pressure) - Neovascular membranes resolve. But over the years their vision is likely to deteriorate. -low vision aids -registration"

Answer 22

a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina) diabetes can cause blindness "microaneurysms -retinal haemorrhages and exudates -neovascularisation (disc/retina) - ischemic retina produces vascular endothelial growth factor- leaky - may have a bleed into the vitreous. " "Flurescein angiography – see leaks -Fundoscopy – microhaemorrhage loss of capillary beds, bloody looking -OCT - If they leak – get fluid in the retina – cystic spaces. Pigment epithelium looks healthy- but leakage of fluid from capillaries." "intravitreal antivegf - Fluid absorbs and dries out -laser – panretinal photocoagulation - Laser burns – destroying the peripheral ischemic retina – so less growth factor is produced. Still gold standard treatment. May give injections then laser to cover the interim -low vision aids -registration" commonest cause of visual impairment in working age population

Answer 23

Guillain-Barré (pronounced ghee-yan bar-ray) syndrome is a very rare and serious condition that affects the nerves. "chances of it increase as you get older. thought to be caused by a problem with the immune system - attacks the nerves. Triggers: food poisoning – (especially Campylobacter), flu, cytomegalovirus, glandular fever, HIV, dengue, Zika virus" "numbness pins and needles muscle weakness pain problems with balance and co-ordination. Later - problems swallowing, double vision, walking, speaking, toilet " no, or reduced reflexes electromyography (EMG), nerve conduction studies, lumbar puncture, Intravenous immunoglobulin (IVIG), plasma exchange, supportive (ventilator, feeding) Guillain-Barré syndrome usually reaches its most severe point within four weeks. It may then remain stable for a few weeks or months before gradually improving. Can be left with ongoing problems.

Answer 24

Motor neurone disease (MND) is a uncommon condition that affects the brain and nerves. It causes weakness that gets worse over time uncommon condition that mainly affects people in their 60s and 70s, but it can affect adults of all ages. " weakness in your ankle or leg slurred speech, difficulty swallowing some foods a weak grip muscle cramps and twitches weight loss – your arms or leg muscles may have become thinner over time difficulty stopping yourself crying or laughing in inappropriate situations" "Usually limb → bulbar → respiratory - combination of UMN and LMN signs - LMN = muscle fasciculations, wasting, weakness – main concern - UMN = increased tone, brisk reflexes - No sensory involvement - 10%+ have cognitive decline" "Unique combination of UMN + LMN signs - EMG - Neurophysiology to confirm muscles denervation, even though can normally been diagnosed in clinic – just to make sure." "Supportive - PEG feed, non-invasive ventilation, physio, OT, SALT, care - Riluzole - delays the onset of ventilator-dependence or tracheostomy in selected patients and may increase survival by approximately two to three months - Anticipatory / palliative care" "It's always fatal and can significantly shorten life expectancy, but some people live with it for many years. 3-5 years from symptom onset - 2-3 years from diagnosis - 50% die within 14 months of diagnosis - Bulbar – swallowing etc. that presentation is more aggressive. Die earlier."

Answer 25

An upper motor neuron lesion (also known as pyramidal insufficiency) occurs in the neural pathway above the anterior horn cell of the spinal cord or motor nuclei of the cranial nerves. "No wasting - Except from disuse – a little bit of atrophy with long standing disease - ↑tone (Rigidity – constant stiffness throughout full movement. Spasticity – only through some of the movement – “a catch”) - ↑reflexes, extensor plantar - Pyramidal pattern of weakness"

Answer 26

lower motor neuron lesion is a lesion which affects nerve fibers traveling from the ventral horn or anterior grey column of the spinal cord to the relevant muscle(s) "↓tone - ↓reflexes, flexor plantar - weakness"

Answer 27

``` rare neurological condition hemicord lesion "Contralateral: ↓ pain ↓ temperature" "Ipsilateral: ↓ vibration ↓ joint position sense Weakness" ```

Answer 28

stroke of the spinal cord Atheromatous disease (aortic aneurysm), Thromboembolic disease (endocarditis, AF), Arterial dissection (aortic), Systemic hypotension, Thrombotic haematological disease, Hyperviscosity syndromes, Vasculitis, Venous occlusion, Endovascular procedures, Decompression sickness, Meningovascular syphilis "May have vascular risk factors - Onset may be sudden or over several hours, Pain, Back pain/radicular, Visceral referred pain, Weakness - Usually paraparesis rather than quadraparesis given vulnerability of thoracic cord to flow related ischaemia - Numbness and paraesthesia - Urinary symptoms - Retention followed by bladder and bowel incontinence as spinal shock settles" "Don’t always get acute UMN signs. Might present flaccidly acutely. -Very rarely posterior spinal artery => dorsal columns spared -Usually anterior spinal artery -Occlusion of a central sulcal artery can present as a partial Brown-Séquard syndrome -Usually mid thoracic -May be spinal shock" MRI- can't always seen something - go off presentation "Reduce risk of recurrence -Maintain adequate BP -Reverse hypovolaemia/arrhythmia -Antiplatelet therapy OT and physiotherapy Manage vascular risk factors" Return of function depends on degree of parenchymal damage, Unless significant motor recovery in first 24 hours chance of major recovery is low. Pain may be persistent and significantly contribute to disability. 20% mortality, only 35-40% have more than minimal recovery

Answer 29

deficiency can cause degeneration of the lateral and posterior columns normally pernicous anaemia from lack of IF (gastrectomy, crohns, autoimmune, tapeworms) or really bad diet. "Paraesthesia hands and feet, areflexia, First UMN sign extensor plantars, Painless retention of urine" "Degeneration of: -corticospinal tracts → paraplegia -Dorsal columns → sensory ataxia" FBC/blood film (can be neg), B12 "Intramuscular B12 (quicker the better) If B12 is low normal and low B12 features – treat." The earlier treated the less likely the they are to be left with a deficit

Answer 30

Defective closure of the caudal neural tube. Affects tissues overlying the spinal cord. Spina bifida = non-fusion of vertebral arches. Neural tissue may or may not be affected

Answer 31

Most minor and common form. Failure of embryonic halves of vertebral arch to grow normally and fuse. Occurs in lower lumbar vertebrae of 10% of otherwise healthy people." Usually no clinical symptoms - neural tissue not affected " May result in dimple with small tuft of hair." may be incidentally picked up on X-ray

Answer 32

Spina bifida with meningocele Rarest form, Protrusion of meninges and cerebrospinal fluid Fluid filled sac. No neural tissue – shouldn’t have affects treatable. "Spina bifida with meningomyelocle Nerve roots and/or spinal cord included in the sac " "Neurological deficits – loss of sensation and muscle paralysis Area affected determined by level of lesion Often associated with hydrocephalus" myeloschisis most severe form - Flattened mass of tissue exposed to amniotic fluid so it degenerates Spinal cord in affected area open due to failure of neural folds to fuse.

Answer 33

common condition that affects the brain and causes frequent seizures. bursts of electrical activity in the brain that temporarily affect how it works. They can cause a wide range of symptoms. Idiopathic, stroke, brain tumour, severe head injury, drug abuse or alcohol misuse, brain infection, lack of oxygen during birth can be random, or in response to triggers: stress, lack of sleep, waking up, drinking alcohol, some medications and illegal drugs, monthly periods, flashing lights (uncommon trigger) "Refer to first seizure clinic - Do an ECG, routine bloods (Glc) - A+E will often arrange a CT From Neurology clinic - May arrange an MRI for focal lesion - May arrange EEG (Usually in <40yrs)" "Discuss Anti-epileptic drugs - Refer to Epilepsy nurse (post diagnostic information) - Discuss driving (inform DVLA)" status epilepticus

Answer 34

used to be called a "petit mal", is where you lose awareness of your surroundings for a short time. They mainly affect children, but can happen at any age. May be provoked by hyperventilation/ Photic stimulation stare blankly into space, look like they're "daydreaming", flutter their eyes, make slight jerking movements of their body or limbs sudden arrest of activity (brief, maybe 15 seconds), will restart what they are doing good history, witness account, EEG Ethosuximide

Answer 35

"A tonic-clonic seizure, previously known as a ""grand mal"". tonic stage – LOC, goes stiff, may fall to the floor clonic stage – limbs jerk about, incontinence of bladder or bowel, lateral tongue bite, difficulty breathing" PMH- complications at birth, Feb conv, trauma, meningitis, brain injuries. May have vague warning, Irritability before them, bad recollection (ambo/hospital), "unpredicible?, Groaning sound, Tonic (rigid phase), clonic - generalised jerking in all four limbs, Eyes open, Staring/ roll upwards, Foaming at the mouth, Jerking for a few minutes and then groggy for 15-30mins -May be agitated afterwards, May have a cluster of episodes, stopping and starting" "EEG, Refer to first seizure clinic -Do an ECG, routine bloods (Glc) -A+E will often arrange a CT" Sodium Valproate, Lamotrigine, Levetiracetam. Acutely: Lorazepam, midazolam (diazepam) first line. Other 2nd line treatments status epilepticus. Side effects of therapy

Answer 36

myoclonic seizure is where some or all of your body suddenly twitches or jerks, like you've had an electric shock "Adolescence/early adulthood - Provoked by alcohol, sleep deprivation" usually only last a fraction of a second, but several can sometimes occur in a short space of time, normally remain awake during them "Can have absence and GTC seizures - Will often have early morning myoclonus - Drop things in the mornings - Brief jerks in limbs" "EEG, Refer to first seizure clinic - Do an ECG, routine bloods (Glc) - A+E will often arrange a CT" Sodium Valproate, Lamotrigine, Levetiracetam side effects of therapy

Answer 37

These seizures are sometimes known as "warnings" or "auras" because they can be a sign that another type of seizure is about to happen "a general strange feeling that's hard to describe a ""rising"" feeling in stomach – like the sensation in your stomach when on a fairground ride, déjà vu, unusual smells or tastes, tingling in arms and legs, an intense feeling of fear or joy, stiffness or twitching in part of your body, such as an arm or hand You remain awake and aware while this happens." "Refer to first seizure clinic - Do an ECG, routine bloods (Glc) - A+E will often arrange a CT From Neurology clinic - May arrange an MRI for focal lesion - May arrange EEG (Usually in <40yrs)" Lamotrigine, Carbamazepine, Levetiracetam side effects of therapy

Answer 38

During a complex partial seizure, you lose your sense of awareness and make random body movements "smacking your lips, rubbing your hands, making random noises, moving your arms around, picking at clothes or fiddling with objects, chewing or swallowing (automatisms) You won't be able to respond to anyone else during the seizure and you won't have any memory of it, disorientated for a spell" "Refer to first seizure clinic - Do an ECG, routine bloods (Glc) - A+E will often arrange a CT From Neurology clinic - May arrange an MRI for focal lesion in <50s - May arrange EEG (Usually in <40yrs)" Lamotrigine, Carbamazepine, Levetiracetam. Other 2nd line treatments side effects of therapy

Answer 39

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures usually occurs in patients with no previous history of epilepsy (stroke, tumour, alcohol) "Be wary of non-convulsive status epilepticus -Prolonged unresponsiveness following a seizure" "First line Midazolam: 10mg by buccal or intra-nasal route, repeated after 10mins if necessary Lorazepam: 0.07mg/kg, usually 4mg bolus repeated once after 10 mins Diazepam: 10 - 20mg iv or rectally, repeated after 15 mins if necessary Second line Phenytoin - slow infusion of 15 – 18mg/kg at 50mg/min Valproate – 20 -30mg/kg iv at 40mg/min Third line Anaesthesia usually with propofol or thiopentone" "Mortality: 5-10%. Mortality greatest in very young and very old (29% of those < 1 year) -Mortality is highest secondary to strokes, encephalitis, mass lesions and trauma -90% of deaths are a result of the underlying cause. secondary damage -neurological problems reported in 24% of children following episode of status"

Answer 40

Pseudoseizures or psychogenic non-epileptic seizures (PNES) are often misdiagnosed as epilepsy great stress, pyschological issues Events may occur at times of stress or while at rest, Will often give lots of detail of others reaction and little of events themselves, May recall what people said during episode, May be prolonged episode, waxing and waining, May describe dissociation resemble epileptic seizures, but are without organic cause and are without simultaneous electroencephalogram (EEG) changes suggestive of epilepsy "Try and capture an episode on an EEG resemble epileptic seizures, but are without organic cause and are without simultaneous electroencephalogram (EEG) changes suggestive of epilepsy. Refer to first seizure clinic - Do an ECG, routine bloods (Glc) - A+E will often arrange a CT" Therapy etc

Answer 41

Alcohol withdrawal - Drug withdrawal - Within few days after a head injury - Within 24hrs of stroke - Within 24hrs of neurosurgery - With severe electrolyte disturbance - Eclampsia

Answer 42

A faint, temporary loss of consciousness usually related to insufficient blood flow to the brain. If they brain doesn’t get the blood supply it wants, it will try get the body to the floor to get it. "Warning- felt lightheaded/clammy/vision blacking out. Very brief LOC - Came round as I hit the ground, Friend standing over them - Fully orientated quickly - Clammy/sweaty - Urinary incontinence -Further similar events aborted by sitting. " "Looked a bit pale -Suddenly went floppy -There may have been a few brief jerks -Brief LOC -Rapid recovery -If more prolonged was the patient propped up -Tongue bite – more at the front" "Examination -Heart sounds, pulse -Postural BPs Must have ECG -Look for heart block -QT ratio May need 24hr ECG May need to see cardiology if recurrent (5 day recordings, reveal devices) -Consider Tilt table" treat cause

Answer 43

Taking blood/medical situations | -Cough, urinating - Change in vagal tone

Answer 44

- Dehydration, medication related (anti-hypertensive) | - Endocrine, autonomic nervous system

Answer 45

Arrhythmia, aortic stenosis. Cardiac output can drop. "Chest pain, palpitations, SOB -Came around fairly quickly -Recovery may be longer -Clammy/sweaty" "may be on exertion. Suddenly went floppy -Looked grey/ashen white -Seemed to stop breathing -Unable to feel a pulse -There may have been a few brief jerks -Variable duration of LOC -Rapid recovery " "Family history important Examination -Heart sounds, pulse Must have ECG -Look for heart block - QT ratio -Refer to cardiology urgently/admission for telemetry -May need 24hr ECG/ECHO/prolonged monitoring" treat cause

Answer 46

injuries to the scalp. Similar to those which can affect the skin, e.g. abrasions, bruises, lacerations, incisions (and burns/scalds) "common site for laceration because it is closely applied to the skull and tearing associated with the application of force. Incised wound – sharp force trauma – cutting. Laceration – blunt force trauma " Scalp is notorious for bleeding a lot. Hair can obscure sizeable injuries to the scalp investigate damage to skull/brain glue if superfical, if deeper (e.g past aponeurosis - may need suturing, staples). Antibiotics bleeding (worse in those with clotting issues, liver/alcoholics. – enough can cause their death – but uncommon to bleed to death from scalp lesions). Infection, skull/brain involvement

Answer 47

fracture to the skull application of force causing deformation of the skull; adult skulls less able to cope with distortion than those of infants "pain, panda eyes, open cuts. Linear: commonly temporo-parietal from blow or fall onto side or top of the head and may continue onto the skull base; “hinge” fracture. Can cause sprung sutures. - Depressed. Not typical of a fall from standing onto a flat surface, e.g. pavement - fractures tend to be linear in this scenario - Comminuted (mosaic): fragmented skull - “Ring” fracture: fracture line encircling the foramen magnum caused by a fall from height, usually landing on the feet, but sometimes the head, leading to the skull base and cervical spine being forced together - “Contre-coup” fracture: fracturing of the orbital plates (anterior fossa) caused by a fall onto the back of the head" head injury assessment, CT antibiotics if open, surgery, heal by themselves Depressed: focal impact which may push fragments inwards to damage the meninges, blood vessels and the brain; risk of meningitis and post-traumatic epilepsy.

Answer 48

Bleeding occurring between the dura and the skull. Accumulation of blood within the rigid skull causes an increase in intracranial pressure (ICP) and results in compression of the brain - this compression causes symptoms, including reduction in conscious level. Vast majority arise from damage to an artery in association with a skull fracture (80-90%) and, therefore, under higher pressure than with venous bleeding, but very occasionally large venous channels can cause EDH. Commonly, middle meningeal artery where it crosses the inner aspect of the squamous temporal bone (pterion) raised intracranial pressure with developing neurological symptoms; the time period for the development of symptoms is variable, can be rapid, but can take many hours. Severe headache, N&V, LOC, weakness, speech difficulty, seizures, “Lucid interval” can occur. Blown pupil. CT, MRI, angiography (non-traumatic causes) monitoring, surgery, burr hole. coning

Answer 49

Bleeding occurring beneath the dura (and above the arachnoid) bleeding from bridging veins which pass from the surface of the brain to drain into the large venous channels within the dura. Any motion which causes rotational or “shearing” forces can cause the veins to be stretch and torn due to the relative movement between the brain and the dura. Generally associated with trauma e.g. accelerated falls. Individuals with atrophic (small) brains are at increased risk Frequently occurs without a skull fracture. “Lucid interval” may be seen with SDH – venous pressure – bleed accumulates at a slower rate. CT Can get chronic subdural haemorrhage, particularly in elderly, and may be a cause of chronic confusion (and may be mistaken for dementia)

Answer 50

Bleeding beneath the arachnoid membrane (and above the brain) "most common cause of SAH is actually natural disease - rupture of a cerebral artery (“berry”) aneurysm - frequently seen in association with cerebral contusions (bruising to the brain) " thunderclap headache - peaks within a few minutes and lasts for at least 1 hour Examination often normal - patient may appear well. Can track further round the brain as the arachnoid isn’t a tightly pulled down as dura "SAME DAY hospital assessment - Does the patient have SAH or another secondary cause - CT brain (3% negative at 12 hrs, 7% negative at 24 hrs) - LP (must be done >12hrs after headache onset) -CT +/- LP is unreliable beyond 2 weeks and angiography is required beyond this time" coiling or clipping

Answer 51

SAH accumulating at the base of the brain typically a result of a forceful impact to the upper part of the side of the neck causing abrupt rotational movement of the head leading to rupture of the vertebro-basilar circulation and a concentration of SAH on the base of the brain; precise mechanism leading to rupture is still not certain Head is very quickly rotated (and slightly upwards). Basically, dead before they hit the ground. No lucid interval. Collapse is usually rapid and death can occur very quickly due to the irritant/pressure effects of blood in the subarachnoid space CT

Answer 52

"Generalised brain swelling in response to focal/diffuse injury. May cause secondary brain ischemia – leads to further swelling." common and rapid result of brain injury, especially in children Can develop in minutes and lead to massive brain swelling with raised intracranial pressure and “coning” "Brain swelling often the cause of death in fatal head injuries. Due to the development of raised intracranial pressure"

Answer 53

bruises on the brain surface – impact of the brain on the skull or by depressed fractures damaging the surface of the brain direct mechanical damage to the brain substance. Temporal poles and under surface of the frontal lobes are most at risk of contusions May occur anywhere on the brain. Coup, Contre-coup. Area is damaged and not functioning properly. Can be hypoxic and therefore can haemorrhage/ bleed a few days later – sudden drop in GCS.

Answer 54

tears on the brain surface. direct mechanical damage to the brain substance More significant damage which usually involves underlying white matter also.

Answer 55

traumatic DAI - trauma. vehicular collisions and falls from a height; serious rotational forces applied to the brain tissue causing shearing of axons. Due to high force rotational acceleration-deceleration injury. victims are comatose when tDAI is fully developed lots of pinpoint haemorrhages. corpus callosum, para-sagittal white matter, posterior internal capsule and dorsolateral aspects of the rostral brainstem, as well as the cerebellar peduncles are most likely affected. CT

Answer 56

primary headache - no underlying medcial cause. Most frequent DISABLING primary headache. 1/3 get an associated aura. complex neurological disorder, the origin of which cannot be ascribed to a single brain site or mechanism. Involves integrated brain mechanisms among a number of central nervous system (CNS) structures (cortex, brainstem, trigeminal system, meninges) and has a complex pathophysiology. It is generally recognized that migraine arises from a primary brain dysfunction that leads to activation and sensitization of the trigeminal system. "chronic disorder with episodic attacks. recurrent and reversible attacks of pain and associated symptoms. Attacks: Premonitory- Mood changes, fatigue, cognitive changes, muscle pain, food craving. Aura- fully reversible neurological changes: vision (lights) → sensory (tingling) → speech (can’t). Early headache- dull, nasal congestion, muscle pain. Advanced headache - unilateral, throbbing, nausea, photophobia, phonophobia, osmophobia Postdrome - fatigue, cognitive changes, muscle pain In-between attacks -Enduring predisposition to future attacks -Anticipatory anxiety" "They often take themselves away from stimulation and are very still. Migraine Triggers -Stress -Hunger -Sleep disturbance -Dehydration -Diet -Environmental stimuli -Changes in oestrogen in women (their cycle) Migraine without aura gets better in pregnancy -Migraine with aura usually does not change" "Abortive treatment -Aspirin 900mg at start, or NSAIDs 800mg at start -Triptans -Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache ``` Prophylactic treatment -Propranolol, Candesartan -Anti-epileptics -Topiramate, Valproate, Gabapentin -Tricyclic antidepressants -amitriptyline, dothiepin, nortriptyline -Venlafaxine Treatment is more difficult in pregnancy -Acute attack: Paracetamol -Preventative: Propranolol or Amitriptyline" The combined OCP is contraindicated in active migraine with aura, ok without ```

Answer 57

Headache present on ≥15 days / month of which ≥ 8 days have to be migraine, for more than 3 months "Transformation can occur with or without escalation in medication use. MOH - Use of triptans, ergots, opioids and combination analgesics >10 days / month -Use of simple analgesics > 15 days per month -Caffeine overuse: coffee, tea, cola, irn bru" "History of episodic migraine Transformed migraine - Migrainous symptoms become less frequent and less severe Many patients have episodes of severe migraine on a background of less severe featureless frequent or daily headache -Increasing frequency of headaches - over weeks / months / years" In patients with medication overuse, discontinuing the overused medication often (but not always) dramatically improves headache frequency

Answer 58

excruciating attacks of pain in one side of the head, often felt around the eye "Alcohol triggers attacks during a bout, but not in remission. Striking circadian rhythmicity - To do with the pain pathways going through the hypothalamus -attacks occur at the same time each day -bouts occur at the same time each year. More common in men in 30s and 40s. Risks: smoking, genetics?" "Pain: mainly orbital and temporal, sharp, throbbing, very severe, unilateral. Carcadian periodicity. strictly unilateral, Rapid onset, Duration: 15 mins to 3 hours (majority 45-90 mins), Rapid cessation of pain. May have associated symptom: a red and watering eye drooping and swelling of one eyelid a smaller pupil in one eye a sweaty face a blocked or runny nostril" "attack frequency: 1-8, Attacks “cluster” into bouts typically lasting 1-3 months with periods of remission lasting at least 1 month. Excruciatingly severe (“suicide headache”) -Patients are restless and agitated during an attack. Prominent ipsilateral autonomic symptoms. Migrainous symptoms often present -Premonitory symptoms: tiredness, yawning -Associated symptoms: nausea, vomiting, photophobia, phonophobia -Typical aura (often under recognised)" "Abortive (Headache) -Subcutaneous sumatriptan 6mg or nasal zolmatriptan 5mg -100% oxygen 7-12 l/min via a tight fitting non-rebreathing max is effective and safe Abortive (Headache bout) - Occipital depomedrone injection (same side as the headache) - Or tapering course of oral prednisone Preventative - Verapamil (high doses may be required) - Lithium - Topiramate" "10-20% have chronic cluster - Bouts last >1 year without remission or - Remissions last <1 month"

Answer 59

debilitating one-sided headache affecting the area around the eye "Pain: mainly orbital and temporal, throbbing, claw-like, or boring pain - Attacks are strictly unilateral - Rapid onset - Duration: 2-30 mins - Rapid cessation of pain -Excruciatingly severe Frequency: 2-40 attacks per day (no circadian rhythm) " "50% are restless and agitated during an attack. Prominent ipsilateral autonomic symptoms -Migrainous symptoms may be present -In 10% attacks may be precipitated by bending or rotating the head -Background continuous pain can be present pain may be accompanied by red and tearing eyes, a drooping or swollen eyelid on the affected side of the face, and nasal congestion" Absolute response to indometacin (prophylaxis only). Alternatives – COX-II inhibitors, Topiramate. chronic, in which patients experience attacks on a daily basis for a year or more, and episodic, in which the headaches may remit for months or years

Answer 60

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) most common in men after age 50 "Unilateral orbital, supraorbital or temporal pain (V1) -Stabbing or pulsating pain -10-240 seconds duration -Cutaneous triggers -Wind, cold -Touch -Chewing" "Attack frequency from 3-200/day, no refractory period -Pain is accompanied by conjunctival injection and lacrimation" "No abortive treatment Prophylaxis: -Lamotrigine -Topiramate -Gabapentin -Carbamazepine / Oxcarbazepine"

Answer 61

chronic pain disorder that affects the trigeminal nerve. Middle age and older isn't known, but it's often thought to be caused by compression of the trigeminal nerve or an underlying condition that affects this nerve - but artery or vein. Compression fifth nerve in the posterior fossa "Paroxysmal attacks of lancinating pain Unilateral maxillary or mandibular division pain > ophthalmic division -Stabbing pain -5 - 10 seconds duration - Cutaneous triggers - Wind, cold - Touch - Chewing" "Attack frequency similar to SUNCT, has a refractory period - Autonomic features are uncommon" "Prophylaxis: - Carbamazepine - Oxcarbazepine Surgical intervention: - Glycerol ganglion injection - Steriotactic radiosurgery - Decompressive surgery"

Answer 62

"Most frequent primary headache, but is NOT disabling and rarely presents to doctors Benign, relatively frequent, universal problem." Lifetime prevalence of 42% in men and 49% in women Mild, bilateral headache which is often pressing or tightening in quality, has no significant associated features and is not aggravated by routine physical activity "Abortive treatment -Aspirin or paracetamol -NSAIDs -Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache Preventative treatment -Rarely required -Tricyclic antidepressants -amitriptyline, dothiepin, nortriptyline"

Answer 63

-Neisseria meningitidis (meningococcus) -Streptococcus pneumoniae (pneumococcus). “classical triad” -fever -neck stiffness -altered mental status Meningism (neck stiffness, photophobia, nausea and vomiting) Cerebral dysfunction (confusion, delirium, declining conscious level), petechial skin rash. Cranial nerve palsy (30%) (Cranial nerves go through the meninges), seizures (30%), focal neurological deficits (10-20%) may also occur. Lumber puncture: opening pressure increased. Cell count high, mainly polymorphs - neutrophils. Reduced glucose. High protein. Blood cultures (bacteraemia) -Lumbar puncture (CSF culture/microscopy) -No need for imaging if no contraindications to LP. Culture streptococcus pneumoniae sensitive to penicillin, antibiotics, supportive care. septicaemia, permanent damage to brain/nerves

Answer 64

enteroviruses. Include polioviruses, coxsackieviruses and echoviruses. “classical triad” - fever - neck stiffness - altered mental status Meningism (neck stiffness, photophobia, nausea and vomiting) Cerebral dysfunction (confusion, delirium, declining conscious level), petechial skin rash. Cranial nerve palsy (30%) (Cranial nerves go through the meninges), seizures (30%), focal neurological deficits (10-20%) may also occur. Lumbar puncture: opening pressure increased or normal. Cell count high, mainly mononuclear cells - lymphocytes. Normal glucose (60% of blood glucose). Slightly increased protein. -Lumbar puncture (CSF culture/microscopy) - No need for imaging if no contraindications to LP. antivirals and supportive care.

Answer 65

inflammation / infection of brain substance "Viral (most common is HSV). (herpes group - VZV, EBV, CMV) Virus remains latent in the trigeminal or sacral ganglion after primary infection. Arbovirus encephalitides -Transmitted to man by vector (mosquito or tick) from non-human host e.g.: - West Nile virus - St Louis Encephalitis - Western Equine Encephalitis - Tick Borne Encephalitis - Japanese B Encephalitis" "Flu-like prodrome (4-10days) - Progressive Headache associated with fever - +/- meningism - Progressive cerebral dysfunction - Confusion - Abnormal behaviour - Memory disturbance - Depressed conscious level - Seizures (which they do not come around) - Focal symptoms / signs Onset of a viral encephalitis is generally slower than for bacterial meningitis and cerebral dysfunction is a more prominent feature " "Blood cultures - Imaging (CT scan +/- MRI) - Lumbar puncture - EEG. Lab diagnosis by PCR of CSF for viral DNA" antivirals - aciclovir Over 70% mortality and high morbidity if untreated - HSV

Answer 66

``` Autoimmune encephalitis is a type of encephalitis that can result from a number of autoimmune diseases Acute onset, confusion, neurological symptoms "Two important antibodies. Anti-VGKC (Voltage Gated Potassium Channel) -Frequent seizures -amnesia (not able to retain new memories) -Altered mental state Anti-NMDA receptor -Flu like prodrome -Prominent psychiatric features -Altered mental state and seizures -Progressing to a movement disorder and coma" "Blood cultures -Imaging (CT scan +/- MRI) -Lumbar puncture -EEG" steriods ```

Answer 67

"Brain abscess: localized area of pus within the brain Subdural empyema: thin layer of pus between the dura and arachnoid membranes over the surface of the brain" "Penetrating head injury - Spread from adjacent infection - Dental, Sinusitis, Otitis media - Blood borne infection - e.g. Bacterial endocarditis - Neurosurgical procedure" "Fever, Headache - Focal symptoms / signs - Seizures, dysphasia, hemiparesis, etc - Signs of raised intracranial pressure (Papilloedema, false localizing signs, depressed conscious level) - Meningism may be present, particularly with empyema - Features of underlying source e. g dental, sinus or ear infection" "“Strep milleri” group, Strep anginosus, Strep intermedius, Strep constellatus. Anaerobes in 40 - 100% of cases - Bacteroides, Prevotella" "Imaging: CT or MRI - investigate source - blood cultures - Biopsy (drainage of pus) - may or may not be difficult. Counter balance the risk of doing a biopsy to not. Depending on site. Culture and sensitivity tests on aspirate provide useful guide" "penicillin-sensitive “Strep milleri” group. Surgical drainage if possible - Penicillin or ceftriaxone to cover streps - Metronidazole for anaerobes - High doses required for penetration" High mortality without appropriate treatment

Answer 68

"a bacterial infection that can be spread to humans by infected ticks. Multi-system - Skin, rheumatological, neurological / neuropsychiatric, cardiac and ophthalmological involvement" "Vector borne: Tick (wooded areas) Spirochaete: Borrelia burgdorferi" Stage 1: Early localized infection (1-30d) - erythema migrans, 50% flu like symptoms (days – 1 week) Fatigue, myalgia, arthralgia, headache, fever, chills, neck stiffness. Stage 2: Early disseminated infection (weeks – months). -One or more organ systems become involved -Neurologic involvement (10-15% untreated patients) (PNS>CNS) and MSK most common. Stage 3: Chronic infection -months to years -occurring after a period of latency. Like stage 2, but with more CNS. "Complex range of serological tests -CSF lymphocytosis – viral pattern -PCR of CSF -MRI brain / spine (if CNS involvement) -Nerve conduction studies / EMG (if PNS involvement)" "Prolonged antibiotic treatment - intravenous ceftriaxone - oral doxycycline"

Answer 69

``` infection of the central nervous system in a patient with syphilis Syphilis (Treponema pallidum) meningitis presentation "3 stage presentation Primary, secondary, latent Tertiary disease (neurosyphilis) years/decades after primary disease - not common" "Treponema specific and non-treponemal specific (VDRL) antibody tests -CSF lymphocytes increased, evidence of intrathecal antibody production" High dose penicillin ```

Answer 70

"Caused by poliovirus types 1, 2 or 3 - all enteroviruses" "99% of infections are asymptomatic - Paralytic disease in ~1% " "infects anterior horn cells of lower motor neurones - Asymmetric, flaccid paralysis, esp legs - No sensory features" Vaccine available

Answer 71

Acute infectious disease of CNS affecting almost all mammals "Transmitted to human by bite or salivary contamination of open lesion - Neurotropic - virus enters peripheral nerves and migrates to CNS" "Paraesthesia at site of original lesion - Ascending paralysis and encephalitis" "No useful diagnostic tests before clinical disease apparent - Diagnosis: culture, detection or serology" "Sedation/intensive care. Active immunisation with killed vaccine. Wash wound, - Give active rabies immunisation - Give human rabies immunoglobulin (passive immunisation) if high risk" death

Answer 72

"infection with Clostridium tetani - anaerobic Gram-positive bacillus, spore forming" "wound may not be apparent - toxin acts at neuro-muscular junction - blocks inhibition of motor neurones - rigidity and spasm (risus sardonicus)" "immunisation (toxoid) - given combined with other antigens (DTaP} - penicillin and immunoglobulin for high risk wounds/patients"

Answer 73

"Binds irreversibly to the presynaptic membranes of peripheral neuromuscular and autonomic nerve junctions - Toxin binding blocks acetylcholine release - Recovery is by sprouting new axons" "Clostridium botulinum - Anaerobic spore producing gram positive bacillus - Neurotoxin. Naturally present in soil, dust and aquatic environments. Infantile (intestinal colonization) - Food-borne (outbreaks) - Wound: Almost exclusively injecting or “popping” drug users" "Incubation period 4-14 days - Descending symmetrical flaccid paralysis (GBS normally ascending) - Pure motor - Respiratory failure - Autonomic dysfunction - Usually pupil dilation" "Nerve conduction studies – get increments - Mouse neutralisation bioassay for toxin in blood - Culture from debrided wound" "Anti-toxin (A, B, E) - Penicillin / Metronidazole (prolonged treatment) - Radical wound debridement"

Answer 74

rare and fatal condition that affects the brain. It causes brain damage that worsens rapidly over time.

Answer 75

Consider in any rapidly progressive dementia. Myoclonus Progressing to global neurological decline. Motor abnormalities, Cerebellar ataxia, Extrapyramidal: tremor, rigidity, bradykinesia, dystonia, Pyramidal: weakness, spasticity, hyper-reflexia -Cortical blindness -Seizures may occur. Often no specific changes on MRI.MRI -EEG -Generalised periodic complexes typical -Often normal/non-specific in initial stages -CSF -Normal or raised protein -Immunoassay 14-3-3 brain protein (non-specific, but very helpful in correct clinical context). Rapid progression -Death often within 6 months

Answer 76

Younger onset <40. Early behavioural changes more prominent - Longer course (average 13 months). Pulvinar sign on MRI. MRI - EEG - Generalised periodic complexes typical - Often normal/non-specific in initial stages - CSF - Normal or raised protein - Immunoassay 14-3-3 brain protein (non-specific, but very helpful in correct clinical context) Rapid progression - Death often within 13 months

Answer 77

``` metastatic spread to the brain from primaries elsewhere in the body. frequently good medium-term remission. Very common presentation – older people who have a first fit at 65+. "renal cell carcinoma -lung carcinoma -breast carcinoma -malignant melanoma -GI tract" medical -steroids, anticonvulsants -radiotherapy -whole brain, stereotactic -surgery ```

Answer 78

"Focal neurological deficit -hemiparesis, dysphasia, hemianopia, cognitive impairment (memory, sense of direction), cranial nerve palsy, endocrine disorders Epilepsy (only in lesions above tentorium) Raised ICP symptoms - headache (typically morning headache), nausea / vomiting, visual disturbance (diplopia, blurred vision), somnolence, cognitive impairment, altered consciousness Raised ICP signs -papilloedema, 6th nerve palsy – longest intracranial course, 3rd nerve palsy CSF Obstuction signs of primary/weight loss in metastases " "Adequate cerebral imaging - CT - MRI - PET - (Angiography) - If suspecting metastasis - CT chest/abdo/pelvis - mammography - biopsy skin lesions/ lymph nodes" "Relevant to issues, any of: corticosteroids (Dexamethasone) - treat epilepsy (anticonvulsant drugs) - analgesics / antiemetics - counselling - surgery - radiotherapy - chemotherapy - endocrine replacement

Answer 79

"derived from astrocytes. most common, most aggressive, fast growing, GBM is often referred to as a grade IV astrocytoma. High grade - Very poor prognosis - ~1 year. Low grade - long life expectancy" "spread by tracking through white mater and CSF pathway -very rarely spread systemically. Diffuse edges. "complete surgical excision impossible -biopsy or debulk only -medical (Steroids, anticonvulsants) -radiotherapy -chemotherapy (temazolamide)

Answer 80

"commonly cured by surgery. Arachnocytes, do not metastasise, but can be locally aggressive. bland cells forming small groups, sometimes with calcification Small groups of cells whorl around each other, resembling an arachnoid granulation" "slow growing -extra-axial -usually benign -arise from arachnoid -frequently occur along falx, convexity, or sphenoid bone -usually cured if completely removed"

Answer 81

tumour of pituitary gland Adenoma most common "visual disturbance - compression of optic chiasm - hormone imbalance" reduced visual field - bitemporal hemaniopia visual field testing. Imgaging, blood tests for hormones Only 1% tumours malignant

Answer 82

schaemic stroke - lack of O2 to the tissues causing cell death - tissue degeneration. Yellow – macrophages start to clean up the area, brain swelling, congested vessels, tissue death. Foamy macrophages. Gliosis – a form of scarring within the CNS. Risk Factors: Modifiable - Hypertension – massively - Smoking - Diet - Sedentary lifestyle - Alcohol - Obesity - Cholesterol Non-modifiable -Previous stroke -Being old -Being male -Having a horrible family history -Diabetic Atheroma + thrombosis of artery causing ischaemia Thromboembolism (for example, from left atrium) causing ischaemia Low O2 in blood (hypoxia with intact circulation of blood). C02 poisoning, near drowning, respiratory arrest Inadequate supply of blood (flow of blood not occurring) – blood may be oxygenated or not. cardiac arrest, hypotension, brain swelling (eg trauma) Inability to use O2 - cyanide poisoning. Symptoms and signs depend on where the stroke occurs. Normally weakness, speech difficulty, cognitive impairment. FAST test. Signs of issue causing stroke. Imaging: CT or MRI thrombolysis (TPA). Thrombectomy. O2. Secondary prevention - bp control, anti platelet, anti-coagulant, statins. Carotid endardectomy.

Answer 83

blood is irritant to tissue and lack of nutrient supply and distal vasospasm. Ruptured aneurysm of a cerebral vessel causing haemorrhage. Weakening of wall + hypertension causes aneurysm to form Wall can then rupture, especially if severe hypertension. Stop bleeding. Bp control.

Answer 84

"Communicating Hydrocephalus (CoH) -Also known as “non-obstructive” hydrocephalus. excess CSF within the intracranial space and, specifically, the intraventricular spaces within the brain" vast majority of cases- a problem with CSF resorption. Infection, SAH, Post-operative, Head trauma. Rare - Choroid Plexus Papillomas = overproduction. If cranial sutures have not yet fused - disproportional increase in head circumference, failure to thrive. If fused sutures/adults, hydrocephalus manifests with symptoms of increased intracranial pressure - Headache, N&V, papilledema, gait disturbance, 6th cranial nerve palsy, upgaze difficulty

Answer 85

"Non-communicating Hydrocephalus (NCH) -Also known as “obstructive” hydrocephalus. excess CSF within the intracranial space and, specifically, the intraventricular spaces within the brain" ANY physical obstruction to the normal flow of CSF before it leaves the ventricles. Aqueductal stenosis, Tumours/Cancers/Masses, Cysts, Infection, Haemorrhage/hematoma, Congenital malformations/conditions Gradual/rapid onset of symptoms depening of rate of development of cause.

Answer 86

"Imaging - CT, MRI. The third ventricle will become ballooned Lateral ventricle size increase Peripheral sulci effaced Evans Ratio ->30% /Ventricular index >50%" External Ventricular Drain (EVD), shunt (Ventriculo-peritoneal is most used), removal of lesion if possible/exists, Third Ventriculostomy is an option for non-communicating hydrocephalus. shunt failure, infection from EVD.

Answer 87

rare preventable and/or reversible causes of dementia. "Wet, Wobbly, and Wacky. Urinary incontinence - Gait disturbance (usually the first symptom to present) – wide stance; short, shuffling steps - Rather quickly-progressive dementia - Communicating hydrocephalus on CT/MRI" "Communicating hydrocephalus on CT/MRI Lumbar Puncture (LP) - Normal opening pressure - Symptoms improve with CSF removal - Gait assessment (time walk and turns) and MMSE" Programmable VP shunt placement Chance of outcome is improved if symptoms have been present for shorter period of time. Most likely symptom to improve is gait>incontinence>memory

Answer 88

most common type of ischaemic stroke -Common sites brainstem, basal ganglia, +cerebellum Small end arteries -high pressure "Devoid of ‘cortical’ signs -E.g. no dysphasia, neglect, hemianopia - Pure motor stroke - Pure sensory stroke - Dysarthria - clumsy hand syndrome - Ataxic hemiparesis" "FOR ALL PATIENTS - Routine blood tests (FBC, glucose, lipids, ESR...) - CT or MRI head scan (infarct vs. haemorrhage) - ECG (?AF, LVH) 24 hr Holter"

Answer 89

stroke originating from a block in the anterior cerberal artery and therefore affecting it's territory. (TACS or PACS) blockage of anterior cerebral artery "Contra-lateral - paralysis of foot and leg - sensory loss over foot and leg - impairment of gait and stance" "FOR ALL PATIENTS - Routine blood tests (FBC, glucose, lipids, ESR...) - CT or MRI head scan (infarct vs. haemorrhage) - ECG (?AF, LVH) 24 hr Holter For anterior circulation stroke patients - Carotid doppler ultrasound (?stenosis)"

Answer 90

stroke originating from a block in the middle cerberal artery and therefore affecting it's territory. blockage of middle cerebral artery "Contra-lateral - paralysis of face/arm/leg - sensory loss face/arm/leg - homonymous hemianopia - Gaze paralysis to the opposite side (can’t look towards weak side, looks towards lesion) - Aphasia if stroke on dominant (left) side of brain - Unilateral neglect and agnosia for half of external space if non-dominant stroke (usually right side)." "FOR ALL PATIENTS - Routine blood tests (FBC, glucose, lipids, ESR...) - CT or MRI head scan (infarct vs. haemorrhage) - ECG (?AF, LVH) 24 hr Holter"

Answer 91

Brain Stem / Cerebellum / Thalamus, Occipital and medial temporal lobes affected when there's a block in the posterior circulation a block in the posterior circulation "Coma, vertigo, nausea, vomiting, cranial nerve palsies, ataxia. - Hemiparesis, hemisensory loss - Crossed sensori-motor deficits - Visual field deficits" "FOR ALL PATIENTS - Routine blood tests (FBC, glucose, lipids, ESR...) - CT or MRI head scan (infarct vs. haemorrhage) - ECG (?AF, LVH) 24 hr Holter"

Answer 92

raised pressure within the skull many "Surgery to relieve pressure - heamatoma, ventricular shunt - Osmotic agents e.g. mannitol – draws fluid from the brain (1st 24hrs) - Nurse with head at 30-45% (Venous return) - Reduce pain - Maintain good PO2, reduce PCO2 - Reduce metabolism (reduce temperature, barbiturates)"

Answer 93

Can be caused by a pontine infarction. patient has total paralysis below the level of the third nerve nuclei (midbrain) and, although able to open, elevate and depress the eyes, has no horizontal eye movements and no other voluntary eye movement diagnosis depends on recognising that the patient can open their eyes voluntarily and signal numerically by eye closure

Answer 94

``` "Anoxic/ ischaemic conditions Metabolic disturbances Intoxications, Systemic infections Hyperthermia/ Hypothermia, Epilepsy" "Toxicology screen including alcohol level Measure blood sugar and electrolytes Assess hepatic and renal function Acid - base assessment and blood gases Measure blood pressure, Consider carbon monoxide poisoning" ```

Answer 95

"Subarachnoid Haemorrhage - Meningitis - Encephalitis" "CT head scan - Lumbar puncture - Appearance, Cell count, Glucose level, Capsular antigen tests"

Answer 96

"Cerebral tumour - Cerebral haemorrhage - Cerebral infarction - Cerebral abscess" "CT or MRI obligatory - If CT/MRI not diagnostic, then investigate as for other causes of coma e.g. including - metabolic screens, lumbar puncture, EEG"

Answer 97

"Unilateral facial weakness - Lower motor neurone type - Often preceded by pain behind ear - Eye closure affected" Steriods. give eye drops. They can get a corneal ulcer and lose vision Risk of corneal damage

Answer 98

bell's palsy, Lyme, sarcoid forehead involved

Answer 99

stroke, tumour forehead spared – bilateral innervation of the forehead

Answer 100

possibly viral Sudden onset, Disabling vertigo, Vomiting, Gradual recovery

Answer 101

upper motor neurone Bilateral UMN lesions e.g. in vascular lesions of both internal capsules, MND dysarthria, dysphonia, dysphagia, spastic, immobile tongue, brisk jaw jerk, brisk gag reflex examination of 9, 10, 12. risky feeding, take care

Answer 102

lower motor neurone "Bilateral LMN lesions affecting IX - XII eg. MND, polio, tumours, vascular lesions of the medulla and syphilis" wasted, fasciculating tongue, dysarthria, dysphonia, dysphagia care in feeding

Answer 103

"A syndrome consisting of: Progressive impairment of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interference in occupational and social role. " "Late onset (65+ yrs) Alzheimer’s (55%) Vascular (20%) Lewy body (20%) Others (5%) Young onset (<65 yrs) Alzheimer’s (33%) Vascular (15%) Frontotemporal (15%) Other (33%) -Toxic (alcohol) -Genetic (Huntington’s) -Infection (HIV, CJD) -Inflammatory (MS)" "Memory, attention, language, visuospatial, Behaviour, emotion, executive function Apraxias. Agnosia." "History (independent witness) -type of deficit, progression, risk factors, FH. Speed of progression -rapid progression (CJD) -stepwise progression (vascular) Other neurological signs -abnormal movements (Huntington’s) (chorea) -parkinsonism (Lewy body) -myoclonus (CJD)" "Treatable causes/mimics Vitamin deficiency - B12 Endocrine- thyroid disease Infective - HIV, syphilis -check. Mimics: Hydrocephalus Tumour - do a scan Depression: “pseudodementia” - assess. routine - bloods, CT / MRI others - CSF, EEG, functional imaging, genetics, (biopsy - only if it will make a difference to management) Screening tests Mini-mental (MMSE), Montreal (MOCA) " "Symptomatic treatment. Non-pharmacological: -Information & support, dementia services -Occupational therapy - manage at home for as long as they can. Alarms for when the try leave the house. -Social work / support / respite / placement -Voluntary organisations Pharmacological: -Insomnia - might want to try things – NOT SEDATIVE. Maybe melatonin -Behaviour (care with antipsychotics), treat -Depression" "antipsychotic increase mortality in dementia. Have to way up aggressive and violent patient against this. "

Answer 104

"Early memory disturbance - Language and visuospatial problems - Personality preserved until later" "Cholinesterase inhibitors (cholinergic deficit) - Donepezil, rivastigmine, galantamine - Small symptomatic improvement in cognition (wash-out) - No delay in institutionalisation - NMDA antagonist (memantine)"

Answer 105

"Early change in personality / behaviour - Tends to spare the hippocampus early. -Often change in eating habits -Early dysphasia -Memory / visuospatial relatively preserved These people tend to do bizarre things. E.g. sexually inappropriate. Become disinhibited. Family members just adapt." no specific treatment

Answer 106

"Mixed picture, Depends where the vascular hit is. Normally have other vascular issues – heart disease etc. Stepwise decline" Vascular lesions can be normal on MRI scans – so can be misdiagnosed with this, need to do it on clinical picture. No good evidence for ↓ vascular risk factors

Answer 107

"Pathology in basal ganglia -predominantly dopamine loss. Idiopathic Parkinson’s disease (-Dementia with Lewy bodies) - Drug-induced (e.g. dopamine antagonists for schizophrenia. Others – valproate. Others. - treatable) - Vascular parkinsonism (lower-half) " "A clinical syndrome with 2 or more of: - Bradykinesia (slowness of movement) - Rigidity (stiffness) - Tremor (shakiness) - Postural instability (unsteadiness / falls)" "Clinical - Bradykinesia + ≥1 tremor, rigidity, postural instability - No other cause / atypical features - Slowly progressive (> 5-10 yrs) Supported by asymmetric rest tremor, good response to dopamine replacement treatment Less likely if rapid progression, symmetrical, lack of rest tremor, poor response to treatment, early falls, early dementia, other abnormal neurological signs" "Early treatment: Levodopa (+ carbidopa/benserazide, COMT inhibitor - enacapone). Dopamine agonists, MAO-B inhibitors. Late treatment: Drugs: -Prolong levodopa half life: -MAO-B inhibitors -COMT inhibitor -slow release levodopa -Add oral dopamine agonist -Continuous infusion (apomorphine, Duodopa) - a pump. Or can get PEJ. Functional neurosurgery (deep brain stimulation), care package. " "Motor fluctuations - levodopa wears off -Dyskinesias - involuntary movements (levodopa) -Psychiatric - hallucinations, impulse control. Depression, Dementia (~50% after 10 yrs) -Autonomic: BP, bladder, bowel -Speech, swallow -Balance"

Answer 108

Multiple system atrophy -Progressive supranuclear palsy / corticobasal degen - Degenerations of other systems. Cerebellar ataxia. Early severe loss of autonomic functions – postural hypotension, impotence, bladder and bowel

Answer 109

Small pupil, anhidrosis and ptosis on the affected side of the face damage to sympathetic system - pancoast tumour, damage in the neck Small pupil, anhidrosis and ptosis on the affected side of the face full investigation of neck area, CT, CXR.

Answer 110

chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles. most commonly affects the muscles that control the eyes and eyelids, facial expressions, chewing, swallowing and speaking. But it can affect most parts of the body. problem with signalling at the NMJ. "droopy eyelids double vision difficulty making facial expressions problems with chewing and difficulty swallowing slurred speech weak arms, legs or neck shortness of breath and occasionally serious breathing difficulties. Fatiguable" blood tests, nerve conduction studies. Pyridostigmine. Steriods. Immunosuppressants. Surgery yo remove enlarged thymus. thymoma

Answer 111

Can affect the cranial nerves and the peripheral nerves schwann cells "8th vestibulocochlear nerve schwannoma, often called ‘Acoustic neuroma’ at angle between pons and cerebellum - Unilateral deafness - Benign lesion but removal technically difficult"

Answer 112

High grade neoplasm. Generally, do not spread outside of CNS "Usually diffuse large B-cell lymphoma -Often deep and central site in brain" Difficult to biopsy Difficult to treat as drug do not cross blood-brain barrier

Answer 113

Tumour of blood vessels "Space occupying - May bleed - Most often in cerebellum"

Answer 114

Tumour of primitive neuroectoderm (primitive neural cells) Sheets of small undifferentiated cells. Children especially Posterior fossa, especially brainstem

Answer 115

Amount of tissue increases - The more tissue, the bigger the problem "Tumours Bleeding (haematoma) Abscess" "Cause internal shift (herniation) between the intracranial spaces -Right-left or left-right (cingulate/Subfalcine) -Cerebrum moves inferiorly over edge of tentorium (uncal herniation) -Cerebellum moves inferiorly into foramen magnum (coning) morning headaches and sickness, papilloedema, blown pupil, Dropping GCS, brainstem death" Tumours squeeze nearby tissue and cause local ischaemia

Neuro Table Flashcards

(139 cards)