Neurological conditions Flashcards

Question

What is functional neurological disorder?

Answer 1

FND is sometimes referred to as a ‘functional stroke’ or a ‘functional stroke mimic’. Caused by a disorder that effects the nervous system rather than the brain resulting in the signals between brain and body being interupted.

Answer 2

Loss of motor control Sensory symptoms Speech problems Seizures Visual symptoms Cognitive problems Bladder and bowel problems.

Answer 3

One localised area of the brain is initially involved – can spread to involve other areas

Answer 4

Provoked (acute symptomatic seizures) Psychogenic non-epileptic seizures (PNES) Vasovagal syncope Cardiogenic events Eclampsia Febrile seizures

Answer 5

Bilateral Tonic-Clonic Seizure

Answer 6

Loss of consciousness Stiffening of muscles Can be have a “crying out” effect as air pushes past vocal cords May bite their tongue

Answer 7

Rhythmic jerking of limbs Loss of control of bladder and/ or bowels Breathing affected – cyanosis may occur

Answer 8

Where there is impaired consciousness and last longer than 10 minutes

Answer 9

The patient is fully aware of surroundings during the seizure but may not be able to move or respond

Answer 10

When awareness is affected at some point during the seizure

Answer 11

Motor - muscle activity localised jerking, loss of tone or repeated movement Non Motor – no muscle activity but may affect emotions, thinking and sensations

Answer 12

Typical absences – usually last around 10 secs but can be in clusters Appear as a “switching off” or “day-dreaming”. A sudden and unexpected stop for a few seconds. Can have some slight jerking movements or eye lid flutter especially with longer absences They do not generally fall but will not know what is happening and can not be brought out of it Some go unnoticed Can have hundreds per day or just occasional ones Most start in childhood or just into adulthood - usually patients with other existing neurological disorders

Answer 13

Atypical absences – usually last up to about 30 secs Similar to typical but last longer and have a slower start and finish May be able to move around but appear clumsy as muscles become limp Can occur in any age group but usually associated with people who have learning difficulties or brain conditions

Answer 14

Can be focal or generalised Mild (twitch) or can be more forceful – enough to throw something they are holding or make them fall over Does not usually affect level of consciousness Usually last for less than a second but can be in clusters

Answer 15

Can be focal or generalised Muscles tense /stiff If standing may fall to the floor Neck extension and eyes open wide and roll upwards Arms might move upwards Legs may stretch or contract May cry out and stop breathing briefly Usually last three seconds to two minutes

Answer 16

Muscles become limp Will fall to floor if standing or may see a drop of the head forward and may “go weak at the knees” Usually lasts less than a couple of seconds

Answer 17

Seizures not caused by epilepsy but by damage to the brain or metabolic issues

Answer 18

May be caused by structural damage to the brain: TBI Brain tumour Stroke Tuberculous meningitis (TBM) Neurocysticercosis May be due to metabolic issues: Alcohol withdrawal and chronic alcohol over use Renal failure Heptatic failure Blood Glucose – hypoglycaemia

Answer 19

Vasovagal syncope

Answer 20

A temporary disruption of the supply of oxygen and glucose to the brain due to a fall in cerebral blood pressure. Has many causes including: Standing for long periods. Excess heat. Intense emotion, such as fear. Intense pain. The sight of blood or a needle. Prolonged exercise. Dehydration. Skipping meals. **and others**

Answer 21

May have very short muscle jerking (usually less than 20 secs) Patient may be able to hear but not respond verbally Once supine recovery is usually quite rapid

Answer 22

Dysrhythmias causing syncope Don't usually cause convulsions but may have impairment of consciousness and have decerebrate posturing

Answer 23

Infection of the protective membranes surrounding the brain and spinal cord, specifically the leptomeninges

Answer 24

**Bacterial** is rarer but usually more serious then viral. If caught early can make a full recovery. Around 1 in 10 cases are fatal **Viral** is rarely life threatening and usually resolves itself in 7 – 10 days **Fungal** is very rare in the UK and is usually only found in immunosupressed patients All can cause septicaemia

Answer 25

Usually caught from someone carrying the virus or bacteria in their nose or throat but not ill themselves (although is occasionally caught from someone with meningitis) Transmitted usually through: Coughing Sneezing Kissing

Answer 26

Anyone can contract meningitis but most common in: <25 yrs old People living in community settings (Refugees, military, students) Pregnant people Animal workers The immunosupressed/deficient

Answer 27

Inflammation of the encephalon (brain)

Answer 28

Anyone can have encephalitis but most common in the very old and very young

Answer 29

The first symptoms of encephalitis can be similar to flu, such as: High temperature Headache Nausea and Vomiting Aching muscles and joints Some people may also have a spotty or blistery rash on their skin These early symptoms do not always appear and the first signs of encephalitis may be more serious symptoms.

Answer 30

Confusion or disorientation Drowsiness Seizures Changes in personality and behaviour (agitation) Difficulty speaking Weakness or loss of movement in some parts of the body Hallucinations (visual and auditory) Loss of feeling in certain parts of the body Uncontrollable eye movements / eyesight problems Loss of consciousness There may also be symptoms of meningitis: Severe headache Photophobia Stiff neck Non- blanching rash

Answer 31

Dizziness is a general, non-specific term to indicate a sense of disorientation. Vertigo is a subtype of dizziness and refers to a false perception of self or object motion or an unpleasant distortion of orientation/sense of gravity whilst stationary It is a result of a mismatch between vestibular, visual, and somatosensory systems. Vertigo is a symptom not a condition.

Answer 32

Peripheral - caused by balance mechanisms in the inner ear Central - caused by issues within the brain

Answer 33

Benign Paroxysmal Positional Vertigo - BPPV Head injury - BPPV(t) Labyrinthitis Vestibular Neuronitis Ménière's disease Taking certain types of medication

Answer 34

Nystagmus is a rhythmical, repetitive and involuntary movement of the eyes. It is usually from side to side, but sometimes up and down or in a circular motion. Both eyes can move together or independently of each other. A person with nystagmus has no control over this movement of the eyes.

Answer 35

BPPV occurs when small crystals of calcium carbonate, shift in the inner ear and/or fall into another area within the balance canals. The crystals may move for many reasons, such as, an inner ear infection, recent surgery, long periods of rest, fever, head injury or whiplash injury.

Answer 36

An inner ear infection. It causes a delicate structure deep inside your ear called the labyrinth to become inflamed, affecting your hearing and balance.

Answer 37

Vestibular neuritis, also known by the name vestibular neuronitis, is thought to be caused by inflammation of the vestibular portion of the eighth cranial nerve. Does not usually affect hearing

Answer 38

Ménière’s disease are caused by the buildup of fluid in the labyrinth. Unknown cause and episodes can last from hours to days. Symptoms include: dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear

Answer 39

Medications Drugs and alcohol MS TIAs Tumors Migraines

Answer 40

A rare condition where the immune system attaks the peripheral nervous system. Can affect all ages but most common in adult males, most recover fully. Symptoms develop usually over hours or days, usually reaching most severe within 4 weeks.

Answer 41

Early symptoms tend to be in feet and hands: Numbness Pins and needles Muscle weakness Pain Balance and coordination problems Usually affect both sides of the body at the same time

Answer 42

Difficulty walking Paralysis DIB Difficulty speaking Difficulty swallowing or chewing Difficulty with bladder and bowel motions Persistent pain

Answer 43

Temporary weakness or lack of movement usually affecting one side of the face (other symptoms include, drooling, drooping eyelid, loss of taste, dry mouth and dry or watering eye). Treated with steroids, eye drops to stop drying out, tape to close eye during sleep. Recovery period is usually around 6 months.

Answer 44

A rare neurological condition that can cause problems with balance, movement, vision, speech and swallowing. It is caused by a build up of protein (tau) damaging brain cells, with increasing damage over time. Other symptoms include falls, changes in behaviour muscle stiffness, inability to control eye movement, memory problems Usually develop in people over the age of 60

Answer 45

**Position** - Supratentorial/Infratentorial **Cells involed** - E.g. astrocytoma **Severity** - i.e. stage and grade

Answer 46

DNA mutations causing uncontrolled cell division, mutations to: **Proto-oncogenes** - Promotion of cell division (Accelerator) **Tumor suppressor genes** - Loss of inhibition of cell division (Brakes) Promotion of the accelerator and a loss of the breaks causes uncontrolled cell division

Answer 47

Benign - Not harmful, self contained Malignant - Cancerous, cross basement membranes

Answer 48

Supratentorial

Answer 49

In glioblastoma, they are dense cellular arrangements that surround necrotic foci, formed when aggresive malignant cell division leads to not enough blood being able to reach the centre of the tumor, the peripheral cells continue to divide.

Answer 50

In parasagittal regions and on the surface of the brain under the dura mater. They form multinuclear synctiums of fused cells, usually arachnoid cap cells

Answer 51

Glioblastomas, a common type of strocytoma - fast growing supratentorial tumors.

Answer 52

Common usually benign tumors formed from the enocrine tissue of the pituiatry, classified by hormones released in tumor form.

Answer 53

Relatively rare supratentorial tumors formed from oligodendrocytes. More common in frontal and temporal lobes where cells are heavily myelinated Relatively slow growing - can become malignant "Fried egg" or "Chicken-wired"

Answer 54

Haemangioblastomas are rare non cancerous (benign) brain tumours. They start in the cells that line the blood vessels in the brain, spinal cord and brain stem. They usually grow slowly over some years. Most haemangioblastomas start in the back of the brain (cerebellum).

Answer 55

-Headaches -Seizures (fits) -Persistently feeling sick (nausea), being sick (vomiting) and drowsiness -Mental or behavioural changes, such as memory problems or changes in personality -Progressive weakness or paralysis on one side of the body -Vision or speech problems

Answer 56

Medical imaging Tissue BIOs

Answer 57

-Steroids -Medicines to help with symptoms -Surgery -Radiotherapy -Chemotherapy

Answer 58

Coup - injury on side of impact Contrecoup - injury on opposite side to impact **Bothh can be present** - Coup-contrecoup

Answer 59

Hypoxia/iscaemia Oedema Haematoma Release of toxic chemicals (Free radicals)

Answer 60

A transient and reversible post-traumatic alteraation to mental status with **no visible structural damage** on imaging, however repeated concussions can lead to traumatic encephelopathy. Neuronal damage caused by excessive release of excitaory neurotransmitters.

Answer 61

Unstable - fragments of bone may move around and cause further damage or Stable - structured resistant to further damage Complete - No function or Incomplete - Some function retained

Answer 62

Spina bifida is when a baby's spine and spinal cord does not develop properly in the womb, causing a gap in the spine. Spina bifida is a type of neural tube defect. The neural tube is the structure that eventually develops into the baby's brain and spinal cord.

Answer 63

Frequent urinary tract infections Fluid buildup on the brain (hydrocephalus) Displaced cerebellum Loss of bowel or bladder control Brain infection (meningitis) Permanent weakness or paralysis of legs This list may not be all-inclusive.

Answer 64

**Surgery** within the first few days of birth is usually the priority Children who also have hydrocephalus may need to have a ventriculoperitoneal shunt placed. This will help drain the extra fluid from the ventricles (in the brain) to the peritoneal cavity (in the abdomen). Antibiotics may be used to treat or prevent infections such as meningitis or urinary tract infections. Most children will need lifelong treatment for problems that result from damage to the spinal cord and spinal nerves.

Answer 65

Umbrella term for conditions marked by impaired muscle coordination (spastic paralysis) and/or other disabilities, typically caused by damage to the brain before or at birth (bleed, hypoxia etc.).

Answer 66

Cerebral palsy

Answer 67

A neurological disorder caused by an abnormal buildup of cerebrospinal fluid in the ventricles (cavities) deep within the brain. This excess fluid causes the ventricles to widen, putting harmful pressure on the brain's tissues.

Answer 68

A mismatch between CSF production and usage e.g. -Obstruction -Poor absorption -Overproduction

Answer 69

-Bulging of the cranium -Eyes fixed downward (sunsetting) -Lethargy -Irritability -Seizures -Nausea and vomiting -Poor eating -Problems with muscle tone and strength

Answer 70

Immune mediated inflammatory disease that attacks myelinated axons of the CNS. Chronic and progressive with episodes of exacerbation and remission.

Answer 71

White blood cells attack myelin surrounding nerve cells leaving scars and plaques. Loss of myelin interferes with conduction leading to dysfunction as impulses are slowed or blocked.

Answer 72

The symptoms of MS vary widely from person to person and can affect any part of the body. The main symptoms include: -Fatigue -Difficulty walking -Vision problems, such as blurred vision -Problems controlling the bladder -Numbness or tingling in different parts of the body -Muscle stiffness and spasms -Problems with balance and co-ordination -Problems with thinking, learning and planning

Answer 73

It's about 2 to 3 times more common in women than men

Answer 74

It can onset at any age but usually in the 20s to 40s

Answer 75

Dysfunction of the extrpyramidal motor system due to progressive degenerative changes in the basal nuclei. Associated with two major pathological findings: 1) A loss of dopaminergic neurons (due to the above) and a decrease in dopamine levels - dopamine has an inhibatory affect on the motor system 2)The presence of Lewy bodies and neurites

Answer 76

clumps of abnormal protein particles that, for reasons that are not fully understood, accumulate in the brain and cause cell damage/dusfunction/death

Answer 77

3 main: Resting tremor Rigidity Bradykinesia Others: Stooped posture Decreased facial expression Balance impairment Depression Reduced dexterity Soft voice Slow thinking Sleep issues

Answer 78

Supportive therapies -such as physiotherapy Medication -Dopamine replacement (Levodopa) -Dopamine agonists -Monoamine oxidase-B inhibitors (Block the effects of an enzyme or brain substance that breaks down dopamine) Surgery (for some people) -Deep brain stimulation

Answer 79

A chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in fluctuating fatigue and weakness of the skeletal muscles. -The immune system releases antibodies that target and block acetylcholine receptors at the neuromuscular junction. Myasthenia gravis affects the voluntary muscles of the body, especially those that control the eyes, mouth, throat and limbs.

Answer 80

-Trouble holding up your head -Drooping eyelids -Eye muscles weakness -Change in your facial expression -Double vision -Shortness of breath -Trouble swallowing -Problems walking and lifting things -Speech problems **In severe MG conditions the respiratory muscles become so weak that one can't control them. This is a medical emergency that requires the use of a ventilator to assist patients in breathing. Around 15% to 20% of people with myasthenia gravis will have at least one myasthenic crisis. It can be caused by an infection, stress, surgery, or a medical reaction.**

Answer 81

An incurable adult onset inherited disorder, associated with cell loss in the brain due to a genetic fault causing a loss of a protein called Huntingtin. It is not fully understood why but the protein is important for neuronal function. This disease specifically affects the neurons of the basal ganglia

Answer 82

The first symptoms of Huntington's disease often include: Difficulty concentrating Memory lapses Depression Stumbling and clumsiness Mood swings, irritability or aggressive behaviour Over time, someone with Huntington's disease may develop: Involuntary jerking Difficulty speaking clearly Swallowing problems Increasingly slow or rigid movements Personality changes Breathing problems Difficulty moving around – they may eventually lose the ability to walk or sit up by themselves In the later stages, people with Huntington's disease find daily activities increasingly difficult and will need full-time nursing care.

Answer 83

Motor neuron disease (MND) refers to a group of chronic sporadic and hereditary neurological disorders characterized by progressive degeneration of motor neurons. Motor neurones degenerate and stop sending signals to the muscles which weaken and atrophy

Answer 84

Amyotrophic lateral sclerosis (ALS) is the most common form of MND.

Answer 85

Exact cause not known but thought to be caused by toxins released by astrocyte cells

Answer 86

Progressively over several years. A person with MND will usually die between two to three years after diagnosis

Answer 87

**ALS**: This is the most common type of MND. It affects both the upper and lower motor neurons — the neurons in the brain and spinal cord **Primary lateral sclerosis**: This affects the neurons in the brain. It is a rare form of MND that advances more slowly than ALS. It is not fatal, but it can affect the quality of life. **Progressive bulbar palsy (PBP)**: This involves the brain stem, and people with ALS often have PBP, too. It causes frequent choking spells and difficulty speaking, eating, and swallowing. **Progressive muscular atrophy**: This type of MND is rare. It affects the lower motor neurons in the spinal cord and causes slow but progressive muscle wasting, especially in the arms, legs, and mouth. **Spinal muscular atrophy (SMA)**: This inherited MND develops in children. It tends to affect the trunk, legs, and arms. The long-term outlook depends on the type.

Answer 88

Bacterial (Meningococcus)

Answer 89

The anatomical site of bacterial invasion from the bloodstream remains unidentified. Experimental evidence suggests that the choroid plexus may be a site of invasion. Meningococci are found in the choroid plexus as well as in the meninges and pneumococci infiltrate the leptomeningeal blood vessels in meningitis.

Answer 90

The pathogens take advantage of the specific features of the immune system in the CNS, replicate and induce inflammation. A hallmark of bacterial meningitis is the recruitment of highly activated leukocytes into the CSF. Beside bacteria, viruses, fungi and non-infectious causes as in systemic and neoplastic disease as well as certain drugs can induce meningeal inflammation. Usually the inflammatory process is not limited to the meninges surrounding the brain but also affects the brain parenchyma (meningoencephalitis), the ventricles (ventriculitis) and spreads along the spinal cord. In recent years the damage of neurons, particularly in hippocampal structures, has been identified as a potential cause of persistent neuropsychological deficits in survivors.

Answer 91

A lumbar puncture (spinal tap)

Answer 92

The occiput (usually)

Answer 93

Temporary loss of vision caused by lack of blood flow to the eyes. Can be a warning sign of a stroke.

Answer 94

Temporary loss of vision caused by lack of blood flow to the eyes. Can be a warning sign of a stroke.

Answer 95

It is a form of vasculitis that commonly affects arteries of the head, neck and body. When it affects the temporal arteries it is known as temporal arteritis. If left untreated GCA cause blindness, CVAs and aneurysms.

Answer 96

It is a form of vasculitis that commonly affects arteries of the head, neck and body. When it affects the temporal arteries it is known as temporal arteritis. If left untreated GCA cause blindness, CVAs and aneurysms.

Answer 97

It is a form of vasculitis that commonly affects arteries of the head, neck and body. When it affects the temporal arteries it is known as temporal arteritis. If left untreated GCA cause blindness, CVAs and aneurysms.