Neurological Pathologies Flashcards
(112 cards)
1
Q
What is raised intracranial pressure?
A
An increase in pressure within the cranial cavity.
2
Q
Which condition describes an increase in pressure within the cranial cavity?
A
Raised intracranial pressure
3
Q
Compression of ______ ______ leads to reduced delivery of oxygen to the brain.
A
Blood vessels
4
Q
List 4 potential causes of raised intracranial pressure.
A
- Tumour
- Haemorrhage
- Hydrocephalus
- Meningitis
- Intracranial abscess
5
Q
What is encephalitis?
A
Inflammation of brain tissue
6
Q
What is hydrocephalus?
A
Excess cerebrospinal fluid around the brain
7
Q
What is meningitis?
A
Inflammation of the meninges surrounding the brain and spinal cord.
8
Q
Name 2 types of brain haemorrhage.
A
Subdural and subarachnoid
9
Q
Name a primary tumour within the brain.
A
Glioma
10
Q
List 5 possible signs/symptoms of raised intracranial pressure.
A
- Headache (worse in the morning / when moving the head)
- Vomitting (without nausea)
- Visual disturbance
- Mood change (irritability, lethargy)
- Impaired mental state
- Fixated/dilated pupil
- Altered speech
- Seizures
11
Q
What is papilloedema and in which pathology might it be present?
A
Bulging of the optic disc
Seen in raised intracranial pressure
12
Q
What is the cushing triad?
A
When a patients blood pressure elevates, but their pulse rate and breathing slow down.
13
Q
What causes the cushing triad?
A
Pressure on the medulla oblongata / it being pushed against the side of the cranium.
14
Q
Why can hydrocephalus lead to irreversible brain damage?
A
Because excess CSF can permeate through the ependymal lining into the surrounding white matter.
15
Q
Hydrocephalus can be caused by either excess production of CSF or (more usually), impaired _______ of CSF.
A
Impaired absorption.
16
Q
List 4 potential causes of hydrocephalus.
A
- Congenital problem
- Infection
- Tumours
- Trauma
- Meningitis
17
Q
List 3 signs/symptoms of hydrocephalus
A
- Headache (worse on waking)
- Vomitting
- Blurred / double vision
18
Q
What is the allopathic treatment for hydrocephalus?
A
- Diuretics
- Draining of the fluid out of the ventricles
- Fitting of a shunt
- Lumbar puncture
19
Q
What is the most commonly used diagnostic procedure for hydrocephalus?
A
CT scan, followed by MRI.
20
Q
List 2 reasons why meningitis can be life-threatening.
A
- It can lead to septicaemia
2. It can cause raised intracranial pressure
21
Q
What is the most common cause of meningitis (90% of cases)
A
Herpes Simplex virus (viral meningitis)
22
Q
What do cold sores and viral meningitis have in common?
A
Both caused by the herpes simplex virus
23
Q
Although much less common, why does bacterial meningitis tend to be more serious?
A
It can become septic much more easily
24
Q
In rare circumstances, meningitis can be caused by a fungus or parasite. True or false.
A
True
25
Which populations is meningitis more likely to affect?
- Immunocompromised patients
- Elderly
- HIV positive
- Cancer patients
26
List 5 signs/symptoms of meningitis
1. A severe, sudden-onset headache
2. Fever
3. Strong sensitivity to light
4. Neck stiffness
5. Vomiting
6. Non-blanching Petechiae - tiny haemorrhages on the skin that show as a red/purple rash, which don't disappear when pressed with a glass tumbler
27
What are non-balancing petechiae, and which pathology are they associated with?
Tiny haemorrhages on the skin that show as a red/purple rash, which don't disappear when pressed with a glass tumbler.
Bacterial Meningitis
28
Meningitis can initially resemble the flu. True or false?
True
29
Which pathology is indicated with non-blanching petechiae, Kernig's sign and Brudzinski's sign?
Meningitis
30
Which form of meningitis is associated with petechiae?
Bacterial meningitis
31
How is meningitis diagnosed?
Via lumbar puncture (to withdraw CSF and analyse the presence of infective organisms)
32
What is the allopathic treatment for meningitis?
- Antibiotics, antivirals and corticosteroids
- Analgesics
- Antipyretics (lower body temperature)
- Intravenous fluids
33
List 3 complications of meningitis
1. Raised intracranial pressure
2. Septicaemia
3. Seizures
34
Define 'concussion'
The temporary loss of neural activity within the brain.
| A reversible head injury.
35
What causes a concussion?
A significant injury / blow to the head
36
List 4 signs/symptoms of a concussion.
1. Disorientation / confusion
2. Headache
3. Lack of memory of the injury
4. Nausea / vomiting
5. Loss of consciousness at the time
37
Name one complication of concussion
Brain haemorrhage
38
What is the treatment for concussion?
Rest.
| If they lost consciousness at all they must avoid any vigorous activity for 3 months.
39
What is a cerebral contusion?
A traumatic brain injury that causes bruising of the brain, ruptured blood vessels and oedema
40
What is usually the cause of a cerebral contusion?
A blunt blow to the head
41
List 4 signs/symptoms of cerebral contusion.
1. Headache
2. Confusion
3. Nausea & vomitting
4. Loss of consciousness
5. Seizures
42
Name one neurological pathology that is a medical emergency.
Cerebral contusion
43
What does 'contusion' mean?
Bruise
44
What is a coup injury?
A traumatic head injury whereby the damage caused is at the site of the primary impact.
45
What is a contrecoup injury?
A traumatic head injury whereby the damage caused is contralateral to (on the opposite side of) the site of the primary impact.
i.e, a punch, which has forced the brain to hit the opposite side of the skull, causing damage via rebound impact.
46
Name the term for a common type of head pain with many causes.
Headache
47
List 5 causes of headaches
1. Dehydration (need 2 litres water per day)
2. Neck issues
3. TMJ issues
4. Tension / stress
5. Congested sinuses
6. Hypoglycaemia
48
Which of the cranial nerves is involved in migraines and cluster headaches?
Trigeminal nerve
49
Define 'migraine'.
A neurological condition that results in recurrent, severe headaches.
50
Does migraine have a familial link?
Yes
51
Which gender are more susceptible to migraines?
Females
52
Which pathology is associated with cerebral depolarisation and subsequent intracranial vascular changes?
Migraine
53
List 5 possible causes of migraine.
1. Food allergies
2. Food additives
3. Alcohol
4. Low serotonin levels
5. Stress
6. Hormonal changes
7. Poor sleep
8. Poor digestive function
54
Low levels of which neurotransmitter / hormone are associated with migraine?
Serotonin
55
Why are there big links between poor digestive function and migraines?
Because low serotonin levels are a very common cause of migraines and most serotonin is in the gut.
56
List 3 signs/symptoms of migraine
1. Aura (in 15%)
2. Unilateral, pulsating headache
3. Moderate to severe headache
4. Photophobia
5. Phonophobia
6. Nausea & vomiting
57
What is the allopathic treatment for migraines?
Analgesics, drugs to increase serotonin (5-HT agonists)
58
In relation to migraines, what is aura?
Unusual visual, olfactory and/or sensory headaches preceding the headache (hours to days before)
59
What is one of the best natural remedies / supplements for migraine headache?
Magnesium
60
Even benign brain tumours can be life threatening. Why is this?
Because they increase intracranial pressure.
61
Most primary brain tumours are _______
Gliomas
62
What is a glioma?
A brain tumour originating from glial cells
63
What are the main symptoms of a brain tumour?
- Morning headaches, increasing in frequency
- Nausea & vomiting
- Uneven pupils & double vision
- Papilloedema (bulging of the optic disc)
(Same symptoms as raised intracranial pressure)
64
Why is the question "what relieves your headache" a good question to ask a patient complaining of headaches?
It allows you to better identify the cause and type of the headache.
i.e, if their answer is "lying in a dark room', you can deduce that the type of headache is a migraine.
65
List 3 headache red flags
- Thunderclap headache
- Signs/symptoms of meningitis
- Signs/symptoms of increased intracranial pressure
- First onset of headaches after 50 years of age.
66
Define epilepsy
A neurological disease, causing sudden hyper-excitable, uncontrolled neuronal activity in the brain.
67
What does 'idiopathic' mean?
No known cause
68
List 4 causes of epilepsy
1. Brain tumour
2. Cerebral infarction or headache
3. Congenital brain deformities
4. Head trauma (loss of consciousness)
5. CNS infections (i.e, meningitis)
6. Some drugs
7. Chemical imbalances (i.e, hypoglycaemia)
69
List 4 triggers of epilepsy
1. Fever
2. Hypoglycaemia
3. Sleep deprivation
4. Hypocalcaemia
5. Flickering lights
6. Lack of sleep
7. Stress
8. Dehydration
70
Name the 2 types of seizures that a patient with epilepsy could present with.
1. Grand Mal seizures (convulsive)
| 2. Petit Mal seizures (non-convulsive)
71
What are Grand Mal seizures?
Convulsive epileptic seizures
72
What are Petit Mal seizures?
Non-convulsive epileptic seizures
| "Absence seizures"
73
Which pathology is associated with tonic-clonic seizures?
Epilepsy
74
Describe the tonic phase of a tonic-clonic / Grand Mal epileptic seizure.
Contraction of all body muscles
75
Describe the clonic phase of a tonic-clonic / Grand Mal epileptic seizure.
Rapid contraction and relaxation of muscles, causing convulsions.
(Ranges from exaggerated twitches to violent shaking)
76
Which type of epileptic seizure is followed by physical and nervous exhaustion?
Grand Mal (tonic-clonic) seizure
77
What type of epileptic seizure is seen mainly in children?
Petit Mal seizures
78
Why is a ketogenic / high fat diet beneficial for epileptics?
It helps to increase the production of GABA, and GABA can help to suppress excess electrical activity.
79
What is the allopathic treatment for epilepsy?
Anti-epileptic drugs
Anti-convulsants (ie, Gabapentin)
Emergency care if needed
80
Name an embryological disease.
Spina Bifida
81
What is Spina Bifida?
An embryological disease characterised by incomplete closure of the spinal column around the spinal cord.
This means the back of the spinal cord in that particular place is more vulnerable to damage.
82
What is the main risk factor for spina bifida?
A lack of vitamin B9 (folate) during pregnancy. Primarily during period directly before pregnancy first 8 weeks gestation.
83
Which part of the spine is typically affected by spina bifida?
The lumbosacral junction (L5/S1)
84
Name the 2 types of spina bifida
1. 'Occulta' (the overlying skin is intact)
| 2. 'Cystica' (A visible cystic mass over the affected area)
85
List 2 complications associated with spina bifida.
1. Meningitis
| 2. Hydrocephalus
86
Why is meningitis a complication associated with spina bifida?
Because it provides an opening for bacteria to get into the meninges (especially spina bifida cystic)
87
What is sciatica?
Pain due to the compression or irritation of the sciatic nerve
88
Which nerve is the longest and widest nerve in the body?
Sciatic nerve
89
List 4 signs/symptoms of sciatica.
1. Pain the the buttock and lower back
2. Pain radiating down the posterior leg to the foot
3. Pins & needles, numbness
4. Weak calf muscles
The pain running into the limb is always worse than the pain in the back.
90
List 3 possible causes of sciatica.
1. Compression of piriformis muscle (and therefore sciatic nerve)
2. Disc herniation (at L4/5 or L5/S1)
3. Tumours in the spinal canal or pelvis
91
What is the allopathic treatment for sciatica?
Physiotherapy, surgery and/or steroid injections
92
How is sciatica diagnosed?
- Straight leg raise test
- Loss of sensation in sciatic nerve dermatome
- Absent ankle jerk reflex
93
What is the straight leg raise test used to diagnose?
Nerve compression in the lumbar spine (usually a disc herniation).
Putting the straight leg up to 45 degrees produces symptoms.
94
What is aspartame?
A non-carbohydrate artificial sweetener, 200 times sweeter than sugar.
95
Which artificial sweetener is a neurotoxin, with neurological-excitatory properties?
Aspartame
96
List 3 pathologies that have been linked to aspartame consumption.
1. Parkinsons Disease
2. Multiple sclerosis
3. Problems with balance
97
Why must you make sure that aspartame is excluded from the diet of someone with a neurological issue?
Because aspartame is a neurotoxin
98
List 5 things you could include / test as part of a neurological examination of a patient.
1. Observation / visual signs (i.e, tremor, rigidity)
2. Motor (power) testing
3. Touch, vibration testing (testing the dorsal columns)
4. Proprioception (via gait analysis) and balance
5. Pin prick and temperature tests (testing the spinothalamic tract)
99
What would you use Romberg's Test for?
To test a patient's proprioception
100
If a patient sways after closing their eyes during Romberg's Test, what does this indicate?
A problem with proprioception
| i.e, damage of dorsal columns in the spinal cord - usually a B12 deficiency
101
Give one nutritional cause of a positive Romberg's Test.
Vitamin B12 deficiency
102
Which endocrine pathology can slow a patient's deep tendon reflexes?
Hypothyroidism
103
Which endocrine pathology can exaggerate a patient's deep tendon reflexes?
Hyperthyroidism
104
What is Babinski Sign?
When the toes flex and fan out when stroking the lateral side of the sole of the foot, rather than the usual response which is toes pointing/curling.
105
What does Babinski sign indicate in anyone over 2 yrs old?
- Corticospinal tract damage
- Multiple sclerosis
- Motor Neurone Disease
106
What is papilloedema and what does it indicate?
Bulging of the optic disc
| Indicates raised intracranial pressure
107
How could hydrocephalus present in infants?
An increase of the actual head circumference
108
What age group is most vulnerable to spinal disc protrusions / herniated discs?
30 - 40yrs
109
What would constitute a positive Straight Leg Raise Test?
Reproduced symptoms down the leg within the first 45 degrees of the leg raise
110
How would you perform Romberg's test?
- Ask the patient to stand with feet flat together (no shoes), hands by their sides. Check for any wobble / balance difficulties.
- Ask the patient to close their eyes and repeat
111
What might an absent knee jerk response indicate?
A peripheral nerve problem, or hypothyroidism
112
An adult has an up-going plantar response to cutaneous testing. What might this indicate?
A CNS lesion
