neurological_conditions_20180310144626 Flashcards
(184 cards)
1
Q
Aetiologies?
A
IdiopathicAssociated with disease of the thymus
2
Q
Pathology?
A
Autoantibodies vs AchR at NMJ Leads to failure of muscles to contract and relax properly
3
Q
Symptoms and signs?
A
Muscle weakness increasing with activity, begins with extraocular and descends with timePtosis, peek sign, snarl, mastication weakness –> dysarthria, dyspnoea, limb weakness and fatigueNO LOSS OF REFLEXES Symptoms worsen during stress and over treatment
4
Q
Investigations and findings?
A
Tensilon test - diagnostic Autoantibodies - positive EMGCT chest - may reveal thyme disease
5
Q
Management?
A
Anticholinesterases Immunosuppression Thymectomy if associated thymus disease
6
Q
Epidemiology?
A
More common in males over 50 and women under 50
7
Q
Aetiologies?
A
Post infective disease Causitive organisms: Camylobacter jejuni, EBV, Mycoplasma pneumonia
8
Q
Pathology?
A
Autoantibodies vs infective agents also acting on myelin sheath Leads to acute demyelinating polyneuropathy
9
Q
Signs and Symptoms?
A
Bilateral ascending muscle weaknessPain Reduced/absent reflexesSensory lossAutonomic signs Respiratory distress
10
Q
Investigations and Findings?
A
Nerve conduction study - slow conductionLumbar puncture - high protein in CSF
11
Q
Management?
A
Resuscitation IV immunoglobulin Plasma exchange
12
Q
Complications?
A
Permanent paralysis in ~10%
13
Q
Epidemiology?
A
More common in males 15-30 and 50-75
14
Q
Aetiologies?
A
IdiopathicViralFamilial
15
Q
Pathology?
A
Progressive destruction of the UMN and LMN in the motor cortex, spinal cord and peripheral nerves
16
Q
Signs and symptoms?
A
Four main patterns:ALS - lateral cortocospinal tract and anterior horn signsHand small muscle wastingBulbar/psuedobulbar palsies Primary lateral sclerosis - purely UMN signs
17
Q
Investigations and findings?
A
Careful history and examination MRI excludatory
18
Q
Management?
A
Palliative - MDT basedSodium channel blocker prolongs life slightly
19
Q
Complications?
A
Prognosis bleak
20
Q
Epidemiology?
A
M > F, 3:2
21
Q
Aetiologies?
A
TraumaNeoplasiaIschaemia Degenerative diseaseDemyelinating diseaseInfection
22
Q
Pathology?
A
Partial/full hemisection causing a combination dorsal column, spinothalamic tract and corticospinal tract lesions
23
Q
Signs and symptoms?
A
Ipsilateral UMN signs in lower sectionsIpsilateral proprioception/vibration loss in lower sections Contralateral pain/temperature loss
24
Q
Investigations and Findings?
A
MRI/CT - will show area and extent of trauma, ischaemia, neoplasia
25
Management?
Treatment of infection if applicable Removal of causative agent if applicable
26
Aetiologies?
Risk factors - cardiovascular disease risk factors
27
Pathology?
Ischaemia of spinal cord portion due to occlusion of a supplying blood vessel
28
Signs and symptoms?
Anything spinal cord related, depends on area of lossUMN signsSensory lossSphincter tone loss
29
Investigations and Findings?
MRI can diagnose - areas of ischaemia seen
30
Management?
Early management vital Surgical repair is an option
31
Complications?
Many will not recover
32
Aetiologies?
Dietary deficiency or lack of gastric intrinsic factor
33
Pathology?
Demyelination
34
Signs and symptoms?
Insidious onset where symptoms begin peripherally and move centrally Spinal cord involvement indicated by UMN signs
35
Investigations and Findings?
B12 serum tests - deficient Intrinsic factor - deficient
36
Management?
B12 supplementation
37
Aetiologies?
Maternal folic acid deficiency
38
Pathology?
Failure of neural tube to fuse during embryogenesis --> spaces in vertebral column
39
Signs and symptoms?
Varying degrees from asymptomatic to complete paralysis Depends on how much of the spinal cord and its coverings protrude through
40
Investigations and Findings?
Severe disease obvious on physical examination Oculta seen incidentally on x-ray later in life Cyst on the back in the midline
41
Management?
Surgical repair ASAP
42
Complications?
Treatment not always successful Quality of life impaired
43
Aetiologies?
Part of MSRarely - sinusitus and other infections
44
Pathology?
Inflammation of the optic nerve +/- optic disc
45
Signs and symptoms?
Visual and colour vision loss Optic pain
46
Investigations and Findings?
Ophthalmoscopy Test for MS
47
Management?
Refer to specialist Corticosteroids
48
Complications?
Progression into MS
49
Aetiologies?
TraumaInfectionInfarctionTumourDiabetic neuropathy Aneurysm Raised ICP
50
Pathology?
Compression or section of the ophthalmic nerve
51
Signs and Symptoms?
Permanent dilatation of eyePainless loss of adduction, extortion and elevation Ptosis
52
Investigations?
Examination
53
Aetiologies?
TraumaInfectionTumourInfarctionDiabetic NeuropathyAneurysmRaised ICP
54
Pathology?
Compression/section of trochlear nerve
55
Signs and symptoms?
Difficulty depressing eyeDiplopia once eye depressed
56
Investigations?
Examination
57
Aetiologies?
TraumaInfectionInfarctionTumourDiabetic NeuropathyAneurysmRaised ICP
58
Pathology?
Compression or section of abducens nerve
59
Signs and Symptoms?
Inability to abduct eye
60
Investigation?
Examination
61
Aetiologies?
TumourInfectionTraumaInfarction MS
62
Pathology?
Demyelination or compression from adjacent structures of trigeminal nerve
63
Signs and Symptoms?
Unilateral sharp, severe bursts of pain in face after a certain trigger
64
Investigations?
History and examination
65
Management?
Carbemazepine Analgesics don't work
66
Aetiologies?
Trauma InfectionTumourInfarction
67
Pathology?
Compression/section of trigeminal nerve or its branches
68
Signs and Symptoms?
Sensory loss in one or more of the six areas in the face Trouble chewing if UMNLMN causes flaccid paralysis of the affected side of the jaw --> deviation
69
Investigations?
Examination
70
Aetiologies?
MNDGuillean - Barre syndrome PolioMyasthenia gravis Brainstem tumours
71
Pathology?
Damage to the CN IX-XII nuclei which causes impairment to the innervation of the bulbar targets LMN lesion
72
Signs and Symptoms?
LMN signs of the tongue and the muscles of talking and swallowing Tongue fasciculation, jaw jerk absence Quiet/hoarse/nasal speech
73
Investigations?
Examination
74
Aetiologies?
Stroke MNDMS
75
Pathology?
Damage to the CN IX - XII which causes impairment to the innervation of the bulbar targets UMN lesionBilateral lesion
76
Signs and Symptoms?
UMN signs of swallowing/talking muscles: slow tongue movements, slow speech, hyperreflexia, emotional incontinence
77
Investigations?
Examination
78
Aetiologies?
Autoimmune with unknown triggerViral MS
79
Pathology?
qAutoimmune inflammation of myelin sheath surrounding nerves causing demyelination Resolving of the lesions incomplete --> scarring Axonal loss in later disease
80
Signs and symptoms?
Common presentation = relapsing symptoms, sensory signs (dysaethesia, optic neuritis, trigeminal neuralgia), UMN signs, GU signs (erectile, urinary), cognitive signs (amnesia, moodiness) Rarer pattern = as above with progressive worsening, no relapse
81
Investigations and Findings?
MRI scan - lesions show up as white plaques, axonal loss as black holes Lumbar Puncture - CSF oligoclonal bands
82
Management?
No cure Immunosuppressants can lessen severity of relapses Biologics lessen frequency, Monoclonal abs prevent BBB crossingMDT based
83
Complications?
Wheelchair bound Life expectancy is reduced
84
Aetiologies?
Environmental and genetic causesRF: strong FH, down syndrome, Vascular RF, alcoholism, smoking
85
Pathology?
Selective neuronal loss in the cortex
86
Signs and Symptoms?
Main initial domains of neuronal loss: spatial awareness, self awareness, memory, higher function, verbal Progresses into intellect/behavioural/psychotic decline
87
Investigations and Findings?
Diagnosis purely clinicalExcludatory investigations
88
Management?
No definitive cureMDT based support for family and patient Acetylcholinesterase inhibitors = symptomatic, BP control
89
Complications?
Progressive decline into sedation
90
Aetiologies?
Associated with parkinson's
91
Pathology?
Lewy body deposits on the brainstem and neocortex resulting in degeneration of neurons
92
Signs and Symptoms?
As Alzheimer's but with fluctuating rather than progressive patternAlso vivid hallucinations
93
Investigations?
Diagnosis purely clinicalExcludatory investigations
94
Management?
No definitive cureMDT based supportAcetylcholinesterase inhibitors - symptomatic, BP control
95
Complications?
Often progresses into Parkinson's disease
96
Aetiologies?
Risk factors = cardiovascular disease risk factors
97
Pathology?
Infarction of brain tissue due to occlusion of blood vesselsUsually a build up of many small infarcts
98
Signs and Symptoms?
As A.D. but with the addition of a higher likelihood of other focal neurological signs
99
Investigations and findings?
Diagnosis purely clinicalExcludatory investigationsInfarctions can be seen
100
Management?
No definitive cure MDT supportAcetylcholinesterase inhibitors = symptomatic, BP control
101
Complications?
Other forms of atheromatous disease
102
Aetiologies?
IdiopathicDrug-inducedVascular Traumatic
103
Pathology?
Degeneration of substantia niagra in basal ganglia --> loss of excitatory dopamine in striatum
104
Signs and Symptoms?
Parkinsonism triad: pill-rolling tremor, rigidity and bradykinesia Additional features: shuffling gait, loss of facial tone, postural difficulties PD defined as 2 or more of parkinsonism without any focal signs
105
Investigations and Findings?
Diagnosis purely clinical Investigations exist but too expensive for routine use
106
Management?
Levodopa but last resort Deep brain stimulation
107
Complications?
Progressive decline into sedentation
108
Aetiologies?
Focal lesionsInfectionsHypoxiaIdiopathic Trauma
109
Pathology?
Generalised - bilateral abnormal brain neuron firing showing general manifestations Focal - as above but only focal signs
110
Signs and symptoms of absence seizures?
Patient will cease activity randomly and stare blankly Skin pallor, twitchingActivity begins where it left off
111
Signs and symptoms of tonic-clonic seizures?
Tonic phase = rigidity, falls, bitten tongue, incontinence Clonic phase = convulsions, frothing of mouth, rhythmic jerking
112
Investigations and Findings?
EEGECGCT scanSerum calcium GlucoseCan exclude epilepsy in many cases
113
Management for absence seizure?
Sodium valproate Lomotrigine
114
Management for tonic - clonic seizures?
Sodium valproate Carbemazepine
115
Complications of absence seizures?
Can progress into tonic clonic epilepsy
116
Complications of tonic-clonic epilepsy?
TraumaRoad traffic accidents loss of driving licence Status epilepticus
117
Aetiologies of status epilepticus?
Anyone with epilepsy can have this type of seizure First presentation as SE is almost unheard of
118
Pathology of status epilepticus?
a seizure which lasts more than 30 mins or 2+ seizures in a row without recovery
119
Investigations for status epilepticus?
ABG Blood glucoseECG
120
Management of status epilepticus?
Secure airway IV/IR diazepam +/- phenytoin if symptoms persist Treat after 5 mins
121
Complications of status epilepticus?
10% mortality
122
Aetiologies?
Infective - meningococcal, pneumococcalInflammatory Drug induced Malignant
123
Pathology?
Infection enters through cranial cavity openings Acute bacterial causes meningeal congestion with neutrophils --> pus Chronic is green exudate with adhesions Viral = lymphocytic inflammation
124
Signs and Symptoms?
Meningism = stiff neck, fever, headache, kerning's sign, photophobiaOthers = pleuritic pain, petechial rash, focal signs, shock, AMS, seizures
125
Investigations and findings?
CT - contra/indicat. LPLumbar puncture - CSF findings high protein, high neutrophils, high pressureSerologyBlood culture FBC, U+Es LFT Glucose - hypoglycaemia Coag
126
Management?
ABCDIV antibiotics (cephalosporin)Antivirals ITU admission
127
Complications?
DeathReduced life expectancyFNS
128
Aetiologies?
Infective (viral - HSV, coxsackle. Bac - TB, mycoplasma, listeria) Inflammatory Metabolic Malignant
129
Pathology?
Inflammation of the brain parenchyma
130
Signs and symptoms?
Classic triad - fever, AMS and headache Others - shock, seizures, focal signs, raised ICP signs
131
Investigations and Findings?
CT - contra/indicat. LPLumbar puncture - CSF findings normal/high protein. high lymphocyte SerologyBlood culture FBC, U+Es, LFTs Glucose - normal CoagEEG
132
Management?
ABCDIV antibioticsAciclovir Symptomatic treatment
133
Complications?
Death Reduced life expectancy FNS
134
Aetiologies?
TumourCystHaemorrhage Meningitis/encephalitis HydrocephalusDiffuse brain swelling
135
Pathology?
Pressure intracranially increases due to an increased volume of substance in the closed space of the cranium
136
Signs and Symptoms?
Headache, visual loss, nausea and vomiting Decreased GCS, cognitive decline, papilloedema, CN palsies, tonsillar compression
137
Investigations and Findings?
Not lumbar puncture CT scan indicated
138
Management?
Treatment of cause Neurosurgery
139
Complications?
Decompensation => tonsillar herniation
140
Aetiologies?
AffluencyIonising radiationImmunosuppression Genetic predisposition
141
Pathology?
Pathological types = glioblastoma (IV), glioma (I-III), meningioma (I), metastases (I-IV)Symptoms usually correlate with increased ICP due to space occupying lesion
142
Signs and Symptoms?
Raised ICPSeizuresFocal neurological signs
143
Investigations and Findings?
CT/MRI/PET brain - brain lesions, mets Imaging of other body for metastases/sourceBiopsies of regional lymph nodes
144
Management?
Palliation is only option in high grade tumoursAnti-epilepticsAnti-emetics Neurosurgery
145
Complications?
Metastases Death
146
Aetiologies?
Blockage at any point of the CSF circulation or overproduction of CSF Tumour Raised ICPPost meningitis Normal pressure hydrocephalus
147
Pathology?
Build up of CSF in ventricular system which can be obstructive or communicating
148
Signs and symptoms in infants?
Enlarged headBulging fontanelles Splayed sutures Sunsetting eyesFTTHigh pitched cry
149
Signs and symptoms in > 18 months?
No enlarged headSigns of raised ICP
150
Management?
Treat cause of obstructionShunts Endoscopic third ventriculostomy
151
Complications
A potentially treatable cause of dementia
152
Modifiable risk factors?
HypertensionSmokingDMHyperlipidaemiaAlcoholism Oestrogen based contraception
153
Non-modifiable risk factors?
Previous TIA/strokeOld age Being male FH of stroke IHDMalignancy Genetic hypercoagubility Vascular malformations
154
Pathology?
Can be occlusive or haemorrhagic Occlusive - infarct blocks blood supply to an area of the brain --> an ischaemic core and penumbra of tissue --> loss of function Haemorrhage - bleed --> tissue damage from blood infiltration and high pressure --> encapsulation in fibrous and glial tissue
155
Signs and symptoms of an anterior cerebral artery stroke?
Contralateral UMN signs and corticosensory lossBehaviour abnormalities Dominant speech difficulties or non-dominant hemineglect
156
Signs and symptoms of a middle cerebral artery stroke?
Controlalateral face UMN weakness and corticosensory lossBehaviour abnormalities Hemiparesis
157
Signs and Symptoms of a posterior cerebral artery stroke?
Vital function loss contralateral hemiparesis Hemisensory loss
158
Signs and symptoms of a lacunar artery stroke?
Non cortical: either purely motor or purely sensory DysarthriaHemiparesis
159
Investigation and Findings?
Urgent CT/MRI brain scanFBCBiochemU+Es Blood pressure
160
Management?
ABCD RecussAssess pros and cons of thrombolysis Anticoagulants when haemorrhage excluded
161
Complications?
Lifetime focal symptoms ComaDeath
162
Aetiologies of tension type headache?
Triggers include stress, noise, prolonged concentration, anxiety, depression, refractive errors, analgesic overuse, hypertension
163
Aetiologies of migraine?
Hypersensitivity to triggers: stress, hormones, hunger, food cravings, sleep disturbance, dehydration, environmental stimuli
164
Aetiologies of Cluster headache?
Sporadic
165
Aetiologies of SUNCT?
SporadicTriggers: wind, touch, cold
166
Aetiologies of thunderclap headache?
Primary headachesSAHTIA/stroke ICHVertebral artery dissection Meningitis
167
Aetiologies of Giant cell arteritis?
Unknown cause
168
Pathology of tension type headache?
Generated by neuromuscular irritation with pain referred to scalp
169
Pathology of migraine?
Complex changes in brain which hypersensitive the trigeminal ganglion
170
Pathology of cluster headache?
Hyperactivity of the trigeminal autonomic systems due to usually unsinister stimuli
171
Pathology of giant cell arteritis?
Inflammation of the large arteries in the brain resulting in granulomatous deposits
172
Signs and symptoms of tension type headache?
Tight band sensationPressure behind the eyesThrobbing sensation
173
Signs and symptoms of migraine?
Prodrome - mood change, yawningAura - Visual cascade, motor dysarthria Headache - very severe, photophobia, phonophobia, nausea and vomiting
174
Signs and symptoms of cluster headache?
Excruciating, unilateral pain in bouts lasting months but then remitting for months Associated with orbital/temporal pain, lacrimation, ptosis Pain ceases rapidly
175
Signs and symptoms of SUNCT?
As cluster headache but with 10s-4min duration up to 200 times a day Associated symptoms include - conjunctival injection and lacrimation
176
Signs and symptoms of thunderclap headache?
Highly intense headache with sudden onset which reaches maximum within 1 minSettles instantaneously
177
Signs and symptoms of giant cell arteritis?
Diffuse headache Systemic unwellJaw claudication Visual disturbance Beaded temporal artery
178
Investigation and findings of headaches?
If suspicious presentation admit for an MRI/CT brain
179
Investigation and findings of giant cell arteritis?
FBC - CRP and ESR elevated, high platelets BiochemU+Es
180
Management of migraine?
TriptansNSAIDs Prophylaxis
181
Management of cluster headache
100% O2 Triptans Short course steroids
182
Management of SUNCT?
Symptomatic reliefAnalgesics Anti epileptics
183
Management of thunderclap headache?
Treat cause
184
Management of giant cell arteritis?
High dose prednisolone
