Neurology Flashcards
(280 cards)
1
Q
Name 3 acute causes of headaches
A
VICIOUS
- Vascular –> haemorrhage, infarction, venous thrombosis
- Infection –> meningitis, encephalitis, abscesses
- Compression –> obstructive hydrocephalus, pituitary enlargement
- ICP –> intracranial HTN
- Ophthalmic –> acute glaucoma
- Unknown –> situational, cough, exertion
- Systemic –> HTN, phaeochromocytoma, infections, toxins (CO)
2
Q
Name 3 chronic causes of headaches
A
- Migraine
- Cluster headaches
- Tension headaches
- Trigeminal neuralgia
- Medication overuse headaches
- GCA
3
Q
Give 2 primary causes of headaches
A
- Migraine
- Tension
- Cluster
4
Q
Give 2 secondary causes of headaches
A
- Meningitis
- Subarachnoid haemorrhage
- GCA
- Medication overuse headache
- Idiopathic intracranial HTN
5
Q
Give 3 red flags for secondary headache
A
- HIV or immunosuppressed
- Fever
- Thunderclap
- Seizure and new headache
- Suspected meningitis or encephalitis
- Acute glaucoma
- Headache and focal neurology
6
Q
Give 3 red flags of a suspected brain tumour
A
- New onset headache and history of cancer
- Cluster headache
- Seizure
- Significantly altered consciousness, memory, confusion, coordination
- Papilloedema
7
Q
Define migraine
A
Recurrent headaches for 4-72 hours with to without aura or GI disturbance
- Episodic cerebral oedema and dilation of the cerebral vessels
8
Q
Give 3 triggers of migraines
A
- Chocolate
- Cheese
- OCP
- Alcohol
- Caffeine
- Anxiety
- Travel
- Sleep
- Exercise
9
Q
What are the features of a migraine?
A
- Unilateral
- Pulsating
- Aggravated by routine physical activity
- MOderate/severe pain
- Nausea
- Photophobia or phonophobia
- 4 to 72 hours
10
Q
What are the features of aura?
A
- Precedes migraine by 15-30 minutes
- Zigzag lines or scotoma
- Hemianopia
- Paraesthesia
- Dysphagia
- Ataxia
11
Q
Describe the clinical presentation fo prodrome
A
Precedes migraine by hours and days
- Yawning
- Food Cravings
- Changes in sleep, appetite and mood
12
Q
Describe the diagnosis criteria of migraine
A
>5 attacks lasting 4-72 hours with N+v or photophobia/phonophbia AND 2 of - Unilateral pain - Throbbing pain - Pain aggravated by physical activity - Moderate/severe pain
13
Q
What is the acute treatment for migraines?
A
- NSAIDS
- Triptans (5HT agonist) = sumatriptan
+/- anti-emetics
14
Q
What are the prophylactic treatments for migraines?
A
- BB = propranolol
- Topiramate (teratogenic)
- Amitriptyline
- Acupuncture
- Valproate, pizotifen, gabapentin
If aura is present, can’t use OCP
15
Q
What are the features of cluster headaches
A
- Rapid onset
- Severe unilateral orbital pain - 15-180 minutes
- Autonomic symptoms =lid swelling, lacrimination, facial flushing, rhinorrhoea, mitosis, ptosis
16
Q
Describe the classification of the cluster headaches
A
Episodic = >2 cluster periods lasting 7 days to a year separated by pain free periods lasting >1 month
Chronic = attacks occurs for more than 1 year without remission or with remission lasting <1 month
17
Q
What is the management for an acute cluster headache?
A
- minutes 100% O2 and triptan (sumatriptan)
18
Q
What is the preventative management for cluster headaches?
A
- Avoid triggers
- Short term corticosteroids
- Verapamil (CCB)
- Lithium
19
Q
What are the features of a tension headache?
A
- Lasts 30 mins - 7 days
- Bilateral
- Pressing/tight band
- Mild/moderate pain
- Not aggravated by exercise
- Photophobia OR phonophobia
20
Q
Describe the classification of tension headaches
A
Episodic = <15 days/month Chronic = >15 days/month for at least 3 months
21
Q
Give 3 causes of tension headaches
A
- Stress
- Depression
- Alcohol
- Skipping meals
- Dehydration
22
Q
Describe the management of tension headaches
A
- Exercise, stress relief
- Symptomatic = aspirin, paracetamol, NSAIDS, NO opioids
23
Q
Define medication overuse headache
A
Chronic headaches resulting from the overuse of medication –> opioids, mixed analgesia, ergotamine, triptans
24
Q
What is the diagnostic criteria for a medication overuse headache?
A
- Headaches present for >15 days/month
- Regular overuse for >3 months of >1 symptomatic treatment drugs
- Headache has developed or markedly worsened during drug use
25
What is the management of a medication overuse headache?
- Remove analgesia
| - Aspirin/naproxen
26
Define trigeminal neuralgia
Paroxysms of unilateral intense stabbing pain the trigeminal distribution precipitated by innocuous stimuli
27
Name 2 triggers for trigeminal neuralgia
1. Washing
2. Shaving
3. Eating
4. Talking
28
Give 2 secondary causes of the trigmeinal neuralgia
1. Compression CN
2. MS
3. Zoster
4. Chiara malformation
5. Meningeal inflammation
6. Tumour
29
What is the clinical features of trigeminal neuralgia?
- No radiation outside of the trigeminal distribution
- Reoccurring paroxysmal attacks from a fraction of a second to 2 minutes
- Severe intensity
- Electric shock like, shutting, stabbing, sharp
- Precipitated by innocuous stimuli to the affected side of the face
30
What is the management for trigeminal neuralgia?
- Anticonvulsant --> carbamazepine, lamotrigine, phenytoin, gabapentin
- Microvascular decompression
31
What is Giant Cell Arteritis (GCA)?
Systemic immune medicated chronic vasculitis affecting medium to large size arteries
32
What condition is GCA associated with?
Polymyalgia rheumatica (PMR)
33
What is the epidemiology of GCA?
Primarily over 50s
| Female > Males
34
What are the symptoms of the headache in GCA?
- New onset unilateral temple/scalp pain and tenderness/headache
- Thickened pulseless, nodular or tender temporal artery
- Jaw claudication
- Amaurosis fugax, diplopia
- Systemic features = fever, fatigue, anorexia, weight loss, depression
35
What investigative results would indicate GCA?
Increased ESR
| Abnormal Temporal artery biopsy
36
What is the treatment for GCA?
High dose prednisolone (40-60mg oral OD)
| - For 2 years
37
Give 2 potential complications of GCA
1. Vision loss
2. Large artery complications --> aortic aneurysm, aortic dissection, large artery stenosis
3. CVD
38
Define subarachnoid haemorrhage
Spontaneous arterial bleeding into the subarachnoid space (between arachnoid and pia)
39
Give 2 causes of a SAH
1. Berry aneurysm rupture (80%)
2. Arteriovenous malformation (10%)
3. Trauma --> contusion, skull base fracture, cerebral artery rupture/dissection
40
Give 4 risk factors for subarachnoid haemorrhages
1. Previous berry aneurysms
2. Smoking
3. HTN
4. Alcohol
5. Family history
6. Disease that predisposes aneurysms --> PCKD, Ehlers dances, coarctation
41
Where are Berry aneurysms most likely to form?
- Junction between posterior communication artery and internal carotid (30%)
- Junction between anterior communicating artery and anterior cerebral (35%)
- Bifurcation of the Middle cerebral artery (22%)
42
Give 3 symptoms of a SAH
1. Sudden onset severe occipital headache (thunderclap)
2. Vomiting
3. Meningism --> neck stiffness, N+V, photophobia
4. Seizures
5. Decreased consciousness --> coma
43
Give 2 signs of a SAH
1. Kernig's sign = can't straighten leg past 135 degrees
2. Brudzinski's sign = neck flexed, hip and knee flex
3. Papilloedema
44
What investigations might you carry out in someone with a suspected SAH?
CT = star pattern (blood in sulci)
| LP (after 12 hours) = bloody then xanthochromic (bilirubin)
45
How do you manage someone with a SAH?
- Nimodipine (CCB) --> reduce vasospasm
- Endovascular surgery --> CT angiography and coiling/cliping
- Bed rest, hydration, BP control
46
Give 2 possible complications of a SAH
1. Rebleeding
2. Cerebral ischaemia
3. Hydrocephalus
4. Hyponatraemia
47
Define and describe the pathophysiology of a subdural haemorrhage
Bleeding of bridging veins between the cortex and sagittal sinus --> accumulating haematoma --> raised ICP --> tentorial herniation/coning
48
What is the most common cause of a subdural haemorrhage?
Minor head injury --> especially deceleration injuries
| - May have happened 8-10 weeks previously
49
Name 3 at risk groups of a subdural haemorrhage
1. Alcoholics
2. Epileptics
3. Elderly --> falls
4. People of anticoagulants
5. Shaken babies
50
What are the symptoms of a subdural haemorrhage?
1. Headache
2. Fluctuating consciousness level
3. Confusion and personality change
4. Sleepiness/drowsiness
5. Unsteadiness
51
What is a sign of a subdural haemorrhage?
Raised ICP --> seizures, papilloedema
| Tentorial herniations and coning
52
What would you see on a CT for someone with a subdural haematoma?
Unilateral crescent shaped blood collection
Midline shift
Clots goes from white to grey over time
53
What is the management for someone with a subdural haematoma?
- Mannitol --> decrease ICP
| - Surgical evacuation of the clot --> burr holes, craniotomy
54
Define an extradural haemorrhage
Often due to a fractured temporal or parietal bone --> laceration of middle meningeal artery/vein --> bleed between bone and dura
55
When should you suspect an extradural haemorrhage?
Head injury --> LOC --> lucid interval --> worsening of symptoms
56
How does an extradural haemorrhage present?
1. Lucid interval (hours/days)
2. Reduced GCS
3. Increased ICP
- Headache
- N+V
- Confusion
- Seizures
- Ipsilateral blown pupil (3nd nerve plasy)
4. Brainstem compression --> deep irregular breathing --> death
57
What investigations would you do on someone with a suspected extradural haemorrhage?
- CT = lens shaped (biconvex) haematoma and possible skull fracture
- LP is CONTRAINDICATED
58
What is the management of a extradural haematoma?
- Neuroprotective ventilation
- Mannitol = decrease ICP
- Craniotomy for clot evacuation
59
Give 3 differences in the presentation of a patient with a subdural haemorrhage compared to someone with an extradural haemorrhage
1. Time Frame = extradural symptoms are more acute
2. GCS = subdural GCS will fluctuate, extradural GCS will drop suddenly
3. CT = extradural ill have a rounder more contained appearance
60
Define Stroke
Rapid onset of focal neurological deficit which is the result of a vascular lesion and is associated with infarction of central nervous tissue lasting >24 hours or leading to death with no apparent cause other than vascular origin
61
What are the 2 main types of stroke?
1. Ischaemic (80%)
| 2. Haemorrhagic (15-20%)
62
Give 2 possible causes of an ischaemic stroke
1. Atheroma --> MCA, small vessel, carotid (atherothromboembolism)
2. Embolism --> cardiac from AF, endocarditis, MI
3. Systemic hypo perfusion
63
Give 2 possible causes of an haemorrhagic stroke
1. HTN
2. Trauma
3. Aneurysm rupture
4. Carotid artery dissection
64
Give 4 risk factors for a stroke
1. HTN
2. Smoking
3. DM
4. Heart disease --> valvular, ischaemic, AF
5. Peripheral vascular disease
6. FHx or previous TIA history
7. COCP
8. Ethnicity (increased in blacks and asians)
9. Clotting abnormalities
10. Alcohol use
11. Hyperlipidaemia
65
What investigations would you do to determine whether someone has had a haemorrhagic or an ischaemic stroke?
CT scan
66
What investigations might you do for a suspected stroke?
- CT head (excludes haemorrhage)
- MRI --> identify ischaemic stroke
- Carotid doppler --> carotid stenosis
- ECG --> MI, AF
67
What is the criteria of a Total Anterior Circulation Stroke (TACS)?
= Large infarct of MCA, ACA or carotid
ALL 3 of:
1. Contralateral hemiparesis and sensory deficit (>2 of face, arm, leg)
2. Homonymous hemianopia (contralateral)
3. Higher cerebral dysfunction --> dysphagia/dysarthria (dominant), visuospatial
68
What is the criteria of a Partial Anterior Circulation Stroke (PACS)?
2/3 of:
1. Contralateral hemiparesis and sensory deficit (>2 of face, arm, leg)
2. Homonymous hemianopia (contralateral)
3. Higher cerebral dysfunction --> dysphagia/dysarthria (dominant), visuospatial
69
What is the criteria of a Posterior Circulation Stroke/Syndrome (POCS)?
1 of:
1. Cranial nerve palsy and a contralateral motor/senosry deficit
2. Bilateral motor/senosry deficit
3. Conjugate eye movement disorder (e.g. gaze palsy)
4. Cerebellar dysfunction --> ataxia, nystagmus, vertigo
5. Isolated homonymous hemianopia or cortical blindness
70
What is the criteria of a Lacunar Infarct?
```
= Perforating arteries supplugng internal capsule and basal ganglia
1 of:
- Pure sensory stroke
- Pure motor store
- Sensori-motor stroke
- Ataxic hemiparesis
```
71
Give 3 signs of a ACA stroke
1. Lower limb weakness and loss of sensation
2. Gait apraxia (unable to initiate walking)
3. Incontinence
4. Drowsiness
5. Akinetic mutism = decrease in spontaneous speech
6. FACE is SPARED
72
Give 3 signs of a MCA stroke
1. Contralateral arm and leg weakness and contralateral sensory loss
2. Hemianopia
3. Aphasia
4. Dysphasia
5. Facial droop
73
Give 3 signs of a PCA stroke
1. Contralateral homonymous hemianopia
2. Cortical blindness
3. Visual agnosia = inability to recognise or interpret visual information
4. Prosopagnosia = inability to recognise a familiar face
5. Dyslexia, anomic aphasia
6. Unilateral headache
74
What are the symptoms of a lacunar stroke?
Absence of:
- Higher cortical dysfunction
- Homonymous hemianopia
- Drowsiness
- Brainstem signs
75
Give 3 signs of a brainstem stroke
1. Hemi/quadra-peresis
2. Conjugate gaze palsy
3. Horner's syndrome
4. Facial weakness
5. Nystagmus, vertigo
6. Dysphagia, dysarthria
7. Decreased GCS
76
What is the treatment for an ischaemic stroke?
- Aspirin 300mg PO (once haemorrhagic stroke excluded)
- Thrombolysis <4.5 hours after symptom onset (alteplase)
- Decompressive hemicraniotomy for some MCAs
77
What non pharmacological treatments are there for people after a stroke?
1. Specialised stroke units = rehab
2. SALT help
3. Physiotherapy
4. Home modifications
78
What are the primary preventative measures for stroke prevention?
= Before stroke occurs
- Control ris factors --> HTN, lipids, DM, smoking, cardiac disease
- Lifelong anticoagulation in AF (CHADVASC)
- Exercise
- Carotid endocardectomy is symptomatic 70% stenosis
79
What are the secondary preventative measures for stroke prevention?
= preventing another stroke occurring
- Statin
- Aspirin and clopidogrel for 2 weeks then just 75mg clopidogrel OR 75mg aspirin OD + 200mg dipyridamole (warfarin is cardioembolic stroke)
- Antihypertensives
80
Define ITA
Sudden onset focal neurology lasting <24 hours due to temporary occlusion of part of the cerebral circulation without evidence of an acute infarct
81
Give 2 possible causes of a TIA
1. Atherthromboembolism of carotid
2. Cardioembolism --> post MI, AF, valve disease
3. Hyperviscosity --> polycythaemia, SCD
4. Vasculitis
82
Give 2 signs of a carotid (90%) TIA
1. Amaurosis fugax = retinal artery occlusion, descending curtain of vision loss
2. Aphasia
3. Hemiparesis
4. Hemisensory loss
83
Give 2 signs of a vertebrobasilar (10%) TIA
1. Diplopia
2. Vomiting
3. Choking
4. Ataxia
5. Hemisenosry loss
84
What is essential to do in someone who has had a TIA?
ABCD2 score = risk of stroke in the next 7 days
85
What is the ABCD2 score?
Assesses his of a stroke in next 7 days
- Age >60
- BP >140/90
- Clinical features
a) Unilateral weakness (2 points)
b) Speech disturbance without weakness (1 point)
- Duration
a) 10-59 minutes (1 point)
b) >1 hour (2 points)
- Diabetes
High risk stroke patients = ABCD2 score >4, AF, >1 TIA in a week
86
What do the scores from an ABCD2 mean?
```
>6 = high risk stroke
>4 = assess within 24 hours
<4 = assess within 1 week
```
87
What is the management of someone with a TIA
1. Control risk factors --> statin, antihypertensives, DM control, diet and exercise
2. Antiplatelet therapy = 2 weeks aspirin and clopidogrel then longterm clopidogrel
3. Specialist referral to TIA clinic and ABCD2 score
88
Give 4 causes of transient loss of consciousness
1. Epileptic seizures
2. Non-epileptic seizures
3. Syncope
4. Intoxication
5. Hypoglycaemia
6. Acute hydrocephalus
89
Define Seizure
A convulsion caused by paroxysmal discharge of cerebral neurones
Abnormal and excessive excitability of neurones
90
Give 3 causes of seizures
1. Epilepsy
2. Febrile convulsions
3. Alcohol withdrawal
4. Psychogenic non epileptic seizures
5. Brain injury or tumour
6. Infection
7. Trauma
8. Metabolic imbalances
91
Define epilepsy
Recurrent, spontaneous, intermittent, abnormal electrical activity in part of the brain manifesting seizures
- At least 2 or more unprovoked seizures occurring >24 hours apart
92
What 2 categories can epileptic seizure be broadly divided into?
1. Focal epilepsy = only 1 hemisphere of the brain is involved, often structural cause
2. Generalised = widespread seizure activity in both hemispheres
93
Give 3 examples of focal seizures
1. Simple partial seizures
2. Complex partial seizures
3. Secondary generalised seizures
94
What are simple partial seizures?
Aura = epigastric rising, deja vu, smells, lights, sounds
- Awareness unimpaired
- Non memory, autonomic or psychic symptoms
95
What are the features of a complex partial seizure?
Disturbance of consciousness or awareness, 5As
- Aura
- Autonomic --> change in sin colour, temp, palpitations
- Awareness los --> motor arrest, motionless stare
- Automatism --> lip smacking, fumbling, chewing, swallowing
- Amnesia
96
What is a secondary generalised seizure?
Focal seizure = generalise
| Aura --> tonic clonic
97
Give 4 types of generalised epilepsy
1. Absence
2. Tonic-clonic
3. Myoclonic
4. Atonic
98
Describer the features of a absence seizure
Often seen in childhood
- Ceases activity and states
- Abrupt onset and offset
- <10 seconds
- Eye = blank stare and glazed
- 3Hz spike and wave on EEG
- Stimulated by hyperventilation and photics
99
Describe the features of a tonic-clonic seizure
- Rigid phase (tonic) --> rhythmic jerking (clonic)
- LOC
- Tongue bring, incontinence, drowsiness
- POst ictal confusion
- Lasts 1-2 minutes
100
Describe the features of a myoclonic seizure
- Sudden isolated jerk of limb, face or trunk and stiffening
- Movement cessation/falling
101
Describe the features of a atonic seizure
- Sudden loss of muscle tone --> fall forwards
102
What features localise a seizure to the temporal lobe?
1. Automatisms = lip smacking, chewing, fumbling
2. Deja vu
3. Delusional behaviours
4. Emotional disturbance = terror, panic, anger
103
What features localise a seizure to the frontal lobe?
Motor features --> arrest, Jacksonism march, Todds plays (post ictal temporary weakness)
104
What features localise a seizure to the parietal lobe?
Sensory disturbance --> tingling, numbness
105
What features localise a seizure to the occipital lobe?
Visual phenomenon --> spots, lines, flashes
106
What are the treatments for generalised seizures (excluding absence)?
Sodium valproate --> lamotrigine --> carbamazepine
107
What are the treatments for absence seizures?
Sodium valproate --> ethosuximide --> lamotrigine
108
What are the treatments for focal seizures?
Carbamazepine --> lamotrigine --> Keppra (levetiracetam)
109
What are the treatments for acute seizures?
Diazepam and lorazepam
110
Give 2 side effects of sodium Valporate
1. Teratogenic (neural tube defects) --> not given to women of child bearing age
2. Increased appetite
3. Liver failure
4. Pancreatitis
5. Hair loss
111
Give 2 side effects of Lamotrigine
1. Skin rash
2. Diplopia and blurred vision
3. Vomiting
112
Give 2 side effects of Carbamazepine
1. Agranulocytosis
2. Skin rashes
3. Decreased effectiveness of OCP
113
Give 2 side effects of Phenytoin
1. Teratogenic (cleft palate)
2. tremor
3. Cerebellar syndrome
4. Diplopia
5. Decreased effectiveness of OCP
114
Which anti epileptics should pregnant women take?
Lamotrigine
- Avoid valporate
- CBA and PHE reduce effectiveness of OCP (enzyme inducers)
115
What is status epilepticus?
Seizure lasting >5 minutes or recurrent seizures without recovery
116
What is the management of status epilepticus?
- Benzodiazepine (lorazepam 0.1mg/kg, diazepam), buccal midazolam if no IV
- Further dose after 10 minutes (if not settled)
- Non response --> phenytoin
- Intubation and GA
117
Define syncope
Transient global cerebral hypoperfusion = insufficiency blood or O2 supply to the brain causes paroxysmal changes in behaviours, sensation and cognitive processes
118
Give 3 signs that a transient loss of consciousness is due to syncope
1. Situational
2. 5-30 seconds
3. Sweating
4. Nausea
5. Pallor
6. Dehydration
7. Rapid recovery
119
Give 3 causes of Syncope
1. Reflex = associated with a sudden decreased in BP and HR in response to a trigger
2. Orthostatic = associated with a sudden drop in BP after standing up
3. Cardiogenic = until ruled out, DO ECG
120
Give 3 possible causes of reflex syncope
1. Vasovagal = triggered by posture, provoking factors (pain, anxiety, medical, stress, heat), prodromal symptoms
2. Situational = triggered by cough, defecation, sense, post micturition, post exercise
3. Carotid sinus hypersensitivity = triggered by sudden head turning, tight collar, shaving
121
What is the criteria for orthostatic syncope?
- Fall in BP of 20mmHg or a fall in diastolic BP of at least 10mmHg within 3 minutes of standing
Due to drugs (antihypertensives, antidepressants), autonomic failure (PD), DM, hypovolvaemia
122
Define psychogenic non epileptic seizures (pseudo seizures)
Mental processes associated with psychological distress cause paroxysmal changes in behaviour, sensation and cognitive processes
123
Give 3 signs of a pseudo seizure
1. Situational
2. 1-20 minutes
3. Eyes closed
4. Emotional = crying, speaking
5. Pelvic thrusting
6. History of psychiatric illness
124
Define Huntington's disease
Neurodegenerative disorder characterised by the lack of inhibitory neurotransmitter GABA
125
What is the inheritance pattern seen in Huntington's disease?
Autosomal dominant = 50% chance of inheritance
126
What is the pathophysiology behind Huntington's disease?
Degeneration of cholinergic and GABA neurones in the striatum (caudate nucleus and putamen) of the basal ganglia --> decreased inhibition o f dopamine --> excessive thalamic stimulation
127
What triplet code is repeated in Huntington's disease?
CAG in the HTT gene on chromosome 4
>35 = possible HD
>39 = adult onset
>60 = early onset
128
Give 3 features of Huntington's disease
1. Chorea
2. Psychiatric problems = personality change, depression, psychosis
3. Dementia
4. Saccidic eye movement
5. Lack of coordination, ataxia
6. Seizures
129
What is the management of Huntington's disease?
Incurable, symptomatic control
- Chorea = sulpiride (neuroleptic, decreases nerve function), tetrabenazine (dopamine depleting)
- Depression = SSRI
- Psychosis = haloperidol
- Aggression = risperidone
130
Give 3 causes of Parkinsonism?
1. Parkinson's disease
2. Parkinson Plus Syndromes
3. Infection --> syphilis, HIV, CJD
4. Vascular --> multiple infarcts
5. Drugs
6. Genetic --> Wilsons
131
Name 3 drugs known to induce parkinsonism
1. Antipsychotics (aripiprazole)
2. Anti-emetics (metoclopramide)
3. SSRIs
4. CCBs
5. Lithium
6. Valporate
7. Cholinesterase inhibitors
132
What are the cardinal signs of Parkinsonism?
1. Asymmetric tremor = worse at rest, exacerbated by distraction, 4-6Hz, pin rolling
2. Rigidity = lead pipe (increased tone in all muscle groups) or cog wheel (rigidity and tremor)
3. Bradykinesia = slow initiation of movements, reduced amplitude and speed on repetition, expressionless face, monotonous voice, microgrpahia
Also festinating gait = short shuffling steps, stooped, decreased arm swing
133
What is Parkinson's disease?
Degenerative movement disorder caused by a reduction in dopamine in the substantial nigra (pars compact) of the basal ganglia
134
Briefly describe the pathophysiology of PD
Loss of dopamine --> thalamus inhibited --> decreased in movement + symptoms present
B amyloid plaques, neurofibrillary tangles and hyperphosphorylated tau
135
Give 5 features of PD
1. Asymmetric tremor
2. Cog wheel rigidity
3. Bradykinesia
4. Postural instability
5. Hyposmia
6. Excessive salvia production
7. Dementia
8. Sleep disorders = insomnia, EDS
9. Depression
10. Autonomic dysfunction = postural hypotension, urinary symptoms, ED, constipation
136
What investigations might you do in someone you suspect to have PD?
- Response to L-Dopa
- DaTSCAN
- MRI and PET scans
137
What is the management of PD?
- Levodopa = dopamine precursor (tyrosine --> L-dopa --> dopamine)
- Dopamine Recepto agonist = bromocriptine, ropinirole, cabergoline --> 1st line in <60y/o
- MAO-B inhibitors = rasagiline, selegiline (inhibits dopamine breakdown)
- COMT inhibitors = entacapone, tolcapone (inhibits dopamine breakdown)
- Anticholinergics (reduce tremor), SSRI (depression)
- Surgical = deep brain stimulation
138
Give 2 possible side effects of L-dopa
1. Dyskinesia --> dystonia, chorea, athetosis
2. On-off phenomena = motor fluctuations
3. Psychosis
4. Insomnia
5. Mouth dryness
6. N+V
7. Excessive daytime sleepiness
139
Give 2 possible side effects of dopamine receptor agonists
1. Tiredness
2. Gambling
3. Hypersexuality
4. Dystonia
140
What are the 4 Parkinson Plus Syndromes?
1. Multiple systems atrophy
2. Progressive supranuclear palsy
3. Corticobasiliar degeneration
4. Lewy body Dementia
141
What are the signs of Multiple systems atrophy?
- Symmetrical onset
- Falls at presentation
- Parkinsonism with autonomic, corticospinal and cerebellar dysfunction
- Autonomic = postural hypotension, impotence, incontinence, increased sweat
- Hot cross bun sing on MRI
142
What are the signs of progressive supra nuclear palsy?
- Postural instability leading to falls
- Speech disturbance
- Vertical gaze plazy
- Hummingbird sing on MRI
143
What are the signs of corticobasiliar degeneration?
- Aphasia, dysarthria, apraxia
- Akinetic rigidity I 1 limb
- Alien limb phenomenon = patient perceives that 1 of their limbs doesn't belong to them
144
What are the signs of lewy body dementia?
- Fluctuating cognition
- Visual hallucinations and delusions
- REM sleep disorders
145
Define dementia
A set of symptoms that may include memory loss and difficulties with thinking, problem solving, attention or language
There is a progressive decline in cognitive function with no impairment of consciousness but interferes with ADLs
146
What are the 4 main types of dementia?
1. Alzheimers (65%)
2. Vascular (20%)
3. Lewy body (10%)
4. Fronto-temporal (5%)
147
Give 3 differentials of dementia
1. Old Age
2. Depression
3. Delirium
4. Vitamin, thiamine, B12 or folate deficiency
5. Hypothyroidism
6. Infection --> HIV, HSV
7. Normal Pressure hydrocephalus
148
Give 3 risk factors for dementia
1. FHx
2. Age
3. Downs Syndrome m
4. Alcohol use
5. Obesity, HTN, hypercholesterolaemia, DM
6. Atherosclerosis
7. Depression
149
Give 3 cognitive impairment symptoms of dementia
1. Memory loss
2. Problems with reasoning and communication
3. Difficulty making decision
4. Dysphagia
5. Difficulty carrying out coordinated movements
6. Disorientation and unawareness of time and place
7. Impairment of executive function
150
Give 3 behavioural and psychological symptoms of dementia (BPSD)
1. Psychosis
2. Agitation and emotional lability
3. Depression and anxiety
4. Withdrawal and apathy
5. Disinhibition
6. Sleep cycle disturbance
151
What investigations might you do for someone with suspected dementia?
1. Good history and examination
2. 6CIT
3. Blood test --> FBC, LFTs, thyroid, B12, folate
4. MMSE
5. ACE 3
6. Psychometric testing
7. MRI
8. PET and SPECT
152
Give 3 ways in which dementia can be prevented
1. Stop smoking
2. Healthy diet
3. Regular exercise
4. Healthy weight
5. Low alcohol intake
6. Education decreased the risk
7. BP control
153
What medication might you give someone with dementia?
- Acetylcholineesterase inhibitors --> donepezil, rivastigmine
- Anti-glutamate --> memantine
- BP control --> reduce vascular damage
154
What is pseudo dementia?
Cognitive impairment secondary to mental illness --> depression, anxiety
155
Describe the pathophysiology of Alzheimers disease
Degeneration of posterior cerebral cortex and medial temporal lobe
Accumulation of Beta amyloid peptide --> progressive neuronal damage, neurofibrillary tangles (accumulation of Tau protein), cortical atrophy
156
Give 3 clinical features of Alzheimers disease
1. Global memory/cognitive decline
2. Episodic memory loss, short term memory first
3. Visuospatial problems
4. 4As = aphasia, anomia, acalculia, ADL decline
5. Later = Psychosis, delusions, hallucinations, motor signs
157
What would you see on functional imaging of someone with Alzheimers?
- Reduced blood flow and reduced glucose metabolism in the tempo parietal regions
- Cortical atrophy
- Enlarged ventricles
158
What is the treatment for Alzheimers?
- Acetylcholinesterase inhibitors --> donepezil, rivastigmine
- Antidepressants/psychotics
- Emotional and social stimulation
159
25% of all patients with AD will develop what?
Parkinsonism
160
What is the pathophysiology of vascular dementia?
Brain damage due to cerebrovascular disease --> multiple infarcts or major stroke s
161
Give 3 risk factors of vascular dementia
1. History of stroke or TIA
2. AF
3. Smoking
4. HTN
5. DM
6. Hyperlipidaemia
7. Coronary artery disease
8. Obesity
162
Give 3 symptoms of vascular dementia
1. Stepwise deterioration with patchy deficits --> mental and physical decline
2. Sundowning
3. Shuffling gait
4. Attention problems
5. Focal neurological abnormalities --> visual disturbance, sensory or motor symptoms
6. Vascular risk factors
163
What is the management for vascular dementia?
- Manage predisposing factors --> especially BP
164
What is the pathophysiology of Lewy body dementia?
Deposition of Lewy bodies (alpha synuclein) in the brainstem and neocortex
165
Give 3 features of Lewy body dementia
1. Fluctuating cognitive impairments
2. Visual hallucinations
3. Parkinsonism = bradykinesia, tremor, rigidity
4. Sleep disorders
5. Psychosis
166
What would you see on psychometric testing in someone with Lewy body dementia?
1. Deficits in attention
2. Executive function decline
3. Fluctuation fo cognitive performance
4. Preservation of episodic memory loss
167
What is the treatment for Lewy body dementia?
- Cholinesterase inhibitors --> donepezil and rivstigmaine
| - Memantine (antiglutamate)
168
What is the pathology of frontotemporal dementia?
- Selective degeneration of frontal and temporal lobes
- Pick bodies (spherical aggregations of tau protein)
- Neurofibrillary tangles
- Senile plaques
169
Which disease is front-temporal dementia associated with?
MND
170
Give 3 clinical features of front-temporal dementia
1. Onset <65 years old
2. Insidious onset
3. Personality change
4. Emotional unconcern
5. Disinhibition
6. Aphasia
171
What would be seen on an MRI of someone with Pick's disease?
Atrophy of fronto-temporal dementia
172
Define MND
Cluster of major degenerative diseases characterised by selective loss of neurones in the motor cortex, cranial nerve nuclei and anterior horn cells
173
What are the causes of MND?
Unknown
10% = familial (SOD1 mutation)
90% = sporadic
174
What is the classification of MND?
1. Amyotrophic lateral sclerosis (ALS)
2. Progressice bulbar plasy
3. Progressive muscular atrophy
4. Primary lateral sclerosis
175
What is affected in ALS?
Loss in motor cortex and anterior horn --> UMN and LMN signs
- Asymmetrical proximal muscle weakness
176
What is affected in progressive bulbar palsy?
CN 9-12 affected = LMN signs only
| - Dysarthria, dysphagia, wasting and fasciculations of tongue
177
What is affected in progressive muscular atrophy?
Anterior horn lesion --> LMN signs only
| - Distal to proximal
178
What is affected in Primary lateral sclerosis?
Loss of Betz cells in motor cortex leading --> UMN signs
| - Marked spastic leg weakness, pseudo bulbar plays (spastic slow tongue movements, brisk jaw jerk)
179
Do you get sensory loss and sphincter disturbance in MND?
NO
180
Are eye movements affected in MND?
NO
181
What are the features of MND?
Mixed UMN and LMN signs
- UMN = hypertonia (spasticity), hyperreflexia, +ve babinski, muscle weakness (pyramidal pattern, upper limb flexors > extensors, Lower limb extensors > flexors)
- LMN = hypotonia, muscle wasting, fasciculations, hyporeflexia
182
Give 2 possible bulbar signs of MND
1. Dysarthria
2. Dysphagia
3. Brisk jaw jerk
4. Wasting and fasciculations of the tongue
183
Give 2 possible respiratory signs of MND
1. Dyspnoea
2. Orthopnoea
3. Poor sleep
184
Give 2 possible Limb onset signs of MND
1. Weakness
2. Clumsiness
3. Wasting muscles
4. Foot drop
185
What investigations would you do on someone with suspected MND?
- Head and spinal MRI
- Blood tests = muscle enzymes, autoantibodiea
- LP = oligoclonal IgG bands
- NCS and EMG = denervation
186
What is the medical management of MND?
Disease modifying drugs = Riluzole (anti-glutamatergic)
| - Prolongs life by 3 months
187
What is the supportive treatment for MND?
```
Dribbling = propantheline or amitriptyline
Dysphagia = NG tube or PEG
Respiratory failure = NIV
Pain = analgesic ladder
Spasticity = baclofen, botox
Counselling
```
188
Define multiple sclerosis
A chronic inflammatory autoimmune T cell mediated condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space
189
Describe the epidemiology of MS
- Presents between 20-40 y/o
- Females >Males
- More popular in temperate climates = low vitamin D
190
Describe the aetiology of MS
- Environmental --> EBV
- Genetic = HLA-DRB1
- Unknown
- Vit D deficiency, smoking, obesity
191
Where would MS plaques be seen histologically?
- Optic nerves
- Spinal cord
- Cerebral hemispheres
- Medulla
- Pons
192
Describe the classifications of MS
1. Relapsing remitting (85%) = defined relapses with no progression between attacks
2. Secondary progressive = initially relapsing remitting followed by progression with or without occasional relapse, minor remission or plateaus
3. Primary progressive = disease progression from onset
193
Define relapse and pseudo relapse in MS
Relapse = experienced by patient but may be confirmable by examination which last >48 hours
Pseudo-relapse = Infection causes relapse symptoms
194
Name 4 clinical features of MS
DEMYELINATION
1. Diplopia
2. Eye movement painful = optic neuritis (unilateral eye pain on movement and loss of central vision)
3. Motor weakness = progressive spastic weakness
4. nYstagmus
5. Elevated temperature worsens = Uthoff's phenomenon
6. Lhermitte's sign = flexion os neck causes shock down spine
7. Intention tremor
8. Neuropathic pain --> e.g. trigeminal neuralgia
9. Ataxia
10. talking slurred
11. Impotence
12. Overactive bladder/incontinence
13. Numbness/tingling
- Also can present as transverse myelitis = focal inflammation fo spinal cord --> paraesthesia, weakness, lhermittes, urinary Sx
195
What investigations might you do for someone with suspected MS?
- MRI brain and spinal cord
- LP --> oligoclonal bands
- NCS and EMG = delayed suggests demyelination
- Visual provoked potential = prolonged reaction
- Antibodies = anti-MBP, NMO-IgG
196
What is the diagnostic criteria for MS?
McDonald criteria
- An inflammatory demyelinating disease of the CNS, >2 lesions
- Dissemination in space
- Dissemination in time
- No alternative neurological disease which may explain the signs and symptoms
- Need at least 1 episode of typical relapse
197
What are the lifestyle management options for MS?
- Regular exercise
- Reduce stress
- Smoking/alcohol cessation
198
What is the drug management of someone having an acute MS attack?
Methylprednisolone
199
Describe the drug management to prevent an MS relapse
DMARDS
- Beta interferon
- Naralizumab
- Dimethyl fumarate
- Alemtuzumab
200
What symptomatic treatment is there for MS patients?
Spasticity = baclofen, botox
Tremor = botox , gabapentin, BB, clonazepam
Thalamic surgery = stereotactic thalamotomy, thalamic electrostimulation
Physio, OT, psychology service, speech therapy
201
What is Myasthenia Gravis?
Autoimmune disease against nicotinic acetylcholine receptors in the neuromuscular junction
- Mediated by antibodies (anti-AchR Abs) against nicotinic Act receptors which interferes with neuromuscular transmission via depletion of working post synaptic receptor sites
202
What is myasthenia graves associated with in <50 year olds?
More common in women
| Associated with other AI disease --> pernicious anaemia, SLE, RA, thymic hyperplasia
203
What is myasthenia graves associated with in >50 year olds?
More common in men
| Associated with thymic atrophy or thymic tumour
204
What is the presentation of myasthenia gravis?
- Fatiguable weakness
- Extraocular = ptosis, diplopia
- Bulbar = voice deteriorates on counting to 50
- Face = myasthenia snarl
- Neck = head droop
- Limbs = asymmetric, proximal weakness
- Normal tendon reflexes but may be fatiguable
- Weakness worsened by pregnancy, hypokalaemia, infection, emotion, exercise, drugs (opiates, BB, gent)
205
What investigations would you carry out in someone with suspected myasthenia gravis?
Antibodies --> Anti-AchR, anti-MuSK
CT thorax --> thymus
EMG
Ice test = ice applied to affected lip and ptosis improves
Tension test (edrophonium test = short acting acetylcholinesterase causes improvement in muscular strength
206
What is the treatment for myasthenia gravis?
- Acetylcholinesterase inhibitors --> pyridostigmine or neostigmine (slow reuptake of Ach)
- Immunosuppression --> prednisolone, azathioprine, methotrexate
- Thymectomy
207
Give 2 possible side effects of anti cholinesterase inhibitors?
Increased
- Salivation
- Lacrimation
- Sweating
- Vomiting
- Diarrhoea
- Miosis
208
What are the potential complications fo myasthenia gravis?
Myasthenic Crisis
- Weakness of respiratory muscles during relapse
- Monitor FVC
Treat with plasmapheresis or IVIg
209
What is Lambert Eaton Syndrome?
Antibodies to VGCC which decreases the influx of Ca2+ during presynaptic excitation leading to decreased presynaptic Ach vesicle fusion
210
What are the 2 main causes of Lambert Eaton Syndrome?
1. AI
| 2. Paraneoplastic from small cell lung carcinoma
211
How does Lambert Eaton Syndrome present?
```
- Same as myasthenia gravis = diplopia, ptosis, slurred speech, dysphagia
AND LEMS
- Leg weakness early
- Extra m= autonomic and areflexia
- Movement improves symptoms
- Small response to edrophonium
```
212
Describe the management of Lambert Eaton Syndrome
IVIg
213
Define Guillain Barre Syndrome
Acute inflammatory demyelinating ascending polyneuropathy affects PNS Schwann cells following URTI or GI infection
214
What are the causes of GBS?
Post infection
Bacterial = Campylobacter, mycoplasma
VIral = CMV, EBV, HIV
215
Give 3 clinical features of GBS
1. Symmetrical ascending flaccid weakness/paralysis
2. LMN signs = areflexia, fasciculations
3. Back pain
4. Little sensory disturbance
5. Autonomic = sweating, tachycardia, BP changes, arrhythmias
216
What investigations might you do on someone with suspected GBS?
- NCS = slow conduction
- LP --> raised protein, normal WCC
- Anti GM1 antibodies (25% of patients)
- Spirometry --> for resp involvement (ITU if decreased)
217
What is the management of GBS?
- IVIg
| - Plasma exchange
218
What is Miller Fisher Syndrome?
Variant of Guillain Barre
- Ophthalmoplegia, ataxia, areflexia (eyes affected first)
- Descending paralysis
219
What is Charcot Marie Tooth Disease?
A group of inherited motor and sensory neuropathies that cause dysfunction in the myelin or the axons
- Genetic tests for PMP22 gene mutation
220
Give 3 causes of Charcot Marie Tooth Disease
ABCDE
1. Alcohol
2. B12 deficiency
3. Cancer and CKD
4. DM
5. Every vasculitis
221
Give 3 clinical features of Charcot Marie Tooth Disease
1. High foot arches (per cavus)
2. Distal muscle wasting (inverted Champagne bottle legs)
3. Weakness in lower legs (loss of ankle dorsiflexion)
4. Symmetrical muscle atrophy --> claw hand
5. Foot drop with high stoppage gait
6. Peripheral sensory loss --> stocking distribution
222
What is the management of Charcot Marie Tooth Disease?
Supportive with physio, podiatry and orthoses
223
What is meningitis?
Inflammation of the meninges of the brain and spinal cord
224
What are the causes of meningitis in
a) Neonates
b) Children
c) Adults
d) Viral
a) Strep agalactiae, E.coli, strep pneumoniae, listeria monocytogenes
b) N. meningitides (g-ve diplocci), strep pneumoniae, HiB
c) Strep pneumoniae (g+ve cocci chain)
d) Enteroviruses (coxsackie), HSV2, CMV, VZV
225
Give 3 risk factors for meningitis
1. Intrathecal drug administration
2. Immunocompromised
3. Incomplete immunisation
4. Elderly and pregnant
5. Crowding
6. Endocarditis
7. DM
8. IVDU
226
Give 5 signs of meningitis
1. Headache
2. Fever
3. Neck stiffness
4. Photophobia
5. Kernigs sign = unable to straighten leg greater than 135 without pain
6. Brudzinskis sign = hip and knees flex when neck is flexed
7. Increased ICP --> papillodema, decreased GCS, focal seizures
227
Give 3 signs of meningococcal sepsis
1. Petechial non blanching rash
2. Fever
3. Decreased BP
4. Increased HR
5. DIC
228
What investigations might you do for someone with suspected meningitis?
1. Blood cultures
2. Throat swabs
3. Bloods --> FBC, U&Es, CRP, serum glucose, lactate
4. LP
5. CT head
229
What does an LP show with a bacterial infection?
- Turbid
- High opening pressure
- High protein
- Low glucose
- Neutrophils
230
What does an LP show with a viral meningitis infection?
- Clear
- Normal opening pressure
- Normal protein
- Normal glucose
- Lymphocytes
231
What does an LP show with a TB meningitis infection?
- Fibrin web
- Massive increase in protein
- Lymphocytic/mononuclear
232
Give 2 contraindications of an LP
1. Thrombocytopenia
2. Increases ICP
3. Unstable --> cardio or resp
4. Coagulation disorder
5. Infection at LP site
233
What is the treatment for bacterial meningitis?
Ceftriaxone/Cefotaxime IV
| + amoxicillin is >60 or immunocompromised
234
What is the treatment given to someone seen in primary care with suspected meningitis?
Benzylpenicillin
235
What is the treatment for viral meningitis?
Watch and wait
| Acyclovir if severe
236
What is encephalitis?
Inflammation of brain parenchyma
237
Give 2 viral and non-viral causes of encephalitis
Viral
1. HSV1/2
2. CMV
3. EBV
4. VZV
5. HIV
Non viral
1. Bacterial meningitis
2. TB
3. Malaria
4. Listeria
5. Lyme disease
238
What investigations would you do with carry out in someone with suspected encephalitis?
- Bloods --> cultures, viral PCR, malaria film
- LP --> increased protein, normal glucose, lymphocytes, PCR
- Contract CT --> SOL
- EEG
239
What is the management of encephalitis?
Acyclovir
240
Give 3 possible causes of spinal cord compression
1. Vertebral tumour (mets = lung, breast, kidney, prostate, myeloma)
2. Disc herniation = centre of disc moved out through annulus
3. Disc prolapse = nucleus pulposus moves and presses against annulus
4. Trauma
5. Infection
241
Give 3 signs of a spinal cord compression
1. Back pain
2. Progressive spastic leg weakness
3. UMN signs below level = hypertonia, hyperreflexia
4. Sensory loss below lesion
5. LAte = bladder/sphincter problems
242
What is the management of a spinal cord compression?
Dexamethasone
Radiotherapy (if malignancy)
Decompressive surgery
243
What is cauda equina?
Compression of spinal cord at cauda equina level = L1 or below
= Surgical emergency
244
Give 2 possible causes of cauda equina
1. Lumbar disc herniation --> L4/5, L5/S1
2. Tumour
3. Trauma
4. Infection
245
Give 3 signs of cauda equina
1. Flaccid and areflexic leg weakness
2. Bilateral sciatica
3. Saddle paraesthesia
4. Loss of sphincter tone --> bladder and bowel dysfunction
5. Erectile dysfunction
246
What investigations might you do for someone with suspected cauda equina?
- MRI/CT back and legs
- DRE = reduced anal tone
- Reflex tests
247
What is the management of someone with cauda equina?
- Immediate surgical decompression
| - Treat cause
248
What is spondylysis and give 2 causes?
Degenerative disc disease
1. Degernation due to trauma/ageing
2. IV dic collapse
3. Osteophytes
249
How does spondylysis present?
- Asymptomatic
- Neck stiffness and crepitus
- Stabbing/dull ache in arm
- Upper limb motor and sensory disturbance according to level of compression
250
What are the 2 specific signs of cervical spondylysis?
1. Lhermitte's = neck flexion causes tingling down the spine
2. Hoffman's = flick middle finger pulp and causes a brief pincer flexion of thumb and index finger
251
What is myelopathy?
Spinal cord disease = UMN problems
252
What is radiculopathy?
Spinal nerve root disease = LMN problem
253
What nerve root compression causes sciatica?
L4-S3 compression
254
What is a mononeuroapthy?
Lesions of individual peripheral or cranial nerves
255
What is Carpal Tunnel Syndrome?
Medical nerve neuropathy = C6-T1
256
Give 2 risk factors for Carpal Tunnel Syndrome
1. Pregnancy
2. Obesity
3. RA
4. Hypothyroidism
5. Acromegaly
257
What are the motor and sensory symptoms of carpal tunnel syndrome?
```
Motor = LLOAF muscle dysfunction and thenar wasting
Sensory = radial 3 and a half fingers, decreased 2 point discrimination
```
258
What nerve neuropathy causes a +ve Fromet's sign?
Ulnar nerve neuropathy = C7-T1
259
What are the features of a common perineal neuropathy?
= L4-S1
Motor = foot drop, weak ankle dorsiflexion and eversion
Sensory = loss of sensation below the knee laterally
260
What is mononeuritis multiplex?
When 2 or more peripheral nerves are affected
261
Give 3 causes of mononeuritis multiplex
WAARDS PLC
1. Wegner's
2. AIDS
3. Amyloid
4. RA
5. DM
6. Sarcoidosis
7. PAN
8. Leprosy
9. Carcinomatosis
262
Give 2 sensory causes of polyneuropathy
1. Alcohol
2. B12
3. DM m
4. Vasculitis
263
Give 2 motor causes of polyneuropathy
1. GBS
2. Lead poisoning
3. CMT
4. Paraneoplastic
264
What does an UMN facial nerve palsy indicate?
A stroke
| - Forehead SPARING due to dual innervation
265
What does a LMN facial nerve palsy indicate?
Bells Palsy
| - Acute unilateral facial nerve weakness or paralysis of rapid onset (<72 hours)
266
What is the treatment for Bells Palsy?
Prednisolone within 72 Horus
Valavivlovir if zoster suspected
Protect the eye --> dark glasses, artificial tear, tape closed at night
267
Outline the Glasgow Coma Scale
Eyes
- Spontaneous = 4
- Verbal = 3
- Pain = 2
- None = 1
Verbal
- Orientated = 5
- Confused = 4
- Inappropriate = 3
- Incomprehensible = 2
- None = 1
Motor Response
- Obeys commands = 6
- Localises pain = 5
- Normal flexion = 4
- Abnormal flexion = 3
- Extends = 2
- None = 1
268
Give 3 possible causes of a coma
1. Drugs and toxins --> opiates, alcohol
2. Anoxia --> post arrest
3. Toxins --> CO
4. Mass lesions --> bleeds, head injuries
5. Infections --> bacterial meningitis
6. Infarcts --> brainstem
7. Metabolic --> hypoglycaemia, DKA, herpatic encephalopathy, uraemia, Wernicke's
8. SAH
9. Epilepsy
10. Tumours
269
What spinal cord tracts carry sensory fibres?
Ascending
1. Dorsal column medical lemniscal pathway (DCML)
2. Anterolateral system (spinothalamic)
3. Spinocerebellar tracts
= 3rd order neurones
270
What information is carried by the DCML pathway?
Fine touch, vibration and proprioception
- Upper limbs (T6 and aboce) = Tavel in fasciculus cuneatus (lateral)
- Lower limbs (below T6) = Tavel in fasciculus gracilis (medial)
Decussate in medulla
271
What information is carried by the lateral spinothalamic tract?
Pain and temperature
272
What information is carried by the anterior spinothalamic tract?
Crude touch and pressure
273
What information is carried by the spinocerebellar pathway?
Unconscious sensation from muscles to the cerebellum
274
What information is carried by the posterior and anterior spinocerebellar tract?
Proprioceptive information from lower limbs to ipsilateral cerebellum
- Anterior = decussate twice end ipsilateral
275
What information is carried by the cuneocerebellar and rostral tracts?
Proprioceptive information from the upper limbs to the ipsilateral cerebellum
276
What spinal cord tracts carry motor fibres?
Descending
1. Pyramidal = corticopsinal, corticobulbar
2. Extrapyramidal = rubrospinal, tectospinal and vestibulospinal
277
What information do the pyramidal descending tracts carry?
Voluntary control of musculature of body and face, originate in cerebral cortex
278
Describe the corticospinal tracts
Musculature of body
1. Lateral = motor cortex --> decussate in medullar --> limb muscles
2. Medial = motor cortex --> ipsilateral --> axial muscles (head and trunk)
279
What information do the extrapyramidal descending tracts carry?
Involuntary autonomic control of all musculature in the body = muscle tone, balance, posture, locomotion
- Originate in brainstem
280
What is Brown Sequard Syndrome?
Hemisection fo the spinal cord
- Damage to the RIGHT corticopsinal tract at L1 = ipsilateral UMN sings in right leg
- Damage to RIGHT dorsal columns at L1 = ipsilateral loss of fine touch, propriocpetion and vibration in right leg
- Damage to lateral spinothalamic tracts = contralateral absence of pain and temperature sensation in left leg
