Neurology Flashcards
1
Q
What is syncope?
A
Temporary loss of consciousness due to a disruption of blood flow to the brain
2
Q
What is syncope also known as?
A
Vasovagal episodes
Fainting
3
Q
What causes a vasovagal episode?
A
A problem with the autonomic nervous system regulating blood flow to the bran.
4
Q
What happens when the vagus nerve recieves a strong stimulus?
A
It stimulates the parasympathetic nervous system, causing the blood vessels in the brain to relax and the cerebral blood pressure to drop, leading to hypoperfusion of brain tissue
5
Q
What is prodrome?
A
The events/ feelings prior to fainting
6
Q
What symptoms may be included in prodrome?
A
Hot or clammy Sweaty Heavy Dizzy/ lightheaded Blurred/ dark vision Headache
7
Q
What are the causes of primary syncope (simple fainting)?
A
Dehydration
Missed meals
Extending standing in warm environment
Strong stimuli
8
Q
What events may strongly stimulate the vagus nerve?
A
Emotional event
Painful sensation
Change in temperature
9
Q
What are the secondary causes of syncope?
A
Hypoglycaemia Dehydration Anaemia Infection Anaphylaxis Arrhythmias Valvular heart disease Hypertrophic obstructive cardiomyopathy
10
Q
What are the key points to take in a syncope history?
A
Differentiate it from seizure Triggers? Concurrent ilnness? Injuries caused by colapse? Associated cardiac or neurological symptoms?
11
Q
What investigations may be done after a vasovagal episode?
A
ECG
24 hour ECG
Echo
Bloods (FBC, electolytes, blood glucose)
12
Q
What is epilepsy?
A
Umbrella term for the tendency to have seizures
13
Q
What are seizures?
A
Transient episodes of abnormal electrical activity in the brain
14
Q
What are the different types of seizure?
A
Generalised tonic-clonic Focal Absence Atonic Myoclonic Infantile spasms Febrile convulsions
15
Q
What is the tonic phase?
A
Muscle tensing
16
Q
What is the clonic phase?
A
Muscle jerking
17
Q
What phase comes first in a generalised tonic-clonic seizure?
A
Tonic phase
18
Q
What may also occur in a tonic-clonic seizure?
A
Tongue biting, incontinence, groaning and irregular breathing
19
Q
What happens after a tonic-clonic seizure?
A
Prolonged post-ictal period
20
Q
What happens in the post-ictal period?
A
Person is confused, drowsy and feels irritable/ low
21
Q
What is the first line management of tonic-clonic seizures?
A
Sodium valproate
22
Q
What is the second line management of tonic-clonic seizures?
A
Lamotrigine or carbamazepine
23
Q
What are focal seizures?
A
Seizures that affect hearing, speech, memory and emotions
24
Q
Where to focal seizures start?
A
In the temporal lobes
25
What are the different ways focal seizures can present?
Hallucinations
Memory flashbacks
Deja Vu
Strange actions on autopilot
26
What is the first line management of focal seizures?
Carbamazepine or lamotrigine
27
What is the second line management of focal seizures?
Sodium valproate or Levetiracetam
28
What are absence seizures?
When patient becomes blank, stares into space and then abruptly returns to normal
29
Who most commonly gets absence seizures?
Children
30
How long do absence seizures typically last?
10-20 seconds
31
What is the first line treatment for absence seizures?
Sodium valproate
32
What are atonic seizures?
Drop attacks- brief lapses in muscle tone
33
How long to atonic seizures usually last?
Less than 3 minutes
34
What syndrome may be the cause of atonic seizures?
Lennox-Gastaut syndrome
35
What is the first and second line management of atonic seizures?
First line= Sodium valproate
| Second line= Lamotrigine
36
What are myoclonic seizures?
Sudden brief muscle contractions
37
When do myoclonic seizures usually manifest?
In children as part of juvenile myoclonic epilepsy
38
What is the management of myoclonic seizures?
1st line= sodium valproate
| 2nd= lamotrigine/ levetiracetam/ topiramate
39
What are infantile spasms?
Clusters of full body spasms
40
What are infantile spasms also known as?
West syndrome
41
When do infantile spasms usually start?
Around 6 months
42
What is the prognosis of infantile spasms?
1/3 die by 25
| 1/3 are seizure free
43
What are febrile convulsions?
Seizures that occur in children whilst they have a fever
44
In what age range do febrile convulsions begin?
6 months- 5 years
45
What key investigations may be done into epilepsy?
EEG
| MRI brain
46
What is an EEG and when would it be performed?
Electroencephalogram, performed after the second instance of simple tonic-clonic seizure
47
When would an MRI brain be considered?
If the first seizure is in a child <2
Focal seizures
No response to medications
48
What can an MRI brain help rule out?
Structural problems and pathology such as tumours
49
What additional investigations may be considered to exclude causes of seizures?
```
ECG
Blood electrolytes
Blood glucose
Blood cultures
Urine cultures
LP
```
50
What general advice is given to patients/ families with new epilepsy diagnosis?
Don't take baths
Be cautious with swimming, heights, traffic and heavy/ electrical equipment
Avoid driving
51
What is the first line medication for most forms of epilepsy?
Sodium valproate
52
Which form of epilepsy is sodium valproate not the first line in?
Focal seizures
53
What is the action of sodium valproate?
Increases the activity of GABA, which has a relaxing effect on the brain
54
What are the key side effects of sodium valproate ?
Teratogenic
Liver damage
Hair loss
Tremor
55
In which patients should sodium valproate be avoided and why?
Girls because it is severely teratogenic
56
What is the first line medication for focal seizures?
Carbamazepine
57
What are the notable side effects of carbamazepine?
Agranulocytosis
Aplastic anaemia
Many drug interactions
58
What are the notable side effects of Phenytoin?
Folate & vitamin D deficiency
Megaloblastic anaemia
Osteomalacia
59
What are the notable side effects of Ethosuximide?
Night terrors
| Rashes
60
What are the notable side effects of Lamotrigine?
Stevens-Johnson syndrome
DRESS syndrome
Leukopenia
61
How should you manage someone having a seizure?
Safe position
Put something soft under head
Remove obstacles/ danger
Make note of start and end
62
When do you call an ambulance with a seizure?
If it lasts more than 5 minutes or is their first seizure
63
What is status epilepticus?
Medical emergency- seizure lasting more than 5 minutes or 2 or more seizures without regaining consciousness
64
How is status epilepticus managed in hospital?
ABCDE
IV lorazepam
IV phenytoin if seizure persists
65
What are simple febrile convulsions?
Generalised tonic, clonic seizures caused by a high fever
66
How long do simple febrile convulsions last?
Less than 15 minutes
67
What are complex febrile convulsions?
Partial or focal seizures, lasting more than 15 minutes or occurring multiple times during the same febrile illness
68
What are the differential diagnoses of a febrile convulsion?
```
Epilepsy
Meningitis/ encephalitis
Intracranial space occupying lesions (brain tumour/ haemorrhage)
Syncopal episode
Electrolyte abnormalities
Trauma
```
69
What is the typical presentation of a febrile convulsion?
18 month year old child presenting with 2-5 minute tonic clonic seizure during high fever
70
How are febrile convulsions managed?
Identify underlying source of infection
| Paracetamol/ ibuprofen
71
What are breath holding spells?
Involuntary episodes during which a child holds their breath
72
What usually triggers breath holding spells?
Something upsetting or scary
73
In what age range do breath holding spells usually occur?
6-18 months
74
What are the two types of breath holding spells?
Cyanotic breath holding spells
| Pallid breath holding spells
75
What are cyanotic breath holding spells?
When the child gets really worked up, lets out a long cry, then stops breathing, becomes cyanotic and loses consciousness
76
What are reflex anoxic seizures?
When the child is startled, the vagus nerve sends strong signals to the heart that causes it to stop beating/
77
What happens after a cyanoti breath holding spell?
The child regains consciousness and starts breathing within a minute
78
What happens during a reflex anoxic seizure?
The child goes pale, loses consiousness and may have some muscle twitching
79
How long do reflex anoxic seizures typically last?
30 seconds
80
How are breath holding spells managed?
Exclude other pathology
Treat any iron deficiency anaemia
Educate and reassure
81
What are the causes of headaches in children?
```
Tension headaches
Migraines
ENT infection
Analgesic headache
Vision problems
Raised ICP
Brain tumours
Meningitis
Encephalitis
Carbon monoxide poisoning
```
82
What is the main cause of headaches in children?
Tension headaches
83
What are tension headaches?
Common type of headache producing mild ache across forehead (band- like pressure)
84
What may trigger tension headaches?
Stress, fear or discomfort
Skipping meals
Dehydration
Infection
85
How are tension headaches managed?
```
Reassurance
Analgesia
Regular meals
Avoid dehydration
Reduce stress
```
86
How long do tension headaches typically last in children?
30 minutes
87
What are the different types of migraine?
Migraine with or without aura
Silent migraine
Hemiplegic migraine
Abdominal migraine
88
What is a silent migraine?
Migraine with aura but without headache
89
What is a hemiplegic migraine?
Migraine that causes temporary weakness down one side of the body
90
What are the common presenting features of a migraine?
```
Unilateral, severe, throbbing pain
Often photo/ phonophobia
Visual auras
N&V
Abdominal pain
```
91
How are migraines in children managed supportively?
Rest/
Fluids
Low stimulus environment
92
What medications can be used to manage migraines in children?
Paracetamol
Ibuprofen
Sumatriptan
Antiemetics
93
What medications can be used as migraine prophylaxis?
Propanolol
Pizotifen
Topiramate
94
What are abdominal migraines?
Central abdominal pain lasting more than 1 hour. Tend to occur in young children before developing traditional migraines when they get older
95
What is cerebral palsy?
Permanent neurological problems resulting from damage to the brain around the time of birth
96
What are the antenatal causes of cerebral palsy?
Maternal infections
| Trauma during pregnancy
97
What are the perinatal causes of cerebral palsy?
Birth asphyxia
| Pre-term birth
98
What are the different types of cerebral palsy?
Spastic
Dyskinetic
Ataxic
Mixed
99
What is spastic CP?
Hypertonia and reduced function
100
What is dyskinetic CP?
Problems controlling muscle tone (both hyper and hypotonia), causing athetoid movements and oro-motor problems
101
What causes spastic CP?
Damage to upper motor neurones
102
What causes dyskinetic CP?
Damage to basal ganglia
103
What is ataxic CP?
Problems with coordinated movement resulting from damage to the cerebellum
104
What is spastic CP also known as?
Pyramidal CP
105
What is dyskinetic CP also known as?
Athetoid or extrapyramidal CP
106
What are the different patterns of spastic cerebral palsy?
Monoplegia
Hemiplegia
Diplegia
Quadraplegia
107
What is hemiplegia?
One side of the body affected
108
What is diplegia?
When all four limbs are affected, but mostly the legs
109
What are the signs and symptoms of CP during development?
```
Failure to meet milestones
Increased/ decreased tone
*Hand preference before 18 months
Problems with coordination, speech or walking
Feeding/ swallowing problems
Learning difficulties
```
110
What gait may you find on examination of a child with CP?
```
Hemiplegic/ diplegic
Ataxic
High stepping
Waddling
Antalgic gait (limp)
```
111
What may be found on neurological examination of a patient with an upper motor neurone cerebral palsy?
Hemipledic/ diplegic gate
Hypertonia
Slightly reduced power
Brisk reflexes
112
What may be found on neurological examination of a patient with a lower motor neurone cerebral palsy?
```
High stepping gate
Reduced muscle bulk with fasciculations
Hypotonia
Dramatically reduced power
Reduced reflexes
```
113
What is a hemiplegic/ diplegic gait?
When there is increased muscle tone and spasticity in the legs, caused them to be extended with plantar flexion. This means they must swing leg around in a large semicircle.
114
What are the complications/ conditions associated with cerebral palsy?
```
Learning disability
Epilepsy
Kyphoscoliosis
Muscle contractures
Hearing/ visual impairment
GORD
```
115
How is cerebral palsy managed?
```
MDT:
Physiotherapy
OT
SALT
Dieticians
Paediatricians
Social workers
Orthopaedic surgeons
```
116
What is strabismus?
Misalignment of the eyes
117
What will a person with strabismus experience?
Double vision
118
What is amblyopia?
Lazy eye (affected eye has reduced function compared to dominant eye)
119
What is esotropia?
Inward positioned squint
120
What is exotropia?
Outward positioned squint
121
What is hypertropia?
Upward moving affected eye
122
What is hypotropia?
Downward moving affected eye
123
What are the causes of strabismus?
```
Idiopathic
Hydrocephalus
Cerebral palsy
Space occupying lesion
Trauma
```
124
What investigations do you do into strabismus?
```
General inspection
Eye movement
Fundoscopy
Visual acuity
Hirschberg's test
Cover test
```
125
What is Hirschberg's test?
Shine pen-torch at patient from 1 meter away. When they look at it, observe reflection of light source on their cornea (should be central and symmetrical)
126
What is a cover test?
Cover one eye and ask patient to focus on an object in front of them. Move the cover across the opposite eye and watch movements of previously covered eye. (Will show exotropia and esotropia)
127
How is strabismus managed?
```
Earlier the better
Occlusive patch
Atropine drops (blurs vision in good eye)
Glasses
Surgery
Botox
```
128
What is hydrocephalus?
Abnormal build up of CSF in the brain and spinal cord
129
What causes hydrocephalus?
An overproduction of CSF or a problem with draining or absorbing it
130
How many ventricles are there in the brain and what are they?
4
| Two lateral ventricles, third and fourth
131
What do the brain ventricles contain?
CSF
132
Where is CSF created?
In the four choroid plexuses (in each ventricle) and by the walls of the ventricles
133
Where is CSF absorbed?
Into the venous system by the arachnoid granulations
134
What is the most common cause of hydrocephalus?
Aqueductal stenosis, leading to insufficient drainage
135
What is the cerebral aqueduct?
Passage connecting the third and fourth ventricle
136
What happens in aqueductal stenosis?
There is stenosis of the aqueduct connect the third and fourth ventricle, blocking the normal flow of CSF out of the third ventricle, causing it to build up in the lateral and third ventricles
137
What are other congenital causes of acqueductal stenosis?
Arachnoid cysts
Arnold-Chiari malformation
Chromosomal abnormalities
Congenital malformations
138
What is an Arnold-Chiari malformation?
Where the cerebellum herniates downwards through the foramen magnum, blocking the outflow of CSF
139
At what age do the cranial sutures fuse?
2 years
140
How does hydrocephalus present in babies?
```
Enlarged and rapidly increasing head circumference
Bulging anterior fontanelle
Poor feeding/ vomiting
Poor tone
Sleepiness
```
141
What is the mainstay of treatment for hydrocephalus?
VP shunt
142
What is a VP shunt?
Catheter placed into ventricle and drains CSF into another body cavity (usually peritoneal)
143
Why is the peritoneal cavity the most commonly used to drain CSF?
There is plenty of space and it is easily reabsorbed
144
What are the complications of a VP shunt?
```
Infection
Blockage
Excessive drainage
Intraventricular haemorrhage
Outgrowing shunt
```
145
How often do VP shunts need replacing?
Every 2 years
146
What is craniosynostosis?
When the skull sutures close prematurely
147
What does craniosynostosis cause if left untreated?
Raised intracranial pressure
Abnormal head shapes
Restriction in brain growth
148
What is the main presenting feature of craniosynostosis?
Abnormal head shape
| small head in proportion to body, anterior fontanella closure before 1
149
What is the head shape in saggital synostosis?
Long and narrow from front to back
150
What is the head shape in coronal synostosis?
Bulging on one side of forehead
151
What is the head shape in Metopic synostosis?
Pointy triangular forehead
152
What is the head shape in lambdoid synostosis?
Flattening on one side of the occiput
153
What investigations are done for suspected craniosynostosis?
Skull Xray
| CT head
154
How are mild cases of craniosynostosis managed?
Monitored and followed up over time
155
How are more severe cases of craniosynostosis managed?
Surgical reconstruction of the skull
156
What is plagiocephaly?
Flattening in an area of the baby's head
157
What is brachycephaly?
Flattening at the back of the head resulting in a short head from back to front
158
What causes plagio/brachycephaly?
Positional plagiocephaly: When a baby has a tendency to rest their head on a particular point, so the bones and sutures mould with gravity
159
When and how do babies usually present with How are mild cases of plagiocephaly?
3-6 months with abnormal head shape
160
What must be excluded when diagnosing plagiocephaly?
Craniosynotosis
| Congenital muscular torticollis
161
What is congenital muscular torticollis?
Shortening of the sternocleidomastoid muscle on one side
162
How is plagiocephaly managed?
Encourage baby to avoid resting on flattened area
| Plagiocephaly helmets
163
What is muscular dystrophy?
Umbrella term for genetic conditions that cause gradual weakening and wasting of muscles
164
What is the main type of muscular dystrophy?
Duchennes muscular dystrophy
165
What are other types of muscular dystrophy?
```
Beckers
Myotonic
Facioscapulohumeral
Oculopharyngeal
Limb-girdle
Emery-Dreifuss
```
166
What sign will be present in children with proximal muscle weakness?
Gower's sign
167
What is Gower's sign?
When standing up from sitting, they get on their hands and knees, then push their hips up and backwards, before transferring weight backwards and transferring hands to knees
168
How is muscular dystrophy managed?
MDT:
OT, PT, equipment (wheelchairs)
Surgical/ medical management of complications (e.g. scoliosis, heart failure)
169
What kind of inheritance pattern is duchennes muscular dystrophy?
X-linked recessive
170
What causes Duchennes muscular dystrophy?
Defective gene for dystrophin on X-chromosome
171
What is Dystrophin?
Protein that helps hold muscles together at the cellular level
172
In which patients does Duchennes muscular dystrophy pretty much solely present and why?
Boys- girls have a spare X chromosome
173
At what age does Duchennes usually present?
3-5
174
How does Duchennes usually first present?
With weakness in muscles around pelvis
175
What is the prognosis of Duchennes?
Progressive disease and eventually all muscles will be affected
Wheelchair bound by teenager
Life expectancy of 25-35 years
176
What can be used to slow the progression of muscle weakness in Duchennes?
Oral steroids
| Createnine can improve muscle strength
177
How does Beckers muscular dystrophy differ from Duchenens?
Dystrophin gene is less severely affected and maintains some function
Presents later and less predictable
178
What are the typical features of myotonic dystrophy?
Progressive muscle weakness
Prolonged muscle contractions
Cataracts
Cardiac arrhythmias
179
What is the key feature of myotonic dystrophy to remember?
Prolonged muscle contraction- e.g. may be unable to let go after shaking hands or opening doorknob
180
What kind of condition is myotonic dystrophy and when does it typically present?
Genetic disorder
| Presents in adulthood
181
What is facioscapulohumeral muscular dystrophy?
Weakness around face, progressing to shoulderns and arms
182
When and how does facioscapulohumeral muscular dystrophy usually present?
In childhood with child sleeping with eyes slighlty open and weakness in pursing lips
183
What is oculopharyngeal muscular dystrophy?
Weakness of ocular muscles and pharynx
184
When and how does oculopharyngeal muscular dystrophy usually present?
Bilateral ptosis, restricted eye movements and swallowing problems in late adulthood
185
What is limb-girdle muscular dystrophy?
Progressive weakness around the limb girdles (hips and shoulders) presenting in teenage years
186
What is Emery-Dreifuss muscular dystrophy?
Dystrophy presenting in childhood with contractures in elbows and ankles, as well as progressive muscle weakness and wasting
187
What is spinal muscular atrophy?
Rare genetic condition causing progressive loss of motor neurones, leading to progressive muscular weakness
188
What kind of genetic condition is spinal muscular atrophy?
Autosomal recessive
189
What neurones does SMA affect?
Lower motor neurones in spinal cord
190
What lower motor neurone signs will you get in SMA?
```
Fasciculations
Reduced muscle bulk
Reduced tone
Reduced power
Reduced/ absent reflexes
```
191
What are the 4 categories of spinal muscular atrophy?
SMA type 1, 2 4 & 4
192
What is SMA type 1?
Onset in first few months of life and progresses to death within 2 years
193
What is SMA type 2?
Onset within first 18 months of life. Most never walk but survive into adulthood
194
What is SMA type 3?
Onset after first year of life. Most walk without support but lose ability. Life expectancy close to normal
195
What is SMA type 4?
Onset in 20s. Most retain ability to walk short distances but everyday tasks can lead to significant fatigue
196
How is spinal muscular atrophy managed?
Supportive with MDT
197
What may be required to prevent respiratory failure in those with SMA?
Non-invasive ventilation
| Tracheostomy with mechanical ventilation (SMA T1)
