Neurology Flashcards
(50 cards)
1
Q
What is frontotemporal dementia
A
- progressive dementia
- atrophy of frontal and temporal lobes
- loss of neurons but no plaque formation
- 50% dominant inheritance
2
Q
Presentation of frontotemporal dementia
A
often tends to be insidious and progressive
- behavioural issues
- progressive aphasia
- semantic dementia
Picks bodies
3
Q
Investigations for frontotemporal dementia
A
- bloods
- FBC and LFTS for encephalopathy
- MMSE
- MRI
4
Q
Treatment for frontotemporal dementia
A
- no cure
- supportive therapy
- SSRIs → behaviour symptoms
- levodopa/carbidopa if Parkinson’s symptoms
- stop exacerbating drugs
5
Q
What is vascular dementia?
A
result of multiple, small infarcts
6
Q
Risk factors for vascular dementia
A
- smoking
- history of TIAs
- AF
- HTN
- T1DM
- hyperlipidaemia
- obesity
- coronary heart disease
one stroke doubles risk of vascular dementia
7
Q
Presentation of vascular dementia
A
- stepwise progression → periods of stable symptoms then sudden increase in severity
- visual disturbances
- UMN signs
- attention deficit
- depression
- incontinence
if infarct was subcortical → dysarthria, pakinsonisms
8
Q
Investigations for vascular dementia
A
- full history → previous stroke/TIA
- cognitive impairment screen
- medication review
- MRI → previous infarcts
9
Q
Treatment for vascular dementia
A
- supportive therapy
- SSRIs/anti-psychotics to control symptoms
- prognosis 3-5yrs
10
Q
What is dementia with Lewy Bodies?
A
- characterised by Lewy bodies in brainstem and neocortex
- substantia nigra depigmentation and amyloid deposits
- on a spectrum
11
Q
Presentation of dementia with Lewy Bodies
A
- initial presentation = dementia
- Parkinsonisms
- visual hallucinations
- sleepless disorders/restless leg syndrome
12
Q
Diagnosis of dementia with Lewy Bodies
A
presence of dementia with 2 of:
- fluctuating attention/concentration
- recurrent visual hallucinations
- spontaneous Parkinsonism
- SPECT/PET scan → low dopamine transporter uptake in basal ganglia
- MMSE
- bloods
- MSU → urine infection
13
Q
Treatment for dementia with Lewy Bodies
A
- supportive therapy
- cholinesterase inhibitors for cognitive decline
- avoid neuroleptic drugs
14
Q
What is carpal tunnel syndrome?
A
- compression of median nerve in carpal tunnel
- median nerve → sensation to thumb/index/middle/half of ring finger
- causes unknown
15
Q
Presentation of carpal tunnel syndrome
A
- pins and needles
- pain in index/middle finger → reaches shoulder
- numbness
- weakness, loss of grip
- worse a night
16
Q
Diagnosis of carpal tunnel syndrome
A
- based on symptoms
- nerve conduction test
- US/MRI
17
Q
Treatment of carpal tunnel syndrome
A
- pregnancy cases resolve postpartum
- rest wrist
- splint
- steroid injections
- surgery if severe
18
Q
What is foot drop?
A
- difficulty lifting front part of foot → toes drag
- permanent/temporary
- damage to common peroneal/fibular nerve
19
Q
Causes of foot drop
A
- injury
- lower back damage
- tumour
- cauda equina syndrome
- MS
20
Q
Presentation of foot drop
A
- unilateral symptoms
- one foot drags across floor
- tripping
- numbness/weakness
21
Q
Diagnosis of foot drop
A
- clinical diagnosis
- find cause using xray/US/CT/MRI/nerve conduction studies
22
Q
Treatment of foot drop
A
- brace/splint
- physiotherapy
- special shoes
- nerve stimulation
- surgery
23
Q
Causes of spinal cord compression
A
- trauma
- tumours → common spinal metastases = breast, prostate, lung
- central disc protrusion
- prolapsed disk
- infection
- epidural haematoma
24
Q
Signs and symptoms of spinal cord compression
A
red flag signs
- loss of bladder/bowel function
- UMN signs in lower limbs eg clonus
- LMN signs in upper limbs eg atrophy
symptoms depend on injury type and site
- paraplegia
- pain
- paraesthesia
25
Diagnosis of spinal cord compression
- xray whole spine
- MRI if indicated
- renal function
- Hb → monitor blood loss
26
Treatment of spinal cord compression
- acute = emergency
- dexamethasone until treatment confirmed
- catheterisation
- analgesi
- surgical decompression
- chemo
27
What is the cauda equina?
formed by nerve roots caudal to spinal cord termination
28
What is cauda equina syndrome?
sudden severe compression of cauda equina
29
Causes of cauda equina syndrome
- herniation of lumbar
- tumours
- trauma
- infection
- late stage ankylosing spondylitis
- post op haematoma
- sarcoidosis
30
Presentation of cauda equina syndrome
- sudden onset → hrs
- saddle paraesthesia
- bladder/bowel dysfunction
- sexual dysfunction
- motor problems
- lower back pain
- bilateral LMN weakness, absent ankle reflex
31
Diagnosis of cauda equina syndrome
- medical emergency
- rectal exam → loss of anal tone/sensation
- MRI spine
32
Treatment of cauda equina syndrome
- surgical decompression
- immobilise spine
- anti-inflammatory agents
- Abs if infection
- chemo
33
What is Wernicke's encephalopathy?
depletion of thiamine → vitB1
34
Causes of Wernicke's
- chronic alcoholism
- severe starvation
- prolonged vomiting
35
Presentation of Wernicke's
classic triad
- confusion
- ataxia
- ophthalmoplegia
- asterixis = liver flap → general sign of metabolic encephalopathy
- diagnosis = clinical
36
Management of Wernicke's
- pabrinex → IV b-vitamins incl thiamine
- complication = Korsakoff's syndrome
37
What is Korsakoff's sybdrome?
- irreversible
- long term brain damage due to B1 deficiency
- decreased ability to acquire new memorites
- retrogade amnesia
- confabulation
38
Primary brain tumours
- less common
gliomas
- astrocytoma
- oligondendroglioma
others
- ependymoma
- meningioma
- schwannoma
- craniopharyngiomas
39
Secondary brain tumours
- much more common
originate from
- non-small cell lung cancer
- small cell lung cancer
- breast
- melanoma
- renal cell carcinoma
- GI
40
What is encephalitis?
- inflammation of brain parenchyma due to viral infection
- other causes = TB, lume disease, toxoplasmosis
41
Viruses that cause encephalitis
- most common = HSV1
- CMV
- EBV
42
Presentation of encephalitis
- fever
- headache
- altered mental status
- can present with signs of meningitis
- confusion/drowsiness
- symptoms of raised ICP
- if caught late, coma
43
Symptoms of raised ICP
- vertigo
- nausea
- headache
- photophobia
44
Diagnosis of encephalitis
- bloods
- CSF → viral PCR to detect virus
- CT/MRI
- blood cultures/gram stain
45
Treatment of encephalitis
- urgent admission
- acyclovir
- stat IV benzylpenicillin
- careful with fluids → cerebral oedema
46
What is Herpes Zoster?
- shingles
- painful rash caused by reactivation of nerve infection caused by varicella-zoster virus
- first presents as chickenpox as a kid
- remains dormant in dorsal root ganglia
- travels through peripheral sensory nerves to skin
47
Risk factors of herpes
- immunocompromised
- HIV
- malignancy
48
Presentation of herpes
rash
- red, painful
- dermatomal distribution → cervical, trigeminal, thoracic, lumbar
- fluid filled blisters
- stabbing/burning pain
- fever, headache, fatigue
- itching
49
Diagnosis of herpes
- PCR
- CSF analysis
- bloods
- diagnosis often clinical
50
Treatment of herpes
antiviral therapy
- acyclovir
- valacyclovir
- famiciclovir
- if immunocompromised → IV acyclovir
- analgesia
- antipyretics
