Neurology Flashcards
1
Q
What is the main function of the spinal cord?
A
Transmission of neural inputs between the periphery and the brain
2
Q
From where does the spinal cord extend?
A
From the medulla oblongata to the conus medullaris near the vertebral level at T12-L1
3
Q
What is the approximate length of the adult spinal cord?
A
45 centimeters
4
Q
What are the two regions where the spinal cord enlarges?
A
- Cervical enlargement
- Lumbosacral enlargement
5
Q
What spinal cord segments are included in the cervical enlargement?
A
Spinal cord segments from about C4 to T1
6
Q
What spinal cord segments are included in the lumbosacral enlargement?
A
Spinal cord segments from L2 to S3
7
Q
What are funiculi in relation to the spinal cord?
A
Neuronal white matter tracts containing sensory, motor, and autonomic pathways
8
Q
What shapes the central region of the gray matter in the spinal cord?
A
Four-leaf clover shape
9
Q
What are the three layers of meninges covering the spinal cord?
A
- Dura mater
- Arachnoid membrane
- Pia mater
10
Q
How many spinal cord segments are there?
A
31 segments
11
Q
How are the spinal nerves formed?
A
Ventral and dorsal roots join to form paired spinal nerves
12
Q
What is the difference between upper motor neurons (UMN) and lower motor neurons (LMN)?
A
UMN originate in the brain and control LMN, which directly innervate muscles
13
Q
What is the term for the collection of lumbosacral spinal nerve roots?
A
Cauda equina
14
Q
What is Brown-Séquard syndrome characterized by?
A
Motor impairment of the ipsilateral side and pain and temperature sensation impairment of the opposite side
15
Q
What are the primary symptoms of Anterior Cord Syndrome?
A
- Motor deficit below the level
- Impairment of pain, temperature, and touch sensations
16
Q
What defines Posterior Cord Syndrome?
A
Lesion of the dorsal columns only, with impaired proprioception
17
Q
What are common clinical features of acute spinal cord lesions?
A
- Flaccid
- Areflexic
- Urinary retention
18
Q
What are some potential aetiologies for spinal cord injuries?
A
- Trauma
- Infections
- Inflammatory
- Vascular
- Demyelinating
- Tumours
- Degenerative
- Toxins
- Developmental
19
Q
What is a common complication of spinal cord injury related to immobility?
A
- Thrombosis
- Pressure sores
- Infections
20
Q
Fill in the blank: The central canal is surrounded by _______.
A
[gray matter]
21
Q
What condition is characterized by lower motor neuron weakness and urinary retention?
A
Cauda equina syndrome
22
Q
What is the characteristic symptom of Central Cord Syndrome?
A
Segmental sensory loss for pain, with proprioception spared
23
Q
What is the role of the corticospinal tract?
A
Motor control pathway
24
Q
What is the significance of the term ‘syringomyelia’ in spinal cord pathology?
A
It refers to a condition that can cause central cord syndrome
25
What are neuromuscular disorders?
Conditions that affect the neuromuscular system, causing problems with nerves, muscles, and neuromuscular junction.
26
What are the categories of neuromuscular disorders mentioned?
* Inflammatory Myopathies
* Dystrophies
* Mononeuropathies
* Polyneuropathies
* Myasthenia Gravis
27
What are idiopathic inflammatory myopathies characterized by?
* Proximal, symmetrical muscle weakness
* Neck flexion weakness
* Respiratory muscle involvement in severe cases
* Occurrence in isolation or with systemic autoimmune diseases
28
What is the prevalence of interstitial lung disease in idiopathic inflammatory myopathies?
About 10% of patients.
29
What is a key diagnostic tool for differentiating types of inflammatory myopathies?
Muscle biopsy.
30
What skin changes are associated with dermatomyositis?
* Heliotrope rash
* Gottron's papules
* Photosensitive rash
* Thickened cuticles
* Dilated nailbed capillary loops
31
True or False: Polymyositis presents with skin changes.
False.
32
What gene mutation causes Duchenne muscular dystrophy?
Mutation in the dystrophin gene.
33
What are common clinical features of Duchenne muscular dystrophy?
* Progressive symmetrical weakness
* Delayed motor milestones
* Wheelchair bound by age 13
* Gower's sign
* Calf pseudohypertrophy
* Respiratory weakness
34
How is Becker's muscular dystrophy different from Duchenne muscular dystrophy?
Becker's is milder and most patients can walk longer, often into adulthood.
35
What is Myasthenia Gravis characterized by?
Painless fatigable muscle weakness.
36
What are the clinical features of Myasthenia Gravis?
* Ptosis or diplopia
* Limb and bulbar muscle weakness
* Worsening of weakness after prolonged muscle contraction
37
What tests are used for diagnosing Myasthenia Gravis?
* Testing for acetylcholine receptor antibodies
* Neurophysiology with repetitive nerve stimulation
* Neostigmine test
* CT-Chest to rule out thymoma
38
What is the prevalence of symmetrical polyneuropathy?
About 2.4%, more common in the elderly.
39
What are the classifications of peripheral nerve diseases according to time course?
* Acute: less than 4 weeks
* Subacute: 4-8 weeks
* Chronic: more than 8 weeks
40
What is the most common cause of axonal neuropathy?
* Diabetes mellitus
* Alcohol
* Uraemia
* Cirrhosis
* Toxins
* Drugs
41
What characterizes Guillain-Barre Syndrome?
Acute inflammatory polyradiculoneuropathy with resultant weakness and diminished reflexes.
42
What are the signs and symptoms of Guillain-Barre Syndrome?
* Ascending weakness
* Bifacial weakness
* Neck flexion weakness
* Bulbar weakness
* Global areflexia
43
What is a common treatment for Guillain-Barre Syndrome?
* Intravenous immunoglobulins
* Plasma exchange
* Respiratory support
44
What distinguishes Chronic Inflammatory Demyelinating Neuropathy (CIDP) from chronic axonal neuropathy?
CIDP responds well to treatment.
45
Fill in the blank: Carpal tunnel syndrome is due to the compression of the _______ under the flexor retinaculum at the wrist.
median nerve
46
What is the typical management strategy for carpal tunnel syndrome?
* Rest
* Weight reduction
* Wrist splints
* Corticosteroid injection
* Operative decompression
47
What is Bell's palsy also known as?
Idiopathic facial paralysis.
48
What are the clinical features of Bell's palsy?
* Acute onset of unilateral facial paralysis
* Decreased tearing
* Hyperacusis
* Taste disturbance
* Poor eyelid closure
49
What is the first-line treatment for Bell's palsy?
Corticosteroid therapy.
50
51
What is the definition of headache?
Encompasses all aches and pains located in the head, but in practice it’s application is restricted to discomfort in the region of the cranial vault.
52
What is the most common symptom presenting to the medical profession?
Headache.
53
What is the third most common cause of disability worldwide?
Headache.
54
What percentage of headaches are tension headaches?
45%.
55
What percentage of headaches are migraines?
30%.
56
What are the physiological sources of intracranial headaches?
* Sinus
* Blood vessels
* Dura (anterior and middle segment CN5, posterior segments CN9/10 C1,2,3)
57
What are the physiological sources of extracranial headaches?
* Scalp muscles or vessels
* Orbits
* Nasal mucosa
* External or middle ear
* Teeth and gums
58
What are the two main types of headaches?
* Primary
* Secondary
59
What are the types of primary headaches?
* Tension-type headache (TTH)
* Migraine
* Cluster headache
60
What are some examples of secondary headaches?
* Low pressure and post dural puncture headache
* Posttraumatic headache
* Temporal/Giant cell arthritis
* Meningeal irritation (infection/bleed)
* Sinus
* Ocular
61
What characterizes a tension-type headache?
Diffuse dull band-like ache, worsened by touch and noise, lasts hours to days.
62
What is the typical demographic for migraines?
Childhood, young adults, with 70% familial history.
63
What are the symptoms of a migraine?
* Acute unilateral throbbing pain
* Nausea and vomiting
* Photophobia
* Phonophobia
64
What are the two types of migraines?
* Migraine with aura
* Migraine without aura
65
What is a cluster headache characterized by?
Unilateral pain around the eye, with conjunctival injection, lacrimation, and rhinorrhea.
66
What defines chronic daily headaches?
Headaches that occur 15 days or more a month for longer than three months.
67
What are common associated symptoms with headaches?
* Light headed
* Fatiguability
* Insomnia
* Irritable
* Lack of concentration
* ‘can’t work’
68
What is temporal arteritis?
Unilateral or bilateral headache, usually temporal, in individuals older than 50 years.
69
What symptoms are associated with raised intracranial pressure?
* Generalized and progressive headache
* Worsens with Valsalva maneuver
* Papilloedema
* Projectile vomiting (no nausea)
* Decreased level of consciousness
70
What is thunderclap headache associated with?
Subarachnoid hemorrhage.
71
What are some causes of secondary headaches?
* Intracranial hemorrhage
* Cerebral venous thrombosis
* Subdural hematoma
* Pituitary apoplexy
* Cervical arterial dissection
72
What is cervicogenic headache?
Pain present in the head and neck arising from cervical origin.
73
What is medication-overuse headache?
Consequence of regular overuse of acute or symptomatic headache medication.
74
What important factors should be assessed in headache history?
* Age
* Gender
* Quality
* Severity
* Location
* Duration
* Time course
* Conditions that produce, exacerbate, or relieve headache
75
76
What are neuromuscular disorders?
Conditions that affect the neuromuscular system, causing problems with nerves, muscles, and the neuromuscular junction.
77
What are idiopathic inflammatory myopathies characterized by?
Proximal, symmetrical muscle weakness and neck flexion weakness, possibly involving respiratory muscles in severe cases.
78
What is a common association of dermatomyositis?
It is associated with malignancy and presents with skin changes that precede or accompany muscle weakness.
79
Define Duchenne muscular dystrophy.
An inherited progressive disorder caused by a mutation in the dystrophin gene, leading to muscle destruction and eventual replacement by fibrous tissue.
80
What is the clinical feature of Becker's muscular dystrophy compared to Duchenne muscular dystrophy?
Milder than Duchenne, with most patients able to walk into their teenage years and beyond.
81
What is Myasthenia Gravis?
The most common autoimmune disease affecting the neuromuscular junction, characterized by painless fatiguable muscle weakness.
82
What are the clinical features of Myasthenia Gravis?
* Ptosis and/or diplopia
* Limb and bulbar muscle weakness
* Worsening of weakness after prolonged contraction
83
What is the most common type of peripheral nerve disease?
Symmetrical polyneuropathy, with a prevalence of about 2.4%.
84
What are the commonest mononeuropathies?
* Carpal tunnel syndrome
* Radial nerve palsy
* Bell's palsy
85
What causes carpal tunnel syndrome?
Compression of the median nerve under the flexor retinaculum at the wrist.
86
What is a sign of radial nerve palsy?
Wrist drop and finger drop.
87
What is the typical time frame for Guillain-Barre Syndrome?
Less than 4 weeks.
88
What are the signs and symptoms of Guillain-Barre Syndrome?
* Ascending weakness
* Bifacial weakness
* Bulbar weakness
* Global areflexia
89
What distinguishes chronic inflammatory demyelinating neuropathies from chronic axonal neuropathy?
CIDP responds well to treatment, while chronic axonal neuropathy does not.
90
Fill in the blank: Myasthenia Gravis is characterized by _______.
painless fatiguable muscle weakness.
91
True or False: Dermatomyositis is more common in males.
False.
92
What is a typical clinical feature of Duchenne muscular dystrophy?
Weakness of hip and knee extension leading to Gower's sign.
93
What is the initial treatment for carpal tunnel syndrome?
Rest, weight reduction, and wrist splints.
94
What are common causes of axonal neuropathy?
* Diabetes mellitus
* Alcohol
* Uraemia
* Cirrhosis
* Toxins
* Drugs
95
What tests are used for diagnosing Myasthenia Gravis?
* Clinical features
* Testing for acetylcholine receptor antibodies
* Neurophysiology with repetitive nerve stimulation
96
What is the typical presentation of polymyositis?
Similar to dermatomyositis but without skin changes, often presenting after the second decade.
97
What is the prevalence of carpal tunnel syndrome in women?
About 5%.
98
What is a significant complication of idiopathic inflammatory myopathies?
Interstitial lung disease develops in about 10% of patients.
99
What is the treatment for Guillain-Barre Syndrome?
* Intravenous immunoglobulins
* Plasma exchange
* Respiratory support
100
101
What is atheroma?
An accumulation of fatty material within the wall of a blood vessel resulting in distortion of the gross architecture.
## Footnote
Atheroma is a key feature of atherosclerosis and can lead to serious cardiovascular issues.
102
List the components of an atheroma.
* Fatty streaks
* Fibrolipid plaques
* Disruption of internal elastic lamina
* Thinning of media
103
What are the major clinical consequences of atherosclerosis?
* Myocardial Infarct
* Cerebral Infarct
* Aortic Aneurysms
* Peripheral Vascular Disease
104
What are the risk factors for atherosclerosis?
* Non-modifiable: Increasing age, male gender, postmenopausal female, family history
* Modifiable: Tobacco smoking, hypertension, diabetes mellitus, hyperlipidaemia
105
What is the definition of hypertension?
Sustained resting BP of more than 140/90 mmHg.
## Footnote
Diagnosis may be challenging due to factors like white coat hypertension.
106
What are the two classifications of hypertension?
* Primary (essential/idiopathic)
* Secondary
107
What characterizes benign hypertension?
Gradual organ damage, such as left ventricular hypertrophy and renal ischemia with scarring.
## Footnote
Histological changes include hyaline arteriolosclerosis.
108
What are the features of malignant hypertension?
* Severe, acute damage
* Diastolic BP > 120 mmHg
* Cardiac failure
* Blurred vision
* Severe headache
* Renal failure
* Fibrinoid necrosis of glomeruli
109
Define cerebral infarct.
Localized area of necrosis within the brain due to impaired blood supply.
## Footnote
Most infarcts occur within the internal carotid territory.
110
List the causes of cerebral infarcts.
* Arterial thrombosis due to atheroma
* Embolism to the brain
* Arterial disease
* Hypercoagulable states
* Dissecting aneurysm of extracranial arteries
* Drug abuse
111
What are the morphological features of a cerebral infarct within the first 48 hours?
Affected tissue is soft and swollen with loss of definition between white and grey matter.
## Footnote
Oedema around the infarct results in a local mass effect.
112
What are the typical findings in a cerebral infarct after 2-10 days?
The brain becomes gelatinous and friable, with a more distinct boundary between infarcted and normal brain.
113
What is the significance of plaque rupture in atherosclerosis?
It can lead to emboli that lodge in distal vessels, causing conditions like cerebral infarction or TIAs.
114
What is the primary mechanism underlying cerebral infarcts?
Impairment in blood supply and oxygenation, often due to arterial thrombosis or embolism.
115
What is the difference between a stroke and a transient ischemic attack (TIA)?
A stroke is an acute neurologic deficit lasting more than 24 hours, while a TIA lasts less than 24 hours.
116
Fill in the blank: Atheromatous plaque is characterized by a central lipid core and a cap of _______.
[fibrous tissue]
117
True or False: The most commonly affected vessels in atherosclerosis include the coronary arteries and the lower abdominal aorta.
True
118
What are the histological features of malignant hypertension?
Fibrinoid necrosis of small arteries and arterioles, onion skin thickening of the vessel wall.
## Footnote
These changes indicate severe vascular damage.
119
What is the role of macrophages in atherosclerosis?
Macrophages engulf lipid and contribute to smooth muscle proliferation and collagen deposition.
120
121
What is Motor Neuron Disease (MND)?
A disease characterized by slow progressive degeneration of motor neurons
122
What are the two types of motor neurons affected in MND?
* Upper motor neurons (UMN)
* Lower motor neurons (LMN)
123
What is a key feature of lower motor neuron dysfunction?
* Atrophy
* Fasciculations
* Weakness
* Loss of deep tendon reflexes
124
What are the features of upper motor neuron dysfunction?
* Spasticity
* Weakness
* Brisk reflexes
* Babinski sign
125
What is bulbar palsy?
Lower motor neuron involvement leading to symptoms such as wasted tongue and decreased gag reflex
126
What is pseudobulbar palsy?
Upper motor neuron involvement characterized by tongue spasticity and brisk reflexes
127
List some examples of lower motor neuron diseases.
* Progressive muscular atrophy
* Spinal muscular atrophy
* Polio
* Progressive bulbar palsy
128
What is Amyotrophic lateral sclerosis (ALS)?
A condition that involves both upper and lower motor neuron degeneration
129
What are the main cells involved in MND?
* Anterior horn cells (LMN)
* Corticospinal tract (UMN)
* Motor cortex (UMN)
130
What percentage of MND cases are sporadic?
90%
131
What genetic mutation is associated with familial MND?
C9ORF72
132
What are common symptoms of MND?
* Slowly progressive weakness
* Cramps
* Stiffness
* Wasting of hand muscles
133
What is the typical age of onset for MND?
40 – 60 years
134
What does the clinical diagnosis of MND typically require?
Evidence of upper and lower motor neuron signs in three regions
135
What is the prognosis for most patients with MND?
Typically fatal within 2-5 years
136
What are some early complications of MND?
* Depression
* Anxiety
* Poor hand function
* Difficulty walking
137
What is the role of Riluzole in MND treatment?
Blocks the effects of glutamate and may extend lifespan by a few months
138
What is the aim of physical and occupational therapy for MND patients?
To assist with functional maintenance and provide adaptive equipment
139
Fill in the blank: MND is characterized by _______ degeneration of motor neurons.
slow progressive
140
True or False: There is currently a cure for MND.
False
141
What is the goal of speech therapy in MND patients?
To assess speech and swallowing and prevent aspiration
142
What physiological changes occur in the spinal cord due to MND?
* Atrophy of the spinal cord
* Thin ventral roots
* Denervation atrophy of affected muscles
143
What are atypical signs that may be present in MND?
* Sensory loss
* Extrapyramidal dysfunction
* Autonomic dysfunction
* Abnormal sphincter control
144
145
What is myelin?
A lipid-rich plasma membrane encasing nerves
## Footnote
Myelin is produced by oligodendrocytes in the CNS and Schwann cells in the PNS.
146
What is the main function of myelin?
To speed up the rate of conduction
147
Define demyelinating disease.
A pathological process that destroys myelin and/or myelin-producing cells
148
Where can demyelinating diseases occur?
In the CNS or PNS
149
What is the effect of demyelination on nerve conduction?
Conduction slowing or failure/block
150
Name the categories of CNS demyelinating diseases.
* Inflammatory/Autoimmune
* Toxic/Metabolic
* Infectious
151
What are the main inflammatory autoimmune demyelinating diseases?
* Multiple Sclerosis (MS)
* Neuromyelitis Optica (NMO)
* Acute Disseminated Encephalomyelitis (ADEM)
152
What is the etiology of Multiple Sclerosis (MS)?
Generally accepted as an immune-mediated illness with incompletely understood pathogenesis
153
What is the peak age of onset for Multiple Sclerosis?
29 years
154
What is the male to female ratio in MS prevalence?
2:1
155
What is the geographical distribution pattern of MS?
Higher incidence in higher latitudes
156
List common clinical presentations of MS.
* Visual impairment
* Paresthesias
* Paresis
* Sphincteric dysfunction
* Double vision
* Dysarthria
* Ataxia
157
What type of MS involves clearly defined relapses with recovery?
Relapsing MS
158
What percentage of MS cases are classified as relapsing MS?
85%
159
What is the diagnostic criteria for MS?
Clinical criteria (McDonald) including dissemination in space and time
160
What is the Uhthoff phenomenon in MS?
Transient reappearance of neurological symptoms due to increased body temperature or illness
161
What is the typical age of onset for Neuromyelitis Optica (NMO)?
39 years
162
What antibody is associated with NMO?
Anti-Aquaporin 4 (IgG)
163
List the core clinical features for diagnosing NMO.
* Optic Neuritis
* Transverse myelitis
* Area Postrema Syndrome
* Acute Brainstem Syndrome
* Symptomatic Narcolepsy
* Symptomatic Cerebral Syndrome
164
What is the typical clinical course of NMO?
Relapsing disorder with incomplete recovery
165
What is the main treatment for NMO during acute phases?
IV steroids and plasma exchange
166
What characterizes Acute Disseminated Encephalomyelitis (ADEM)?
An immune-mediated diffuse inflammatory demyelinating disease of the brain and spinal cord
167
What is the typical onset pattern for ADEM?
Acute onset, monophasic disease
168
What is a common clinical clue for diagnosing ADEM?
Encephalopathy in the absence of fever with multifocal neurological dysfunction
169
What is the treatment approach for ADEM?
Pulsed IV steroid therapy followed by oral taper
170
What is the typical recovery pattern for ADEM?
Spontaneous improvement and is self-limiting
171
What are the characteristic MRI findings in MS?
Periventricular and black holes
172
What differentiates NMO from MS in terms of disability progression?
NMO has relapses with incomplete recovery, while MS can have nearly normal recovery between relapses
173
What is the significance of oligoclonal bands in CSF for MS?
Positive in 85-90% of cases
174
What are common treatments for long-term management of MS?
* Immunotherapy
* Spasticity management
* Bladder incontinence management
* Fatigue management
175
What systemic autoimmune diseases are often associated with NMO?
* SLE
* Thyroiditis
* Sjögren's syndrome
176
177
What is the spinal cord?
A thin, tubular structure that is an extension of the central nervous system from the brain
## Footnote
It is enclosed in and protected by the bony spine (vertebral column)
178
What is the main function of the spinal cord?
Transmission of neural inputs between the periphery and the brain
179
Where does the spinal cord extend from and terminate?
Extends from the medulla oblongata to the conus medullaris at vertebral level T12-L1
180
What is the length and shape of the adult spinal cord?
Approximately 45 centimeters long and ovoid-shaped
181
What are the two regions where the spinal cord enlarges?
Cervical enlargement and lumbosacral enlargement
182
What nerves do the cervical enlargement innervate?
Upper limb via brachial plexus nerves
183
What spinal cord segments correspond to the cervical enlargement?
Spinal cord segments from about C4 to T1
184
What nerves do the lumbosacral enlargement innervate?
Lower limb via lumbosacral plexus nerves
185
What spinal cord segments correspond to the lumbosacral enlargement?
Spinal cord segments from L2 to S3
186
What is contained within the funiculi of the spinal cord?
Neuronal white matter tracts including sensory, motor and autonomic pathways
187
What is the shape of the gray matter in the spinal cord?
Four-leaf clover shaped
188
What structures cover the spinal cord?
Dura mater, arachnoid membrane, pia mater
189
How many spinal cord segments are there?
31 segments
190
What are the types of spinal cord nerve segments?
* 8 cervical segments
* 12 thoracic segments
* 5 lumbar segments
* 5 sacral segments
* 1 coccygeal segment
191
What happens to the spinal cord segments in adults compared to fetuses?
In adults, the cord ends around the T12/L1 vertebral level
192
What is the cauda equina?
Lumbosacral spinal nerve roots that arise from the conus and are considered part of the cauda equina
193
What is Brown-Séquard syndrome?
Motor impairment of the ipsilateral side and pain/temperature sensation impairment of the opposite side
194
What characterizes Anterior Cord Syndrome?
Lesion in the anterior 2/3, motor deficit below the level, impairment of pain and temperature sensations
195
What is impaired in Posterior Cord Syndrome?
Proprioception, with normal power and normal pain and light touch
196
What are the clinical features of acute spinal cord lesions?
* Spinal shock
* Flaccid
* Areflexic
* Urinary retention
197
What are common aetiologies of spinal cord injury?
* Trauma
* Structural
* Infections
* Inflammatory
* Vascular
* Demyelinating
* Tumours
* Degenerative
* Nutritional
* Toxins
* Developmental
198
What can be a complication of spinal cord injury?
* Immobility
* Infections
* Flexor spasms
* Spasticity
* Autonomic reflex dysfunction
199
Fill in the blank: The spinal cord is protected by the _______.
bony spine (vertebral column)
200
True or False: The spinal cord contains both sensory and motor pathways.
True
201
202
What is the definition of a seizure?
Transient signs and/or symptoms due to abnormal excessive neuronal activity in the brain.
## Footnote
Seizures can manifest in various forms and intensities.
203
What characterizes epilepsy?
Tendency to recurrent unprovoked seizures.
## Footnote
Epilepsy is diagnosed after at least two unprovoked seizures.
204
What are provoked seizures?
Seizures that occur due to identifiable triggers or conditions.
## Footnote
Examples include CNS infections, trauma, and metabolic disturbances.
205
What is the prevalence of seizures in the general population?
Approximately 10% of people have a seizure at some time in their life.
## Footnote
The prevalence is higher in developing countries.
206
What percentage of the population is affected by epilepsy?
0.5 - 1% of the population.
## Footnote
This percentage is higher in developing countries due to various factors.
207
How are seizures classified based on their onset?
Focal onset and generalized onset.
## Footnote
Focal onset seizures originate in one area of the brain, while generalized seizures involve both hemispheres.
208
What is a focal seizure?
Abnormal electrical discharge begins in a limited area of the brain.
## Footnote
Focal seizures can be classified as simple or complex.
209
What distinguishes simple partial seizures from complex partial seizures?
Simple partial seizures retain awareness, while complex partial seizures impair awareness.
## Footnote
The distinction is crucial for diagnosis and treatment.
210
What are the clinical features of focal seizures?
Signs/symptoms depend on the site of electrical discharge, including:
* Motor
* Sensory
* Autonomic
* Cognitive
## Footnote
Symptoms can vary widely based on the affected brain region.
211
What are common psychiatric symptoms associated with complex partial seizures?
Abnormal affect, illusions, hallucinations, and dyscognitive states.
## Footnote
These symptoms can complicate the clinical picture.
212
What defines generalized seizures?
Electrical discharge occurs in both hemispheres simultaneously.
## Footnote
Not all generalized seizures are motor; some can be non-motor.
213
What is a generalized tonic-clonic seizure?
A seizure characterized by both tonic and clonic phases.
## Footnote
It involves loss of consciousness and significant motor activity.
214
What is absence seizure?
A type of generalized seizure with a peak age of onset between 5-10 years.
## Footnote
Typically, absence seizures are brief with no postictal confusion.
215
What occurs during the tonic phase of a generalized tonic-clonic seizure?
Generalized increased tone and loss of consciousness.
## Footnote
This phase can lead to tongue biting and respiratory distress.
216
What are the two types of etiology for seizures?
* Idiopathic: Genetic basis, no cause found
* Symptomatic: Due to identifiable causes like stroke or infection
## Footnote
Understanding the etiology is important for treatment strategies.
217
Define status epilepticus.
Continuous seizures or recurrent seizures without recovery of consciousness for ≥5 minutes.
## Footnote
This condition is a medical emergency requiring immediate intervention.
218
What is the risk associated with generalized tonic-clonic status?
High morbidity and mortality.
## Footnote
Any seizure type can progress to status epilepticus, making rapid recognition critical.
219
220
What are the main types of movement disorders?
Akinetic-rigid syndromes, Excessive Parkinsonism, Involuntary Movements
## Footnote
These categories help classify various movement disorders based on their characteristics.
221
What is Idiopathic Parkinson’s Disease?
A degenerative disease of the Basal ganglia affecting people in middle to late life, with a mean age of onset of 55-60 years
## Footnote
Idiopathic Parkinson's Disease is the most common form of Parkinsonism.
222
What was the global burden of Parkinson’s disease in 1990 and 2016?
1990 - 2.5 million people; 2016 - 6.1 million people
## Footnote
This indicates a significant increase in the prevalence of Parkinson's disease over the years.
223
What are the presumed causes of Idiopathic Parkinson’s Disease?
Combination of genetic susceptibility and environmental factors
## Footnote
Familial cases are very few.
224
What are the cardinal features of Idiopathic Parkinson’s Disease?
* Tremor
* Rigidity
* Bradykinesia
* Disturbance in posture or equilibrium
## Footnote
These features assist in the clinical diagnosis of the disease.
225
What characterizes the tremor in Idiopathic Parkinson’s Disease?
Present at rest, pill-rolling, 4-6Hz frequency, usually unilateral, usually in the upper limb
## Footnote
Absence of tremor casts doubt on the diagnosis of IPD.
226
What type of rigidity is associated with Idiopathic Parkinson’s Disease?
Cog-wheel type, increased muscle tone in both flexors and extensors
## Footnote
Rigidity can be elicited using slow passive movement.
227
What are the observable signs of akinesia/bradykinesia in Idiopathic Parkinson’s Disease?
* Facial expression
* Blink rate
* Soft monotonous voice
* Small writing
* Arm swing
## Footnote
These signs can be observed during a clinical examination.
228
What are common gait characteristics in Idiopathic Parkinson’s Disease?
* Stooped posture
* Decreased arm swing
* Shuffling gait
## Footnote
Gait abnormalities are prominent in patients with IPD.
229
What symptoms indicate advanced disease in Parkinson’s Disease?
Freezing episodes, inability to initiate walking
## Footnote
Motor tricks can help initiate movement during freezing episodes.
230
What are some nonmotor symptoms of Parkinson’s Disease?
* Mood disorders (depression, anxiety, apathy/abulia)
* Sleep disturbances
* Fatigue
* Abnormal sense of smell
* Constipation
* Pain and sensory dysfunction
* Sialorrhea
* Cognitive decline and dementia (late)
## Footnote
Nonmotor symptoms can significantly impact quality of life.
231
What are secondary causes of Parkinsonism?
* Drugs
* Toxins (Manganese, MPTP, Copper, Carbon monoxide, Cyanide)
* Head trauma
## Footnote
Identifying secondary causes is crucial for appropriate management.
232
What causes drug-induced Parkinsonism?
Caused by neuroleptics and drugs that block dopamine receptors
## Footnote
Antipsychotics and Metoclopramide are common examples.
233
What is Manganese's role in Parkinsonism?
Occupational exposure to manganese can lead to Parkinsonism
## Footnote
Manganese inhibits tyrosine hydroxylation, which is crucial for dopamine synthesis.
234
What is MPTP and its significance?
A chemical that inhibits tyrosine hydroxylation, leading to Parkinsonism
## Footnote
It was produced accidentally during the manufacture of synthetic heroin.
235
When should Parkinson plus syndromes be suspected?
* Absent tremor
* Symmetrical onset
* Young patient
* Axial rigidity
* No response to L-DOPA treatment
* Presence of eye movement abnormalities
* Other systems involved (autonomic, cerebellar, cortical)
## Footnote
These criteria help differentiate Parkinson plus syndromes from Idiopathic Parkinson’s Disease.
236
Define tremor.
A rhythmic to and fro movement about a joint
## Footnote
Tremors can be classified into different types based on their characteristics.
237
What are the types of tremors?
* Resting Tremors
* Postural Tremors
* Kinetic Tremors
## Footnote
Each type has different clinical implications.
238
What is Essential Tremor?
The commonest type of tremor, autosomal dominant with incomplete penetrance
## Footnote
It may start in the upper limbs and can involve the head and voice in advanced cases.
239
What characterizes Chorea?
Irregular, brief, jerky, unpredictable movements that flit from one body part to another
## Footnote
Chorea is a hallmark of several neurological disorders.
240
What are the clinical manifestations of chorea?
* Movement disorder of limbs
* Hippus pupil
* Jack-in-the-box tongue
* Milkmaid/cinema grip
* Hung up reflexes
## Footnote
These manifestations help in diagnosing chorea.
241
What are some causes of Chorea?
* Sydenham's Chorea
* Huntington's Disease
* Wilson’s Disease
* Vascular causes
* Autoimmune conditions (e.g., SLE)
* Drugs (oral contraceptives, neuroleptics, L-Dopa)
* Metabolic conditions (hyperthyroid, low calcium, glucose, HIV)
## Footnote
Identifying the underlying cause is crucial for treatment.
242
What is Sydenham's Chorea?
A movement disorder that develops post group A strep infection, commonly seen in ages 5-15
## Footnote
It is one of the major criteria for diagnosing rheumatic fever.
243
What is the clinical triad of Huntington’s Chorea?
* Psychiatric features
* Chorea
* Cognitive decline and eventual dementia
## Footnote
This triad is essential for diagnosing Huntington’s Disease.
244
What is Dystonia?
A disorder characterized by sustained muscle contractions causing twisting and repetitive movements or abnormal postures
## Footnote
Dystonia can affect various body regions and can be classified accordingly.
245
What are the classifications of Dystonia by distribution?
* Focal
* Segmental
* Generalized
## Footnote
Each classification helps in understanding the extent and treatment of dystonia.
246
What are some secondary causes of dystonia?
* Perinatal brain injury
* Dystonic cerebral palsy
* Drugs (dopamine blockers, neuroleptics)
* Toxins (manganese, carbon monoxide, copper excess)
## Footnote
Secondary causes must be ruled out for accurate diagnosis.
247
What are tic disorders?
Abrupt, transient, repetitive, stereotypical movements varying in intensity occurring at irregular intervals
## Footnote
A classic example is Tourette’s Syndrome.
248
What is the age of onset for Tourette syndrome?
< 18 years, usually around 7 years old
## Footnote
It includes multiple motor and vocal tics that must be present for at least 1 year.
249
Define myoclonus.
Sudden, brief shock-like involuntary movements
## Footnote
Myoclonus can be physiological, epileptic, or part of a progressive or static encephalopathy.
250
251
What is the most expensive injury to treat?
Head injury
## Footnote
Head injuries are the greatest economic drain of all injuries.
252
What demographic groups are most affected by head injuries?
* Very young
* Elderly with falls
* Young adults with traffic accidents
* Firearms
* Alcohol
* Sports
## Footnote
These demographic influences highlight the varying risks associated with different age groups and activities.
253
What are the diverse definitions of head injury?
* Head (excluding brain)
* Airway and oesophagus
* Eyes
* ENT
* Cervical spine injury
* Brain
* Open versus closed
* Penetrating versus perforating
* Primary versus secondary
## Footnote
These definitions illustrate the complexity of head injuries and their classifications.
254
What are the two types of traumatic brain injury (TBI)?
* Primary TBI
* Secondary TBI
## Footnote
Primary TBI occurs at the moment of impact, while secondary TBI develops later due to various factors.
255
What injuries are categorized as primary focal injuries?
* Subdural haematomas
* Extradural haematomas
* Intraparenchymal haematomas
* Contusions
* Subarachnoid Haemorrhage
## Footnote
These injuries occur at the moment of the traumatic event.
256
What are the characteristics of primary diffuse injuries?
They can be mild, moderate, or severe depending on initial Glasgow Coma Scale and/or Post Traumatic Amnesia
## Footnote
Primary diffuse injuries affect brain function broadly and vary in severity.
257
What are secondary brain injuries?
Brain injuries that are a consequence of primary trauma and occur at a delayed interval
## Footnote
They are the main cause of morbidity and mortality in head injuries.
258
What physiological concepts are important in understanding head injuries?
* Monroe-Kellie doctrine of intracranial pressure and volume
* CBF, CPP, CVR, MAP, and ICP
* Glucose-dependent metabolism
* Aerobic versus anaerobic metabolism
## Footnote
These concepts are crucial for managing and understanding brain function post-injury.
259
What are intracranial causes of secondary brain injury?
* Raised intracranial pressure
* Haematomas
* Oedema
* Hydrocephalus
* Herniation syndromes (Subfalcine, Transtentorial, Transforamen magnum)
## Footnote
These factors can exacerbate brain injury after the initial trauma.
260
What are extracranial causes of secondary brain injury?
* Airway issues
* Breathing issues
* Circulation issues
* Glucose imbalance
* Electrolytes
* Epilepsy
* Temperature
## Footnote
These issues can significantly impact recovery and outcomes following a head injury.
261
What is the management approach for mild TBI?
* Supportive care
* Analgesics
* Antibiotics
* Addressing post-concussion syndrome (headaches, memory, temper, attention issues)
## Footnote
Mild TBI is the commonest form of head injury.
262
What are the surgical management objectives for moderate and severe head injuries?
* Restore anatomical integrity of scalp, skull, and dura
* Monitor intracranial pressure and brain oxygenation
* Normalize intracranial pressure and brain shift
## Footnote
Surgery aims to stabilize the patient and prevent further injury.
263
What are some chronic issues associated with head injuries?
* Neuro physical deficits
* Neuro cognitive deficits
* Neuro behavioral and neuro psychiatric issues
* Post traumatic epilepsy
* Divorce
* Job losses
* Loss of self-esteem
## Footnote
These chronic effects can severely impact quality of life.
264
What are the goals of physical therapy in TBI?
* Improving balance, coordination, and stability
* Increased alertness and attention
* Muscle strength, flexibility, and mobility
* Improved injury levels and less fatigue
* Better movement patterns
* Return to fitness, sports, and recreational participation
## Footnote
Physical therapy is essential for rehabilitation post-injury.
265
What are the objectives of occupational therapy in TBI?
* Relearning activities
* Progress with daily activities
* Cognitive exercises
* Memory strengthening activities
* Fatigue management plans
* Routine planning and motivation
* Community access support
* Return to work
* Sleep hygiene
## Footnote
Occupational therapy focuses on restoring independence in daily life.
266
What does speech therapy in TBI aim to achieve?
* General responses to sensory stimulation
* Teaching family members how to interact
* Maintaining attention for basic activities
* Reducing confusion
* Orienting person to date, time, place
* Finding ways to improve memory
* Working on social skills
* Assessing swallowing ability
## Footnote
Speech therapy is critical for communication and cognitive recovery.
267
What is the significance of early feeding in TBI management?
* Full feeds before day 7 post injury
* Types of feeds: NGT vs TPN
* Glycemic control
* Vitamins and supplements
* Adequate feeding
## Footnote
Nutrition plays a vital role in recovery from brain injuries.
