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Neurology Flashcards

Learn Strokes Elsewhere (160 cards)

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1
Q

Signs of Alcohol Intoxication

A
  • smells like ETOH
  • Cerebellar gait
  • Disinhibited behaviour
  • Slurred speech
  • Somnolence
  • Urine on clothes
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2
Q

Signs of Withdrawal ETOH

A
  • shaky/ tremor
  • increased BP and pulse
  • seizures
  • n+v
  • anxiety
  • agitiation
  • hallucination
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3
Q

What is the tx of ETOH Withdrawal

A
  • Benzodiazepine
  • Thiamine (Vit B1) to prevent wernicke’s encephalopathy
  • Rehydration
  • Counselling
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4
Q

Signs of Opiate Toxicity:

A
  • reduced resp rate
  • somnolence
  • constricted pupils
  • track marks
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5
Q

Treatment for Opiate Toxicity:

A
  • Naloxone injection
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6
Q

Define Multiple Scleroisis:

A

autoimmune destruction of CNS myelin sheath

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7
Q

Risk factors for developing Multiple Sclerosis:

A
  • females
  • 20-30s
  • european
  • smokers
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8
Q

Initial sx of Multiple Sclerosis:

A
  • Motor/ sensory/ optic sx
  • Tingling, paraestesias, numbers
  • Optic neuritis
  • Acute focal motor weakness
  • Balance difficulties
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9
Q

Later sx of Multiple Sclerosis:

A
  • Tingling, parastesia, numbness continue
  • worsening chronic focal motor weakness
  • balance difficulties
  • urinary sx
  • constipation
  • sexual dysfunction
  • cognitive loss
  • debilitating fatigue
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10
Q

Treatment of Multiple Sclerosis:

A
  • Neurologist r/w and annualy
  • DMARDs
  • Steroids for acute attacks

1st line
* beta interferons
* Glatiramir acetate
* Teriflunomide
* dimethyl fumarate
* fingolimod

  • supportive care
  • PT/OT
  • psych support
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11
Q

Define Guillain Barre Syndrome:

A

A rapidly evolving symmetric, poly radicular, demyelinating neuropathy, usually affecting motor function > sensory.

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12
Q

Causes of GBS

A
  • 1-3 week ?post infection
  • Campylobacter
  • mycoplasma
  • EBV
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13
Q

Sx of Guillain Barre Syndrome:

A
  • symmetrical
  • progressive weakness in arms and legs
  • areflexia
  • Lower back pain
  • Paraesthesia, often preceding motor symptoms
  • Lower motor neurone signs in the lower limbs: hypotonia, flaccid paralysis, areflexia
  • Cranial nerve signs: ophthalmoplegia, lower motor neurone facial nerve palsy, bulbar palsy, diploid, facial droop
  • Potential autonomic dysfunction (e.g., arrhythmia, labile blood pressure)
  • resp muscle involvement
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14
Q

Ix GBS:

A
  • FVC
  • Cardiac
  • ABG + bloods
  • Anti-ganglioside antibody serology
  • LP- albuminocytological dissociation
  • nerve conduction
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15
Q

Treatment of Guillain Barre Syndrome:

A

Supportive:
* Regular monitoring of FVC
* VTE prophylaxis: TEDS + LMWH
* Analgesia: NSAIDs or opiates/ gabapentin

Specific medical management for those with significant disability (e.g., inability to walk) include:
* Intravenous immunoglobulin (IVIG) over a 5-day course
* Plasmapheresis, which has similar efficacy to IVIG but is associated with more side effects.

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16
Q

Symptoms of Peripheral Neuropathies:

A
  • burning feet
  • tingling
  • pin + needles
  • ice sensation
  • hypersensitive
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17
Q

Tx of Peripheral Neuropathies:

A
  • exercise
  • diet/ weight loss
  • anti- convulsants
  • tricyclic anti depressants/ SNRI
  • tramadol (weak opiates)
  • lidocaince patches/ topical creams

1st line Gabapentin/ pregabalin

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18
Q

Sx of Shingles:

A

2-4 days before rash appears:
* pain
* tingling
* itching
Grouped vesicular rash

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19
Q

Tx of Shingles:

A
  • Within 72 hrs onset = antivirals
    - Oral Acyclovir 800 mg 5x daily 7/7
    - Vacyclovir 1g PO 7/7 ??
  • analgesia
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20
Q

Define Post-herpetic Neuralgia:

A

this is the persistence of pain in area prev. affected by HZV for more than 3 months after resolution of rash

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21
Q

Sx of Post-herpetic Neuralgia:

A
  • severe, electric shock like pain
  • deep, severe itching
  • hypersensitive skin
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22
Q

Treatment of Post-herpetic Neuralgia:

A
  • 1st line GABAPENTIN
  • antidepressants TCA
  • Tramadol for analgesia- patch/ topical
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23
Q

Define Radiculopathies:

A

pain in arm/ leg which radiates in a dermatomal pattern of a peripheral nerve.

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24
Q

Causes of Radiculopathies:

A
  • trauma
  • Herniated disc
  • Arthritis
  • Nerve root swelling
  • metastases
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25
Sx of Radiculopathies:
* pain * muscle weakness * bladder/ bowel incontinence
26
Tx of Radiculopathies:
* NSAIDs * PT * rest * steroid injection ?
27
Most common type of dementia:
Alzheimer's
28
Define Alzheimer's Dementia:
Slow, progressive memory loss and other cognitive decline
29
Pathophysiology of Alzheimer's Dementia:
* neurofibrillary tangles * neuritic plaques * cerebral atrophy
30
Sx of Alzheimer's Dementia:
* progressing memory loss despite being alert * inattention * unable to solve problems of daily life * language difficulties * worse at night * wandering * personality changes
31
Treatment for Alzheimer's Dementia:
Acetylcholinesterase inhibitor: * donepezil * galantamin * rivastigmine Do not give sedatives Supportive: * carer * memory clinic * OT/PT
32
Define Vascular Dementia:
Caused by stroke and is a step-wise-progression. Usually become worse abruptly after stroke and remain that way.
33
Risk factors of Blow Induced Dementia
* rugby * boxing * head butt ball * DV survivors w head trauma
34
Risk factors of Frontotemporal dementia?
35-70 yrs age
35
Sx of Frontotemporal dementia?
* disinhibition * inappropriate behavior leading to being arrested by police * deny that anything is wrong with them and refuse help
36
Pathophysiology of Huntington's Disease:
* expanded CAG repeat on Chr 4 * Autosomal Dominant inheritance
37
Risk factors of Huntington's Disease:
* 35-45 yrs * white people * 'founder' people
38
Sx of Huntington's Disease:
* Progressive Chorea * Dementia * Bursts of anger * antisocialism * Depression
39
Treatment of Huntington's Disease:
No cure Chorea management: Medications such as tetrabenazine. Depression management: SSRIs 1st line Psychosis management: Antipsychotics, atypical agents- lower rates of extrapyramidal side effects Supportive care: physical and emotional support from a multidisciplinary team Tetrabenazine/ VAMT2 dopamine depleting agents can help chorea but increase risk of depression End of life care planning
40
Define Creutzfeldt-Jakob Disease:
This is a rare, progressive, fatal cause of dementia. Bovine spongiform Encephalitis
41
Sx of Creutzfeldt-Jakob Disease:
Neuropsychiatric symptoms * Rapidly progressive dementia * Psychiatric or behavioural abnormalities * Sleep disturbances * Aphasia * Apraxia Involuntary movements: * Myoclonus * Tremor * Nystagmus Other features: * Ataxia * Rigidity * Dystonia
42
Management of Creutzfeldt-Jakob Disease:
No cure Symptom control: Medications to control psychiatric symptoms, myoclonus, and other neurological symptoms Palliative care: Pain control, nutrition support, and management of other distressing symptoms
43
Define Mild Cognitive Impairment:
A clinically Significant memory impairment that doesn't meet the criteria for Dementia.
44
Classification of Mild Cognitive Impairment:
Amnestic- common Non-amnestic * issues in executive function, language, visuospacial function
45
Management of Mild Cognitive Impairment:
Aim to prevent progression: * control BP, glucose, cholesterol * smoke/ etoh cessation * Diet- high in omega 3 fatty acid * mentally active
46
Normal Pressure Hydrocephalus:
Triad of sx including Dementia, Gait disturbance, Urinary incontinece
47
Pathophysiology of Normal Pressure Hydrocephalus:
Primary NPH - common in pt with larger head/ HTN Secondary NPH - Impaired CSF reabsorption across arachnoid villi due to fibrosis caused by SAA, trauma, meningitis, cancer.
48
Signs and Symptoms Normal Pressure Hydrocephalus:
Gait: * short steps; feet are stuck to the floor- falls common Urinary Incontinence * urinary Urgency at the beginning Cognitive Impairment: * psychomotor slowing * reduced executive function * reduced attention * reduced concentration * apathetic * may look depressed but aren't sad ??
49
Treatment of Normal Pressure Hydrocephalus:
* ventricular shunt placement to drain the fluid
50
Pseudotumor Cerebrii
IIH
51
Sx of Pseudotumor Cerebrii:
* headache gets worse over time * diplopia * flashes of light * hearing pulsations inside head
52
Tx of Pseudotumor Cerebrii:
* weight loss * Sodium reabsorption * Carbonic anhydrase inhibitor - azetazolamide * Diuretics 2nd line
53
Define Progressive Bulbar Palsy:
Weakness of muscles unnerved by the cranial nerves.
54
Define Primary Lateral Sclerosis:
Upper motor neuron damage causing deficit in limbs only
55
Define Progressive spinal muscle atrophy:
Lower motor neurone damage only
56
Define Amyotrophic Lateral Sclerosis:
Is a progressive neurodegerative disease that attacks both upper and lower motor neurons resulting in muscle weakness and atrophy. Caused by excessive Glutamate
57
Sx of Amyotrophic Lateral Sclerosis:
* asymmetric * weakness in arm/ leg * weakness in facial muscles * Fasciculations * stiffness * weight loss/ muscle atrophy * worsening fatigue * NO pain/ sensory sx/ loss of bladder/ bowel control/ extra-ocular movement difficulty
58
Signs of Amyotrophic Lateral Sclerosis:
* weakness * atrophy * Hyperreflexia * drooling * emotionally liable
59
Tx of Amyotrophic Lateral Sclerosis:
* Riluzole * PT/OT * speech therapy
60
Definition of Myasthenia Gravis:
Autoimmune disorder- When a patient has autoantibodies to the Ach receptirs which lower the effectiveness of the neurotransmitters in the neuromuscular junction with repetitive firing.
61
Risk factors of Myasthenia Gravis:
* younger women * older men
62
Causes of Myastenia Gravis:
* BB * Li * Pencellamine * gentamicin * quinolone * Phenytoin
63
Sx of Myasthenia Gravis:
* muscle fatigue with repetition of movements e.g., climbing stairs * facial weakness * weakness in proximal arm muscles * ptosis * diplopia * changes in speech and swallow
64
Ix of Myasthenia Gravis:
* Ice-pack test * Bloods: serum Ach R antibody + tyrosine kinase antibody * chest CT for thymic hyperplasia, thymoma * nerve conduction/ EMG * FVC
65
Tx of Myasthenia Gravis:
* Mestinon/ pyridostigmine = Ach-esterase inhibitor * immunosuppression DMARDs * prednisolone * Plasmapheresis * IV Immunoglobulin
66
Sx of Bell's Palsy:
* Acute not sudden * facial muscle weakness over days-weeks * change in taste, lacrimation, hyperacusis * facial tingling/ pain near ear * "numbness" "heaviness"
67
Ix of Bell's Palsy:
* FBC * ESR, CRP * viral serology * Lyme serology * otoscopy * Electromyoscopy * MRI/ CT
68
Tx of Bell's Palsy:
* Steroids 50 mg OD for 10 days + Acyclovir * Eye patch * analgesia
69
Causes and risk factors of Bell's Palsy:
* infections (lyme disease, herpes simplex, EBV, VZV) * women (pregnant) * T2DM
70
Sx of Restless Leg Syndrome
* uncontrollable urge to move legs * something crawling inside leg * never get a full night sleep
71
Tx of Restless Leg Syndrome:
* treat causes * anti-parkinsonian medications * benzodiazepines * anti-convulsants * long acting opiates
72
Define Essential Tremor:
Can have autosomal dominant pattern of inheritance
73
Sx of Essential Tremor:
* 6-8 Hz tremor most noticable when arms outstretched * impairment when using cutlery/ writing * improves with alcohol intake in 2/3 patients
74
Tx of Essential Tremor:
Low dose BB no tx usually
75
Conditions classed as a Parkinsonian Syndrome:
* Progressive supranuclear palsy * Multisystem atrophy * Drug-induced Parkinsonisms * Essential Tremor * Dementia with Lewy Bodies
76
Define Parkinson's Disease:
77
Pathophysiology of Parkinson's Disease:
The degeneration of cells in the substantia nigra which causes dopamine deficiency and imbalance between dopamine and acetylcholine.
78
Sx of Parkinson's?
* moves and thinks slowly * sad/ depressed * stiff * tremors * gait changes
79
Signs of Parkinson's Disease
* bradykinesia * dementia * depression * cogwheeling rigidity * tremor (resting/ pill-rolling) * postural instability * micrographia * gait changes
80
Ix Parkinson's Disease:
* clinical diagnosis * must have 2/3 trial signs * good response to dopaminergic agents * CT/ MRI/ nerve conduction/ serology to rule out other studies.
81
Tx of Parkinson's Disease:
In GP= refer to movement disorder specialist Pharmacologic * levodopa/ carbidopa * dopamine antagonist (pramipexole/ mirapexin) * MAO-B inhibitor = selegiline/ elderpryl * COMT inhibitor = entacapone/ comtess Non-pharmacologic * psych care * PT * OT * social support/ hospice Surgical * Deep brain stimulation
82
What the the advanced/ later signs of Parkinson's Disease?
* fatigue/ daytime sleepiness * dementia * depression * postural instability * rapid eye movement sleep behaviour disorder * hallucinations * delusions * orthostatic hypotension * severe urinary incontinence worse at night
83
What is the triad of sx in Parkinson's Disorder:
* bradykinesia * tremor * rigidity
84
Define Epilepsy
Can have Epilepsy if: * have more than 2 unprovoked seizures more than 24 hours apart * diagnosing of an epilepsy syndrome
85
What is the causes of Epilepsy:
* genetics * metabolic * idiopathic * structural brain malformations
86
How to Ix seixures:
* Hba1c * BM * U & Es * pregnancy * infectious causes * alcoholism/ drugs screen * LP * MRI * EEG
87
What is the first line treatment of seizures?
* benzodiazepines: Lorazepam
88
What is the treatment of Epilepsy:
Depends on the type of disease: * Sodium Valproate * Lamotrigine * Levetiracetam * Carbamazepine * Oxcarbazepine Remember that some drugs may be 1st line for some seizures but is contraindicated for other types.
89
What is the 1st line Tx of Focal Seizures:
* Lamotrigine * Levetiracetam
90
What is the 1st line Tx of Abscence seizures:
* Ethosuximide
91
What is the 1st line Tx of Myoclonic Seizures:
* Carbamazepine
92
Define Status Epilepticus:
* seizures lasting more than 5 mins OR * multiple seizures over 5 mins without returning to a full level consciousness
93
What is the acute management of Status Epilepticus:
see notes- Emergency station
94
What is the Tx of Status Epilepticus:
1. secure airways, give O2 2. glucose if BM low 3. thiamine and Mg 2+ if known alcoholic 4. Lorazepam IV 2mg EVERY MINUTE (max. 0.1 mg/kg) 5. phenytoin 20mg/kg IV 6. Phenobarbital/ general anesthesia
95
What are the different types of seizures named by the location of onset
* focal * generalised * unknown * focal to generalised
96
What are the different types of seizures named by the awareness:
* Aware- knows whats happening * Impaired awareness- can remember some details * unaware- remember nothing about what happened
97
Focal Onset Seizure:
Seizures that start in one area of the brain
98
Generalized Onset Seizures:
Seizures starting in both sides of the brain at roughly the same time.
99
Unknown Onset Seizures:
location of onset unknown
100
Focal to Generalised Seizures:
Seizures starts in one are of the brain or one network of brain cells and spread to other areas in both hemispheres
101
What are the different types of seizures named by the motor involvment:
* Automatisms * tonic involvement * clonic movement * non motor involvement
102
What are Automatisms in seizures:
Repetitive semi-purposeful movements during the seizure: * lip smacking * saying same words repetitively * hand patting * wandering
103
What are Tonic Involvement in seizures:
* stiffening and flexure of limbs
104
What are Clonic Movement in seizures:
Jerking and twitching movements of the limbs
105
What are Non-motor involvement in seizures:
* aura * emotions * autonomic
106
Differentials for someone who comes with Seizures:
* syncope * substance abuse/ withdrawal * infection * Stroke/ TIA/ brain bleed * tumors * Hypoxia * Hypoglycemia * metabolic disorders * migraine with aura * epilepsy syndromes
107
Risk F. of Tension Headaches:
* Women * stress
108
Sx of Tension Headaches:
* bilateral, non-pulsatile headaches * tight sensation like a 'band' * scalp muscle tenderness Common cause of chronic recurring pain.
109
Tx of Tension Headache:
* analgesia * stress management * acupuncture * Amitriptyline
110
Risk F. of Cluster Headaches:
* Men * 20-40 yrs * smokers
111
Sx of Cluster Headached:
* recurrent unilateral periorbital pain of sudden onset * watery, bloodshot eye * rhinorrhoea * miosis * ptsosis * lid swelling * facial flushing * lasting 15 mins to 3 hrs * occurs 1/2 times daily over 4-12 weeks THEN pain-free for several months
112
Ix of Cluster Headaches:
* Angiogram if this si first headache with HORNERS sx
113
Tx of cluster Headaches:
* avoid triggers * prophylaxis: verapamil * 1st line: 100% O2 via non-rebreathe mask and or nasal triptan (AVOID IN COPD) * greater occipital nerve block
114
Risk factors for migraines
* women * 25-55
115
Sx of Migraines:
* unilateral throbbing headache * visual/ sensory aura * last 4-72 hours * photophobia and phonophobia * triggers
116
Ix of Migraines
* fundoscopy * Chronic more that/ equal to 15 days per month of headache (8 days with migraine features)
117
Tx of Migraines:
* avoid triggers * Prophylaxis: propanolo/ topiramate * oral triptans (never give to those with IHD) * analgesia
118
Sx of GCA?
* Jaw claudication * Temporal headache * vision loss (Amaurosis fugax?) * systemically unwell in >50 yrs old * hard, non-pulsating temporal artery
119
Ix of GCA?
* USS and Biopsy GOLD
120
Management of GCA
High dose steroids
121
Define Venous Sinus Thrombosis:
* thrombosis of cerebral vein/ dural sinus * lead to increased intracranial pressure
122
Sx of Venous Sinus Thrombosis?
* headaches * seizures * reduced consciousness * focal neurological signs
123
Tx of Venous Sinus Thrombosis?
* warfarin/ heparin * Neurosurg/ ENT intervention
124
Define Encephalitis:
Inflammation of the brain parenchyma:
125
Causes of Encephalitis:
Viral: * HSV-1 most common * HSV-2 * EBV * VZV * HIV * Arbovirus Bacterial * Lyme disease * Mycoplasma * Malaria = RARE Autoimmune Encephalitis
126
Sx of Encephalitis:
* NO NECK STIFFNESS * fever * flu-like prodromal illness * Seizure * focal neurological deficits * headaches * Behavioural changes (weird behaviour- crawling on the floor)
127
What are the Ix of Encephalitis:
* Suspect in anyone with sudden onset * FBC, CRP * blood culture * LP for CSF analysis with viral PCR + DIAGNOSTIC * Malaria blood films in case of exposure risk * CT/ MRI- b/l media temproal lobe involvement
128
Tx of Encephalitis:
Broad spectrum abx * 2g IV ceftriaxone BD AND * 10 mg/kg IV aciclovir TDS for 14 days
129
Define Meningitis:
* inflammation of meninges
130
Causes of Meningitis:
Vial more common but less severe: * enterovirus * herpes * MMR * rabies Bacterial more severe * Strep. p. * Neisseria meningitidis * Haem. Influenzae * Listeria Mono. Fungal (common in immunosuppressed) * Cryptococcus neoformans Parasite * Amoeba * toxoplasmosis gondii Non-infective Causes * malignancies * Chemical * NSAIDS, Trimethoprim * Inflammatory diseases
131
Sx of Meningitis:
* headache * fever * malaise * N+V * neck stiffness * focal neurology deficits * Seizures * reduced consciousness * features of sepsis * non-blanching petichial rash (DIC)
132
Signs of Meningitis:
* Kernig's= pain when extending knee * Brudzinski's= flex neck leads to hip flexion which is +++
133
Ix of Meningitis:
* FBC * ABG * blood cultures * CT head * LP for CSF analysis
134
Tx of Meningitis:
* IV Benzylpenicillin in GP * 2g IV ceftriaxone BD + IV amox (listeria); chloramphenicol (pen, allergy) * IV acyclovir * IV dexamethasone (pneumococcal)
135
Complications of Meningitis:
* sepsis * DIC * Coma * subdural effusion * ADH increases * Seizure * Hearing loss * blindness * ataxia * death
136
CSF features of Bacterial Meningitis:
* clear/ turbid * +ive culture * high protein * low glucose
137
CSF features of Aseptic Meningitis
* clear/ turbid * protein 0.5-1 g/L * 15-500 lymphocytes * -ive cultures * normal glucose
138
CSF features of Tubercular Meningitis
* clear/ turbid * 30-500 lymphocyte * -ve gran stain * Proten 1-6 g/L * glucose 0-2.2
139
CSF features of Cryptococcal Meningitis
* high opening pressure * antigen testing/ india ink stain
140
Define Lyme disease:
Infectious disease caused by Borrelia Sp. bacteria which infects a person via a tick bite.
141
Sx of Lyme disease:
* within a few days to a month * fevers * myalgia * rigors * Migrating polyarthritis * erythema migraines rash with central clearing
142
Risk F. of Lyme disease
* Hikers * NE europe and USA
143
Complications of Lyme Disease:
* Large joint monoarthritis * facial nerve palsy * neuropathic pain * palpitations
144
Ix of Lyme Disease:
* ELIZA * western blot * synovial fluid (arthritis) for PCR DNA testing
145
Tx of Lye Disease:
* remove and disinfectant tick and bite * doxycycline for 2 weeks (3-4 weeks if advanced)
146
Define Multiple Sclerosis:
Chronic, inflammatory autoimmune disorder of the CNS, marked by localised areas of myeline loss along the nerves.
147
Risk F. of Multiple Sclerosis:
* female * 30 years
148
Causes of Multiple Sclerosis:
* HLA DRB1 * viral pathogens
149
Sx of Multiple Sclerosis:
* Sensory disease * Optic neuritis * internuclear ophthalmoplegia * Subacute cerebellar ataxia * Spastic paraparesis * untoffs phenomenon- worse in warm conditions ?? * Lhermitte's sign (electric sensation down the spine)
150
Ix of Multiple Sclerosis:
* MRI = periventricular white matter lesions * oligoclonal bands on CSF * plaques of demyelination
151
Acute Treatment of Multiple Sclerosis:
* IV Ig Methyprednisalone once evry 24 hrs for 3 days * plasma exchange * look for secondary cause
152
Chronic Tx of Multiple Sclerosis:
* FIRST LINE: beta-interferon + glatiramer * dimethyl fumarate * natalizumab * anticholinergics for fatigue bladder dysfunction * amantadine
153
Causes of Diabetic Neuropathy
Chronic hyperglycaemia
154
Ix of Diabetic Neuropathy:
* nerve conduction studies * blood tests
155
Sx of Diabetic Neuropathy:
SEE NOTES
156
What is the cause of Ramsay Hunt Syndrome:
* VZV
157
Sx of Ramsay Hunt Syndrome:
* facial paralysis * ear pain * hearing loss * vertigo * rash * affect tongue ??
158
What is the Ix ov Ramsay Hunt Syndrome:
* lymphocytes in CSF * raised CSF protein
159
Tx of Ramsay Hunt Syndrome:
* Antiviral agents * Aciclovir IV
160
LEARN STROKES SEE NOTES !!!

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