Flashcards in Neurology Deck (188)
Where does damage occur between in an UMN lesion?
Damage to motor fibres between pre-central gyrus and anterior horn cells of spinal cord
Where does damage occur between in a LMN lesion?
Damage to motor fibres between anterior horn cells of spinal cord and peripheral nerve
What is the pattern of involvement/distribution in UMN disease?
Pyramidal (affects corticospinal tract)
What is the difference in pattern of sensory loss between UMN and LMN lesions?
UMN: central sensory loss
LMN: glove-stocking/nerve distribution sensory loss
What is the difference in pattern of tendon reflexes and tone between UMN and LMN lesions?
UMN: hyper-reflexia, hyper-tonia
LMN: hypo-reflexia, hypo-tonia
The anterior cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?
Supplies frontal and medial part of the cerebrum
Weakness and numbness in the contralateral leg + arm symptoms
The middle cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?
Supplies lateral hemispheres
Contralateral hemiparesis + hemisensory loss in face and arm
Contralateral homonymous hemianopia
Cognitive change - dysphasia, visuo-spatial disturbance
The posterior cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?
Supplies occipital lobe
Contralateral homonymous hemianopia with macular sparing
List general causes of headache
Giant cell arteritis
Venous sinus thrombosis
List red flags for headache
New onset in over 55 yo
Early morning onset
Exacerbated by Valsalva
What is the commonest cause of intermittent headache?
What is the proposed pathophysiology of migraine?
Vascular constriction-dilation, substance P and 5-HT release, trigeminovascular activation, cerebral hyperactivity
All of the above are proposed to play some role
What are some risk factors/aetiology for migraine?
Excess oestrogen, OCP use
Patent foramen ovale
CHOCOLATE: CHeese, Oral contraceptive, Caffeine, alcohOL, Anxiety, Travel, Exercise
What are some prodromal signs of migraine?
Change in sleep/appetite/mood
What are some auras that might occur prior to migraine headache?
Visual - central scomata/fortification/hemianopia
Motor - dysarthria, ataxia, ophthalmoplegia
Sensory - paraesthesiae
What is the criteria for diagnosing migraine without aura?
5 or more eps of headache lasting 4-72h
1 of nausea, vomiting, photophobia, phonophobia
2 of unilaterality, pulsating, limiting, worse on activity
What is the treatment for acute migraine?
NSAID (aspirin, ibuprofen)
What drugs can be used for migraine prophylaxis?
What are some contraindications to triptan use?
IHD, coronary spasm
Recent lithium/SSRI use
What are trigeminal autonomic cephalgias?
Headaches in a unilateral trigeminal distribution with cranial nerve features
List the main trigeminal autonomic cephalgias?
What causes cluster headache?
Superior temporal artery smooth muscle hyperactivity to 5-HT
Describe the presentation of cluster headache, commenting on pain and duration
Rapid onset severe unilateral orbital pain
Watery, bloodshot, oedematous eye with miosis
Lasts 15 mins - 3 hours, occurring once or twice a day
Clusters last 4-12 weeks with pain-free periods
How is cluster headache treated?
Acute: high-flow O2, sumatriptan
Prophylaxis: verapamil, topiramate, steroid
What causes trigeminal neuralgia?
Compression of trigeminal nerve root by e.g. aneurysm, tumour, inflammation
Triggered when pressure applied in trigeminal region
Describe the presentation of trigeminal neuralgia, commenting on pain and duration
Paroxysmal intense stabbing pain in V2/V3 region
Triggered typically by washing, shaving, eating, denchers
Lasts 1 - 90 seconds
Can get up 100 eps a day
How is trigeminal neuralgia treated?
What is SUNCT?
Short Unilateral Neuralgiform headache with Conjunctival infections and Tearing
How long does SUNCT typically last?
5 seconds - 2 mins
Occurs in frequent bouts