Neurology Flashcards
What is papilloedema?
- swollen optic nerve causing visual disturbances, headaches and nausea - is a ophthalmology emergency
Define Bell’s palsy.
Idiopathic lower motor neurone facial nerve palsy.
What are the risk factors for Bell’s palsy?
o IDIOPATHIC
- however, 60% are preceded by an upper respiratory tract infection -> suggests that it has a viral or post-viral aetiology
What are the presenting symptoms of Bell’s palsy?
Unilateral facial weakness and droop
50% experience facial, neck or ear pain or numbness
Hyperacuisis (due to stapedius paralysis)
Loss of taste (uncommon)
Tearing or drying of exposed eye
- some cases experience prodrome pre-auricular pain
What are the signs of Bell’s palsy on examination?
o Lower motor neurone weakness of facial muscles - affects ipsilateral muscles of facial expression
o Bell’s Phenomenon - eyeball rolls up but the eye remains open when trying to close their eyes
o Despite unilateral facial numbness, clinical testing of sensation is normal
How do upper and lower motor neurone palsy’s of CN 6 differ?
o Lower (Bell’s) does NOT spare the muscles of the upper part of the face unlike upper motor neurone facial nerve palsy
What are the appropriate investigations for Bell’s palsy?
o Usually unnecessary (except for excluding other causes)
- EMG - may show local axonal conduction block
What is the treatment for Bell’s palsy?
o 85-90% make a full recover in 2-12 weeks without treatment
- Protection of cornea with protective glasses/patches or artificial tears
- High-dose corticosteroids is useful within 72 hrs (if Ramsey-Hunt Syndrome is excluded)
- Surgery - lateral tarsorrhaphy (suturing the lateral parts of the eyelids together)
- all eye orientated
What is Ramsey-Hunt syndrome?
An acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle (also termed herpes zoster oticus), and/or mucous membrane of the oropharynx.
What are the possible complications of Bell’s palsy?
o Corneal ulcers
o Eye infection
o Aberrant reinnervation -> blinking may cause contraction of the angle of the mouth due to aberrant sympathetic innervation of orbicularis oculi and oris
o Crocodile Tears Syndrome - parasympathetic fibres may aberrantly reinnervate the lacrimal glands causing tearing whilst salivating
Define cluster headache.
A neurological disorder characterised by recurrent, severe headaches on one side of the head typically around the eye, tending to recur over a period of several weeks.
What are the risk factors for cluster headaches?
- genetics
- being male
- 20-40 years of age
Define episodic cluster headaches.
Cluster headaches occurring in periods lasting 7 days - 1 year, separated by pain-free periods lasting a month or longer.
Cluster periods usually last between 2 weeks - 3 months.
Define chronic cluster headaches.
Cluster headaches occurring for 1 year without remissions or with short-lived remissions of less than a month.
Chronic cluster headaches can arise de novo or arise from episodic cluster headaches.
Describe the pattern of occurrence of cluster headaches.
o Headaches occur in bouts lasting 6-12 weeks - tend to occur at the same time each year
o Headaches typically occurs at night, 1-2 hours after falling asleep
o The interval between bouts tends to be the same
o 10% with episodic cluster headaches go on to develop chronic cluster headaches
What are the presenting symptoms of cluster headaches?
o Intense, sharp, penetrating pain comes on rapidly over around 10 mins
o Pain is unilateral and centred around the eye, temple or forehead
o Associated autonomic features: ipsilateral lacrimation, rhinorrhoea, nasal congestion, eye lid swelling, facial swelling, flushing, conjunctival injection, partial Horner’s syndrome
o Patients find it difficult to stay still and will pace around, occasionally banging their heads on things
What are the triggers of cluster headaches?
ALCOHOL - major precipitant
Exercise and solvents
Sleep disruption
What are the appropriate investigations for cluster headaches?
CLINICAL diagnosis based on history
Neurological examination may be useful
Define dementia.
A chronic and progressive deterioration of cognitive function due to organic brain disease. It is irreversible and consciousness is not impaired.
What are the 4 types of dementia?
Alzheimer’s disease (50%) - degeneration of the cerebral cortex, with cortical atrophy and reduction in acetylcholine production
Vascular Dementia (25%) - brain damage due to several incidents of cerebrovascular disease (e.g. strokes/TIAs)
Lewy Body Dementia (15%) - deposition of abnormal proteins (Lewy bodies) within the brain stem and neocortex
Frontotemporal Dementia - specific degeneration of the frontal and temporal lobes
Describe Alzheimer’s.
- degeneration of the cerebral cortex, with cortical atrophy and reduction in acetylcholine production
Describe vascular dementia.
- brain damage due to several incidents of cerebrovascular disease (e.g. strokes/TIAs)
Describe Lewy Body dementia.
- deposition of abnormal proteins (Lewy bodies) within the brain stem and neocortex
What are the presenting symptoms of dementia?
- a progressive loss of memory and cognitive function