Neurology Flashcards by Kat Qiao

What are some metabolic causes of a coma?

Drug overdose

Hypoglycaemia

Hypercalcaemima

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A coma can also be caused by damage to the brain. Give some examples of damage to the brain which can cause coma.

Head injury

Meningitis

SAH

Encephalitis

Epilepsy

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A coma can also be caused by damage to A SPECIFIC AREA of the brain. Give some examples of this.

Cerebral infarct

Cerebral haemorrhage

Subdural haemorrhage

Extradural haemorrhage

Abscess

Tumour

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Brainstem injury can also cause a coma. What are some examples of this?

Brainstem infarct

Tumour

Abscess

Cerebellar haemorrhage

Cerebellar infarct

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What is a vegetative state?

When there has been overwhelming injury to the brain, but the brainstem is still working. There is vast destruction of the other intellectual processes so they are still alive, but they cannot communicate.

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What is brainstem death?

The individual cannot survive without artificial intervention because the brainstem is damaged.

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What is locked in syndrome?

Ventral pons in the brainstem is damaged, so the patient can still breathe and survive without artificial life support but they can’t move at all.

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What is the definition of a seizure?

Paradoxical discharge of cerebral neurons which is apparent to an external observer (e.g. generalised seizure) or as an abnormal perceptual experience by the subject.

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What is epilepsy?

A recurrent tendency to have seizures.

You need at least 2 seizures to be an epileptic.

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What can you give for status epilepticus?

Rectal diazepam

Buccal midazolam

IV lorazepam

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What are some differentials for an acute single headache?

Febrile illness
First attack of migraine
Trauma
Meningitis

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What are some differentials for recurrent headache?

Migraine
Cluster headache
Episodic tension headache
Trigeminal or post-herpetic neuralgia

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What can trigger a headache?

Coughing, straining

Sexual intercourse

Food and drink

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What are some differentials of a dull headache which increases in severity?

Overuse of medication e.g. codeine

HRT, contraceptive pill

Neck disease

Temporal arteritis

Benign intracranial hypertension

Cerebral tumour

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If a patient says that they feel dizzy, how would you try and categorise it?

Vertigo
Syncope
Hypotension
Hypoglycaemia
Epilepsy
Migraine

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What are some causes of syncope due to heart rate?

Bradycardia

Complete heart block

Tachycardia

Ventricular tachycardia

What are some causes of syncope related to stroke volume?

Dehydration

Haemorrhage

Pulmonary embolus

Addisonian crisis

Cardiac tamponade

Aortic dissection

Cough/micturition syncope

What are some chronic causes of syncope?

Aortic stenosis

Atrial myxoma

Cardiomyopathy

What are some causes of syncope due to peripheral resistance?

Neuropathic

Guillan-Barre’s syndrome

CNS: Parkinson’s, primary autonomic failure

What are two common causes of syncope, particularly in younger patients?

Vasovagal syncope

Drugs including alcohol

How is the heart rate and blood pressure related to syncope?

Heart rate increases

Blood pressure sharply falls

What is the definition of a stroke?

Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or more with no apparent cause other than that of a vascular origin

What are some stroke mimics?

Tumour

Epilepsy

Bells’ Palsy

Meningitis

What are some symptoms you’d expect if the anterior circulation of the circle of Willis is compromised?

Hemiparesis

Aphasia

Apraxia

Neglect

What are some symptoms you'd expect if the posterior circulation of the circle of Willis is compromised?

Diplopia Dysarthria Dizziness Dysphagia Face, arm, leg and crossed findings

What is a TIA?

Transient ischaemic attack Acute episodes of focal loss of cerebral or visual function which resolves within 24 hours, which are attributed to an inadequate blood supply.

What are some risk factors for stroke?

Hypertension Cardiac disease Atrial fibrillation Smoking Alcohol Diabetes Dyslipidaemia Carotid stenosis

Which nerve supplies the intracranial blood vessels and the dura mater?

Trigeminal nerve (CN V)

What are some bacterial infections which can cause meningitis?

Neisseria meningitidis (most common) Streptococcus pneumoniae (most common) Listeria monocytogenes Group B Streptococcus Haemophilus influenzae Mycobacterium tuberculosis

What are some viral infections which can cause encephalitis?

Herpes simplex Varicella zoster MMR

What is Parkinson's disease?

Striatal deficiency of dopamine following neuronal degeneration within the substantia nigra

What are some signs and symptoms of Parkinson's?

Blank, expressionless face Reduction in blinking Soft monotonous voice Resting tremor, worsened by stress Slow, shuffling gait, hunched over Increased rigidity, especially when asking them to do something else Cogwheeling

What drugs can you give to treat Parkinson's?

L-Dopa e.g. sinamet, madopar You can also give domperidone which is the gold standard

What are the side effects of L-Dopa?

Nausea/vomiting Postural hypotension Worsening of peptic ulcer symptoms Sweating Discoloration of urine/sweat Hallucinations and psychosis may occur with long term use

What is multiple sclerosis (MS)?

Inflammation of the brain causing destruction of the myelin sheath, yet sparing the neurone. Plaques are scattered throughout the brain and the spinal cord. Symptoms and signs are disseminated through the neuroaxis and time.

What are some causes of neuropathy with predominantly sensory symptoms?

Diabetes Thiamine deficiency Malignancy Leprosy Hereditary sensory neuropathies Amyloidosis Uraemia

What are some causes of neuropathy with predominantly motor symptoms?

Guillain-Barre's syndrome Porphyria Diphtheria Botulism Lead toxicity Charcot-Marie-Tooth disease