Neurology Flashcards
1
Q
What is cerebral palsy?
A
Abnormality of movement + posture –> limited activity
2
Q
What 5 things is cerebral palsy associated with most?
A
LD (60%) Epilepsy (40%) Squints (30%) Vision problems (20%) Hearing problems (20%)
3
Q
Majority (80%) causes of cerebral
A
Antenatal
Vascular occlusion
Structural malformation
Cortical migration disorder
4
Q
2 other types of causes of cerebral palsy
A
Hypoxic ischaemic injury
Postnatal origin
5
Q
Examples of post-natal origins of cerebral palsy (6)
A
Preterm Meningitis Encephalitis Trauma Hypoglycaemia Hydrocephalus
6
Q
Features cerebral palsy in early childhood (7)
A
Abnormal limb/trunk posture Delayed motor development Slow growing head Feeding difficulties --> oromotor coordination Abnormal gait Asymmetric hand fct <12m Remaining primitive reflexes
7
Q
RF for developing cerebral palsy (12)
A
LBW Prematurity Multiple pregnancy Placental abnormalities Birth defects Meconium aspiration Emergency CSC Birth asphyxia Neonatal seizure Resp distress Hypoglycaemia Infection in neonatal period
8
Q
What are the 3 types of CP
A
Spastic
Dyskinetic
Ataxic
9
Q
What % of CP is spastic?
A
90%
10
Q
Why does spastic CP occur?
A
Damage to UMN - motor cortex
11
Q
Sx Spastic CP (think, its UMN)
A
Uni/bilateral hypertonia (velocity dependent) hyperreflexia Extensor plantar response Hypotonia of H+N
12
Q
What are the 3 types of spastic CP
A
Hemiplegia
Quadriplegia
Diplegia
13
Q
Features of hemiplegia spastic CP (4)
A
Unilateral involvement arm/leg
Arms worse legs
Face spared
Fisting of hand
14
Q
Features of quadriplegia spastic CP (4)
A
All 4 limbs affected
Often severe + assoc w/ epilepsy, microcephaly + LD
Trunk involved = opisthonus
Poor head control + decr tone
15
Q
Opithonus
A
Extensor protrusion –> arching of back
16
Q
Features of diplegia CP (4)
A
All 4 limbs affects
Legs > arms
Walking abnormal
Hand fct remains normal
17
Q
What is associated with hemiplegia spastic CP
A
Neonatal stroke
18
Q
What is associated with quadriplegia spastic CP
A
HIE
19
Q
What is associated with diplegia spastic CP?
A
Pre-term
Periventricular brain damage
20
Q
What % CP is dyskinetic
A
6%
21
Q
What structure is affected in dyskineitc CP
A
Basal ganglia
22
Q
Most common cause dyskinetic CP
A
HIE
23
Q
Features dyskinetic CP (4)
A
Variable tone
SOmetimes chorea or athetosis
Normal intellect sometimes
Presents floppy
24
Q
What is chorea
A
Irregular, sudden + brief non-repetitive movements
25
What is athetosis
Slow writing movements occuring more distally
26
Features Ataxic CP (4)
Hypotonia of limbs + trunk
Poor balance
Delayed motor development
May develop incoordinate movements, intention tremor + ataxic gait
27
How is ataxic CP acquired
Genetically determined
| Brain injury
28
2 main goals of physiotherapy in CP
Prevent weakness
| Prevent mm rigidity
29
2 Dx used in CP
Diazepam
| Baclofen
30
Use of orthopaedic surgery in CP (4)
Last resort - severe spasticty/fixed contractures
Repair scoliosis
Tendon lengthening
Osteotomy to realign limb
31
Prevalence epilepsy?
1/200
32
Generalised seizures featuers (4)
Discharge from both hemi-spheres
No warning
Consciouness loss
Usually symmetrical
33
Features absence seziures (3)
TLOC
Abrupt start + stpo
No motor phenomenon apart from eye flickering
34
What brings on absence seizures?
Hyperventilation
35
Myoclonic seizures features
Brief, repetitive jerking movements
36
Tonic seizures features
Generalised increase in tone
37
Tonic clone seizures features
Rhythmical contraction of mm groups following tonic phase
| Lasts seconds/mins following by unconsciousness/deep sleep
38
Tonic phase of T-C seizures
Incr tone, fall to ground, cyanosis
39
Clonic phase of a T-C seizure
Limb jerking, irreg breathing + tongue biting
40
Atonic seizure features
Loss of mm tone --> sudden fall/drop of head
41
Features focal seziure
Can be conscious/not
| May proceed into T-C
42
Frontal seizure features
Motor --> clonic movements
43
Temporal seizure features (3)
Auditory/sensory - aura w/ smell/taste
Distortions sound + shape
Lip smacking
Impaired consciousness
44
Features occipital seizure
Distortion of vision
45
Features parietal seizure
Contra-lateral altered sensation
46
Which focal seizure is the most common?
Temporal
47
What does an EEG identify? (3)
Abnormal background
Asymmetry/slowing hence structural abnormalities
Neuronal hyperexcitability
48
Structural imaging for epilepsy (2)
MRI
| CT
49
Indications for structural imaging for epilepsy (2)
Neurological signs between seizures
| Focal seizure
50
Functional imaging for epilepsy (2)
PET
| SPECT
51
1st line Ix for epilepsy
EEG
52
4 Ix for epilepsy
EEG
MRI/CT
Metabolic Ix (developmental regression/feeding issue)
Genetic study (SCNA1)
53
Rescue therapy in prolonged therapy epilepsy (2)
Rectal diazepam
| Buccal midalozam
54
When should anti-epileptic medication be stopped?
If seizure free 2 years
55
1st line Dx TC seizures
Valporate or carbamazepine
56
1st line Dx absence seizures
Valporate or ethosuximide
57
1st line Dx myoclonic seizures
Valporate
58
2nd line Dx generalised seizures
Lamotrigine
59
1st line Dx - focal seizures
Carbamazepine, lamotrigine or valporate
60
SE valporate (2)
Incr W
Hair loss
Liver failure (rare)
61
SE carbamazepine (5)
```
Rash
Neutropenia
Decr Na
Ataxia
Enzyme induction
```
62
SE lamotrigrine
Rash
63
SE Ethosuximide
N+V
64
Non-Dx Tx epilepsy (3)
Ketogenic diet
Vagal nn stimulation
Surgery - focal resection/hemispherectomy
65
What is SUDEP?
Sudden unexpected death in epilepsy
66
RF SUDEP (2)
Poor control
| Seizures in sleep
67
Preventing SUDEP (5)
```
Good AED adherence
Seizure diary
Avoid triggers
Bed alarm
ID jewelry or epilepsy awareness cards
```
68
What is a febrile seizure?
Seizure + fever/viral infection
69
What age range gets febrile seizures?
6m --> 5y/o
70
What type of seizure is a febrile seizure usuaully?
T-C
71
What % febrile seizures have recurrence?
40%
72
Do febrile seizures affect brain performance?
No
73
What % chance is there of having a febrile seizure + going on to develop epilepsy
1-2%
74
Mx febrile seizures (7)
```
Ensure case isnt > serious (rule out meningitis)
Inform parents, reassure
DONT - use anti-pyretics, AED or EEG
Recovery position
Place in safe location
Stay w/ child
Call for help >5mins
```
75
When does expiratory apnoea syndrome occur?
In toddlers when upset/tantrum
76
What happens in expiratory apnoea syndrome?
Cry --> hold breath --> cyanosed --> brief LOC + rapid recovery
77
Triggers of reflex anoxic seizure (4)
Pain
Head trauma
Cold food
Fright
78
What causes reflex anoxic seizures
Asystole from vagal inhibition
79
What is Ataxia?
Incoordination of mm movements
| Lack of balance, staggering gate, difficulty sitting, clumsy
80
What is the most common cause of ataxia?
Post infection
81
Causes acute (<72hrs) ataxia (7)
```
Post infection (varicella, EBV)
Toxins
Tumour
Trauma
Metabolic
Infection
Vascular
```
82
Toxins that can cause acute ataxia (4)
Phenytoin
Benzos
Anti-H
Alcohol
83
Causes of episodic/recurrent ataxia (4)
Toxin ingestion
Basillar aa migraine
Seizure disorder
Metabolic
84
Causes of chronic ataxia (7)
```
Tumours
Hydrocephalus
Metabolic
Congenital malformation
Hereditary
Ataxic cerebral palsy
```
85
Examples of hereditary causes of ataxia (2)
Freidrich's ataxia
| Ataxia telangiectasia
86
What is Freidrich's ataxia?
Autosomal recessive, worsening ataxia, distal wasting in legs, absent leg reflex
87
What is Ataxia telangiectasia
Disorder of DNA repair, autosomal recessive, dystonia + cerebellar signs
88
Ix ataxia (6)
```
Hx
CT
Bloods - g, U/E, gluc
Metabolic screening
Genetic testing
Lumbar puncture (hydrocephalus)
```
89
Symptoms of raised ICP in children (5)
```
Headache, worse in morning
Vomiting on waking
Behaviour change
Visual disturbance
Papilloedema
```
90
Symptoms of raised ICP in infants
```
Vomit
Bulging fontanelle
Incr head circumference
Head tilt
Developmental delay/regression
```
91
Sx supratentorial tumour (3)
Seizures
Hemiplegia
Focal neurology
92
Sx midline tumour (2)
VF loss - bitemporal hemianopia
| Pit failure - growth failure, diabetes insipidus, incr W
93
Sx cerebellar tumour (3)
Ataxia
Co-ordination issues
Abnormal eye movements
94
Sx brainstem tumour (3)
CN defect
Pyrimidal tract - motor issues
Cerebellar ataxia
(No Sx incr ICP)
95
When does Bratten's syndrome begin
4-10y/o
96
Features Bratten's syndrome
Gradual onset:
| Visual disturbance + seizures --> behaviour, speech + learning regression --> dementia --> death
97
What is Leukodystrophies
Disorder in WM of brain b/c incorrect myelin sheath
98
Features leukodystrophies
Gradual decline
| Loss movement --> speech --> vision --> hearing + behaviour
99
What is Wilsons disease
Disorder hepatic Cu deposition
| Decr Cu in serum --> incr in Liver --> liver injury
100
Features Wilsons (5)
```
Acute liver failure --> CLD
Severe depression
Asymmetrical tremor
Difficulty speaking, MASK face, clumsy, personality change
Gait change
```
101
What is SSPE
Subacute sclerosis paencephalitis
| Persistent infection w/ immune resistant measles --> progressive encephalitis
102
Prognosis SSPE
Death within 5 days
| No Tx
103
Progression of SSPE
1' measles <2
6-15 years asymp
Gradual psychological + neuro deterioration
104
When does most of head growth occur ?
First 2 years of life
105
When does posterior fontanelle close?
By 8 weeks
106
When does anterior fontanelle close?
by 12-18 months
107
If there is a rapid incr in head circumference, what must be excluded?
Incr ICP
108
What is macrocephaly?
Head circumference >98th centile
109
Causes macrocephaly (8)
```
Tall stature
Familial
Incr ICP
Hydrocephalus
Chronioc subdural haematoma
Tumour
NFM
Cerebral gigantism
```
110
Ix macrocephaly if fontanelle open
USS
111
Ix macrocephaly if fontanelle closed
MRI or
| CT
112
What is microcephaly?
Head circumference <2nd centile
113
Causes microcephaly (4)
Familial
Auto recessive
Congenital infection e.g. ZIKA
Insult to brain during development (hypoxia, hypoglycaemia, meningitis)
114
What is Craniosynostosis
Premature fusion of 1 or > sutures --> distortion of head shape
115
Which sutures are usually affected by craniosynostosis
Sagittal
116
Appearance of craniosynostosis - sagital suture
Long, narrow skull
117
Appearance of craniosynostosis - lambdoid suture
Skull asymmetry/flat
118
Key DDx craniosynostosis
Plagiocephaly
119
Causes craniosynostosis (2)
If Single suture - unknown
| Multiple - genetic syndrome
120
S+S craniosynostosis (5)
Fused sutures
Unusual shape, headaches
Developmental delay, LD or visual problems
121
What is hydrocephaly
Obstruction in flow of CSF --> dilation of ventricles
122
What is obstructive/non-communicating hydrocephaly due to
Structure within ventricles or aqueduct blocking flow hence enlargement
123
Causes communicating hydrocephaly (3)
Congenital malformation
Posterior fossa neoplasm
Interventricular haemorrhage
124
Congenital malformations causing communicating hdyrocephaly (2)
Aqueduct stenosis
| Atresia of foramine 4th ventricle
125
2 causes non-obstructive hydrocephaly
```
Incr CSF prod (choroid plexus tumour)
Decr resorption (meningitis, haemorrhage)
```
126
External hydrocephaly
Benign enlargement of SAS in infancy
| Self-limiting - resolves in following years :)
127
Features hydrocephaly (5)
```
Large head circumference
Excessive rate of growth
Bulging fontanelle
Distended scalp vv
Sunset eyes
```
128
Tx hydrocephaly
Insertion ventriculoperitoneal shunt
129
What % migraines have no aura
90%
130
Features migraine w/o aura: (6)
```
Last 4-72hrs
Usually bilateral
Pulsatile
Over temporal/frontal area
+ N+V, abdo pain, photophobia, phonophobia
Incr by exercise
```
131
Tx migraine w/o aura
Ibuprofen
| Sumitriptan nasal spray
132
Features migraine w/ aura (3)
Preceded by; visual, sensory or motor aura
Most common = visual disturbances
Lasts few hrs
133
Tx migraine w/ aura
sleep
134
Features of tension headache (4)
Symmetrical
Gradual onset
Tight/band pressure
No other Sx
135
What can a 2' headache be due to? (6)
```
Head/neck trauma
Vascular malformation or haemorrhage
Incr ICP
HTN
Substance use/withdrawal
Meningitis/encephalitis
```
136
Red flags - headache (4)
Worse when lying down, night time waking or worse in morning
Morning vom
CHanges mood, personality, performance
Neuro defects, papilloedema
137
Cause of subdural haematoma (2)
Shaken baby syndrome
| Falling from >3m
138
Sx subdural haematoma (8)
```
Headache
Confusion
Hemiparesis
Lethargy
Pupils asymmetrical
Convulsions
Incr ICP
? Retinal haemorrhages
```
139
Features of myopathies
Mm weakness (usually proximal)
Wasting
Gait
140
How to diagnose myopathies (3)
Creatinine phosphokinase **
Mm biopsy
Genetic testing
141
Sx myotonic dystrophy (6)
```
Myotonia - prolonged mm contraction
Slurred speech
Temporary locking of jaw
Cataracts
Cardiac arrhythmias
Wasting - LL, hands, neck + face
```
142
Features of congenital mm dystrophy (2)
@ birth
Weakness, hypotonia + contractures
Proximal weakness
143
Features of neuropathies
Motor weakness
| Sensory - impaired perception/loss reflexes
144
How to Ix neuropathies (3)
Nn conduction studies
DNA testing
Electromyography
145
What precedes Guillian-Barre
2-3 weeks prev - URTI/GE (campy)
146
Features GB (4)
Ascending symmetrical loss reflexes + autonomic involvement
Abnorm sensory in legs
Bulbar mm - difficulty chewing + swallowing
? resp depression
147
What % GB recover
95%
148
Mx GB
Supportive therapy
149
Charcot-Marie tooth cause
Hereditary (AD)
150
Features CMTooth (2)
Symmetrical + slowly progressive mm wasting in distal --> proximal pattern
50% - spinal issues e.g. scoliosis
151
Medical Mx chronic pain
Local - anaesthetic, nn blocks
Analgesia
Sedatives - midalozam, NO, GA
Neuropathic - AED or anti-D
152
Mild analgesia for chronic pain (2)
Paracetamol
| NSAIDS
153
Mod analgesia for chronic pain (2)
Codeine
| NSAIDS
154
Strong analgesia for chronic pain
Morphine
