Flashcards in Neurology & Neurosurgery Deck (36):
What are the sinister causes of headache it is important to rule out?
Vascular - SAH, haematoma (subdural or extradural), cerebral venous thrombosis, infarct
Infection - Meningitis or encephalitis
Vision-threatening - Temporal arteritis, acute glaucoma, pituitary apoplexy, posterior leucoencephalopathy
Intracranial pressure - SOL, cerebral oedema, hydrocephalus
Dissection - Carotid dissection
What are the headache red flags?
Decreased level of consciousness
Sudden onset/worst headache ever
Seizures/focal neurological deficit
Reduced visual acuity
Persistent headache (worse when lying down or progressive)
Constitutional symptoms - Weight loss, night sweats, fever
What are the main causes of SAH?
Rupture of an arterial aneurysm (usually a berry aneurysm)
How do TCA overdoses present?
They present with both sympathetic and parasympathetic symptoms
Dilated pupils, sinus tachycardia, brisk reflexes, urine retention
BUT also dry mouth and drowsiness
What are the types of epileptic seizures?
- Unimpaired and impaired
- Or by area affected
Describe a tonic-clonic seizures
Patients are initially rigid (tonic phase) and then convulse, making rhythmical muscular contractions (clonic phase)
Describe an absence seizure
Usually in children, the patient loses consciousness and appears vacant and unresponsive to observers for up to 30 seconds
Describe an atonic seizure
A brief loss of muscle tone, causing the patient to fall to the ground
Describe a myoclonic seizure
An extremely brief muscle contraction
What are the means of categorising partial seizures?
Can be divided into those where consciousness is unimpaired (simple) and those where it is impaired (complex).
Alternatively they may be classified by the brain area affected
What is the classic presentation of Parkinson's disease?
Tremor, rigidity and hypokinesia
How can CSF sampling being used to diagnose the causative organism type in meningitis?
High cell count, mainly neutrophils, high protein => bacterial
Lymphocytes and high glucose => viral
Lymphocytes and low glucose => fungal and TB
What is the most commonest causative organism of bacterial meningitis?
How will it appear in culture?
Gram positive diplococci
What are the causes of viral meningitis?
- HSV type II
- VZV and other herpesviruses (EBV, CMV, HHV-6)
- Lymphocytic choriomeningitis virus
How can HSV encephalitis present?
Which HSV strain is usually implicated?
What is the treatment?
Usually affects the temporal lobe (opening and closing of mouth)
Presents with altered conscious level, confusion and seizures
Treated with acyclovir
What characteristic positioning of the limbs is associated with brain herniation?
Elbows, wrists and fingers flexed with legs extended and rotated inwards
What are the features of generalised epilepsy?
What are the features of focal epilepsy?
What is Sturge-Weber syndrome?
Vascular abnormalities leading to dystrophic calcification of vessels in cortex
What is lissencephaly
How does it present?
Literally mean smooth brain
Rare brain formation disorder caused by defective neuronal migration during 12th to 24th weeks of gestation
Affected children display psychomotor retardation, failure to thrive, seizures, and muscle spasticity or hypotonia
What is nodular gray matter heterotopia?
Neurological condition caused by clumps of gray matter being in the wrong place
Usually causes some degree of epilepsy or recurring seizures
What is polymicrogyria?
Multiple small gyri create excessive folding of the brain leading to an abnormally thickened cortex
May affect one or multiple regions of the brain
What is tuberous sclerosis?
What has been implicated?
A rare multisystem genetic disease that causes benign tumours to grow in the brain and on other vital organs
Combo of symptoms including seizures, intellectual disability, developmental delay, lung and kidney disease etc.
PI3K-mTOR implicated in cell growth of tubers
What is ulegyria?
What are its signs and symptoms?
"Mushroom-shaped" gyri, in which scarring causes shrinkage and atrophy in the deep sulcal regions
Mental retardation, cerebral palsy, and seizures
What are the causes of subarachnoid haemorrhage?
85% - Rupture of saccular aneurysm in cerebral vasculature (berry aneurysm)
What are the risk factors for chronic subdural haemotoma?
How can neurological assessment be used in cauda equina syndrome to localise the lesion
Level - Sensory deficit - Motor deficit - Effect on reflexes
L2 - Antero-lateral thigh - Hip flexion - N/A
L3 - Medial thigh and knee - Quad and knee extension - Knee
L4 - Medial calf and malleolus - Knee extension - Knee
L5 - Dorsum and lateral calf - EHL - Ankle
S1-S2 - Lateral foot - Plantar flexion - Ankle
S3-S4 - Saddle region - Sphincters - Anal
What are the most common locations of disk herniation?
L4-5 and L5-S1
This is caused by an injury to C5,6 often during excessive downward traction on the upper limb during a difficult delivery
Shoulder abduction, elbow flexion and supination of the forearm are all affected => waiter's tip sign
Caused by injury to T1, often due to hyperabduction of the shoulder (eg in a breach delivery)
Leads to wasting of the small muscles in the hand
What is the cause of a winged scapula?
Injury to the long thoracic nerve that lead to paralysis of serratus anterior
Can occur during axillary clearance (eg for breast carcinoma)
What is important about the path of the common fibula nerve?
What might happen if it is injured?
It wraps around the proximal end of the femur, superficially
Therefore vulnerable to trauma => foot drop
What is Bell's Palsy?
An inflammatory disease of unknown origin in which all the facial muscles on one side are paralysed
The site of pathology is within the facial canal, just above the stylomastoid foramen
What is torticollis?
What are the possible causes?
AKA wryneck = excessive contraction of sternocleidomastoid and trapezius leading to the neck to be pulled to the ipsilateral side and the face rotated contralaterally
Inflammation of the spinal root of the accessory nerve, injury to the nerve during lymph node biopsy or sternocleidomastoid injury during birth
What is thoracic outlet syndrome?
Compression of the neurovasucular structures in the area above the first rib and behind the clavicle
Structures are the lower trunk of the brachial plexus, the subclavian vein and the subclavian artery
Clinical signs and symptoms include ischaemia, swelling, pain , paraesthesia of the hand, and wasting of the small muscles of the hand