Neurology Intro Flashcards
(38 cards)
1
Q
What is included in a neurological systems review?
A
- Fits, faints and funny turns
- Headaches
- Memory problems
- Altered vision
- Hearing difficulties
- Speech and swallowing difficulties
- Weakness
- Numbness, tingling
- Balance or co-ordination difficulties (vertigo/dizziness)
- Incontinence or erectile dysfunction
2
Q
What are the features of a cluster headache?
A
- Occur lots in the space of a few weeks before having months symptom free
- Usually occur at night
- Unilateral retro-orbital pain with red eye and watering
- Tend to last between 15-180 mins, with most episodes lasting less than an hour
- Sufferer will be unable to stay still
- Associated with unilateral autonomic dysfunction, including eye watering, eye injection and nasal congestion
3
Q
What are the features of a migraine?
A
- Evenly spread episodes throughout the year
- Can last from a few hours to 72hrs
- Tend to relieve symptoms by lying down in a dark room
- Unilateral, pounding
- Aura symptoms
- N+v
- Photophobia
- Phonophobia
4
Q
What is a tension headache?
A
Tight, band-like sensation, precipitated by stress.
5
Q
What is trigeminal neuralgia?
A
Brief, stabbing pain when brushing teeth or chewing
Do not give opioids
6
Q
What are the characteristic features of meningitis?
A
- Photophobia
- Neck stiffness
- Fever
7
Q
How does raised ICP and SAH present?
A
- Raised ICP is headache triggered by changes in position or exertion, changes in vision with leaning forward.
- SAH: sudden onset, excruciating headache
8
Q
What is acute glaucoma and sinusitis?
A
- Acute glaucoma: pain around eye, blurred vision with halo around lights
- Sinusitis: facial tenderness, rhinorrhoea
9
Q
What are the NICE headache red flags?
A
- Sudden onset with high severity headache
- Headache with fever
- New onset neurological deficit
- New onset cognitive dysfunction
- Change in personality
- Impaired level of consciousness
- Recent head trauma (within 3 months)
- Headache triggered by cough, sneeze, exercise or changes in posture (valsalva manoeuvres)
- Headache associated with halos around lights or headaches get worse in the dark
- Headache associated with jaw claudication and scalp tenderness
10
Q
What are the different types of TLoC?
A
- Syncope: vasovagal or cardiogenic
- Seizure: provoked or unprovoked
- Psychogenic non-epileptic attacks (Non-Epileptic Attack Disorder - NEAD)
- Rarer causes: migranous events, vestibular disorders, cerebrovascular events, sleep disorders
11
Q
How do you diagnose TLoC?
A
HISTORY
- Pre-syncopal symptoms - cold, lightheaded
- Seizure, jerking/twitching
- Abnormal taste/smell
- After were they confused
- Were they unconscious
12
Q
What are the features of syncope?
A
- Syncope: loss of consciousness caused by lack of cerebral blood supply
- Motor activity is common - esp. if prolonged or upright (symptoms don’t last long): twitching of limbs, stiffening + jerking, tongue biting and incontinence can occur
- Clear presyncopal symptoms (PPP): position, provocation, prodromal (visual blurring etc)
13
Q
What is non-epileptic attack disorder?
A
- Causes episodes of LOC with no electrical abnormality
- Usually pelvic thrusting and back arching whilst conscious - bilateral limb movement
- Presents also as slumping suddenly - HR and BP remain normal
- Psychogenic condition - treatment is psychotherapy
14
Q
What conditions cause TLoC?
A
- Postural hypotension: triggered by suddenly standing
- Vasovagal syncope: triggered by fear, pain, micturition or prolonged standing. Preceded by pallor, nausea or sweating. No confusion after.
- Aortic stenosis: chest pain, SOB and collapse on exertion
- HCOM/cardiogenic syncope: triggered by vigorous exercise in young person
- Arrhythmia/cardiogenic syncope: palpitations or chest pain beforehand, FH of sudden unexplained death
- Carotid sinus hypersensitivity: collapse on shaving or turning head
15
Q
How would absence seizures present?
A
Being told off by teachers for seemingly daydreaming.
16
Q
How would vasovagal syncope present?
A
Pale and sweaty beforehand, jerking of limbs, eyes rolled back, short duration of episode, no confusion afterwards.
17
Q
How would generalised tonic clonic seizures present?
A
Crying out, falling to floor, period of stiffness followed by rhythmic jerking that gradually decreases in amplitude and frequency, period of confusion for 30 mins afterwards.
18
Q
How would psychogenic non-epileptic attack present?
A
Violent shaking, head moving side to side, arching back, episodes of stillness before starting again, forced eye closure.
19
Q
What is part of the upper motor neurones?
A
- White matter tracts
- Spinal cord
- Motor cortex
- CNS
20
Q
What is part of the lower motor neurones?
A
- Anterior horn cell
- Nerve root
- Motor nerve
- Neuromuscular junction
- PNS
21
Q
What are the signs of UMN lesion?
A
- Increased tone (spasticity)
- Weakness (variable)
- Brisk reflexes
- Sustained clonus
- Pathological reflexes e.g. extensor plantars
22
Q
What are the signs of LMN lesion?
A
- Reduced or normal tone
- Muscle wasting
- Weakness
- Fasciculations
- Reduced or absent reflexes - no pathological reflexes
23
Q
What are the motor signs from a lesion?
A
- Motor pathways cross at the medulla so lesions proximal to that will show contralateral signs and distal will show ipsilateral signs
- Brainstem lesions will show contralateral signs in the limbs and ipsilateral cranial nerve signs
24
Q
What are the sensory pathways?
A
- Dorsal column: fine touch and proprioception
- Spinothalamic tract: pain and temperature sensations
25
How will injury to the dorsal column present?
The dorsal columns decussate at the medial leminiscus at the brainstem, meaning that injury to the dorsal columns on one side will interrupt transmission of vibration and proprioception ipsilateral to the lesion.
26
How will injury to the spinothalamic tract present?
Pain and temperature fibres cross as they enter the spinal cord and continue their journey up the contralateral side of the spinal cord.
27
What are the signs of Brown-Sequard Syndrome?
From level of lesion:
- Ipsilateral - complete loss of sensation, UMN weakness, loss of vibration, proprioception and fine touch, paralysis
- Contralateral - loss of temperature/pain and pinprick
- IPCS Ipsilateral paralysis and contralateral sensory loss (I Paralysed Cait's Senses)
28
What are the main investigations for neurology?
- CT: can identify collections of blood e.g. in SAH and extradural haematoma
- MRI: useful for intrinsic brain pathology e.g. lesions caused by MS or tumours
- LP: assess pressure of CSF and can determine if there is infection or inflammation
- EEG: for suspected disorders of brain e.g. epilepsy or encephalopathy
- Nerve conduction studies/electromyography (EMG): can assess neurological structures in the peripheral nerves, muscle and NMJ
29
What is Hoover's sign?
Differentiates between organic and non-organic leg weakness. If a patient is genuinely trying, the examiner will feel the normal limb pushing down on the hand as patient tries to lift weak leg - organic cause of paresis. If examiner does not feel normal limb pushing downwards as patient tries to lift weak leg this is suggestive of underlying functional weakness (conversion disorder).
30
What is a supinator catch?
Hyperreflexia and contraction of muscle groups not expected in the usual reflex - extra movements (problem with spinal cord across myotomes)
31
What are the cervical cord syndromes?
- Inflammatory: MS, post infective, NMO, CTD related (lupus, Sjogren's)
- Compressive: discs, tumours
- Infective: viral (VZV, HIV)
- Metabolic: B12, copper deficiency
32
How do you quantify power in a neurological examination?
0) No power
1) Twitching but no movement
2) Movement, but cannot overcome gravity
3) Can overcome gravity
4) Movement against gravity and resistance
5) Normal muscle strength
33
What medications can cause headaches?
- Opiates, triptans, NSAIDs, paracetamol
- Taking >15 days a month, regular overuse for >3 months of 1 or more of the drugs, also a pre-existing headache disorder
34
What causes postural hypotension with compensatory tachycardia?
- Deconditioning
- Dysfunctional heart: aortic stenosis
- Dehydration: disease (acute illness, adrenal insufficiency), dialysis, drugs (diuretics, narcotics)
- Drugs: anti-anginals, anti-parkinsonian medication (levodopa), antidepressants, antipsychotics, anti-BPH medication (tamsulosin)
35
Motor loss in relation to the lesion
- Lesion proximal to brainstem = contralateral motor and CN signs (sensory loss)
- Brainstem lesion = contralateral limb signs (and ipsilateral CN signs)
- Distal to brainstem = ipsilateral limb signs (sensory contra/ipsilateral depending)
36
Sensory loss in relation to the lesion
- Dorsal column (fine touch, proprioception, vibration) = decussates in brainstem - lesion = ipsilateral sensory loss
- Spinothalamic tracts = decussate as they enter the spinal cord = lesion = contralateral sensory loss
37
What are the features of encephalitis?
- Fever, headache, psychiatric symptoms, seizures, vomiting
- Focal features e.g. aphasia
- Peripheral lesions (e.g. cold sores)
- Typically affects temporal and inferior frontal lobes
- IV aciclovir should be started in all cases of encephalitis
38
What are the investigations for encephalitis?
- CSF: lymphocytosis, elevated protein
- PCR for HSV
- CT: temporal and inferior frontal lobe changes (e.g. petechial haemorrhages)
- MRI is better
- EEG pattern: lateralised periodic changes at 2 Hz
