neurology p237 Flashcards

Question

stroke risk factors

Answer 1

hypertension - diastolic 110mmHg then 15x greater risk, even borderline hypertension has massively inc risk smoking alcohol ischaemic heart disease atrial fibrilation - atria never completely empty, clots form and are fired off from the aorta as emboli diabetes mellitus

Answer 2

venous thrombosis * OCP use * polycythaemia * thrombophilia - factor V Leiden border zone infarction * severe hypotenion - hypoxic damage * cardiac arrest - if BLS carried out for more than 5 mins then permanent damage is usually seen vasculitis * inflammation of vessek, sjorgen's syndrome is a vasculitis disease so increase risk of stroke

Answer 3

diet, smoking, alcohol, antiplatets anticoagulants - apixiban carotid endarterectomy - severe stenosis, previous TIA, \<85 years old

Answer 4

Differentials - Infarct/Bleed/Subarachnoid Haemorrhage Imaging * CT scan - rapid easy access but is poor for ischaemic stroke * MRI scan - difficult to obtain quickly, but better at visualising early changes of damage, MRA (Angiography) is best investigation for brain circulation * Digital subtraction angiography - if MRA isn’t available \*CT - brain bone space \*MRI - shows fluid and brain - better for stroke imaging \> shows infarction unlike a CT

Answer 5

Carotid ultrasound Cardiac ultrasound (LV thrombus) ECG Blood Pressure Diabetes screen Thrombophilia screen in young patients

Answer 6

Loss of functional brain tissue immediate nerve cell death nerve cell ischaemia in penumbra (the area immediately outside an ischaemic area) \> must be protected Gradual or rapid loss of function Some of the loss of function is due to inflammation - therefore time is the main teller in stroke recovery

Answer 7

Motor function loss * Cranial nerve * Somatic nerves (opposite side) - can cause phantom limb sensation * Autonomic in brainstem lesions * Dysphonia * Dysphagia - can cause aspiration of food/saliva which can lead to pneuomnia and death because of the inability to choke/cough Cognitive impairment * appreciation of things * Processing * understanding of speech/language * understanding of info * dysphasia/lexia/graphia/calculia memory impairment emotional lability and depression

Answer 8

penumbra region - survivable ischamia - Nimodipin - Ca²⁺ blocker that has the added effect of reducing neurlogical deficit in delayed ischaemic strokes improving perfusion - thrombolysis within 3 hrs - Alteplase - tissue plasminogen activator maintain normoglycaemia - hypo/hyper harmful remove haemoatoma - subarachnoid haemorrhage only prevent future risk - Aspirin 300mg, anticoagulant if stroke caused by AF or LV thrombus, given 2 weeks after event

Answer 9

nursing and rehab immobility support * bed sores - tissue necrosis from pressure on skin for too long * physiotherapy - prevent contracture speech and language therapy * communications * swallowing and earing occupational therapy

Answer 10

Poor attendance and OH - due to mobility and dexterity issues Communication difficulties - either due to muscles of speech or within brain Risk of cardiac emergencies - MI or secondary stroke Loss of protective reflexes * Aspiration * Managing saliva - **Atropine** (Anti-cholinergic) - antisialogogue Loss of sensory infromation difficulty in adapting to oral environment e.g new dentures Stroke pain - CNS generated pain perception

Answer 11

GABA (gamma-Aminobutyric acid) chief inhibitory neurotransmitter in the CNS It reduces neuronal excitability throughout the nervous system It is also directly responsible for regulation of muscle tone In epilepsy levels of GABA are reduced in the brain - this leads to abnormal cell to cell message propogation

Answer 12

generalised * tonic clonic * absence * myoclonic/atonic seizure partial * simple * complex * simple sensory

Answer 13

a.k.a. grand mal seizures loss of consiousness, muscle stiffness and convulsions and jerking for 1-3mins tonic phase - stiffness, loss of consiousness and possibly noises clonic phase - rapid and rhythmic jerking start on one side of the brain and progress to the whole brain or sometimes just starts simultaneously on both sides

Answer 14

Brief transient seizures where the person stops whatever activity they are doing for a brief time, and becomes unresponsive but conscious, they may appear ‘absent’ or their eyes glaze over and drop what theyre holding It usually only lasts half a minute maximum aka petit mal seizure may have mild tonic and clonic components but often almost inperceptible Often associated with Porphyria in children as porphyrin inducing factors can cause these sizures

Answer 15

Happens to everyone at some point, i.e random foot jerk in bed, knee gives way when walking, hiccups etc However with persistence it can be a sign of a neurological disorder i.e CJD, Huntington’s Disease or Multiple Sclerosis

Answer 16

myoclonic seizures

Answer 17

can affect special senses, autonomic nervous system or GI organs Jacksonian seizures localised to one particular area of brain

Answer 18

muslce jerking randomly in the face or limbs

Answer 19

idiopathic trauma (head injury) heatstroke - febrile seizure - hyperthermia remedied with anti-pyrexic drugs (paracetamol, ibuprofen) CNS disease - tumour, stroke, CJD, meningitis, encephalitis Social - late nights, alcohol, hypoglyceamia, flashing lights

Answer 20

withdrawal/poor med compliance epileptogenic drugs - some GA agents, alcohol, tricyclic antidepressants and selective serotonin, reuptake inhibitors fatigue/stress, infection and menstruation

Answer 21

anticonvulsant drugs * valproate - increases GABA level at the GABA transaminase inhibitor * Carbamazepine - works well for myoclonic seizures * Phenytoin - Serotonin release agonist and also a SRI? action unsure * Gabapentin - reduces muscle spasticity and involuntary eye movement (nystagmus) * Phenobarbitone - Very cheap and effective anti-epileptic * Lamotrigine - Increases action of existing GABA, is chemically different than other anti-convulsants being a phenyltriazine

Answer 22

usually just supportive tx if unconcious - airway and O2 status epilepticus - use Benzodiazepines (e.g. Diazepam) GABA action inc at the GABAA receptor

Answer 23

Complications of fits * Oral soft tissue injury * dental injury/fracture Complications of treatment * Gingival Hyperplasia (Phenytoin) * Bleeding tendency (Valproate) * Folate deficiency Assess their risk of having a seizure * good and bad phases * ask when last three fits were * ask about medication compliance * ask about medication changes

Answer 24

- muscle weakness - visual disturbance ] Optic neuritis - optic atrophy ] Optic neuritis - paraesthesia - autonomic dysfunction - dysarthria

Answer 25

Most common disorder of the CNS in the young * 8:1000 prevalence CNS lesions only Demyelination of axons Usuallty patchy distribution progressive functional loss over time women in the 4th decade onet most severe

Answer 26

Susceptibility acquired during childhood altered host reaction vs infective agent background in genetic immune factors more common in identical twins more common amongst immediate family members generally unknown - combo genetic, environmental and social

Answer 27

MRI CSF analysis - reduced lymphocytes, increased serum IgG level, visual evoked potentials (patterns on screense etc)

Answer 28

Incurable and is degenerative Steroids are good for acute exacerbations but cant cure No effective treatment but just symptom management * Antibiotics * Antispasmodics - e.g Atropine for GI symptoms * Analgesics * PT and OT

Answer 29

limited mobility and psychological disorders treat under LA Orofacial motor and sensory disturbance in younger patients Chronic Orofacial pain syndromes Enhanced trigeminal neuralgia risk again in younger patients

Answer 30

No sensory loss in this disease which helps to differentiate it from MS Unknown aetiology but theorised to be viral in origin Degeneration in the spinal cord (corticospinal tracts and anterior horns) Bulbar motor nuclei i.e limbs etc Patients aged 30-60 with a prognosis of 3 years of life after diagnosis 2.5:1 Male to female

Answer 31

progressive loss of motor function * limbs * intercostal * diaphragm * motor cranial nerves VII-XII death due to * ventilation failure * aspiration pneumonia

Answer 32

None effective PT and OT Riluzole (delays MND by delaying the death of neurones to skeletal muscle) helps extend life 6-9 months Aspiration prevention * PEG tube feed * Reduce salivation

Answer 33

difficulty accepting care due to head an dneck weakness realistic tx plannning drooling and swallowing difficulties

Answer 34

Degeneration of the dopaminergic neurons in the substantia nigra in the basal ganglia of the midbrain 50/50 male to female cause unclear * may be due to previous Cerebrovascular disease or head trauma drug induced - phenothiazine, butrophenones, valproate, metoclopramide Associated parkinson’s dementia

Answer 35

bradykinesia rigidity tremor (slow amplitude) postrual instability

Answer 36

slow movement and initiaion of said movement

Answer 37

inc muscle tone

Answer 38

impaired gait and falls impaired use of upper limbs mask like face swallowing problems

Answer 39

treatment medical - drugs can alleviate symptoms in early phase of disease * dopaminergic drugs * Levodopa with carbidopa - dopamine replacment * apomrphine - dopamine receptor anatgonist PT and OT sugical - sterotactic surgery, stem cell transplant

Answer 40

difficulty accepting tx tremour at rest facial tremor reduces purposeful movement e.g. chewing/mouth opening dry moth from anticholinregic drugs drug interactions

Answer 41

Antibody mediated autoimmune disease Deficiency of function muscle ACh receptors that leads to muscle weakness Disorder affects young women Sometimes associated with Eaton-Lambert syndrome which is a disease of the NMJ in the hips and limbs However in MG the muscles get weaker with activity but in straight ELS the muscles get stronger with activity

Answer 42

Rapid onset unilateral ache behind the ear Weakness worsens over 1-2 days Prednisalone given for 5 days to reduce neural oedema N.B, If bilateral presentation could be Sarcoidosis, Guillain-Barré syndrome or Melkersson-Rosenthal syndrome (Tongue fissures, unilateral facial palsy, facial swelling, similar lesions to crohn's)

Answer 43

a.k.a Ramsay Hunt cerebellar syndrome rare form of cerebellar degeneration which involves myoclonic epilepsy, progressive ataxia, tremor and dementing process

Answer 44

a.k.a Herpes Zoster Oticus reactivation of varicella zoster in the geniculate ganglion of the brain (nerve bundle CNVII) profound facial paralysis vesicles in the pharynx

Answer 45

disorder of the motor function secondary to cerbral damage associated with birth injury/hypoxia 3 main types 1. spastic - muscles contracted with associated epilepsy 2. ataxic - cerebellar lesion results in disturbance of balance 3. athetoid - writhing type movements

Answer 46

vertebral arches fail to fuse due to folate deficiency may have inability to walk, epilepsy or learning difficulties or a combo of all three

Answer 47

benign tumour occuring at the cerbello pontine angle on the vestibular part of the vestibulocochlear nerve CNVIII CNV, VII, IX and X may also be involved leads to tinnitus, deafness and vertigo facial twitching and parasthesias also possible, however these exclude the angle of the mandible which is innervated by the cervical nerves

Answer 48

autosomal dominant disorder (chromosome 4) progressive dementia (atrophy of the caudate nucleus of basal ganglia) with marked involuntary movements doesn't appear till middle age Midazolam is a remarkable drug for people with this as a sedative

Answer 49

autosomal recessive disorder or sometimes sex linked degeneration of the spinal cord can also lead to scoliosis, heart disease and diabetes

Answer 50

* *1) Alzheimer’s Disease** - Amyloid Beta and Tau protein * *2) Vascular dementia** - hypoxic degeneration * *3) Dementia with Lewy bodie**s - lewy bodies are abnormal protein aggregates that develop in neurons * *4) Parkinsons’s** - see notes above * *5) Frontotemporal Dementia** - personality changes * *6) Creutzfeld Jakob Disease** - caused by prions

Answer 51

Early stage - forgetfulness, losing track of time, lost in familiar places Middle stage - forget names, lost at home, communication difficulty, need persona care, wandering, repeated questioning Late stage - forget family, walking, recognising relatives and friends

Answer 52

traumatic brain injury focal diffuse

neurology p237 Flashcards

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