Phase 2 > Neuro > Flashcards

Neuro Flashcards

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1
Q

What is the treatment for TIA

A
  • Stroke prevention
    • Aspirin
    • Statins
    • ACE inhibitors
    • Lifestyle changes
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2
Q

Describe the Aetiology of Stroke (3)

A
  • Ischaemic (80%)

- Haemorrhagic (17%)

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3
Q

How might someone with an anterior cerebral artery stroke present (5)

A
  • Contralateral leg weakness/numbness
  • Difficulty speaking
  • Decreased consciousness
  • Ataxia
  • Incontinence
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4
Q

How might someone with a middle cerebral artery stroke present (4)

A
  • Contralateral leg AND arm weakness/numbness
  • Visual loss in ONE eye
  • Difficulty understanding words
  • Facial drooping
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5
Q

How might someone with a posterior cerebral artery stroke present (4)

A
  • Vision loss
  • Difficulty interpreting vision
  • Generalised weakness
  • Headache
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6
Q

What tests would you run for stroke

A
  • URGENT HEAD CT
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7
Q

How would you treat a stroke acutely (3)

A
  • Oxygen and fluids
  • If ischaemic
    - Thrombolysis within 4.5 hours
    - iv alteplase followed by clopidogrel 24 hours after
  • If Haemorrhagic
    - iv Mannitol (decrease ICP)
    - Surgery
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8
Q

How might someone with SAH present (5)

A
  • Thunderclap headache
  • Nausea, vomiting, seizure, coma
  • Decreased consciousness
  • Vision loss/double vision
  • Neck stiffness
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9
Q

What tests would you do for SAH

A

Head CT

- Diagnostic

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10
Q

How would you treat SAH

A
  • iv mannitol
  • Stabilise patients
  • Neurosurgery
  • Endovascular stent
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11
Q

How might someone with a SDH present (6)

A
  • Decreasing cognition
  • Personality change
  • Headache
  • Nausea and Vomiting
  • Decreasing conscouisness
  • Focal Neurology (late)
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12
Q

What tests would you do for SDH

A
  • Head CT

- Sickle shaped bleed

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13
Q

How do you treat SDH (3)

A
  • Stabilise patient
  • Iv Mannitol
  • Neurosurgery- drain
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14
Q

How might someone with an EDH present (5)

A
  • Head trauma then unconsciousness
  • Often followed by lucid period
  • Severe headache
  • Nausea, vomiting, seizure, coma
  • Decreased consciousness
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15
Q

What tests would you do for EDH

A
  • Head CT

- Lemon shaped bleed

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16
Q

What are the partial triggers of migraine

A 
Chocolate
Hangover
Orgasm
Cheese
Oral contraception
Lie in
Alcohol
Tunus (loud noise)
Exercise
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17
Q

How does migraine present (4)

A
  • With/without aura
  • 30 mins - 72 hours
  • At least 3/4
    1) Unilateral
    2) Pulsing
    3) Moderate/severe pain
    4) Worse with movement
  • At least 1/2
    1) Nausea/vomiting
    2) Photophobia/phonophobia
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18
Q

How do you treat Migraine

A 
Acute
- Sumatriptan
- NSAIDs (Naproxen) avoid ibuprofen/paracetamol
- Anti-emetics
Prevention  
- Avoid triggers (headache diary)
- Beta blockers
- Amitriptyline 
- Topiramate
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19
Q

How might someone with Tension Headache present (5)

A
  • Mins to days
  • Bilateral
  • Pressing
  • Mild/moderate
  • Scalp tenderness
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20
Q

How do you treat tension headache (4)

A
  • Paracetamol/Aspirin/Ibuprofen
  • Use sparingly to avoid medication overuse headache
  • Avoid opiates
  • Amitriptyline if severe
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21
Q

How might someone with cluster headache present (5)

A
  • Sudden onset debilitating unilateral pain
  • Localised to one eye or temple or forehead
  • Crescendo pattern
  • Clusters of attacks followed by remission
  • Can be chronic
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22
Q

How do you treat cluster headache (3)

A 
Acute attack
- Sumatriptan
- Oxygen
Prevention
- CCB (verapamil) 1st line prevention
- Prednisolone + alcohol avoidance during cluster
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23
Q

What is the aetiology of trigeminal neuralgia (2)

A
  • Usually trigeminal compression due to loop of artery or vein
  • May be caused by a tumour or aneurysm
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24
Q

How might someone with trigeminal neuralgia present (2)

A
  • At least 3/4
    1) Attacks last 1 sec to 2 mins
    2) Severe
    3) electric shock/stabbing like pain
    4) Brought on by innocuous stimuli eg. shaving
  • At least 3 attacks for diagnosis
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25
How do you treat trigeminal neuralgia (3)
- Anti-convulsant (carbamazepine) - Surgery to relieve compression - Surgery to remove tumour/clip aneurysm if present
26
What can cause epilepsy (5)
- Idiopathic (2/3) - Tumour - Stroke - Dementia - Cortical scarring
27
What are the 2 general categories of epileptic seizure
- Primary Generalised (40%) - Electrical activity throughout entire cortex - Simultaneous, bilateral motor onset - Associated with loss of awareness/consciousness - Partial/Focal (57%) - Focal onset, may later become generalised - Often seen with underlying structural disease
28
What are the types of Primary generalised seizure (5)
- Generalised tonic clonic seizure - Loss of consciousness (eyes remain open) - Rigidity (fall) followed by jerking (may be incontince) - Post-ictal confusion/drowsiness - Absence seizure - Stop activity and pale/stare, then resume - Unaware they have had seizure - Myoclonic seizure - Sudden jerking of limb - Tonic seizure - Sudden onset rigidity plus associated grunt - Atonic seizure - Sudden loss of muscle tone/movement
29
How might Partial/Focal seizure present (4)
- Temporal - Aura and out of body experience or anxiety - Frontal - Motor movements eg. peddling legs - Parietal - Tingling/numbness - Occipital - Spots/lines/flashes
30
How would you diagnose epilepsy
- 2 seizures more than 24 hours apart | - EEG (supports diagnosis)
31
How do you treat epilepsy (4)
- Diazepam (rectally during seizure) - Carbamezapine (Not in abscence) - Sodium Volproate - Educate patients eg. don't swim alone
32
How might frontotemporal (picks) dementia present
- Middle aged onset - Personality change - decreased inhibitions, inappropriate behaviour - Picks - Pricks
33
How might someone with alzheimers present (4)
- Slow progressive onset - Usually short term memory loss first noticed - Progressive decline in cognition/motor skills - Personality change
34
How might someone with Vascular dementia present (2)
- Stepwise deterioration | - Signs of vascular disease eg. high B.P or stroke
35
How might someone with Lewy-bodies dementia present (4)
- Fluctuation in cognition/skills - Hallucinations - Often associated with Parkinsons - Lowered inhibitions
36
How might you diagnose dementia (2)
- History and assess cognitive function - Mini metal state examination - >25 = normal - 18-24 = mild/moderate impairment - <17 = severe impairment
37
How do you treat dementia (5)
- Encourage healthy lifestyle - Inform/educate friends and family - Nurse at home/care home - Acetylcholinerase inhibitors (rivastigimine) - B.P control in vascular dementia
38
Define parkinsons disease
- A degenerative movement disorder caused by a lack of dopamine in the substantia nigra - Triad of - Bradykinesia - Rigidity - Resting tremor
39
Describe the pathophysiology of parkinsons
- Destruction of dopaminergic neurones in substantia nigra | - Decreased dopamine to striatum so decreased stimulation of thalamus leading to decreased movemnet
40
How might someone with parkinsons present (4)
- Asymmetrical and progressive - Bradykinesia - Shuffling walk/narrow stance - Decreased arm swing - Drags one leg - Resting tremor (vs active in BET, asymmetrical) - Difficulty with fine motor skills eg. doing buttons/writing - Rigidity - Pain rolling over in bed
41
How do you diagnose parkinsons
- Clinical diagnosis based on examination | - Confirmed by medication response
42
How do you treat parkinsons (2)
- Dopamine agonist used initially to delay use of L-Dopa due to side effects (ropinirole) - Levo-Dopa combined with decarboxylase inhibitor to reduce peripheral conversion to dopamine - Careldopa
43
What is huntingtons chorea
- A progressive neurodegenerative disorder caused by lack of GABA (inhibitory NT) that causes chorea - Chorea is involuntary jerking movements that cease during sleep
44
Describe the pathophysiology of huntingtons
- CAG repeat mutation on huntingtin gene on chromsome 4 - Leads to progressive cerebral atrophy especially in the striatum - This leads to decreased GABA synthesis causing decreased inhibition of the thalamus causing increased movement
45
How might someone with huntingtons present (6)
- Progressive involuntary, jerky, explosive movements - Ceases when alseep - Can't sit still - Increased aggression - Depression - Unclear speech
46
How do you diagnose huntingtons (3)
- Mostly clinical diagnosis - Genetic testing (CAG repeats) - Head CT
47
How do you treat huntingtons (3)
- Diazepam (increases GABA binding) - Antidepressants eg. SSRI - Tertrabenazine (dopamine deleting agent)
48
How might someone with MS present (8)
- Usually monosymptomatic to start - Usually relapsing and remitting - Trigeminal neuralgia - Limb parasthesiae - Worse on exercise and heat - Optic neuritis (unilateral) - Ataxia - Leg weakness
49
How do you diagnose MS (2)
- At least 2 attacks in different CNS areas | - MRI is diagnostic if supported by clinical history
50
What is the treatment for MS (3)
- Acute attack give iv Methylprednisolone - Disease modifying agents - iv alemtuzumab - iv natalizumab - Stem cell transplant
51
Describe the pathophysiology of myasthenia gravis
- Anti-AchR antibodies block and destroy nicotinic Ach receptors on neuromuscular post-synaptic junction - This leads to decreased muscle excitation
52
How might myasthenia gravis present (6)
- Progressive muscle weakness - Uusally affects facial/eye, limb and speech muscles - Ptosis (upper eyelid droop) - Double vision - Ask patient to count to 50, voice becomes less audible - Ask patient to watch raised finger without moving head, they cannot for more than a few seconds
53
How would you diagnose myasthenia gravis (2)
- Serum anti-AchR | - EMG and NCS
54
How do you treat myasthenia gravis
- Acetylcholinerase inhibitors (Rivastigimine) | - Immunosuppression (prednisolone +/- Azathioprine)
55
How might MND present (5)
- UMN and LMN signs with NO SENSORY LOSS - Weakness, hyper-reflexia, wasting and fasciculations - Wrist and foot drop - Over 40 - Dementia in 25%
56
How do you diagnose MND (5)
- LMN + UMN in 3+ sites is definite - LMN + UMN in 2 sites is probable - LMN + UMN in 1 site is possible - UMN or LMN in 1+ site is suspected - Confirmed by EMG
57
How do you treat MND (4)
- Antiglutaminergic drugs (riluzole) - Nasogastric tube - Mechanical ventilation - Analgesia (NSAIDs and opiates)
58
Describe the pathophysiology of Guillan-Barre syndrome
- Mostly post infection - Thought that the pathogens share antigens with schwann cells - This leads to autoimmune mediated demyelination of PNS neurones causing polyneuropathy
59
How might Guillan-Barre present (4)
- 1-3 weeks post infection acute ascending muscle weakness that may result in paralysis - Proximal muscles affected the most - May be paraesthesiae/pain or no sensory signs - May be autonomic signs eg. raised B.P or sweating
60
What is the treatment for Guillan-Barre syndrome (3)
- Ventilation if respiratory arrest - IV immunoglobulins for 5 days - LMW heparin (enoxaparin)/stockings
61
What is the epidemiology of brain tumours (5)
- Secondary more common - 16th most common in adults - 2nd most common in children - Most common are gliomas - Astrocytomas most common overall
62
How might someone with a brain tumour present (4)
- 4 Cardinal signs 1) Signs of raised ICP - Progressive headache - Drowsiness - Vomiting - Papilloedema 2) Seizures 3) Progressive neurology 4) Lethargy and tiredness
63
How might you diagnose a brain tumour (2)
- CT/MRI | - Biopsy
64
What is the epidemiology of encephalitis (3)
- Mostly viral cause - Mostly seen in elderly and infants - More common in imunocompromised
65
How might encephalitis present (5)
- Triad of headache, fever and altered mental state - Starts with headache/fever/myalgia - Progresses to Dec. consciousness/confusion - Focal neurology - Seizure
66
How do you diagnose encephalitis (3)
- MRI - Inflammation of brain tissue - EEG - Lumbar puncture
67
How do you treat encephalitis
- Anti-virals (aciclovir)
68
What is the epidemiology of shingles (herpes zoster) (3)
- Re-activation of chicken pox virus - Can occur at all ages but mostly seen in elderly - Incidence and severity increases with age
69
How might someone with shingles present
- Pain and paraesthesiae in one dermatome - Painful red rash on one dermatome - May be headache/malaise/myalgia
70
How do you treat shingles
- Anti-virals (aciclovir) x5 daily | - Analgesia for pain eg. NSAIDs
71
How might a median nerve palsy present
- Numbness/parasthesiae of palm, thumb and first two fingers + 1/2 of third - Weakness of thumb (thenar wasting)
72
How might an ulnar nerve palsy present
- Loss of wrist flexion - Can't cross fingers - Loss of sensation on back of hand
73
How might a radial nerve palsy present
- Wrist and finger drop (extension of wrist) | - Loss of sensation of anatomical snuff box
74
How might a CN 3 palsy present
- Ptosis - Down and out eye - Pupil dilation
75
How might a CN 4 palsy present
- Diplopia when looking down (eg. stairs) | - Head tilted to correct
76
How might a CN 5 palsy present
- Sensory loss of face - Jaw deviation to side of lesion - Loss of mastication muscles
77
How might a CN 6 palsy present
- Adducted eye/weakness of abduction
78
How might a CN 7 palsy present
- Facial droop/weakness | - Associated with Bells palsy- caused by HSV, treat with prednisolone
79
How might a CN 8 palsy present
- Vertigo/balance difficulty | - Hearing loss
80
How might a CN 9 palsy present
- Dysphagia | - Palate and tongue sensation impairment
81
How might a CN 10 palsy present
- Uvula deviation away from lesion - Dysphagia - Hoarse/nasal voice
82
How might a CN 11 palsy present
- Diminished SCM/weakness
83
How might a CN 12 palsy present
- Tongue weakness/paralysis | - Deviation towards lesion
84
What is neurofibromatosis
``` Type 1 - Causes tumours to grow on nerves - Cafe au lait spots - Abnormal clusters of freckles Type 2 - Associated with acoustic neuromas ```
85
What is tubular sclerosis
- Predisposes to tumours most often affect the brain, skin, kidneys, heart, eyes and lungs. - epilepsy - learning disabilities - behavioural problems – such as hyperactivity or an autistic spectrum disorder - skin abnormalities – such as patches of light-coloured or thickened skin or red acne-like spots on the face
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