Flashcards in Neurology Conditions Deck (118)
1
What is the common triad of symptoms seen in parkinson patients
Bradykinesia
Rigidity
Tremor
2
Causes of Parkinsonism
1. Parkinsons Disease
2. Parkinsons plus syndrome
- Progressive subnuclear palsy
- Corticobasilar degeneration
- Lewy body dementia
3
List the other non neurological causes of parkinsonism
Infection
- Syphilis
- HIV
- CJD
Vascular
- Multiple infracts in the substantia nigra
Drugs
- Antipyschotics
- Metocloppramide
Genetics
- Wilsons' s Disease
4
List the 5 vivid red flags of parkinsonism
- Vertical gaze palsy (progressive supranuclear palsy)
- Impotence + incontinence ( Multiple system atrophy)
-Visual hallunicantions and early dementia ( Lewy body)
-Interferring activity, kinetic rigidity one limb ( Cortical degeneration)
- Diabetic hypertensive patient (Vascular parkinsons)
5
Pathology of parkinson
Zone compact of the substantial nigra
Mitochondrial destruction of the dopaminergic neurones in pars compacta.
Presences of B amyloid plaques
Inclusions of levy bodies
Neurofibrillary tangles ( alpha- synuclein and ubiquitin)
Decrease the stratal dopamine levels
Dopamine helps to coordinate the control muscle activity.
With the loss of dopamine, the striatum fires out excessive unbalanced signals
6
Clinical features of PD
TRAPPS PD
- Tremor ( pin rolling)
- Rigidity (cog wheel rigidity)
- Akinesia
- Postural instability
- Postural hypotension
- Sleep disorders
-Psychosis ( visual hallucinations)
- Depressions, dementia
7
Management of parkinson disease
1) DA (Dopaime agonists): React with dopamine receptors
Rapinirole
Pramipexole
Bromocryptine
2) MOA-B inhibitor: Alternative to dopamine agonist (Blocks the enzyme down that breaks down dopamine)
Selegline
3) L-Dopa: Combined with decarbosxylase inhibitor) Allows it to cross the blood brain barrier.
4) Anticholinergic drugs : Good for tremor, reserved for young people.
Benzhexol
Do not start too early on L-Dopa
Can also use a COMT inhibitor Tacalpone
8
Side effects of dopamine
Dyskinesia
On-off phenomena
Psychosis
ABP ( reduced arterial blood pressure)
Mouth dryness
Insomnia
Naseau and vomiting
Excessive daytime sleepiness ( EDS)
9
Define GBS
Acute autoimmune demyelinating polyneuropathy (AIDP)
10
Causes of GBS
Abs croos react with gangliosides found in the grey matter of the brain
Bacteria: C.Jejuni, Mycoplasma
Viruses: CMV, EBV, HSV, HIV, Flu
Vaccines: Rabies
11
Clinical features of GBS
Growing weakness: Symmetrical ascending flaccid weakness
LMN signs
Proximal muscle weakness
Breathing and bulbar problems
Sensory disturbance
Immune: Anti-ganglioside Abs
Demyelinating nerve conduction studies: slow
12
Treatment of GBS
Iv IgG Immunoglobulins
Supportive care
13
Types of brain tumours
Gliomas
Medullablastomas
Meningiomas
Acoustic neuromas
Neurofibromas
Secondaries
- Lung
-Breast
- Thyroid
- Prostate
- Blood
14
Discuss the features of the main primary brain tumours
GLIOMA
- Malignant tumours of the neuroepithelial origin
- Spread by direct erosion
- Astrocytomas: grow slowly from astrocytes
- Oligodendrogliomas: oligodendrovytes calcification is common
MENINGIOMAS
- Benign tumours from the arachnoid can erode into the skull. Often occur in venous sinuses
NEUROFIBROMAS
- Arises from the schwann cells
- Often occur through venous sinuses
15
Clinical features of brain tumours
Headache ( new, unexplained, worse in the morning)
Nausea and vomiting
New onset seizures
Focal neurological deficit
- Diplopia
- Upper/Lower limb deficits
- Behavioural symptoms
- Papilloedema ( loss of the crisp optic nerve, venous enlargement, retinal oedema, haemorrhage)
16
List the different types of gliomas
Grade I: Pilocytic astrocytoma
Grade II: Premalignant tumour
Grade III: Anaplastic astrocytoma
Grade IV: Glioblastoma multiforme
All gliomas become GBM
17
Treatment of brain tumours
1. Surgery
- Where possible
- To reduce mass effect
2. Radiation
External beam radiotherapy
3. Chemotherapy
Provided moderate benefit
Dexamethasone: rapidly improves improves brain performance
Reduced tumour inflammation/oedema
18
Causes of spinal cord compression
Secondary to malignancy
Inflammatory (epidural abscess)
Crush fracture
Spinal cord tumour
Corda equina
Myeloma
19
Clinical features of cord compression
Spinal/root pain
Arm weakness
Bladder (and anal tone) sphincter involvement
(Hesitancy, frequency , painless retention)
UMN signs above the lesion
LMN sings at the level of the lesion
20
Clinical features of cauda equina
Back pain
Radicular pain
Asymmetrical
Atrophic
Areflexic paralysis of the back of the legs
Saddle anasthesia
21
Management of cauda equina
Urgent MRI
Urgent surgical decompression
22
Clinical features of a tension headache
Tight band around head
Dull pain
Aggravated by noise
No nausea or vomiting
No photophobia
23
Treatment of a tension headache
Episodic <15 days per month
Chronic > 15 days per month
Physical therapies: massage, relaxation therapies
Chronic rx with amitriptyline
Beware of an analgesic induced headache: wean the patient of analgesics
Start on a low does of amitriptyline
24
List the clinical features of a migraine
Periodic attacks
Unilateral
Complete resolution between attacks
Severe pain, pulsatile
Photophobia
Nausea and vomiting
Aura
Visual: scotoma, fortification spectra
Sensory: tingling
Motor: aphasia, hemiplegia
25
List the triggers for migraine
Food (coffee, cheese, chocolate, red wine)
Drink ( alcohol)
Lack of sleep
Too much sleep
Noise
Lights
Stress
26
Management of a migraine
Stop the contraceptive pill
Resolution: dark and sleep
Mild: paracetamol, anti-emetics
Severe: Triptans ( serotonin-agonists)
Propphylaxis: Beta-blockers, amitriptyline
27
Clinical features of a cluster headache
Very painful
Unilateral ( temple, forehead or behind the eye)
Rapid onset
Autonomic
- Ipsilateral lacrimation
- Rinorrhoea
- Facial sweating
- Miosis
Depression
Exhaustion
Anxiety (suicide headache)
Last 45-90 minutes
Occurs once or twice a day
Clusters of a few weeks and then attack free periods
28
Acute and long term management of a cluster headache
Acute:
- 100% inhaled oxygen (15L 15-20 litres)
- IM Sumatriphan
Chronic/Prophylaxis
- Verapamil (CCB)
- Topiramate ( anti-epileptic)
29
Clinical features of a headache of raised ICP
Generalised ache
Aggravated by bending, coughing or straining
Worse in the morning
Wake patients from sleep
A/w
- Vomiting
- Visual obstructions
- Progressive focal neurological signs
- Papilloedema, enlarged blind spots
- Risk of herniation
30
Clinical features of giant cell artheritis
Granulomatous inflammatory disease of the blood vessels
Disease of the elderly
Extreme scalp tenderness
Fever
Anorexia and weight loss due to jaw claudication
Link to polymyalgia rheumatic
Visual disturbance (amaurosis fugax)
Risk of sudden irreversible blindness
31
Treatment of GCA
Ix
Bloods (raised ESR)
Temporal artery biopsy
Management
Acute: oral prednisolone ( very large doses) (60mg)
Aspirin ( reduce visual loss)
32
Branches of the trigeminal nerve
Ophthalmic branch (V1): traverse the lateral wall of the cavernous sinus and enters the orbit
Supplies the corneal reflex
Maxillary branch (V2): Lower lateral wall of the cavernous sinus and exits the skull in the foramen rotunda
Mandibular branch (V3): Motor component, supplies the muscles of mastication
33
Clinical features of trigeminal neuralgia
Electric shock/ shooting pain
Triggered by
- washing face
- shaving
- cold wind
- eating
Unilateral pain
Reactive depressive illness
34
Treatment of trigeminal neuralgia
Carbamazepeine ( Memebrane stabilizer)
Gabapentin ( less effective)
Iamotrigine ( less effective)
Surgical decompression ( microvascular)
35
What is the triad seen in Horners Syndrome
Miosis (constricted pupil)
Ptosis (dropping of the upper eye lid)
Anhydrosis (lack of sweating)
Due to lesions of the sympathetic nervous system of the eye
36
Explain the pathology of Huntingdon's Chorea
Atrophy and neuronal loss of the striatum and the cortex
Loss of the inhibitor NT = GABA ( degeneration of the neurones)
Normal levels of dopamine
37
Clinical features of hungtindons
Presents in middle age
Prodromal Phase
- Depression
- Irritability
- Incoordination
Progression
- Chorea
- Dementia
- Fits
- Death
38
Define MS
A chronic inflammatory condition of the CNS, characterised by multiple plaques of demyelination disseminated in time and space
39
List the different types of MS
1. Relapsing and remitting (80%)
2. Secondary progressive
3. Primary progressive
4. Progressive relapsing
40
Clinical features of MS
Tingling
Eye (Optic neuritis)
Ataxia + cerebellar signs
Motor ( usually spastic paraparesis)
Lhemitters sign: When you flex your neck, you get an electric shock
Uthofers phenomen: Symptoms get worse with heat
41
Investigations of MRI
MRI: Galadenium enhancing to show new lesions due to a compromised blood brain barrier
LP: IgG oligoclonal bands
Abs: Anti-MBP
42
Dx of MS
McDonalds Criteria
- 2+ lesions desimminated in time and space
43
Management of MS
Acute Attacks: Methlyprednisolone (500mg), reduce duration and severity of the attacks
Preventing relapses
1) DMARDs
- IFN-B
- Glatirmer
2) Biological
- Natalizumab
- Alemtuzamab (destroys lymphocytes)
Spasticity
- Physio
- Baclofen (GABA analogue)
- Dantrolene ( muscle relaxant)
Bladder
- Botox injections
44
Pathology of MG
Autoimmune disorder
Anti-AChR blocker the Ach receptor
Insufficient ACh receptors in the NMJ = no muscular contractions
45
Clinical features of MG
Eye signs
- Ptosis
- Diplopia
- Peek sign
Swallowing + speech difficulties ( voice weakness)
Muscles of the face (open mouth, losing head)
Painless, normal tendon reflexes
Strong association with thyoma ( do a thymus CT)
46
Treatment of MG
Anti cholinesterase inhibitor: Pyridostigmine
Rx relapse with prednisolone
Thymectomy
47
Causes and treatment of a myasthenia crisis
Causes
- Infection
- Post surgery
- Drug induced ( B-BLockers)
- Phenytonin
Management
- Resp failure ( intubate and ventilate)
- Plasmapheresis
- IV Ig
48
Define MND
Neurodegenerative disease
Selective loss of neurones in motor cortex, cranial nerve nuclei and anterior horn cells
NO SENSORY LOSS OR SPHINCTER DISTURBANCE
49
Clinical features of MND
UMN signs
- Spasticity
- Reflexes
- Upgoing plantars
LMN signs
- Wasting
- Fasciculation of tongue, ado, thigh
Speech and swallowing impairment
Fronto-temporal dementia
50
Dx of MND
DX of exclusions
MRI: exclude structural causes
LP: exclude inflammatory causes
EMG: denervation, exclude neuropathies
51
List the types of MND
Amyotrophic Lateral Sclerosis
- involvement of both upper and lower motor neurones
- Muscle weakness
- Wasting
- Brisk reflexes
- Extensor plantar response
- Spasticity
Progressive muscular atrophy
- Lower motor neurones
- Weakness and wasting of the distal muscles
- Fasciculations
- Absent reflexes
Progressive bulbar palsy (LMN)
- Weakenss of tongue, palate, pharyngeal muscles
- Dysphagia
Primary lateral sclerosis
- Only UMN
- Spastic leg weakness
52
Treatment of MND
No cure
Will die by 3yrs ( most of them)
Riluzole (increase life expectancy by 3 months)
Non-invasive ventilation
Baclofen (for spasticity)
Buscopan ( for secretions)
Common cause of death
Aspiration pneumonia
53
Causes of a subarachnoid haemorrhage
Rupture of Berry aneurysm
- Associated with ADPKD, Marfans, Ehlers Danlos)
54
Clinical features of a subarachnoid haemorrhage
Thunderclap headache
Kerning's sign +ve
- Flexion of the hip and the knee causes pain
Meningism
Retinal haemorrhage
55
Investigations and treatment of a subarachnoid haemorrhage
CT
- Acute blood will be hyper dense and bright on scan
- looks like a STAR MAN
ECG
- Deep T wave inversion
Rx
- Endovascular coiling
- Nimodipine (Ca2+ antagonist) to reduce vasospasm
56
Clinical features of subdural haemorrhage
Headache
Drowsiness
Confusion (can fluctuate)
Chronic subdural can be a cause of confusion in the elderly
57
Cause of subdural haemorrhage
Bleeding from the bridging veins of the cortex and the sinus
Risk factors
- Age
- Alcohol
- Anticoagulants
58
Investigations and management of a subdural haemorrhage
CT scan
- Crescentic clot with midline shift
Mx
- Burr hole craniotomy
If left untreated = tentorial herniation
59
Causes of extradural haemorrhage
Skull fractures ( temporal or parietal bone)
Middle meningeal artery tear
60
Clinical features of extradural haemorrhage
Lucid period
Detonation of GCS after head injury causing no or brief LOC
Rapid increase in ICP
- Headache
- Nausea and vomiting
- Seizures
- Confusion
- Brisk reflexes
- Ipsilateral pupil dilates
- Deep irregular breathing (brainstem compression)
61
investigations and management of an extradural haemorrhage
CT scan
- Bi convex
- Well demarcated lesion of hyper density
Mx
- Urgent neurosurgery
- Clot evacuation
- Vessel ligation
62
Define a TIA
Brief episode of neurological dysfunction due to temporary focal cerebral or retinal iscahemia without infractions
Last second - minutes with complete recovery
63
Causes and risk factors of TIA
Micro emboli from
- Atheromatous plaques
- Cardiac mural thrombi
- AF
Risk factors
- Hypertension
- Smoking
- DM
- Peripheral artery disease
- Carotid artery occlusion
64
Rx of TIA
Rx
- Aspirin ( 300mg)
- Start on warfarin if in AF
- Carotid endarterectomy if >70% stenosis
Secondary prevention
- Statins
- Antihypertensives
- Lifestyle factors
65
How to calculate the level of risk of stroke following a TIA
ABCD2 score
- Age >60
- BP >140/90
- Clinical features ( unilateral weakness, isolated speech disturbance)
- Duration
- Diabetes
<3 points = see a specialist in 1 week
>4 = see a specialist in 24hrs
66
Rules involving a TIA and driving
One month off driving if one TIA
Three months off driving if multiple
67
Define a stroke
Rapid osent, focal neurological deficit due to a vascular lesion lasting more than 24hrs
Due to infarction or bleeding into a part of the brain
68
Clinical features of a total anterior stroke (TACS)
All three of
- Hemiparesis ( contralateral) and sensort deficit
- Homonymous hemianopia
- Higher cortical dysfunction
(Dominant lobe: Broccas Non dominant: hemiparietal neglect)
Blood supply
- Carotid
- MCA
- ACA
69
Clinical features of a Partial anterior circulation stroke
infarct in the carotid/MCA/ACA territory
Two of the following
- Hemiparesis ( contralateral) and/or sensory deficit
- Higher cortical dysfunction
- Higher cortical dysfunction
(Dominant lobe: Broccas Non dominant: hemiparietal neglect)
70
Clinical features of lacunar syndrome
Small infarcts around the basal ganglia
One of the following
- Purely sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic stroke
71
Clinical features of a posteoir circulation stroke
Infarct in the veterobasilar territory
One of
- Cranial nerve palsy (contralateral motor/sensory defect)
- Conjugate eye movement palsy
- Cerebellar dysfunction
- Isolated homonymous hemianopia or cortical blindness.
72
Treatment of stroke
Ix
- CT to exclude haemorrhage
- MRI
- Carotid doppler
- Blood
Rx
- Thrombolysis for ischaemic stroke
- Alteplase <4.5hrs
- Aspirin 300mg switch to clopidogrel)
- Haemorrhagic stroke:
Control bleeding
Stop anticoagulants ( if on warfarin give beriplex)
May need neurosurgery intervention to receive pressure
Coil bleeding aneurysms
NOTE
1. Ischaemic stroke
- Carotid bruits
- AF
- Previous TIA
- Ischaemic heart disease
2. Haemorrhagic stroke
- Meningism
- Severe headache
- Coma
- Drowsiness
- Reduced GCS
- Vomiting
- Focal deficit
73
Define epilepsy
Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, that manifests as a seizure
74
Causes of epileptic seizures
Congenital
- NF
- TORCH
Acquired
- Vascular ( CVA)
- Cortical scarring
- SOL
Provoked seizures
- Withdrawal ( alcohol/ opiates/benzos)
- Metabolic
- Increase in ICP
- Infection
- Eclampsia
75
Types of seizures
Tonic-clonic
- Body stiffens
- Repetitive jerking
Absence
- Short
- Appears spaced out
Myoclonic
- Sporadic jerking movements of limbs
Clonic
- Repetitive jerking movements
Atonic
- Loss of muscle tone
Partal seizure (5 A's)
- Aura
- Autonomic ( change in temp, skin, pals)
- Awareness lost ( motor arrest)
- Automatism ( lip smacking, chewing)
- Amnesia
76
Treatment of epilepsy
Tonic-clonic
- Sodium valproate
- Iamotrigine
- Carbamezepeine
- Topiramate
- Phenytonin
Absence
- Sodium valproate
- Iamotrigine
Partial
- Iamotrigine
- Cabamazepeine
- Sodium valproate
- Phenytonin
***Pregnancy: Iamotrigine
77
List the side effects of the following anti epileptics
1. Sodium valproate
2. Iamotrigine
3. Carbamazepeiene
4. Levatiracetram
Sodium Valproate
- Teratogenic
- Hepatotoxic
- Increases appetite
- Ataxia
- Encephalopathy
Lamotrigine
- Rash ( hypersensitivity)
- Nausea
- Dizziness
- Ataxia
Carbamazepeine
- aplastic anaemia
- Hyponatraemia
- Hepatic enzyme inducer
- Leukopenia
- Diplopia
- Blurred vision
- Impaired balance
- Drowsiness
Levatiracetram
- well tolerated
- Anxiety
- Instability
- Depression
- Suicidal ideation
Phenytonin
- Cerebellar syndrome due to overdose
- Has a very narrow therapeutic window
78
Define a non epileptic seizure
Paroxysmal event, changes in behaviour, sensation and cognitive function, caused by mental processes associated with psycosocial distress
Features
- Situational
- 1-20 minutes
- Dramatic motor phenomena or prolonged ataxia
- Eyes closed
- Ictal crying/ speaking
79
Define status epilepticus
Seizures lasting > 30 minutes or repeated seizures w/o intervening consciousness
80
Management of states epileptics
Wide IV access
Bloods ( FBC, ABG, U&E's, Ca2+)
BM
Rectal diazepam/buccal midazolam (wait five minutes)
IV lorazpam
Phenytonin (IV) ECG monitoring
Phenobarbital
81
What is the cause of nursemaids elbow and in who is it most common
Sublaxation of radial head
Common in children
Caused by a sudden outward pull
82
What is the CSF profile seen in
a. viral meningitis
b. bacterial meningitis
VIRAL
- normal opening pressure
- normal protein
- normal glucose
- lymphocyte predominant
BACTERIAL
- increased opening pressure
- high protein
- low glucose
- neutrophil predominant
83
Discuss the pathophysiology of Lambert Eaton syndrome
Antibodies ( anti-P/Q) against voltage-gated calcium channels in presynaptic membrane.
84
What is the triad seen in normal pressure hydrocephalus
Gait dysparexia
Fluctuating confusion
Urinary incontinience
Note: no papilloedema
85
Causes of normal pressure hydrocephalus
Subarachnoid haemorrhage
Meningitis
Head injury
CNS tumour
86
Treatment of normal pressure hydrocephalus
Medical
- Serial lumbar punctures
- carbonic anhydrase inhibitors (acetazolamide)
- Not advisable for a long period of time
Surgery
- Insertion of a CSF shunt
87
Emergency treatment of raised ICP
ABC
Rx seizures ( as per status epileptics)
Correct HTN
Elevate the bed to 40o
Neuroprotective ventilation
- PaO2> 13kPa
- PCO2> 4.5kPa
- Good sedation
Give mannitol ( osmotic diuretic)/ hypertonic salaine
Mannitol give 1g/kg
88
Emergency treatment of myoxedema coma
Pt looks HYPOTHYROID
Bloods ( TFT's, FBC, U&Es, glucose)
Give T3/T4 infusion slowly IV
Hydrocortisone (100mg IV)
89
Emergency management of thrombolic stroke
CT head to confirm thrombotic stroke
If within 4.5 hrs = thrombolysis with altepase
<6 hrs thrombectomy ( neurosurgery input)
All patients give Aspirin 300mg
Give aspirin for two weeks and then switch to clopidogrel
90
Contraindications for thrombolysis
Convulsion accompanying stroke
History of stroke in patients with diabetes
Hyperglycaemia
Hypoglycaemia
Severe stroke
Stroke in last 3 months
91
Contrindications for all fibrinolytics
Active pulmonary disease with cavitation
Acute pancreatitis
Aneurysm
Aortic dissection
Bacterial endocarditis
Bleeding diatheses
Coagulation defects
Coma
Heavy vaginal bleeding
History of cerebrovascular disease (especially recent Events or with any residual disability)
Oesophageal varices
Pericarditis
Recent haemorrhage
Recent surgery (including dental extraction)
Recent symptoms of possible peptic ulceration
Recent trauma
Severe hypertension
92
Causes of a brain abscess
Bacteria
- Staphaureus
- Streptococcus
- Bacteroides
Fungi
- Aspergilles
- Candidia
- Cryptococcus
93
Clinical features of a brain abscess
Fever
Focal motor and sensory deficit
Papilloedema
Ataxia
Confusion
94
Management of a brain abscess
Intracranial drainage
Empirical antibiotic therapy started ( third generation cephalosporin)
Pus sent for cultures and abs adjusted accordingly.
95
Define cataplexy
Sudden loss of muscle tone or power in response to a strong emotion.
It always and only occurs as part of nacrolepsy
96
Clinical features of nacrolepsy
TETRAD
- Excessive daytime sleepiness (KEY)
- Cataplexy (KEY)
- Sleep paralysis
- Hynagonic hallucinations
97
Define encephalitis
Inflammation of the brain parenchyma in association with clinical evidence of neurological dysfunction
NOTE
Encephalopathy: disruption of brain function in the absence of a direct inflammatory process
98
Causes of encephalitis
Viral
- HSV
- CMV
- EBV
Non-viral
- Any bacterial meningitis
- TB
- Malaria
- Lyme disease
99
Clinical features of encephalitis
Infectious prodrome: fever, rash, LNs, cold sores
Personality change
Confusion
Decreased GCS
Feer
Headache
Seizures
100
Management of encephalitis
Aciclovir ( STAT): 10mg/kg/8h
Supportive measures
Phenytonin for seizures
101
Define Horner's syndrome
Interruption of the sympathetic pathway
- Unilateral miosis
- ptosis
- anhidrosis
102
Define anterior cord syndrome
Direct anterior cord compression
Leads to variable paralysis below the lesion of the cord with the loss of pain and temperature.
Dorsal columns are mainly persevered
Poor prognosis
103
Clinical features of cerebellar dysfunction
Ataxia of the limbs
Dysarthia
Nystagmus
Dysdiadochokinesis
Pendular reflexes
104
Causes of cerebellar dysfunction
Vascular
- Stroke
Infections
- Post infection
Toxins
- Alcohol
- Anticonvuslants
Metabolic
- Myxodema
Trauma
Neurodegenerative conditions
- Multiple system atrophy (MSA)
Inherited cerebellar ataxia
- Friedreich ataxias
105
Differential diagnosis of epilepsy
Non-epileptic seizures
Syncope
Vasovagal
Cardiogenic
Migraine
Vertigo
Hypoglycaemia
Drugs
Alcohol
106
Upper Motor Neurons
Lesion on the brain and spinal cord
Signs on the OPPOSITE SIDE of the lesion
Causes
- Stroke
- Tumour
- MS
- MND
Clinical features
Hypertonia,
Spasticity (clasp knife),
hyperreflexia,
Extensor plantar response,
Pronator drift
107
Lower Motor Neurons
Signs on the same side as the lesion
Fasciculation,
Muscle wasting,
Hypotonia,
Loss of tendon reflexes
Flaccid
108
What is Bell's palsy
Left facial nerve palsy due to a lower motor neurone lesion causing hemifacial palsy
No forehead sparing
109
Causes of Bell's palsy
Idiopathic
Parotid infiltration
Pontine tumours
Herpes zoster
110
Treatment of Bell's palsy
High dose steriods
Acyclovir if due to herpes zoster
111
Explain afferent and efferent pupillary light reflex
Afferent: Light is detected on retina and transmitted via optic nerve (CN2) to lateral geniculate body then to midbrain
Efferent: Edinger- Westphal nucleus (midbrain)- pupillary constriction mediated by parasympathetic fibres of occulomotor nerve (CN3)
112
List causes of afferent pupillary light reflex
The pupil won’t respond to light but constricts to a beam in the other eye (consensual response) causes- optic neuritis, optic atrophy, retinal disease
113
List the causes of efferent eye defects
Pupil doesn’t react to light- complete 3rd nerve palsy (ptosis, fixed dilated pupil, eye deviated down and out). Causes- cavernous sinus lesions, diabetes, coning
114
Risk factors for venous sinus thrombosis
Pregnancy
Malignancy
COCP
Antiphospholipid syndrome
115
Clinical features of a venous sinus thrombosis
Headache
Fever
Papilloedema
Epilepsy
Vomiting
Visual disturbance
116
Investigation and treatment of venous sinus thrombosis
Ix: CT venogram ( empty delta sign)
Rx: Anticoagulate with heparin, followed by warfarin
117
List the primary and secondary prevention of stroke
PRIAMRY
- Control risk factor ( HTN, DM)
- Consider lifelong anticoagulation in AF
- Carotid endarectomy ( if severe)
- Exercise
SECONDARY
- Statin
- Aspirin ( stepwise)
- Carotid endartectomy
118