Neurology Conditions Flashcards

(118 cards)

1
Q

What is the common triad of symptoms seen in parkinson patients

A

Bradykinesia
Rigidity
Tremor

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2
Q

Causes of Parkinsonism

A
  1. Parkinsons Disease
  2. Parkinsons plus syndrome
    - Progressive subnuclear palsy
    - Corticobasilar degeneration
    - Lewy body dementia
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3
Q

List the other non neurological causes of parkinsonism

A

Infection

  • Syphilis
  • HIV
  • CJD

Vascular
- Multiple infracts in the substantia nigra

Drugs

  • Antipyschotics
  • Metocloppramide

Genetics
- Wilsons’ s Disease

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4
Q

List the 5 vivid red flags of parkinsonism

A
  • 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)
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5
Q

Pathology of parkinson

A

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

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6
Q

Clinical features of PD

A

TRAPPS PD

  • Tremor ( pin rolling)
  • Rigidity (cog wheel rigidity)
  • Akinesia
  • Postural instability
  • Postural hypotension
  • Sleep disorders
  • Psychosis ( visual hallucinations)
  • Depressions, dementia
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7
Q

Management of parkinson disease

A

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

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8
Q

Side effects of dopamine

A
Dyskinesia
On-off phenomena
Psychosis
ABP ( reduced arterial blood pressure)
Mouth dryness
Insomnia
Naseau and vomiting 
Excessive daytime sleepiness ( EDS)
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9
Q

Define GBS

A

Acute autoimmune demyelinating polyneuropathy (AIDP)

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10
Q

Causes of GBS

A

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

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11
Q

Clinical features of GBS

A

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

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12
Q

Treatment of GBS

A

Iv IgG Immunoglobulins

Supportive care

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13
Q

Types of brain tumours

A
Gliomas
Medullablastomas 
Meningiomas 
Acoustic neuromas 
Neurofibromas 

Secondaries

  • Lung
  • Breast
  • Thyroid
  • Prostate
  • Blood
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14
Q

Discuss the features of the main primary brain tumours

A

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
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15
Q

Clinical features of brain tumours

A
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)
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16
Q

List the different types of gliomas

A

Grade I: Pilocytic astrocytoma
Grade II: Premalignant tumour
Grade III: Anaplastic astrocytoma
Grade IV: Glioblastoma multiforme

All gliomas become GBM

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17
Q

Treatment of brain tumours

A
  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

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18
Q

Causes of spinal cord compression

A
Secondary to malignancy 
Inflammatory (epidural abscess) 
Crush fracture
Spinal cord tumour
Corda equina
Myeloma
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19
Q

Clinical features of cord compression

A

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

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20
Q

Clinical features of cauda equina

A
Back pain 
Radicular pain 
Asymmetrical 
Atrophic
Areflexic paralysis of the back of the legs 
Saddle anasthesia
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21
Q

Management of cauda equina

A

Urgent MRI

Urgent surgical decompression

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22
Q

Clinical features of a tension headache

A
Tight band around head 
Dull pain 
Aggravated by noise 
No nausea or vomiting 
No photophobia
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23
Q

Treatment of a tension headache

A

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

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24
Q

List the clinical features of a migraine

A
Periodic attacks 
Unilateral 
Complete resolution between attacks 
Severe pain, pulsatile
Photophobia 
Nausea and vomiting 

Aura
Visual: scotoma, fortification spectra
Sensory: tingling
Motor: aphasia, hemiplegia

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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
Characteristic features of levy body dementia
Cognitive impairment (fluctuating) Parkinsonism Visual impairment Can also have rapid eye movement sleep disorders and autonomic disturbance