Flashcards in Neuro Deck (116)
What is the pathophysiology of multiple sclerosis
acquired chronic immune mediated inflammatory condition of the CNS.
autoimmune destruction of oligodendrocytes by T cells
gliosis - scarring
neuronal damage leading to cell loss
What are the different types of MS
Describe the course of relapsing remitting MS
symptoms come and go. Periods of good health or remission are followed by sudden symptoms or relapses
Describe the course of secondary progressive MS
the onset of MS is of the RRMS pattern. But, at some point later, the disease course changes and neurological function gradually worsens, with or without continued relapses.
Describe the course of primary progressive MS
from the beginning, symptoms gradually develop and worsen over time
Define a relapse in MS
onset of new or worsening of current symptoms
attributable to demyelinating disease
absence of infection, fever, metabolic disturbance
What are the most common presentations of MS
optic neuritis - partial or total unilateral visual loss, pain on movement, dereased visual acuity, decreased colour sensitivity
transverse myelitis - paresthesia or weakness below level of inflammation
cerebellar problems - ataxia, vertigo, clumsiness, dysmetria
brain stem problems - ataxia, abnormal eye movements, dysphagia
What is Lhermitte’s phenomena
shock like sensation radiating down the spine induced by neck flexion
Give some differentials for MS
low vit B12
What is the key diagnostic investigation in MS
MRI head - periventricular lesions and discrete white matter abnormalities
What is the treatment for a relapse of MS
IV or oral steroids - metyhlprednisolone for 5 days
What is the treatment long term for MS
DMARDs - eg. interferon beta
management of long term problems of fatigue, pain etc
What causes a seizure
neurons synchronously depolarising due to increased excitation or decreased inhibition
What are the main excitatory and inhibitory neurotransmitters in the brain
transient occurrence of signs and symptoms due to abnormal electrical activity in the brain
What is the difference between a partial seizure and a generalised seizure
partial - only part of the brain is affected
generalised - both hemispheres affected
What is the difference between a simple partial seizure and a complex partial seizure
partial - no loss of consciousness, remember what happened
complex - partial or complete loss of consciousness, may not remember it
What is a secondary generalised seizure
started as partial, becomes generalised
What happens in a tonic seizure
become stiff, flexed. fall backwards
What happens in an atonic seizure
become relaxed, complete loss of tone, fall forwards
What happens in a clonic seizure
What happens in a tonic-clonic seizure
increased tone and convulsions
What happens in a myoclonic seizure
short muscle twitches
What happens in an absence seizure
lose and regain consciousness, zones out
What is a Jacksonian march
seizure starts in small area eg hand, then spread to larger eg arm. Can become generalized
What are some of the signs or symptoms of post-ictal period
Drowsiness or amnesia.
Injury, including bites to the sides of the tongue.
Aching limbs or headache.
Focal neurological deficit, that slowly recovers.
What is Todd's paralysis
a focal neurological deficit, most commonly weakness, that occurs after a seizure
fully recovers after 48 hours
How is epilepsy defined
At least two unprovoked seizures occurring more than 24 hours apart.
One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, occurring over the next 10 years.
Diagnosis of an epilepsy syndrome — there are at least 30 different epilepsy syndromes distinguished by their seizure type, age of onset, family history, neurological findings, cerebral imaging (such as CT or MRI scan), electroencephalogram (EEG) pattern, and underlying cause.
What are the causes of epilepsy
fetal hypoxia or trauma
cortical or vascular malformation