Neurology Notes 3

Motor weakness.

Pure motor, pure sensory, mixed motor and sensory signs, or ataxia.

Decrease in the level of consciousness, seen in up to 50% of hemorrhagic stroke patients.

Headache.

Basal ganglia, thalamus, and internal capsule.

The brain moves within the skull, interfering with electrical signals.

The Oxford Stroke Classification (Bamford Classification).

Ventriculoperitoneal shunting.

A type of stroke that primarily affects sensory functions without motor impairment.

A syndrome involving impairment of multiple higher cortical functions, such as memory, thinking, orientation, comprehension, and language.

Alzheimer's disease, followed by vascular and Lewy body dementia.

Pseudotumour cerebri.

Problems with visual or speech disturbance, balance, muscle power, and paraesthesia.

Up to 25%.

Computed tomographic angiography (CTA) or magnetic resonance angiography (MRA).

Memantine, an NMDA receptor antagonist.

A speech problem.

To classify strokes based on initial symptoms.

1. Unilateral hemiparesis and/or hemisensory loss of the face, arm & leg; 2. Homonymous hemianopia; 3. Higher cognitive dysfunction (e.g., dysphasia).

Approximately 15%.

A brief period of neurological deficit due to a vascular cause, typically lasting less than an hour.

A score of 24 or less out of 30.

Clear fluid leaking from the ear or nose, periorbital haematoma, bleeding from ears, and Battle's sign.

Headache, nausea, blurred vision, memory loss, cognitive impairment.

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

MRI, including diffusion-weighted and blood-sensitive sequences.

'Mini-stroke'.

Confirmed occlusion of the proximal anterior circulation and potential to salvage brain tissue.

The impact on daily activities, school, sports, work, driving, and relationships, as well as how carers are coping.

Symptoms develop rapidly.

Swallowing problems.

Grey and white matter changes.

Falling from height.

10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT), and the mini-mental state examination (MMSE).

Young, overweight females.

Acetylcholinesterase inhibitors: donepezil, galantamine, and rivastigmine.

Obesity, female sex, pregnancy, and certain drugs.

1. Unilateral hemiparesis and/or hemisensory loss of the face, arm & leg; 2. Homonymous hemianopia; 3. Higher cognitive dysfunction (e.g., dysphasia).

Blurred vision and enlarged blind spot.

A collection of blood deep between the Dura mater and arachnoid matter of the brain.

Frontotemporal dementia (Pick's disease), Progressive non-fluent aphasia, and Semantic dementia.

Perforating arteries around the internal capsule, thalamus, and basal ganglia.

The blood is not within the substance of the brain.

Alzheimer's disease.

It inhibits carbonic anhydrase and may cause weight loss.

Unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all three.

Face, Arms, Speech, Time.

Balance problems.

Pupil size and reactivity.

Nausea and vomiting.

Continue the current dose of aspirin until reviewed by a specialist.

A sudden onset of a focal neurologic symptom lasting less than 24 hours due to a transient decrease in blood flow.

Approximately 25%.

The NINDS - AIREN criteria.

Involves smaller arteries of anterior circulation with 2 of the 3 criteria present.

Basic and advanced adult or paediatric trauma life support protocols.

Approximately 15%.

A sudden interruption in the vascular supply of the brain.

Damage to the smallest blood vessels in the brain.

NICE does not recommend antidepressants for mild to moderate depression in dementia patients.

Common peroneal nerve lesion.

Cognitive stimulation programs, multisensory stimulation, music and art therapy, and animal-assisted therapy.

Only for patients at risk of harming themselves or others, or when severe distress is caused by agitation, hallucinations, or delusions.

Ataxia (limb, truncal).

Spinothalamic tract.

Around 10%.

Sensory loss.

Small infarcts around the basal ganglia, internal capsule, thalamus, and pons.

Homonymous hemianopia.

Strokes that present with isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia.

78%.

Hypertension.

Call 999.

Road traffic accidents and sports-related accidents.

Focal neurological abnormalities, gait disturbance, difficulty with attention and concentration, seizures, memory disturbance, speech disturbance, and emotional disturbance.

To assess stroke risk in medical professionals.

Areas of hyperdense material (blood) surrounded by low density (oedema).

Through a comprehensive history and physical examination, formal screening for cognitive impairment, medical review to exclude medication causes, and MRI scans.

The third most common type of cortical dementia after Alzheimer's and Lewy body dementia.

Management with the specialist team.

Changes in grey and white matter density.

Ipsilateral signs.

As soon as possible for people last known to be well between 6 hours and 24 hours previously.

Being slow to get up after hitting their head.

FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12, and folate levels.

Symptomatic treatment to address individual problems and provide support to patients and carers.

Release of chemicals that interfere with normal brain function.

Seizures, infection, and intracerebral hemorrhages.

A condition characterized by weakness on one side of the body accompanied by coordination problems.

An injury to the brain due to head trauma.

It corresponds with the responsible arterial clot.

It tends to be visible immediately.

Middle and anterior cerebral arteries.

A progressive neurodegenerative disease affecting motor neurons.

A blood screen.

Progressive atrophy of the frontal and/or temporal lobes, leading to impairments in behavior, personality, language, and motor functions.

Clopidogrel.

Approximately 25%.

Neuroimaging.

Sudden onset focal neurological deficit that resolves, typically within 1 hour.

To reduce non-HDL cholesterol by more than 40%.

Hemispheres, brain stem, cerebellar, spinal cord, neuromuscular junction, and muscles.

Less than 15 on initial assessment.

If the patient has suffered a stroke or TIA in the carotid territory and is not severely disabled.

Increasing age, Caucasian ethnicity, Down's syndrome, family history of Alzheimer's, and 5% of cases inherited as an autosomal dominant trait.

Repeated lumbar puncture.

Addressing risk factors to prevent recurrent strokes.

A build-up of amyloid protein deposits around brain cells and tau protein tangles within brain cells.

Aspirin 300mg for 2 weeks.

Stroke-related VD, subcortical VD, and mixed dementia.

Intention tremor.

Arrange assessment within 24 hours by a specialist stroke physician.

Lateral hemisection of the spinal cord.

Patients have fluent but empty speech that conveys little meaning, with better memory for recent rather than remote events.

Ipsilateral weakness below the lesion, ipsilateral loss of proprioception and vibration sensation, and contralateral loss of pain and temperature sensation.

Optic nerve sheath decompression and fenestration.

Exclude hypoglycaemia.

Possible cervical spine injury.

A non-contrast CT head scan.

Papilloedema.

Aspirin + dipyridamole.

Physical rest, adequate sleep, and mental rest, avoiding reading or screens.

Middle and anterior cerebral arteries.

Only for patients at risk of harming themselves or others, or when agitation, hallucinations, or delusions cause severe distress.

Whether it is an ischaemic stroke or a haemorrhagic stroke.

Physical, occupational, and speech therapy.

Clopidogrel is recommended ahead of aspirin plus modified-release dipyridamole.

Symptoms of anxiety, low mood, flashbacks, and nightmares.

70%.

Intranuclear ophthalmoplegia.

Symptoms usually resolve within 4 weeks.

For imaging to exclude a haemorrhage.

Prolonged confinement, recent weight loss, Baker's cysts, and plaster casts to the lower leg.

High-impact trauma.

Cortical plaques due to type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by tau protein aggregation.

Patients should be commenced on a statin.

NCS measures the electrical conduction in nerves, while EMG assesses the electrical activity of muscles.

Hypotonia.

Ipsilateral CN III palsy and contralateral weakness.

Friedreich's ataxia, neoplastic conditions, multiple sclerosis, alcohol, stroke, hypothyroidism, and certain drugs.

Contralateral hemiplegia, contralateral sensory loss, homonymous hemianopia, dysphasia.

A reversible cause of dementia seen in elderly patients.

Conservatively, with the hope that they will dissolve with time.

It is associated with worse long-term outcomes.

Cautious clinical and radiological observation.

Unsteadiness, confusion, falling over, and ataxia.

Drowsiness, worsening headache, weakness or tingling in limbs, vomiting, amnesia, and collapse/seizures.

For moderate Alzheimer's who are intolerant to acetylcholinesterase inhibitors, as an add-on for moderate or severe Alzheimer's, or as monotherapy in severe Alzheimer's.

A progressive degenerative disease of the brain.

Weight loss, carbonic anhydrase inhibitors, and medications like topiramate.

On the same day as the specialist assessment, if possible.

Dysdiadochokinesia and Dysmetria.

Unilateral weakness or sensory loss, aphasia or dysarthria, ataxia, vertigo, loss of balance, and visual problems.

Most patients' symptoms will have resolved.

L5 radiculopathy, sciatic nerve lesion, superficial or deep peroneal nerve lesion, central nerve lesions (e.g., stroke).

Sudden transient loss of vision in one eye.

The second most common form of dementia, caused by impaired blood flow to the brain due to vascular damage.

A blood vessel 'bursts' leading to a reduction in blood flow.

Spherical aggregations of tau protein that are silver-staining.

If the patient has suffered stroke or TIA in the carotid territory and has carotid stenosis > 70% according to ECST criteria or > 50% according to NASCET criteria.

Death, intracranial lesions, skull fractures, seizures, hypopituitarism, depression, PTSD, and cognitive impairment.

Discuss the need for admission or observation urgently with a stroke specialist.

A type of ischaemic stroke caused by thrombosis from large vessels, e.g., carotid.

With several months or years of sudden or stepwise deterioration of cognitive function.

L5 radiculopathy.

The thin skull at the pterion overlies the middle meningeal artery, making it susceptible to injury.

Crescentic in shape, not restricted by suture lines, and compress the brain ('mass effect').

Initially loses, briefly regains, and then loses consciousness after a low-impact head injury.

They are hypodense (dark) compared to the substance of the brain.

The brief regain in consciousness that is lost due to the expanding haematoma.

Ischaemic or haemorrhagic stroke (including brainstem strokes).

Urinary incontinence, dementia and bradyphrenia, and gait abnormality.

If the patient is on anticoagulants, has a bleeding disorder, or unless there is clinical suspicion of an alternative diagnosis.

Full cervical spine immobilization.

They should be stopped to minimize further bleeding.

Approximately 25%.

Symptoms lasting more than a couple of weeks after a concussion.

Acute, Subacute, and Chronic.

Stroke, encephalitis, and temporal seizures.

Shock, loss of consciousness, post-traumatic seizure, amnesia, persistent headache, vomiting, and suspected fractures.

Immediate antithrombotic therapy, specifically aspirin 300 mg.

1. Cerebellar or brainstem syndromes, 2. Loss of consciousness, 3. Isolated homonymous hemianopia.

A disturbance of normal brain function due to head injury.

If the patient has a bleeding disorder or is taking an anticoagulant.

Rupture of small bridging veins within the subdural space resulting in slow bleeding.

Non-fluent speech with short, agrammatic utterances.

MRI, CT scanning, Nerve conduction studies (NCS), and electromyography (EMG).

To assess the level of consciousness in individuals with head injuries.

Limb sensory loss.

Comprehensive history, examination of consciousness, vital signs, and signs of visible trauma.

Refer for specialist assessment as soon as possible within 7 days.

Stroke symptoms onset within 4.5 hours, haemorrhage excluded, and no previous intracranial haemorrhage.

To assess electrical activity in the brain, with specific indications and limitations.

An exciting new treatment option for acute ischaemic stroke, offered as soon as possible within 6 hours of symptom onset.

Maintain blood pressure at <140/80 mm Hg.

The uncus of the temporal lobe herniates, leading to a fixed and dilated pupil due to compression of the third cranial nerve.

Decussates in the medulla and travels down to the cord on the ipsilateral side.

Weakness of the foot dorsiflexors.

To slow down the progression of the disease.

Onset before 65, insidious onset, personality change, social conduct problems, and relatively preserved memory and visuospatial skills.

Ischaemic and Haemorrhagic.

Unless there are complications such as hypertensive encephalopathy.

To check for atherosclerosis in the carotid artery, which may be a source of emboli.

More than 1 point.

Atrophy of the frontal and temporal lobes.

Only if clopidogrel is contraindicated or not tolerated.

Any issues with alcohol and drug misuse, and offer support as needed.

Discuss the need for admission or observation urgently with a stroke specialist.

Widespread cerebral atrophy, particularly involving the cortex and hippocampus.

A collection of blood between the skull's inner surface and the dura mater.

1. Unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all three; 2. Pure sensory stroke; 3. Ataxic hemiparesis.

In the anterior horn cell, motor nerve roots, and peripheral motor nerves.

Contralateral homonymous hemianopia with macular sparing and visual agnosia.

No fasciculations and no significant wasting (some disuse atrophy).

Lateral medullary syndrome (Wallenberg syndrome).

Decreased (hypotonia, flaccid) or normal.

Neurosurgical evaluation, admission to neuro ICU or stroke unit, and blood pressure control.

Age, smoking, hypertension, hyperlipidaemia, and diabetes mellitus.

Group cognitive stimulation therapy.

Lumbar puncture.

Weird (dementia), Wet (urinary incontinence), and Wobbly (abnormal gait).

Blood glucose, hydration, oxygen saturation, and temperature.

Thrombectomy together with intravenous thrombolysis.

To gradually return to normal activities and maintain a regular schedule of activity and sleep.

Personality change, impaired social conduct, disinhibition, hyperorality, increased appetite, and perseveration behaviors.

Vertebrobasilar arteries.

Any trauma to the head other than superficial injuries to the face.

AChE inhibitors or memantine, but only if there is suspected comorbid Alzheimer's disease, Parkinson's disease dementia, or dementia with Lewy bodies.

A collection of blood within the subdural space that has been present for weeks to months.

Diplopia and homonymous hemianopia.

Perforating arteries around the internal capsule, thalamus, and basal ganglia.

85%.

Contralateral hemiparesis and sensory loss, upper extremity > lower, contralateral homonymous hemianopia, and aphasia.

Elderly and alcoholic patients due to brain atrophy and fragile bridging veins.

Almost always caused by trauma, typically low-impact trauma like a blow to the head or a fall.

The '4As': Amnesia, Agnosia, Aphasia, and Apraxia.

Thrombolysis with alteplase should be offered if the stroke is ischaemic and certain criteria are met.

CTA, MRA, CTV, MRV, and angiography catheter studies.

A subtype of ischaemic stroke with sudden onset of focal neurologic symptoms lasting less than an hour.

At the level of entry in the anterior commissure.

Amiodarone, metronidazole, isoniazid, nitrofurantoin, and vincristine.

2 to 3 months.

Surgical decompression with burr holes.

Right-sided weakness, right-sided loss of vibration/proprioception, and left-sided loss of pain and temperature.

2 of the above criteria.

'Blockage' in the blood vessel stops blood flow.

Urgent neuroimaging to classify the stroke as ischaemic or haemorrhagic.

Give aspirin 300 mg immediately.

Certain positions such as leg crossing, squatting, or kneeling.

Subacute (within 3 days to 3 weeks) and chronic (>3 weeks).

Wallenberg's syndrome.

In the cerebral hemispheres, cerebellum, brainstem, and spinal cord.

History of stroke or TIA, atrial fibrillation, smoking, hypertension, hyperlipidaemia, diabetes mellitus, obesity, coronary heart disease, and family history of stroke or cardiovascular issues.

Weakness of foot dorsiflexion and eversion with normal reflexes.

CT imaging.

Progressive history of increasing confusion, reduced consciousness, and worsening neurological deficit.

They do not recommend their use.

Recent memories are lost first.

Ipsilateral facial paralysis and deafness, ataxia, and nystagmus.

Conservative management, avoiding leg crossing, squatting, and kneeling.

Acetylcholine receptor antibodies for myasthenia gravis, CK for myositis, and autoimmune antibodies screen for autoimmune encephalitis.

Reduced CSF absorption at the arachnoid villi, possibly secondary to head injury, subarachnoid hemorrhage, or meningitis.

Peripheral nerve trauma/compression, spinal muscular atrophy, and amyotrophic lateral sclerosis.

Over a few months.

Headache, nausea or vomiting, confusion/reduced consciousness, focal neurological signs, and diminished eye, verbal, or motor response.

Approximately 25%.

Nystagmus (horizontal = ipsilateral hemisphere).

Contralateral hemiparesis and sensory loss, with lower extremity > upper.

Ataxia.

Not until brain imaging has excluded haemorrhage, usually not until 14 days have passed.

Ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy (e.g., Horner's syndrome).

Slurred staccato speech and scanning dysarthria.

Arrange urgent assessment by a specialist stroke physician within 24 hours.

Usually caused by a blood clot, fat, air, or clumps of bacteria acting as an embolus.

Mass effect, midline shift, or herniation.

Bilateral symptoms, fasciculations, or other abnormal neurological findings (e.g., hyperreflexia).

Decompressive craniectomy.

Exaggerated or brisk (hyperreflexia).

Quadriplegia and lock-in syndrome.

Atrial fibrillation.

As a biconvex (or lentiform), hyperdense collection around the surface of the brain, limited by the suture lines of the skull.

Hydrocephalus with ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement.

Lumboperitoneal or ventriculoperitoneal shunt.

Offering a range of activities to promote well-being tailored to the person's preference.

'Locked-in' syndrome.

Dorsal column.

In the medulla.

Around 60%.

Craniotomy and evacuation of the haematoma.