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Neurology (Nerves (Multiple Sclerosis (Pathophysiology: Autoimmune attack…

- - - - More common than type 2; Gene found on chromosome 17 and codes for neurofibromas a tumour suppressor protein; Autosomal dominant
      - Sx: Café au lait spots, axillary/inguinal freckles, lish nodules (iris hamartomas), neurofibromas, glioma of the optic nerve
      - Rx: Monitor disease and try and prevent complications
    - - Found on chromosome 22 ; Codes for merlins protein, a tumour suppressor protein in Schwann cells leading to the development of Schwannomas
      - Sx: Associated with acoustic neuromas, tumours can also develop in the brain and spinal cord
      - Rx: Can have surgery to remove the tumours but risk permanent nerve damage
- - - - Ischaemic (80%): Atheroma, emboli (cardiac - AF, IE, valves, MI)
      - Haemorrhagic (20%): 1) Hypertensive arteriopathy (deep), Cerebral Amyloid Angiopathy (lobar); 2) Vascular malformations (aneurysms, AV mal) tumour, trauma, anticoagulant, thrombolysis
      - Both cause hypoperfusion and infarction
    - - Contralateral sensory loss (parietal)
      - Contralateral hemiplegia (frontal)
      - Flaccid --> spastic (UMN)
      - Homonymous hemianopia (occipital)
      - Hemi-spatial neglect (parietal) - one side is ignored rather than not seen/heard/felt
      - Dysphasia (Broca’s frontal + Wernicke’s temporal) - dominant
    - - Quadriplegia
      - Disturbance of gaze and vision
      - Locked-in syndrome
    - - Ataxic hemiparesis
      - Pure motor
      - Pure sensory
      - Sensorimotor
      - Dysarthria/clumsy hand
      - Cognition/conscioussnes are intact except in thalamic stroke
      - Caused by ischaemia in basal ganglia, int. capsule, thalamus, pons
    - - Urgent Imaging - to rule out haemorrhage
      - Thrombolysis with IV Alteplase if <4.5 hours since onset
      - Aspiring 300mg 2 weeks --> Clopidogrel 75 mg
      - BP: In Ischaemic stroke do not lower BP acutely; In haemorrhage stroke do lower BP if >150
      - If haemorrhage urgent neurosurgery review
  - - - Spontaneous bleeding into subarachnoid space - often due to berry aneurysm
      - Sx: Thunderclap headache , Kernig's (6 hours), neck stiffness, Terson's syndrome
      - Ix: CT head - detect >90% in first 48 hours; LP if no CI
      - Mx: Neurosurgery referral; Medical - Maintain perfusion (IV fluids), Nimodipine (60mg/4h 3 weeks) - reduces vasospasm and mortality; Surgery - Endovascular coiling
    - - Often occurs in elderly due to atrophy (RF are anything that causes the brain to atrophy e.g. alcohol, age, dementia) making bridging veins more susceptible. Most caused by minor trauma
    - - Caused by rupture of the middle meningeal artery in the temporo-parietal region; Associated with temporal bone fracture/trauma; Have lucid period then rapid decline
  - - - Multiple Systems Atrophy: Autonomic dysfunction (postural hypotension, bladder dysfunction), Cerebellar + pyramidal signs, high pitched voice, rigidity > tremor, Hot cross bun sign (MRI)
      - Progressive Supranuclear Palsy: Postural instability (falls), speech disturbance, vertical gaze, low pitched voice, Hummingbird sign (MRI)
      - Corticobasilar Degeneration: Aphasia, dysarthria, apraxia, akinetic rigidity in one limb, asterognosis, alien limb phenomenon
      - Lewy Body Dementia: Fluctuating cognition, visual hallucinations
- - - - A – Alcohol/Abuse of substances
      - E – Epilepsy/Electrolyte disturbances/Endocrine diseases (Addison’s or thyroid)/Encephalopathy
      - I – Infection
      - O – Overdose/Oxygen deficiency
      - U – Uremia
      - T – Trauma/Tumour
      - I – Insulin (hypoglycaemia, HHS)
      - P – Psychogenic/Poisons
      - S – Stroke/Shock