Neurology Flashcards
Motor neuron disease
Symptoms/signs
Management
Complications
a combination of upper motor neuron (UMN) and lower motor neuron (LMN) findings.
No sensory or bladder/bowel deficits!!!
Limb weakness Poor gait/balance Painful muscle spasms Head drop/poor posture Hyperreflexia Progressive dysphagia, dysarthria Emotional incontinence May present with frontotemporal dementia
Clincal diagnosis, consider EMG
Riluzole + treatment of symptoms
Respiratory failure
Brain tumor symptoms?
headaches
seizures (fits)
persistently feeling sick (nausea), being sick (vomiting) and drowsiness
mental or behavioural changes, such as memory problems or changes in personality
progressive weakness or paralysis on one side of the body
vision or speech problems
Multiple sclerosis Symptoms/signs Investigations Management Complications
Classically presents in white women, aged between 20 and 40 years, with temporary visual or sensory loss.
Visual disturbance - pain, blurring, loss of colour discrimination
Sensory phenomenon - patch of wetness/burning/tingling/numbness, hemibody sensory loss , Lhermitte’s sign(tingling may occur in the limbs on neck flexion), trigeminal neuralgia. symptoms may worsen in heat or with exercise
Cerebellar dysfunction signs - ataxia, nystagmus, intention tremor
Weakness e.g. in legs, foot dragging, spasticity, cramping, paraplegia
Urinary frequency, bowel dysfunction
Optic neuritis
MRI brain and spinal cord = 1st line = periventricular plaques MRI brain, demyelinating lesions in the spinal cord, particularly the cervical spinal cord lumbar puncture (oligoclonal IgG bands)
acute attack = IV steroids - methylprednisolone
Prevention of future attacks = disease-modifying therapies(B interferon)
spasticity = baclofen
State 3 causes of raised ICP
Symptoms, ivestigations?
Too much cerebrospinal fluid Bleeding into the brain, Swelling in the brain Aneurysm Brain or head injury, Brain tumor Infections such as encephalitis or meningitis Hydrocephalus High blood pressure Stroke
Headache
Blurred vision
Weakness, vomiting
LP, MRI
Myasthenia gravis Symptoms/signs Investigations Management Complications
Antibodies to the POST-SYNAPTIC
ACh receptor at the neuromuscular junction in skeletal muscle
muscle weakness that worsens with continued activity and improves on rest.
Ptosis, diplopia Bulbar symptoms - dysphagia, dysarthria Proximal limb weakness Facial paresis Dyspnea - resp involvement
Serum AchR antibody analysis = 1st line
Acetylcholinesterase inhibitor = pyridostigmine
70% patients have thymic hyperplasia
10% have a thymoma
No ocular involvement if anti Musk antibodies present
Idiopathic intracranial hypertension/ pseudomotor cerebri
Symptoms/signs
Investigations
Management
mainly in overweight women of childbearing years
- Visual field loss, decreased visual acuity, transient visual obscurations, retrobulbar pain, photophobia, diplopia
- Ocular motility defects - cranial nerve 6 paresis
- Optic disc swelling/papilloedema
- Headaches
- Tinnitus
eliminating causal factors, such as drugs - vitamin A, danazol, tetracyclines
Weight reduction
acetazolamide when indicated
Refractive cases = CSF shunt
Optic nerve sheath fenestration for visual loss
Cauda equina syndrome
Symptoms
Management
Compression of spinal roots L2 and below often due to intervertebral disc herniation or tumour
Loss of bladder and anal sphincter control - finding it hard to start peeing/cant pee, cant control when you poo
Saddle anesthesia - numbness around genitals or anus
Weakness or numbness in both legs that is severe/getting worse
Bilateral Sciatica
Surgery
- Cauda equina compression causes flaccid paralysis with loss of reflexes. Cord compression usually causes spastic paralysis with brisk reflexes. Both cause sensory and power loss.*
What is syringomelia?
Symptoms?
Development of fluid filled cyst (syrinx) within your spinal cord.
Bilateral loss of sensitvity to pain and temperature
What is brown sequard syndrome?
Hemisection of the spinal cord
Weakness of paralysis on one side of the body
Loss of sensation on the other side - read up more on condition
WERNICKE’S ENCEPHALOPATHY
Symptoms/signs
Management
Classic triad = confusion, ophthalmoplegia, ataxia
Causes by b1 deficiency. Therefore other signs may be seen e.g peripheral neuropathy (dry beri beri) high output cardiac failure (wet beri beri) and koraskoff syndrome
Oculomotor findings - gaze palsies, sixth nerve palsies, and impaired vestibulo-ocular reflexes
Acute = Thiamine + magnesium + multivitamins
Bells Palsy
Symptoms/signs
Management
Unilateral facial palsy
Abscence of constitutional symptoms
Deviation of mout to normal side
Upper motor neurone lesion like stroke is forehead sparing! Bell’s palsy is not
- dry eye, hyperacusis and dysgeusia can also occur!!
High-dose corticosteroids/prednisolone!!!
Migraine
Symptoms + managament
nausea/vomiting
Photophobia, phonophobia
Unilateral, pulsatile, aura
Acute = NSAIDs, Triptans if severe
anti-CGRP(e.g erenumab) in disabling cases
Prophylaxis = topiramate, propranolol, amitriptyline
Parkinsons disease
Symptoms
Management
Bradykinesia, resting tremor
Masked facies, micrographia
MPTP in illegal drugs = RF
Levodopa = FIRST line control of motor symptoms
MAO-B inhibitor (rasagiline, selegiline), dopamine agonists(pramipexole, ropinirole), amantadine to increase dopamine availability, carbidopa/levodopa, amantadine,
Tension headache
Management
Acute = analgesia. Chronic = TCAs (e.g. amitriptyline, doxepin), CBT
Subarachnoid hemorrhage
Symptoms/signs
Investigations
Management
Depressed levels of consciousness
Neck stiffness, muscle aches and other signs of meningismus
Photophobia, nausea, vomiting
Rfs: age, HTN, alcohol, smoking, connective tissue disease, cocaine use, family history, ADPKD
Urgent non-contrast CT - hyperdense areas in the subarachnoid space/basal cisterns
If CT is negative with high suspicion = LP = bloody CSF (xanthochromia
Nimodipine + analgesia
Consider endovascular coiling/surgical clipping
Subdural hemorrhage
Symptoms
Investigations
Management
RFS: age>65, trauma, anticoagulant use/coagulopathy,
Headache, nausea/vomiting, confusion
Non contrast CT - crescent shaped hemorrhage. Hypodense on CT if chronic
Acute hematoma of small size = monitoring + prophylactic antiepileptics
Acute of large size = surgery + anti-epileptics
Extradural hemorrhage
Symptoms/signs
Investigation
Management
Transient loss of consciousness followed by recovery period then rapid deterioration
Scalp hematoma
Non-contrast CT - hyper dense blood collection that doesn’t cross suture lines
Management - craniotomy
Caused by rupture of middle meningeal artery
Axillary nerve lesion results in?
Flattened deltoid
Loss of arm abduction at shoulder
(Loss of sensatoon over deltoid and lateral arm)
Musculocutaneous nerve lesion results in?
Weakness of forearm flexion
Loss of sensation over lateral forearm
Radial nerve lesion results in?
Wrist drop(loss of extension) (Loss of sensation over posterior arm, forearm and dorsal hand)
Median nerve lesion results in?
Loss of wrist flexion, flexion of lateral 3.5 fingers(POPES blessing when you try and make a fist), thumb opposition(APES hand), lateral lumbricals
Loss of sensation thenar eminence and lateral 3.5 digits
(M) edian nerve affects thu(M)b
