Osmosis Neuro

Question 1

Level of vertebrae for LP?

Answer 1

L3/4

Question 2

Main excitatory neurotransmitter? Receptor?

Answer 2

Glutamate

NMDA

Question 3

Focal seizure that starts in one muscle group and then spreads is called? Type of seizure?

Answer 3

Jacksonian march

Focal without impaired awareness (likely to remember it)

Question 4

Tonic seizure?

Answer 4

Muscles become stiff and flexed

-> tend to fall backwards

Question 5

Atomic seizure?

Answer 5

Muscles become relaxed

-> tend to fall forwards

Question 6

Myoclonic?

Answer 6

Short muscle twitches

Question 7

Post vital Sx?

Answer 7

Confusion
Paralysis (Todd’s paresis - around 15 hours -2 days)
-due to supression of area of brain affect

Question 8

What happens in MS?

Answer 8

Demyelination of brain and spinal cord
T cell mediated autoimmune

Type IV hypersensitivity reaction

Question 9

What produces myelin

Answer 9

Oligodendrocytes

Question 10

Which cytokines are made by T cells?

Answer 10

IL-1, IL6

TNF-a, INF-y

Question 11

Rf for MS?

Answer 11

Genetic

• female
• HLA-DR2

Environment

• Infection
• vit D deficiency

Question 12

4 main types of MS?

Answer 12

Relapsing remitting (most common) 
-may be months-years between bouts with residual disability 

Secondary progressive
Initially similar to RRMS -> progressive

Primary progressive
Steady progression of disability

Progressive relapsing
Progression with additional bouts

Question 13

Usual age of MS

Answer 13

Usually aged 20-40

Question 14

What Sx triad in MS?

Answer 14

Charcots

Dysarthria - difficult / unclear speech
-plaques in brain stem

Nystagmus

• plaques on optic nerve -> loss of vision Eg blurring / dark spot
• may have pain / double vision

Intention tremor

• plaques on motor pathways of spinal cord
• muscle weakness, spasms, ataxia as well

Question 15

Can you get sensory sx in MS?

Answer 15

Yes

Numbness, parathesia …

Question 16

Key sign in MS?

Answer 16

Lhermittes
-electric shock runs down back and radiates to limbs when bending neck forward

Uhthoffs
-Exacerbation of Sx in heat Eg bath / exercise

Question 17

What happens if ms plaques in autonomic nervous system?

Answer 17

Bowel/bladder - eg incontinence

Sex - eg dysfunction

Question 18

Ix of MS

Answer 18

Sx with spread over space and time

MRI - multiple white matter plaques

LP - presence of oligoclonal bands on gel electrophoresis

Visual evoked potential - Measure response to visual stimuli

Bloods
Anti-MOG, AQP-4
Metabolic causes of neuropathy
-FBC, inflammatory markers, B12/folate, HIV, Ca, Glucose

Question 19

Tx of MS? Which type are these useful for?

Answer 19

Relapse

• Corticosteroids - high dose methyprednisolone
• Plasmapheresis - removes autoantibodies

1st line Prevention

• immunosuppressants - Eg B-INF
• Dimethyl fumarate
• alentuzumab

2nd line

• Natalizumab
• fingolimod
• cyclophosphamide (cell cycle inhibitor)
• IVIg

RRMS

Question 20

What is treatment for progressive MS?

Answer 20

Mainly to manage Sx
Eg. Depression, bladder dysfunction

Cognitive rehabilitation therapy / Physio
?Vit D

Question 21

Diagnosis of RRMS?

Answer 21

Mc Donald criteria

Evidence of 2 events, disseminated by space and time (at least 30 days apart)

Time
-evidence of new lesions on follow-up MRI with reference to baseline

Space

• At least 1 lesion in 2+ out of 4 areas of CNS
• Periventricular, juxtacortical, infrateriotoral, spinal cord

Question 22

Mechanism of tissue damage in wilsons?

Answer 22

Free copper -> free radicals

Question 23

How does the copper get into blood ?

Answer 23

Absorbed in gut 
-> liver 
If ATP7B is defective -> free copper in hepatocyte 
-> damage 
-> copper into extra cellular space 
-> blood

Question 24

2 functions of ATP7B?

Answer 24

Bind copper to apoceruloplasmin

Package copper into vesicles -> bile

Question 25

Bar liver what other organs are affected in Wilson’s disease ?

Answer 25

Brain
Basal ganglia -> movement disorder similar to Parkinson’s
Cortex -> neuronal cells death and dementia

Cornea
Kayser fleischer rings

Hepatosplenomegaly

Renal disease

Haemolytic anaemia (from free Cu in blood)

Question 26

Ix? WD

Answer 26

Blood

• Decreased ceruloplasmin
• Increased copper

Urine
-Increased copper

Question 27

Mx

Answer 27

Penicillamine - copper chelation

Zinc -> reduce copper reabsorption -> more excreted in urine

If liver cirrhosis / failure -> transplant

Question 28

Gene in Huntington’s? Chromosome? How many repeats to be called hungtingtons ?

Answer 28

Huntingtin - Chromosome 4

36

Question 29

Which part of brain is affected by HD

Answer 29

Basal ganglia (putamen + caudate)

Question 30

What is anticipation

Answer 30

Earlier Sx onset. With each generation

Question 31

Neurotransmitter changes in HD? How this reflects class of drugs for chorea Mx?

Answer 31

Decreased GABA + Ach

Increased Dopamine

Chorea -> Dopamine receptor antagonists (Antipsychotics)
-Tetrabenazine (depletes dopamine)

Question 32

Injury to receptors in Myasthenia gratis is by?

Answer 32

Type II hypersensitivity
Cytotoxic injury
-> Damaged receptors -> lack of contraction

Also triggers classical complement pathway
-> muscle cell destruction

Question 33

MX of myasthenia gravis

Answer 33

Acetylcholinesterase inhibitors (Neostigmine) -> Increase Ach

Immunosuppression - prednisolone

Surgical removal of thymus -> reduces muscle weakness

Question 34

What factors can worsen fibromyalgia?

Answer 34

Depression
Anxiety
Negative beliefs

Question 35

Neurotransmitter changes in polymyalgia?

Answer 35

Decreased serotonin -> less pain inhibition

Increased Nerve growth factor + substance p

Question 36

Diagnosis of fibromyalgia

Answer 36

Pain in 7+ areas

Symptom severity score 5+ /12
-Eg headache, poor sleep, fatigue, ‘fibro fog’

Duration >3months

OR
Pain in 5 locations and a score of 9/12

Question 37

Mx of polymyalgia

Answer 37

Exercise

Relaxation and good sleep hygiene

Pharma
Amitriptyline
SNRIs
Anticonvulsants (pregabalin and gabapentin) -> help with sleep problems

Question 38

General sx of polymyalgia

Answer 38

Long lasting 
Widespread muscle pain 
Low threshold to pain 
Excessive tenderness
Sleep disturbance