8 TIA Polyneuropathy

Question 1

TIA Features

Answer 1

usually resolves within 1h, Amaurosis fugax (Transient curtain coming down, Internal carotid) MRI DWI same day, Do not do CT unless another clinical suspicion

Question 2

TIA management

Answer 2

Treatment: 300 Aspirin + clopidogrel 300, aspirin 75 + clopidogrel 75 for 2-3 weeks then switch to clopidogrel, to reduce further attacks/strokes/ long term treatment, usually with statin

Question 3

TIA scoring

Answer 3

ABCD2
1point: above 60, HTN, DM, 10-60 min, speech
2 point: Above 1h, unilateral weakness

Question 4

Actions based on scoring?

Answer 4

score 4-5: imaging within 24h, Score 6-7= urgent imaging

Question 5

Does TIA cause LOC?

Answer 5

NO

Question 6

Carotid artery endarterectomy indication?

Answer 6

Stenosis above 50-70, symptomatic,

Question 7

Carotid artery endarterectomy timing?

Answer 7

ASAP within 1-2weeks

Question 8

what disease shows string of beads and where?

Answer 8

Fibromuscular dysplasia in Renal arteries and Internal carotid arteries

Question 9

what is Transient global amnesia?

Answer 9

sudden anterograde amnesia, disorientation of time and place, doesn’t know themselves, resolves within 24h, benign, it is not an TIA, No need for treatment, 10% risk of recurrence

Question 9

Fredreich ataxia pattern?

Answer 9

autosomal recessive, GAA repeat, no anticipation,

Question 10

Fredreich ataxia features?

Answer 10

chronic progressive cerebellar ataxia, areflexia, babinski +(upgoing plantars), joint position vibration, dysarthria, horizontal nystagmus

Question 11

Fredreich ataxia complications?

Answer 11

HOCM 90% (most common cause of death), DM, optic atrophy, pes cavus (high arch plantar), kyphoscoliosis, life expectancy 35 years

Question 12

Ataxia Telangiectasia features?

Answer 12

Ataxia +telangiectasia +IgA deficiency, hypogammaglobulinemia ( recurrent Respiratory infection), risk lymphoma leukemia,

Question 12

Fredreich ataxia diagnosis?

Answer 12

Frataxin gene

Question 13

Ataxia Telangiectasia Gene pattern onset?

Answer 13

autosomal recessive, 1-5 year onset,

Question 14

what is Arnold-chiary malformation?

Answer 14

Downward displacement/herniation cerebellar tonsils through foramen magnum, congenital or acquired

Question 15

Arnold-chiary malformation features?

Answer 15

Hydrocephalus non communicating, syringomyelia, headache

Question 16

Arnold-chiary malformation types?

Answer 16

Chiari type 1: 17y-45, enlarged cerebellar tonsils, headache neck pain exacerbated by coughing, muscle weakness ataxia downbeat nystagmus, cape sensory loss, problem going up and down stairs
Chiari type 2(arnold chiari): Younger

Question 17

Describe Peripheral neuropathy

Answer 17

Begins distally, progresses proximally,
Sensory: usually has pain and loss of proprioception and vibration sense, stocking-glove
Motor: Distal weakness (foot drop, difficulty fine motor task), Areflexia
Autonom: Orthostatic hypotension, bowel/bladder/sexual/sweating

Question 18

Investigation for Polyneuropathy?

Answer 18

Glucose B12, thyroid, Autoimmune, infection, NCS, EMG, CSF if inflammatory like GBS

Question 19

Peripheral neuropathy Management?

Answer 19

Remove underlying cause, Gabapentin, pregabalin, amitriptyline, Physiotherapy, occupational therapy, orthotics

Question 20

Name axonal causes of polyneuropathy

Answer 20

Metabolic: DM (most common), hypothyroid, uremia,
Toxic: Alcohol, chemotherapy (Vincristine, Cisplatin) Heavy metal Arsenic lead
Nutritional: B12, B1, Folate
Infectious: HIV, Leprosy, Lime
paraneoplastic, Hereditary sensorimotor neuropathy 2

Question 21

Name demyelinating causes of polyneuropathy

Answer 21

Demyelinating: Reduced velocity
Guillain barre, CDIP, Multifocal motor Neuropath, amiodarone, MM Paraprotein, Hereditary sensorimotor neuropathy1 (charcot marie), both

Question 22

name mixed polyneuropathy

Answer 22

Vasculitis

Question 23

what is B12 deficiency called in neurology?

Answer 23

Subacute degeneration of spinal cord

Question 24

Describe B12 deficiency in neuro

Answer 24

1-UMN (hypertonia/spastic legs, Babinski +, brisk knee reflex) 2- LMN (absent ankle reflex) 3-Peripheral neuropathy ( vibration,joint ) First sign 4-ataxia(positive romberg) 5-vision ( even sudden loss), alcohol, subacute degeneration Lemon skin

Question 25

B12 deficiencty Investigation? and how to differentiate from folate deficency?

Answer 25

Folate: Normal MMA elevated homocysteine, B12 elevated MMA and homocysteine

Question 26

B12 in MRI?

Answer 26

Increased posterior columns signal in T2