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3A > Neurology - Movement disorders > Flashcards

Neurology - Movement disorders Flashcards

1
Q

What is Parkinson’s

A

Loss of dopaminergic neurons in substantia nigra in basal ganglia
More common in males

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2
Q

What causes Parkinson’s

A

Age
Repeated head trauma - Boxing

Metoclopramide
Neuroleptics - EPSE

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3
Q

Parkinson’s DDx

A

Other causes of tremor

  • SSRI
  • Amphetamines
  • Salbutamol
  • Lithium
  • Alcohol
  • Hyperthyroidism
Wilson's disease 
Cerebellar tumour 
EPSE 
Normal pressure hydrocephalus 
Lewy body dementia
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4
Q

Parkinson’s TRIAD

A

Bradykinesia
Resting tremor - Pill rolling
Rigidity - COG WHEEL

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5
Q

Additional Parkinson’s symptoms

A 
REM sleep disorders
Shuffling gait 
Anosmia 
Monotone voice 
Micrographia 
Loss of facial expressions
Dementia - Visual hallucinations 
Depression 
Urinary incontinence 
Sexual dysfunction
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6
Q

Parkinson’s investigations

A

Clinical diagnosis - TRIAD

Histology

  • Lewy bodies
  • Eosinophilic cytoplasmic inclusions consisting of alpha synuclein

SCREEN FOR DEPRESSION

Exclude differential

  • Drugs
  • Cerebellar disorder - Imaging
  • Wilson’s - Cu bloods
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7
Q

Parkinson’s dopamine management

A

Increase dopamine

  • Levodopa
  • Dopamine agonist - Ropinirole
  • Delay as much as possible, body stops responding after 5-10 years

Stop dopamine breakdown

  • MOA-B inhibitor - Rasagiline, selegiline
  • COMT inhibitor - Entacapone
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8
Q

Parkinson’s tremor management

A

Amantadine

Anticholinergics - FALL RISK

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9
Q

Parkinson’s non-pharmacological management

A 
Physio
S/L therapy 
Occupational therapy
Deep brain stimulation
Surgery - Interrupt overactive BG circuits
SSRI for depression
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10
Q

Side effects of ropinirole

A 
Drowsiness 
Impulsivity/inhibition disorder
N/V
Dizziness
Visual hallucinations
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11
Q

Parkinson’s plus

A

VIVID

Vertical gaze palsy - Supranuclear gaze palsy
Impotence/incontinence - Multiple system atrophy
Visual hallucinations - LBD
Interfering limb - Cortico-basal degeneration
Diabetes/HTN - Vascular Parkinson’s

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12
Q

Causes of tremor

A

Cerebellar disease - DANISH
Parkinson’s

Essential tremor

Orthostatic - Legs
Multiple system atrophy - Autonomic symptoms

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13
Q

Drugs causing tremor

A 
Salbutamol
Lithium 
Caffeine 
Valproate
SSRI 
Amphetamines
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14
Q

Causes of normal pressure hydrocephalus

A

Reduced CSF resorption at arachnoid villi

Idiopathic 
Meningitis 
Head injury 
CNS tumour 
SAH
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15
Q

NPH presentation

A

WET - Urinary incontinence
WACKY - Dementia
WOBBLY - Falls

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16
Q

NPH investigations

A

RULE OUT PARKINSON’S

CT - Enlarged 4th ventricle
LP - CSF pressure normal

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17
Q

NPH management

A

Ventriculoperitoneal shunt

Acetazolamide

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18
Q

Hydrocephalus causes

A

Obstructive

  • Tumour
  • Haemorrhage

Non-obstructive

  • NPH
  • Increased production - Choroid plexus tumour
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19
Q

Hydrocephalus presentation

A

Raised ICP

  • Headache
  • N/V
  • Papilloedema
  • Confusion
  • HTN
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20
Q

Hydrocephalus investigations

A

CT - Dilatation of ventricles above lesion

LP - Diagnostic and therapeutic - Do not perform in obstructive

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21
Q

Hydrocephalus management

A

Eternal ventricular drain

Ventriculoperitoneal shunt

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22
Q

What causes Huntington’s

A 
Autosomal dominant
Mutation of Huntingtin gene
4p16.3
Trinucleotide CAG repeat
Degeneration of cholinergic and GABA neurons in basal ganglia
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23
Q

Early symptoms of Huntington’s

A 
Self neglect / apathy
Personality changes 
Clumsiness 
Chorea 
Tics 
Myoclonus
24
Q

Late symptoms of Huntington’s

A

Seizures
Spasticity
Clonus
Supranuclear gaze palsy

25
Q

Psychiatric symptoms of Huntington’s

A

Apathy
Dementia
Depression

26
Q

Huntington’s investigations

A

Genetic testing
MRI
- Loss of corpus striatum volume
- Large frontal horns of lateral ventricles

27
Q

Huntington’s management

A

Chorea - Benzodiazepines, valproate
Dopamine depleting agents - Tetrabenzene

Deep brain stimulation
SSRI
Antipsychotics

28
Q

Reflex syncope

A

Most common
Vasovagal - Emotion, stress, standing
Situational - Cough, micturition, GI, exercise
Carotid sinus hypersensitivity

29
Q

Cardiogenic syncope

A 
ARRHYTHMIAS 
Structural - MI, valve disease, aortic stenosis, tamponade, dissection
BBB
Brugada syndrome 
Heart block 
WPWS
30
Q

Orthostatic hypertension

A

Dehydration - Infection, haemorrhage
Drugs - Diuretics, alcohol, vasodilators
AI failure - Parkinson’s, LBD, uraemia, diabetic neuropathy

31
Q

Syncope presentation

A

Transient global cerebral hypoperfusion

LOC
Clonic jerking
Rapid post-octal recovery

32
Q

Syncope investigations

A 
Orthostatic BP - Change > 20/10 is abnormal
ECG - 24 hours 
Full cardio exam 
Tilt table test 
FBC - Anaemia 
ESR - Infection 
EEG - Epilepsy
33
Q

Essential tremor characteristics

A

Can affect vocal cords
Worse with arms outstretched
Improved by alcohol and rest
May be caused by BB

34
Q

GBS pathophysiology

A

Immune mediated
Demyelination
Polyneuropathy

35
Q

GBS aetiology

A

Post-viral

Campylobacter jejuni
CMV
EBV

36
Q

GBS presentation

A

AAAAA - Hours to days

Symmetrical

Ascending weakness - Proximal muscles
Absent reflexes
Autonomic dysfunction - Urinary retention / tachy
- Arrhythmias

Paraesthesia
Respiratory depression

Miller Fisher syndrome - Ataxia and paraesthesia

37
Q

GBS investigations

A

Nerve conduction studies

Anti ganglioside antibodies
Spirometry

LP - Protein ^

ECG - Arrhythmias

38
Q

GBS management

A

IV IG

ECG - Monitor for arrhythmias

VTE prophylaxis

Plasmapheresis if severe

39
Q

GBS complications

A

Respiratory depression

Death

40
Q

MS aetiology

A 
Females 
Away from the equator 
20-40 
Smoking 
Previous mono infection
41
Q

MS pathophysiology

A

Autoimmune destruction of myelin sheath by autoantibodies

42
Q

MS presentation

A

Eyes

  • Optic neuritis
  • Internuclear ophthalmoplegia
  • Optic atrophy

Motor - Spastic weakness

Sensory

  • Lhermitte’s sign
  • Trigeminal neuralgia
  • Numbness

Urogen

  • Sexual dysfunction
  • Incontinence

Cerebellar

  • Ataxia
  • Tremor

Cognitive impairment

UHTOFF’S PHENOMENON

43
Q

MS types

A

Relapsing and remitting - Most common
Primary progressive
Secondary progressive

44
Q

MS investigations

A

MRI - 2 lesions disseminated in time and space
LP - Oligoclonal bands
Anti-MOG

45
Q

MS management

A

Acute - Methylprednisolone

Chronic

  • Interferon
  • Galantamir
  • Natalizumab

Other

  • Muscle relaxant - Baclofen
  • Reduce tremor - BB
46
Q

Myasthenia gravis pathophysiology

A

Antibodies to Ach receptors

47
Q

Myasthenia gravis aetiology

A

Associated with

  • Thyroid
  • Parkinson’s
  • Thymoma
48
Q

Myasthenia gravis presentation

A

Proximal weakness and fatiguability
Normal reflexes - Synapses aren’t fatigued on brief contraction

Eyes

  • Diplopia
  • Ptosis - Better after ice

Bulbar

  • Dysphagia
  • Dysphasia
  • Difficulty chewing
49
Q

Myasthenia gravis common complaints

A

Peek sign - Gentle sustained lid closure - Then lids separate

Difficulty watching TV - Eyes get tired

Can’t count to 50 - Voice fades

50
Q

Myasthenia gravis exacerbation triggers

A

Drugs

  • BB
  • Opioids
  • Gentamicin
  • Lithium

Pregnancy
Infection
Change in environment

51
Q

Myasthenia gravis investigations

A

Electromyography - Decreased evoked potentials

AntiMuSK antibodies
AntiAchR antibodies

CT - Thymoma
Spirometry

52
Q

Myasthenia gravis management

A

Pyridostigmine

Steroids

Azathioprine

53
Q

Myasthenia gravis complications

A

Respiratory collapse

54
Q

Lambert Eaton syndrome

A

Associated with small cell lung cancer

Similar to myasthenia gravis

Repated muscle contraction - Increased muscle strength

55
Q

Cerebellar disorders cause

A

VITAMIN DD

Vascular - Stroke
Infection - Meningitis, encephalitis, VZV, mumps
Trauma
Autoimmune
Metabolic - B12, thiamine, hypothyroid, hypoparathyroid
Iatrogenic - Lithium, phenytoin, isoniazid, metronidazole
Neoplasm

Degenerative

56
Q

Cerebellar disorders presentation

A

DANISH P

Dysdiadochokinesis
Ataxia - Vermis
Nystagmus 
Intention tremor 
Slurred speech 
Heel shin test / hypotonia

Pendular reflexes

3A (31 decks)

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