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Flashcards in CNS Deck (18):
1

What is Parkinsonism?

Movement disorder of bradykinesia plus rigidity/tremor/postural instability

2

What are the causes of Parkinsonism?

Idiopathic - PD
Lewy Body Dementia
Dementia pugilistica
Normal pressure hydrocephalus
Parkinson plus syndromes - multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration
Drugs - chlorpromazine, metoclopramide, prochlorperazine, sodium valproate, methyldopa
Wilson's disease

2

Features of multiple systems atrophy

Parkinsonism
Autonomic failure
Cerebellum dysfunction
Pyramidal signs

3

What is a Lewy body?
In what diseases are they found?

Cytoplasmic inclusion protein of alpha synuclein

Lewy body dementia
Parkinson's disease
Alzheimer's

4

Features of progressive supranuclear palsy

Most common Parkinson plus syndrome
Supranuclear gaze palsy - abnormal vertical then horizontal saccades
Difficulty opening eyes
Significant problems with falls

5

Causes of a unilateral ptosis

3rd nerve palsy
Horner's syndrome
Myasthenia gravis
Congenital

6

Causes of bilateral ptosis

Myasthenia gravis
Tabes dorsalis (dorsal column demyelination from syphilis)
Myotonic dystrophy
Syringomyelia causing b/l horner's
Miller fisher syn (GBS and ocular paralysis)
Nuclear 3rd nerve palsy

7

Symptoms and Causes of a central Horner's syndrome (1st order neurone)

Ptosis, miosis and anhidrosis of face/arm/upper trunk

Demyelination
Brainstorm or cord tumour/haemorrhage/infarct
Neck trauma
Syringomyelia
Basal meningitis

8

What are the structures of the cavernous sinus?

CNs: 3, 4, 6, V(1 and 2)
internal carotid a
sympathetic carotid plexus

9

Features of a cavernous sinus lesion

unilateral CN palsies (3 4 and 6)
decreased sensation in V1 (ophthalmic) and V2 (maxillary)
loss of corneal reflex (V1)
proptosis (if pulsatile suggests carotico-cavernous fistula)
visual loss
papilloedema

10

Causes of an upward gaze palsy?

progressive supranuclear palsy
Graves ophthalmopathy
Myasthenia Gravis
Miller Fisher syndrome
Muscular dystrophy
Parinaud syndrome

11

What is the pathophysiology of Myasthenia Gravis

autoimmune destruction of nicotinic acetylcholine receptors on the post-synaptic membrane.
80-90% have anti-AChr antibody

12

DDx for bilateral ptosis and facial weakness

Miller Fisher syndrome
botulism
lambert-eaton myasthenic syndrome LEMS (paraneoplastic anti voltage gated calcium channels, from small cell lung ca)

14

DDx for bitemporal hemianopia

optic chiasm lesion
pituitary adenoma (upper vision affected 1st)
craniopharyngioma (lower vision affected 1st)
suprasellar meningioma
glioma
granuloma
metastases

15

features of myotonic dystrophy

wasting and weakness of hands
myotonia (grip hands then let go)
DM (dip urine)
catatarcts
distal areflexia
ptosis
dysarthria and dysphagia (ask about swallowing)

16

investigations for ?MS

CSF - oligoclonal IgG bands
MRI - periventricular white matter plaques
Visual evoked potentials - delayed velocity but normal amplitude

17

Mx of MS

interferon-beta and glatiramer - decrease relapse rate but don't slow progression
monoclonal antibodies eg rituximab
methyl-pred during relapses
baclofen
laxatives and intermittent self catheterisation

18

Causes of spastic legs

inflam - MS
trauma
MND
syringomyelia
spinal cord compression/cervical myelopathy
Friedreich's ataxia
subacute combined degeneration of the cord