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Neuro Flashcards

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1
Q

What are the side effects of phenytoin?

A

Gingival hyperplasia
Peripheral neuropathy
Megaloblastic anaemia
Teratogenic
Cerebellar syndrome

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2
Q

What are the EEG findings for absence seizures?

A

Symmetrical 3Hz spike and wave pattern

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3
Q

What are the signs of Charcot Marie Tooth Disease?

A

Pes cavus
Inverted champagne bottle appearance
Scoliosis
Hand muscle wasting

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4
Q

What anterior horn cell diseases can cause a flaccid paraparesis?

A

MND
Poliomyelitis

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5
Q

Name 6 causes of inflammatory motor neuropathies

A

Sarcoid, vasculitis, GBS, CIDP, multifocal motor neuropathy, amyloidosis

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6
Q

Name 5 other causes of motor neuropathy

A

HSMN (CMT)
HIV
Diabetic amytrophy
Ciclosporin
Lyme disease
Porphyria

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7
Q

Myasthenia gravis and Lambert-Eaton Myasthenic syndrome are examples of what disorder that can cause a flaccid paraparesis?

A

Neuromuscular junction

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8
Q

In a unilateral cerebellar lesion, to which side does the patient veer towards when walking?

A

Towards the side of the lesion

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9
Q

What are the most common causes of ataxia?

A

Demyelinating disease
Stroke/SOL
Paraneoplastic

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10
Q

For ataxia, what clues point towards a demyelinating cause?

A

Internuclear ophthalmoplegia
RAPD
UMN weakness
Sensory disturbance
Bowel/bladder history

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11
Q

What are some rarer causes of ataxia?

A

Alcohol
Phenytoin
Miller-Fisher syndrome
Friedrich’s ataxia
Wilson’s disease
Ataxic telangiectasia
Spinocerebellar ataxia

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12
Q

What is the cause of bulbar palsy?

A

Diseases affecting the lower cranial nerves (7-11)

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13
Q

What is the cause of pseudobulbar palsy?

A

Disease of corticobulbar tracts to medullary brainstem motor nuclei

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14
Q

What is the difference in signs between bulbar and pseudobulbar palsy?

A

Bulbar:
-Weak and wasted tongue with fasciculations
-Gag reflex absent
-Jaw jerk absent/normal
-Nasal speech

Pseudobulbar:
-Spastic paralysed tongue, no fasciculations
-Gag reflex increased or normal
-Jaw jerk increased
-Spastic speechW

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15
Q

What are the causes of pseudobulbar palsy?

A

MND
MS
Bilateral CVA
Brainstem tumours

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16
Q

What are the causes of bulbar palsy?

A

MND
GBS
MG (with ptosis and ophthalmoplegia)
Syringobulbia

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17
Q

What are the signs of sciatic nerve palsy?

A

Foot drop
Weak knee flexion
Absent ankle reflex
Widespread sensory loss
Loss of plantarflexion, dorsiflexion, eversion, inversion

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18
Q

Palsy of which nerve can cause foot drop?

A

Common peroneal

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19
Q

What are the signs of lumbosacral plexopathy?

A

Foot drop
Sensory loss on sole, anterolateral shin, dorsum of foot
Loss of inversion, eversion, and dorsiflexion
Cannot straight leg raise

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20
Q

Foot drop with no sensory deficit is likely to be caused by…

A

MND

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21
Q

What muscle is involved in foot drop?

A

Anterior tibialis

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22
Q

What is the cause of Friedrich’s ataxia?

A

Autosomal recessive trinucleotide repeat disorder (GAA) which codes for frataxin

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23
Q

What are the signs of FA?

A

Presents at 10-15 years
Gait ataxia
Optic atrophy
Dysarthria
Absent ankle jerks
Extensor plantars
Peripheral sensory neuropathy
Hammer toes and pes cavus

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24
Q

What are the complications of Friedrich’s ataxia?

A

Hypertrophic cardiomyopathy in 90%
Diabetes mellitus

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25
How is FA diagnosed?
Nerve conduction studies - motor velocities >40ms in arms, absent sensory action potentials Genetic analysis
26
What is the cause of myotonic dystrophy?
CTG trinucleotide repeat disorder at DMPK gene
27
What are the signs of myotonic dystrophy?
Myotonic facies Frontal balding Bilateral ptosis Cataracts Dysarthria Weakness of arms and legs (DM1 - distal, DM2 - proximal) PPM
28
What are the complications of myotonic dystrophy?
Cardiomyopathy, heart block Testicular atrophy Diabetes mellitus
29
What are the signs of spinal muscular atrophy type 3?
Proximal muscle weakness Bulbar palsy
30
What is the cause of Huntington's disease?
Mutation in huntingtin gene on chromosome 4 - CAG repeat expansion
31
What are the genetic characteristics of Huntington's disease?
Compete penetrance Anticipation
32
What is the pathophysiology of Huntington's disease?
Loss of dopamine D2 receptors and neurodegeneration in cortex, striatum, and caudate nucleus
33
What are the signs of Huntington's disease?
Slow saccadic eye movements Chorea Depression Behavioural changes
34
What is the triad of normal pressure hydrocephalus?
Urinary incontinence Dementia Bradyphrenia
35
What are the risk factors for idiopathic intracranial hypertension?
Obesity Female Pregnancy COCP, steroids, tetrocyclines, vitamin A, lithium, isotretinoin
36
What are the signs of IIH?
Papilloedema 6th nerve palsy
37
What is the management of IIH?
Rule out cerebral venous sinus thrombosis LP for high opening pressures - therapeutic Weight loss Acetazolamide Topiramate 2nd line
38
What is syringomyelia?
Dilatation of a CSF space within the spinal cord, usually within cervical or thoracic segments Causes compression of spinothalamic tracts
39
What are the signs of syringomyelia?
Loss of sensation of pain and temperature in a cape-like distribution Extension of syrinx with coughing or sneezing Pyramidal signs in lower limbs
40
What are the features of pituitary apoplexy?
Mimics SAH + features of pituitary insufficiency (hypoadrenalism leading to hypotension and hyponatraemia Extra ocular nerve palsies
41
What malignancies is LEMS associated with?
Small cell lung cancer Breast cancer Ovarian cancer
42
What antibody is seen in LEMS?
Antibody against pre-synaptic voltage gated calcium channels
43
What are the signs of LEMS?
Repeated muscle contractions lead to increased muscle strength Proximal > distal Hyporeflexia which recovers following brief muscle activation Dry mouth Impotence
44
What are the signs of PSP (progressive supranuclear palsy)?
Impairment of vertical gaze (difficulty reading/descending stairs) Stiff broad based gait Postural instability and falls Parkinsonism with prominent bradykinesia Cognitive impairment Poor response to levodopa
45
What are the signs of multiple system atrophy?
Parkinsonism Cerebellar signs Autonomic disturbance - ED, postural hypotension, atonic bladder
46
What is affected in anterior spinal artery syndrome?
Lateral corticospinal and spinothalamic tracts at the level of and below the lesion.
47
What are the signs of anterior spinal artery syndrome?
Bilateral spastic paresis Bilateral loss of temperature and pain sensation
48
Which inflammatory myopathy initially affects finger and wrist flexion and is non-tender?
Inclusion body myositis
49
What is seen on muscle biopsy in inclusion body myositis?
Cytoplasmic inclusions
50
Which drugs affect the ear?
Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine
51
Which antibodies are seen in myasthenia gravis?
ACh receptors Anti-muscle specific tyrosine kinase antibodies
52
What are the signs of myasthenia gravis?
Muscle fatiguability Extra ocular muscle weakness - diplopia Proximal muscle weakness Ptosis Dysphagia
53
Which drugs worsen myasthenia symptoms?
Aminoglycosides
54
What are the associations with myasthenia gravis?
Thymoma Thymic hyperplasia
55
What is the management of myasthenia gravis?
EMG CT thorax for thymoma Autoantibody testing Long acting AChE inhibitors e.g. pyridostigmine Thymectomy Immunosuppression
56
What is the management of myasthenic crisis?
Plasmaphresis IVIG
57
What are the characteristics of multifocal motor neuropathy?
Demyelinating Acute onset - over a week Distal neuropathy Anti-GM1 antibodies Conduction block
58
What is the management of MND?
MRI head/neck to rule out intracranial SOL and cervical myelopathy EMG - acute and chronic denervation Riluzole NIV Physiotherapy Management of spasticity
59
What are the signs of ataxic telangiectasia?
Cerebellar ataxia Telangiectasia IgA deficiency and hypogammaglobulinaemia
60
What are the signs of Miller-Fisher syndrome?
Ophthalmoplegia Areflexia Ataxia Descending paralysis
61
What are the forms of multiple sclerosis?
Relapsing remitting Primary progressive Secondary progressive
62
How is MS diagnosed?
McDonald criteria MRI - demyelinating lesions CSF - high levels of immunoglobulin with oligoclonal bands, high protein
63
What are the signs of tuberus sclerosis?
Ash leaf spots - fluoresce under UV light Shagreen patches over lumbar spine Adenoma sebaceum over nose Subungal fibromata Cafe au lait spots Developmental delay
64
What are the associations of tuberus sclerosis?
Retinal hamartomas Rhabdomyomas of the heart PKD
65
What is neuromyelitis optica?
Relapsing remitting demyelinating CNS disorder
66
What are the features of neuromyelitis optica?
Bilateral optic neuritis Myelitis Spinal cord lesions Aquaporin 4 antibody
67
What are the features of basilar migraine?
Brainstem associated range of symptoms - LOC, vertigo, dysarthria
68
What are the signs of Ramsey-Hunt syndrome?
Unilateral facial nerve palsy with taste loss in anterior 2/3 of tongue Vesicles on external auditory meatus/soft palate Vertigo Sensorineural hearing loss
69
What is the management of TIA?
MRI brain Clopidogrel and aspirin 300mg followed by DAPT at 75mg for 21 days Then monotherapy with clopidogrel 75mg PPI Carotid dopplers
70
What is an acceptable blood pressure prior to thrombolysis?
185/110
71
What is the time threshold for thrombolysis in acute stroke?
4.5 hours
72
After 4.5 hours, when is thrombolysis indicated in acute stroke?
Symptoms within 9 hours/9 hours from midpoint of sleep Core-perfusion mismatch on CT or MR perfusion OR DWI-FLAIR mismatch on MRI
73
What is the criteria for mechanical thrombectomy in acute anterior circulation stroke?
Symptoms within 6 hours Proximal large artery (ICA/M1) mRS 0-2 NIHSS 6 or more
74
What are some differentials for multiple sclerosis?
Hereditary spastic paraplegia Cerebral SLE Sarcoidosis AIDS
75
What are the symptoms of optic neuritis?
Unilateral reduction in vision Painful eye movements Loss of colour vision (particularly for red)
76
What autonomic symptoms are seen in MS?
Bladder: impaired emptying, urgency, frequency, incontinence Bowels: incontinence Sexual problems Loss of thermoregulation
77
What features may point towards MS?
Lhermitte's sign Symptoms worse after a hot bath
78
What is the management of MS?
Oral methylprednisolone 5/7 for flares DMARDS for relapsing remitting (e.g. interferon beta, natalizumab, glatiramer) Baclofen and diazepam for spasticity ISC Exercise and smoking cessation Exercise programmes Optometry, SALT, PTOTW
79
What is the difference between MND and cervical myeloradiculopathy?
MND has no sensory disturbance
80
Which drugs cause seizures?
Isoniazid TCAs BDZ withdrawal Alcohol withdrawal/binge
81
What is the diagnostic criteria for epilepsy?
At least two unprovoked seizures more than 24h apart
82
What are some differentials for a seizure?
Transient global amnesia TIA Migraine Hypoglycaemia Sleep disorder NEAD Syncope Cardiac arrhythmia Tic disorder
83
How is epilepsy diagnosed?
Video recording MRI EEG, if normal can consider sleep deprived EEG
84
What are is the management of epilepsy?
GTCS: lamotrigine/Keppra Focal: lamotrigine/carbamazepine Absence: ethosuximide Epilepsy specialist nurse Patient education and seizure diary Pre-conception counselling Occupation: unable to work at heights Do not swim or bath alone Trigger avoidance
85
What are the DVLA rules for seizures?
6 months seizure free
86
What is the non pharmacological management of PD?
Physiotherapy - gait re-training Occupational therapy Speech and language therapy (Lee Silverman Voice treatment) Inform DVLA Social care assessment PD specialist nurse
87
What medications are used in PD?
Early: MAO-i, dopamine agonist, levodopa, amantadine Later: add COMT inhibitor if on levodopa
88
What are the complications of drug treatment in PD?
Wearing-off effect On-off fluctuations Dyskinesias Hallucinations and psychosis Compulsive behaviours
89
What is a Holmes-Adie pupil?
Myotonic pupil with or without hyporeflexia which responds slowly to light and dilates slowly following normal accommodation
90
What is an Argyl-Robertson pupil?
Irregular pupil, does not constrict to light but accommodates normally on convergence
91
What are the signs of 4th nerve palsy?
Innervates superior oblique muscle Diplopia Contralateral head tilt
92
What are the signs of a 3rd nerve palsy?
Deviated down and out (diplopia looking nasally and upwards) Ptosis Dilated pupil Fails to adduct/supraduct/infraduct (supplies IR, IO, MR, SR)
93
What are the signs of a 6th nerve palsy?
Eye deviated inwards Unable to abduct
94
What is a cause of 3rd nerve palsy?
Posterior communicating artery aneurysm

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