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Neuro Flashcards

1
Q

Causes of sudden Vs Gradual onset neural symptoms

A

Sudden

  • Cerebrovascular event
  • Space occupying lesion
  • Frontotemporal dementia
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2
Q

Features of temporal lobe lesion

A 
Receptive aphasia (difficulty with comprehension - Wernickes)
Contralateral upper quadranopia (piTS)

Altered auditory/visual perception

Altered personality/sexual behaviour

long term memory impaired

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3
Q

Features of a Frontal lobe lesion

A

Change in personality

Anosmia (lost smell)

Expressive aphasia (Brocas, broken words)

Contralateral hemiparesis

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4
Q

Features of Parietal lesion

A

Hemiparesis

Decreased 2-point discrimination

Astereogenesis (cant recognise object in hand)

Sensory inattention (e.g. will only draw half clock face

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5
Q

Gerstmann Syndrome

  • Site of lesion
  • 4 symptoms
A

Lesions near the temporal and parietal lobe junction

Dysgraphia (lost ability to write)

Dyscalculia (cant do maths)

Finger agnosia (cant distinguish fingers on hand)

Left-right disorientation

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6
Q

Features of occipital lesion

A

Contralateral homonymous hemianopia

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7
Q

Features of midbrain lesion

A

Short term amnesia
Confabulation
Strong desire to sleep

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8
Q

What can cause a cerebellar lesion?

Pres?

A

Cerebrovascular event
SOL
Infection
Wernicke’s

DANISH (Dysdiadokinesia - hand turn, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia/Heel-toe

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9
Q

Which tumour is seen in cerebellar pontine angle?

How can it present?

A

Acoustic neuroma

Ipsilateral deafness, Tinnitus, Facial/ trigeminal palsy (Facial numb/weakness)

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10
Q

Vision for:
1) Optic nerve lesion

2) Optic chiasm (central) lesion
3) Prechiasmal lesion
4) Optic tract lesion

A

Blindness on affected side

Bitemporal vision loss

Homonymous hemianopia of contralateral side of vision to lesion (3/4)

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11
Q

GCS

A

EVM 456

Best eye movement (out of 4)

Best verbal response (out of 5)

Best motor response (out of 6)

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12
Q

Headache Red Flags

A

New/change in pattern (if over 50)

Seizure

Systemic ill (fever, malaise, weight loss)

Personality change

Acute onset worst ever headache

Scalp tender jaw claud

Focal signs

Raised ICP (vomiting)

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13
Q

Meningism triad

A

Headache
Photophobia
Nuchal rigidity

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14
Q

Meningitis RF

A 
CSF shunts
Spinal anaesthetic
DM
Alcohol
IVDU
Crowding
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15
Q

Meningitis organism

A

Viral: mumps, HSV

Bacterial:

  • neonate: GBS
  • children: H.influenza b
  • adults: Strep pneumoniae, Neisseria meningitidis, Hib
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16
Q

Non infective causes meningitis

A

Malignancy
Sarcoidosis
SLE

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17
Q

Meningitis pres

A

Meningism Triad (headache, photophobia, nuchal rigid)

Opisthotonos (arching back)

Altered mental state

If Bacteraemia (purpuric rash)

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18
Q

Meningitis Ix

A

LP - gram stain, Ziehl nelson, glucose, protein, culture

Blood: FBC, Glucose, U&E, culture

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19
Q

Raised ICP symptoms

A

Vomiting

Reduced consciousness

Headache

Fits

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20
Q

CSF Bacterial meningitis

  • Opening pressure
  • Appearance
  • Predominant cell type
  • Protein
  • Glucose
A

High pressure

Turbid

Neutrophils

Protein high

Glucose low

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21
Q

CSF Viral meningitis

  • Opening pressure
  • Appearance
  • Predominant cell type
  • Protein
  • Glucose
A

High pressure

Clear

Mononucelar lymphocytes

High/Normal protein

Normal Glucose

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22
Q

TB LP

  • Opening pressure
  • Appearance
  • Predominant cell type
  • Protein
  • Glucose
A

High

turbid (fibrin web)

Mononuclear lymphocytes

Very High protein

Low gulcose

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23
Q

Lumbar puncture contraindications

A

Raised ICP (focal neurology, bradycardia, hypertension, GCS under 9)

COag abnormlities

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24
Q

LP complications

A

Postpunctural headache

Infection

Bleeding

Cerebral herniation (if high ICP)

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25
Meningitis management
Fluids, antipyretic, antiemetic Viral - acyclovir Bacterial IV ceftriaxone (add vancomycin if penucoccla)
26
Community Abx for meningitis
Benzylpenicillin
27
Meningitis complications
``` Sepsis/septic shock DIC Seizures Coma Raised ICP SIADH Deafness ```
28
Meningitis prevention
Vaccination (Hib, Neisseria, S.Pneum) Ciprofloxacin to contacts (prophylaxis
29
Usual organism for meningococcal septicaemia? | Describe the organism..
Neisseria meningitidis Gram -ve diplococci
30
Meningococcal septicaemia Presentation
Non-blanching petechial rash Meningism Septic (cold periph, cap refill over 2s, hypotensive) Give IV/IM Benpen if suspected
31
Meningococcal septicaemia investigations
FBC: low Pts Blood cultures LP Pharyngeal swab
32
Meningococcal septicaemia management in hospital
<3months - cefotaxime + amoxicillin >3 months - ceftriaxone Resuscitation if needed
33
Suspected Meningococcal septicaemia community management
IV/IM Benzylpenicillin
34
Prevention of meningococcus
Ciprofloaxcin ± menigicoccal vaccine prophylaxis (esp for uni student)
35
Encephalitis - What is - Common cause - Pres - Pres in neonate
Inflammation of brain parenchyma Viral - HSV - 1 Fever, headache, altered mental state, headache, seizures. lethargy, poor feeding, bulging fontanelle
36
Encephalitis causes
HSV-1 (Most commonly) HSV-2, CMV Bacterial (TB, Listeria)
37
Encephalitis IX
Bloods (leukocytosis), CT to exclude stroke/SOL LP - Viral picture + viral PCR
38
Encephalitis Tx
``` IV acyclovir IV Benpen (if bacterial) ```
39
Encephalitis complications
SIADH Cardiac/Resp arrest Epilepsy (esp temporal) Prsonality change
40
SAH - Usual cause - Other causes/RF
Berry aneurysm SVM, vasculitis, HTN, cocaine, ADPKD, MArfans/Ehlers-Danlos
41
Pres of | SAH
Sudden occipital headache, vomiting, dizziness, confusion
42
Common place for berry aneurysm
Junction of anterior communicating artery and anterior cerebral artery (front part circle of willis)
43
SAH signs
Meningism (6h following headache) Altered GCS Intraoccular haemorrhage Focal neurology
44
CNIII palsy aneurysm location
Posterior communicating artery - Internal carotid junction
45
SAH Ix and findings
CT head: sub arach bleed LP: xanthochromia. yellow discolouration of CSF after 12 hrs Cerebral angiography to locate aneurysm ECG - QT prolongation (risk arrest)
46
CSF - Prod - Absorbed
Choroid plexus in ventricles make CSF Flows in subarachnoid space Absorbed by dural venous sinuses
47
SAH management + complications
Labetalol for HTN, Nimodipine for vasospasm Coiling (femoral catheter) or clipping (craniotomy) Complications: Haemorrhagic stroke, Rebleeding, cerebral ischaemia (vasospasm - give Nimodipine) hydrocephalus, cardiac arrest
48
Most common cancer mets to brain
1. Lung 2. Breast 3. Colon 4. Melanoma
49
Raised ICP presentation
Headache worse on waking, bend, cough Papilloedema Vomitng without nausea Altered mental state
50
Raised ICP presentation
Headache worse on waking, bend, cough Papilloedema Vomitng without nausea Altered mental state (irritable, lethargy, COMA) 6th nerve palsy
51
What is seen in Papilloedema
Venous engorement give blurred disc margins | Haemorrhage
52
Investigating raised ICP
CT/MRI head
53
Management of ICP
Anticonvulsants for seizures Mannitol (diuretic used in ICP) Analgesia
54
What may SOL mimic (false localising sign)
CNVI palsy (inward turned eye, cant abduct) most vulnerable CN as longest Horner's syndrome - sympathetic trunk (Miosis, ptosis, anhidrosis) Cerebellar signs (DANISH)
55
Common vessel in Extra dural haemorrhage
Middle meningeal artery Blood between bone and dura
56
Extra-dural - Cause - Initial pres - Later pres
Trauma + LOC Lucid interval Headache Deterioration N+V, Seizure, altered GCS, Bradycardai
57
Reason for deterioration following lucid interval in Extra-dural
ICP due to metabolites cause osmotic swelling and deterioration
58
Extra-dural - Ix - Mx
CT head (haematoma) Bloods - FBC, U&E, Coag X-ray skull fracture Mannitol/hypertonic saline Surgery: Burr hole craniotomy and clot evacuation
59
Extra-dural complication
Neurological deficits, Post-Trauma seizures
60
Preventing extradural
Helmets
61
Extradural CT
Lens shaped haematoma Doesn't cross suture lines Might have midline shift
62
Subdural haematoma - Location of blood - Mech - Pres timing - Cause to remember
Blood in space between dura and arachnoid Bridging vein tear (cortex to venous sinus). Elderly - cerebral atrophy. tension on veins = inc risk. Acute, subacute (3-7d post trauma), chronic (2-3w) Could be NAI ...
63
Subdural RF
Elderly (cerebral atrophy) Alcoholism (prolonged bleeding) Anticoagulation
64
Subdural presentation pattern
Lucid interval (can be hours - acute, or days/weeks - chronic) Gradually worsening anorexia, N&V, headache, limb weakness, speech impair, Raised ICP
65
Subdural Ix and Tx
Non-contrast CT Bloods Resus and Mannitl/hypertonic saline Surgery: Craniotomy + clot evacuation
66
Subdural Complications
Cerebral herniation /oedema Seizures Permanent neurological deficit
67
Subdural cT
Crescent shaped haematoma crossing suture lines Mid line shift
68
Fracture base of skull signs
Panda eyes Battle sign (bruising over mastoid process) Blood in middle ear CSF: Rhinorrhoea, otorrhoea
69
Migraine triggers mnemonic
CHOCOLATE ``` CHeese Oral contraceptive Caffeine alcOhoL Anxiety Exercise ```
70
Types of migraine
With aura With aura Aura without headache Hemiplegic (headache + hemiplegia) Menstrual
71
Migraine pres
Aura in 1/3 before headache (scintillating scotoma, somatosensory - unilateral numbness hand/arm/face) Headache: unilateral, pulsating, 4-72hrs N&V, photophobia/phonophobia Irritable
72
Management of migraine (acute attack)
Analgesia (para, aspirin) Triptan Ergotamine (vasoconstrictor)
73
When are triptans CI
5-HT (serotonin) Receptor agonist - serotonin mediated vasoconstriction Uncontrolled HTN, CHDm CVD, Angina
74
Migraine preventative Tx
1st line: Beta-blocker 2nd: Topiramate (anticonvulsant) Amitriptyline, Gabapentin
75
CI to beta blockers
Asthma Peripheral vascular disease (lower systemic vasc pressure bad for claudication) Myasthenia gravis (inc weakness)
76
Migraine and COCP - relationship - why
COCP CI in migraine (esp with aura) Inc risk of ischaemic stroke
77
Migraine in preg. What drugs cant be given
Aspirin (Reyes) Triptans
78
Cluster headache - who - usual pattern
Male 20-40 yr 45-90mins, 1-2 times day over 6-12 weeks Usually yearly
79
Cluster headache pres
Sharp, localised around the eye Autonomic features (Lacrimation, rhinorrhoea, flushing, partial horners) Restless/cant keep still (opposite of migraine)
80
Cluster headache - triggers - acute stage Tx
Alcohol, GTN (vasodilation) Subcut Sumatriptan + O2
81
Cluster headache prevention
Stop smoking / alc 1st line: Verapamil Prednisolone 2nd line: Lithium
82
Tension headache presentation
Gradual onset bilateral band like fronto-occipital/neck radiation No other disturbance (photo/phonophobia, visual, sensory)
83
Tension headache Tx
Stress, anxiety decrease NSAID, Paracetamol, Amitriptyline
84
Trigeminal neuralgia - Who - Pathology/cause - Triggers
Females 50-60 Neuropathic/sharp pain in trigeminal distribution (maxillary/mandibular) Idiopathic, Compression by loop of artery, tumour, AMV, MS. Shaving, brushing teeth, washing, eating
85
Pattern in trigeminal neuralgia
Sudden facial Pain for Secs/Mins Sharp, shock-like Can have 100s of attacks a day
86
Trigeminal neuralgia management
MRI to exclude secondary cause Carbamazepine/Lamotrigine Surgery: Gamma-knife, microvascular decompression if due to organic pathology
87
Giant cell arteritis - Pathology RF
Immune mediated vasculitis of medium/large arteries Age (60-80) Female
88
GCA Pres
Headache - temporal, severe scalp tenderness, Jaw claudication, Amaurosis fugax
89
Ix and Tx of GCA
Raised ESR ± CRP Temporal artery biopsy/USS Prednisalone (High dose)
90
GCA complications
Aortic aneurysm/dissection Loss of vision (20% in severe) CNS - seizures Steroid complications: immunosuppressive, osteoporosis, thinning skin, narrow angle glaucoma
91
TIA pathology
Temporary iscahemia of part of the brain Usually embolic - Carotid (80%), AF, valve disease, Pos MI mural thrombus
92
Carotid Vs Vertebrobasillar TIA
Hemiparesis, Motor, dysphasia, amaurosis fugax Homonymous hemianopia hemiparesis cerebellar signs
93
RF stroke/TIA
``` HTN Smoking DM Heart disease (iscahemia, Valve, AF) COCP Carotid bruit Polycythemia ```
94
Examinatiory finding for cause of TIA
AF HTN HEart murmur Carotid bruit
95
What score estimates stroke risk following TIA
ABCD2 score ``` Age BP (0ver 140) Clinical features of TIA Duration (over 60min) Diabetes ```
96
TIA Tx & complications
Aspirin in acute TIA Secondary prevention of stroke with Clopidogrel (If CI then Aspirin + Dipyridamole-ADP PT block) If AF, Warfarin Stroke, MI
97
ABCD2 use
Indicates for use of diffusion weighted MRI 2day stroke risk 4-5 moderate 6-7 high
98
Causes of stroke in young Vs old
Young: Vasculitis, thrombophilia, SAH Old: Thromboembolism, atherosclerosis (carotid, heart - AF, HTN), Aneurysm rupture
99
Stroke types
Ischaemic (thromboembolic) Haemorrhagic (SAH/Aneurysm)
100
Ischaemic Vs Haemorrhagic signs
Carotid bruit, AF, TIA Hx Meningism (from haemorrhage), severe headache, Coma within hours
101
Cerebral hemisphere stroke pres
Cantrlateral hemiplegia (Flaccid--> Spastic) Contralateral sensory loss Homonymous hemianopia Dysphasia
102
Brainstem stroke pres
Quadrplegia Visual changes Cerebellar signs Locked in syndrome (aware, can only blink and move eyes)
103
Lacunar stroke pres
Pure sensory or pure motor or mixed ataxia Intact cognition/consciousness
104
Rosier score - what is - what score indicative
Score of over 0 means a stroke is likely
105
What is TACI
TACI = total anterior circulation infarct. Middle and anterior cerebral arteries Has all 3 in Bamford criteria (hemiparesis/hemisensory loss, hemianopia, cognitive dysfunction - dysphasia)
106
PACI
Involves a division of meddle cerebral artery supply (partial anterior circulation) 2 of Bamford criteria
107
Bamford criteria
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg 2. homonymous hemianopia 3. higher cognitive dysfunction e.g. dysphasia
108
What is Lacunar infarct
Infarct involving perforating arteries around internal capsule pure sensory, pure motor or mixed. cognition intact
109
Long term stroke complication
``` Motor impair Communication (dysphasia) Bed sores Malnutrition Aspiration pneumonia Depression ```
110
CI to thrombolysis
``` Haemorrhagic stroke Seizures (suggest SAH) Head injury Bleed (GI, Uro, surgery) AVM/Anuerysm ```
111
Stroke prevention
Lifestyle + BP control | AF (warfarin)
112
Anticoagulation following TIA
Aspirin in acute phase Give Clopidogrel 1st line If not tolerated then Dipyridamole ± Aspirin Statins
113
How to assess baseline cognition in delerium
Collateral history from family etc
114
RF Delerium
Age Male PRe-exhisting cognitive impair Operation/Infection
115
Causes of Delerium
Acute infection Drug: Benzo, anticonvulsants Surgery Toxic withdrawal Hypoxia, hyper/hypoglycaemia Traum - head etc ...
116
Delerium presentation
Acute onset, fluctuating course Disordered thinking Fearful/Angry Language disorders Hallucination, Delusions and Illusions Short term memory deficit
117
Types of Delerium
Hypo and hyperactive
118
Delerium Ix
Abbreviated mental test CAM-ICU (confusion assessment) Bloods- FBC, U&E, culture, TFT, Glucose, B12 Urine - dipstick m culture
119
Delerium Tx
Supportive: communication, orientation (clock, familiar staff/room) Try and normalise sleep and nutrition Haloperidol
120
Delerium prevention
Prevent: Polypharmacy Hospital acquired infection
121
Triad of dementia symptoms
Cognitive impairment - Short term memory, orientation Psych - depression, delusions Difficulty with ADLS - drive, shop
122
Dementia assessment
GPCOG, MMSE, AMT: - tests memory, orient, spacial awareness Blood (FBC, U&E, culture, LFT, TFT, Glucose B12) MSU CXR MRI head
123
Wholistic management in dementia
Advanced statements Lasting power of attorney DVLA Therapy: dance, art, music Challenging behaviour: Haloperidol, lorazepam Carer groups & Respite
124
Alzheimer's Pathology
Increased beta amyloid plaques Neurofibrillary tangles Decreased Ach Widespread cortical atrophy
125
RF for dementia
``` Age Caucasian FH Female Head injury Vascular RF ```
126
Early Pres Dementia
ST memory loss, difficulty finding words
127
Later pres dementia
Language difficulty, confusion, disorientation, depression, hallucination/delusion, disinhibition
128
Pathology Vascular dementia & RF
Ischaemia ± haemorrhage fro CVD Multiple small infarcts gives stepwise progression Hx of stroke TIA, AF, HTN, DM, Smoking, Obesity
129
Diagnosis of Vascular dementia
Memory loss, impaired cognitive function Cerebrovascular disease (on clinical Ex/Imaging) Relationship between the above (deterioration following stroke or stepwise deterioration of cognitive decline)
130
Vascular dementia imaging
MRI head | infarcts, cortical lacunae, white matter changes
131
Tx Vascular dementia
Tx vascular RFs AchE inhibitors: Donepazil, Galatamine, Rivastigmine
132
Lewy body dementia Pathology
Eosinophilic intracytoplasmic neuronal inclusion bodies (Lewy bodies) in brainstem and cortex
133
Lewy body dementia Ix
Dementia test: GPCOG, MMSE, AMT, Bloods, MRI head SPECT scan = low dopamine uptake in BG
134
Clinical features Lewy Body dementia
Dementia Fluctuating attention Well formed visual hallucination Spontaneous Parkinsonism (Dementia is prominent sympt in contrast to parkinson's)
135
Management Lewy Body
Rivastigmine + Holistic management DO NOT give antipsychotics, dopamine block = severe deterioration
136
FTD pathology
Atrophy in frontal and temporal lobe No plaques/protein inclusions Tau in cells Seen in MND, Corticobasal syndrome
137
FTD pres - Behaviour - Semantic - Progressive non-fluent aphasia
Behaviour - Disinhibition, lost motivation/empathy, change in personality Semantic - Loss of vocabulary or recognition of people/things Progressive non-fluent aphasia - diffucult/slow speech, grammar errors
138
Investigation FTD
GPCOG, MMSE, AMT MRI head - frontal/temporal atrophy Genetics (Huntingtons) LP - Tau protein
139
Management
Power of attorney etc, Therapy (mscis etc), AchE, If challenging: Haloperidol
140
Parkinsonism
Tremor: resting, pill rolling Rigidity: inc tone, leadpipe Bradykinesia: reduced arm swing, shuffle, mask like face (reduced expression)
141
Causes of Parkinsonism
``` PD Multiple cerebral infarcts Lewy body Antipsychotics Metochlopramide (dopamine block) Wilsons disease (copper in BG) ```
142
PD presentation
Insidious unilateral (gives instability) onset Parkinsonism Dementia (less prominent the Lewy) Micrographia
143
PD pathology
Reduced dopamine from Substantia Nigra in BG Reduced BG to cortex communication, reduced movement initiation
144
PD investigations
PET with flouradopa can localise dopamine deficiency in BG Trial of dopaminergic agent = improve
145
PD management
1st line Levodopa + Decarboxylase inhib ](Carbidopa - prev periph breakdown) 2nd line Dopamine agonist Bromocriptine, ropinirole 3rd line COMTI, or MAO-B inhib DVLA Carer suport
146
PD complications
Dementia (AchEi) | Infections, aspiration pneumonia, pressure sores, depression
147
Levodopa complications
On-Off phenomenon (dyskinesia and wearing off effect) | - Add Dopamine agonist or smaller freq doses of L-dopa
148
What is Parkinsonian crisis
Acute kinesia
149
Triad in normal pressure hydrocephalus
Urinary Incontinence Dementia Abnormla gait
150
Normal pressure hydrocephalus Ix & Tx
MRI/CT head (enlarged 4th ventricle) VP shunting
151
Huntington's genetics and Pathology
``` Autosomal dominant (50% chance in offspring) CAG repeats = huntingtin protein Progressive neurodegenerative disease ```
152
Huntington's age onset
Determined by number of CAG | 30-50
153
Hunttingtons Pres
Personality changes, self neglect, apathy, clumsy Later: chorea, Parkinsonism, Dementia, Dysarthria (unclear speech), dysphagia, Aggression
154
Huntington's Ix
Exclude SLE (ESR, ANA), Thyroid (TSH, T3/T4), WD (caeruloplasmin) MRI/CT - loss striata volume Genetic testing/counselling
155
Huntington's Tx
Benzodiazepines Parkinsonism - L-Dopa/Bromocriptine Depression - SSRI Psychosis - clozapine Deep brain stimulation
156
Left hemiparesis and sensory loss legs more than arms. which vessel?
Right anterior cerebral artery (supplies "mohawk) | Top part of parietal homunculus is legs
157
Right hemiparesis and sensory loss in arms more than legs
Left middle cerebral artery | supplies outer aspect of brain
158
Epilepsy investigations
EEG ECG MRI head
159
When to do MRI in epilepsy
Onset before age of 2 or new epilepsy i adult Suspected focal illness Continued despite meds
160
1st Tx for Epilepsy
Focal/Partial - Carbamazepine Generalised - Sodium Valproate In preg: Lamotrigine
161
Grand mal | Petit mal
Both types of generalised seizure Gran mal - tonic clonic Petit - absence Both get Valproate
162
Status epilepticus 1st line - No Iv - IV 2nd line
Buccal midazolam IV Lorazepam Sodium Valproate
163
Motor tracts
``` Pyramidal (corticospinal) Extra pyramidal (reticulospinal, vestibulospinal) ```
164
Sensory motor tracts
Dorsal column (Gracile - medial, to legs and cuneate - lateral, to arms fasciculus) Anterior and posterior spinocerebellar Anterolateral system (Spinothalamic tracts)
165
Brown Sequard syndrome
Incomplete lesion of spinal cord - ipsilateral paralysis + proprioception loss (corticospinal, dorsal column) - Contralateral loss of pain and sensation (Spinothalamic - cross immediately)
166
Corticospinal tract: - Function - Where does it cross
Decussate in medulla Voluntary movement Loss = hemiplegia and spasticity (Babinski +ve)
167
Dorsal column Functions and deficit
Light touch/two-point discrimination, Vibration, Proprioception Numbness, Position and vibration loss
168
Lateral spinothalamic function + | Where it crosses.
Sensory: Crude touch and pain, Temp Crosses in cord (deficit = contralateral loss pain and temp)
169
Corticospinal tract Route
From cerebral cortex Fibres in the internal capsule Cross at the medulla to contralateral spinal cord to form lateral tracts
170
UMN and LMN, Where to where?
UMN from cerebral cortex to anterior horn cell (or CN nucleus) LMN form the peripheral nerve to NMJ
171
UMN signs
Pronator drift Hypertonia Hyperreflexia Babinski sign
172
Features of Pyramidal UMN lesion in upper Vs Lowe limb
Upper limb: Flexor stronger than extensor Lower limb: extensor stronger than flexor
173
Babinski sign
Normal = Flexor plantar Babinski +ve = Extensor plantar
174
LMN lesions
Muscle wasting Fasciculations (motor unit denervation) Hyporeflexia, hypotonia
175
Guillain Barre
``` Acute inflammatory demyelination Immune attack (anti-gm1) of peripheral nerves. E.g. post Campylobacter gastroenteritis ``` Distal to proximal weakness, 25% resp involvement Iwatch for failure - O2) Nerve conduction studies LP - raised protein Spirometry IVIg, Plasma exchange, SC heparin (VTE prophylaxis)
176
Cerebellar causes of dysfunction
INfarct MS Alcohol abuse Compression (Tumour, abscess)
177
Two scoring systems in deciding whether to anticoagulate
CHA2DS2VASc HASBLED
178
What are you likely to see on MRI for stroke
Cerebral oedema
179
What is a Jacksonian seizure
Partial seizure in the motor cortex
180
Features of Epileptic seizure
Prodrome Rhythmic jerk (Tonic clonic) Tongue biting Incontinence
181
Antiepileptic in preg
Lamotrigine
182
Driving in Epilepsy
Seizure free for 1 year
183
What is Myasthenia Gravis
Autoimmune against AChR on NMJ
184
Myasthenia Gravis signs & symptoms
Muscular fatigue Chewing, swallowing Ptosis, diplopia,
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MG Ix
AntiAChR, Anti MuSK (Muscle tyrosine kinase) CT thorax (thymoma) Ice test: crushed ice improves ptosis
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MG Tx
Acetylocholinesterase inhibitors - Pyridostigmine Immunosuppressants - steroids, MTX, azathioprine Thymectomy IVIg for exacerbations
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Myathenic crisis - Def - When does it occur?
Severe weakness including resp muscles need intubation and mechanical ventilations Infection, post surgery
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What is MND
Loss of motor cortex and Anterior horn cells causing weakness, wasting, fasciculations No sensory, Never affects eyes
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MND 4 types
ALS:muscle atrophy and UMN affect of corticospinal tract (weakness and spasticity) Progressive bulbar palsy: CN VII - XII) Progressive muscular atrophy: pure LMN Primary lateral sclerosis: pure UMN
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ALS signs
LMN: limb weakness, wasting, fasciculations UMN: Hypertonia, Brisk reflexes, upgoing plantars
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Muscles affect in Bulbar palsy
Talking, chewing, swallowing Flaccid, fasciculation tongue
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MND Mx
Respiratory support Riluzole (delays need for tracheostomy) OT and speech and language therapist Feeding support Antidepresants Spacticy - Baclofen (muscle relaxant)
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LP level
L3/4
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Excitatory NT + Receptor
Glutamate NMDA (Ca2+)
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Inhib NT + Receptor
GABA GABA-R
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MS Pathophysiology What cells
Demyelination of brain and spinal cord T-cell mediated agains Oligodendrocytes Autoimmune, Type 4 hypersesnsitivity
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Cytokines from T-Cells
IL-1 IL-6 TNF-Alpha Interfernon-gamma
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RF for MS
Genetics Female Env (clean hypothesis)
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MS Usual age of onset
20-40
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Types of MS
Relapsing remitting (maths-yrs between bouts) Secondary progressive (relapsing remitting initially but progressive) Primay progressive: progressive from the start
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Triad of symptoms in MS
Charcots dysarthria (unclear speech - brainstem plaques) Nystagmus (optic nerve plaques, may get loss of vision) Intention tremor (motor pathway plaques) Other: muscle weakness, ataxis, spasm, numbness, parasthesia
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Lhermittes and Unthoffs | - KEY signs in MS
Lhermittes: electric shock down back to limbs when bend neck forward Unthoffs: Symptoms worse with heat e.g. bath/exercise
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Effect of ANS plaques in MS
Incontinence (bowel/bladder) Sexual dysfunction
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MS investigation
Hx: spread over space and time MRI: white matter plaques, periventricular LP: Oligoclonal bands on gel electrophoresis (immunoglobulins)
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MS Tx - Relapse - Prevention of relapse
Corticosteroids (high dose Methylprednisolone) Plasmapherisis (removes autoantibodies) Immunosuppressants: Beta-Interferon, Deimethyl fumarate, alentuzumab Other: BOTOX for spasticity

Final (26 decks)

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