NEURO - Epilepsy, MS + Parkinsons Flashcards
(100 cards)
1
Q
Def Syncope
A
Transient LOC due to cerebral hypoperfusion
2
Q
What are the 3 main types of syncope
A
Vaso-vagal
Postural HoTN
Post-prandial HoTN
3
Q
What is Vasovagal syncope
A
Fainting due to a sudden reflex bradycardia and peripheral vasodilation
4
Q
What is vasovagal syncope in response to? (4)
A
Standing
Fear
Venesection
Pain
5
Q
LOC time vasovagal syncope
A
<2mins
6
Q
Recovery - vasovagal syncope
A
Rapid
7
Q
Mx vasovagal syncope
A
None req
8
Q
What is postural HoTN
A
Drop in SBP by >2-+ on standing
9
Q
Ix postural HoTN
A
Measure sitting + standing BP at 1,5,10mins
10
Q
What is post-prandial HoTN
A
Drop in 20+ SBP after eating
B/c pooling blood in splanchnic vasculature
11
Q
Other types of syncope (4)
A
Carotid sinus
Anaemia
Micturition
Exertion
12
Q
Ix recurrent syncope (5)
A
Bloods - FBC/U+E/glucose Lying/standing BP ECG/24h tape EEG CT head
13
Q
Advise to pt w/ recurrent syncope pre-Ix
A
NO DRIVING until cause is found
14
Q
Classic features of a generalised seizure (4)
A
Aura
LOC
Tonic/Clonic
Post ictal phase (drowsiness)
15
Q
Def focal seizure
A
Originating from within the networks of 1 hemisphere
16
Q
Do you lose consciousness in a simple focal seizure?
A
No
17
Q
Types of generalised seizures (6)
A
Abscence TC Clonic Tonic Myoclonic Atonic
18
Q
Temporal seizure classic Sx
A
LIp smacking/chewing
19
Q
Frontal seizure classic Sx
A
MOtor movements
Speech
20
Q
Parietal seizure classic Sx
A
Sensory changes
21
Q
Occipital seizure classic changes
A
Vision changes
22
Q
What is Todds paresis?
A
Temporary paralysis of affected limb, post focal seizure
23
Q
Causes of seizures (7)
A
Idiopathic mostly Cerebrovascular Head injury CNS infection SOL Neurodegen disease Metabolic - GI/Na/K
24
Q
Anti-epileptics - 1st line for generalised
A
Na valporate
25
Anti-epileptics - 2nd line for generalised
Lamotrigine
26
Anti-epileptics - 1st line for absence seizures
Ethosuximide
27
Anti-epileptics - 1st line for focal seizures (2)
Carbamazepine
| Lamotrigine
28
Mode of action - Na valporate
Potentiates GABA
| Blocks NA channels
29
SE Na Valporate (5)
```
Rash
Sedation
Weight gain
Hair loss
Tremor
```
30
Who cannot take Na Valporate (3)
Pregnant F
Thrombocytopenia
Liver damage
31
Mode of action - Lamotrigine
Blocks Na channel
32
What is there a risk of when taking Lamotrigine?
BM toxicity
33
Mode of action carbamazepine
Na channel blocker
34
SE carbamazepine (4)
Rash
Dizzy
Double vision
AGRANULOCYTOSIS
35
drug interactions carbamazepine
P450 pathway
| Inducer
36
SE Phenytoin (2)
Gum hypertrophy
| Nystagmus
37
Why must phenytoin be monitored?
Zero order kinetics :/
38
Which medication must be prescribed in caution w/ phenytoin
COC
| can lead to failure of COC as is enzyme inducer
39
Driving rules (CAR) - epileptic
Can't drive
After 1 y can reapply for licence
This is 10 years for a lorry driver
40
Driving rules (CAR) - 1st unprovoked seizure
No driving for 6 months at least
41
Driving rules (CAR) - provoked seizure
Epilepsy regulations apply
| Possible exemption if seizure @ time of head injury
42
Def MS
Relapsing episodes of immunologically mediated demyelination of CNS --> neuro degeneration
43
M:F MS
1:2
44
Classic age of onset MS
200-45
45
What is the genetic predisposition to MS
HLA-DR2
46
Where are areas of demyelination classically seen in MS? (5)
```
Optic nn
Angles of lateral ventricles
cerebellar peduncles
Brainstem
Dorsal/CCS tracts
```
47
What are the 3 patterns of MS
Primary progressive MS (10-20%)
Relapsing/remitting MS (80%)
Fulminating MS (<10%)
48
Features of primary progressive MS
No clear cut relapses/remissions
49
When is primary progressive MS diagnosed?
If progressive deterioration for >1y
50
Features of relapsing/remitting MS
Initial eps resolve completely
Subsequent events --> residual disability
Eventually develops 2' progressive MS
51
Features fulminating MS
Debilitating progressive deterioration from early stage
52
Optic Sx MS
```
Optic neuritis:
> Sudden painful LOV
> Loss colour vision (esp red)
> Swollen optic disc
> Diplopia
```
53
UMN Sx MS
CCS
| --> hemi/monoparesis
54
Sensory Sx MS
Dorsal tract
Paresthesia
Proprioceptive loss
55
Cerebellar Sx MS
Intention tremor
| Nystagmus
56
What is Uthoff's phenomenon
Sx of MS being worse in the head
57
1' care Ix MS
```
FBC
U+E
LFT
ESR
TFT
Glucose
Ca
B12
HIV
```
58
2' care Ix MS
MRI
CSF
Visual evoked response
59
MRI features MS
> 10 plaques visible
60
CSF features MS
Incr cell count
Incr protein
Oligoclonal IgG bands present
61
Visual evoked response features - MS
Delayed EEG reaction in occipital lobe to visual stimuli
62
DDx - R/R MS (3)
TIA
SLE
CNS sarcoid
63
DDx - 1' progressive MS (3)
MND
CNS mass
Parkinsons/HD
64
Mx - acute relapse MS
Ix - rule out other cause
| High dose CCS: PO methylprednisolone 0.5mg/day for 5 days
65
How long does it take for an acute MS relapse episode to recover
2-3 months
66
LT Mx MS
MDT + annual review
Lifestyle
UTI will exaccerbate
Dimethyl fumuarate/teriflunomide - R/R
67
Mx R/R MS if severe (2+ relapses in 1 y)
Natalizumab
68
Complications MS (8)
```
Fatigue
Spasticity
Ataxia/tremor
Mobility
Bladder dysfunction
Sexual dysfunction
Pressure sores
Depression
```
69
LE MS
20-30 y
70
Poor prognostic factors MS (3)
Incr age of PS
Early cerebellar involvement
Loss mental fct
71
Mx fatigue in MS
Amantadine + CBT
72
Mx spasticity in MS
Baclofen + physio
| Botox injection
73
Mx bladder dysfunction in MS
Oxybutynin/toleridine
| If >100ml - int self-catheterisation
74
Anatomical changes - Parkinsons
Degeneration of the SN pars compacta
| --> Decreased dopamine activity
75
Features Parkinsons - BRIT WGM
```
Bradykinesia
Rigidity
Instability
Tremor
Writing (micro)
Gait
Mask face
```
76
Classic triad Parkinsons disease
Bradykinesia
Rigidity
Tremor
77
Def Bradykinesia
Progressive reduction in speed/amplitude
78
Def rigidity
Increased tone throughout range of movements
| 'lead pipe/cog wheeling'
79
Rigidity vs spasticity
Rigidity = increased tone w/ tremor
| Spasticity - velocity dependent
80
What type of tremor typically do pt w/ PD get
Pill rolling
| Occurring at rest + w/ movement
81
Gait changes PD
Festinant shuffle
Decreased arm swing
Turning hesitation/freezing
82
Speech changes PD
Monotonous pronunciation
83
Non-motor features PD (4)
GI - dysphagia/constipation/urinary freq
Vivid dreams
Depression
Cognition/dementia
84
Causes Parksinsons disease (4)
Idiopathic
Dx - neuroepileptics/anti-psychotics
Vascular
Toxin - Wilsons
85
What is Parkinsons plus syndrome (3)
Progressive supranuclear palsy
Multiple system atrophy
Lewy body dementia
86
Features of supranuclear palsy PD +(3)
Symmetrical onset
Postural instability/sleep problems
Limitation in movement down gaze
87
Features of multiple system atrophy PD+ (3)
```
Autonomic - postural HOTN, bladder dysfunction, sweating
Cerebellar sins
Pyramidal signs (incr plantars/hyperreflexia)
```
88
5 main sets of Meds used in PD Tx
```
Levodopa/Carbidopa
DA receptor agonists - ropinirole/bromocriptine/cabergoline
MAOI
Anticholinergics (tremor)
COMT inhibitors - entacapone/tolcapone
```
89
Levodopa effects - motor Sx:
> improvement in motor Sx
90
Levodopa effects - ADL
> improvement in ADLs
91
Levodopa effects - motor complications
> motor complications
92
Levodopa - adverse events
< specified adverse events
93
DA agonists - motor Sx
< improvement in motor Sx
94
DA agonists - ADLs
< improvement on ADLs
95
DA agonists - Motor complications
< motor complications
96
DA agonists - adverse effects
> specified adverse events
97
MAO-B-I - motor Sx
< improvement in motor Sx
98
MAO-B-I - ADLs
< improvements in ADLs
99
MAO-B-I - motor complications
< motor complications
100
MAO-B-I - adverse events
< specified adverse events
