Neurology 1 Flashcards by H JP

Name an example of a 5-HT3 antagonist

Adverse effects (2)

Ondansetron

Prolonged QT
Constipation

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Absence seizure
Typical age range
Gender
Provoked by (2)

3-10yo
F>M
Stress, hyperventilation

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Absence seizure
EEG:

Bilateral, symmetrical spikes and wave pattern

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What is a positive Babinski?

Suggestive of upper motor neuron disease
Dorsiflexion of big toe and fanning out of the others

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Lesions that can cause both absent ankle jerks and extensor plantars (Babinski) (6)

Upper and lower motor neuron disease

Subacute combined degeneration of the cord
Motor neuron disease
Friedreich’s ataxia
Synringomelia
Tabparesis (syphillis)
Conus medullaris lesion

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What is Friedreich’s ataxia?
AD/AR
Age
Features other than ataxia (2)
Later features (3)

AR mitochondrial disease, trinucleotide repeat
Usually causing ataxia, HOCM and DM
Upper and lower motor neuron, absent ankle jerks, extensor plantar, optic atrophy
10-15yo
Later - heart failure, loss of vision and hearing

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Receptive aphasia
Broca/Wernicke?

Where you lack comprehension, but can speak well, but none of what you’re saying makes sense because you can’t comprehend. i.e word salad

Wernicke’s aphasia

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Expressive aphasia
Broca/Wernicke?

When you understand what people are saying but struggle to get the words out, speech is non fluent, repetitive and laboured.

Broca’s aphasia

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What is conduction aphasia?

Usually secondary to a stroke to the arcuate fasiculus - connection between Broca’s and Wernicke’s

Comprehension is normal, aware of the errors
Repetition is poor
Speech is fluent

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Global aphasia

Results in both receptive and expressive aphasia, may still be able to communicate with gestures

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What is ataxia telangiectasia?
AD/AR
Age of onset
Features (3)
Increased risk of which two cancers?

AR
1-5yo

Cerebellar ataxia
Telangiectasia
Recurrent chest infections secondary to IgA deficiency
Increased risk of lymphoma and leukaemia

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Explain autonomic dysreflexia

Occurs in patients who have a spinal cord injury at or above T6

Triggered by faecal impaction or urinary retention causes a sympathetic spinal reflex up the spinal cord. But due to lesion/ injury at T6 or above it is unable to deliver it all the way to the brain. This results in sympathetic activation below T6 and parasympathetic response above T6 leading to:

HTN
Bradycardia
Sweating
Flushing
Agitation
Haemorrhagic stroke

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Bell’s palsy
Age range
Common in which type of patient?
Forehead or no forehead sparing?

20-40yo
Pregnant women
No forehead sparing due to lower motor neuron facial nerve palsy

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Bell’s palsy features (5)

Paralysis of one side of the face including forehead
Post-auricular pain
Altered taste
Dry eyes
Hyperacusis

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Bell’s palsy
Mx (2)

When to refer to ENT?
Prognosis?

Prednisolone PO if within 72 hours of onset of symptoms
Artifical tears and eye lubricants

If no improvement after 3 weeks
Full recovery within 3-4 months
15% have permanent weakness

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What situations may cannabis based medicinal products be used?

Chemotherapy induced N&V (nabilone)
Spasticity in adults with MS (sativex nasal spray)

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Partial seizures
1st line mx

Carbamazepine

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SE carbamazepine (3)

What is autoinduction?

Leucopenia and agranulocytosis
Hyponatraemia secondary to SIADH
Visual disturbances

May see a return of seizures after 3-4 weeks of treatment

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What is cataplexy?
What condition is it associated with?

Sudden and transient loss of muscular tone caused by a strong emotion

2/3 of patients with narcolepsy have cataplexy

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What is Charcot-Marie-Tooth disease?
Features (6)

Most common form of hereditary peripheral neuropathy
AD

Features:
Foot drop (frequently sprained ankles)
Pes cavus (high arched feet)
Hammer toes
Stork leg deformity
Hyporeflexia
Distal muscle weakness and atrophy

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Cluster headaches
Trigger (1)
Mx acute (2)
Chronic (1)

ETOH

Mx
Acute 1. 100% oxygen, 2. SC triptan

Chronic 1. Verapamil

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Foot drop is secondary to which nerve lesion?
Other features for this nerve lesion (3)

Common peroneal

Loss of dorsiflexion
Loss of eversion
Sensory loss of dorsum of the foot

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Type I and Type II complex regional pain syndrome

Complex regional syndrome pain syndrome mx (3)

Type I - no demonstratable lesion to a major nerve
Type 2 there is a lesion to a major nerve

Physiotherapy
Neuropathic analgesia
Pain team

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CN
I
II
V

I smell
II sight
V (trigeminal) facial sensation, muscles of masticatio

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CN III occulomotor IV trochlear VI abducens

Eye movement III - MR, IO, SR, IR, constriction, accommodation, eyelid opening IV - SO VI - LR

Clinical signs with lesions on Trigeminal (2) Occulomotor (2) Abducens (1) Trochlear (2)

Trigeminal neuralgia, loss of corneal reflex Occulomotor down and out eye, dilated fixed pupil Abducens Horizontal diplopia Trochlear downward gaze, vertical diplopia

CN VII VIII IX Function

Facial anterior 2/3 of tongue, lacrimation, salivation Vestibulocochlear hearing balance Glossopharyngeal posterior 1/3, swallowing

CN 10-12 function

X vagus gag reflex XI accessory head and shoulder movement XII hypoglossal tongue movement

Clinical signs CN 7 (3) CN 8 (2) CN 9 (1)

7 loss of corneal reflex, taste, hyperacusis 8 hearing loss, vertigo 9 loss of gag reflex

Clinical signs 10-12

10 uvula deviates away from site 11 weakness turning head to contralateral side 12 tongue deviates towards side of lesion

Corneal + Lacrimation reflex afferent efferent

v1 trigeminal ophthalmic VII facial nerve

Jaw jerk afferent efferent

V3 mandibular mandibular

Gag + glossopharyngeal afferent efferent

In on 9 out on 10

Pupillary light reflex

In on 2 out on 3

What is Hoffman's sign?

Reflex test for cervical myelopathy Hand resting, flick one finger, +ve test = if other fingers on the same hand also flex

Gold standard Ix for degenerative cervical myelopathy (1) Mx (2)

MR Urgently refer to neurosurgery or ortho spinal surgery

Dermatome Thumb and index finger = Middle finger and palm = Ring and little finger = Nipples

C6 C7 C8 T4

Dermatome Umbilicus Knee caps Big toe + dorsum Lateral foot and small toe

T10 L4 L5 S1

Name five drugs that can cause peripheral neuropathy HINT NAVIM

Nitrofurantoin Amiodarone Vincristine Isoniazid Metronidazole

DVLA seizures First unprovoked seizure

6 months unless abnormalities on imaging or EEG in which case 12 months

DVLA Epilepsy/ multiple unprovoked siezures

Need to have been free from seizures for 12 months If no seizures in last 5 years then licence restored (until 70)

DVLA Withdrawal of epilepsy medication

No driving whilst it is being withdrawn and for six months after the last dose

DVLA Single episode syncope, explained and treated =

4 weeks

DVLA single episode syncope unexplained

= 6 months

DVLA two or more episodes of syncope =

12 months

DVLA Stroke/ TIA Multiple TIAs

1 month do not need to inform DVLA 3 months inform DVLA

DVLA Craniotomy Pituitary tumour

= 1 year off driving = 6 months

Difference between Duchenne muscular dystrophy and Becker muscular dystrophy Age of onset

5yo and >10yo Intellectual impairment in Duchenne No intellectual impairment in Becker's

What is Gower's sign?

Uses arms to stand up from squatted position

Infantile spasms Occur at what age? Describe the seizure AKA EEG

First few months of life Flexion of head, trunk, arms then extension of arms Salaam attack EEG: hypsarrhythmia (high amplitude waves with irregular spikes)

Lennox Gastaut syndrome Age EEG Mx Features (4)

Extension of infantile spasms Aged 1-5yo EEG slow spike Mx ketogenic diet Atypical absences, falls, jerks Moderate to severe handicap

Benign rolandic epilepsy Most common in Gender Features (2) EEG

Childhood, males Paraesthesia (unilateral face) Characteristic partial seizures at night Centro temporal spikes

Juvenile myoclonic epilepsy AKA Age of onset Gender Type of seizures Usually when? caused by what? Other features (2) Mx (1)

Janz syndrome Teenage F>M Infrequent generalised seizures Often in the morning/ following sleep deprivation Daytime absences Shock like myoclonic seizures Mx sodium valproate

When do you start anti-epileptics following the first seizure? (4)

Neurological deficit Structural abnormality on imaging EEG unequivocal epileptic activity Patient/ family wishes

Mx Generalised tonic clonic seizures M (1) F (2)

Males SV Females lamotrigine or levetiracetam

Mx Focal seizures 1st line 2nd line

1st line Lamotrigine or levetiracetam 2nd line carbamezapine, oxcarbazepine or zonisamide

Absence seizures Mx 1st line 2nd line

Ethosuximide M SV F lamotrigine or levetiracetam

What medication can exacerbate absence seizures?

Carbamazepine

Myoclonic seizures mx Tonic or atonic seizures mx

M SV F Levetiracetam M SV SV Lamotrogine

Essential tremor Worse when? Improved by? Mx 1st line 2nd line

Arms outstretched ETOH and rest Propranolol Primidone

Vertical diplopia Subjective tilting of objects Head tilting Affected eye may deviate upwards and rotate outwards =

Fourth nerve palsy (trochlear)

GCS explained

M6V5E4 M 1 none, 2 extend to pain, 3 abnormal flexion, 4 withdraws to pain, localises pain, obeys commands V 1 none, 2 sounds, 3 words, 4 confused, 5 orientated E 1 none, 2 open to pain, 3 open to voice, 4 spontaneous

Guillain Barre syndrome = Commonly which bacteria triggers it? Antibodies present in 25% of pts

Immune mediated demyelination of the peripheral nervous system triggered by infection Campylobacter jejuni Anti-GM1 antibodies

What is Miller Fisher syndrome? Antibodies present in 90% of cases Ascending or descending Features (3)

Similar to GBS however associated with ophthalmoplegia, areflexia and ataxia Descending paralysis Anti-GQ1b antibodies

Guillian Barre Features (3) LP findings (2)

Ascending paralysis Reflexes absent or reduced Mild/ few sensory signs Raised protein Normal WCC

Huntington's AD/AR Age of onset Features (4)

AD Trinucleotide repeat disorder CAG 35yo Chorea, personality changes, dystonia, saccadic eye movements

Idiopathic intracranial hypertension RF (4)

Obesity COCP Female Pregnancy

Name five drugs than can cause IIH

COCP Tetracyclines Steroids Vitamin A Lithium

IIH features (4)

Headache Papilloedema 6th nerve palsy (abducens) Enlarged blind spot

Mx IIH (3)

1. Weight loss 2. Acetazolamide 3. Topiramate

Lamotrogine adverse effect MOA

Steven Johnson syndrome Sodium channel blocker

Leg cramps mx (3)

1. Stretching exercises for calves 2. Quinine - stop if no benefit 3. Referral to secondary care

Migraine diagnostic criteria:

At least x5 attacks of criteria B-E B Headache lasting 4-72 hours AND C x2 of: - unilat - pulsating - mod to severe pain - avoidance of routine activity AND D x1 of nausea/vomiting photophobia + phonophobia AND E not attributed to any other disorder

Migraine Mx Acute 1st line (2) If aged 12-17 consider 2nd line (2) 3rd line (2)

1. Combi therapy with PO triptan + NSAID/paracet If aged 12-17 nasal triptan instead If not effective then for: 2nd line: non PO metoclopramide/ prochlorperazine 3rd line +/- non oral NSAID/triptan

Migraine prophylaxis When should it be given? Mx 1st line (2) 2nd line (1) Recommendation

If 2 or more attacks per month 1st line Topiramate or propranolol 2nd line 5-8 session of acupuncture Recommend riboflavin 400mg OD

Mx for menstrual migrane (2)

Frovatriptan 2.5mg BD or zolmitriptan

Migraine during pregnancy Mx (2)

1. Paracetamol 2. NSAIDs (first and second trimester)

Migraine in children more typically have which symptoms? (3)

Bilateral Shorter lasting GI symptoms have more prominence

Neurology 1 Flashcards

(78 cards)