neurology Flashcards
which AED is associated with steven -johnson syndrome?
Lamotrigine
what are the features of wallenberg syndrome?
- posterior inferior cerebellar artery.
Cerebellar features
- ataxia
- nystagmus
Brainstem features
- ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
- contralateral: limb sensory loss
whats the difference in features seen in Anterior inferior cerebellar artery occlusion vs PICA?
The main difference between AICA and PICA is that AICA involves facial paralysis andPICA involve Nucleus Ambiguous ( Hoarseness, loss of gag, dysphagia). Other involvement(vestibular,spinothalamic,Horner,trigeminal and inferior cerebellr peduncle) are common among both.
what are the features of ataxisa telengiectasia?
- cerebellar ataxia
- telangiectasia (spider angiomas)
- IgA deficiency resulting in recurrent chest infections
- 10% risk of developing malignancy, lymphoma or leukaemia, but also non-lymphoid tumours
what is the most common cardiac complication of myotonic dystrophy?
heart block - PR interval prolonged
cardiomyopathy
what is conduction aphasia?
The arcuate fasciculus is a bundle of axons that generally connects Broca’s area and the Wernicke’s area. Lesions in this area result in conduction aphasia.
Characterised by fluent speech, relatively intact comprehension and poor repetition. The main deficit in this scenario is impaired repetition.
Good comprehension and good speech but poor repetition
what are the features of CJD?
myoclonus + dementia
what are the investigations that help confirm CJD
MRI: hyperintense signals in the basal ganglia and thalamus
EEG: biphasic, high amplitude sharp waves (only in sporadic CJD)
what are the features of variant CJD?
psychological symptoms such as anxiety, withdrawal and dysphonia are the most common presenting features
younger patients
The typical presentation is that of a younger patient with progressive dementia (less rapid the sporadic CJD) with myoclonus and, in the later stages, mutism and vertical upgaze palsy (found in 50%)
MRI brain reveals a characteristic ‘hockey stick sign’ where the pulvinar region and dorsomedial thalamus are hyperintense on T2-weighted imaging (or pulvinar sign where the pulvinar region is hyperintense only)
what condition causes hypertension in patients with neurofibromatosis?
Pheochromocytoma is associated with 1, 2, 3
- NF-1
- MEN-2
- VHL (chromosome 3)
tx for generalised tonic clonic seiures?
male: sodium valproate
female : lamotrigine or levetiracetam
tx for focal seizures?
1st - lamotrigine or levetiracetam
2nd - carbamazepine, oxcarbazepine or zonisamide
tx for absence seizures?
1st - ethosuxamide
2nd - male - sodium valproate
female - levetiracetam
tx for myoclonic seizures?
males: sodium valproate
females: levetiracetam
tx for atonic seziures?
males: sodium valproate
females: lamotrigine
what tracts are affected by subacute degeneration of the spinal cord?
dorsal columns, lateral corticospinal tracts and spinocerebellar tracts..
which drugs may exacerbate myaesthenia gravis?
- penicillamine
- quinidine, procainamide
beta-blockers - lithium
- phenytoin
- antibiotics: gentamicin, macrolides, quinolones, tetracyclines
what are features of ramsay hunt syndrome?
- facial nerve palsy
- auricular pain
- vesicular rash around the ear
- vertigo and tinnitus
common regional lesion symptoms of strokes?
Astereognosis = parietal.
Visual agnosia = occipital.
Disinhibition = frontal.
Broca’s = frontal.
what is the chromosomal abnormallity seen in von hippel lindau syndrome?
VHL tumour suppressor gene situated on chromosome 3 and predisposes patients to visceral cysts and tumours
associated with renal cell carcinoma
what is used in the prophylaxis of cluser headaches?
verapamil
what are the side effects of sodium valproate?
VALPROATE
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Anorexia
Tremor
Enzyme inhibition
how do you differentiate transient global amnesia from transient psychogenic amnesia?
Transient global amnesia is a clinical syndrome of uncertain aetiology, characterised by a discrete episode lasting for a few hours (always less than 24 hours) of anterograde amnesia, retrograde amnesia, repetitive questioning with an absence of other cognitive or neurological impairments.
person with psychogenic amnesia is profoundly unable to remember personal information about themselves; there is a lack of conscious self-knowledge which affects even simple self-knowledge
what is the most common cause of vascular cognitive impairment in the young?
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADSIL)
an autosomal dominant condition caused by a NOTCH3 mutation on chromosome 19
features: migraine with aura, and a family history of such, which can ultimately lead to stroke-like features and is a recognised important cause of stroke in the young
It usually presents with the onset of migraines in middle age, followed by recurrent TIAs and strokes, and resulting in neuro-cognitive decline, psychiatric problems and dementia.
MRI often shows multiple widespread hyper-intense lesions in the white matter, basal ganglia, thalamus and pons.
