Neurology Flashcards
(36 cards)
How does mononeuritis multiplex present?
Acute onset, peripheral neuropathy. Asymmetric and asychronous. Pain, weakness. LMN symptoms only. Associated w diabetes.
What are the symptoms of restless leg syndrome?
Urge to move legs/arms assoc w unpleasant senstion; resting induces symptoms; gets better w activity; evening and night time worse. Rarely painful, some movements but no sustained contractions.
What are the associations with restless leg syndrome? What are the differentials?
Iron deficiency, CKD, peripheral neuropathy, pregnancy, MS, parkinsons, dopamine antagonists can exarcerbate. DDx: akathisia, nocturnal leg cramps (pain + tight, need stretch), arterial disease/claudication, periodic limb movements - involuntary jerks.
What are the non-pharm management options for restless legs syndrome?
Walk/exercise before bed, avoid coffee/alcohol/smoking, gentle stretching hamstrings before bed, doing mental activities when resting. Aim ferritin > 50
What drugs are used for restless legs? What are the risks?
Levodopa + bensazeride or carbidopa. SE: nausea, postrual drop, gambling, hypersexuality. Symptom may augment come earlier or get worse + rebound when stopping. Alt: gabapentins, pramipexole.
What are the symptoms of trigeminal neuralgia? Investigation and mx.
Unilateral shock like pain, can be triggered by wind, touch, eating, shave. Seconds to minutes. Recommend MRI for structural cause. Mx: carbamazepine 100mg BD (2nd line: oxcarbazepine)
How is a TIA defined? What tests are indicated and when is emergency recommended?
Symptoms resolving < 24h and no MRI evidence of stroke. Do CT angio,ECG, echo + carotid doppler within 2 days. Consider Age >60, BP >140, unilateral weakness, duration > 60 min or diabetes as high risk for 2nd event.
When is endarterectomy recommended?
Stenosis >70% + symptoms, within 2 weeks. If < 50%, meds only.
How is a TIA managed?
Aim BP 120-130, high potency statin, long term antiplatelet - combo if high risk, or 1. Avoid driving 2 weeks, risk further TIA 3 mo. Anticoagulate if AF.
What are the signs of an UMN and LMN lesion?
UMN: Increased tone, stiff, spasticity, hyperreflexia, full weakness, upgoing plantar, no fasciculation, wasting late. LMN: Weakness, wasting, fasciculation, hyporeflexia, distal weakness first.
How does amyotrophic lateral sclerosis present? Signs, prognosis, followup.
Combined upper/lower motor neuron symptoms, asymmetric and focal onset. Weakness, then dysarthria and dysphagia. Atrophy, hyperreflexia, splint hand - lose thumb muscles. No bowel/bladder or eye involvement. 3-5y incurable death. Genes hard to find, 1-3% FDR risk, use tests for prenatal counselling.
What are the features of a complex partial and simple partial seizures?
CP: unaware, disturbance of perception eg. hallucination, illusion, deja vu, may have lip smacking or pacing. SP: Jacksonian, jerking near hand or mouth that marches to rest of body.
Abscence seizure - age, features, tests, treatment.
From 4yo to puberty, brief LOC up to 30sec. 3Hz wave and spike on EEG. Responsive to treamtnet and often resolve by puberty. 1st line: ethosuxamide.
How is epilepsy managed - drugs, monitoring, driving.
If partial: carbamazepine (affects OCP). General: valproate (not in preg). Monitor effect not levels. No driving for 1st 6mo, then conditional licence until 2 years no seizure and 1 year no med change.
Narcolepsy - symptoms, treatment.
Brief spells of irresistible sleep. Sleep attacks, cataplexy (loss muscle tone), sleep paralysis, terrifying hallucinations. Tx: modafinil.
What are 6 causes of peripheral vertigo? What are 4 causes of central vertigo?
P: BPPV, menieres disease, vestibular neuritis/labyrinthitis, ramsay hunt syndrome, cholesteatoma, acoustic neuroma. C: Cerebellar infarct/haemorrhage, vertebrobasilar insufficiency, MS, migraine.
What are 3 features of nystagmus concerning for a central cause of vertigo? Why is otoscopy used in exam?
Purely vertical or torsional; can’t suppress with fixation; bidirectional. Herpes zoster, retraction pocket in cholesteatoma.
Features and treatment of meniere’s disease
Episodes lasting hours, with hearing loss, fullness and tinnitus. Reduce salt < 2g/day, reduce coffee/alcohol, vestibular rehab. ?Betahistine, ?HCT. Surgery or injections if required.
Features of vestibular neuritis and labyrinthitis. Management.
VN: balance only. L: hearing + tinnitus. Post viral, acute onset, may have N/V. Often improve over days, if severe, prednisolone high dose 5 days then taper.
Essential tremor - cause, features, triggers, workup, mx.
Autosomal dominant w variable penetrance. Young w slight tremor to hands or head. Anxiety worsens, alcohol helps. Exclude thyroid or drugs. 1st line propranolol 10mg BD, or primidone.
What are the main signs of parkinsons disease? How is it treated?
Bradykinesia, muscle rigidity (cogwheel), assymetric rest tremor. Early dementia, falls and autonomic dysfunction are rare. Treat w levodopa w benserazide or carbidopa to see if effective.
Myasthenia gravis - symptoms, diagnosis, tests, workup.
Fluctuating weakness + fatigue. No sensory or reflex loss. Ach-R antibodies 85% OR MuSK antibodies, neurophysiological tests, edrophonium if needed by specialists. Check thyroid, b12 +CT chest for thymoma.
What are the differentials for unilateral facial weakness?
Bell’s palsy, MS, Ramsay hunt syndrome, stroke, tumour, acoustic neuroma or cholesteatoma can compress, parotid tumour can compress.
What are the symptoms and management of bell’s palsy?
Whole side affected, taste of anterior tongue. May get sound sensitivity + dry eye from not closing. If < 72 hr, give pred 1mgkg 5 days. If shingles, add antiviral. If eye symptoms, patch + eye drops. Should recover, MRI at 4mo. Risk of regeneration - eyes water w chewing.
