Neurology Flashcards by Christine M

when do you see oligoclonal bands

whenever BBB is disrupted / intrathecal production of IgG
MS, Lyme disease, autoimmune disease, brain tumour, lymphoproliferative disease
not seen in normal people
very non specific finding

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indications for CEA

70-99% if symptomatic but not disabling
50-69% if symptomatic
> 60% asymptomatic

ideally within 2/52 by a skilled surgeon with < 3% periop mortality

NOT RECOMMENDED
< 50% symptomatic
< 60% asymptomatic
carotid stenting

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Myasthenia gravis AChR Ab vs MuSK Ab Rx difference

AchR Ab - can use steroids + IVIG or PLEX
MuSK Ab - steroids + PLEX works best; thymectomy no benefit; pyridostigmine little benefit
(MuSK Ab - increased likelihood of bulbar involvement, increased ICU admission, mestinon response usually poor, no benefit of thymectomy)

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wernicke-korsakoff

ataxia
encephalopathy
oculomotor - resolve straight away with thiamine

korsakoff - amnesia

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NF1

Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris: Lisch nodules in > 90%
Scoliosis
Pheochromocytomas
chromosome 17 (17 letters!)

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NF2

bilateral acoustic neuromas

chromsome 22

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parkinsons disease

avoid dopamine antagonists

domperidone anti emetic of choice as only acts in periphery

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Neuromyelitis Optica NMO Devic’s disease

NMO IgG to aquaporin 4 70% in foot processes of astrocytes
optic neuritis, myelitis 90% recur
a/w SLE sjogrens
long cord lesions; no brain lesions

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ICU myopathy

a/w GCC, asthma
increased CK; reflexes absent or low
NCS: sensation - normal; motor - decreased
EMG: fibrillation

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ICU neuropathy

a/w SIRS, reflexes absent or low
NCS: decreased motor and sensory amplitudes
EMG: late - fibrillation
axonal, normal CK

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alzheimers disease

CSF: increased tau; decreased beta amyloid

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multiple sclerosis

HLA DR2 confers 3-4 X increased risk

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anti neuronal Abs

paraneoplastic

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myasthenia gravis

MUSK receptor Abs - worse disease
ACh R Abs
10% thymic CA; thymic hyperplasia common
Rx: IVIg

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CN3 lesion

pupil spared in DM

pupil fibres travel on outside of bundle so impaired with compression

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Guillain Barre

AIDP demyelinating
AMAN, AMSAN - axonal
reflexes absent or low
NCS: normal sensory (but paraesthesias)
a/w campylobacter, dysautonomia, increased CSF protein
GQ1b Abs

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hunger centre

hypothalamus

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MCA

superior division - frontal signs
inferior division - temperoparietal signs
lenticulostriate (perforator) - no cortical signs

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brain lesions

cryptococcus - lesions
toxo - multiple ring enhancing lesions
neurocysticercus - focal lesions, focal presentation - seizure, h/a, stroke; multiple small lesions
echinococcus - hydatid - large singular well defined lesion

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lamotrigine

risk of SJS; clearance slowed by use of valproate

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carbamazepine

HLA B1502 a/w SJS

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meningioma

dural tail on imaging
NF2 ch 22
hormone sensitive - more in women, obese

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MSA

hot cross bun sign on imaging
autonomic features
neck flexion
6th decade

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PSP

Study These Flashcards

hummingbird sign on imaging
neck extension; early falls
7th decade

GBS intubation indications

VC < 20ml/kg or < 1L or fall of 30% negative inspiratory force < 30cm H2O severe oropharyngeal weakness fatigue

demyelination

conduction slowing, block

axonal

decreased amplitude

INO

ipsi eye cannot adduct contra eye has leading eye nystagmus medial longitudinal fasciculus lesion bilateral is pathognomonic of MS

lateral medullary syndrome

``` ipsi ataxia arm, leg contra pain temp arm leg; ipsi face ipsi horners CN 9, 10, 11 lesion PICA ```

Gerstmann syndrome

``` dominant parietal lobe RAAF right to left confusion agraphia acalculia finger agnosia ```

lost in space

``` non dominant parietal lobe neglect one side body anosognosia (dont realise deficit) autotopagnosia (dont recognise limb) visual field issues apraxia dysarthria ```

eye deviation

away from paresis if hemispheric | toward paresis if pontine lesion

HLA in MS

HLA DR2 3-4 times increased risk from baseline EBV 2.3 X increased risk

risk 2nd attack in possible MS

biggest predictor is number of lesions on baseline MRI

Uhthoffs

very MS specific | may be related to change in Na channels with temperature

Lhermittes

non specific

dissemination in time MS

> 1 month | or simultaneous enhancing and non enhancing lesions on MRI

ADEM acute disseminated encephalomyelitis

1-4 weeks pos EBV, mycoplasma, strep pyogenes, CMV, rickettsiae, varicella IVMP once infx ruled out

fingolimod

MS treatment - oral S1P receptor modulator prevents lymphocyte egress from LNs selectively targets CCR7+ cells i.e. Th17

fampridine

MS treatment improvs walking speed closes K+ channels on demyelinated axons

enzymopathies

glycolytic defect - failure of rise in lactate | amino acid defects - failure of rise in ammonia

myotonic dystrophy

``` AD anticipation from maternal side CTG triplet repeat cataracts ptsis distal wasting, weakness cardiac conduction defects myotonia; frontal balding, low IQ, hypersomnolence,insulin resistance, hypogonadal, hypopit ```

dermatomyositis

more cancer risk esp ovarian OR 4.4 | more dysphagia, more acute

polymyositis

cancer risk esp NHL 2.1

amyloid

extracellular

neurofibrillary tangles / tau

intracellular

PD Rx

``` DAs: pramipexole, apomorphine, bromocriptine, pergolide, cabergoline sleepiness - amantadine, selegiline hallucinations - clozapine, quetiapine nausea - ondansetron, domperidone confusion - rivastigmine, donepezil ```

Charcot Marie Tooth

``` motor and sensory neuropathy slowly progressive distal weakness, atrophy, los sof reflexes PMP22 gene duplication ch 17 uniform slowly on NCS ```

heriditory neuropathy with pressure palsies HNPP

microdeletion PMP22 ch 17 focal palsies post minor trauma auto domt

pure motor neuropathy

MND, polio, lead, vincristine, amiodarone, dapsone

pure sensory neuropathy

DM, HIV, B12 def, amyloid, sarcoid, sjogrens, paraneoplastic, B6 intoxication

lamotrigine interactions

+ valproate = rash, increased valproate levels + OCP = poor lamotrigine efficacy OK in pregnancy

carbamazepine interactions

induces warfarin metabolism HLA B1502 DRESS SJS + phenytoin = rash

pain and temp

spinothalamic | cross almost immediately (1-2 segments above entry)

vibe

dorsal columns | cros in medulla

motor

corticospinal | cross in medulla

L4/5 lesion

L5 radiculopathy as roots emerges below the vertebrae but knocked off on way through

MND gene

c9orf72 24% but 95% is sporadic Rx riluzole

TIA ABCD2 score

``` A age > 60 1 BP > 140/90 1 Unilateral weak 2 speech 1 > 60mins 2; > 10 mins 1 DM admit if > 4; 8% risk stroke next 3/12 if > 6 ```

Neurology Flashcards

(59 cards)