Neurology Flashcards
(121 cards)
How do you diagnose CJD
CSF > RTQuIC (Real time quaking induced conversion) test
RTQUiC is now considered better than CSF for 14.3.3 protein.
What are the Ix to Dx Myasthenia
> Serum Acetylcholine receptor Abs
Single fibre electromyogram
Repetitive nerve stimulation
when do you see anti-striated muscle Abs +ve in myasthenia
When they are associated with thymomas
when do you test for Anti-MUSK Abs in myasthenia
When you are suspecting myasthenia, by the
Anti-Cholistensterase receptor Abs are negative
what are the features of subacute sclerosing pane-encephalitis
> Chronic measles infections
Pt. will have had a measles infection from which they would have recovered
Will be symptom free for 6-8 years
Followed by , decline in school, studies, Followed by myoclonic jerks and visual disturbances
Can be associated with seizures
Followed by pyramidal signs ( rigidity/unresponsiveness)
Death (No Tx available )
What are the medications of Choice to Tx Juvenile Myclonic Epilepsy
> Lamotrigine/ Levetiracetam.
What are the feature software Juvelinel Myoclonic epilepsy
Teenage onsent- morning myoclonus
Absence seizures
Generalised tonic clonic seizures
Life long disorder
(Note: Sleep deprivation and alcohol can lower seizure threshold)
What is the best technique to reduce post LP headaches
Using atraumatic needle
how do you differentiate between benign fasciulations and Mcardles disease
In mcardle disase>
pain is severe on exercise
In benign fasciulations> excercise is not affected as much , can carry on > noted after exercise / alcohol etc
Mx: usually no Mx, but if severe, Carbamzepine/ Phenytoin
What are the features of transient global amnesia
> Amnesia with no there neurological deficits
Usually has complete spontaneous recovery
Pt. has retrograde and anterograde amnesia and has repetitive questions
what is the key difference between Bolutinum and Tetanus
Botulism has flaccid Paralysis
vs
Tetanus has Increased muscle tone
What is an Imp thing to consider in pt.’s with IIH
Secondary causes such as venous thrombus
( Do an MR venogram )
Risk factors- obesity, smoking, cocp, tetracyclines, oral retinoids, amiodarone, cimetidine, miocycline
what does phytanic acid defects
( excess) seen in
Refsums disease
What are the features of refsum disease ( autosomal recessive)
> Sensorimotor periperhal neuropathy
Excess phtanic acid due to defect in its oxidation
Onset late teens to early 20’s
Sensorineural deafness
CerbellarAtaxia
Ansomia
Pes cavus
shortened 4th toe
Night blindness ( retintis pigmentosa)
Mx: Dietary restriction of phytanic acid
What are the features of Holmes-Adies Pupil
> Large , irregualr, sluggishly reactive pupils
Absent ankle reflexes ( deep tendon)
What Features of essential tremor
Arms, head, neck
Worse on a action, extending
( Note in Parkinsons - it improves on a action )
Alcohol helps tremor
mx: Propranolol
What is the inheritance of Beckers muscular dystrophy
X linked
Common long term symptoms - heart issues (arrhythmia )
What are the keys feature of mystic dystrophy
Muscle weakness
Ptosis
Cataracts
Mild intelectual impairment
Cardiomyopathy
Conduction defects
Glucose intolerance
Low IgG
What is the mx of cluster headaches
> High flow O2
Intra nasal triptan
long term prophylaxis- Verapamil
what is the definitive mx of high grade glioma
Surgery followed by adjuvant chemo + Radiotherapy
When do you use whole brain irradiation
Multiple brain mets
What are the keys features of CADASIL Syndrome ( Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy)
H/o migraine with aura
Stroke like symptoms
+ve family history of migraines and early onset dementia
MRI shows- Diffuse bilateral periventricular white matter
Normal LP findings
What do you see in MELAS syndrome ( mitochondrial disease)
Migraine + Stroke like disease
But Pt. will have raised LP and Blood lactate
What is the difference between sporadic CJD and new variant CJD
> New variant seen in younger
Sporadic seen in older ( 50-60)
EEG
> Sporadic ( Periodic sharp and slow wave complexes )
> New Variant ( EEG can be variable )