Neurology Flashcards
(218 cards)
1
Q
What can cause autonomic neuropathy?
A
Diabetes
Parkinson’s
Multi-system atrophy
HIV
Lyme Disease
SLE
Drug induced
2
Q
Features of autonomic neuropathy?
A
Orthostatic hypotension
Resting tachycardia
Gastroparesis
Erectile dysfunction
Anhidrosis/ hyperhidrosis
3
Q
Investigations for autonomic neuropathy?
A
HR variability testing
Tilt table test
Sweat test
4
Q
Risk factors for intracranial venous thrombosis?
A
COCP
Pregnancy
5
Q
Investigation for intracranial venous thrombosis?
A
MRI venogram
If unavailable CT venogram
6
Q
CT venogram sign in intracranial thrombosis?
A
Empty delta sign
7
Q
Management of intracranial venous thrombosis?
A
LMWH tx dose
Address risk factors
8
Q
Cause of cavernous venous sinus thrombosis?
A
Commonly infection from orbits, paranasal sinuses, danger zone of the face
9
Q
Features of cavernous sinus thrombosis?
A
Headache
Unilateral periorbital oedema
Proptosis
Photophobia
CN palsy (3,4,6,7)
10
Q
What nerves run through the cavernous venous sinus?
A
3
4
6
7
11
Q
What does CN III, oculomotor nerve, innervate?
A
Remaining extra-ocular muscles
- Levator palpebrae superioris
- Others except LR and SO
- Pupil constriction
12
Q
How is third nerve, oculomotor, palsy seen?
A
Eye down and out (unopposed LR and SO)
Ptosis
13
Q
What is a medical III CN palsy?
A
Poor blood supply to central motor fibres causing sparing of pupil (not dilated)
14
Q
Medical causes of III CN, oculomotor, palsy?
A
DM
Ischaemic stroke
HTN
Vasculitis
15
Q
What is a surgical III CN, oculomotor, palsy?
A
Pupil dilated due to external compression of parasympathetic fibres running at the edge
16
Q
Causes of surgical III CN, oculomotor, palsy?
A
Posterior communicating aneurysm
Tumour
Thrombus of cavernous sinus
17
Q
What does facial nerve, 7, innervate?
A
Face, ear, taste, tear
Face- muscles of facial expression
Ear- stapedius
Taste- anterior 2/3rd tongue
Tear- parasympathetic to lacrimal and salivary glands
18
Q
Facial palsy how to differentiate between UMN and LMN causes?
A
Sparing of the forehead in UMN lesions
Forehead affected in LMN lesions
19
Q
Causes of bilateral facial nerve palsy?
A
Sarcoidosis
Guillian- barre
Lyme disease
Bilateral acoustic neuromas (NF 2)
Occasionally bells palsy
20
Q
UMN causes of facial nerve, 7, palsy?
A
Stroke
MS
21
Q
LMN causes of unilateral facial nerve palsy?
A
Bells palsy
Ramsay hunt syndrome
Acoustic neuroma
Parotid tumour
HIV
MS
DM
22
Q
What is Bell’s palsy?
A
Idiopathic damage to facial nerve with facial weakness sparing extraocular muscles and muscles of mastication
23
Q
Management of bell’s palsy?
A
Within 72 hours
50mg Pred 10 days then taper
Artificial tears, eye patch
24
Q
What is Ramsay Hunt Syndrome?
A
VZV reactivation causing otalgia and rash on the external auditory meatus
25
Management of Ramsay Hunt Syndrome?
Acyclovir
+
Prednisolone
26
What is trigeminal neuralgia?
Severe shooting pain in distribution of the trigeminal nerve triggered by light touch commonly
27
Causes of trigeminal neuralgia?
Primary
Secondary
- Malignancy
- AV malformation
- MS
- Sarcoidosis
- Lyme disease
28
Red flags for secondary causes of trigeminal neuralgia?
<40
Resistant to carbamazepine
Sensory changes
Deafness
Optic neuritis
FHx MS
29
Management of trigeminal neuralgia?
Carbamazepine
30
Side effects of carbamazepine?
SJS
Agranulocytosis
P450 inducer
SIADH
31
Cause of bitemporal hemianopia?
Lesion at optic chiasm
32
Upper > Lower bitemporal hemianopia?
Inferior chiasmal compression
Pituitary tumour
33
Lower > upper bitemporal hemianopia?
Superior chiasmal compression
Craniopharyngioma
34
Lesion of the optic tract or optic radiations?
Contralateral homonymous hemianopia
35
Quadrantanopias?
PITS
Parietal inferior
Temporal superior
36
Central scotomas are caused by?
Lesion to optic nerve or macula
37
Macular sparing is seen in?
Occipital cortex lesions
38
Sagittal sinus thrombosis can be seen with what features?
Seizure and hemiplegia
39
What is internuclear opthalmoplegia?
Lesion of the medial longitudinal fasciculus blocking connection between contralateral abducens and ipsilateral oculomotor
40
How is internuclear ophthalmoplegia seen?
Ipsilateral impaired adduction in the eye
41
Causes of internuclear opthalmoplegia?
Stroke
MS (more often bilateral)
42
Investigation for INO?
MRI for ischaemia/ demyelination
LP for oligoclonal bands
43
What is Erb's palsy?
C5-6 damage
44
How is Erbs palsy seen?
Waiter's tip position
C5-6 sensory loss
Winged scapular
45
What causes Erbs palsy?
Damage to C5-6 due to breech or falling increasing angle between neck and shoulder
46
What is Klumpke's palsy?
Damage to T1
47
How is klumpke's palsy seen?
Ulnar sensory loss
Claw deformity
Weakness of intrinsic hand muscles
48
How is Brown-sequard syndrome seen (hemi section of the cord)?
Ipsilateral hemiplegia
Ipsilateral loss of proprioception and vibration
Contralateral loss of pain and temp sensation
49
What is the descending motor tract called and where does it cross?
Corticospinal tract
Crosses at pyramids in medulla
50
What ascending sensory tract covers proprioception, touch and vibration and where does it cross?
Dorsal column
Crosses in midbrain
51
What is the ascending sensory tract that supplies temperature, pain, tickle and itch, and where doe is cross?
Spinothalamic tract
At SC level
52
Investigation for spinal stenosis?
MRI whole spine
53
How is cervical spindylosis seen?
Flaccid upper limb paresis
Variable sensory changes
Spastic paraparesis
54
What is transverse myelitis?
Inflammation of the spinal cord due to viruses, bacteria, fungi, MS or NMO
55
Investigation for transverse myelitis?
MRI
LP (PCR)
56
Management of transverse myelitis?
Treat underlying cause
Steroids in acute viral illness
57
How is acute viral myelitis seen?
Weakness and sensory disturbance
Pain
Fever
Meningism
UMN/LMN signs
58
What is neuromyelitis optics (NMO) AKA Devic disease?
Relapsing remitting demyelination of optic nerve and cervical spinal cord
59
How is neuromyelitis optica seen?
Optic neuritis
Myelitis
2 of the following:
- SC lesions in 3+ levels
- Normal MRI initially
- Aquaporin 4 +ve serum antibody
60
What antibody is associated with NMO?
Aquaporin 4
61
Investigations for NMO?
Aquaporin 4
MRI
62
Management of acute attack of NMO?
IV methylprednisolone
63
Maintenance management of NMO?
Monoclonal antibodies
- eculizumab
- ravulizumab
64
What is inclusion body myositis?
degenerative condition of muscles due to inflammation with wasting of quadriceps and fingers >50 years old
65
What is charcot marie tooth syndrome?
AD inherited sensori-motor neuropathy
66
AD mutation in charcoat marie tooth syndrome?
PMP22
67
Presentation of charcot marie foot disease?
Sensory-motor loss in feet around puberty with progression
Thickening of nerves
Distal muscular atrophy
Pes cavus
68
Physical signs of charcot marie tooth?
Enlarged nerves with palpable lateral popliteal nerve
Champagne bottle legs due to distal muscular atrophy
69
Diagnosis of charcot marie tooth syndrome?
Nerve conduction studies
genetic testing
70
Prognosis of charcot marie tooth?
Incurable but normal life expectancy
71
What is affected in anterior spinal artery occlusion?
Lateral corticospinal and spinothalamic tracts causing:
- Bilateral spastic paresis
- Bilateral loss of pain and temperature sensation
72
Management of TIA?
Aspirin 300mg STAT
TIA clinic
DAPT: Aspirin 75mg OD for 21 days + clopidogrel lifelong
PPI cover for aspirin
High dose statin
Carotid USS
73
Imaging for TIA?
MRI with DWI
CT only if concern of other pathology
74
Stroke mimics?
Hypoglycaemia
SOL
TIA
Hemiplegic migraine
Todd's paresis
75
Management of haemorrhagic stroke?
Neuro observations
BP <140/80
Neurosurgery d/c- decompressive hemicranioctomy if >3cm
Consider toxicology for cocaine
76
What area in a stroke can recover post thrombolysis?
Penumbra
77
Where is affected in a TACS?
Anterior and middle cerebral arteries
78
How is TACS seen?
Contralateral hemiplegia
+
Contralateral homonymous hemianopia
+
Aphasia/ neglect
79
Where causes PACS?
Upper or lower division of middle cerebral artery
80
How is PACS seen?
2 of TACS
Contralateral hemiparesis
Homonymous hemianopia
Aphasia/ neglect
81
How is an MCA stroke seen?
- Contralateral hemiplegia upper > lower and sensory loss
- Aphasia
- Homonymous hemianopia
82
What is affected in a lacunar stroke (brain areas)?
Basal ganglia
Thalamus
Internal capsule
83
How is a lacunar stroke seen?
* Unilateral weakness of face/arm/leg or all 3
* Pure sensory stroke
* Ataxic hemiparesis
* Clumsy hand syndrome- genu of internal capsule
84
Where does POCS affect?
Vertebrobasilar arteries which branches to the cerebellum, brainstem, occipital lobe
85
How is POCS seen?
* Cerebellar dysfunction
OR
* Loss of consciousness
OR
* Isolated contralateral homonymous hemianopia
86
Contralateral homonymous hemianopia with macular sparing, visual agnosia is?
Posterior cerebral artery stroke
87
Locked in syndrome with preserved consciousness and ocular movements?
Basilar artery occlusion stroke
88
What is lateral pontine syndrome?
Anterior inferior cerebellar artery stroke
Seen with:
- Facial paralysis
- Deafness
89
What is Wallenberg syndrome AKA?
Lateral medullary syndrome
90
What is wallenberg syndrome AKA lateral medullary syndrome?
Posterior inferior cerebellar artery stroke seen with:
- Ipsilateral facial pain loss and temp
- Contralateral loss of pain and temp in torso
- Ataxia/ nystagmus
91
What is weber's syndrome?
Ipsilateral CN palsy stroke
92
Assessment of stroke?
BM
Rosier score/ NIHSS
Non contrast CT
Bloods- Lipids, HbA1c, INR
93
Management of ischaemic stroke?
1. Aspirin 300mg STAT
2. Thrombolysis/ Thrombectomy
3. If no no 2 aspirin 300mg OD 2 weeks then clopidogrel lifelong
4. cardioembolic cause DOAC after 14 days
94
What is used in thrombolysis?
Alteplase
Tenecteplase
95
When is thrombolysis indicated?
- <4.5 hours of onset
- 4.5-9 hours of onset or within 9 hours of midpoint of sleep AND CT perfusion shows penumbra
96
What are the absolute contraindications to thrombolysis?
Previous intracranial haemorrhage
Seizure at onset
Intracranial neoplasm
LP <7 days
GI bleed <3 weeks
Stroke or TBI <3 months
Oesophageal varices
Uncontrolled HTN >200/120 (lower to 185/110)
97
Indications for thrombectomy?
Confirmed:
- Proximal anterior circulation stroke
<6 hours on onset + thrombolysis
6-24 hours with limited infarct core volume
- Proximal posterior circulation stroke
<24 hours and CT perfusion limited infarct core volume
98
Further investigations for stroke?
Carotid USS
Statin if cholesterol >3.5
ECG ? AF
Bedside Swallow
Bubble ECHO if DVT
Physio
99
When to do endarterectomy?
Stenosis >50%
100
When to introduce statin in stroke?
48 hours later due to risk of haemorrhagic transformation
101
Stroke in younger patients consider?
Vasculitis screen
Thrombophilia screen
102
String of beads appearance on imaging?
Fibromuscular dysplasia
103
How is fibromuscular dysplasia diagnosed?
Catheter angiography
104
What is the most common primary brain tumour?
Gliobastoma
105
Imaging of glioblastoma (most common primary brain tumour)?
Solid tumour with central necrosis and enhancing rim
106
Where do meningomas arise?
Benign and extrinsic from meninges causing problems with compression
107
CT of meningioma?
Enhancement with contrast
108
What is associated with bilateral vestibular schwannomas?
Neurofibromatosis 2
109
Astrocytomas are?
Common in children
Seen with Rosenthal fibres (corkscrew eosinophilic bundle)
110
Fried egg appearance of brain tumour?
Oligodendroma
111
Haemangioblastoma is associated with?
Von hipple lindaue
112
Treatment of cerebral oedema?
Weeks course of dexamethasone with PPI cover
113
Management of raised ICP?
Dexamethasone 8mg BD then mannitol if not working
114
Following Head Injury CT within 1 hour if?
GCS <13 on initial assessment
GCS <15 2 hours post injury
Suspected open/ depressed skull fracture
Basal skull fracture signs
Post traumatic seizure
Focal neurological deficit
>1 episode of vomiting
115
Following head injury CT head within 8 hours if?
TLOC or amnesia with any other below:
65+ years
Bleeding or clotting disorder
On anticoagulants
Dangerous mechanism
>30 mins retrograde amnesia
On warfarin alone
116
What is an extradural haematoma?
Collection of blood between dura and skull from middle meningeal artery classically torn at pterion
117
Presentation of extradural haematoma?
TLOC, lucid interval then low GCS
118
CT sign of extradural haematoma?
Lemon sign
119
Management of extradural haematoma?
Surgery
120
What is a subdural haemorrhage?
Venous bleed between the dura and arachnoid mater
121
Presentation of subdural haemorrhage?
Fluctuating confusion and headache and can present late
122
CT of subdural haemorrhage?
Banana
123
What is a subarachnoid haemorrhage?
Haemorrhage under arachnoid mater
124
Causes of SAH?
Traumatic
Spontaneous: AV malformation, berry aneurysms, pituitary apoplexy
125
What are risk factors for berry aneurysms?
PCKD
EDS
Coractation of the aorta
126
What ECG change can sometimes be seen in SAH?
ST elevation
127
Investigation for SAH?
Non contrast CT Head
- If <6h of symptom onset = ruled out
- If >6h of symptom onset = LP
LP 12 hours after symptom onset for xanthochromia
128
Management of SAH?
Reverse anticoagulation
Neurosurgery (? endovascular coiling/ clipping or craniotomy)
Nimodipine to prevent vasospasm
Manage BP, bed rest
129
Investigations for spontaneous SAH?
CT intracranial angiogram
130
Management of essential tremor?
Propranolol
131
Causes of parkinonism?
Parkinson's disease
Parkinson plus syndromes
Drug induced
Vascular
Wilsons disease
Dementia pugilistica
Post encephalitis
Toxins
132
What drugs can cause drug induced parkinsonism?
Haloperidol
Risperidone
Metoclopramide
133
How is drug induced parkinsonism seen?
Rapid motor signs
Symmetrical signs
Motor and tremor signs less common
134
Treatment of drug induced parkinsonism?
Procyclidine
Trihexyphenidyl
135
What is the queens square brain bank diagnostic criteria for parkinsons disease?
Bradykinesia + 1 of:
- Rigidity
- 4-6Hz rest tremor
No exclusion criteria
136
First line treatments for PD?
Motor symptoms affecting QOL: Levodopa
Motor symptoms NOT affecting QOL: dopamine agonist, levodopa or MAO-B inhibitor
137
Name the dopamine receptor agonists?
Ergot derived: Bromocriptine, Cabergoline
Non ergot derived: pramipexole, ropinirole, rotigotine, apomorphine
138
What are ergot derived dopamine agonists associated with?
Retroperitoneal, pulmonary and cardiac fibrosis needing ECHO, CXR, ESR, creat prior to commencing
139
Risks of using dopamine agonists?
Impulse control disorders
Excessive daytime somnolence
140
Name MAO-B inhbitors?
Selegiline
Rasagiline
141
What are COMT inhibitors?
Entacapine
Tolcapone
142
Treatment of psychosis or hallucinations in PD?
Quetiapine
143
Risks of stopping PD meds acutely?
Acute akinesia
NMS
144
When is PD dementia seen?
Years after motor symptom onset
145
When is lewy body dementia seen?
Memory concerns at the same time or before motor symptoms
146
What are the 3 parkinson plus syndromes?
Progressive supranuclear palsy
Multisystem atrophy
Corticobasal degeneration
147
How is progressive supranuclear palsy seen?
Vertical gaze palsy
Gait instability- falling backwards
Frontal lobe dysfunction
Fast progression
Poor response to levodopa
148
What is the cause of progressive supranuclear palsy?
Frontal tau deposition
149
What is multisystem atrophy caused by?
Alpha synuclein deposition in the basal ganglia, cerebellum and brainstem
150
How is MSA seen?
Autonomic dysfunction (ED, postural hypotension, atonic bladder)
Cerebellar signs
Death within 10 years
151
What is corticobasal degeneration?
Aphasia and ataxia
Alien hand syndrome
152
What are cerebellar signs?
DANISH
Dysdiadochokinesia
Ataxia
Downbeat nystagmus
Intention tremor
Slurred speech
Hypotonia
Titubation
153
Causes of cerebellar dysfunction?
Wernicke's encephalopathy
Alcohol excess
Drugs (valproate, phenytoin)
Stroke
MS
Meningitis
Friedrichs ataxia
154
What is Friedrich's ataxia?
AR early onset hereditary ataxia due to trinucleotide GAA repeat in X25 gene on Chr 9 (frataxin)
155
What does freidreichs ataxia not show?
Anticipation
156
How does Friedrich's ataxia present?
10-15 year olds with lower limb weakness, gait ataxia and kyphoscoliosis
Mixed UMN and LMN signs - absent reflexes
Intention tremor
157
Non motor features of Freidrich's ataxia?
HOCM (most common cause of death)
Optic atrophy
T1DM
High arched palate
158
Prognosis of friedrichs ataxia?
Wheelchair by 20
Death by cardiac complications 40's
159
What is ataxia telangectasia?
AR combined immunodeficiency syndrome due to defect in ATM gene which encodes DNA repair enzymes
160
How does ataxia telangiectasia present?
1-5 year olds with cerebellar ataxia, telangestasia, IgA deficiency (recurrent chest infections
161
Risk in ataxia telangiectasia?
10% malignancy
Leukaemia, lymphoma
162
What is Huntington's disease?
AD disorder of CAG repeat in Chr 4 huntingtin gene leading to degeneration of the cholinergic and GABAergic neurones in the striatum of the basal ganglia
163
How is huntingtons disease seen?
Chorea
Personality change
Intellectual impairment
Dystonia
Saccadic eye movements
Dementia
164
What is dystonia?
Prolonged, painful muscle contraction
165
Causes of dystonia?
Idiopathic
Anti psychotics
Metoclopramide
Wilson's disease
PD
MSA
Torticolis
Trismus
166
Management of acute dystonia?
Procyclidine
167
Signs and symptoms of MS?
Optic neuritis
INO
Uhthoff's phenomena
paraesthesia/ numbness
Trigeminal neuralgia
Lhermitte's sign
Paraparesis
168
How is optic neuritis seen?
loss of colour vision
Painful eye movements
APD
169
What is uhthoff's phenomena in MS?
Worsening of vision following rise in body temperature
170
Investigations for MS?
MRI
Oligoclonal bands in CSF
171
MRI in MS?
Periventricular white mater lesions
High signal T2 lesions
Dawson fingers on FLAIR
172
Management of acute flair in MS?
High dose methylprednisolone 5 days
173
Indications for disease modifying treatment in MS?
Relapsing remitting disease + 2 relapses in the past 2 years + able to walk 100m unaided
OR
Secondary progressive disease + 2 relapses in past 2 years and able to walk 10m aided or unaided.
174
Disease modifying agents in MS?
Natalizumab
Ocrelizumab- anti CD20
175
Concern in using natalizumab?
Risk of progressive multifocal leukoencephalopathy (PML) reactivation of JC virus
176
Management of fatigue in MS?
Rule out other causes
Amantidine
177
Management of spasticity in MS?
Baclofen
Gabapentin
If fails diazepam and dantrolene
178
What is Holmes-Aide Pupil?
Dilated pupil
Slow accommodation
Poor light response
179
Argyll-Robertson Pupil is?
Prostitute pupil- DM and neurosyphilis
Constricted pupil
Accommodates but doesn't react to light
180
What is Horner's Syndrome?
Damage to the sympathetic nervous system to the face causing:
- Miosis (small pupil)
- Ptosis
- Anhidrosis (on one side)
181
Congenital horners syndrome is seen by?
Heterochromia
182
How to localise horner's syndrome?
Central lesions
- Anhidrosis to face-arm-trunk
Pre-ganglionic lesions
- Anhidrosis to face
Post ganglionic lesions
- No anhidrosis
183
What are the causes of central, pre-ganglionic and ganglionic lesions in horner's syndrome?
Central: SSST
Stroke
Sytingomyelia
Multiple sclerosis
Tumour
Pre-ganglionic: TTTT
Tumour- pancoast
Thyroidectomy
Trauma
Top rib- cervical rib
Post ganglionic: CCCC
Carotid dissection
Carotid aneurysm
CVST
Cluster headache
184
What is syringomyelia?
Fluid filled cavity in SC disrupting ventral horns and lateral spinothalamic tract
185
Causes of syringomyelia?
Type 1 Chiari malformation
Tumour
Trauma
Idiopathic
186
Presentation of syringomyelia?
Loss of pain and temp in shawl like distribution
Flaccid paresis
Upgoing plantars
187
Investigations for syringomyelia?
MRI whole spine
MRI brain to exclude Chiari malformation
188
What is spastic paraparesis?
UMN lower limb spasticity
Due to:
- MS
- Cerebral palsy
- SCC
- Disc prolapse
- Syringomyelia
- Transverse myelitis
- Hereditary
- Infection
- Trauma
189
What does the medial nerve supply?
Motor: LOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Sensory supply to plasma thumb and 2.5 fingers
190
Damage to median nerve at wrist level results in?
Paralysis and wasting of thenar eminence
Sensory loss to thumb and 2.5 fingers palmar
191
Damage to median nerve at elbow?
Unable to pronate forearm
Weak wrist flexion
Ulnar deviation at wrist
192
What does common perineal nerve lesion cause?
Foot drop
Weak dorsiflexion and eversion
Sensory loss to foot dorsum
High stepping gait
193
What is meralgia paresthetica?
Compression of the lateral cutaneous nerve seen with outer thigh pain
194
Presentation of motor neurone disease?
UMN and LMN signs
Asymmetric limb weakness
Wasting of small hand muscles
NEVER any sensory symptoms
Fasciculations
195
Investigations for MND (to rule out treatable differentials)?
TFTs
Protein electrophoresis
MRI brain and Spinal cord
EMG
Conduction studies
196
EMG in MND?
Reduced number of action potentials with increased amplitude
197
Conduction studies in MND?
Normal
198
Treatment of MND?
Riluzole
NIV BIPAP
Baclofen for spasticity
PEG
199
Inheritance and mutation of Duchenne's muscular dystrophy?
X linked recessive frameshift mutation affecting dystrophin
200
How does duchenne's muscular dystrophy present?
Muscle wasting and weakness in early childhood (5)
Gowers sign
Bulky appearance
201
Prognosis of duchenne's muscular dystrophy?
Wheelchair bound by puberty
Death in early twenties
202
Inheritance and mutation in Becker's muscular dystrophy?
X linked recessive insertion mutation affecting dystrophin
203
Presentation of beckers muscular dystrophy?
Muscle wasting and weakness in late childhood (10)
204
Investigations for muscular dystrophy?
CK raised
EMG
Muscle biopsy
Genetic testing- gold standard
205
Complication of Beckers muscular dystrophy?
Dilated cardiomyopathy
206
Inheritance of myotonic dystrophy?
AD trinucleotide repeat in 20-30 year olds with abnormal chloride channels
207
Mutations in myotonic dystrophy?
DM1: DMPK distal weakness
DM2: ZNF9 proximal weakness
208
Presentation of myotonic dystrophy?
Weakness
Frontal balding
Early cataracts
Myopathic faces
Percussion myotonia
Dysarthria
First degree HB
209
Inheritance of facioscapulohumeral muscular dystrophy?
Facial, scapular and upper arm weakness with winging of shoulder blades
210
What is myasthenia gravis?
Autoimmune condition leading to progressive weakness with use
211
Antibodies with myasthenia gravis?
ACh receptor antibodies
MuSK antibodies
LRP4 antibodies
212
Associations with myasthenia gravis?
Thymoma
Thymic hyperplasia
Autoimmune disorders
213
Exacerbating factors in myasthenia gravis?
Gentamicin
Infection
BB
Lithium
Penicillamine
Quinolones -oxacins
Tetracyclines
Phenytoin
Procainamide
214
Investigations of myasthenia gravis?
Antibodies
CT chest
Nerve conduction studies
215
Treatment of myasthenia gravis?
Pyridostigmine
Immunosuppression: Prednisolone/ azathioprine
Thymectomy
216
Myasthenic crisis is?
Acute worsening of symptoms commonly triggered by infection needing BIPAP/ intubation
217
Treatment of myasthenic crisis?
IV immunoglobulins
Plasma exchange
Intubation and ventilation if FVC 15ml/kg or less
218
