Neurology 🧠 Flashcards by Clare Dempsey

What are Argyll-Robinson pupils?

2 different sized pupils

Associated with Syphilis

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What is Uthoff’s phenomenon?

Symptoms being worse with heat.

Seen in pts with MS

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A young woman presents with arm pain on movement and visual disturbances. She has had these symptoms before and they usually subside within a week.

What does she have?

Multiple Sclerosis

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How do you manage MS relapses?

Methylprednisolone

Reduces duration but does not change prognosis

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What is used to treat muscle spasms (usually in MS)?

Baclofen

*Note: can also be used for hiccups

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What is Charcot-Marie-Tooth disease?

A collection of peripheral neuropathies.
Progressive.
Px: muscle weakness (1st in ankles and feet), curled toes, foot drop, parasthesia in hands and feet.

May also have cold hands and feet due to poor circulation

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What investigation findings would indicate a diagnosis of Myasthenia Gravis?

Anti-AchR Ab +ve
MUSK Ab +ve
Single fibre EMG showing a “jitter” and “blocking” pattern

*NOTE: Also do a contrast CT to exclude a Thymoma

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How do you differentiate between Multiple Sclerosis and Motor Neurone Disease?

MND = sphincter disturbances, but no sensory loss

MS = sensory loss but no sphincter disturbances

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What Anti-Epileptic Drug (AED) should be avoided in pregnancy?

Sodium Valporate

Teratogenic

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A pt has a seizure lasting longer than 5 mins and has already been given IV Lorazepam, what do you do next?

Give another dose of IV Lorazepam.

If this is unsuccessful, give IV Phenytoin

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What is a typical history of Myasthenia Gravis?

Weakness of extra-ocular region —> bulbar —> face —> neck—> limb—> trunk

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How do you manage Myasthenia Gravis?

Pyridostigmine (Ach inhibitor) + immunosuppression

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What is the drug Riluzole used for?

Motor Neurone Disease

It is a neuro-protective drug called an anti-glutamate

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What is Horner’s Syndrome the triad of?

Anhydrosis (dry eyes)
Ptosis (droopy eyes)
Myosis (constricted pupils)

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How do you manage temporal arteritis?

High dose oral prednisolone

If no dramatic response, consider another diagnosis

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What condition is temporal arteritis associated with?

Polymyalgia Rheumatica

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What is the common Px of temporal arteritis?

Headache
Jaw claudication
Fatigue
Over 60
Morning stiffness
Visual disturbances

Skip lesions found on histology/biopsy

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How do you manage an acute migraine?

Oral triptan (e.g. Sumatriptan) + NSAID or paracetamol

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Migraine prophylaxis?

Topiramate or Propranolol

NOTE: topiramate is teratogenic, so give Propranolol to women of child-bearing age

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Cluster headache prophylaxis

Verapamil

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How do you manage acute cluster headaches?

100% oxygen via non-rebreather

Can also give subcut/nasal Triptan

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Management of acute tension headaches

Aspirin, NSAIDs or paracetamol

Trigeminal Neuralgia Px

Brief electric shock-like pains, abrupt onset and termination, limited to 1/2 divisions of the trigeminal.
Pain evoked by light touch and actions eg brushing teeth
Nasolabial fold is v susceptible

How do you manage trigeminal neuralgia?

Carbamazepine

What is a thunderclap headache indicative of?

Subarachnoid haemorrhage

What kind of haemorrhage can be caused by beri aneurysms?

Subarachnoid

If pt presents with subarachnoid haemorrhage symptoms (worst headache ever had, nausea, vomiting, seizures) but CT is -ve, what do you do?

Lumbar puncture - look for blood in CSF

What are chronic subdural haematomas/ haemorrhages caused by?

Rupture of the small bridging veins; slow bleeding

In what type of haemorrhage do you get a lucid interval?

Epidural haemorrhage

What type of haemorrhage is associated with elderly + alcoholics?

Subdural

What is the triad of meningism?

Nuchal rigidity, photophobia and headache

What are the early features of meningitis?

Headache and leg pains Fever with cold hands and feet Abnormal skin colour

What type of rash indicates meningitis?

Non-blanching petechial rash Especially in meningiococcal septicaemia

What bacteria cause meningitis is 0-3 month olds?

Group B Streptococcus (most common in neonates) E.Coli Listeria Monocytogenes

What bacteria cause meningitis in any patients over 3 months old?

Neisseria Meningitidis Streptococcus Pneumoniae Note* H. Influenzae causes meningitis in the old (over 60) and the young (3 months - 6yrs)

What is the bacterial cause of meningitis in immunocompromised pts?

Listeria Monocytogenes

What is the management of meningitis?

Ceftriaxone Add Amoxicillin if >60yrs or immunocompromised If signs if meningism - give Dexamethasone (but DO NOT GIVE if meningococcal septicaemia)

What do you give as prophylaxis to close contacts of pts with meningococcal meningitis?

Ciprofloxacin or Rifampicin Also offer vaccines NOTE* do not give prophylaxis to close contacts of pts with pneumococcal meningitis

What is 'status epileptics'?

Status epilepticus is defined as: a single seizure lasting >5 minutes, or >= 2 seizures within a 5-minute period without the person returning to normal between them This is a medical emergency. The priority is the termination of seizure activity, which if prolonged will lead to irreversible brain damage.

3rd nerve palsy Px?

- Eye deviated "down and out" - Ptosis - Pupil may be dilated (sometimes called surgical 3rd nerve palsy)

What are the causes of 3rd nerve palsy?

- Diabetes - Vasculitis Eg temporal arteritis, SLE - False localising sign due to uncal herniation through tentorium if raised ICP - Posterior communicating artery aneurysm - Cavernous sinus thrombosis - Weber's syndrome: ipsilateral 3rd nerve palsy with contralateral hemiplegia - caused by midbrain strokes - Amyloidosis - MS

Where does C6 innervate?

Thumb + index finger Make a 6 with thumb +index finger - C6

Where does T4 innervate?

T4 at the Teat Pore = Nipples

Where does T10 innervate?

Umbilicus - BellybuT-TEN

Where does L1 innervate?

Inguinal ligament - L for ligament, 1 for 1inguinal

Where does L4 innervate?

Knee caps - Down on aLL fours (L4)

L5 Innervation?

Big toe, dorm of foot (except lateral aspect) L5 = Largest of the 5 toes

S1 Innervation?

Lateral foot, small toe S1 = the smallest one

Lacunar stroke Px?

- Unilateral motor disturbance affecting the face, arm or leg or all 3. - Complete one sided sensory loss. - Ataxia hemiparesis

Which abx increase risk of intracranial HTN?

Tetracyclines Eg Doxycycline

What are the features of idiopathic intracranial HTN?

``` Headache Blurred vision Papilloedema (usually) Enlarged blind spot 6th nerve palsy may be present ```

Rx of idiopathic intracranial HTN?

Weight loss Diuretics eg acetazolamide Topiramate can be used Repeated LP

What are the main migraine triggers?

``` CHOCOLATE: C - chocolate H - hangovers O - orgasms C - cheese + caffeine O - oral contraceptive pill L - lie-ins A - alcohol T - travel E - exercise ```