2neurp Flashcards
cerebellar lesion in gait ataxia vs finger-nose ataxia
gait - hemisphere
finger nose - vermis
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be
admitted immediately for imaging to exclude a haemorrhage
A 28-year-old man is reviewed in clinic accompanied by his housemate. The man explains that on a few occasions, he has had short episodes, around 30 seconds, where he is unresponsive to his surroundings, but does not lose consciousness. During these times, he has a strange smell and unusual taste in his mouth. His housemate says he will smack his lips and always move his right hand in a finger-picking motion whilst he’s unresponsive.
He has no medical history and no drug allergies.
Given the likely diagnosis, what is the appropriate management?
Lamotrigine is the correct answer. This man has presented with repeated episodes of focal-aware seizures. This is likely to be originating in the temporal lobe given the presenting symptoms of change in taste and smell, repetitive finger-picking movements and lip-smacking. It is a focal aware seizure as even though he is unresponsive during episodes, he is retaining consciousness throughout. Typically these only last for approximately 30 seconds. The first-line treatment for focal seizures in men is lamotrigine or levetiracetam, making lamotrigine the correct answer (as levetiracetam is not an answer option).
Ethosuximide is incorrect. This is the appropriate treatment for an absence seizure. Whilst this can present in a similar way, typical symptoms of an absence seizure include staring into space for a few seconds and can be accompanied by lip-smacking and eyelid rapid blinking. In this man, the presence of a change in taste and smell, along with the finger-picking movement should raise suspicion of a focal seizure, in particular, originating in the temporal lobe.
epilepsy medication males
Epilepsy medication for males:
generalised seizure: sodium valproate
focal seizure: lamotrigine or levetiracetam
A 24-year-old woman presents for advice. Over the past few months she has been having increasing problems with migraine around the time of menstruation. Her current migraine started around 6 hours ago and has not responded to a combination of paracetamol and aspirin. What is the most appropriate next step to relieve her headache?
sumatriptan
waddling gait vs ataxic gait
waddling - Typically seen in muscular dystrophy and it is characterised by a swaying motion of the hips, resulting in a waddling-like walking pattern
ataxic - unsteady, uncoordinated walking pattern characterised by wide-based steps, difficulty maintaining balance, and a loss of the normal heel-toe pattern.
ataxic gait causes
cerebellar injury -
classic triad of huntingtons disease
Middle-aged, personality changes, involuntary movements
ALS vs subacute combined degeneration of the cord presentation
loss of sensation and proprioception, and ataxia, in subacute combined degeneration
both have UMN and LMN signs
both would have progressive weakness in the upper and lower limbs. On examination, you note brisk knee reflexes, absent ankle jerks, and extensor plantars. Power is reduced in all muscle groups
