6. Chronic Neuro

Question 1

What is MS?

Answer 1

Chronic inflammatory demyelinating disease of CNS. Loss in myelin and oligodendroglial and axonal pathology.

Question 2

What are the three types of MS?

Answer 2

Relapsing-remitting
Secondary progressive (relapsing remitting that adds features onto the baseline)
Primary progressive (slow progression to disability)

Question 3

MS symptoms?

Answer 3

Optic neuritis
Motor weakness
Fatigue
Sensory disturbance (not common in other neuro conditions)
Hemiparesis/hemosensory loss
Lhermitte's sign (neck shock)

Question 4

Diagnosing MS?

Answer 4

1. Exclude other diagnosis
2. Dissemination in time (shows progression over time)
3. Dissemination in space

Use MRI, CSF (oligoclonal bands), electrophysiology. Mostly history and examination

Question 5

What is myasthenia gravis?

Answer 5

Autoantibodies against AChR at NMJ.
Some patients may have anti-MuSK antibodies.

Thymus associations too! Hyperplasia (70%) or rarer thymomas.

Question 6

Symptoms of myasthenia gravis?

Answer 6

Ptosis
Diplopia
Dysarthria
Dysphagia
SOB (late stage)
Fatigable muscles
Normal reflexes

All muscles fatigue with use, hence causing these

Question 7

How to diagnose myasthenia gravis?

Answer 7

Bloods for autoantibodies
EMG for weaker signals as muscles tire
CT/MRI for thymus malignancy

Question 8

Motor neurone disease symptoms?

Answer 8

Progressive muscle weakness
Dysphagia
SOB
Sparing oculomotor, sensory and autonomic

Signs incl. wasting of tongue and hypothenar

Question 9

Parkinson’s disease pathophysiology?

Answer 9

Loss of dopaminergic neurones in the substantia nigra

Question 10

Parkinson’s symptoms?

Answer 10

Classical triad -
Resting tremor
Rigidity
Bradykinesia

Extras - 6 Ms
Monotonous hypotonic speech
Micrographia (small handwriting)
March a petit pas (stooped with small steps, shuffling gait)
Misery (depression)
Memory loss (dementia)
hypoMimesis (featureless)

Question 11

Symptoms of huntington’s?

Answer 11

Motor - choreic movements, dysphagia, athetosis (uncontrolled movements), ataxia
Cognitive - depression etc.

CAG repeat testing is diagnostic

Question 12

5 As of alzheimer’s

Answer 12

Amnesia
Anomia (naming objects)
Apraxia (inability to perform learned commands)
Agnosia (difficulty understanding)
Aphasia (communication)

Question 13

Alzheimer’s test

Answer 13

MMSE
Addenbrooke’s cognitive assessment
MOCA

Question 14

What is wernicke’s encephalopathy?

Answer 14

Thiamine deficiency causing a loss of cortical tissue in the brain.

Question 15

Triad for wernicke’s encephalopathy?

Answer 15

Ataxia
Eye signs
Confusion

Also signs of causes e.g. alcohol and malnourishment

Question 16

Diagnosing wernicke’s?

Answer 16

Bloods - albumin for causes, B1
ECG
CT
Neuropsychology for confusion

Question 17

Why is wernicke’s a medical emergency?

Answer 17

Death in 20%

It can become chronic in korsakoff’s, this is then irreversible and the patient is confused. Confabulation too.