9. Common Neurology Flashcards
Outline carpal tunnel syndrome
Compression of the median N in the carpal tunnel (BORDERS = flexor retinaculum, CONTAINS = medium N, flexor pollicis longus, 4 flexor digitorum superficialis, 4 flexor digitorum profundus)
S+S = pain, numbness, tingling in the thumb, index finger, middle finger and the thumb side of the ring finger, thenar eminence wasting, weak thumb abduction
RF = obesity, repetitive wrist work, pregnancy, genetics, RF, DM, hypothyroid
Ix = clinical Dx
Mx = wrist splint, corticosteroid injections, surgery to cut the transverse carpal ligament
Describe ulna nerve palsy
Ae = trauma, entrapment, olecranon #, distal humerus #, medial epicondylar #, valgus stress, childhood supracondylar #, transient occlusion brachial artery (surgery), subdermal contraceptive (implant), haemophilia, tumour, blunt injuries
S+S = numbness, tingling in fourth and fifth digits, half of 3rd digit, weak finger abduction (wasted interossei), clawed little finger + ring finger, wasted (concave) hypothenar eminence
Ix = N conduction exam, X ray, FBC urinalysis, MRI, USS
Mx = NSAIDs, corticosteroid injections, splinting, surgical cubital tunnel release
List the causes of epilepsy and outline the pathophysiology
- none found
- infection (meningitis)
- hypoNa
- hypoglycaemia
- hypoCa
- hypoMg
- toxins
- trauma
- tuberous sclerosis
- febrile
- CNS tumour/malformation
PROVOKING = flickering lights, hyperventilation, sleep/deprivation, alcohol, menstruation
Path = tendency to intermittent abnormal electrical brain activity, seizures (abnormal excessive neuronal activity)
How can epilepsy present/what are the types?
GENERALISED (EEG abnormal, normal MRI)
- Tonic-clonic = stiffen then jerk with LOC, aura, cry, pot ictal phase, tongue biting, incontinence, unwell after (headache, confusion, muscle ache)
- Myoclonic = brief (<0.1s) shock-like jerks of a muscle or group of muscle
- Absence = brief pauses, eyes may roll up, unaware of attack, motor activity (repetitive, lip smacking, eye fluttering), short duration, multiple attacks
FOCAL (abnormal EEG + MRI)
- Temporal lobe = deja-vu, lip smacking, repetitive movements
How should suspected epilepsy be Ix?
EEG = 3-4Hz spike and wave complexes
- only supports Dx of epilepsy, if no findings does not rule it out
MRI - if focal neurological signs, ?lesion
- can do CT head if time not permitting
ECG - routinely performed as cardiac arrhythmia can mimic epilepsy
Bloods = electrolytes, glucose
Briefly describe the Mx of epilepsy
Single ep = confirm, establish cause, advice on avoiding, discuss RF, inform DVLA (withdraw driving privileges for 1y)
***enhance GABA, supress glutamate
FOCAL = lamotrigine, carbamazepine (+ vit D supplements)
GENERALISED =
- Tonic-clonic = Na valproate (teratogenic), lamotrigine
- Absence = ethosuximide, Na valproate (teratogenic)
- Myoclonic = Na valproate (teratogenic)
Other Mx = ketogenic diet, vagal N stim, surgery (isolation of the hemispheres), refer to epilepsy clinic, Vit D levels if on Na valproate (induces met)
Outline Bell’s palsy
Facial paralysis - dysfunction of facial N, CN 7
Ae = unknown
RF = preg, URTI, DM, herpes simplex, herpes zoster, EBV, CMV, mumps, rubella
S+S = ipsilateral paralysis (including forehead), muscle twitching, weakness, loss of taste sensation in the anterior 2/3 of the tongue, normal sounds are very loud (tympanic branch), change in tears/salivation
Ix = Dx of exclusion, check ear for ramsey hunt syndrome
Mx = corticosteroids, tear-like eye drops, eye protector, physio
- Sx should resolve within a month
Outline cervical/lumbar spondylosis
Degenerative OA of intervertebral joints in the C/L spine
Pressure changes across disk = osteophytes
Pressure on nerve roots = radiculopathy (paraesthesia, pain, motor weakness)
Pressure on cord = myelopathy (global weakness, gait dysfunction incontinence)
Ix = x-ray, CT/MRI, myelography, N conduction studies
Mx = NSAIDs, corticosteroids, muscle relaxants (cyclobenzaprine), gabapentin/pregabalin, anti-depressants, physio, surgery
Outline polyneuropathy
Damage/disease affecting peripheral Ns in roughly the same areas on both sides of the body
- Distal axonopathy = interrupted function of peripheral Ns (DM, kidney failure, CT disease, malnutrition, alcoholism)
- Myelinopathy = loss of myelin or Schwann cells (Guillain–Barré syndrome)
- Neuronopathy = issues in the PNS (MND, toxins, autonomic dysfunction)
S+S
- Sensory polyneuropathy – ataxia, numbness, muscle wasting and paraesthesiae.
- Hereditary polyneuropathy – scoliosis and hammer toes
Ix = Hx, exam, toxins, electrodiagnostic testing, serum protein electrophoresis, nerve conduction studies, urinalysis, serum CK, Ab testing
Mx = weight decrease, walking aid, OT, BP control (DM)
What are the possible causes of parkinsonism
Paralysis agitans (IPD)
Drugs: Typical antipsychotics (haloperidol, chlorpromazine), GI prokinetic (metoclopramide), heroin
Neurodegenerative disorders - MSA, PSP, CBD
Vascular pseudoparkinsonism
Infection - encephalitis lethergica
Met - Wilsons
Toxins - MPTP, Mn, CP
Outline hyperkinetic movement disorders
CHOREA = huntingtons, Sydenham’s drug induced, wilsons, thyroid conditions
DYSTONIA = fixed/mobile, prim/sec, gen/localised
TREMOR = fine/course, fast/slow, symmetry/body part, intermittent/persistent, rest/action/postural, relieving/provoking
MYOCLONUS (jerks) =
1) tics - often facial + small, simple repetitive single muscle group, multiple associated with grunts/noises
2) myoclonus - cortical, spinal (exclude), hypoxia, CJD
Outline radial N palsy
Ae = humeral fracture (mid-shaft), crutch compression in axilla
S+S =
- Weak wrist extension - wrist drop
- Weak finger extension
- Bottom of thumb, extensor side, - sensory loss
Outline axillary N palsy
Ae = fracture/dislocation of head of humerus, brachial neuritis
S+S =
- Wasting of the deltoid
- Weakness of shoulder abduction
- Sensory loss over regimental badge
Outline Juvenile myoclonic epilepsy
Common syndrome of tonic-clonic seizures and myoclonic jerks, sometimes absences
Begins in childhood/adolescence and often persists into adulthood. It has a genetic predisposition
Contributing factors - alcohol, poor med adherence, sleep deprivation, carbamazepine
Mx =
- If on carbamazepine switch
- Na valproate
- ECG (routine as cardiac probs can mimic epileptic seizures)
- Referral to neurology
Briefly outline non-convulsive status epilepticus
Electrographic seizure activity on EEG associated with minimal or no motor movements
Suspect when = long postictal period, altered sensation with subtle signs such as blinking/twitching, fluctuating mental status
Ix = EEG, glucose, LP (infection), CT head (lesion)
Mx =
- Benzo: diazepam, lorazepam
- Valproate or phenytoin - if failure to respond to benzo
