Acute weakness Flashcards
What is lambert eaton syndrome?
Classed as paraneoplastic
Antibodies against pre-synaptic voltage gated Ca channels
Most have underlying Ca - usually SCLC
Weakness = proximal muscles in arms/legs
- Mostly affects legs so hard to stand up/climb stairs (in comparison to MG)
- Gets better with exercise
64 yo lady referred with a tremor. PMH of diet controlled T2DM. Exam - L sided resting tremor + no other findings on neuro exam. Pt continues to cycle 2 miles a day + does not want tx that may affect this. What is most likely diagnosis?
- MSA, essential tremor, IPD, cortico-basal degeneration, PSP
Idiopathic Parkinson’s disease
64 yo lady referred with a tremor. PMH of diet controlled T2DM. Exam - L sided resting tremor + no other findings on neuro exam. Pt continues to cycle 2 miles a day + does not want tx that may affect this. What is the most appropriate tx for this pt?
- Co-careldopa, selegiline, rotigotine, entacapone, amantadine
Selegiline
82 yo man with known PD presents to neuro with worsening motor function + recurrent falls over 6m. Tx with co-beneldopa 200mg QDS, ramipril 2.5mg OD, bisoprolol 2.5mg OD + warfarin. He describes periods of stiffness + increased tremor in between doses. He has a pill rolling tremor affecting both hands which is markedly worse on right. He has shuffling gait + almost falls over when he tries to run. What is most likely reason for presentation?
- Peripheral SE of levodopa
- Progression to MSA
- Intracerebral bleed
- Motor fluctuations 2. to levodopa resistance
- Poor compliance with meds
Motor fluctuations secondary to levodopa resistance
82 yo man with known PD presents to neuro with worsening motor function + recurrent falls over 6m. Tx with co-beneldopa 200mg QDS, ramipril 2.5mg OD, bisoprolol 2.5mg OD + warfarin. He describes periods of stiffness + increased tremor in between doses. He has a pill rolling tremor affecting both hands which is markedly worse on right. He has shuffling gait + almost falls over when he tries to run. How can the management of PD be optimised?
- Add DA receptor antagonist
- Switch to co-careldopa
- Increase dose of co-beneldopa
- Refer for deep brain stimulation therapy
- Add MAO-B inhibitor
Add MAO-B inhibitor
A 33-year-old man known to drink large amounts of alcohol is admitted to AMU with acute alcohol withdrawal. He is very aggressive to the nursing staff and has required multiple doses of sedative drugs over the last two days. You are called to review the patient as he has suffered a fall on the ward. On examination, he has symmetrical rigidity in his upper limbs and is drooling saliva. There is no tremor, but the patient has difficulty picking up a pen. His cognition is unaffected. What is most likely cause for the patients rigidity?
- Pabrinex
- Chlordiazepoxide
- Corticol degeneration 2. to alcohol abuse
- Haloperidol
- Progression to WE
Haloperidol
A 78-year-old woman is admitted to hospital with CURB 3 community-acquired pneumonia. She is clinically dehydrated and is commenced on IV fluids and IV antibiotics. She is very drowsy and is unable to tolerate any oral medication. She is known to have Parkinson’s Disease and normally takes 150mg of levodopa per day.
What is the best course of action?
Omit levodopa until patient has recovered
Start patient on a 2mg/24 hour rotigotine patch
Start patient on a 4mg/24 hour rotigotine patch
Start patient on a 6mg/24 hour rotigotine patch
Refer the patient for a PEG tube
Start patient on a 4mg/24h rotigotine patch
A 64-year-old patient presents with recurrent episodes of falls where he trips over objects. He also reports a worsening tremor in his right hand. On examination, the patient is unable to twist from side to side whilst sat in a chair, and he has a pill-rolling tremor in the right hand. An MRI brain scan reveals the ‘hummingbird sign’. What is the most likely diagnosis? Drug-Induced Parkinsonism Cortico-basal degeneration Progressive Supranuclear Palsy Idiopathic Parkinson’s Disease Multi System Atrophy
Progressive supranuclear palsy
A 73-year-old woman presents with recurrent falls. She also reports feeling profoundly dizzy when she stands, and this has resulted in her becoming largely house-bound. She has recently purchased a commode due to recurrent episodes of urinary incontinence. On examination, she has hypomimia, bradykinesia, rigidity and tremor. Her BP is 130/70 sitting down but falls to 92/45 on standing.
What is the most likely diagnosis? Drug-Induced Parkinsonism Cortico-basal degeneration Progressive Supranuclear Palsy Idiopathic Parkinson’s Disease Multi System Atrophy
Multi system atrophy
An 84-year-old man is brought to the neurology clinic by his daughter with worsening mobility and deteriorating cognitive function. His daughter reports that the patient has become increasingly forgetful and has been unable to care for himself. On examination, the patient has an asymmetrical tremor affecting only the right-side. There is associated rigidity and bradykinesia. The patient scores 15/30 on the Mini-Mental State Examination. An MRI shows increased prominence of the sulci.
What is the most likely diagnosis? Drug-Induced Parkinsonism Cortico-basal degeneration Progressive Supranuclear Palsy Idiopathic Parkinson’s Disease Multi System Atrophy
Cortico-basal degeneration
What is agnosia?
Inability to process sensory information -can’t recognise common objects, faces, sounds
What is apraxia?
Being unable to carry out skilled movements + gestures
Paralysis in cauda equina
Flaccid paralysis with loss of reflexes
- Sensory + power loss
Paralysis in SCC
Spastic paralysis with brisk reflexes
- Sensory + power loss
Symptoms suggesting cauda equina in patients with lower back pain
Bilateral sciatica Bladder dysfunction Perianal paraesthesia Gait disturbance Lower limb weakness Erectile dysfunction
