capsule neuro Flashcards
parkinsons sign (3)
unilateral tremor in arm worse when arm not in use or pt anxious and then spreads to involve other limbs in asymetrical manner
lead pipe or cogwheel ridgidity
inc tone in limbs and trunk (UMN)
treatment for parkinsons
levodopa to inc dopamine, can lead to psychosis if too much dopamine
SPA: need to dec dopamine so pt can have parkinson like sympotms
sudden onset left sided facial weakness, initial pain around left ear, taste altered, dribbling saliva, difficulty closing left eye.
CN VII palsy, eg bells palsy
also cause paralysis of stepedius muscle and hyperacusis
taste impairement in ant tongue and speech impairment
cause of bells pasly
can be idiopathic, or viral aetiology secondary to Herpes simplex virus
Ix for bells palsy
clinical diagnosis but can also have nerve conduction studies in persisitent bells palsy
Mx bells palsy
short course oral prednisolone if pt present early (before 72hrs) to reduce nerve oedema
, consider anti viral agent orally,
encourage eyelid closure to protect eye
but most recover completelry in 3 months
Ix for sub arachnoid haemorrage
CT can pick up SAH in first 6 hours, but does not exclude it. if still high clinical suspiciion then should do LP which may show RBC in CSF, but best done in 12 hrs of symptom onset
lamotrigene risk
rash, interact with other medication including OCP, risk of harm to fetus if she falls pregnant again
PC MS
mono symptomatic presentation:
-optic neuritis (painful loss of vision)
-limb numbness or paraesthesia. double vision, ataxia
-headache= most common
-fatigue, vertigo, memory loss, depression
-impotence, constipation, urinary incompetence
myasthenia gravis
fatiguable muscle weakness
Ix for MS (3)
MRI of brain (multiple focal white matter lesions suggestive of demyelination) and spine and LP (oligoclonal IgG bands)
RF MS
feamle, mean age of presentation=30, Sx worsen in heat or exercise
Mx of MS (3)
bolus methylprednisolone (shorten length of relapse)
beta interferon (reduce frequency of relapse- disease modifiying treatment)
baclofen- treat spasticity
parkinsons disease
age of onset 50-85
tremor (common but can present without it)
positive family history in younger patients
can also present wiht pain, depression, sleep disturbances
initial Mx of parkinsons disease
levo-dopa (avoid in younger patients due to inducing dyskinesia and motor fluctuations later in disase)
physiotherapy
side effects of dopamine agonist
behavioural changes- gambling, hypersexuality, compulsive behaviors= impulse control disorder
PC of MND
mixed UMN and LMN signs affecitve limbs (fasciulations, wasting-L, hyper reflexia-UMN) bulbar (tongue fasiculation?), resp muscle (use of accessory)
risk of aspiration pneumonia
PC of peripheral vascular disease
claudication
where in brain does parkinsons affect?
degernative changes in dopmainergic neuons in substantia nigra
heroin can chemically destroy neurons in substantia nigra
where in brain does parkinsons affect?
degernative changes in dopmainergic neuons in substantia nigra
heroin can chemically destroy neurons in substantia nigra
essential tremor
DDX: parkinsons, enhanced physiology (anxiety)
PX: gradual onset, worse when lifting up cup, bilateral, no other associated sympotms
Ix: blood test to rule out other causes of tremor
Mx: reduce caffeine,propranolol (contra indicated in asthma due to resp depression) primidone
parkinsons vs drug induced parkinson
both have gradual onset and can cause postural instability
but: parkinsosn has symptomatic benefit from levodopa, dysdiakinesia not caused by parkinsons medication generally but parkinsons not cause this side effect
need DaT scan scan that shows loss of dopaminergic neurons implying neurodegenerative disease eg PD
which SPA medication is less likely to give you parkinson like side effects
quetiapine, so should switch from risperidone
pt cant see fingers in left side of vision
homonymous field defect- lesion behind chiasm so in brains- both eyes.
only 1 eye: problem in front of chiasm- eye, retina, optic nerve
prblem on right side, so left arm weakness, somatosensory neglect
which cancers are most likely to metastasise to brain
melanoma and squamous cell carcinoma.
thyroid or basal cell carcinoma do not metastasise outside theri organ of origin but may invade adjacent tissue
how does vestibular problems usually present?
dizziness and problems with movement
brisk relfexes in lower limb, muscle wasting in upper limb
UMN signs on lower limb-CNS problem involving corticospinal (pyramidal, motor) tracts.
wasting in hands- involvement of LMN in cervicals spinal cord
pt dizzy and nauseas and vertigo when awake, repeated throughout the day
BBPV-hallpike test
treatment for BBPV (4)
epley manouvre
vestibular rehab- carthorne-cooksey exercise
self limiting so watch and wait
drus are innefective
what precedes cardiac syncope
chest pain, palpitations, SOB. but exercise induced cardiovascular syncope is also possible
common PC of vasovagal syncop
feeling dizzy, nauseaus, heat. vision went grey and able to use phone afterwards
why is FHx of sudden unexplained death worrying
can suggest heritable cardiac arrythmia: eg long QT syndrome.
what CSF result suggests MS
antibodies in CSF that isnt in serum. immunnoglobulin cross BBB and so electrophoresis of proteins in CSF shows gamma globulins just as serum protein electrophoresis does
OLIGOCLONAL BANDS!
how would you diagnose relapsing remiting MS
CNS inflammation not due to alternative cause in different places in CNS and at different times (dissemination in time and place)
how to manage moferate level relapsing remitting MS
beta interferon, dimethyl fumarate
