CNS Flashcards
What is Parkinsonism?
Movement disorder of bradykinesia plus rigidity/tremor/postural instability
What are the causes of Parkinsonism?
Idiopathic - PD
Lewy Body Dementia
Dementia pugilistica
Normal pressure hydrocephalus
Parkinson plus syndromes - multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration
Drugs - chlorpromazine, metoclopramide, prochlorperazine, sodium valproate, methyldopa
Wilson’s disease
Features of multiple systems atrophy
Parkinsonism
Autonomic failure
Cerebellum dysfunction
Pyramidal signs
What is a Lewy body?
In what diseases are they found?
Cytoplasmic inclusion protein of alpha synuclein
Lewy body dementia
Parkinson’s disease
Alzheimer’s
Features of progressive supranuclear palsy
Most common Parkinson plus syndrome
Supranuclear gaze palsy - abnormal vertical then horizontal saccades
Difficulty opening eyes
Significant problems with falls
Causes of a unilateral ptosis
3rd nerve palsy
Horner’s syndrome
Myasthenia gravis
Congenital
Causes of bilateral ptosis
Myasthenia gravis
Tabes dorsalis (dorsal column demyelination from syphilis)
Myotonic dystrophy
Syringomyelia causing b/l horner’s
Miller fisher syn (GBS and ocular paralysis)
Nuclear 3rd nerve palsy
Symptoms and Causes of a central Horner’s syndrome (1st order neurone)
Ptosis, miosis and anhidrosis of face/arm/upper trunk
Demyelination Brainstorm or cord tumour/haemorrhage/infarct Neck trauma Syringomyelia Basal meningitis
What are the structures of the cavernous sinus?
CNs: 3, 4, 6, V(1 and 2)
internal carotid a
sympathetic carotid plexus
Features of a cavernous sinus lesion
unilateral CN palsies (3 4 and 6)
decreased sensation in V1 (ophthalmic) and V2 (maxillary)
loss of corneal reflex (V1)
proptosis (if pulsatile suggests carotico-cavernous fistula)
visual loss
papilloedema
Causes of an upward gaze palsy?
progressive supranuclear palsy Graves ophthalmopathy Myasthenia Gravis Miller Fisher syndrome Muscular dystrophy Parinaud syndrome
What is the pathophysiology of Myasthenia Gravis
autoimmune destruction of nicotinic acetylcholine receptors on the post-synaptic membrane.
80-90% have anti-AChr antibody
DDx for bilateral ptosis and facial weakness
Miller Fisher syndrome
botulism
lambert-eaton myasthenic syndrome LEMS (paraneoplastic anti voltage gated calcium channels, from small cell lung ca)
DDx for bitemporal hemianopia
optic chiasm lesion
pituitary adenoma (upper vision affected 1st)
craniopharyngioma (lower vision affected 1st)
suprasellar meningioma
glioma
granuloma
metastases
features of myotonic dystrophy
wasting and weakness of hands myotonia (grip hands then let go) DM (dip urine) catatarcts distal areflexia ptosis dysarthria and dysphagia (ask about swallowing)
