Common diseases_ from the notes Flashcards
Investigations for MS and what can be seen
- MRI of the brain and spinal cord -> multiple lesions on white matter (the most common locations: periventricular region, corpus callosum, brainsteam, cervical cord)
- LP -> oligoclonal IgG bands and possibly increased proteins
Treatment for relapsing-remitting MS
- Relapse management: high dose steroids (methylprednisolone) for a short time -> this will speed up the recovery
- Disease-modifying therapies:
- Interferon - beta -> to reduce relapse frequency
- Natalizumab -> given for those with aggressive relapses
- neurosensory rehab, MDT etc
What are the elements of Charcot’s neurological triad in MS
Charcot’s triad (MS):
- dysarthria
- nystagmus
- intention tremor
What’s Lhermitte’s sign?
Lhermitte’s sign is in a patient with MS
When a pt bend their neck forward -> an ‘electric shock’ runs from their back and radiates to the limbs
What pattern of clinical presentation would Brown - Sequard syndrome cause?
Brown Sequard syndrome
- lateral hemisection of spinal cord
Injury pattern/mechanism:
- ipsilateral weakness (motor) below the lesion
- ipsilateral loss of proprioception and vibration sensation
- contralateral loss of pain and temperature sensation
*this is because the pathway for pain/temperature sensation decussates at the level of the nerve root.
Pattern and features of Bell’s palsy
Bell’s palsy
Pattern: acute, unilateral, idiopathic facial nerve paralysis
Features:
- LMN facial n. palsy -> forehead is affected
- post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis (discomfort, hypersensitivity to loud noises)
Management and prognosis in Bell’s Palsy
Management
- prednisolone 1mg/kg for 10 days should be prescribed for patients within 72 hours of onset of Bell’s palsy.
* Adding in aciclovir gives no additional benefit
- eye care is important - prescription of artificial tears and eye lubricants should be considered
Prognosis
- if untreated around 15% of patients have permanent moderate to severe weakness
The pattern of weakness affecting forehead in:
- UMN
- LMN
- UMN: forehead is spared (not affected)
- LMN: forehead is affected
What happens in cerebellar tonsil herniation?
Cerebellar tonsillar herniation
- affects the medulla oblongata
- often a terminal event in an unconscious patient
- results in asystolic cardio-respiratory arrest
What’s the diagnosis?
A combination of ipsilateral ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy with contralateral hemisensory loss
Lateral Medullary Syndrome
(ischaemia of the lateral part of the medulla)
*from the blockage of vertebral a. or posterior cerebellar a.
Isolated hemisensory loss
What’s possible pathology?
Lacunar infract
(3) features of common lacunar stroke presentation
Lacunar strokes can present with
- unilateral motor disturbance affecting the face, arm or leg or all 3
- complete one sided sensory loss
- ataxia hemiparesis
Gower’s sign - what is this
- suggestive of muscular dystrophy
- cannot get up off the floor without the use of the arms
What’s the diagnosis?
Ptosis + dilated pupil
3rd nerve motor palsy
What’s the diagnosis?
Ptosis + constricted pupil
Horne’s syndrome
Classes of meds used in migraine
A. Prophylaxis
B. Acute attacks
A. Prophylaxis - 5HT receptor antagonist
B. Acute attacks - 5HT receptor agonist
1st line Rx in acute migraine attack
irst-line: combination therapy: oral triptan and an NSAID, or an oral triptan and paracetamol
*Triptan = 5 HT agonist
1st line prophylaxis Rx for migraine
- criteria
- meds used
Criteria: at least 2 migraine attacks per month
Meds: topiramate or propranolol’
* Propranolol should be used in preference to topiramate in women of child bearing age as it may be teratogenic and it can reduce the effectiveness of hormonal contraceptives
Topiramate = anti-convulsant
Features of a headache associated with migraine
Headache has at least two of the following characteristics:
- unilateral location*
- pulsating quality (i.e., varying with the heartbeat)
- moderate or severe pain intensity
- aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
During headache at least one of the following:
- nausea and/or vomiting
- photophobia and phonophobia
What diagnosis should we suspect in:
unilateral hearing loss who presents with reduced facial sensation and balance problems
Acustic neuroma/ vestibular schwannoma
*1st line investigation: audiogram & gadolinium enhanced MRI scan
What’s the likely diagnosis?
Parkinsonism + autonomic disturbance
(e.g. urinary incontinence, hypotension)
Multiple System Atrophy
(Shy-Drager syndrome - type of Multiple System Atrophy)
Features:
- parkinsonism
- autonomic disturbance (atonic bladder, postural hypotension, erectile dysfunction)
- cerebellar signs
Neurofibromatosis type 1 vs neurofibromatosis type 2
NF1 NF2
- Café-au-lait spots (>= 6, 15 mm in diameter)
- Axillary/groin freckles
- Peripheral neurofibromas
- Iris hamatomas (Lisch nodules)in > 90%
- Scoliosis
- Pheochromocytomas
- Bilateral vestibular schwannomas
- Multiple intracranial schwannomas, mengiomas and ependymomas
What’s CHA2DS2VASC used for?
CHA2DS2VASC
- it is used for a risk assessment of stroke in a patient with atrial fibrillation
What’s ROSIER assessment for?
ROSIER is an acronym for ‘Recognition Of Stroke In the Emergency Room’.
- to assess stroke symptoms in an acute setting.
What’s ABCD2 used for?
- ABCD2 is used to assess a patient’s stroke risk after a TIA
Features of motor neurone disease
There are a number of clues which point towards a diagnosis of motor neuron disease:
- fasciculations
- the absence of sensory signs/symptoms*
- the mixture of lower motor neuron and upper motor neuron signs
- wasting of the small hand muscles/tibialis anterior is common
Other features
- doesn’t affect external ocular muscles
- no cerebellar signs
- abdominal reflexes are usually preserved and sphincter dysfunction if present is a late feature
Wernicke’s aphasia is due to the lesion to what part of the brain?
Left superior-temporal gyrus
Broca’s aphasia is a result of a lesion to what part of the brain?
Left inferior frontal gyrus
1st line management for trigeminal neuralgia
Carbamazepine
*if that does not work or atypical features (e.g. trigeminal neuralgia in a patient <50y old) -> refer to neurology
Management of a patient who presents with suspected TIA (within 24 hours of symptoms onset)
- Aspirin 300mg immediately
- urgent specialist referral (within 24 hours)
