Exam 3 Flashcards
Cause of myasthenia gravis
Auto-Ab against the nicotinic acetylcholine receptor
Associations of myasthenia gravis
Thymoma or thymic hyperplasia
Distinguishing features of the muscle weakness in myasthenia gravis (4)
Fatiguable and mainly proximal
Treatment of myasthenia gravis (3)
Pyridostigmine- acetylcholinesterase inhibitor
Thymectomy
Prednisolone
Cause of Lambert-Eaton myasthenic syndrome?
Antibodies to pre-synaptic voltage gated calcium channels
Lambert-Eaton is associated with what disease?
Small cell lung cancer
Management of myasthenic crisis
IVIG
Feature of LEMS which may distinguish it from MG?
Signs of autonomic dysfunction
Commonest form of motor neurone disease and associated symptoms
Amytrophic lateral sclerosis. Mix of UMN and LMN signs
Subtypes of MND:
a) dyarthria, dysphagia, wasted fasciculated tongue
b) UMN signs exclusively
c) LMN signs exclusively, best prognosis
a) progressive bulbar palsy
b) primary lateral sclerosis
c) progressive musclar atrophy
Motor neurone disease never affects…(4)
sensation
sphincters
cerebellum
eye muscles
Impairment of cognitive function seen in 10-35% MND patients?
Frontotemporal dementia
Drug which has a modest impact on survival in MND
Riluzole- antilgutamergic
Gene implicated in 20% of familial cases?
Superoxide dismutase 1 (SOD1)
Upper motor neurone signs (2)
Increased tone
Hyper-reflexia
Lower motor neurone signs (4)
Decreased tone
Fasciculation
Wasting
Hyporeflexia
How can spinal stenosis be differentiated from claudication?
Spinal stenosis tends to get better when walking uphill/cycling, since this causes back flexion
Arreflexic flaccid paralysis in reponse to acute cord transection
Spinal shock
Brown-Sequard syndrome symptoms?
Ipsilateral dorsal column and corticospinal tract level
Contralateral spinothalamic tract level
Patient presentation- “cape-like” pain/temperature loss, with distal upper limb weakness
Central cord syndrome
What usually causes central cord syndrome?
Hyper-extension or hyper-flexion to an already stenosed neck
Cause of syringomyelia
Expansion of the central cord canal due to CSF blockage
Symptoms of syringomyelia
Cape-like spinothalamic loss
LMN signs in upper limbs
UMN signs in lower limbs
Malformation commonly associated with syringomyelia
Chiari malformation- extension of the cerebellar tonsils into the spinal cord
Back pain red flags (5)
Cauda equina symptoms (urinary retention/incontinence, faecal incontinence, saddle anaesthesia) Nocturnal pain Fever/chills Unexplained weight loss Past history of cancer
