Extra Flashcards
An 18-year-old male patient describes periods of twitching of the left side of his face that spreads to affect his left arm and shoulder. Afterwards he describes weakness of his left arm
Jacksonian seizure/march
what is a Jacksonian seizure/march
form of simple complex seizures
seizure spreads from the distal part of the limb toward the ipsilateral face (on same side of body
what is the first line treatment for Delirium in the elderly
0.5mg Haloperidol
what causes Wernicke Encephalopathy
Thiamine deficiency
what is pathological seen in W.E
petechial haemorrhages in mamillary bodies and ventricle walls
Tx for W.E
Thiamine replacement
what would developing the inability to acquire new memories and confabulation suggest with the background of W.E.
patient has developed Korsakoff’s Syndrome
Urinary incontinence + gait abnormality + dementia = ???
Normal pressure hydrocephalus
what would be seen on imaging in normal pressure hydrocephalus
enlarged forth ventricle
what is Tx of normal pressure hydrocephalus
Ventriculoperitoneal shunting
what is used as a prognostic score in TIAs
ABCD2
Age > 60 (1 pt)
Blood pressure > 140/90 (1 pt)
Clinical features - unilateral weakness (2 pts)
- speech disturbance, no weakness (1pt)
Duration of Sx - >60mins (2 pts)
- 10-59 mins (1pt)
Diabetes (1pt)
Total = 7
what is Tx if patient has ABCD2 > 4
Aspirin 300mg daily (and Dipyridamole)
measures for secondary prevention
what should be given to stroke patients immediately IF a haemorrhagic stroke has been excluded
Aspirin 300mg (as soon as possible)
Thrombolysis (Alteplase)
what are Sx of Brown-Sequard Syndrome
IPSILATERAL
- loss of touch, vibration, proprioception
- hyper-reflexia
- extensor plantar reflex
CONTRALATERAL
- loss of pain and temperature
what are Sx/signs seen in Tuberous Sclerosis
Café-Au-Lait
“Ash-leaf” spots
Shagreen patches (roughened patches of skin over lumbar spine)
Subungual fibromata
Epilepsy (infantile spasms or partial)
Development delay
Polycystic kidneys
what are the mnemonics of Neurofibromatosis
NF1 Chr 17 (Neurofibromatosis has 17 characters)
NH2 Chr 22 (all the 2’s)
what are features of NF1
Cafe-au-lait spot Axillary/Groin freckles Peripheral Neurofibromas Lisch nodules Scoliosis
what are features of NF2
Bilateral acoustic neuromas
what is seen in ALS
LMN signs in the arm
UMN signs in the leg
in familial cases of ALS what gene is affected
Chr 21
what is seen in PLS
UMN signs only
what is seen in progressive muscular atrophy
LMN signs only
Affects distal muscle before proximal
what is seen in Bulbar palsy
palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem
what muscles common waste in MN disease
small hand muscles
tibialis anterior
what will nerve conduction studies shows in MN disease
normal conduction
what will electromyography show in MN disease
decrease number of AP with increase amplitude
what anti-glutamate drug is used in ALS
Riluzole
what signs show UMN and what shows LMN
UMN - extensor plantar
LMN - absent ankle jerk
what seizures can carbamazepine exacerbate
absence seizures
what is a characteristic EEG of an absence seizure
bilateral, symmetrical 3Hz (spike and wave) pattern
what should a women do if she is pregnant and on anti-epileptic medication
stop anti-epileptic medication
take 5mg/day folic acid (prevents neural tube defects)
what AED are associated with what birth defects
Sodium Valproate = neural tube defects
Phenytoin = cleft palate (expecting mums taking this are given Vit K last month of pregnancy to prevent clotting disorders)
what is the gold standard investigation for functional seizures
Video Telemetry
what drugs lead to drug induced parkinsonism
Metoclopramide
Haloperidol
Chlorpromazine
Levodopa is sometimes the initial treatment of Parkinsons, what are the side effects of the drug
Dyskinesia Postural hypotension Cardiac Arrhytmias Nausea and Vomiting Psychosis Reddish discolouration of urine on standing
how do MAO-B inhibitors worj
inhibits the breakdown of dopamine secreted by the dopaminergic neurones
parkinsonsim + impairment of vertical gaze (complain of difficulty reading/going down stairs)
Progressive Supranucleur Palsy
what is Pick disease
frontotemporal lobar degeneration
Sx of Pick disease
aggressiveness inappropriate behaviour change in behaviour apathy depression
speech and language abnormalities begin early and progress rapidly
memory less affected than in Alzheimer and may score high on MMSE
what is an essential tremor (features)
AD condition made worse when arms are outstretched
made better by alcohol and propranolol
what is second line treatment in essential tremor if propranolol is contraindicated
Primidone (anti-convulsant)
what is Creutzfeldt-Jakob Disease (CJD)
incurable and universally fatal neurodegenerative disease caused by prion protein
Sx of CJD
Dementia
Cerebellar ataxia
Myoclonic jerks
what are key Ix findings suggestive of CJD
EEG = non specific slowing periodic sharp wave complexes (PSWCs) of 1-2 Hz
Prior protein in CSF and in tonsils
Pulvinar sign on MRI
Facial Palsy + convergent squint
lesion in the pons
how does a UMN lesions and a LMN lesion on the face differ
UMN lesion - spares upper face i.e. forehead
LMN lesion - affects all facial muscles
what is seen on MRI and CSF in MS
MRI
- high signal T2 lesions
- periventricular plaques
CSF
- oligoclonal bands (and not is serum)
ptosis + dilated pupil = ??
Third nerve palsy
ptosis + constricted pupil = ??
Horner’s Syndrome
what is Argyll-Robertson pupil and why is it also known as “Whore’s Eye”
small irregular pupils that do not react to light but react to accommodation (reduce in size when focusing on a near object)
associated with tertiary syphilis
what causes Argyll-Robertson pupil
MS, Sarcoidosis, DM, Tertiary Syphilis
painful 3rd nerve palsy + headache =
posterior communicating artery aneurysm
features of 3rd nerve palsy
eye deviated ‘down and out’
ptosis
dilated pupil
what is Weber’s Syndrome
ipsilateral 3rd nerve palsy with contralateral hemiplegia caused by midbrain strokes
what is Lambert-Eaton Myasthenia syndrome
seen in associated with small cell lung cancer but can occur independently as an autoimmune condition
caused by antibody directed against pre-synaptic voltage gated calcium channel in the PNS
what are features of Lambert-Eaton
repeated muscle contractions leads to increased muscle strength
limb girdle weakness - proximal more commonly
hyporeflexia
autonomic Sx = dry mouth, impotence
no eye features like myasthenia gravis
Tx of Lambert Eaton
Immunosuppresion
- prednisolone and/or azathioprine
what are features of a vestibular schwannoma
HL, vertigo, tinnitus
absent corneal reflex
facial palsy
Ix for vestibular schwannoma
MRI of cerebellopontine angle
drug that can cause demyelinating peripheral neuropathy
amiodarone
how does alcoholic neuropathy present
sensory symptoms present before motor symptoms
what does a vitamin B12 deficiency cause
subacute combined degeneration of the spinal cord
Dorsal column usually affected first
how do nerve conduction studies differ in demyelinating and axonal neuropathy
demyelinating
- reduced conduction velocity
- normal amplitude
axonal
- normal conduction velocity
- reduced amplitude
what infection classically triggers Guillain Barre Syndrome
Campylobacter jejuni
but also can be Chlamydia, HBV, Mycoplasma pneumonia, CMV, EBV, HZV, HIV
what Sx are seen in Guillain Barre Syndrome
paralysis noted by weakness in the legs that spreads to upper limbs and face
loss of deep tendon reflexes
what is seen in Toxoplasmosis if a CT was done and Tx
multiple ring enhancing lesions
Tx = sulfadiazine and pyrimethamine
what is Tx of migraine during pregnancy
1st line = paracetamol 1g
2nd line = in 2nd and 3rd trimester
- Aspirin 300mg or Ibuprofen 400mg
when is the COC pill an absolute contraindication
migraine with aura
