Extra neuro questions Flashcards
Absolute CI to thrombolysis x11
Previous haemorrhagic stroke Suspected SAH LP in the last 7 days Stroke or traumatic brain injury last 3 months Seizure at onset of stroke Intracranial neoplasm Active bleeding GI haemorrhage last 3 weeks Oesophageal varices Pregnancy Uncontrolled HTN >200/120
Relative CI to thrombolysis
Major surgery or trauma last 2 weeks Concurrent anticoagulation with INR >1.7 Bleeding diathesis (predisposition to bleeding) Suspected intracardiac thrombus Active diabetic haemorrhagic retinopathy
Features of normal pressure hydrocephalus
Dementia, urinary incontinence and gait abnormalities
Diagnosis of normal pressure hydrocephalus
Diagnostic CSF removal (draining lumbar puncture etc)
Will cause improvement in symptoms
Management of normal pressure hydrocephalus
Surgical CSF shunting
First line for neuropathic pain
Amitryptilline
Gabapentin
Pregabalin
Duloxetine
First line for trigeminal neuralgia
Carbamazepine
What is intranuclear opthalmoplegia
Cause of horizontal disconjugate eye movement
Due to lesion in medial longitudinal fasciculus
Impaired adduction of eye on same side as lesion
Nystagmus of abduction of eye on other side
Causes of intranuclear opthalmoplegia
MS
Vascular disease
Antibodies in GBS
Anti-ganglioside - present in MIller-Fischer
25% of GBS
Infective agent in GBS
Commonly campylobacter jejuni
What causes huntington disease
Trinucleotide repeat expansion (CAG) in huntingin gene on chromosome 4p- autosominal dominant inheritance - exhibits anticipation
Initial features of HTD
Insidious onset in middle-age, fidgeting and clumsiness
Develops into involuntary, jerky, dyskinetic movements
Grunting and dysarthria
Late disease features of HTD
Rigid
Akinetic and bed-bound
Cognitive abilities in HTD
Early cognitive, emotional and behavioural changes - lability, dysphoria, anxiety and then dementia
Examination signs of HTD
Chorea, dysarthria
Slow voluntary saccades and supranuclear gaze restriction
Parkinsonism and dystonia ( especially juvenile onset)
How many repeats needed for HTD diagnosis
> 39 CAG repeats
27-39 exist with reduced penetrance
What is seen on CT/MRI in HTD
Symmetrical atrophy of striatum (esp, caudate nuclei)
Butterfly dilation of lateral ventricles
Treatment of chorea in HTD
Dopamine-depleting drugs (reserpine, tertabenazine)
Benzo’s
Prognosis of HTD
Most die 15-20years after first onset of symptoms - usually from resp infection
How does inclusion body myositis differ from other inflammatory myopathies (dermato and polymyositis)
Can cause neck droop (affects erector spinae muscles) and dysphagia
Insidious onset over months-years
Most common in >50 yr old
Distinguishing features of CSF on varying meningitis
Bacterial - cloudy, high neutrophils, high protein and low glucose
Viral - high lymphocytes and protein and normal glucose
TB - fibrinous CSF, high lymphocytes and protein and low glucose
Treatment of meningitis
Cefotaxime
Benzylpenicllin good for meningococcus
Amox + gent for listeria
Chloramphenicol if penicillin allergic
Also dexamethasone IV (QDS for 4 days)
Prevalence of migraines in men and women
Men 6% and women 18% therefore 3x more common in women
What is Alport syndrome
Genetic condition with sensorineural hearing loss, kidney dysfunction (haematuria and proteinuria) and vision problems
What is pendred syndrome
Genetic disorder leading to bilateral sensorineural hearing loss and goitre with euthyroid or slightly hypothyroid
