MLA Neurology Flashcards
What’s an acoustic neuroma?
Benign, slow-growing tumours on the vestibular nerve
Symptoms: hearing loss, tinnitus, balance, facial numbness, eye irritation, headaches, confusion
Treatment: surgery or stereotactic radiation
What’s the most common cause of brain abscess?
Fungal or bacterial infection that spread through blood
Risks: weakened immune system, chronic disease, corticosteroids, chemotherapy, congenital heart disease, head and neck infections
How does a congenital heart disease contribute to a brain abscess?
Eg. left to right shunt
It allows unfiltered blood to get into the brain
How is chronic fatigue syndrome managed?
- Don’t overexert, take rest
- Balanced diet
- Vitamin supplements
- Offer CBT and antidepressants
What are some different types of diabetes neuropathy?
- Peripheral
- Autonomic: issues with BP, bladder, impotence, sweat glands, heart
- Focal: single nerve damage. Carpel tunnel is most common
- Proximal: affects nerve in hip, buttock, or thigh. Very rare, and usually one-sided
What are the different types of epilepsy?
- Generalised
Eg. tonic-clonic (grand mal), absence (petite mal), atonic (drop attacks), myoclonic - Focal
Eg. focal aware, impaired awareness, bilateral tonic-clonic, parietal lobe, occipital lobe
How in Meniere’s disease diagnosed?
Criteria:
- 2+ episodes of vertigo lasting 20min-12 hours
- Hearing issues like tinnitus or fullness feeling
- Balance related issues
MRI/CT would be done to rule out other diseases and electrocochleography to measure electrical activity in the ear
What is Meniere’s disease?
Ear disease causing vertigo, nausea, vomiting, tinnitus, hearing loss, balance issues, headaches
Caused by endolymphatic fluid build up
- Has autoimmune component
What is the treatment for Meniere’s disease?
- Symptomatic treatment for vertigo and nausea
- Limiting salt intake
- Corticosteroid injections
No cure. Gentamycin injection will permanently damage the ear to stop symptoms
What is the neurological involvement in malaria?
Occurs in severe malaria usually by plasmodium falciparum
Cerebral malaria presents as: coma, impaired consciousness, seizures. Causes long-term neurocognitive impairments
Post-malaria neurological syndromes:
- Acute disseminated encephalopathy
- Delayed cerebellar syndrome
- Acute idiopathic demyelinating polyneuropathy
What are the different types of motor neurone disease?
- Amyotrophic lateral sclerosis (ALS) (most common). Affects upper and lower motor neurons and causes weakness, stiffness, and overactive reflexes.
- Progressive bulbar palsy (PBP). Affects upper and lower neurons, but speech and swallowing muscles are affected first. Starts as speech changes and slurring
- Spinal muscular atrophy (SMA)
- Kennedy’s disease (AKA X-linked spinobulbar muscular atrophy (SBMA). Causes muscle cramps and twitches, weakness in the face, arms, and legs, and difficulty swallowing and speaking
-Hereditary spastic paraparesis (HSP)
- Post-polio syndrome (PPS)
What are the different motor neurones?
Upper: originate in brain and travel to brain stem
Lower: Begin at spinal cord and travel to muscles
What are the symptoms of upper vs lower MND?
Upper: Muscle weakness, atrophy, fasciculations
Lower: Muscle stiffness, overactive reflexes, slow movements
What is the difference between a T1 and T2 contrast MRI?
T1: fat appears bright
- Used to identify tumours, injuries, developmental issues
T2: water appears bright
- Used to identify swelling, infarcts, MS
What are the different types of MS?
Relapsing remitting MS (most common)
- Symptoms flare up but then go away
- Over time, it develops into secondary progressive MS.
Secondary progressive MS
- Symptoms are present all the time and slowly worsen
Primary progressive MS (least common)
- Symptoms slowly worsen over time and there are no periods of remission
How might MS initially present?
Visual:
- Blurred/double vision
- Loss of vision
- Painful eye movements
Movement:
- Unsteadiness or weakness
Sensation:
- Tingling, numbness, altered sensation
Other: fatigue, depression, sexual dysfunction, bladder/bowel dysfunction
What is the pathophysiology of MS?
Autoimmune demyelination
Lesions occur when the astrocytes have attempted to heal, producing glial scars (gliosis)
What is the pathophysiology of Parkinson’s disease?
Neurodegenerations caused by loss of dopaminergic cells is the substantia nigra causing a reduction in direct pathways and therefore a restrictive action of movement (rigidity)
What are the Braak stages?
Post-mortum staging to classify the degree of pathology in Parkinson’s and Alzheimer’s disease
What is the clinical presentation of Parkinson’s disease?
-Motor: slowness, stiffness, unilateral tremor
-Autonomic: constipation, hypersalivation, urinary dysfunction, sexual dysfunction
-Cognitive: low mood, anxiety
-Other: sleep disturbance, anosmia
Reported by family: cognitive decline, REM sleep disorder, small handwriting
How is Parkinson’s disease diagnosed?
- Lab investigation to rule out other causes
- Dopamine active transported (DaT) scan is definitive, but reserved only when diagnosis is uncertain because it’s expensive
What is the medical management of Parkinson’s disease?
(Replace dopamine or stope dopamine breakdown)
1st line: Levodopa
- MOA-B inhibitors (Selegiline) block dopamine breakdown
- Dopamine agonists (Ropinirole) stimulate dopamine receptors
- COMT inhibitors (entacapone) decrease dopamine breakdown
What are the key prescribing facts to pass on for Parkinson’s?
- Time-sensitive meds: if late or missed, there will be ‘freezing’ (akinesia)
- Neuroleptic malignant syndrome is suddenly stopped
- Response deteriorates over time but higher doses have more side effects
What are some complications of Parkinson’s disease?
- Lewy Body dementia
- Parkinson’s dementia
- Hallucinations leading to paranoia
- Aspiration pneumonia (end-stage)
What are some different peripheral nerve palsies?
- Carpel tunnel syndrome (median nerve)
- Ulnar nerve palsy
- Peroneal nerve palsy: decreased sensation in lower leg, foot drop, slapping gait, muscle loss
- Sciatic nerve
- Spinal accessory nerve injury: causes scapular winging and atrophy of trapezius muscle
What are some common radiculopathies?
- Cervical: pain and weakness in shoulders, arms, and hands
- Lumbar (sciatica): pain and weakness in lower back, arms, and legs
- Thoracic: pain, tinging, and numbness in chest, rib, side, or abdomen
What is a radiculopathy?
Pinching of the nerve at the root
What is the management of myasthenia gravis?
- Corticosteroids (prednisolone) for 2-6 months
- In generalised MG, Azathioprine is given to keep prednisolone dose minimal
Alternatives: ciclosporin, methotrexate
What’s trigeminal neuralgia?
Unilateral, chronic condition causing severe, sudden episodes of pain in the face
Cause: blood vessels pressing on the trigeminal nerve
What is the management of trigeminal neuralgia?
- Reduce frequency of attacks using carbamazepine, gabapentin, or phenytoin
- Microvascular decompression (making hole in skull bigger for the nerve)
- Psychological interventions for mental health and well-being
How can trigeminal neuralgia be diagnosed?
History and examination mainly
MRI can confirm structural abnormalities
Who presents with trigeminal neuralgia?
Women 50+ years
Co-morbidies like MS or hypertension
What is Wernicke’s encephalopathy?
A neurological emergency caused by thiamine deficiency
Symptoms: altered consciousness, ataxia, eye abnormalities
What is Korsakoff’s syndrome?
Develops from Wernicke’s encephalopathy but this is permanent damage to memory
Related to alcohol misuse
