more neuro Flashcards
pre-synaptic NMJ disorders (2)
lambert eaton
botulism
pathophysiology of lambert eaton
antibodies against pre-synaptic calcium channels
treatment of lambert eaton
treat underlying cancer
immunosuppress eg steroids and azathioprine
3,4 diaminopyridine
how to distinguish lambert eaton from myasthenia
strength increases with use in lambert
fatigues in use in myasthenia
pathophysiology of myasthenia
antibodies against post synaptic Ach receptors
main feature of lambert eaton
repeated muscle use leads to increased muscle strength
cancer assoc with myasthenia
thymoma
eye symptoms in myasthenia
diplopia- double vision
ptosis
in myasthenia if negative for anti- acetylcholine receptor antibodies what antibody should be checked for
anti-muscle-specific tyrosine kinase antibodies
investigation for myasthenia
EMG + ct to exclude thymoma
treatment of myathenia
pyridostigmine - anticholinesterase inhibitor
what antibiotic is contr-indicated in myasthenia and why
Gentamicin as it can reduce the effectiveness of neuromuscular transmission and exacerbate symptoms of the disease.
what drugs can make myastheni aworse
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
treatment of HTn in CKD
first lin e= ACEi
seocnd - furosemide
what part of sleep has increased cerebral blood flow w
REM Sleep
what type of sleep is the majority
non rem sleep
what is parasomnia
acting out dreams
when is parasomnia seen
parkinsons
what is sleep walking an example of
parasomnia
investigation for narcolepsy
overnight polysomnopgraphy
what is the criteria to diagnose chronic insomnia
trouble falling asleep or staying asleep at least three nights per week for 3 months or longer.
what medications can cause insomnia
steroids
treatment of short term insomnia
hort-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).
time fram for subacute headache
mins to hours
criteria fro migraine
min 5 attacks lasting 4-72 hours
2 of : severe unilat, throbbing , worse on movement
and 1 of - n&v or photo/phonophobia
examples of auras
hemianopic loss
central scotoma
what neurotransmitter is invloved with migrains
serotonin
first line treatment for migraine
triptan and NSAID
triptan and paracetamol
what type of drugs are triptans
5-ht receptor agonist
prophylaxis of migraine , 1st, 2nd and 3rd line
1st - amitriptyline
2nd - propanalol
3rd - topiramate
what patient group should topiramate be avoided in and why
women of child bearing age - teratogenic and reduces effectiveness of contraception
when should prophylaxis be offered in migraine
more than 3 attacks in a month
chronic tension headache defined as
tension headache occur on 15 or more days per month.
acute treatment of tension headache
NSAID, aspirin or paracetamol
prophylaxis of tension headache
amirtiptyline or acupuncture - 10 sessions over 5-8 weeks
what are the 4 type of trigeminal autonomic cephalgias
- cluster
- paroxysmal hemicrania
- hemicrania continua
SUNCT
who tends to get cluuster headaches
young men 30-40
how long do clusters tend to last in cluster headaches
4-12 weeks
how long does an apisode of lcuster headache last
15mins- 2hours
what can trigger a cluster headache
alcohol
what autonomic features are seen in all the trigeminal autonomic cephalgias
- nasal stuffiness
- ptosis
-miosis - small pupils - tearing
-puffy eyelid - N&V
what investigation is done in those with trigeminal cephalgias
MRI with gadalinium contrast
management of acute cluster headache
high flow oxygen for 20 mins
s/c sumatriptan
prophylaxis for cluster headach
verapamil
features of paroxysmal hemicranis
severe unilateral headache- usually orbital or temporal region with unilat autonomic features
duration and frequency of episodes in paroxysmal hemicranis
<30 mins
1-40 times a day
treatment for paroxsymal hemicranis
indomethicine
what is a SUNCT headache
short - 15-120 seconds
unilateral
nearalgiform headache
conjunctival injections
tearing
treatment for a SUNCT headache
lamotrigene or gabapentin
risk factors for idiopathic intracranial hypertension
female
obesity
pregancy
drugs - COCP, steroids, tetracyclines, lithium , retinoids
management of intercranial hypertension
acetazolamide and weight loss
LP pressure in IIH
increased opening pressure
management of trigeminal neuralgia
carbamazapine
gold strandard for treating brain aneurysms
DSA - digital subtraction angiography
normal ICP
7-15mmHg
most common cause of cauda equina
the most common cause is a central disc prolapse
this typically occurs at L4/5 or L5/S1
investigation for cauda equina
MRI
first line treatment options for neuropathic pain
amitriptyline duloxetine, gabapentin or pregabalin
what should be used for rescue therapy in neuropathic pain
tramadol
what can be used for localised neuropathc pain
topical capsaicin
symptoms in wernickes
opthalmoplegia/ nystagmus
ataxia
encephalopathy
(+ peripheral neuropathy)
investigations in werniceks
MRI
decreased red cell transketolase
symptoms in korsakoffs
wernickes - opthal/nystag, atax, enceph
PLUS - antero/retrograde amnesia and confabulation
how long after alcohol withdrawal does delirium tremens kick in
48-72 hrs
where is the lesion in wernickes aphasia (receptive)
superior temporala gyrus
where is lesion in brocas apahasi
inferior frontal gyrus
what type of aphasia auses word salad
wernickes
where is the lesion in coductive aphasia
arcuate fasiculus - the connection between wernickes and brocas
what type pf aphasia results in poor repitiion
conductive aphasia
where is the lesion in erbs palsy
C5, 6
where is the lesion in trunkal ataxia/ gait ataxia
cerebellar midline
where is the lesion in past pointing
cerebellar hemisphere
