Motor Deficit conditions

Question 1

What is multiple sclerosis

Answer 1

Multiple sclerosis (MS) is a chronic and progressive autoimmune condition - destroys myelin sheath causing patchy demyelination in the central nervous system.

Question 2

Initial Sx of multiple sclerosis

Answer 2

Tingling
Parasthesias
Numbness
OPtic neuritis - pain in one eye worse with movement - acute vision loss follows pain
Acute focal motor weakness - foot drop
Balance difficulties

Question 3

Later symptoms of multiple sclerosis

Answer 3

Tingling
Parasthesias
Numbness
Worsening chronic focal motor weakness
Balance difficulties
Urinary urgency, frequency and incontinence
Constipation
Sexual dysfunction
Cognitive loss
Debilitating fatigue

Question 4

MRI findings for MS

Answer 4

Focal demyelination of white matter (causes bright white patch) in more than one region of the brain

Question 5

How to diagnose MS

Answer 5

Neuro exam
History
MRI
CSF

Question 6

Types of MS

Answer 6

Relapsing - remitting (pt return to normal between attacks)

Secondary progressice - relapsing remitting but steadily progressive

Primary progressive - progressive from onset

Transverse meylitis - demyelinating lesions of spinal cord

Question 7

Chronic treatment for MS (medical and supportive)

Answer 7

First-line injectables such as beta-interferon and glatiramer

New oral agents such as dimethyl fumarate, teriflunomide and fingolimod

Biologics such as natalizumab and alemtuzumab

Medications for symptoms e.g. urinary incontinence (anticholinergics) , depression (SSRIs) , sexual dysfunction (sidenafil)

Physical/occupational therapy

Question 8

Acute treatment of multiple sclerosis

Answer 8

Glucocorticods - IV methylprednisolone

Question 9

What is guillain barre syndrome?

Answer 9

ACUTE inflammatory demyelinating polyneuropathy characterised by a RAPID PROGRESSIVE, ascending SYMMETRIC weakness, often preceded by INFECTION

causes bilateral and symmetric limb weakness

Question 10

Key signs of guillain barre syndrome

Answer 10

acute, rapidly progressive and symmetric weakness in both arms and legs
areflexia
bilateral facial muscle involvement

elevated CSF protein - not needed tho

Question 11

Treatment for guillain barre syndrome

Answer 11

Emergency - admit to hospital

IV immunoglobulins or plasmapheresis
Cardiac monitory
Pain control - gabapentin or opiates
Physical therapy

Question 12

Name chronic inflammatory demyelinating polyneuropathy conditions

Answer 12

Myaesthenia Gravis
Bells Palsy
Motor Neurone disease
Amytrophic lateral sclerosis

Question 13

Name acute inflammatory demyelinating neuropathy

Answer 13

Guillan Barre
Multiple sclerosis

Question 14

Difference between acute inflammatory demyelinating neuropathy and chronic inflammatory demyelinating neuropathy

Answer 14

Chronic
- more insidious and over longer time (months instead of days/weeks)
- doesn’t cause cardiac or resp failure
- same treatment but also requires long term immunosupression

Question 15

What does Motor neurone disease affect

Answer 15

Peripheral and central motor nerves = upper and low motor neurone signs

Voluntary muscles affected = speaking, walking, breathing and swallowing affected

Question 16

What is amyotrophic lateral sclerosis

Answer 16

Progressice neurodegenerative disease

• attacks both upper and low motor neurones leading to muscle weakness and atrophy

Question 17

Upper motor neurone signs
vs lower motor neurone signs

Answer 17

UMN
- Weakness
- No atrophy or fasiculations
- Reflexes and tone increased

LMN
- Weakness
- atrophy and fasiculations
- reduced reflexes and tone

Question 18

Amyotrophic lateral sclerosis symptoms

Answer 18

Weakness in arms/legs
Weakness in facial muscles - trouble speaking, swallowing, chewing, coughing, drooling
Fasciculationg/twitching
Stiffness
Weight loss - muscle atrophy
Worsening fatigue
Hyper reflexia

NO PAIN!!!!
No sensory symptoms
No loss of bowel or bladder control
No difficulties with ocular movements!

Question 19

Treatment of amytrophic lateral sclerosis

Answer 19

Riluzole

Symptomatic treatment
Poor prognosis - die due to resp failure from weak diaphragm

Question 20

What is myasthenia gravis

Answer 20

autoimmune condition affecting the neuromuscular junction (due to antibodies produced against nicotinic acetylcholine receptors)

It causes muscle weakness that progressively worsens with activity and improves with rest.

Question 21

Sx of myasthenia gravis

Answer 21

Muscle fatigue with repetition of movements
Facial weakness (due to above)
Weakness in proximal ar muscles
Ptosis
Diplopia (also due to eye movements)

Question 22

Myasthenia gravis diagnosis

Answer 22

Serologic testing for acetyl choline receptor antibodies

Repetitive stimulation EMG

Question 23

Myasthenia gravis treatment

Answer 23

Mestinon (acetylcholineesterase inhibitor)
Immunosuppression (azothiprine, methotrexate)
Prednisolone
Plasmaphresis or Intravenous immunoglobulin in severe cases

Question 24

What is Bell’s Palsy

Answer 24

damage to CN VII (facial nerve)

• may be caused by lyme disease of herpes simplex or EBV

Question 25

Bell’s palsy symptoms

Answer 25

Facial muscle weakness over day - weeks (chronic compared to stroke)
Forehead not spared (unlike stroke)
No symptoms in arms and legs (unlike stroke)
Dry eyes / mouth
Hyperacusis - intolerance to loud sounds
Ear pain

Question 26

Bell’s Palsy treatment

Answer 26

Steroids and aciclovir

Symptomatic treatment - eye patch/tape with artificial tears (ocular lubricants) and pain control (gabapentin)

Question 27

Inflammatory myopathies / mysoitis

Answer 27

Autoimmune diseases that attack muscles and cause weakness
- polymyositis
- dermatomysositis
- polymyalgia rheumatica
- metabolic myopathies

Question 28

Treatment of inflammtory myopathies / myositis

Answer 28

Immunosupression
steroids