Neuro Flashcards
Type of speech difficulty in MG
dysarthria
difference in MS and MG face palsy
MS = pseudobulbar palsy (UMN, spastic tongue, no wasting) MG = bulbar palsy (LMN, wasted tongue, absent reflexes)
MG tests
tensilon test
CT upper thorax for thymoma/thymic hyperplasia
ACh receptor antibodies
TFTs
Ice-pack cooling to affected eyelid resolves ptosis
EMG tests
what is myasthenic crisis?
muscle weakness leading to respiratory failure
worsened by anaesthetic and certain drugs (tetracycline)
what are you worried about after tensilon tests?
when drug wears off it can precipitate a myasthenic crisis
treatments for MG
steroids azathioprine ACh-esterase inhibitors (rivastigmine) IVIG/plasmaphoresis for crisis thymectomy
symptoms of giant cell arteritis
frontal headache pain on palpation pain brushing hair jaw claudication on eating visual loss
symptoms of trigeminal neuralgia
intermittent sharp pain
in mandibular/maxillary distribution
worse on eating but episodic and severe
physical examination of giant cell arteritis
temporal tenderness
palpable thickened temporal artery
visual loss
3 tests for giant cell arteritis
ESR
temporal artery biopsy
USS temporal artery
initial treatment of Giant Cell arteritis
high dose steroids (IV if visual problems) until symptoms resolve
commence osteoporosis prophylaxis
associated condition with giant cell arteritis
polymyalgia rheumatica
sensitivity of CT head on SAH
> 95 if done within 6h
signs of SAH on LP
xanthochromia if within 4h
what is Lhermitte’s sign
tingling of limbs on neck flexion in MS/cervical spondylosis
investigations for MS
LP
MRI brain/cord
features of demyelination
IgG oligoclonal bands in CSF
clinical features
MRI features don’t corelate to severity of disease (T2 hyperintense lesions)
most common feature in MS
headache
epidemiology of MS
F>M
M do worse and more likely to have primary progressive course
worsened by heat, but more common in colder climates
Treatment for MS
Bolus pred to shorten relapse
Beta interferon reduces frequency of relapse
baclofen for spasticity
GBS weakness distribution
Starts distal, gets proximal
Respiratory failure type in GBS
Type 2 (CO2 rises early and O2 falls later)
what FVC would indicate imiment respiratory failure
<1.5L with >30% drop lying flat
how does inclusion body myositis present
> 50y
slow progressive weakness of proximal and distal muscles, mimicking MND
pattern for MND
LMN and UMN signs
dysphagia/dysarthria
respiratory involvement
normal sensation
how to confirm MND
EMG/Nerve Conduction Studies
medication for MND
riluzole - doesn’t improve symptoms but slows progression
respiratory changes in MND
elevated hemidiaphragm on CXR
spiro: reduced FVC/FEV1 with restrictive pattern
which recreational drug can cause parkinsonism in young people
heroin. MPTP in synthetic heroin can chemically destroy neurons in the substantia nigra
what is a progressive supranuclear palsy?
vertical gaze palsy
parkinsonism features
axial ridigity
how does midbrain stroke present
internuclear ophthalmoplegia and loss of conjugate eye movement
how does cortical-basal ganglionic degeneration present
Parkinson + syndrome
apraxia, akinesia, sensory neglect, behavioural change and aphasia
what would you see on fundoscopy in reaised ICP
optic disc swelling
what visual defect would you see in raised ICP
enlarged blind spots and constricted fields acutely
more advanced there will be loss of central vision and visual acuity
risk factors for idiopathic intracranial hypertension
F, high BMI, tetracycline use
when should pt with SAH undergo LP
12h after pain onset if CT is normal
why do we no longer prescribe ergot dopamine agonists
pleural/cardiac fibrosis
why do we give COMTi in addition to L-dopa
help with motor complications like ‘wearing off’. slows breakdown of levodopa, prolonging effect
what is ‘wearing off’ in parkinson’s
symptoms returning before next dose and relieved after
what is ‘peak dose dyskinesia’
shaking shortly after taking medicine that subsides after
characteristics of essential tremor
gradual onset over 5 years no other symptoms symmetrical worse on performance of tasks 50% have FH
treatment for essential tremor
reduce caffeine
primidone
beta blockers if not asthmatic
difference between parkinsons and parkinsonism
parkinsonism = dyskinesia, bilateral rest tremor, levodopa doesn’t help
how to see dopaminergic neurone loss
DaT scan
causes of third nerve palsy
internal carotid artery dissection
intracranial aneurysm pressing on nerve
thrombotic occlusion of blood supply to nerve
where would lesion be in
homonoymous hemianopia
behind chiasm i.e in brain
treatment for BPPV
1) epley
2) Cawthorne cooksey exercise
3) watch and wait
4) prochlorperazine
what is juvenile myoclonic epilepsy
syndrome of TC seizures and myoclonic jerks, sometimes absence seizures. Begins in childhood and often persists into adulthood
what is Jacksonian march
spreading of seizure symptoms from one part of the body to another
what is Todd’s paresis
temporary weakness in body part after seizure - mimics stroke
investigations for seizures
blood glucose
MRI brain
diagnostic criteria for RRMS
CNS inflammation not due to alternative cause, in different places in CNS and at different times.
treatment for RRMS
acutely: methylprednisolone
chronically: beta-interferon, dimethyl fumarate
second line natalizumab
x-ray view for occiput
Towne’s view
what vessel is implicated in subdural haematoma
tearing of a bridging vein from cerebral cortex and a draining venous sinus
eye signs in raised ICP
venous pulsations
later you get papilloedema
causes of bilateral ptosis
MG
congenital
what’s the difference between spasticity and rigidity
spasticity = increased tone early on rigidity = increased tone throughout
pt with weakness down left side. why would you CXR?
aspiration
metastasis/lung cancer
enlarged heart/heart failure
how many cafe au lait spots if pathological
more than 6
features of type 1 NF
more than 6 CaL spots frecking in axilla/neck/groin dermal neurfibroma nodular neuroibroma optic glioma fundal changes lisch nodules (iris hamartomas) - need a slit lamp
Triad of: Neurofibroma, CaL spots, Lisch nodule
features of type 2 NF
bilateral 8th nerve palsy
nervous system tumours
Complications of NF
hypertension - RAS
thoracic kyphosis - resp compromise
malignant change - 10%
learning difficulty
what is Crowe’s sign?
freckling of axilla
which motor lesions spares the forehead
UMN
if facial nerve palsy what else do you look for
ears for Ramsay-Hunt syndrome and acute otitis media (hyperacusis as well)
parotids for other nerves
anterior 2/3 tongue for taste
how to localise lesion in 7th nerve palsy with other nerves
6th = pons lesion
5th and 8th = cerebello-pontine angle
earliest sign for cerebello-pontine lesions
loss of corneal reflex
