Neuro Flashcards
DKA diagnosis
raised blood glucose(>11.1 mmol/L), or known diabetes
ketonuria ++ or more
serum bicarbonate <15 mmol/L
pH<7.3 (if measured)
management of DKA
1st step
1- fluid resus
dehydration and intravascular volume depletion is paramount and it is important to use the largest bore cannula possible (e.g. 14G) in at least two sites
1 litre of 0.9% sodium chloride as a bolus, followed by 1 litre over 1 hour, 1 litre over the next 2 to 4 hours, then 1 litre over 4 to 6 hours thereafter
2nd line management of DKA
watch out for plasma sodium / potassium irregularity
give 0.95 soidum w 40 mmol of potassium
once glucose down think of 10% dextrose
what should you be worried about in a DKA once treatment has been started?
hypikalaemia due to insulin therapy
= arrythmias
myeloma investigations
blood films bone marrow apirate mri whole spine serum proetien lectrophoresis and free lgith chains skeletal survey thoracic and lumbar spine radiograph
management of hypercalcaemia in myeloma?
stop thiazide diuretics
start loop diuretics
hydration
haemodialysis
bisphonates
where is the lesion?
what are the possibilites
brain/ brainstem
spinal cord
nerve roots
peripheral nerves
neuromuscular junctions
pathology how can you categorise?
infection
inflammation
malignancy
UMN lesion sign?
tone?
power?
reflexes?
increased Spasticity
reduced power
hyperreflexia / brisk
plantar upgoing
LMN signs
tone
power
reflex
tone reduced / flaccid
power reduced
reflex diminished
what lesion gives you cranial nerve palsy?
brainstem lesion
if there is widespread neuro signs where can the lesion be?
if symmetrical limbs weakness / cranial nerves
must be a lesion in the neuromuscular junction
if pt presents with widespread cranial/ limb weakness [motor]
where would lesion be ?
what would be your top ddx?
what if this was also associated with pus filled abscesses on the skin?
neuromuscular junction problem
myasthenia gravis
must be an infectious cause
like botulism toxin
what toxin causes a lesion at neuromuscular junction
what neurotransmitter does it affect?
how does it work
ACTH
neuromuscular junction to cause muscle paralysis by inhibiting the release of acetylcholine from presynaptic motor neurons.
cerebeller signs
ataxia nystagmus dysdiadochokinesia intention tremor speech
clinical features of cerebeller disease can be remmebered by the mneumonic DANISH
Dysdiodochokinesia Ataxia Nystagmus Intention tremor slurred speech - dysarthria Hypotonia
what does a hemisensory loss indicate as to where a lesion may be?
lesion at cortex
i.e stroke
if sensory loss is bilateral to a point where would that inidcate the lesion is?
spinal cord as problems are at a sensory level
if dermal areas affected?
where is the lesion
what is this called?
nerve root
which would indicate a radiculopathy
what is a normal HBA1c mmol/mol?
4 – 5.6% (20 – 38 mmol/mol)
prediabetes HBA1c
5.7% and 6.4% (39 – 46 mmol/mol)
HBA1c diabetes mmol/mol
6.5% (47 mmol/mol)
normal eGFR
stage 2 eGFR
mL/min
above 90
60-89
first-line peripheral neuropathy drug?
what other antidepressanrt is commonly prescribed for neuropathy
dulexetine - SNRI
amitriptyline - TCA
what is the difference between neuropathy and radiculopathy?
firstly anatomically how do they differ?
give an example of neuropathy and radiculopathy
radiculopathy deals with damage to nerves associated with the spine
pinched nerves in the spine
Sciatica / lumbar radiculopathy L4/ L5 L5/S1
neuropathy is is damage to secondary nerves located at the peripheral of the body
damage to peripheral nerves [ outside the spine cord / brain ]
carpal tunnel syndrome
peripheral neuropathy toxic/metabolic causes?
what two common conditions?
drugs / alcohol
b12 deficiency
diabetes / hypothyroidism
uraemia
how would you find out if vit b12 deficiency was causing peripheral neuropathy?
anaemai and an increased MCV
why is a hx of myeloma / chronic infection / inflammation imp when investigating neuropathy?
checking for amyloidosis
build up of amyloid protein
this is often secondary to infection, inflammation, malignancy
infection
inflammation
malignancy
causes of peripheral neuropathy?
infection : HIV
inflammation: connective tissue disease like rheumatoid arthritis
malignancy: paraproteinaemia in myeloma
what is a good sign of hereditary neuropathies on an xray of the foot?
what is one condition that causes this?
pes Cavus
high arch
charcot marie tooth
parkinsons is defined by?
loss of dopamingeric neurons in the substantia nigra
tremor
rigidity
bradykinesia
Parkinsonian features, upgaze abnormality
what condition presents with this?
progressive supra-nuclear palsy
Features of Alzheimer’s disease, Parkinson’s & hallucinations
what condition?
lewy body
GCS
eyes :
verbal response
motor respnse
4
5
6
motor response
GCS
1-6
6 = Obeys commands 5 = Localizes pain 4 = Withdraws to painful stimuli 3 = Abnormal flexion 2 = Extension 1 = No movements
verbal response in GCS
5 = Oriented 4 = Confused 3 = Words 2 = Sounds 1 = No sounds
eyes
GCS
4 = Spontaneous 3 = Opens in response to voice 2 = Opens in response to painful stimuli 1 = Does not open
TIA
therapy/ management
aspirin
carotid doppler
risk factor modify
management for parkinsons
1st line
For first-line treatment:
if the motor symptoms are affecting the patient’s quality of life: levodopa
if the motor symptoms are not affecting the patient’s quality of life: dopamine agonist (non-ergot derived),
Pramipexole
Ropinirole
levodopa or monoamine oxidase B (MAO‑B) inhibitor
selegiline hydrochloride
bilateral hypertonia
hyper reflexia
ankle clonus and upgoing plantar
UMN signs
eye blurred vision
on fundoscopy - optic neuritis
what can this be ?
suggest inflammation of spinal cord
spastic paraperesis - MS
vascular - stroke infection inflammation - MS toxic/metabolic tumour -
if a lesion is bilateral where is the lesion?
spinal cord not brainstem or cortical
compression of nerve pattern?
sensory loss over a dermatome pattern
nerve affected
median nerve distribution?
anterior aspect of hand and thumb, first 2 fingers
ulnar nerve distribution?
pinky posteriorly
radial nerve
thumb and first finger base - posteriorly
what nerve supplies palmar part of hand?
median and ulnar
what nerve supplies back of hand?
radial and ulnar- ulnar is pinky and ring
radial is thub base
radiculopathy sensory loss
distribution?
dermatomes affected
limited upgaze abnormality and parkinsonian features
progressive supranuclear palsy
kernigs sign
extension of knee
then there is paiin§
