Neuro Flashcards
Alzheimer’s is a progressive degeneration of the cerebral cortex with widespread atrophy. What key thing is happening in affected neurones?
Amyloid plaque deposits
Alzheimer’s is a progressive degeneration of the cerebral cortex with widespread atrophy. What key thing is happening in affected neurones?
Amyloid plaque deposits with reduced Ach production
Neurofibrillary tangles
Gene in some alzheimers ?
Apolipoprotein E
[APP, PSEN1, PSEN2 - can think of Persons SENile 1 and 2]
Dementia with hallucinations/sleep disorder in Q. What else might they mention?
Lewy body
Parkinsonism
Personality change being a key part of dementia in?
Fronto temporal
Some dementia symptoms but starting in 30’s with psychosis and abnormal movements
huntingtons
gait disturbance, cognitive impairment, and impaired bladder control
normal pressure hydrocephalus
Rapid progression in <50s with myoclonic jerks, seizures and cerebral ataxia
prion disease
Uncertain but want to make diagnosis of AD
Consider PET CT
CSF for tau protein / amyloid B
AD and DVLA
DVLA must be informed
Pharma Rx of AD
Cholinesterase inhibitors - Donepezil, rivastigmine, galantamine
NMDA receptor antagonist - memantine
Safest antiepileptic in pregnancy
Lamotrigine for labias
Phenytoin can be used in pregnancy - what needs to happen? 3 parts
Ensure pt gets folic acid (as affects synthesis)
Vitamin K from 36weeks gestation to counteract possible neonatal coagulopathy
Detailed US scan at 18-20 weeks
Huntington’s - genetics? Which chrom?
Huntingtin gene on chromosome 4 -> CAG repeat
Dominant pattern with anticipation
What is the common presentation of juvenile Huntingtons
Hypo kinetic, rigid picture with parkinsonism
CT huntingtons
Loss of striatal volume and increased size of the frontal horns of the lateral ventricles
Alcohol and diabetes are the most common forms of peripheral neuropathy - what would make you think alcohol rather than diabetes?
anaemia with macrocytosis
Derranged LFTs
Low Calcium / Magnesium
Cluster headaches are always UNILATERAL and last 15min - 3 hrs. Often associated with ipsilateral autonomic symptoms. Management for acute attack? Prevention?
Acute - Oxygen +/- sumatriptan
Chronic - Verapamil
[Topiramate, valproate, and lithium may be used]
Why avoid haloperidol in dementia
More susceptible to extrapyramidal eg parkinsonism side effects
Early Parkinsons associated with what gene?
PARK1
Bar antipsychotics which other drugs may cause parkinsonism
Metoclopramide
proclorperazine
Valproate, litium
General buzz pathology of Parkinsons
loss of dopaminergic neurones in substantial nigra
Parkinsonism with significant autonomic disturbance?
Multi-system atrophy
Parkinsonism with prominent cerebella signs
Multi system atrophy
Parkinsonism with the inability to look up. If the neck is flexed the gaze will remain to look forward. What is this called? What is the diagnosis?
vertical supranuclear gaze palsy
Progressive supranuclear palsy
Early falls in clinical course with parkinsonism consider?
Normal pressure hydrocephalus
PSP
Vascular parkinsonism seen in ?
Corticobasal syndrome
Parkinsons DVLA
Must inform
1st line Rx of parkinsons
Levodopa with a dopa-decarboxylase inhibitor Eg
Co-caredopa
Bar co-careldopa/co-beneldopa what other key medication classes in parkinsons
Dopamine agonists - pramipexole, ropinirole or rotigotine
MAO-B inhibitors - segeligine, rasagiline
[Do NOT cause rection after consumption of tyramine rich food]
COMT inhibitors - entacapone
Issue with using ergot-derived dopamine agonists eg cabergoline and pergolide?
Cardiac fibrosis when used for a long time
Surgical Parkinsons
Electrodes into deep brain nuclei -> stimulation of thalamic nucleus
Hemiballism is what? which brain structure is damaged?
“hyperkinetic involuntary movement disorder characterized by intermittent, sudden, violent, involuntary, flinging, or ballistic high amplitude movements”
Subthalamic nucleus
Damage to red nucleus leads to?
tremor
[Tremor with glass of red wine it pours everywhere]
Damage to ventral pallidum caudate nucleus
chorea
Damage to the dentate nucleus causes?
ataxia
[Dentists dint pay taxes]
Most common primary brain tumour
Glioma
Glioblastoma multiforme looks greyish macroscopically. What features are diagnostic?
Vascular proliferation and thombois
Necrosis
Astrocytoma (another main type of glioma) wont have these features above and usually looks whiter
Most commonly inherited polyneuropathy?
charcot-marie-tooth disease
[Will present with a slow symetrical weakness/ sensory loss / muscle loss / areflexia]
How does freidrich’s ataxia present? common non neuro issue?
slow progressive cerebellar ataxia in young adults / kids (2-25yrs) with absent reflexes
Cardiomyopathy
Rx of migrane acute?
Acute
-Analgesia - Aspirin 900mg, NSAID, para
-Sumatriptin
Only sumartriptan at START of headache - not when aura starts
Eg of migrane prophylaxis
propranolol
topiramate
amitriptyline
Smoker. Proximal weakness which is worse in morning and gets better with exertion. Assoc symptoms of autonomic Eg Dry mouth. Cause/antibodies? Pathology? Ix? Rx?
Lambert-eaten myasthenic syndrome
Paraneoplastic usually associated with small cell lung cancer
-Pre synaptic autoantibodies to voltage gated Ca channels
Nerve conduction studies / CT chest to exclude malignancy
3,4-diaminopyridine [sometimes pyridostigmine / steroids / plasma exchange]
Management of Tics
Risperidone if bad
CBT if not
Gillian-barre
Most common bug?
CSF finding?
Rx?
C jejuni
Raised protein [can be normal at start]
IVIG + Plasma exchange
Variant Creutzfeldt-Jakob disease gives what finding on MRI? Histology?
Increased signal in pulvinar of thalamus
Vacuolar degeneration
What would diffuse white-matter disease on t2 weighting indicate?
Vascular dementia
myoclonus
dementia
ataxia
psych/behavioural
Age 20s
=
Varient Creutzfeldt-Jakob disease
[Very young]
Differentiate sporadic vs Variant Creutzfeldt-Jakob disease
Variant Creutzfeldt-Jakob disease - presents earlier Ie in 20s
Psychiatic prodrome to symptoms
Painful sensory symptoms
Actue slurring of speech, horners syndrome, facial pain and vertigo =?Which vessle?
Lateral medullary syndrome
[posterior inferior cerebellar artery syndrome]
Vertebral artery - most common. Then PICA
Anterior vs middle cerebral artery if lower limb more affected?
Anterior - paralysis affecting LEGS most
‘Cape like’ distribution loss of pain and temperature? What follow? Pathology?
Syringomyelia
Other symptoms if gets bad eg propioception / power moving up from hands / lower limb sx
[May get horners syndrome if involves sympathetic pathways of cervical cord]
Fluid filled cyst in spinal cord
Most common type of MS? Most common mode of presentation
Relapsing remitting
Optic neuritis with visual field loss
MS gene risk factor
HLA DRB1
2 things on CSF of MS
Oligoclonal bands
Intra theacal IgG synthesis
Complete opthalmoplegia of eye. Where is lesion? If raised inflam markers what is it likely?
Cavernous sinus (on ipsilateral side)
Tolosa-hunt syndrome (TotalLoss eye) [Granulomatous process]
What do you get in cavernous sinus issues? Eg Neoplastic, vascular, inflamation
CN III, IV, VI -> eye muscle weakness
V (trigeminal) - face sensory
Horners syndrome
Facial paraesthesia
Cell type in Lyme disease CSF meningitis
Lymphocyte predominant
High protein
Normal glucose
Do you give steroids in GBS
no
Loss of pain and temp on face and on CONTRALATERAL side of body? Usual cause?
Lateral medullary syndrome
Vertebral artery dissecition -> PICA occlusion
Max time for TIA?
24hrs
Who has high risk of berry aneurysms
PCKD
Drug of choice for stroke thrombolysis? time frame to treat? When can you do thrombectomy?
altepase if <4.5hrs
Thrombectomy (incombination with altepase) <6hrs
PICA occusion leads to? what symptoms
Lateral medullary syndrome
nystagmus and vomiting
Ipsilateral pain and temp sensation in face
-Ipsilateral horners
Contra lateral pain and temp in limbs
[but ipsilateral limb ataxia]
Non-epileptic seizures. Important ways of differentiating from true
EEG + video
TONGUE biting - virtually never in pseudo
Serum prolactin - temporary raise in real seizures
What happens in loss of dolls eye reflex. When might this be seen.
Pupils dont move on head turning
Brainstem death Eg massive pontine haemorrhage
Proptosis not from graves usually?
Malignant
Eg tumour in orbital apex
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and virbration
Anterior spinal artery occulusion
Posterior artery suppilies posterior aspect with proprioception and vibration
Best antiepileptic if liver impairment
Lamotrigine - also only one which doesnt interfere with warafrin
[Lamotrigine for liver]
Can use keppra - though will still need dose reduced if severe impairment
First line drugs for epilepsy are as you’d imagine. Keppra, valproate, carbamazepine, lamotrigine…. What is the one for absence seizures?
Ethosuximide
All types of MND have weakness in limbs. AML is the most common type and affects UMN/LMN as well as speech and respiratory involvement.
What are some differentiating factors of the others ?
PBP / PMA / PLS
Progressive bulbar palsy
-Weakness of facial muscles predominant
-Often emotional liability
Progressive muscular atrophy
-Only LOWER motor neurones
Primary lateral sclerosis
-Progressive SPASTIC weakness of limbs
-Sensation intact
-may still get dysarthria / dysphagia
Only drug for MND
Riluzole - only adds a couple months to life expectancy
Condition which may seem similar to MND -
Lower MND involving limbs and bulbar muscles
with - Gynaecomastia and reduced fertility ?
Kennedy disease (x-linked spinobulbar muscular atrophy)
Juvinile myoclonic epilepsy - choice of drug?
Valproate
-Keppra if want to get preg etc..
Kids like a VK drink
Blurring of disk and Arcuate visual loss usually in what condition
Glaucoma
[bow-shaped (arcuate) visual field defect]
Loss of ability to detect size shape and orientation of objects in one hand. MRI of what
Head - not C spine
Damage to anterior parietal cortex would cause this
Brown-Séquard syndrome - neurology
paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.
Unilateral dilated pupil which contracts slowly and loss of deep tendon reflexes? Option for management
What is hypohidrosis? What name of syndrome if that happens along with above?
Holmes-aldie syndrome (pupil)
-Usually due to viral damage at some point
-Reading glasses or pilocarpine drops TDS to constrict pupil
Lack of ability to sweat
Ross syndrome
Syphilis -> bilateral slighly dilated poorly light reactive pupils with normal accommodation.
Argyll-robertson pupil
Broca vs wernickes
Broca - Frontal lobe
- Pure speech disturbance
Wernikes - Temporal lobe
- Comprehension
Bells palsy linked to which bug?
Symptoms?
Key other cause to rule out?
HSV-1
Facial muscles palsy
HYPERacuisus
Reduced salivation
May cause pain usually auricular
Dry eyes
Borrelia burgdoferi serology
Bells palsy - 2 main parts of Rx?
If complete paralysis ?
Eye protection - artificial tears
corticosteroids
Often aciclovir +/- surgical decompression
Bells palsy vs UMN lesion if able to wrinkle head
Preserved ability to wrinkle forehead is UMN lesion
Hypo/hyperkalaemia and temporary global muscle weakness
periodic paralysis
Periodic paralysis with lots of physical deformities
andersen-tawil syndrome
Periodic paralysis usually associated with potassium problems. What is the other type
Thyrotoxic
Bells palsy with vesicular rash = ?
CSF findings?
Ramsay hunt - VZV (Herpes Zoster) in the geniculate nucleus
May have lymphocytosis / mildly raised protein
Painless intermittent diplopia which worsens through day. Ptosis
?
Occular myasthenia gravis
[most common initial presentation]
Interossi muscles of hands and sensory medial upper arm nerve root
T1
Tricepts muscle and sensory forearm + hand around middle finger nerve route
C7
Elbow and wrist extension issues which brachial plexus nerve ? Sensory issues
Radial
Sensory lateral forearm and lateral dorsal hand (anatomical snuff box)
Loss of pain and temperature in arm with preservation of proprioception and vibration? (If repeated trauma in question?) How would it progress?
Syringomyelia
(if trauma eg repeated rugby scrum - cervical spondylosis)
Wasting of small muscles of hand moving proximally
Increased tone bilat lower limb -> spastic paralysis
Smoking HTN and cocaine are risks for SAH/Aneurysm. What are inherited risks?
PKD
Marfan, ehlers-danlos
NF type 1
Fat, headaches, visual disturbance? Key finding on exam?
idiopathic intracranial hypertension
-swelling of optic disk /papilloedema
Rx of IIH? If severe headaches?
Surgical? If threat to vision?
Acetazolamide / topiramate
Pred if severe headaches
Therapeutic LPs to relieve pressure
May get VP shunt for recurrent disease
Optic nerve fenestration if risk to vision
Differentiate cauda equina and conus medullaris.
Presentation
Reflexes
Pain
Sensory
Sphincters
Conus
-Sudden and bilart
-Knee jerk preserved. Anke affected
-more severe back pain, less radicular
-Symetrical and bilat sensory disturbance
-Urinary retention and faecal incontinence early
Cauda
-Slower onset
-Areflexic
-Less severe back pain, more sever radicular pain
-Retention presents late in disease
wants to get preg. On phenytoin and keppra. What is plan
Wean to a single agent -
Keep keppra at lowest dose for seizure control
Folic acid 5mg daily
Arnold-chiari nystagmus type?
Downbeat
What is most common cause of pendular nystagmus? (movement equal speed both ways)
MS
Symptoms of brown sequard
Ipsilateral - weakness, vibration and proprioception
Contralateral - Pain and temp
Muscular dystrophy - what is best predictor of death
Vital capacity
Differentiate sporadic / varient CJD.
Best Ix
Sporadic
-Age 45-75
-Myoclous and dementia
-De novo mutation
-LP/MRI
Variant
-Average age 26
-Psychiatric prodrome
-Painful psych symptoms
-MRI best (EEG/LP less sensitive in this one)
Rx of myoclonus in CJD
Clonazepam / valproate
Most common cause of roth spots
Subacute bacterial endocarditis
Unable to pronate arm. Which nerve
Anterior interossus - Branch of median
Cushings response to head injury
RR - decreases
Bradycardia
systolic BP increase
MRI spine findings of Subacute degeneration of spinal cord (eg b12 deficiency)
Increased T2 signal in posterior columns
MS MRI Spine
T2 Diffuse patchy white matter lesions
RX ramsay hunt
Acyclovir + pred
Lubricating eye drops
Flu like illness -> ophthalmoplegia, areflexia and ataxia
Miller-fisher syndrome
[variant of gillian barre]
Left inferior homonymous hemaniopia where is lesion
Right parietal
[Lateral fibres cross at chiasm]
Bar CN III, IV and 6, what else goes through cavernous sinus?
Maxillary (sensory) branch of CN V
Carotid artery
Most common sight issue in IIH
Enlarged blind spot
(from optic disk swelling)
Prev significant spinal trauma with lower limb wasting. Now loss of pain and temp over upper limbs. What has happened
Post-traumatic sryngomyelia
Facial weakness, winging of scapular, proximal upper limb weakness, foot drop
Fascioscapulohumeral muscular dystrophy
Focal seizures usually from which lobe?
Temporal
Epidural / LP then couple days later
Droswsy, severe headaches, raised ICP eg seizures….
Central venous thrombosis
MOST likely Superior sagittal sinus thrombosis
For what length of time does xanthachromia remain very specific
12hrs after onset for 2 weeks
(100% sensitivity after 2 weeks still)
Essential tremor 2 main drugs for Rx
Propanolol
[Primidone (barbituate)
Topiramate]
Inheritance of tremor? how does age of presentation change whats likely?
AD in 50%
If presents after age 40 -> likely sporadic
Key drug in neuroleptic malignant syndrome
dantrolene
EEG of sCJD
1-Hz periodic discharges
(myoclonic movements)
diabetes insipidus, childhood-onset diabetes mellitus, a gradual loss of vision caused by optic atrophy, and deafness.
DI-DM-OA-D
DIDMOAD syndrome also known as
Wolfram syndrome
Score for disease status in MS
EDSS
Expanded disability status score
Usual first line Rx MS with mpred
Interferon or
Glatiramer acetate
Early highly active RRMS rx
Autologus haematopoetic stem cell transplant
Relapse of MS doses of pred in hospital
Mpred 1g IV 3 days
500mg oral 5 days
What happens to pregnant pts with MS
Usually get less attacks
still treat with steroids / Plasma exchange if needed
Finger drop / radial deviated wrist extension. Nerve?
Doral (posterior) interossus nerve
Dermatome c5-t1
Dermatome
C5: lateral aspect of arm
C6: lateral aspect of forearm and hand
C7: middle finger and ray
C8: medial aspect of hand
T1: medial aspect of forearm
Myotome and reflex C5-T1
C5: Elbow flexion
-Biceps
C6: Wrist extension
-Supinator
-Biceps
C7: Elbow extension
-Triceps
C8: Middle finger flexion
T1: Little finger abduction
Disc prolapse -> loss of triceps reflex. Where
C6,7
prolapse affects nerve root below prolapse
Multifocal motor neuropathy with conduction block. What is this? Sensory involvement?
Rx first line?
Form of MND
No sensory involvement
Treat with IVIg
Multifocal motor neuropathy with conduction block. Key findings on EMG?
Rx first line?
it is what it says on the diagnosis. Eg right hand and left foot symptoms
Conduction block and No sensory involvement on EMG
Treat with IV Ig
What is the most common form of GBS called. WHat is the pattern of peripheral nerve pathology
Acute inflammatory demyelinating polyneuropathy
AIDP
Segmental demyelination
What is wallerian degeneration
Demyelination which occurs distal to a region of focal (axonal) damage.
->Nerve needs to regenerate
DDs for subacute lymphocytic meningitis
TB
Cryptococcus - if immunocompromised and opening pressure >40cmH2O
Lyme diseae
Head injury LOC. Quick recovery
Lucid period
-> quick deterioration ?
Extradural
(middle meningeal artery bleed -> more rapid symptoms)
cerebral aneurysm which is best Coil or clipping
Coil
Cerebellar signs and tremor in a young person …
Wilsons
1st line Ix of wilsons? Gene?
24hr urine copper is Ix of choice - raised
Slit lamp - sunflower cataracts / kayser fletcher rings
[Serum ceurloplasumin and copper - usually low/normal]
ATP7B gene - diagnosis
Rx Wilsons
Avoidance of copper containing foods
Penicillamine - copper chelation
Juvenile myoclonic epilepsy first line ?
Valproate
Differentiate vestibular neuroma and menniers
Cancer - unilateral hearing loss, tinnitus and trigeminal neuralgia. Eg absent corneal reflex
Menniers - hearing loss, tinnitus and vertigo
No pain / trigeminal involvement
Key risks for vestibular shwannoma
Neurofibromatosis
Loss of chromosome p22 gene
[Shwannomin gene which is a tumour suppressor gene)
Rx of vestibular schannoma
50% small and dont require Rx
Surgery /
radio - ‘gamma knife’ radiotherapy
Upbeat nystagmus. Where is lesion
Lesion in medulla
What is spared in anterior spinal artery occlusion?
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and virbration
What is spared in anterior spinal artery occlusion?
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and vibration
What is spared in anterior spinal artery occlusion?
Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and vibration
Older diabetic. Transient weakness eg of face. Then couple of months later weakness / sensory loss of common peroneal. Both recovered spontaneously after couple weeks. Dx?
Rx?
Mononeuritis multiplex
Improve BM control
[MS would present <60 usually / UpperMN signs]
What can apomorphine be used forr
Alleviate late motor Sx Eg dyskinesia of dopamine therapy in parkinsons
Numbness medial thigh and reduced hip adduction nerve
Obturator
Weak hip abduction and Trendelenburg gait nerve
Superior gluteal
Sciatic nerve route? becomes what?What sx?
L5-S2
Becomes tibial and common perineal
-> eg foot drop
Pharma rx of tics
Risperidone
Pregnant then excessive vomiting.. Wide-based gait and double vision. Deficient in what
Thiamine (Vit B1)
Stroke / TIA DVLA rules
No car for 1 month
No HGV for 1 year
Homonymous hemianopia with sparing of macula (central field)
Occipital stroke
If no sparing may be optic tract
CN palsies, horners syndrome, and UMN signs in limbs, sensory change
Sryngobulbia
Kennedy disease also called
x linked spinobulbar atrophy
[like MND but gynecomastia, diabetes and infertile]
Weakness of all ankle movements / ankle jerk =
Sciatic
Drug used in SAH to minimise vasospasm and further infaarct
Nimodipine
Pyramidal weakness, reduced deep tendon reflexes
Reduced proprioception and vibration but nil else sensory =
b12 deficinecy
Which infection causes progressive myelopathy with prominent bladder disturbance
HTLV-1
Bilat weakness in upper limbs.
LMN signs. No sensory involvement
Demyelination and conduction block on EMG /conduction studies.
Multifocal motor neuropathy
Multifocal motor neuropathy Ix? Antibody? Rx?
EMG /conduction studies.
Anti-aminoglycoside [Anti-GM1] antibody 50%
IV Ig
What makes you think idiopathic parkinsons rather than one of the parkinsonsoniam cause
Asymmetry in idiopathic parkinsons
differentiate holmes aidie pupil and physiological aniscoria
Aidie - poor constriction to light with normal accommodation
[Due to damage to parasympathetic supply]
Pysiological - difference remains the same in light and dark
differentiate holmes aide pupil and physiological anisocoria
Aidie - poor constriction to light with normal accommodation
[Due to damage to parasympathetic supply]
Physiological - difference remains the same in light and dark
Upper and LMN signs with sensory changes? What if evidence of brainstem involvement Eg CN palsy
Syringomyelia
syringobulbia if brainstem involved
Brainstem stroke with impaired vertical eye movements. Where is the lesion for eye movements?
Dosal midbrain - vertical eye movements
Stroke long term secondary prevention? 2nd line?
Clopidogrel 1st line
2nd line aspirin + dipyridamole
miller fisher syndrome basics presentation
Weakness affecting eyes and then progresses distally
Phenytoin dose change - how long to check level
2 weeks
Fevers, lethargy. Painful neuropathies affectting different nerves. Rash. Raised inflam markers. What is the cause of neuropathies? Cause? Ix?
Mononeuritis multiplex
[probably caused by vasculitis given rash ]
Nerve biopsy
global wasting of the hand muscles damage to?
T1 (median and ulnar)
HIV progressive memory loss. MRI shows global atrophy and mild white matter hyperintensity?
HIV dementia
[PML would usually have some focal neuro symptoms]
Pituitary apoplexy (bleeding into adenoma). Ix of choice?
MRI brain
[dont need angio as MRI will show adenoma and haemohharge]
Paroxysmal vertigo, deafness lasting for hours? Rx acute? Prophylaxis?
What if old and symptoms only short lived?
Meniers
Prochlorperazine / cyclizine
Beta histine, low salt +/- diuretics
Vertebrobasilar insufficiency if old and short-lived sx
[no hearing loss in BPPV]
Labyrinthitis how long for symptoms
Lasts 1-3 weeks and
NO hearing loss
Labyrinthitis how long for symptoms? What symptom is absent?
Lasts 1-3 weeks and
NO hearing loss
Deliver baby -> severe dehydration
Then develop neuro signs Eg seizure / focal weakness what has happened
Sagittal sinus thrombosis
which artery supplies brocca
Middle cerebral
Hemiparesis mostly involving llegs
Anterior cerebral
- Unsteady gait, alcoholic, reduced lower limb reflexes, increased tone and spastic bilat . Loss of vibration sense
B12 deficiency
Injury to the neck. Weakness down left side 4/5. LMN arm, UMN leg. Dx?
Cervical myelopathy
[Sryngomyelia would have more likely started as cape-like distribution]
Miller fisher syndrome antibody
IgG anti‐GQ1b
Axonal vs myelin disorder on EMG
Axonal - Loss of action potential size (amplitude)
Myelin - Reduction in velocity Or blocks
Painful paraesthesia in CJD means what is involved
Thalamus
Old person with CJD best Ix
LP [for RT-QuIC]
Right parietal damage in right-handed person -> ?
Visual disturbance
Arnold chiari nystagmus
Downbeat
agraphia
acalculia
finger agnosia
left-right disorientation .
Gerstmann syndrome
agraphia (inability to write),
acalculia (inability to perform mathematical calculations)
finger agnosia (inability to name, discriminate, or identify fingers)
left-right disorientation (inability to distinguish left from right)
Dominant vs non dominant parietal lobe lesion
Dominant - Language, agnosia, apraxia, Gesterman syndrome
Non-dominant - Visuospacial, apraxia
-Eg copy a drawing
URTI. Now progressive weakness of lower limbs
CSF - lymphocytes, normal protein
?
Post viral transverse myelitis
[Will have sensory level sensation loss]
Difficulties relaxing grip, facial weakness family Hx?
Myotpnic dystrophy type 1
AD
Indian with Palpable nodule on skin -> seizure = ?
What is bug causing ?
Cysticercosis
Tape worm (Taenia Solium)
GBS poor prognosis
Age
speed of sx
Hx of
Finding in blood
> 40
Rapid onset / vent requirement
Hx of diarrhoeal illness(campylobacter)
High Anti-GM1 in blood
Bar MRI what 2 Ix good for MS
Visual evoked potentials (or optic neuritis)
LP
Presents as Huntington’s with Fhx but has Asterixis? What is asterixis?
Wilsons
Asterixis inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements.
IV or oral Mpred in MS attack?
Oral .5g for 5 days
IV 1g is reserved for people who need to be admitted for monitoring Eg depression, diabetes
Which order of horners if internal carotid?
Syringomyelia?
3rd order (postganglionic)
1st order
tetnus Abx
Penicilin or metronidazole
Pupil non-reacctive to light and diminished reflexes globally
Holmes aidie
Dysarthria and clumsiness + more forgetfulness in 30s. Family hX and has mild hepatomegaly
Wilsons
Eyes
Loss of adduction with contralateral nystagmus of the other eye. =?
Damage where? If bilateral what is going on?
Internuclear opthalmoplegia
-Lesion in medial longitudinal fasiculusis
[Connects CN VI to contralateral CN III]
MS very likely if bbilat
Sudden onset unilateral weakness without language disturbance or visual field defect or neglect =
Lacunar stroke - affecting the corticospinal tract
Lacunar stroke if
Pure sensory
Pure motor
Clumsy hand syndrome
Severe headaches confusion hypertensive retinopathy on fundoscopy =
Hypertensive encephalopathy
Needs iv sodium nitroprusside
Primary cervical torticolis Rx
Botox
What is a chiari type 1 malformation?
Presents with?
Type 2 presents how?
Elongated cerebellar tonsils are displaced into the cervical canal through the foramen magnum
-Presents with cerebellar signs (downbeat nystagmus), weakness of the upper limb and sensory issues
Type 2 presents young with features of brainstem dysfunction
On lamotrigine and phenytoin. Seizure free 5 years. Presents during preg with seizure. Plan?
Slowly withdraw phenytoin and keep lamotrigine
[2 agents significantly more risk of teratogenicity]
Amyloid neuropathy presents how
Polyneuropathy with Autonomic symptoms eg Postural hypotension
Optic neuritis
MRI has >3 white matter lesions what is the chance of developing MS in 5 years?
MRI has 1 lesion, what is the chance of developing MS in 15 years?
50%
50%
Most common genetic form of vascular dementia ? Cromosome
CADSIL
Cerebral Autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy
chrome 19q3 - NOTCH3 gene
Most common genetic form of vascular dementia ? Cromosome
CADSIL
Cerebral Autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy
chrome 19q3 - NOTCH3 gene
Proximal limb aching + headaches then altitudinal visual field loss
GCA
[Altitudinal visual field loss very common way to lose vision in ischemic optic neruitis]
Differentiate weber and Wallenberg syndrome…Sx? Where is lesion? Usual vessel?
Both ipsilateral CN 3 palsy
Weber - Contralateral hemiparesis + hemiparkinsonism
-Midbrain, corticospinal tract and substantial nigra
-Paramedian branches of posterior cerebellar artery
Wallenberg - ipsilateral pain temp loss on face with contralateral pain temp on body
-Midbrain / brainstem
-PICA
Syndrome with occlusive disease of internal carotids -> lots of collateral vessels. Presents with recurrent TIAs headaches or seizures? How is it described on cerebral angiogram ?
Moya moya
‘hazy’ or ‘puff of smoke’
Ipsilateral CN 6 brainstem syndrome?
Millard-gubler
Pons
Normal pressure hydrocephalus Rx?
Shunt
[Only large volume LPs if unfit for surgery]
COCP with headache pappilodema and CN 6 palsys. CT low-density area with haemorrhagic component. What ix next?
MR Venography
-Likely has CVST
[CTA is not used to look for CVST apparently]
CN originates from…
Cerebrum - 1 and 2
Midbrain - 3 and 4
Pons - 5,6,7 and 8
Medulla - 9, 10, 11and 12
2/2/4/4
Unable to abduct eye and ipsilateral facial weakness - lesion where?
Pons
Whoh gets statins post stroke?
Everyone
Parkinsons for 2 years. On sinemet TDS and feels gets off symptoms… what next
Increase to QDS
Antiepileptic with weight loss and renal stones?
Topiramate
Most common side effect of lamotrigine?
Skin rash
[Some get steven johnsons]
Poorly controlled diabetes
Mix of UMN/LMN signs in limbs and weakness
Loss of pinprick sensation to mid shin bilat
Dx?
Amyotrophic lateral sclerosis
Loss of sensation is due to complication from diabetes!
Beckers inheritance. Where is the wekaness initially?
X linked
Proximal (so often develop big calves at first)
Charcot-marie-tooth symptoms
Purely motor / sensory. Presents in 20s
[NO UMN]
Weakness of quadriceps and fingers with asymmetry =? exclude polymyositis?
Inclusion body myositis
CK normal (helps rule out polymyositis)
Speech aphasia issues, headache
Left hemiparesis -> deteriorate and new R side CN 3 palsy, Where is the lesion?
Temporal lobe with haemorrhage/oedema -> brainstem compression
[Not midbrain initially as doesn’t explain speech]
Booze. wakes with weakness brachioradialis, wrist and finger extension =
‘Saturday night palsy’
radial nerve at spiral groove
Acoustic neuromas often affect which extra nerve? Sx?
Trigeminal sensory ranch - loss of corneal reflex first sign
When vit k in coagulopathy
If INR >2
R limb weakness with L CN 6 and facial weakness. Lesion where?
Left Pons
Pins and needles start in foot and run up body to arm . Happens often
Focal aware seizure
[new name for parital seizures]
GQ1B antibodies in
MIller fisher syndrome
Right-sided upper limb with fasciculations and wasting. Conduction block on EMG = Antibodies common?
Multifocal motor neuropathy
[Conduction block on EMG key to Dx]
Anti GM-1
Presents as encephalitis. Inflam markers normal. Lesions in both temporal lobes =?
HSV encephalitis
[Often has normal inflam markers]
BPPV which for Dx which for Rx?
Dix-hallpike
Epley
60s presents with difficulty naming things or recognising faces?
Unable to verbalise things normally - - main issue is phone conversations?
Where are the lesions in these conditions
Semantic dementia
-Temporal lobe
Progressive non-fluent aphasia
-Left perisylvian region
[types of FTD]
Given Abx for sinusitis. Severe headache
CSF - Lymphocytosis, mild low glucose, mild elevated protein
Partially treated bacterial meningitis
Looks similar to viral
Common peroneal sensory
Dorsum of foot
[basically same as motor]
Which Abx make MG worse? cardiac?
Aminoglycosides and fluoroquinolones
B blockers
Procainamide
Exposure to nitrous oxide leads to what neurological manifestation? Who is at risk?
Sensory and weakness
presents similar to B12 deficiency and people who have b12 deficiency much more at risk
[due oto methionine synthesis ]
Long-term use of antiepileptic which leads to lymphadenopathy and Dupuytren’s contracture ?
Phenytoin
How to prevent neuropathy with isoniazid prescription
Pyridoxine
First line primary generalised epilepsy in men
Valproate
Lamotrigine
Alternating nystagmus - where is lesion
Cerebellum
Nystagmus in pons lesion
Upbeat
Facial weakness and sensation issues + tinnitus. Where is lesion
Cerebellopontine angle
V, VII, VIII all close together here
Medical fasciculus lesion. Right or left if left eye fails to adduct
Left
What do you need to check before giving Igs in rx of gillian barre? Why?
IgA levels
Risk of anaphylaxis when giving Ig to IgA deficiency
Child, ataxia and UMN signs
Friedrich’s ataxia
CMT - no UMN
Ocular MG Rx initial
Pyridostigmine 30mg QQDS
