Neuro Flashcards
Friedrich’s ataxia
Progressive limb and gait ataxia / Loss of tendon reflex / Motor weakness LL -> UL / Sensory loss proprio/vibration / DYsphagia / Hearing loss / Visual / Bladder / Kyphoscoliosis/ Motor neuropathy / Daytime somno / Preserved cog
Optic neuritis
Painful eye with loss of vision and ipsilateral RAPD. Causes include MS, neuromyelitis optica, B12 def, Ischaemia, Leber’s, EBV, Drugs (etoh, ethambucol)
Features of MS
Relapse/Remit | Onset 15-50y | optic neuritis | Lhermitte sign | internuc ophthalmoplegia | fatigue | heat sensitive (Uhthoff)
Features of PML (JC virus). Which MS drug is it assoc. with?
Progression over weeks / presence of cortical sx / behavioural alter / hemiparesis / retrochiasmal visual deficit (?contralateral homonymous hemianopia)
Assoc. with Natalizumab
What is Ocrelizumab used for? What is its mechanism
Primary progressive MS. Anti-CD20 expressing cells
Wallenburg / lateral medullary syndrome features. Which vessel affected?
PICA. Sx vertigo, n+v, ataxia
Ipsilateral facial pain/temp, palate/vocal cord, Horner’s syndrome, cerebellar signs incl. nystagmus
Contralateral trunk lower limb pain/temp
Features of Gerstmann syndrome
Agraphia, acalculia, finger agnosia, L/R disorientation
Features of idiopathic intracranial hypertension IIH
Loss of vision, swollen optic discs, persistent headache
Rx: Weight loss, acetazolamide, frusemide, topiramate. NOT steroids
Difference between EMG and NCS
EMG - electrical signals from muscles when at rest / being used
NCS - how fast and how well electrical signals conduct down your nerves
Riluzole - what condition is it used for and what is its mechanism
Marginally slows progression in motor neuron disease.
Na channel blocker inhibiting glutamate release
What is the difference between primary muscular atrophy and primary lateral sclerosis?
PMA - LMN signs only
PLS - UMN signs only
Features of 3rd nerve palsy and DDx >5
Down and out, ptosis +/- dilated pupil
1) Diabetic - pupil sparing
2) Vasculitis e.g. GCA
3) Weber syndrome - Midbrain. Ipsilateral 3rd with contralateral hemiplegia
4) PICA aneurysm with headache
5) Cavernous sinus thrombosis
6) MS/amyloid
Features of PSP (2 types)
“Classic” - Gait disturbance, frequent falls, supranuclear gaze palsy. Poor response to Levodopa
PSP-parkinsonism - Asymmetric limb sx, tremor and initial response to Levodopa (but not sustained)
Dysarthria, dysphasia, rigidity, frontal cog, sleep disturbances
Features of radial nerve palsy?
C5-8 – affects finger extensors
Wrist drop
Absent sensation over snuffbox
Weakness of finger and thumb extension
Loss of triceps reflex
Features of median nerve palsy?
C6-T1
Carpal tunnel - weakness abductor pollicis brevis
Cubital fossa lesion - failure of index finger flexion, loss of sensation over palmar thumb+2/3/lateral 4th. Weakness of thumb abduction and opposition
Features of ulnar nerve?
C8-T1 – affects small muscles of hand
Clawing of 4/5th finger
Loss of sensation over palmar 5th and medial half 4th
Weakness of 5th finger flex and add/abd fingers
Features of complete brachial plexopathy
Horner’s syndrome
LMN
Sensory loss over whole arm limb
Deep tendon reflexes - which nerve roots?
Biceps C5
Brachioradialis C6
Triceps C7
Knee L4
Ankle S1
DDx of foot drop (3)
Common peroneal nerve
Sciatic nerve
L5 radiculopathy – absent ankle jerk
What is syringomyelia?
Fluid filled cyst (syrinx) forms within spinal cord and can cause compression
Features of femoral nerve palsy
L2-4
Weakness of knee extension (quads)
Absent knee jerk
Sensory loss inner thigh/leg
Features of Charcot Marie Tooth
Hereditary sensory motor neuropathy
HMSN1 and 2
HMSN1 - motor >sensory (glove/stocking) with loss of balance, muscle weak, foot deformities. Slowed NVCs and hypertrophic myelin with onion bulbs and 2’ axonal disease. Onset teens-young adult
HMSN2 - Milder weakness of feet and leg muscles and sensory distal LL>UL. Normal NCVs and axons
Most common type of muscular dystrophy? Features
Facioscapulohumeral dystrophy FSHD. A dominant. Onset 20y. Initial facial weakness then shoulders w winging, mildly raised CKD.
Features of myotonic dystrophy
Muscle wasting, cataracts, heart conduction, endocrine changes and myotonia. Onset at any age
EMG features of dermatomyositis, MND and Myasthenia?
DM - reduced amplitude and duration of motor units
MND - fibrillation
MG - diminished response to repetitive stimulation
Features of SUNCT
Short lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing
Men >50y. Severe headaches lasting seconds-minutes. >20 attacks. No acute Rx but preventative including anti-epileptics
What is paroxysmal hemicrania
Unilateral severe headaches lasting 2-45mins, up to x5/day with marked autonomic symptoms. Rx Indomethacin
RCVS features
Reversible Cerebral Vascoconstriction syndrome
Bilateral recurrent thunderclap headaches. Spontaneous, exertion, or hx weed/amphe use. Rx with Verapamil to prevent infarction
Rx for MS (5)
1/ IV methylpred if functional status impaired
2/ IF beta 1a/b - reduces risk of relapse and slows disability progression
3/ Glatiramer acetate - reduces relapse rate. No SE
4/ Natalizumab - monoclonal ab a4 integrin. Assoc. JC PML
5/ Mitoxantrone DNA topoisomerase - used for rapidly worsening disease. SE leukaemia, cardiotoxicity, infertility
What is Dandy’s criteria used for and what is it?
Idiopathic intracranil hypertension / pseudotumour cerebri - Rx acetazolamide, frusmide, topiramate
- Sx raised ICP
- No focal neurology other than CN6 palsy
- Pt awake and alert
- Normal CT/MRI
- LP pressure >25 with normal biochem/cyto CSF
6, No other explanation
Location and features of Millard-Gubler syndrome
Pons - CN 6-7 affected
Contralateral hemiplegia (not face)
Ipsilateral LR palsy + diplopia
Ipsilateral facial paresis
