Neuro Flashcards
Causes of complex opthalmoplegia
(eye movement weaknesses that cannot be explained by isolated/multiple CN palsies)
Myasthenia gravis
Kearns-Sayre (complex progressive external ophthalmoplegia)
Graves ophthalmoplegia
Miller fisher syndrome
Mononeuritis multiplex
Botulinum poisoning
Trauma and local infection
Elevated 14-3-3 in CSF
CJD
Creutzfeldt-Jakob MRI findings
Hyperintense signals - in basal ganglia + thalamus
Features of CJD
Rapid cognitive decline
Myoclonus
Extrapyramidal signs
Startle response
Drugs which exacerbate myasthenia gravis
Penicillamine
Beta-blockers
Lithium
Phenytoin
Antibiotics
Myasthenia gravis 1st-line management
Pyridostigmine
Pyridostigmine MOA
Long-acting acetylcholinesterase inhibitor
Features of Superficial Siderosis
Dementia
Ataxia
Sensorineural hearing loss
Anosmia
Anisocoria
Superficial siderosis pathophysiology
Chronic iron deposition in CNS, secondary to SAH/SDH
Syringomelia classic presentation
Neck + arm loss of temperature sensation.
Most common primary brain tumour in adults
Glioblastoma multiforme
Management of glioblastoma multiforme
Surgery followed by chemo-radiotherapy
Second most common primary brain tumour in adults
Meningioma
Glioblastoma multiforme prognosis
~ 1 year
Fascioscapulohumeral dystrophy inheritance
AD
Fasciocapulohumeral dystrophy presentation
Shoulder, upper arm and facial muscles affected
Progressive
Motor neuron disease - medical management (in ALS)
Riluzole
Riluzole MOA
Inhibits glutamate receptors
Idiopathic intracranial hypertension - associated drugs
- Contraceptives
- Steroids
- Tetracyclines
- Vitamin A
- Lithium
- Levothyroxine
Idiopathic intracranial hypertension - management
Weight loss
Acetazolamide, Topiramate
Repeated lumbar puncture
Surgery: optic nerve sheath decompression/fenestration. Shunt.
MS MRI findings
High signal T2 lesions
Periventricular plaques
“Dawson fingers” - hyperintense lesions perpendicular to corpus callosum
MS CSF findings
Oligoclonal bands (and not in serum)
Increased intrathecal IgG
Wernicke’s encephalopathy classic triad
Opthalmoplegia/nystagmus
Ataxia
Confusion
Miller-Fisher syndrome classic triad
Opthalmoplegia
Ataxia
Arreflexia
Imaging for suspected TIA
MRI brain with diffusion-weighted imaging
Features of myotonic dystrophy
Myotonic facies
Frontal balding
Bilateral ptosis
Cataracts
Dysarthria
Which gene is affected in myotonic dystrophy DM1
DMPK gene
Which gene is affected in myotonic dystrophy DM2
ZNF9 gene
Myotonic dystrophy - DM1 vs DM2 presentation
DM1 - Distal weakness more prominent
DM2 - Proximal weakness more prominent
1st-line treatment in Parkinson’s isease if motor symptoms are affecting QOL
Levodopa
1st-line treatment in Parkinson’s disease if motor symptoms are NOT affecting QOL
Dopamine agonist, non-ergot (ropinirole)
or
Levodopa
or
MAO-B inhibitor (selegiline)
Parkinson’s disease, patient still symptomatic despite optimal levodopa treatment
Add in one of:
Dopamine agonist (ropinirole)
MAO-B inhibitor (selegiline)
COMT inhibitor (entacapone)
Medication for orthostatic hypotension in PD
Midodrine
Midodrine MOA
Metabolite = a1 agonist
Causes peripheral vasoconstriction
Management of drooling in PD
Glycopyrronium
Lambert-Eaton syndrome - antibodies
Anti-VGCC (voltage-gated calcium channel)
Tumours that commonly metastasise to brain
Breast
Lung
Kidney
Bowel
Skin (melanoma)
Glioblastoma multiforme on imaging
Solid tumour
Central necrosis
Contrast-enhancing ring
Vasogenic oedema
Glioblastoma multiforme - histology
Pleomorphic tumour cells, bordering necrotic areas
Meningioma - histology
Spindle cells in concentric whorls
Calcified psammoma bodies
Vestibular schwannoma - histology
Antoni A/B
Acellular Verocay bodies
Pilocytic astrocytoma - histology
Rosenthal fibres (corkscrew eosinophilic bundle)
Medulloblastoma - histology
Small blue cells.
Rosette pattern with mitotic figures.
ePendymoma - histology
Perivascular Pseudorosettes
Oligodendroma - histology
Calcifications with fried egg appearance
Haemangioblastoma - histology
Foam cells and high vascularity
Antibiotic contraindicated in myasthenia gravis
Gentamicin - can trigger myasthenic crisis
Antibody in Guillain-Barre
anti-GM1
Antibody in Miller Fisher Syndrome
anti-GQ1b
Antibodies in myasthenia gravis
anti-AChR in 85%
anti-MuSK in 40% of remaining patients (anti-muscle-specific tyrosine kinase)
Anti-aquaporin-4 antibodies associated with
Neuromyelitis optica (demyelinating disorder)
Anti-N-methyl D-aspartate receptor associated with
Autoimmune encephalitis
Anti-glutamic acid decarboxylase - associated with
Stiff man syndrome
(+ LADA diabetes)
Anti-Hu - associated paraneoplastic syndromes
Painful sensory neuropathy
Cerebellar syndrome
Encephalitis
Steele-Richardson-Olszeeski syndrome AKA
Progressive supranucelar palsy
Normal CSF opening pressure
10 - 20 cm H2O
Normal CSF white cell count
0 - 5 cells/uL
Normal CSF glucose level
> 60% of serum glucose
Normal CSF protein level
<45 mg/dL
CSF white cell count in bacterial meningitis
Raised (unless partially treated)
CSF glucose in bacterial meningitis
Low (<40% of serum glucose)
CSF glucose in bacterial meningitis
Low (<40% of serum glucose)
CSF protein in bacterial meningitis
Raised
CSF white cell count in TB meningitis
Raised (Lymphcytosis)
CSF glucose in TB meningitis
Very low
CSF protein in TB meningitis
Raised
Imaging to confirm PD
123I-FP-CIT SPECT
Tuberous sclerosis cystic features
Glioma
Retinal hamartoma
Heart rhabdomyoma
Lymphangioleiomyoma of lung
Renal angiomyolipoma and polycystic kidneys
Neurofibromatosis 1 - which gene and chromosome
Neurofibromin gene on chromosome 17
Neurofibromatosis 2 - which chromosome
Chromosome 22
NF1 (Recklinghausen’s) features
Cafe-au-lait spots + axillary freckles
Peripheral neurofibromas
Phaeochromocytomas
Iris hamatomas (Lisch)
Scoliosis
NF2 features
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, meningiomas and ependymomas
Tics - treatment options
Clonidine
Atypical antipsychotics eg risperidone
Paraneoplastic syndrome associated with Anti-Yo causes what syndrome
Cerebellar syndrome