NEURO Flashcards
anti-VGCC antibodies associated with what syndrome
lambert eaton
triptan MOA
5 HT1 agonist
STROKE: Haemorrhagic stroke excluded- when should anticoagulant for AF be started
after 14 days :
until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke’
stroke thrombolysis timeframe
and criteria
within 4.5 hrs of onset
and
If Imaging has def excluded haemorrhage
stroke thrombectomy: timeframe
within 6 hrs onset
PITS used in what type of visual defect
Homonymous quadrantopia
tuberous sclerosis inheritance
autosomal dominant
tuberous sclerosis CFs
cutaneous, neuro, and others
Cutaneous:
Shagreen patches
Ash leaf spots (UV light)
angiofibromas over nose
cafe au lait spots
neuro features:
Developmental delay
epilepsy
intellectual impairment
Other:
retinal hamartoma(white plaque on retina)
polycystic kidneys
lung cysts
rhabdomyomas of the heart
Bitemporal hemianopia
lesion of optic chiasm
upper quadrant more affected: inferior chiasmal compression, commonly a pituitary tumour
lower quadrant more affected= superior chiasmal compression, commonly a craniopharyngioma
Homonymous quadranopia
superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe
mnemonic = PITS (Parietal-Inferior, Temporal-Superior)
Homonymous hemianopia
Homonymous hemianopia
incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex
CRIT
Cong=radiation
Incong=tract
guillian barre common triggered by
antibodi
campylobacter
anti-GQ1b antibodies
miller fisher= variant
first line anti seizure medication males myoclonic seizures
sodium valproate
cerebellar syndrome symptoms+ mneumonic
DANISH:
D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia
which antipsychotic /anti epileptic associated w SJS
lamotrigine
Palatal myoclonus == where in brain affected
olivary nucleus
PALATE=FOOD=OLIVE
wernickes aphasia comes from which brain region
temporal lobe- brodmann 22 in sup temporal gyrus
brocas aphasia from which brain region
frontal lobe
BRODIE= frontal lobe
mneumonic for
what is brocas aphasia
BEROCCA to FRONT the cold
expressive aphasia- cannot speak fluently
wernickes aphasia
comes up TIME and TIME again— TEMPORAL lobe
wernickes= fluent aphasia
degenerative cervical myelopathy symptoms
- neck/arm/leg pain
- Loss of motor function (digital dexterity, arm/leg weakness/stiffness=impaired gait
- Loss of sensory function causing numbness
- Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
- Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
gold standard Ix Degenerative cervical myelopathy and management
MRi cervical spine
Mx DCM= urgent spinal surgery referral
what is syringomyelia
CFs
collection of CSF within spinal cord,
CFs:
cape like (neck shoulder arms) loss of sensation to pain- BUT light touch and proprioception preserved
spinothalamic sensory loss (pain and temperature)
spastic weakness, upgoing plantars, neuropathic pain horners syndrome)rare-
Phenytoin side effects + mneumonic
and how to monitor levels of it
HOT MALIKA
H - hirsutism and facial feature coarsening
O- osteomalacia
T - teratogenic
M- megaloblastic anemia
A- arrhythmia in high dose
L- lymph node enlargement
I- insulin decrease
K- vitamin K decrease
A- ataxia in high dose
serum trough levels taken STRAIGHT BEFORE NEXT DOSE
when can stop AEDs
when seizure free over 2 years , taper dose over 2-3 months
treatment ramsay hunt syndrome
oral aciclovir and oral corticosteroids
post stroke management meds
300mg aspirin for 2 weeks and then 75mg clopi life long
hypodense (dark), crescentic collection around the convexity of the brain, hypodense collection around the convexity of the brain that is not limited to suture lines.
chronic haematomas
LIMITED TO SUTURE LINES= EXTRA dural
not limited to suture lines-subdural
A CT head with contrast is performed, which shows a solitary ring-enhancing lesion in the left temporal lobe.
and which treatment
brain abscess- treat with antibiotics
IV CEFTRIAXONE and IV METRONIDAZOLE
neuroleptic malignant syndrome
CFs
Tx
rare antipsychotic side effect
and when parkinsons meds suddenly stopped
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
A raised creatine kinase
Tx: DANTROLENE and supportive measures
treatment neuroleptic malignant syndrome
admit
iv fluids
bromocriptine ocreotide
A 55-year-old man presents complaining of visual disturbance. Examination reveals a right congruous homonymous hemianopia with macula sparing. Where is the lesion most likely to be?
left occiptal cortex
which antisickness medications is most likely to precipitate extrapyramidal side-effects?
metoclopramide
von Hippel-Lindau syndrome
autosomal dominant condition predisposing to neoplasia. It is due to an abnormality in the VHL gene located on short arm of chromosome 3
Features
cerebellar haemangiomas: these can cause subarachnoid haemorrhages
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts: epididymal, pancreatic, hepatic
endolymphatic sac tumours
clear-cell renal cell carcinoma
Normal pressure hydrocephalus TRIAD of symtpoms
TRIAD:
-. urinary incontinence
-. dementia and
-. bradyphrenia/gait abnormality
management normal pressure hydrocephalus
Management
ventriculoperitoneal shunting
around 10% of patients who have shunts experience significant complications such as seizures, infection and intracerebral haemorrhages
trigeminal neuralgia management
carbamazepine first line
laughter and collapse = ?
cataplexy= narcolepsy
Lip smacking + post-ictal dysphasia are localising features of a ? lobe seizure
TEMPORAL lobe seizure
how long not allowed to drive after first seizure, but imaging and eeg normla
6 months
TACS stroke criteria (3)
ALL 3 NEEEDED TO BE TACS:
- Unilateral weakness (and/or sensory deficit) of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
PACS criteria
2 of the TACs crieteria needed:
1. Unilateral weakness (and/or sensory deficit) of the face, arm and leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)
LACs criteria
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
Posterior circulation infarcts POCS criteria
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
what arteries affected IN TACS
Middle and Anterior cerebral arteries
what arteries affected in PACS
smaller arteries of anterior circulation e.g. upper or lower division of MCA
what arteries affected IN LACS
Arteries around the internal capsule, thalamus and basal ganglia
what arteries affected in POCS
Vertebrobasilar arteries
another name for lateral medullary syndrome
wallenbergs syndrome
what is lateral medullary syndrome
which aa affected
CFs
cerrebellar and brainstem features
post inferior cerebellar artery PICA
Cerebellar CFs
ataxia
nystagmus
BRAINSTEM CFs
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
what is webers syndrome
ipsilateral III palsy
contralateral weakness
status epilepticus time
single seizure lasting OVER 5 mins
OR
= 2 seizures within a 5-minute period without the person returning to normal between them
first line med for absence seizure
ethosuxamide
but if female adult - lamotrigine
which anti epileptic drug can exacerbate absence seizures
carbamazepine
focal seizure first line AED
lamotrigine
if u FOCUS you can get a LAMBO
which AED can cause visual defects
vigabatrin
BPPV treatment and diagnosis
DIAGNOSIS= DIX HALLPIKE (D AND D)
MANAGEMENT= EPLEY
when should LP be done post subarach haemorrhage
12 hours post symptom onset
procyclidine MOA
antimuscarinic
A 65-year-old gentleman presents with progressive dementia and behavioural abnormalities. On closer questioning, he seems to have deficits in concentration, memory and judgement difficulties. There is a family history of psychosis. During the consultation, you notice the patient’s gait is ataxic with a notable jerk of his left hand and general hypokinesia. There is also nystagmus during horizontal gaze. Romberg’s and Dix-Hallpike tests are negative. What is the most likely diagnosis?
Creutzfeldt-Jakob disease
cabergoline severe lung side effect
pulmonary fibrosis
Miller Fisher syndrome -
areflexia, ataxia, ophthalmoplegia
variation of guillan barre syndrome
restless leg syndrome- which blood test to diagnose
serum ferritin
Which AEDs cant breastfeed on
no need to change- all AEDs ok for breastfeeding
ondansetron moa
and where in the brain does it act
5ht3 antagonist
affects medulla oblongata
myoclonic seizures first line treatment
sodium valproate- in males
females ; lamotrigine - levetiracetam
migraine treatment in pregnancy
1st line
second line
- paracetamol
- ibuprofen 400mg
foot drop nerve
- common peroneal nn
ropinirole MOA
dopamine agonist
SAH investigation
ct non contrast
CNs
OOOTOAFVGVAH
OLFACTORY
OPTIC
OCULOMOTOR
TROCHLEAR
TRIGEMINAL
ABDUCENS
FACIAL
VESTIBULOCOCHLEAR
GLOSSOPHARYNGEAL
VAGUS
ACCESSORY
HYPOGLOSSAL
intracranial venous thrombosis
gold standard ix
Ix gold standard- MRI
myasthenia gravis - which antibodies
CFs
Proximal or distal mms affected ?
Mx
Acute myasthenic crisis mx
antibodies against anticholinesterase
mm weakness as day progresses
diplopia (extraocular mm weakness)
PROXIMAL mm weakness- neck, face, limb girdle
Mx: pyridostigmine- long acting AChE inhibitors
prednisolone initially
Long term- immunosuppression#
Mx acute myasthenic crisis-
IVIG
plasmaphoresis
Demyelination of the central nervous system is the pathophysiology in ??
Multiple sclerosis
Demyelination of the PERIPHERAL nervous system is the pathophysiology in ???
Guillan barre syndrome
hoffman sign used in ? spine conditio
DCM
a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
what neuro condition is improved by alcohol?
essential tremor
Essential tremor CFs
Mx
inheritance
CFs
postural tremor- worse if hands outstretched
improved by alcohol and rest
most common titubation cause
Mx=
propanolol (if pt has asthma give primidone)
primidone (barbituate)
Inheritance= aut dom
Lambert Eaton syndrome
antibody
CFs
Ix and results
Mx
Lambert eaton == myasthenic syndrome, commonly ass’d with SCLC
Anti VGCC antibody (voltage-gated calcium channel)
CFs
repeated muscle contractions lead to increased muscle strength (in contrast to myasthenia gravis)
waddling gait
Lower limb weakness first
Hyporeflexia
dry mouth, impotence, difficulty weeing
Ix
EMG - increment in muscle action potentials after exercise.
Mx
Tx underlying condition eg SCLC
Immunosuppression- azathioprine , prednisolone
IVIG sometimes
MRI is performed which reveals bilateral asymmetric and poorly marginated hyperintense T2-weighted and FLAIR lesions within the subcortical white matter. A lumbar puncture reveals no oligoclonal bands in the CSF.
patchy haemorrhagic changes
Dx?
acute disseminated encephalomyelitis
(Enchephalomyeltis= lnflam. Of white matter ) by meaning.
*In herpes simplex it is encephalitis.
*So, mentioning lesions in white matter means ADEM.
Acute disseminated encephalomyelitis
CAUSES/triggers
time frame
Mx
autoimmune demyelinating disease of the central nervous system.
post viral resp infec
weeks-months post infection
Management involves intravenous glucocorticoids and the consideration of IVIG where this fails.
eyes DOWN AND OUT== nn palsy?
ipsi/contralat?
3rd nerve oculomotor nn palsy
ptosis (levator palpabrae affected too)
ipsilateral
can be associated with uncal herniation AND raised ICP
most common complication post meningitis
SNHL
upbeat nystagmus and
downbeat mystagmus
causes
upbeat nystagmus= cerebellar vermis lesion
VERMIN RUN UP PIPES
downbeat nystagmus=
arnold chiari malformation
migraine +COCP why CI?
signif increase risk of stroke
first line meds for spasisity in MS
first line non med mx
baclofen
gabapentin
physio
Acute MS relapse Tx
- High dose steroids pred
Drug options for reducing the risk of relapse in MS
natalizumab
ocrelizumab
fingolimod
beta interferon
glatiramer acetate
Restless leg syndrome medication
ropinirole
Diabetic neuropathy, myasthenia gravis and Guillain Barre syndrome would cause??UMN OR LMN signs
LMN signs only
cannot drive how long post stroke/TIA
1 month if one episode
if multiple TIAs=== 3 months
wake up stroke rules
if patient was previously well and wakes up with stroke symptoms:
mechanical thrombectomy within 24 hrs
AND IF CT
shows ACA infarct and LIMITED infarct core
Internuclear ophthalmoplegia occurs mostly in which neuro condition
CFs
MS -
Internuclear ophthalmoplegia occurs due to a lesion in the medial longitudinal fasciculus
CFs:
horizontal eye movement issues
impaired adduction of the eye on the same side as the lesion
horizontal nystagmus of the abducting eye on the contralateral side
severe serotonin syndrome treatment
CYPROHEPTADINE
LEARN THIS:
Midbrain: vertical gaze palsy
Pons: horizontal gaze palsy
pON: horizONtal gaze palsy
Midbrain: vertical gaze palsy
Pons: horizontal gaze palsy
pON: horizONtal gaze palsy
SIADH- urinary sodium and urinary osmolality raised or low or normal
SIADH = Everything in Urine is ‘high’ (Raised urinary Sodium and raised urinary Osmolality)
distal muscle weakness and atrophy, weak ankle dorsiflexion, depressed tendon reflexes, and pes cavus foot deformity
?condition
charcot marie tooth disease
Charcot-Marie-Tooth disease
peripheral neuropathy
affects distal mms
frequent ankle dislocations
high arches
hammer toes
pes cavus foot (high arched feet)
distal mm weakness and atrophy
hyporeflexia
spastic paraparesis = UMN or LWM
causes
UMN signs
eg hyper brisk reflexes
increased tone
conditions causing spastic paraparesis:
demyelination e.g. multiple sclerosis
cord compression: trauma, tumour
parasagittal meningioma
tropical spastic paraparesis
transverse myelitis e.g. HIV
syringomyelia
hereditary spastic paraplegia
osteoarthritis of the cervical spine
What brain lobe causes chorea
chorea- Caudate nucleus
First fit/seizure/unprovoked seizure and EEG and brain imaging normal – how long cannot drive?
6 months
Subacute combined degeneration of spinal cord- where does it affect
cause
Vit B12 deficiency cobalamin
dorsal columns + lateral corticospinal tracts are affected
joint position and vibration sense lost first then distal paraesthesia
upper motor neuron signs = HYPERREFLEXIA develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks
dorsal columns and lateral corticospinal tract- loss of vibration and priorioception
mm weakness and HYPERREFLEXIA
MND treatment
- NIV better than medication
- Riluzole- decreased glutamate receptor stimulation
Types of motor neuron disease (4) and what is the most severe type
which is the most common
best prognosis
worst= 1. progressive bulbar palsy
- progressive musulcar atophy- BEST prognosis
LMN only
distal mms affected first - Primary lateral sclerosis
UMN only - Amylotrophic lateral sclerosis- 50% pts
mix UMN and LMN– MOST COMMON TYPE
first line imaging for suspected stroke
NC CT head
what can cause Anti-NMDA receptor encephalitis
CFs
Tx
ovarian teratoma in half adult female pts
CFs
agitation, hallucinations, delusions and disordered thinking; seizures, insomnia, dyskinesias and autonomic instability
Tx
immunosuppression IV steroids, IGs, rituximab, cyclophosphamide or plasma exchange, alone or in combination. Resection of teratoma is also therapeutic
cause of CT head showing temporal lobe changes -
herpes simplex encephalitis
Tachycardia with lower limb hyporeflexia and flaccid paralysis and urine retention
GBS
Guillan barre syndrome
CFs
UMN or LMN
weakness pattern
CFs
LMN signs only
hyporeflexia
flaccid paralysis
weakness is ascending- Legs affected first
creutzfeldt jakob disease
cfs
ix
mx
CFs
myoclunus and dementia
Ix
CSF normal
EEG= biphasic high amplitude sharp waves
MRI: hyperintense signals in the basal ganglia and thalamus
Mx
myotonic dystrophy
CFs
Ix
Tx
distal weakness initially
autosomal dominant
diabetes
dysarthria
LOSS of red reflex - due to bil cataracts , bilateral ptosis
small testicles
Aortic regurg
a trinucleotide repeat disorder
treatment myasthenic crisis
IVIG or plasma phoresis
PITS– if left eye affected- which side is the lesion?
the opposite side
Left parietal lobe = right inferior homonymous quadrantanopia
Left temporal lobe = right superior homonymous quadrantanopia
Right occipital lobe = left homonymous hemianopia with macular sparing
Right parietal lobe = left inferior homonymous quadrantanopia
prophylaxis cluster headache med
verapamil
treatment wests syndrome
vigabatrin and steroids
has a poor prognosis
conduction dysphasia brain area affected
arcuate fasciculus (arcuate sounds like articulate)
hemiballism- ipsi or contralateral to affected brain side
can be caused by damage to WHERE in the brain
contralateral
subthalamic nucleus affected
what condition is common after SAH
SIADH
? klumpes paralysis
T1 nerve damage
damage to innervation of intrinsic hand muscles - ulnar nerve
nerve damage causing erb duchenne paralysis- winged scapula
C5 C6
can be caused by birth trauma- breech presentatio
trinucleotide repeats for
friedrichs ataxia
huntingtons chorea
myotonic dystrophy
fragile x
Freidrich’s ataxia- GAA- gaa so many a’s
huntingtons chorea- CAG (posh- caggie)
myotonic dystrophy- CTG (T in the middle)
fragile x - CGG (XX=GG)
which condition ass’d with low orexin (hypocretin) levels
narcolepsy cataplexy
brown sequard syndrome
lateral hemisection of SC
IPSILATERAL loss of vibration and proprioception and weakness
CONTRALATERAL loss of pain and temperature
important eg pain and temp cross over first
medication over use treatment
IMMEDIATELY stop meds
including stopping triptans
only slowly withdraw opiods
ischaemic stroke long term tx
clopidogrel only
if clopi is CI or not tolerated:
give aspirin and dypiridamole
barthel scale used for
measures disability or dependence in activities of daily living in stroke patients
sub dural or extra dural-
head injury with initial LOC but then regained conciousness and then LOC again
which vessel affected
EXTRADURAL- USUALLY caused by blunt force trauma
middle meningeal artery is the primary pathology in extradural haematomas.
diffuse axonal injury cause
diffuse axonal injury occurs as a result of mechanical shearing following deceleration, causing disruption and tearing of axons
lamotrigine MOA=
sodium channel blocker
can causE SJS
how is lambert eaton syndrome different to MG
lambert eaton syndrome— repeated mm contractions IMPROVE symptoms
MG= repeated contractions==> fatigue
neuromyelitis optica VS MS
Both MS and neuromyelitis optica:
Optic neuritis
Acute myelitis
Neuromyelitis ONLY
BRAIN MRI not meeting MS criteria
NMO-IgG seropositive status
The MRI finding of enhancement of the mamillary bodies due to ??
wernickes encephalopathy caused by XS alcohol
Hyperintense T2 signal extending across the spinal cord, between the levels of T9 and T12====?
cause and ass’d infections
Transverse myelitis
caused by viral infection - such as varicella, herpes simplex, EBV and HIV
DIFFERENCE between parkinsons and progressive supranuclear palsy
Progressive supranuclear palsy
- impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)
POST LP headache treatment
blood patch
IV caffeine
epidural saline
to prevent subdural haematoma
Typical features
usually develops within 24-48 hours following LP but may occur up to one week later
may last several days
worsens with upright position
improves with recumbent position
dopamine receptor agonists used in the management of Parkinson’s disease is least associated with pulmonary, retroperitoneal and pericardial fibrosis?
ropinirole
foster kennedy syndrome
where is the tumour
ipsi and contralateral CFs
frontal lobe tumour
ipsilateral optic atrophy
contralateral papillodema
baclofen MOA
GABA agonist
where is medial longitudinal fasciculus located
(affected by internuculear opthalmoplegia)
medial longitudinal fasciculus is located in the paramedian area of the midbrain and pons
gerstmanns syndrome
cfs
cause
defect where in the brain
how to decide right or left parietal side affected
type of parietal lobe lesion
CFs
alexia, acalculia, finger agnosia and right-left disorientation
RIGHT LEFT disorientation
common post stroke
if patient is right handed (will show right left disorientation), so the dominant side=left side in brain= LEFT parietal lobe affected
drugs causing tinnitus
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
drugs causing peripheral neuropathy
IAM Very Numbed
I isoniazid
A amiodarone
M metronidazole
V vincristine
N nitrofurantoin
Friedreich’s ataxia
CFs
cause
cause GAA chr 9
aut rec
absent ankle jerks
cerebellar ataxia
optic atrophy
DM
cardiomyopathy
kyphosis
spinocerebellar degeneration
high arched palate
GAA, can’t look Friedreich in the eye because he has nystagmus, optic atrophy, diabetic retinopathy and is looking at the floor (kyphoscoliosis).
CADASIL mutation- ?
what is cadasil
NOTCH 3 MUTATION
aut dom
CADASIL is a rare cause of multiple cerebral infarctions
onset of migraines in middle age, followed by recurrent TIAs and strokes, and resulting in neuro-cognitive decline, psychiatric problems and dementia. MRI often shows multiple widespread hyper-intense lesions in the white matter, basal ganglia, thalamus and pons.
STATUS EPILEPTICUS MX
First-line drugs are IV benzodiazepines such as diazepam or lorazepam
can repeat after 10 mins
ongoing established seizing== give IV phenytoin
45 mins == Induce GA
Ataxic telangiectasia
aut rec
Ataxia telgenectasia: All the As
ATM gene
Ataxia + abnormal movements
IgA deficency, frequent infections
Angiomas
A lot of cancers (all the Ls)
conductive hearing loss +tinnitus + family hx=?
otosclerosis
Mx= hearing aid
stapedectomy
medications that exacerbate myasthenic crisis
PPP LGBQA
Procainamide
phenytoin
penicillamine
Lithium
Gentamicin
Beta blockers
Quinine
Antibiotics- macrolides, quinines tetracyclines
manage drooling of saliva in people with Parkinson’s disease
glycopyrronium bromide
Left trochlear nerve palsy vertical diplopia - which way willl head tilt to compensate
head tilts to the right
management confirmed aneurysm caused SAH
nimodipine to prevent vasospasm
coil
4 functions of facial nn cn7
face ear taste tear
Supply - ‘face, ear, taste, tear’
face: muscles of facial expression
ear: nerve to stapedius
taste: supplies anterior two-thirds of tongue
tear: parasympathetic fibres to lacrimal glands, also salivary glands
LMN causes of facial nn palsy
Bell’s palsy
Ramsay-Hunt syndrome (due to herpes zoster)
acoustic neuroma
parotid tumours
HIV
multiple sclerosis*
diabetes mellitus
what is the only UMN cause of facial nn palsy
STROKE
wernickes vs korsakoff symptoms
COAT RACK
POOR PROGNOSTIC feature GBS
Poor prognostic features
age > 40 years
poor upper extremity muscle strength
previous history of a diarrhoeal illness (specifically Campylobacter jejuni)
high anti-GM1 antibody titre
need for ventilatory support
Unicentric Castleman’s disease
Unicentric Castleman’s disease is a lymphoproliferative disorder associated in a subset of cases with HIV and HHV-8. Patient’s with unicentric Castleman’s disease tend to be asymptomatic and lymphadenopathy is constrained to one lymph node group.
Biopsy of the lymph node commonly shows regressed germinal centres surrounded by prominent mantle zones.
GBS nerve conduction study shows:
decreased velocity
transient global ischaemia
acute onset anterograde amnesia= cannot make new memories
anxiety
REPEATING questions
resolves fully within 24 hrs
neurofibromatosis
NF1
Chr 17
skin patches, scoliosis, freckles,
phaeochromocytomas
NF2
Chr 22
schwannomas
bil acoustic neuroma
meningioma
treatment neuroleptic malignant syndrome
treatment serotonin syndrome
neuroleptic= bromocriptidine
serotonin- cyproheptadine
gingival hyperplasia causes
Gingival Hyperplasia
PANiC
Phenytoin
AML
Nifedipine
Cyclosporin
CCB
Painful third nerve palsy
Posterior communicating artery aneurysm
slow relaxing grip =
myotonic dystrophy
otitis externa tx
topical steroid and amynoglycoside
when to give prednisolone in bells palsy
within 72 hrs onset
whcih type of anti epileptic causes visual field defect
V for Vigabatrin - V for Visual field defects
p smacking + post-ictal dysphasia are localising features of a ???lobe seizure
Focal awareness impaired, temporal lobe
what vein damaged in subdural haematoma
bridging veins
how to remember what is used in acute to treat migraine
and how to prevent migraine
5-HT agonists used when you are in agony
5-HT antagonists used when you are not
what CFs of cavernous sinus
orbital apex syndroe
superior orbital fissure syndrome
3, 4, 6 involvement with 1st division of trigeminal and there is proptosis, vision loss and fixed dilated pupil = orbital apex syndrome
only proptosis and fixed dilated pupil - superior orbital fissure syndrome.
Cavernous sinus etiology is varied but absence of proptosis with pupillary sparing can be seen only in cavernous sinus etiology.
CFs of spastic paresis
Spastic paraparesis describes a upper motor neuron pattern of weakness in the lower limbs
selegilineMOA
selegiline= MAO B Inhibitor
Bilateral spastic paresis and loss of pain and temperature sensation==?
- anterior spinal artery occlusion
if LMN lesion= where in the face is affected
forehead affected
in contrast, an upper motor neuron lesion ‘spares’ the upper face
important side effect of topiramate
migraine prophylaxis
can cause closed angle glaucoma
contraindication to triptan use
prev cardiovascular IHD
distinguish a diagnosis of vestibular neuronitis rather than viral labyrinthitis.
vestibular neuronitis = absence of hearing loss
viral labyrinthitis = normal hearing
charcot marie tooth inhertance
aut dom
acute disseminated encephalomyelitis
no oligoclonal bands
post viral illness (weeks)
motor weakness, encephalopathy, seizures and coma
MRI imaging which reveals poorly-defined hyperintensities in the subcortical white matter.
motion sick ness meds
HCP
Hyoscine
Cyclizine
Promethazine
brocas = which artery and side affected
LEFT MCA
prolactinoma Cfs and biochem
hypogonadism
low sex hormones
positive galacctorrhoea
fascioscapulohumeral muscular dystrophy CFs
inheritance
aut dom
Features
facial muscles are involved first - difficulty closing eyes, smiling, blowing etc
weakness of the shoulder and upper arm muscles
abnormal prominence of the borders of the shoulder blades - ‘winging’
lower limb: hip girdle weakness, foot drop
IMPORTANT TO PREDICT PROGNOSIS= FVC
is botulisim exo or endo toxin
botulism is an exotoxin
seligine MOA
MOA B inhibitor
difference between ramsey hunt and herpes zoster opthal
ramsey hunt = ear involvement and tongue involvement == FACIAL NERVE
herpes zoster opthalmicus== eg trigem nn distrubution only plus vesicles
UMN causes and how it affects face
UMN lesion is only caused by stroke
Upper face SPARED
what type of ACH receptor affected in MG
NICOTINIC AChE receptors
what causes RAPD
optic nerve lesion or severe retinopathy
how to distinguis neuroleptic malignant syndrome vs serotonin
neuroleptic syndorme has NO CLONUS
serotonin syndrome= HAS MYOCLONUS
reduce risk relapse in ms
natalizumab antagonises alpha-4 beta-1-integrin found on the surface of leucocytes
ocrelizumab anti cd20
fingolimod
sphingosine 1-phosphate (S1P) receptor modulator
interferon beta
which antipsychotic is CI in parkinsons for old ppl
DO NOT GIVE HALOPERIDOL– movement disorder
therefore give IM Loraz
