Neuro Flashcards by Adam Moorcroft

Fx of charcot marie tooth disease

Bilateral foot drop
High stepping gait
Champagne bottle legs
Bilateral pes cavus

Weakness and mild sensory loss

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What is miller-fischer syndrome

Proximal variant of GBS causing ataxia, opthalmoplegia, areflexia (anti-GQ1b antibodies)

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GBS Mx

IVIG
Methylprednisolone

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Cerebellar signs

Dysdiadochokinesia.
Ataxia (wide-based gait and posture)
Nystagmus.
Intention tremor.
Slurred, staccato speech.
Hypotonia/heel-shin test

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Differential diagnoses if it is MND

Cervical myeloradiculopathy (would have sensory disturbance)

Multifocal motor neuropathy

Syringomyelia (but would have sensory disturbance)

Friedreich’s ataxia (but would have cerebellar signs and dorsal column sensory loss)

Subacute combined degeneration of the cord (but would have dorsal column sensory loss)

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Types of MND (4)

Amyotrophic lateral sclerosis: Mixed upper and lower motor neurone signs
Primary lateral sclerosis: Upper motor neurone signs only
Progressive muscular atrophy: Lower motor neurone signs only
Progressive bulbar/pseudobulbar palsy

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Mx of MND

Physio, SALT, specialist nurse

Anticholinergics, baclofen, Riluzole

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Fx of Klinefleters
Tx?

Subfertility
Gynaecomastia
Tall
Small testes
Sparse facial & body hair

Testosterone injections
Referal to fertility clinic (intracytoplasmic sperm injection)

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Mx of TIA

ABCD2 score - admit for urgent assessment if score 4 or more/crescendo TIAs/AF/taking anticoagulant therapy (need to exclude a bleed)

Aspirin 300mg daily, then clopidogrel 75mg OD after 2 weeks

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Ix of myasthenia gravis

AChR antibodies
Tensilon test (give IV anticholinesterase injection and look for improvement in ptosis)

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Most common adult muscular dystrophy

Myotonic dystrophy

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Pakrinson’s Ix

CT/MRI to rule out vascular cause

Ioflupane I123 injection
- Binds to dopaminergic neurones and allows visualisation of substantial nigra

Caeruloplasmin (low in Wilson’s)

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Parkinson’s Mx

MDT approach: neurologist, physio

L-DOPA + Carbidopa or benserazide
Da agonists: ropinerole
MAO-B inhibitors: rasagline

Citalopram if depressed

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L-Dopa side effects

Dyskinesia
Mouth dryness
Insomnia
N/V

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Differentials for tremor

Parkinson’s
Intention tremor - cerebellar
Benign essential tremor

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Cerebellar syndrome Mx

MDT approach, reduce alcohol

Specific causes:
MS: methylprednisolone
EtOH: Pabrinex, tapering course of chlordiazepoxide
Infarct: consider thrombolysis
Schwannoma: gamma-knife, surgery
Wilson’s: penicillamine

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Fx of Friedrich’s ataxia?

Pes cavus
Bilateral cerebellar ataxia
Leg wasting + areflexia but extensor plantars
Loss of vibration and proprioception

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UMN signs (4)

↑ tone

Pyramidal distribution of weakness
Leg: extensors stronger than flexors
Arm: flexors stronger than extensors

Hyper-reflexion

Extensor plantars

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Likely cause of UMN signs bilaterally in lower limb

MS
Cord Compression
Cerebral palsy
Cord Trauma

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Likely cause of UMN signs unilaterally in lower limb

Stroke
MS
SOL
Cord Compression
Cerebral Palsy

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What is Beck’s syndrome?

Infarction of spinal cord in distribution of anterior spinal artery: ventral 2/3 of cord

Quadriparesis
Impaired pain and temperature sensation
Preserved touch and proprioception

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Fx of Syringomelia

Cape distribution of loss of pain and temperature sensation

Wasting/weakness of hands ± Claw hand
Loss of reflexes in upper limb
Charcot joints: shoulder and elbow

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dDx for stroke

Head injury
↑ or ↓ glucose
SOL
Infection
Drugs: e.g. opiate OD

Acute stroke MX

Consider thrombolysis if 18-80yrs and <4.5hrs since onset of symptoms
Alteplase (rh-tPA)
→ ↓ death and dependency (OR 0.64)
CT 24h post-thrombolysis to look for haemorrhage

Aspirin 300mg PO/PR once haemorrhagic stroke excluded ± PPI
Clopidogrel if aspirin sensitive

MS ix

MRI LP

Prevent a relapse of MS

Natalizumab IFN - B

MS Tx (FDPSUET)

Fatigue: modafinil Depression: SSRI (citalopram) Pain: amitryptylline, gabapentin Spasticity: physio, baclofen, Urgency / frequency: oxybutynin ED: sildenafil Tremor: clonazepam

Poor prognosis in MS

Older female Motor signs @ onset Many relapses early on Many MRI lesions

dDx for MND

Cervical cord compression Brainstem lesion Polio

dDx for mixed UMN and LMN signs

MND Friedrich's ataxia SCDC - Subacute combined degeneration of the spinal cord

MND Ix

Brain/spine MRI LP to exclude inflammatory cause

MND Mx

MDT approach Riluozle Supportive Mx (e.g. NIV for resp failure, amitriptyline for drooling)

Types of MND

Amyotrophic Lateral Sclerosis (50%) Primary lateral sclerosis (30%) (mainly UMN) Progressive bulbar palsy (only affects CN 9-12) Progressive Muscular Atrophy (LMN only)

LMN signs

Wasting Fasciculation Hypotonia Hyporeflexia

Fx of peripheral polyneuropathy?

Bilateral, symmetrical, glove and stocking distribution of sensory loss LMN signs, weakness

Mx of peripheral polyneuropathy

MDT approach Foot care Optimise glycaemic control Avoid alcohol Neuropathic pain: amitriptyline, gabapentin

dDx for peripheral polyneuropathy?

DM Alcohol B12 deficiency Drug induced (isoniazid, vincristine)

Sx of Charcot-Marie Tooth syndrome

Pes Cavus Champagne bottle legs High-stepping gait: foot drop Weak foot and toe dorsiflexion Absent ankle jerks Variable loss of sensation

Charcot Marie Tooth Mx

MDT approach Foot care Ankle brace

Myasthenia Gravis Mx

Pyridostigmine Immunosuppresants: steroids and azathioprine Acute: Plasmapharesis or IvIg

dDx for bilateral ptosis

MG Myotonic dystrophy Congenital Senile

GBS Ix

Evidence of infection: e.g. stool MC+S Anti-ganglioside Abs LP: ↑↑ CSF protein Nerve conduction studies: demyelination

Facial nerve palsy Ix

Glucose Serology: VZV, Lyme disease MRI

Palsy caused by a posterior communicating artery aneurysm

Occulomotor

Holmes-aide pupil

Dilated pupil that has no response to light and sluggish response to accommodation

Argyll Robertson Pupil?

Small, irregular pupils Accommodate but doesn’t react to light

Most common causes of RAPD

MS Glaucoma

Causes of bitemporal hemianopia

Lesion at optic chiasm Pituitary tumour Craniopharyngioma

Fx of CN4 palsy

Slight head tilt: ocular torticollis Appear normal in rest position Failure to depress eye in adduction Diplopia maximal down and in May have trouble walking down stairs

What is an Internuclear Ophthalmoplegia

Failure of ipsilateral adduction Nystagmus in the contralateral abducting eye

Where does sound lateralise to in Weber's test

Conductive: lateralises to abnormal ear SNHL: lateralises to normal ear

What is meant by: dysphonia dysarthria dysphasia

Dysphonia: impaired production of voice sounds Dysarthria: impaired articulation of sound → words Dysphasia: impairment of language

Where is Wernicke's and Brocas. What do they affect

Broca’s area: frontal lobe Non-fluent speech Comprehension intact Wernicke’s Area: temporal lobe Fluent but meaningless speech Comprehension impaired

What causes claw hand (4th and 5th finger)

Ulnar nerve palsy

What causes weakness of wrist extension?

Radial Palsy

What is myotonic dystrophy

Trinucleotide repeat Presents in early adulthood, progressive muscle wasting Myopathic facies, frontal balding, cataracts, decreased power in face and bulbar muscles Wasting of face, neck and distal arms Absent reflexes Weakness

What can cause: Asymmetric LMN paralysis No sensory involvement

Polio