Neuro Flashcards
Fx of charcot marie tooth disease
Bilateral foot drop
High stepping gait
Champagne bottle legs
Bilateral pes cavus
Weakness and mild sensory loss
What is miller-fischer syndrome
Proximal variant of GBS causing ataxia, opthalmoplegia, areflexia (anti-GQ1b antibodies)
GBS Mx
IVIG
Methylprednisolone
Cerebellar signs
Dysdiadochokinesia.
Ataxia (wide-based gait and posture)
Nystagmus.
Intention tremor.
Slurred, staccato speech.
Hypotonia/heel-shin test
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)
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
Mx of MND
Physio, SALT, specialist nurse
Anticholinergics, baclofen, Riluzole
Fx of Klinefleters
Tx?
Subfertility
Gynaecomastia
Tall
Small testes
Sparse facial & body hair
Testosterone injections
Referal to fertility clinic (intracytoplasmic sperm injection)
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
Ix of myasthenia gravis
AChR antibodies
Tensilon test (give IV anticholinesterase injection and look for improvement in ptosis)
Most common adult muscular dystrophy
Myotonic dystrophy
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)
Parkinson’s Mx
MDT approach: neurologist, physio
L-DOPA + Carbidopa or benserazide
Da agonists: ropinerole
MAO-B inhibitors: rasagline
Citalopram if depressed
L-Dopa side effects
Dyskinesia
Mouth dryness
Insomnia
N/V
Differentials for tremor
Parkinson’s
Intention tremor - cerebellar
Benign essential tremor
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
Fx of Friedrich’s ataxia?
Pes cavus
Bilateral cerebellar ataxia
Leg wasting + areflexia but extensor plantars
Loss of vibration and proprioception
UMN signs (4)
↑ tone
Pyramidal distribution of weakness
Leg: extensors stronger than flexors
Arm: flexors stronger than extensors
Hyper-reflexion
Extensor plantars
Likely cause of UMN signs bilaterally in lower limb
MS
Cord Compression
Cerebral palsy
Cord Trauma
Likely cause of UMN signs unilaterally in lower limb
Stroke
MS
SOL
Cord Compression
Cerebral Palsy
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
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
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
