Neuro Flashcards
Acute Mx of migraine
triptan (5HT agonist) + NSAID/paracetamol +/- metoclopramide*/prochlorperazine
*may cause acute dystonic reactions in young
who should have migraine prophylaxis?
what drugs?
> 2 attacks/month
1) topiramate or propanolol
* propanolol preferenced for women of child bearing age as ?teratogenic for topiramate
2) acupuncture or gabapentin
causes of restless leg syndrome
Fe deficiency uraemia DM pregnancy idiopathic - positive FH in 50%
Mx of restless leg syndrome
massage/stretching dopamine agonist (ropinirole)
Reasons to start antiepileptics after 1st seizure
unacceptable consequences of second seizure
structural changes on brain imaging
unequivical epileptic activity on EEG
neurological deficit
1st line meds for:
generalised seizures
partial seizures
sodium valproate (weight gain) carbamazepine
pathological changes in Alzheimers disease
intraneuronal neurofibrillary Tau protein tangles
neuronal plaques
deposition of type A beta-amyloid protein in cortex
Mx of Alzheimers disease
mild-mod: acetylcholinesterase inhibitors - donepezil, galantamine, rivastigmine
mod-severe: NMDAr antagonist - memantine
symptoms of normal pressure hydrocephalus
urinary incontinence
gait disturbance
dementia and bradyphrenia (slow thoughts)
pathological cause of normal pressure hydrocephalus
secondary to what?
Mx
reduced CSF absorption at the arachnoid villi
secondary to head injury, SAH, meningitis
Mx: ventriculoperitoneal shunt
medical management of MND
riluzole - prevents glutamate r stimulation
mainly used in amyotrophic lateral sclerosis
increases life by 3months
Chorea - which part of the brain affected
basal ganglia, especially caudate nucleus
what is Uhthoff’s phenomenon?
worsening of neurological symptoms following rise in body temperature with demyelinating conditions
symptoms of MS
vision: Internuclear ophthalmoplegia, optic neuritis, optic atrophy
sensory: Lhermitte’s syndrome, paraesthesia
motor: spastic weakness (legs more commonly)
cerebellar: ataxia
urinary incontinence, sexual dysfunction
what is Lhermitte’s sign?
shooting pain down the spine on flexion of the neck
ass. with MS
Dx criteria for migraine
atleast 5 attacks of: - headache lasting 4-72hrs - n&v or photo/phonophobia - >2 of: pulsating nature unilateral disrupts usual activity mod-severe
features of CN III palsy
eye “down and out”
diplopia
ptosis
mydriasis (dilated pupil if “surgical”) - affected parasympathetic innervation
features of Horner’s syndrome
miosis (constricted pupil)
ptosis
anhydrosis
Features of neurofibromatosis type 1:
cafe-au-lait spots (>6) axillary/groin freckles peripheral neurofibromas Lisch nodules in the iris (pigmented spots) scoliosis phaeochromocytoma
features of neurofibromatosis type 2
bilateral acoustic neuromas
chromosomes affected in neurofibromatosis 1 and 2
NF1 - 17 - 17 characters in neurofibromatosis
NF2 - 22 - all the 2s
risk factors for cluster headaches
male
smoking
features of cluster headache
lacrimation, redness, nasal congestion
pain around 1 eye,
1 or 2 attacks/day
cluster for 4-12 weeks
Mx of cluster headache, acute and prophylaxis
100% oxygen, SC sumatriptan, nasal lidocaine
prophylaxis: verapamil, pred
pathology of Parkinson’s disease
progressive neurodegeneration of dopaminergic neurones in the substantia nigra
classical triad of Parkinson’s disease
bradykinesia, resting tremor, rigidity
typically asymetrical
features of meniere’s disease
vertigo, tinnitus, SN hearing loss, feeling of pressure/fullness in ear
Mx of meniere’s
refer to ENT
acute: prochlorperazine
prevention: beta histine
inform DVLA - cease driving until symptoms controlled
features of MND
fasciculation
LMN signs in arms, UMN signs in legs
sensation and cerebellum unaffected
normal nerve conduction studies
ABCD2 score
what is it for
what are the criteria?
risk strafication after a TIA
age >60 - 1
BP >140/90 - 1
clinical features: unilateral weakness - 2
speech disturbance only - 1
duration of symptoms: >60mins - 2
10-59mins - 1
Diabetes - 1
post TIA management
ABCD2 score 4-7: - 300mg aspirin - specialist review in <24hrs - secondary prevention measures (BP statin clopidogrel) ABCD2 score 0-3: - specialist review in 1 week
Mx of MS
acute relapse - IV methylpred
beta-interferon (reduce relapse rate by 30%)
baclofen and gabapentin for spasticity
physio
others: glatiramer acetate, natalizumab, fingolimod
classic triad of wernicke’s encephalopathy
Cause
nystagmus ophthalmoplegia ataxia (also confusion, peripheral neuropathy) B1 (thiamine) deficiency - can recover
bitemporal hemianopia
upper quadrants affected ?cause
lower quadrants affected ?cause
upper quadrants= inferior chiasmal compression - pituitary tumour
lower quadrants = superior chiasmal compression - craniopharyngioma
features of Lewy Body dementia
progressive cognitive decline
parkinsonism
visual hallucinations
worsening with antipsychotics
pathology of Lambert-Eaton syndrome
paraneoplastic autoimmune reaction to pre-synaptic calcium channels
associated with small cell lung cancer.
features of Lambert Eaton syndrome
limb girdle weakness (affects legs first)
hyporeflexia
autonomic dysfunction: impotence, dry mouth, difficulty micturating
secondary prevention meds in stroke Mx
clopidogrel
statin if cholesterol >3.5
carotid doppler –> endarterectomy if >70% stenosed
causes of bilateral facial nerve palsy
sarcoidosis guillian barre polio lyme disease neurofibromatosis type 2 (bilateral acoustic neuromas)
which infection is most strongly associated with Guillian-Barre syndrome?
campylobacter jejuni
cause and features of lateral medullary syndrome (Wallenburg’s syn)?
occulsion of post inf cerebellar artery
cerebellar signs: ataxia and nystagmus
contralateral limb sensory loss
ipsilateral: dysphagia, facial numbness, CN palsy
pathology of Brown-Sequard syndrome?
features?
spinal cord hemisection
ipsilateral spastic paresis
ipsilateral loss of proprioception and vibration (dorsal column)
contralateral loss of temperature and pain (spinothalamic)
what are the features of post-concussion syndrome
headache
fatigue
anxiety/depression
dizziness
Side effects of triptans?
contraindications?
‘triptan sensations’ - tingling, heat, tightness (chest and throat), heaviness, pressure
C/I in IHD or CVD
definition of cataplexy
sudden and transient loss of muscle tone due to strong emotion
associated with narcolepsy
features of Bells palsy
Mx
LMN facial nerve palsy (forehead is affected)
pts also get periauricular pain, dry eye, hyperacusis, altered taste
oral pred 25mg BD if presented within 72hrs of onset.
which antibody is found in Guillian Barre syn
anti-ganglioside antibody (anti-GM1)
What is Miller Fisher syndrome?
which antibodies are present?
variant of Guillian Barre syn,
ophthalmoplegia, ataxia, areflexia. Eyes are typically affected first - presents as a descending paralysis
anti-GQ1b found in 90%
Symptoms of a parietal lobe lesion
sensory inattention Gerstmann's syndrome inferior homonymous quadrantinopia apraxia tactile agnosia (asteriognosis) [unable to identify object from touch alone]
Mx of BPPV
Epley manoeuvre (sucessful in 80%) teach pt exercises at home - Brandt-Daroff exercises
causes of neuroleptic malignant syndrome
NMS is due to a sudden decrease in dopamine activity
adverse reaction to atypical antipsychotics after altering dose
sudden stopping of dopaminergic medications
anti-doperminergic meds eg metoclopramide
lithium
Features of neuroleptic malignant syndrome
muscle rigidity, tachycardia, fever, autonomic instability, altered mental state
elevated CK, may have leukocytosis
Mx of neuroleptic malignant syndrome
stop offending drug
IV fluids
dantrolene may be used
bromocriptine (dopamine r agonist) may be used
Pathology and features of multifocal motor neuropathy (MMN)
Autoimmune demyelinating neuropathy affecting peripheral nerves
associated with motor block
raised anti-GM1
progressive asymmetric muscle weakness, no sensory signs, fasciculation, normal reflexes
features of Human T-lymphotrophic virus - 1 (HTLV-1)
seen in HIV patients
tropical spastic paresis - progressive weakness, urinary retention.
HTLV-1 positive
causes of a spastic paresis
UMN lesion
brain - infarct, haemorrhage, meningioma, blastoma
spine - trauma, tropical spastic paresis (HTLV-1), syringomyelia, transverse myelitis (eg HIV)
demyelination eg MS
OA cervical spine
features of Chronic inflammatory demyelinating polyneuropathy(CIDP)
progressive motor and sensory neuropathy with loss of reflexes.
conduction studies show demyelination
elevated CSF protein
pathology of multifocal motor neuropathy
autoimmune demyelinating motor neuropathy
reflexes and sensation unchanged
slowly progressive
anti GM1 antibodies frequently raised.
contraindications to antieptileptics
a) sodium valproate
b) carbamazepine
sodium valproate:
C/I in hepatic disease and pregnancy
-> lamotrigine
carbamazepine:
C/I in heart defects (potentiates AV conduction problems) and pregnancy, previous bone marrow suppression
Common precipitating infections for Gillian Barre
Chlamydia, campylobacter, hep B, mycoplasma pneumoniae, CMV, EBV, HZV, HIV
Management of narcolepsy
Non pharmalogical - sleep diary, decrease alcohol
Methylphenidate (CNS stimulant)
Mx of cataplexy
Fluoxetine or clomipramine
