neuro Flashcards
pathophysiology parkinsons disease
progressive reduction of dopamine in the basal ganglia of the brain
sx parkinsons disease
Classic triad: Resting tremor (pill rolling, unilateral), Rigidity (cogwheel), Bradykinesia
other: Depression, Sleep disturbance and insomnia, Loss of the sense of smell (anosmia), Postural instability, Cognitive impairment and memory problems
mx parkinsons diease
Levodopa: less effective over time, SE=dyskinesias
COMT Inhibitors e.g. entacapone
Dopamine Agonists e.g. bromocryptine. SE=pulmonary fibrosis
parkinsons plus syndromes
Progressive supranuclear palsy:
Multiple system atrophy
Cortico-basal degeneration:
Lewy body dementia:
progressive supranuclear palsy
Parkinisonism and vertical gaze palsy.
multiple system atrophy
Parkinisonism and early autonomic clinical features such as: postural hypotension, incontinence, and impotence
cortico basal degeneration
parkinisonism and involves spontaneous activity by an affected limb, or akinetic rigidity of that limb.
lewy body dementia
Parkinisonism and fluctuations in cognitive impairment and visual hallucinations, often before Parkinsonian features occur.
types of motor neuron disease
Amyotrophic lateral sclerosis
Primary lateral sclerosis:
Progressive muscular atrophy
Progressive bulbar palsy
amyotrophic lateral sclerosis
50% of patients): typically LMN signs in arms and UMN signs in legs
primary lateral sclerosis
UMN only
progressive muscular atrophy
LMN signs only, affects distal muscles before proximal
progressive bulbar palsy
palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei, carries worst prognosis
pathophysiology motor neuron disease
progressive degeneration of both upper and lower motor neurones. The sensory neurones are spared
sx motor neuron disease
lower motor neurone disease (Muscle wasting, Reduced tone, Fasciculations, Reduced reflexes) and upper motor neurone disease (Increased tone or spasticity, Brisk reflexes, Upgoing plantar responses)
Often present as: late middle aged (e.g. 60) man, possibly with an affected relative. There is an insidious, progressive weakness of the muscles throughout the body affecting the limbs, trunk, face and speech. There may be increased fatigue when exercising. They may complain of clumsiness, dropping things more often or tripping over. They can develop slurred speech (dysarthria).
UMN signs
Increased tone or spasticity, Brisk reflexes, Upgoing plantar responses
LMN signs
Muscle wasting, Reduced tone, Fasciculations, Reduced reflexes
mx motor neuron disease
no effective treatments for halting or reversing the progression of the disease.
Riluzole can slow the progression of the disease and extend survival by a few months in ALS.
Patients usually die due to resp failure or pneumonia
pathophysiology MS
demyelination of the myelinated neurones in the central nervous system. This is caused by an inflammatory process involving the activation of immune cells against the myelin.
causes MS
Combination of: Multiple genes, Epstein–Barr virus (EBV), Low vitamin D, Smoking, Obesity
presentation MS
Optic neuritis, Eye movement abnormalities, Focal weakness (Bells palsy, Horners syndrome, Limb paralysis, Incontinence), Focal sensory symptoms (Trigeminal neuralgia, Numbness, Paraesthesia, Lhermitte’s sign), ataxia
disease courses MS
Clinically Isolated Syndrome: the first episode
Relapsing-remitting: episodes of disease and neurological symptoms followed by recovery
Secondary progressive: was relapsing-remitting disease at first, but now there is a progressive worsening of symptoms with incomplete remissions
Primary progressive: worsening of disease and neurological symptoms from the point of diagnosis without initial relapses and remissions
diagnosis MS
MRI scanscan demonstrate typical lesions – disseminated in time and space
Lumbar puncturecan detect “oligoclonal bands” in the cerebrospinal fluid (CSF)
mxMS
Relapses: methylprednisolone
Disease modification: disease-modifying drugs and biologic therapy
Symptoms: Exercise to maintain activity and strength, Neuropathic pain can be managed with medication such as amitriptyline or gabapentin, Depression can be managed with antidepressants such as SSRIs, Urge incontinence can be managed with anticholinergic medications such as tolterodine or oxybutynin (although be aware these can cause or worsen cognitive impairment), Spasticity can be managed with baclofen, gabapentin and physiotherapy