Neuro Flashcards
1
Q
Parkinsons disease:
- Definition
- Risk factors + protective factors
- Symptoms
- Investigations + diagnostic criteria
- Management
- Complications
A
Parkinsons disease:
- Definition : progressive destruction of dopaminergic neurones in substantia niagra
- Risk factors + protective factors : fx, head injury. Prot: smoking, exercise, caffeine
- Symptoms: assymmetrical muscle cogwheel ridigity, bradykinesia (micrographia, hypokinesia), resting tremor (pinrolling, 4-6hz), postural instability, cognitive impairment, disturbed sleep, speech/swallow issues, ansomia, depression, stooped posture + forward tilt, reduced arm swing, shuffling gait, slow turning, facial masking, difficulty initiating movement
- Investigations + diagnostic criteria: exclude parkinsonism, uk park dis society brain bank (bradyk with one of the others + excluding criteria), structural mri/spect/olfactory testing if unsure
- Management:
if affecting qol levodopa (dopamine precursor - dyskinesia (dystonia, chorea, athetosis), dry mouth, anorexia, palpits, post hypotension, psychosis, end of dose wearing off) + carbidopa (peripheral decarboxylase inhibitor)
entacapone (comt inhibitor)
rasagiline (monoamine oxidase inhib inhibits breakdown dopamine - abdo pain, conjunct, headache)
dopamine agonists (ropinirole, rotigotine - pul/cardiac fibrosis (so echo + cxr + creatinine + esr before), impulse control disorders, daytime sleepiness), deep brain stimulation - Complications
2
Q
Parkinsonism:
- Definition
- Causes (5)
A
Parkinsonism:
- Definition : bradykinesia with either rigidity, tremor
- Causes (5)
1. drugs: antipsychotics, metoclop
2. multiple system atrophy: degen of basal gang hence parkinsons symptoms (+ responds to levodopa) + early onset autonomic dysfunction (post hypo/constip/sweat/ed) + cerebellar dysfunction)
3. dementia with lewy body
4. progressive supranuclear palsy: post instab (broad based gait), impaired vertical gaze, cognitive impairment
5. corticobasal degeneration
3
Q
Benign essential tumour:
- Definition
- Causes
- Symptoms
- Investigations + criteria
- Management
- DD for tremor
A
Benign essential tumour:
- Symptoms: bilateral fine postural tremor (worse with arms outstretched), 6-12hz, worse with movement, improves with alc, absent when sleeping - strong fx auto dom
- Investigations + criteria: international parkinsons + movement disorder society (isolat bilat tremor, >3 years, absence neurolog signs)
- Management : avoid caffeine/stress, propranolol, primidone, gabapentin, deep brain stimulation, botulin inj
- DD for tremor: parkinsons, parkinsonism, hyperthy, anxiety, toxicity, cerebellar, copd co2 retention, hepatic encephalopathy
4
Q
Motor neurone disease:
- Definition + types
- Risk factors
- Symptoms
- Investigations
- Management
- Complications
A
Motor neurone disease:
- Definition + types: progressive degeneration of umn + lmn nerves in sc/bstem. ALS amyotrophic lateral sclerosis, bulbar palsy (lmn only overactive gag reflex, tongue spasticity, fasciculations), muscular atrophy, primary lateral sclerosis
- Risk factors : fx, smoking, heavy metals, pesticides
- Symptoms: assymp progressive weakness with upper limbs noticed first, clumsy/wasting of hands, slurred speech, swallow liquids harder, facial weakness/hypophonic speech, t2 resp failure, umn + lmn signs, fasciculations, no sensory symptoms + eye movements spared + no cerebellar signs
- Investigations: ck, nerve conductions studies, emg (dec ap, inc amplitude), mri
- Management : riluzole, bipap, baclofen, quinine, glycopromide, benzos, augmentative alternative communication, peg
- Complications : death in 3 years, frontotemp dementia, resp failure, dysphagia
5
Q
Gullian barre syndrome:
- Definition + pathophysiology
- Symptoms
- Investigations
- Management - supportive + definitive
- Complications
A
Gullian barre syndrome:
- Definition + pathophysiology: polyneuropathy where b cells make ab attack schwann cells demyelinate peripheral nerves
- Symptoms: preinfection campylobacter/cmv/ebv/mycopplasma then symmetrical pain + weakness from legs up, mild sensory loss, facial weakness, lmn signs (hyporeflexia), autonomic dysfunction (retention, ileus, arrhythmia, post hypotension)
- Investigations: stool cultures, fbc/u+es/ck/anti ganglioside ab, emg, nerve conduction studies dec, lp shows inc protein + normal wcc, spirometry
- Management - supportive + definitive : amitriptylline, physio, salt, ecg/lfts every 4 hours, ivig/plasmapharesis if <2 weeks
- Complications : vte, aspiration, resp failure
lambert eaton assoc with sclc where ab against ca channels in peripheral ns. Repeated muscle contraction leads to inc muscle strength with lower limbs affected first, hyporef, autonomic dry mouth/impotence/retention. Need to treat the sclc + immunosuppression
6
Q
Myasthenia gravis:
- Definition
- Symptom
- Investigations
- Management
- Complications
A
Myasthenia gravis:
- Definition : autoimmune condition where ab to ach receptors meaning less binds causing dec muscle contraction
- Symptoms : fatiguable weakness (worse with b blockers, penicillamine, stress, succinyl, lithium), diplopia when looking up, ptosis, speech + swallow, jaw fatigue, sob - no sensory or pupil involvement
- Investigations: fatigue recovery test, ice test, tensilon test (iv edrophonium but not if arryth/asthma), ab (anti chr, musk, lrp4), emg, ct thorax for thyoma , abg
- Management : oral pyridostigmine (acetylcholinesterase inhibitor), pred, azathioprine, if fvc <15 then ventilation
- Complications : resp failure, aspiration, vte, cholinergic crisis, myas crisis (ivig + ventiltion, plasmapharesis)
7
Q
Epilepsy:
- Definition
- Definition of a seizure
- Causes of a seziure
- Risk factors
- Triggers for a provoked seizure
- Complications
- Investigations
- General management for epilepsy (not medications)
- DVLA criteria
A
Epilepsy:
- Definition : at least 2 unprovoked seizures occurring >24 hours apart or 1 with high likelihood of another occurring. Associated cerebral palsy + tuberous sclerosis + mitrochondrial diseases
- Definition of a seizure : transient episode of abnormal electrical activity
- Causes of a seizure: electrolyte abnormal, epilepsy, head injury, meningitis/enceph, febrile, vasovagal episode, arrhythmia, hypoglycemia, stroke
- Risk factors: fx, complex febrile, infection, trauma
- Triggers for a provoked seizure: flashing lights, aminophylline, bupivacaine, alc, fever
- Symptoms: bite, incontinence, aura, post ictal (confused, drowsy)
- Complications : injury, status, RTA, drowning
- Investigations : ecg, u+es/glucose/cultures/fbc/crp/toxicology, eeg after second, mri brain if <2 years/focal/no response to antiep
- General management for epilepsy (not medications): showers, swimming, if >2 years can slowly over 2-3 months withdraw meds
- DVLA criteria: if just seizure no for 6 months, if diag then not for 12 months after seizure
8
Q
Epilepsy:
Types + management:
- Focal
- Generalised
In children:
- Infantile spasms + EEG changes
- Lennox gastaut syndrome
- Benign rolandic epilepsy
- Juvenille myoclonic
- Absence + EEG changes
- Medication SE:
- Sodium valporate
- Carbamezepine
- Phenytoin
- Ethosuximide
- Lamotrigine
- Levetiracetam
A
Epilepsy:
Types + management:
- Focal: involve one side of brain, awareness either known or unknown - carbamazepine, lamotrigine
temporal: aura (epig sensation, deja vu, hallucination), lip smacking
frontal (motor): movements, jacksonian march, post ictal weak
parietal: parasthesia
occipital: flashes/floaters - Generalised: both sides, no concious, tonic clonic or absence or tonic (muscle tensing) or clonic (jerking) or myoclonic (rapid muscle jerks) or atonic (drop attacks)
In children:
- Infantile spasms (west) + EEG changes : brief spasms, first few months life, hypsarrhythmia, poor prognosis - vigabatrin, pred
- Lennox gastaut syndrome - extension of infantile spasms, 1-5 years, slow spike - ketogenic diet
- Benign rolandic epilepsy: unilat face usually waking up
- Juvenille myoclonic : teenage years, seizures in morning esp if sleep deprived - na valp
- Absence + EEG changes : 4-8 years, 3hz generalised + symmetrical = na valp + ethosuximide
- Medication SE:
- Sodium valporate : inc gaba activity - inc appetite, teratogenic, alopecia, pancreatitis, p450 inhib, ataxia, tremor, hepatitis - monitor bmi, fbc, lfts
- Carbamezepine : inc na channel activity, p450 inducer, dizzy, ataxia, agranulocytosis, siadh, diplopia
- Phenytoin : na channel blocker - p450 inducer, dizzy, ataxia, gingival hyperplasia, hirsutism, peripheral neuro, osteomalacia, megaloblastic anaemia, lymphad
- Ethosuximide - night tremors
- Lamotrigine : na ch blocker - SJS
- Levetiracetam : abnormal behaviour
9
Q
Multiple sclerosis:
- Definition + what cells does it affect
- Risk factors
- Pattern of disease
- Symptoms (common presentations)
- Investigations
- Management
- Complications
A
Multiple sclerosis:
- Definition + what cells does it affect : chronic autoimmune condition where demyelination of the CNS (the myelin sheath of oligodendrocytes) - 2 episodes of neurolog dysfunction separated in time and space
- Risk factors : fx, 20-40, vitamin d deficiency, hot climate
- Pattern of disease: relapsing + remitting, secondary progressive, primary progressive
- Symptoms (common presentations)
1. optic neuritis
2. transverse myelitis in lumbar spine
3. cerebellar symptoms (sensory ataxia, tremor)
4. bstem issues (internuclear ophthalmoplegia - diplopia)
5. autonnomic symptoms (constip, incont, ED)
6. lhermittes sign (means disease in dorsal column)
7. uhthoffs phenomenom
8. sensory issues: parasthesia, trigeminal neuralgia
9. spastic weakness esp in legs - Investigations : fbc, b12/f, tfts, u+es, mri t2 brain + gadolinium contrast (hyperintensive white matter plaques), LP for csf electrophoresis (oligoclonal bands of igG + high protein), mcdonald criteria
- Management : if acute relapse then methylpred 5 days. DMARDs if >2 relapse + remitting in 2 years and able to walk - iv natalizumab (or ocrelizumab, fingolimod), amantadine for fatigue, baclofen + gabapentin for spasticity, solifenacin for bladder issues (do uss first and give this if no residual vol but if there is then self catheterisation), gabapentin for oscillopsia
- Complications : fatigue, spasticity, oscillopsia, ataxia, uui
10
Q
Polyneuropathies:
- Symptoms
- Causes
- Investigations
A
- Symptoms : glove + stocking symmetrical sensation loss, lmn signs
- Causes: vasculitis, inflamm, toxic alcohol, autoimmune gbs, meds (isoniazid, nitrofuratoin, amiodarone, metronidazole), idiopathic, nutrition b12/f deficiency, diabetes, ckd
- Investigations : emg, nerve cond studies, autoimmune screen, fbc/b12/f/u+es/hb1a1c
11
Q
Facial nerve palsy:
- Definition
- Signs
- Causes of UMN lesion in face
- Causes of LMN lesion in face
- bells mx
- What is ramsey hunt syndrome + management
A
Facial nerve palsy:
- Definition : supplies facial expression, strapedizus inner ear, platysma, taste ant 2/3 tongue and subman/ling glands
- Signs: facial droop (no forehead sparing) inc eyelid, hyperacusis, loss nasolabial fold, assymp smile
- Causes of UMN lesion in face : strokes, tumours, bilat lesions (mnd)
- Causes of LMN lesion in face : bells, ramsey, infections (otitis media/hiv/lymes), acoustic neuroma, trauma, diabetes, sarcoidosis
- bells mx: if within 72 hours pred, lub eye drops, microporous tape at night, if no improvement after 3 weeks refer to ent, 2-4 months recovery
- What is ramsey hunt syndrome + management : vzv infection in geniculate ganglion of facial nerve - vesicular rash + pain in ear = needs aciclovir + pred 7 days
12
Q
Brain tumours
A
- mets: lung, breast, bowel, melanoma, kidney
- glioblastoma: solid tumour with central necrosis + rim
- meningioma: benign tumours of cns causing symptoms of compression
- vestibular schwannoma: benign tumours of vestibuloc nerve often seen in cerebellopontine angle - h loss sensor, facial nerve palsy(absent corneal reflex), tinnitus,vertigo, Needs mri, annual observation, microsurgery or radiotherapy. If bilat assoc with neurofibromatosis type 2
- pit adenoma
13
Q
Headaches:
- trigeminal neuralgia
- migraine
- med overuse
- gca
- cluster
- tension
A
- trigeminal neur: compression of trigem roots (tumours/vasculitis). Unilat brief electric shocks evoked by touch/cold/talking/teeth brushing with preceeding tingling symptoms. Needs carbamazepine
- migraine: unilat throbbing, nausea, photoph, phonophob up to 72 hours. Can get aura. Triggered when tired/cocp/alc/menstruation/lack food or dehyd. When attack oral triptan + nsaid/paracetamol (if 12-17 nasal triptan). If doesnt work then metoclop/prochlor. Then prophylaxis propranolol, topiramate (unless childbearing age), amitrip. If fails acupuncture 8 weeks. If due to menstruation then frovatriptan or zolmitriptan
- med overuse: if >15 days a month >3 months esp if opioids >10 days or triptans or nsaids >15 days. Withdraw abruptly (unless opioids)
- cluster: triptans, high flow oxy. Proph verapamil, lithium, pred, occiptal nerve block
- other causes: sinusitis, meningitis, tumour, haemorrhage
14
Q
Huntingtons
- definition
- symptoms
- mx
A
Huntingtons
- definition: auto dom where progressive neurolog dysfunction. Due to trinuc HTT repeat so degen of cholinergic + gabaergic neurones in striatum of basal ganglia. Death in 20 years
- symptoms: cognitive + psych + mood problems then chorea, dystonia, rigidity, saccadic eye movements, dysarthria and dysphagia
- mx: genetic counselling, physio, salt, tetrabenazine for symptoms, antidep
15
Q
Friedreichs ataxia:
- definition
- symptoms
A
- def: auto recessive GAA trinuc repeat
- symptoms: 10-15 years old onset absent ankle jerk, cerebellar ataxia, optic atropy, spinocerebellar tract degen, HOMC, diab
