Neuro Flashcards
5-HT3 antagonists? MoA & exams;e
ct in the chemoreceptor trigger zone area of the medulla oblongata.
chemotherapy-related nausea
ondansetron
prolonged QT interval
Types of aphasia
Wernicke’s (receptive) aphasia - superior temporal gyrus. Comprehension is impaired
Broca’s (expressive) aphasia- inferior frontal gyrus. comprehension intact. speech = non-fluent and halting. Repetition is impaired
Conduction aphasia. arcuate fasiculus - the connection. comprehension intact. speech = fluent. Repetition is impaired
Ataxia telangiectasia features
Autosomal recessive - DNA repair enzyme defect
an inherited combined immunodeficiency disorder - IgA deficiency resulting in recurrent chest infections
presents in childhood (1-2) w abnormal movements. Cerebellar ataxia.
Telangectasia
increased risk of haematological malignancy
Frederick’s ataxia features
autosomal recessive, trinucleotide repeat disorder (but unusually no anticipation)
Late childhood presentation (10-15)
spinocerebellar tract degeneration
Gait ataxia - cerebellar ataxia
kyphoscoliosis
Neurological features
absent ankle jerks/extensor plantars
optic atrophy
HOCM
DM
Bell’s palsy tx
oral prednisolone within 72 hours of onset
eye care
if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT
Brachial plexus injuries
Erb-Duchenne paralysis
- damage to C5,6 roots
- winged scapula
- waiter dip deformity
- may be caused by a breech presentation
Klumpke’s paralysis
- damage to T1
- loss of intrinsic hand muscles - claw hand
- due to traction
Brain abscesses mx
CT scanning
IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
surgery
a craniotomy & cavity debrided
intracranial pressure management: e.g. dexamethasone
Brown-Sequard syndrome features
lateral hemisection of the spinal cord
ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation
Cluster headache mx
acute
- 100% oxygen (80% response rate within 15 minutes)
- subcutaneous triptan (75% response rate within 15 minutes)
prophylaxis
- verapamil
- potentially tapering dose of prednisolone
Cerebellar syndrome symptoms
D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia
common peroneal nerve lesion
foot drop.
weakness
- foot dorsiflexion
- foot eversion
- extensor hallucis longus
(TIPPED
Tibial - inversion - plantarflex
Peroneal - eversion - dorsalflex)
- sensory loss - dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles
(weakness of hip abduction is suggestive of a L5 radiculopathy)
DVLA neuro
first unprovoked/isolated seizure: 6 months off if no structural/ EEG abnormalities, otherwise 12mo
established epilepsy- 12 mo, after 5 years - till 70 license
withdrawing epilepsy meds - 6 mo after last dose
stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit
multiple TIAs over short period of times: 3 months off driving and inform DVLA
Dystrophinopathies
inheritance
X-linked recessive
Duchenne - more sever due to frameshift mutation
Becker
Encephalitis Ix & mx
(HSV-1 )
Ix
CSF - lymphocytosis, elevated protein, PCR for HSV, VZV and enteroviruses
MRI
medial temporal and inferior frontal changes (e.g. petechial haemorrhages)
EEG
intravenous aciclovir
Epilepsy tx
Generalised tonic-clonic
males: sodium valproate
females: lamotrigine or levetiracetam
Absence seizures (Petit mal)
first line: ethosuximide
second line: as per tonic clonic
Myoclonic seizures
males: sodium valproate
females: levetiracetam
Tonic or atonic seizures
males: sodium valproate
females: lamotrigine
Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine
Idiopathic intracranial hypertension
weight loss!!
1. acetazolamide
2. topiramate
Intracranial venous thrombosis ix & mx
MRI venography is the gold standard
- Sagittal sinus thrombosis - ‘empty delta sign’
anticoagulation
typically with low molecular weight heparin acutely (warfarin usually for long term)
Medication overuse headache mx
simple analgesics and triptans should be withdrawn abruptly (may initially worsen headaches)
opioid analgesics should be gradually withdrawn
Migraine: management
Acute treatment
first-line: offer combination therapy with
an oral triptan and an NSAID/paracetamol
( 12-17 years -nasal triptan)
(no triptan or NSAID in pregnancy)
Prophylaxis
1. propranolol / topiramate (CI in women) / amitriptylin
2. 10 sessions of acupuncture over 5-8 weeks’
( 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis)
MS mx
acute
High-dose steroids (e.g. oral or IV methylprednisolone) for 5 days
Prevention of relapse
natalizumab
Fatigue - amantadine, CBT
Spasticity - baclofen and gabapentin
Oscillopsia -
Bladder dysfunction - ultrasound first to assess bladder emptying, if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics may improve urinary frequency
Myasthenia gravis mx
Mx
- long-acting acetylcholinesterase inhibitors - pyridostigmine is first-line
Management of myasthenic crisis
- plasmapheresis
- intravenous immunoglobulins
neurofibromatosis features
AD
NF1
- chromosome 17
Café-au-lait spots
Axillary/groin freckles
Iris hamatomas (Lisch nodules)
Pheochromocytomas
NF2
- chromosome 22
Bilateral vestibular schwannomas
Neuroleptic malignant syndrome features & mx
antipsychotic medication or dopaminergic drugs (such as levodopa) stopping
pyrexia
muscle rigidity
decreased reflexes
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
raised CK, AKI, leukocytosis
Mx
- stop antipsychotic
- dantrolene, IV fluids to prevent renal failure
- bromocriptine, dopamine agonist, may also be used
Neuropathic pain
first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug
treatment does not work try one of the other 3 drugs
switched, not added
tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
Radial nerve damage
Triceps - Loss of elbow extension
forarm muscles (supinator, brachioradialis, etc..) - Weakening of supination
Wrist drop
raised ICP mx
underlying cause
head elevation to 30º
IV mannitol may be used as an osmotic diuretic
controlled hyperventilation-> reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP
removal of CSF,
reflex & nerve roots?
ankle - s1 & 2
knee - L3 & 4
biceps - c5 & 6
triceps - c7&8
S1-S2 button my shoe
L3-L4 kick the door
C5-C6 pick up sticks
C7-C8 open the gate
Restless legs syndrome (RLS) mx
bloods such as ferritin to exclude iron deficiency anaemia
dopamine agonists are first-line treatment (e.g. Pramipexole, ropinirole)
Subacute combined degeneration of the spinal cord features
(vitamin B12 & E deficiency)
- Bilateral spastic paresis
- Bilateral loss of proprioception and vibration sensation
- Bilateral limb ataxia
Anterior spinal artery occlusion px
- Bilateral spastic paresis
- Bilateral loss of pain and temperature sensation
Syringomyelia px
- Flacid paresis (typically affecting the intrinsic hand muscles)
- Loss of pain and temperature sensation
Neurosyphilis (tabes dorsalis) neuro px
Loss of proprioception and vibration sensation
Ischemic stroke mx
non-contrast CT head scan - low density/ ‘hyperdense artery’
aspirin 300mg orally or rectally
thrombolysis- patients present with 4.5 hours of onset of stroke symptoms
thrombectomy asap w/in 6 hours of symptom onset, together with intravenous thrombolysis (if within 4.5 hours)
- proximal anterior circulation
thrombectomy between 6 & 24 hrs:
- proximal anterior circulation & potential to salvage brain tissue
AF anticoagulant - 2 weeks after onset
secondary prevention
- 1. clopidogrel (2.aspirin plus MR dipyridamole)
TIA mx
aspirin 300 mg
more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
discuss the need for admission or observation urgently with a stroke specialist
suspected TIA in the last 7 days:
arrange urgent assessment (within 24 hours)
TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days
carotid artery endarterectomy:
- carotid stenosis > 70%
Tuberous sclerosis (TS) features
depigmented ‘ash-leaf’ spots
roughened patches of skin over
lumbar spine (Shagreen patches)
adenoma sebaceum (angiofibromas)
fibromata beneath nails (subungual fibromata)
café-au-lait spots
Neuro: developmental delay, epilepsy (infantile spasms or partial), intellectual impairment,
retinal hamartomas,
rhabdomyomas of the heart
