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Neuro Flashcards

1
Q

What are the side effects of phenytoin?

A

Gingival hyperplasia
Peripheral neuropathy
Megaloblastic anaemia
Teratogenic
Cerebellar syndrome

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2
Q

What are the EEG findings for absence seizures?

A

Symmetrical 3Hz spike and wave pattern

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3
Q

What are the signs of Charcot Marie Tooth Disease?

A

Pes cavus
Inverted champagne bottle appearance
Scoliosis
Hand muscle wasting

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4
Q

What anterior horn cell diseases can cause a flaccid paraparesis?

A

MND
Poliomyelitis

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5
Q

Name 6 causes of inflammatory motor neuropathies

A

Sarcoid, vasculitis, GBS, CIDP, multifocal motor neuropathy, amyloidosis

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6
Q

Name 5 other causes of motor neuropathy

A

HSMN (CMT)
HIV
Diabetic amytrophy
Ciclosporin
Lyme disease
Porphyria

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7
Q

Myasthenia gravis and Lambert-Eaton Myasthenic syndrome are examples of what disorder that can cause a flaccid paraparesis?

A

Neuromuscular junction

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8
Q

In a unilateral cerebellar lesion, to which side does the patient veer towards when walking?

A

Towards the side of the lesion

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9
Q

What are the most common causes of ataxia?

A

Demyelinating disease
Stroke/SOL
Paraneoplastic

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10
Q

For ataxia, what clues point towards a demyelinating cause?

A

Internuclear ophthalmoplegia
RAPD
UMN weakness
Sensory disturbance
Bowel/bladder history

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11
Q

What are some rarer causes of ataxia?

A

Alcohol
Phenytoin
Miller-Fisher syndrome
Friedrich’s ataxia
Wilson’s disease
Ataxic telangiectasia
Spinocerebellar ataxia

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12
Q

What is the cause of bulbar palsy?

A

Diseases affecting the lower cranial nerves (7-11)

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13
Q

What is the cause of pseudobulbar palsy?

A

Disease of corticobulbar tracts to medullary brainstem motor nuclei

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14
Q

What is the difference in signs between bulbar and pseudobulbar palsy?

A

Bulbar:
-Weak and wasted tongue with fasciculations
-Gag reflex absent
-Jaw jerk absent/normal
-Nasal speech

Pseudobulbar:
-Spastic paralysed tongue, no fasciculations
-Gag reflex increased or normal
-Jaw jerk increased
-Spastic speechW

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15
Q

What are the causes of pseudobulbar palsy?

A

MND
MS
Bilateral CVA
Brainstem tumours

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16
Q

What are the causes of bulbar palsy?

A

MND
GBS
MG (with ptosis and ophthalmoplegia)
Syringobulbia

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17
Q

What are the signs of sciatic nerve palsy?

A

Foot drop
Weak knee flexion
Absent ankle reflex
Widespread sensory loss
Loss of plantarflexion, dorsiflexion, eversion, inversion

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18
Q

Palsy of which nerve can cause foot drop?

A

Common peroneal

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19
Q

What are the signs of lumbosacral plexopathy?

A

Foot drop
Sensory loss on sole, anterolateral shin, dorsum of foot
Loss of inversion, eversion, and dorsiflexion
Cannot straight leg raise

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20
Q

Foot drop with no sensory deficit is likely to be caused by…

A

MND

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21
Q

What muscle is involved in foot drop?

A

Anterior tibialis

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22
Q

What is the cause of Friedrich’s ataxia?

A

Autosomal recessive trinucleotide repeat disorder (GAA) which codes for frataxin

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23
Q

What are the signs of FA?

A

Presents at 10-15 years
Gait ataxia
Optic atrophy
Dysarthria
Absent ankle jerks
Extensor plantars
Peripheral sensory neuropathy
Hammer toes and pes cavus

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24
Q

What are the complications of Friedrich’s ataxia?

A

Hypertrophic cardiomyopathy in 90%
Diabetes mellitus

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25
Q

How is FA diagnosed?

A

Nerve conduction studies - motor velocities >40ms in arms, absent sensory action potentials
Genetic analysis

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26
Q

What is the cause of myotonic dystrophy?

A

CTG trinucleotide repeat disorder at DMPK gene

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27
Q

What are the signs of myotonic dystrophy?

A

Myotonic facies
Frontal balding
Bilateral ptosis
Cataracts
Dysarthria
Weakness of arms and legs (DM1 - distal, DM2 - proximal)
PPM

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28
Q

What are the complications of myotonic dystrophy?

A

Cardiomyopathy, heart block
Testicular atrophy
Diabetes mellitus

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29
Q

What are the signs of spinal muscular atrophy type 3?

A

Proximal muscle weakness
Bulbar palsy

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30
Q

What is the cause of Huntington’s disease?

A

Mutation in huntingtin gene on chromosome 4 - CAG repeat expansion

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31
Q

What are the genetic characteristics of Huntington’s disease?

A

Compete penetrance
Anticipation

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32
Q

What is the pathophysiology of Huntington’s disease?

A

Loss of dopamine D2 receptors and neurodegeneration in cortex, striatum, and caudate nucleus

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33
Q

What are the signs of Huntington’s disease?

A

Slow saccadic eye movements
Chorea
Depression
Behavioural changes

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34
Q

What is the triad of normal pressure hydrocephalus?

A

Urinary incontinence
Dementia
Bradyphrenia

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35
Q

What are the risk factors for idiopathic intracranial hypertension?

A

Obesity
Female
Pregnancy
COCP, steroids, tetrocyclines, vitamin A, lithium, isotretinoin

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36
Q

What are the signs of IIH?

A

Papilloedema
6th nerve palsy

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37
Q

What is the management of IIH?

A

Rule out cerebral venous sinus thrombosis
LP for high opening pressures - therapeutic
Weight loss
Acetazolamide
Topiramate 2nd line

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38
Q

What is syringomyelia?

A

Dilatation of a CSF space within the spinal cord, usually within cervical or thoracic segments
Causes compression of spinothalamic tracts

39
Q

What are the signs of syringomyelia?

A

Loss of sensation of pain and temperature in a cape-like distribution
Extension of syrinx with coughing or sneezing
Pyramidal signs in lower limbs

40
Q

What are the features of pituitary apoplexy?

A

Mimics SAH + features of pituitary insufficiency (hypoadrenalism leading to hypotension and hyponatraemia
Extra ocular nerve palsies

41
Q

What malignancies is LEMS associated with?

A

Small cell lung cancer
Breast cancer
Ovarian cancer

42
Q

What antibody is seen in LEMS?

A

Antibody against pre-synaptic voltage gated calcium channels

43
Q

What are the signs of LEMS?

A

Repeated muscle contractions lead to increased muscle strength
Proximal > distal
Hyporeflexia which recovers following brief muscle activation
Dry mouth
Impotence

44
Q

What are the signs of PSP (progressive supranuclear palsy)?

A

Impairment of vertical gaze (difficulty reading/descending stairs)
Stiff broad based gait
Postural instability and falls
Parkinsonism with prominent bradykinesia
Cognitive impairment
Poor response to levodopa

45
Q

What are the signs of multiple system atrophy?

A

Parkinsonism
Cerebellar signs
Autonomic disturbance - ED, postural hypotension, atonic bladder

46
Q

What is affected in anterior spinal artery syndrome?

A

Lateral corticospinal and spinothalamic tracts at the level of and below the lesion.

47
Q

What are the signs of anterior spinal artery syndrome?

A

Bilateral spastic paresis
Bilateral loss of temperature and pain sensation

48
Q

Which inflammatory myopathy initially affects finger and wrist flexion and is non-tender?

A

Inclusion body myositis

49
Q

What is seen on muscle biopsy in inclusion body myositis?

A

Cytoplasmic inclusions

50
Q

Which drugs affect the ear?

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

51
Q

Which antibodies are seen in myasthenia gravis?

A

ACh receptors
Anti-muscle specific tyrosine kinase antibodies

52
Q

What are the signs of myasthenia gravis?

A

Muscle fatiguability
Extra ocular muscle weakness - diplopia
Proximal muscle weakness
Ptosis
Dysphagia

53
Q

Which drugs worsen myasthenia symptoms?

A

Aminoglycosides

54
Q

What are the associations with myasthenia gravis?

A

Thymoma
Thymic hyperplasia

55
Q

What is the management of myasthenia gravis?

A

EMG
CT thorax for thymoma
Autoantibody testing
Long acting AChE inhibitors e.g. pyridostigmine
Thymectomy
Immunosuppression

56
Q

What is the management of myasthenic crisis?

A

Plasmaphresis
IVIG

57
Q

What are the characteristics of multifocal motor neuropathy?

A

Demyelinating
Acute onset - over a week
Distal neuropathy
Anti-GM1 antibodies
Conduction block

58
Q

What is the management of MND?

A

MRI head/neck to rule out intracranial SOL and cervical myelopathy
EMG - acute and chronic denervation
Riluzole
NIV
Physiotherapy
Management of spasticity

59
Q

What are the signs of ataxic telangiectasia?

A

Cerebellar ataxia
Telangiectasia
IgA deficiency and hypogammaglobulinaemia

60
Q

What are the signs of Miller-Fisher syndrome?

A

Ophthalmoplegia
Areflexia
Ataxia
Descending paralysis

61
Q

What are the forms of multiple sclerosis?

A

Relapsing remitting
Primary progressive
Secondary progressive

62
Q

How is MS diagnosed?

A

McDonald criteria
MRI - demyelinating lesions
CSF - high levels of immunoglobulin with oligoclonal bands, high protein

63
Q

What are the signs of tuberus sclerosis?

A

Ash leaf spots - fluoresce under UV light
Shagreen patches over lumbar spine
Adenoma sebaceum over nose
Subungal fibromata
Cafe au lait spots
Developmental delay

64
Q

What are the associations of tuberus sclerosis?

A

Retinal hamartomas
Rhabdomyomas of the heart
PKD

65
Q

What is neuromyelitis optica?

A

Relapsing remitting demyelinating CNS disorder

66
Q

What are the features of neuromyelitis optica?

A

Bilateral optic neuritis
Myelitis
Spinal cord lesions
Aquaporin 4 antibody

67
Q

What are the features of basilar migraine?

A

Brainstem associated range of symptoms - LOC, vertigo, dysarthria

68
Q

What are the signs of Ramsey-Hunt syndrome?

A

Unilateral facial nerve palsy with taste loss in anterior 2/3 of tongue
Vesicles on external auditory meatus/soft palate
Vertigo
Sensorineural hearing loss

69
Q

What is the management of TIA?

A

MRI brain
Clopidogrel and aspirin 300mg followed by DAPT at 75mg for 21 days
Then monotherapy with clopidogrel 75mg
PPI
Carotid dopplers

70
Q

What is an acceptable blood pressure prior to thrombolysis?

A

185/110

71
Q

What is the time threshold for thrombolysis in acute stroke?

A

4.5 hours

72
Q

After 4.5 hours, when is thrombolysis indicated in acute stroke?

A

Symptoms within 9 hours/9 hours from midpoint of sleep
Core-perfusion mismatch on CT or MR perfusion OR DWI-FLAIR mismatch on MRI

73
Q

What is the criteria for mechanical thrombectomy in acute anterior circulation stroke?

A

Symptoms within 6 hours
Proximal large artery (ICA/M1)
mRS 0-2
NIHSS 6 or more

74
Q

What are some differentials for multiple sclerosis?

A

Hereditary spastic paraplegia
Cerebral SLE
Sarcoidosis
AIDS

75
Q

What are the symptoms of optic neuritis?

A

Unilateral reduction in vision
Painful eye movements
Loss of colour vision (particularly for red)

76
Q

What autonomic symptoms are seen in MS?

A

Bladder: impaired emptying, urgency, frequency, incontinence
Bowels: incontinence
Sexual problems
Loss of thermoregulation

77
Q

What features may point towards MS?

A

Lhermitte’s sign
Symptoms worse after a hot bath

78
Q

What is the management of MS?

A

Oral methylprednisolone 5/7 for flares
DMARDS for relapsing remitting (e.g. interferon beta, natalizumab, glatiramer)
Baclofen and diazepam for spasticity
ISC
Exercise and smoking cessation
Exercise programmes
Optometry, SALT, PTOTW

79
Q

What is the difference between MND and cervical myeloradiculopathy?

A

MND has no sensory disturbance

80
Q

Which drugs cause seizures?

A

Isoniazid
TCAs
BDZ withdrawal
Alcohol withdrawal/binge

81
Q

What is the diagnostic criteria for epilepsy?

A

At least two unprovoked seizures more than 24h apart

82
Q

What are some differentials for a seizure?

A

Transient global amnesia
TIA
Migraine
Hypoglycaemia
Sleep disorder
NEAD
Syncope
Cardiac arrhythmia
Tic disorder

83
Q

How is epilepsy diagnosed?

A

Video recording
MRI
EEG, if normal can consider sleep deprived EEG

84
Q

What are is the management of epilepsy?

A

GTCS: lamotrigine/Keppra
Focal: lamotrigine/carbamazepine
Absence: ethosuximide

Epilepsy specialist nurse
Patient education and seizure diary
Pre-conception counselling
Occupation: unable to work at heights
Do not swim or bath alone
Trigger avoidance

85
Q

What are the DVLA rules for seizures?

A

6 months seizure free

86
Q

What is the non pharmacological management of PD?

A

Physiotherapy - gait re-training
Occupational therapy
Speech and language therapy (Lee Silverman Voice treatment)
Inform DVLA
Social care assessment
PD specialist nurse

87
Q

What medications are used in PD?

A

Early: MAO-i, dopamine agonist, levodopa, amantadine
Later: add COMT inhibitor if on levodopa

88
Q

What are the complications of drug treatment in PD?

A

Wearing-off effect
On-off fluctuations
Dyskinesias
Hallucinations and psychosis
Compulsive behaviours

89
Q

What is a Holmes-Adie pupil?

A

Myotonic pupil with or without hyporeflexia which responds slowly to light and dilates slowly following normal accommodation

90
Q

What is an Argyl-Robertson pupil?

A

Irregular pupil, does not constrict to light but accommodates normally on convergence

91
Q

What are the signs of 4th nerve palsy?

A

Innervates superior oblique muscle
Diplopia
Contralateral head tilt

92
Q

What are the signs of a 3rd nerve palsy?

A

Deviated down and out (diplopia looking nasally and upwards)
Ptosis
Dilated pupil
Fails to adduct/supraduct/infraduct (supplies IR, IO, MR, SR)

93
Q

What are the signs of a 6th nerve palsy?

A

Eye deviated inwards
Unable to abduct

94
Q

What is a cause of 3rd nerve palsy?

A

Posterior communicating artery aneurysm

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