Neuro Flashcards

Question

Ix MS

Answer 1

MACDONALD'S CRITERIA!! At least 2 events disseminated by time and space -- GS!! (w above) - **MRI W CONTRAST** Lesions appear white Lumbar puncture w CSF electrophoresis (inflam proteins only in CSF bc nervous system disease) Evoked potentials - how long impulses travel the more demyelination, the slower the conduction

Answer 2

Acute attacks = IV methylprednisolone

Answer 3

NO CURE! 1st Line - beta interferon and glatiramer acetate 2nd Line - IV alemtuzumab, IV natalizumab -- Sx Tx : Tremor - BB Muscle spasticity - Mild-Mod : Oral diazeam, baclofen Focal disabling : periph nerve blocks e.g. botulinum, alcohol, phenol SEVERE : Reversible invasive procedures e.g. intrathecal baclofen Irreversible e.g. functional neurosurgery

Answer 4

Injection site reactions Flu Sx (will decrease after first few months) Mild lymphopenia Mild-mod rise in liver enzymes

Answer 5

CD52 monoclonal antibody that targets T cells

Answer 6

acts against VLA-4 receptors that allow immune cells to cross the BBB and therefore reduces number of immune cells that can enter the CNS and cause damage

Answer 7

Autoimmune disease against nicotinic acetylcholine receptors in the neuromuscular junction

Answer 8

Acute, inflamm demyelination polyneuropathy Affects PNS - Schwann cells Following URTI or GI tract infection

Answer 9

**Within 4 weeks of URTI or GI tract infection Symmetrical, ascending muscle weakness** Proximal muscles more commonly affects - trunk, resp and Cranial nerve esp CN7 REFLEXES LOST (deep tendon refleces) RESP INVOLVEMENT - affects diaphragm = death!! Paraesthesia, numbness Back/limb pain Cranial nerve involvement - Diplopia, dysarthria Autonomic fts - Sweating, ↑Pulse, postural hypotension, arrhythmias

Answer 10

Clots - PE!! Resp system - if affects diaphragm = death

Answer 11

Triggered by infection! - usually GI tract or Upper resp tract **Campylobacter jejuni** MC **Cytomegalovirus** **EBV**

Answer 12

MOLECULAR MIMICRY Infection occurs ∴ immune response Body produces antibodies against antigens But these antigens similar to those on Schwann cells ∴ attacks Schwann cell ∴ Demyelination + Acute polyneuropathy

Answer 13

MONITOR BREATHING BC RESP INVOLVEMENT!!

Answer 14

Clinical diagnosis, no GS Nerve conduction studies Lumbar puncture (L3/4) to test CSF - ↑protein, normal WCC, normal glucose

Answer 15

IV Ig for 5 days Plasma exchange - remove Abs (CI in IgA def patients!! will cause allergic reaction) Supportive care VTW prophylaxis (LMWH) e.g. SC enoxaparin and compression stockings - bc clots are common Spirometry! If FVC < 0.8, consider intubation and ITU

Answer 16

80% recover completely - bc myelin sheath recovers 15% lasting weakness 5% die

Answer 17

GB syndrome

Answer 18

Female < 40 Males > 60

Answer 19

MND never affects eye movements!

Answer 20

MUSCLE WEAKNESS Worse at end of day/with exertion Better with rest Starts w/ head and neck! then progresses to lower body Eye muscle weakness - diplopia Ptosis Myasthenic snarl - hard to smile, looks weird Jaw fatigue Dysphagia - bulbar weakness Dysphasia

Answer 21

Normally, acetylcholine crosses synaptic gap and attaches to receptors MC!! - Immune system produces **Nicotinic Ach-R antibodies**, bind to receptors and blocks! ∴ ↓ muscle contraction As muscles are used, more receptors are blocked! ∴ **↑ ACTIVITY = ↑ WEAKNESS** ALSO : Muscle Specific Kinase (**MuSK**) and low-density lipoprotein receptor related protein 4 (LRP4)

Answer 22

**Serology** - Anti-AchR and Anti-MuSK **Tensilon/Edrophonium test**! Administer Edrophonium, POS test = ↑↑muscle power for a few seconds Also, repeatedly blink causes ptosis Look up for a while causes diplopia Repeatedly abduct arm causes unilateral muscle weakness when compare arms Count to 50 - as higher numbers, voice get less audible ALSO : FVC! to test resp muscles

Answer 23

1st Line = ACh inhibitors! NEOSTIGMINE, PYRIDOSTIGMINE 2nd Line = Immunosuppression - steroids (prednisolone/azathioprine) Monoclonal Abs - Rituximab, eculizumab Thymectomy

Answer 24

**Lambert-Eaton Myasthenic Syndrome!** Paraneoplastic condition, SCLC Weakness will improve AFTER exercise

Answer 25

**Thymoma!** / Thymic hyperplasia Autoimmune disease - RA, SLE, pernicious anaemia

Answer 26

IV Ig Plasmapheresis

Answer 27

Autoantibodies against calcium channels in SCLC cells Also target calcium channels in presynaptic terminals ∴ ↓ ACh released

Answer 28

Same as Myasthenia Gravis But start w extremities rather than head and neck

Answer 29

Rule Myasthenia Gravis out !! (aka if ACh-R antibodies = Myasthenia Gravis) MRI - SCLC

Answer 30

Treat any malignancy ACh inhibitors - pyridostigmine, neostigmine Amifampridine - improves muscle strength If v severe - immunosuppression/IV Ig/Plasmapheresis

Answer 31

Progressive reduction of dopamine in the basal ganglia

Answer 32

Neurodegen loss of substantia nigra in pars compacta ∴ ↓ Dopamine levels ∴ Thalamus is inhibited ∴ ↓ Movement ∴ Symptoms of Parkinson's

Answer 33

1. Resting tremor 2. Bradykinesia 3. Rigidity

Answer 34

**T**remor - pin-rolling **R**igidity - cogwheel **A**kinesia **P**ostural instability

Answer 35

Parkinson's disease Vascular parkinsonism Infections - encephalitis, creutxfeldt-Jakob disease Toxin induced - carbon monoxide, drugs

Answer 36

People are getting older Population is increasing

Answer 37

Striatum - putamen and caudate nucleus Globus pallidus - external and internal Substantia nigra - produces dopamine Subthalamic nucleus

Answer 38

TRAP - ASYMM tremor, rigidity, akinesia, postural instability Small shuffling steps Reduced arm swing Difficulty initiating movement - struggle to start walking Hypomimia - ↓ facial expressions, mask-like face Depression Memory problems Anosmia Constipation ↑ Urinary freq, NOT incontinence

Answer 39

**TIDES** **Tremor in action** **I**ncontinence **D**ementia **E**arly falls **S**ymmetry -- Normal pressure hydrocephalus Essential tremor

Answer 40

Better with alcohol Action tremor

Answer 41

Deep brain stimulation BB Primidone

Answer 42

**Usually from history and exams** DaTSCAN Head CT/MRI Microscopy - Lewy bodies

Answer 43

FHx Male ↑ Age Smoking seems to be protective!

Answer 44

Resting tremor Bradykinesia Rigidity Postural instability

Answer 45

NO CURE -- **LEVODOPA + Carbidopa** Can cross BBB, dopamine can't NOT GIVEN INITIALLY bc effect will wear off after a while ∴ saved for when symptoms are rlly bad Has on/off fluctuations!! - Sx can be well controlled, then suddenly not controlled -- Dopamine agonists - Bromocriptine, Ropinirole COMT inhibitors - entacapone, rasagiline MAO-B inhibitors - selegiline

Answer 46

silly you can't do that bc dopamine can't cross the BBB and will cause arrhythmias etc

Answer 47

Carbidopa ensures Levodopa is not metabolised peripherally, otherwise can cause arrhythmias

Answer 48

Parkinson's dementia

Answer 49

Lewy Body dementia w Parkinsonism

Answer 50

Inhibit the inhibition of dopamine

Answer 51

Obvs stroke Hypoglycaemia Migrainous aura Mass lesions

Answer 52

Atherosclerotic rupture Thrombus, embolus Shock Cardiac emboli - AF, MI, IE (blood stasis) Atherothromboembolism - from carotid artery Vasculitis

Answer 53

Atherosclerosis RF Ethnicity - black or asian HTN Smoking DM Age Alcohol Past TIA Heart disease AF

Answer 54

**A**ge > 60 (1) **B**P > 140/90 (1) **C**linical Sx - unilateral weakness (2), slurred speech, no weakness (1) **D**uration Sx - 1 hour (2), 1 hour (1) **D**MT2 (1) > 6 REFER TO NEUROLOGY ASAP

Answer 55

**D CLIT** **D**rowsiness **C**ontralateral leg weakness +/- sensory loss (arms probs not affected too but could happen) **L**ogical thinking and personality affected **I**ncontinence **T**runcal/Gait ataxia

Answer 56

MOST COMMON PRESENTATION!! **CASH** **C**ontralateral motor weakness/sensory loss - both arms and legs **A**phasia - Wernicke's or Broca's **S**mile droop (facial droop) **H**emiplagia

Answer 57

**VIP** **V**isual agnosia - can't interpret visual info **I**solated homonymous hemianopia or cortical blindness **P**ropagnosia - can't recog faces

Answer 58

Balance disorder Coordination disorder

Answer 59

Larger region supplied by this artery ∴ More catastrophic effects

Answer 60

Sudden vomiting Vertigo Ipsilateral Horner's syndrome Facial numbness Limb ataxia Dysphagia Dysarthria

Answer 61

Urgent NCCT!!!!! EXCLUDE HAEMORRHAGE Immediate 300mg loading dose Aspirin Then continue this for 2 weeks **Thrombolysis w IV Alteplase** - WITHIN 4.5 HOURS OF SX ONSET !!!! Lifelong Clopidogrel after 2 weeks of aspirin (75mg) -- Thrombectomy - within 6 hours of symptom onset!! Only indicated if severe - large artery has been affected

Answer 62

History of stroke in DM patients Severe stroke Stroke in last 3 months Active malignancy

Answer 63

if Px on anticoags, always suspect to be haemorrhagic stroke until proven otherwise

Answer 64

Anything that increases risk of vessel rupture HTN 2º to ischaemic stroke! - causes stiff, brittle vessels prone to rupture Head trauma AV malformations Vasculitis Vascular/Brain tumours Cerebral amyloid angiopathy Carotid artery dissection

Answer 65

Virtually indistinguishable from Ischaemic infarct LoC and headache more likely Papilloedema

Answer 66

Middle meningeal artery

Answer 67

Bridging cranial veins

Answer 68

Berry aneurysm in circle of Willis

Answer 69

Alzheimer's - MC! Vascular Lewy-Body Fronto-Temporal (Pick's)

Answer 70

MENINGITIS!

Answer 71

Notify Public Health!!

Answer 72

Elderly or very young children Immunocompromised Non-vaccinated Crowded environments

Answer 73

1. Headaches 2. Photophobia 3. Neck stiffness

Answer 74

Paraneoplastic Drug S/E Autoimmune e.g. RA, SLE

Answer 75

Neisseria Meningitis Strep. Pneumoniae Listeria spp Group B strep Haemophilus influenzae B E. Coli

Answer 76

Herpes Simplex Virus Varicella zoster virus Enterovirus - Coxsackie

Answer 77

Mycobacterium Tuberculosis Syphilis

Answer 78

MENINGOCOCCAL SEPTICAEMIA !!

Answer 79

Non-Blanching Purpuric Rash Disseminated Intravascular clotting - v easy bleeding

Answer 80

Papilloedema GCS < 12 Focal neuro signs - weakness, paralysis, headaches, ataxia, visual impairment etc Continuous or uncontrolled seizures

Answer 81

Neisseria Meningitidis - Kids/Teenagers Step Pneumoniae - Young children OR adults Listeria spp - Immunocomp, pregnancy Group B Strep - neonates bc colonises maternal vagina

Answer 82

Gram Neg Diplococcus

Answer 83

Gram Pos Diplococcus

Answer 84

Gram Pos Coccus in chains

Answer 85

Gram Pos Bacillus

Answer 86

HEADACHE, NECK STIFFNESS, PHOTOPHOBIA Fever Kernig's sign Brudzinski's sign

Answer 87

Give IM Benzylpenicillin + admit to hospital!!!

Answer 88

CHEESE ∴ pregnant women advised to try and avoid

Answer 89

1. ABCDE + GCS score 2. Blood cultures! 3. Broad spec Abx (don't wait for results) - **IV ceftriaxone** or **Cefotaxime** If immunocomp - ADD high dose amoxicillin If recent travel - ADD IV Vancomycin If pencillin allergy (severe - anaphylaxis) - Give Chloramphenicol 4. Steroids - IV Dexamethasone (↓Neuro comps) 5. **LUMBAR PUNCTURE!**

Answer 90

BC there is a 10% chance that if they react to penicillins, they will react to cephalosporins

Answer 91

Bc recent travel increases chance of penicillin resistance

Answer 92

Abnormal clotting If on anti-coags Petechial rash (Indicates meningococcal sepsis - DIC) Infection at LP site (e.g. shingles) ↑ ICP - bc risk of coning

Answer 93

LP TABLE !!!!!

Answer 94

Inform Public health And identify close contacts! (Living together esp in first 7 days of infection!) Give prophylaxis Abx - Ciprofloxacin or Rifampicin if CI !!

Answer 95

**SAH!** - thunderclap Migraine Flu Sinusitis - facial pain Brain abscess Malaria

Answer 96

Epilepsy usually has amnesia - forget what happened straight after episode

Answer 97

HERPES SIMPLEX (MC by far!!) Varicella zoster (chicken pox) Measles, Mumps Rubella EBV HIV CMV Coxsackie ALSO : TB, Malaria, Rabies Non-Infective : Autoimmune, paraneoplastic

Answer 98

Hours to Days Preceding : Flu-like illness THEN, triad of : 1. Altered GCS - confusion, drowsiness, coma 2. Fever 3. Headache Also : Seizures, Memory loss +/- history of meningism (may have progressed from meningitis)

Answer 99

MRI head - shows swelling/inflamm + midline shift (bc ↑ICP) ECG - periodic sharp and slow waves Lumbar puncture - done after, ↑lymphocytes HIV test

Answer 100

Mostly supportive IV Aciclovir - if HSV or VZV If seizures - carbamazepine If meningitis sus - IM benzylpenicillin

Answer 101

**CHOCOLATE** **C**hocolate **H**angovers **O**rgasms **C**heese **O**ral contraception **L**ie-ins **A**lcohol **T**umult - loud noises **E**xercise

Answer 102

Unilateral, recurrent throbbing headache +/- aura Mod - Severe pain Often w vision changes Usually bc of specific trigger MC cause of recurrent headache

Answer 103

Women under 40 If over 50, should be sus of underlying cause

Answer 104

1º - syndrome is based on Sx 2º - symptoms bc of underlying cause e.g. SAH

Answer 105

A - 5 attacks of B - 4 - 72 hours C - 2 of : Unilateral, pulsing, mod/severe, aggravated by routine physical activity D - Headache comes w/ N+V OR Photophobia + Phonophobia

Answer 106

**A - At least 2 attacks fulfilling B + C :** **B - At LEAST 1 reversible aura Sx :** Visual - zigzags, spots Unilateral sensory - tingling, numbness Speech - aphasia Motor weakness - hemiplegic migraine (rule out stroke/TIA) **C - AT LEAST 2 of following :** * ≥ 1 aura Sx spread gradually over 5 mins +/- ≥ 2 aura Sx in succession * Each aura Sx = 5 - 60 mins * ≥ 1 aura Sx is unilateral * Aura accompanied/followed within 1hr of headache

Answer 107

Clinical diagnosis Diagnostic criteria w/ normal neuro exam! Exclude other causes e.g. SAH

Answer 108

Worst headache of life - thunderclap Rapid onset Progressive headaches Unresponsive headaches

Answer 109

Conservative - avoid triggers ACUTE : Mild - NSAIDs, paracetamol Severe - oral triptan e.g. sumatriptan Avoid opioids if possible! bc risk of dependence and worsens nausea

Answer 110

1st Line - propanolol or topiramate (anti-convulsant) 2nd Line - acupuncture 3rd Line - Amitriptyline 4th Line - Botulinum toxin Type A

Answer 111

Tension headache

Answer 112

Bilateral generalised headache, radiates to neck / trapezius Like a rubber band / clamp around head NO motion sickness / N+V / aura

Answer 113

SImple analgesia - aspirin, paracetamol Avoid opioids! (dependence!!)

Answer 114

**MC SCOLD** **M**issed meals **C**onflict **S**tress **C**lenched jaw **O**verexertion **L**ack of sleep **D**epression

Answer 115

Unilateral periorbital pain w/ autonomic features (15 - 160 mins) Rises in severity Excruciating pain - hot/boring poker characteristic Usually in middle of night/morning hours Rare-ish

Answer 116

Conjunctival infection + lacrimation (watery bloodshot eyes) Ptosis Miosis (dilated unilateral pupil) Rhinorrhoea

Answer 117

At least 5 similar attacks confirms diagnosis

Answer 118

Acute : SC sumatriptan IM Zolmitriptan 100% O2 therapy! (unless COPD)

Answer 119

Verapamil Lithium Corticosteroids

Answer 120

Chronic, debilitating condition Causes intense and extreme episodes of pain Almost always unilateral

Answer 121

50 - 60 years

Answer 122

MS!!!!!!!!! ↑ Age Female

Answer 123

Eating Shaving Talking Brushing teeth

Answer 124

Electric shock pain (seconds-mins)

Answer 125

At least 3 attacks

Answer 126

Carbamazepine Surgery if nothing else works

Answer 127

Tonic-Clonic Myoclonic Absence Tonic Atonic

Answer 128

Recurrent tendency to have spontaneous, intermittent, abnormal electrical activity that manifests as seizures **AT LEAST 2 SEIZURES TO BE EPILEPTIC **

Answer 129

Spontaneous, intermittent, uncontrolled electrical brain activity

Answer 130

The epilepsy attack

Answer 131

Non-specific symptoms that precede an epileptic attack

Answer 132

Sensory disturbances that precede an epileptic attack, usually by minutes More specific than Prodrome

Answer 133

Can happen at age Highest < 20 and > 60

Answer 134

FHx Premature birth Developmental abnormalities Trauma Drugs e.g. cocaine Space occupying lesion - tumour, infection, haematoma Alzheimer's /Dementia

Answer 135

1. **Primary Generalised** Originates in midbrain/brainstem Electrical discharge in _both_ hemispheres Assoc w/ LOC 2. **Partial/Focal** - MC Electrical discharge restricted to _one_ hemisphere May develop into generalised (2º)

Answer 136

Partial WITHOUT impairment of conciousness e.g. déjà vu, Jacksonian seizures Partial WITH impairment of consciousness e.g. psychomotor seizures

Answer 137

Often no aura Tonic : stiffening of the limbs, tongue biting, incontinence, no breathing (10-60s) Clonic : Convulsions, limb jerking, eye rolling, uncoordinated breathing (secs-mins)

Answer 138

Common! Drowsy Confusion Headache

Answer 139

Childhood Conscious but unresponsive Can occur many times a day Usually very short, normal function resolves quickly

Answer 140

Sudden _isolated_ jerk of limb, face or trunk May fall suddenly to the ground

Answer 141

Sudden increased tone, RIGID No jerking!

Answer 142

Sudden loss of muscle tone + movement RESULTS IN A FALL

Answer 143

No LOC or loss of memory Isolated limb jerking Head turning! (away from side of seizure) Isolated paraesthesia TODD's PARALYSIS - temporary paralysis/weakness

Answer 144

Usually from temporal lobe Can affect awareness +/- memory - before, during or after! Visual/auditory halluciations LIP SMACKING Automatism Post-ictal confusion/drowsiness Sx depend on lobe involved!

Answer 145

Partial seizure that spread to lower brain area ∴ Initial a generalised seizure usually tonic-clonic

Answer 146

Seizure lasting longer than 5 minutes or more than 1 within 5 minutes without returning to normal consciousness in between

Answer 147

Convulsive : Jerking, grunting, drooling, nystagmus Non-Convulsive : NO jerking, confusion, unable to speak, behavioural changes

Answer 148

IV benzodiazepine - Lorazepam, diazepam Rectal benzodiazepine - Buccal midazolam Phenobarbital - 2nd Line Phenytoin - 3rd Line

Answer 149

Can cause circulatory depression

Answer 150

Can cause severe cardiac arrythmia

Answer 151

Clinical diagnosis - **AT LEAST 2 or more unprovoked seizures > 24 hours apart !!** EEG - Not diagnostic Can support diagnosis but might show false negatives MRI/CT - can show focal lesions to identify cause Bloods - FBC, U&E, LFTs, BM (to look for potential cause)

Answer 152

Sodium Valproate UNLESS female of childbearing age - Lamotrogine

Answer 153

Sodium Valproate UNLESS female of childbearing age - Lamotrogine

Answer 154

Sodium Valproate UNLESS female of childbearing age - Lamotrogine

Answer 155

Sodium Valproate UNLESS female of childbearing age - Levetiracetam or Topiramate

Answer 156

1. Ethosuximide 2. Sodium Valproate UNLESS female of childbearing age - Ethosuximide

Answer 157

Lamotrigine or Carbamazepine

Answer 158

**1. Amyotrophic Lateral Sclerosis** (ALS) Loss of MN in motor cortex + ant. horn UMN + LMN SIGNS **2. Progressive Bulbar Palsy** Affects brainstem motor nuclei, CN nerves 9-12 !! UMN + LMN **3. Progressive Muscular Atrophy** LMN only! Distal muscles before proximal **4. Primary Lateral Sclerosis** UMN signs only!

Answer 159

**1. ALS** Progressive focal wasting, weakness and fasciculations spreading to other limbs! Cramps Spasticity Brisk reflexes **2. Progressive Bulbar Palsy** CN 9-12 affected ∴ PALSY of the tongue, chewing/swallowing and facial muscles **3. Progressive Muscular Atrophy** Weakness + Fasciulations starts in one limb, progresses to adjacent spinal segments Distal before proximal!! LMN only! **4. Primary Lateral Sclerosis** Slow progressive tetraparesis and pseudobulbar palsy UMN only!

Answer 160

**U**MN = Everything goes **UP**! -- ↑Muscle tone = spasticity Hyperreflexia (overrative/overresponsive reflexes) NO Fasciculations! ++POS BABINSKI SIGN - Extensor plantar response Pyramidal/Pronator drift CORTICAL SENSORY LOSS _Maybe_ emotional lability Upper limb extensor weaker than flexor! Lower limb flexors weaker than extensor! Fine movements impaired

Answer 161

Everything goes **DOWN** ↓Muscle tone (Hypotonia) - Flaccid (can be normal) HYPOreflexia (reduction or absence of reflex) FASCICULATIONS ! Muscle wasting! Can be Bulbar (speech/swallowing muscles), Upper limb (hand), Lower limb RESPIRATORY! - weakness of breathing muscles, most patients will die bc of this Diaphragm higher up!!

Answer 162

When you stroke sole of foot, normally big toe will go down If positive = will go up = UMN lesion

Answer 163

Hold arms out w palms up, eyes closed Arm will "drift" away (or turn so palm down? idk need to check this)

Answer 164

Wasting of tibialis anterior muscle = BILATERAL FOOT DROP & Prominent tibial bones

Answer 165

Cervical spine lesion - can present with UMN + LMN in arms and legs Idiopathic multifocal motor neuropathy - weakness in hands and profuse fasciculations

Answer 166

CLINICAL DEF = **LMN + UMN signs in at least 3 regions** -- MRI of brain/spine Nerve conduction studies Electromyography - can confirm LMN

Answer 167

NO NEED WEAKNESS TOO!!!!!

Answer 168

Usually fatal within 2-4 years

Answer 169

Usually sporadic, no known RF MIGHT be linked to a mutation in SOD-1 (scavenging enzyme superoxide)

Answer 170

1. No sensory loss = RULE OUT MS or MYELOPATHY 2. No disturbances in eye movements = RULE OUT MYASTHENIA GRAVIA OR MS 3. No sphincter disturbances = RULE OUT MS

Answer 171

NO CURE! Oral Riluzole Palliative :(

Answer 172

NG/PEG tube - Dysphagia Oral amitriptyline - Drooling (bulbar palsy) Baclofen - spasticity Analgesic ladder - Joint pain

Answer 173

Na+ channel blocker Inhibits Glutamate release

Answer 174

Bell's = Lesion in CN 7 NOT FOREHEAD SPARING - forehead and lip droop Stroke = Central lesion FOREHEAD SPARING - ONLY lip droop

Answer 175

**ABCDE** **A**lcohol **B**12 deficiency **C**ancer and CKD **D**M and Drugs - isoniazid, amiodarone, cisplatin **E**very vasculitis

Answer 176

2 Patterns - Axonal Loss and Demyelination 1. Axonal loss Sensory changes - symmetrical numbness, burning or pins and needles THEN progresses to motor symptoms 2. Demyelination Motor changes - Weakness THEN progresses to motor symptoms -- Slow healing Sensitivity to touch Persistent injury Lack of sensation Burning pain Ulcers

Answer 177

Nerve conduction studies Rule out DDx

Answer 178

Olfactory Anosmia - Can't smell

Answer 179

Optic Visual defect - depends on location of lesion! LEARN

Answer 180

Occulomotor Ptosis - drooping eyelid Fixed dilated pupil Eye down and out

Answer 181

↑ICP DM HTN Giant cell arteritis

Answer 182

Trochlea Diplopia when looking down (e.g. walking downstairs)

Answer 183

Trigeminal Jaw deviates to side of lesion Loss of corneal relex

Answer 184

Facial Facial droop and weakness (BELL'S) Dribbling at side of mouth

Answer 185

Vestibulocochlear Hearing impairment, Vertigo, Lack of balance

Answer 186

Local tumours - if tumour in internal acoustic meatus, will press on CN7+8 Skull fracture - CN8 close to bone Ear infections

Answer 187

Glossopharyngeal + Vagus Gag reflex issues Dysphagia - Uvula deviates AWAY from side of lesion Vocal issues

Answer 188

Jugular foramen lesion

Answer 189

Accessory Sternocleidomastoid and Trapezius palsy Can't shrug shoulders or shake head

Answer 190

Hypoglossal Tongue deviates towards side of lesion

Answer 191

Alzheimer's - MC !! (50%) Vascular Lewy-Body Fronto-Temporal Can be mixed - more than one cause

Answer 192

Must inform DVLA!!! Can't drive until seizure free for one year!!

Answer 193

↑ Age - usually develops after 60 FHx Mutations in amyloid precursor protein Apoprotein E allele E4 - encodes a cholesterol transport protein Caucasian Down's

Answer 194

Beta amyloid plaques and neurofibrillary tangles accumulate causing neuronal death Also, loss of ACh

Answer 195

**4 A's** **A**mnesia - recent mems lost first **A**phasia - speech muddled/disjointed **A**gnosia - recog problems **A**praxia - can't carry out fine/skilled tasks despite normal motor function -- gradual onset!

Answer 196

MRI !! Degen of cerebral cortex w/ Cortical atrophy

Answer 197

Acetylcholine inhibitor e.g. Donepezil, Rivastigmine Memantine Social support

Answer 198

Atrophy to frontal and temporal lobes!

Answer 199

Onset BEFORE 65 Memory + Visuospatial skills are preserved Personality changes and social conduct problems !!

Answer 200

Insidious onset Rapid progress

Answer 201

Supportive

Answer 202

Brain damage from a cerebroVASCULAR disease

Answer 203

Hx of Stroke/TIA HTN DM Smoking Obesity Coronary hear disease FHx of Stroke

Answer 204

**STEPWISE DETERIORATION OF COGNITION** - w short periods of stability Attention deficits Loss of exec function (kinda like organising, scheduling, memory - stuff for work)

Answer 205

MRI - infarcts

Answer 206

ALPHA-SYNUCLEIN AGGREGATES form Lewy body deposits within neurons Found in substantia nigra and cortex!!

Answer 207

After onset of dementia, PARKINSONISM follows ! :( Cog fluctuations Visuospatial abilities impaired REM sleep affected Visual hallucinations ↑↑Exec dysfunction!

Answer 208

Usually clinical diagnosis

Answer 209

Abrupt OR Gradual

Answer 210

Acetylcholinesterase inhibitors - rivastigmine, donepexil Memantine

Answer 211

Autosomal dominant neurodegen movement disorder FULL PENETRANCE - all gene carriers WILL get the disease

Answer 212

↑ CAG repeats ! < 28 = normal 28 - 35 - high risk > 36 = DIAGNOSTIC ! -- CAG repeats form faulty protein This protein builds up in striatum ∴ cell death + loss of cholinergic + GABA-nergic neurons ∴ ↓ACH and ↓ GABA synthesis in striatum ↓ GABA = less regulation of dopamine ∴ **XS dopamine** ∴ chorea

Answer 213

Continuous flow of involuntary, jerky, semi-purposeful movements Cease during sleep

Answer 214

More repeats each generation

Answer 215

50% ONLY IF THEY HAVE THE GENE THEY WILL GET IT

Answer 216

**1st Phase** Depression Incoordination Personality change **2nd Phase** Chorea Abnormal eye movement Loss of coord Dysarthria Dementia Depression Rigidity

Answer 217

PCR testing - shows CAG repeats MRI/CT - shows atrophy of striatum (caudate and putamen)

Answer 218

No cure. Symptoms management = FOR CHOREA - Antipsychotics e.g. Risperidone or Tetrabenazine FOR DEPRESSION - SSRI e.g. Sertraline FOR AGGRESSIVE BEHAVIOUR - Antipsychotics e.g. Risperidone

Answer 219

Suicide :((( rlly rlly sad :( Aspiration pneumonia also common cause

Answer 220

Dopamine receptor antagonists

Answer 221

Depletes dopamine