Neuro Flashcards

Question

Bell’s palsy Mx

Answer 1

eye drops close eyelid at night high dose steroids if seen \<72hrs consider referral if still weak at 6/12 check BP, sometimes vascular cause

Answer 2

tremor rigidity bradykinesia loss of postural reflexes

Answer 3

ADLs handwriting (micrographia) buttons and shoelaces turning over in bed at night getting in and out of car

Answer 4

poverty of facial expression 5Hz tremor cogwheel rigidity at wrist thumb finger test toe tap test function exclude Parkinson’s plus

Answer 5

parkinsons disease vascular parkinsonism parkinsons-plus syndromes other (antidopaminergics, Wilson’s)

Answer 6

progressive supernuclear palsy : vertical limitation, axial rigidity multi-system atrophy- cerebellar signs, autonomic problems corticobulbar degeneration lewy body dementia

Answer 7

loss of arm swing (early) hesitancy shuffling hurrying (festination) retropulsion (falling backward) clock face turning

Answer 8

drug induced dyskinesias: choreo-athetoid movements fluctuations: predictable (end of dose) unpredictable (on-off effect) all commoner with L dopa and less common with DA agonists

Answer 9

wernickes encephalopathy stroke demyelinating disease MS

Answer 10

clinical exam and hx may be sufficient 2 separate attacks affecting different parts of the CNS MRI: periventricular and juxtacorticol plaques visually evoked potentials: delay in EEG response due to optic neuropathy somatosensory evoked potentials: delay in EEG response after episode of sensory demyelination CSF- oligoclonal bands (60% after one attack, 90% after 2)

Answer 11

may not need treatment if just sensory IV methylprednisolone for 3 days reduces length and severity, no impact long term small risk of psychosis, diabetes, AV necrosis femoral head high dose oral may be effective, but also increase relapse rate of optic neuritis

Answer 12

partial ptosis eye abducted and depressed pupil dilated (loss of parasympathetic fibres)

Answer 13

Diabetes (pupil often spared) PCA aneurysm (often painful) raised ICP (false localising)

Answer 14

parasympathetic fibres have a separate blood supply from the nerve sheath vessels

Answer 15

slight ptosis constricted pupil reduced sweating on forehead eye is bloodshot early loss of alpha vasoconstrictor tone

Answer 16

The nucleus is in the lower pons. The nerve exits anteriorly and travels up the brainstem on either side of the basilar artery, in the subarchnoid space (here it is susceptible to meningitis and rarely basilar aneurysms) It passes forward over the base of the skull towards the tip of the petrous temporal bone (here it.can be damaged by severe ear infections associated with bone infections- osteomyelitis- as well as by skull fractures and by nasopharyngeal cancer) It enters the cavernous sinus and then goes through the superior orbital fissure to reach the eye.

Answer 17

Brain stem vascular accident (associated contralateral hemiparesis) acoustic neuroma, within the cerebello-pontine angle trauma Ramsay hunt syndrome - Hz affecting geniculate ganglion bells palsy- in facial canal pagets disease of bone parotid trauma, surgery, tumour mononeuropathy - sarcoid diabetes

Answer 18

Look for signs of CVA (hemiparesis) Parkinson's disease, scleroderma etc; Then say Hello, my name is ....., would you mind if I ask you some questions to check your speech and memory? Check orientation while listening to quality of voice Can you tell me your name? How old are you? Do you know what day of the week it is? And what year this is? And where are we at the moment? If you suspect problems with cognitive function after this, proceed with mini mental state examination including counting backwards from 20 etc Check for dysphasia Can you lift your left hand and place it on top of your head? (tests receptive dysphasia- important not to move your arm as patient may copy you- you need to check that spoken instruction is understood without any visual clues). What is this? (tests for nominal dysphasia using keys or pen or newspaper etc) Check for dysarthria If the speech is suggestive of dysarthria, ask patient to say "Baby hippopotamus" or "British constitution" or "West Register Street, Edinburgh". May be appropriate to check cerebellar signs; eg ask patient to stretch out their arms looking for ataxia of upper limbs. If pseudobulbar palsy suspected, look in mouth (for spastic tongue) plus check jaw jerk- increased in pseudobulbar palsy. Ask about symptoms If no abnormality demonstrated, proceed to listen to a longer segment of speech and check symptoms: “What symptoms led to your admission to hospital?” In general Be prepared to modify your approach according to what you find eg if patient has Parkinson’s, be prepared to demonstrate the signs once you have listened to the voice. Remember that the examiners will probably point you in the right direction if you are going down a blind alley. The main thing to demonstrate is that you are aware of simple ways to elicit dysphasia, dysarthria and orientation.

Answer 19

difficulty with mechanism of speech bulbar palsy= flacid pseudobulbar palsy = spastic cerebellar = staccato myasthenic = weak, quiet, fatigable

Answer 20

Difficulty with processing of speech expressive (Broca’s)= knows what they want to say, but can’t say it Receptive (Wernicke’s)= fluent, effortless, lacks meaning, can’t follow cues written/spoken.

Answer 21

Dopamine transporter scan single photon scan with contrast normal ‘comma’ appearance of basal ganglia loss of DA neurones in lentiform nucleus occurs in Parkinson’s and parkinsonism not essential tremor

Answer 22

parkinsons less effective then LDopa but cause less effects, so used in younger people used in addition to LDopa in advanced stages older ones e.g. pergolide cause pulmonary and cardiac fibrosis —\> MR side effects sleepiness hallucinations impulse control

Answer 23

Probably autoimmune once triggered antigens attack myelin and oligodendrocye glycoprotein initial attack leaves inflammation of the bbb allows B and T cells to cross direct damage to axons and indirect damage (demyelination)

Answer 24

Relapsing remitting 80% primary progressive 10% benigh 10% secondary progressive (after about 10 years of relapsing remitting)

Answer 25

sensory 40% optic neuritis 20% cerebellar/vertigo 20% internuclear opthalmoplegia 10% motor (usually spastic paraparesis) 10%

Answer 26

MS amyotrophic lateral sclerosis transverse myelitis spinal cord compression/trauma intramedullary structural lesions cervical myelopathy spinocerebellar degeneration B12 deficiency Luetic disease

Answer 27

ambulant patients with RRMS \>2 relapses in 2 years one relapse + radiological progression