Neuro Flashcards
first-line treatemnt for spasticity in multiple sclerosis
Baclofen and gabapentin
Rules about stopping
anti epileptic drugs
can be considered if been seizure free for 2 years. AEDs to be stopped over 2-3 months
A 45-year-old female with multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck. What is this an example of?
This is a classic description of Lhermitte’s sign which indicates disease near the dorsal column nuclei of the cervical cord. It is also seen in subacute combined degeneration of the cord and in cervical stenosis
seen in MS
what is Uhthoff’s phenomenon?
Uhthoff’s phenomenon: worsening of vision following rise in body temperature
MS
Lewy body dementia typically presents with…in contrast to other forms of dementia
Lewy body dementia typically presents with fluctuating cognition in contrast to other forms of dementia
most common complication following meningitis
Sensorineural hearing loss is the most common complication following meningitis
Lip smacking would indicate which type of seizure
Lip smacking would indicate a temporal lobe seizure.
Paraesthesia is a feature of… seizures
Paraesthesia is a feature of parietal lobe seizures
A Jacksonian march is a feature of… seizures.
A Jacksonian march is a feature of frontal seizures.
Plucking of clothes is typically seen in…seizures
Plucking of clothes is typically seen in temporal lobe seizures
brain abscess causes
extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries and embolic events from endocarditis
brain abscess features and investigations
You arrange an urgent CT head that shows a frontal ring enhancing lesion.
management of brain abscess
surgery
* a craniotomy is performed and the abscess cavity debrided
* the abscess may reform because the head is closed following abscess drainage.
IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
intracranial pressure management: e.g. dexamethasone
triad in wernick’s encelopathy
oculomotor dysfunction
* nystagmus (the most common ocular sign)
* ophthalmoplegia: lateral rectus palsy, conjugate gaze palsy
gait ataxia
encephalopathy: confusion, disorientation, indifference, and inattentiveness
peripheral sensory neuropathy
wernick’s encelopathy management
give Pabrinex (IV B/C vitamins) as they have thiamine deficiency
Suspected optic neuritis investigation of choice
MRI of the brain and orbits with gadolinium contrast is the investigation of choice
parietal lobe seizure would typically present with
Parietal lobe is incorrect. A parietal lobe seizure would typically present with sensory disturbances, such as paraesthesia, electric shock type sensations, hallucinations, or dizziness.
A temporal lobe seizure usually presents with
A temporal lobe seizure usually presents with automatisms, such as lip-smacking, grabbing, or plucking at clothes, along with sudden emotional disturbance or a feeling of deja vu
Seizures originating in the occipital lobe typically present as
Seizures originating in the occipital lobe are typically visual, presenting with flashers and floaters, or lines in the vision
cerebellar damage symptoms
While the cerebellum can indirectly cause epileptic seizures, they are unlikely to originate in the cerebellum itself. Symptoms of cerebellar damage include gait disturbance, jerky movements, and speech disturbance, which are similar to those seen here. However, a frontal lobe seizure is more likely.
frontal lobe seizure presents as
The history of clonic movements starting in one extremity and moving proximally through the body is typical of a Jacksonian March. This, combined with post-ictal weakness usually indicates a frontal lobe origin.
A 65-year-old woman presents with fatigue, paraesthesia in her hands and feet, and mild gait unsteadiness. She reports that her symptoms have developed over several months. Her diet is limited, and she admits to rarely consuming meat or dairy products. On examination, you notice reduced vibration and proprioception in the lower limbs.
Blood tests show:
Hb 90 g/L (115 - 160)
Mean cell volume 110 fL (80 - 100)
Vitamin B12 34 ng/L (200 - 900)
Folate 1.5 nmol/L (> 3.0)
What is the most appropriate next step?
Administer IM B12 followed by oral folic acid
In patients with both vitamin B12 and folate deficiencies, the vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord
what is used to prevent vasospasm in aneurysmal subarachnoid haemorrhages
Nimodipine is used to prevent vasospasm in aneurysmal subarachnoid haemorrhages
Of the antiparkinson drugs…associated with the greatest improvement in symptoms and activities of daily living
Of the antiparkinson drugs, levodopa (co-carledopa) is associated with the greatest improvement in symptoms and activities of daily living
Which vitamin, present in Pabrinex, can prevent progression of symptoms to Wernicke’s encephalopathy?
B1
First line treatment in diabetic neuropathy is with
First line treatment in diabetic neuropathy is with amitriptyline, duloxetine, gabapentin or pregabalin
Drug-induced parkinsonism compared to Parkinson’s disease:
motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommon
S1 lesion features
S1 lesion features = Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test
migraine attack prevention in asthmatics
topiramate
syncope vs seizures
Syncopal episodes are associated with a rapid recovery and short post-ictal period. Seizures are associated with a far greater post-ictal period
What is the most common clinical pattern seen in motor neuron disease?
Amyotrophic lateral sclerosis (ALS) (Lou Gehrig’s disease), most common form of motor neuron disease.
* both upper and lower motor neurons.
* leads to progressive weakness and atrophy of voluntary muscles.
* The pattern of ALS is typically characterised by a relentless progression of symptoms over time.
…symptoms suggests idiopathic Parkinson’s
Asymmetrical symptoms suggests idiopathic Parkinson’s
