Neuro 2 Flashcards
secondary causes of demyelination
central pontine myelinosis, progressive multifocal leucoencephalopathy, subacute sclerosis pariencephalitis, AIDs, axonal degeneration
MS when
any age but childhood and over 50 is rare
where are the plaques
in white matter (so external brain and spinal cord looks fine)
commonly in optic nerve, periventricular white matter, corpus callous, brain stem and spinal cord
what can plaques of MS act like
SOL
acute MS
chronic MS
yellow/brown, ill defined edge
well demarcated grey/brown, classically lateral ventricles
ix for MS
MRI
CSF - 90% show oligoclonal bands
relapsing remitting
distinct symptom that fade away partially or completely
secondary progressive
relapsing and remitting that stops relapsing
progressive relapsing
relapses then doesn’t relapse again
primary progressive
no remissions just worsens
commonest type of MS
relapsing remitting
treatment of fatigue
amontodine
modafinic if sleepy
hyperbaric oxygen
treatment of acute exacerbation
methylprednisolone PO
severe - admit and IV steroids
regular relapses - aziothoprine
pyramidal
OT, physio
spasticity
physio, baclofen, gabapentin, botulonim toxin
sensory
gabapentin, amitrip, acupuncture, ligocaine infusion
LUT
oxybutinin, desmopressin, catheter
DMARDs first line
interferon beta and copioxon
tecfidera (dimethylfumeratic)
DMARDs second line
tysabri (natalzimub) or lemtrada (alemtrizumab)
fingolimed
third line DMARD
mitoxantrone
first line when
interferon beta and copioxone or tecfidera (dimethyl)
at least 2 attacks both times recovered partially or completely, can walk 100m
relapsing remitting
tysabri (natalzimub) or lemtrada (alemtrizumab)
monoclonal antibodies
highly active RR rapidly evolving or high disease activity despite treatment with interferon beta
mitoxantrone
Relapsing progressive
12 infusions over 2 years
cardiac toxicity dose related
motor features of parkinson’s
tremor, muscular rigidity, amnesia, resting tremor, gait, postural impairment
non motor features of parkinsons
when
olfactory dysfunction, cognitive impairment, psych symptoms, sleep disorders, autonomic dysfunction, pain and fatigue, RBD
can be present for a decade before motor symptoms
commonest neuro degen
2nd
alzheimers
parkisnosn
after 17 yrs of parkinson’s
80% gait freezing
50% choking
after 20 yrs of parkinsosn
83% have dementia
ix for RBD
overnight polysomnography to rule out mimics - obstructive sleep apnea, seizures, rapid eye movement parasomnia
rx of RBD
cx
clonazapam or melatonin at bedtime
isolated increases the risk of neurodegen dx
with PD - severe autonomic dysfunction, gait impairment, dementia
loss of what in pd
dopimergic neurones in the SNpc and lewy body pathology sections through the brain stem show loss of normally black pigment in substantia nigra and locuscoerleus
pigment correlates with dopinemergic loss
SNCA Px
LRRK2 Px
inherited
dom PD
treatment of early px
levodopa and careldopa/sinemet dopamine agonist (ropinirole, pramipexole) MAO/bi - selegiline
treatment of late px
patient on levodopa and developed motor complications
MAOIB, apomorphine, entacapone (COMTI)
anticholinergic in px
trihexypheridyl/clozapine for tremor
cause confusion in elderly
SE of DA
nausea, daytime solemence, oedema, avoid in patients with history of addiction, OCD, impulse personality
commonly associated with hallunicaiton - not given to elders esp those with cognitive impairment
long term cx of levodopa and DA
motor fluctuations and dyskinesia in later stages
non motor fluctuations
psychosis
decrease fluctuations
Add DA, MAOBI, COMTI (tolapone, entacapone)
direct delivery of stable levedopa
carbidopa gel/duodopal into dueodenum
sub cut infusion od
apomorphine - potent DA
psychosis
clozapine
2nd quetiapone
visual hallucinations and delusions in dementia
also for
rivastigamine
late stage dementia in PD
when does dyskiniesia occur with levedopa
movements at peak of concentration
or at beginning and end of dose (biphasic dyskinesia)
constipation
GI motility
fatigue
orthostatic hypotension
polyethyleneglyco
domperidone
methylphenidate, madanfil
clomperidone, fludrestirone, midorine, pyridogmiostigine
vascular parkinsonism symp
ix
lower body predom affected
no resting tremor
other signs of brain lesions vascular
poor levodopa response. do structural brain imaging
drug induced
symm. coarse postural tremor. tardy dystonia. akathesia
essential tremor
symm postura/kinetic 12Hz
autosomal dom
alcohol responsive
propanolol
resting tremor in parkinson’s
3-6Hz
multisystem atrophy
who
ix
60-70s
suboptimal and short lived levedopa response
only 1/3 get a response
MRI
cerebellar and pontine atrophy
hot cross bun sign
progressive supra nuclear palsy
ix
vertical supranuclear palsy
reterocolitis
staring
no response to levedopa
fragile x tremor and ataxia syndrome what is it who symp females children ix
abnormal number of CGGs in FMRI gene >50s cerebellar symptoms premature ovarian failure, early menopause classical fragile x syndrome
Mri - T2 hypersensitivities in middle cerebellar peduncles
molecular testing to confirm
