Neuro Flashcards
LMN signs
Wasting
Hypotonia
Hypo-reflexia
Fasciculations
Others: stocking sensory loss, loss of proprioception, high stepping gait, sensory ataxic gait, pes cavus
UMN signs
Hypereflexia Increased tone - spasticity Up going plantars - babinski Hoffmans reflex Spastic gait
Triptans
Constrict cranial arteries
Also inhibit release of neurotransmitters involved in pain
Ci: IHD, uncontrolled BP, lithium, SSRIs
Migraine - international headache society
A - 5 attacks fulfilling criteria for b-d
B - 4-72 hours
C - characteristics, unilateral, pulsatile, moderate/severe pain, avoidance/aggravated by daily activities
D - during - nausea or vomiting, photphobia, phonophobia
E - exclude other causes
Migraine prophylaxis
If more than 2 a month
- Propranolol, topiramate
- Valproate, pizotifen
Essential tremor features
Familial - autosomal dominant
In both upper limbs
Worse if outstretched
Relieved by alcohol/rest
Parkinson’s typical symptoms
Resting tremor
Bradykinesia
Rigidity
ROSIER Score
Risk of stroke
Stroke is likely if score >0
Carpal tunnel syndrome
Compression of median nerve
Shaking hands relieves pain
Guillain-Barré syndrome
Campylobacter jejuni
CMV
CSF: increased protein
Signs: areflexia
Can have cranial nerve involvement and auto mind nervous system involvement
NPH triad
Urinary incontinence
Gait disturbance
Dementia/bradykinesia
No papilloedema
Enlarged 4th ventricle on imaging
Benign intracranial hypertension management
Weight loss
Diuretics
Topiramate
Repeated LP
Epilepsy management
Partial - carbamazepine
Generalised tonic-clonic - sodium valproate, lamotrigine, carbamazepine
Absence: valproate, ethosuximide
Myoclonic: valproate, clonazepam, lamotrigine
Valproate side effects
Appetite increase, weight gain Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenic, tremor, thrombocytopenia Encephalopathy
Parkinson’s gait
Shuffling gait - festinance
Stooped
Reduced arm swing
Narrow base
Features of Parkinson’s
Tremor Bradykinesia Rigidity Posture and gait Speech Face Depression Dementia Hallucinations
L-dopa side effects
Nausea, diarrhoea, GI upset
Dyskinesias
Hypotension
Arrythmias
Psychosis - confusion, disorientation, insomnia, nightmares
Compulsive behaviours - gambling, spending, sexual
On-off effect
Parkinson’s plus syndromes
Progressive supra nuclear palsy Multi system atrophy Cortico-basal degeneration Lewy body dementia Vascular parkinsonism
ABCD2 scoring system
Risk of stroke after TIA
A age >60 1 point
B blood pressure at presentation >140/90 - 1 point
C clinical features
- unilateral weakness - 2 points
- speech disturbance without weakness - 1 point
Duration of symptoms:
- >60 mins - 2 points
- 10-59 minutes - 1 point
D diabetes - 1 point
Causes of TIA
Atherothromboembolism - carotid
Cardio embolism - AF, mural thrombus, valve disease, prosthetic valve
Hyper viscosity - polycythaemia, sickle cell, wcc
Vasculitis
Differentials of stroke
Head injury Subdural Intracranial tumours HypoglyCaemia Wernickes Drug overdose Abscesses Epilepsy Hemiplegic migraine TIA Bells palsy
Causes of polyneuropathies
Metabolic Vasculitides Malignancy Inflammatory Infections Nutritional Inherited syndromes Toxins Drugs Others
Autonomic neuropathy causes
Diabetes Amyloid GBS HIV paraneoplastic syndromes Leprosy
Epilepsy driving requirements
First seizure - 6 months off driving
Established epilepsy - fit free for one year
Epilepsy medications
Partial - carbamazepine
Generalised tonic-clonic: valproate, lamotrigine, carbamazepine
Absence: valproate, ethosuximide
Myoclonus: valproate, clonazepam, lamotrigine
Epilepsy in pregnancy
5mg folic acid
Breastfeeding ok for most antiepileptics
Post-herpetic neuralgia
Amitriptyline
Topical capsaicin
Tramadol for rescue therapy
Trigeminal neuralgia management
MRI to exclude secondary cause
Carbamazepine
Branches of trigeminal nerve
V1 ophthalmic - superior orbital fissure
V2 maxillary - foremen rotundum
V3 mandibular - foramen ovale
Types of tremor
Essential Postural Anxiety Thyrotoxicosis Co2 retention Drug withdrawal Hepatic encephalopathy Cerebellar disease
Complications of seizures
Injuries
Hypoglycaemia
Pulmonary hypertension and oedema
Increase in ICP
When to consider stopping antiepileptics
If seizure free for more than two years, withdraw over 2-3 months
What is cataplexy?
Sudden and transient loss of muscular tone caused by strong emotion
2/3 of narcoleptic shave cataplexy
Causes of a LMN Facial palsy
Bell's palsy Ramsay hunt syndrome Acoustic neuroma Pontine tumours Middle ear problems Parotid problems
What causes a bilateral facial palsy?
Sarcoidosis
Tuberous sclerosis
AD
Like neurofibromatosis
Subungal fibromata
Stroke territory
ACA - contralteral hemiparesis and sensory loss, more in lower extremities
MCA - contralateral hemiparesis sensory loss more in upper limbs. Contralateral homonymous hemianopia. Aphasia
PCA - Contralateral homonymous hemianopia with macular sparing. Visual agnosia
Inheritance of duchennes
X-linked recessive
Grading muscle power
0 total paralysis 1 palpable or visible contractions 2 movement with gravity eliminated 3 movement against gravity 4 weaker than usual 5 normal
Concussion management
Cold compression Rest Pain relief - paracetamol, avoid NSAIDs Avoid alcohol/drugs Avoid contact sports for about 3 weeks Return to school/driving when you feel recovered Someone to stay with them for 48 hours
Neuroleptic malignant syndrome
commonly young males
antipsychotic medications
Fever tachycardia
Rigidity
Management:
- Stop medication
- fluids to prevent renal failure
- dantrolene/bromocriptine
Acute generalised weakness differentials
Stroke/TIA
GBS MG Tetanus MS Spinal cord compression Polymyositis Alcoholic myopathy Botulism Diptheria Lead poisoning
WFNS scale
scoring system for SAH Grades I - IV I GCS 15 no motor deficit II 13-14 and motor deficit III gcs 7-12 IV gcs 3-6
Other grading systems: Fischer and Classen. Hunt & Hens
Migraine treatment
NSAIDs - ketoprofen, aspirin
Triptans
Migraine prophylaxis
> 2 a month
Propanolol/Topiramate
Try for 3 months before changing
12-17 year olds - use nasal triptans
Migraine in pregnancy
Paracetamol 1g
Aspirin 300mg/Ibuprofen 400mg (1st and 2nd trimester)
Features of Parkinsonian gait
Loss of arm swing Hesitancy Shuffling Festination Clock face turning
Most common type of ms
Relapse remitting
CSF results for ms
Oligoclonal bands
Key places to look on an MRI in ms
Peri ventricular
Juxtacortical
Infratentorial
Spinal cord
How does sulfasalazine work?
Inhibits output of Tnf and cytokines
CSF analysis meningitis
Bacteria - polymorphs
Viral - lymphocytes
