Neuro Flashcards
Where do the demyelinating plaques occur in MS? and what symptoms does this give?
Occurs:
- Optic nerves: optic neuropathy & pain on movement
- Paraventricular regions: slow gait speed and mental ability
- Brainstem: sudden diplopia and nystagmus
- Spinal cord: spastic paraparesis + urinary symptoms
Explain Unthoffs phenomena
Unthoffs phenomena - symptoms worse on heat and exercise
What investigations could you do to someone with MS and what would they show?
MRI - multiple plaques seen in paraventricular regions, corpus callosum, cerebellar peduncles, brainstem and cervical cord
LP - Oligoclonal bands IgG electrophoresis
EV - evoked potentials
What do you have to have to make a diagnosis of MS?
Lesions disseminated in time and space
What treatment can you give for
a) acute relapses
b) Active relapsing and remitting
c) Severe relapsing and remitting
a) Acute relapses = steroids: methylprednisolone
b) Active relapsing and remitting = beta interferons,
c) Severe relapsing and remitting = monoclonal antibodies: Natalizumab
What are the different types of MS?
Relapsing and remitting
Rapdily progressive
Primary progressive
Secondary progressive
What are the differentials for MS?
SLE
CNS sarcoidosis
Describe Gillian-barre syndrome
= acute inflammatory demyelinating polyneuropathy
Trigger = infection
Progressive symmetrical weakness/numbness of the distal muscles which can eventually progress to the proximal muscles
Areflexia
Autonomic neuropathy: arrhytmias, increased HR, Sweating and urinary retention
What are the diagnostic features of GBS?
Required: progressive weakness of all 4 limbs & areflexia
Supportive: progressive over 4 weeks, symmetrical, mild sensory impairment, autonomic dysfunction, no fever at onset
Recovery 2 weeks after the period of progression has stopped
How do you treat BGS?
Suportive AAAA Airway support Analgesia: NSAID Autonomic: catheters Antithrombin: LMWH
Iv Immunoglobulin
Plasma exchange
Which gland is associated with MG?
Thymus
What type of medication is pyridostrigmine?
Anticholinesterase
What are the treatment options for MG?
Symptoms: anti cholinesterase = pyridostigmine
Immunosuppression: Prednisolone/methotrexate
Thymectomy
Which nerve is involved in carpal tunnel syndrome?
What movement does this nerve do?
Median nerve - C6-T1
Pincer grip
What is dysphonia?
Give some causes
Dysphonia = difficulty producing sound of the voice - hoarse/whispered speech
Causes: laryngitis, CNX lesions, Parkinsonism
What is dysarthria?
Give some causes
Difficulty speaking - poorly articulated/slurred
Basal ganglia - parkinsonism, dystonic
Motor-end plate - MG
Brainstem- bulbar
What is dysphagia?
Disorder of language content
What are the two different types of aphasias?
1) Fluent/receptive aphasia
Problem understanding - werkicke’s aphasia
2) Non-fluent/expressive aphasia
Problem articulating
Broca’s aphasia
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
c) PCA
Amaurosis fugax
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)
Amaurosis fugax
d) retinal/opthalamic artery
‘Locked-in’ syndrome
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)
‘Locked-in’ syndrome
e) Basilar artery
Contralateral hemiparesis and sensory loss, lower extremity > upper
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)
Contralateral hemiparesis and sensory loss, lower extremity > upper
a) ACA
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)
b) MCA
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)
PICA
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
a) ACA
b) MCA
c) PCA
d) Retinal/opthalamic artery
e) Basilar Artery
f) Weber’s syndrome (branches of the PCA that supply the mid brain)
g) PICA (lateral medullary syndrome, Wallenberg syndrome)
Webbers syndrome
What is menieres disease?
Disorder of the inner ear - intermittent endoolymph HTN
Attacks of severe vertigo, N&V, low frequency hearing loss, tinnitus and a feeling of a full ear
How do you diagnose benign paroxysmal positional vertigo?
Hallpikes Manoeuvre
How do you diagnose menieres disease?
Audiomety documented low to medium frequency sensioneural hearing loss
>2 episodes of vertigo between 20m-12 hours long
Fluctuating aural symptoms
How do you treat menieres disease?
Low sodium diet
Thiazide diuretic - bendroflumethiazide
Surgical - endolymphatic sac removal
What spinal cord disorders can cause dizziness?
MS
B12 deficiency
What are the 3 parts of GCS and what are they out off?
What is the value for a comatose patient and a totally unresponsive patient?
Eye opening /4 Verbal /5 Motar /6 Comatose = 8/15 Totally unresponsive = 3/15
Give some causes of coma
V = cerebrovascular disease, hypoxic-ischamic injury
I = meningitis, encephalitis, sepsis
T = trauma
A
M = Hypoglycemia, DKA, hyperglycaemia hyperosmolar state, hypothyroid, acute renal failure, hepatic encephalopathy
I = Opioid (give naloxone) Benzodiazepine (flumazenil)
How can you tell if someone is brain stem dead?
Eyes: 1) pupil 2) blink 3) move side-side
Ears: Eye movement to temp
Gag, cough and pain
Pupillary light reflex
Corneal reflex - V & VII
Oculocephalic reflex - eyes move side to side when head is move to remain looking at a fixed position
Caloric reflex - eyes move to ear when warm/cold water is added
Pharyngeal gag reflex, laryngeal cough reflex
Response to pain in the trigeminal distribution
What is a apnea test?
This is mandatory to diagnose someone as brain stem dead - ventilatory support is slowly turned off and their co2 levels are monitored
+ve - if they rise and there is no response/increased respiratory effort made
What is Guillian-Barre syndrome?
It is an acute demyelinating polyneuropathy with absent reflexes
What can trigger GBS?
Campylobacter jejuni
EBV
CMV
HIV
What are the signs that you might see with GBS?
Observation - fasciculations T: Hypotonia P: reduced power S: Altered sensation R: absent or reduced reflexes
What might you see in LP of GBS?
Increase in CSF proteins but not cells
How do you treat GBS?
Supportive - analgesia, catheters or LMW heparin (DVT prophylaxis is essential)
- Plasma Exchange (remove the abs)
or// - IV immunoglobulins (reduce to immune response)
What are the complications of GBS?
Persistent paralysis
Resp failure (measure FVC 4 hourly)
VTE
Cardiac arrhythmias
What is MG?
Its an AI disease with auto-abs to the ACh receptors at the NMJ
Which drugs can exacerbate MG?
BB Aminoglycoside abs (gentamicin)
What is Lambert-eaton syndrome and what conditions is it associated with?
It is opposite to MG
Repeated muscle contractions leads to increased muscle strength (less fatiguability following repetition)
Its due to abs against the pre-synaptic voltage gated calcium channels in the peripheral NS
Associated with SCLC, breast and ovarian ca
The Revised El Escorial Criteria is used to make sure other possible causes have been ruled out before making a diagnosis on MND.
What pointers are suggestive of MND?
Asymmetrical distal weakness
Brisk reflexes in a wasted limb
No major sensory/pain
Relentless progression of signs and symptoms
What are the SE of levodopa?
Dyskinesia
“on/off” effects
Postural hypotension
Psychosis
Give examples of the dopamine receptor agonists
& SE
Bromocriptine, ropinirole + cabergoline
SE: impulse control, excessive daytime sleeping, hallucination, postural hypotension
What can you give for prophalaxis of cluster headaches?
Verapamil
What are the red flags of headaches?
Signs of raised ICP (worse in the morning, vomiting)
Headache with new onset seizure/focal neurological deficit
Thunderclap
Jaw claudication/visual disturbances
Signs of meningism - neck stiffness/photophobia
Progressively worsening
What are SAH associated with?
HTN + Poly cystic kidney disease
What would you see on a LP of SAH?
Xathnochromia
How would you treat SAH?
A–>E
Prevent vasospasm = Nimodipine
Prevent re-bleeding = endovascular clipping and coiling
