Neuro Flashcards
What is a myelopathy
problem with the spinal cord
stiffness
tongling numbness weakness more prominent than pain
What is a radiculopathy
problem with the spinal nerve root
What is a neuropathy
Disease of the peripheral nerve
What kind of neurology presents with cervical or lumbar degenneration?
if central - myelopathy, if lateral then radiculopathy
What are the causes of myelopathy
sponylosis rheumatoid arthiritis disc prolapse spinal stenosis vertebral collapse
most tend to be older. men over 60 and women over 50
what is the treatment for spondylosis?
stiff collar or surgical decompression
How do you distinguish a myopathy from a neuropathy?
neuropathy - distal weakness, paraesthesia
myopathy - proximal weakness, preserved reflexes
What are the causes of cerebellar syndrome
PASTRIES Paraneoplastic - bronchial carcimona alcohol - b12/thiamine Stroke - vertibrobasilar Tumour Rare - freisdricks, MSE Iatrogenic phenytoin Endocrine - hypothyroid Sclerosis
What distribution of weakness would you find with ACA stroke
Legs > arms with facial sparing
What distributoin of weakness would oyu see in MCA stroke
Facial and arms >legs (forehead sparing)
What does the posterior CA supply?
occipital lobes
presents with homonymous hemianopia with macula sparing
What does the vertibrobasilar circulation supply?
cerebellum ?occipital lobe and brainstem
would cause cerebellar signs plus CN and hemi/quadraplegia
What is lateral medullary syndrome?
blockage of one single vertebral artery or one posteria inferior cerebellar artery (PICA)
DANVAH Dysphagia ataxia(ipsilateral) Nystagmus vertigo Anaesthesia - numbness in face ipsilaterally and pain loss on contralateral side. Horners (ipsi)
What causes locked in syndrome
lesion of the pons usually basilar artery infarction
central pontine demyelinolysis
What is subclavian steal syndrome
retrograde flow through vertebral arteries to supply arm due to a blockage in the proximal part of the subclavian artery
causes syncope dizziness, arm symptoms
bp difference in arms
What is cerebellar pontine angle syndrome
myriad of symptoms caused by compression within the brain. usually due to a growing mass - schwannoma, met, meningioma astrocytoma. C5678 palsys on same side and cerebllar signs.
Muscle weakness differentials
Cortex - infarct, SOL, haemorrhage encephalitis, MS
Cord - Myelopathy, trauma, anterior spinal artery infarction, MS
Anterior horn: MND, polio
Nerve roots - spondylosis of lower spine, cauda equina
motor neurones - MMN, GB
What is CIDP
Chronic inflamatory demyelinating polyradiculoneuropathy
Lower motor neurone signs
NCS - slow velocities
LP - high protein
Management of CIDP
methylpred
IVIg
therapy for pain management - gabapentin
Difference between CIDP and AIDP/GBS
rate of onset. GBS is less than 1 month
What type of neuropathy do you get with diabetes
Peripheral pattern rather than distal with greater sensory symptoms compared to motor symptoms
Differentials for a neuropathy
Diabetes b12/folate alcohol thyroid disease amyloid SLE
What sensory disturbance is typically present in GBS
tingling in extremeties
What is charcot marie tooth also known as?
hereditary motor and sensory neuropathy
most common form is demyelinating
Features of charcot marie tooth?
Hereditary - positive fhx
pes cavus
champagne bottle legs due to muscle wasting
poor extensor and dorsoflexion. foot drop, high stepping gait.
symptoms are symetrical.
variable loss of sensation usually in a glove and stocking distribution
What is the common gene involved in charcot marie tooth?
PMP22
What conditions present with a mixture of upper and lower signs?
MND
Cervical spondylosis with myelopathy and radiculopathy - upper below the lesion and lower at the level of the lesion
What is the most common type of dystrophy?
duchenne - x linked dystrophin abnormalities
weak muscles abnormal postures due to weakness. pseudohypertrophy of calves (fat deposition)
tight achiles - tip toe walking
protruded stomach
presents by 4/5 years old and need a wheelchair by teens
How do you investigate duchenne?
CK - raised due to breakdown and loss
What is the difference between beckers and duchenne?
beckers is less severe - later onset - partially functioning dystrophy
Key features of MSA?
multi system atrophy is a parkinsinsons plus syndrome
parkisnons
autonomic dysfunction - orthostatic hypotension, urogenital dysfunction - incont +ED
cerebellar ataxia
lesions in which lobe cause inferior quandrantopias
parietal
Lesions in which lobe cause superior quandrantopias
temporal
Cabergoline well know side effect?
pulmonary fibrosis
Causes of a medical third nerve palsy?
Diabetes - mononeuritis
MS
midbrain infarct
migraine
Causes of a surgical third nerve palsy
Riased ICP - causes transtentorial uncal herniation
PCA infarct (painful)
cavernous sinus thrombosis
riluzole?
MND -confers survival benefit
prevents stimulation of glutamate recepters
used in ALS
3 months additional life
mydriasis
blown pupil
miosis
contricted pupil
why do shoulder and upper thoracic injuries cause horners?
sympathtic neurones which supply the retractor lids and sweating and pupil dilators come out at c8-t2 and travel back up via the cerivical ganglia
brachial plexus injuries damage this area
what drugs used to sedate someone?
offer oral lorazepam 2mg and then go to IM olanzapine?
commonest risk factor for bells palsy
pregnanacy
Features of wernickes encephalopathy?
CAN OPEN confusion ataxia nystagmus opthalmoplegia perihpheral neuropathy
What things can cause dizziness?
Illusion of self motion
Cardiovascular disease - LOW BP hyperventialation Anxiety - hyperventilation migraine epilepsy
Migraine of menopause?
dizziness, light headed, myalgic weak
vestibular funcrion?
absolute motion of the head through space. allows us to interpret things the rest of our proprioceptive skills and interpretations of light cannot
Menieres disease (true vestibular)
Dilation of endolymphatic spaces within the labyrinth:
Episodes last hours upto 12 aural fullness tinitus vertigo nausea and vomiting progressive hearing loss!!(sensorineural)
functional vertigo
may arise from high anxiety states and stressful situations. like still being on a boat/ on the sea etc. near miss in a car crash.
What is BPPV
Benign parxysmal positional vertigo
due to debris in the canals from the otoliths
classically middle aged after head trauma
comes on with sudden rotational vertigo caused by head turning
causes nystagmus
hangover(functional state) from the single 1 minute episode
How do you diagnose BPPV?
hall pike manoevre - causes upbeat torsional nystagmus
How do you treat BPV
epley manoevre - self limiting - betahistine can help
what do you call the infection which would commonly cause vertigo?
viral labrynthitis or vestibular neuronitis
Causes sudden severe vertigo can cause vomiting. may last a couple of days but wil pass. cyclizine for sickness
treatment for menieres disease?
avoid triggers - alcohol, tiredness, caffeine. salt.
betahistone -histamine agonist?
What is ramsay hunt syndrome?
Reactivation of herpes zoster in the geniculate ganglion of facial 7th nerve distibution.
rash in the hard palate, and in the auditory meatus
may cause ear pain or stiff neck
causes a palsy, hyperacusis, lack of taste in anterior 2/3 of tongue
What is the treatment and prognosis for those with ramsay hunt syndrome?
give valaciclovir and steroids within 72hr. 75% do well.
upto 1in 3 do poorly and are left with weakness. some may stay the same.
What are the 4 main signs and symptoms of MS?
TEAM Tingling Eyes - optic neuritis - loss of vision(particularly central) and pain on moving, colour vision loss, and acuity loss Ataxia and cerebellar signs Motor sx - spastic paraparesis.
What would you see on LP of MS
IgG oligoclonal bands
Mainstay of treatment for MS?
Methylpred
IFN beta
Natalizumab
Alemtuzamab
Require whole host of other medications usually to manage other effects of the disease
Spasticity - physio baclofen, botox Fatigue - modafinil Tremor - depression - citalopram pain - amytriptiline or gabpentin urgency - oxybutinin/tolteridine ED - sildenafil
Classical symptoms of lumbosacral spondylosis?
low back pain
paraestheisa on straight leg raise
limited spinal flexion
L5 - foot drop due to reduced dorsoflexion and inversion
foot drop with STRONG inversion
common peroneal lesion
foot drop with WEAK inversion
L5 Radiculopathy
What are the risk factors for wernickes
alcohol
post GI surgery - eg bariatrics
malnutrition
AIDS
signs of wernickes
gait disturbance, opthalmoplegia, confusion
confabulation is a sign of permanence i think?
Another name for extradural?
epidural
Indications for a CT head in trauma?
Immediately(less than 1hr) if: GCS less than 13 after GCS less than 15 after 2 hours neurological deficit seizure more than 1 episode of vomiting suspected basal skull fracture
within 8 hours if LOC with:
Amnesia - more than 30 mins
coagulopathy
over 65
Risk factors for subdural haematoma?
old age
Alcoholism
falls
anticoagulation - warf
Signs of coning?
HTN - to adequately perfuser the brain
Cushings triad
Widening of the pulse pressure
Irregular breathing (cheyne stokes)
bradycardia
Also - unreactive pupils
diffuse axonal damage?
occurs from rapid acceleration and deceleration tearing brain axons and causing many haemorrhages
brain dead possibly
