Neuro

Question 0

Syringomyelia signs (cervical syrinx)

Answer 0

1. Dissociated sensory loss (ie. spinothalamic tract involvement without dorsal column)
2. Loss of upper limb reflexes
3. Spastic paraparesis
4. Wasting of muscles of hands and arm
5. Neuropathic joints
6. Brainstem signs: bulbar palsy, nystagmus (flocculonodular node), Horner’s, CN7&8.

Question 1

MILLER FISHER SYNDROME

1. Aetiology
2. Triad of symptoms

Answer 1

1. Antibody against ganglioside GQ1b. Rare.

2. Ophthalmoplegia; ataxia; areflexia

Question 2

Symptoms and signs of TABES DORSALIS (x5)

2. Site of lesion

Answer 2

1. Lightening pains
2. “Ataxia” + stomping gait, loss of reflexes etc
3. Neuropathic joints (and muscle wasting)
4. Argyll-Robertson pupils
5. Ptosis + optic atrophy

Site of lesion = 1a neurons from muscle, therefore areflexic

Question 3

Tabes paresis signs

Other differentials

Answer 3

Usually progress from tabes dorsalis, when the CST is involved.

Extensor plantar (CST involvement) + absent knee reflexes (loss 1a spindles from tabes dorsalis)

"MAST"
Mononeuron disease
Friederich's Ataxia
Subacute degeneration of spinal cord
Tabes paresis

Question 4

FRIEDERICH’S ATAXIA

1. Genetics
2. Lesion sites
3. Signs and symptoms

Answer 4

1. Autosomal recessive, triple repeat GAA

2. "SPuDC"
Spinocerebellar tracts (from Clarks column with proprioceptive info up to inferior cerebellar peduncle)
Peripheral nerves (areflexic)
Dorsal column
Corticospinal tract

3. All cerebellar signs
Up going plantars
Absent reflexes
Loss of proprioception.
Pes caves + scoliosis

Question 5

TUBEROUS SCLEROSIS signs and symptoms

Answer 5

ASHLEAF
Ashleaf spots
Shagreen patches
Heart rhabdosarcomas
Lung hamartomas
Epilepsy
Angmyolipomas in Kidneys
Facial angiomas

Question 6

Management of myasthenia gravis

Answer 6

Acute flare: plasmapheresis, IVIg

Symptomatic relief: pyridostigmine

Disease modifying: azathioprine, methotrexate