Neuro - Chronic Disorders Flashcards
what triad of symptoms makes up parkinsonism?
rigidity
tremor
bradykinesia
risk factors for parkinson’s?
age
FHx
head injury
drugs
what drugs can cause parkinsonism?
typical antipsychotics (older) legal highs anti emetics (dopamine antagonist e.g prochloperazine)
features of parkinson’s?
pill rolling tremor at rest cog wheel shuffling gait postural instability lack of arm swing hypomimia reduced blink rate micrographia
systemic features of parkinson’s?
anosmia REM sleep disorders retention/constipation depression hallucination postural hypotension
how can drug induced parkinson’s present?
symmetrical
tardive dyskinesia
akathasia
orolingual dyskinesia
pathology or parkinson’s?
loss of dopaminergic neurons in the substantia nigra of the basal ganglia
Ix for parkinson’s?
clinical (improves with L dopa use) MRI DAT scan (reduced uptake in basal ganglia)
Tx for parkinson’s?
L dopa + COMT inhibitor (e.g carbidopa)
dopamine agonist e.g pramipexole, bromocriptine
MAO B inhibitor e.g selegeline
complications of dopaminergic therapy?
dyskinesias (‘freezes’ as drug stops working then excess movement)
compulsive behaviour
nausea
hypotension
arrythmias
is smoking good or bad for parkinson’s?
good
what are parkinson’s plus syndromes?
have the core features of parkinsonism but can be distinguished
how to distinguish multi system atrophy from parkinson’s?
impotence
urinary retention/incontinence
how to distinguish progressive supranuclear palsy from parkinson’s?
difficulty moving eyes vertically
loss of balance
how to distinguish corticobasal degen from parkinson’s?
movement disorder is worse
what are LMN signs?
weakness
fasciculations
atrophy
hyporeflexia
what features MND NOT have?
sensory loss
sphincter disturbance
eye movement changes
most common type of MND? what signs are there?
ALS
UMN + LMN
what does progressive bulbar palsy affect?
CN IX-XII
progresses to ALS
what does progressive muscular atrophy affect?
LMN
distal then proximal muscles
best prognosis
what does primary lateral sclerosis affect?
UMN
in MND, where can there be a loss of neurone?
pre central gyrus
motor CNs
anterior horn cells
Tx for MND?
MDT approach
riluzone
baclofen
antidepressants
what happens in myasthenia gravis?
antibodes to acetyl choline receptors attack
destroy post synaptic membrane of the NMJ
reduced muscle fibre action potentials
features of myasthenia gravis?
muscle weakness worse at end of day proximal weakness ptosis diplopia dysphagia dysarthria facial weakness SOB normal reflexes
Ix for myasthenia gravis?
serum AChR Abs
MuSK Abs
pulmonary function tests (FVC)
Tx for myasthenia gravis?
pyridogstimine
pred
IV Igs/plasma in crisis
in a myasthenia gravis crisis, what changes can occur on PFTs?
low FVC
low NIF
what are those with myasthenia gravis at higher risk of developing?
thymoma
