Neuro Conditions

Question 1

What is Myasthenia Gravis?

Answer 1

Auto-immune disorder resulting in insufficient ACh receptors

Question 2

What are the presenting features of myasthenia gravis?

Answer 2

Fatiguability
Diplopia
Proximal myopathy - face, neck, limb girdle
Ptosis
Dysphagia

Question 3

What conditions are associated with myasthenia gravis?

Answer 3

Autoimmune e.g. pernicious anaemia, thyroid, rheumatoid, SLE

Question 4

What investigations are used to diagnose myasthenia gravis?

Answer 4

Serum ACh receptor antibody analysis

Question 5

What is the management for acute myasthenia gravis?

Answer 5

Intubation and mechanical ventilation
Plasma exchange (5 treatment of 1-1.5 plasma volume) OR IV immunoglobulin

Question 6

What is the management for less severe, ongoing MG?

Answer 6

Cholinesterase inhibitor e.g. pyriogostigmine

Most pts need immunosuppression e.g. pred

Question 7

What is myalgic encephalomyelitis?

Answer 7

Chronic fatigue syndrome

Question 8

How is chronic fatigue syndrome characterised?

Answer 8

Debilitating fatigue for more than 6 months
Cognitive dysfunction
Total body pain
Unrefreshing sleep that does not restore normal function
Post-exertional malaise

Question 9

What investigations are done for chronic fatigue?

Answer 9

Many to exclude other pathology

DePaul symptom questionnaire

Question 10

What is the management for chronic fatigue syndrome?

Answer 10

CBT
Graded exercise therapy - formal supervised programme
Pacing activity to avoid tiring
Low-dose amitriptyline for sleep