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3rd year > Neuro core conditions > Flashcards

Neuro core conditions Flashcards

1
Q

What is a TIA?

A

An acute loss of cerebral or ocular function
symptoms last less than 24 hours
caused by an inadequate cerebral or ocular blood supply due to ischaemia or embolism

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2
Q

How long do the symptoms of a TIA usually last?

A

minutes

may last a few hours

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3
Q

What are the 2 main types of ischaemic stroke?

A

Thrombotic ischaemic stroke

embolic stroke

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4
Q

What is a thrombotic ischaemic stroke?

A

blood clot spontaneously forms in the brain

common complication of atherosclerosis

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5
Q

What is an embolic stroke?

A

part of the fatty material from an atherosclerotic plaque or a clot in larger artery or the heart breaks off and travels to the brain

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6
Q

What are embolic strokes common complications of?

A

AF

Atherosclerosis of the carotid arteries

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7
Q

What % of strokes are ischaemic?

A

85

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8
Q

What are the 2 types of hemorrhagic stroke?

A

Intracerebral and subarachnoid

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9
Q

What is a intracerebral haemorrhagic stroke and what causes them?

A

Bleeding from a blood vessel within in the brain

High blood pressure

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10
Q

What is a subarachnoid haemorrhagic stroke?

A

bleeding from a blood vessel between the surface of the brain and the arachnoid tissue

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11
Q

What are the risk factors for strokes?5

A 
high BP
age 
DM 
smoking 
alcohol
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12
Q

What are the FAST symptoms and signs of a stroke? And how do you elicit them?

A

FACIAL WEAKNESS
- ask person to smile or show their teeth
will be facial asymmetry

ARM WEAKNESS
Lift arm to 90 or 45 (if lying)
will fall or drift down

SPEECH PROBLEMS
slurred
struggles to find the name of commonplace objects

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13
Q

What are the features of a sudden onset focal neurological deficit (found in strokes)? 8

A

usually unilateral

facial weakness

unilateral weakness and sensory loss of upper and/or lower limb

speech problems

visual defects

disorders of perception

disorders of balance

coordination disorders

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14
Q

What investigations do you do in suspected stroke?

A

CT scan

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15
Q

How do you calculate the risk of stroke following a TIA?

A

ABCD2 score:
A- age >60 -1 point

B- BP 140/90 -1 point

C- clinical features:

  • unilateral weakness- 2 point
  • speech disturbances without weakness- 1 point

D-duration of symptoms

  • =/>60mins - 2points
  • 10-59 mins - 1 point

D- Diabetes - 1 point

People are at high risk of a stroke if they have a score of 4 or more
AF
more than 1 TIA a week
TIA whilst on anticoagulants

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16
Q

How do you manage people at high risk of a stroke post TIA?

A

refer within 24 hours

Give statin- e.g. simvastatin

If they aren’t currently on any blood thinners immediately give clopidogrel or aspirin

DON’T start anti-platelet treatment until haemorrhagic stroke has been ruled out

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17
Q

How do you manage a haemorrhagic stroke?

A

Control bleeding

anticonvulsants to control bleeding e.g. diazepam

antihypertensives- to stem the growth of the haematoma

osmotic diuretics- to decrease intracranial pressure in the subarachnoid space

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18
Q

What is the management for secondary prevention of strokes?

A

Manage: AF, diabetes, hypertension
Antiplatelet drug
statin

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19
Q

What are the neurological complications of strokes? 9

A 
Neurological problems:
balance 
movement 
tone 
sensation

Disturbances of spatial awareness- neglect
Visual agnosia- disturbance of perception
aphasia, dysarthria, apraxia of speech

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20
Q

Where is pain felt as a complication of stroke?

A

Pain:
Neuropathic
shoulder pain and subluxation
MSK pain

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21
Q

What are the mental health complications of stroke?6

A 
Depression 
anxiety 
emotionalism 
disturbed social interaction 
attention and concentration problems 
memory problems
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22
Q

What are the causes of a subarachnoid haemorrhage? (SAH)

A

aneurysmal rupture

traumatic brain injury- most common

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23
Q

What causes a spontaneous SAH? 5

A

Bleeding from a berry aneurysm - 85%

Non-aneurysmal peri-mesencephalic haemorrhage-10%

vascular abnormalities- 5%:
arteriovenous malformation
vasculitis
abnormal blood vessels associated with a tumour

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24
Q

What is the mean age for SAH?

A

50

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25
Q

Is SAH more common in F or M

A

F

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26
Q

Which ethnic group is SAH more common in?

A

Afro-Caribbean

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27
Q

What are the risk factors for a spontaneous SAH? 8

A 
1-HTN 
2-smoking 
3-cocaine 
4-excess alcohol 
5-Family history - get at younger age and more likely to have larger and multiple ones
6- autosomal dominant adult polycystic disease
7-Ehler's Danlos syndrome type IV 
8- Neurofibromatosis type 1
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28
Q

What are the features of a SAH headache? 3

A

Sudden explosive headache - thunder clap
May lasts seconds or even fraction of a second
Typically pulsates towards occiput

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29
Q

What are the other symptoms of SAH? 4

A

seizure
confusional state
Vomiting
Neck stiffness and other signs of meningism- usually around 6 hours post onset of SAH

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30
Q

What are the warning symptoms of an SAH and what are they due to? 10

A

Sentinel bleeds= small leaks or expansion of the aneurysm
May be up to 3 weeks prior to SAH

Symptoms: 
Headache like an SAH but usually resolves itself 
dizziness
orbital pain 
diplopia 
visual loss 
sensory or motor disturbances
seizures 
ptosis
bruits 
dysphasia
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31
Q

What may be seen on fundoscopy in a patient with SAH? 2

A

Intraocular haemorrhages:

  • 15%
  • especially if they’ve got depressed level of consciousness
  • occurs due to raised pressure

Isolated pupillary dilation with loss of light reflex
-may indicate brain herniation due to rising ICP

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32
Q

What is the main focal neurological sign that may be present in SAH? And what does it suggest?

A

suggest stroke and bleeding from posterior communicating artery
1- complete or partial palsy of the oculomotor nerve

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33
Q

What causes the associated cardiac arrhythmias in SAH?

A

Marked rise in BP due to a sympathetic response and surges of adrenaline

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34
Q

What does SAH in a person with known seizures suggest?

A

Arteriovenous malformation

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35
Q

What do new-onset seizures and SAH suggest?

A

Berry Aneurysm

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36
Q

What should be done immediately in patients that present with severe sudden headache?

A

CT scan

CT scan without contrast is the first line

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37
Q

Once acute SAH has been confirmed what further investigation should follow?

A

Angiography

either cerebral angiography or CT angiography

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38
Q

When do you do a lumbar puncture in suspected SAH?

A

If the CT scan is negative but the history is suggestive

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39
Q

How long after the onset of SAH do you do a lumbar puncture?

A

12 hours

To allow time for red blood cells in the CSF to undergo sufficient lysis for oxyhaemoglobin and bilirubin to have formed

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40
Q

What investigation do you carry out on the CSF in SAH?

A

spectrophotometry

to detect small amounts of xanthochromia= yellow discolouration of spinal fluid

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41
Q

What ECG changes occur in SAH? Why should caution be taken?

A

CT prolongation, Q waves, dysrhythmias and ST elevation

May be interpreted incorrectly as an MI –> thrombolysis being given = DISASTROUS in SAH

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42
Q

what are the surgical options to occlude an aneurysm in SAH?

A

Endovascular obliteration by means of platinum spirals- preferred
-through femoral catheterisation it obliterates the artery by causing a blood clot to form

Direct neurosurgical approach-clipping

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43
Q

How do you manage delayed cerebral ischaemia due to vasospams in SAH?

A

Oral nimodipine (Ca channel blocker) and maintaining circulatory volume

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44
Q

Hydrocephalus can be a side effect of SAH in the first hours or days, how do you treat this?

A

Lumbar puncture or ventricular drainage

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45
Q

Hypertension as a response to SAH is a common complication, how do you manage this?

A

Nitroprusside- a potent vasodilator and labetolol (b-blocker)
Need BP to be low enough to prevent re-bleeding whilst high enough to maintain cerebral perfusion

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46
Q

What preventative measures can be taken to stop re-bleeding?

A

Clipping or coiling aneurysm

Antifibrinolytic drugs

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47
Q

What are the complications of an SAH?

A 
1- overall death rate= 50% 
2- cardiac arrest 
3- cerebral ischaemia
4- hydrocephalus 
5-can develop epilepsy 
6- re-bleeding 
7-intra-parenchymal haematomas
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48
Q

What are the differential diagnoses for SAH? 8

A

Other causes of stroke
Meningitis-rarely features thunderclap headache

For the headache: 
Primary sexual headache
cerebral venous sinus thrombosis 
Cervical artery dissection 
Carotid artery dissection 
hypertensive emergency
Pituitary apoplexy= infarction or haemorrhage of the pituitary gland
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49
Q

How does peripheral neuropathy happen?

A

Axonal degeneration- nerves becomes electrically inert within a week

Demyelination

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50
Q

What are the health conditions that causes peripheral neuropathy?

A 
1-DM 
2- surgery 
3-shingles
4-alcohol 
5-low vit B12 
6-hypothyroidism 
7-CKD
8-chronic liver disease 
9-vasculitis 
10- MGUS (monoclonal gammopathy of undetermined significance = presence of abnormal protein in the blood)
11- myeloma 
12-lymphoma 
13- Charcot-Marie-Tooth disease 
14- lead, arsenic or mercury 
15- Guilain Barre syndrome 
16- Amyloidosis 
17 rheumatoid 
18- lupus
19-sjorgen's syndrome
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51
Q

What medications can cause peripheral neuropathy?

A 
chemotherapy 
Metronidazole or nitrofurantoin if taken for months 
Phenytoin (epilepsy) 
amiodarone 
thalidomide
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52
Q

What factors increase your risks of developing peripheral neuropathy if you have DM? 3

A

Smoke
alcohol
>40

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53
Q

What are the signs and symptoms of peripheral neuropathy? 6

A 
Paraesthesia 
burning pain 
numbness 
loss of vibration and position sense
muscle wasting 
ataxia due to loss of sense of posture
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54
Q

Where is usually first affected in peripheral neuropathy?

A

feet

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55
Q

How do you relieve neuropathic pain? 7

A 
Amitryptyline
Duolextine 
Pregabalin 
Gabapentin 
Capsaicin cream 
Lidocain plaster 
Tramadol- when other treatments haven't worked
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56
Q

How do you treat hyperhydrosis?

A

Botulin injection

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57
Q

What are the complications of peripheral neuropathy?

A

Foot ulcers –> sepsis and and gangrene

May affect nerves controlling autonomic functions of the heart and circulatory system= cardiovascular neuropathy

  • may need treatment for hypotension: fludrocortisone or midodrine
  • or in rare cases a pacemaker
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58
Q

what is an epileptic seizure?

A

A transient occurs of signs/ symptoms due to abnormal electrical activity in the brain

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59
Q

When can you declare seziure epilepsy?

A

Once they’ve had at least 2 unprovoked seizures occurring more than 24 hours apart

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60
Q

Who gets provoked seizures that are not of primary cerebral origin?

A 
People exposed to trainsient noxious stimulus 
People with:
alcohol or drug withdrawal 
Fever 
hypoxia 
hypoglycaemia
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61
Q

What is status epilepticus?

A

A continuous seizure of 30mins or longer or recurrent seizures without regaining consciousness lasting 30mins or longer

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62
Q

What causes epilepsy?8

A

2/3rds do not have anatomically identifiable cause

1/3rd have symptomatic epilepsy= epilepsy due to underlying disease or condition:

  • most common cause of epilepsy in older people
  • cerebrovascular disease
  • cerebral tumour
  • post traumatic epilepsy
  • foetal hypoxia or trauma
  • cortical or vascular malformation
  • cerebral abscess or tuberculoma
  • surgery to brain
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63
Q

When does epilepsy most commonly start?

A

Children

or over 60s

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64
Q

What are the risk factors for epilepsy? 11

A 
1-learning disabilities 
2-childhood epilepsy syndromes- genetic
3-tuberous sclerosis- genetic 
4-neurofibromatosis- genetic 
5- FH 
6- Previous febrile seizures in childhood
7- Previous intracranial infections 
8- Brain trauma or surgery 
10- cerebrovascular disease
11-cerebral tumours
65
Q

What are examples of seizure triggers?

A

walking
sleep deprivation
flashing lights

66
Q

What are auras?

A

simple partial seizures with no loss of consciousness

67
Q

What are the symptoms of temporal lobe auras?

A

Unexpected tastes and smells
paraesthesia
rising abdominal sensation

68
Q

What happens in tonic seizures?

A

impairment of consciousness
stiffening
Trunk may be either straight or flexed at waist

69
Q

What happens in clonic seizures?

A

Impairment of consciousness

jerking

70
Q

What happens in Tonic-clonic seziures?

A

Impairment of consciousness

stiffening and jerking

71
Q

What happens in absence seizures? And when do they begin? And how long do they last?

A

Begin in childhood

sharp onset and offset with no residual symptoms
child stares for a few seconds
eyelids may twitch
small jerking movements of the fingers may occur- usually not noticed

Last 5-10 seconds, and less than 30 seconds

72
Q

What happens in myoclonic seizures?

A

Brief shock like contraction of the limbs without apparent impairment of consciousness

73
Q

What happens in focal motor seizures?

A

Jerking movement
typically beginning at the face or one hand
spreading to involve limbs

74
Q

What happens in focal sensory seizures?

A

Typically involves the temporal lobe

may causes sensory, autonomic, emotional, cognitive or other changes

75
Q

what happens in the post-ictal period (residual symtpoms) after a seizure?

A 
Drowsiness 
amnesia
Injury- biting the tongue 
aching limbs 
headaches
Focal neurological deficit that slowly recovers
76
Q

What are the differential diagnoses in epilepsy?

A

syncope
cardiac arrhythmias
Panic attacks with hyperventilation
Non-epileptic attack disorders- F>M, provoked by stressful situations
Children- night terrors, breath holding attacks

77
Q

How do you treat people having a tonic-clonic seizure for more than 5 mins or who have more than 3 seizures?

A

Buccal midazolam
Rectal diazepam- if buccal midazolam isn’t available
IV lorazepam if IV access already establishes

78
Q

What are the long-term management options for epilepsy?

A 
Carbamazepine 
phenytoin 
primidone
sodium valoprate 
may increase risk of osteoperosis--> give vit D supplements
79
Q

what are the viral causes of meningitis? 3

A

Enteroviruses:
Coxsackie A &B
Echovirus

Herpes simples 2 (genital herpes complication)

Usually self limiting

80
Q

What are the fungal causes of meningitis? 2

A

LIFE THREATENING, but rare

cryptococcus- most common
tuberculos meningitis

81
Q

What are the bacterial causes of meningitis is in children >3months and adults? 3

A 
Neisseria meningitides (--> meningococcal disease) 
Strep pmeumoniae 
H. influenzae type b
82
Q

What are the bacterial causes of meningitis in neonates (<1month)?4

A

Streptococcus agalactiae
E.coli
S.pneumoniae
Listeria monocytogenes

83
Q

What are the autoimmune causes of meningitis?2

A

SLE

Behcet’s syndrome

84
Q

What are the risk factors for meningitis?7

A 
Young age 
winter season 
>65 
immuno-compromised 
organ dysfunction 
smoking 
overcrowded housing
85
Q

What are the non-specific symptoms of meningitis? (common signs are often missing in infants) 9

A 
fever 
vomiting/ nausea 
lethargy 
irritabillity/ unsettled
ill appearance 
refusing food/drink 
headache 
muscle ache/ joint pain 
respiratory symptoms
86
Q

What are the specific symptoms of meningitis? 14

A 
Non-blanching rash 
stiff neck 
cap refill time >2secs 
unusual skin colour 
shock and hypotension
leg pain 
back rigidity 
bulging fontanelle 
photophobia 
paresis 
seziures
Focal neurological deficit 
Kernig's sign 
brudzinksi's sign
87
Q

What is Kernig’s sign?

A

Person is unable to fully extend at knee when hip is flexed

88
Q

What is Brudzinksi’s sign?

A

Person’s hips and knees flex when neck is flexed

89
Q

What are the features of the rash?

A

Scanty petechial rash- purple or red non-blanching macules <2mm

Pupuric (haemorrhagic) rash- spots >2mm. May be absent in early phase of illness, may intially be blanching or macular

90
Q

What are the indications that meningococcal disease is likely to develop, in children? 4

A

The petechiae start to spread
The rash become pupuric
There are signs of bacterial meningitis
There are signs of meningococcal septicaemia

91
Q

What investigations do you do in meningitis?

A

Lumbar puncture

92
Q

How do you manage a patient with meningitis?

A

If they have a rash: single dose of parenteral benzylpenicillin asap- ideally IV but can do IM

Antibiotics + corticosteroids
Benzylpenicillin
if allergic: cefotaxime or chloramphenicol

Give prophylaxis of close contacts

93
Q

What are the complications of meningitis? 8

A 
death
neurological damage 
hearing loss
seizures 
motor deficit 
cognitive impairment 
hydrocephalus 
visual disturbances
94
Q

What is a common migraine?

A

Migraine without aura

95
Q

What are classic migraines?

A

Migraines with aura

96
Q

What is contraindicated in migraines with aura?

A

the contraceptive pill

97
Q

What are the risk factors for migraines? 7

A 
FH 
stress 
depression 
anxiety 
menstruation 
menopause 
head or neck trauma
98
Q

What are the common internal triggers for migraines? 4

A

Menstrual cycle
altered sleep pattern
stress
relaxation after stress- weekend migraine

99
Q

What are the external triggers for migraines?

A

Specific foods- only suspect as trigger if migraine occurs within 6 hours of eating it
strenuous exercise- for those not used to it (however regular exercise helps migraines)
strong smells
bright light
dehydration
missed meals
jet lag

100
Q

Are migraines more common in M or F?

A

F

101
Q

When is the mean onset of migraines for F?

A

18

102
Q

When is the mean onset of migraines for M?

A

14

103
Q

What are the diagnostic criteria for migraine without aura?

A

Recurrent episodes of headaches
lasting between 4-72hours

associated with either nausea/ vomiting or photophobia and phonophobia or both

usually unilateral
Pulsating in character

aggravated by routine physical activity

104
Q

What are the diagnostic criteria for migraine with aura?

A

Symptoms of a migraine are preceded by the onset of an aura of visual or sensory symptoms or dysphasia

Visual symptoms- zig-zag or flickering lights, spots, lines or loss of vision

Sensory symptoms- pins and needles or numbness

105
Q

What are episodic migraines?

A

headache which occurs on <15 days/ month

chronic = >15

106
Q

When do menstrually related migraines occur?

A

2 days before and 3 days after the start of menstruation

107
Q

What are the acute treatment options for migraines?

A

Oral combination therapy of oral triptan and an NSAID or paracetamol

consider an antiemetic- metoclopermaide, domperidone or prochloerperazine

108
Q

What oral triptans can be used?

A

sumatriptan

zolmitriptan, naratriptan, rizatriptan, eletriptan, almotriptan and frovatriptan

109
Q

What are the prevantative treatment options for migraines?

A

topiramate or propanolol first line

If after 2 months these aren’t working then offer 10 sessions of acupuncture over 5-8weeks

110
Q

What are the risks with topiramate?

A

can impair effectiveness of oral contraceptives

can cause foetal malformations

111
Q

Who can’t take propanolol?4

A 
People with
asthma 
COPD
PVD 
or uncontrolled heart failure
112
Q

What are the complications of migraines? 6

A

Medication overuse
status migrainosus- migraine .72hours
increased risk of ischaemic stoke
migraine with aura might increase risk of haemorrhagic stroke
depression, bipolar, anxiety and panic disorder are all associated with migraine
migraine triggered seizure

113
Q

What classifies as an infrequent tension headache?

A

At least 10 episodes of TTH

On less than 1 day/month

114
Q

What classifies as a frequent episode of tension headaches?

A

At least 10 episodea
On 1 day or more each month
On less than 15 days per month for at least 3 months

115
Q

What classifies as a chronic tension headache?

A

Occurs on 15 days or more per month
lasts for more than 3 month at a time
or for more than 180 days in a year

116
Q

Are tension headaches more common in F or M?

A

F

117
Q

How long do tension headaches last?

A

30 mins to 7 days

118
Q

To be diagnosed as a tension headache they have to have two of what criteria? 5And have both of what features?

A 
Bilateral 
pressing or tightening (non-puslating)
mild to moderate intensity 
not aggravated by exercise
Radiate to or arise from the neck

Not associated with nausea or vomiting
Photophobia or phonophobia may be present, but NOT both

119
Q

How do you manage an acute tension headache?

A

Paracetamol
aspirin (not for under 16s)
NSAIDs

120
Q

Who gets preventative treatment of tension headaches?

A

People requiring analgesia 2 or more days each week

121
Q

What are the preventative options for a tension headache?

A 
Acupuncture 
Amitryptiline (or if not tolerated nortriptyline)
122
Q

How long are people on the upper does of amitryptilne for in tension headaches?

A

2 months

Then decrease dose by 10mg to 25mg each week

123
Q

What causes Parkinson’s disease?

A

Loss of dopamine containing cells in the substantia nigra

124
Q

What is Parkinsonism?

A

Umbrella term for clinical syndrome involving bradykinesia plus at least one of:
tremor
rigidity
postural insatbility

125
Q

What are the causes of Parkinsonism? 6

A 
Parkinson's disease= most common 
drug incuded
cerebrovascular disease
Lewy body dementia
multiple system atrophy 
progressive supranuclear palsy
126
Q

What are the risk factors for Parkinson’s? 2

A

Age

FH

127
Q

Is it more common in M or F?

A

M

128
Q

What are the motor symptoms of Parkinson’s? 6

A 
Bradykinesia 
Hypokinesia = poverty of movement
stiffness or rigidity 
resting tremor 
postural instabillity 
Frezing gait
129
Q

How does bradykinesia in Parkinson’s present?

A

slowness in initiation of voluntary movements

with progressive reduction in speed and amplitude of repetitive actions such as finger or foot tapping

130
Q

How does hypokinesia in Parkinson’s present?

A

Reduced facial expression, arm swing or blinlinh
difficulty with fine movements- buttons, opening jars,
small cramped handwriting= micrographia

131
Q

What are the two types of rigidity in Parkinson’s?

A

Lead pipe-
constant resistance when a limb is passively flexed in the presence of increased tone without tremor

Cogwheel rigidity
regular intermittent relaxation of tension when a limb is passively flexed in the presence of tremor and increased tone

132
Q

What are the features of the resting tremor in Parkinson’s?

A

Usually improves with moving, mental concentration and during sleep
May affect thumb and index finger= pill rolling
wrist, leg, lips, chin or jaw
absent in 30% of people at disease onset

133
Q

Are the features of parkinson’s unilateral or bilateral?

A

Early disease they are usually unilateral, become bilateral as the disease progresses

134
Q

What are the non-motor symptoms of parkinson’s? 7

A 
depression 
anxiety 
fatigue 
reduced sense of smell 
cognitive impairment 
sleep disturbance 
constipation
135
Q

What are the differential diagnoses of parkinson’s disease? 7

A 
drug induced Parkinsonism 
cerebrovascular disease 
Non-Parkinson's dementia 
progressive supranuclear palsy 
multiple system atrophy 
corticobasal degeneration 
Wilson's disease
136
Q

What are the medication options for managing motor symptoms in Parkinson’s? 6

A

Levodopa
COMT inhibitors- entacapone
Dopamine agonists- pramipexole, ropinirole
Amantadine
Anticholinergic drugs
MAO-B inhibitors- selegiline or rasagiline

137
Q

Where does deep brain stimulation stimulate in Parkinson’s treatment? And who gets it?

A 
subthalamic nucleus 
People with motor symptoms who are: 
Fit enough 
Levodopa responsive 
have no co-morbid health problems
138
Q

What anti-emitcs can’t you use in Parkinson’s and which one can you use?

A

NOT: metoclopramide or prochlorperazine

Low dose domperidone is ok

139
Q

What causes fluctuations in motor symptoms in Parkinson’s? 2

A

End to end dose failing

On-off phenomenon

140
Q

What are the mental health complications of parkinson’s? 7

A 
depression 
anxiety 
apathy 
dementia 
cognitive impairment 
impusle control disorders 
psychosis
141
Q

What are the autonomic complications of parkinson’s? 8

A 
constipation 
postural hypotension 
dysphagia 
weight loss 
excessive salivation 
hyperhidrosis 
bladder problems 
sexual problems
142
Q

What are the most common type of proximal myopathies?

A

Muscular dystrophies e.g. Duchene

143
Q

What are the inherited causes of peripheral myopathies? 2

A

Myopathies- e.g. Duchene, Becker’s

Inherited biochemical defects e.g myochondrial myopathy or lipid storage disease

144
Q

What are the aquired causes of myopathies? 4

A

Immunologically mediated- SLE, RA

Non-inflammatory myopathies- Hyper/hypothyroidism. DM, Cushing’s

Toxic and cachetic myopathies- alochol, protein malnutrition, statins, steroids

Infection-HIV, cosackie

145
Q

What are the signs and symptoms of myopathies? 5

A

weakness

myalgia- may occur in inflammatory myopathy

fluctuating muscle power- suggests metaboluc myopathy

Malaise/ fatigue

Atrophy of muscles with reduced reflexes - occurs late with myopathies (early with neuropathies

146
Q

What are the features of weakness associated with myopathy? 5

A

Predominately affects proximal muscle groups- limb girdle and shoulders

–> decreased foteal movements in utero

floppy infant neonatally

reduced muscle strength and power

symmetrical proximal muscle weaknes with paraesthesia

147
Q

What are the complications of peripheral myopathies? 4

A

respiratory failure
aspiration pneumonia
Joint contractures
chest and spinal deformities

148
Q

What is MS?

A

an autoimmune condition characterised by repeated episodes of inflammation of nervous tissue in the brain and spinal cord –> loss of myelin sheath –> slows or blocks signals

149
Q

What are the causes of MS?

A

Genetic

Environmental

150
Q

Is MS more common in M or F?

A

F

151
Q

When is the peak incidence for MS?

A

40-50

152
Q

What are the eye signs and symptoms of MS? 3

A

Optic neuritis- painful reduction of vision in 1 eye
symmetrical jerking nystagmus –> double vision
Lateral rectus weakness

153
Q

What are the other (aside from eye) symptoms of MS?) 8

A 
Bell's Palsy 
Deafness and feeling unsteady 
progressive loss of memory and language skills 
no-specific pain 
loss of sensation in legs ascending to the trunk
incontinence 
impotence 
loss of thermoregulation
154
Q

What will a MRI show in MS?

A

Periventricular lesions and discrete white matter abnormalities

155
Q

What can electrophysiology detect in MS?

A

demyelination

156
Q

What will be found in CSF in MS?

A

Rise in total protein

Increase in immunoglobulin concentration with presence of oligoclonal cases

157
Q

What do you give for symptom exacerbations in MS?

A

Steroids

usually methylprednisolone for 5 days

158
Q

What are the medication options to stop remitting and relapsing in MS> 7

A 
Azathioprine 
Interferon-beta 
Glatiramer- designed to mimic the main protein in myelin 
Dimethyl fumarate 
teriflunomide 
aletuzumab

3rd year (9 decks)

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