Neuro - inflammation and infection Flashcards
MULTIPLE SCLEROSIS
i) what is it? what is the charac pattern? what is avg age onset?
ii) name six symptoms? which motor neurons does it affect? what part of the CNS does it affect? is weakness seen?
iii) what should be done first? what should be done following this?
iv) how may an acute relapse be treated?
i) autoinflammatory demyelinating disease of the CNS with relapsing/remitting or progressive
age 20-40
ii) dysphagia, tremor, sensory change, ataxia, visual loss, urinary urgency, fatiuue, diplopia, spasticity
affects UMN and white matter in CNS (brain, sp cord, optic nerves)
dont see weakness as doesnt affect grey matter
iii) do brain MRI - see lesions
then confirm inflamm by taking CSF - see oligoclonal bands
iv) acute relapse - tx with steroids (500mg oral pred for 5d), immunomod, disease mod tx
MS EYE DISEASE
i) what is optic neuritis? how does it present? name four key features
ii) which nerve is implicated if pt px with diplopia?
iii) what is internuc opthalmoplegia?
iv) what is conjugate lateral gaze disorder?
i) demyelination of the optic nerve and loss of vision in one eye
unilat vis loss presenting over hours to days
central scotoma (enlarged blind spot), pain on eye movement, impaired colour vision, relative afferent pupil defect
ii) diplopia > CN6 palsy
iii) IO - problems with muscles around the eye involving nerve fibres that connect cranial nerve nuclei 3/4/6 - co-ord eye movement to mke sure that eyes move together
iv) conjugate gaze disorder - affected eye cannot abduct therefore when looking to one side eg left - right eye looks to left but left eye stays central
GUILLIAN BARRE SYNDROME
i) what is it? what nerves does it affect? name four symptoms?
ii) where positionally is inflammation seen? what may be seen in CSF (2) how are reflexes affected?
iii) what studies can be done to look at affected nerves? when does it usually start after an infection? where do symptoms start? how long may recovery period be
iv) what criteria can be used for dx? name two investigations tht can support dx?
v) how is it managed? (3) what must be given to prevent the leading cause of death?
i) demyelinating polyneuropathy affecting peripheral nerves/LMNs
paraesthesia (pins and needles), leg weakness, inco-ord, voice change, facial nerve weakness, dysphagia
scute symmetrical ascending weakness that can also cause sensory symptoms
ii) proximal symptoms
CSF > raised protein and WCC
reduced reflexes
iii) nerve conduction studies
usually starts within 4 weeks and recovery period may be months to years
iv) brighton criteria
nerve conduc studies (reduced conduc) and CSF - raised protein normal glucose
v) manage with IV immunoglobulin, plasma exchange and supportive care
must give VTE prophylaxis as PE is a leading cause of death
MYASTHENIA GRAVIS
i) what is it? what does it principally lead to? what makes it worse? what makes it better?
ii) what type of tumour is there a strong link with? what type of antibodies are produced? what causes further worsening of symptoms?
iii) which muscles are principally affected? name five symptoms?
iv) how can fatiguability be elicited on exam? (3)
v) what type of ABs are found in 85% of patients? what are found in 10%? what are foundd in less than 5%
i) autoimmune condition that leads to muscle weakness thay gets progressively worse with activity and improves with rest (fatiguability)
ii) strong link with thymoma
production of acetyl choline receptor antibodies
further worsen of symp as ABs activate complement which damages the post syn membrnae
iii) principally affects proximal muscles and small muscles of head and neck
extraoc muscle weak > diplopia
eyelid weak > ptosis
weakness in facial movement, dysphagia, fatigue in jaw when chewing, slurred speech
iv) fatiguability - repeated blinking exac ptosis, prolonged upward gazing will exac diplopia, repeated abduc of arm 20 times > unilateral weakness of that arm
v) Ach-R abs in 85%, MuSK ABs in 15%, LRP4 ABs in less than 5%
MYASTHENIA GRAVIS TREATMENT
i) what is the edrophonium test and how does it work?
ii) name two drugs that may be given? resection of which gland can improve symptoms?
iii) name two MABs that can be used in tx?
iv) what is myasthenic crisis? what may it be triggered by? what may patients require? name two medical treatments
i) edrophonium chloride aka neostigmine - blocks cholinesterase enzymes therefore increse Ach levels at NMJ > brief and temp relief of weakness > dx of MG
ii) can give reversible Ach esterase inhibitors eg pyriddostigmine or neostigmine to increase am of ach in NMJ
immunosupp eg pred or azathioprine to supress produc of Abs
removal of thymus
iii) rituximab, ecluizumab
iv) crisis - acute worsening of symptoms, triggered by another illness eg RTI
can lead to resp fail after resp muscle weakness - may req NIV eg bipap or full intubation
tx with immunomod therapies eg IV immunoglobulin and plasma exchange
ENCEPHALITIS
i) what is it? what is most commonly caused by in the UK?
ii) what are the four signs to look out for? what three investigations may be done?
iii) what should be done first and foremost if suspected?
i) inflammation of the brain itself
usually caused by HSV
ii) altered mental state + fever, seizure, focal signs
CSF sample (PCR to det HSV), MRI, EEG
iii) treat with aciclovir on suspect then investigate
