Neuro last min stuff Flashcards
Treatment of Absence seizures?
1st - Valproate or Ethosuximide
2nd - topiramate or levetiracetam
Treatment of Atonic/Tonic-Clonic seizures?
1st - Valproate
Levetiracetam
Lamotrigine
Topiramate
Treatment of Myoclonic seizures?
1st - Valproate, Levetiracetam or Clonazepam
2nd - Lamotrigine, topiramate
Treatment for focal seizures?
1st - carbamazepine
2nd - Lamotrigine, valproate, topiramate
Parkinson’s treatment:
- gold standard?
- dopamine agonists?
- COMT inhibitors?
- MOAI?
- Why is apomorphine used?
Sinemet (levodopa + carbidopa)
D anon - Pramipexole, apomorphine, roprinirole
COMT - Entacapone
MOAI - Selegeline, rasageline
Apomorphine - sudden ‘off’ states
5 parkinson plus syndromes?
Progressive supra nuclear palsy:
- vertical gaze palsy, speech and swallowing problems
Multi-system atrophy:
- Autonomic dysfunction, cerebellar dysfunction
- MRI - hot cross bun sign due to pontine & cerebellar atrophy
Corticobasal degeneration:
- One limb is prominent, apraxia, alien-limb phenomenon
LBD:
- cognitive decline, hallucinations
Vascular parkinsonsim:
- predominantly lower limbs with gait disturbance, pyramidal signs and cognitive dysfunction
Wilson’s disease presentation?
Young, parkinsonism, behavioural change & cognitive decline, hepatic and renal failure, keyser-fleischer rings in eyes
Treatment of dystonia:
- general?
- Focal?
- acute?
general - Baclofen
focal - botulinum toxin
acute - procyclidine
How to differentiate MND from myasthenia graves and MS/neuropathy?
myasthenia - it doesn’t affect eyes
MS/neuropathy - no sensory involvement
4 types of MND and features?
ALS: most common
- UMN in legs, LMN in arms
PLS:
- UMN only - loss of benz cells in motor cortex
Spinal muscular atrophy:
- purely LMN - loss of anterior horn cells
Progressive bulbar palsy:
- LMN - Affects CN IX, X and XII first - drooling, dysphagia, aspiration
What is pseudo bulbar palsy?
What is it seen in?
UMN lesions affecting CNIX, X and XII
Can be seen as part of PLS, parkinson’s etc
(if mix or UMN and LMN then likely bulbar onset ALS)
Myasthenia Gravis:
- Rx?
- Crisis treatment?
Rx - pyridostigmine
Crisis - IV Ig or plasmapheresis
Neurophysiology for:
- myasthenia gravis?
- lambert eaton?
MG - single fibre jitter, low amplitude potentials, decreased twitches with repeated stimulation
LEMS - low frequency AP’s, increase in twitch amplitude with exercise, increase in fasciculation with exercise
Rx for lambert eaton?
3,4 - diaminopyradine
If acute: IV Ig
What is botulism?
Infection with clostridium botulinum
Toxin blocks Each presyaptic terminals
Present with flaccid paralysis - afebrile
Rx: anti-toxin
Stokes adams attack?
Pre-attack?
Attack?
Recovery?
Transient arrhythmia causing by reduced cardiac output and loss of consciousness - multiple times per day in any posture
pre: palpitations
attack: fall with LOC, pallor, slow/absent pulse
post: within seconds, flushing
Diagnosis of epilepsy?
Largely clinical
CT/MRI to rule out structural abnormality
Investigations for MS?
MRI - plaques of demyelination
LP - oligoclonal bands of IgG
Evoked potentials - delayed
MS symptom management:
- spasticity?
- Sensory? (numbness, tingling, pain)
- Bladder dysfunction?
- Fatigue?
spas - Baclofen, physio, OT
sens - amitriptyline, gabapentin, TENS, acupuncture
Bladder dysfunction - bladder training, oxybutynin
Fatigue - hyperbaric oxygen, modafinil
Relapse management in MS?
IV Methylprednisolone
Plasma exchange
Disease modifying drugs in MS:
- 1st line?
- 2nd line?
3rd line?
1st: Tecfedira, B interferon, Capaxone
2nd - Tysabari, Fingolimod
3rd - Mitoxantrone
Tecfedira/Tysbari SE?
reactivation of JC virus causing progressive multifocal leukoencephalopathy