Neurological disorders

Question 1

What is Parkinson’s disease?

Answer 1

Long term degenerative disorder of the central nervous system. Mainly affects the motor system.

Question 2

What’s the trio of Parkinson’s symptoms?

Answer 2

Pill rolling tremor at rest

Cog-wheel rigidity

Bradykinesia

Question 3

Symptoms of Parkinson’s?

Answer 3

Rigidity (cog wheel, lead pipe)
Pill rolling tremor
Bradykinesia
- micrography
- monotonous voice
- blank facial expression

Stooped posture
Sleep disorders
Depression
Dementia
Psychosis: visual hallucinations
Postural hypotension
Shuffling gait

Question 4

Which drugs can induce parkinsonism?

Answer 4

Typical anti-psychotics
Metoclopramide (anti-emetic)

Dopamine receptor antagonists, so less dopamine able to bind to receptors to pass nerve impulses along

Question 5

Diagnosis of Parkinson’s?

Answer 5

Clinical

DAT Scan

Question 6

Management of Parkinson’s?

Answer 6

Drugs:

Levo-dopa
Dopamine agonist ropinerol
Dopamine deoxycarbylase inhibitor - carbidopa
MAO B inhibitor - selegeline

Postural physiotherapy
Screen for depression

Deep brain stimulation

Question 7

Side effects of Levo-dopa?

Answer 7

Gambling, loss of inhibitions
Psychosis
Dry mouth
Daytime sleepiness
Insomnia
N + V

Question 8

Differential diagnosis of Parksinson’s features?

Answer 8

Parkinson’s disease

Drug induced: typical anti-psychotic, metoclopramide

Wilson’s disease

Infection: HIV, syphilis, CJD

Lewy body dementia

Multiple infarcts in substantia nigra

Question 9

Pathophysiology of Parkinson’s?

Histopathology

Answer 9

Pars compacta of substantia nigra

Destruction of dopaminergic neurons in pars compacta of substantia nigra

Because of:
B amyloid plaques
Lewy bodies
Neurofibrillary tangles

Question 10

3 signs in acute dystonia?

In what situations do these occur?

Answer 10

Torticolis: abnormal head/neck posture

Oculogyric crisis: eyes roll into back of head

Trismus: lockjaw, cant open properly

After use of typical anti-psychotics

Question 11

Give some examination findings of Parkinson’s?

Answer 11

Cog wheel rigidity hypertonia
Pill rolling tremor
Shuffling gait
Bradykinesia
Postural instability

Question 12

Describe the writing of a Parkinson’s patient?

Answer 12

Micrographia

That tails off

Question 13

What are some Parkinson’s plus diseases?

Answer 13

Lewy body dementia

Multiple system atrophy

Question 14

What investigation would you do for a patient with ataxia, urinary incontinence and dementia?

To rule out what specifically?

Answer 14

Head CT

To rule out normal pressure hydrocephalus

Question 15

What are the three main features of normal pressure hydrocephalus?

Answer 15

Ataxia
Incontinence
Dementia

Question 16

What is normal pressure hydrocephalus?

Answer 16

Chronic dilation of the lateral cerebral ventricles and distortion of the fibres in the corona radiata

CSF pressure is normal

Question 17

Management of normal pressure hydrocephalus?

Answer 17

Shunt from the ventricles to the peritoneal cavity

Question 18

What is multiple system atrophy?

Answer 18

Damage to nerve cells in the CNS
Causing dysfunction

Parkinsonism
Autonomic dysfunction

Question 19

Differentiate Lewy body from other dementias?

Answer 19

DAT scan

Question 20

Differentiate fronto-temporal from other dementias?

Answer 20

SPECT scan

Question 21

Essential tremor, clinical features?

Answer 21

Bilateral upper limb
Initially transient then persistent
Can involve head, jaw

Improved by alcohol and concentrating on task

Question 22

Management of essential tremor?

Answer 22

Propanolol
Primidone
Gabapentin

Deep brain stimulation

Question 23

Trigeminal neuralgia, clinical features?

What triggers it?

Answer 23

Paraesthesia prodrome

Then sharp ipsilateral pain affecting cheek, eyes, lips, scalp!

Triggered by vibration, skin contact (e.g. shaving), brushing teeth, eating, drinking, the wind

Question 24

Pathophysiology of trigeminal neuralgia?

Answer 24

Compression (by blood vessels), demyelination (MS), degeneration

Question 25

Which branches of trigeminal nerve are affected in trigeminal neuralgia?

Answer 25

Maxillary

Mandibular

Question 26

Investigations and management of trigeminal neuralgia?

Answer 26

MRI

Carbamazepine
Gabapentin
Surgery

Question 27

What would you see on a CT head in Parkinson’s

Answer 27

Nothing

Normal