Neurological Dysfunction Flashcards
1
Q
What risk factors at birth can contribute to developing epilepsy?
A
Intrauterine infections (Rubella, Toxoplasmosis)
Maternal drug abuse
Perinatal trauma and anoxia
2
Q
What antibiotics can increase the risk of seizures?
A
Penicillins
Cephalosporins
Quinolones
3
Q
When would a CT be carried out in the context of a seizure?
A
Clinical/Radiological skull fracture Deteriorating GCS Focal signs Head injury Failure to have a GCS of 15 four hours after arrival Suggestion of other pathology
4
Q
What investigation is mandatory on admission with a seizure?
A
ECG
5
Q
How is an EEG useful in epilepsy?
A
Classification
Confirmation of non-epileptic attack
Surgical evaluation
Confirmation of non-convulsive state
6
Q
What is the prevalence of seizures?
A
2-5%
7
Q
What is the prevalence of epilepsy?
A
0.5%
8
Q
After your first seizure, what are the DVLA rules for driving?
A
Cannot drive a car for 6 months during which you must be seizure-free
Cannot drive a HGV/PCV for 5 years during which you must be seizure-free
9
Q
If diagnosed with epilepsy (>=2 seizures), what are the DVLA rules for driving?
A
No car driving until seizure-free for 1 year
HGV/PCV drivers must be seizure-free for 10 years OFF medication
10
Q
During what, if a seizure occurs, might there be no DVLA penalty?
A
Sleep
11
Q
What are some common epilepsy mimics?
A
Syncope Non-epileptic attack disorder: - Pseudoseizures - Psychogenic non-epileptic attacks Panic/Hyperventilation Sleep phenomenon
12
Q
What are epileptic seizures?
A
Abnormal synchronisation of neuronal activity: - Usually excitatory - High frequency APs Interruption of normal brain activity: - Focal OR - Generalised Usually brief (seconds - minutes)
13
Q
What is the incidence of epilepsy?
A
50-80/100,000
14
Q
In what populations is epilepsy most common?
A
Infants
Elderly
15
Q
What is the overall mortality for epilepsy?
A
1/400 per year
16
Q
What is the overall mortality for severe epilepsy in young adults?
A
1/100
17
Q
What are the types are generalised seizures?
A
Absence Myoclonic Atonic Tonic Tonic-clonic
18
Q
What is a simple partial seizure?
A
Focal site of origin
WITHOUT impaired consciousness
19
Q
What is a complex partial seizures?
A
Focal site of origin
WITH impaired consciousness
20
Q
What predisposition do most generalised epilepsies have?
A
Genetic
21
Q
When are generalised epilepsies most common?
A
Childhood
Adolescence
22
Q
What is the EEG appearance of a generalised epilepsy?
A
Generalised spike-wave abnormalities
23
Q
What is the first line treatment for primary generalised seizures?
A
Sodium valproate
24
Q
What is the first line treatment for primary generalised seizures in pregnancy?
A
Lamotrigine
25
Early morning jerks, generalised seizures. Triggered by sleep deprivation and 'flashing light's in a 12 year old boy?
Juvenile myoclonic epilepsy (Janz syndrome)
26
What is the first line treatment for partial seizures?
Carbamazepine
27
What is the first line treatment for partial seizures in pregnancy?
Lamotrigine
28
What is a common type of frequent partial seizures?
Complex partial seizures with hippocampal sclerosis
29
What drugs inhibit presynaptic voltage-gated sodium channels?
Carbamazepine
Lamotrigine
Phenytoin
Topiramate
30
What drugs inhibit presynaptic voltage-gated potassium channels?
Retigabine
31
What drugs inhibit presynaptic voltage-gated calcium channels?
Pregabalin and Gabapentin (N-type channels)
| Ethosuximide (T-type channels)
32
What drug inhibit synaptic vesicle glycoprotein 2A (SV2A)?
Levetiracetam
33
What drugs increase the postsynaptic GABAa receptor activity?
Benzodiazepines
Barbituates
Felbamate
Topiramate
34
How does sodium valproate work?
Increases GABA synthesis
35
How does Tiagabine work?
Inhibits the GABA transport (which removes GABA from synapse)
36
How does Vigabatrin work?
Inhibits GABA transaminase (which degrades GABA)
37
When is phenytoin used in seizures? Why?
Acute management only
| Rapid loading possible
38
What is a side effect of phenytoin?
Enzyme inducer
39
What are the side effects of sodium valproate?
Weight gain
Teratogenesis
Hair loss
Fatigue
40
What effect can carbamazepine have on primary generalised seizures?
Can make them worse
41
What is a Jacksonian March?
A sign of a focal seizure
| Starts in a distal body part and spreads proximally
42
What is a down-side to lamotrigine?
Takes a long time to titrate up
43
Why is levetiracetam good?
Few interactions
| Usually well tolerated
44
What is a side effect of levetiracetam?
Mood swings
45
What are some side effects of Topiramate?
Sedation
Dysphasia
Weight loss
46
If the first line therapies for partial/focal seizures do not work, what can be offered?
Oxycarbazine
Levetiracetam
Topiramate
Sodium valproate
47
What are the first line drugs for generalised absence seizures?
Sodium valproate
OR
Ethosuximide
48
What are the second line drugs for generalised absence seizures?
Topiramate
OR
Levetiracetam
49
What are the first line drugs for generalised myoclonic seizures?
```
Sodium valproate
OR
Levetiracetam
OR
Clonazepam
```
50
What are the second line drugs for generalised myoclonic seizures?
Lamotrigine
Or
Topiramate
51
What is the first line drug for atonic/tonic/tonic-clonic generalised seizures?
Sodium valproate
52
What are the second line drugs for atonic/tonic/tonic-clonic generalised seizures?
```
Levetiracetam
OR
Topiramate
OR
Lamotrigine
```
53
How many patients are seizure free on monotherapy?
55%
54
How many additional patients are seizure free on polytherapy?
10%
55
Why should non-pregnant women be wary of taking anti-epileptics?
Some are enzyme-inducers (carbamazepine, phenytoin, topiramate)
Affect efficacy of COC
56
What shouldn't women use for contraception when taking anti-epileptics and why?
POP
| Implants
57
What contraceptive requires more frequent dosing if also taking an AED?
Depot progestogen
58
What effect does taking AEDs have on emergency contraception?
Ineffective
| Dose needs increased
59
During pregnancy, what doses of folic acid does a pregnant woman need to take if on an AED? What is the normal dose?
5mg per day
| usually 400mcg
60
After how long is a person deemed to be in status epilepticus?
5 minutes
61
What are the types of status epilepticus?
```
Generalised Convulsive Status Epilepticus
Non-convulsive states:
- Conscious
- In an 'altered' state
Epilepsia Partialis Continua:
- Continual focal seizures
- Consciousness preserved
```
62
What severe metabolic disorders can trigger status epilepticus?
Hyponatraemia
| Pyridoxine deficiency
63
Why can status epilepticus cause lasting damage?
Excess cerebral energy demand
| Poor substrate delivery
64
What can status epilepticus result in?
Respiratory insufficiency and hypoxia
Hypotension
Hyperthermia
Rhabdomyolysis
65
How do we treat hypoglycaemia in status epilepticus?
50ml of 50% IV glucose
66
What anticonvulsants can be given after 5 minutes of seizures activity (ie patient is in status epilepticus) in hospital?
```
Lorazepam 4mg IV (first line)
OR
Midazolam 10mg buccally/intranasally
OR
Diazepam 10mg IV/PR
```
67
What anticonvulsants can be given in primary care in status epilepticus?
Midazolam 10mg buccally/intranasally
OR
Diazepam 10mg PR
68
How often and when can benzodiazepines be repeated in status epilepticus?
Repeated ONCE after 5 minutes
69
If benzodiazepines fail to control status epilepticus, what drugs can be given within 30 minutes of onset of seizures?
Phenytoin 18mg/kg IV at 50mg/min:
- ECG monitoring is ESSENTIAL
OR (if no ECG/Phenytoin) available
Sodium valproate 20-30mg/kg IV at 40mg/min
70
If status epilepticus persists beyond 60 minutes of onset, how is it treated?
Admit to ITU
| Administer general anaesthesia (Thiopentane or Propofol)
71
If the patient is malnourised or alcohol abuse is suspected, what else can be prescribed during status epilepticus?
IV Thiamine 250mg over 30mins
72
What is the incidence of spontaneous subarachnoid haemorrhage?
6/100,000 (per year)
73
How does a subarachnoid haemorrhage present?
```
Sudden onset severe headache
Collapse
Vomiting
Neck pain
Photophobia
```
74
What are some differentials for the thunderclap headache in subarachnoid haemorrhage?
Migraine
| Benign coital cephalagia
75
What focal deficit signs might be seen in subarachnoid haemorrhage?
Dysphasia
Hemiparesis
CN iii palsy
76
What might be seen on fundoscopy in subarachnoid haemorrhage?
Retina/Vitreous haemorrhage
77
When is an LP safe in the context of a subarachnoid haemorrhage?
If no neurological deficit AND If no papilloedema
OR
With a normal CT
78
What does CSF look like in subarachnoid haemorrhage and in what time frame?
Bloodstained or Xanthochromic
| 6-48 hours after haemorrhage
79
What technique is used for cerebral angiography? Via what artery?
Seldinger technique via femoral artery
80
When might cerebral angiography miss an aneurysm?
Vasospasm
81
What are some complications of a subarachnoid haemorrhage?
```
Re-bleeding
Delayed ischaemia
Hydrocephalus
Hyponatraemia
Seizures
```
82
What is the re-bleed risk in the first 14 days following a subarachnoid haemorrhage?
20%
83
What is the re-bleed risk in the first 6 months following a subarachnoid haemorrhage?
50%
84
When do Delayed Ischaemic Neurological Deficits occur following a subarachnoid haemorrhage and how do they present?
3-12 days later
| Altered conscious level or focal deficit
85
What causes a Delayed Ischaemic Neurological Deficit?
Vasospasm
86
How can a Delayed Ischaemic Neurological Deficit be prevented? How does it work?
Nimodipine:
| - Prevents vasospasm and ischaemic
87
What is 'Triple H' therapy and what does it treat/prevent?
```
Induced:
- Hypertension
- Hypervolaemia
- Haemodilution
Treats vasospasm and prevents DIND
```
88
How does hydrocephalus present?
Increasing headache
| Altered conscious level
89
How can hydrocephalus be treated?
CSF drainage:
- LP
- External ventricular shunt
- Ventricular-peritoneal shunt
90
Why do we not fluid restrict in hyponatraemia following subarachnoid haemorrhage?
It is often just transient
91
How can hyponatraemia following subarachnoid haemorrhage be treated?
Fludrocortisone
92
What are 50% of intracerebral haemorrhages secondary to?
Hypertension:
- 'Charcot-Bouchard' microaneurysms of small perforating vessels
- Basal ganglia haemorrhage
93
What are 30% of intracerebral haemorrhages secondary to?
Aneurysm OR
| AVM
94
How does an intracerebral haemorrhage present?
Headache
Focal neurological deficit
Reduced consciousness
95
What investigations are important in intracerebral haemorrhage?
CT (urgent if reduced consciousness)
| Angiography (if suspected aneurysm/AVM)
96
How is an intracerebral haemorrhage treated?
Surgical evaluation +/- treatment of underlying cause
97
What factors contribute to a poor prognosis in intracerebral haemorrhage?
Large basal ganglia/thalamic clot with:
- Major focal deficit OR
- Deep coma
98
Where are most AVMs located?
Within the brain parenchyma
99
How can AVMs present?
Seizures
| Headache
100
What is Steal syndrome?
Ischaemic syndrome
| Resulting from a vascular assist device (eg. AV fistula)
101
How is an AVM treated?
Surgery
Endovascular embolisation
Stereotactic radiotherapy
Conservative
102
Where do LMNs run from?
Ventral horn (of spinal cord) to muscle
103
What are the signs of an UMN lesion?
Increased tone
Minimal muscle wasting
NO fasciculations
Hyperreflexia
104
What are the signs of a LMN lesion?
Reduced tone
Muscle wasting
Fasciculations
Diminised reflexes
105
What can cause chronic spinal cord compression?
Degenerative disease (spondylosis)
Tumours
Rheumatoid arthritis
106
How do chronic compressions present?
Similar to acute compressions except UMN signs predominate
107
A patient presents initially with a flaccid, areflexic paralysis. There is some return of reflexes 2 days later. 2 weeks later, increased tone and hyperreflexia are noted.
Cord transection - "Spinal shock"
108
A patient presents with right sided loss of motor function from the umbilicus down. There is a loss of proprioception, vibration and touch sensations from the umbilicus downwards on the right side. From the pubic symphysis downwards, there is a loss of pain and temperature sensation on the left side. What is this condition and where has the lesion occur?
Brown-Sequard syndrome:
| - Right sided cord hemisection at T10 level
109
A 68 year old patient experiences a hyperestension injury to his neck. There is noticeable upper limb weakness. There is loss of pain and temperature sensation in both of the upper limbs, and across the chest and upper back. On examination, power is preserved in the lower limbs and proprioception, fine touch and vibration is preserved in both upper and lower limbs. There is evidence of urinary retention. He has a past medical history of osteoarthritis in his cervical and lumbar spine. What is this condition? Why are the upper limb motor functions affect more? Why are proprioception, vibration and fine touch sensations normal?
Central cord syndrome:
- Neurones supplying upper limb are more central in the lateral corticospinal tract
- Dorsal column is left intact
110
How can lung/breast/kidney/prostate cancers result in spinal cord compression?
Metastasis to extradural space
111
What intradural extramedullary tumours can cause spinal cord compression?
Meningioma
| Schwannoma
112
What intradural intramedullary tumours can cause spinal cord compression?
Astrocytoma
| Ependyoma
113
What infections can cause epidural abscesses resulting in spinal cord compression?
Bloodborne Staph.
| TB
114
How do we manage spinal trauma?
```
Immobilise
Investigate:
- Xray/CT
- MRI
Methylprednisolone:
- Bolus
- 24 hour infusion
Surgical decompression and traction/ex-fix
```
115
What are dissociative seizures, non-epileptic attack disorder, pseudoseizures, psychogenic non-epileptic seizures and hysterical seizures all types of?
Functional attacks
116
What are non-epileptic seizure attacks related to?
Traumatic events
Physical/Sexual abuse
Other stress
Anxiety/Depression
117
How can a functional attack be diagnosed?
History
Linguistic analysis
Outpatient EEG (+ video with provocation)
Longterm video EEG monitoring
118
Where do somatosensory auras arise from?
```
Somatosensory cortex (parietal lobe)
Occasionally insular lobe
```
119
Where do visual auras arise from?
Occipital lobe
| Occasionally temporal lobe
120
Where do auditory auras arise from?
Auditory cortex (temporal lobe)
121
What are vertiginous auras? Where do they arise from?
Vertigo-attacks
| Arise from temporoparietal lobe (near visual and auditory association areas)
122
Where do autonomic auras arise from?
Temporal lobe:
- Insula
- Amygdala
123
How is a functional attack defined?
1. Attacks with prominent motor activity
2. Episodes of collapse with no movement
3. Abreactive attacks
- Fear
- Gasping
- Hyperventilation
124
How long do function attacks last?
10-20 minutes (prolonged compared to epileptic seizures)
125
What are the signs of peripheral autonomic neuropathy?
Postural hypotension
Impotence
Nausea and vomiting
126
What are the signs of peripheral small fibre neuropathy?
Pain dysaesthesia
127
What are the signs of peripheral large sensory fibre neuropathy?
Numbness
Paraesthesia
Unsteadiness
128
What are the signs of peripheral large motor fibre neuropathy?
Weakness
Unsteadiness
Wasting
129
What is pseudoathetosis?
Abnormal writing (usually of the fingers) due to loss of proprioception (seen in large sensory fibre neuropathy)
130
How does Mononeuritis Multiplex present?
Simultaneous/Sequential neuropathy (sensory and motor deficits) of non-contiguous nerve trunks
131
What is Mononeuritis Multiplex associated with?
```
Diabetes
GPA
EGPA
Rheumatoid arthritis
SLE
Sarcoidosis...
```
132
A patient experiences some weakness that she initially described as starting in her feet and ankles. Over time this spread up to her knees at which she also started to experience some weakness in her hands. There was also some loss of sensation in the same distribution. What is this condition? What is the name of the distribution?
Length-Dependant Peripheral Neuropathy
| 'Glove and stocking' distribution
133
What is a plexopathy?
Disorders typically affecting the brachial (C5-T1) and/or lumbosacral plexuses (T12-L4 and L4-S3/4)
134
What is a radiculopathy?
Disorders affecting the nerve roots
135
What are some differential diagnoses of radiculopathies?
Carpal tunnel (median nerve) vs C8 radiculopathy
136
What do nerve conduction studies show in axonal loss?
Reduced amplitude
| Normal velocity and latency
137
What do nerve conduction studies show in demyelination?
Slowed velocity
Prolonged latency
Normal/Slightly reduced amplitude
138
What are some acute demyelinating neuropathies? How long do they develop over?
Guillaine-Barre Syndrome
Acute Inflammatory Demyelinating Polyradiculopathy
Days-Weeks
139
What are some chronic demyelinating neuropathies?
Chronic Inflammatory Demyelinating Polyneuropathy
| Hereditary Sensory Motor Neuropathy (ie. Charcot-Marie-Tooth Disease)
140
What is the incidence of Guillaine-Barre Syndrome?
1-2/100,000 per year
141
How does Guillaine-Barre Syndrome present?
Progressive paraplegia over days - 4 weeks
Sensory symptoms precede weakness
Pain
142
When do symptoms of Guillaine-Barre Syndrome peak?
10-14 days
143
What is Guillaine-Barre Syndrome associated with?
GI infection (Campylobacter)
144
How do Guillaine-Barre Syndrome patients die?
ANS failure resulting in cardiac arrhythmias
145
How is Guillaine-Barre Syndrome treated?
Ig infusion and/or
Plasma exchange
(Minimal role for steroids)
146
What are the variants of hereditary neuropathies?
Pure motor/sensory
Sensorimotor
Small fibre (ie. Congenital Insensitivity to Pain +/- Anhydrosis)
147
What is the most common mutation in hereditary neuropathies?
CMT1a
148
What can cause an ANA/ENA positive vasculitis axonal neuropathy?
Rheumatoid arthritis
| Sjogrens
149
What cancers can result in paraneoplastic syndromes with axonal neuropathy features?
Myeloma
Ab mediated:
- Breast cancer
- SCLS
150
What infections can result in an axonal neuropathy?
HIV
Syphilis
Lyme
Hepatitis B/C
151
What drugs can result in an axonal neuropathy?
```
Alcohol
Amiodarone
Phenytoin
Chemotherapy:
- Cisplatin
- Vincristine
```
152
What metabolic conditions are associated with axonal neuropathies?
```
Diabetes
B12/Folate deficiency
Hypothyroidism
Chronic uraemia
Porphyria
```
153
What conditions can result in chronic autonomic neuropathy?
Diabetes (gastroparesis)
Amyloidosis
Hereditary
154
What conditions can result in acute autonomic neuropathy?
Guillan-Barre
| Porphyrias
155
How is a vasculitic axonal neuropathy treated?
Pulsed IV:
- Methylprednisolone AND
- Cyclophosphamide
156
How is a demyelinating peripheral neuropathy treated?
IV Ig (pooled from donors)
Steroids
Azathioprine, Mycophenalate, Cyclophosphamide
157
What are pyramidal/UMN features?
Pyramidal weakness:
- Upper limb extensors weaker than flexors
- Lower limb flexors weaker than extensors
Spasticity
158
Where do extrapyramidal symptoms arise?
Basal ganglia
159
What are signs of cerebellar disease (ataxia)?
Lack of voluntary coordination
Gait abnormality
Disdiadochokinesia
160
How does an UMN lesion affect deep tendon, superficial and pathological reflexes?
Deep tendon - Increased
Superficial - Reduced
Pathological - Increased
161
What general signs are seen in muscle disease?
Wasting (usually proximal)
Reduced tone
Reduced/Absent deep tendon reflexes
162
What do fasciculations, babinski reflex and wasting indicate?
LMN lesion
163
What general signs are seen in NMJ disease?
Fatiguable weakness
Normal/Reduced tone
Normal tendon reflexes
No sensory symptoms
164
What pattern of sensory loss is seen in UMN lesions?
Central
165
What can cause an UMN lesion?
Stroke
Space occupying lesion
Spinal cord injury
166
What UMN sign a does parasagittal frontal lobe lesion cause?
Paraparesis (partial paralysis of lower limbs)
167
What can cause a LMN lesion?
MND
Spinal muscular atrophy
Lead poisoning
Poliomyelitis
168
What is the muscle, nerve and nerve root responsible for shoulder abduction?
Deltoid
Axillary
C5
169
What is the muscle, nerve and nerve root responsible for elbow extension?
Triceps
Radial
C7
170
What is the muscle, nerve and nerve root responsible for finger extension?
Extensor digitorum
Posterior interosseus (radial)
C7
171
What is the muscle, nerve and nerve root responsible for index finger abduction?
1st dorsal interosseus
Ulnar
T1
172
What is the muscle, nerve and nerve root responsible for hip flexion?
Iliopsoas
Femoral
L1/L2
173
What is the muscle, nerve and nerve root responsible for knee flexion?
Hamstrings
Sciatic
S1
174
What is the muscle, nerve and nerve root responsible for ankle dorsiflexion?
Peroneals
Common fibular and sciatic
L4/L5
175
What is the muscle, nerve and nerve root responsible for great toe dorsiflexion?
Extensor hallucis longus
| Common fibular L5
176
What does a hemianaesthesia suggest?
Contralateral cerebral lesion
177
If there are no other signs in a hemianaesthesia, what should we suspect?
Non-organic cause
178
What signs does "dissociated sensory loss" mean?
Lost spinothalamic function (pain and temp.)
| Preserved dorsal column function
179
What does dissociated sensory loss suggest? What can cause this?
Hemicord damage:
- Anterior spinal artery syndrome
- Brown-Sequard syndrome
- Syringomyelia
180
How would a cerebellar gait be described?
Broad-based
| Unsteady
181
How can an intention tremor or ataxia be assessed in cerebellar disease?
Finger-nose test
| Knee-heel test
182
What is disdiadochokinesis?
Clumsy, fast, alternating movements
183
What are some possible addition features of cerebellar disease?
Nystagmus
| Dysarthria
184
What is the pattern of extrapyramidal symptoms in Parkinson's Disease?
Usually asymmetrical
185
What is the pattern of extrapyramidal symptoms in drug-induced or atypical Parkinson's?
Symmetrical
186
What lobe is responsible for executive functions, self-criticism and trying again?
Frontal
187
What lobe is responsible for responding to primitive stimuli?
Orbitofrontal cortex
188
What does orbitofrontal cortex damage cause?
Disinhibition
189
What is the function of the dorsolateral prefrontal cortex?
Response to external stimuli and executing work responsibilities
190
What parts of the brain are responsible for motivation? Damage can cause abulia (lack of will) and akinetic mutism.
Cingulate gyrus and dorsomedial frontal lobe
191
What sort of gait is seen in frontal lobe dysfunction?
Magnetic gait (feet carried up and forward)
192
What kind of aphasia can be seen in frontal lobe dysfunction?
Expressive/Broca's
193
What is agnosia? Damage to what lobe can result in this?
Inability to interpret sensations and recognise things
| Temporal
194
What type of aphasia is seen in temporal lobe damage?
Receptive/Wernicke's
195
What visual field defects are seen in temporal lobe damage? Is the defect contralateral/ipsilateral? What part of the optic pathway is affected?
Congruous upper homonymous quadranantopia
Contralateral
Meyer's loop
196
Why can auditory dysfunction arise in temporal lobe damage?
Heschel's gyrus (Temporal transvers gyrus):
| - Hearing represented bilaterally
197
What are signs/symptoms of a temporal lobe seizure?
```
Deja-vu
Jamais-vu
Amnesia
Auditory/Visual/Gustatory/olfactory/sensory hallucinations
Emotional lability
```
198
What visual defect is seen in parietal lobe damage? Is the defect contralateral/ipsilateral? What part of the optic pathway is affected?
Congruous lower homonymous quadrantanopia
Contralateral
Superior optic radiations (Baum's loop)
199
This is a disease of the dominant angular gyrus (part of the inferior parietal lobe). It presents with:
- Dysgraphia
- Left-right disorientation
- Finger agnosia
- Acalculia
Gertmann's Syndrome
200
What does damage to the non-dominant angular gyrus of the parietal lobe cause?
Inattention
201
What happens to levodopa when taken?
Crosses BBB
| Converted to dopamine in the brain
202
How can peripheral breakdown of levodopa be prevented?
Carbidopa
203
What can levodopa be broken down by in the brain? What drugs can prevent this?
Catechol-O-Methyltransferase (COMT)
COMT inhibitors:
- Entacapone
- Tolcapone
204
What receptors do dopamine agonist work on?
Act on D2-type receptors
205
What are some examples of dopamine agonists?
Pramipexole
Ropinirole
Bromocriptin
206
What anticholinergics can reduce the tremor in Parkinson's?
Trihexyphenidyl
| Diphenhydramine
207
Why are anticholinergics typically avoided in Parkinson's?
Can cause severe side effects:
- Delirium
- Drowsiness, vertigo, headache
- Dry mouth
- Mydriasis +/- Photophobia
208
What effect can amantadine have in Parkinson's?
Many alleviate levodopa-related dyskinesias
Mild attenuation of:
- Tremor
- Dystonia
209
In Parkinson's, failure to respond to high does levodopa is a strong indicator for what?
Non-idiopathic Parkinson's
210
Visual compromise (optic neuritis, nystagmus, diplopia), stiffness and weakness are presenting features of what?
MS
211
Oligoclonal bands in CSF
MS
212
What effect does fever have in MS?
Can worsen symptoms
213
What MND has pure UMN features?
Primary Lateral Sclerosis
214
What is it important to ask about in assessing MND?
```
Cramps
Fasciculations
Foot drop
FHx
Behavioural changes
```
215
Fasciculations (including the tongue) and wasting in muscle groups outside a single myotome are what sort of signs?
LMN
216
Increased tone, clonus, loss of dexterity, brisk reflexes (preserved in wasted/fasciculating muscles) and Babinski reflex are what sort of signs in MND?
UMN
217
What is an MRI used for in stroke?
To identify:
- Old lesions
- Non-vascular lesions
218
What is a diffusion-weighted MRI used for in stroke?
To identify new ischaemic lesions (hyperintense)
219
What is a T2 sequence MRI used for in stroke?
Identify bleeds and microbleeds
220
What are time-of-flight MRI sequences used for in stroke?
To identify occlusions of extra- and intracranial arteries
221
What are perfusion-weighted MRI sequences useful for in stroke?
Identify areas at risk of iscaemia
222
What do CT hyperintesities in stroke indicate?
Bleed
223
What are early CT signs of a stroke?
Loss of lentiform nucleus
Poor grey-white matter differentiation
Loss of insular ribbpn
