Neurology Flashcards
List the main causes of epilepsy.
Remember *VITAMINS*
Vascular (Ischaemic/Haemorrhagic Stroke)
Infection (Meningitis/Encephalitis/Brain Abscess)
Trauma / Toxins (Amphetamine overdose/Alcohol withdrawal/ Isoniazid (TB drug)
Autoimmune (CNS vasculitis or SLE)
Metabolic (Hyponatraemia/Hypocalcaemia/Hypo or Hyper glycaemia/ Hyperthyroidism/ Uraemic Hepatic and Wernickes Encephalopathy)
Idiopathic (epilepsy)
Neoplasm
Syncope
3 signs of cerebellar disease
Ataxia
Dysarthria
Nystagmus
ADN or DNA to remember
or remember DANISH
Disdiadokinesia
Ataxia (wide set gait)
Nystagmus
Intentional tremor
Slurred speech (dysarthria)
Hypotonia
Parkinson’s disease signs
Tremor (rolling pin - 3-5Hz)
Bradykinesia
Rigor/rigidity
Postural instability
Facial drooping
3 forms of management for MND used to slow the progression of the disease.
Riluzole
Edaravone (not licenced yet in uk)
NIV
Myasthenia gravis is associated strongly with which other condition?
Thymoma (tumours of the thymus)
Name the three antibodies used for diagnosis of Myasthenia Gravis?
Ach - R
MuSK (muscle specific kinase antibodies)
LRP- 4 (lipoprotein related protein)
Management options for myasthenia gravis.
Medical:
Reversible Acetylcholine esterase inhibitors (e.g neostigmine / pyridostigmine)
Immunosuppressives (e.g Prednisolone or azathioprine)
If this fails monoclonal antibodies can be a treatment option (e.g rituximab)
Surgical:
Thymectomy
What is the management options for generalised seizures?
(a) Generalised
1st Line : Sodium Valproate (beware teratogenic) - accentuates GABA activity
2nd Line: Carbamezapine / Lamotrogine both inhibit sodium channels and thus depolarization and glutamate release.
What is the management options for Focal Seizures?
(b) Focal
1st Line : Carbamezapine or Lamotrigine
2nd Line: Sodium Valproate or Levotiracetam
What are the side effects of Sodium Valproate in the treatment of epilepsy?
Teratogenic (30-40% risk) : To be completely avoided in women of child bearing age.
Liver damage and hepatitis (Raised lfts)
Hair loss
Tremor
What is the class and side effects of carbamezapine?
Na channel antagonist - prevent action potential and glutamate release.
Side effects:
Aplastic anaemia
Agranulocytosis
CYP450 lots of interactions - reduce effectgveness of contraceptives
Erythema multiforme
Arrhythmias
Hepatitis
*Not to be used in Asian patients as increased risk of SJS*
What side effect is to be worried about in the Na channel blocker lamotrigine?
Serious skin rashes:
Steven - Johnson and Dress Syndrome (both life threatening).
What side effect is common to all types of anti-epileptic drugs and can occur as soon as a week into medication?
Suicidal Thoughts and behaviour change
How does guillain-barre syndrome present?
Ascending weakness
Loss of peripheral sensation
Peripheral Pain or neuropathic pain
Facial weakness
Reduced Reflexes
Preceding infection (Campylobacter/Mycoplasma/EBV) followed by a Motor dominant peripheral neuropathy and areflexia is typical of guillain-barre syndrome.
Remember carl in bed couldnt move his arms when examining him and he was completely areflexic

Which criteria is used to diagnose GBS? And what are the two main components.
Brighton Criteria:
Nerve Conduction Studies Lumbar Puncture (expect high protein but normal cell count and glucose).
*High protein due to the presence of antibodies*
What is the management of guillan-barre syndrome?
First line: IV immunoglobulins
Second line: Plasma exchange
Most important is respiratory support and VTE prophylaxis as the leading cause of death in GBS is pulmonary embolism due to immobilisation in hospital.
Prognosis is good with 80% of patients making a full recovery.
Most important complication of GBS
Respiratory: PE and pneumonia (from lack of ventilation)
4 characteristics of UMN lesion
Hypertonia
Hyperreflexia / upgoing plantar
Spasticity
Weakness
4 characteristics of LMN lesion
Reduced reflexes - mute or downward plantar
Hypotonia
Wasting and Fasciculations
Weakness
Causes of polyneuropathy
ABCDE and infections
Alcohol/Autoimmune (ex. GBS)
B12 / Thiamine deficiency
Carcinoma (paraneoplastic syndrome - LE) /Charcot-Marie-Tooth disease (comprises genetic causes of neuropathy) and Chronic Kidney Disease (CKD)
Diabetes/Drugs (TB drugs - isoniazide / Metronidazole/Nitrofurantoin/ amiodarone)
Every Vasculitis (RA/SLE/Polyarteritis nodosa)
And Infections (Herpes Zoster/ HIV/ Lymes/ Syphillis and leprosy).
How does the distribution of nerve weakness differ between GBS and Myasthenia gravis/Labert-Eaton myasthenic syndrome?
GBS - Ascending (i.e distal to proximal)
Myasthenia Gravis (post synaptic AChR) and Lambert-Eaton Myasthenic syndrome (Pre-Synaptic Ca channels) (Both Proximal muscle wasting)
However MG gets worse on physical exertion (ex. bilateral ptosis on sustained upward gaze)
whereas
LEMS improves throughout the day with physical activity
Lambert - Eaton Myasthenic Syndrome is a paraneoplastic syndrome arising from ____ Lung cells and uses antibodies to target ___ channels on the ____ synaptic membrane.
Small cell
Ca channels
Pre
What are the 4 first line treatments for neuropathic pain?
Remember Mnemonic *A Dying GP”
Amitryptilline (TCA - Increase serotonin and NE in synaptic cleft)
Duloxetine (SNRI)
Gabapentin (Anticonvulsant - mimics gaba signalling but does not bind to GABA receptors)
Pregabalin (Anticonvulsant - same as above)
What does the mnemonic ‘SNOOP’ stand for when assessing red flags for headaches?
The mnemonic “SNOOP”, without the “D-O-double G”, summarizes some of the red flags.
“S” is for systemic symptoms like fever or weight loss.
“N” is for neurological symptoms, like weakness, sensory deficits, or vision loss.
The first “O” is for a new or sudden onset headache.
The second “O” is for other associated conditions, like trauma.
The “P” stands for progression or pattern, such as a headache that is worsening in severity or frequency.
**Remember COCP can also cause headache**





