Neurology Flashcards
Treatment for migraine prevention
Topiramate
Propanolol
Acute management of cluster headaches
Oxygen
SC triptan
Prophylaxis of cluster headaches
Verapami
What drugs cause peripheral neuropathy?
Amiodarone Isoniazid Vincristine Nitrofurantoin Metronidazole
Features of multi system atrophy
Parkinsonism Autonomic disturbance Erectile dysfunction Postural hypotension Atonic bladder Cerebellar signs
What is friedreichs ataxia?
Autosomal recessive condition that develops around age 10 - 15.
- Gait ataxia and kyphoscolliosis
- Absent ankle jerks
- Cerebellar ataxia
- Optic atrophy
- Spinocerebellar tract degeneration
- HOCM
- Diabetes
- High arched palate
Most common cause of death in friedreichs ataxia
HOCM
Subacute combined degeneration of the spinal cord.
- Bilateral spastic paresis
- Bilateral loss of prorioception and vibration
- Bilateral limb ataxia
Treatment of primary open angle gluacoma
- Prostoglandin analogue eye drop
2. Beta blocker, carbonic anhydrase inhibitor
Subthalamic nucleua of the basal ganglia
Hemibalism
Striatum (caudate nucleaus) of the basal ganglia
Huntingtons corea
What is von hippel lindau syndrome?
Autosomal dominant condition predisposing to neoplasia. - Cerebella haemangiomas Retinal haemangiomas Renal cysts Phaeochromocytoma Extra renal cysts Endolymphatic sac tumours Clear cell renal cell carcinoma
Best form on imaging for a TIA
MRI (with diffusion weighted imaging)
Treatment for glioblastoma multiforme?
Chemoradiotherapy with temozolamide (they have a synergistic effect on killing tumour cells.
Antibodies in myaesthenia gravis
Antibodies to acetylcholine receptors
ANti muscle specific tyrosine kinase antibodies
Treatment for myasthenia gravis
Pyridostigmine
Immunosupression may be needed in addition (initially prednisolone then azathioprine, cyclosporin or mycophenolate)
Thymectomy
Treatment of trigeminal neuralgia
Carbamazapeine
Microvascular secompression
Treatment of guillain barre
IV IG or Plasma exchange
Drugs that can exacerbate myaesthenia gravis
Penicillamine Quinidine Procanamide Beta blocker Lithium Ohenytoin Gentamicin, maclorlide, quinolones, tetracyclines
Symptoms of sporadic CJD
rapidly progressive dementia
Depression, apathy, euphoria, anxiety and emotional lability
Myoclonus, ataxia, nystagmus and hyperreflexia
MRI findings in CJD
Hypertintense signals in the basal ganglia and thalamus
Treatment for tics?
Clonidine
Atypical antipsychotics
Features of myotonic dystrophy
- features occur at age 20 - 30.
- Myotonia (tonic spasm of muscle)
- Mental impairment
- Diabetes
- Testicular atrophy
- Cardiac involvment (heart block, cardiomyopathy)
Dysphagia
Treatment for paroxysmal hemicrania
Indomethacin
Treatment for neuroleptic malignant syndrome
IV fluids
Dantrolene
Bromocriptine
What is facioscapulohumeral muscular dystrophy?
Autosomal dominant muscular dystrophy that affects the face, scapula and upper arms first (symptoms tend to present by age 20)
How do you test for friedrichs ataxia?
Serum genetic testing of the GAA trinucleotide repeat
What is neuromyelitis optics (devics disease)
Demyelinating CNS disorder. - Bilateral optic neuritis - Myelitis - Spinal cord lesion invloving 3 or more spinal levels - Normal M~RI brain Aquaporin 4 positive serum antibody
Treatment of neuromyelitis optica
Immunosupressants (eg rituximab)
Which type of lunch cancer is associate with sensory neuropathy?
Small cell lung cancer (Anti Hu antibodies) Also causes cerebellar synndrome and enchephalomyelitis
What is the treatment of valproate induced hyperammonaemic encephalopathy
L Carnitine
What do you see in the CSF of patients with guillan barre syndrome
High protein
What medications increase the risk of idiopathic intracranial hypertension?
COCP Steroids Tetracyclines Vitamin A Lithium
Medications used in idiopathic intracranial hypertension
Acetazolamide
Topiramte
Treatment ladder in parkinsons disease
- Levodopa (if symptoms impact on quality of life)
- Dopamine agonist of MAOB inhibitors if symptoms not impacting on quality of life
- MAO B inhibitor on COMT inhibiitors as an adjunct to people on levodopa who are having fluctiatioms despite optimal therapy
What does entacapone do?
COMT inhibitor that reduced the breakdown on L dopa (can be used as ad adjunt to levo dopa if ongoing motor symptoms)
What medication can be used to help daytime sleepiness in parkinsons disease?
Modafinil
What medication can be used to help REM sleep behaviour disorder in parkinsons?
Clonazepam or melatonin
What medication can be used for postural hypotension in parkinsons disease?
Midodrine
What medicatin can be used to help with drooling in people with parkinsons disease>
Glycopyrronium bromide
Investigations in myaesthenia gravis?
Single fibre electromyography
CT Thorax (to exclude thymoma)
CK (normal)
Autoantibodies- Acetylcholine receptor, anti muscle specific tyrosine kinase antibodies)
Tensilon test (edrophonium reduced muscle weakness temporarily
Management of myasthenic crisis?
Plasmapheresis
IVIG
Nerve conduction tests - normal velocity but reduced amplitude
Axonal pathology - Diabetes - B12 - Paraneoplastic HIV
Nerve conduction tests - reduced velocity and normal amplitude
Demyelination
- MS
- Guillan barre
CIDP
What do glioblastoma look like on imaging?
Solid tumours with central necrosis and a rim that enhances with contrast.. Also associated with vasogenic oedema.
What do meningioma look like on imaging?
Contrast enhancing lesion
Total anterior circulation infarcts
All of…
1. Unilateral hemiparesis/hemisensory loss of the face arm and leg
2. Homonymous hemianopia
3. Higher cognitive dysfunction eg dysphasia
Middle and anterior cerebral arteries
Partial anterior circulation infarcts
2 of
1. Unilateral hemiparesis/hemisensory loss of the face arm and leg
2. Homonymous hemianopia
3. Higher cognitive dysfunction eg dysphasia
Involves the smaller arteries of the anterior circulation.
Lacunar infarcts
1 of the following 1. Unilateral weakness 2. Pure sensory stroke 3. Ataxis hemiparesis Involves perforating arteries of the unternal capsule, thalamus and basal ganglia
Posterior circulation infarcts
1 of the following
- Cerebellar or brainstem syndrome
- Loss of consciousness
- Isolated homonymous hemianopia
What is the criteria for needing ventilatory support in guillan barre syndrome?
FVC of less than 15 - 20.
What is miller fisher syndrome?
Variant of guillan barre syndrome associated with opthlmoplegia, areflexia an ataxia. The eye muscles are affected first and it usually presents with a descendng paralysis rather than ascending.
Anti GQ1b antibodies are present in 90% of cases.
Drug used after levodopa for tremor predmiant parksinons disease?
Anticholinergics such as procyclidine
