Neurology Flashcards
Emergency Plans: Seizures
- Epilepsy Australia website template
Emergency plans: Migraines
Emergency plans: dystonic crisis
Emergency plans: respiratory infections for neuromuscular conditions
Emergency plans: relapsing demyelinating conditions
Why should we NOT give sodium valproate to teenage girls?
Due to 30% risk of teratogenicity
Epilepsy long case questions
- Diagnosis:
- Age of first seizure, doing what, seminology, treatment, investigations
- Focal vs generalised; structural vs genetic vs metabolic
- Progress:
- What types of seizures since?
- Frequency of seizures
- Average duration of seizures
- Triggers
- Presentations with status
- Febrile seizures
- ICU admissions
- Investigations
- EEG, MRI, PET, CSF, genetics
- Management
- Medications trialed
- Current medications
- Other: keto / diet / surgery
- Goals:
- Complications
- SUDEP
- Water / roads / heights / locked rooms
- Monitoring
- Emergency Management
Neuromuscular disease
- Cardiovascular consequences
- Cardiomyopathies
- Arrhythmias
- Increased risk of MI
Localising the lesion in a neuro short case
- Cerebral cortex / cerebellum / brain stem
- Tumor
- Stroke
- Ataxia telangiectasia
- Cranial nerve
- Mobius: absence of cranial nerves
- Spine
- Tumor
- Infarct
- Anterior horn cell
- SMA
- Peripheral nerve
- Hereditatory motor-sensory
- Charcot Marie Tooth
- Toxic
- Guillian Barre
- Lambert Eaton
- SLE
- Fabry
- Porphyria
- Hereditatory motor-sensory
- NMJ
- Myasthenia gravis
- Transient myasthenic syndrome
- Congenital
- Botulism / tick
- Muscle
- Myopathies
- Congenital
- Endocrine + toxic
- Metabolic
- Muscular dystrophies
- BMD / DMD
- Emery-Dreifuss
- Myotonic
- Limb girdle
- Fascioscapulohumeral
- Congenital
- Myopathies
3yr old M, examine the gait
HC: 45cm (microcephalic) Wt: 21kg
Not dysmorphic
Small lump on head: underlying device
Mild hypotonia
Ataxic wide-based gait
Mild dysmetria
Plantars down, normal power
- Lesion: cerebellum
- Differential diagnosis
- Battens disease
- Stroke: posterior circulation
- Arteriovascular malformation
- Hereditary ataxia
- Friederichs ataxia
- Spinocerebellar
- Ataxia telangiectasia
- Glucose transport deficiency
- Cerebellum tumor: medulloblastoma or pilocytic astrocytoma
8yr old M examine his gait
Ht 105cm, Wt 52kg, HC 54cm
BP 130/80
Increased central adiposity / abdominal striae
Wide based gait + waddling, gower +
Calf hypertrophy
Decreased power especially proximal muscles
Absent knee + ankle jerks
Duchenne muscular dystrophy
Complications:
- Steroid complications: cataracts + glaucoma/ central adiposity / striae / hypertension /
- Scoliosis
- Restrictive lung disease
- Contractures
- Cardiomyopathy
11yr old F examine gait
HC 52cm, Wt 40kg, Ht 155cm
Hemiparetic gait
Circumduction R) leg, reduced R) arm swing
Power 5/5 in all muscle groups L
Power 4/5 in all muscle groups R (stronger in flexors)
Upgoing plantar R) foot
Differential diagnosis
L) MCA infarct
Tumur or dysplasia over the L) central region
Ramussen syndrome
- Immune mediated response that causes one hemisphere of the brain to become inflamed and deteriorate
Acute:
- Hemiplegic migraine
- ADEM
- Todds paresis
Primitive / Developmental Reflexes
Craniosynostosis types + fontanelle closure
Causes of macrocephaly
- Hydrocephalus: tense fontanelle, distended scalp veins
- Vacular malformations: cranial bruit
- Tumour: abnormal neurology
- Subdural haematoma : bruising
- Fragile X: developmental delay, large ears
- Neurofibromatosis: cafe-au-lait patches, axillary freckles
- Overgrowth syndromes
- Sotos : developmental delay, large hands/feet
- Metabolic
- Mucopolysaccharidoses : developmental delay, course features
- Familial macrocephaly
Causes of acute stroke in childhood
- Haematological
- Sickle cell disease (most common)
- Polycythaemia
- Leukaemia
- Disorders of coagulation
- Cardiac
- Confenital (cyanotic)
- Endocarditis
- Embolic
- Infection
- Meningitis
- Local infections or bacteraemia
- Intracerebral vascular
- AVM
- Aneurysm
- Autoimmune
- SLE
- Sarcoidosis
- JIA
- Metabolic
- Homocystinuria
- Mitochondial
- Trauma
Causes of developmental regression
- Acquired brain injury
- Hypoxia
- Meningitis
- Seizure disorders
- West syndrome
- Landau-Kleffner
- Neurometabolic/degenerative
- Mitochondrial disorders
- Tay-Sachs
- Toxic substances
- Lead
- Infections
- Panencephalitis
- Prion
- Developmental disorder
- Autism
- Retts
Complete 3rd nerve palsy findings
- Ptosis
- “Down and out” position of the involved eye
- Paralysis of most eye movements (sparing only lateral rectus and superior oblique function)
- Dilated pupil
- Lack of direct and consensual pupillary light response
Dwayne Syndrome
- Isolated cranial nerve 6 palsy
Senoforis
Heterochromia
Senoforis = monobrow
Heterochromia = multi-colour iris
Horners Syndrome
- Ptosis, meiosis, anhydrosios
Causes
Thoracic surgery
Neuroblastoma
Birth trauma
Congenital horners
Causes of glaucoma
Sturge Weber
Marfans
Homocystinuria
Causes of coloboma
Clinical findings in 4th nerve palsy
- Diplopia on looking down and in
6th nerve palsy findings
- Lack of lateral movement with diplopia most marked on looking towards the affected side
Bells Palsy Differential Diagnosis
- Herpes zoster (Ramsay Hunt)
- Otitis media
- Guillain Barre Syndrome
- HIV infection
- Sarcoidosis
- Sjogren syndrome
- Tumour syndrome
- Stroke
Ptosis
- Nerve involved + causes
Nerve: cranial nerve 3
Causes
- Congenital (most common)
- Myopathies
- 3rd cranial nerve palsy
- Haemangioma
- Orbital cellulitis
*Bilateral ptosis = neuromuscular or myasthenia gravis
*Horner’s causes a partial ptosis*
Aniridia
- What is it?
- Causes
Hypoplasia of the iris (coloured part): pupil looks markedly dilated
Causes
- Inherited: autosomal dominant
- WAGR syndrome (Wilms Aniridia Genitourinary abnormalities Retardation-ID)
- Can cause: cataracts, glaucoma, corneal opacification
Causes of cataracts
Cataracts: = opacity of the lens
Causes
- Hereditary: autosomal dominant
- Chromocomal disorders (T21, Noonan)
- TORCH infections
- Metabolis: galactosaemia, diabetes
- Steroids
Ectopia lentis causes
Displacement of the lens
Upward
- Marfan
Downward
- Homocystinuria
Squit (stabismus)
Non-paralytic
Paralytic
Non-paralytic
- Convergent (esotropia)
- Divergent (exotropia); intermittent + constant
Paralytic
- 3rd nerve palsy; frequently congenital, divergent squint + downward deviation of eye + ptosis
- 4th nerve palsy; congenital or acquired from head trauma, head tild towards opposite shoulder to eliminate vertical deviation
- 6th nerve palsy; convergent squit
What is the normal visual acuity at 18 months + 2 years
18 months = 6/9
2 years = 6/6
At what age is strabismus abnormal
From 6 months of age
Common cause of horizontal conjugate nystagmus
Most common- anticonvulsant medications
If NOT an anticonvulsants then most common cause = cerebellar
Horizontal nystagmus causes
- Cerebellar
- Vestibular
- Visual
Causes of vertical nystagmus
- Visual causes
- Brainstem causes
Causes of bilateral proptosis
- Thyroid eye disease
- Neuroblastoma
- Leukaemia
- Craniofacial conditions
- Craniosynotoses
- Apert
- Crouzon
- Craniosynotoses
- Thrombosis
- Glaucoma (includes in SWS)
- Harmangioma
