Neurology Flashcards
The presence of headaches, nausea, and transient vision loss in an obese woman with an unremarkable MRI and a raised opening pressure on lumbar puncture indicates what disease?
Idiopathic intracranial hypertension
How do you diagnose IIH?
1st - MRI to look for any features - if unremarkable then 2nd - LP for opening pressure
Management of IIH
weight loss, acetazolamide therapy
What group of ppl do you suspect IIH in
Obese females
what do you suspect in patients with headaches, nausea and vision loss
SOL, tumour, IIH
How do you differentiate between syringomyelia and degenerative cervical myelopathy
Cervical myelopathy - sensory loss, neck stiffness, LMN signs at level of lesion and UMN signs below the level of the lesion
Synringomyelia - Typically presents with bilateral loss of sensory function limited to the upper extremities
what is the management of suspected cervical myelopathy
Immediate referral to neurosurgery for decompression as the damage can be permanent
What blood vessel is affected in EDH?
Middle meningeal artery
What are the specific side effects of ergot derived dopamine agonists such as bromocriptine, cabergoline
Pulmonary, retroperitoneal and cardiac fibrosis - need echo, ESR, creatinine and CXR
What are the side effects of dopamine agonists
impulse control disorders (gambling) and excessive daytime somnolence
What are the side effects of levodopa
dyskinesia (involuntary writhing movements), ‘on-off’ effect, dry mouth, anorexia, palpitations, postural hypotension, psychosis, drowsiness
no use in neuroleptic induced parkinsonism
WHat is the defect seen in cranial nerve IV palsy
Eye deviated upwards and rotated outwards
What is the difference between communicating and non-communicating hydrocephalus
Communicating - There is a problem with the secretion or absorption
Non-communicating - there is a problem of flow from the ventricles to the subarachnoid space
What are the special features of cluster headaches?
Cluster headaches are typically characterized by unilateral and severe headaches often associated with autonomic symptoms such as ptosis, miosis, conjunctival injection and excessive lacrimation.
Why are triptans contraindicated in patients with heart problems?
It should be avoided in patients with a history of coronary artery disease (CAD) as it has the potential to cause coronary vasospasm.
What are the antibodies detected in myanesthia gravis
anti-achR antibodies
anti-muscle specific kinase (anti-MUSK) - seronegative
What are the diagnostic tests for MG?
1st line - blood antibodies (anti-achR and anti-MUSK)
2nd- EMG - electromyography - decremental response to repetitive nerve stimulation
What is the most common sequelae of meningitis
sensorineural hearing loss (most common)
What is the pathophysiology of Narcoplexy?
Loss of lateral hypothalamic neurons, which produce orexin A and orexin B (i.e., hypocretin-1 and hypocretin-2) → severe orexin deficiency → dysregulation of sleep-wake cycles
Orexin is a neurotransmitter essential for promoting wakefulness and inhibiting REM sleep.
What are the characteristic features of narcoplexy?
- typical onset in teenage years
- hypersomnolence - excessive daytime sleepiness despite night sleep
- cataplexy (sudden loss of muscle tone often triggered by emotion - laughing or crying)
- sleep paralysis
- vivid hallucinations on going to sleep or waking up
what is the investigation for narcoplexy?
multiple sleep latency EEG
What is the treatment for narcoplexy?
daytime stimulants (e.g. modafinil) and nighttime sodium oxybate
What is the precaution to be taken with sodium oxybate?
Sodium oxybate should never be taken with alcohol or other CNS depressants because doing so may cause life-threatening respiratory depression!
What do you suspect in Bilateral acoustic neuromas ?
Neurofibromatosis type II