Neurology Flashcards
Viral encephalitis
Cause:VIRAL»
HSV,VZV
Flu like symptoms headache photophobia +- neck stiffness negative kernig
CSF»Nothing on culture
CT»Normal CSF
PCR:Shows HSV,VZV after 48hr
Drop
All become unconscious except Drop attack in Elderly (No LOC)
1.Drop Attack
⏭️⏭️ No warning signs before,
No LOC and No confusion afterward.
Older pts with Lower limb weakness ie from Cauda equina or Vertebrobasilar insufficiency.
- Vasovagaal syncope
⏭️ fear,pain, excitement, prolonged standing, young pt. - Stoke adams⏭️
3rd H.block,
transient hypoperfusion to brain.pt become pale before fall
Stokes Adams= Unconscious + abnormal ECG
Hypoglycemia= Unconscious / Decreased level of conscious + sweating
VasoVagal = Unconscious + prolonged standing/straining/pooping/heavy weight lifting
Epilepsy = unconscious + maybe post seizure confusion
Upward gaze palsy + Backward falls (stiff axial muscles ) eye looking
Think of Progressive Supranuclear Palsy as taking some features from
Parkison’s disease (shuffling gait, bradikinesia/akinesia) and
Frontotemporal dementia( in appropriate behaviours)
but the features typical of PSP are:
fixed upward gaze(restricted downward gaze),
axial rigidity and hence tendency to fall backwards.
Girls hanging out with friends in a restaurant and suddenly LOC and twitching and then REGAIN CONCIOUSNESS AGAIN
Vasovagal syncope (Most common in women ) Not HYPOGLYCAEMIA because of regain consciousness
occurs when you faint because
body overreacts to certain triggers,eg blood or extreme emotional distress.
also called Neurocardiogenic syncope.
THERE MAY BE TWITCHING
In vasovagal syncope, if the person does not fall into a fully flat, supine position, and the head remains elevated above the trunk, a state similar to seizure may result from the blood’s inability to return quickly to the brain, and the neurons in the body will fire off and generally cause muscles to twitch very slightly.
Hyperdipsia and polyphagia in a Liver cirrhosis patient with secondary metasis
which part is effected
Pons medulla midbrain cerebellum or Diencephalon
Diabetes Insipidus
⏭️⏭️ Diencephalon (Thalamus, Hypothalamus,epithalamus,Subthalamus)
SIADH
⏭️⏭️Cerbellum/Cerebrum.
Most common Motor Neuron disease
= ALS
ice bucket challenge for charity
ALS is chronic progressive dis , balbar paralysis + ascending paralysis…eye and sphincter are spared ( remember Stephen Hawking)
MGravis - eye muscles
Rapid progress withing months
Swallowing difficulity
then months bed ridded with
BELLS PALSY with Extra cranial Motor palsy only no other associated symptoms like vertigo or hemiplegia or any other weakness only muscles of facial muscles weakness
> > PREDNISOLONE within 72 hrs for 10 days…
Cranial nerves nucleus: 1,2 –> cerebral cortex 3,4–> midbrain 5,6,7,8 –> pons 9,10,11,12 –> medulla 2-2-4-4
Cranial nerves nucleus: 1,2 –> cerebral cortex 3,4–> midbrain 5,6,7,8 –> pons 9,10,11,12 –> medulla 2-2-4-4
Syringomyelia: -
Dorsal column is spared
Pain and temperature and Motor is effected
No cranial nerve involvement. -
Upper limb= LMNL+ loss of spinothalamic tract function. -
Lower limb= UMNL. - Unilateral/ bilateral Horner’s syndrome.
ramsy hunt:
Presents with palsy of facial nerve, decreased hearing on the affected side +/- tinnitus it also presents with Vesicular rash around the auricle HZO: is the reactivation of VZ affects the opthalmic branch of Trigeminal nerve : pain , tingling and rash on scalp, most importantly it is sight threatning so immediate mx: by Acyclovir 14 days + steriods for pain
ramsy hunt:
Presents with palsy of facial nerve, decreased hearing on the affected side +/- tinnitus it also presents with Vesicular rash around the auricle HZO: is the reactivation of VZ affects the opthalmic branch of Trigeminal nerve : pain , tingling and rash on scalp, most importantly it is sight threatning so immediate mx: by Acyclovir 14 days + steriods for pain
trigeminal neuralgia :corneal reflex normal
-STABBING , SHOOTING , ELECTRICAL SHOCK PAIN FROM JAW RADIATE -
USUALLY INTACT* CORNEAL REFLEX
- ABRUPT ONSET AND TERMINATION
- AGG. BY TOUCH , EATING , MOVEMENT OF JAW
- CARBAMA ZEPINE / LAMOTIGINE THEN SURGERY
Temporamandibular joint disorder has facial pain,restricted joint movement,assosiated with bruxism(grinding of teeth)
Horner syndrome in Pancoast Tumor
Carcinoma of on the apex of the lung
at the anatomical site there are (Recurrent laryngeal nerve/ SVC / Sympathetic chain / near the first rib Brachial plexus )
Causes of Horner syndrome in Pancoast tumor (apical lung tumor) = compression or underactivity (not irritation not hyperactivity) of sympathetic chain. Syringomyelia or spinal cord lesions: involvement of hypothalamospinal tract
WH 1020 Girl post abortion Classical triad (Confusion / ataxia / Opthalomopegia (Horizontal or vertical nystagmus ))
“ Wernicke’s Encephalopathy is also seen in pregnancy where there is sever persistent hyperemesis gravitatum “
acute alcohol withdrawl symptoms then give Diazepam +thiamine if alcohlic hallucinosis then same as above if seizures due to withdrawl then iv Lorazepam if delerium tremens then iv lorazepam if wernickes encaphlopathy then first give IV thiamine followed by chlordiazepoxide as he has already developed it so we will treat its cause thats thiamine deficiency if korsakoff then diazepam +antipschotics but never give antipsychotics alone in elderly patients as they will mask the effect of symptoms
Meningitis
Low glucose + Neutrophils»_space;»Bacterial Low glucose +Lymphocytes»_space;»Tuberculous meningitis Normal glucose +Lymphocytes»_space;»Viral
Diencephalon
As there is polyuria + Polydipsia with Hx of brain lesion → think of Cranial (central) Diabetes Insipidus (DI). ♦ DI → DIencephalon. ♦ SIADH → Cerebrum/ Cerebellum. • Diencephalon → (Thalamus, hypothalamus, epithalamus, subthalamus and Posterior pituitary). • Cranial diabetes insipidus is a condition in which the hypothalamus does not produce enough anti-diuretic hormone (ADH). • Nephrogenic diabetes insipidus is a condition in which the kidneys fail to respond to the anti-diuretic hormone.
CS 3510
Patients with Alzheimer’s are not aware of their memory impairment so they won’t visit a doctor by themselves with such a complaint.
True dementia including Alzheimer’s disease: patient is brought to the doctor/hospital by someone (family member/neighbour/police) .. this denotes that they do not have insight about their problem and unaware of their condition. Psudodementia (depressive dementia) : as depression patients they also have insight about their problem and they presnt on their own and usually they have a past hisoty of depression
Alcohol and related symptoms
ACUTE ALCOHOL WITHDRAWL - Chlordiazepoxide
DELIRIUM TREMENS - Diazepam/Lorazepam
WERNICKE’S ENCEPHALOPATHY - Thiamine (High Potency Vitamins)
triad - ataxia / ophthalmoplegia (nystagmus) / confusion
if kosarcoff = above three + confabulation and memory disturbance (dt damage ot mammalory bodies)
NU 4450
Irregular breakdown of articulation = staccato speech, seen in cerebellar lesions
Opthalmoplegia = brainstem
Nystagmus = cerebellum
Cerebellum Vertigo with NAD N- Nystagmus A- Ataxia D- Dysarthria
Broca’s area) of the language-dominant hemisphere has been shown to significantly affect the use of
spontaneous speech and motor speech control. Words may be uttered very slowly and poorly articulated.
NE 0016
In Old patient with AF taking Warfarin
Sudden loss of consciousness and paraplegia
Most worried is SDH intracranial hemorrhage
associated with fall or injury
DVLA
in case of a bus or lorry license
if you have a single seizure attack you must complete 5 years free from seizure
and without antiepileptic medication to drive again ,
if multiple attacks this will be 10 years !
CL0017
To review
MG vs LES
- Muscle weakness, improves with exercise -> Lamert-Eaton $ (assoc. with Small Cell Lung Ca). mostly autoimmune
Reflexes = absent, improve with exercise - Muscle weakness, worsens with exercise (FATIGUE) -> MG (assoc. with hyperthyroidism).
Reflexes = normal - Muscle weakness + sensory affection, random areas of body (optic neuritis common) + episodic -> Multiple Sclerosis -
Muscle weakness (progressive, limb/thoracic/abdominal) + Dysphagia/hoarseness (late) + increased deep tendon reflexes -> ALS -
Muscle weakness + sensory affection, bilateral + symmetric + ascending from L.L upwards, often
Hx of infection -> Guillain Barre. Deep reflexes = absent
NU 3100
House maid with severe headache at the back of the neck and while flexing the neck (early sign ) for several days
cervical spondylitis
related to work related activity such as heavy lifting, twisting and over activities
where gelly like material of the disc dries out,
this is common in 30’s age, may be that’s why housemaid is mentioned
NU 3100
House maid with severe headache at the back of the neck and while flexing the neck (early sign ) for several days
cervical spondylitis
related to work related activity such as heavy lifting, twisting and over activities
where gelly like material of the disc dries out,
this is common in 30’s age, may be that’s why housemaid is mentioned
CL 0082
Visual field lost - Homonymous right hemianopia - PCA
not Total vision loss - Amaurosis fungax
post managemet of MI
1-dual antiplatlets with aspirin life long and clopidogrel for 12 months
2-Beta blockers
3-ACE
4- Statins
post TIA/STROKE managemnt
clopidogrel life long and statins life long .
note if A-feb is present then warfarin lifelong for both strokes and MI .
AND DONT FORGET to do doopler for carotids in cases of stroke
post managemet of MI
1-dual antiplatlets with aspirin life long and clopidogrel for 12 months
2-Beta blockers
3-ACE
4- Statins
post TIA/STROKE managemnt
clopidogrel life long and statins life long .
note if A-feb is present then warfarin lifelong for both strokes and MI .
AND DONT FORGET to do doopler for carotids in cases of stroke
BPPV.. Vertigo (sec)
V. neuritis… Vertigo (hours-) + Hx common cold.
Labrynitis… Vertigo (hours-days)+ Hx common cold + hearing loss/ tinnitus. .
Meniere… DVT (deafness, vertigo, tinnitus) + ear fullness + normal MRI.
V. neuroma (schwannoma)… DVT + CN palsy + MRI (cerebroponatine angle) is needed.
Second line drug for Alzheimer with Bradycardia
first line meds:
acetylcholinesterase inhibitors
ie donepezil, galantamine, rivastigmine.
important to note that this meds induce iatrogenic bradycardia.
they are therefore contraindicated in dysarythmic cardiac diseases.
MEMANTINE is second line!!!!!!!
Just to make it simple for whoever may need this, everytime you come across a lesion that affects both the ipsilateral and contralateral side of the body as well as the entire side of the body I.e the arms and legs, think of the brainstem because the cerebral cortex lesions affect the contralateral side alone and affect either the upper limb or lower limb more while the brain stem because of the cranial nerves can also affect the ipsilateral side of the body.
SLeep apnoea
alcoholic fatty male
snoring and
Best initial : Pulse oximetry and sleep studies
Best definitive : polysomnography(sleep study + EEG )
Parkisonism Prescrebed Co carbidopa
improvements seen
but 15 days later Hallucination
what to do
NU 4570
Careldopa for Parkinsonism Hallucinations: decrease the dose. Morning Rigidity and Bradykinesia: switch to controlled released (SR) version.
NE 0796
What is the best thing to do next
Severe pain in the back like Kicked in the head with n and v and now 12 hours
Ct show no abnomality
what to do next
W n see for 24 / MRI / LP
SAH - LP then MRI but 12 hour has passed so less sensitive
First time Seizure
what to do
NU 1480
Refer to first fit clinic
Neuro
Multiple sclerosis Search of optic neuritis or pale optic disc Relapsing remitting pattern various symptoms of asymmetry and UMNL - stiffness
Dx mostly clinical dx
MRI
Tx - Acute relapsing - IV methyl prednisolone
Interferon Beta or Glatiremer Acetate
`Bacterial meningitis with Gram Positive
S. Pneumonia – Gram +ve diplococci (coagulase -ve)
S. Aureus –Gram +ve cocci in clusters ( coagulase and catalase +ve)
N. Meningitidis – Gram -ve diplococci
L. Monocytogenes – Gram +ve bacilli
H. influenzae – Gram -ve coccobacilli
NU 0080
Dementia with visual hallucination
MRI done with brain atrophy
what is the next appropriate investigation
Dopamine transporter reuptake imaging (Lewy body dementia )
Pregnancy and Anti epileptic
Lamotrigine > Carbamazepine
Sodium Valproate is absolute contraindication
Brain stem vs Cerebellar stoke
In addition to vertigo Brainstem "ADD FOG" A- Ataxia D- Diplopia D-Dysarthria F-Facial numbness O-Ophthalmoplegia G-Gaze palsy Cerebellum
“NAD” N-Nystagmus A-Ataxia D-Dysarthria
NU 4390
Grief or Dementia or Pseudodementia
Grief is < 1 year i think 6 months
Multiple Sclerosis
Ds modifying drugs– dimethylfumerate, alemtuzumab, natalizumub
Management of MS #For relapse–Methyl prednisolone
#Symptom control -- *Spasticity : 1st line-baclofen/gabapentin 2nd line--tizanidine/dantrolene *Tremor-- botulinum toxin *Fatigue-- amantadine *Urgency /frequency --self catheterization (>100 ml) Tolterodine(<100 ml)
CL 0004
“Hyponatremia following SAH is most commonly associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Other associated causes include acute cortisol insufficiency, cerebral salt wasting syndrome (CSW), excessive fluid therapy and/or diuretic therapy”…
Spinal bifida
Spina bifida with UTI»_space;»> urinary pads
Spina bifida with Incontinence (UTI recently treated )»»>intermittent catheterize
