Neurology Flashcards
What is Brown-Sequard syndrome?
- hemisection of spinal cord
- most common cause = penetrating trauma
- most cases = cervical region
Signs and symptoms of Brown-Sequard syndrome
- total ipsilateral loss of position, light touch, vibration sensation at lesion level
- contralateral loss of pain/temperature below lesion
- sphincter disturbances
- ipsilateral spastic paraparesis
Diagnosis of Brown-Sequard syndrome
- radiographs for trauma
- MRI for extent of injury
- neuro exam for level of injury
Treatment of Brown-Sequard syndrome
- spine immobilisation
- steroids decreased swelling
- therapy
- surgery
What is Charcot Marie Tooth?
- heterogenous group of inherited peripheral neuropathies
- autosomal dominant
What are the 4 major categories for Charcot Marie Tooth?
- CMT1
- CMT2
- CMT3
- CMTX
Signs and symptoms of Charcot Marie Tooth
- muscle weakness in lower limbs
- highly arched/very flat feet
- curled toes
- awkward/high step and difficult using ankle muscles
- lack of sensation to arms and feet
- poor circulation → cold peripheries
- wasting of muscles in lower legs
- fatigue
Diagnosis of Charcot Marie Tooth
- bloods
- CSF examination
- MRI brain, SC
- genetic studies
- nerve conduction studies
- nerve biopsy if genetic studies inconclusive
Treatment of Charcot Marie Tooth
- no cure
- supportive therapy
- analgesia
- surgical correction of spinal deformity
- avoid neurotoxic drugs eg vincristine
What is DMD?
- progressive muscle wasting and weakness
- X linked recessive
- results in damage to dystrophin gene → dystrophin strengthens muscle fibres and protects from injury
Signs and symptoms of DMD
- presents in early childhood
- progressive proximal muscular dystrophy with characteristic pseudohypertophy of calves
- major milestones delayed
- recurrent falls
- speech delay
- fatigue
Diagnosis of DMD
- serum creatinine kinase → v high
- genetic analysis
- muscle biopsy with assay for dystrophin protein
- muscle strength test
- gait assessment
Complications of DMD
- join contractures
- respiratory failure
- cardiomyopathies, HF
- gastric dilation
- learning difficulties
Treatment of DMD
- MDT care
- vaccines → influenza/pneumococcal
- physiotherapy
- vitD/bisphosphonates
- corticosteroids
- end of life care
What is Lamber Eaton?
- disorder of neuromuscular transmission
- caused by impaired presynaptic release of acetylcholine
- caused by autoimmune attack of VG Ca2+ channels
Signs and symptoms of Lambert Eaton
- similar to myasthenia gravis
- can present with small cell lung cancer
- insidious onset
- proximal muscle weakness
- depressed tendon reflexes
- gait changes
- dry mouth
- impotence in males
- eyelid ptosis
Diagnosis of Lambert Eaton
- ACh receptors indicate MG
- nerve stimulation
- serum test for VG Ca2+ channels
- MRI for malignancy
Treatment of Lambert Eaton
- treat any cancer
- AChEi
- amifampridine → muscle strength
- immunosuppression
- surgery
What is Amaurosis Fugax?
painless, temporary loss of vision in one/both eyes
Causes of Amaurosis Fugax
- embolic
- haemodynamic
- ocular
- neurological
- idiopathic
Presentation of Amaurosis Fugax
- black curtain coming down vertically into visual field
- vision loss/blurring/fogging/dimming
- lasts seconds to hours
Diagnosis of Amaurosis Fugax
- clinical diagnosis
- full history
- ophthalmic exam
- ESR level
- CT head
Treatment of Amaurosis Fugax
- treat underlying cause
- can cause stroke if untreated
What are peripheral neuropathies?
- damage to one/more peripheral nerves
- results in transmission blockages between PNS and CNS
- can be acute or chronic
Causes of peripheral neuropathies
- diabetes = most common
- dietary deficiencies
- medication
- alcohol excess
- CKD
- connective tissue disorders
- inflammatory conditions
- inherited conditions
axonal degeneration → DM, B12 deficiency, lead poisoning
segmental demyelination → GBS, CMT
Sensory symptoms of peripheral neuropathies
loss of
- touch
- proprioception
- temperature/pain
- sensation
- paraesthesia
- +ve Romberg test → sensory ataxia
Motor symptoms of peripheral neuropathies
- distal weakness
- proximal weakness
- muscle wasting
- fasciculations
- absent tendon reflexes
Diagnosis of peripheral neuropathies
- history
- bloods
- nerve conduction studies
- electromyography
- nerve biopsy
Treatment of peripheral neuropathies
- treat underlying cause
- pregabalin/gabapentin for pain
- supportive therapy
