Neurology 🧠 Flashcards
what is myasthenia gravis
autoimmune neuromuscular disease charactered by generalised muscle weakness
more common in females
pathophysiology of myasthenia gravis
autoantibodies against postsynaptic acetylcholine receptors
clinical features of myasthenia gravis
muscle fatiguability - muscles become progressively weaker during periods of activity - at end of day
diplopia
ptosis
dysphagia
associated conditions with myasthenia gravis
Thyomomas
autoimmune disorders
thyme hyperplasia
ix to perform for myasthenia gravis
- blood test for serum acetylcholine receptor antibody
mx myasthenia gravis
long acting acetylcholinesterase inhibitor
pyridostigmine
which drugs may exacerbate myasthenia gravis
beta blockers
penicillamine
lithium
what is multiple sclerosis
chronic degenerative autoimmune disease chacterised by demyelination in CNS
more common in women and those further away from equator
visual features of MS
optic neuritis - most common
sensory features of MS
pins/needles, numbness
Lhermitte’s sign : shooting electric sensation down the spine after flexion of neck
bilateral trigeminal neuralgia
motor features of MS
spastic weakness most commonly in legs
dx of MS
MRI brain + spine - FLAIR sequence
mx of MS
no cure but focuses on reducing frequency and duration of relapses
in acute relapse - high dose steroids
beta-interferon
what is uhtoff’s phenomenon
transient worsening of neurological symptoms in MS when the body becomes overheated
what is huntingtons disease
autosomal dominant disorder caused by >38 repeats of CAG
usually presents between 35-45 years
clinical features
demential, behavioural changes, hallucinations
CHOREA
dystonia
ataxia
usually results in death 20 years after initial symptoms develop
MRI and CT scans will show what in huntingtons
atrophy of caudate nucleus
features of Parkinson’s
bradykinesia - short shuffling gait, reduced arm swing
tremor at rest
rigidity
First line treatment of atomic seizures
Sodium valproate - not used in women of childbearing age
Lamotrigine
First line treatment of absence seizures
Sodium valproate
Ethosuximide
First line treatment of tonic clonic seizures
Sodium valproate or lamotrigine
First line treatment of myoclonic seizures
Sodium valproate unless the patient is a female of childbearing age
Then levetiracetam or tropiramate should be used
Symptoms of Ramsay hunt syndrome
Vesicular rash ipsilateral ear
Vesicular rash on ipsilateral hard palate and anterior two thirds of the tongue
Hearing loss
Ipsilateral facial weakness
Post-auricular/ear pain
Difficulty chewing
Incomplete eye closure
Drooling
Tingling
Signs of Ramsay hunt syndrome
Vesicular rash on ear
Loss of nasolabial fold
Drooping of eyebrow
Drooping of corner of mouth
Asymmetrical smile
Management of Ramsay hunt syndrome
Anti-virals typically oral acyclovir
Corticosteroids typically oral prednisolone
Good eye care
Acute management of MS
An acute attack of MS should be treated with glucocorticoids
1g of IV methylprednisolone every 24 hours for 3 days
What is a TIA
Sudden onset focal neurological deficit of vascular aetiology with symptoms usually lasting less than an hour and no evidence of acute infarct on imaging
Risk factors for TIA
Diabetes mellitus
High cholesterol
Hypertension
Smoking
Family history
AF
Presentation of TIA
Focal neurological deficit such as speech difficulty or arm/leg weakness/sensory changes
Most symptoms resolve within 1 hour
First line treatment of patient with status epilepticus in a hospital setting
IV lorazepam
Classical presentation of spinal stenosis
Back pain with associated leg or buttock pain often relieved with flexion and worsened with extension
Leg pain brought on by exercise
How do you investigate for a subarachnoid haemorrhage
Non contrast CT brain scan ASAP
A lumbar puncture is indicated where a CT head does not confirm the diagnosis should be done 12 hours after symptom onset
Management of SAH
Can be split into medical, radiological and surgical management
Medical
Nimodipine has been used to prevent vasospasm
Radiological & surgical
Endovascular techniques exist for coiling or stenting
Surgical techniques include clipping
what are Parkinson-plus syndromes
4 main ones
they present as Parkinsonism (triad of resting tumour, hypertonia and bradykinesia) with additional clinical features
describe progressive supranuclear palsy
Parkinsonism and vertical gaze palsy
presentation multiple system atrophy
Parkinsonism and early autonomic clinical features such as postural hypotension, incontinence and impotence
cortico-basal degeneration presentation
Parkinsonism and fluctuations in cognitive impairment and visual hallucinations
acute management of suspected acute bacterial meningitis in a community based scenario e.g in a GP waiting for hospital transfer
IM benzylpenicillin if there is a non-blanching rash
acute management of suspected acute bacterial meningitis
2g of IV ceftriaxone twice daily with the addition of IV amoxicillin in young/old patients to better cover listeria
IV acyclovir if viral encephalitis is suspected
how does vestibular neuritis present
commonly occurs after an URTI and presents with short bursts of dizziness
DANISH
cerebellar dysfunction
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
if a patient has a posterior circulation stroke what you thinking
cerebellar dysfunction symptoms DANISH
factors that are associated with worse prognosis in MS
older
male
motor signs at onset
early relapses
many MRI lesions
axonal loss
features of extradural haemorrhage
haemorrhage between the skull and dura mater of the meninges
tend to have a preceding history of head trauma and are rarely spontaneous
bi-convex shape
features of subdural haemorrhage
haemorrhage between the dura mater and arachnoid mater
tend to present more gradually than extradural haemorrhages with gradually increasing headache and confusion
tend to occur in older patients and alcoholics
on CT they have a crescent-shape
features of subarachnoid haemorrhage
a haemorrhage underneath the arachnoid mater
presents as acute severe headaches often described as a blow to the back of the head
what is Lambert-eaton myasthenia syndrome
auto-immune disorder characterised by antibodies against the pre-synaptic voltage-gated calcium channels
what does Lambert-eaton myasthenia syndrome cause
progressive muscle weakness with increased use as a result of damage to the neuromuscular junction
symptoms tend to be more insidious and less pronounced than in myasthenia gravis
who does Lambert-eaton typically occur in
patients with small-cell lung cancer
result of antibodies produced by the immune system against voltage-gated calcium channels in small cell lung cancer
presentation of Lambert-eaton
ascending pattern of weakness that improves upon repetition/usage
Small cell lung cancer paraneoplastic syndrome
can be remembered by the SCLC mnemonic
SIADH
CUSHINGS
LEMS
CEREBELLAR DEGENERATION
Treatment for cluster headaches
Prophylaxis with verapamil
Nasal Triptan
Presentation of cluster headaches
Recurrent attacks of sudden onset unilateral periorbital pain associated with a watery and bloodshot eye
Nocturnal headaches
Last 15 mins to 3 hours once or twice a day for a period of time
Bedside tests for myasthenia gravis
Ice pack test
Application of an ice pack to to the eyes for 2-5 minutes
If positive for myasthenia gravis, the patient no longer has characteristic ptosis
A 34-year-old obese female presents with a severe headache across both sides of her head and blurring of the vision in her right eye.
you note that in her right eye she has papilloedema and a CNVI palsy. Her blood pressure is 160/100mmHg. She is currently on the combined oral contraceptive pill (COCP)
what is the most likely diagnosis
idiopathic intracranial hypertension
classically seen in young overweight females
mx idiopathic intracranial hypertension
weight loss
diuretics
