Neurology Flashcards
What are the diagnostic criteria for Parkinson’s disease?
Presence of bradykinesia with either rest tremor, rigidity or both
What are the three research criteria for PD?
Preclinical - Neurodegeneration without symptoms/signs
Prodromal - Symptoms/signs present but insufficient for diagnosis
Clinical - Diagnostic criteria met
What are the early symptoms/signs of PD?
REM behaviour disorder
Hyposmia
Constipation
Early motor impairment
Depression/anxiety
Executive dysfunction
What is the biggest risk factor for PD development?
Sibling with PD <50yo at diagnosis (LR+ 7.5)
What is the most protective factor against PD development?
Smoking (LR- 0.45)
What are the key histopathological findings of PD?
Lewy bodies (intracytoplasmic inclusions) and Lewy neurites (intra-axonal neurites) comprised of ubiquitin and alpha-synuclein
What is the biggest prodromal risk factor for PD?
RBD (LR+ 130)
What are the two most important genetic variations contributing to PD?
Glucocerebrodase (GBA) 10%
LRRK2 1-2%
What is the primary/concerning adverse effect of ergot-based dopamine agonists?
Cardiac, pulmonary and retroperitoneal fibrosis
Quetiapine is often used for confusion/hallucinations in PD. What important interaction needs to be considered when using quetiapine?
Long QT with used with domperidone (for nausea)
What adverse effect is more commonly seen with dopamine agonists than with levodopa?
Impulse control disorder
What adverse effect is more commonly seen with levodopa when compared to other PD treatments?
Dyskinesia
What are the features of peak-dose dyskinesia?
Onset 30-60 minutes post-dose, upper body chorea, patient often unaware
What are the features of end-dose dyskinesia?
Onset 3-4 hours post-dose, dystonic reactions of feet (most often), painful
What is the average time to onset of dementia in PD patients?
10 years
What red flags in a PD patient warrant review of the diagnosis?
Absence of tremor
Symmetrical signs
Falls within the first year of diagnosis
Marked speech/dysphagia
Early urinary incontinence
Early dementia within first two years
What are the four classic signs of PSP (Richardson’s syndrome)?
Early falls
Supranuclear down gaze palsy
Postural instability
Frontal dementia
What are the classic features of PSP-Parkinson’s?
Asymmetric onset
Tremor
Response to levodopa
Better prognosis
What is the most common presentation of corticobasal syndrome?
Useless, rigid, jerking arm
What causes are there of corticobasal syndrome?
Corticobasal degeneration
PSP
Pick disease
Alzheimers
DLB
CJD
What feature distinguishes the bradykinesia of PD from other causes?
Fatiguing
King Penguin sign on MRI is indicative of what?
PSP
Normal midbrain with pons atrophy is indicative of what on MRI?
MSA
What age and gender are predominantly affected by MS?
Females aged 20-40
Which five characteristic signs of MS are there?
Internuclear ophthalmoplegia
Optic neuritis
Acute partial myelopathy
Lhermitte’s symptoms
Uhtoff’s symptoms
What is the difference between relapsing remitting MS and progressive MS?
RRMS - Complete resolution of symptoms between attacks
PPMS - Progressive deterioration without resolution from time of disease onset
SPMS - Progressive deterioration without resolution after previous post-attack resolution
What level of the spinal cord are MS lesions most commonly seen?
Cervical
What proportion of patients with CIS and an abnormal MRI will develop MS?
70-90%
What CSF findings are seen with MS?
Normal CSF profile +/- mildly elevated lymphocytes
Oligoclonal bands + IgG levels
Normal serum oligoclonal bands
What relapse rates are seen with pregnant women with MS?
Increased relapse rates in first and second trimester (2-3 fold), decreased risk in third trimester
What are the three most important risk factors for ischaemic strokes?
Age, hypertension, atrial fibrilation
What are the two most important risk factors for haemorrhagic strokes?
Hypertension, cerebral amyloid angiopathy
What is the most common foetal abnormality seen with anti-epileptics?
Cardiac malformations
What is the typical age of onset for myasthenia gravis?
75 years
What is the test diagnostic of MG in 80% of cases?
Acetylcholinesterase antibodies
What is the secondary receptor to which antibodies are formed in MG?
Muscle Specific Kinase
Which HLA is MUSK MG associated with?
HLA DR14-DQ5
What is the primary treatment for MG?
Acetylcholinesterase inhibitors
What secondary means of treatment are there for MG?
Steroids, steroid-sparing (AZA, MTX), rituximab/eculizumab
What is the life-threatening complication of myasthenic crisis?
Diaphragmatic/intercostal involvement
What proportion of LEMS is paraneoplastic?
50% (usually SCLC)
What HLA class is associated with LEMS?
HLA B8-DR3
What antibodies are the cause of LEMS?
Anti-voltage gated calcium channel antibodies
What is the primary treatment of LEMS?
3-4 diaminopyridine (potassium channel blocker)
What is the most sensitive test for MG?
EMG
What is the most common pattern of peripheral neuropathy?
Distal symmetrical neuropathy
