Neurology Flashcards
Differentiate carpal tunnely syndrome from pronatory syndrome
Palmar cutaneous branch. Splits off before carpal tunnel and goes above flexor retinaculum
In CTS, lateral pal spared
In pronator syndrome, lateral palm involved
Rapidly progressive dementia associate with myoclonus
CJD
Adies pupil
Loss of parasympathetic consrictors of pupil
Different from CN III lesion where opthalmoplegia occur
Management of IIH
1st line weight loss
2nd - medical (acezetolamide, topiramate)
3rd - surgery
CSF changes in Alzheimer’s
Earliest signs of pre-clinical Alzheimer’s disease
Early - Low CSF AB peptide 42
Next - High CSF Tau
High PET amyloid tracer retention
Imaging changes for Alzheimers
- MRI
- MRI - hippocampal atrophy
Which primary headache type can you use botulinum toxin in?
Chronic migraine (16-30 days of headache per month)
Use 2nd line
Most common ongoing outcome of Wernicke’s
Amnestic memory loss i.e Korsakoff’s syndrome
DDx of bilateral temporal lobe MRI changes
Infection
Inflammation - Limbic encephalitis (paraneoplastic or autoimmune)
Rx of serotonin syndrome
Cyproheptadine
Rx of NMS
Bromocriptine
Signs and Rx of malignant hyperthermia
Fever, hypcarbia, rigidity after volatile induction anaesthetic
Rx - dantrolene (direct muscle relaxant)
Which side of brain are speech centres?
Usually L - Left dominance
Another name for essential tremor
Benign familial tremor
Management of psychosis in Parkinson’s
Withdraw Parkinson’s meds in order of least effective (anticholinergics first)
Rx - quetiapine, clozapine
Treatment of CVST
LWMH/heparin
Aim for therapeutic anticoagulation for 3-6 months
Main risk factors for CVST
Pregnancy/puepuerium
COCP use
Malignancy
Treatment of eclampsia - features of hypermagnesiaemia
Loss of deep tendon refexes –> hypermagnesaemia
Episodic vertigo/ataxia
Interstitial keratitis
Oscilopsia (sensation of unstable vision
Cogan syndrome
Treat with pred and DMARDs - MTX
Hemiballismus. Lesion where?
Subthalamic nucleus
Components of basal ganglia
Striatum - caudata/putamen
Globus pallidus
Subthalamic nucleus
Substantia nigra - pars compact (Da) and parts reticulata (GABA)
Trauma, neck pain, headache, horner’s syndrome
Carotid artery dissection
Rhomberg test -positive and negative results intepretation
Positive - ataxia due to sensory loss (proprioception)
Negative - ataxia due to cerebellar cause
Endolymphatic hydrops
Menierre disease
Rinne and Weber
Rinne - tunin fork on mastoid and next to ear. Normal is air > bone
Weber - if Rinne abnormal, can distinguish conductive vs sensironeural. cOnductive localises bad ear, sensironeural localises good ear
Parkinsonism
Postural instability/frequent falls
PSP
Parkinsonism
Asymmetric
Alien limb phenomenon
Athetosis, chorea
Corticobasal degeneration
Parkinsonism
Predominant autonomic symptoms
MSA
Features of prodromal PD
RBD
Hyposmia
Anxiety
Significance of RBD
50% will develop synucleopathy - iPD, MSA
GBA1 gene
- heterozygous - increased risk?
- homozygous - increased risk?
Heterozygous - 10% Parkinsons’
Homozygous - Gaucher disease
A/e of ergot Da agonists (hence not used)
Valvulopathy
Raynaud’s
Erythromelalgia
Pulmonary fibrosis
Retroperitoneal fibrosis
COM-T - what is it and benefit of blocking
Degrades dopamine
Entacapone blocks COM-T, so reduces rate of breakdown of Da (and therefore L-dopa), potentiating effect (increasing half-life. Good for wearing off periods
Treatment of REM sleep behaviour disorder
Clonazepam
Risk of starting Da agonists
Impulse control disorders
- Pathological gambling
- Hypersexuality
- Compulsive shopping, bing eating
Repetitive sterotype movements in patient with Parkinson’s on treatment
Name?
Cause?
Punding
Feature of dopamine dysregulation syndrome, due to Da agonists
Management of off periods
Add entacapone
Add amandatadine
Add Da agonist
Increase L-dopa dose or frequency
Which Parkinson medication has anticholinergic activity
Amantadine
Gene for Wilson’s
ATP7B
- homozygote - confirms diagnosis
- heterozygote - confirms, most patients are compound heterozygotes
Neurological manifestations in Wilson’s in terms of frequency
Dysarthria - most common
Dystonia
Tremor
Parkinsonism
Diagnostic approach to Wilson’s
Caeroplasmin low, 24 urinary copper excretion high, Kayser fleischer rings confirm diagnosis
Any one of above not present - obtain liver biopsy or ATP7B gene testing to confirm
Oral disease modifying therapy for MS
Fingolimod
Teriflunomide
Dimethyl fumarate
MoA fingolimod
Decreases ability of lymphocytes to enter CNS by preventing lymphocytes leaving lymphatic tissue
A/E of fingolimod
Bradycardia and heart block
Overwhelming hsv
Downregulates spingosine 1 phosphate receptor subtypes
MoA of teriflunomide
Inhibits pyrimidine synthesis
NMOSD
- Name
- Cell involved
Neuromyelitis optica spectrum disorder
Astrocytes
APQ4 antibody
NMOSD
NMOSD mimicker:
- Classic clinical presentations
Bilateral/rapidly sequential optic neuritis
Tranverse myelitis (often > 3 segments)
Area postrema syndrome -Intractabile hiccups, nausea
NMOSD diagnosis
Clinical features (3)
APQ4 antibody
MOGAD disease presentation
ADEM in children
- Confusion
- Demyelination - weaness, numbness, bladder/bowel changes
MOGAD Ab
Myelin oligodendrocyte gylcoprotein associated Ab (MOGAD)
MS in pregnancy
Can use GIN
- glatiramer, inteferon, nataluzimab.
Aim for quiscient disease. Pregnancy is protective for MS relapse so can w/h altogether
Oftatumumab
Anti-CD20 for MS
Dominant lobe
- Side
- Symptoms
Left usually (for R hand people)
Aphasia - Broca’s and Wernicke’s
Non-dominant lobe
- Side
- Symptoms
R usually
Neglect, homonomous heminopia
Gerstman syndrome
- Location
Inferior angular gyrus parietal lobe dominant side
L PCA syndrome
- Normal
- Gerstmand
Normal - Alexia (reading issue), but no agraphia
Gerstman - Agraphia, (issue with writing), acaculia, Agnosia, L-R disorientation
L vs R PCA syndrome
- Similar
- Different
Both can have homonomous heminopia with macular sparing
L - Alexia without agraphia, Gerstman
R - more likely to have neglect
Blind but denies blindness
- Name?
- Cause
Anton syndrome
Bilateral PCA artery
Decreased conscious state
Gaze palsy
Dilated pupils
Top of the basilar stroke