Neurology Flashcards
Presentation of poliomyelitis
Muscle atrophy
LMN signs
Can be unilateral or bilateral
Cause of poliomyelitis
Motor lesion in anterior horns
Results in LMN signs
Management of poliomyelitis
Supportive
Muscle relaxants for spasms
Surgery to correct deformities
Presentation and cause of Charcot-Marie-Tooth
Foot drop
High-arched feet (pes cavus)
Champagne bottle legs
Peripheral sensory loss
LMN signs
Cause by autosomal dominant mutation affecting myelin sheath
Investigations and management of Charcot-Marie-Tooth
Nerve conduction studies
Genetic testing
MDT
Neurologist and genetecists to diagnose
Physiotherapy
Occupational therapy for ADL
Orthopaedic surgeons to correct deformities
Parkinsons cause and presentation
Progressive reduction of dopamine in substantia nigra of basal ganglia
Stooped posture
Reduced arm swing
Shuffling gait (bradykinesia)
Facial masking (hypomimia)
Unilateral fine tremor, worse at rest
Cogwheel rigidity
Anosmia
Parkinsons investigations
Clinical
Trial with levodopa
Single photon emission computed tomography
Parkinsons management
Levodopa (not a dopamine agonist, as it needs to be converted in the brain into dopamine) with carbidopa (decarboxylase inhibitor)
Dopamine agonists can be given if motor symptoms not affecting QOL
MAO-B inhibitor
Causes of upper motor neuron unilateral cerebellar signs
Stroke
Tumour
Trauma
Multiple sclerosis
Patient has the following:
UMN: weakness, spasticity
Cerebellar: ataxia, tremor
Sensory: pins/needles, numbness
What other signs could you expect and what is the cause?
Optic neuritis
Internuclear opthalmoplegia
Uhthoff’s phenomenon
Lhermitte’s sign
Multiple sclerosis (UMN, sensory, and eyes)
Multiple sclerosis investigations
Anti-maltose binding protein
CSF and serum: oligoclonal bands
MRI with contrast: periventricular plaques, dawson fingers
Multiple sclerosis medical management (acute and long-term)
Acute: high-dose steroids
Long-term: IV natalizumab for relapse risk reduction
Causes of peripheral neuropathy (sensory/motor)
Alcohol
B12 deficiency
Cancer and CKD
Diabetes and drugs (amiodarone, isoniazid)
Every vasculitis
Causes of Horner’s syndrome
Central: stroke, tumour, multiple sclerosis
Pre-ganglionic: pancoast’s, thyroidectomy
Post-ganglionic (no anhidrosis): carotid artery dissection, cavernous sinus thrombosis, cluster headache
Management of Horner’s (acute and long term)
Acute: find and treat cause e.g. stroke, tumour, trauma
Long-term: MDT, artificial tears, botox for ptosis, emotional support
Presentation of motor neuron disease (different types)
Amyotrophic lateral sclerosis: UMN in legs, LMN in arms
Primary lateral sclerosis: UMN
Progressive muscular atrophy (best prognosis): LMN
Progressive bulbar palsy (worst prognosis): palsy of tongue, facial muscles affected (brainstem motor nuclei affected)
Causes of upper motor neuron signs
Stroke
Tumour
Trauma
Multiple Sclerosis
Motor neuron disease
Parkinsons
Causes of lower motor neuron signs
Guillain-Barre syndrome
Myasthenia gravis
Trauma (nerve injury)
Motor neuron disease
Polio
Muscular dystrophy
Causes of mixed upper and lower motor neuron signs
ALS
Polio
(also the boundary is the anterior horn cells in the spinal cord)
Types of multiple sclerosis
Relapsing-remitting
Secondary progressive
Primary progressive
Definition of multiple sclerosis
Multiple lesions in the CNS separated by space (multiple locations) and time (new lesions occuring over time)
Causes of sensorineural and conductive hearing loss
Sensorineural: age, loud noise, ototoxic medications
Conductive: earwax, otitis media, perforation of ear drum
Causes of internuclear opthalmoplegia
Multiple sclerosis
Stroke
Tumour
Trauma
Infections e.g. encephalitis and meningitis
(Impaired adduction of eye ipsilateral to medial longitudinal fasciculus, nystagmus in other eye)
Eye palsy signs
3rd: down and out, may be dilated (mydriasis), ptosis
4th: up and out, vertical diplopia
6th: adducted eye, horizontal diplopia
What is RAPD and its causes?
Swinging light test
Both eyes dilate when light shone into affected eye (they will constrict if it is not swung)
Retinal detachment
Optic neuritis e.g. multiple sclerosis
Examples of dopaminergic and antidopaminergic drugs
Dopaminergic
- levodopa
- dopamine agonists e.g. bromocriptine
- MAO-B inhibitors
Antidopaminergic
- Haloperidol (typical)
- Risperidone (atypical)
- Metaclopramide
Power meanings 0-5/5
0: no contraction
1: contraction but no movement
2: move without gravity (different position)
3: move against gravity
4: little resistance
5: maximal resistance
How is benign essential tremor different to parkinsons?
Symmetrical
Better at rest
Worse with intention
Improves with alcohol (parkinsons doesn’t change)
Causes of intention tremor
Multiple sclerosis
Cerebellar disease
Essential tremor
Stroke
What are Parkinson’s plus syndromes
Conditions which cause Parkinsonism as part of their features
Multiple system atrophy: multiple areas in brain affected (including basal ganglia), also causes autonomic dysfunction (consiptation, sweating), and cerebellar dysfunction (ataxia)
Dementia with Lewy Bodies
How does drug-induced parkinsonism present differently?
Rapid onset
Bilateral
Rigidity and rest tremor uncommon
Side effects of levodopa
Dry mouth
Palpitations
Psychosis
What signs does cerebral palsy cause (i.e. UMN/LMN etc.)?
UMN signs: spastic
Cerebellar: ataxic
Myasthenia gravis presentation, investigation, management
Extraocular muscle weakness: diplopia
Ptosis
Proximal muscle weakness
EMG
ACh-r antibodies
CT thorax
ACh-esterase inhibitors: pyridostigmine
Crisis: IVIG, plasmapheresis
Causes of proximal muscle weakness
Inflammation: polymyositis, dermatomyositis
Neurological: multiple sclerosis, MND
Trauma
Vtiamin D or calcium deficiency
What is Lambert-Eaton?
Similar to myasthenia gravis
Small cell lung cancer antibodies against VGCCs
No ophthalmoplegia and ptosis
What are the 12 cranial nerves?
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
