Neurology Flashcards
1
Q
What are the 3 layers of the meninges?
A
Dura - outer
Arachnoid- keeps CSF in contact with brain
Pia- on brain surface, present between vessels and neurons
2
Q
Where does the circle of Willis lie?
A
Subarachnoid - between arachnoid and pia
3
Q
What myelinates axons in the brain?
A
Oligodendrocytes
4
Q
What myelinates axons in the rest of the body?
A
Schwann cells
5
Q
What are 3 functions of the frontal lobe?
A
Voluntary movement on opposite side of body
Dominant hemisphere controls speech and writing (right handed = left dominant)
Reasoning
Memory
Intellectual functioning
6
Q
What is the primary function of the parietal lobe?
A
Receives and interprets sensations (pain, touch, size, shape and proprioception)
7
Q
What is the primary function of the temporal lobe?
A
Understand spoken word (wernickes) and sounds
8
Q
What are the 2 primary functions of the occipital lobe?
A
Understanding visual images
Understanding meaning of written words
9
Q
Where is CSF produced?
A
Ependymal cells in choroid plexuses of lateral ventricles
10
Q
Where is CSF absorbed?
A
Arachnoid granulations in superior sagittal sinus
11
Q
Where do sympathetic nerves arise from?
A
Thoracic and lumbar regions of spinal cord
12
Q
What receptors are present at Presynaptic sympathetic neurones?
A
Nicotinic
13
Q
What receptors are present at postsynaptic sympathetic neurones?
A
Adriinergic receptors
14
Q
What neurotransmitter is used at presynaptic sympathetic neurones?
A
Acetylcholine
15
Q
What neurotransmitter is used at postsynaptic sympathetic neurones?
A
Noradrenaline
16
Q
What neurotransmitter is used at presynaptic parasympathetic neurones?
A
Acetylcholine
17
Q
What neurotransmitter is used at postsynaptic parasympathetic neurones?
A
Acetylcholine
18
Q
What receptors are present at presynaptic sympathetic neurones?
A
Nicotinic
19
Q
What receptors are present at postsynaptic parasympathetic neurones?
A
Muscarinic
20
Q
What are 3 functions of the sympathetic system?
A
Inc HR
Increases force of contraction
Vasoconstriction
BronchoDILATION
Reduces gastric motility
Male ejaculation
21
Q
What are 3 functions of the parasympathetic nervous system?
A
Decreases heart rate
Decrease force of contraction
Vasodilation
BronchoCONSTRICTION
Increases gastric motility
INCREASED gastric secretions
Male erection
22
Q
Define dermatome
A
Area of skin supplied by a single spinal nerve
23
Q
Define myotome
A
Volume of muscle supplied by a single spinal nerve
24
Q
Define transient ischaemic attack (TIA)
A
Brief episode (5-15 mins) of neurological dysfunction due to ischaemia without infarction
25
What are the risk factors of TIA?
Age
Smoking
HTN
Past TIA
Heart disease
AF
26
What are 3 causes of TIA?
Atherthromboembolism from carotid (MC)
Small vessel occlusion
Valve disease
Hyperviscosity
27
What 2 regions of circulation can be affected by TIA?
90%= anterior circulation (carotid artery)
10% = posterior circulation (vestibulobasilar artery)
28
What are the symptoms of an anterior/carotid TIA?
Weak/ numb contralateral leg
Amaurosis fugax
Dysphasia
Hemiparesis (one sided weakness)
29
Define amourosis fugax
Sudden transient loss of vision in one eye
“Curtain comes down vertically into one field of vision”
30
What causes amaurosis fugax?
Temporary reduction in blood flow to the retinal,ciliary or ophthalmic artery causing temporary retinal hypoxia
31
What is amaurosis fugax a sign of?
Imminent stroke
32
What are the symptoms of a posterior TIA?
Diplopia (double vision)
Vertigo
Vomiting
Choking
Ataxia (no control of body movement)
Transient global amnesia
Can be unconscious
33
What is the differential diagnosis of TIA?
Stroke
- impossible to differentiate until after
- TIA usually resolves, stroke often doesn’t
- stroke infarct
34
How is TIA diagnosed?
Usually clinical
Diffusion weighted MRI (1st line)
Carotid artery doppler ultrasound to find issues
Bloods: polycythaemia, vasculitis ect
35
How is stroke risk predicted after TIA?
ABCD2
36
What ABCD2 score strongly predicts a stroke?
6<
Greater than 4 should be seen within 24 hrs
37
How is TIA treated acutely?
Immediate 300mg aspirin
AF = anticoag
38
How is TIA treated long term?
Aspirin + Clopidogrel (P2Y12 inhibitor) 75mg
Long term statin
Control CV factors
39
What is an example of a statin?
Simvastatin
40
What are the 2 types of stroke?
Haemorrhagic
Ischaemic
41
Define stroke
Rapid neurological disturbance lasting >24 hours caused by infarction
42
Who is most commonly affected by strokes?
BAME
Men
Increases with age
43
What type are most strokes?
Ischemic
44
Define ischaemic stroke
Arterial embolism occludes a vessel resulting in infarction
45
Define haemorrhagic stroke
Rupture of blood vessel leading to infarction
46
What are 3 risk factors of strokes?
Increased age
HTN
Smoking
Past TIA
DM
Heart disease
47
What are 3 causes of ischaemic stroke?
Thromboembolism
Cardioembolism
Hyperviscosity
Hypoperfusion (blood loss)
48
What are the symptoms of a stroke in the ACA region?
Leg weakness
Gait apraxia (loss of function in lower limbs)
Incontinence
Drowsiness
49
What are the symptoms of a stroke in the MCA region?
Contralateral arm and leg weakness+ sensory loss
Aphasia/ Dysphasia
Facial droop
Homonymous hemianopia
50
What is the MC stroke region presentation?
MCA
51
What are the symptoms of a stroke in the PCA territory?
Contralateral homonymous hemianopia (visual field loss in same halves of both eyes)
Cortical blindness
Visual agnosia
Prosopagnosia (cant see faces)
Unilateral headache
52
What are the symptoms of a stroke in the posterior (vestibulobasilar) region?
Very catastrophic
Facial paralysis
Quadriplegia
Altered consciousness
53
What are 2 differential diagnoses of stroke?
Hypoglycaemia
Intracranial lesion
Syncope
54
Define lacunar stroke
Infarct of small arteries supplying the midbrain (internal capsule, basal ganglia ect)
55
What are the symptoms of a lacunar stroke?
Pure sensory loss
Ataxic hemiparesis
Unilateral weakness
56
How is stroke diagnosed?
1. Immediate non contrast CT (identifies haemorrhagic)
GS: MRI
ECG for AF or MI
Bloods: thrombocytopenia ect
57
How is stroke classified?
Bamford classification
58
How is ischemic stroke treated?
Immediate 300mg aspirin
Thrombolysis with altepase (within 4.5 hours)
After:
Aspirin for 2 weeks
Clopidogrel
59
How is haemmoragic stroke treated?
Neurosurgery immediately
Stop anticoags
Mannitol (diuretic) to decrease pressure
60
What is a specific sign of stroke?
Pronator drift
- arm on affected side will pronate with palm down when patient asked to lift arms to ceiling
61
What are 4 types of haemmorhage?
Intracerebral
Subarachnoid
Extradural
Subdural
62
Define subarachnoid haemorrhage (SAH)
Spontaneous bleeding into subarachnoid space (between arachnoid and pia)
63
What is the MC cause of SAH rupture?
Berry aneurysm
Also
Trauma
AV malformation
Idiopathic
64
What age is commonly affected by SAH?
35-65
65
Define berry aneurysm
Rupture at the junction of circle of Willis
66
What is the MC site of a berry aneurysm?
Anterior communicating/ ACA junction
67
What are the risk factors of SAH?
HTN
FHx
Polycystic kidneys
Connective tissue disorders
Coarctation of aorta
68
What is the mortality rate of SAH?
50% <
The rest usually left with significant disability
69
What are the symptoms of SAH?
Sudden onset of severe occipital headache ‘thunderclap”
May have sentinel headache (early sign before)
Meningitis signs
Decreased consciousness
Fixed dilated pupils
70
What are 2 differential diagnoses of SAH?
Migraine
Meningitis
Intracerebral bleeds
71
How is SAH diagnosed?
Head NC-CT (GS)- star shaped
Lumbar puncture if CT doesn’t confirm
- xanthochromia confirms
72
What does a star shape in the middle of the brain on CT indicate?
SAH
73
How is SAH treated?
Refer to neurosurgeon - endovascular coiling
Nimodipine (CCB)
74
What are 2 complications of SAH?
Re bleeding
Hydrocephalus
Cerebral ischaemia
75
Define Subdural haemorrhage (SDH)
Accumulation of blood between the arachnoid and dura mater following the rupture of a bridging vein between cortex and venous sinus
76
What are the risk factors of SDH?
Small brain: babies, alcoholics, dementia
Trauma- can be long ago or very minor
Anticoag
77
What are 3 causes of SDH?
Deceleration trauma
Shaken babies/abuse
Brain atrophy
78
Outline the pathophysiology of SDH
Bleeding from bridging veins into SD space -> clot -> later clot autolyses (draws water and expands) -> increase in ICP -> shifting of midline structures -> hernia and death
79
What are the symptoms of SDH?
Long interval between injury and symptoms and gradual onset
Decreased/ fluctuating consciousness
Drowsiness
Behaviour change
Signs of increased ICP: Cushing triad
80
How is SDH diagnosed?
NC-CT head - crescent shaped/banana
Acute = hyperdense, chronic = hypodense
Midline shift
81
What is banana shape on CT indicative of?
SDH
suBdural = Banana
82
What is Cushings triad? (signs of ICP)
Bradycardia
Irregular breathing
hypertension
83
How is SDH treated?
Surgery: burr hole and craniotomy
IV mannitol to decrease ICP
84
Define extradural haemorrhage (EDH)
Collection of blood between the dura mater and bone usually due to head injury
85
What is the MC cause of EDH?
Rupture of middle meningeal artery after fracture of the temporal bone
86
What are the risk factors of EDH?
Young adult - decrease risk when age increases
Trauma
87
Why is EDH uncommon in older people?
Dura more adhered to skull
88
What are the symptoms of EDH?
Head injury -> initial loss of consciousness and drowsiness -> lucid interval -> rapid deterioration
“I feel fine”
Late onset = severe headache, nausea, vomiting, decreased GCS, death (resp arrest) ect
89
What are the differential diagnoses of EDH?
Epilepsy
CO poisoning
Meningitis
90
How is EDH diagnosed?
NC-CT head: shows lemon shape
Confined to cranial sutures
May show skull fracture
Midline shift
91
What is a lemon shape on CT head indicative of?
EDH
92
How is EDH treated?
Urgent surgery to evacuate clot and ligate vessel
ABCDE
IV mannitol
93
What causes Intracerebral haemorrhage?
Spontaneous due to ischemic infarction or aneurysm rupture
94
What are the signs of Intracerebral haemorrhage on CT?
Acute/fresh bleed is hyperdense on CT (bright white)
95
Define meningitis
Inflammation of the meninges
96
What is the MC cause of meningitis in pregnancy?
Listeria monocytogenes
97
What are 2 causes of meningitis in neonates?
Group B haemolytic strep (colonises vagina)
- S.agalactiae
E. Coli
98
What are 3 causes of meningitis in children?
N. Meningitidis
Strep. Pneumoniae
Haemophilius influenzae
99
What are 3 causes of meningitis in elderly people/immunocompromised?
Cytomegalovirus
Cryptococcus neoformans
TB
HIV
HSV
100
What is fungal cause of meningitis?
Cryptococcus neoformans
101
What type of bacteria is n. Meningitidis?
Gram negative diplodoccus
102
What is the MC cause of meningitis?
Viral (Enteroviruses) eg
HSV2
Varicella
Measles
103
What is the sign of N. Meningitidis?
Non blanching purpuric rash
104
What is the appearance of S. pneumoniae?
Gram positive diplococcus in chains
105
What vaccine is available against N.Meningitidis?
Men B+C
Men ACWY
106
What vaccine is available against s. Pneumoniae?
PCV
107
What are the risk factors of meningitis?
Intrathecal drug administration (spinal canal)
Age extremes
Pregnancy
Crowding
Endocarditis
108
What are the general symptoms of meningitis?
Headache
Neck stiffness
Fever
109
What are the symptoms of bacterial meningitis?
Sudden onset
Triad of normal symptoms
Papillodema
Non blanching purpuric rash
Altered mental state
Positive signs
Nerve palsies (III)
110
What are the 2 signs of meningitis?
Kernig’s sign
Brudzinski’s sign
111
What is Kernig’s sign?
Can’t extend knee without pain when hip is flexed
112
What is Brudzinski’s sign?
Knees and hips automatically flex when neck is flexed
113
What are the symptoms of viral meningitis?
Benign and self limiting
Headache can last for a few months
114
How is meningitis diagnosed?
Blood tests before LP
LP and CSF analysis
115
What is present in bacterial meningitis CSF?
Cloudy yellow colour
Neutrophilia and polymorphs
Low glucose
Increased opening pressure
116
What are the CSF findings in viral meningitis?
Clear CSF
Lymphocytes
Normal glucose
Normal opening pressure
117
What are the CSF findings of TB meningitis?
Ziehl Neelson stain
Low glucose
High opening pressure
118
How is bacterial meningitis treated in the community?
Immediate IV or IM benzylpenicillin
119
How is bacterial meningitis treated in hospital?
IV cefotaxime or ceftriaxone
+ amoxicillin for neonates and elderly
+ vancomycin for travellers
Also dexamethasone to reduce cerebral oedema
120
What is given to those in contact with people with meningitis?
Ciprofloxacin (all ages and pregnant)
Or
Rifampicin (NOT FOR PREGNANCY)
121
How is viral meningitis treated?
Usually fine
Acyclovir for HSV
122
What are 2 differential diagnoses of meningitis?
Subarachnoid haemorrhage
Migraine
123
What are 3 complications of meningitis?
Hearing loss
DIC (septicaemia)
Waterhouse freidrechsen syndrome (adrenal haemorrhage -> adrenal insufficiency)
124
Define encephalitis
Infection and inflammation of the brain parenchyma
125
What is the MC cause of encephalitis/
HSV-1
Also: varicella, HIV, EBV, toxioplasmosis (cats)
126
What are the risk factors of encephalitis?
Extremes of age
Immunocompromised
127
What are the symptoms of encephalitis?
Triad: fever, headache, altered mental state
Features of viral infection
Seizures
Whole brain affected = problems of consciousness
128
How is encephalitis diagnosed?
MRI
CSF shows elevated lymphocytes
EEG shows sharp and slow waves
129
What lobe is MC affected by encephalitis?
Temporal
130
How is encephalitis treated?
IV aciclovir
Mostly supportive
If seizures give primidone
131
What are the causes of seizures?
VITAMIN DE
Vascular
Infection
Trauma
Autoimmune
Metabolic
Idiopathic (EPILEPSY)
Neoplasms
Dementia and drugs
Eclampsia
132
Define epilepsy
Recurrent tendency to have seizures (>2 >24 hours apart) with no apparent cause
133
Define seizure
Spontaneous, uncontrolled, intermittent abnormal electrical activity in the brain
134
What are the qualities of ictus/ epileptic seizures?
Eyes open
Synchronous movements
Can occur in sleep
135
What are the risk factors of epilepsy?
>20 or 60<
FHx
Premature birth
Alzheimer’s
136
Outline the pathophysiology of epilepsy
Normal balance between GABA (-) and glutamate (+) shifts towards glutamate
- Glutamate is more excitatory
137
Define prodrome
Nonspecific behavioural symptoms that can occur in the hours/days before a seizure
138
Define aura
More specific sensory disturbances (bad feeling, strange smells ect) that can occur before a seizure
139
What are the 2 classifications of seizure?
Generalised
Partial/focal
140
Are most seizures generalised or focal?
Focal
141
Define generalised seizure
Simultaneous onset of electrical discharge throughout the whole cortex, and ALWAYS is associated with loss of consciousness/awareness
142
How long do epileptic seizures usually last?
30-120 seconds
143
Define focal seizure
Electrical discharge is limited to one area of the brain, but can later become generalised
144
Outline the process of an epileptic seizure
Prodrome -> aura -> ictal event/seizure -> post ictal period
145
Define post ictal period
The period after a seizure
146
What are the symptoms in a post ictal period?
Headache
Confusion
Todd’s paralysis (temporary paralysis and muscle weakness)
Dysphasia
Amnesia
147
What symptom of a post ictal period is specific to epilepsy?
Sore tongue
148
What are 5 types of generalised seizure?
Tonic-clonic/grand-mal
Absence
Myoclonic
Tonic
Atonic/akinetic
149
What are 5 features of tonic-clonic seizures?
Often no aura
Loss of consciousness
Tonic phase: rigid and stiff limbs (fall)
Clonic phase: muscles jerking
Period of drowsiness, confusion, coma after
150
What are 4 features of absence seizures?
Usually occurs in children
Cease of activity, stares and pales for a few seconds
Amnesia of attack
3-Hz spike on ECG
151
What is the feature of myoclonic seizures?
Sudden isolated jerk of limb, face or trunk
- May suddenly fall
152
What is the feature of tonic seizures?
Sudden intense stiffening usually with grunt/cry
- NOT followed by jerking
153
What is the feature of atonic seizures?
Sudden loss of muscle tone (floppy) and cessation of movement causing a fall
154
What are 3 types of focal seizures?
Simple partial seizure
Complex partial seizure
Partial seizure with secondary generalisation
155
Define simple focal seizure
No LOC or memory and awareness is unimpaired, no post-ictal symptoms
156
Define complex focal seizure
Affecting awareness at some point, and patient is unaware and there is a post ictal period
157
Define focal seizure with secondary generalisation
Focal seizures spread widely, causing a secondary generalised seizure
2/3 of patients have this
158
Where do most complex focal seizures arise from?
Temporal lobe
159
What are the features of a simple focal seizure?
Isolated limb jerking
Head turning away from side of seizure
Todds paralysis
160
What are the features of a complex focal seizure?
Hallucinations
Lip smacking
Automatism
161
What are most secondary generalised seizures?
Tonic-clonic
162
What are the features of temporal lobe seizures?
Aura- deja but, hallucinations, fear ect
Anxiety o out of body experiences
Dysphasia
Post-ictal period
163
What are the symptoms of a frontal lobe seizure?
Motor features such as posturing or peddling
Jacksonian march- marches up or down homunculus starting in face or thumb
Post-ictal Todd’s palsy (of limbs involved in seizure)
164
What are the symptoms of a parietal lobe seizure?
Sensory disturbances- tingling or numbness
165
What are the symptoms of occipital lobe seizures?
Visual phenomenons - spots, flashes ect
166
What are features that differentiate epilepsy from syncope?
Tongue biting
Head turning
Muscle pain
LOC
Cyanosis
Post-ictal symptoms
167
How is epilepsy diagnosed?
Must have at least 2 seizures 24+ hours apart
ECG- not diagnostic
MRI with hippocampus imaging
CT head to check for lesion
FBC to check for metabolic causes
168
Define status epilepticus
Complication of epilepsy
Seizure >5 mins OR more than one seizure within 5 mins
169
What are the symptoms of status epilepticus?
Convulsive: jerking, grunting, drooling
Non-convulsive: no jerking, confusion, unable to speak
170
How is status epilepticus treated?
IV or rectal benzodiazepines
- lorazepam or buccal midazolam
Second line = phenytoin
171
How are tonic-clonic seizures treated?
Men + non-childbearing women: sodium valporate
Childbearing women: lamotrigine/levetiracetam
172
How are tonic/atonic seizures treated?
Men: sodium valoprate
Women: lamotrigine
173
How are myoclonic seizures treated?
Men: sodium valoprate
Women: levetiracetam
174
How are absence seizures treated?
Ethosuximide
2nd is the usual
175
How are focal seizures treated?
Lamotrigine or levetiracetam
2. Carbamazepine, oxcarbaepine, zonisamide
176
What are 2 side effects of sodium valoprate?
Teratogenic
Hair loss and growing back curly
Weight gain
Oedema
177
What is a side effect of carbamazepine?
Agranulocytosis
Aplastic cytosis
178
What are the side effects of ethosuximide?
Night terror and rash
179
What are 2 side effects of lamotrigine?
Steve Johnson syndome
Leukopeni
180
How does sodium valoprate work?
Increases GABA
181
How does carbamazepine work?
Increases refractory period of sodium channels
182
How does lamotrigine work?
Na channel blocker
183
What are some surgical treatments for epilepsy if drugs are ineffective?
Surgical resection for hippocampal sclerosis or tumour
Vagal nerve stimulation
184
What are the causes of status epilepticus?
Abruptly stopping treatment
Alcohol abuse
Poor therapy compliance
185
When can epilepsy patients drive?
After they have been free from daytime seizures for a year
186
Define spina cord compression/myelopathy
Compression of the spinal cord resulting in upper neurone signs and symptoms specific to the site of compression
187
What are 2 causes of spinal cord compression?
Vertebral body neoplasms
Secondary malignancy from lungs, breast, prostate ect
188
What are 2 consequences of spinal cord compression?
Disc herniation- centre moves out of the outer part
Disc prolapse- nucleus pulposus moves and can create a bulge in the disc
189
What are the symptoms of spinal cord compression?
Progressive leg weakness with UMN signs
Sensory loss below the level of the lesion
Can have sphincter involvement
190
How is spinal cord compression diagnosed?
MRI- GS and done AS SOON AS POSSIBLE
CXR to see malignancy
191
How is spinal cord compression treated?
Malignancy = IV dexamethasone
Neurosurgery
- microdisectomy (remove herniated tissue)
- laminectomy (remove lamina/spongy tissue)
192
Define sciatica
S1 nerve root compression
193
Define cauda equina syndrome
Compression below conus medullaris/ cauda equina - distal to termination of spinal cord at L1/L2
194
What is the MC cause of cauda equina?
Lumbar disc herniation (occurs in around 2%)
Spondylolistesis, tumours, abscesses, trauma
195
What are the symptoms of cauda equina?
Leg weakness and LMN signs
Saddle anaesthesia- loss of sensation when wiping/perineum
Bladder and bowel dysfunction
Variable areflexic flaccid leg weakness
196
How is cauda equina diagnosed?
MRI to localise lesion
197
How is cauda equina treated?
Refer to neurosurgeon asap for surgical decompression
Can give surgical spine sensation, spinal fusion/ fixation
198
What are 3 causes of cranial nerve lesions?
Tumour
MS
Trauma
Aneurysm
Infection
199
What are the symptoms of CN 3/ Oculomotor palsy?
Ptosis- dropping eyelids
Fixed dilated pupil
Eye down and out
Double vision
200
What are 3 causes of CN 3 palsy?
Raised ICP
Diabetes
HTN
Giant cell arteritis
201
What are the symptoms of CN 4/ trochlear nerve palsy?
Head tilt to unaffected side to correct lack of superior oblique
Diplopia when looking down
202
What causes CN 4 palsy?
Trauma to orbit only
203
What are the signs of CN 6 palsy?
Eyes will be adducted as it innervates lateral rectus
204
What are the symptoms of CN 5/ trigeminal palsy?
Jaw deviates to side of lesion
Loss of corneal reflex
205
What are the symptoms of CN VII/ facial nerve palsy?
NOT FOREHEAD SPARING (that would be UMN)
Facial droop and weakness
Ocular dryness
Decreased taste
Incomplete eye closure
Ear pain
Difficulty chewing
206
What are the causes of CN VII palsy?
Bell’s palsy- may be due to inflammation and oedema of facial nerve due to viral infection or autoimmune
Middle ear infection
Inflammation of the parotid gland
207
Define trigeminal neuralgia
Episodes of acute severe facial nerve pain of the trigeminal nerve
208
How is Bell’s palsy treated?
Supportive
Can give Prednisolone
Eye care: lubricants, sunglasses ect
209
What are the causes of trigeminal neuralgia?
Vascular compression (MC)
Compression by other lesions
MS
Idiopathic
210
What are the symptoms of trigeminal neuralgia?
Short lived episodes of electric shock pain in the distribution of the trigeminal nerve
Can be triggered by cold air or eating
211
How is trigeminal neuralgia diagnosed?
CT/MRI to find lesion
Clinical diagnosis: short bursts of pain (>3 with unilateral facial pain)
212
What type of drug is carbamazepine?
Anticonvulsant
213
How is trigeminal neuralgia treated?
Carbamazepine
2. Gabapentin/lamotrigine
Surgery = micro vascular decompression
214
What are the symptoms of CN VIII/ vesibulocochlear palsy?
Hearing impairment
Vertigo and lack of balance
215
What are the causes of CN 8 palsy?
Close to bone so- bone fracture
Ear infections
Tumours in internal acoustic meatus
216
What are the symptoms of CN 9/10 lesion?
Impaired gag reflex
Swallowing issues
Vocal issues
217
What is the cause of CN 9/10 lesions?
Jugular foramen lesion
218
What are the symptoms of CN 11 lesion?
Can’t shrug shoulders
Can’t turn head against resistance
219
What are the symptoms of CN 12 palsy?
Tongue deviates towards the side of the lesion
220
Define myasthenia gravis (MG)
Autoimmune condition against nicotinic acetylcholine receptors in the NMJ that gets better with rest and worse with activity
221
What age does MG present in women?
30-40
222
What age does MG usually present in males?
60
223
What is MG in women associated with?
Autoimmune disease
- pernicious anaemia (B12)
- SLE
- RA
- Thymic hyperplasia
224
What is MG associated with in men?
Thymic tumour / thymic hyperplasia
225
What can cause transient MG?
D-Penicillamine treatment for Wilson’s disease
226
Outline the pathophysiology of MG
Anti-AChR antibodies made -> block NMJ -> prevent ACh activation -> activate complement system -> damages NMJ
In exercise more receptors used -> more blocked -> increased muscle weakness
227
What are the symptoms of MG?
Muscle weakness worse in exercise and better at rest
Eye issues: ptosis, piplopia, myasthenic snarl when smiling
Jaw and speech fatiguability
Chewing and swallowing difficulties (bulbar)
Tendon reflexes can fatigue
228
What are 2 differential diagnoses of MG?
Lambert-Eaton myasthetic syndrome
MS
Hyperthyroidism
GBS
229
How is MG diagnosed?
Anti AChR + Anti MuSK (muscle specific tyrosine kinase)
Clinical diagnosis
EMG (electromyography) and NCS (nerve conduction studies)
CT of thymus
Tensilon test
230
What is a Tensilon test?
Used to diagnose MG
IV edrophonium (anti-cholinesterase) given and muscle power will increase
231
What are the side effects of a Tensilon test?
Cardiac arrhythmia
232
How is MG treated?
Anti-cholinesterase **pyridostigmine** so ACh stays in NMJ
Immunosupression- Prednisolone
Thymectomy
233
What is an example of an anti-cholinesterase?
neostigmine
pyridostigmine
234
What are the side effects of anti-cholinesterases?
DUMBELLS
Diarrhoea
Urination
Miosis
Bradycardia
Emesis
Lacrimation
Lethargy
Salivation
235
What is a complication of MG?
Myasthenic crisis
236
What are the features of myasthenic crisis?
Weakness of respiratory muscles in a relapse
237
How is myasthenic crisis treated?
Plasma exchange
IV IG
238
What is monitored in MG?
FVC for myasthenic crisis
239
What 2 drugs can worsen MG?
Beta blockers
Antibiotics
240
What is Lamber-Eaton syndrome associated with?
Small cell lung cancer
241
Define Lamber-Eaton syndrome
Autoantibodies against presynaptic voltage gated calcium channels preventing the release of ACh
242
What are the symptoms of Lamber-Eaton syndrome?
Very similar to MG but
Gets better with exercise and not associated with thymus
Symptoms start in extremities+ head and neck
243
How is Lambert-Eaton syndrome treated?
Treat malignancy
**Amifadiprine** - potassium channel blocker
Acetylcholineesterase inhibitor- pyridostigmine
Consider IVIG and plasma exchange
244
What are 2 causes of sciatica?
Spinal: IV Disc hernia
Non-spinal: piriformis syndrome
245
What are the symptoms of sciatica?
Pain from buttock down lateral leg -> pinky toe
Weak plantar flex ion
Absent ankle jerk
246
How is sciatica diagnosed?
Can’t straighten straight leg without pain
MRI
247
Define syncope
Temporary loss of consciousness due to disrupted blood flow to the brain, often causing a fall
248
What are the other terms for syncope?
Vasovagal episodes
Fainting
249
Outline the pathophysiology of syncope
Strong stimulus in vagus nerve -> parasympathetic NS activated -> counteracts sympathetic NS -> brain blood vessel vasodilates -> cerebral circulation BP drops -> hypoperfusion of brain
250
What are the symptoms of syncope?
Prodromal- before the attack: hot/clammy, light headed, dizzy, blurred vision
Sudde loss of consciousness and fall to ground
Unconscious until blood flow returns
May be twitching, shaking or convulsion
251
What are 3 primary causes of syncope?
Missed meals
Dehydration
Extended standing in warm environment
In response to a stimuli eg. Blood
252
What are 3 secondary causes of syncope?
Hypoglycaemia
Anaemia
Infection
Anaphylaxis
Arrhythmia
Cardiomyopathy
253
How is syncope investigated?
Full history and exam
ECG- arrhythmia or long QT
Bloods- anaemia, electrolytes, blood glucose
254
How is syncope treated?
Basically avoid causes
When experiencing Prodromal symptoms, sit or lie down
255
What are 4 limb neuropathies/mononeuropathies?
Carpal tunnel syndrome
Wrist drop
Claw hand
Foot drop
256
Define carpal tunnel syndrome
Pressure and compression on the median nerve as it passes through the carpal tunnel in the wrist
257
What are the risk factors of carpal tunnel syndrome?
Female
Hypothyroidism
DM
Pregnancy
Obesity
RI
Acromegaly
258
What are the symptoms of carpal tunnel syndrome?
Gradual onset of symptoms
Aching pain in hand
Tingling in thumb, index, middle, and 1/2 the ring finger and palm
Relieved by dangling hand over edge
May have sensory loss and thenar degradation
259
How is carpal tunnel syndrome diagnosed?
Phalen’s test
Tinel’s test
Electromyography (EMG)
260
What is Phalen’s test?
Patient can only maximally flex wrist for 1 minute without pain (back of palms against each other)
261
What is Tinel’s test?
Tapping on nerve at wrist causes tingling
262
How is carpal tunnel syndrome treated?
Wrist splint at night
Local steroid injection
Surgical decompression
263
What muscles are supplied by the median nerve?
LOAF
2 lumbricals
Opponents pollicis
Abductor pollicis brevis
Flexor pollicis brevis
264
What causes wrist drop?
Radial nerve palsy
265
How is wrist drop treated?
Splint
Analgesia
266
What causes claw hand?
Ulnar nerve palsy
267
What causes foot drop?
Peroneal nerve compression
268
What are 2 causes of foot drop?
Knee injury compression
Muscle or nerve disorders
Brain and spinal cord disorders
Bone lesions
269
What are the symptoms of foot drop?
Foot dragging when lifting
Steeppage gait- one thigh raised higher than other
Numbness of top of foot and toes
Bi/unilateral
270
How is foot drop diagnosed?
Clinical
Nerve conduction studies
X-ray, USS, CT, MRI
271
How is foot drop treated?
Braces or split
Physical therapy
Nerve stimulation
Surgery
272
Who is affected by giant cell arteritis?
~50 year old Caucasian women
273
What are the symptoms of giant cell arteritis?
Unilateral tender scalp
Intermittent jaw claudication
Worse case = amaurosis fugax
274
How is giant cell arteritis diagnosed?
Temporal artery biopsy
- Big part as skip lesions
Shows granulomatous non cesating inflammation of intima and media with skip lesions
Normocytic normochromic anaemia
275
How is giant cell arteritis treated?
Corticosteroids - Prednisolone
Amaurosis fugax = IV methylprednisolone
276
Define multiple sclerosis
Chronic autoimmune T cell mediated demyelination of the CNS
277
What cells are affected by MS?
Oligodendroyctes
278
Who is commonly affected by MS?
Females> males
20-40 years
White people
279
What are the risk factors of MS?
Female
FHx
EBV
Low vitamin D
Genetics
280
What gene increases the risk of MS?
HLA-DR2
281
Outline the pathophysiology of MS
Molecular mimicry
Initial infection -> cell recognition -> after infection myelin recognised as antigen -> cytokine release and antibody formation
282
What are the 3 types of MS?
Relapsing + remitting
Primary progressive
Secondary progressive
283
What is the MC type of MS?
Relapsing + remitting
284
Describe relapsing + remitting MS
Symptoms occur in attacks, then periods of good health/remission, then relapse again
285
Describe primary progressive MS
Gradually worsening disability without relapse or remission
286
Describe secondary progressive MS
Follows on from relapsing and remitting
Symptoms then gradually worsen
287
How many patients with relapsing and remitting MS will develop secondary progressive MS?
75% within 35 years after onset
288
What is Charcot’s neurological triad (MS)?
Scanning or staccato speech
Intention tremor
Nystagmus
289
What are the optic symptoms of MS?
Unilateral optic neuritis -> loss of colour discrimination and eye can change colour
Inter nuclear opthalmoplegia (cant adduct right eye when looking to left)
Vision worse when hot
290
What are the sensory symptoms of MS?
Uhtoff’s phenomenon (transient neurological dysfunction when temperature increased)
Lhermitte’s sign (electric shocks going down the cervical spine radiating down the limbs)
291
What are the motor symptoms of MS?
Spasticity
Ataxia
UMN signs
292
How is MS diagnosed?
MRI: lesions in the periventricular regions and discrete white matter abnormalities
CSF: oligoclonal bands of IgG and increased lymphocytes
Evoked potential test
292
What criteria is used to diagnose MS?
McDonald’s criteria
293
What is McDonald’s criteria for MS?
2 or more attacks at separate times and affecting different parts of the CNS
294
How is MS treated acutely?
3 days IV methylprednisolone
295
What is the prophylaxis for MS?
Beta interferons
Biologicals
296
How is tremor in MS treated?
Clonazepam
297
How is fatigue in MS treated?
Modafinil
298
How is spacisity in MS treated?
Baclofen
299
How is Incontenence in MS treated?
Anticholinergics
- Eg. Oxybutin
300
Define Guillain Barre syndrome
Acute, inflammatory, autoimmune demyelinating polyneuropathy characterised by ascending weakness
301
What is the MC acute polyneuropathy?
GBS
302
What are the causes of GBS?
GI or upper respiratory tract infection
Campylobacter jejuni
CMV
Mycoplasma
Zoster
HIV
EBV
303
Outline the pathophysiology of GBS
Molecular mimicry
Infection and response -> antigens similar to Schwann cells so -> autoimmune destruction of Schwann cells -> demyelination -> acute polyneuropathy
304
What are the symptoms of GBS?
1-3 weeks post infection symmetrical ascending muscle weakness + paralysis
Loss of reflexes
Some have respiratory failure
Often reduced sensation
305
What are 2 differential diagnoses of GBS?
Sarcoidosis
MG
Stroke
B12 deficiency
Lyme disease
306
How is GBS diagnosed?
Nerve conduction tests + EMG
Lumbar puncture: raised protein and normal WCC
Anti GM1
307
How is GBS treated?
IV immunoglobulin
Plasma exchange
308
What should be monitored in GBS?
FVC to check for respiratory failure
309
What is the leading cause of death in GBS?
PE
310
Define Parkinson’s
Degenerative movement disorder caused by dopamine neuron degeneration in the substantia niagra
311
What is the Parkinson’s triad?
Rigidity
Bradykinesia
Resting tremor
312
What are the risk factors of Parkinson’s?
Male
Increased age
FHx
Non-smoker!
313
What are the causes of Parkinson’s?
Idiopathic
Drug induced
Environmental factors
Parkinson genes
314
What are the features of a parkinsonian tremor?
Asymmetrical
Pill rolling of thumb
Exacerbated by rest
315
What are the features of parkinsonian rigidity?
Cogwheel rigidity
Increased tone in limbs and trunk
Can cause pain and problems when turning in bed
316
What are the features of gait in Parkinson’s?
Reduced asymmetrical arm swing
Narrow gait
Stooped posture and small steps
Shuffling and may drag feet
317
What are the symptoms of Parkinson’s?
Parkinsonian triad
Onset is ALWAYS ASYMMETRICAL
Changes in gait
Smaller handwriting
Expressionless face
Loss of sense of smell
318
Outline the pathophysiology of Parkinson’s
Dopamine depletion from substantia niagra due to Lewy body deposition -> decreased activity of direct pathway -> increased activity of indirect pathway -> thalamic inhibition
319
How is Parkinson’s diagnosed?
Clinically mainly
Can confirm by response to levodopa
320
How is Parkinson’s treated?
GS: levodopa + decarboxylase inhibitors
Dopamine agonist
MAO-B inhibitors
COMT inhibitors
321
How does levodopa work?
Precursor to dopamine so can cross BBB so it can be converted to dopamine in brain and used
322
How do decarboxylase inhibitors work?
Prevent peripheral conversion of L-dopa to dopamine so reduces peripheral side effects and maximise dose that crosses BBB
323
What are 2 decarboxylase inhibitors?
Co-careldopa
Co- beneldopa
324
What are the side effects of levodopa?
Postural HTN
Psychosis
Arrhythmia
325
What is a dopamine agonist used to treat Parkinson’s?
pramipexole
ropinirole
326
How do MAO-B inhibitors work?
Inhibit MAO-B enzymes that break down dopamine, causing a reduction in dopamine breakdown
327
What are 2 MAO-B inhibitors?
Selegiline
Rasagiline
328
What are the side effects of dopamine agonists?
Compulsive behaviour
Drowsiness
Hallucinating
329
How do COMT inhibitors work?
Inhibits COMT which breaks down dopamine
330
What are 2 COMT inhibitors?
Entacapone
Tolcapone
331
What is Parkinson’s plus?
Parkinsonism + early autonomic clinical features
332
What are 2 Parkinson plus syndromes?
Multiple system atrophy- postural HTN, incontenence
Lewy body dementia
Corticobasal degeneration- spontaneous rigidity
Progressive supranuclear palsy- vertical gaze palsy
333
What are the complications of Parkinson’s?
Depression
Wearing off medication
334
Define Huntingtons disease
Autosomal dominant neurodegenerative movement disorder characterised by lack of GABA
335
Define chorea
Continuous flow of jerky, semi purposeful movements flitting from one part of the body to another
CEASES IN SLEEP
336
What gene is mutated in Huntington’s?
CAG trinucleotide repeat disorder on chromosome 4 in HTT gene
337
What can happen with trinucleotide repeat disorders?
Anticipation
Successive generations have more repeats causing earlier onset and increased severity
338
What degenerates in Huntington’s?
Degeneration of caudate nucleus and putamen
- Lack of input nuclei
- Increased size of frontal lateral horns
339
How many gene repeats of CAG will guarantee Huntington’s?
>40
340
What occurs in the brain in Huntington’s?
Cholinergic and GABAnergic neuron degeneration in basal ganglia
341
How many repeats of CAG is normal?
<35
342
Outline the pathophysiology of Huntington’s chorea
Progressive cerebral atrophy -> loss of GABA-nergic and cholinergic neurons-> excessive thalamic stimulation -> chorea and excessive movements
343
What are some non-Huntington’s causes of chorea?
Sydenham’s chorea (rheumatic fever)
Wilsons
SLE
344
What are the symptoms of Huntington’s?
Prodromal phase of mild psychotic and behavioural symptoms
Chorea
Dysarthria (unclear speech)
Behaviour changes: agression, addiction, apathy, self neglect
Depression
Death within 15 years
345
How is Huntingtons diagnosed?
Mainly clinical
Genetic testing shows >35 repeats
MRI shows caudate nucleus atrophy and increased size of frontal horns
346
What is the young onset variant of Huntington’s?
Westphal variant
347
How is Huntington’s treated?
Counselling- genetic, helping them prepare
Dopamine depleting agent for chorea
348
What is a dopamine depleting agent and how does it work?
Tetrabenazine- irreversibly blocks VMAT
349
Define dementia
Neurodegenerative condition characterised by a decrease in cognition (memory, judgement and language)
350
What is the MC cause of dementia?
Alzheimer’s
351
What dementia is MC in women?
Alzheimer’s
352
What dementia is MC in men?
Vascular and mixed
353
What are the risk factors of Alzheimer’s?
Increased age
Fhx
Downs syndome
Caucasian
354
Outline the pathophysiology of Alzheimer’s
Beta amyloid plaques and tau protein tangles accumulate -> neuronal death, brain atrophy, decreased ACh
355
What are the symptoms of Alzheimer’s?
4As
Amnesia (recent memories lost first)
Aphasia( speech muddled)
Agosia (recognition problems)
Apraxia (cant carry out tasks despite normal motor function)
356
What gene mutation increases the risk of Alzheimer’s?
Apoprotein E allele E4
357
How is Alzheimer’s treated?
Acetylcholinesterase inhibitors (donepezil/rivastigmine)
- stops breakdown of ACh
Memantine
358
What is an example of a Acetylcholinesterase inhibitor?
Donepezil
Rivastigmine
359
What causes frontotemporal dementia?
Pick inclusion bodies (silver aggregated Tau proteins) can be seen post mortem
360
What are the features of frontptemporal dementia?
Younger onset (45-64)
Personality changes and social conduct problems (frontal)
Speech and language affected (temporal)
361
What causes Lewy body dementia?
Alpha-synuclein aggregates form Lewy body deposition in neurons in the substantia niagra and cortex
362
What is Lewy body dementia associated with?
Parkinson’s
363
What are the symptoms of Lewy body dementia?
Visual hallucinations
Problems with REM sleep
Cognitive fluctuations
Prominent executive dysfunction
Parkinsonism
364
What is Parkinsonian dementia?
Parkinson’s THEN Lewy body dementia
365
How is Lewy body dementia treated?
Acetylcholinesterase inhibitors
Mematine
366
How does vascular dementia progress?
Stepwise
367
Define vascular dementia
Cognitive impairment caused by cerebovascular disease
368
What are the risk factors of vascular dementia?
Stroke or TIA
Hypertension
DM
Smoking
Obesity
CHD
369
What are the symptoms of vascular dementia?
Stepwise deterioration
Attention defects
Misplacing items
Forgetting past/current events
370
How is dementia diagnosed?
MMSE (mini mental state examination)
Brain MRI shows cortical atrophy
370
How is dementia prevented?
Stop smoking, good diet, exercise, low alcohol
Engage in >6 leisurely activities
Mental activity
371
What MMSE is normal?
>25/30
372
What MMSE indicates severe imparement?
<17/30
373
What are the 2 categories of headache?
Primary- no underlying cause
Secondary- underlying cause of the headache
374
What are 3 causes of secondary headache?
GCA
Meningitis
Medication overuse
Trauma
SAH
Infection
375
What are 4 primary headaches?
Migraine
Cluster
Tension
Trigeminal neuralgia
376
Define migraine
Recurrent throbbing headache often preceded by an aura and associated with N+V and vision changes
377
Who is migraine MC in?
Women <40
378
What are the triggers of a migraine?
CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult/loud noise
Exercise
379
What are the symptoms of a migraine?
Severe throbbing headache
Nausea, photophobia, phonophobia
May be preceded by aura
Can last 4-72 hours
380
How is migraine diagnosed?
Usually clinical:
Aura
N+V OR photophobia and 2 of
Unilateral headache, worsened by daily activity, pulsating, moderate to severe pain, motion sensitivity
Exclude clinical causes (CT/MRI)
381
How are migraines acutely treated?
NSAIDs + sumatriptan
Give anti emetic
382
What is an example of an anti emetic?
Prochlorperazine
383
How are migraines prevented?
Propanolol
Anti convulsant: topiramate
384
When is topiramate CI?
Pregnancy
Reduces effects of oral contraceptives
385
What are the MC chronic daily recurrent headache?
Tension headache
386
What is the MC primary headache?
Tension headache
387
What are the causes/triggers of tension headaches?
Stress
Sleep deprivation
Bad posture
Hunger
Eye strain
Noise
388
What are the symptoms of tension headache?
Bilateral
“Band like” sensation around head
Non pulsatile
May have scalp muscle tenderness
Pressure behind eyes
389
How are tension headaches treated?
Lifestyle changes
Stress relief: massage or acupuncture
Aspirin+ NSAIDs or paracetamol
390
What is the headache that is MC in males?
Cluster headache
391
What are the risk factors of cluster headaches?
Smoker
Male
Autosomal dominant gene
392
What are the symptomss of cluster headache?
Abrupt onset and ALWAYS UNILATERAL ON THE SAME SIDE
Excruciating pain around ONE eye, temple, or forehead
Can have ptosis and bloodshot eye
Stuffy nose
Crescendo pattern
393
How are cluster headaches treated acutely?
100% oxygen for 15 mins
SC sumatriptan
394
How are cluster headaches prevented?
Verapamil (CCB)
395
What are red flags in a headache?
Fever
Neoplasm history
Pregnancy
Sudden onset
Older onset
LOC
Papillodema
Worse by sitting/ standing
396
Define motor neurone disease
Degenerative disease caused by loss of neurones from the motor cortex, anterior horn cells, and cranial nerve nuclei
397
What are the risk factors of MND?
FHx
Smoking
Exposure to pesticides and heavy metal
398
What are upper motor neurone signs?
More muscle tone/Spascisity
More/Brisk reflexes
Positive babinski sign
Toes point UP
Upper limb extensor
399
What are lower motor neurone signs?
Less muscle tone/ flaccid
Fasciculations (twitching)
Muscle wasting
Less reflexes
Visible spontaneous contraction of motor units
Toes point down
Negative babinski
400
What is Babinski sign?
toes go UP when foot stroked
401
What gene is linked to MND?
SOD-1
402
What should mixed UMN and LMN signs indicate?
MND
403
How is MND distinguished from MG?
MND never affects eye movements
404
How is MND distinguished from MS?
MND Never affects senses or sphincters
405
What are the symptoms of MND?
Stumbling spastic gait
Foot drop
Weak grip
Shoulder abduction hard
Absence of sensory symptoms
406
When does MND usually present?
>40 years old but usually middle age
407
How is MND diagnosed?
Mainly clinical
- definitive of LMN and UMN signs present in 3 regions
Nerve conduction studies
EMG
408
What are the 4 types of MND?
Amyotrophic lateral sclerosis (ALS)
Progressive muscular atrophy (PMA)
Progressive bulbar palsy (PBP)
Primary lateral sclerosis (PLS)
409
What is the MC MND?
ALS
410
What occurs in ALS?
Loss of motor neurones in motor cortex
411
What are the symptoms of ALS?
UMN+LMN signs
Painless progressive spastic paraplegics
Split hand sign- thumb adrift
412
What are the symptoms of PMA?
LMN ONLY
Weakness, muscle wasting starting in one limb and spreading
Starts distally
413
What is affected in PBP?
Lower cranial nerves (9+)
414
What are the symptoms of PBP?
LMN ONLY
Tongue palsy
Trouble swallowing
Choking
Trouble chewing
415
What causes PLS?
Loss of Betz cells in motor neurones
416
What are the symptoms of PLS?
UMN ONLY
Spastic leg weakness
Progressive tetraparesis
417
How is MND treated?
Riluzole
Analgesia
Palliative
418
How does riluzole work?
Antiglutamatergic
Na+ channel blocker inhibits glutamate release
419
Where are LMN located?
Anterior horns of spinal cord and in cranial nerve nuclei in brain stem
420
Define peripheral neuropathy
Damages to peripheral nerves causing motor and sensory changes
421
What are the causes of peripheral neuropathy?
ABCDE
Alcohol
B12 deficiency
Cancer and CKD
DM and drugs
Every vasculitis
422
What are 2 mechanisms of peripheral neuropathy?
Axonal loss
Demyelination
Compression
Wallerian degeneration (nerve cut and dies distally)
423
How does axonal loss in peripheral neuropathy present?
Sensory changes: numbness, burning, pins and needles
THEN
Motor symptoms
424
How does demyelination present in peripheral neuropathy?
Motor changes then sensory
425
How is peripheral neuropathy diagnosed?
Nerve conduction studies
426
Define mononeuritis multiplex
Peripheral neuropathy affecting several individual nerves
427
What are the causes of mononeuritis multiplex?
WARDS PLC
Werner’s
AIDS/ amyloidosis
RA
DMT2
Sarcoidosis
Polyarteritis nodosa
Leprosy
Carcinoma
428
What causes Brown-Sequard syndome?
Hemisection of spinal cord
429
What are the symptoms of Brown-Sequard syndome?
In relation to lesion
Ipsilateral hemiplegia
Ipsilateral loss of proprioception, motor and vibration
Contralateral loss of pain and temperature
430
Describe why the symptoms of Brown-sequard syndrome occur
Ipsilateral loss of motor ect= corticospinal cord decussates at medulla
Contralateral loss= spinothalamic cord descussates in spinal tract
431
Define Charcot-Marie Tooth syndrome
Inherited disease affecting motor + sensory nerve caused by a dysfunction in myelin OR axons
432
What are the 2 types of Charcot-Marie Tooth syndrome?
Type 1: demyelinating (MC)
Type 2: axonal
433
What gene is mutated in CMT?
Autodom mutation of PMP22 gene on chromosome 17
434
What are the symptoms of CMT?
Firstly affects feet, then progresses to hands
Clumsiness
Weak ankles/ strained ankles
HIGH FOOT ARCH AND HAMMER TOES (pes cavus)
Foot drop
STORK LEGS
435
How is CMT diagnosed?
Nerve conduction tests (reduced in type 1)
Genetic testing
Nerve biopsy
436
How is CMT treated?
Physio
Exercise
Supportive
437
What is Wernickes encephalopathy?
Reversible acute emergency of severe thiamine deficiency
438
What is the MC cause of Wernickes encephalopathy?
Excess alcohol
439
What are the symptoms of Wernickes encephalopathy?
Triad:
Ataxia
Confusion
Opthalmoplegia
440
How is Wernickes encephalopathy diagnosed?
Clinical
Macrocytic anaemia
Deranged LFT
441
How is Wernickes encephalopathy treated?
Parenteral pabrinex
Oral thiamine for prophylaxis
442
What is the complication of Wernickes encephalopathy?
Korsakoff syndrome
Irreversible damage and increased memory loss
443
Define Duchenne muscular dystrophy
X linked recessive mutated dystrophin gene
444
What occurs in Duchenne muscular dystrophy?
Muscle replaced with adipose
445
What are the symptoms of Duchenne muscular dystrophy?
Gower’s sign (cant get up from lying down)
Skeletal deformities
Wheelchair bound
Respiratory arrest by 20s :(
446
How is Duchenne muscular dystrophy diagnosed?
1. Creatine kinase
Genetic testing
447
Define tremor
Voluntary rhythmic oscillatory movement
448
What are the features of an essential tremor?
Alcohol suppresses
Progressive
Quite fast
449
What are the features of a dystonic tremor?
Task specific
Variable axis
Little finger hyperextended
450
What are the features of a functional tremor?
Disttractabilty (improves when attention shifts)
Variability
Slow, effortful
Archimedes spiral
451
Define dystonia
Agonist and antagonist muscle activated simultaneously causing twisting movements
452
What are the features of dystonia
Better walking backwards
Spontaneous remission
Stress exacerbated
453
Define chorea
Abnormal, abrupt, unpredictable involuntary movement
454
Define myoclonus
Sudden, brief, involuntary jerk of movements
455
Define tic
Brief movement or vocalisations that resemble voluntary actions
456
How is Bell’s palsy differentiated from a stroke?
Bell’s palsy affects forehead
457
Are primary or secondary brain tumours more common?
Secondary
458
What is the MC origin of a brain tumour?
Non small cell lung
459
What is the MC primary brain tumour?
Astrocytoma
460
What are 3 primary brain cancers?
Astrocytoma
Oligodendrocytoma
Meningioma
461
How is Astrocytoma graded?
WHO I-IV
462
What are the 4 categories of Astrocytoma?
I: pilocytic
II: diffuse astrocytoma
III: anaplastic astrocytoma
IV: glioblastoma multiforme (WORST)
463
What are the symptoms of a primary brain tumour?
Increased ICP: headache, drowsiness, vomiting, PAPILLODEMA
Neuro defecit
Seizure (focal)
Lethargy/tiredness
464
How are brain tumours diagnosed?
CT with contrast /MRI
465
Should a lumbar puncture be done in brain tumours?
No
Can provoke coning (herniation through foramen magnum -> brain stem compression -> potential death)
466
How are brain tumours treated?
Surgery
Chemo
467
What haemmorage involves veins?
SDH
468
What is the Mc cause of bacterial meningitis?
Streptococcus pneumoniae
469
What haemmorage does not cross sutures?
EDH
