Neurology Flashcards
Creutzfeldt-Jakob disease
Deposition of abnormal prion proteins causing progressive neurodegeneration
- Majority sporadic
Features:
- Early - anxiety, personality change, neurosis, forgetfulness, hallucinations
- Late - myoclonus, ataxia, dementia, akinetic mutism, seizures
Investigations:
- EEG
- Triphasic sharp waves
- Myoclonic spikes
- Generalised suppression
- RT-QuIC on CSF
- MRI brain
- Autopsy
Stroke and driving advice
No driving for 1 month after stroke with mild deficit or TIA
If severe persistent neurology, must discuss with DVLA
Lateral medullary / Wallenberg’s syndrome
Classically due to occlusion of the posterior inferior cerebellar artery
Features:
- Cerebellar
- Ipsilateral limb ataxia - cerebellar peduncle
- Vertigo
- Nystagmus to side of lesion
- Brainstem
- Sudden dizziness + vomiting = [VIII]
- Dysphagia + dysarthria
- Ipsilateral Horner’s syndrome
- Ipsilateral facial pain/temp loss = [V]
- Ipsilateral IX + X palsies
- Contralateral limb/truncal pain/temp loss
(spinothalamic)
Meralgia paraesthetica
Entrapment neuropathy or neuroma of the lateral cutaneous nerve
- L2/L3 fibres via the lumbar plexus
- Runs under or through the inguinal ligament
- Main risk factor is obesity or weight gain
Features:
- Numbness, parasthesia, pain in the anterolateral thigh
Lumbar spinal stenosis
Narrowing of the lumen of the lumbar canal, usually due to progressive hypertrophy of the facet joints + disc degeneration
Features:
- Cramping or burning pain in leg with evidence of neurogenic claudication
- Alleviated by leg flexion, sitting, forward
flexion of lumbar spine
- ‘shopping cart’ sign
- Lower extremity muscle weakness
- Diminished reflexes
- Parasthesias
- Impaired balance
Management:
- Medications - unclear benefit, can trial NSAIDs and SSRIs
- Physiotherapy
- Spinal decompression surgery
Tuberculous meningitis
Features:
- Subacute timescale
- Asymmetrical neuropathies - esp. [III] and [V]
- Fever
- Headache
- Confusion
- Meningism
- Weight loss
- Raised ICP
Risk factors:
- HIV
- Malignancy
- Malnutrition
Investigations:
- LP - low glucose, high protein, lymphocytosis, mildly raised opening pressure
- Send CSF for NAAT, AFB, and culture
- Screen for comorbid HIV
- Imaging:
- MRI head
- CXR chest
Management:
- 2/12 RIPE then a further 7-10/12 RI
- 8/52 dexamethasone with taper
Complications
- Cranial nerve palsy
- Cerebral oedema
- Venous sinus thrombosis
Syringomyelia
Aetiology:
- Congenital - typically Chiari malformation
- Post-traumatic
Features:
- Shawl-like loss of pain and temperature sensation
- Can also affect [V]
- If post-traumatic, symptoms spread upwards
from site of trauma
Management:
- Surgical decompression
Mononeuritis multiplex
A sensory and/or motor peripheral neuropathy affecting at least two different nerves
- Painful
- Asymmetrical
Aetiology:
- Diabetes mellitus
- Autoimmune e.g. SLE, vasculitis
- Infection e.g. Lyme disease, leprosy
- B12 deficiency
- Sarcoidosis
Complications include recurrence, deformity, and muscle atrophy
Median nerve neuropathy
Aetiology:
- Carpal tunnel syndrome
- Trauma
Risk factors:
- Pregnancy
- Obesity
- Rheumatoid arthritis
- Hypothyroidism
- Occupational
Features:
- Tinel’s and Phalen’s positive
- Weakness of 1st + 2nd lumbricals, OPB, APB, FPB
- Sensory loss thumb, forefinger, middle finger, 1/2 ring finger
Management:
- Analgesia
- Splinting
- Steroid injection
- Surgical release
Ulnar radiopathy at the elbow
aka cubital tunnel syndrome
Most commonly due to trauma
Features:
- Weakness of FCU, dorsal and palmar interossei, hypothenar muscles
- Sensory loss + paraesthesias along 1/2 of 4th + little finger
- Pain at elbow
- Froment’s +ve
Radial nerve palsy
Aetiology:
- Trauma
- Compression or damage of the radial nerve in
the spinal groove of the humerus
- Inflammatory
- Infection
Features:
- Wrist drop
- Sensory loss over dorsum of hand and 1st web space
Management:
- If compressional, usually spontaneously recovers within 6 weeks
- Cock-up wrist and finger splints
- Physiotherapy to prevent flexion contracture
Femoral neuropathy
Aetiology:
- Retroperitoneal haematoma
- Hip dislocation
- Lithotomy positioning
Features:
- Impaired hip flexion and knee extension
- Sensory loss anteromedial leg
- Reduced patellar reflex
Management:
- Usually self-limiting
Sciatic neuropathy
Usually due to the peroneal division of the sciatic nerve
Aetiology:
- Trauma during hip arthroplasty
- Prolonged lithotomy positioning
- Vasculitis
- Tumour
- Idiopathic
Features:
- Weakness of ankles and toes
- Sensory loss in foot and distal lateral leg
- Reduced ankle and hamstring reflexes
Peroneal neuropathy
Most common lower limb neuropathy
Due to compression at the lateral border of the knee
Features:
- Foot drop
- Weak foot eversion
- Flail foot
- Sensory loss dorsum of foot + lateral border of shin
Neurological disease in HIV
Split into focal and generalised disorders:
- Focal
- Toxoplasmosis
- TB meningitis or abscess
- Generalised
- PML - JC virus
- CMV encephalitis
- Cryptococcal meningitis
- Atypical neurosyphilis - myelopathy, retinitis,
meningitis.
Meningitides:
- Non-specific fever, headache, meningism
- Cryptococcal - subacute (1-2 weeks) with
disorientation and confusion
- TB - subacute (2-4 weeks) with consitutional sx
