Neurology Flashcards
What may exacerbate myasthenia gravis
BETA BLOCKERS
penicillamine
quinidine, procainamide
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
What does subacute combined degeneration of the spinal cord affect
dorsal columns (proprioception, vibration sense and tactile discrimination).
What cause subacute combined degeneration of the spinal cord
B12 Deficiency
Why should B12 levels be checked before folate supplementation
Folate supplementation can precipitate subacute combined degeneration of the spinal cord if B12 levels are already low
What are the features of Weber’s syndrome
ipsilateral CN III palsy and contralateral hemiparesis
How is myasthenia gravis managed
long-acting acetylcholinesterase inhibitors
pyridostigmine is first-line
immunosuppression is usually not started at diagnosis, but the majority of patients eventually require it in addition to long-acting acetylcholinesterase inhibitors:
1) prednisolone initially
2) azathioprine, cyclosporine, mycophenolate mofetil may also be used
How is myasthenic crisis managed
plasmapheresis
intravenous immunoglobulins
Describe Syringomyelia
Classically presents with cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine
Drug options for reducing the risk of relapse in MS
natalizumab (IV) - 1st line
ocrelizumab (IV) - 1st line
How to manage Spasticity in MS
baclofen and gabapentin
What can be used in the management of acute relapse of MS
high dose steroids (methylprednisolone)
What are some risk factors for idiopathic intracranial hypertension
obesity
female sex
pregnancy
drugs:
combined oral contraceptive pill
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium
How does Thoracic outlet syndrome present
Painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping
sensory symptoms such as numbness and tingling may be present
if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling
What may precede thoracic outlet syndrome
There is usually a history of neck trauma preceding TOS
neck trauma can either be a single acute incident or repeated stresses
anatomical anomalies can either be in the form of soft tissue (70%) or osseous structures (30%)
a well-known osseous anomaly is the presence of cervical rib
What can be used to differentiate between a true seizure and a pseudoseizure
Prolactin
What is a positive hoffman’s sign and what does it indicate
A positive Hoffmans sign is a sign of upper motor neuron dysfunction and points to a disease of the central nervous system
To elicit it, the examiner should flick the patients distal phalanx (usually of the middle finger) to cause momentary flexion. A positive sign is exaggerated flexion of the thumb.
