Neurology Flashcards
How does mononeuritis multiplex present?
Acute onset, peripheral neuropathy. Asymmetric and asychronous. Pain, weakness. LMN symptoms only. Associated w diabetes.
What are the symptoms of restless leg syndrome?
Urge to move legs/arms assoc w unpleasant senstion; resting induces symptoms; gets better w activity; evening and night time worse. Rarely painful, some movements but no sustained contractions.
What are the associations with restless leg syndrome? What are the differentials?
Iron deficiency, CKD, peripheral neuropathy, pregnancy, MS, parkinsons, dopamine antagonists can exarcerbate. DDx: akathisia, nocturnal leg cramps (pain + tight, need stretch), arterial disease/claudication, periodic limb movements - involuntary jerks.
What are the non-pharm management options for restless legs syndrome?
Walk/exercise before bed, avoid coffee/alcohol/smoking, gentle stretching hamstrings before bed, doing mental activities when resting. Aim ferritin > 50
What drugs are used for restless legs? What are the risks?
Levodopa + bensazeride or carbidopa. SE: nausea, postrual drop, gambling, hypersexuality. Symptom may augment come earlier or get worse + rebound when stopping. Alt: gabapentins, pramipexole.
What are the symptoms of trigeminal neuralgia? Investigation and mx.
Unilateral shock like pain, can be triggered by wind, touch, eating, shave. Seconds to minutes. Recommend MRI for structural cause. Mx: carbamazepine 100mg BD (2nd line: oxcarbazepine)
How is a TIA defined? What tests are indicated and when is emergency recommended?
Symptoms resolving < 24h and no MRI evidence of stroke. Do CT angio,ECG, echo + carotid doppler within 2 days. Consider Age >60, BP >140, unilateral weakness, duration > 60 min or diabetes as high risk for 2nd event.
When is endarterectomy recommended?
Stenosis >70% + symptoms, within 2 weeks. If < 50%, meds only.
How is a TIA managed?
Aim BP 120-130, high potency statin, long term antiplatelet - combo if high risk, or 1. Avoid driving 2 weeks, risk further TIA 3 mo. Anticoagulate if AF.
What are the signs of an UMN and LMN lesion?
UMN: Increased tone, stiff, spasticity, hyperreflexia, full weakness, upgoing plantar, no fasciculation, wasting late. LMN: Weakness, wasting, fasciculation, hyporeflexia, distal weakness first.
How does amyotrophic lateral sclerosis present? Signs, prognosis, followup.
Combined upper/lower motor neuron symptoms, asymmetric and focal onset. Weakness, then dysarthria and dysphagia. Atrophy, hyperreflexia, splint hand - lose thumb muscles. No bowel/bladder or eye involvement. 3-5y incurable death. Genes hard to find, 1-3% FDR risk, use tests for prenatal counselling.
What are the features of a complex partial and simple partial seizures?
CP: unaware, disturbance of perception eg. hallucination, illusion, deja vu, may have lip smacking or pacing. SP: Jacksonian, jerking near hand or mouth that marches to rest of body.
Abscence seizure - age, features, tests, treatment.
From 4yo to puberty, brief LOC up to 30sec. 3Hz wave and spike on EEG. Responsive to treamtnet and often resolve by puberty. 1st line: ethosuxamide.
How is epilepsy managed - drugs, monitoring, driving.
If partial: carbamazepine (affects OCP). General: valproate (not in preg). Monitor effect not levels. No driving for 1st 6mo, then conditional licence until 2 years no seizure and 1 year no med change.
Narcolepsy - symptoms, treatment.
Brief spells of irresistible sleep. Sleep attacks, cataplexy (loss muscle tone), sleep paralysis, terrifying hallucinations. Tx: modafinil.
What are 6 causes of peripheral vertigo? What are 4 causes of central vertigo?
P: BPPV, menieres disease, vestibular neuritis/labyrinthitis, ramsay hunt syndrome, cholesteatoma, acoustic neuroma. C: Cerebellar infarct/haemorrhage, vertebrobasilar insufficiency, MS, migraine.
What are 3 features of nystagmus concerning for a central cause of vertigo? Why is otoscopy used in exam?
Purely vertical or torsional; can’t suppress with fixation; bidirectional. Herpes zoster, retraction pocket in cholesteatoma.
Features and treatment of meniere’s disease
Episodes lasting hours, with hearing loss, fullness and tinnitus. Reduce salt < 2g/day, reduce coffee/alcohol, vestibular rehab. ?Betahistine, ?HCT. Surgery or injections if required.
Features of vestibular neuritis and labyrinthitis. Management.
VN: balance only. L: hearing + tinnitus. Post viral, acute onset, may have N/V. Often improve over days, if severe, prednisolone high dose 5 days then taper.
Essential tremor - cause, features, triggers, workup, mx.
Autosomal dominant w variable penetrance. Young w slight tremor to hands or head. Anxiety worsens, alcohol helps. Exclude thyroid or drugs. 1st line propranolol 10mg BD, or primidone.
What are the main signs of parkinsons disease? How is it treated?
Bradykinesia, muscle rigidity (cogwheel), assymetric rest tremor. Early dementia, falls and autonomic dysfunction are rare. Treat w levodopa w benserazide or carbidopa to see if effective.
Myasthenia gravis - symptoms, diagnosis, tests, workup.
Fluctuating weakness + fatigue. No sensory or reflex loss. Ach-R antibodies 85% OR MuSK antibodies, neurophysiological tests, edrophonium if needed by specialists. Check thyroid, b12 +CT chest for thymoma.
What are the differentials for unilateral facial weakness?
Bell’s palsy, MS, Ramsay hunt syndrome, stroke, tumour, acoustic neuroma or cholesteatoma can compress, parotid tumour can compress.
What are the symptoms and management of bell’s palsy?
Whole side affected, taste of anterior tongue. May get sound sensitivity + dry eye from not closing. If < 72 hr, give pred 1mgkg 5 days. If shingles, add antiviral. If eye symptoms, patch + eye drops. Should recover, MRI at 4mo. Risk of regeneration - eyes water w chewing.
How does idiopathic intracranial hypertension present? Symptoms, exam, test, mx.
Overweight young women, headache worse lying down +/- tinnitus, blurred vision. Papilodema + peripheral field defects. Normal MRI, elevated LP pressure. Weight loss + acetazolamide.
What is brudzinki’s sign? Treatment of meningitis and C/I to LP and CT.
Passive neck flexion causes hip flexion. Ceftriaxone 2g IVor 2.4g benpen IV/IM. CT first if focal neurology, papilloedema, deteriorating consciousness, new seizures. No LP if bleeding disorder, infection over skin, unstable BP.
What are the signs/symptoms of MS? Diagnosis
Can be UMN or LMN. Symptoms for hours/days, remit over weeks. Sensory loss, weakness, unilateral visual sx. Optic neuritis, INO, shocks down back/limbs w neck flexion, heat sensitivity. D: separate in time and space, evidence of CNS involvement (MRI or LP).
1st episode is clinically isolated syndrome.
Guillain-Barre Syndrome: symptoms/presentation, cause, management.
Autoimmune progressive weakness and sensory disturbance - peripheral impaired reflexes with lower motor neuron pattern. Can be triggered by campylobacter, CMV/EBV. Confirm on LP. Hosptial to treat w IVIg, plasma exchange, may need ventilator.
How are tension headaches and medication overuse headaches managed?
TTH: panadol/NSAID, 2ndline: amitriptyline. Overuse from opioid/triptan or panadol/nsaid. Switch to a preventer, use bridging naproxen or prednisolone.
What are the features of a cluster headache? How are they managed acutely and long term?
Unilateral, severe w autonomic fx: tearing, ptosis, sweat, rhinorrhoea. Last 15min to hours, few per day. MRI pituitary recommended. Acute: high flow oxygen + subcut sumatriptant. Long term: verapamil (monitor ECG), home oxygen, valproate, nerve blocks/stimulator.
What are the non-pharm management options for acute migraines? Prevention?
Rest in quiet, dark room; neck stretch/mobilisation; heat pack neck/shoulder; counter stimulation w icepack to head or strong mint/sour candy. SMART: sleep regular, meals + hydration, activity and avoid screens, relaxation techniques, trigger diary and avoid.
How are acute migraines managed with meds in adults and kids?
Aspirin 900mg or ibuprofen 400-600, rpt 6hr; add maxalon if nausea. Triptan once per attack - riza 10mg. In kids, avoid aspirin due to reyes and maxalon due to dystonia. Can use sumatriptan.
What are 5 options for migraine prophylaxis?
Amitriptyline, propranolol (avoid asthma), pregabalin, candesartan, topiramate (avoid if kidney stones, depression).
What are the canadian head CT rules?
GCS < 15 2hr post injury, age > 65, vomiting 2+, suspected fracture/base of skull, amnesia >30min pre injury, high risk mechanism (MVA, fall >1m)
How can concussion be assessed? What is the management? When to refer?
SCAT5 on and off field. Physical and cognitive rest. Return to sport when symptom free , graded return and stop if symptoms worsen. Symptoms > 2 weeks in adult or 4 in child needs referral.
What is neurogenic claudication? Risk?
Pain to back/legs w walking and standing, relieved by leaning forward/sitting. If cauda equina, ED.
