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Neurology Flashcards

1
Q

when do you see oligoclonal bands

A

whenever BBB is disrupted / intrathecal production of IgG
MS, Lyme disease, autoimmune disease, brain tumour, lymphoproliferative disease
not seen in normal people
very non specific finding

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2
Q

indications for CEA

A

70-99% if symptomatic but not disabling
50-69% if symptomatic
> 60% asymptomatic

ideally within 2/52 by a skilled surgeon with < 3% periop mortality

NOT RECOMMENDED
< 50% symptomatic
< 60% asymptomatic
carotid stenting

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3
Q

Myasthenia gravis AChR Ab vs MuSK Ab Rx difference

A

AchR Ab - can use steroids + IVIG or PLEX
MuSK Ab - steroids + PLEX works best; thymectomy no benefit; pyridostigmine little benefit
(MuSK Ab - increased likelihood of bulbar involvement, increased ICU admission, mestinon response usually poor, no benefit of thymectomy)

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4
Q

wernicke-korsakoff

A

ataxia
encephalopathy
oculomotor - resolve straight away with thiamine

korsakoff - amnesia

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5
Q

NF1

A 
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris: Lisch nodules in > 90%
Scoliosis
Pheochromocytomas
chromosome 17 (17 letters!)
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6
Q

NF2

A

bilateral acoustic neuromas

chromsome 22

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7
Q

parkinsons disease

A

avoid dopamine antagonists

domperidone anti emetic of choice as only acts in periphery

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8
Q

Neuromyelitis Optica NMO Devic’s disease

A

NMO IgG to aquaporin 4 70% in foot processes of astrocytes
optic neuritis, myelitis 90% recur
a/w SLE sjogrens
long cord lesions; no brain lesions

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9
Q

ICU myopathy

A

a/w GCC, asthma
increased CK; reflexes absent or low
NCS: sensation - normal; motor - decreased
EMG: fibrillation

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10
Q

ICU neuropathy

A

a/w SIRS, reflexes absent or low
NCS: decreased motor and sensory amplitudes
EMG: late - fibrillation
axonal, normal CK

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11
Q

alzheimers disease

A

CSF: increased tau; decreased beta amyloid

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12
Q

multiple sclerosis

A

HLA DR2 confers 3-4 X increased risk

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13
Q

anti neuronal Abs

A

paraneoplastic

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14
Q

myasthenia gravis

A

MUSK receptor Abs - worse disease
ACh R Abs
10% thymic CA; thymic hyperplasia common
Rx: IVIg

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15
Q

CN3 lesion

A

pupil spared in DM

pupil fibres travel on outside of bundle so impaired with compression

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16
Q

Guillain Barre

A 
AIDP demyelinating
AMAN, AMSAN - axonal
reflexes absent or low
NCS: normal sensory (but paraesthesias)
a/w campylobacter, dysautonomia, increased CSF protein
GQ1b Abs
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17
Q

hunger centre

A

hypothalamus

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18
Q

MCA

A

superior division - frontal signs
inferior division - temperoparietal signs
lenticulostriate (perforator) - no cortical signs

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19
Q

brain lesions

A

cryptococcus - lesions
toxo - multiple ring enhancing lesions
neurocysticercus - focal lesions, focal presentation - seizure, h/a, stroke; multiple small lesions
echinococcus - hydatid - large singular well defined lesion

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20
Q

lamotrigine

A

risk of SJS; clearance slowed by use of valproate

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21
Q

carbamazepine

A

HLA B1502 a/w SJS

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22
Q

meningioma

A

dural tail on imaging
NF2 ch 22
hormone sensitive - more in women, obese

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23
Q

MSA

A

hot cross bun sign on imaging
autonomic features
neck flexion
6th decade

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24
Q

PSP

A

hummingbird sign on imaging
neck extension; early falls
7th decade

25
Q

GBS intubation indications

A

VC < 20ml/kg or < 1L or fall of 30%
negative inspiratory force < 30cm H2O
severe oropharyngeal weakness
fatigue

26
Q

demyelination

A

conduction slowing, block

27
Q

axonal

A

decreased amplitude

28
Q

INO

A

ipsi eye cannot adduct
contra eye has leading eye nystagmus
medial longitudinal fasciculus lesion
bilateral is pathognomonic of MS

29
Q

lateral medullary syndrome

A 
ipsi ataxia arm, leg
contra pain temp arm leg; ipsi face
ipsi horners
CN 9, 10, 11 lesion
PICA
30
Q

Gerstmann syndrome

A 
dominant parietal lobe
RAAF 
right to left confusion
agraphia
acalculia
finger agnosia
31
Q

lost in space

A 
non dominant parietal lobe
neglect one side body
anosognosia (dont realise deficit)
autotopagnosia (dont recognise limb)
visual field issues
apraxia
dysarthria
32
Q

eye deviation

A

away from paresis if hemispheric

toward paresis if pontine lesion

33
Q

HLA in MS

A

HLA DR2
3-4 times increased risk from baseline
EBV 2.3 X increased risk

34
Q

risk 2nd attack in possible MS

A

biggest predictor is number of lesions on baseline MRI

35
Q

Uhthoffs

A

very MS specific

may be related to change in Na channels with temperature

36
Q

Lhermittes

A

non specific

37
Q

dissemination in time MS

A

> 1 month

or simultaneous enhancing and non enhancing lesions on MRI

38
Q

ADEM acute disseminated encephalomyelitis

A

1-4 weeks pos EBV, mycoplasma, strep pyogenes, CMV, rickettsiae, varicella
IVMP once infx ruled out

39
Q

fingolimod

A

MS treatment - oral
S1P receptor modulator
prevents lymphocyte egress from LNs
selectively targets CCR7+ cells i.e. Th17

40
Q

fampridine

A

MS treatment
improvs walking speed
closes K+ channels on demyelinated axons

41
Q

enzymopathies

A

glycolytic defect - failure of rise in lactate

amino acid defects - failure of rise in ammonia

42
Q

myotonic dystrophy

A 
AD anticipation from maternal side 
CTG triplet repeat
cataracts ptsis
distal wasting, weakness
cardiac conduction defects
myotonia; frontal balding, low IQ, hypersomnolence,insulin resistance, hypogonadal, hypopit
43
Q

dermatomyositis

A

more cancer risk esp ovarian OR 4.4

more dysphagia, more acute

44
Q

polymyositis

A

cancer risk esp NHL 2.1

45
Q

amyloid

A

extracellular

46
Q

neurofibrillary tangles / tau

A

intracellular

47
Q

PD Rx

A 
DAs: pramipexole, apomorphine, bromocriptine, pergolide, cabergoline
sleepiness - amantadine, selegiline
hallucinations - clozapine, quetiapine
nausea - ondansetron, domperidone
confusion - rivastigmine, donepezil
48
Q

Charcot Marie Tooth

A 
motor and sensory neuropathy
slowly progressive
distal weakness, atrophy, los sof reflexes
PMP22 gene duplication ch 17
uniform slowly on NCS
49
Q

heriditory neuropathy with pressure palsies HNPP

A

microdeletion PMP22 ch 17
focal palsies post minor trauma
auto domt

50
Q

pure motor neuropathy

A

MND, polio, lead, vincristine, amiodarone, dapsone

51
Q

pure sensory neuropathy

A

DM, HIV, B12 def, amyloid, sarcoid, sjogrens, paraneoplastic, B6 intoxication

52
Q

lamotrigine interactions

A

+ valproate = rash, increased valproate levels
+ OCP = poor lamotrigine efficacy
OK in pregnancy

53
Q

carbamazepine interactions

A

induces warfarin metabolism
HLA B1502 DRESS SJS
+ phenytoin = rash

54
Q

pain and temp

A

spinothalamic

cross almost immediately (1-2 segments above entry)

55
Q

vibe

A

dorsal columns

cros in medulla

56
Q

motor

A

corticospinal

cross in medulla

57
Q

L4/5 lesion

A

L5 radiculopathy as roots emerges below the vertebrae but knocked off on way through

58
Q

MND gene

A

c9orf72 24%
but 95% is sporadic
Rx riluzole

59
Q

TIA ABCD2 score

A 
A age > 60 1
BP > 140/90 1
Unilateral weak 2
speech 1
> 60mins 2; > 10 mins 1
DM
admit if > 4; 8% risk stroke next 3/12 if > 6

FCRAP (19 decks)

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