Neurology Flashcards
1
Q
What are the symptoms of absence seizures / petit mal seizures?
A
- Seen in children < 10 years;
- Stares blanky into space;
- Loss of awareness (seems like it’s daydreaming);
- Eyelids may flutter
- Eyes may turn up
2
Q
What is the investigation in absence seizure?
A
EEG
3
Q
What is the difference between acute withdrawal symptoms and delirium tremens?
A
► Delirium tremens
- Acute withdrawal symptoms
- Altered mental status
- Hallucinations indistinguishable from reality.
► Acute withdrawal symptoms
- Mental status NOT ALTERED (hallucinations are mild).
- Tremor
- Anxiety
- Nausea
- Sweating
4
Q
What is the pathophysiology of alzheimer's disease?
A
There is a ⬇︎ in acetylcholine production caused by:
- Amyloid plaques
- Neurofibriliary tangles.
5
Q
What are the risk factors for alzheimer's disease?
A
- Down syndrome
- Apolipoprotein E4 inheritance
- Family history
- Ageing
First 2 high yield.
6
Q
What are the symptoms for alzheimer's disease?
A
- Poor memory
- Forgetting names and places
- Easily gets lost
- Difficulty with language
- Urinary incontinence
7
Q
What is the investigation done in alzheimer's disease?
A
Goldstandard: MRI
8
Q
What is the Rx of alzheimer's disease?
A
◉ First line:
➜ Acetycholinesterase inhibitors
- Donepezil
- Rivastigmine
- Galantamine
- Dr G. (memorise it)
◉ Second line:
➜ NMDA
- Memantine
Acetycholinesterase inhibitors: are contraindicated in:
- Bradycardia
- Heart block
9
Q
Describe the cause of Amaurosis Fugax?
A
➜ It is caused by retinal ischemia due to:
- Platelet emboli passing through retinal circulation.
- OR
- Stenosis of the ispilateral carotid artery.
10
Q
Describe the symptoms of Amaurosis Fugax?
A
- Painless
- Sudden unilateral vision loss (black curtain coming down)
- Lasts for 5-15 min
- Resolves within 24h
- Associated with giant cell arteritis
11
Q
What is the investigation done in Amaurosis Fugax?
A
◆ Carotid ultrasound: assessment of carotid artery stenosis
◆ Echocardiogram: If a cardiac source of emboli is suspected
12
Q
Describe the treatment of Amaurosis Fugax?
A
- AAS
- Statins
13
Q
Describe what is amyotrophic lateral scerosis?
A
➜ It is a degenerative condition affecting the motor neurons of the spinal cord and the motor cranial nuclei.
14
Q
Describe the symptoms of amyotrophic lateral sclerosis ?
A
- Limb weakness (upper limb usually)
- Foot drop
- Slurring of speech
- Dysphagia
- Fasciculations
15
Q
Describe the treatment of amyotrophic lateral sclerosis?
A
- Riluzole
- Non-invasive pressure ventilation
- Nutrional support (percutaneous endoscopic gastrostomy)
16
Q
What is the cause of Bell's palsy?
A
Lower motor neuron facial nerve palsy.
17
Q
What are the symptoms of Bell's palsy?
A
- Unilateral (ipsilateral) facial weakness
- Difficulty in eye closure
Associated with pregnancy and DM.
18
Q
What is the treatment of Bell's palsy?
A
Within 72h of symptoms:
- Prednisolone
- Eye patch
19
Q
What is the cause of benign paroxysomal positional vertigo?
Bening paroxysomal positional vertigo is the most common cause of vertigo.
A
It is due to otoliths.
20
Q
What are the symptoms of benign paroxysomal positional vertigo?
A
- Sudden onset of vertigo triggered by a change of head position.
- Lasts 20-30 sec.
- Nausea
21
Q
How is the diagnosis of benign paroxysomal positional vertigo?
A
Dix-Hallpike’s test will be positive.
22
Q
What is the treatment of benign paroxysomal positional vertigo?
A
- Epley’s manouevre.
Repositions the otoliths.
23
Q
In brocal aphasia, where is the lesion located?
A
Inferior frontal gyrus of dominant hemisphere.
24
Q
Symptoms of brocal aphasia?
A
➜ Patient understands but cannot express it
- Patient can understand
- Broken speech
25
In **wernick aphasia**, where is the `lesion located`?
Superior temporal gyrus of dominant hemisphere.
26
Symptoms of **wernick aphasia**?
➜ **Patient `DOES NOT` understand but `CAN express` himself well**
- Fluent but nonsense speech
- Patient does not understand
27
Describe what is **cauda equina syndrome**.
Compression of the cauda equina due to:
- Disk herniation
- Tumour
- Trauma
28
Symptoms of **cauda equina syndrome**.
- Back pain that radiates to the legs
- Weakness of the legs
- Saddle and perineal paresthesia
- Faecal incontinence
- Urinary retention / incontinence
29
What is the `Rx` of **cauda equina syndrome**?
**SURGICAL EMERGENCY**
- Urgent surgical decompression
- Corticosteroids
30
What is the investigation done in **cauda equina syndrome**?
Urgent MRI.
31
What is the **cause** of `cavernous sinus thrombosis`?
**Sinuses infection** caused by:
- S. Aureus
- Streptococcus
32
What are the **symptoms** of `cavernous sinus thrombosis`?
- Headache
- Unilateral periorbital oedema
- Photophobia
- Proptosis
- Diplopia (paralysis of cranial nerve VI)
- Mydriasis, ptosis, eye muscle weakness (paralysis of CN III)
## Footnote
Symptoms start unilateraly but progress to become bilateral.
33
Investigation done in `cavernous sinus thrombosis`?
- CT scan
- MRI venography
34
What is the **Rx** of `cavernous sinus thrombosis`
- Anticoagulation
- Antibiotics
- Referral to `neurosurgery`
- Corticosteroids
35
What is the `step by step` **IMMEDIATE** `management` of **TIA**?
**If patient is taking anticoagulation FIRST CT scan to rule out haemorrhagic stroke**
- AAS 300 mg (for 2 weeks)
- Statins
- Referral to specialist to be seen in 24h
36
What is the `LONG TERM` `management` of **Stroke**?
CT scan within 1h.
`Ischaemic stroke & AF`
- DOAC & statins
`Ischaemic stroke without AF`
- Clopidogrel & statins
37
What is the `IMMEDIATE` `management` of **ischaemic stroke**?
Alteplase
- Within 4.5 h of stroke symptoms.
38
When do you **pick MRI** over CT scan for stroke `investigation`?
- If location of stroke in brain is not clear on the CT.
- Suspicion of posterior stroke
- Suspicion on posterior circulation stroke (CT is normal)
39
What is the `step by step` **IMMEDIATE** `management` of **ischaemic stroke**?
- CT scan
- Thrombolysis within 4.5h of onset
- Avoid antiplatelets for first 24h post thrombolysis
- Repeat CT scan after 24h (if normal then next step)
- AAS 300 mg for 2 weeks (if thrombolysis not done)
40
What is the `step by step` `management` of **haemorrhagic stroke**?
- CT scan
- *If on anticoagulation:* reversal of anticoagulants
- BP control
- Evacuation of haemotoma surgically
41
What is the `step by step` **LONG TERM** `management` of **ischaemic stroke**?
CT scan within 1h.
**`Ischaemic stroke & AF`**
- DOAC/warfarin & statins
**`Ischaemic stroke without AF`**
- Clopidogrel & statins
42
What is the `step by step` **LONG TERM** `management` of **TIA**?
- Clopidogrel 75mg
- Statins
| Clopidogrel after 2 weeks of AAS.
43
Describe the `anatomy` of the **middle cerebral artery**.
- Originates from the internal carotid artery
- Part of the anterior cerebral circulation
- Supplies the lateral surfaces of the hemispheres and temporal pole of the brain.
44
Describe the symptoms of the **middle cerebral artery `stroke`**.
**Occlusion of MCA & branches**
- Contralateral hemiplegia *(paralysis)*
- Hemianaesthesia *(loss of sensation on one side of the body)*
- Dysarthria (due to facial weakness
**MCA Stroke**
- Speech is affected
45
Describe the `anatomy` of the **anterior cerebral artery**.
- Originates from the internal carotid artery.
46
Describe the symptoms of the **anterior cerebral artery `occlusion`**.
| Stroke of ACA are very rare.
- Motor deficits of the contralateral lower limb
- Paresis of the contralateral arm
- Urinary incontinence
- Altered mental status
47
Describe the `anatomy` of the **posterior cerebral artery**.
- Originates from the basilar artery
- It supplies mainly the occipital lobe.
48
Describe the symptoms of the **posterior cerebral artery `occlusion`**.
Homonymous hemianopia
## Footnote
- **Visual field loss** in the `same halves` of the visual field of each eye.
- For example, in right HH, the visual field loss is on the right side in the right eye and on the right side in the left eye.
49
What are the **CSF findings** in `meningites`?
`Bacterial`
➜ **Glucose:** low
➜ **Protein:** high
➜ **White cells:** mainly neutrophils
➜ **Appearance:** purulent, turbid, cloudy
`Viral`
➜ **Glucose:** normal
➜ **Protein:** normal to high
➜ **White cells:** mainly lymphocytes
➜ **Appearance:** clear
## Footnote
"Bacterias eat glucose, viruses don't."
50
What are the **symptoms** of `meningitis`?
- Headache
- Fever
- Photophobia
- Neck stiffness
- Non-blanching rash *(Meningococcal)*
51
Describe the **Kernig's sign** and the **Brudzinski's sign** seen in `meningitis`.
**Kernig's sign**
- Pain and resistance on passive knee extension with hips fully flexed
**Brudzinski's sign**
- Hips flex on bending the head forward.
52
What is the **treatment** for `bacterial meningitis`?
- **< 60 years:** Ceftriaxone IV
- **> 60 years:** Ceftriaxone IV + Ampicillin
53
What is the **treatment** for `viral meningitis`?
- Supportive Rx
- No antivirals given.
54
What is the **treatment** for `TB meningitis`?
Anti-tuberculosis medication.
55
What is the **prophylaxis treatment** of *closed contacts* of a patient with `meningococcal meningitis`?
- Ciprofloxacin
or
- Rifampicin
56
What are the **symptoms** of `cluster headache`?
- Unilateral
- Near the ispilateral eye
- Ipsilateral: lacrimation, conjuctival injection, nasal congestion and rhinorrhea;
- Agitation, restless
- Happens 1-2x/day for 6-12 weeks;
- Lasts 15min - 3h;
- It occurs every 1-2 years
- Common in males.
57
What is the **Rx** of `cluster headache`?
**Acute attack:**
- Sumatriptan SC or nasal
- O₂
**Prophylaxis:**
- Verapamil
58
What are the `tests` done when **suspecting dementia**?
## Footnote
Cognitive assessment tool
- Mini-Mental State examination (MMSE)
- Addenbrooke's cognitive examination (ACE)
- Montreal cognitive assessment (MoCA)
59
What is the most common cause of dementia?
Alzheimer’s disease.
60
What are the different types of dementia?
- Alzheimer’s disease
- Parkinson’s disease
- Frontotemporal dementia (Pick’s disease)
- Vascular dementia
- Lewy body dementia
- Normal-pressure hydrocephalus
- Pseudodementia
61
What is the pathophysiology of **frontotemporal dementia** (Pick’s disease)?
Degeneration of the frontal and temporal regions of the brain.
62
What is the pathophysiology of vascular dementia?
Dementia secondary to cerebrovascular insults.
63
What is the pathophysiology of Lewy body dementia?
Deposit of proteins known as Lewy bodies.
64
What is the pathophysiology of Parkinson’s disease?
Degeneration of the dopaminergic pathways of the substantia nigra.
65
What is the pathophysiology of normal pressure hydrocephalus?
Ventricular dilation without a raise in CSF pressure.
66
What is the pathophysiology of pseudodementia?
Severe depression masquerading as dementia.
67
What is the difference between **delirium** and **dementia?**
**Delirium**
- Acute onset: hours to days
- Symptoms fluctuate thorough the day (on and off)
- Hallucinations
- Reversible
**Dementia**
- Gradual onset: over months;
- Symptoms have a progressive course;
- Hallucinations are not common;
- Irreversible
68
**DDX between:**
- Guillain-Barré syndrome
- Myasthenia gravis
- Motor neuron disease
• Weakness
• Fatigue
• Reflexes
• Pain
• Fasciculations
**Guillain-Barré**
- Weakness: Yes
- Fatigue: No
- Reflexes: absent or decreased
- Pain: often
- Fasciculations: No
**Myasthenia gravis**
- Weakness: Yes
- Fatigue: Yes
- Reflexes: Present
- Pain: No
- Fasciculations: No
**Motor neuron disease**
- Weakness: Yes
- Fatigue: No
- Reflexes: Increased
- Pain: No
- Fasciculations: Yes
69
What disease is cryptococcal meningitis associated with?
- HIV
- Usually with CD4 < 200
70
What are the symptoms of cryptococcal meningitis?
- Headache
- Altered mental state
- Signs of meningitis
- Coma
71
Investigation done in cryptococcal meningitis?
**Lumbar puncture**
- CSF: cryptococcal antigen positive.
72
What is the treatment for cryptococcal meningitis?
**Acute Rx**
- Amphotericin + Flucytosine
**Maintenance**
- Fluconazole
73
What are the symptoms of delirium?
- **Often in elderly patients**
- **Acute onset** (hours to days)
- Fluctuating level os consciousness
- Disorientation
- Mood changes
- Memory impairment
74
What are the precipitating factors of delirium?
- Metabolic disorders
- Hypoxia
- Infection
- Dehydration
- Constipation
- Urinary retention
- Medications (benzodiazepines)
75
Rx of delirium?
- Treat the underlying cause;
- Consider antipsychotics.
76
What is the cause of **diabetic amyotrophy** (proximal diabetic neuropathy)?
Poorly controlled diabetes.
77
Symptoms of **diabetic amyotrophy** (proximal diabetic neuropathy)?
- Muscle pain (unilateral)
- Wasting
- Weakness
- Sensory loss (proximal leg or pelvic griddle)
78
DDX of traumatic brain injury.
**Extradural/Epidural haematoma**
- Lucid intervals (becomes lucid carries on with tasks before becoming unconscious)
- (Usually) unilateral pupil dilation
- Injury to the middle meningeal artery
**Subdural haematoma**
*Chronic subdural haematoma*
- Elderly on anticoagulation or alcoholic
- Slow onset
- After a minor fall
*Acute subdural haematoma*
- Onset faster than chronic subdural but slower than epidural
- Trauma
- Lucid intervals
**Subarachnoid haemorrhage**
- Thunderclap headache / “Worse headache of my life”
- Meningeal irritation (neck stiffness, photophobia)
- Due to aneurysm formation (usually)
- Associated with polycystic kidney disease and Ehlers danlos syndrome
79
What are the recommendations for DVLA (for cars)?
**First epileptic seizure**
- Patient must inform DVLA
- Cease driving for 6 months (from the date of the seizure) if normal investigations
- Cease driving for 12 months if abnormal investigations
**Epilepsy**
Can drive if
- Seizure free for 1 year
- If medication changed recently: seizure free for the past 6 months.
**Dementia + Alzheimer’s**
- Patient must inform DVLA
- Usually can keep on driving unless told not to.
- If continues to drive when told not to drive then Doctor must inform DVLA.
**OSA syndrome**
Suspicion
- Advise to stop driving.
Confirmed with sleep studies (moderate to severe)
- Patient must inform DVLA.
If patient refuses to inform:
- Dr. must inform DVLA
**TIA**
- Stop driving for 1 month
- No need to inform DVLA
- If severe neurological injury, inform DVLA after 1 month.
**DVT and PE**
- No need to inform DVLA
80
In a pregnant woman, which antiepileptic drug is most commonly associated with increased risk of teratogenicity?
Sodium valproate.
- Should be changed to another medication (if not pregnant yet)
- If already pregnant leave it as it is.
81
What anti epileptic medications are recommended in pregnancy?
1. Lamotrigine
2. Carbamazepine
82
Symptoms of essential tremors?
- Improve after alcohol consumption (in 50% of patients);
- Do not happen at rest
- Do not improve with distractions
- Bilateral
- Distal symmetric on the upper limbs
- Family history
83
Treatment of essential tremors?
- Propranolol
84
What is the cause of Epidural / Extradural haematoma?
- Skull fracture
- Middle meningeal artery injury
- Involves arterial blood.
85
What are the symptoms of Epidural / Extradural haematoma?
- Raised ICP
- Lucid interval
86
Investigation in epidural (extradural) haematoma?
CT scan.
87
Treatment of epidural (extradural) haematoma?
**Initial**
- Burr hole
**Definitive**
- Craniotomy and evacuation of the haematoma
88
How to different epidural and subdural haematoma on CT scan?
**Epidural haematoma**
- Lemon
**Subdural haematoma**
- Banana
89
What is fibromyalgia?
It is a chronic pain disorder condition that affects mainly women with the following characteristics:
- Pain exacerbated by pressure on muscles and joints
90
Symptoms of fibromyalgia
- Pain on muscles and joints
- Fatigue
- Morning stiffness
- Sleep disturbances
- Anxiety
91
Investigation done in fibromyalgia?
- ESR
- C-reactive protein
- Thyroid function test
92
DDX between:
- Fibromyalgia
- Myalgic enchephalomyelitis
**Fibromyalgia**
- Pain
- Tenderness
**Myalgic enchephalomyelitis**
- Fatigue after recent URTI.
93
What is the epidemiology of frontal temporal dementia?
- Usually 50 - 65 yo
- If < 35 yo DEFINITELY FRONTAL TEMPORAL DEMENTIA.
94
Symptoms of frontotemporal dementia?
- Behavioural changes (social withdrawal)
- Sexual disinhibition
- Difficulty initiating gait (frontal lobe)
-
95
Investigation done in frontotemporal dementia?
**MRI**
Atrophy of the:
- Orbitofrontal cortex (high yield)
- Frontal lobe
- Inferior or anterior.
96
Treatment of frontotemporal dementia?
- No treatment.
- If sexual disinhibition: cimetidine or spironolactone.
97
What is the cause of subdural haematoma?
Rupture of **bridging veins**.
98
What is the cause of intraparenchymal bleeding and Subarachnoid haemorrhage?
Middle cerebral artery injury.
99
DDX of dizziness.
**Benign paroxysmal positional vertigo**
- Dizzy when rolling over bed.
**Orthostastic hypotension**
- Dizzy when getting up from bed
**Migraine**
- Light sensitivity during dizzy spells
**Vestibular neuritis**
- Severe vertigo
- Lasts for hours
- Vomiting
**Meniere’s disease**
- One ear feels full before or during dizzying attack
100
What is the physiology of Guillain-Barré syndrome?
Due to demyelination of neurons.
101
What is the cause of Guillain-Barré syndrome?
- Infection (2/3 of cases)
- Antibodies of the organism attack the neurons.
102
What are the symptoms of Guillain-Barré syndrome?
SAM’S LOSS
**Symmetrical ascending motor and sensory loss**
**1. Infection**
- History of URTI or gastroenteritis
**2. Weakness**
- Starts in the lower limbs
- Symmetrical ascending pattern
- Onset symptoms peak after 2 weeks
- Respiratory failure (due to respiratory muscle weakness on severe cases).
- Dysphagia and dysarthria (severe cases).
**3. Pain**
- Neuropathic pain (legs mainly)
**4. Reflexes**
- Reduced or absent
**5. Sensory**
- Paresthesia and sensory loss (starts from legs)
103
What is the investigation in Guillain-Barré syndrome?
**Gold standard**
- Nerve conduction studies
**Initial**
- Lumbar puncture (rise in CSF protein, cell count normal)
- Spirometry
104
What is the treatment of Guillain-Barré syndrome?
- Plasma exchange
- IV immunoglobulins
- Respiratory support
105
DDx between:
- Guillain-Barré syndrome
- Myasthenia gravis
- Multiple sclerosis
**Deep tendon reflexes**
- Guillain-Barré: Decreased or absent
- Myasthenia gravis: Normal
- Multiple sclerosis: Increased
106
Describe how is the vision affected in Guillain-Barré syndrome?
- Vision is not affected
- Muscles that control eye movement are affected causing double vision **Miller Fisher syndrome**(variant of GBS with ophtalmoplegia)
107
Describe the physiology of **Myasthenia gravis**.
Autoantibodies attack acetylcholine receptors.
108
What are the symptoms of **Myasthenia gravis**?
- Weakness that increases with exercise:
• Tired by the end of the day;
• Fatigue on voice after counting to 50
- **Diploplia** (often the first sign)
- Ocular muscles fatigue:
• Drooping eyelids at the end of the day
- Dysphagia
- Dysarthria
- Normal reflexes
- Associated with hyperthyroidism
109
What is the investigation done in **Myasthenia gravis**?
**First line**
- Serum anti-acetylcholine receptor antibodies.
110
What condition is **Myasthenia gravis** associated with?
Thymoma.
111
What is the treatment of **Myasthenia gravis**?
**First line**
- Pyridostigmine (acetylcholinesterase inhibitor)
**2nd line to modify the disease**
- Immunosuppression:
• Corticosteroids
• Azathioprine
**Other**
- Thymectomy
112
What is the management of **Myasthenia gravis** with respiratory failure?
- Intubation and ventilation
- IV immunoglobulins
- Plasma exchange
- Steroids
113
Describe the physiology of **Lambert-Eaton Myasthenic syndrome**
Autoantibodies towards the presynaptic voltage-gated calcium channels.
114
What are the symptoms of **Lambert-Eaton Myasthenic syndrome**?
- Limb weakness (proximal);
- **Facilitation**: strength and reflexes improve with repeated testing;
- Waddling gait;
- Associated with small cell cancer of the lung.
115
Investigation done in **Lambert-Eaton Myasthenic syndrome**?
- Chest CT/MRI (malignancy)
- Repetitive nerve stimulation test (improves strength momentarily)
- Serum measurements of voltage-gated calcium channels antibodies
116
What is the treatment of **Lambert-Eaton Myasthenic syndrome**?
- Treating the underlying neoplasm
- Diaminopyridine
117
Describe **Multiple Sclerosis**.
- Autoimmune disorder causing demyelination of the neurons in the brain and spinal cord.
- Neurological dysfunction at multiple sites of the central nervous system.
118
Symptoms of **Multiple Sclerosis**?
- **Optic neuritis**: painful vision loss
- Double vision
- Facial weakness
- Paresthesia and numbness of the extremities.
119
Investigation done in **Multiple Sclerosis**?
- `MRI:` Periventricular lesions
- `CSF:` oligoclonal bands
120
Treatment for **Multiple Sclerosis**?
**Initial / 1st line**
- Methylprednisolone IV/ oral
**Long term**
- Interferon beta
- Glatiramer
- Natalizumab
121
Describe what is **Papiloedema**.
Swelling of the optic disk caused by increased ICP.
122
What are the causes of **papiloedema**?
- Brain tumor
- Idiopathic ICP
- Cerebral venous sinus thrombosis
- Intracranial haemorrhage
123
**Symptoms** of `Idiopathic intracranial hypertension` ?
- Throbbing headache (worse in the morning)
- Headaches worse on bending or straining
- Bilateral papiloedema
- Visual blurring
- Visual loss (momentarily)
124
What are the **symptoms** of `Lewy body dementia`?
- Dementia (fluctuating levels of awareness)
- `Visual hallucinations`
- Mild parksonism:
◆ Tremor
◆ Rigidity
## Footnote
**HIGH YIELD:** **`Dementia`** preceeds the **`parksonism`** signs.
125
What is the **investigation** of `Lewy body dementia`?
**MRI:** Parietal atrophy
**SPECT (DATscan):** ⬇︎ dopamine uptake in basal ganglia.
126
Describe **nerve root** `entrapments`.
◉ **L4:**
- Motor weakness of knee extension
◉ **L5:**
- Motor weakness of big toe dorsiflexion
◉ **S1:**
- Motor weakness of foot plantarflexion
◉ **S1 & S2:**
- Ankle jerk reflex changes
◉ **L3 & L4:**
- Knee jerk reflex changes
127
**Symptoms** of `Meniere's disease`?
- `Vertigo`
- Deafness: increased feeling of pressure in the ear
- Dizziness
- Tinnitus
128
What is the **investigations** of `Meniere's disease`?
- MRI is normal (to exclude acoustic neuroma)
129
What is the **treatment** of `Meniere's disease`?
- Prochlorprazine
- Cyclizine
- Promethazine
130
What is the **treatment** for `migraines`?
**First line:**
- Paracetamol
- Ibuprofen
**2nd line:**
- Triptans (oral but if vomiting nasal or SC)
**Prophylaxis:**
- `Beta blockers:` Propranolol
- Amitriptyline
- Topiramate (contraindicated in pregnancy)
131
What are the **symptoms** of `ME: myalgic encephalomyelites / chronic fatigue syndrome`?
- Flu like symptoms
- Fatigue that gets worse by activity and it is not relieved by rest;
- Brain fog (memory problems)
- Pain
132
What is the classification of **neurofibromatosis**?
**Type 1:**
- `Café-au-lait spots`
- Scoliosis
- Associated with phaeochromocytomas
**Type 2:**
- `Bilateral acoustic neuromas`
- Multiple intracranial schwannomas
133
What are the **symptoms** of `normal pressure hydrocephalus`?
- Confusion & memory loss
- Urinary incontinence
- Gait disturbance
## Footnote
`Wacky, Wet, Wobbly grandpa.`
134
What are the **investigations** done in `normal pressure hydrocephalus`?
**CT/MRI:**
- **`Enlarged ventricles`** without global athrophy
**Lumbar puncture:**
- CSF: normal or slightly elevated
135
What is the **treatment** done in `normal pressure hydrocephalus`?
**Definitive:**
- CSF shunting
**Others:**
- Acetazolamide (decreases CSF)
- Serial lumbar puncture (if unfit for surgery)
136
What is the **investigation** done in `OSA`?
**Goldstandard:**
- Polysomnography
**Others:**
- Overnight oximetry
137
What is the **treatment** of `OSA`?
- CPAP
- Weight loss
- ⬇︎ alcohol & smoking
138
What are the **symptoms** of `Parkison's disease`?
- **`Resting tremors`**
- Rigidity
- Bradykinesia
- Abnormal gait
- Mask like face
139
What is the **treatment** of `Parkison's disease`?
**First line:**
- `Levodopa`
- `Carbidopa`
**Others:**
- MAO-B inhibitors: selegiline
- Dopamine antagonist: pramipexole and ropinirole
- Amantadine
140
Describe the **management** of **`psychosis`** related to `Parkinson's disease`.
**Rapid tranquility desired** `(aggressive patient)`:
- Benzodiazepine
**Rapid tranquility NOT desired:**
- ⬇︎ dose of levodopa
OR
- Antipsychotics: `Quetiapine` or `clozapine`
141
What are the **symptoms** of `Progressive Supranuclear Palsy` (PSP)?
- Eye movement restriction (downgaze more affected)
- Falling backwards
- Change in behaviour
142
What is the **cause** of `Ramsay Hunt syndrome`?
Herpes Zoster oticus.
143
What are the symptons of `Ramsay Hunt syndrome`?
- Ipsilateral facial paralysis
| Caused by lower motor neuron facial nerve paralysis
144
DDX between **Bell's Palsy** and `Ramsay Hunt syndrome`?
**Ramsay Hunt syndrome**
- Ipsilateral facial paralysis
- `Vesicles in ear or palate`
- `Pain`
- Antivirals + Prednisolone
**Bell's palsy:**
- Ipsilateral facial paralysis
- Prednisolone
145
What is the Rx of `Ramsay Hunt syndrome`?
**- Antivirals:** within 72h and 1 week from onset.
**- Prednisolone:** within 2 weeks of onset.
146
What are the **symptoms** of `REM sleep behaviour disorder`?
- Vivid dreams (might be violent or cause injuries)
- May fall out of bed.
147
What is the **Rx** of `REM sleep behaviour disorder`?
**First line:**
- Clonazepam
**2nd line:**
- Melatonin
148
What `drugs worsen` **Parkinson symptoms**?
**Nausea & vomit:**
- Metaclopramide
- Cinnarizine
- Prochlorperazine
**Delirium & confusion**
- Haloperidol
- Risperidone
- Olanzapine
**Cough & cold**
- Ephedrine
- Pseudoephedrine
| **Avoid all of them.**
149
# **Parkinson patient**
`Presenting with new symptoms:`
- Due to parkinson medication?
- Due to worsening of the disease?
**Dyskinesia**
`➜ Extra movements`
- Caused by medications (levodopa)
**Bradykinesia**
`➜ ↑ rigidity, less movements`
- Caused by worsening of Parkinson disease
- Insufficient medication.
150
What `diseases` is **SAH** (subarachnoid haemorrhage) `associated with`?
- HTA
- **`Polycystic kidney disease`** `(Berry aneurysm)`
- Ehler Danlos syndrome
151
How the `diagnosis` of **SAH** done?
- CT
`- Lumbar puncture`:
◆ CSF bloody ➝ xanthochromic (bilirubin)
152
What is the `Rx` of **SAH**?
Nimodipine.
153
Describe what is `syringomyelia`.
Cyst in the spinal cord (usually cervical).
154
What are the **symptoms** of `syringomyelia`?
- Loss of pain and temperature sensation (arms and hands)
- Progressive weakness of arms and hands
- Headaches
- Bladder disturbances
155
What is the **investigation** in `syringomyelia`?
MRI
156
What is `syringobulbia`?
When syrinx extends the brain stem.
157
DDX of **neuro infection** associated with `HIV`?
**Toxoplasmosis**
- MRI / CT scans: enhanced rings
- Rx: pyrimethamine + sulfadiazine
**Cryptococcal meningitis**
- Meningism
- Rx: Amphotericin + Flucytosine
158
Describe **Neurocysticercosis**.
**► Caused by taenia solium (pork tapeworm)**
- Seizures
- `CT:` calcified lesions
- `Rx:` Praziquantel & Niclosamide
159
Describe what is **Transverse myelitis**.
Spinal cord inflammation (that might happen) after infection.
160
What is the `investigation` done in **Transverse myelitis**?
**MRI**
- Spinal cord lesion that is `enhaced by gadolinium`.
161
What are the **symptoms** of `trigeminal neuralgia`?
- Electric shooting pain
- Unilateral on the distribution of trigeminal nerve
- Lasts < than 2 min.
162
What is the **management** of `trigeminal neuralgia`?
**1st line:**
- Carbamazepine
**2nd line:**
- Gabapentin
- Lamotrigine
- Phenytoin
163
DDx of **tremors**.
**Essential tremors:**
➔ `Most common type`
- Improves with alcohol
- Doesn't dissapear with distraction
**Parkisonian tremor:**
- Occurs at rest
- Dissapears with voluntarily movements
**Psychogenic tremor:**
- Dissapears with distraction
- Appears and dissapears suddenly
**Cerebellar tremor:**
- Intentional tremors: gets worse with volutarily movements
