Neurology Flashcards
Causes of sensorimotor polyneuropathy?*
(ABCDEs)
Alcohol
An underactive thyroid
A high urea
CIDP/GBS
Charcot-Marie-Tooth
Paraneoplastic (cancer)
Diabetes
Drugs (vincristine, cisplatin, nitrofurantoin, amiodarone)
Vasculitis (every vasculitis)
Sarcoidosis
Causes of a motor neuropathy?*
Porphyria
Lead
Diptheria
CIDP/GBS
Dapsone
Causes of a sensory neuropathy?*
Alcohol
An underactive thyroid
A high urea
CIDP/GBS
Charcot-Marie-Tooth
Paraneoplastic (cancer)
Diabetes
Drugs (isoniazid, metronidazole, hydralazine)
Vasculitis (every vasculitis)
Sarcoidosis
IN ADDITION:
Vitamin B12 deficiency
Amyloidosis
Infections (HIV, Lyme, leprosy)
Causes of an autonomic neuropathy?
GBS
Botulism
Porphyria
Paraneoplastic
Diabetes
Chagas
HIV
Amyloidosis
What does ‘small fibre neuropathy’ mean?*
Subtype of peripheral neuropathies in wich there is impairment of small calibre sensory nerve fibres (myelinated A-delta fibres (cold, pain) and unmyelinated C fibres (warmth))
Vibration sense and proprioception preserved
What are the causes of demyelinating polyneuropathies?*
CIPD
Multiple myeloma
Hereditary causes
Refsum’s disease
HIV
Drugs causing neuropathy?*
Sensory: isoniazid, metronidazole, hydralazine
Motor: dapsone
Sensorimotor: vincristine, cisplatin, nitrofurantoin, amiodarone
Causes of mononeuritis multiplex?*
Diabetes
Vasculitis (GPA, eGPA, MPA, PAN)
RA, SLE, Sjogren’s
How would you investigate a patient with peripheral neuropathy?*
FBC, ESR, U+E, LFT, glucose, thyroid, B12 and folate, protein electrophoresis, autoimmune profile
Urine for glycosuria
Nerve conduction studies
Charcot Marie Tooth findings?*
Wasting of distal LL with preservation of thigh muscle (inverted champagne)
Pes cavus (imbalance between anterior and posterior tibialis)
Weakness of distal muscles
Glove and stocking sensory loss (mild)
High stepping gait (foot drop)
Palpable lateral popliteal nerve in 1A
N.B. Pain and temperature usually not affected in CMT as these fibres are not myelinated
Subtypes of CMT?*
Divided according to neurophysiological findings (axonal versus demyelinating) and inheritance pattern
Type 1A most common (autosomal dominant demyelinating)
How would you manage a CMT patient?*
MDT (neurologists, orthopoedic surgeons, physiotherapists, OTs)
Patient education
Exercises
Walking aids
Orthotics for foot drop
OT
Analgesia for MSK/neuropathic pain
Orthopoedic surgery to correct deformities
Genetic counselling
Difference between stroke and TIA? How would you investigate?*
Rapid onset focal neurological deficit due to a vascular lesion lasting >24 hours versus <24 hours (typically <30 minutes)
FBC, CRP/ESR, HbA1c, lipids, renal function
ECG AF
CXR aspiration
CT head infarct or bleed, territory
MRI brain salvageable versus irreversibly infarcted brain tissue
24 hour Holter
Echo
Carotid doppler
Consider CT angiogram, MRA or MVA if suspecting dissection or VST, clotting screen if suspecting thrombophilia, vasculitis screen in young stroke
Management of stroke?*
Thrombolysis within 4.5 hours
Thrombectomy up to 24 hours of acute ischaemic stroke if CTA shows proximal occlusion
Aspirin 300mg for first two weeks
Referral to specialist stroke unit for MDT
DVT prophylaxis
Refer for carotid endarterectomy if anterior circulation stroke and >70% stenosis of ipsilateral internal carotid
Anticoagulation if AF (not in acute phase)
Address CV risk factors
DVLA advice
Bamford classification of stroke?*
TACS
Hemiplegia, Homonymous hemianopia, Higher cortical dysfunction (dysphasia, dyspraxia, neglect)
PACS
2/3 above
LACS
Pure hemi-motor or sensory loss
Lateral medullar stroke (PICA stroke)
Vertigo, vomiting, ipsilateral Horner’s, contralateral loss of pain and temperature sensation
