Neurology Flashcards
Aside from levodopa, what medication groups might be used to treat Parkinson’s disease?
Monoamine oxidase B inhibitors(MAO-B inhibitors)
COMT inhibitors
Dopamine agonists
Amantadine
Anticholinergics
Aside from medications, what treatments are available for Parkinson’s disease?
Deep brain stimulation
Physio, SALT, OT
At what vertebral level is an LP taken?
L3/L4
Describe CSF analysis indicative of a bacterial infection
Opening pressure: High
Appearance: cloudy/yellow
Glucose: serum: low(<50%)
Protein: High: >1g/L
WWC: high-neutrophilia
Describe CSF analysis indicative of a fungal/TB infection
Opening pressure: High
Appearance: cloudy/fibrous
Glucose: serum: low(<50%)
Protein: High: >1g/L
WWC: high-lymphocytosis
Describe CSF analysis indicative of viral infection
Opening pressure: normal
Appearance: clear/cloudy
Glucose: serum:high: >60%
Protein: normal
WWC: high-lymphocytosis
Define a TIA
Sudden onset focal neurological deficit with a vascular aetiology typically lasting <1hr but always <24 hours
Completely resolves
Descirbe the clinical features of Brown-Sequard syndrome
Ipsilateral weakness below lesion
Ipsilateral loss of proprioception and virbation sensation
Contralateral loss of pain and temperature sensation
Descirbe the symptoms of a Wallenberg’s stroke
Ipsilateral Horner’s syndrome
Ipsilateral loss of pain and temperature sensation in face
Contralateral loss of pain and temperature sensation in trunks and limbs
Ipsilateral cerebellar signs
Ipsilateral bulbar muscle weakness
Diplopia
Describe a focal saware seizure
Patients retain consciousness experiencing only focal symtpoms
Usually no ictal symptoms
Describe a focal seizure with impaired awareness
Patients lose consciousness, usually post an aure or at seizure onset
Commonly originate from the temporal lobe
Describe a myoclonic seizure
Sudden jerks of a limb, trunk or face
Describe a secondary generalised seizure
Focal seizure that evolves into a bilateral tonic-clonic seizure
Describe a tonic clonic seizure
Loss of consciousness
Stiffening(tonic) and jerking(clonic) of limbs
Post-ictal confusion common
Describe an absence seizure
Brief pauses for <10 seconds
Describe an atonic seizure
Sudden loss of muscle otne causing the patient to fall with consciousness retained
Describe some potential signs/symptoms of brain metastases
Headache: worse on waking, lying down or with coughing/straining
Raised ICP
Neuro deficits
Cushing’s reflex
Systemic: weight loss, night sweats, fevers etc
Describe the acute management of a cluster headache
100% oxygen-usually effective in <10 minutes
SC triptan
Describe the acute management of a migraine
Avoid triggers
Oral triptan +NSAID OR oral triptan+ paracetemol(may use nasal tripatn especially in younger people
Non-oral metoclopramide or prochlorperazine and add non-oral NSAID/triptan
Describe the acute management of an ischamic stroke
Rule out haemorrhagic: NCCT head
Aspirin 300mg orall/rectally
<4.5 hours post onset: thrombolysis with IV alteplase
CT/MRI angiography
Mechanical thrombectomy
Describe the acute management of an MS flare?
High dose IV methylprednisolone for 5 days
Reduce duration or relapse not severity
Rule out infection
Describe the aetiology of a brain abscess
Usually contiguous spread of infection from sinusitis, otitis media or dental infection
Haematogenous spread from distant sources; endocardities etc
Direct inoculation: trauma/neurosurgery
Describe the aetiology of a TIA
MC: Embolism: often from atherosclerotic plaques in the heart
Lacunar
Haemodynamic compromise(stenosis of major artery)
Describe the aetiology of acoustic neuroma
Develop from Schwann cells of vestibulocochlear nerve
Majority are sporadic cases
Can be associated with NF2
Describe the aetiology of Bell’s palsy
Unknown
Linked to HSV1
ebv
vzv
Describe the aetiology of Charcot neuropathy
DM(mc)-> microvascular disease, autonomic and peropheral neuropathy-> cumulative damage to joints
Also:
Chronic alcohol abuse
Syringomyelia
Syphilis
Describe the aetiology of chronic fatigue syndrome
Unknown
Triggers like EBV
Psychological stress
Describe the aetiology of diabetic peripheral neuropathy
Chronic hyperglycaemia-> accumulation of advanced glycation end products, oxidative stress and inflammatory pathways
Describe the aetiology of Duchenne muscular dystrophy
X linked recessive-> mutation in dystrophin genes
Describe the aetiology of encephalitis
HSV1 responsible for 95% of cases in adults
Also: HSV2, CMV, EBV, VZV, HIV
Autoimmune encephalitis: NMDA receptor antibody associated encephalitis
Describe the aetiology of epilepsy
Idiopathic generalised epilepsy
:Childhood absence
Juvenile absence
Juvenile myoclonic
generalised tonic clonic
Structural:
Stroke
Trauma
Malformations
Genetic
Infectious
Metabolic
Immune
Unknown
Describe the aetiology of essential tremorr
Not fully understood
50% of cases have an autosomal dominant trait
Describe the aetiology of Guillain Barre syndrome
1-3 weeks post infection-mc Campylobacter
Others: mycoplasma and EBV
40% idiopathic
Others: CMV, HIC, hepatitis A, vaccinations
Describe the aetiology of herpes zoster ophthalmicus
Varicella zoster virus which remains dormant in the trigeminal ganglion following chickenpox, reactivates andn spreads along the opthlamic division of the trigeminal nerve
Describe the aetiology of Huntington’s disease
Autosonomal dominant mutation involving excessive repetition of CAG nucelotide in huntingtin gene
Gradual degeneration of caudate nucleus and putamen
Describe the aetiology of ischaemic strokes
Thrombotic: thrombus wihtin artery supplying blood to brain(atherosclerosis)
Embolic: embolus from elsewhere in the body
Describe the aetiology of meniere’s disease
Dilatoin of endolymphatic spaces of membranous labyrinth resulting in an increased fluid pressure within the inner ear
Describe the aetiology of MS
Combination of genetic and environmental factors including potential viral pathogens
CD4 mediated destruction og oligodendrogial cells and humoral response to myelin binding protein
Describe the aetiology of neurofibromatosis type 1
Mutation on chromosome 17 which codes for neurofibromin(tumour suppressor protein)
Describe the aetiology of neurofibromatosis type 2
Mutation on chromosome 22->merlin-> tumour suppressor protein important in schwann cells resultling in schwannomas
Describe the aetiology of SAH
MC: head injury
LC: spontaenous
Berry aneurysm: 85% of cases
AVM’s
Pituitary apoplexy
Myocitic(infective) aneurysms
Describe the aetiology of sub-acute combined degeneration of the spinal cord
Anything that can cause B12 deficiency:
Pernicious anaemia
Malabsorption syndromes
Dietary deficiencies
Recreational nitrous oxide inhalation
Describe the aetiology of trigeminal neuralgia
Primary-idiopathic or secondary
Secondary causes include:
Malignancy-nerve compression
AVM
MS
Sarcoidosis
Lyme disease
Describe the causes of mononeuropathies
Fixed: Nerve compression against hard surface, entrapment of nerves in narrow anatomical spaces
Transient: Repetitive actions that cause trauma to neuron
Describe the clinical features of a cluster headache
Severe intense stabbing sharp pain aorund one eye
Conjunctival lacrimation, redness, lid swelling
Mitosis/ptosis
Attacks last 15 minutes-2 hours
Generally attacks in clusters for 4-12 weeks then remission for months/years
Describe the clinical features of a tension headache
Episodic primary headache
‘tight band’ or pressure sensation, usually bilateral
Lower intensity than migraine
No aura, n+v
Related to stress
May co-exist with migraine
Describe the clinical features of idiopathic intracranial hypertension
Non-pulsatile bilateral headaches, worse in the morning or after bending forwards
Morning vomiting
Visual disturbances: transient visual darkening/loss-> optic nerve ischaemia
Bilateral papilloedema on fundoscopy
6th nerve palsy: horizontal diplopia
Pulsatile tinnituss
Photopsia
Describe the clinical features of narcolepsy
Typical onset in teenage years
Hypersomnolence
Cataplexy(sudden loss of muscle tone often triggered by emotion)
Sleep paralysis
Vivid hallucinations on going to sleep/waking up
Describe the clinical features of normal pressure hydrocephalus
‘Wet, wacky and wobbly’
Incontinence
Dementia
Magnetic gait-often appear as though ‘stuck’ can’t lift feet off floor
Describe the direct movement pathway in the substantia nigra
Excitatory
Increases thalamus activity-> increase movement
Describe the drivinfg rules for a patient with a TIA
Cannot drive until seen by a specialist
If dr happy and no lasting effects: cand rive again after 1 month
If lorry/bus: 1 year
Describe the epidemiology of a cluster headache
Middle aged men
Smokers
Related to nocturnal sleep
Can be triggered by alcohol
Describe the epidemiology of a subdural haemorrhage
Elderly: >65 years
Infants-shaken baby
Describe the epidemiology of a TIA
Peak >70 years
M>F
Describe the epidemiology of bell’s palsy
Peak incidence: 15-45 years
Higher prevalence in pregnant women
Describe the epidemiology of central venous sinus thrombosis
F>M
20-35yrs
Describe the epidemiology of charcot arthropathy
MC in pts with long standing DM
Middle aged and elderly population
Describe the epidemiology of chronic fatigue syndrome
Peak: 30-40 years
F:M:2:1
Describe the epidemiology of diabetic peripheral neuropathy
Common complication of both types of diabetes
Occurs in 50% of long term diabetic patients
Risk increases with duration of diabetes and poor glycaemic control
Describe the epidemiology of Duchenne muscular dystrophy
Males predominnalty affected with females are carreirs(X linked)
