Neurology Flashcards
Gingival hyperplasia causes
phenytoin, ciclosporin, calcium channel blockers and AML
Baclofen MoA
GABA agonist
Autoantibody associated with Lambert-Eaton myasthenic syndrome
anti voltage gated calcium channel
Two cardinal features of sporadic Creutzfeldt-Jakob disease
rapidly progressive mental deterioration and myoclonus (usually provoked by startle)
C cerebellar signs
J jerks (myoclonus)
D dementia
Wernicke’s encephalopathy MRI findings
Enhancement of the mamillary bodies
Wernickes apashia Sx?
Speech fluent, comprhension abnormal, repetition impaired
Wernicke=Wtf are you talking about? ( No sense)
Broca’s= Broken Words
W - wernicke
T - temporal
F - fluency present
Idiopathic intracranial hypertension management and MoA
Acetazolamide is a carbonic anhydrase inhibitor that is used to treat idiopathic intracranial hypertension
In subacute combined degeneration of the spinal cord which parts of the spinal cord aare effected?
dorsal columns and lateral corticospinal tracts are affected and spinocerebellar tracts..§
antiepileptic drug most commonly associated with weight gain
Sodium Valprroate
Antieplieptic that increases risk of heamorrhagic disease of the newborn if taken in pregnancy
Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for heamorrhagic disease of the newborn
transient global amnesia diagnostic criteria
onset of retrograde amnesia with preserved orientation and consciousness
Transient global amnesia is characterized by the acute onset of anterograde amnesia (the inability to form new memories). The aetiology is unknown, thought to be due to transient ischaemia to the thalamus (in particular the amygdala and hippocampus).
Features
patients may appear anxious and repeatedly ask the same question
episodes are self-limited and resolve within 24 hours
Motor neurone disease medication that improves prognosis
Riluzole
prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months
currently the only disease-modifying therapy approved for use in amyotrophic lateral sclerosis
Broca’s dysphasia occurs due to a lesion of
the inferior frontal gyrus of dominant hemisphee
Wernicke’s aphasia occurs due to a lesion of
superior temporal gyrus of dominant hemisphee
What is the neuronal bundle that connects Broca’s and Wernickes
Arcuate fasiculus
Conduction aphasia
Inability to repeat (damage to arcute fascilus which connects brocas and wernickes), recognise and try to correct
Anomia
Word blindness/difficulty naming
Lesion in angluar gyrus
Listeria monocytogenes meningitis ABx
AMPICILLIN
IV ceftriaxone and ampicillin i
why might see a return of seizures after 3-4 weeks of treatment with carbemazepine
Auto-induction of CPY
Carbamazepine induces its own metabolism via the hepatic microsomal enzyme system CYP3A4 system. This process is known as auto-induction. The half-life of carbamazepine decreases considerably as auto-induction takes place. In practical terms, this means that carbamazepine levels fall significantly (by about 50%) after several weeks of treatment, which may result in seizure recurrence within this period of auto-induction. For this reason, the dose should be increased every 2 weeks.
Progressive supranuclear palsy cardinal Sx
Progressive supranuclear palsy: postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
Does not respond well to L-dopa
Mutisystem atrophy cardical SX
Multiple system atrophy is a rare neurodegenerative disorder that shares some features with Parkinson’s disease such as parkinsonism; however, it also involves autonomic dysfunction (such as orthostatic hypotension) and cerebellar ataxia. While multiple system atrophy may cause gait disturbances similar to those seen in this patient, it does not typically present with cognitive impairment or vertical gaze palsy.
Myotonic dystrophy characeteristics
Dystrophia myotonica - DM1
distal weakness initially
autosomal dominant
diabetes
dysarthria
frontal balding
Mild mental impairment
Myotonic dystrophy (also called dystrophia myotonica) is an inherited myopathy with features developing at around 20-30 years old. It affects skeletal, cardiac and smooth muscle. There are two main types of myotonic dystrophy, DM1 and DM2.
General features
myotonic facies (long, ‘haggard’ appearance)
frontal balding
bilateral ptosis
cataracts
dysarthria
Other features
myotonia (tonic spasm of muscle)
weakness of arms and legs (distal initially)
mild mental impairment
diabetes mellitus
testicular atrophy
cardiac involvement: heart block, cardiomyopathy
dysphagia
Sow-relaxing grip may be noticed on initial hand-shake with the patient and is typical of myotonic dystrophy.
Hoffman’s sign
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick
Dementia pugilistica,
Dementia pugilistica: think of Muhammad ali. He suffered from parkinsoniam.
Dementia pugilistica, also known as chronic traumatic encephalopathy (CTE), is a neurodegenerative condition associated with repeated head trauma, commonly seen in boxers and other contact sport athletes. It presents with a spectrum of symptoms that overlap with Parkinsonism.
Pathophysiology: Characterised by the accumulation of hyperphosphorylated tau protein, leading to neurofibrillary tangles and neuronal loss, particularly in the frontal and temporal lobes.
Clinical Features: Symptoms may include:
Cognitive decline (memory impairment, executive dysfunction)
Behavioural changes (aggression, impulsivity)
Motor symptoms resembling Parkinsonism (bradykinesia, rigidity, tremor)
Diagnosis: Primarily clinical; imaging may show atrophy in affected brain regions. Definitive diagnosis is post-mortem via histopathological examination.
Management: Currently symptomatic; no disease-modifying treatments exist. Supportive care and rehabilitation are essential.
Lead poisioning neurrological effects
Predominantly motor peripheral neuropathy.
n the treatment of migraine, sumatriptan is an example of a
5HT1agonist
They work by constricting blood vessels in the brain that are involved in causing migraine headaches
Think that all the good stuff (chocolate coffee etc) causes a migraine -> uses up th serotonin so this adds it back in
CT head timing for SAH Dx
if CT H -ve and done within 6 hrs of Sx onset NO NEED FOR LP
If CT H -ve and done >6 hrs frrom Sx onset, consider LP
hemiballismus
characterised by unilateral, repetitive, uncontrollable limb movements. These often decrease in intensity when the patient is relaxed or asleep.
lesion most commonly in basal ganglia
Antidopaminergic agents (e.g. Haloperidol) are the mainstay of treatment
Myasthenia Gravis antibodies
Anti-MuSK (anti muscule specific tyrosine kinase)
And
The anti-AChR antibody
antibody is classically associated with guillan barre?
Anti-GM1 (anti - ganglioside-monosialic acid)
Lateral medullary syndrome
PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner’s
cataplexy
So for Cataplexy laughter is NOT the best medicine,
The correct answer in this case is cataplexy. Cataplexy is a sudden and transient episode of muscle weakness typically triggered by strong emotions, such as laughter, anger, or surprise. It is often associated with narcolepsy, a chronic sleep disorder characterized by excessive daytime sleepiness and other symptoms like sleep paralysis and hypnagogic hallucinations. The patient’s history of leg weakness following bouts of laughing and brief collapse after a similar episode are classic presentations of cataplexy.
It’s CRITical that you remember this.
C(ongruous) = Radiation lesion.
I(ncongruous) = Tract lesion.
in conext of hemianiopias
The ‘2’ syndrome:
2 sides accustic neuroma—> NFM 2 –> 22 chromosome
Neurofibramoatosis T1 has 17 letters
In subacute combined degeneration of the spinal cord, the dorsal columns and lateral corticospinal tracts are affected
Waterhouse-Friderichsen syndrome
adrenal insufficiency secondary to adrenal haemorrhage
Drug treatment according to the type of epilepsy
Generalised tonic-clonic seizures
males: sodium valproate
females: lamotrigine or levetiracetam
girls aged under 10 years and who are unlikely to need treatment when they are old enough to have children or women who are unable to have children may be offered sodium valproate first-line
Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
Absence seizures (Petit mal)
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures
Myoclonic seizures
males: sodium valproate
females: levetiracetam
Tonic or atonic seizures
males: sodium valproate
females: lamotrigine
Neurofibromatosis type 1 is due to a mutation in chromosome 17, von-Hippel Lindau is inherited via chromosome 3 and tuberous sclerosis is often associated with a mutation in chromosome 16 (as is polycystic kidney disease type 1)
localising features of a temporal lobe seizure
Lip smacking + post-ictal dysphasia
May occur with or without impairment of consciousness or awareness
An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as dejà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)
Seizures typically last around one minute
automatisms (e.g. lip smacking/grabbing/plucking) are common
Localising features of a frontal lobe seizure
Frontal lobe (motor) Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Localising features of a parietl seizure
Parietal lobe (sensory) Paraesthesia
Loacalising features of an occipital lobe seizure
Occipital lobe (visual) Floaters/flashes
Ovarian teratoma is associated with Anti-NMDA receptor encephalitis
Essentail tremor pharmacological management
- Propanolol
- Primidone acts by modulating GABAergic neurotransmission, enhancing inhibitory effects in the central nervous system. This leads to decreased neuronal excitability, which may help alleviate tremors.
SJS drugs
SJS happens in 3 PLACES
P-Phenytoin
P-Phenobarbitone
P-Penicillin
L-Lamotrigine
A-Allopurinol
C-Carbamazepine
E-Erythromycin
S-Sulfa Drugs
Patients with von Hippel-Lindau syndrome may develop retinal haemangiomas which present as a vitreous haemorrhage
Intraacrain HTN drug causes
LAST-C(See) Fat Pregnant Lady
- lithium
- Vitamin A
- Steroid
- Tetracyclin
- COCP
or spotty pregnant lady as lots of these drugs used to treat acne
Wernicke and Korsakoff syndrome localises to the medial thalamus and mammillary bodies of the hypothalamus. Huntington chorea is localised to the striatum (caudate nucleus) of the basal ganglia. Parkinson’s disease is caused by disease of the substantia nigra of the basal ganglia. Kluver-Bucy syndrome is caused by damage both temporal lobes including the amygdala.
Hypothalamic Functions (Simplified)
Ventromedial: Satiety center (controls feeling of fullness)
Anterior: Heat dissipation (cooling the body)
Posterior: Heat generation (warming the body)
Paraventricular + Supraoptic: Antidiuretic hormone (ADH) & oxytocin production
Natalizumab can cause reactivation of the JC virus causing progressive multifocal leukoencephalopathy (PML)
Paraneoplastic syndromes affecting nervous system
Lambert-Eaton myasthenic syndrome
associated with small cell lung cancer (also breast and ovarian)
antibody directed against pre-synaptic voltage gated calcium channel in the peripheral nervous system
can also occur independently as autoimmune disorder
Anti-Hu
associated with small cell lung carcinoma and neuroblastomas
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis
Anti-Yo
associated with ovarian and breast cancer
cerebellar syndrome
Anti-GAD antibody
associated with breast, colorectal and small cell lung carcinoma
stiff person’s syndrome or diffuse hypertonia
Anti-Ri
associated with breast and small cell lung carcinoma
ocular opsoclonus-myoclonus
Purkinje cell antibody
- peripheral neuropathy in breast cancer
Anti-Ri (Rieally blurry vision)Anti GAD GAAAAD he’s stiff (stiff man syndrome)Anti-Hu who kicked my chair (pain) and then fell over (ataxia)Anti yo- Yo lady give me back my danish (cerebellar syndrome, lady for breast + ovarian)
anti GAD in Arabic means a serious person:: so a serious person = stiffed
My way of remembering
anti Ri : conect it to RiO Ocular OpsOclOnus-myOclOnus
and ive read somewhere
anti H : imagine H sticks as 2 lungs or 2 brain hemispheres
anti Yo : imagine Y as lady’s private organ
CADASIL
CADASIL (also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is the most common cause of hereditary cerebral small-vessel disease and vascular cognitive impairment in young adults. It is, as implied by the name, an autosomal dominant condition caused by a NOTCH3 mutation on chromosome 19.
Klumpke’s paralysis:
T1 nerve root damage
Myotonic Dystrophy
- Features can be remembered with 3T 3D
- 3T: Toupee (balding), ticker (cardiomyopathy), testicles (atrophy)
- 3D: diabetes, dysarthria, learning disability
- Also Both CTG and myotonic have T in the middle
- D for autosomal dominant (along with Facioscapulohumeral dystrophy) whereas Duchenne and Becker are X-linked recessive
Carrbamazepine is contraindicated in what typ of seizue?
Abscense seizure
to remember this, absence seizures happen in children and adolescents mostly and we don’t give them cars
Juvenile myoclonic epilepsy
Juvenile myoclonic epilepsy first presents in teens. Seizures typically occur upon waking in the morning, associated with sleep deprivation. Myoclonic jerks can occur, preceding generalised seizures. Absence seizures are also often observed, but not in every case. Juvenile myoclonic epilepsy often necessitates life-long anti-convulsant, but patients respond well; sodium valproate is first-line but should be avoided in girls of child-bearing age.
benign rolandic epiliepsy
Benign rolandic epilepsy presents in children aged 5-12 on average, causing focal aware seizures or generalised tonic-clonic seizures occurring during the night. Seizures are infrequent, and the majority of children do not require treatment and become seizure-free in adulthood.
Hyponogogic myoclonus
Hypnogogic myoclonus is a physiological phenomenon that causes sudden and involuntary jerking just as a person is falling asleep. They are often associated with a feeling of shock. These involuntary movements and not related to seizure activity and would not progress to a generalised seizure.
Lennox-Gestault syndome
Lennox-Gastaut syndrome is an epileptic encephalopathy causing both tonic and atonic seizures. The condition presents in pre-school years and carries a poor prognosis.
Rett syndrome
Rett syndrome is a genetic disorder causing developmental regression after 12-18 months of normal development. Seizures can occur, but not in every case; the first presentation is often around 1 year of age.
Medication that precipitate acute angle closure glaucoma
Topiramate can precipitate acute angle closure glaucoma
egot derived DA agonist complications
fibrosis - retroperitoneal, pulmonaay & peircardiala
ergot-derived dopamine agonists such as Pergolide, Lisuride, Bromocriptine and Cabergoline are associated with an increased risk of these fibrotic reactions due to their mechanism of action on serotonin 5-HT2B receptors which can cause fibrotic changes in tissues.
Mumps meningitis CSF picturee
Viral CSF picture BUT with abnormally low glucose
(same with herpes simplex)
S1-2- buckle your shoe (ankle reflex)
L3-4- kneel on the floor (knee reflex)
C5-6- pick up sticks (biceps reflex)
C7-8- shut the gate (triceps reflex)
S1-2- buckle your shoe (ankle reflex)
L3-4- kneel on the floor (knee reflex)
C5-6- pick up sticks (biceps reflex)
C7-8- shut the gate (triceps reflex)
bilateral asymmetric and poorly marginated hyperintense T2-weighted and FLAIR lesions within the subcortical white matter.
Acute diseeminated encephalomyelitis
Meningitis flow chart:
High WCC –> No: not infectious/Yes: continue
Polymorphs –> No: lymphocytes, continue/Yes: Bacterial
Low glucose –> No: Viral/Yes: continue
High protein –> No: Mumps/Yes: TB or Fungal
Motor neurone disease with worst prognossi
Progreessive bulbar palsu
Huntingtons MRI finding
caudate atrophy
CJD MRI finding
hockey stick sign/pulvinar