Neurology Flashcards
Multifocal motor neuropathy vs MND
Like MND although MND usually involves bulbar signs
Differential
- thunderclap headache + normal CTH + normal LP
Reversible cerebrovascular vasoconstrictor syndrome
CADASIL
- presentation
- genetics
Usually migraine with aura by 30s, TIAs in 40s and dementia in 50s
NOTCH3, Ch 19
What is a scissoring gait?
What can it be a sign of?
= legs crossing over each other as walk
= UMN
e.g. cervical myelopathy
Prophylaxis in cluster headache
Verapamil
Management of Parkinson’s Dementia
Rivastagmine
- has been shown to be of some benefit
Hyperviscosity syndrome + intra-cranial mass
Haemangioblastoma
- can secrete epo = hyperviscosity syndrome
Management of ophthalmic shingles
PO aciclovir
No role for topical treatments
Dysarthria
Poor coordination
Ataxia
New T2DM
Young
- additional signs that may be present
- diagnosis
- confirmation?
Upgoing plantars
Absent ankle jerk
= Frederich’s ataxia
Genetic testing
Areas of brain vulnerable during sustained hypotension
Posterior parietal lobes
= watershed area between middle and posterior cerebral artery territories
Cluster headache VS paroxysmal hemicrania
Cluster = attacks are longer, less frequent
May also have a circadian rhythm
Paroxysmal hemicrania = shorter duration, ipsilateral autonomic features
Management of cluster headache
Oxygen
Nasal/SC triptan
Management of paroxysmal hemicrania
Indomethacin
Myasthenic crisis - what do you need to assess?
FVC
- allows both inspiratory and expiratory mechanisms to be assessed
TIA - is there loss of consciousness?
NO THERE IS NOT
Haemorrhagic stroke
+ free thrombus
- management?
Usually IV heparin - easier to reverse
Essential tremor features (4)
Isolated tremor
Worse on posture
Head bobbing
No cerebellar symptoms
Management of acute sickle cell infarct
Exchange transfusion
Multiple infarcts inconsistent with territory
Seizures
Early onset dementia
Focal weakness
MELAS = mitochondrial encephalopathic lactic acidosis syndrome
CNS lymphoma
- appearance
- management
= homogenous mass in frontal lobe
Mx: steroids, methotrexate
Bilateral tremor
Drug-induced parkinsonism
Anterior uveitis management
Topical steroids
Topical cycloplegic drops
Drug-induced Parkinson’s
Rapid onset
Bilateral
Rigidity unusual as a feature
Management of motor symptoms in Parkinson’s Disease
Can add in adjuncts to improve symptoms
e.g. selegiline (MAO), bromocriptine/cabergoline (dopamine agonist)
Cabergoline
- drug class
- side effects
Dopamine agonist
Associated with fibrosis e.g. cardiac, respiratory
Contralateral hemiparesis
- lower > upper
Anterior cerebral infarct
Contralateral hemiparesis
Contralateral homonymous hemianopia
Aphasia
Middle cerebral infarction
Macula sparing contralateral homonymous hemianopia
Visual agnosia
Posterior cerebral infarction
Visual agnosia =
= cannot recognise faces/people/objects
Ipsilateral CN III palsy
Contralateral weakness
Weber’s Syndrome
- branches of posterior cerebral artery that supply midbrain
Criteria for thrombolysis (3)
Within 4.5 hours if haemorrhage excluded
Consider if can be started 4.5-9 hours within known onset + radiological evidence of salvageable tissue
BP should be <185/110
Contra-indications to thrombolysis (7)
Haemorrhage previously
Seizure at onset of stroke
Brain tumour
Uncontrolled HTN
Varices
GI bleeding <3 weeks
LP within 7 days
Thrombectomy
- status
- criteria (3)
Status = must have Rankin <3 and >5 on NIHSS
- Within 6 hours and thrombolysis to proximal anterior
- 6-24 hours and salvageability to proximal anterior
- Consider with thrombolysis up to 24 hours + salvageability to proximal posterior
Pseudo lumen of carotid artery
= carotid artery dissection
- A cause of Horner’s syndrome
- May need an anti-platelet
What is neuromyelitis optica?
- criteria
- management
= relapsing and remitting demyelinating disorder
Criteria = spinal cord lesion >= 3 levels, normal MRI brain, aquaporin 4 antibody positive
Treat with IV methylprednisolone
NMDA encephalitis
- features (4)
Female, viral prodrome, memory complaint, catatonia
Sodium valproate overdose
- result
- management
= hyperammoneic encephalopathy
= give L-cartinine (activates the enzyme which metabolises ammonia into urea)
Mechanism of Huntington’s chorea
- management
excess of dopamine, use dopamine depleting agents
e.g. reserpine/tetrabenazine (can cause depression)
Features of sporadic CJD (5)
Ataxia, Dementia, Myoclonus, elevated 14-3-3 protein, periodic sharp waves
Management of severe Alzheimer’s
Memantine
Central retinal vein occlusion appearance
Cheese and tomato pizza
Temporal field corresponds to what part of retina
Nasal field
Status epilepticus not responding to benzo or 2nd line treatment
GA with thiopentone (barbituate)
Trigeminal neuralgia vs SOL
No sensory loss in trigeminal neuralgia
Need to check for SOL or demyelinating disorder
Superior sagittal sinus thrombosis
- presentation
- radiological sign
Sudden onset headache
Empty delta sign
(on contrast scan, superior sagittal sinus should be opaque with contrast, if thrombus there, cannot fill with contrast = empty)
Miller-Fisher
anti-GQ1 antibodies
Investigating recurrent laryngeal nerve injury
Laryngoscope
Modality of choice in acute stroke
DWI MRI
(FLAIR better for looking for chronic ischaemia)
Starting SSRI in <25 year old
- immediate follow up
See after 1 week - increased risk of suicidal ideation
Management of tremor predominant PD
Anticholinergic
e.g. procyclidine, oprphenadrine
Causes of peripheral neuropathy
- investigation findings
Either axonal degeneration or demyelination
Axonal = diabetes, B12 deficiency, uraemia. HIV, inherited
Normal velocity, reduced amplitude in NCS
Demyelination = autoimmune, paraproteinaemia
Reduced velocity, normal amplitude in NCS
Papilloedema
Normal visual acuity
- suspected IIH, management
Acetazolamide
Normal visual testing despite papilloedema
VTE prophylaxis
- stroke + high risk of haemorrhagic transformation
Intermittent pneumatic compression
Progressive neurological symptoms
Evidence of demyelination on imagine
Consider progressive multifocal leukoencephalopathy
Need to determine HIV status
What is ischaemic penumbra?
Salvageable ischaemic tissue
Dopamine agonist + increased spending
Impulse control disorder
Headache with maximal intensity in minutes
Postural element
- diagnosis?
- investigation of choice?
= spontaneous idiopathic hypotension
Contrast MRI
Management of lewy body dementia
Rivastigmine
Donepezil
Carotid artery stenosis identified in context of stroke - when endarectomy?
Within 14 days
Management
- if BP too high for thrombolysis
Aim to reduced BP <185/110 to allow for thrombolysis (rather than just treat suboptimal with aspirin)
Contralateral hemiparesis
Ipsilateral CN III
- diagnosis
- blood supply
Weber’s syndrome
Posterior cerebral artery
Personality change
Dementia
Hyperintense lesions on MRI
CJD
Management of acute isolated optic neuritis
IV methylprednisolone
Demonstrated superior to PO prednisolone
Personality change and strange behaviour
Hypodense lesions predominantly in medial temporal region
Encephalitis
Weakness
Nil sensory symptoms
Muscle wasting
Demyelination
NCS = f waves and H-reflexes
- diagnosis
- management
Multifocal motor neuropathy
IVIg as management
Side effect associated with ropinrole
Psychosis
Management of CIDP
High dose steroids
- remember similar presentation to GBS but chronic/more indolent
Antibodies present in some myaesthenia gravis cases
Muscle specific kinase antibodies (MUSK antibodies)
Cheese tomato pizza retina
Immunosuppressed
CMV retinitis
Lateral medullary syndrome
- pathophysiology
- cause
Caused by interrupted blood supply to posterior inferior cerebellar artery
Can be as a result of vertebral artery dissection e.g. hyperextension injury
= need CTA to diagnose dissection
Hereditary neuropathy with liability to pressure palsy
- gene implicated
- pattern
PMP22 gene
Usually neuropathy after extended pressure e.g. sleeping on arm
What can you use for acute confusion in Parkinson’s Disease?
Quetiapine
Investigation of choice in TIA
Diffusion weighted MRI
Chronic paroxysmal hemicrania
Multiple (>20) short (minutes) headaches
Cluster tends to be fewer and longer
Management of stroke in sickle cell
Exchange transfusion
Basal CN palsy
Malaise
CSF - lymphocytosis, raised protein, low glucose
- diagnosis
TB meningitis
Drugs to avoid in myaesthenia gravis (8)
Pencillamine
Quinine
Procainamide
BB
Lithium
Magnesium
Gentamicin
Macrolide antibiotics
Early postural symptoms
Falls
Swallowing issues
Personality change
- diagnosis?
Progressive Supranuclear Palsy
Progressive Supranuclear Palsy
- features (4)
Early postural symptoms
Falls
Swallowing issues
Personality change
- diagnosis?
Driving and transient global amnesia
No restrictions on driving if investigated
Dysarthria
Hearing loss
Headache
Less than 1 hour duration
- diagnosis
Basilar migraine (migraine with brainstem aura)
Immunocompromised
Retinal necrosis
Toxoplasmosis
Regression in development
Seizures
Myoclonic jerks
Wolff Parkinson White Syndrome
Optic Atrophy
- inheritance
- diagnosis
MERRF = myoclonic epilepsy with ragged red fibres
Mitochondrial inheritance
Muscle biopsy
Upgoing plantars
Absent ankle jerks
- differential
Subacute degeneration of the cord
Syphillis
Frederich’s ataxia
Motor neurone disease
Upgoing plantars
Hyperreflexic
Tropical spastic paraparesis
Poor prognosis in intracranial haemorrhage
Low GCS
Key feature of Miller Fisher syndrome
Abnormal eye movements
Multiple cord level involvement
Streak of demyelination
Optic nerve involvement
- diagnosis
- alternative name
Neuromyelitis optica
Delvic’s disease
