Neurology Flashcards
What is the treatment of hypokalemic periodic paralysis?
Acetazolamide
Potassium sparing diuretics
What are the investigations for McArdle syndrome?
No sustained increase in lactate levels post exercise, definitive investigation: muscle biopsy
Exercise induced muscle pain and stiffness
Myoglobinuria seen
What are the features of progressive supranuclear palsy?
Tremor
Rigidity
Falls
Cognitive impairment
Personality changes
Gaze palsy: Mainly restricted upward and lateral gaze
Autonomic neuropathy: postural hypotension
Pseudobulbar palsy
No resting tremor
Poor response to Levodopa
Also called Steel-Richardson/Olszewski syndrome
What are the features of multi-system atrophy?
Parkinson’s features
Autonomic features
Cerebellar signs
Also called Shy-Drager syndrome
What are the features of olivo-ponto cerebellar ataxia
Parkinson’s and predominantly cerebellar signs
What are the features of Friedrich’s ataxia?
Autosomal recessive
Age of onset: teens
Ataxia
Cerebellar dysarthria
Lower limb areflexia
Loss of proprioception/vibration
Pyramidal weakness
Extensor plantar response
Foot/spine deformity
Cardiomyopathy
What is spino-cerebellar ataxia?
Cerebellar features plus dementia/extra pyramidal features/ophthalmoplegia
NO autonomic features
What are the features of Whipple’s disease ?
Fever/weight loss/anaemia/GI symptoms
Hyperpigmentation
Lymphadenopathy
Memory loss
Supranuclear ophthalmoplegia
Nystagmus
Ataxia
Myoclonus and seizures (Oculo-masticatory movements)
Inv: PAS positive jejunal biopsy and CSF
What is the treatment of Tourette’s syndrome
Haloperidol (D2 blocker)
In addition to mouth ulcers, uveitis and arthritis, what is Behcet’s syndrome associated with?
Deep vein thrombosis
Aneurysm (intracranial mainly)
Erythema nodosum
What is unilateral hypoglossal nerve palsy associated with?
Mets to base of brain from breast/lung
What type of weakness does Bell’s palsy cause?
LMN lesion of CN VII causing complete paralysis of ipsilateral face
What gene abnormality is seen in myotonic dystrophy?
Trinucleotide repeat disorder affecting the DMPK gene
What are the features of temporal lobe epilepsy?
Oral automatisms
Deja vu
Epigastric sensation +/- LOC
Note: Past h/o febrile seizures > hippocampal sclerosis
What are the investigations for sporadic CJD?
CSF for 14-3-3 protein and RTQuIC
MRI
EEG
What is the most characteristic feature of inclusion body myositis?
Involvement of forearm flexors and quadriceps
Inv:
Not too elevated CK
EMG, muscle biopsy
What happens in lateral inferior pontine infarction?
Occlusion of anterior inferior cerebellar artery
Ipsilateral cerebellar signs
Vertigo
Vomiting
Nystagmus
Tinnitus
Ataxia
Ipsilateral LMN facial weakness
Ipsilateral hemiplegia
Contralateral spinothalamic tract involvement
What happens in Holmes Aide syndrome?
Large irregular sluggishly reactive pupil
Absent ankle reflexes
What happens in multifocal motor neuropathy?
Isolated single limb motor weakness without sensory involvement
Autoimmune, treated with IVIG
What happens in tropical spastic paraparesis?
HTLV 1 myelopathy
Common in Caribbean, Central Africa and South America
Transmitted by blood and sexual contact
What are the features of Lewy body dementia?
Visual hallucinations
Rigidity
Bradykinesia
Cognitive impairment
Involuntary movements
What is the best management of hypertensive retinopathy and high BP on admission? (evidence of end organ damage ie. hypertensive emergency)
IV Sodium nitroprusside
IV Labetalol
