Neurology Flashcards
Features and management of motor neurone disease
Asymmetrical weakness in legs and hands, fasciualtions.
Mixed UMN and LMN signs.
Does not affect extra-ocular muscles, cerebellum or abdominal reflexes.
No sensory loss
- ALS most common (50%)- UMN affect lower limbs, LMN upper
- PLS- UMNs of arms legs and face
- PMA- LMN only
- Bulbar palsy- worst prognosis
Management- Riluzole (2-4 month benefit), NIV at night, PEG for feeding
Lambert Eaton syndrome vs Myasthenia Gravis
L.E- limb girdle/proximal muscle weakness, improves with use. Autoantibodies vs voltage gated calcium channels. EMG- incremental response to repetitive stimulation. Associated with small cell lung cancer
M.G- Fatiguable weakness. IgG antibodies vs nicotonic AcH receptors. Diplopia, ptosis, dysphonia. Features worsen with fatigue/throughout the day.
* Ix- serum anti-acetylcholin receptor antibody (90%)
* EMG- decremental response to nerve stimulation
* 1st- pyridostigmine
NMS vs Serotonin Syndrome
- NMS- antipscyhotic meds or suddenly stopping levodopa/DA/PD meds. Pyrexia + rigidty + ANS stimulation. Normal pupils, slower onset. High CK. IV fluids, dantrolene
- Serotonin syndrome- myoclonus, faster onset, increased reflexes + dilated pupils
Ergot vs non-ergot derived dopamine receptor agonists
- Non-ergot derived- Ropinirole/Apomorphine
- Ergot derived- Cabergoline/Bromocriptine
^pulmonary fibrosis, cardiac fibrosis.. need baseline Echo, CXR, ESR, Cr- regular Echos during treatment.
Can cause impulse control disorder, daytime sleepiness
Mx of Mild, Moderate, Severe alzheimer’s disease
Mild-Moderate- AChI:
* Donepezil- relaitive contraindications: bradycardia, side effects insomnia, rivastigmine, galantamine
* 2nd line- memantine (NMDA reeptor antagonist). + to first line treatments in moderate AH or if AChl not tolerated
Severe- memantine monotherapy
Investigations for myasthenia gravis (inc antibodies)
- Serum anti-achetylcholine receptor antibody testing (90% positive)
- If negative- 40% positive for antimuscle specific kinase antibodies (anti-MuSK)
What AED can exhibit autoinduction where pts see a return of seizures after 3-4 weeks of treatment
Carbamazepine
