Neurology Flashcards
How do you diagnose CJD
CSF > RTQuIC (Real time quaking induced conversion) test
RTQUiC is now considered better than CSF for 14.3.3 protein.
What are the Ix to Dx Myasthenia
> Serum Acetylcholine receptor Abs
Single fibre electromyogram
Repetitive nerve stimulation
when do you see anti-striated muscle Abs +ve in myasthenia
When they are associated with thymomas
when do you test for Anti-MUSK Abs in myasthenia
When you are suspecting myasthenia, by the
Anti-Cholistensterase receptor Abs are negative
what are the features of subacute sclerosing pane-encephalitis
> Chronic measles infections
Pt. will have had a measles infection from which they would have recovered
Will be symptom free for 6-8 years
Followed by , decline in school, studies, Followed by myoclonic jerks and visual disturbances
Can be associated with seizures
Followed by pyramidal signs ( rigidity/unresponsiveness)
Death (No Tx available )
What are the medications of Choice to Tx Juvenile Myclonic Epilepsy
> Lamotrigine/ Levetiracetam.
What are the feature software Juvelinel Myoclonic epilepsy
Teenage onsent- morning myoclonus
Absence seizures
Generalised tonic clonic seizures
Life long disorder
(Note: Sleep deprivation and alcohol can lower seizure threshold)
What is the best technique to reduce post LP headaches
Using atraumatic needle
how do you differentiate between benign fasciulations and Mcardles disease
In mcardle disase>
pain is severe on exercise
In benign fasciulations> excercise is not affected as much , can carry on > noted after exercise / alcohol etc
Mx: usually no Mx, but if severe, Carbamzepine/ Phenytoin
What are the features of transient global amnesia
> Amnesia with no there neurological deficits
Usually has complete spontaneous recovery
Pt. has retrograde and anterograde amnesia and has repetitive questions
what is the key difference between Bolutinum and Tetanus
Botulism has flaccid Paralysis
vs
Tetanus has Increased muscle tone
What is an Imp thing to consider in pt.’s with IIH
Secondary causes such as venous thrombus
( Do an MR venogram )
Risk factors- obesity, smoking, cocp, tetracyclines, oral retinoids, amiodarone, cimetidine, miocycline
what does phytanic acid defects
( excess) seen in
Refsums disease
What are the features of refsum disease ( autosomal recessive)
> Sensorimotor periperhal neuropathy
Excess phtanic acid due to defect in its oxidation
Onset late teens to early 20’s
Sensorineural deafness
CerbellarAtaxia
Ansomia
Pes cavus
shortened 4th toe
Night blindness ( retintis pigmentosa)
Mx: Dietary restriction of phytanic acid
What are the features of Holmes-Adies Pupil
> Large , irregualr, sluggishly reactive pupils
Absent ankle reflexes ( deep tendon)
What Features of essential tremor
Arms, head, neck
Worse on a action, extending
( Note in Parkinsons - it improves on a action )
Alcohol helps tremor
mx: Propranolol
What is the inheritance of Beckers muscular dystrophy
X linked
Common long term symptoms - heart issues (arrhythmia )
What are the keys feature of mystic dystrophy
Muscle weakness
Ptosis
Cataracts
Mild intelectual impairment
Cardiomyopathy
Conduction defects
Glucose intolerance
Low IgG
What is the mx of cluster headaches
> High flow O2
Intra nasal triptan
long term prophylaxis- Verapamil
what is the definitive mx of high grade glioma
Surgery followed by adjuvant chemo + Radiotherapy
When do you use whole brain irradiation
Multiple brain mets
What are the keys features of CADASIL Syndrome ( Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy)
H/o migraine with aura
Stroke like symptoms
+ve family history of migraines and early onset dementia
MRI shows- Diffuse bilateral periventricular white matter
Normal LP findings
What do you see in MELAS syndrome ( mitochondrial disease)
Migraine + Stroke like disease
But Pt. will have raised LP and Blood lactate
What is the difference between sporadic CJD and new variant CJD
> New variant seen in younger
Sporadic seen in older ( 50-60)
EEG
> Sporadic ( Periodic sharp and slow wave complexes )
> New Variant ( EEG can be variable )
What are the features of Vertebral artery dissection
> Similar to lateral meduallry syndrome
due to possible hyper extension of neck
there will be dizziness, headache, neck pain associated with, possible
Horners, numbness on one side of face, contralateral, loss of pain and temperature
What is the mx of myasthenia
Pyridostigmine
( inhibiting the acetylcholinesterase (AChE) enzyme from breaking down the neurotransmitter acetylcholine (ACh)
What are the features of Fredricks ataxia
> Presents in Late teens , early 20’s ( before 25)
Progressive limb and gait ataxia
Absent lower limb deep tendon reflexes
muscle wasting can be seen
sensory incapacity. can also be seen
can be associated with deafness, visual problems (nystagmus) , speech problems ( dysarthria)
MRI shows Shrinkage of Cervical spinal cord
Affects both sexes equally
What is the key feature in Multiple system atrophy
Automatic dysfunction
Postural drop (70%)
Erectile dysfunction
Bladder dysfunction
Note: Look for other signs of autonomic dysfunction as well, not juts postural drops
What is a key note, to consider when pt. has myasthenia and becomes pregnant/ possibly pregnant
It can cause relapse of myasthenia
What is the Mx of Lamber Eaton Syndrome
3,4-diaminopyridine
If above fails, can consider prednisolone
What is the key feature of brachial neuritis
> following vaccination, surgery, trauma
initially severe pain int eh right arm/ shoulder
following this, pain resolves
2-3 weeks after, followed by weakness of arm, sensory los and possible wasting
Spontaneously resolves, but sometimes can take months
What is the mx of Ramsay Hunt syndrome
oral aciclovir + pred ( 1mg/kg)
( for presentation within 72 hrs of symptoms )
What is the mx of Parkinson related psychosis
Clozapenine
What are the keys features of mythic dystrophy
Autosomal dominant with anticipation
>frontal balding
> Mytonia
> Catatracts
> Wasting of sternocleidomastoid
>Dysphagia
> Muscle weakness
Ix: EMG
If a pt. has multiple relapses of MS ; what can be used to reduce relapse frequencies
Fingolimod
What are the two key differences between Lambert Eaton and Myasthenia
Lambert eaton -
Gets better with excercise
has autonomic involvement ( dryness of mouth, etc)
Myasthenia
Worse with exercise
No autonomic dysfunction
What are some of the key differences between Marian’s and Homocistenuria
Marfans - upward lens dislocation
Homocistenuria - lower lens dislocation
Homocistinuria -
has learning disabilities and rashes
( levido reticualris)
Not seen in Marfans
What is one of the keys differences between frontal lobe seizures and REM Sleep disorder
In REM sleep disorders, they can recollect the dreams the next day
in Frontal lobe seizures, they CANNOT recollect the seizures and they will also have some post octal confusion
Both ahem involuntary movement at night with speaking incompressible words, etc
Note:
EEG in frontal loe seizures will also show epileptiform activity inn Frontal lobes
What is the Dx of choice for carotid artery dissection
Contrast angiography.
If Pt. has broke like symptoms
MRI + angiography
Which lobes are affected in HSV encephalitis
Temporal
what is the ix o choice for BIH
LP
( once CT and MRI are done)
What are the features of Tourette’s syndrome
Sniffs, grunts, snorting repetitive explosive words
ADHD and OCD can be present
Intelligence is not affected
Mx: Dopamine receptor blockers : Haloperidol
what is the mx of trigeminal neuralgia
Carbamazepine
What are some other causes of Wernicke’s other than alcohol
Severe malnutrition, electrolyte abnormalities
( can be seen in IBD who have an ideal resections )
What is the triad of Wernicke’s
Opthalmoplegia, Ataxia, Delirium
What is the mx of Spinal muscular Atropy ( SMA)
risdipalm
What is critical illness myopathy
Usually seen in multi-organ failure that is treated with inotropes, muscle relaxants and steroids
( Failure to extubatne successfully) due to myopathy
Bloods show elevated CPK ( Creatine phosphokinase )
EMG shows myopathic motor unit potential and fibrillations)
Reduced sensory loss and absent reflexes can be seen
CN IX, X, XI. inv.
Pulsatile tinitus
( eg ; can hear heartbeating in ear)
Difficutly swallowing
Conductive hearing loss
What is your Dx
Glomus Jugulare Tumour
What are the features of Lacunar infarct Stroke (LACS)
LACS +ve; if any one of the following;
> Unilateral weakness ( and/ or sensory deficit). of face-arm , arm-legs, or all three
Pure sensory loss
Ataxic hemiparesis
What are the features of TACS ( Total ant. circulation syndrome) stroke
All three present ;
>Unilateral weakness ( and/or sensory loss ) of face, arm, legs
>Homonymous hemianopia
>Higher cerebral dysfunction (Dysphasia, visuo-spatial disorders)
Note:
PACS if 2/3 present
What is the criteria for POCS ( Posterior circulation Syndrome strokes )
if any one of the following ;
> Cerbellar or brainstem syndromes
Loss of consciousness
isolated homonymous hemianopia
Which nerve injury can be seen with hip dislocation and what can be the symptom
Sciatic nerve
Pt. can have foot drop
What are some of the key features of McArdles syndrome
Glycogen storage disorder
> Painful exercise
Muscle pan, stiffens, contractures
Myoglobinuria +ve ( borne urine )
post exercise : lactate is normal
Ix: Muscle Biopsy
How do you treat carotid artery dissection
Dual antiplatlet
No role of carotid endartectomy ( can worsen symptoms )
How do you treat restless leg syndrome
Pramipexole ( dopamine agonist)
Ropinirole
If symptoms worsen after starting above Tx, then switch to gabapentin, pregabalin
What is the difference between paroxysmal hemicranial ( Ice pick headaches) vs Cluster headache
Paroxysmal hemicrania has increased frequency (25-50) vs 1-4 in cluster
Hemicrania has shorter duration (2-25 mins) vs 10-60 mins
Mx: of hemicrania: indomethacin
( excellent repose)
vs high Flow O2 and intranasal triptan in Cluster
which hormone is elevated transiently after a Epileptic seizure
Prolactin
( when measured after 10-20 mins of seizure)
what is the best initial ix for MS
MRI head
when do you consider carotid endarterectomy
When “Internal carotid” stenosis in >50%
note: you do not do this for external carotid
What do you when someone has a TIA then on aspirin
Switch to clopidogrel x 75mg x OD
what do you need to consider when. a young pt. presents what stroke
Possible patent Foramen oval
( may be associated with atrial steptal aneurysm)
What are some of the causes of restless leg syndrome
Fe deficiency anemia , Hypothyroid, DM, COPD, CKD , Gastric Sx, PD, Chronic venous insufficiency, B-blocker,H2 anatagonists, Neuroleptics
What is the best Ix for duschen Muscular dystrophy
Genetic testing for dystrophin gene mutations
( mutation in the DMD gene)
What are the key features of hashimotos encephalopathy
Combination of neuro-psych symptoms, movement disorders, myoclonic encephalopathy.
Starting of myclonu son startling.
Cerbellar ataxia
TSH : high
Anti-TPO : +ve
Traumatic brain injury/ features»_space;> then followed by meningitis.
What is the possible Dx and Mx
Staph Aureus
Mx: Iv Linezolid
Alternative ( vanc)
What do you see in CMV meninoencephalitis
Mild elevation of CSF pressure
Elevated protein
“Elevated Lymphocytic pleocytosis”
Reduced Glucose
Bickertsaff encephalitis
Progressive, symmetric ophthalmoplegia, ataxia, disturbance to consciousness, and extensor plantar reposes +/- hyper-reflexia
Leg symptoms + visual symomts on BG of MS and MRI spine shows changes ( increased T2 signals)
Transverse myelitis
Mx:
Methylpred
What are some of the disorders associated with myasthenia
Thyrotoxicosis, hypothyroidism, RA, DM, Dermatomyosits, pernicious anemia, Thymic tumor
What are the common infections preceding GB syndrome.
Campylobacter, EBV, HIV, Influenza A, Mycoplasma, H. Influenza
Other infections that mimic GBS is ;
Diphtheria and Lymes
What is the Mx of absence seizures
Levetiracetam , Lamotrigine
NOTE: Carbamazepine actually worsens absence seizures
What is reversible cerebral vasoconstrictive syndrome ( RCVS)
Headache, focal neurological deficits
MRA - shows cerebral artery
vasconstriction
Common causes: Drugs that cause vasoconstriction ( Flu remedies - pseudoephedrine)
Triptan, amphetamine, cocaine, ecstasy , TAcrolius, cyclophosphamide, bromocriptine, adrenaline.
Mx:
Remove underlying cause and then control BP with CCB, labetalol
How do you differentiate inclusion body myositis and polymyositis
Polymysoits has Pain, rash, significant elevated CK
Whereas Inclusion body mystics, will not have pain and CK will be mildly raised to normal
Note: Both will have proximal muscle weakness
Which vitamin excess can cause increased risk of IIH
Vitamin A excess
Some other causes:
COCP, Phenytoin, dopamine agonists,
What is the first line mx for Juvenile Mycolonic Epilepsy
if <55 age
( Levetiracetam)
What are some of the risk factors for relapse of seizures of stopping anti-epelitc meds in someone with epilepsy when considering possible relapse!
> Older age at diagnosis
On multiple ani-epileptics
If the Pt. has Tonic -clonic or myoclonic type for seizures
Prev. abnormal imaging or EEG
What is the difference between
SMA1 and SMA3
( Spinal muscle atrophy)
Autosomal recessive
SMA1- death at birth or immediately after
SMA3- Progressive lower motor weakness
present after age of 18months
can have normal life expectancy
proximal ,muscle weakness
bulbar weakness later in life - end to recurrent chest infection. and swallowing issues
Which muscle group is affected in winging of scapula
Seratus Anterior
Retinitis pigmentosa
Opthalmoplegia
ptosis
Cardiac conduction defects
cerebellar ataxia
What is your Dx?
A Kearns-Syre Syndrome
(mitochondrial disorder)
Retinitis pigmentosa
Deafness
ataxia
Neuropathy
What is your Dx?
refsum disease
( excess of phytanic acid)
how do you differentiate between Vertebral artery dissection and carotid artery dissection
✅ Carotid Dissection → Think Horner’s syndrome + ipsilateral headache
✅ Vertebral Dissection → Think occipital headache + brainstem signs (dizziness, ataxia, dysphagia)
what re the key feature of neuroleptic malignant syndrome (NMS)
🔑 MRCP Exam Clues
✅ Patient on antipsychotic with fever + rigidity → Think NMS
✅ Recent dopamine antagonist use or Parkinson’s drug withdrawal
✅ High CK & “lead-pipe” rigidity without clonus
What are the key difference between NMS and Serotonin syndrome
🧠 Mnemonic to Remember the Differences
🔹 NMS = “Neuroleptic Malignant Stiffness”
→ Stiff (rigidity), Slow (gradual onset), Severe CK rise
🔹 SS = “Serotonin Shaky Syndrome”
→ Shaky (clonus, tremors), Speedy (hyperreflexia, fast onset)
🔑 MRCP Exam Clues
✅ Patient on antipsychotics with fever + rigidity? → NMS
✅ Patient on SSRI with hyperreflexia + clonus? → Serotonin Syndrome
What is a key difference between CADASIL and MELAS
MELAS will have raised blood and LP lactate
What are the key differences between polymyositis and Inclusion body myosiits
🔑 Key MRCP Exam Clues
✅ Young patient, proximal weakness, high CK, responds to steroids? → Polymyositis
✅ Elderly patient, proximal + distal weakness, finger flexor involvement, normal CK, steroid-resistant? → Inclusion Body Myositis
unilateral weakness, ipsilater loss of vibration and proprioception
and contralateral pain/temp loss?
→ what is your dx
Think Brown-Séquard Syndrome!
Usually follows trauma
What EEG changes do you see in CJD
1 or 2 s triphasic sharp waves against Bg of depressed activity
What is the genetic defect in Myotonic dystrophy
Trinucleotide repeat disorder affecting DMPK gene
What are the keys differences between myopic dystrophy and Beckers muscular dystrophy
🔑 Key MRCP Exam Clues
✅ Patient with distal weakness, myotonia, cataracts, and arrhythmias? → Think Myotonic Dystrophy
( DMPK gene affected)
✅ Teenage boy with proximal weakness, calf pseudohypertrophy, and high CK? → Think Becker’s Muscular Dystrophy
( dystrophin gene affected)
what are the key features of myotonic dystrophy
difficulty releasing grip, distal weakness, cataracts, and testicular atrophy, Frontal balding
What is the ix of choice for Dx, MND
Nerve Conduction studies and EMG
NOTE:
NO role for muscle biopsy
Movement disorder
Behaviour changes
Cognitive impairment
+ve family history and family history of suicides
What is you r Dx
Huntington’s
Ix: genetic testing
Penetration with anticipation
What are the features of temporal lobe epilepsy
Focal seizures that may or may not evolve into generalized seizures.
Aura (preictal sensation): Patients may experience an aura before the seizure, which can include:
Déjà vu (feeling that something familiar is occurring)
Jamais vu (feeling that something familiar is unfamiliar)
Visual disturbances (flashing lights, shapes)
Auditory hallucinations (hearing sounds or voices)
Epigastric rising sensation (feeling of a “stomach rising” sensation)
Automatisms: Repetitive, involuntary behaviors during seizures, such as:
Lip-smacking, swallowing, chewing, or fumbling movements.
Postictal confusion: After the seizure, patients often feel confused or disoriented for minutes to hours.
Which artery is affected in Lateral medullary syndrome
Vertebral artery
Ipsilteral Horner
Ipsilateral Ataxia
Contra-lateral loss of pain and temperature
Where do you see temporal lobe atrophy
Alzheimers
What is the target BP in hemorrhagic stroke
SBP : 140
What is a key difference between Lance Adam Syndrome ( period of cerebral hypoxia ) and post ITU delirium
Both have;
Disorientation and some short term memory loss ;
But Lance Adam Syndrome has intentional myoclonus +++
Which sign is associated with Early onset Parkinson
REM sleep behaviour disorder
What are some of the common causes of absent ankle reflexes and upping plantars
Syringomyelia, MND, Clonus Medullaris, Fredricks ataxia ; Subacute degeneration of spinal cord, Tbao-parasesis form of tertiary syphilis
What are the key features of PSP
🔑 MRCP Exam Clues
✅ Frequent backward falls + vertical gaze palsy + poor levodopa response → Think PSP!
✅ Early postural instability + surprised facial expression + axial rigidity → PSP (NOT Parkinson’s)
What are the 📌 Key Features of Syringomyelia
- “Cape-like” Sensory Loss (Dissociated Sensory Loss)
✅ Loss of pain and temperature sensation in the upper limbs and upper chest (cape distribution)
✅ Preserved fine touch, vibration, and proprioception (because the dorsal column is spared) - Upper Limb Weakness (LMN Signs)
✅ Wasting & weakness of hand muscles (affects small hand muscles first)
✅ Absent reflexes in upper limbs (due to anterior horn cell involvement) - Lower Limb Spasticity (UMN Signs)
✅ Hyperreflexia, spasticity, and weakness in lower limbs (corticospinal tract involvement) - Neuropathic Symptoms
✅ Chronic neuropathic pain in the neck, shoulders, or arms
✅ Horner’s syndrome (if the syrinx extends to the sympathetic chain) → Ptosis, miosis, anhidrosis - Bladder & Bowel Dysfunction (Late-stage)
✅ Urinary retention or incontinence
✅ Constipation - MRI Findings
✅ Syrinx (fluid-filled cavity) within the spinal cord
✅ Often associated with Chiari malformation (cerebellar tonsillar herniation)
🔑 MRCP Exam Clues
✅ Young patient with progressive hand weakness + dissociated sensory loss + absent reflexes? → Think Syringomyelia!
✅ “Cape-like” pain and temperature loss + upper limb LMN + lower limb UMN signs → Classic for Syringomyelia
What do you see in subdural empyema
Usually precede from a frontal / ethmoid sinus infection ( Streptococci - most common) followed by staph , E.coli, Proeteus ; pseudomonas
What are the key features of mitochondrial myopathic syndrome
Common Mitochondrial Myopathy Syndromes
MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes)
Stroke-like episodes, seizures, lactic acidosis, short stature, diabetes
MERRF (Myoclonic Epilepsy with Ragged Red Fibers)
Myoclonus, epilepsy, ataxia, sensorineural hearing loss, ragged red fibers
Kearns-Sayre Syndrome (KSS) Progressive external ophthalmoplegia, ptosis, pigmentary retinopathy, heart block
Leigh Syndrome Infantile-onset, progressive neurodegeneration, brainstem & basal ganglia involvement, lactic acidosis
Pearson Syndrome Severe infantile anemia, pancreatic insufficiency, failure to thrive
What are the key features of lateral medullary syndrome
🔎 MRCP Exam Clues
✅ “Crossed sensory loss” (ipsilateral face + contralateral body) → Think lateral medullary syndrome
✅ Dysphagia, hoarseness, loss of gag reflex → Unique to lateral medullary stroke (not seen in medial medullary syndrome)
✅ No limb weakness → Motor pathways (corticospinal tract) are spared!
PICA ( post inf. cerebella artery affected)
What are the key features if sciatic nerve palsy
🔑 MRCP Exam Clues
✅ “Foot drop + weak plantarflexion + absent ankle jerk + posterior leg sensory loss” → Think sciatic nerve palsy
✅ “Foot drop with sensory loss over dorsum of foot only” → Think common peroneal nerve palsy (not full sciatic)
✅ “Sciatic nerve injury after hip replacement surgery” → Common iatrogenic cause
Sciatic nerve ( L4- S3)
What is the key difference between ;
acid maltase deficiency (Pompe disease) and Hypokalemic periodic paralysis
Clues for MRCP:
Pompe Disease:
“Infant with heart failure, enlarged tongue (macroglossia), hypotonia, and cardiomegaly” → Pompe disease (acid maltase deficiency).
“Adult with progressive proximal muscle weakness but no significant cardiac involvement” → Late-onset Pompe disease.
Key tests: Enzyme assay, genetic testing, and muscle biopsy showing glycogen accumulation.
Hypokalemic Periodic Paralysis:
“Young adult with episodic muscle weakness/paralysis (especially after exercise or high-carb meals)” → Hypokalemic periodic paralysis.
Key tests: Serum potassium levels, EMG showing reversible depolarization.
Which juice can affect statins and lead to worsening of its affects and rhabdomyolysis
Grapefruit
Which drug is given post ( berry) aneurysm surgery to reduce morbidity
Nimodipine ( CCB)
What medication can be used in Periodic hypokalmic paralysis
Acetazolamide
Note: can also use potassium sparing diuretics
What is Bells palsy featurs and mx
LMN of face
But no other focal neurology
if presents within 72 hrs;
Oral pred + Eye Taping
what can you use as a bridging medication when you are stopping/ tapering down meds that cause medication over-use headache
Naproxen
What do you suggest someone with. glycogen storage disorder with recurrent fasting hypoglycaemia’s ( Von Gierke disease) have to reduce frequency
( hypos between meals)
Frequent small meals with cornstarch supplementation ( provides slow and steady release of glucose )
What is the diagnostic test for McArdle disease
Muscle Biopsy
What is the key finding in anterior spinal cord syndrome
Supplies ant. 2/3rd of spinal cord
> Complete more paralysis below the lesion
Pain and temperature loss
But vibration and proprioception is intact
Corticospinal affected, Spinothalamic affected, but dorsal columns preserved
what do you see in neuralgia paresthetica
Neuralgia Paresthetica is caused by compression of the lateral femoral cutaneous nerve, leading to burning pain, tingling, and numbness in the outer thigh. It is typically aggravated by prolonged standing, sitting, or tight clothing.
Deep palpation below ASIS reoroduces pain
Risk factors; Obesity, tight pants, tight belt
what is the MRI finding you see in neurocystesercosis
Calcified cysts - multiple
what is the mx of CIDP
High dose pred or immunoglobulin
What are the key features of multifocal motor neuropathy
just one limb affected
Weakness and wasting seen
( weakness if profound an disproportionate to wasting)
Pure motor
No sensory deficits
Fasiculations be +ve
Nerve conduction shows- patchy block of never conduction
would you prefer EMG or Nerve Conduction studies for Diagnosing Myasthenia
EMG
Note: in myasthenia, nerves are normal, so no role for nerve conduction studies
What is a big risk factor of hemorrhagic transformation of an ischaemic stroke
if NIHSS score >15 at initial presentation
