Neurology Flashcards
GBS:
Sensory loss (–)
Ankle reflex (–)
ANS involvement (+)
Joint position/vibration (reduce)
NCS - abnormal by day 10
Wilson Dz
Neuro Signs
(behaviour change, parkinson, tremor, ataxia, dystonia)
Family Hx Liver Dz(+)
Most accurate Test: 24 hr urine Cu++
Most rapid Dx sign: KF ring
Idiopathic intracranial HTN
Dx ?
Rx ?
other features ?
LP (Dx + Rx)
sudden onset headache (worse in morning/increase with cough)
Rx: Weight loss, BP 140 labetalol
Rule out cerebral venous sinus thrombosis
6th CN palsy: False localizing sign
Myotonic dystrophy Type1
Myotonia (problem opening eyes)
difficult to release hand grip quickly
Distal limb involvement
mild intelectual impairment
DMPK gene defect
worse in cold
B/L cataract
B/L ptosis
cardiomyopathy, conduction defects
Myasthenia Gravis
cold improves NMJ transmission (ice-pack test)
MG vs LEMS ?
ANS dysfunction (–) in MG
ANS dysfunction (+) in LEMS
(ANS = dry mouth/erectile dysfunction)
B12 deficiency
Dx features ?
SCD
Demyelination of
1) Spinocerebellar
2) Corticospinal
3) Dorsal column
……………………………
Features:
Ataxia,
paresthesia,
impaired joint position/vibration.
MND
Most imp feature ?
Sensory Loss (Negative)
Temporal lobe epilepsy
features ?
Deja Vu
epigastric sensation -
loss of consciousness
Oral automatism (lip smacking)
CJD
features ?
Progressive mental decline (100%)
Myoclonus/movement disorder (100%)
cerebellar signs (70%)
pyramidal (60%)
extra-pyramidal signs
behaviour problem (55%)
visual changes
……………..
Dx - MRI late stage = cerebral atrophy,
CSF = increase protein, increase IgG
skull injury
Rx ?
staph
flucloxacillin + Genta
(linezolid - variable effects)
Nocturnal seizures
Features ?
Dx ?
stupor
incontinence
post-event drowsiness
headache
muscle pain
+/- severe learning disability
lack of sleep/TV - trigger attack
………………………
Dx - EEG
Paragangionoma
Features ?
pulsatile tinnitus (conductive hearing loss)
CN 10, 11, 12 palsy
Hypoglossal tumor
Features ?
CN 12 palsy
Acoustic neuroma
Features ?
CN 5 to 8 palsy
Mitochondrial disorder
features ?
ataxia
deafness
epilepsy
Eye movement problem
DM
holmes-adie pupil
Features ?
large, irregular, sluggish reactive pupil
DTR (-)
Accomodation (N), visual acquity (N)
Tertiary syphilis
features ?
memory impairment
gait ataxia
Brown sequard syn:
Features ?
Ipsilateral
*vibration/propioception
*hypertonia/hyperreflexia
*weakness
extensor plantor
……………
contralateral
pain/temperature
……………………
segmental anesthesia
*at level of lesion
stroke prevention
medications ?
clopidogrel
atorvastation
perindopril (BP Mx)
carotid endarctectomy
absolute c/i ?
asymptomatic complete carotid occlusion
Post-TIA/Stroke
Rx ?
dual anti-PLT 3weeks
long term clopidogrel
early parkinson feature ?
REM Sleep behavior disorder
Lewy body dementia
Rx ?
pyridostigmine (ACh inhibitor)
drug worsening psychotic/behavior problem in parkinson ?
Ropinarole (D agonist)
inclusion-body myositis
Features ?
progressive, painless, late-onset muscle weakness
wasting of forearm flexor/quadriceps
CK - High
solitary, 1 unprovoked seizure
DVLA ?
6 months off driving
MELAS
Features ?
DM
Short stature
proximal myopathy
stroke-like event
MRI - Multiple cortical lesion
CADASIL
Features ?
Migraine with aura
family Hx Migraine/early dementia
stroke-like episode
Typical MRI findings
Botulism
features ?
*ophthalmoplegia (blurred vision)
*descending paralysis (CN - Arm - leg)
*severe cases - resp failure
features < 48 hrs food poisoning
Tourette syn
Rx ?
haloperidol (D2 receptor blocker)
miller-fischer syn
Dx ?
features ?
Anti-GQ1b
ophthalmoplegia
areflexia
ataxia
………………..
*if cognitive impairment - Miller fischer is NOT dx
Lamber-Eaton Myasthenia Syn
Rx ?
3,4 Diaminopyridine
Argyl-Robertson pupil
Features ?
B/L occipital Cortical infarct
pt believes, he can see, but actually he can’t
trigeminal neuralgia
rule out ?
r/o structural lesion/MS causing demyelination as pt have decrease corneal reflex
Myotonic dystrophy
features ?
myotonia (impaired relaxation of muscle after voluntary contraction)
muscle atrophy (face, neck)
frontal bald
cataract
heart abnormality
hypogonadism
tardive dyskinesia
features ?
chronic dopamine blocking agents leads to involuntary movement
acute dystonia
s/e of metoclopramide
sagital sinus thrombosis
features ?
risk factors ?
headache, increase ICP, venous infarction, seizures
………….
risk factors - dehydrate/pregnancy
wernickie-enceph
features ?
risk groups ?
complications ?
delirium
ocular signs
ataxia
thiamine deficiency
hypoTN/hypothermia
……………..
risk groups ?
alcoholic
malnourished (hyperemesis gravidarum)
recent GI surgery
………………
failure to treat - chronic cognitive impairment (korsakoff syn)
cluster headache
Acute Rx ?
Prevention ?
high flow O2/sumatriptan
prevention - verapamil
Anterior spinal cord syn
(supplies anterior 2/3 spinal cord)
features ?
1)Corticospinal tract (motor paralysis)
2)Spinothalamic tract (loss of pain)
*Vibration=preserved (Dorsal column)
NPH
3 features ?
ataxia
cognitive impair
urinary incontinence
Lewy body dementia
features ?
Rx ?
parkinson + hallucination on up-titration of dopamine medicine
Rx - increase anti-parkinson medicine - s/e confusion/hallucination. Rx atypical anti-psychotic (risperidone)
Basilar A dissection
features ?
SAH symptoms
rare Dz
Progressive supra-nuclear pasly
features ?
Early falls
vertical gaze supra-nuclear palsy
involuntary eye closure/twitching
initially vague personality change (apprehension)
Multiple-system atrophy
ataxia
orthostatic hypotension
syncopal episodes
urinary symptoms
parkinson features - poor response to levodopa
ataxia telangiectasis
features ?
childhood ataxia
friedrich ataxia
features ?
teen-age
progressive ataxia
lower limb areflxia
plater - extensor
vibration/propioception - reduce
cardiomyopathy (70%)
DM, Deafness
Spinal muscular atrophy type3
Rx ?
Risdi plan (Dz modifying Rx)
Cerebellum tumor (hemangioblastoma)
features ?
h/o minor symptoms (Headache, lethargy) - leads to sudden deterioration (ataxia, obstruction, hydrocephalus)
corpus callosum lesion ?
inability to read written words
Amygdala (limbic system)
function ?
decision making
emotional response
memory
hippocampus (limbic system)
function ?
saving memory
1 of 1st part affected by alzheimer’s
TB meningitis
CSF protein - increase
lymphocytes - increase
glucose - decrease
+/- obstructive hydrocephalus
+/- CN palsy
cryptococcal meningitis
CSF protein - increase
CSF pressure - increase
h/o pnemonitis - weeks earlier
HIV (+)
Hydrocephalus
Coxsackie meningitis (aseptic)
entero-virus
CSF protein - less elevated
Glucose - Normal
CMV meningoencephalitis ?
CSF pressure - increase
lymphocytes - increase
protein - increase
glucose - decrease
MRI - ependymal enhancement
HSV encephalitis
drowsiness
mood changes
memory loss
mumpts meningoencephalitis
parotid swelling
LN enlarged
headache
confusion
Amylase - increase, epigastric pain
CSF - monocytosis, increase protein, Glucose Normal
Ropinarole
indications ?
D agonsit
Rx Parkinson, restless leg syn
decrease ON/OFF phenomenon (but no prognostic benefit)
restless leg syn
pramipexole > ropinarole
entecapone/selegiline
decrease motor fluctuations
use alongwith levodopa
carbamazepine
Rx trigeminal neuralgia
apomorphine
s/c pump, use in late stage dz
amantadine
mild anti-parkinson effect
clozapine
pt with auditory hallucination/suicidal attempt
