Neurology 2 Flashcards
When to do surgery in ICH?
Cerebellar hemorrhage > 3cm, Brainstem compression
Hydrocephalus
What is rule of 0,3,6,12 rule?
Restart NOAC after 0 days - TIA 3 days - small infarct 6 days - medium infarct 12 days - large infarct
Dabigatran compare to warfarin?
Lower ICH risk but higher GI bleeding risk
Dabigatran, Rivaroxaban compare to warfarin?
apixaban compare to warfarin?
Lower ICH risk but higher GI bleeding risk
Lower ICH/GI and all bleeding risk - superior to warfarin
In embolic stroke of unknown source ? (ESUS)
Use only aspirin. The rest not beneficial
Raedar syndrome?
Ipsilateral trigeminal sensory deficits + Partial horner ( without anhidrosis)
+
Headache mimic trigeminal cephalagia
Why partial horner’s syndrome?
The sweat glands travel together with external carotid artery ( which is not affected)
Pathophysiology of Raedar syndrome?
Lesion in internal carotid artery compressing sympathetic ganglion + it’s pathway
Multiple sclerosis - pathophysio?
B cell mediated - trigger B/T cells towards specific antigen
- lead to axonal loss/astrocyte gliosis
- then re-myelination
Majority of Optic neuritis location?
Retrobulbar - so no optic disc swelling
Oligoclonal bands in CSF are what type of Ig]?
IgG
Strong predictor of MS?
Oligoclonal bands and CIS
Older Men, spinal cord lesions likely to have one pattern of MS?
Primary progressive MS
Which approach treatment better for MS?
Intensive/induction therapy
- less disability
- more time spent in Single PMS time
Glatiramer Acetate mechanism of action in MS?
Act as altered MHC II - stimulate Treg cells
Side effect of Teriflunomide?
Hair thinning/ GI upset/ Teratogenic
Dimethyl fumarate mechanism of action in MS?
Commonest side effect?
Activate Nuclear factor erythroid 2 - Nrf2 transcriptional pathway ( protective) - reduce lymphocytes
diarrhea - commonest
PML!
Similarity of Natalizumab and Fingolimod?
Rebound post cessation of therapy
Fingolimod extremely high risk of what side effects ?
First dose - bradycardia
Macular oedema - OCT every 6 months
Varicella zoster re-activation
JC virus does what?
When virus titre consider high risk?
Attack oligodendrocytes - so demyelination
> 1:5
PML treatment?
Pembrolizumab - use for BK virus as well
Alemtuzumab known to cause what autoimmune disease?
Graves disease
ITP
Best MS treatment in reducing relapse?
Natalizumab
Best Primary progressive MS + Oligoclonal bands in CSF treatment?
Ocrelizumab
Best Secondary progressive MS treatment?
Best Relapse Remitting MS treatment?
Siponimod ( 2nd generation fingolimod)
Ofatumomab
Aggressive secondary progressive MS treatment?
Known side effect of this treatment?
Mitoxantrone ( chemo - inhibits B/T cells)
Cardiac toxicity - don’t use if EF < 50%
Drugs in MS treatment - avoid in pregnancy?
Teriflunomide
Dimethyl fumarate
Fingolimod
Rituximab/Ocrelizumab - not to use in 2nd/3rd trimester
MOG antibody found in what disorder?
Recurrent bilateral ON
ADEM
Treatment for NMO?
Inebilizumab (anti-CD19) - mainly targets plasma cells/plasmablasts
Eculizumab
Satralizumab (IgG bind to IL6)
What is Valproic-acid role in patient with encephalopathy?
Risk factors?
Induce hyperammonaemia = causing cerebral oedema
Sodium valproate inhibits glutamate - can’t metabolise nitrogen
risk factor = Urea cycle disorder, topiramate
