Neurology Flashcards
What type of signs does MS give? Upper or Lower?
UMN signs
(MS) How is vision effected?
Washed out colors, especially red.
Nystagmus.
(MS) What lesions can you see on an MRI?
Periventricular lesions in CORPUS CALLOSUM.
(MS) What can a lumbar puncture show?
Oligoclonal Bands
Useful in differential diagnoses, SLE and Sjogren’s (increase in cells WBCs?)
Test antibodies
(MS) How do you treat relapses?
Maintenance treatment?
IV methylprednisalone
Beta-Interferon and Azothioprine
Can treatment slow progression?
No, it may decrease relapses however.
What is the differential for Parkinson’s disease?
Ideopathic PD Wilson's Multiple System Atrophy (MSA) Drug induces Progressive Supranuclear Palsy (PSP) Corticobasal Degeneration (CBD) Frontotemporal Dementia (FTD) Vascular Tumours/SOL Repeated head injury MPTP drug use Magnesium poisoning
Drugs used in PD?
Dopamine Agonists (apomorphine, rapinerol)
Levodopa
COMT inhibitors
MAOi (A and B) (A=anti-depressant; B=PD) (Tyrosin cheese reaction is a side effect)
Deep Brain Stimulation (DBS)
Acetly Choline inhibitors (v. bad side effects hallunicaitons, confusion)
Treatment should start once ADL are effected.
What are the main features of PD?
T - (resting pill rolling) tremor
R - cog wheel rigidity
A - akinesia/bradykinesia (short shuffling gait, fatiguing small movements)
P - postural instability
What can you look for on examination to rule our potential differentials?
Cerebellar signs (CBD)
Are signs bilateral (if +ve then prob PD plus)
Eye movements (PSP has decreased vertical movements)
Kayser–Fleischer rings - Wilson’s
Signs in lower limbs? - Vascular
SOL - check eyes for papilloedma
MSA patients will have autonomic problems such as post. hypotension and sinus arrhythmia (breathing in and out)
Risk factors for stroke?
HTN
Cardiac disease: arrythmias, enlargement, failure
Diabetes
Heredity
Blood lipids, cholesterol, smoking, diet/obescity
Race
Oral contraceptives
Levels of cerebral blood flow (ml/100g/min) produce which events?
20 - electrocortical function affected
15 - electrical failure
10 - ion pump failure
<10 - death
Classification of the subtypes of cerebral infarction:
TACS (Total Ant Circulation Syndrome)
Motor and sensory deficit
Hemianopia
Higher function disturbance (dysphasia)
PACS (Partial Ant Circulation Syndrome)
2 of the above or isolated cerebral funciton disturbance
POCS (Post Circulation Syndrome)
Signs of brainstem dysfunction
Isolated hemianopia
LACS (Lacunar Ant Circulation Syndrome) Pure motor stroke or Pure sensory stroke or pure sensorimotor stoke or hemiparesis
Investigations?
- Confirm Dx:
CT scan - ID site of primary lesion:
US of extra-/intracranial vessels
Transthoracic cardiac US (esp in young: structural defect)
MRA/CTA
DSA (digital intravernous subtraction angiography)
3. ID factors influencing treatment: CXR ECG Blood glucose Serum lipids/cholesterol ESR/antibodies - vasulitis causing disorders FBC - thrombocytopenia/polycythemia INR Drug Hx
Management?
Ensure adequate oxygen and glucose supply. Hydration, oxygenation, BP, glucose all v important.
Thrombolysis: give within 4.5 hours (NICE g’s) of ant stroke
Assess swallow for apsiration pneumonia
Early mobilisation
Prevention of further stroke
What deficiency causes Wernicke Korsakoff syndrome?
Thiamine
Symptoms of Wernicke’s (acute)?
Abdormal eye movements (horizontal and vertical nystagmus) and conjunctival haemorrhage
Ataxia
Confusion
Symptoms of Korsakoff’s psychosis (chronic)?
Selective impairment of short term memory
Confabulation
Treatment of WK syndrome?
IV Pabrinex immediately
First line treatment in idiopathic generalized epilepsy?
Diazepam PR 20mg
How can you differentiate Bell’s (ideopathic ) from other causes of facial nerve palsy?
Bell’s palsy can display a symptom of hypersensitivity to sounds
What are the features of benign essential tremor?
Both hands usually effected
Fine action tremor
Made worse by: stress, difficult tasks, caffeine, cold
Made better by: Beta-blocker, alcohol
What are the symptoms/signs of benign intracranial HTN?
Gradual presentation
Normal MRI
Increased ICP
Strong link with obesity
What type of Sz is Jacksonian?
Partial - when a simple foal sz spreads from a distal part of the limb towards the face, ipsilaterally.
What are the functions of the Facial Nerve?
Sens: Taste Ant 2/3 (chrodae tympani)
Motor: Muscles of facial expression
Parasym: Submandibular and sublingual glands
What is a common side effects of anticonvulsants?
Ataxia
What should always be considered in an epileptic with recurrent seizures?
Patient adherence to medication - you can check blood levels of phenytoin for example
How do patients with primary generalised epilepsy present post-ictally?
Drowsy, low GCS
First intervention in someone with comprimised airway?
Jaw thrust and head tilt/chin lift (no in trauma/?C spine injury)
This type of head injury results in a lucid phase but will present acutely…
Extra-dural - these present acutely unlike sub-dural which can take weeks/months to declare themselves
