Neurology Flashcards
causes of myopathy
- Hereditary muscular dystrophy
- Congenital myopahties
- acquired (PACE PODS)
Polymyositis or dermatomyositis
Alcohol
Carcinoma
Endocrine( hypothyroidism, hyperthyroidism, Cushing’s syndrome, acromegaly, hypopituitarism)
Periodic paralysis (hyperkalaemic or hypokalaemic or normakalaemic)
Osteomalacia
Drugs ( chloroquine, steroids)
sarcoidosis
causes of mononeuritis multiplex (refers to separate involvement of more than one peripheral or rarely cranial nerve, e.g. a common peroneal nerve palsy plus an axillary nerve palsy)
- acute (usually vascular): a. diabetes mellitus, polyarteritis nodosa or connective tissue disease- SLE. rhematoid arthritis)
- chronic: a. multiple compressive neuropathies, b. sarcoidosis, c. acromegaly, leprosy, carcinoma(rare), idiopathic
causes of periphearl neuropathy
- drugs and toxins: vincristine, phenytoin, amiodarone, cisplatinum, isoniazid
2 Alcohol ( with or without vitsm b1 deficiency) amyloidosiis - Metabolic - diabetes, ureaemia, hypothyroidism, porphyria
- Immune-mediated - Guillain-Barre syndrome
- Tumour - lung carcinoma
- Vitamin B12 or B1 deficiency
- Idiopathic
- connectiv etissue disease or vasculitis - SLE , polyarteritis nodosa
- Hereditary
(DAMIT BICH)
common cause of a motor neuropathy
Guillain-Barre syndrome,
CIDP
drug (dapsone) /lead
porphyria
common causes of sensory neuropathy
Diabetes Alcohol Drugs (hydralazine, isoniazid, metronidazole, chloroquine) Infections (Lyme, HIV, Sarcoidosis Vasculitis Infiltration: Amyloidosis Paraneoplastic Kidney chronic disease (ureaemia) T: hypothyroidism Vitamn B12 deficiency
cause of autonomic neuropathy
Guillain-Barre syndrome Diabetes Paraneoplastic Porphyria HIV Deposition (Amyloidosis)
common causes of demyelinationg polyneuropathies
CIDP, multiple myeloma, MGUS, Poems, HIV, hereditory motor and sensory neuropathy, hereditary neuropathy with pressure palsy, multifocal motor neuropathy
common cuases of mononeuritis multiplex
Diabetes, polyarteritis nodosa, Granulomatosis with polyangiitis, Rheumatoid arthritis, SLE, Sjogren’s syndrome, Sarcoidosis, amyloidosis, carcinoma
causes of painful peripheral neuropathy
Diabetes mellitus Alcohol Vitamin B1 or B12 deficiency CArcinoma porphyria
causes of proximal weakness
Myopahty, neuromuscular junction disease, Neurogenic (motor neurone disease, )
Approach to cognitive impairment
ORA RLC
O rientation: year/season/month/day/date, country/state/city/hosptial/floor
R registration - window, basketball, tree
A attention- backwards from 100 by sevens, world
R recall
L language skill- repeat “west register street, naming two objects, obeying a three stage command, reading and writing a sentences
C construction copying two intersecting pentagons
Antiepileptic agents for
partial or generalised tonic clonic seizure
absence, myoclonic seizure,
second line treatment
partial or generalised tonic -clonic seizures _ sodium valproate, carbamazepine, phenytoin
Absence seizure - ethosuximide, sodium valproate
Myoclonic seizure- sodium valproate, lamotrigine, topiramate
Second - line therapy for partial and generalised tonic clonic seizures - topiramate, gabapentin, lamotrigine, levetiracetam
combination should be considered only after two sequential monotherapy attmpts with two different agents have failed.
carbamazepine and phenytoin can cause interstitial nephritis, two can cause induction of the hepatic cytochrome P-450 enzyme system, while valproate casues an inhibition of the same.
weakness : myopathy, neuromuscular junciton, lower motor neuron, , motor neuron
Upper: UL extension, LL flexion, non atrophy, no fac. inc.tone, inc. reflex, present babinski
LMN: distal ,segment wekness, severe atrophy, common fasci, dec. tone, dec. reflex, absent babinski
NJ: ocular, bulbar, proximal limb, non atrophy, non fasc, normal reflex, normal tone, absent babinski
Myopathy: proximal symm, mild atrophy, non fasc, nomrl or dec tone, normal or dec. reflex, absent babinski
What is ‘pyramidal distribution’ and why
(ie. upper limb has greater flexor strength relative to extensor strength and the opposite is true in the lower limb). With a corticospinal lesion, you get a spastic hard pyramidal paresis in the anterior muscles above T6 and posterior muscles below T6 ispilaterally. The PMRF (pontomedullary reticular formation) inhibits ipsilateral anterior muscles above T6, and ipsilateral posterior muscles below T6. Decreased FOF (freq. of firing) of the neurons in this pathway, like in functional deafferentation, pushes the central integrative state of involved alpha motoneurons toward facilitation. This = increased tone in a pyramidal distribution Extrapyramidal tract is inhibited and has lost its ability to perform its requisite inhibitory functions that modulate pyramidal influences. Inhibit an inhibitory function = movement/spasticity
what are symptoms and signs in dominant parietal lobe
dysphasia,
acalculia, agraphia, left- right disorientation
finger agnosia
AALF
what are symptoms and signs in non dominant parietal lobe
agraphaesthesia, sensory and visual inattention dressing and contrucitonal apraxia spatial neglect lower quadrantic hemianopia seizure
Temproal lobe dysfunciton
memory loss
upper quadrantic hamianopia
dysphasia (receptive if dominant lobe)
seizure
frontal lobe dysfunction
personality change primitive reflexes: grasp, pout optic nerve compression gait apraxia leg weakness loss of micturition control dysphasia (expressive), dysgraphia
occipital lobe dysfunction
homonymous hemianopea
alexia (inability to read, word blindness)
what are the causes of pseudobulbar palsy
Motor neurone diseae Multiple sclerosis bihemispheric vascular disease brainstem tumour trauma
What are the disorder of lower motor neurones (true bulbar palsy)
motor neurone diseae brainstem vascular diseae brainstem tumour guillain barre syndorme subacute menignitis poliomyelitis myastehnia graivs
whach t are the common causes of cerebellar syndrome
demyelination - MS alcoholic cerebellar degeneration posterior fossa sapce occupying lesions brainstem lesions paraneoplastic cerebellar degeneration drugs: friedreich's ataxia arnold- chiari malformation
Lateral medullary syndrome
ipsilateral horner’s syndrome
ipsilateral cerebellar signs
ipsilateral V, iX, X, and Xi nerve signs
contralateral spinothalamic signs (below the lesion)
“crosing “ of weakness or sensory disturbance is highly suggestive for a unilateral brainstem syndrome owing to crossing of corticospinal tract and spinothalamic sensory fibres causal to the mid-brainstems.
treatment of MS
general: urinary spasm(baclofen), urgency(amitryptilline), tics(carbamazepine), intention tremor( propranolol, clonazepam)
immunomodulators: Interferon beta, glatiramer acetate, natalizumab, sphingolimod
managment of realpse:methylpred, ivig, plasmapharesis)
