Neurology Flashcards
Features of essential tremor
Essential tremor (previously called benign essential tremor) is an autosomal dominant condition which usually affects both upper limbs
Features
➡️5-10hz (Parkinson’s 3-5hz)
➡️Always bilat
➡️postural tremor: worse if arms outstretched
➡️improved by alcohol and rest
➡️most common cause of titubation (head tremor)
➡️No micrographia
Management
➡️propranolol is first-line
➡️primidone is sometimes used
Scoring system if previous TIA to predict stroke risk
Age >= 60 --------->1
BP >=140/90 ------> 1
Clinical features
Speech disturbance, no weakness --->1
Unilat weakness ---->2
Duration 10-59min ---->1
>60min ------>2
Diabetes --------------->1
0-7
>4 is high risk
Management from abcd2 scores
High risk >4 300mg aspirin daily immediately Specialist assessment and investigation within 24hr below 4 assessment within 1wk
but if 2 TIAs or more in a week, then HIGH RISK
OSCES description of Parkinson’s
Parkinson’s disease is a progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra.. This results in a classic triad of features: bradykinesia, tremor and rigidity. The symptoms of Parkinson’s disease are characteristically asymmetrical.
Drug induced Parkinson’s vs Parkinson’s disease
Drug-induced parkinsonism has slightly different features to Parkinson’s disease:
➡️motor symptoms are generally rapid onset and bilateral
➡️rigidity and resting tremor are uncommon
Symptom presentation of Parkinson’s disease indicating prognosis (from Majeed teaching)
PD has a Better prognosis if in a woman (about twice as common in men), or if presents with tremor symptoms first
There is a Worse prognosis if presents with rigidity first
Presenting symptoms of MS
Commonest presenting symptoms (nearly all have fatigue too)
➡️Limb weakness 40%
➡️Optic neuritis 22% (classically greying monocular visual loss with colour desaturation and painful eye movements -this often precedes visual loss)
➡️Parasethesia 21%
➡️Diplopia 12%
➡️Vertigo 5%
➡️Trigeminal neuralgia 2% (rarely presenting complaint but is seen more in MS patients)
What is Uhthoff’s
Seen in MS. Specifically visual loss after exercise (but often just referred to as after any heat, eg hot bath)
Previous optic neuritis causing heat dependent visual loss
What is L’Hermittes?
Symptom seen in MS
➡️Electrical shock paraesthesia down limbs when stretch
➡️Due to previous demyelination of cervical cord, so they become mechano-sensitive
Definition of relapse in MS
(?check)
New neurological disturbance which lasts longer than 24 hrs (they usually last 6wk)
Diagnosis of MS
At least TWO neurological events separated by time and space
So➡️ exclude mimics (sarcoidosis, hiv, lupus)
➡️ MRI looking for dawsons fingers, ventricular dilation, cerebral atrophy
➡️ LP with inflam, oligoclonal bands (positive in95%, not specific)
➡️ visually evoked potential, look for delay
Signs of cerebellar damage
Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
Peripheral neuropathy
Alcohol B12 Chronic renal failure Diabetes and drugs (tb meds etc) Every vasculitis Cancer (paraneoplastic), lymes and Charcot Marie tooth
Who needs ct head after head injury?
If any of the following are present, a CT is required immediately:
➡️GCS once
Loss of consciousness AND any of the following:
➡️Age ≥65
➡️Coagulopathy
➡️’Dangerous mechanism of injury’, eg car crash or fall from great height
➡️Anterograde amnesia of >30min
When might you get ‘claw hand’? And what other signs?
Ulnar nerve palsy (claw hand is due to loss of lumbrical innervation)
Weak pincer grip
Loss of sensation on fifth finger and ulnar half of fourth finger
Wasting of first dorsal interosseous muscle
Causes of carpal tunnel syndrome…
Rheumatoid arthritis Acromegaly Pregnancy Idiopathic Diabetes Trauma Tenosynovitis of flexor tendons Thyroid (hypo)
