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RACP > Neurology > Flashcards

Neurology Flashcards

1
Q

Pathogenesis of MS

Cells Effected in MS

A

Multifactorial

  • Inflammation
  • Demyelination
  • Axonal degeneration

Mostly effecting Oligodendracyte

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2
Q

Diagnosis of MS

A

MacDonald Criteria

  1. Separation of Time
    - >2 clinical neurological events @ different time intervals
    - Separated on MRI gadolinium scan
  2. Separation of Space
    - >2 different clinical neurological features
    - >2 lesions on MRI in deferent areas
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3
Q

Subtypes of MS

A
  1. Relapsing and remitting
    - 90%
    - Return to some residual deficit
    - F > M
  2. Secondary progressive
  3. Primary Progressive
    - 10%
    - M > F
  4. Progressive Relapse
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4
Q

Treatment of MS

- limited head to head studies

A

Interferon
- monitor LFTs
- Flu like symptoms
#

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5
Q

Dx of MS

A

oligoclonal bands in the cerebrospinal fluid

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6
Q

syringomyelia

A

Cyst in the middle of spinal cord

White T2 Image

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7
Q

GBS

A

Campylobacter jejuni

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8
Q

Aetiology of epilepsy

A
  1. Genetic: direct result of a known or presumed genetic defect that is the core symptom of the disor-der
  2. Structural or metabolic: structural or metabolic condition or disease that has demonstrated to be associated with a substantially increased risk of developing epilepsy
  3. Gentic: tuberous sclerosis or malformations of cortical development
  4. Aquired: stroke, trauma or infection
  5. Autoimmune
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9
Q

Epilepsy in elderly

Aetiology

A
  1. CVA
  2. Dementia
  3. Intracranial tumors
  4. Unknown one-third to half
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10
Q

Dystonia

A
  • Sustained or intermittent muscle contraction causing abnormal movements and/ or postures
  • Often repetitive
  • Twisting pattern
  • Worsened by voluntary action
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11
Q

Chorea

A
  • Involuntary movements limbs, trunk, neck or face; which rapidly flit from region to region Irregular pattern, unpreductable manner ‘no sense of abnormal muscle contraction’
  • Not repetitive
  • ?caudate nucleus & putamen
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12
Q

Myoclonus

A

Fast hyperkinetic disorder
Sudden increase in muscle tone
Focal, multifocal, segmental or generalised

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13
Q

Dyskinesia

A

Overactivity of movement

ie. Over treatment in Parkinsons (motor fluctuation)

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14
Q

Resting tremor

A

When the limbs are completely at rest

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15
Q

Postural tremor: when the arms are held up by the patient

A
  1. Kinetic tremor: during movement, may significantly worsen toward the end of
    movement
  2. Intention: coarse terminal tremor when limb approaches a target
  3. Action tremor: postural + kinetic
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16
Q

Essential tremor

A
  • Bilateral, mildly asymmetrical involving the hands and forearms
  • May have concomitant head and jaw tremor
  • Can be at rest but posture predominant
  • Slow progression
  • Begins 60’s
  • ETOH improves
    Family history - 30-50% familial form
    Treatment (May not require treatment)
  • First line: propranolol & primidone
  • Second line: clonazepam, topiramte, gabapentin and nimodipine
  • Others: botulinum toxin & DBS
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17
Q

Physiologic tremor

A
  • Bilateral symmetrical
  • Onset any age
  • Worsened by anxiety & fatigue
  • No family history
  • Possible identification of enhancing cause
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18
Q

Dystonic tremor

A
  • Irregular and jerky oscillatory

- Other signs of dystonia

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19
Q

Phenytoin

A
  • 90% bound to albumin
  • 10% free
  • Free is important to levels - active
  • only need to change dose if symptomatic
20
Q

Stroke management

A

1.

21
Q

Migraine

A 
# acute: triptan + NSAID or triptan + paracetamol
# prophylaxis: topiramate or propranolol
- if 2 or more attacks per month
22
Q

Visual field defects:

A
  • left homonymous hemianopia means visual field defect to the left, i.e. lesion of right optic tract
    homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
  • incongruous defects = optic tract lesion; congruous defects= optic radiation lesion or occipital cortex
23
Q

Homonymous hemianopia

A
  • incongruous defects: lesion of optic tract
  • congruous defects: lesion of optic radiation or occipital cortex
  • macula sparing: lesion of occipital cortex
24
Q

Homonymous quadrantanopias*

A
  • superior: lesion of temporal lobe
  • inferior: lesion of parietal lobe
  • mnemonic = PITS (Parietal-Inferior, Temporal-Superior)
25
Q

Bitemporal hemianopia

A
  • lesion of optic chiasm
  • upper quadrant defect > lower quadrant defect = inferior - chiasmal compression, commonly a pituitary tumour
  • lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
26
Q

Cataplexy

A

sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened). Around two-thirds of patients with narcolepsy have cataplexy.

27
Q

Eclampsia

A
  • condition seen after 20 weeks gestation
  • pregnancy-induced hypertension
  • proteinuria
    Mx
  • IV Magnesium Sulphate (to prevent and treat seizures
  • Fluid restriction - prevent fluid overload
28
Q

Bells Palsy

A
  • LMN - affects forehead
  • Often associated with pain around the ear (Ramsey-Hunt syndrome), altered taste, dry eyes, hyperacusis
    Mx
  • Prednisalone
  • Aciclovir adds no benefit

Note UMN (Stroke) - spares forhead

29
Q

Myasthenia gravis

A
  • The key feature is muscle fatigability
  • Antibodies to acetylcholine receptors are seen in 85-90% of cases*
    Management
  • long-acting anticholinesterase e.g. pyridostigmine
  • immunosuppression: prednisolone initially
  • thymectomy
    Management of myasthenic crisis
  • plasmapheresis
  • intravenous immunoglobulins
30
Q

Guillain-Barre syndrome

A
  • immune mediated demyelination of the peripheral nervous system
  • Often triggered by an infection (classically Campylobacter jejuni).
    Management
  • Plasma exchange
  • IVIG - as effective as plasma exchange
  • No benefit in combining treatments
  • steroids and immunosuppressants have not been shown to be beneficial
  • FVC regularly to monitor respiratory function

Prognosis
- 20% suffer permanent disability, 5% die

31
Q

Subdural haemorrhage

A

Basics

  • most commonly secondary to trauma e.g. old person/alcohol falling over
  • initial injury may be minor and is often forgotten
  • caused by bleeding from damaged bridging veins between cortex and venous sinuses

Features

  • headache
  • classically fluctuating conscious level
  • raised ICP

Treatment
- needs neurosurgical review ? burr hole

32
Q

Epilepsy medication:

A

first-line

  • generalised seizure: sodium valproate
  • partial seizure: carbamazepine
33
Q

Tuberous sclerosis (TS)

A
  • is a genetic condition of autosomal dominant inheritance.

- Like neurofibromatosis, the majority of features seen in TS are neuro-cutaneous

34
Q

Dopamine receptor agonists

A
  • e.g. Bromocriptine, ropinirole, cabergoline, apomorphine
35
Q

Progressive supranuclear palsy

A
  • parkinsonism
  • impairment of vertical gaze
    Management
  • poor response to L-dopa
36
Q

Idiopathic intracranial hypertension

A

Classically

  • Obese
  • young female with headaches / blurred vision
37
Q

cholinesterase inhibitors

A
  • Only role is to improve some cognitive function and improvement in activities of daily living.
  • There is no role for cholinesterase inhibitors in advanced Alzheimer’s disease.
38
Q

Tremor

A
  • Difficulty in initiating movement (bradykinesia), postural instability and unilateral symptoms (initially) are typical of Parkinson’s.
  • Essential tremor symptoms are usually eased by alcohol. - Mx by propranalol
39
Q

acoustic neuroma

A

Classically

  • Loss of corneal reflex
  • Hearing loss
40
Q

Motor neurone disease

amyotrophic lateral sclerosis

A
  • mixture of upper and lower motor neurone signs
  • normal sensation
    C9ORF72 is associated with an autosomal dominant inheritance of motor neurone disease and frontotemporal dementia

Mx (Riluzole)

  • prevents stimulation of glutamate receptors
  • prolongs life by about 3 months

FXN is the gene for Friedreich Ataxia

41
Q

Vertigo

A
  • Viral labyrinthitis typically causes constant symptoms of a shorter duration.
  • Meniere disease usually have associated hearing loss and tinnitus. Also, the vertigo associated with Meniere disease typically lasts much longer
42
Q

Normal pressure hydrocephalus

A

Classically

- Urinary incontinence + gait abnormality + dementia

43
Q

Von Hippel-Lindau syndrome

A
  • Retinal and cerebellar haemangiomas are key features

- Retinal haemangiomas are bilateral in 25% of patients and may lead to vitreous haemorrhage

44
Q

Normal pressure hydrocephalus

A

Classical triad

  • urinary incontinence
  • dementia and bradyphrenia
  • gait abnormality (may be similar to Parkinson’s disease)
45
Q

Neglect in Stroke

A

often contralateral stroke of parietal lobe

46
Q

Medication to improve severe motor deficits post stroke

FLAME Trial - The Lancet Neurology. 2011. 10(2):123-130

A
  • fluoxetine
  • initiated 5 to 10 days after stroke onset
  • in addition to conventional physiotherapy
  • improves motor recovery in patients with moderate to severe motor deficits due to ischemic stroke.
47
Q

Meniere disease

A

Triad

  • episodic vertigo
  • sensisorineural hearing loss
  • tinnitus

RACP (15 decks)

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