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Neurology Flashcards

1
Q

Mean onset of Parkinson’s

A

45-60

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2
Q

Pathology of Parkinson’s

A

Loss of dopaminergic neurons in the basal ganglia - substantia nigra. Surviving nuerons have aggregations of protein (a-synuclein) called Lewy bodies

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3
Q

Course of Parkinson’s

A

Slowly progressive disease with degeneration of neurons, without remission. 10-15 years

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4
Q

Triad of symptoms in Parkinson’s

A

Bradykinesia, tremor and rigidity (cogwheel). Power and sensory remain normal

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5
Q

Describe the gait seen in Parkinson’s

A

Slow shuffling steps, reduced arm swing, difficult to get started, stopped, narrow based

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6
Q

Other symptoms of Parkinson’s

A

Slow monotonous speech, mask like face, reduced blinking, agnosia, depression, dementia, hallucinations, violent dreams, handwriting smaller and spidery

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7
Q

Which drugs can cause Parkinson’s symptoms

A

Dopamine antagonists - Neuroleptics, metoclopramide, phenozanthines

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8
Q

Drug treatment of Parkinson’s

A

Levodopa - precursor of dopamine that can cross the BBB, short half life so usually given with carbidopa to prolong this

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9
Q

Side effects of l-dopa

A

Decreased efficacy over time, psychosis, compulsive behaviour, nausea, dyskinesia

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10
Q

Other drugs used in Parkinson’s

A

Amantadine - adjunct to ldopa

Anticholinergics - in pts on antipsychotics

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11
Q

How do you distinguish migraine from TIA

A

TIA - sudden onset, maximum deficits immediately, headache rare

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12
Q

Causes of migraine

A 
Chocolate
Hangover
Orgasm
Cheese/caffeine
Oral contraceptive
Lie ins
Alcohol
Travel
Exercise

Stress, puberty, menstruation, pregnancy

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13
Q

Clinical features of migraine

A

Visual aura - lines, scotoma, techopsia, 15-60 mins, reduced blood flow to occipital cortex
Throbbing, photophobia, unilateral, nausea and vomiting, heightened pain, no neuro signs

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14
Q

Pathology of migraines

A

Dilation and construction of cerebral vessels

Oligaemia causes aura then hyperaemia causes pain

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15
Q

Treatment of migraine

A

Analgesia, antiemetic if needed
Anticonvulsants eg lamotrigine
rebreathing into paper bag

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16
Q

Prophylaxis of migraine

A

Pizotifen, propranolol, amitriptyline

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17
Q

Tension headache

A

Bilateral, pressure throbbing, rubber band, no neuro signs, no vomiting. Caused by stress, fumes, visual stress

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18
Q

Cluster headache

A

M:F 5:1, episodic intense unilateral pain often behind eye for 30-90 mins. Wakes up from sleep, lacrimation and bloodshot

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19
Q

Treatment of cluster headache

A

100% oxygen, s/c sumatriptan

Prophylaxis verapamil, corticosteroids

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20
Q

Temporal arteritis

A

Inflammation of walls of arteries, vessels harden, pulse lost, scalp may be red.
Claudication of jaw, visual loss, scalp tenderness

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21
Q

Investigations in GCA

A

Raised ESR, low albumin, increased gamma GT, temporal artery biopsy - before or within 7 days of starting steroids
Intimal hypertrophy and inflammation

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22
Q

Treatment of GCA

A

Corticosteroids - prednisolone
Calcium and vitD while of steroids
Don’t use NSAIDS

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23
Q

Which disease if GCA associated with

A

Polymyalgia rheumatica

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24
Q

What is huntingtons disease

A

Autosomal dominant disorder that shows full penetrance

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25
Genetics of Huntington's
Defect in chromosome 4, Normal gene codes for glutamine, CAG repeats, 36-40 disease exists, 40+ full penetrance. Length of repeat determines disease severity and onset
26
Pathology of huntingtons
Cerebral and caudate nucleus/corpus striatum atrophy due to loss of GABA-nergic and cholinergic neurons
27
What would you see on imaging in HD
Squaring of ventricle edges - boxcar ventricles where caudate nucleus has atrophied
28
Presentation of HD
35-50, sporadic -> progressive | Chorea, agitation, dementia +_ seizures, death
29
What is chorea?
Involuntary short sharp muscle movements
30
Treatment of HD
Supportive, genetic testing for family, counselling | Antipsychotics can help reduce chorea and agitation
31
What is Guillain-Barré syndrome
Acute, inflammatory demyelination get polyneuropathy which typically comes on several weeks after a viral infection, also causes by HIV
32
Clinical features of Guillain Barre
Always motor and sometimes sensory, ascending symmetrical muscle weakness, buckle knees, progresses over 4 weeks, pain common, proximal muscles more affected, can affect cranial nerves and resp, autonomic signs
33
Pathology of GB
Viral infection causes production of autoimmune antibodies against peripheral nerves, myelin damaged leading to transmission reduced/blocked
34
Investigations and results in Guillain barre
LP - increased protein in CSF, WCC normal | Nerve conduction slowed
35
Treatment of Guillain barre
Intubate if necessary, maintain resp function, IV immunoglobulin, don't use corticosteroids, plasmapheresis removes antibodies
36
Mechanism of subarachnoid haemorrhage
Rupture of blood vessel/aneurysm, berry aneurysm
37
Mechanism of subdural haemorrhage
Bridging veins, trauma could be minor and months ago, acute and or chronic, often in elderly due to cerebral atrophy
38
Mechanism of extradural
Direct moderate/severe trauma, typically around the eye causing fracture of parietal or temporal bone resulting in laceration of middle meningeal artery/vein
39
Describe the pain in subdural haemorrhage
Sudden onset, painful, usually back of head
40
Describe the pain in subdural haemorrhage
Possible minor dull headache
41
Describe the pain in extradural headache
Likely severe pain but not sudden onset
42
Describe the difference in consciousness in different brain haemorrhages
Subarachnoid - impaired quickly Subdural - fluctuating over weeks/months Extradural - initial lucid period followed by impaired consciousness
43
Investigations and results in subarachnoid
CT shows star shaped bleed, LP xanthochromia in CSF (12 hours)
44
Difference on imagine between subdural and extradural haemorrhage
Subdural - crescent shaped, midline shift | Extradural - lens shaped, biconvex, LP contraindicated
45
Management of haemorrhages
Subarachnoid - clipping/cooking of aneurysm, nimodipine Subdural - Burr hole/craniotomy Extradural - surgery to evacuate blood and linage bleeding vessels
46
What is motor neurone disease
Progressive degeneration of motor neurons in the motor cortex and spinal cord, affecting upper and lower motor neurons
47
Features of amyotrophic lateral sclerosis
75% of cases, LMN and UMN in same muscle (fasciculations, wasting and hyperreflexia), progressive weakness and wasting of the limbs
48
Features of progressive bulbar palsy
Speech and swallowing problems, bulbar and pseudobulbar signs
49
Epidemiology of MND
5 per 100,000, male predominance, mean onset 60, 5 year survival from diagnosis <10%
50
Potential causes of MND
Aging, genetics, chemicals, biochemical - associated with hyperparathyroidism
51
Pathology of MND
Oxidative damage, aggregation of protein inside cell, glutamate problems, apoptosis, prolonged caspase activity
52
Clinical features of MND
``` Usually no pain Muscle weakness and wasting usually at extremities Fasciculations Cramps Dysphagia, dysarthria, choking Eye movements spared Reflexes lost/increased Dementia - frontotemporal NO SENSORY LOSS/SPHINCTER DISTURBANCE ```
53
Diagnosis and investigations in MND
Clinical diagnosis EMG - denervation and fibrillation Bloods - elevated CK due to muscle breakdown
54
Drug therapies in MND
Riluzole - increases survival by 3-5 months Baclofen - reduce spasticity Amitriptyline - helps drooling
55
What is myasthenia gravis
Acquired autoimmune condition
56
Which receptors do the antibodies attack in myasthenia gravis
Nicotinic Acetylcholine receptors (AChR)
57
Which muscles is mysathenia gravis likely to affect
Ocular, bulbar and proximal skeleton
58
What is a key symptom of myasthenia gravis?
Fatiguability
59
Which 2 groups of people are more susceptible to myasthenia gravis
Women 20-35 and men 60-75
60
Pathology of myasthenia gravis
IgG autoantibodies attack the post synaptic AChR receptor at the neuromuscular junction
61
What other pathologies is myasthenia gravis associated with
Diseases of the thymus - hyperplasia, thymoma
62
Signs and symptoms of MG
``` Crises and remittance Muscle fatigue and weakness Ocular - Ptosis, diplopia Bulbar - dysphagia, dysarthria Proximal - shoulders, thighs Axial - neck, trunk, resp ```
63
How can you elicit fatiguability
Ask the pt to repeat a movement for 30-60s Report that their symptoms get worse as day goes on
64
Is their sensory disturbance in MG?
No, and no muscle wasting unless sever disease
65
How do you test for myasthenia gravis
TENSILON test Edrophipnium - prevents breakdown of ACh and atropine to prevent cardiac s/e Within seconds dramatic improvement Serum ACh antibodies positive, other autoantibodies likely present Electromyography, CT/MRI thymus, spirometry
66
Management of MG
Pyridostigmine - oral anticholinesyersae inhibitor
67
What is Multiple Sclerosis?
An autoimmune inflammatory condition that affects the oligodendrocites of the CNS
68
Mean age of onset of MS
20-45, twice as common in females
69
What are oligodendrocites?
CNS equivalent of Schwann cells
70
Pathology in MS
Destruction of myelin and axonal loss. Macrophages cannot normally cross BBB but in MS they exhibit a glycoprotein allowing them to cross. Plaques are sites of inflammation - common at optic nerves, brainstem and cerebellar connections. Conduction loss causes symptoms
71
4 patterns of progression
Relapsing remitting Primary progressive Secondary progressive Progressive - relapsing
72
Clinical features of MS
Optic neuropathy, optic disc swelling Sensory signs Autonomic defects - urinary incontinence, constipation, sexual dysfunction Fatigue
73
What is Uthoff's phenomenon?
MS symptoms are worse in heat - bath, exercise, weather due to heat slowing conduction
74
What is Lhermitte's sign?
On voluntary flexing of the head there is electric sensation travelling down spine and into limbs
75
Investigations and results in MS
MRI - definitive - plaques Visual evoked potential - delayed response Oligoclonal bands on CSF
76
Diagnosis of MS
Lesions disseminated in time and place
77
Acute management of MS relapse
Steroids - methylprednisolone | To induce remission, shouldn't use more than twice a year
78
Managing MS - preventing relapse
B-interferon - doesn't alter long term outcome - reduces relapse rate Natalizumab - monoclonal antibody
79
Conservative management of MS
Treat infections promptly, physio, cannabis? Avoid pressure sores
80
2 non motor symptoms of Parkinson's
Anosmia, depression, dementia (lewy body), REM sleep disorder
81
What is trigeminal neuralgia?
Paroxysms of intense stabbing pain, lasting seconds, in the triennial nerve distribution. Brought on by.. washing face, cold wind, eating
82
Treatment of trigeminal neuralgia?
Carbamazepine first line, surgery if unresponsive
83
Define seizure
Spontaneous uncontrolled abnormal brain activity
84
What is epilepsy?
Tendency to have seizures
85
Causes of epilepsy
Genetic, development abnormalities, trauma, hypoxia, pyrexia, stroke, metabolic
86
Pathology of epilepsy
- abnormal synchronised discharge of neurones | - seizure threshold lowered, neurones hyperexciteable
87
Triggers of seizures
``` Sleep deprivation Flashing lights Alcohol (intake and withdrawal) Drug misuse Physical/mental exhaustion Infection Metabolic disturbance ```
88
Describe a tonic clinic seizure
``` Often preceding aura Tonic phase (10-60s) - rigidity, tongue biting, incontinence, hypoxia/cyanosis Clonic phase (s-mins) - convulsions, jerking, eye rolling, tachy ```
89
What is status epilepticus
Seizures that last >30 mins or seizures between which consciousness is not recovered MEDICAL EMERGENCY Cells swell due to electrolyte imbalance as body isn't able to meet energy demands
90
How do you treat status epilepticus
Acute - rectal/IM lorazepam midazolam Phenobarbital 2nd line Phenytoin IV
91
Driving and epilepsy
Tell pt to inform DVLA can't drive if.... - changed meds in last 6 months - seizure in last 12 months
92
Drug treatment of epilepsy
After 2 fits First line for partial - carbamazepine First line for general - sodium valproate Lamotrigine, phenytoin, phenobarbital
93
What is meningitis?
Inflammation of the meninges | Caused by virus (most common) or bacterial (rarer and more severe)
94
Features of meningitis
Headache, stiff neck, photophobia, tachy, fever, altered consciousness, vomiting, seizures shock Bacterial - rash, Petechial and non blanching
95
What is kernigs sign?
Flex the hip with knee flexed, positive if spasm of hamstrings
96
What is brudzinkis sign?
Passively flex the neck, positive if flexion of hip or knee
97
Causes of viral meningitis
``` Echovirus Mumps - rare in UK due to MMR Herpes - simplex, EBV, chicken pox Influenza Treat symptoms ```
98
Describe the neuropathy seen in diabetes
Peripheral, motor or sensory but usually sensory, LMN only
99
Describe what happens in Brown Sequard syndrome
Ipsilateral paralysis and loss of light touch and vibration | Contralateral loss of pain and temp

Phase 3A (2 decks)

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