Neurology Flashcards
Symptoms of raised ICP
Headache, papilloedema, vomiting
DANISH
Dysdiadokinesia & dysmetria Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
Brown sequard
Ipsilateral motor weakness Ipsilateral loss of touch Contralateral pain & temperature
Central cord syndrome symptoms
More weakness in upper versus lower limbs Varying level of sensation below level of lesion Possibly micturition difficulties
Myasthenia Gravis
Ptosis Fatigue Double vision Decreased strength Fasciculations
Hydrocephalus
Communicating vs non-communicating Congenital - agenesis of foramen of monroe Acquired - Tumours, aqueduct stenosis
Normal pressure hydrocephalus
Wet (incontinence) Wacky (confusion) Wobbly (gait distrurbance)
Multisystem atrophy
Wet & wibbly wobbly Ataxia, postural hypotension, incontinence
Supranuclear palsy
Wobbly (bradykinsea) Winky (ophthalmoplegia)
Parkinson’s Plus Syndromes
MSA SNP Dementia with Lewybodies
Most common primary brain tumour
Glioma Then astrocytoma
Signs of coning (4)
CN VI palsy (stretches over brain stem) Upgoing plantars Cheynes stoke respiration (progressively deeper, then faster, then slower breathing) Cushigns reflex - High BP
How to manage raised ICP (4)
Raised head of the bed to 45*C Neuroprotective hyperventilation (CO2 blow-off constricts cerebral vessels) IV mannitol Dexamethasone (if SOL)
Management acute dystonia
Procyclidine IM - antimuscarinic
Sign of venous sinus thrombosis on CT
Empty Delta sign
Botulism symptoms
Blurred vision Difficulty speaking & swallowing
Name three drugs that reduce seizure threshold
Amitriptyline Metronidazole Antidepressants
Give three none tumour causes of Spinal Cord Compression
Trauma Haematoma Advanced spondylosis
Man with SCC presents with low blood pressure & slow heart rate
Neurogenic shock due to lesions above T6 damaging the sympathetic pathway
Two causes of RAPD
Optic neuritis Acute ischaemic optic neuropathy
MS 2x classic symptoms
Uhtoff phenomena - vision gets worse with increased temperatures Bilateral intranuclear opthalmoplegia
Two treatments for neurogenic shock
Dopamine ADH
What is intranuclear ophthalmoplegia?
A lesion in the medial longitudinal fasiculus connecting CN3 and CN6, resulting in failure of adduction of affected eye and nystagmus in contralateral
Give four investigations for MS
BLOODS: - FBC, Inflammatory markers, U&E, LFT, TFT, glucose, HIV serology, calcium and B12 levels - anti-myelin basic protein autoantibodies Other fluids: - rise in total protein with increase in immunoglobulin concentration with presence of oligoclonal case X: MRI for sclerotic plaques of CN Electrophysiology: Demyelination detection
Management of MS Acute Chronic
Acute - methylprednisolone Chronic - DMARDS, Interferon beta • 2 relapses in past 2 yrs • able to walk 100m unaided
Atypical features of MS (worse prognosis)
- Primary Progressive MS - Male - Age >40 - motor syptoms @ presentaiton - early relapses - incomplete remissions
Contraindications to lumbar puncture
Try LP Unless ContraINdicated Thrombocytopenia <50 Late - ABx would be delayed Pressure - RICP Unstable - CV/resp sx Coagulation disorder Infection at LP site Neurology
Lumbar puncture meningitis
Glucose low everything else high
Long term complications of meningitis
Sensorineural hearing loss
First sign Cervical syringomyelia
Loss of pain/temp in cape distribution
MG links
Grave’s disease Thymus disease
Ptosis test
Apply ice to eyelid in MG, should stay open
MG management
Corticosteroids (pred) & pyridostigmine (anticholinesterase inhibitor)
Paraneoplastic MG symptoms
Lambert Eaton myasthenic syndrome -> Occurs in paraneoplastic syndrome due to anti-voltage gated calcium channel autoantibody production
Migraine management
o Migraine Sumitriptan – acute!! Topimarate
peripheral neuropathy causes
- Diabetic neuropathy - Alcohol neuropathy - B12 deficiency - Uraemia - Syphillis
Management acute seizure
A-E – recovery position IV lorazepam 4mg – 10-minute interval Escalate IV phenytoin 18mg/kg, rapid sequence induction & intubate, ITU
Management GUillan Barre
IV IG Intubation
Most common type of MND
Amyotrophic Lateral Sclerosis
Management MND
Riluzole
Management of spasticity
Baclofen