Neurology Flashcards
Main features of lewy body dementia
Pschiactric/memory before movement disorder.
Episodic
Visual hallucinations → pleasant
Progressive memory loss
Mobility problems
CJD
Prion disease - rapidly worsening symptoms over few months Sporadic - rare Varient - mad cow disease Familail/inherited Iatrogenic
Cause Parkinson
↓ dominergic neurones in substantia nigra in nigrostriatrial pathway - important for initiating and facilitate movement
- lose 80% of neurones before clinical symptoms
Parkinson Triad
Bradykinesia
Rigidity
Tremor - pill rolling
Micographoa, ↓ blink, hypomimic face, cogwheel, ↓ postural reflexes
Mgmt of tremor in PD
anticholinergic - benzhexol
Mgmt of nausea & vomiting in PD
Domperidone - doesn’t cross BBB
Cannot tolerate levodopa
Dopamine agonist - bromocriptine
Acute psychosis in PD
reduce the parkinson medication they are on that could be causing psychotic symptoms
May need antipsychotic - atypical e.g. clozapine (typicals could add in more parkinson symptoms)
Uncontrolled despite maximum oral therapy
Apomorphine - give domperidone prophylactic
Tx of restless leg syndtome
Ropinirol, pramipexole, levodopa, gabapentin
What should you consider in someone presenting with parkinson’s before mgmt?
Cause of parkinson’s
Is this parkinson’s disease? Parkinsonism? Or parkinson’s plus
Mgmt of parkinsons
- Replace dopamine - L-DOPA (levodopa or carbidopa)
- Dopamine agonist (bromocriptine, cabergoline, pramipexole, ropiniroel)
- Stop breakdown of dopamine
a) MAO-B inhibitors (Selegine)
b) COMT inhibitors
c) dopamine decarboxylase inhibitors - Tremors: anticholinergic - benzhexol
- Glutamate antagnost - amantadine
Parkinson plus syndrome
Multiple system atrophy
Parkinsoniam Autonmic disturbance Cerebellar signs Lean to side on walking - pisa signs 3 subtypes
→ parkinson or cerebella dominant
Progressive supra nuclear palsy
Parkinsonism
Vertical gaze palsy
Cognitive deterioration
- Doesn’t response well to L-dopa → dopamine agonist
Corticobasal degeneration
Parkinsonism
Cerebellar signs
Poor executive function - alien limb - clumsiness, jerking
Facial grimacing, writhing movements of arms + Fhx
Huntingdon’s disease
Tremor both arms, worse outstretch (positional), no present at rest, improves with alcohol
Essential tremor - BB
Rapidly progressive memory over last few months + jerking
CKD
Tremor worse at rest, unilateral stiffness, moving slowly
Idiopathic parkinson’s disease
Difficulty walking, falls backwards, rigidity, difficult looking downwards
Progressive supra nuclear palsy
Walks slowly, leans to left, fainted, urge incontinencem BP drops when standing
Multisystem atrophy
Multiple sclerosis
Background
Chronic, inflammatory, multifocal, demyelinating disease of CNS • UMN • W>M, 20-50 • Northern european + N america • genetic
Multiple sclerosis
CF
Signs on exam
Hours - days - depends where lesion is Optic neuritis Diplopia Weakness Spasiticy Paraesthesia ↓ co-ordination
UMN
Lhermittes sign
What is Lhermittes sign
Bend head forward get shooting pains in limbs
3 subtypes
Relapsing remitting - most common (80% become secondary progressive)
primary progressive
secondary progressive
Diagnosis of MS
Criteria
Bloods: vasculitic screen
Imaging: > 2 lesions on MRI
CSF analysis: ↑IgG
McDonald’s criteria - dissemination in space and time of CNS lesions
Mgmt of MS
- Education + counselling
- Acute attack - high dose steroids - methylpred
- Prevention of relapse - immunomodulators - interferon beta
- Symptom mgmt - analgesis for neuropathic pain, Tx depression
- Physiotherapy
Myaesthenia Gravis
- who does it commonly effect
- CF
- does it effect eyes
- what makes it worse
- what happens if they count to 50
Young women with muscle weakness
Autoimmune condition (other conditions?)
Antibody to Each receptor on post-synaptic membrane
Progressie weakness, swallowing, eye involvement (bilateral ptosis, diplopia)
Worse in pregnancy
Sensation, tone & reflexes normal
Voice will tail off when count to 50
Gold standard test for MG
Tensillon test
What happens on EMG
↓ muscle action after continuous stimulation
Lambert-Eaton Syndrome - what cancer is associated with
Small cell lung cancer
Cause
Pre-synapri membrane antibody to Ca receptor
Any eye signs
no
LES + exercise
Improves
EMG for lambert-eaton
↑ muscle action after continuous stimulation
24 female, unilateral ↓vision, painful
Optic neuritis
pregnant lady, ↑ muscle weekness + double vision and dropping eyelids, can’t keep her head up
Myaesthenia gravis
↑ muscle weakness, ↑ after walking dog, clothing baggy, hoarse voice, cough
Lambert-Eaton syndrome with SC lung cancer
Pain in L eye, weakness on R leg, 2 months earlier had pain and double vision
Multiple sclerosis - 2 lesions, separated in time.
