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Neurology Flashcards

0
Q

Upper motor neurone signs

A 
Hypertonia, Spasticity
Clonus 
Weakness- in pyramidal pattern  
Hyperreflexia 
Pathological reflexes (eg extensor plantars)
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1
Q

Lower motor neurone signs

A 
Muscle wasting 
Fasciculations 
Hypotonia 
Reduced power not in pyramidal pattern 
Reduced or absent reflexes
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2
Q

Cerebellar dysfunction

“am i std please”

A

alcohol
ms (demyel)

inherited - friedrich (young)

stroke
tumour
drugs (isoniazid, henytoin)

paraneopastic

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3
Q

cerebellar signs

A 
DANISH
dysdiadocokinesia
ataxia
nystagmus
intention tremor
slurred speech
hypotonia
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4
Q

peripheral neuropathy

A 
Polyneuropathy I DAVID
- can be sensory, motor or mixed
S: dm, alcohol
M: GB, polio
MS: CMT, CIDP

Radiculopathy

  • often w spondylosis
  • pain, ting, sensory dist, motor dist

Mononeuropathy

  • eg carpal (median), common peroneal (foot drop), radial (wrist drop), ulnar (hand)
  • can get multiplex in DM, hypothyroid, vasculitis
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5
Q

speech problems

A

cortical - dysphasia - expressive, receptive or mixed

cerebellar - staccato, loss of normal scanning

parkinsonian - hypophonic

pseudobulbar - spastic, hot potato

bulbar (palatal paralysis) - nasal

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6
Q

leg myotomes

A

hip flex: L1/2

hip ext: L5 S1

knee flex: S1

knee ext: L3/4 (jerk)

ankle dorsi: L4
ankle plantar: S1/2 (jerk)

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7
Q

arm myotomes

wrist extension (cocked)

A

shoulder: C5 axillary

bicep: C5/6
(reflex C5/6)

tricep: C7 radial
(reflex C7/8)

(supinator C6/7)

wrist ext: C7 radial nerve
wrist flex: C8 uln and med

fingers: T1 ulnar
thumb: C8 median

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8
Q

stroke

A

sudden neurolog deficit of vascular origin
1/6 are hem; 5/6 are infarct

Assess w Rosier criteria

abc, source of embolus, assess swallow
do CT asap to rule out hem,
- thrombolysis (alteplase) if w/in 4.5 hrs
- if CI 300mg aspirin stat,

other: bloods (fbc, esr, clot), cxr, ecg, carotid ddoppler

mx: longterm CLOPIDOGREL
mdt rehab,
treat htn/chol/diab
?endarterectomy ?warfarin (if AF)

embolism - AF, valvular disease, recent MI
thrombosis - atheroma

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9
Q

stroke prognosis

A

25% die in a year
50% dependant
25% independant

mdt rehab - phsyio, ot, salt
stop: smoking, cocp, hrt
manage bp, chol, diab
clopidog (stroke) asp + dipyrid (tia)
?warfarin ?endarterectomy
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10
Q

AC stroke

carotid circultaion

A

1) cortical deficit - Aphasia, visuospatial, attention
2) homonymous hemianopia
3) hemiparesis including face (+sensation)

all - TACS
or partial - PACS

highest mortality

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11
Q

lacunar strokes

A

pure motor or sensory

cognitive impairment

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12
Q

PC stroke

vertebrobasilar circulation

A

1) brainstem - cerebellar (ataxia), CN, bulbar (swallowing), dysphasia, horners,

2) hemiparesis on opposite sides to CN
3) hemianopia

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13
Q

extradural haematoma

aka epidural

A

tearing of meningeal artery - often middle near pterion
history of trauma -> lucid period -> icp and gcs (coma)

ct: biconvex
not spread past falci
midline shift

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14
Q

TIA

A

less than 24 hrs
Assess w ABCD

hemiparesis and aphasia - common
amaraurosis fugax, amnesia

Could do ecg, carotid duplex

30% stroke in 5 yrs
- start aspirin + dipyradamole daily

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15
Q

sah

A

sudden (thunderclap) occipital
meningism - neck stiff, photophob
papilloedma ?focal neurology

ruptured berry aneurysm, avm

ct
lp (xanthochromia, blood on serial tap)

mx:
maintain bp
nimodipine (prev ischaemic damage)
surgical - coiling

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16
Q

subdural haematoma

A

venous bleed in oldies
can be chronic + acute

gradual accum of neuro defecits - may be non specific (off legs, cogntiive)

ct: concave density (but old bleed are isodense)
can spread around brain

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17
Q

Epilepsy history

A

Preceding factor

  • head injury, infection
  • stress, tiredness, alcohol, missed meals

Fh?
Pmh? - febrile seizures as child?

Seizure markers

  • tongue biting
  • incontinence
  • confusion/tiredness afterwards
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18
Q

Epilepsy management

A

Generalized

1) sodium valproate (avoid in reproductive female)
- se: wg, tremor, (tiredness, nausea at first)
2) lamotrigine

Focal

1) Lamotrigine
2) carbamazepine

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19
Q

treatment for generalized vs focal epilepsy

A

Generalised (inc absence)

  • sodium valproate
  • (se: weight gain, temporary hair loss, ntd)
  • lamotrigine if pregnancy risk

Partial: carbamezipine (se rash)

general se: drowsy, dizzy, nausea
sv: avoid alcohol

for absence - ethosuximide is second line

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20
Q

Focal seizures

A 
Start w strong aura
Affect specific distribution
Short duration
Stereotyp pattern
Altered consciousness
  • must image brain (mri)
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21
Q

Juvenile myoclonic epilepsy

A

Three features

  • myoclonus - often in morning
  • absense seizures
  • gen tonic clonic

Do eeg if suspected

Start SV if man, lamotrigine if woman

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22
Q

Status epilepticus

A

Pre hosp rescue therapy - buccal medazolam

Hosp

  • iv lorazepam
  • ?phenytoin
  • ?aneasthetize

Identify/treat cause
ie hypoglycaemia?

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23
Q

status epilepticus mx

A

recovery posit
avoid injury
call amb
buccal medaz or rectal diaz

in hosp
iv loraz
o2
check glucose

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24
Q

cluster headache

A

severe, quick onset, around eyes
runny noise, red eye
*come in clusters, daily 4-12 weeks

T: acute: O2, nasal triptan
proph: verapamil

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25
Q

tension headache

A

tightness, bilateral
recurrent/chronic, worse at end of day
precip: stress, noise, depression, analgesia overuse

tension, tenderness, stiff neck

m: simple analgesia
lifestyle - stress, alcoho, exercise, antidep
avoid analgesia overuse
physical massage/icepacks

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26
Q

treat migraine

A

attack: analgesia, metoclopramide, sleep/darkness, triptans

lifestyle - avoid triggers (sleep, eat well)

prophylaxis if severe, affecting life, frequent

  • b block (avoid asthma, raynauds)
  • topiramate (avoid if preg risk)
  • acupuncture, gabapentin
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27
Q

migraine

A

unilateral, throbbing

pre: aura - visual, sensory
assoc: photo/phonophobia, nausea, vom

aggrav/triggered by choc, caffeine, alcohol, exercise

acute: analgesia, triptan
prevent: b block, or topiramate, or amitript

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28
Q

giant cell arteritis eg temporal

A

painful - rapid, unilat, v tender, erythema
jaw claudication

! risk visual loss

clinical diagnosis: give prednisolone
see rasied ESR, do biopsy

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29
Q

trigeminal neuralgia

A

unilateral face pain in trigem distrib - brief, severe, shock/stab, w/or w/out background ache
triggered by shaving/washing face/wind

treat: carbamezipine

check neuro signs - suggest tumour/lesion
(can be sign of MS)

pt typically > 50 yrs

may be idiopathic
due to compression of sensory root adjacent to brainstem
- eg tumour in cerebello pontine angle (v, vii, viii),
- also multiple sclerosis if younger patient

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30
Q

ms presentation

A

lethargy

ocular

  • unilateral blurry/loss of vision
  • pain - dull ache, worse w move
  • colour desat
  • RAPD, nystag (INO)
  • late optic atrophy

worse with temperatrue - uhtoff’s phenom
neck bend->paraesth - lhermitte’s phenom

sensory and motor signs
trigem neuralgia
cerebellar signs - ataxia, tremor
urinary
cog/psych
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31
Q

investigations and treatment in ms

A

mri - visualise plaques
vep - slowed
csf - lymphocytes, protein, oligoclonal bands

steroids for relapses
?disease modifier: beta IFN, azathioprine
mdt support
treat symptoms (see card)

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32
Q

patterns of ms

A

relapsing remitting

primary progressive
- little or no recovery from episodes

secondary progressive
- starts as relapse/remit but recovery becomes less and less

aetiology: genetic and environmental, not fully understood
- certain parts of the world

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33
Q

specific treatmetns in ms

A

shooting pains, paraesthesia - gabapentin, carbamazepine

bladder - oxybutinin, self cath

constip - laxaives

muscle spasticity - baclofen

depression - ssri (fluox, cital)#

erectile - viagra

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34
Q

Acute spinal cord compression

A
  • primarily MOTOR dysfunction below certain level - weakness, umn
  • sensory level

may not be symmetrical

  • tumour (slow appearance)
  • prolapsed disc (more acute)

similar pic may be due to
- transverse myelitis
- ant spinal artery thrombosis
(no compression, weakness tends to be flaccid)

–> do urgent MRI

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35
Q

Progressive spastic paraparesis

A

Bilateral weakness and spasticity of legs

Differentials

  • B12 deficiency (SACD)
  • also copper deficiency (SACD)
  • HEREDITARY spastic paraparesis
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36
Q

B12 deficiency - subacute combined degeneration of spinal cord (SACD)

May precede megaloblastic anaemia

A

1) Corticospinal tract
- prog spastic paraparesis

2) Dorsal columns
- proprioception, vibration, fine touch
- see high stepping gait, rhombergism, pseudoathetosis

3) Peripheral neuropathy
- sensory and motor

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37
Q

Cervical spondylotic myelopathy

A

Vertebral degen can cause

1) radiculopathy of local nerve roots
- pain, tingling, sensory dist, lmn signs

2) spinal cord syndrome
- spastic paraparesis
- gait and sphincter dysturb

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38
Q

Transverse myelitis

A

Localised inflammatory lesion across one level of SC

—> acute flaccid weakness w sensory level below this point

1) viral (recent flu-like) illness
2) MS

Do MRI to rule out SC compression

39
Q

Transverse myelitis

A

Inflam on spinal cord across transverse plane
Often self limiting

Often viral - tends to be complete - paraplegia
Also w MS - tends to be partial - patchy motor sensory loss

40
Q

Spinal shock

A

Sudden transaction of spinal cord (trauma)

Loss of autonomic control of vasoconstriction
- catastrophic hypotension - need fluid

41
Q

Neuromuscular disease

A

1) MND
2) MG
3) Muscular disorders

42
Q

mnd

A

upper and lower mn signs
no sensory signs
CLASSICALLY: >40, ataxia develops, weak grip
survival 2-5 yrs

TYPES:

50% amyotrophic lateral sclerosis
- UMN legs, LMN arms

primary lat sclerosis - only UMN

progressive muscular atrophy - only LMN, best prog

progressive bulbar palsy - swallowing/speech prob
- worst prog

43
Q

myaethenia gravis

A

autoimmune vs ACh at nmj
fatiguable
particularly ocular (diplopia and ptosis) and facial muscle
- also bulbar, respiratory, limb

assoc w thymoma
80% succesfully managed with iv Ig (remission/improvement)

44
Q

MG examine and invest

A

fatiguability
- eg counting and rep movem

impaired upward gaze

nb reflexes normal

Ix:
antibody to ACh
nerve conduction
tensilon test - improves with edrophonium

?thymoma

45
Q

Muscle disorders

A

Distinguished by weakness with normal reflexes

Muscular Dystrophy

  • inherited x linked - present in childhood - life exp ~ 20’s
  • duchennes and beckers
  • prog wasting and weakness

Myotonic Dystrophy

  • hered autosomal dom
  • male pattern baldness
  • dm, cataracts, cardiac, sleep
  • successive generations more severe
  • distal weakness and wasting
    • diff relaxing grip **

Also

  • inflammatory (myositis)
  • metaboilic (steroids, cushings, thyroid)

Ix: creatinine phosphokinase
EMG, biopsy
genetics

46
Q

Peripheral neuropathy subtypes

A 
Polyneuropathy I DAVID
- can be sensory, motor or mixed
S: dm, alcohol
M: GB, polio
MS: CMT, CIDP

Radiculopathy

  • often w spondylosis
  • pain, ting, sensory dist, motor dist

Mononeuropathy

  • eg carpal (median), common peroneal (foot drop), radial (wrist drop), ulnar (hand)
  • can get multiplex in DM, hypothyroid, vasculitis
47
Q

polyneuropathy

  • length dependant
A

I DAVID

inherited - charcot marie tooth
diabetes
alcohol
vitamin B12
inflammatory GB, CIPD, polio
drugs - isoniazid, vincristine
48
Q

neuropathy w nutritional deficit

A

thiamine - beriberi
- peripheral neurop + WK (confusion, speech probs, nystagmus)

wernicke korsakoff

- seen w thiamine def
- W enceph: confusion, nystag, ataxia
- K psychosis: amnesia, halluc, confabulation

B12- subacute combined degen

  • peripheral neurop
  • prop and vib (dorsal column)
  • umn signs (corticospinal)
49
Q

Guillain barre

A

immune mediated demyel of PNS

  • often triggered by infec
  • classically campyobacter jejuni

prog weakness of 4 limbs (starts in legs)
reduced reflexes
?paraesthesia
?cranial nerve

Ix:
nerve conduction
monitor lung function
CSF: increased protein

T: IV Ig

50
Q

charcot marie tooth

A

hered sensory motor polyneuropathy

weakness, wasting distally especially lower limbs
atrophic calf, prominent shin, champagne bottles

variable sensory loss
proprio loss - sensory ataxia, high step gate,

pes cavus and clawing of toes

51
Q

mononeuropathies

A

carpal tunnel - median

saturday night - radial - wrist drop

common peroneal - foot drop

52
Q

wrist drop

Mono or radiculo?
- from c7 nerve root lesion or radial nerve lesion

A

Test brachioradialis

  • innervated by radial but not c7
  • affected in radial lesion but not c7 lesion

Also mononeuritis multiplex

53
Q

Foot drop

A

Mononeuropathy or radiculopathy?

Often L5 or common popliteal lesion

  • get patient to invert foot - this uses median popliteal, L5
    • ability retained in comm perin lesion not L5

Also could be
- diabetic mononeuritis multiplex

If bilat: i david

54
Q

T1 vs ulnar lesion

Mono or radiculo

A

T1 nerve root lesion
- takes out all the muscles of the hand - wasting and weakness

Ulnar nerve root lesion

  • thenar eminence preserved
  • causes claw hand (4th and 5th fingers drawn in)
55
Q

carpal tunnel

A

Idiopathic or 2dry to ra, trauma, preg, hypothyroid, dm

Numb pain at night and on waking

  • relieved by shaking
  • thenar wasting if severe

T:

  • splinting at nights
  • corticosteroid temporary but effective relief
  • surgical decompression
56
Q

Parkinsonism exam

A

General around bed
- salbut, thyroid, ldopa

Facies - hypomymia
Eyes - blink rate, upgaze
Nose - anosmia
Greasy skin
Glabellar tap
Speech - hypophonic

Look: Tremor rest, amplify, essential, intention
Feel: Rigidity
Move: Brady (quack), handwriting

Posture (stooped)
Righting reflex
Gait
- shuffle festinant small steps
- no arm move
- difficult initiating, freezing, turning
- stooped

Follow up with

  • lying standing bp
  • righting reflex
  • look at meds

Good Q - turning over in bed

Differentials

  • PSP - up gaze
  • MSA - cerebellar, post hypot, incontinence
  • LBD - dementia
  • Drug induced - haloperidol, prochlorpromazine
57
Q

parkinsons management

A

Mdt etc

co-beneldopa - L dopa + periph inhibitor

  • v effective (not vs tremor) but limited after 5 years
  • dyskinesia, painful distonia, on/off
  • se: halluc, post hypo

dopamine alternative/adjuncts:

  • selegeline (MAOi),
  • ropinirole (dop rec ag),
  • amantadine (block dop reuptake),

give domperidone if drugs casue nausea

vs tremor - anti-muscarinics (orphenadine, benzhexol)

58
Q

Parkinsons plus

A

MSA - autonomic, cerebellar

PSP - upgaze impaired

LBD - dementia

59
Q

movement disorders

A

tremor - rhythmic oscillate

dystonic - invol contract

myoclonus - jerks

tic - can transiently suppress, relief post move

athetosis - slow writhing

choreoform - randome flowing dance-like

ballismus - high amplitude limb flail

60
Q

essential tremor

A

exag by arms outstretch
dec with alcohol

T: propranolol

61
Q

huntingtons

A 
hereditary chorea (inviol writhing)
dementia/behavioural element - cerbreal atrophy

onset in 30’s, progressive, usually die within 15yrs

autosomal dominant

62
Q

causes of choreoform

A

huntingtons
wilsons
ataxic telangectasia

sle
antiphospholipid

drugs - L dopa, antipsych

63
Q

meningitis

A

fever, headache, stiff neck, photophobia

bacterial 
- may be sepetic - tachy, hypot, shock 
-> purpuric rash, DIC
- neisseiria meningitidis (meningococcus), strep pneumonia
- risk neuro deficits - deaf, blind, cog
Ix: blood cluture, csf
T: high dose ceftriaxone
viral 
- often sefl limiting
- less meningism (neck, photo)
- often enterovirus
T: treat as bacterial until ruled out,
rehydrate, analgesia, ?acyclovir
64
Q

encephalitis

A

fever, headache, confusion/drosy/changed behaviour, seizures

CSF - lymphocytes

most treatable form in herpes - so give acyclovir

  • affects temporal lobes (seen on eeg, mri)
  • affects memory and speech
  • poor prognosis
65
Q

cerebral abscess

A

rare

headache, fever (swingin), focal neurology
signs of raised ICP - papilloed

spread from ears, sinuses, or embolic

do not perform LP - risk coning

T - prolonged abx and surgery
25% mortality

66
Q

Brain tumours

A

Can be classified as supratentorial and infratentorial
50% secondary - look for primary

Generally present w
Headache - constant, at night, worse w cough/bend
Seizures
ICP - ha, vom, drowsy, papilloedema
Focal neurology

If suspected do contrast enhanced CT

Supratentorial

  • more of a mass effect - ICP and focal neuro
  • inc astrocytoma, oligodendroglioma, lymphoma, meningioma

Infratentorial

  • often specific defects (CN) and early/dramatic ICP rise
  • eg acoustic neuroma most common
67
Q

tumours metastasising to brain

A

LUNG, breast, genitourinary, bone

68
Q

acoustic neuroma

benign tumour (schwannoma) in cerebellopontine angle

A

Schwanoma of sheath of 8th cn

affects nerve 8 first:
unilateral sn hearing loss
then vertgo

then affects 5 and 7:
trigem neuralgia?
unila facial weakness

69
Q

Neurocutaneous syndromes

assoc w phaeochromocytoma

A

Neurofibromatosis

  • type 1 - skin nf’s, cafe au lait, axillary freckles
    • brain/meningeal tumours
  • type 2 central tumours common - eg bilateral acoustic neuroma, also cutaneous

Von hippel lindau
- brain, renal, adrenal tumours

70
Q

Dementia types

A

Alzheimers

  • senile (beta amyloid) plaques and neurofibrillary tangles
  • also cerebral atrophy on mri
  • gradual progressive decline
  • memory, visuospatial, nocturnal wondering, verbal, intellect, personality, self care

Vascular

  • stepwise cog decline, vascular risk factors/history
  • characteristic gait: march a petit pas
  • cerebral atrophy and vascular lesions on mri

Lewy body

  • parkinsonism - tremor, rigid, brady, gait - non treatable w dopa
  • fluctuating consciousness
  • nocturnal visual halluc
71
Q

normal pressure hydrocephalus

A

triad

gait disorder
dementia (reversible)
urinary incontinence

  • see enlarge of 4th ventricle
72
Q

hydrocephalus

A

infantile: arnold chiari malf
- cereb tonsils in f.m.
- assoc spina bifida, syringomyelia

adult: tumour, post SAH (clot blocks ventricles)

73
Q

Visual field defects

A

homonymous hemi
- lesion in contralat optic tract

homonymous quadratanopia
-PITS
(parietal inferior, temporals superior)

macula sparing - occip cortex

temporal - optic chiasm eg pit tumour

74
Q

Cranial nerves 1 and 2

A

1 - olfactory

2 - optic 
- FARO(C)
- fields
- acuity
- reflexes: light, accom
- opthalmoscopy 
(- colour - ishihara)

Fields
- 4 quadrants, inattention, blind spot

Acuity
- wearing correction, 1 eye at a time

Reflexes

  • light: hand divider. direct, consensual, swing (rapd)
  • accom
75
Q

Cranial nerve 3, 4, 6

A 
3 Oculomotor 
4 trochlear (sup oblique)
6 abducens (lat rectus)

Look for ptosis, squint
Ask about diplopia
Do H ?nystag or diplopia

76
Q

3rd nerve palsy

A 
eye down and out
ptosis
pupil dilate (in aneurysm)

post comm artery aneurysm

  • painful
  • pupil dilate

DM

weber’s syndrome - midbrain stroke
- w contralat hemiplegia

77
Q

6th nerve palsy

A

failure of lateral rectus
may have strabismus (bad eye pulled in)
diplopia and strabismus maximal on lateral gaze
- eye may visibly fail to abduct
- patient reports double vision
- cover one eye at a time
- false image is fainter and more lateral

causes

  • trauma
  • diabetes, ms, tumour affecting 6th nerve
78
Q

Cranial nerve 5, 7

A

5: trigeminal
- muscles of mastication
- sensation throughout face (opthalmic, maxillary, mandibular)
(corneal reflex)

7
- facial movements

79
Q

bilateral facial weakness

A

primary muscle disease - muscular distrophy

nmj disease - myaeshenia gravis (bilat ptosis, opthalmopleia, fatiguable)

80
Q

bells palsy

A

idiopathic unilateral lmn facial paralysis
? viral aetiology ?herpes simplex

onset over hours
assoc w pain in/behind ear

if caught early could start prednis and aciclovir
also eye drops to pretect cornea or tape down eyelid

90%self-limiting - few weeks
few have only partial recovery

81
Q

7th facial nerve palsy

Upper vs lower motor neurone

A

Forehead will be spared in upper motor neurone lesion

Lower motor neuron (Bell’s) - whole side affected

82
Q

Cranial nerves 8 - 12

A

8 - vestibulocochlear

  • any hearing changes - rhinnes and webers
  • any vertigo

9 glossopharyngeal
10 vagus
11 accessory
12 hypoglossal

83
Q

causes pes cavus

A

Charcot Marie tooth disease
Hereditary spastic paraplegia
Cerebral palsy

84
Q

causes of high stepping gait

A

sensory ataxia - sacd

peripheral neuropathy - bilat foot drop

85
Q

Increased physiological blind spot

A

Pappiloedema

86
Q

Level that spinal cord stops

A

L1/L2

87
Q

post herpetic neuralgia treat

A

amitriptyline

pregabalin

88
Q

Spinal cord tracts

A

Descending: Corticospinal

  • decussation at medullar oblongata
  • lateral and anterior cs tracts
  • carry motor signals

Ascending

Dorsal column
- proprio, vibration, fine touch

Spinothalamic

  • lateral and anterior tracts
  • pain and temp; curde touch/pressure
89
Q

neuro systems review

A

headache
fit faint funny turn
memory

eyes - diplopia
speech and swallow

weakness
tingling or loss of sensation

90
Q

Approach to exam

A

Power- test normal side first

Sensory- test abnormal side first

91
Q

EXPLAN: MS

A

disease where body attacks nerves in cns (brain and sc)

  • causes injury to the insulation/coating of nerves
  • impairs function

Can occur at different sites and come and go (r+r, episodic)

  • often eyes - blurry vision, pain, colour/loss, movements
  • weakness - limbs (spasticity), face, speech
  • sensation - tingling, numb
  • bladder
  • coordination

FATIGUE AND DEPRESSION

All can come and go, but may have left over problems: accumulate disability
- very variable - three main patterns - after ten year some will be disabled, wheelchair, some functioning ok

Ix to monitor (mri, ver, csf)
Tx: prednis for attack
beta IFN prevents relapses
physio and support

92
Q

EXPLAN: temporal arteritis

A

body attacks and causes inflammation in artery in side of face
- not fully understood, genetic and environmental factors

pain, claudication, v tender
FATIGUE MALAISE

can be assoc PMR - mornign v stiff in muscles

prednisiolone for about 2 years, slowly reducing
aspirin (prevent thrombo-occlusion)

MUST LOOK OUT FOR VISUAL CHANGES

se steroids:
gastric
bones
infection
sleep
cushing
93
Q

Signs of raised ICP

A

headache (progressive, worse w bending, coughing, on waking)
vomitting
visual disturbance, pupillary changes, papilloedema
reduced consciousness

94
Q

rarer causes of dementia

A

Picks disease - Fronto Temporal dementia
- largely personality change - disinhibition, emotional unconcern

Normal pressure hydroceph
- gait, urinary, dementia

Pellagra

  • niacin defic
  • dementia, diarrrhoea, dermatitis

Prion disease

  • dementia, myclonus, ataxia, blindness
  • associated w CJD
95
Q

infantile hydrocephaly features

A 
big head
'sunset' appearance of eyes
mental impair
convulsions
diplegic spasticity
optic atrophy
96
Q

causes of ptosis

A

congenital
- often w impaired upgaze (sup rectus)

acquired

  • CN 3 palsy - eye down and out
    • 2dry to PCA aneurysm; DM
  • Horner’s - w anhydrosis and miosis
  • MG - fatiguable
  • myotonic dystrophy - w catarract

Senile myogenic ptosis

  • most common*
  • degen of muscle w age

Progress test packs (16 decks)

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