Neurology Flashcards
Symptoms from B12 deficiency
Parasthesia
Personality changes
Symptoms from Folate deficiency
peripheral neuropathy
Features on EEG of childhood absence epilepsy?
3 per second spike and wave discharges
Features on EEG of tonic clonic seizure?
10 Hz activity during tonic phase
Slow waves during clonic phase
Treatment of status epilepticus?
- ABC , IV glucose, IV thiamine
- IV Benzodiazepines (lorazepam)
- x2 - Phosphenytoin OR phenytoin
- ICU with infusion of midazolam/propofol/phenobarbitol
Indication for starting anti epileptics ?
EEG: abnormal spine, poly spike discharge, spike wave complex Abnormal neuro exam Findings on MRI Nocturnal seizure Unprovoked recurrent seizures
What is atonic seizure?
Treatment of atonic seizure?
No LOC
No Tone
Valproate
Treatment of absence seizure?
ethosuxamide
Treatment trigenimal neuralgia?
Carbamazepine
Investigations for myasthenia gravis?
Tensilon test
Anti Acetylcholine R assay Ab
Icepack over eyelids
MRI/CT for thymoma
Symptoms of myasthenia gravis
Ptosis
Double vision
Fatigue
Weakness
Treatment myasthenia gravis ?
pyridostigmine
acethylcholine esterase inhibitor
What is lambert-eaton?
Ab against Ca channels
Mostly paraneoplastic cause from SCC
Symptoms of lamberton eaton?
Proximal muscle weakness
Reduced reflexes
Diagnosis of Gillian Barre?
Protein +++ in LP
Cause of Gillian Barre?
Campylobacter
EBV
other infection
Treatment of Gillian Barre?
IVIG
Findings on LP for Multiple Sclerosis?
Oligoclonal bands on LP
MRI: Periventricular white matter plaques
What is Lhermitts phenomenon?
Flexion of the neck causes shock waves sensation down the leg
What is Uhthoff’s Phenomenon?
Worsening of symptoms in the heat
What is the acute treatment of MS?
IV prednisolone
What are disease modifying agents for MS?
Teriflunomide
Interfuron beta
Symptomatic treatment for spasticity, bladder dysfunction, pain, fatigue, depression, constipation, sexual dsfxn
Education, counselling g
Indication for good prognosis?
Young Female Relapse/Remitting Optic neuritis Low burden of disease on MRI
Acute stroke treatment?
- rtPA - recombinant tissue plasminogen activator
- if within 4.5 hours of onset of symptoms - Aspirin if did not get rtPA
- Withhold antihypertensive therapy
- Avoid hyperglycaemia
- lower temperature if febrile
- DVT prophylaxis
- NPO if dysphagia
Secondary stroke prevention treatment?
Antiplatelet agent (aspirin, if happened while on aspirin, clopidogrel) Anticoagulant if found to have AF HTN control Diabetes control Commence statin Cease smoking Exercise Carotid endarterectomy if > 70 w/ sx surgery or > 80% occlusion
Contraindications to rtPA
Prior SAH Pregnant Recent GI or urinary hemorrhage Recent LP or arterial function Recent major surgery (14 days) Minor sx
Features of an MCA stroke?
Contralateral UL + Face
Motor + sensory
If L side: aphasia (dominant )
If R side: neglect
Features of an ACA stroke?
Contralateral LL
Motor + sensory
Features of PCA stroke?
Homonymous hemianopia / Quandrantanopia
Features of Posterior Internal Capsule Infarct?
Pure motor hemiparesis
Features of a thalamic infarct?
Pure sensory deficit
Opening pressure in idiopathic intracranial HTN
> 20 mmhg
Features of anterior pons infarct?
Dysarthrria
Facial weakness
Dysphagia
Mild hand weakness/clumsiness
Which areas are lacunar?
Internal Capsule Pons Thamalus Deep MCA Basilar Vertebral arteries
Syndrome of of posterior inferior cerebellar artery infarct?
Wallenberg Syndrome
What’s Wallenberg syndrome?
Ipsilateral ataxia
Nystagmus
Ipsilateral Horner
Sensory: ipsilateral face, contralateral body to pain and temp
Syndrome of Vertebral artery infarct?
Medial medullary syndrome
Features of medial medullary syndrome?
Contralateral motor
Contralateral discriminative touch deficit (intact temp/pain)
CN XII lesion
Features of proximal basilar artery stroke?
CN VI palsy
Impaired horizontal EOM
Vertical nystagmus
Miosis
What causes locked in Syndrome?
Basilar artery clot
Features of distal basilar artery stroke?
Reduced LOC
CN III Palsy
