Neurology Flashcards
to remember the facts forgotten
What is the most common CNS disease in the young?
MS
MS define
Type IV hypersensitivity reaction
Inflammatory demyelination of neurones in the brain and CNS - eventually neurodegeneration and brain atrophy
typical ms ptt
young white female in 20s
lives away from equator
Types of MS
Relapsing remitting
secondary progressive (starts of relapsing remitting then moves on to one continuous attack on myelin)
primary progressive - continuous
progressive-relapsing - continuous with superimposed even worse bouts
Pathophysiology of MS
peripheral activation of immune cells
activated immune cells manage to cross BBB
cytokine release and further inflammation disrupts BBB
more damage can happen
regulatory T cells relieve inflammation - remits
oligondendrocytes recover, until next relapse.
genetics and environmental factors implicated in MS
MHC genes
specifically HLA-DRB1 which is involved in T-helper cell differentiation
There is also a role of environment:
e.g. infections (herpes 6, EBV), Vit D and smoking
differentials for ms
Lyme disease lupus migraine encephalitis stroke tumour
Symptoms of MS not incl Charcot’s Triad
Eyes - Optic Neuritis, diplopia, Ears and balance - Vertigo, Ataxia Bladder/Bowel dysfunction Altered sensation and Pain Spasticity Sexual dysfunction Cognitive impairment
Charcot’s Neurologic Triad
plaques in
Brain stem - dysarthria
eye nerves - nystagmus, optic neuritis, lov
motor pathways - intention tremor
Diagnosing MS
Many criteria exist - Posser, Barkoff, Mcdonald etc.
>2 episodes of symptoms dif points in time dif areas of NS absence of other treatable causes \+/- results of neuro tests (clinical diagnosis)
Rx of MS during acute attack
For acute relapse DMT methylpred IV immunoglobs plasma exchange physical therapy psychosocial support
Rx of ms to prevent relapse
drugs
1st line - beta interferon (SE infections)
DECREASE RELAPSE BY 30%
also, doxorubicin analogue: Glatiramer acetate
2nd line - Natalizumab - prevents BBB crossover
Alemtuzamab - inhibits T-cells
symptom management of someone with ms
pain control bladder and bowel antispasmodics fatigue splint contractures counselling baclofen for the spasticity
ix for ms
mri - plaques
lp- antibodies in csf
What is the presentation of optic neuritis
Subacute loss of vision
painful eye movements
red desaturation
dyschromatopsia - reduced colour vision
give methylprednisolone, then pred can delay onset of ms
status epil
Prolonged seizure - more than 30 mins.
Recurrent attacks w/o regaining
consciousness.
Medical emergency.
Poor prognosis w/o proper treatment
Requires resuscitation, i.v. drugs, sometimes
I.C.Uwhat se does carbamazepine share with small cell lung cancer?
SiADH
na valp se
vomiting, alopecia, liver toxicity, pancreatitis/pancytopenia, retain fat (weight gain), oedema (edema), appetite increase, tremor, and enzyme inhibitor (cytochrome P450)
which aed can cause rash
lamotrigine
+/- SJS!
which aed - gingival hyperplasia
phenytoin coarsening facial features lips get bigger ging hyperplasia (n.b nifedipine, amlodipine can also cause this) hirsutism
Mastoid surgery after cholesteatoma risk
Facial nerve palsy altered taste sensation csf leak tinnitus vertigo hearing loss
why is it important to further do ix if adult with otitis media e effusion?
because ome = eustachian tube dysfunction
common in children BUT
adults - post nasal space tumours
remember eustachian tube connects to nasopharynx
hx prog hearing loss tinnitus improved hearing in noisy surroundings fhx
ex
schwartze’s sign - pink tm
ix typanogram normal type a audiogram conductive hearing loss carhart notch at 2khz
otosclerosis
mature bone becomes woven bone
stapes fixed on to oval window \
conservative rx : hearing aid
surgery: stapedectomy
once sound reaches stapes, how do we hear
stapes articulates with oval window moves perilymph and these vibrations transmitted through endolymph to the tectorial membrane moves hair cells depolarisation transmiited via cochlear nerve
what tuning fork freq for rene/webers
256Hz
512Hz
threshold on pure tone audiogram for normal
anything above 20dB
why mri hearing loss unilater sensorineural
vestibular schwanoma
dif b/w presbyopia and presbycusis
byopia- lens of the eye not able to accomodate as well
cusis - bilateral sensorineural hearing loss old age
tympanogram
types a, b, c what mean
a=normal - 0dB
b=flat - effusion or perforation
c=eustachian tube dysfunction - peak has -ive pressure
trigeminal neuralgia management
Management
carbamazepine is first-line
failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology
ct early ischaemic stroke findings
reduced grey/white matter distinction bc oedema
increased density of occluded vessel due to clotted blood
psoriasis rx
general lisetyle, smoking-sunlight-soap subs-lose wught
topicals
steroids, vit d analogues, coal tar, dithranol, retinoids
phototherapy
systemic therapy
mtx
acitretin
ciclosporin
biologic - check tb status hiv
ethanercept - anti tnfa
mtx se
liver lung fibrosis
mouth ulcers
gi upset
Erythroderma
90% skin covred skin failure
admit supportive care emollients and wet wraps treat complications prophylaxis for infection topical steroids systemic treatment - mtx, ascitretin, cyclosporin
How to decide whether or not to start anticoagulation in a PT?
Weight up risks and benefits using CHA2DS2VAsc and HASBL(A)D scores
C - CHF H - htn A >75 gets two points D - diabetes S- stroke gets two points Vascular problems e.g. mi A - age over 65 S - sex is female
H - Htn
A - age >65
S - stroke
B - bleeding tendency
L - Labile INR
A - abnormal liver or renal
D - drugs such as aspirin/nsaids/alcohol
