Neurology Flashcards
Multiple systems atrophy - clinical features
Pathognomonic MRI finding
Cerebellar
Autonomic neuropathy
Parkinsonism
Hot cross bun sign
14-3-3 CSF protein association
CJD
Anti VGKC
Anti LGI 1 limbic encephalitis
Faciobrachiodystonic seizures
Lacunar stroke patterns
- Pure Motor- internal capsule/pons
- Ataxic hemiparesis- internal capsule/pons/corona radiata
- Dysarthria-clumsy hand syndrome- pons/internal capsule
- Pure sensory stroke- VPL nucleus of the thalamus
- Mixed sensorimotor stroke- Thalamus+internal capsule
4 Midline structures
Motor Tract (Cerebrospinal)
MLF
Medial Lemniscus Pathway (Dorsal column)
Motor Nucleus
4 Side structures
Spinothalamic Tract
Spinocerebellar tract
Sensory nucleus of CN V
Sympathetic Tract
4 midline motor nuclei
III, IV, VI, XII
Cortical Signs- Frontal Lobe
Primary Motor Cortex Personality Primitive reflexes Expressive Dysphasia Anosmia Gait Apraxia Optic Nerve compression
Cortical Signs- Temporal Lobe
Receptive Dysphasia
Primary Auditory cortex
Memory
Upper qudrantanopia
Cortical Signs- Parietal Lobe
Sensory Cortex Attention Construction and dressing apraxia Lower qudarantanopia Gerstmann
Cortical Signs- Occipital Lobe
Vision- Homonymous hemianopia
Anton’s Syndrome- cortical blindness with confabulation
Alexia without agraphia
Gerstmann Syndrome
Acalculia
Agraphia
L-R disorientation
Fingeragnosia
PSP - clinical features
Pathognomonic MRI finding
downgaze palsy
Personality and cognitive change
Hummingbird sign
EEG - Focal prominent intermittent high amplitude slow waves (delta and theta slowing) with occasional periodic lateralised epileptiform discharges in the affected region
HSV encephalitis
EEG - Periodic sharp wave discharges (tri-phasic)
CJD
EEG - Generalized polyspike and slow wave discharges (4 - 6 Hz) with frontal predominance over normal background activity
JME
AED - visual field defect
Vigabatrin
AED - zero order kinetics, hirsutism, gingival hyperplasia
Phenytoin
AED - Steven Johnson syndrome
Carbamazepine
HLA B 15:02 Chinese
HLA B 31:01 Caucasians
AED - weight loss
Topiramate
Also causes renal stones and glaucoma
AED - irritability & psychiatric symptoms
Levetiracetam
Levetiracetam MOA
SV2A-mediated neurotransmitter release
Ethosuximide MOA
Calcium channel blockade - T - type
Gabapentin MOA
Pregabalin MOA
Alpha-2 Delta subunit of calcium channel
Carbamazepine MOA
Sodium channel blockade
Lacosamide MOA
Sodium channel blockade
Lamotrigine MOA
Sodium channel blockade
Phenytoin MOA
Sodium channel blockade
Topiramate MOA
Sodium channel blockade
AMPA antagonist
GABA agonist
Vigabatrin MOA
GABA agonist
Valproate MOA
Sodium channel blockade
GABA agonist
T-type calcium channel antagonist
Excitatory Seizure Channels
Sodium channel (voltage gated) Calcium channel (voltage gated) Potassium channel (voltage gated) Glutamate (NMDA and AMPA)
Inhibitory Seizure Channels
GABA
Lewy Body Dementia - Clinical signs
Visual hallucinations
Fluctuating cognition
RBD
Parkinsonism
Lacunar stroke with contralateral weakness (upper and lower limb) and contralateral ataxia
Ataxic hemiparesis
Posterior limb of external capsule, basis pontis
Small penetrating arteries of MCA
Contralateral upper quadrantanopia
+ either receptive aphasia (dominant) or constructional apraxia (non-dominant)
Inferior division of MCA infarct
affecting temporal lobe
Contralateral hemineglect, hemiparesis (face, arm >leg), expressive aphasia
Superior division of MCA infarct
Can write but cannot read
Alexia without agraphia
PCA stroke - collosal branches
Left occipital region plus splenium of corpus callous
Balint syndrome
Bilateral posterior cerebral artery stroke affecting parieto-occipital lobes
Bilateral loss of voluntary but not reflex eye movements
Bilateral optic ataxia
Bilateral asimultagnosia
Anton syndrome
Bilateral posterior cerebral artery stroke affecting occipital lobes
Bilateral visual loss
Unawareness/denial of blindness
Weber syndrome
Penetrating PCA arteries to midbrain Contralateral weakness (upper and lower limb) with ipsilateral lateral gaze weakness (CN III)
Wallenberg syndrome
Lateral medullary syndrome
PICA artery (arises from vertebral artery)
ipsilateral CN V (pain/temperature)
ipsilateral ataxia, vestibular dysfunction, dysphagia, Horner’s
Contralateral loss of pain/temperature of body (spinothalamic tract)
Dejerine syndrome
Medial medullary syndrome
Contralateral pyramidal tract
Contralateral hemisensory loss - vibration/proprioception (medial leminiscus)
Ipsilateral tongue weakness (CN XII)
Locked in syndrome
Bilateral ventral pons
Bilateral corticospinal, corticobulbar, CN VI weakness
Fingolimod (MOA, AE) tablets
Singosphine - 1 - phosphate receptors (blocks ability of lymphocytes to leave lymph nodes)
Bradycardia, macular edema, shingles, hepatopathy, PML (rare)
Natalizumab (MOA, AE)
Alpha 4 subunit of integrin molecules
PML, hypersensitivity
Teriflunomide (MOA, AE) tablets
Inhibits pyrimidine synthesis
Hepatopathy, lymphopenia, hair loss, GI upset
Glatiramer acetate subcut injections (MOA, AE)
Contains 4 amino acids that are similar to myelin basic protein - induce and activate T-lymphocyte suppressor cells specific for a myelin antigen
Joint pain, injection site idiosyncratic reactions
Alemtuzumab (MOA, AE)
Anti CD 52
Infections
Autoimmunity - especially thyroid
Daclizumab (MOA, AE)
Anti CD 25
Injection site reactions, eczema, deranged LFTs
Interferons (MOA, AE)
Enhancement of suppressor T cell activity
Flu-like symptoms, depression, injection site reactions
Radial nerve palsy
Wrist drop, brachioradialis weakness, dorsal hand sensation affected Can flex wrist Spares triceps (if above spiral groove)
C7 radiculopathy
Wrist drop, weak wrist flexion, triceps weakness, spares brachioradialis
L4, L5 radiculopathy
Weak foot eversion and inversion
Ankle jerk spared
Sciatic nerve
Weak foot eversion, inversion, ankle jerk
Common perineal nerve
Weak eversion
Ankle jerk and inversion spared
