Neurology Flashcards
Optic chiasm tumour superior or inferior
Bitemporal hemianopia
More UQ - superior eg pit tumour
More LQ - inferior - craniopharyngioma
Homonymous quadrantopia
PITS
Macula sparing
Occipital lesion
L homonymous hemianopia
R sided stroke
GBS - what is it
immune mediated patchy demyelination of the PNS often triggered by an infection (Campylobacter jejuni), viral EBV, CMV.
Miller Fisher syndrome
variant GBS
ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
descending paralysis rather than ascending
anti-GQ1b antibodies
Treatment GBS
IV immunoglobulins
Plasmapheresis
Features GBS
progressive weakness of all 4 limbs- ascending i.e. the lower extremities are affected first
proximal > distal
Sensory symptoms tend to be mild (e.g. distal paraesthesia)
Some patients - back pain initially
Areflexia
cranial nerve involvement e.g. diplopia
autonomic involvement: e.g. urinary retention, diarrhoea
papilloedema: thought to be secondary to reduced CSF resorption
DVLA unprovoked seizure
6 months off
Structural abnormalities - 12
DVLA epilepsy
12 months, normal liscence if seizure free 5 years
DVLA withdrawal epilepsy meds
6 months
DVLA - explained/ unexplained syncope
4 weeks
6 months
DVLA - stroke/ TIA
1 month, inform in residual neuro deficit
DVLA - craniotomy for meningioma, pit tumour
1 year
6 months
DVLA - chronic neuro disorder
Tell DVLA
PK1 form - state of health application
Cerebellar Disease causes
M - MS A - alcohol V - vascular I - Inherited - Freidrich's S - SOL
UMN lesion
decreased power
increased tone, spasticity
increased reflexes
pyramidal
LMN lesion
decreased power, tone, reflexes
muscle wasting
fasciculations
Bamford Classification
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Progressive supranuclear palsy
Early postural instability vertical gaze palsy ± falls rigidity of trunk > in limbs symmetrical onset speech and swallowing problems little tremor
Multiple system atrophy
Early autonomic features, eg impotence/incontinence, postural BP
Cerebellar + pyramidal signs
rigidity > tremor
MUSK antibodies
MG
MG pathophysiology
antibodies to nicotinic acetylcholine receptors (AChR)
interfering with neuromuscular transmission via depletion of working post-synaptic receptor sites
MG tx
Anticholinesterase, eg pyridostigmine
Lambert–Eaton myasthenic syndrome
paraneoplastic (SCLC) / autoimmune Gait difficulty before eye signs Autonomic involvement Hyporeflexia and weakness, improves after exercise Antibody to pre-synaptic membrane’s voltage-gated Ca2+ channels anti-P/Q type VGCC antibodies in 85% Tx: 3,4-diaminopyridine or IV Ig CXR/ CT regular to check cancer
Syringomyelia
cape-like’ (neck and arms) loss of sensation to temperature but preservation of light touch, proprioception and vibration
full spine MRI with contrast to exclude a tumour or tethered cord. A brain MRI is also needed to exclude a Chiari malformation.
anti-GQ1b antibodies
GBS
UMN lesion
Weak, spastic tone
Hyperreflexia
upward plantars
LMN lesion
reduced reflexes
plantars down
muscle atrophy, fasciculations
Flaccid tone
wernicke’s aphasia
left middle side of the brain
difficulty with language comprehension
receptive aphasia
fluent nonsense
Broca’s aphasia
is a non-fluent type
expressive dyshpasia
Comprehension intact - understands but cannot say sentence
anterior brain
Cerebellar signs
DANISH Dysdiadokinesia / dysmetria. Ataxia. Nystagmus. Intention tremor. Speech - slurred or scanning. Hypotonia.
Management of TIA
See within 24 hours, aspirin 300mg
Syringomyelia
Collection of CSF in the spinal cord
Chiari malformation etc
