Neurology Flashcards
Lateral spinothalamic tract
Ascending pathway
Pain and temperature
PaTeLa
Posterior column
Sensory - fine touch, proprioception, vibration
Anterior spinothalamic Tract
Ascending pathway
Primarily responsible for coarse touch and pressure
Lateral cerebrospinal tract
Descending motor pathway
Begins in the cerebral cortex, decussates in the pyramids of the lower medulla and proceeds down the contra lateral side of the spinal cord
Voluntary movement of limbs
Apomorphine infusion in Parkinson’s
Dopamine agonist
Helps smooth out motor fluctuations and dyskinesias
AE: dopamine agonists can cause impulsive behaviour
Horner’s
Interruption of the sympathetic innervation of the eye
Partial ptosis
Constricted pupil that responds normally to light
Decreased sweating on affected side
Side of Horners = side of lesion
Medial medullary syndrome
Dejerine Syndrome Ipsilateral hypoglossal palsy Contralateral impairment of fine touch, vibrations, proprioception Contralateral hemiparesis Nystagmus
Lateral medullary syndrome
Horner Syndrome Ipsilateral ataxia Contralateral impairment of sensation of pain and touch to the body Ipsilateral impairment of sensation of pain and touch to the face Nystagmus Ipsilateral hearing loss Hoarse voice Loss of taste Hiccups Cardiac arrhythmia
Presentation of carotid artery dissection
Ipsilateral cervical pain
Headache
Horner syndrome - caused by compression of the ascending sympathetic supply in the carotid sheath
Features of diabetic mono-neuritis of the eye
Unilateral pain, ptosis and diploplia with sparing of pupillary function
History and examination in Idiopathic Intracranial Hypertension
Hx: headache, papilloedema, visual loss, pulsatilla tinnitus, overweight females of childbearing age
Ex: papilloedema, visual field loss, 6th nerve palsy
Ix: Normal MRI, elevated opening pressure on LP
Rx: weight loss, carbonic anhydrase inhibitors (e.g. acetazolamide), loop diuretics, surgery (if previous fail)
Activation of NMDA receptors?
NMDA is a glutamate receptor and ion channel protein found in nerve cells
Activated when glutamate and glycine bind to it
Azithromycin SE
Torsades de Pointes
SJS
Ototoxicity
Prolonged QT
Ciprofloxacin SE
SJS/TENS
Peripheral neuropathy
C. Diff
Tendon rupture (esp Achilles tendon)
Clindamycin AE
C. Diff
Flucloxacillin AE
LFT derangement
AIN
Nitrofurantoin AE
Peripheral neuropathy Hepatotoxicity Pulmonary toxicity SJS Haemolytic anaemia in G6PD deficiency
Carbimazole AE
Agranulocytosis
Most likely in first 3 months of treatment
Febuxostat MOA
Inhibits xanthine oxidase, enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid thereby decreasing uric acid
Anti-Hu encephalomyelitis
Multi focal
Often involve dorsal root ganglia causing a subacute sensory neuropathy
SCLC found in most patients
Ma2-associated encephalitis
Paraneoplastic - testicular cancer
Anti-GABA-A receptor encephalitis
Rapidly progressive encephalitis with with refractory seizures, status epliepticus and/or epilepsia partialis continua
CSF - lymphocytic pleocytosis with increased plasma concentration
MRI- multifocal cortical / subcortical and widespread FLAIR and T2 signal abnormalities
Anti-MNDA encephalitis
Prodromal headache, fever, viral-like illness followed by
- prominent psych manifestations (anxiety, agitation, hallucinations)
- Insomnia
- Memory deficits
- seizures
- decreased LOC
- dyskinesias
- autonomic instability
- language dysfunction
Anti-Caspr2 associated encephalitis
Predominantly men >65 yo
Cognitive changes, cerebellar symptoms, peripheral nerve hyper excitability, autonomic dysfunction, insomnia, neuropathic pain, weight loss
Amaurosis Fugax
Ipsilateral carotid artery stenosis
Type 1 muscle fibres
High capillary density Low glycolytic activity High resistance to fatigue Very high mitochondrial density Slow contraction time High oxidative capacity Suited for activities requiring strength and endurance that depend for energy metabolism on oxidative processes
Type 2 muscle fibres
Low capillary density High glycolytic activity Fairly high to low resistance to fatigue High to low mitochondrial density Fast contraction time High to low oxidative capacity Less suited to continuous types of activity More suited to rapid alternating effort
