Neurology Flashcards
Name the ascending tracts that convey SENSORY information to the brain
DCML
Anterolateral system which is also called spinothalamic
Spinocerebellar tracts
Name the descending tracts that convey MOTOR information to the brain
Pyramidal tract which is also called corticospinal tract
Cortcicobulbar tract
Extrapyramidal tracts
Which sensory information does the DCML convey?
Fine touch, proprioception
Which sensory information does the Anterolateral system convey?
Crude touch, temperature, pain
Where does the DCML fibres decussate?
Medulla
Where does the anterolateral fibres decussate?
Segmentally
For which cranial nerves’ motor nuclei does the corticobulbar fibres supply?
V, VII, X, XII
What is Parkinson’s triad?
Akinesia/Bradykinesia
Rigidity
Resting Tremor
TACS
3/3 of
Homonymous hemianopia
Neurological deficit
motor OR sensory loss in 2/3 of face/arms/legs
PACS
2/3 of
Homonymous hemianopia
Neurological deficit
motor OR sensory loss in 2/3 of face/arms/legs
POCS
Brainstem effects: cranial nerve palsy, BILATERAL motor/sensory deficit Cerebellar dysfunction Homonymous hemianopia (occipital lobe dysfunction)
LACI
Any one of:
motor OR sensory loss in 2/3 of face/arms/legs
Motorsensory loss in 2/3 of face/arms/legs
Ataxic hemiparesis in 2/3 of face/arms/legs
Erb’s / Klumpke’s nerves
Erb’s C5 - C6
Klumpke’s C8 - T1
Give some examples of acetylcholinesterase inhibitors
Memantine
Donepezil
Rivastigmine
Galantamine
What are Pick’s cells and what are they pathognomic of?
Swollen neurons secondary to abnormal protein deposition & neuronal loss & gliosis.
Frontotemporal dementia
What are Lewy Bodies and what are they pathognomic of?
Intracellular eosinophilic structures with dense cores & pale halo of protein aggregates
Lewy Body Dementia (assoc parkinson’s)
Which dementias are primarily managed using acetylcholinesterase inhibitors?
Dementia with Lewy Bodies
Alzheimer’s
Vascular dementia (plus assessment of cardiac risk factors)
acetylcholinesterase inhibitors work by slowing cognitive decline T/F
True
What are the contraindications for acetylcholinesterase inhibitors?
Severe asthma/ COPD, active peptic ulcer disease
What is the first line management for Parkinson’s?
Levodopa (dopamine replacement agent)
Principles of using Levodopa?
DO NOT ACUTELY STOP due to risk of neuroleptic malignancy syndrome.
Effectiveness reduces with time (2yrs.)
Causes motor complications in the long run.
What are the side effects of Levodopa?
Dyskinesia - involuntary writhing movements
Psychosis
Dry mouth, anorexia, palpitations, postural hypotension, drowsiness
When should use of Levodopa be avoided?
Personality disorders - risk psychosis
If Levodopa is not tolerated, what are the alternatives for managing parkinson’s?
Dopamine agonists (Bromocriptine, Cabergoline) MAO-B inhibitors (Selegilinw)
Which part of the motor neurone system is affected in each form of motor neurone disease?
Amytrophic lateral sclerosis - both UMN & LMN
Progressive muscular atrophy - LMN only
Primary lateral sclerosis - UMN only
Bulbar palsy - CN IX, X, XI, XII
What is the mainstay of medical management for motor neurone disease?
Riluzole - this works by preferentially blocking the sodium channels asociated with damaged neurones
Incidence of each form of motor neurone disease?
Amytrophic lateral sclerosis - most common. 50%
Progressive muscular atrophy - 10%
Primary lateral sclerosis - 2%
Bulbar palsy - 2%
Which form of motor neurone disease has the best prognosis
Primary lateral sclerosis (UMN sx)
In Brown Sequard Syndrome, which tracts would present with ipsilateral sx & which would present with contralateral sx?
Ipsilateral: ALL motor symptoms & DCML symptoms (fine touch, vibration, pressure)
Contralateral: Anterolateral (pain, crude touch, temperature)
Which tracts are affected in anterior cord syndrome?
Anterolateral (pain, crude touch, temperature)
Pyramidal/corticospinal (voluntary control of muscles of body & face)
Band-like sensory symptoms plus motor symptoms primarily in upper limb suggests?
Central cord syndrome
Hoffmann’s sign tests for?
Hyperreflexia
UMN signs, loss of digital dexterity & loss of autonomic function (urinary/faecal incontinence/impotence) in an older individual suggests what?
Cervical myelopathy
Driving regulations & seziures?
1st unprovoked (car) - 6 months seizure free Established epilepsy (car) - 1 yr seizure free 1st unprovoked (truck) - 10yrs seizure free
