Neurology Flashcards
Seizure Pathophysiology
- *“Good” transmitters** which reduce seizures (2) - drugs potentiate these
- *“Bad” transmitters** which increase seizures (4) - drugs block these
Good - K channels, GABA
Bad - Glutamate, AMPA, NMDA, Na channel
Gerstmann Syndrome
Anatomical Location
Features (5)
Angular gyrus of the lower dominant parietal lobe
-associated with posterior circulation stroke
Features
- Agraphia
- Constructional apraxia
- Acalculia
- Left/Right dissociation
- Finger agnosia
TPA in acute stroke - indication and contraindications
Treatment of choice for trigeminal neuralgia
carbamazepine - 100mg BD to TDS, works within a few days
Auto-antibody of Lambert Eaton Myasthenic Syndrome
Anti- Voltage Gated Calcium Channel
Rate of congenital abnormalities in women taking AEDs
and
Advice re folic acid
Rate: 4 - 6%
Approximately double the national average of women without epilepsy
Folic acid
5mg daily for at least 3 months before and after conception
Both hemicrania continua and paroxysmal hemicrania both respond 100% to
Indomethacin!
This is the diagnostic criteria
Sydenham Chorea
- causative infection
- first line AEDs
- What else should the patient be on?
Pharmacological management of Tics
Glial cells
Oligodendrocytes are what is lost/defective in MS
Types of nerve fibres
Brown Sequard Syndrome
Pathogenesis of GBS
-most common preceeding infection
GBS: Presentation
Prognosis of GBS
Atypical degenerative causes of Parkinsonism: PSP
Atypical degenerative causes of Parkinsonism: MSA
triad of: autonomic failure, parkinsonism and cerebellar signs
*autonomic failure does not present so early on in disease of PD whereas in MSA they can develop autonomic failure and orthostatic hypotension quite early on
Atypical degenerative causes of Parkinsonism: CBA
Alien hand!
Braak Stages of PD
Risk factors and Protective Factors for Parkinson’s Disease
Treatment Options/Principles in PD
- While medications improve motor and non-motor symptoms, they do not improve balance
Treatment of Other Aspects of PD
Management of Essential Tremor
- *Carbamazepine**
- mechanism
- use
- contraindications (4)
- pregnancy?
- HLA we test for, who is more likely to have it
- HLA we don’t test for
Ethosuximide
- mechanism
- use
- contraindications (1)
- pregnancy?
Initial Management of Tonic-Clonic Seizures
Gabapentin
Lennox-Gastaut Syndrome
Familial Hemiplegic Migraine
RARREEE
weakness that takes up to 72 hours to resolve
assoc with strong family histroy
must rule out stoek and TIA
FHM1 is assoc with CANA1A gene
Chronic Migraine Definition
Lifestyle modifications for Migraine (8)
Guide to Prophylaxis choice in Migraine
Types of localised focal epilepsies and characteristics
TLE = single most common form of epilepsy!
Risk factors - prolonged febrile convulsions and CNS infections
Most common cause of drug refractory epilepsy requiring surgery!
Low CSF pressure HA
Worse in evening improved on lying flat.
may be associated with ‘coat-hanger’ pain across the shoulders of pulsatile tinnitus. Intracranial pressure < 6cmH20
may be spontaneous or follow trauma or post LP
Epilepsy classification
Definition and Epidemiology of Epilepsy
Helpful investigations in Epilepsy
Response to optimally used AED therapy
If failure of first therapy (after reaching optimal dose, ensuring compliance), gradually switch to another monotherapy.
May go to dual IF already efficacy, felt that severe therapy unlikely to respond to single therapy
Therapies for patients with drug-resistant epilepsy who are not surgical candidates.
LOW YIELD, but just be aware
Side Effects of Anterior temporal lobectomy for treatment of temporal lobe epilepsy
Natalizumab
Biggest issue with each MS medication
Risk factors for PML with natalizumab
MS vs PML - presentation
Fingolimod
AVOID in pregnancy
Glatiramer
BEST for pregnancy
Causes of Seizures in the Elderly
Dimethylfumarate
WORST tolerated but relatively safe in pregnancy
NO live vaccines
Ocrelizumab
Alemtuzumab
Interferon Beta
- What are 4 reasons why you wouldn’t use interferon beta?
