Neurology 🧠 Flashcards
What are Argyll-Robinson pupils?
2 different sized pupils
Associated with Syphilis
What is Uthoff’s phenomenon?
Symptoms being worse with heat.
Seen in pts with MS
A young woman presents with arm pain on movement and visual disturbances. She has had these symptoms before and they usually subside within a week.
What does she have?
Multiple Sclerosis
How do you manage MS relapses?
Methylprednisolone
Reduces duration but does not change prognosis
What is used to treat muscle spasms (usually in MS)?
Baclofen
*Note: can also be used for hiccups
What is Charcot-Marie-Tooth disease?
A collection of peripheral neuropathies.
Progressive.
Px: muscle weakness (1st in ankles and feet), curled toes, foot drop, parasthesia in hands and feet.
May also have cold hands and feet due to poor circulation
What investigation findings would indicate a diagnosis of Myasthenia Gravis?
Anti-AchR Ab +ve
MUSK Ab +ve
Single fibre EMG showing a “jitter” and “blocking” pattern
*NOTE: Also do a contrast CT to exclude a Thymoma
How do you differentiate between Multiple Sclerosis and Motor Neurone Disease?
MND = sphincter disturbances, but no sensory loss
MS = sensory loss but no sphincter disturbances
What Anti-Epileptic Drug (AED) should be avoided in pregnancy?
Sodium Valporate
Teratogenic
A pt has a seizure lasting longer than 5 mins and has already been given IV Lorazepam, what do you do next?
Give another dose of IV Lorazepam.
If this is unsuccessful, give IV Phenytoin
What is a typical history of Myasthenia Gravis?
Weakness of extra-ocular region —> bulbar —> face —> neck—> limb—> trunk
How do you manage Myasthenia Gravis?
Pyridostigmine (Ach inhibitor) + immunosuppression
What is the drug Riluzole used for?
Motor Neurone Disease
It is a neuro-protective drug called an anti-glutamate
What is Horner’s Syndrome the triad of?
Anhydrosis (dry eyes)
Ptosis (droopy eyes)
Myosis (constricted pupils)
How do you manage temporal arteritis?
High dose oral prednisolone
If no dramatic response, consider another diagnosis
What condition is temporal arteritis associated with?
Polymyalgia Rheumatica
What is the common Px of temporal arteritis?
Headache Jaw claudication Fatigue Over 60 Morning stiffness Visual disturbances
Skip lesions found on histology/biopsy
How do you manage an acute migraine?
Oral triptan (e.g. Sumatriptan) + NSAID or paracetamol
Migraine prophylaxis?
Topiramate or Propranolol
NOTE: topiramate is teratogenic, so give Propranolol to women of child-bearing age
Cluster headache prophylaxis
Verapamil
How do you manage acute cluster headaches?
100% oxygen via non-rebreather
Can also give subcut/nasal Triptan
Management of acute tension headaches
Aspirin, NSAIDs or paracetamol
Trigeminal Neuralgia Px
Brief electric shock-like pains, abrupt onset and termination, limited to 1/2 divisions of the trigeminal.
Pain evoked by light touch and actions eg brushing teeth
Nasolabial fold is v susceptible
How do you manage trigeminal neuralgia?
Carbamazepine
What is a thunderclap headache indicative of?
Subarachnoid haemorrhage
What kind of haemorrhage can be caused by beri aneurysms?
Subarachnoid
If pt presents with subarachnoid haemorrhage symptoms (worst headache ever had, nausea, vomiting, seizures) but CT is -ve, what do you do?
Lumbar puncture - look for blood in CSF
What are chronic subdural haematomas/ haemorrhages caused by?
Rupture of the small bridging veins; slow bleeding
In what type of haemorrhage do you get a lucid interval?
Epidural haemorrhage
What type of haemorrhage is associated with elderly + alcoholics?
Subdural
What is the triad of meningism?
Nuchal rigidity, photophobia and headache
What are the early features of meningitis?
Headache and leg pains
Fever with cold hands and feet
Abnormal skin colour
What type of rash indicates meningitis?
Non-blanching petechial rash
Especially in meningiococcal septicaemia
What bacteria cause meningitis is 0-3 month olds?
Group B Streptococcus (most common in neonates)
E.Coli
Listeria Monocytogenes
What bacteria cause meningitis in any patients over 3 months old?
Neisseria Meningitidis
Streptococcus Pneumoniae
Note* H. Influenzae causes meningitis in the old (over 60) and the young (3 months - 6yrs)
What is the bacterial cause of meningitis in immunocompromised pts?
Listeria Monocytogenes
What is the management of meningitis?
Ceftriaxone
Add Amoxicillin if >60yrs or immunocompromised
If signs if meningism - give Dexamethasone (but DO NOT GIVE if meningococcal septicaemia)
What do you give as prophylaxis to close contacts of pts with meningococcal meningitis?
Ciprofloxacin or Rifampicin
Also offer vaccines
NOTE* do not give prophylaxis to close contacts of pts with pneumococcal meningitis
What is ‘status epileptics’?
Status epilepticus is defined as:
a single seizure lasting >5 minutes, or
>= 2 seizures within a 5-minute period without the person returning to normal between them
This is a medical emergency. The priority is the termination of seizure activity, which if prolonged will lead to irreversible brain damage.
3rd nerve palsy Px?
- Eye deviated “down and out”
- Ptosis
- Pupil may be dilated (sometimes called surgical 3rd nerve palsy)
What are the causes of 3rd nerve palsy?
- Diabetes
- Vasculitis Eg temporal arteritis, SLE
- False localising sign due to uncal herniation through tentorium if raised ICP
- Posterior communicating artery aneurysm
- Cavernous sinus thrombosis
- Weber’s syndrome: ipsilateral 3rd nerve palsy with contralateral hemiplegia - caused by midbrain strokes
- Amyloidosis
- MS
Where does C6 innervate?
Thumb + index finger
Make a 6 with thumb +index finger - C6
Where does T4 innervate?
T4 at the Teat Pore = Nipples
Where does T10 innervate?
Umbilicus - BellybuT-TEN
Where does L1 innervate?
Inguinal ligament - L for ligament, 1 for 1inguinal
Where does L4 innervate?
Knee caps - Down on aLL fours (L4)
L5 Innervation?
Big toe, dorm of foot (except lateral aspect)
L5 = Largest of the 5 toes
S1 Innervation?
Lateral foot, small toe
S1 = the smallest one
Lacunar stroke Px?
- Unilateral motor disturbance affecting the face, arm or leg or all 3.
- Complete one sided sensory loss.
- Ataxia hemiparesis
Which abx increase risk of intracranial HTN?
Tetracyclines Eg Doxycycline
What are the features of idiopathic intracranial HTN?
Headache Blurred vision Papilloedema (usually) Enlarged blind spot 6th nerve palsy may be present
Rx of idiopathic intracranial HTN?
Weight loss
Diuretics eg acetazolamide
Topiramate can be used
Repeated LP
What are the main migraine triggers?
CHOCOLATE: C - chocolate H - hangovers O - orgasms C - cheese + caffeine O - oral contraceptive pill L - lie-ins A - alcohol T - travel E - exercise
