Neurology disease Flashcards
1
Q
Symptoms of muscle disease?
A
weakness of skeletal muscle, SOB, poor swallow, cardiomyopathy, cramp, pain, stiffness, myoglobinuria
2
Q
Signs of muscle disease?
A
wasting/ hypertrophy, normal or reduced tone and reflexes, motor weakness (nOT sensory)
3
Q
What are the congenital genetic classes of muscle disease?
A
structural- muscular dystrophies
Contractile- congenital myopathies
Coupling- channelopathies
Energy- enzymes/ mitochondria
4
Q
What are the acquired classes of muscle disease?
A
metabolic, endocrine (thyroid, adrenal, vit D), inflammatory muscle disease, iatrogenic: medication (steroids/statins)
5
Q
Examples of muscular dystrophies?
A
Duchenne’s MD, Becker’s MD, facioscapulohumeral MD, myotonic dystrophy, limb-girdle MD
6
Q
What are channelopathies and give examples?
A
Disorders of Ca, Na, K and Cl channels,
examples include: familial hypokalemicperiodic paralysis (all Ca, Na, K), hyperkalemic periodic paralysis (Na), paramyotonia congenita (Na), myotonia congenita (Cl)
7
Q
Examples of metabolic muscle diseases?
A
disorders of carbohydrate metabolism (glycogenoses), disorders of lipid metabolism, mitochondrial myopathies/ cytopathies
8
Q
Examples of inflammatory muscle disease?
A
polymyositis, dermatomyositis
9
Q
Investigations used for inflammatory muscle disease?
A
high CK, EMG (inflammation and myopathic), biopsy (polymyositis: CD8 cells, dermatomyositis: humeral-mediated, B cells and CD4 cells)
10
Q
How do you treat inflammatory muscle diseases?
A
immunosuppresion
11
Q
What is myasthenia gravis a disease of anf how does it present?
A
Myasthenia Gravis is a disease of the NMJ, and symptoms include: fatiguable weakness of limbs, muscles of mastication, ptosis, SOB and diplopia
12
Q
What investigations would you use for Myasthenia gravis?
A
AChR ab, anti MuSK ab, neurophysiology (repetitive stimulation, jitter), CT chest
13
Q
How would you treat myasthenia gravis?
A
symptomatic: acetylcholinesterase inhibitor (pyridostigmine), immunosuppresion (prednisolone, steroid saving agent (eg. azathioprine), immunoglobin/ plasma exchange, thymectomy
14
Q
What does the peripheral nerve consist of?
A
sensory axons (small fibres for pain and temp and large fibres for joint position sense and vibration), motor axons, autonomic axons and nerve sheath (myelin)
15
Q
Causes of generalised peripheral neuropathy?
A
Hereditary
Infectious (lyme, HIV, leprosy)
Metabolic (alcohol, diabetes, renal, B12)
Toxic (drugs
Inflammatory demyelinating (acute= Guillain Barre syndrome, chronic= chronic inflammatory demyelinating polyneuropathy)
Malignacy (paraneoplastic)
HIM TIM
16
Q
Symptoms of disease of nerve root?
A
myoromal wasting and weakness, reflex change, dermatomal sensory change
17
Q
Symptoms of disease of individual nerve?
A
wasting and weakness of innervated muscle, specific sensory change
18
Q
Symptoms of disease of generalised peripheral neuropathy?
A
sensory and motor symptoms, usually starting distally and moving proximally
19
Q
Investigations for disorders of the peripheral nerve?
A
blood tests, genetic analysis, nerve conduction studies, lumbar puncture (CSF analysis), nerve biopsy (nb sensory nerve)
20
Q
What disease is caused from disorder of the anterior horn cell?
A
Motor neuron disease (amyotrophic lateral sclerosis)
21
Q
Symptoms of motor neuron disease?
A
Combination of UMN and LMN signs: muscle fasciculations, wasting, weakness, increased tone, brisk reflexes (no sensory involvement)
22
Q
Treatment of Motor Neuron disease?
A
supportive- PEG feed, non-invasive ventilation, physio, OT
Riluzole
Anticipatory/ palliative care
23
Q
What are the expected signs of cord pathology on upper motor neuron?
A
no wasting, increased tone, increased reflexes (extensor plantar), pyramidal pattern of weakness
24
Q
What are the expected signs of root pathology on lower motor neuron?
A
decreased tone, decreased reflexes (flexor plantar), weakness
25
If the dorsal column is affected what symptoms can you expect?
decreased vibration snese and joint position sense
26
If the spinothalamice tract is affected what symptoms can you expect?
decreased pain and temperature
27
What sensory signs can you expect from cord damage?
myelopathy- sensory level loss and hemicord Lesion (Brown-Sequard syndrome)
28
What sensory signs can you expect from root damage?
radiculopathy- dermatomal sensory loss
29
Surgical causes of myelopathy or radiculopathy
tumour, vascular abnormalities (haemorrhage, ABM, dural fistula), degenerative, trauma
30
Types of tumours of spinal cord?
extradural, intradural/ extramedullary, intramedullary
31
Medical congenital/ genetic causes of myelopathy?
Friedrich's ataxia, spinocerebellar ataxias, hereditary paraparesis
32
Medical acquired causes of myelopathy?
Inflammation, infection, vascular, metabolic, malignant, idiopathic
33
Inflammatory causes of myelopathy?
demylination (multiple sclerosis), autoimmune (antibody mediated eg aquaporin 4, lupus)
34
Infective causes of myelopathy?
viral-herpes simplex/zoster, EBV, CMV, measles, HIV
Bacterial- TB, borrelia (Lyme), syphilis, brucella
Other- schistosomiasis
35
Metabolic causes of myelopathy?
B12 deficiency
36
Causes of spinal cord ischaemia
atheromatous disease, thromboembolic disease, arterial dissection, systemic hypotension, thrombotic haematological disease, vasculitis, venous occlusion, decompression sickness, meningovascular syphilis
37
How does a spinal cord stroke present?
pain- back pain/radicular, visceral referred pain, weakness (paraparesis), numbness and paraesthesia, urinary retention followed by bladder and bowel incontinence
38
How is demyelinating myelitis characterised?
by pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction, white matter is affected
39
What is pernicious anaemia?
autoimmune condition in which antibodies to intrinsic factor prevent B12 absorption
40
How does B12 deficient myelopathy present?
paraesthesia hands and feet, areflexia, degeneration of: corticospinal tracts (paraplegia), dorsal columns (sensory ataxia), painless retention of urine
41
Types of primary headacche?
tension type headache, migraine, cluster headache
42
Types of secondary headache?
tumour, meningitis, vascular disorders, systemic infection, head injury, drug-induced
43
What are the 5 steps of a migraine?
Premonitor, aura, early headache, advanced headache, postdrome
44
Describe the symptoms in the premonitor stage of a migraine
mood changes, fatigue, cognitive changes, muscle pain, food craving
45
Describe the symptoms in the aura stage of a migraine
fully reversible, neuroligal changes: visual somatosensory
46
Describe the symptoms in the early headache stage of a migraine
dull headache, nasal congestion, muscle pain
47
Describe the symptoms in the advanced headache stage of a migraine
unilateral throbbing, nausea, photophobia, phonophobia, osmophobia
48
Describe the symptoms in the postdrome stage of a migraine
fatigue, cognitive change, muscle pain
49
How long does the aura stage of a migraine last and why?
15-60 minutes
| and you get transient neurological symptoms resulting from cortical or brainstem dysfunction
50
Define a chronic migraine
Headache on >/=15 day/month, of which >= days are migraines, for more than 3 months`
51
What medication should you avoid if pregnant
anti-epileptics
52
Types of trigeminal autonomic cephalagias?
cluster headache, paroxysmal hemicrania, SUNCT and SUNA
53
What does SUNCT and SUNA stand for?
SUNCT-short-lasting unilateral neuralgiform headache with conjunctival injection and tearing
SUNA- Short-lasting unilateral neuralgiform headache with autonomic symptoms
54
Go over trigeminal autonomic cephalagias?
on spreadsheet
55
Go over migraines
on spreadsheet
56
Difference in type of pain between cluster headache/ paroxysmal hemicrania and SUNCT
cluster headache/ paroxysmal hemicrania= sharp, throbbinf
SUNCT= stabbing, burning
57
What presentations are more likely to have a sinister cause?
associated head trauma, thunderclap onset, new daily persistent headache, change in headache pattern or type, returning patient
58
Some redflag symptoms or signs of headaches?
new onset, new or change in headache and aged over 50 or immunosuppresion or cancer, change in ha frequency, characteristics , focal/non-focal neurological symptoms, abnormal neurological examination, neck stiffness/fever, high pressure (worse lying down, wakening patient up, precipitated by: physical exertion, valsalva manoeuvre), risk factors for cerebral venous sinus thrombosis, low pressure headache, Giant cell arteritis
59
Go over thunderclap headache, subarachnoid haemorrhage and intracranial hypotension, giant cell arteritis
on spreadsheet
60
causes for raised intracranial pressure?
glioblastoma multiforme, cerebral abscess, meningioma, hydrocephalus, venous infarct with focal area of haemorrhage, pappilloedema
61
Severity of head injury as represented by GCS
```
13-15 = mild injury
9-12 = moderate injury
3-8= severe injury
```
62
Describe a linear skull fracture
commonly temporo-parietal from blow or fall onto side or top of the head (eg fall on pavement) and may continue on to the skull base, "hinge" fracture
63
Describe a depressed skull fracture
focal impact which may push fragments inwards to damage the meninges, blood vessels and brain, increases the risk of meningitis and post-traumatic epilepsy
64
Describe a comminuted skull fracture
fragmented skull
65
Describe a ring skull fracture
fracture line encircling the foramen magnum caused by a fall from height, leading to the skull base and cervical spine being forced together
66
Describe a contre-coup skull fracture
fracturing of the orbital plates caused by a fall onto the back of the head
67
Go over haemorrhages
on spreadsheet
68
Go over cerebral oedema and contusions and diffuse traumatic axonal injury
on spreadsheet
69
The 3 categories of syncope
Reflex, orthostatic and cardiogenic
70
Causes of reflex syncope
taking blood/ medical situations, cough, micturation
71
Causes of orthostatic syncope
dehydration, medication related (anti-hypertensive), endocrine, ANS
72
Causes of cardiogenic syncope
arrhythmia, aortic stenosis
73
How to assess syncope
examinaton- heart sounds, pulse, postural BPs, ECG
74
symptoms of cardiogenic syncope
chest pain, palpitations, SOB, clammy/sweaty, came around quickly, seemed to stop breathing when passes out, unable to feel pulse while passed out
75
Causes of provoked seizures
alcohol or drug withdrawl, few days after head injury, within 24hrs of stroke, neurosurgery, severe electrolyte disturbance, eclampsia
76
Types of generalised seizures
absence sei.., generalised tonic-clonic s, myoclonic epilepsy, atonic sei
77
Types of focal seizures
simple partial seizures, complex partial seizures, secondary generalised, or by localisation of onset
78
Describe primary generalised?
no warning, <25 years, history of absences and myoclonic jerks, generalised abnormality on EEG, family history
79
Describe focal/ partial epilepsies
may get an "aura", any age, simple partial and complex partial seizures can become secondarily generalised, focal abnormality on EEG, MRI may show causes
80
Go over seizures
spreadsheet
81
Ischaemia definition
;lack of blood flow
82
Hypoxia definition
lack of O2
83
Interruption of supply of O2 is caused by cjanges in what?
vessels wall, blood flow and pressure and blood consituents
84
3 main causes of localised interrupted blood flow?
atheroma + thrombosis, thromboembolism, ruptured aneurysm
85
Which bracnh of the internal carotid artery tends to get ischaemia as a result of atheroma and thrombosis?
middle cerebral artery
86
What kind of stroke do you get due to a ruptured vessel?
haemorrhage and distal ischaemia due to spasm of artery
87
What are the 2 common sites of ruptured vessels causing haemorrhagic stroke?
basal ganglia- microaneursyms
Circle of Willis- berry aneursym
88
Causes of generalised interrupted blood supply or hypoxia?
Low O2 in bloof, inadequate supply of blood and inability to use O2
89
Causes of low O2 in blood?
CO2 poisoning, near drowning, respiratory infarct
90
Causes of inadequate supply of blood?
cardiac arrest, hypotension, brain swelling
91
causes of inability to use O2?
cyanide poisoning
92
What kind of injury is causes by generalised interrupted blood supply due to hypotension?
watershed infarction
93
What kind of injury is causes by generalised interrupted blood supply due to cardiac arrest?
cortical infarction
94
Name the common types of primary brain tumour
Neuroepithelial tissue (glioma- glioblastoma multiforme), meninges (menigioma), pituitary (adenoma)
95
What are the commonest tumours that spread to the brain?
renal cell, lung and breast carcinoma, malignant melanoma and GI tract
96
Describe glioma carcinomas?
Gliomas are derived from astrocytes, they are graded by WHO I-IV, IV is the most common and most aggressive known as Gliobastoma multiforme and is spread by white matter and CSF pathway
97
Describe meningiomas
arise from arachnoid, they are slow growing normally benign tumours, they frequently occur along the falx, convexity or sphenoid bone and are completly cured if removed
98
Describe pituitary tumours
adenoma, only 1% are malignant, present with visual distubance and hormone imbalance
99
How do brain tumours present?
raised intracranial pressure, focal neurological deficit, epileptic fits, CSF obstruction
100
Symptoms of raised ICP
morning headache, n/v, visual disturbance, somnolence, cognitive impairment, altered consciousness
101
Signs of raised ICP
papilloedema, 6th nerve palsy, cognitive impairments, altered consciousness, 3rd nerve palsy
102
How much CSF is produced in a day?
400-450 cc/day
103
Where is a tumour likely to be if hydrocephalous is a symptom?
posterior fossa tumours
104
Focal neurological deficit symptoms
hemiparesis, dysphasia, heminaopia, cognitive impairment, cranial nerve palsy, endocrine disorders
105
What tumour is likely to be found in the cerebellum?
Menigioma
106
In what type of lesions do you get epilepsy as a symptom?
in lesions above tentorium
107
Management options for glioblastoma multiforme
complete surgical excision, steroids, anticonvulsants, radiotherapy, chemotherapy (temazolamide)
108
Management options for metastasis brain tumour
steroids, anticonvulsants, radiotherapy, surgery
109
When should you not perform a lumbar puncture and why?
when there are signs and symptoms that suggest an intracranial mass lesion and because it could cause a herniation syndrome and death of patient
110
what are the functions of the frontal lobe
Voluntary control of movement (precentral gyrsu), speech (pars opercularis, pars triangularis), saccadic eye movements (frontal eye field), bladder control (paracentral lobule), gait (periventricular), higher order (restraint, initative, order (RIO))
111
What job does the orbitofrontal cortex have?
restraint- mediates empathic, civil and socially appropriate behaviour
112
How would you test the function of the orbitofrontal cortex?
Is speech and behaviour appropriate, go/no-go tests, stroop tests
113
How would you exam the function of the frontal lobe?
inspection- decorticate posture, magnetic gait, urinary catheter, abulia, UMN signs, pronator drift, saccadid eye movements, primitive reflexes, speech
114
What is the job of the supplementary motor cortex/ anterior cingulate
Initiative
115
How would you test the supplementary motor cortex function?
lack of motivation, apathy, abulia, depression
116
What is the function of the dorsolateral prefrontal cortex?
Order- integration of sensory infor, generation of responses to environmental challenges, selection of most appropriate reponse, maintenance of task seet, sequential ordering of data, self-evaluation of performance
117
How would you test the dorso-lateral cortex
Ability to make and appointment and keep to time, ability to give coherent account of history, spell WORLD, say as many words as possible with a particular letter
118
How would you exam someone's language ability?
1st ensure their hearing is intact and speak english, check fluency (Broca's), normal aphasia, repetition (arcuate fasciculus), 3 step command (Wernicke's), "Baby hippopotamus" (cerebellar), orofacial movement (ppp, ttt, mmm), reading, writing
119
What are the functions of the parietal lobe?
Primary somatosensory area, multimodality assimilation, visuospatial coordination, language, numeracy
120
How would you examine the parietal lobe when looking at cortical sensory symptoms?
sensory inattention, astereoagnosia, dysgraphasthesia, 2 point discrimiation
121
What symptoms could you expect when the parietal lobe is affect on the dominant side? (Gerstman's syndrome)
Dyscalculia, finger anomia, left/ right disorientation, agraphia
122
What symptoms could you expect when the parietal lobe is affected on the non-dominant side?
ideomotor apraxia-"How to do"- light a match, ideational apraxia- "what to do"- What's a comb for,constructional apraxia- draw this 3d box,dressing apraxia, hemineglect, loss of spatial awareness
123
What are the functions of the temporal lobe?
process auditory input (Heschl gyrus), language, encoding declarative long0term memory (hippocampus), emotions (amygdala), visual fields (Meyer's loop)
124
Symptoms when the cerebellum is affected?
```
DANISH P
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremors
Slurred speech
Hypotonia
Past pointing
```
125
Patient who presents with magnetic gait, a urinary catheter and decorticate posture is likely to have which lobe of the brain affected?
Frontal lobe
126
Patient who presents with failed stroop test and is speaking to you inappropriately is likely to have which lobe of the brain affected?
In the frontal lobe- the orbitofrontal cortex
127
Patient who presents with failure to give coherent account of history, can't spell words backwards and can't provide any words when asked to name as many words possible starting with "P" is likely to have which lobe of the brain affected?
Frontal lobe- dorsolateral prefrontal cortex
128
Patient who presents with lack of motivation, depression and abulia is likely to have which lobe of the brain affected?
Supplementary motor cortex of the frontal lobe
129
Patient who presents with sensory inattention, inability to identify an object by touch, inability to determine what's been written on them by touch alone and 2 point discrimination is likely to have which lobe of the brain affected?
Parietal lobe
130
Patient who presents with maths difficulty, inability to distinguish fingers, loss in ability to communicate through writing and left/right disorientation is likely to have which lobe of the brain affected?
Dominant side of parietal
131
Patient who presents with inability to wave, get dressed, has hemineglect and loss of spatial awareness is likely to have which lobe of the brain affected?
Non-dominant side of parietal lobe
132
Patient who presents with loss of long-term memory is likely to have which lobe of the brain affected?
Temporal lobe
133
Patient who presents with slurred speech, hypotonia and a broad, course and low frequecny tremor is likely to have which lobe of the brain affected?
Cerebellum
134
Define abulia
Inability to act instinctively
135
Define Astereoagnosia?
Inability to identify an object by touch
136
What is the clinical definition for inability to determine what is being written on you rhand by touch alone?
Dysgraphasthesia
137
Define finger anomia?
Inbility to distinguish fingers
138
Define dyscalculia?
Maths difficulty
139
Define agraphia?
Loss in ability to communicate through writing
140
Define Ideomotor apraxia?
Inability to perfom tools and waving, eg ask patient to show how you would light a match
141
Define ideational apraxia?
Inability to conceptualise, plan and execute complex sequences of motor actions eg ask them what is the pur[ose of a comb
142
Define constructional apraxia?
Inability of patients to copy accurately a drawing of a 3D oblect
143
Describe an intention tremor
broad, course and low frequency tremor
144
How do you know it's radiculopathy?
unilateral, single myotome, single dermatome, LMN
145
How do you know it's a peripheral nerve affected?
unilateral, motor and sensroy deficit fits with pn, LMN
146
How do you know it's myelopathy
bilateral motor and sensory level, UMN
147
What common symptoms do you get with peripheral neuropathy?
feels like wearing glove and stockings.
148
Myelopathy symptoms
clonus, upgoing plantars, hypertonicity, Hoffman's sign, brisk reflexes, proprioception impairment (Romberg's test, tandem walking)
149
What supplies the anterior circulation of the brain?
2 internal carotid arteris, 2 anterior cerebral artery, 2 middle cerebral artery
150
What supplies the posterior circulation of the brain?
2 vertebral arteries, 3 pairs of cerebellar arteries, 2 posterior cerebral arteries
151
What are the symptoms of anterior cerebral artery occlusion?
Contra-lateral: paralysis of foot and leg, sensory loss over foot and leg, impairment of gait and stance
152
What are the symptoms of middle cerebral artery occlusion?
Contra-lateral- paralysos/ sensory loss of face/arm/leg, homonymous heminaopia, gaze paralysis to opposite side,
aphasia if stroke is of dominant side
Unilateral neglect and agnosia if non-dominant side
153
What are the symptoms of middle cerebral artery occlusion of the left hemisphere (dominant)
Hemiplegia, homonymous hemianopia, dysphasia
154
What are the symptoms of middle cerebral artery occlusion of the right hemisphere (non-dominant)
Left hemiplegia, homonymous hemianopia, agnosias- visual, sensory, anosagnosia, prosopagnosia
155
Define anosagnosia
denial of hemiplegia
156
Define prosopagnosia
Failure to recognise faces
157
Lacunar stroke syndromes
No dysphasia, neglect or hemianopia
| Can be pure motor stroke, pure sensory stroke, dysarthria (clumsy hand syndrome), ataxic hemiparesis
158
Posterior circulation occlusion symptoms?
coma, vertigo, n/v, cranial nerve palsies, ataxia, hemiparesis, hemisensory loss, crossed sensori-motor deficits, visual field deficits
159
What anatomy is involved when there is posterior circulation occlusion
brain stem, cerebellum, thalamus, occipital and medial temporal lobes
160
When a patient presents with impairment of gait, has a paralysed right foot and sensory loss in leg and foot where is there a vessel occluded?
left anterior cerebral artery occlusion
161
When a patient presents with right paralysis of leg and sensory loss in leg, homonymous hemianopia and gaze paralysis to right side where is there a vessel occluded?
Left middle cerebral artery occlusion
162
When a patient presents with incoordinated movements along with weakness in one side of the body (ataxic hemiparesis) and complains of dropping things ore often what type of stroke would you expect?
Lacunar stroke syndrome
163
When a patient presents with paralysis on one side of the body (hemiplegia), dysphasia and homonymous hemianopia where is there a vessel occluded?
Dominant side, middle cerebral artery occlusion
164
When a patient presents with left paralysis of body (hemiplegia) but denies this paralysis (anosagnosia), inability to process sensory information (sensory agnosia) and failure to recognise their family (prosopagnosia)where is there a vessel occluded?
non-dominant hemisphere, middle cerebral artery
165
When a patient presents with vertigo, n/v, 1 dilated pupil, ptosis, visual field deficitis, incoordinated movements (ataxia), hemipareis where is there a vessel occluded?
in posterior circulation
166
How would you treat a stroke?
thrombectomy, aspirin (ischaemic), stroke units, tissue plasminogen activator
167
Name 4 members of the stroek unit
clinical staff, stroke nurses, physiotherapists, speech and language therapists, occupational therapists, dietician, psychologist, orthotpist
168
What are the 4 OCSP stroke classifications?
Total Anterior Circulation Stroke, Partial anterior circulation stroke, lacunar stroke, posterior circulation stroke
169
OCSP table
on sheet
170
When would you use tissue plasminogen activator
<4.5hrs from symptom onset, disabling neurological deficit, symptoms present >60 mins, consent obtained
171
Exclusion criteria for IV tissue plasminogen activator?
Anything increasing chance of haemorrhage- blood on CT scan, recent surgery, recent episodes of bleeding, coagulation problems,
BP>185 sytolic or >110 diastolic
Glucose <2.8 or >22mmol/L
172
What investigations would you complete for stroke?
routine blood tests (FBC, glucose, lipids, ESR), CT or MRI, ECG, echocardiogram, carotid doppler ultrasound, cerebral angiogram/ venogram, hyper-coagulable blood screen`
173
What is used for secondary prevention of strokes?
Anti-hypertesnives, anti-platlets, lipid lowering agents, warfarin (AF), carotid endarectomy
174
Define dementia
A syndrome consisiting of progressive impairment of multiple domains of cognitive function in alert patients leading to loss of acquired skills and interference in occupational and social role
175
Causes of late onset dementia (65+ yrs)
Alzheimer's, vascular, Lewy body, others (ALVO)
176
Causes of young onset (<65yrs) dementia?
Alzheimer's, vascular, frontotemporal, other (toxic (alcohol), genetic (Huntington's), infection (HIV, CJD), inflammatory (MS)
177
What are some treatable causes of dementia?
Vitamin deficiency eg B12, endocrine (thyroid disease), infection (HI, syphillis)
178
What conditions can mimic dementia?
Hydrocephalus, tumour, depression- pseudodementia
179
How would you diagnose dementia?
History, examination (cognitive function, neurological, vascular), investigations- blood, CT, MRI, CSF, EEG, functional imaging, genetics
180
If the dementia had a rapid progression and the patient had the sign myoclonus, what would be the cause?
CJD
181
If the dementia had a stepwise progression what would be the liekly cause?
vascular
182
If the patient who'd been diagnosed with dementia also had abnormal movements what would you believe the cause was?
Huntington's
183
If the patient who'd been diagnosed with dementia also had parkinsonism what would you believe the cause was?
Lewy body
184
What type of dementia is Alzheimer's disease?
Temporo-parietal dementia
185
What are the symptoms of Alzheimer's disease (temporo-parietal dementia)?
early memory disturbance, language and visuospatial problems, personality preserved until later
TAM- temporo-parietal demntia= Alzheimer's= memory loss
186
What are the symptoms of frontotemporal dementia?
early change in personality/ behaviour, often changes in eating habits, early dysphasia, memory/ visuospatial relatively preserved
187
What are the symptoms of vascular dementia?
Mixed picture, stepwise decline
188
Symptomatic treatment of dementia?
Info and support, dementia services, OT, social work/ support, insomnia, behaviour, depression
189
Specific treatment for Alzheimer's disease
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine), NMDA antagonist (memantine)
190
Define Parkinsonism
A clinical syndrome caused by loss of dopamine in the basal ganglia, with >/=2 of: bradykinesia (slow movement), rigidity, tremor, postural instability
191
Causes of parkinsonism?
Idiopathic-dementia with Lewy bodies
Drug induced (dopamine antagonists)
Vascular parkinsonism
Parkinson's plus syndromes (multiple system atrophy, progressive supranuclear palsy/ corticobasal degeneration)
192
What is the early medical treatment of Parkinson's
Levodopa,
MAO-B inhibitors- selegiline, rasagiline, safinamide
COMT inhibitors- entacapone
Dopamine agonists- ropinirole, pramipexole, rotigotine
193
What is the late treatment of Parkinson's
MAO-B inhbitors, COMT inhibitors, slow release levodopa (to prolong levodopa half life), add oral dopamine agonist, continuous infusion of apomorphine and duodopa
functional neurosurgery
194
What are later drug-induced complications in Parkinson's
motor fluctuation- as levodopa wears off, dyskinesias- involuntary movements (levodopa), hallucinations, impulse control
195
What are later non-drug induced complications in Parkinson's
depression, dementia, autonomic- BP, bladder, bowel, speech, swallow, balance
