Neurology Lists Flashcards
Causes of ACUTE polyneuropathy (4)
also for predominantly motor neuropathy
Guillain-Barre Syndrome
Lead Toxicity
Porphyria
Diptheria
Causes of SUBACUTE polyneuropathy (3)
Drugs - “PAIN”
Toxins - EtOH
B12 deficiency
Hypothyroidism
Causes of CHRONIC polyneuropathy (4)
Diabetes
Malignancy / paraneoplastic / paraproteinaemia
Hereditary conditions
Uraemia
Drugs that cause peripheral neuropathy (4)
PAIN drugs!
Phenytoin
Amiodarone
Isoniazid
Nitrofurantoin
Investigations for peripheral neuropathy? Nerve related (2) Underlying cause (7)
Nerve conduction studies
-> axonal vs demyelinating
EMG
Fasting glucose / HBa1C UEC TFT ESR / Auto-antibodies B12 levels SPEP \+/- LP -> raised proteins for GBS
Initial investigations to guide acute management if GBS suspected?
Vital capacity ABG Bulbar function ECG + BP - autonomic compromise / arrhythmia Stool culture - campylobacter
Palpable peripheral nerves (4)
Hereditary forms of neuropathy
Leprosy
Acromegaly
Amyloidosis
Difference between demyelinating neuropathy and axonal neuropathy
Demyelinating = loss of velocity
Axonal = loss of amplitude
Can have secondary axonal loss in demyelinating neuropathy
Small fibre neuropathy
Pain and temperature - small diameter axons
(vibration / proprioception relatively preserved)
Diabetes
Alcohol
Features of autonomic neuropathy (6)
Postural hypotension Arrhythmia Abnormal sweating Ileus Urinary retention Impotence
Management of peripheral neuropathy (4)
Reverse underlying cause if possible
Treat pain with neuropathic agents
Monitor for complications such as ulcers
Appropriate footwear / gait aid to improve function
Mononeuropathy multiplex can mimick polyneuropathy - what are the causes (5)
Diabetes Vasculitis CT disease Malignancy Amyloidosis
Miller-Fisher Syndrome (3)
Associated with anti-ganglioside antibodies in serum
Ataxia
Arreflexia
Opthalmoplegia
MRC grading scale
0 = no contraction 1 = flicker 2 = active movement when gravity is eliminated 3 = active movement against gravity 4 = active movement against gravity and resistance 5 = full power
Cerebellar face signs (4)
Head tremor
Jerky eye movements
Nystagmus
Dysarthric speech
Cerebellar arm signs (3)
Rebound phenomenon
Intention tremor and/or past pointing (dysmetria)
Dysdiadochokinesia
Cerebellar leg signs (3)
Heel shin incoordination
Ataxic gait
Romberg’s NEGATIVE in pure cerebellar syndrome
Common causes of cerebellar ataxia
“Drugs Make Vera Tumble”
3 D 2 M 2 V 1 T
Developmental - Arnold Chiari Degenerative - Spinocerebellar ataxia Drugs - phenytoin / EtOH Metabolic - thiamine deficiency Multiple sclerosis Vascular - stroke Viral / infective - viral cerebellitis (children) Tumours - primary, secondary, paraneoplastic
Causes of paraneoplastic cerebellar syndrome
Small cell lung cancer
Ovarian carcinoma
Lymphoma
Associated with anti-neuronal antibodies
Anti Yo + Anti Hu
Friedreich’s ataxia - other features (5)
Kyphoscoliosis Optic atrophy Sensory neuropathy Cardiomyopathy Diabetes
What are the causes of spastic paraparesis?
Intrinsic (4)
Extrinsic (3)
Congenital (3)
Degenerative (1)
Transverse myelitis
Connective tissue disorders
Demyelination
Spinal cord infarction
Spondylosis
Tumour
Haematoma
Spina bifida
Cerebral Palsy
Hereditary spastic paraparesis
Primary lateral sclerosis
