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Neurology - Movement disorders Flashcards

1
Q

What is Parkinson’s

A

Loss of dopaminergic neurons in substantia nigra in basal ganglia
More common in males

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2
Q

What causes Parkinson’s

A

Age
Repeated head trauma - Boxing

Metoclopramide
Neuroleptics - EPSE

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3
Q

Parkinson’s DDx

A

Other causes of tremor

  • SSRI
  • Amphetamines
  • Salbutamol
  • Lithium
  • Alcohol
  • Hyperthyroidism
Wilson's disease 
Cerebellar tumour 
EPSE 
Normal pressure hydrocephalus 
Lewy body dementia
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4
Q

Parkinson’s TRIAD

A

Bradykinesia
Resting tremor - Pill rolling
Rigidity - COG WHEEL

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5
Q

Additional Parkinson’s symptoms

A 
REM sleep disorders
Shuffling gait 
Anosmia 
Monotone voice 
Micrographia 
Loss of facial expressions
Dementia - Visual hallucinations 
Depression 
Urinary incontinence 
Sexual dysfunction
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6
Q

Parkinson’s investigations

A

Clinical diagnosis - TRIAD

Histology

  • Lewy bodies
  • Eosinophilic cytoplasmic inclusions consisting of alpha synuclein

SCREEN FOR DEPRESSION

Exclude differential

  • Drugs
  • Cerebellar disorder - Imaging
  • Wilson’s - Cu bloods
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7
Q

Parkinson’s dopamine management

A

Increase dopamine

  • Levodopa
  • Dopamine agonist - Ropinirole
  • Delay as much as possible, body stops responding after 5-10 years

Stop dopamine breakdown

  • MOA-B inhibitor - Rasagiline, selegiline
  • COMT inhibitor - Entacapone
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8
Q

Parkinson’s tremor management

A

Amantadine

Anticholinergics - FALL RISK

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9
Q

Parkinson’s non-pharmacological management

A 
Physio
S/L therapy 
Occupational therapy
Deep brain stimulation
Surgery - Interrupt overactive BG circuits
SSRI for depression
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10
Q

Side effects of ropinirole

A 
Drowsiness 
Impulsivity/inhibition disorder
N/V
Dizziness
Visual hallucinations
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11
Q

Parkinson’s plus

A

VIVID

Vertical gaze palsy - Supranuclear gaze palsy
Impotence/incontinence - Multiple system atrophy
Visual hallucinations - LBD
Interfering limb - Cortico-basal degeneration
Diabetes/HTN - Vascular Parkinson’s

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12
Q

Causes of tremor

A

Cerebellar disease - DANISH
Parkinson’s

Essential tremor

Orthostatic - Legs
Multiple system atrophy - Autonomic symptoms

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13
Q

Drugs causing tremor

A 
Salbutamol
Lithium 
Caffeine 
Valproate
SSRI 
Amphetamines
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14
Q

Causes of normal pressure hydrocephalus

A

Reduced CSF resorption at arachnoid villi

Idiopathic 
Meningitis 
Head injury 
CNS tumour 
SAH
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15
Q

NPH presentation

A

WET - Urinary incontinence
WACKY - Dementia
WOBBLY - Falls

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16
Q

NPH investigations

A

RULE OUT PARKINSON’S

CT - Enlarged 4th ventricle
LP - CSF pressure normal

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17
Q

NPH management

A

Ventriculoperitoneal shunt

Acetazolamide

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18
Q

Hydrocephalus causes

A

Obstructive

  • Tumour
  • Haemorrhage

Non-obstructive

  • NPH
  • Increased production - Choroid plexus tumour
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19
Q

Hydrocephalus presentation

A

Raised ICP

  • Headache
  • N/V
  • Papilloedema
  • Confusion
  • HTN
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20
Q

Hydrocephalus investigations

A

CT - Dilatation of ventricles above lesion

LP - Diagnostic and therapeutic - Do not perform in obstructive

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21
Q

Hydrocephalus management

A

Eternal ventricular drain

Ventriculoperitoneal shunt

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22
Q

What causes Huntington’s

A 
Autosomal dominant
Mutation of Huntingtin gene
4p16.3
Trinucleotide CAG repeat
Degeneration of cholinergic and GABA neurons in basal ganglia
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23
Q

Early symptoms of Huntington’s

A 
Self neglect / apathy
Personality changes 
Clumsiness 
Chorea 
Tics 
Myoclonus
24
Q

Late symptoms of Huntington’s

A

Seizures
Spasticity
Clonus
Supranuclear gaze palsy

25
Psychiatric symptoms of Huntington's
Apathy Dementia Depression
26
Huntington's investigations
Genetic testing MRI - Loss of corpus striatum volume - Large frontal horns of lateral ventricles
27
Huntington's management
Chorea - Benzodiazepines, valproate Dopamine depleting agents - Tetrabenzene Deep brain stimulation SSRI Antipsychotics
28
Reflex syncope
Most common Vasovagal - Emotion, stress, standing Situational - Cough, micturition, GI, exercise Carotid sinus hypersensitivity
29
Cardiogenic syncope
``` ARRHYTHMIAS Structural - MI, valve disease, aortic stenosis, tamponade, dissection BBB Brugada syndrome Heart block WPWS ```
30
Orthostatic hypertension
Dehydration - Infection, haemorrhage Drugs - Diuretics, alcohol, vasodilators AI failure - Parkinson's, LBD, uraemia, diabetic neuropathy
31
Syncope presentation
Transient global cerebral hypoperfusion LOC Clonic jerking Rapid post-octal recovery
32
Syncope investigations
``` Orthostatic BP - Change > 20/10 is abnormal ECG - 24 hours Full cardio exam Tilt table test FBC - Anaemia ESR - Infection EEG - Epilepsy ```
33
Essential tremor characteristics
Can affect vocal cords Worse with arms outstretched Improved by alcohol and rest May be caused by BB
34
GBS pathophysiology
Immune mediated Demyelination Polyneuropathy
35
GBS aetiology
Post-viral Campylobacter jejuni CMV EBV
36
GBS presentation
AAAAA - Hours to days Symmetrical Ascending weakness - Proximal muscles Absent reflexes Autonomic dysfunction - Urinary retention / tachy - Arrhythmias Paraesthesia Respiratory depression Miller Fisher syndrome - Ataxia and paraesthesia
37
GBS investigations
Nerve conduction studies Anti ganglioside antibodies Spirometry LP - Protein ^ ECG - Arrhythmias
38
GBS management
IV IG ECG - Monitor for arrhythmias VTE prophylaxis Plasmapheresis if severe
39
GBS complications
Respiratory depression | Death
40
MS aetiology
``` Females Away from the equator 20-40 Smoking Previous mono infection ```
41
MS pathophysiology
Autoimmune destruction of myelin sheath by autoantibodies
42
MS presentation
Eyes - Optic neuritis - Internuclear ophthalmoplegia - Optic atrophy Motor - Spastic weakness Sensory - Lhermitte's sign - Trigeminal neuralgia - Numbness Urogen - Sexual dysfunction - Incontinence Cerebellar - Ataxia - Tremor Cognitive impairment UHTOFF'S PHENOMENON
43
MS types
Relapsing and remitting - Most common Primary progressive Secondary progressive
44
MS investigations
MRI - 2 lesions disseminated in time and space LP - Oligoclonal bands Anti-MOG
45
MS management
Acute - Methylprednisolone Chronic - Interferon - Galantamir - Natalizumab Other - Muscle relaxant - Baclofen - Reduce tremor - BB
46
Myasthenia gravis pathophysiology
Antibodies to Ach receptors
47
Myasthenia gravis aetiology
Associated with - Thyroid - Parkinson's - Thymoma
48
Myasthenia gravis presentation
Proximal weakness and fatiguability Normal reflexes - Synapses aren't fatigued on brief contraction Eyes - Diplopia - Ptosis - Better after ice Bulbar - Dysphagia - Dysphasia - Difficulty chewing
49
Myasthenia gravis common complaints
Peek sign - Gentle sustained lid closure - Then lids separate Difficulty watching TV - Eyes get tired Can't count to 50 - Voice fades
50
Myasthenia gravis exacerbation triggers
Drugs - BB - Opioids - Gentamicin - Lithium Pregnancy Infection Change in environment
51
Myasthenia gravis investigations
Electromyography - Decreased evoked potentials AntiMuSK antibodies AntiAchR antibodies CT - Thymoma Spirometry
52
Myasthenia gravis management
Pyridostigmine Steroids Azathioprine
53
Myasthenia gravis complications
Respiratory collapse
54
Lambert Eaton syndrome
Associated with small cell lung cancer Similar to myasthenia gravis Repated muscle contraction - Increased muscle strength
55
Cerebellar disorders cause
VITAMIN DD Vascular - Stroke Infection - Meningitis, encephalitis, VZV, mumps Trauma Autoimmune Metabolic - B12, thiamine, hypothyroid, hypoparathyroid Iatrogenic - Lithium, phenytoin, isoniazid, metronidazole Neoplasm Degenerative
56
Cerebellar disorders presentation
DANISH P ``` Dysdiadochokinesis Ataxia - Vermis Nystagmus Intention tremor Slurred speech Heel shin test / hypotonia ``` Pendular reflexes

3A (31 decks)

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