Osmosis Neuro Flashcards
Level of vertebrae for LP?
L3/4
Main excitatory neurotransmitter? Receptor?
Glutamate
NMDA
Focal seizure that starts in one muscle group and then spreads is called? Type of seizure?
Jacksonian march
Focal without impaired awareness (likely to remember it)
Tonic seizure?
Muscles become stiff and flexed
-> tend to fall backwards
Atomic seizure?
Muscles become relaxed
-> tend to fall forwards
Myoclonic?
Short muscle twitches
Post vital Sx?
Confusion
Paralysis (Todd’s paresis - around 15 hours -2 days)
-due to supression of area of brain affect
What happens in MS?
Demyelination of brain and spinal cord
T cell mediated autoimmune
Type IV hypersensitivity reaction
What produces myelin
Oligodendrocytes
Which cytokines are made by T cells?
IL-1, IL6
TNF-a, INF-y
Rf for MS?
Genetic
- female
- HLA-DR2
Environment
- Infection
- vit D deficiency
4 main types of MS?
Relapsing remitting (most common) -may be months-years between bouts with residual disability
Secondary progressive
Initially similar to RRMS -> progressive
Primary progressive
Steady progression of disability
Progressive relapsing
Progression with additional bouts
Usual age of MS
Usually aged 20-40
What Sx triad in MS?
Charcots
Dysarthria - difficult / unclear speech
-plaques in brain stem
Nystagmus
- plaques on optic nerve -> loss of vision Eg blurring / dark spot
- may have pain / double vision
Intention tremor
- plaques on motor pathways of spinal cord
- muscle weakness, spasms, ataxia as well
Can you get sensory sx in MS?
Yes
Numbness, parathesia …
Key sign in MS?
Lhermittes
-electric shock runs down back and radiates to limbs when bending neck forward
Uhthoffs
-Exacerbation of Sx in heat Eg bath / exercise
What happens if ms plaques in autonomic nervous system?
Bowel/bladder - eg incontinence
Sex - eg dysfunction
Ix of MS
Sx with spread over space and time
MRI - multiple white matter plaques
LP - presence of oligoclonal bands on gel electrophoresis
Visual evoked potential - Measure response to visual stimuli
Bloods
Anti-MOG, AQP-4
Metabolic causes of neuropathy
-FBC, inflammatory markers, B12/folate, HIV, Ca, Glucose
Tx of MS? Which type are these useful for?
Relapse
- Corticosteroids - high dose methyprednisolone
- Plasmapheresis - removes autoantibodies
1st line Prevention
- immunosuppressants - Eg B-INF
- Dimethyl fumarate
- alentuzumab
2nd line
- Natalizumab
- fingolimod
- cyclophosphamide (cell cycle inhibitor)
- IVIg
RRMS
What is treatment for progressive MS?
Mainly to manage Sx
Eg. Depression, bladder dysfunction
Cognitive rehabilitation therapy / Physio
?Vit D
Diagnosis of RRMS?
Mc Donald criteria
Evidence of 2 events, disseminated by space and time (at least 30 days apart)
Time
-evidence of new lesions on follow-up MRI with reference to baseline
Space
- At least 1 lesion in 2+ out of 4 areas of CNS
- Periventricular, juxtacortical, infrateriotoral, spinal cord
Mechanism of tissue damage in wilsons?
Free copper -> free radicals
How does the copper get into blood ?
Absorbed in gut -> liver If ATP7B is defective -> free copper in hepatocyte -> damage -> copper into extra cellular space -> blood
2 functions of ATP7B?
Bind copper to apoceruloplasmin
Package copper into vesicles -> bile
Bar liver what other organs are affected in Wilson’s disease ?
Brain
Basal ganglia -> movement disorder similar to Parkinson’s
Cortex -> neuronal cells death and dementia
Cornea
Kayser fleischer rings
Hepatosplenomegaly
Renal disease
Haemolytic anaemia (from free Cu in blood)
Ix? WD
Blood
- Decreased ceruloplasmin
- Increased copper
Urine
-Increased copper
Mx
Penicillamine - copper chelation
Zinc -> reduce copper reabsorption -> more excreted in urine
If liver cirrhosis / failure -> transplant
Gene in Huntington’s? Chromosome? How many repeats to be called hungtingtons ?
Huntingtin - Chromosome 4
36
Which part of brain is affected by HD
Basal ganglia (putamen + caudate)
What is anticipation
Earlier Sx onset. With each generation
Neurotransmitter changes in HD? How this reflects class of drugs for chorea Mx?
Decreased GABA + Ach
Increased Dopamine
Chorea -> Dopamine receptor antagonists (Antipsychotics)
-Tetrabenazine (depletes dopamine)
Injury to receptors in Myasthenia gratis is by?
Type II hypersensitivity
Cytotoxic injury
-> Damaged receptors -> lack of contraction
Also triggers classical complement pathway
-> muscle cell destruction
MX of myasthenia gravis
Acetylcholinesterase inhibitors (Neostigmine) -> Increase Ach
Immunosuppression - prednisolone
Surgical removal of thymus -> reduces muscle weakness
What factors can worsen fibromyalgia?
Depression
Anxiety
Negative beliefs
Neurotransmitter changes in polymyalgia?
Decreased serotonin -> less pain inhibition
Increased Nerve growth factor + substance p
Diagnosis of fibromyalgia
Pain in 7+ areas
Symptom severity score 5+ /12
-Eg headache, poor sleep, fatigue, ‘fibro fog’
Duration >3months
OR
Pain in 5 locations and a score of 9/12
Mx of polymyalgia
Exercise
Relaxation and good sleep hygiene
Pharma
Amitriptyline
SNRIs
Anticonvulsants (pregabalin and gabapentin) -> help with sleep problems
General sx of polymyalgia
Long lasting Widespread muscle pain Low threshold to pain Excessive tenderness Sleep disturbance
