Passmed neuro incl cauda equina Flashcards
What is charcot marie tooth disease
Hereditary sensory and motor peripheral neuropahty
What is prognosis of DUchennes musular dystrophy
Progressive degneration and weakness of specific muscle grouos -> lose ability to walk at 12, ventialtion by 25
SCDC presentation
Ataxic gait(degen of dorsal columns), mixed UMN and LMN signs (degne lateral motor tracts and peripheral erve)
How does charcot marie tooth syndrome present
V slow degenrative condition, hereditary. Sensory and motor - LMN in all libs and reduced sensation
What should be given before endoscopy with sus variceal haemorrhag e
Terlipressin and ceftriaxone
Nimodipine use
CCB - prevent cerebral vasospasm after aneurysmal SA
When is propanolol given with sus variceal bleed endoscopy
Afterwards
Prevention of variceal bleeding - indicated after bleeding cessation and post endoscopy
Acute spinal cord compression symptoms
Back pain
Bilateral motor loss
Sensory level
Loss of anal tone
What would poorly controlle DM and raising CRP/fever be a warning of neurologically
Epidural abscess
MRI, neurosurgery, prolonged IV antibiotics
Why do early falls occur in MS
Postural hypotnesion due to autonomic dysfucntion in MS
MS features
Urinary incontinence, erectile dysfunction, vulval insensitivity, severe REM sleep disorder, polyminimyoclonus fingers
PSP features
Backwards falls
Gaze palsy
Double vision
Dysarthria
Axial rigidity
Bloods for fatigue and sensory neural signs
- FBC
- U+Es
- TFTs
- HbA1c
- B12/folate
- Ferritin
- Bone panel
- LFTs
Summary of SACD
Demyelination of fibres of dorsal and lateral areas of spinal cord from B12 deficiency —>
Mix sensory and UMN signs
Reduced sensation, vibration, proprioception, ataxia, spastic loss of power and upgoing plantars - babinskis sign
B12 deficiency affects distal limbs in length dependent pattern
Raised MCV causes
Hypothyroidism
B12/folate
Alcohol
Red flag questions for backpain
- Sciatica (pain radiating down back of leg)
- Leg weakness
- Saddle paraesthesia (numbness or changed sensation to the perineum)
- Urinary symptoms (difficulty initiating urination, reduced sensation of urination, urinary incontinence)
- Bowel symptoms (faecal incontinence)
- Recent trauma
- Fevers/Night sweats
- Weight loss
- Pain that disturbs sleep
- History of intravenous drug use
- Osteoporosis
- Prolonged use of steroids (raises risk of osteoporosis)
Investigations for cauda equina
PR exam - loss of anal tone, reduced sensation
Post void bladder scan- retention - complete CE
Full spine MRI
What is gold standard in cauda equina
full spine MRI (within 1 hour preferable but not beyond 24)
Symptoms of suspected cauda equina
- Bilateral sciatica
- Leg weakness
- Saddle paraesthesia
- Bladder disturbance
- Bowel disturbance
Complete auda equina symptoms
- Urinary retention
- Overflow urinary incontinence
- Loss of anal tone and peri anal sensation
- fAECAL INCONTINENCE = LATE SIGN
- sADDLE PARAESTHESIA - WIDESPREAD and complete
Incomplete cauda equina syndrome
Subjective reduced urination sensation
Difficult passng, poor stream
Reduced urge to void bladder
Anal tone/sensation may be normal
Pathcy unolateral paraesthetisa saddle
Reduced power and reflexes, sciatic pain
Causes of cauda equina
Disc herniation
Haematoma
Malignancy
Spinal abscess
Stenosis Vertberal fracture
Treatment of cauda equina
Emergency surgery in next 48 hours
Laminectomy, dicectomy
High dose steroids - reduce swelling and oedema
Analgesia #Bloods - group and sace and coag
Urethral catherer if needed
Monitor for deterioration
Complications of cauda equina
Long term pain, motor function, badder/bowel disturbance, sexual dysfunction
