Review Flashcards
lesions disseminated in time and space refers to the diagnostic criteria of which neurological condition?
MS
causes of SC compression?
disc herniation spondylolisthesis haematoma tumour abscess cyst
?onset of weakness in patient-subacute would argue against a haematoma
where is lesion likely to be if pt presents with proximal muscle WEAKNESS?
NMJ e.g. MG or lambert-eaton myasthenic syndrome
muscle e.g. polymyositis, dermatomyositis, or secondary to other conditions e.g. hyperparathyroidism, or drugs e.g. statins.
*note PMR affects proximal muscles, always shoulders, but causes pain and stiffness NOT weakness
how can the aura of a migraine be distinguished from that seen prior to a epileptic seizure?
time scale:
aura in migraine tend to evolve over 20-30 min whereas epilepsy auras tend to occur over seconds
what should we suspect as the diagnosis in a pt with dementia and a gait abnormality and urinary incontinence?
normal pressure hydrocephalus-results from impaired CSF reabsorption secondary to disrupted arachnoid villi function e.g. SAH, meningitis or head injury.
represents a reversible cause of dementia, neuroimaging reveals hydrocephalus with enlarged 4th ventricle
tment=ventriculoperitoneal shunting
1st line treatment for trigeminal neuralgia?
carbamazepine
differentials for gait abnormalities in elderly patient?
Neurological: brain-stroke-weakness extrapyramidal-parkinsons, cerebellar dysfunction peripheral neuropathy-DM, alcoholic muscle-MG Vascular: PVD MSK: hip and knee pathology-OA, NOF fractures Syncope: postural hypotension cardiac syncope
what is the amber care pathway, when is it used?
this is a systematic approach to managing the care of hospital patients who are facing an uncertain recovery and are at risk of dying in the next few months.
it does not change the patient’s treatment or care, can continue to be treated actively, but helps staff to realise when they should talk with patients about the care and treatment they would like to receive should the worst happen.
what is the defining characteristic of neurological conditions affecting the NMJ e.g. MG?
fatiguability
common presenting features of bell’s palsy?
acute unilateral facial drooping, with affected forehead-unable to raise eyebrow on affected side, as LMN lesion post-auricular pain altered taste-chorda tympani dry eyes hyperacusis-nerve to stapedius
bell’s palsy treatment?
prednisolone 1mg/kg 10 day course
aciclovir no added benefit
artifical tears and eye lubricant
features of syringomyelia?
condition in which fluid filled cavities develop in the SC, (enlargement of the central canal) selectively affecting the spinothalamic tracts due to their decussation via the anterior white comissure, but may also extend and damage anterior horn cells causing LMN features
sensory: loss of pain and temperature sensation, bilaterally but may be asymmetrical at 1st
slowly progressive, possibly over years
motor: wasting and weakness of arms
hyporeflexia
horner’s syndrome also seen
and look for scars and healing lesions on the hands due to loss of pain and temperature sensation.
what condition is strongly associated with syringomyelia?
arnold-chiari malformation: herniation of cerebellar tonsils through the foramen magnum
what is a paradoxical embolus?
venous embolus travels into the arterial circulation through an opening in the heart (PFO, ASD or VSD), which can cause a stroke.
why should a reflex tachycardia not be relied upon as a necessary finding in an elderly pt in ED presenting with shock?
unlikely to be demonstrated due to medications causing bradycardia, less cardiac functional reserve and concomitant heart disease.
