Revision List Neurology Flashcards
1
Q
Depression
A
It is characterized by persistent sadness and a lack of interest or pleasure in previously rewarding or enjoyable activities. It can also disturb sleep and appetite; tiredness and poor concentration are common.
2
Q
What are the risk factors for depression?
A
- Stressful events - bereavement/ relationship breakdown
- Personality - low self esteem/ overly self critical and other certain personality traits
- Family history
- Giving birth - hormonal and physical changes and added responsibility
- Loneliness
- Alcohol and drugs - too much alcohol and drugs affect chemistry of brain
- Illness - higher risk of depression if physically limited
3
Q
Diagnostic criteria of depression?
A
2 main and at least 3/4 minor symptoms.
4
Q
What are the 2 main symptoms of depression?
A
- Persistent sadness or low mood nearly every day
2. Loss of interest or pleasure in most activities
5
Q
Other symptoms of depression
A
- Fatigue/loss of energy
- Worthlessness, excessive or inappropriate guilt
- Recurrent thoughts of death, suicidal thoughts or actual suicide attempts
- Diminished ability to think/ concentrate or increased indecision
- Insomnia/hypersomnia
- Psychomotor agitation or retardation
- Change in appetite and or weight loss
6
Q
What test is used to assess depression in GP settings?
A
PHQ9 or GAD7
7
Q
Lifestyle modifications to treat depression?
A
- Drink less alcohol
- Eat healthily
- Exercise more
8
Q
Non pharmacological management of depression?
A
- CBT
- Interpersonal therapy
- Electroconvulsive therapy
9
Q
Pharmacological management of depression?
A
SSRI?
10
Q
What are SSRI? How do they work?
A
Selective serotonin reuptake inhibitor
Limiting its reabsorption (reuptake) into the presynaptic cell, increasing the level of serotonin in the synaptic cleft
11
Q
Example of an SSRI?
A
Sertraline
12
Q
Risk factors for subarachnoid haemorrhage?
A
- Smoking
- Hypertension
- Bleeding disorders
- Polycystic kidney disease
- Ehler Danlos
- Coarctation of aorta
13
Q
Clinical presentation of subarachnoid haemorrhage?
A
- Thunderclap headache
- Vomiting, collapse, seizure, coma
- Neck stiffness
- Papilloedema/vision loss/ diplopia
- Kernig’s and Brudzinki’s sign
- Focal neurological: fixed dilated pupil - CN3 palsy in posterior communicating artery
14
Q
What is Kernig’s sign?
A
When thigh flexed - knee extension is painful/stiff
15
Q
What is Brudzinki’s sign?
A
When neck is flexed, hip and knee flex
16
Q
Diagnosis of subarachnoid haemorrhage?
A
- ABG - exclude hypoxia
- CT Head - star shape lesion
- CT angiography
- Lumbar puncture - blood initially then xanthochromic
17
Q
Treatment of subarachnoid haemorrhage?
A
- Refer to neurosurgeon
- Maintain cerebral perfusion - IV fluid if BP <160
- Calcium channel blocker - nimodipine IV
- Endovascular coiling - preferred to surgical clip promote thrombosis and aneurysm ablation
- Surgery - intracranial stents and balloon remodelling for wide necked aneurysms
18
Q
What are nimodipine used for?
A
Decreased vasospasm and morbidity from cerebral ischaemia
19
Q
Complications of SAH?
A
- Rebleeding
- Cerebral ischaemia due to vasospasm
- Hydrocephalus
- Hyponatraemia
20
Q
How long do trigeminal neuralgia last?
A
1-180s
21
Q
Triggers for trigeminal neuralgia?
A
- Washing affected area
- Shaving
- Eating/talking
- Dental prostheses
22
Q
Treatments for trigeminal neuralgia?
A
- Carbamazepine
2. TCA - amitriptyline
23
Q
Define Parkinson’s disease?
A
Degenerative movement disorder characterised by decrease in dopamine in the susbtantia nigra
24
Q
What is Parkinson’s disease characterised by?
A
- Bradykinesia/Akinesia
- Resting tremor
- Rigidity
25
Epidemiology of parkinson's?
1. M>F and prevalence increase with age - 55-65 years
26
What can Parkinson's present as before developing motor symptoms?
1. Anosmia
2. Depression/anxiety
3. Ache and pain
4. REM sleep disorders
6. Hypotension and constipation/ urinary urgency
27
Describe Parkinson's tremor in more detail?
1. Worse at rest
2. Unilateral/asymmetrical
3. Pill rolling thumbs
4. Writing smaller
5. 4/6 cycles per sec - slower than cerebellar
6. Improved by voluntary movements/ anxiety worsens
28
Describe Parkinson's rigidity in more detail?
1. Extrapyramidal lesions - increase tone in limbs and trunk
2. Limbs resist passive extension throughout movement
3. Can cause pain and problems when turning in bed
29
Describe Parkinson's brady/akinesia in more detail?
1. Difficulty initiating movement and slow and low amplitude
2. Problems doing fine movements
3. Monotonous hyphonic speech micrographia
30
Name two hardware problems:
1. Huntington's
| 2. Parkinson'
31
Name 3 software problems:
1. Dystonia
Essential tremor
3. Tourette
32
Describe the gait in Parkinson's?
1. Shuffling gait - small steps
2. Reduced arm swing - asymmetrical
3. Drag foot with flexed trunk - stooped posture
4. Difficulty initiating movement and turning
33
What are some non motor symptoms of Parkinson's?
1. Difficulty swallowing --> late presentation as aspiration pneumonia
2. Depression/constipation/increased urinary frequency
3. Psychiatric problems: phobia, anxiety disorder
34
Aetiology of Parkinson's disorders?
1. Environment - pesticides, MPTP
2. Genetics: mutations in the alpha synuclein gene, parkin gene
3. Oxidative stress and mitochondrial dysfunction
35
Pathophysiology of Parkinson's?
1. Decrease dopaminergic neurones in substantia nigra pars compacts
2. Decreased striatal dopamine levels
3. Neuronal inclusions of Lewy bodies - contains tangles of alpha synuclein and ubiquitin
- -> gradually more widespread
36
Treatment of Parkinson's?
1. Levodopa oral + decarboxylase inhibitor e.g. co-beneldopa
2. Dopamine agonists - ropinirole, pramiprexole
3. Monoamine oxidase B inhibitors - rasigiline/seligiline
4. Catechol-O-methyl transferase - entacapone, tolcapone
5. SSRI Tx depression etc...
37
How do Levodopa work?
Dopamine precursor that can cross BBB to increase dopamine levels in SN
38
How do decarboxylase inhibitors work?
Decreasse peripheral conversion of L-Dopa to dopamine - maximise dose and decrease SE peripherally
39
SE of Levodopa+decarboxylase inhibitors?
Nausea/vomiting, hallucination, compulsive behaviour
40
How do dopamine agonists work?
Stimulates dopamine receptors in the SN
41
SE of dopamine agonists?
Drowsy, nausea/vomiting, hallucinations, compulsive behaviour
42
How do MAO/COMT inhibitors work?
Decrease breakdown of catecholamines
43
SE of MAO inhibitors?
Postural hypotension
| AF
44
SE of COMT inhibitors?
Esp tolcapone = liver damage
45
Late stage PD motor complications?
1. Wearing off: decrease efficacy over time even when dose is increased
2. On-dyskinesia: hyperkinetic, choreiform movement whenever drugs work
3. Off-dyskinesia: fixed, painful dystonic posture
4. Freezing - unpredictable loss of motility
46
Factors that indicate that it is not Parkinson's?
1. Incontinence
2. Dementia
3. Symmetry
47
Definition of motor neurone disease
Cluster of major degenerative diseases characterised by selective loss of neurones in motor cortex, cranial nerve nuclei and anterior horn cells.
48
Pathophysiology of MND?
1. Mainly affects anterior horn cells.
2. Relentless unexplained destruction of UMN and anterior horn cells in brain and spinal cord.
3. Production of ROS --> damage DNA, lipids, proteins
49
Difference between MND and myasthenia gravis?
Eye movements affected in myasthenia gravis
50
MND vs MS/polyneuropathy?
No sensory loss or sphincter dysfunction in MND.
51
4 types of MND
1. Amyotrophic lateral sclerosis
2. Progressive muscular atrophy
3. Progressive bulbar palsy
4. Progressive lateral sclerosis
52
Clinical presentation of amyotrophic lateral sclerosis?
1. Loss of motor neurones in motor cortex and anterior horn of spinal cord
2. UMN signs: Plantar upping, spastic gait
3. LMN signs: wasting/fasciculation/ foot drop/wrist drop +/- proximal myopathy, weak grip
4. Split hand signs: thenar wasting, hypothenar wasting = less
5. Cramps - common but not specific
53
Clinical presentation of progressive muscular atrophy?
1. Weakness, muscle wasting, fasciculation - start in one limb and spread
2. Distal muscles first
54
Clinical presentation of progressive bulbar palsy?
1. Lower cranial nerves 9-12, dysarthria, dysphagia, nasal regurgitation of fluids and choking
2. LMN lesion of tongue + swallow + talk muscles --> flaccid, fasciculating tongue. speech - hoarse quiet nasal
55
Clinical presentation of progressive lateral sclerosis?
1. Loss of Betz cells in motor cortex
2. Spastic weakness of leg
3. Progressive tetraparesis amd pseudobulbar palsy.
56
Differential diagnosis of MND?
1. MS or polyneuropathy
2. Myasthenia gravis
3. Diabetuc amytrophy
4. Guillan Barre syndrome
5. Spinal cord tumour
57
Diagnostic criteria for MND?
1. LMN + UMN signs in 3 regions
2. LMN + UMN signs in 2 regions = probable
3. LMN +UMN in 1 region/UMN in >1 region + EMG acute denervation needs labs support
58
Investigations used to identify MND?
Brain/cord MRI - exclude structural causes
2. Lumbar puncture - exclude inflammatory causes
3. Nerve conductions studies and electromyography --> denervation of muscle due to degeneration of LMN's - EMG confirmation
59
Treating MND?
1. Antiglutamergic drugs: oral riluzole
Na+ channel blocker inhibits glutamate release
2. Drool due to bulbar palsy - oral propantheline/ amytriptilline
3. Dysphagia - blend food, NG tube, PEG
4. Spasm - oral baclofen
