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Neurology > Weakness > Flashcards

Weakness Flashcards

1
Q

Describe the pathophysiology of multiple sclerosis

A
  • Autoimmune demyelination

- Affects CNS only

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2
Q

Which group of people are most commonly affected by multiple sclerosis?

A

Young women

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3
Q

Describe the clinical features of multiple sclerosis (presentation, pattern, characteristic features)

A

Two or more episodes of CNS dysfunction disseminated in space (clinically or on MRI) and time (>1 month apart)

Relapsing-remitting pattern

Characteristic features:

  • Optic neuritis (blurred vision, unilateral eye pain)
  • Brainstem lesions (diplopia, dysphagia, dysarthria, facial weakness/paraesthesia)
  • Spinal cord lesions (limb weakness/paraesthesia, sexual dysfunction, bladder/bowel dysfunction)
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4
Q

What is Uhthoff’s sign?

A

Temporary worsening of MS signs caused by an increase in temperature (e.g. hot bath)

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5
Q

what is Lhermitte’s sign?

A

MS sign - sudden, ‘electric-shock’ sensation, typically from the neck down into the spine

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6
Q

Describe the investigation of multiple sclerosis

A

MRI

LP shows oligoclonal bands

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7
Q

Describe the management of multiple sclerosis

A
  • Steroids

- Beta-interferon

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8
Q

What are the clinical features of spinal cord compression?

A

Weakness and paraesthesia of the legs (and arms, if the level of compression is above the thoracic spine)
- Bladder/bowel involvement

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9
Q

What are the causes of spinal cord compression? How can the causes be classified into two categories?

A

Acute:

  • Trauma
  • Infection

Chronic:

  • Tumour (i.e. metastasis)
  • Osteoarthritis
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10
Q

Describe the investigation of spinal cord compression

A

MRI

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11
Q

Describe the management of spinal cord compression

A

Surgical decompression

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12
Q

Describe the pathophysiology of cauda equina syndrome

A

Spinal damage at or below L1, resulting in compression of the cauda equina

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13
Q

What is the most common cause of cauda equina?

Give some other causes

A
  • Lumbar disc prolapse (most common)
  • Tumour
  • Trauma
  • Infection
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14
Q

What are the clinical features of cauda equina?

A
  • Leg weakness and paraesthesia
  • Low back pain
  • Bladder/bowel dysfunction
  • Saddle anaesthesia
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15
Q

Describe the investigation of cauda equina

A

MRI

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16
Q

Describe the management of cauda equina

A

Surgical decompression

17
Q

Describe the pathophysiology and aetiology of Guillian-Barre syndrome

This is usually triggered by…

A
  • Autoimmune demyelination
  • Polyneuropathy (affects multiple peripheral nerves)

Usually triggered by an infection, e.g. Campylobacter

18
Q

Describe the clinical features of Guillian-Barre syndrome

Give an example of a life-threatening complication of Guillian-Barre syndrome

A
  • Ascending limb weakness and paraesthesia
  • Autonomic dysfunction, e.g. postural hypotension, cardiac arrhythmia

Potential complication: life-threatening respiratory muscle weakness

19
Q

Describe the investigation and diagnosis of Guillian-Barre syndrome

A

Diagnosis:
- Clinical diagnosis

Investigation:

  • LP: isolated rise in protein
  • Nerve conduction studies (NCS) show demyelination
20
Q

Describe the management of Guillian-Barre syndrome

A

IVIG (alternatively plasma exchange)

21
Q

Describe the prognosis of Guillian-Barre

A

Extremely variable - recovery may take weeks to years

22
Q

Describe the pathophysiology of radiculopathy

A

Spinal nerve root impingement

23
Q

What are the causes of radiculopathy

A
  • Disc prolapse
  • Tumour
  • Trauma
  • Osteoarthritis
24
Q

What are the clinical features of radiculopathy? (cervical and lumbar)

A

Cervical radiculopathy:
- Weakness, paraesthesia in the upper limbs

Lumbar radiculopathy:
- Weakness, paraesthesia in the lower limbs, bladder/bowel dysfunction, sexual dysfunction

25
Q

Describe the investigation of radiculopathy

A

MRI

26
Q

Describe the management of radiculopathy

A

Definitive management is surgical

27
Q

Describe the aetiology and pathophysiology of myasthenia gravis

Myasthenia gravis may be associated with…

A
  • Autoimmune
  • Antibodies to ACh receptors (at the postsynaptic membrane of the NMJ)

Thymic hyperplasia/thymoma

28
Q

Describe the clinical features of myasthenia gravis

Give an example of a life-threatening complication of myasthenia gravis

A

Weakness and fatiguability on repeated movements, mostly affecting the following muscles:

  • Ocular (e.g. ptosis, diplopia)
  • Bulbar (dysphagia, dysarthria)
  • Proximal limb muscles (stairs, chair, hair)

Myasthenic crisis: life-threatening respiratory muscle weakness

29
Q

Describe the investigation of myasthenia gravis

A
  • Serum antibodies: anti-AChR antibodies
  • EMG (electromyogram) - drop in evoked potential
  • CT chest to check for thymoma
30
Q

Describe the medical management of myasthenia gravis and myasthenic crisis

A

Myasthenia gravis:

  • Long acting acetylcholinesterase, e.g. pyridostigmine
  • Immunosuppressant drugs, e.g. steroids

Myasthenic crisis:
- IVIG

Neurology (9 decks)

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