Neurology Conditions Flashcards Preview

Neurology > Neurology Conditions > Flashcards

Flashcards in Neurology Conditions Deck (118)
1

What is the common triad of symptoms seen in parkinson patients

Bradykinesia
Rigidity
Tremor

2

Causes of Parkinsonism

1. Parkinsons Disease
2. Parkinsons plus syndrome
- Progressive subnuclear palsy
- Corticobasilar degeneration
- Lewy body dementia

3

List the other non neurological causes of parkinsonism

Infection
- Syphilis
- HIV
- CJD

Vascular
- Multiple infracts in the substantia nigra

Drugs
- Antipyschotics
- Metocloppramide

Genetics
- Wilsons' s Disease

4

List the 5 vivid red flags of parkinsonism

- Vertical gaze palsy (progressive supranuclear palsy)
- Impotence + incontinence ( Multiple system atrophy)
-Visual hallunicantions and early dementia ( Lewy body)
-Interferring activity, kinetic rigidity one limb ( Cortical degeneration)
- Diabetic hypertensive patient (Vascular parkinsons)

5

Pathology of parkinson

Zone compact of the substantial nigra
Mitochondrial destruction of the dopaminergic neurones in pars compacta.
Presences of B amyloid plaques
Inclusions of levy bodies
Neurofibrillary tangles ( alpha- synuclein and ubiquitin)

Decrease the stratal dopamine levels

Dopamine helps to coordinate the control muscle activity.

With the loss of dopamine, the striatum fires out excessive unbalanced signals

6

Clinical features of PD

TRAPPS PD
- Tremor ( pin rolling)
- Rigidity (cog wheel rigidity)
- Akinesia
- Postural instability
- Postural hypotension
- Sleep disorders
-Psychosis ( visual hallucinations)
- Depressions, dementia

7

Management of parkinson disease

1) DA (Dopaime agonists): React with dopamine receptors
Rapinirole
Pramipexole
Bromocryptine

2) MOA-B inhibitor: Alternative to dopamine agonist (Blocks the enzyme down that breaks down dopamine)
Selegline

3) L-Dopa: Combined with decarbosxylase inhibitor) Allows it to cross the blood brain barrier.

4) Anticholinergic drugs : Good for tremor, reserved for young people.
Benzhexol

Do not start too early on L-Dopa

Can also use a COMT inhibitor Tacalpone

8

Side effects of dopamine

Dyskinesia
On-off phenomena
Psychosis
ABP ( reduced arterial blood pressure)
Mouth dryness
Insomnia
Naseau and vomiting
Excessive daytime sleepiness ( EDS)

9

Define GBS

Acute autoimmune demyelinating polyneuropathy (AIDP)

10

Causes of GBS

Abs croos react with gangliosides found in the grey matter of the brain
Bacteria: C.Jejuni, Mycoplasma

Viruses: CMV, EBV, HSV, HIV, Flu

Vaccines: Rabies

11

Clinical features of GBS

Growing weakness: Symmetrical ascending flaccid weakness
LMN signs
Proximal muscle weakness

Breathing and bulbar problems

Sensory disturbance

Immune: Anti-ganglioside Abs

Demyelinating nerve conduction studies: slow

12

Treatment of GBS

Iv IgG Immunoglobulins

Supportive care

13

Types of brain tumours

Gliomas
Medullablastomas
Meningiomas
Acoustic neuromas
Neurofibromas

Secondaries
- Lung
-Breast
- Thyroid
- Prostate
- Blood

14

Discuss the features of the main primary brain tumours

GLIOMA
- Malignant tumours of the neuroepithelial origin
- Spread by direct erosion
- Astrocytomas: grow slowly from astrocytes
- Oligodendrogliomas: oligodendrovytes calcification is common

MENINGIOMAS
- Benign tumours from the arachnoid can erode into the skull. Often occur in venous sinuses

NEUROFIBROMAS
- Arises from the schwann cells
- Often occur through venous sinuses

15

Clinical features of brain tumours

Headache ( new, unexplained, worse in the morning)
Nausea and vomiting
New onset seizures
Focal neurological deficit
- Diplopia
- Upper/Lower limb deficits
- Behavioural symptoms
- Papilloedema ( loss of the crisp optic nerve, venous enlargement, retinal oedema, haemorrhage)

16

List the different types of gliomas

Grade I: Pilocytic astrocytoma
Grade II: Premalignant tumour
Grade III: Anaplastic astrocytoma
Grade IV: Glioblastoma multiforme

All gliomas become GBM

17

Treatment of brain tumours

1. Surgery
- Where possible
- To reduce mass effect

2. Radiation
External beam radiotherapy

3. Chemotherapy
Provided moderate benefit

Dexamethasone: rapidly improves improves brain performance
Reduced tumour inflammation/oedema

18

Causes of spinal cord compression

Secondary to malignancy
Inflammatory (epidural abscess)
Crush fracture
Spinal cord tumour
Corda equina
Myeloma

19

Clinical features of cord compression

Spinal/root pain
Arm weakness
Bladder (and anal tone) sphincter involvement
(Hesitancy, frequency , painless retention)

UMN signs above the lesion
LMN sings at the level of the lesion

20

Clinical features of cauda equina

Back pain
Radicular pain
Asymmetrical
Atrophic
Areflexic paralysis of the back of the legs
Saddle anasthesia

21

Management of cauda equina

Urgent MRI
Urgent surgical decompression

22

Clinical features of a tension headache

Tight band around head
Dull pain
Aggravated by noise
No nausea or vomiting
No photophobia

23

Treatment of a tension headache

Episodic <15 days per month

Chronic > 15 days per month

Physical therapies: massage, relaxation therapies

Chronic rx with amitriptyline

Beware of an analgesic induced headache: wean the patient of analgesics
Start on a low does of amitriptyline

24

List the clinical features of a migraine

Periodic attacks
Unilateral
Complete resolution between attacks
Severe pain, pulsatile
Photophobia
Nausea and vomiting

Aura
Visual: scotoma, fortification spectra
Sensory: tingling
Motor: aphasia, hemiplegia

25

List the triggers for migraine

Food (coffee, cheese, chocolate, red wine)
Drink ( alcohol)
Lack of sleep
Too much sleep
Noise
Lights
Stress

26

Management of a migraine

Stop the contraceptive pill
Resolution: dark and sleep
Mild: paracetamol, anti-emetics
Severe: Triptans ( serotonin-agonists)
Propphylaxis: Beta-blockers, amitriptyline

27

Clinical features of a cluster headache

Very painful
Unilateral ( temple, forehead or behind the eye)
Rapid onset

Autonomic
- Ipsilateral lacrimation
- Rinorrhoea
- Facial sweating
- Miosis
Depression
Exhaustion
Anxiety (suicide headache)
Last 45-90 minutes
Occurs once or twice a day
Clusters of a few weeks and then attack free periods

28

Acute and long term management of a cluster headache

Acute:
- 100% inhaled oxygen (15L 15-20 litres)
- IM Sumatriphan

Chronic/Prophylaxis
- Verapamil (CCB)
- Topiramate ( anti-epileptic)

29

Clinical features of a headache of raised ICP

Generalised ache
Aggravated by bending, coughing or straining
Worse in the morning
Wake patients from sleep

A/w
- Vomiting
- Visual obstructions
- Progressive focal neurological signs
- Papilloedema, enlarged blind spots
- Risk of herniation

30

Clinical features of giant cell artheritis

Granulomatous inflammatory disease of the blood vessels
Disease of the elderly

Extreme scalp tenderness
Fever
Anorexia and weight loss due to jaw claudication
Link to polymyalgia rheumatic
Visual disturbance (amaurosis fugax)
Risk of sudden irreversible blindness

31

Treatment of GCA

Ix
Bloods (raised ESR)
Temporal artery biopsy

Management
Acute: oral prednisolone ( very large doses) (60mg)
Aspirin ( reduce visual loss)

32

Branches of the trigeminal nerve

Ophthalmic branch (V1): traverse the lateral wall of the cavernous sinus and enters the orbit
Supplies the corneal reflex

Maxillary branch (V2): Lower lateral wall of the cavernous sinus and exits the skull in the foramen rotunda

Mandibular branch (V3): Motor component, supplies the muscles of mastication

33

Clinical features of trigeminal neuralgia

Electric shock/ shooting pain
Triggered by
- washing face
- shaving
- cold wind
- eating
Unilateral pain
Reactive depressive illness

34

Treatment of trigeminal neuralgia

Carbamazepeine ( Memebrane stabilizer)
Gabapentin ( less effective)
Iamotrigine ( less effective)

Surgical decompression ( microvascular)

35

What is the triad seen in Horners Syndrome

Miosis (constricted pupil)
Ptosis (dropping of the upper eye lid)
Anhydrosis (lack of sweating)

Due to lesions of the sympathetic nervous system of the eye

36

Explain the pathology of Huntingdon's Chorea

Atrophy and neuronal loss of the striatum and the cortex
Loss of the inhibitor NT = GABA ( degeneration of the neurones)
Normal levels of dopamine

37

Clinical features of hungtindons

Presents in middle age
Prodromal Phase
- Depression
- Irritability
- Incoordination

Progression
- Chorea
- Dementia
- Fits
- Death

38

Define MS

A chronic inflammatory condition of the CNS, characterised by multiple plaques of demyelination disseminated in time and space

39

List the different types of MS

1. Relapsing and remitting (80%)

2. Secondary progressive

3. Primary progressive

4. Progressive relapsing

40

Clinical features of MS

Tingling
Eye (Optic neuritis)
Ataxia + cerebellar signs
Motor ( usually spastic paraparesis)

Lhemitters sign: When you flex your neck, you get an electric shock

Uthofers phenomen: Symptoms get worse with heat

41

Investigations of MRI

MRI: Galadenium enhancing to show new lesions due to a compromised blood brain barrier

LP: IgG oligoclonal bands

Abs: Anti-MBP

42

Dx of MS

McDonalds Criteria
- 2+ lesions desimminated in time and space

43

Management of MS

Acute Attacks: Methlyprednisolone (500mg), reduce duration and severity of the attacks

Preventing relapses
1) DMARDs
- IFN-B
- Glatirmer

2) Biological
- Natalizumab
- Alemtuzamab (destroys lymphocytes)

Spasticity
- Physio
- Baclofen (GABA analogue)
- Dantrolene ( muscle relaxant)

Bladder
- Botox injections

44

Pathology of MG

Autoimmune disorder
Anti-AChR blocker the Ach receptor
Insufficient ACh receptors in the NMJ = no muscular contractions

45

Clinical features of MG

Eye signs
- Ptosis
- Diplopia
- Peek sign

Swallowing + speech difficulties ( voice weakness)

Muscles of the face (open mouth, losing head)

Painless, normal tendon reflexes

Strong association with thyoma ( do a thymus CT)

46

Treatment of MG

Anti cholinesterase inhibitor: Pyridostigmine
Rx relapse with prednisolone
Thymectomy

47

Causes and treatment of a myasthenia crisis

Causes
- Infection
- Post surgery
- Drug induced ( B-BLockers)
- Phenytonin

Management
- Resp failure ( intubate and ventilate)
- Plasmapheresis
- IV Ig

48

Define MND

Neurodegenerative disease
Selective loss of neurones in motor cortex, cranial nerve nuclei and anterior horn cells

NO SENSORY LOSS OR SPHINCTER DISTURBANCE

49

Clinical features of MND

UMN signs
- Spasticity
- Reflexes
- Upgoing plantars

LMN signs
- Wasting
- Fasciculation of tongue, ado, thigh

Speech and swallowing impairment

Fronto-temporal dementia

50

Dx of MND

DX of exclusions
MRI: exclude structural causes
LP: exclude inflammatory causes
EMG: denervation, exclude neuropathies

51

List the types of MND

Amyotrophic Lateral Sclerosis
- involvement of both upper and lower motor neurones
- Muscle weakness
- Wasting
- Brisk reflexes
- Extensor plantar response
- Spasticity

Progressive muscular atrophy
- Lower motor neurones
- Weakness and wasting of the distal muscles
- Fasciculations
- Absent reflexes

Progressive bulbar palsy (LMN)
- Weakenss of tongue, palate, pharyngeal muscles
- Dysphagia

Primary lateral sclerosis
- Only UMN
- Spastic leg weakness

52

Treatment of MND

No cure
Will die by 3yrs ( most of them)

Riluzole (increase life expectancy by 3 months)
Non-invasive ventilation
Baclofen (for spasticity)
Buscopan ( for secretions)

Common cause of death
Aspiration pneumonia

53

Causes of a subarachnoid haemorrhage

Rupture of Berry aneurysm
- Associated with ADPKD, Marfans, Ehlers Danlos)

54

Clinical features of a subarachnoid haemorrhage

Thunderclap headache
Kerning's sign +ve
- Flexion of the hip and the knee causes pain
Meningism
Retinal haemorrhage

55

Investigations and treatment of a subarachnoid haemorrhage

CT
- Acute blood will be hyper dense and bright on scan
- looks like a STAR MAN

ECG
- Deep T wave inversion

Rx
- Endovascular coiling
- Nimodipine (Ca2+ antagonist) to reduce vasospasm

56

Clinical features of subdural haemorrhage

Headache
Drowsiness
Confusion (can fluctuate)
Chronic subdural can be a cause of confusion in the elderly

57

Cause of subdural haemorrhage

Bleeding from the bridging veins of the cortex and the sinus

Risk factors
- Age
- Alcohol
- Anticoagulants

58

Investigations and management of a subdural haemorrhage

CT scan
- Crescentic clot with midline shift

Mx
- Burr hole craniotomy
If left untreated = tentorial herniation

59

Causes of extradural haemorrhage

Skull fractures ( temporal or parietal bone)
Middle meningeal artery tear

60

Clinical features of extradural haemorrhage

Lucid period
Detonation of GCS after head injury causing no or brief LOC

Rapid increase in ICP
- Headache
- Nausea and vomiting
- Seizures
- Confusion
- Brisk reflexes
- Ipsilateral pupil dilates
- Deep irregular breathing (brainstem compression)

61

investigations and management of an extradural haemorrhage

CT scan
- Bi convex
- Well demarcated lesion of hyper density

Mx
- Urgent neurosurgery
- Clot evacuation
- Vessel ligation

62

Define a TIA

Brief episode of neurological dysfunction due to temporary focal cerebral or retinal iscahemia without infractions

Last second - minutes with complete recovery

63

Causes and risk factors of TIA

Micro emboli from
- Atheromatous plaques
- Cardiac mural thrombi
- AF

Risk factors
- Hypertension
- Smoking
- DM
- Peripheral artery disease
- Carotid artery occlusion

64

Rx of TIA

Rx
- Aspirin ( 300mg)
- Start on warfarin if in AF
- Carotid endarterectomy if >70% stenosis

Secondary prevention
- Statins
- Antihypertensives
- Lifestyle factors

65

How to calculate the level of risk of stroke following a TIA

ABCD2 score
- Age >60
- BP >140/90
- Clinical features ( unilateral weakness, isolated speech disturbance)
- Duration
- Diabetes

<3 points = see a specialist in 1 week
>4 = see a specialist in 24hrs

66

Rules involving a TIA and driving

One month off driving if one TIA
Three months off driving if multiple

67

Define a stroke

Rapid osent, focal neurological deficit due to a vascular lesion lasting more than 24hrs

Due to infarction or bleeding into a part of the brain

68

Clinical features of a total anterior stroke (TACS)

All three of
- Hemiparesis ( contralateral) and sensort deficit
- Homonymous hemianopia
- Higher cortical dysfunction
(Dominant lobe: Broccas Non dominant: hemiparietal neglect)

Blood supply
- Carotid
- MCA
- ACA

69

Clinical features of a Partial anterior circulation stroke

infarct in the carotid/MCA/ACA territory

Two of the following
- Hemiparesis ( contralateral) and/or sensory deficit
- Higher cortical dysfunction
- Higher cortical dysfunction
(Dominant lobe: Broccas Non dominant: hemiparietal neglect)

70

Clinical features of lacunar syndrome

Small infarcts around the basal ganglia

One of the following
- Purely sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic stroke

71

Clinical features of a posteoir circulation stroke

Infarct in the veterobasilar territory

One of
- Cranial nerve palsy (contralateral motor/sensory defect)
- Conjugate eye movement palsy
- Cerebellar dysfunction
- Isolated homonymous hemianopia or cortical blindness.

72

Treatment of stroke

Ix
- CT to exclude haemorrhage
- MRI
- Carotid doppler
- Blood

Rx
- Thrombolysis for ischaemic stroke
- Alteplase <4.5hrs
- Aspirin 300mg switch to clopidogrel)

- Haemorrhagic stroke:
Control bleeding
Stop anticoagulants ( if on warfarin give beriplex)
May need neurosurgery intervention to receive pressure
Coil bleeding aneurysms

NOTE
1. Ischaemic stroke
- Carotid bruits
- AF
- Previous TIA
- Ischaemic heart disease

2. Haemorrhagic stroke
- Meningism
- Severe headache
- Coma
- Drowsiness
- Reduced GCS
- Vomiting
- Focal deficit

73

Define epilepsy

Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, that manifests as a seizure

74

Causes of epileptic seizures

Congenital
- NF
- TORCH

Acquired
- Vascular ( CVA)
- Cortical scarring
- SOL

Provoked seizures
- Withdrawal ( alcohol/ opiates/benzos)
- Metabolic
- Increase in ICP
- Infection
- Eclampsia

75

Types of seizures

Tonic-clonic
- Body stiffens
- Repetitive jerking

Absence
- Short
- Appears spaced out

Myoclonic
- Sporadic jerking movements of limbs

Clonic
- Repetitive jerking movements

Atonic
- Loss of muscle tone

Partal seizure (5 A's)
- Aura
- Autonomic ( change in temp, skin, pals)
- Awareness lost ( motor arrest)
- Automatism ( lip smacking, chewing)
- Amnesia

76

Treatment of epilepsy

Tonic-clonic
- Sodium valproate
- Iamotrigine
- Carbamezepeine
- Topiramate
- Phenytonin

Absence
- Sodium valproate
- Iamotrigine

Partial
- Iamotrigine
- Cabamazepeine
- Sodium valproate
- Phenytonin

***Pregnancy: Iamotrigine

77

List the side effects of the following anti epileptics
1. Sodium valproate
2. Iamotrigine
3. Carbamazepeiene
4. Levatiracetram

Sodium Valproate
- Teratogenic
- Hepatotoxic
- Increases appetite
- Ataxia
- Encephalopathy

Lamotrigine
- Rash ( hypersensitivity)
- Nausea
- Dizziness
- Ataxia

Carbamazepeine
- aplastic anaemia
- Hyponatraemia
- Hepatic enzyme inducer
- Leukopenia
- Diplopia
- Blurred vision
- Impaired balance
- Drowsiness

Levatiracetram
- well tolerated
- Anxiety
- Instability
- Depression
- Suicidal ideation

Phenytonin
- Cerebellar syndrome due to overdose
- Has a very narrow therapeutic window

78

Define a non epileptic seizure

Paroxysmal event, changes in behaviour, sensation and cognitive function, caused by mental processes associated with psycosocial distress

Features
- Situational
- 1-20 minutes
- Dramatic motor phenomena or prolonged ataxia
- Eyes closed
- Ictal crying/ speaking

79

Define status epilepticus

Seizures lasting > 30 minutes or repeated seizures w/o intervening consciousness

80

Management of states epileptics

Wide IV access
Bloods ( FBC, ABG, U&E's, Ca2+)
BM
Rectal diazepam/buccal midazolam (wait five minutes)
IV lorazpam
Phenytonin (IV) ECG monitoring
Phenobarbital

81

What is the cause of nursemaids elbow and in who is it most common

Sublaxation of radial head
Common in children
Caused by a sudden outward pull

82

What is the CSF profile seen in
a. viral meningitis
b. bacterial meningitis

VIRAL
- normal opening pressure
- normal protein
- normal glucose
- lymphocyte predominant

BACTERIAL
- increased opening pressure
- high protein
- low glucose
- neutrophil predominant

83

Discuss the pathophysiology of Lambert Eaton syndrome

Antibodies ( anti-P/Q) against voltage-gated calcium channels in presynaptic membrane.

84

What is the triad seen in normal pressure hydrocephalus

Gait dysparexia
Fluctuating confusion
Urinary incontinience

Note: no papilloedema

85

Causes of normal pressure hydrocephalus

Subarachnoid haemorrhage
Meningitis
Head injury
CNS tumour

86

Treatment of normal pressure hydrocephalus

Medical
- Serial lumbar punctures
- carbonic anhydrase inhibitors (acetazolamide)
- Not advisable for a long period of time

Surgery
- Insertion of a CSF shunt

87

Emergency treatment of raised ICP

ABC
Rx seizures ( as per status epileptics)
Correct HTN
Elevate the bed to 40o
Neuroprotective ventilation
- PaO2> 13kPa
- PCO2> 4.5kPa
- Good sedation
Give mannitol ( osmotic diuretic)/ hypertonic salaine
Mannitol give 1g/kg

88

Emergency treatment of myoxedema coma

Pt looks HYPOTHYROID

Bloods ( TFT's, FBC, U&Es, glucose)
Give T3/T4 infusion slowly IV
Hydrocortisone (100mg IV)

89

Emergency management of thrombolic stroke

CT head to confirm thrombotic stroke
If within 4.5 hrs = thrombolysis with altepase
<6 hrs thrombectomy ( neurosurgery input)
All patients give Aspirin 300mg

Give aspirin for two weeks and then switch to clopidogrel

90

Contraindications for thrombolysis

Convulsion accompanying stroke
History of stroke in patients with diabetes
Hyperglycaemia
Hypoglycaemia
Severe stroke
Stroke in last 3 months

91

Contrindications for all fibrinolytics

Active pulmonary disease with cavitation
Acute pancreatitis
Aneurysm
Aortic dissection
Bacterial endocarditis
Bleeding diatheses
Coagulation defects
Coma
Heavy vaginal bleeding
History of cerebrovascular disease (especially recent Events or with any residual disability)
Oesophageal varices
Pericarditis
Recent haemorrhage
Recent surgery (including dental extraction)
Recent symptoms of possible peptic ulceration
Recent trauma
Severe hypertension

92

Causes of a brain abscess

Bacteria
- Staphaureus
- Streptococcus
- Bacteroides

Fungi
- Aspergilles
- Candidia
- Cryptococcus

93

Clinical features of a brain abscess

Fever
Focal motor and sensory deficit
Papilloedema
Ataxia
Confusion

94

Management of a brain abscess

Intracranial drainage
Empirical antibiotic therapy started ( third generation cephalosporin)
Pus sent for cultures and abs adjusted accordingly.

95

Define cataplexy

Sudden loss of muscle tone or power in response to a strong emotion.
It always and only occurs as part of nacrolepsy

96

Clinical features of nacrolepsy

TETRAD
- Excessive daytime sleepiness (KEY)
- Cataplexy (KEY)
- Sleep paralysis
- Hynagonic hallucinations

97

Define encephalitis

Inflammation of the brain parenchyma in association with clinical evidence of neurological dysfunction

NOTE
Encephalopathy: disruption of brain function in the absence of a direct inflammatory process

98

Causes of encephalitis

Viral
- HSV
- CMV
- EBV

Non-viral
- Any bacterial meningitis
- TB
- Malaria
- Lyme disease

99

Clinical features of encephalitis

Infectious prodrome: fever, rash, LNs, cold sores
Personality change
Confusion
Decreased GCS
Feer
Headache
Seizures

100

Management of encephalitis

Aciclovir ( STAT): 10mg/kg/8h
Supportive measures
Phenytonin for seizures

101

Define Horner's syndrome

Interruption of the sympathetic pathway
- Unilateral miosis
- ptosis
- anhidrosis

102

Define anterior cord syndrome

Direct anterior cord compression
Leads to variable paralysis below the lesion of the cord with the loss of pain and temperature.
Dorsal columns are mainly persevered
Poor prognosis

103

Clinical features of cerebellar dysfunction

Ataxia of the limbs
Dysarthia
Nystagmus
Dysdiadochokinesis
Pendular reflexes

104

Causes of cerebellar dysfunction

Vascular
- Stroke

Infections
- Post infection

Toxins
- Alcohol
- Anticonvuslants

Metabolic
- Myxodema

Trauma

Neurodegenerative conditions
- Multiple system atrophy (MSA)

Inherited cerebellar ataxia
- Friedreich ataxias

105

Differential diagnosis of epilepsy

Non-epileptic seizures
Syncope
Vasovagal
Cardiogenic
Migraine
Vertigo
Hypoglycaemia
Drugs
Alcohol

106

Upper Motor Neurons

Lesion on the brain and spinal cord
Signs on the OPPOSITE SIDE of the lesion

Causes
- Stroke
- Tumour
- MS
- MND

Clinical features
Hypertonia,
Spasticity (clasp knife),  
hyperreflexia,
Extensor plantar response,
Pronator drift

107

Lower Motor Neurons

Signs on the same side as the lesion

Fasciculation,
Muscle wasting,
Hypotonia,
Loss of tendon reflexes
Flaccid

108

What is Bell's palsy

Left facial nerve palsy due to a lower motor neurone lesion causing hemifacial palsy
No forehead sparing

109

Causes of Bell's palsy

Idiopathic
Parotid infiltration
Pontine tumours
Herpes zoster

110

Treatment of Bell's palsy

High dose steriods
Acyclovir if due to herpes zoster

111

Explain afferent and efferent pupillary light reflex

Afferent: Light is detected on retina and transmitted via optic nerve (CN2) to lateral geniculate body then to midbrain

Efferent: Edinger- Westphal nucleus (midbrain)- pupillary constriction mediated by parasympathetic fibres of occulomotor nerve (CN3)

112

List causes of afferent pupillary light reflex

The pupil won’t respond to light but constricts to a beam in the other eye (consensual response) causes- optic neuritis, optic atrophy, retinal disease

113

List the causes of efferent eye defects

Pupil doesn’t react to light- complete 3rd nerve palsy (ptosis, fixed dilated pupil, eye deviated down and out). Causes- cavernous sinus lesions, diabetes, coning

114

Risk factors for venous sinus thrombosis

Pregnancy
Malignancy
COCP
Antiphospholipid syndrome

115

Clinical features of a venous sinus thrombosis

Headache
Fever
Papilloedema
Epilepsy
Vomiting
Visual disturbance

116

Investigation and treatment of venous sinus thrombosis

Ix: CT venogram ( empty delta sign)

Rx: Anticoagulate with heparin, followed by warfarin

117

List the primary and secondary prevention of stroke

PRIAMRY
- Control risk factor ( HTN, DM)
- Consider lifelong anticoagulation in AF
- Carotid endarectomy ( if severe)
- Exercise

SECONDARY
- Statin
- Aspirin ( stepwise)
- Carotid endartectomy

118

Characteristic features of levy body dementia

Cognitive impairment (fluctuating)
Parkinsonism
Visual impairment

Can also have rapid eye movement sleep disorders
and autonomic disturbance