Neurology Conditions Flashcards
(118 cards)
What is the common triad of symptoms seen in parkinson patients
Bradykinesia
Rigidity
Tremor
Causes of Parkinsonism
- Parkinsons Disease
- Parkinsons plus syndrome
- Progressive subnuclear palsy
- Corticobasilar degeneration
- Lewy body dementia
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
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)
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
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
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
Side effects of dopamine
Dyskinesia On-off phenomena Psychosis ABP ( reduced arterial blood pressure) Mouth dryness Insomnia Naseau and vomiting Excessive daytime sleepiness ( EDS)
Define GBS
Acute autoimmune demyelinating polyneuropathy (AIDP)
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
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
Treatment of GBS
Iv IgG Immunoglobulins
Supportive care
Types of brain tumours
Gliomas Medullablastomas Meningiomas Acoustic neuromas Neurofibromas
Secondaries
- Lung
- Breast
- Thyroid
- Prostate
- Blood
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
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)
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
Treatment of brain tumours
- Surgery
- Where possible
- To reduce mass effect - Radiation
External beam radiotherapy - Chemotherapy
Provided moderate benefit
Dexamethasone: rapidly improves improves brain performance
Reduced tumour inflammation/oedema
Causes of spinal cord compression
Secondary to malignancy Inflammatory (epidural abscess) Crush fracture Spinal cord tumour Corda equina Myeloma
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
Clinical features of cauda equina
Back pain Radicular pain Asymmetrical Atrophic Areflexic paralysis of the back of the legs Saddle anasthesia
Management of cauda equina
Urgent MRI
Urgent surgical decompression
Clinical features of a tension headache
Tight band around head Dull pain Aggravated by noise No nausea or vomiting No photophobia
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
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