NEUROLOGY REVISION - GP
- Dementia
- Alzheimer's Disease - gradual onset, progressive; #1 AChEi (donepezil,
galantamine, rivastigmine), #2 memantine
- Vascular - abrupt onset, stepwise decline; focal neurological signs (unsteadiness
and falls)
- Lewy body - insidious onset, fluctuating decline; hallucinations + Parkinsonism
- Frontotemporal - insidious onset, rapid decline; Pick’s Disease most common
with personality change + impaired social conduct + weight gain
- Epilepsy
- Focal onset (involves one side of brain) either aware or impaired awareness
- Frontal - motor (Jacksonian march - seizure spreads from the distal limb)
- Parietal - sensory
- Temporal - ‘HEAD’ - Hallucinations (olfactory, gustatory, auditory),
Epigastric rising/Emotional, Automastisms (lip smacking, clothes plucking),
Deja vu/Dysphagia postictal
- Occipital - eyes
- Todd’s paresis - postictal weakness
- Generalised onset (involves both sides of brain) always LOC - tongue biting and
incontinence common, 15m postictal drowsiness, raised prolactin
- Pseudoseizures - ability to control location, widespread seizure without LOC,
gradual onset, pelvic thrusting, FHx of epilepsy, female sex, postictal crying
- Vasovagal syncope - stress, twitching or jerking of limbs, rapid recovery and short
postictal period
- Headaches
- Cluster - O2 + sumatriptan; prophylaxis with verapamil
- Migraine - sumatriptan; prophylaxis with topiramate or propranolol
- Trigeminal neuralgia - carbamazepine
- Think intracranial hypertension if headache worse on lying vs intracranial
hypotension if worse on standing
- Multiple sclerosis - gradual visual disturbances and peculiar sensory changes, #1
RRMS; optic neuritis, Uhthoff’s phenomenon; steroids if relapse
- Guillain-Barre syndrome - rapid muscle weakness (peripheral → proximal) and sensory
changes after infection, classically Campylobacter jejuni; acute autoimmune
(antiganglioside) demyelination of peripheral nerves; NCS (slowing) + LP (high protein);
plasma exchange or IGIg
- Myasthenia Gravis - gradual muscle weakness (UL > LL) which worsens with exercise
and extraocular and facial weakness; chronic autoimmune (AChR, MuSK) attack of
postsynaptic nicotinic ACh receptors; antibodies, CT chest (thymoma) + EMG
(decremental); pyridostigmine
, - Lambert-Eaton myasthenic syndrome - gradual muscle weakness (LL > UL) which
improves with exercise and xerostomia; chronic autoimmune attack of presynaptic Ca
channels; CT chest (SCC lung) + EMG (incremental)
- Parkinson’s disease - bradykinesia + tremor + rigidity; levodopa + decarboxylase
inhibitor (carbidopa or benserazide), DA (bromocriptine, ropinirole, cabergoline), MAO-Bi
(selegiline), COMTi (entacapone), domperidone for N&V
- Parkinson-plus syndromes - bradykinesia + tremor + rigidity and other features
- Lewy body dementia - hallucinations
- Multisystem atrophy - autonomic dysfunction (orthostatic hypotension,
incontinence, impotence), backward falls
- Progressive supranuclear palsy - backward falls, problems with vision,
speech and swallowing
- Motor neurone disease - muscle weakness, atrophy and stiffness with spastic ataxic gait
and problems with speech and swallowing; riluzole, BiPAP
- Amyotrophic lateral sclerosis - LMN signs in arms, UMN signs in legs
- Primary lateral sclerosis - UMN signs only
- Progressive muscular atrophy - LMN signs only
- Progressive bulbar palsy - bulbar palsy
- Degenerative cervical myelopathy - smoking; pain, motor deficits (digits), sensory
deficits, autonomic dysfunction, Hoffman’s sign; MRI c-spine; surgical decompression
- Syringomyelia - shawl-like sensation loss (particularly pain and temperature)
- Vestibular schwannoma - CN VIII (vertigo, sensorineural hearing loss, tinnitus), CN V
(absent corneal reflex), CN VII (CN VII palsy); MRI cerebellopontine angle; surgery
- Tuberous sclerosis - AD; ash-leaf spots (fluoresce under UV), Shagreen patches,
butterfly angiofibromas, subungual fibromata, cafe-au-lait spots
- Neurofibromatosis - AD; NF1 - cafe-au-lait spots, axillary/groin freckles, peripheral
neurofibromas; NF2 - intracranial schwannomas (bilateral vestibular schwannomas),
meningiomas and ependymomas
- Essential tremor - AD; worse when arms outstretched, better with alcohol and rest;
propranolol
- Restless legs - akathisia (night → day → rest), paraesthesia; conservative + DA
