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Cerebellar syndrome - A [8]
Vascular lesion, alcohol, demyelination, tumours, paraneoplastic phenomenon, hypothyroidism, phenytoin toxicity, metabolic disorders (e.g. Wilson\\\'s disease)
Cerebellar syndrome - Sy [2]
Poor balance, dysphasia
Cerebellar syndrome - Si [6]
DANISH: Dysdiadochokinesis, Ataxia, Nystagmus, Intension tremor/past pointing, Scanning speach/dysarthria, Hypotonia/hyporeflexia
Cerebellar syndrome - Ix
Cerebellar syndrome - Rx
Treat underlying disorder
Meningitis - P
Infection of the meninges, commonly with Strep. pneumoniae (also N. meningitidis, H. influenzae, Listeria monocytogenes, M. tuberculosis, viruses, and fungi
Meningitis - Sy [5]
Headache, photophobia, nausea, vomiting, neck pain
Meningitis - Si [6]
Fever, neck stiffness, confusion, drowsiness, petechiae, Kernig\\\'s sign
Meningitis - Ix
FBC, U&E, LFT, coagulation, blood cultures, CXR, LP
Meningitis - LP
Bacterial: ^^^neut, ^lymp, ^protein, _gluc; Viral: ^neut, ^^^lymph, ^protein; Tuberculosis: ^neut, ^^^lymph, ^protein, _gluc
Meningitis - Rx
Immediate 3rd generation cephalosporins (e.g. cefotaxime), plus ampicillin is Listeria suspected; Rifampicin prophylaxis for close contacts
Meningitis - Cx [7]
Seizures, hydrocephalus, cerebral venous/saggital sinus thrombosis, neurological sequelae, DIC, multi-organ failure, death
Encephalitis - definition
Infection of the brain parenchyma
Encephalitis - Ae
Primary or secondary to viral infection (10% herpes simplex)
Encephalitis (HSV) - S [8]
Prodromal viral symptoms; headaches, fever, meningism, confusion, delirium, seizures, neurological deficits
Encephalitis - Ix
FBC, U&E, clotting, septic screen
Encephalitis (HSV) - Rx
Aciclovir, supportive/symptomatic treatment
Encephalitis - Cx
Fatal if untreated (within 7-10 days), neurological sequelae (seizures, amnesia, motor deficits, etc.)
Migraine - description of pain [4]
4-72h, usually unilateral, throbbing or pulsating, moderate to severe
Migraine - associated S+S [6]
n&v, photophobia, phonophobia, visual/sensory aura, nasal congestion, aggravated by activity
Migraine - Rx [7]
Sleep hygiene, b-blockers, anticonvulsants, TCAs; Abortive: pain relief, 5-HT agonists, Ergot derivatives
What alternative treatments may be effective in menstrual-related migraine? [2]
Oestrogen or magnesium therapy
Tension headache - description of pain [4]
30m to 7 days, bilateral, squeezing/pressure, mild or moderate
Is tension headache usually associated with nausea or vomiting?
Tension headache - Rx [3]
Prophylactic: TCAs, SSRIs. Abortive: ibuprofen
Cluster headache - description of pain [5]
15-180m, may be many per day, unilateral (orbital, supraorbital, temporal), sharp or stabbing, severe
Cluster headache - associated S+S [6]
Ipsilateral lacrimation, rhinorrhoea, miosis/ptosis, and eyelid oedema. Restlessness, post-headache fatigue
Cluster headache - Rx [8]
Prophylactic: prednisolone taper, ergotamine, nerve block. Acute: oxygen, ergotamine, triptan nasal spray, intranasal lidocaine.
Trigeminal neuralgia - description
Paroxysmal pain involving divisions of trigeminal nerve. Touching area may produce pain.
Trigeminal neuralgia - Rx [3]
Anticonvulsants, baclofen, surgical decompression.
Delerium - characteristics [5]
Acute, fluctuating course, fluctuating attention, hours to weeks, frequent hallucinations,
Multiple sclerosis - P
Chronic autoimmune inflammatory disease of the CNS, with white plaques, occuring anywhere in the CNS
What is the cause of white plaques in MS? [2]
Demyelination and perivascular inflammation
Multiple sclerosis - A
HLA-A3, A7, DR2, DQ1; effects people within reproductive years, ?immune dysfunction, ?viral association, incidence increases with distance from the equator
Multiple sclerosis - S+S
Visual (blurred vision, pain on eye move), sensory (pins and needles, numbness, burning), motor (limb weakness, spasms, stiffness, heaviness), autonomic (urge, hesitancy, incontinence, impotence), psychological, Uhtoff\\\'s
Describe Uhtoff\\\'s phenomenon
Temporary increase or recurrance of MS symptoms precipitated by a rise in body temperature
Describe Lhermitte\\\'s phenomenon
A Shock-like sensation in the arms and legs precipitated by neck flexion
Multiple sclerosis - o/e [11]
Vision: _acuity, colour loss, central scotoma, RAPD, loss of smooth pursuit, internucleur ophthalmoplegia. Sensory: paraesthsia. Motor: UMN signs. Cerebellar: intention tremor, dysmetria. Lhermitte\\\'s.
Multiple sclerosis - Ix [5]
Lumbar puncture/CSF (^protein, ^Ig levels, oligoclonal bands), visual evoked potentials, MRI T2
Multiple sclerosis - Rx [5]
High-dose steroids for exacerbations, interferon-B, baclofen (for muscle spasms), clonazepam (tremor), gabapentin (pain)
Multiple sclerosis - Px
Mean prognosis 25-35 years, increased risk of suicide
List the four types of multiple sclerosis
Benign, relapsing-remitting, chronic progressive, primary progressive
Guillain-Barré syndrome - description
Acute ascending inflammatory demyelinating polyneuropathy
Guillain-Barré syndrome - Ae [5]
Precise aetiology unknown. Idiopathic (40%), post-infective (HZV, CMV, C.jejuni), malignancy (lymphoma, Hodgkin\\\'s), SLE, post-operative.
Guillain-Barré syndrome - E
1-2 per 100,000, all ages
Guillain-Barré syndrome - clinical presentation [4]
Ascending symmetrical limb weakness (over < month), paraesthesia, CN involvement, respiratory complications
Guillain-Barré syndrome - o/e
Hypotonia, flaccid paralysis, ascending arreflexia, CN palsy, type II resp failure
Guillain-Barré syndrome - P
Possibly immune cell-mediated demyelination of peripheral nerves and/or spinal roots. Macrophages and lymphcytes.
Guillain-Barré syndrome - Ix [4]
LP (^CSF protein, cell count and glucose normal), EMG _conduction velocity, antiganglioside antibodies in 25%.
Guillain-Barré syndrome - Rx [3]
Supportive. High-dose IV immunoglobulins or plasmapheresis may reduce duration and severity.
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