p.12
Thiamine Deficiency and Related Neuropathies
What is Korsakoff's Syndrome?
A marked memory disorder often seen in alcoholics.
p.11
Thiamine Deficiency and Related Neuropathies
What is the role of thiamine (B1) in the body?
Thiamine is important in the catabolism of sugars and amino acids.
p.1
Lambert Eaton Myasthenic Syndrome
What conditions are associated with Lambert Eaton Myasthenic Syndrome?
Small cell lung cancer, breast cancer, and ovarian cancer.
p.4
Multiple Sclerosis and Its Subtypes
What MRI findings are indicative of this condition?
High signal T2 lesions, periventricular plaques, and Dawson fingers.
p.20
Parkinson's Disease and Movement Disorders
What additional features are associated with Progressive supranuclear palsy?
Vertical gaze palsy, postural falls, and primarily frontal lobe dysfunction.
p.17
Parkinson's Disease and Movement Disorders
What is the action of midodrine?
It acts on peripheral alpha-adrenergic receptors to increase arterial resistance.
p.1
Lambert Eaton Myasthenic Syndrome
What are common features of Lambert Eaton Myasthenic Syndrome?
Limb-girdle weakness, hyporeflexia, and autonomic symptoms.
p.20
Parkinson's Disease and Movement Disorders
What characterizes Cortico-basal degeneration?
Akinetic rigidity or spontaneous activity by an affected limb.
p.6
Neuromyelitis Optica Spectrum Disorders
What causes pruritus in NMO?
Inflammation of fibers in the spinothalamic tract.
p.17
Parkinson's Disease and Movement Disorders
What should be added if a patient has symptoms despite optimal levodopa treatment?
Dopamine agonist, MAO-B inhibitor, or COMT inhibitor.
p.6
Neuromyelitis Optica Spectrum Disorders
How does NMO relate to multiple sclerosis?
It is often a differential diagnosis as it shares similarities, including optic neuritis.
What are common features of encephalitis?
Fever, headache, vomiting, psychiatric symptoms, seizures, and focal features like aphasia.
p.28
Neuromyelitis Optica Spectrum Disorders
How does viral meningitis compare to bacterial meningitis?
Viral meningitis is considered a more benign condition and is much more common.
p.11
Thiamine Deficiency and Related Neuropathies
What are the symptoms of Korsakoff's syndrome?
Amnesia and confabulation.
p.12
Thiamine Deficiency and Related Neuropathies
What condition often precedes Korsakoff's Syndrome?
Untreated Wernicke's encephalopathy.
p.1
Assisted Ventilation in Respiratory Failure
What is an indicator for requiring assisted ventilation?
PaO2 is <8kPa despite 60% O2.
p.11
Thiamine Deficiency and Related Neuropathies
What are the clinical consequences of thiamine deficiency?
They are first seen in highly aerobic tissues such as the brain (Wernicke-Korsakoff syndrome) and the heart (wet beriberi).
p.6
Neuromyelitis Optica Spectrum Disorders
What is believed to cause most cases of NMO?
IgG Antibodies to Aquaporin-4 (AQP4 - Abs) leading to CNS damage.
What is sarcoidosis characterized by?
Non-caseating granulomas.
What is a common clinical scenario in HIV patients regarding CNS lesions?
Differentiating between toxoplasmosis and lymphoma.
p.22
Parkinson's Disease and Movement Disorders
What type of tremor is associated with Parkinsonism?
Resting, 'pill-rolling' tremor.
What MMSE score suggests dementia?
A score of 24 or less out of 30.
What EEG findings are characteristic of encephalitis?
Lateralized periodic discharges at 2 Hz.
p.20
Parkinson's Disease and Movement Disorders
What cognitive symptoms are associated with Lewy body dementia?
Fluctuations in cognitive impairment and visual hallucinations.
What is the ABC approach in managing bacterial meningitis?
Airway, Breathing, Circulation, Disability (GCS, focal neurological signs, seizures, papilloedema).
What causes hypercalcaemia in sarcoidosis?
Macrophages inside the granulomas increase conversion of vitamin D to its active form.
What is encephalitis?
A pathological condition characterized by inflammation of the brain parenchyma.
p.12
Thiamine Deficiency and Related Neuropathies
What is retrograde amnesia?
The inability to recall memories formed before the onset of the disorder.
p.4
Multiple Sclerosis and Its Subtypes
What cognitive impairments are observed in the late stages of the disease?
Cognitive impairment and dementia, especially in 50-60% of cases.
p.20
Parkinson's Disease and Movement Disorders
What is a common triad of symptoms in Parkinsonism?
Resting tremor, hypertonia, and bradykinesia.
What neuroimaging findings are associated with encephalitis?
Medial temporal and inferior frontal changes, such as petechial hemorrhages; normal in one-third of patients.
p.6
Neuromyelitis Optica Spectrum Disorders
What symptoms are associated with transverse myelitis in NMO?
Limb weakness, paroxysmal tonic spasms, sensory loss, bladder dysfunction, and radicular pain.
p.4
Multiple Sclerosis and Its Subtypes
What do Dawson fingers represent in MRI imaging?
Hyperintense lesions perpendicular to the corpus callosum.
What are some symptoms of HIV-associated dementia?
Cognitive impairment, memory impairment, speech impairment, movement problems, visual disturbances, psychiatric symptoms, and incontinence.
p.4
Multiple Sclerosis and Its Subtypes
What is observed in visual evoked potentials in this condition?
Delayed but well-preserved waveform.
p.6
Neuromyelitis Optica Spectrum Disorders
What is Neuromyelitis Optica (NMO)?
A spectrum of rare autoimmune demyelinating CNS conditions.
p.20
Parkinson's Disease and Movement Disorders
What are the four main Parkinson-plus syndromes?
Progressive supranuclear palsy, Multiple system atrophy, Cortico-basal degeneration, and Lewy body dementia.
p.11
Thiamine Deficiency and Related Neuropathies
What are common causes of thiamine deficiency?
Alcohol excess and malnutrition.
p.19
Parkinson's Disease and Movement Disorders
What condition are antimuscarinic drugs now more commonly used to treat?
Drug-induced parkinsonism.
What assessment tools are recommended by NICE for diagnosing dementia?
10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT), and the mini-mental state examination (MMSE).
p.20
Parkinson's Disease and Movement Disorders
What autonomic features are present in Multiple system atrophy?
Postural hypotension, incontinence, and impotence.
p.22
Parkinson's Disease and Movement Disorders
What is the characteristic of essential tremor?
Involuntary shaking or trembling, most commonly in the hands and arms.
p.10
Diabetic Neuropathy and Its Management
What is a common problem in clinical practice related to diabetic neuropathy?
Painful diabetic neuropathy.
What tests does NICE recommend for dementia management?
FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12, and folate levels.
p.6
Neuromyelitis Optica Spectrum Disorders
How common is pain as a symptom in NMO?
Very common, occurring in 80% of attacks, often involving the eye or trunk/legs.
What imaging findings are typically seen in toxoplasmosis in HIV patients?
Single or multiple ring-enhancing lesions with possible mass effect on CT.
p.4
Multiple Sclerosis and Its Subtypes
What are common psychiatric symptoms associated with cognitive impairment in this condition?
Depressive episode (about 50% lifetime risk) and euphoria (about 10%).
What are other common types of dementia following Alzheimer's disease?
Vascular dementia and Lewy body dementia.
p.1
Lambert Eaton Myasthenic Syndrome
What causes Lambert Eaton Myasthenic Syndrome?
An antibody directed against presynaptic voltage-gated calcium channels.
What are acute features of sarcoidosis?
Erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia.
p.6
Neuromyelitis Optica Spectrum Disorders
What are the symptoms of brainstem syndromes in NMO?
Intractable hiccups, nausea, or vomiting due to area postrema lesions.
p.19
Parkinson's Disease and Movement Disorders
Name an example of an antimuscarinic drug used for drug-induced parkinsonism.
Procyclidine, benzotropine, or trihexyphenidyl (benzhexol).
What is meningitis?
An inflammation of the meninges.
p.19
Parkinson's Disease and Movement Disorders
What is a common cause of drug-induced parkinsonism?
Antipsychotics or metoclopramide.
What are common symptoms of meningitis?
Fever, headache, nausea/vomiting, photophobia, neck stiffness, purpuric rash, seizures, drowsiness.
p.19
Parkinson's Disease and Movement Disorders
How do the motor symptoms of drug-induced parkinsonism differ from idiopathic Parkinson's disease?
They are generally rapid onset and bilateral, with patients usually only suffering from bradykinesia.
p.4
Multiple Sclerosis and Its Subtypes
What is increased in the CSF of patients with this condition?
Increased intrathecal synthesis of IgG.
p.20
Parkinson's Disease and Movement Disorders
What medications are used in the management of Lewy body dementia?
Acetylcholinesterase inhibitors (e.g., donepezil, rivastigmine) and memantine.
p.14
Myositis: Polymyositis and Dermatomyositis
What does a muscle biopsy show in polymyositis?
Endomysial inflammatory infiltrates.
What type of neurological complications can HIV cause?
Focal neurological lesions and generalized neurological diseases.
What virus is responsible for 95% of encephalitis cases in adults?
HSV-1 (Herpes Simplex Virus type 1).
In which demographic is sarcoidosis more common?
Young adults and people of African descent.
p.28
Neuromyelitis Optica Spectrum Disorders
What are common causes of viral meningitis?
Non-polio enteroviruses, mumps, herpes simplex virus, cytomegalovirus, herpes zoster viruses, HIV, and measles.
What are the common bacterial causes of meningitis?
Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes.
What are insidious features of sarcoidosis?
Dyspnoea, non-productive cough, malaise, weight loss.
What should be done if meningococcal disease is suspected in a pre-hospital setting?
Intramuscular benzylpenicillin may be given, as long as it doesn't delay transit to hospital.
p.5
Multiple Sclerosis and Its Subtypes
What is the primary focus of treatment in multiple sclerosis?
Reducing the frequency and severity of relapses and managing symptoms.
What is the management for toxoplasmosis in HIV patients?
Pyrimethamine and sulfadiazine.
Which brain regions are typically affected by encephalitis?
Temporal and inferior frontal lobes.
What does cerebrospinal fluid analysis show in encephalitis?
Lymphocytosis, elevated protein, and PCR for HSV, VZV, and enteroviruses.
p.17
Parkinson's Disease and Movement Disorders
What should be done if orthostatic hypotension develops in a patient?
Conduct a medication review and consider midodrine if symptoms persist.
p.11
Thiamine Deficiency and Related Neuropathies
What is the classic triad of symptoms for Wernicke's encephalopathy?
Ophthalmoplegia/nystagmus, gait ataxia, and encephalopathy.
p.27
Assisted Ventilation in Respiratory Failure
What prophylaxis should be offered to households of patients with meningococcal meningitis?
Prophylaxis needs to be offered to households and close contacts.
p.16
Parkinson's Disease and Movement Disorders
How is Parkinson's disease primarily diagnosed?
It is primarily a clinical diagnosis, supported by a positive response to treatment trials.
p.28
Neuromyelitis Optica Spectrum Disorders
What are common clinical features of viral meningitis?
Headache, fevers, neck stiffness, photophobia, and confusion.
p.11
Thiamine Deficiency and Related Neuropathies
What is the relationship between Wernicke's encephalopathy and Korsakoff syndrome?
If not treated, Korsakoff's syndrome may develop, leading to Wernicke-Korsakoff syndrome.
p.22
Parkinson's Disease and Movement Disorders
What exacerbates essential tremor?
Anxiety, stress, and social interaction.
p.14
Myositis: Polymyositis and Dermatomyositis
Which other muscle enzymes are elevated in 85-95% of patients?
Lactate dehydrogenase (LDH), aldolase, AST, and ALT.
What are some warning signs that require senior review in suspected bacterial meningitis?
Rapidly progressive rash, poor peripheral perfusion, abnormal respiratory or pulse rates, abnormal pH or WBC, GCS < 12 or a drop of 2 points, poor response to fluid resuscitation.
p.34
Huntington's Disease and Movement Disorders
What type of genetic disorder is Huntington's disease?
An autosomal dominant disorder.
p.22
Parkinson's Disease and Movement Disorders
What is a common family history pattern in essential tremor?
Strong family history – autosomal dominant.
p.21
Parkinson's Disease and Movement Disorders
What does a poor response to L-dopa indicate?
It may suggest advanced disease or other complications.
p.12
Thiamine Deficiency and Related Neuropathies
What is anterograde amnesia?
The inability to form new memories after the onset of the disorder.
p.17
Parkinson's Disease and Movement Disorders
What common side effect is associated with dopaminergic therapy?
Impulse control disorders.
What is a characteristic CT finding in primary CNS lymphoma?
Single homogenous enhancing lesions (one large circular lesion).
p.10
Diabetic Neuropathy and Its Management
What is the typical sensory loss distribution in diabetic neuropathy?
'Glove and stocking' distribution.
p.11
Thiamine Deficiency and Related Neuropathies
What is Wernicke's encephalopathy?
A neuropsychiatric disorder caused by thiamine deficiency.
p.27
Assisted Ventilation in Respiratory Failure
What types of PCR tests are mentioned for meningitis investigation?
Meningococcal and pneumococcal PCR, enteroviral, herpes simplex, and varicella-zoster PCR.
p.10
Diabetic Neuropathy and Its Management
What are common first-line treatments for diabetic neuropathy?
Amitriptyline, duloxetine, gabapentin, or pregabalin.
p.4
Multiple Sclerosis and Its Subtypes
What does the presence of oligoclonal bands in CSF indicate?
They are very sensitive for multiple sclerosis and are not found in serum.
What is the management for suspected encephalitis?
Intravenous aciclovir should be started in all cases.
p.10
Diabetic Neuropathy and Its Management
What investigations are used to assess diabetic neuropathy?
Neurological examination, nerve conduction studies, and blood tests.
p.27
Assisted Ventilation in Respiratory Failure
When should meningococcal vaccination be offered?
When serotype results are available, including booster doses for those vaccinated in infancy.
p.11
Thiamine Deficiency and Related Neuropathies
What is the treatment for Wernicke's encephalopathy?
Urgent replacement of thiamine.
p.18
Parkinson's Disease and Movement Disorders
What is levodopa commonly combined with to prevent peripheral metabolism?
A decarboxylase inhibitor (e.g., carbidopa or benserazide).
p.34
Huntington's Disease and Movement Disorders
What is the genetic basis of Huntington's disease?
It is a trinucleotide repeat disorder with repeat expansion of CAG.
p.16
Parkinson's Disease and Movement Disorders
What treatment options are available if motor symptoms do not affect the patient's quality of life?
Dopamine agonist (non-ergot derived) or levodopa or monoamine oxidase B (MAO-B) inhibitor.
p.3
Multiple Sclerosis and Its Subtypes
What characterizes relapsing-remitting disease?
Acute attacks followed by periods of remission.
p.19
Parkinson's Disease and Movement Disorders
What diagnostic method does NICE recommend if differentiating between essential tremor and Parkinson's disease is difficult?
123I-FP-CIT single photon emission computed tomography (SPECT).
p.14
Myositis: Polymyositis and Dermatomyositis
What are anti-Jo-1 antibodies associated with?
Lung involvement, Raynaud's, and fever.
What are common symptoms of toxoplasmosis in HIV patients?
Constitutional symptoms, headache, confusion, drowsiness.
p.12
Thiamine Deficiency and Related Neuropathies
What causes Korsakoff's Syndrome?
Thiamine deficiency causing damage and hemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus.
p.28
Neuromyelitis Optica Spectrum Disorders
What is viral meningitis?
Inflammation of the meninges attributed to a viral agent.
p.12
Thiamine Deficiency and Related Neuropathies
What is confabulation in the context of Korsakoff's Syndrome?
The creation of false memories without the intention to deceive.
What is the general management for primary CNS lymphoma?
Steroids, chemotherapy (e.g., methotrexate), and possibly whole brain irradiation.
What is dementia?
A syndrome involving impairment of multiple higher cortical functions such as memory, thinking, orientation, comprehension, and language.
p.4
Multiple Sclerosis and Its Subtypes
What is required for the diagnosis of this condition?
Demonstration of lesions disseminated in time and space.
p.6
Neuromyelitis Optica Spectrum Disorders
What are common features of optic neuritis in NMO?
May be bilateral, unilateral, or sequential; includes eye pain and severe visual loss.
What is the preferred imaging method for encephalitis?
MRI is better than other imaging methods.
p.28
Neuromyelitis Optica Spectrum Disorders
Who are at risk for viral meningitis?
Patients at extremes of age, immunocompromised individuals, and intravenous drug users.
p.27
Assisted Ventilation in Respiratory Failure
Who should receive prophylactic antibiotics after exposure to bacterial meningitis?
People who have had close contact within 7 days before onset.
p.16
Parkinson's Disease and Movement Disorders
What indicates that idiopathic Parkinson's disease is unlikely?
An absolute failure to respond to 1 - 1.5g of levodopa daily.
p.28
Neuromyelitis Optica Spectrum Disorders
What are less common features of viral meningitis?
Focal neurological deficits and seizures, which suggest meningoencephalitis.
p.11
Thiamine Deficiency and Related Neuropathies
What investigations are used to diagnose Wernicke's encephalopathy?
Decreased red cell transketolase, neurological examination, and MRI of the head.
p.8
Neuromyelitis Optica Spectrum Disorders
What are the main aims of treatment for the condition?
To reduce the frequency and severity of attacks.
p.13
Myositis: Polymyositis and Dermatomyositis
What is the suspected aetiology of Polymyositis?
Thought to be a T-cell mediated cytotoxic process directed against muscle fibres.
p.13
Myositis: Polymyositis and Dermatomyositis
What are common features of Polymyositis?
Proximal bilateral muscle weakness, muscle pain, Raynaud's, respiratory muscle weakness, and dysphagia.
p.26
Assisted Ventilation in Respiratory Failure
What should be used for patients over 50 years old with suspected infection?
Cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin).
p.22
Parkinson's Disease and Movement Disorders
What history is associated with hepatic encephalopathy?
History of chronic liver disease.
What are the CSF findings in Cryptococcus infection?
High opening pressure, elevated protein, reduced glucose, normally lymphocyte predominance.
p.34
Huntington's Disease and Movement Disorders
What are the three characteristic symptoms of Huntington's disease?
Chorea, cognitive impairment (dementia), and character changes (e.g., irritability, apathy, depression).
p.18
Parkinson's Disease and Movement Disorders
What should not be done acutely with levodopa?
It should not be stopped suddenly, especially if a patient is hospitalized.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What lumbar puncture findings support the diagnosis of CIDP?
Elevated CSF protein with leukocyte count <10/mm3.
p.14
Myositis: Polymyositis and Dermatomyositis
What is a common treatment for myositis?
High-dose corticosteroids tapered as symptoms improve.
p.1
Lambert Eaton Myasthenic Syndrome
How does muscle strength change with repeated contractions in Lambert Eaton Myasthenic Syndrome?
Muscle strength increases initially but may decrease after prolonged use.
p.14
Myositis: Polymyositis and Dermatomyositis
What is the most sensitive indicator for muscle damage?
Elevated creatine kinase.
p.1
Lambert Eaton Myasthenic Syndrome
What is a key investigation for diagnosing Lambert Eaton Myasthenic Syndrome?
EMG showing incremental response to repetitive electrical stimulation.
p.26
Assisted Ventilation in Respiratory Failure
What should be done if a lumbar puncture cannot be performed within the first hour?
IV antibiotics should be given after blood cultures have been taken.
p.20
Parkinson's Disease and Movement Disorders
What are the key features of Progressive supranuclear palsy?
Postural instability, bradykinesia, impairment of vertical gaze, and cognitive impairment.
What symptoms may indicate neurological involvement in neurosarcoidosis?
Facial numbness, dysphagia, hoarseness, headache, visual field defects, polydipsia, hearing impairment.
p.29
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What should be administered if there is suspicion of bacterial meningitis?
Broad-spectrum antibiotics with CNS penetration, e.g., ceftriaxone and aciclovir.
p.3
Multiple Sclerosis and Its Subtypes
What is secondary progressive disease?
Describes relapsing-remitting patients who have deteriorated and developed neurological signs and symptoms between relapses.
p.23
Parkinson's Disease and Movement Disorders
Give an example of generalized dystonia.
Flatau - Sterling syndrome.
p.13
Myositis: Polymyositis and Dermatomyositis
What underlying conditions are associated with Dermatomyositis?
Connective tissue disorders and malignancies, particularly ovarian, breast, and lung cancer.
p.5
Multiple Sclerosis and Its Subtypes
What should be assessed before treating bladder dysfunction in MS?
An ultrasound to assess bladder emptying.
p.8
Neuromyelitis Optica Spectrum Disorders
What are some options for monoclonal antibody treatment?
Eculizumab, Rituximab, and Satralizumab.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What medications may be used for neuropathic pain in CIDP patients?
Gabapentin or pregabalin.
p.3
Multiple Sclerosis and Its Subtypes
What cerebellar symptoms may occur during an acute relapse?
Ataxia and intention tremor.
What are the CT findings in AIDS dementia complex?
Cortical and subcortical atrophy.
p.19
Parkinson's Disease and Movement Disorders
What symptoms are uncommon in drug-induced parkinsonism?
Rigidity and rest tremor.
p.5
Multiple Sclerosis and Its Subtypes
What is a common treatment for acute relapse in multiple sclerosis?
High-dose steroids, such as oral or IV methylprednisolone, for 5 days.
p.18
Parkinson's Disease and Movement Disorders
What are common adverse effects of levodopa?
Dry mouth, psychosis, palpitations, postural hypotension, nausea & vomiting, anorexia, reddish discolouration of urine upon standing.
What is Waterhouse-Friderichsen syndrome?
Adrenal insufficiency secondary to adrenal hemorrhage, associated with meningococcal meningitis.
p.16
Parkinson's Disease and Movement Disorders
What are examples of non-ergot derived dopamine agonists?
Ropinirole, rotigotine, Apomorphine.
p.5
Multiple Sclerosis and Its Subtypes
What are the typical indications for disease-modifying drugs in MS?
Relapsing-remitting disease with 2 relapses in the past 2 years and able to walk 100m unaided, or secondary progressive disease with 2 relapses in the past 2 years and able to walk 10m.
p.8
Neuromyelitis Optica Spectrum Disorders
When is plasma exchange therapy (PLEX) used?
If unresponsive to corticosteroids, usually for 5 cycles.
p.7
Neuromyelitis Optica Spectrum Disorders
What antibodies are typically present in the serum for Neuromyelitis Optica?
Aquaporin 4 - IgG antibodies and Anti - MOG antibodies.
p.29
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What is the typical course of viral meningitis in immunocompetent patients?
Self-limiting, with symptoms improving over 7 - 14 days.
p.18
Parkinson's Disease and Movement Disorders
What are some examples of dopamine receptor agonists?
Bromocriptine, ropinirole, cabergoline, apomorphine.
p.3
Multiple Sclerosis and Its Subtypes
What is Lhermitte's syndrome?
Paraesthesiae in limbs on neck flexion.
p.26
Assisted Ventilation in Respiratory Failure
What investigations should be performed on blood samples?
Full blood count, renal function, glucose, lactate, clotting profile, CRP.
p.8
Neuromyelitis Optica Spectrum Disorders
What is vital for managing symptoms like neuropathic pain and fatigue?
A referral to a local pain management team.
p.23
Parkinson's Disease and Movement Disorders
What investigations are commonly done for dystonia?
Detailed medical history, neurological examination, neuroimaging (e.g., MRI), genetic testing, evaluation of response to pharmacologic interventions.
p.20
Parkinson's Disease and Movement Disorders
How is Lewy body dementia typically diagnosed?
Usually clinical, with SPECT increasingly used.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What is the suspected aetiology of Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)?
It is thought to be an autoimmune condition.
When should antipsychotics be used in dementia patients?
Only for patients at risk of harming themselves or others, or when agitation, hallucinations, or delusions cause severe distress.
What are some neurological complications of meningitis?
Sensorineural hearing loss, seizures, focal neurological deficit.
p.8
Neuromyelitis Optica Spectrum Disorders
What is the first-line treatment for acute attacks?
Intravenous Methylprednisolone for 5 days.
What is a key decision regarding lumbar puncture in bacterial meningitis?
Whether to attempt a lumbar puncture, considering the risks and benefits of obtaining a CSF sample.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What primary tests are recommended to diagnose CIDP?
Sensory and motor nerve conduction studies, nerve biopsy, MRI, and lumbar puncture.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What does a nerve biopsy show to support a CIDP diagnosis?
Evidence of demyelination and/or remyelination by electron microscopy.
What is the glucose level in CSF for viral meningitis?
60 - 80% of plasma glucose.
p.8
Neuromyelitis Optica Spectrum Disorders
What is recommended for prophylaxis and remission treatment?
Long-term immunotherapy as soon as a diagnosis is made.
p.34
Huntington's Disease and Movement Disorders
What is the role of genetic testing in Huntington's disease?
It is confirmatory and allows for predictive testing in at-risk family members with pre-test genetic counseling.
p.23
Parkinson's Disease and Movement Disorders
What are secondary dystonias usually attributable to?
Specific causes or conditions, often related to drug use or neurological diseases.
p.3
Multiple Sclerosis and Its Subtypes
What are common sensory symptoms in multiple sclerosis?
Patchy paraesthesia, pins/needles, numbness, and trigeminal neuralgia.
p.23
Parkinson's Disease and Movement Disorders
What are common signs and symptoms of dystonia?
Prolonged muscle contractions, abnormal postures, repetitive movements, cramping or pain in affected muscles.
p.23
Parkinson's Disease and Movement Disorders
What is trismus?
Difficulty opening the mouth due to muscle spasm.
p.16
Parkinson's Disease and Movement Disorders
What additional investigations can be considered in atypical cases of Parkinson's disease?
MRI Head or a Dopamine Transporter Scan (DaT scan).
p.1
Lambert Eaton Myasthenic Syndrome
What treatments are available for Lambert Eaton Myasthenic Syndrome?
Treatment of underlying cancer, immunosuppression, intravenous immunoglobulin therapy, and plasma exchange.
p.3
Multiple Sclerosis and Its Subtypes
What is multiple sclerosis?
A chronic cell-mediated autoimmune disorder characterized by demyelination in the central nervous system.
p.10
Diabetic Neuropathy and Its Management
What management options are available for gastroparesis?
Metoclopramide, domperidone, or erythromycin.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What are common symptoms of CIDP?
Tingling or no feeling in fingers and toes, weakness of arms and legs, loss of deep tendon reflexes, and fatigue.
p.14
Myositis: Polymyositis and Dermatomyositis
What does a muscle biopsy show in dermatomyositis?
Perivascular and perimysial inflammatory infiltrates.
p.22
Parkinson's Disease and Movement Disorders
What are usual signs of thyrotoxicosis?
Weight loss, tachycardia, feeling hot.
p.18
Parkinson's Disease and Movement Disorders
What is the 'end-of-dose wearing off' phenomenon?
Symptoms worsen towards the end of the dosage interval, leading to a decline in motor activity.
p.34
Huntington's Disease and Movement Disorders
Which neurons are primarily affected in Huntington's disease?
Cholinergic and GABAergic neurons in the striatum of the basal ganglia.
p.18
Parkinson's Disease and Movement Disorders
What is the 'on-off' phenomenon in Parkinson's treatment?
Large variations in motor performance, with normal function during the 'on' period and weakness during the 'off' period.
What is the recommended initial corticosteroid dose for neurosarcoidosis?
40-80 mg of daily prednisolone equivalent.
p.7
Neuromyelitis Optica Spectrum Disorders
What is expected in the CSF analysis for Neuromyelitis Optica?
CSF oligoclonal bodies are absent.
p.18
Parkinson's Disease and Movement Disorders
What potential side effects are associated with ergot-derived dopamine receptor agonists?
Pulmonary, retroperitoneal, and cardiac fibrosis.
p.3
Multiple Sclerosis and Its Subtypes
What motor symptoms are most commonly seen in multiple sclerosis?
Spasticity and weakness, particularly in the legs.
p.34
Huntington's Disease and Movement Disorders
Which type of medications are preferred for managing psychosis in Huntington's disease?
Atypical antipsychotics due to lower rates of extrapyramidal side effects.
p.23
Parkinson's Disease and Movement Disorders
What is torticollis?
Abnormal, often painful, neck positioning.
p.10
Diabetic Neuropathy and Its Management
What symptoms are associated with gastroparesis in gastrointestinal autonomic neuropathy?
Erratic blood glucose control, bloating, and vomiting.
p.13
Myositis: Polymyositis and Dermatomyositis
What is Polymyositis?
An inflammatory disorder causing symmetrical, proximal muscle weakness.
p.26
Assisted Ventilation in Respiratory Failure
What antibiotics are recommended for patients under 3 months old?
Cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin).
p.27
Assisted Ventilation in Respiratory Failure
Is prophylaxis generally needed for pneumococcal meningitis?
No, but exceptions exist if a cluster of cases occurs.
p.26
Assisted Ventilation in Respiratory Failure
What is the recommended antibiotic treatment for patients aged 3 months to 50 years?
Cefotaxime (or ceftriaxone).
p.5
Multiple Sclerosis and Its Subtypes
What are disease-modifying drugs used for in multiple sclerosis?
To reduce the risk of relapse in patients with MS.
What should be prioritized if there is any doubt about performing a lumbar puncture?
IV antibiotics should be given as a priority.
p.7
Neuromyelitis Optica Spectrum Disorders
What are the criteria for diagnosing Neuromyelitis Optica?
At least 1 core clinical characteristic, positive Aquaporin 4 antibodies, and exclusion of alternative diagnoses.
p.16
Parkinson's Disease and Movement Disorders
What is the role of monoamine oxidase B (MAO-B) inhibitors in Parkinson's disease management?
They reduce dopamine breakdown peripherally and increase central uptake of levodopa, often used in combination with levodopa later in the disease.
p.13
Myositis: Polymyositis and Dermatomyositis
What are some characteristic skin lesions of Dermatomyositis?
Heliotrope rash, Gottron's papules, and mechanic's hands.
p.7
Neuromyelitis Optica Spectrum Disorders
What might an MRI of the head reveal in a patient with Neuromyelitis Optica?
It is often normal, but demyelinating lesions may be found, especially peri-aqueductal lesions or lesions in the thalamic and hypothalamic regions.
p.18
Parkinson's Disease and Movement Disorders
What is the role of MAO-B inhibitors in Parkinson's treatment?
They inhibit the breakdown of dopamine secreted by dopaminergic neurons.
p.23
Parkinson's Disease and Movement Disorders
What common drugs can cause secondary dystonias?
Anti-dopaminergic drugs such as antipsychotics or anti-emetics (e.g., metoclopramide).
p.18
Parkinson's Disease and Movement Disorders
What is the function of COMT inhibitors in Parkinson's disease?
They inhibit the breakdown of dopamine and are used with levodopa in established PD.
p.23
Parkinson's Disease and Movement Disorders
What are some management strategies for dystonia?
Withdrawal of offending agents, pharmacological therapies (e.g., botulinum toxin injections), oral medications, physical therapy, deep brain stimulation, genetic counselling.
When should a lumbar puncture (LP) be delayed?
If it can't be done within 1 hour, signs of severe sepsis, rapidly evolving rash, signs of raised intracranial pressure, severe respiratory/cardiac compromise, or significant bleeding risk.
What neurological manifestations are common in neurosarcoidosis?
Bell's palsy and lymphocytic meningitis.
p.29
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What is the glucose level range in cerebrospinal fluid for viral meningitis?
2.8 – 4.2 mmol/L or 2/3 serum glucose.
p.34
Huntington's Disease and Movement Disorders
What phenomenon may occur in Huntington's disease due to its genetic nature?
Anticipation, where the disease presents at an earlier age in successive generations.
What are common symptoms of Cryptococcus infection?
Headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit.
p.13
Myositis: Polymyositis and Dermatomyositis
What serious complication can arise from respiratory muscle weakness in Polymyositis?
Type 2 respiratory failure.
p.13
Myositis: Polymyositis and Dermatomyositis
What is Dermatomyositis?
A variant of myositis characterized by muscle weakness and skin lesions.
p.26
Assisted Ventilation in Respiratory Failure
When should dexamethasone be considered in treatment?
Particularly if pneumococcal meningitis is suspected in adults, preferably starting before or with the first dose of antibacterial.
p.34
Huntington's Disease and Movement Disorders
What neuroimaging findings are associated with moderate to severe Huntington's disease?
Loss of striatal volume and an enlarged frontal horn of the lateral ventricles.
p.23
Parkinson's Disease and Movement Disorders
What are examples of focal dystonias?
Musician's cramp and spasmodic torticollis (cervical dystonias).
p.13
Myositis: Polymyositis and Dermatomyositis
What is the significance of interstitial lung disease in Polymyositis?
It indicates a poor prognosis and can manifest as fibrosing alveolitis or organizing pneumonia.
What are the symptoms of PML?
Behavioural changes, speech, motor, visual impairment.
What are the CT findings in PML?
Single or multiple lesions, no mass effect, don't usually enhance.
p.3
Multiple Sclerosis and Its Subtypes
What are some other features of multiple sclerosis?
Fatigue, urinary frequency & incontinence, brisk reflexes, and sexual dysfunction.
p.3
Multiple Sclerosis and Its Subtypes
What is the most common form of multiple sclerosis?
Relapsing-remitting disease, accounting for around 85% of patients.
p.10
Diabetic Neuropathy and Its Management
What causes gastro-oesophageal reflux disease in diabetic neuropathy?
Decreased lower oesophageal sphincter (LES) pressure.
p.8
Neuromyelitis Optica Spectrum Disorders
What is the second-line treatment for acute attacks?
Oral prednisolone tapered over weeks to months.
p.23
Parkinson's Disease and Movement Disorders
What are dystonias?
A spectrum of movement disorders characterized by involuntary muscle contractions leading to abnormal, often repetitive, movements and postures.
p.5
Multiple Sclerosis and Its Subtypes
What is the mechanism of action of natalizumab?
It inhibits the migration of leucocytes across the endothelium and the blood-brain barrier.
p.23
Parkinson's Disease and Movement Disorders
What are primary dystonias?
Idiopathic in nature, often genetic, and can be generalized or focal.
What is a common CSF finding in tuberculous meningitis?
Slight cloudy appearance with a fibrin web.
What is the typical presentation of Cryptococcus infection?
Meningitis, but may occasionally cause a space-occupying lesion.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What is the first-line treatment for CIDP?
60mg OD oral prednisolone for 6 weeks.
p.7
Neuromyelitis Optica Spectrum Disorders
What does an MRI of the spinal cord show in Neuromyelitis Optica?
Longitudinal and central cord lesions, with 3 or more contiguous vertebral segment lesions.
p.26
Assisted Ventilation in Respiratory Failure
What tests should be performed on CSF if a lumbar puncture has been done?
Glucose, protein, microscopy, and culture.
p.34
Huntington's Disease and Movement Disorders
What type of care is essential for patients with Huntington's disease?
Supportive care, including physical and emotional support from a multidisciplinary team.
p.2
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
What MRI findings support a CIDP diagnosis?
Gadolinium enhancement and/or hypertrophy of the cauda equina, lumbosacral or cervical nerve roots, or the brachial or lumbosacral plexuses.
p.5
Multiple Sclerosis and Its Subtypes
What is a first-line treatment for fatigue in multiple sclerosis?
A trial of amantadine after excluding other problems.
p.3
Multiple Sclerosis and Its Subtypes
What visual symptom is associated with optic neuritis?
Loss of central vision and painful eye movements.
What is the typical white cell count in bacterial meningitis?
10 - 5,000 polymorphs/mm³.
p.26
Assisted Ventilation in Respiratory Failure
What initial steps should be taken for patients with signs of raised intracranial pressure?
Get critical care input, secure airway + high-flow oxygen, IV access, and arrange neuroimaging.
p.34
Huntington's Disease and Movement Disorders
What is the first-line treatment for managing depression in Huntington's disease?
Selective serotonin reuptake inhibitors (SSRIs).
p.7
Neuromyelitis Optica Spectrum Disorders
How do visually evoked potentials help in diagnosing Neuromyelitis Optica?
They differentiate it from other causes of optic neuropathy, showing reduced amplitudes or prolonged latencies.
What are the symptoms of AIDS dementia complex?
Behavioural changes, motor impairment.
p.13
Myositis: Polymyositis and Dermatomyositis
What is a common screening practice after diagnosing Dermatomyositis?
Screening for underlying malignancy.
p.18
Parkinson's Disease and Movement Disorders
What side effects are associated with amantadine?
Ataxia, slurred speech, confusion, dizziness, and livedo reticularis.
p.23
Parkinson's Disease and Movement Disorders
What is an oculogyric crisis?
Upward deviation of the eyes.
