Neurology/Opthalmology
Dr Liz Cloudhard
Contents
• Disease of the neuromuscular junction
• Movement disorder
• Neurological complication
• Cerebellar disease
• Sp...
Myasthenia Gravis
• Autoimmune disease – antibodies to acetylcholine receptor (AChR).
Affects mainly younger women and mid...
Myasthenia Gravis Cont.
• Treatment
– Acetylcholine esterase inhibitor (eg pyridostigmine)
– Steroids/azathioprine
– Plasm...
Lambert Eaton Myasthenic syndrome
• Autoimmune condition with presynaptic voltage gated
calcium channel antibodies
• 50% a...
Btulism
• Neurotoxin produced by Clostridium botulinum binds
irreversibly to presynaptic membranes blocking
acetylcholine ...
A 39 year old undertaker has had increasing difficulty
swallowing liquid over the past 2 weeks. This seems to
be worse in ...
What is the most likely Diagnosis?
What is the most likely Diagnosis?
A. Guillain Barre
B. Miller-Fisher Variant of Guillain Barre
C. Lambert Eaton Myastheni...
Upcoming SlideShare
Loading in …5
×

Neurology and Ophthalmalogy - MRCP 1 - 123Doc Education

1,031 views

Published on

Neurology and Ophthalmalogy, as part of the MRCP 1 course. These are slideshows only. The demonstration with video presentation and explanation that goes along with these slides, as well as free example exam questions and the paid full e-lecture can be viewed at https://www.123doc.com/electures/neurologyopthalmology/

Published in: Health & Medicine
0 Comments
10 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,031
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
57
Comments
0
Likes
10
Embeds 0
No embeds

No notes for slide

Neurology and Ophthalmalogy - MRCP 1 - 123Doc Education

  1. 1. Neurology/Opthalmology Dr Liz Cloudhard
  2. 2. Contents • Disease of the neuromuscular junction • Movement disorder • Neurological complication • Cerebellar disease • Spinal cord syndrome • Headache • Multiple sclerosis • Motor neuron disease • Dementia • Myopathy • Epilepsy
  3. 3. Myasthenia Gravis • Autoimmune disease – antibodies to acetylcholine receptor (AChR). Affects mainly younger women and middle aged/elderly men • FATIGUABLE – Dysphagia (for liquids) and nasal regurgitation, diplopia, ptosis, other muscle weakness (proximal limbs, facial, bulbar and respiratory muscle), Thymoma • Investigations • AChR antibodies (90%) • Antisrtieted muscle antibodies (80% with thymoma) • CXR/CT (thymoma) • Neurophysiology (single fiber EMG and repetitive nerve stimulation) • Tensilon test(short acting Ach esterase inhibitor)
  4. 4. Myasthenia Gravis Cont. • Treatment – Acetylcholine esterase inhibitor (eg pyridostigmine) – Steroids/azathioprine – Plasmapheresis and intravenous immunoglobulin (if brittle, myasthenic crisis or intercurrent infection/operation) • Complications – Myasthenic crisis (can required ventilatory support) – Antibodies can cross the placenta (neonatal MG). – MG is exacerbated by certain drugs (eg gentamicin, verapamil, procainamide. – High anesthetic risk if neuromuscular blockade with vecuronium or curare is prolonged. – Associated with other autoimmune disease eg thyroid disease.
  5. 5. Lambert Eaton Myasthenic syndrome • Autoimmune condition with presynaptic voltage gated calcium channel antibodies • 50% associated with underlying malignancy (SCLC) • Slowly progressive proximal leg weakness, dry mouth and skin, ptosis or bulbar weakness (<30%), aching muscles • FACILITATION – strength improves with repeated tapping • Investigations – EMG, antibodies, search for underlying tumour. • Treatment - treat tumour. if no tumour consider immunomodulation.
  6. 6. Btulism • Neurotoxin produced by Clostridium botulinum binds irreversibly to presynaptic membranes blocking acetylcholine release. • GI or flulike illness followed by cranial nerve (blurred vision, ptosis, bulbar weakness, fixed pupils) and then rapidly descending paralysis • Automatic involvement (bladder distention, blood pressure changes and dry eyes and mouth) • Treatment is supportive (ITU) and debridement if toxin entered via wound • Toxin sometimes found in body fluids and EMG may be suggestive
  7. 7. A 39 year old undertaker has had increasing difficulty swallowing liquid over the past 2 weeks. This seems to be worse in the evening. He has no past medical history, apart from the chest infection, treated with antibiotics, two years ago. On examination, tone power, reflexes and co-ordination are all normal, although towards the end of the examination there is the suggestion that he may be more weak proximally. Sensory examination is entirely normal.
  8. 8. What is the most likely Diagnosis?
  9. 9. What is the most likely Diagnosis? A. Guillain Barre B. Miller-Fisher Variant of Guillain Barre C. Lambert Eaton Myasthenic Syndrome D. Botulism toxicity E. Myasthenia Gravis

×