NEURology
, AUTONOMIC NEUROPATHY
Dysfunction of sympathetic & parasympathetic nervous systems so impaired cardiovascular, genitourinary, gastrointestinal regulation
Features (multisystem) Investigations
• Cardiovascular - postural hypotension, reduced or absent HR • Cardiovascular autonomic test - HR variability, lying/
• Erectile dysfunction standing BP
• Impaired sweating or anhidrosis • Pupillary pharmacological testing
• Gastroparesis -> early satiety, nausea, bloating • Blood tests - HbA1c, B12, autoimmune screen, HIV, syphilis
• Pupillary denervation hypersensitivity -> dilates with adrenaline • Sweat testing, MRI brain/spine, nerve conduction studies
Causes Management
• Diabetes - most common cause • Treat underlying cause
• Gulliain-Barré syndrome, Parkinson’s disease • Postural hypotension
• Multiple system atrophy/Shy-Drager syndrome - Conservative = fluids, salt, TEDS
• Infections = HIV, Chagus’ disease, neurosyphilis - Medications = fludrocortisone or midodrine
• Drugs = antihypertensives, TCAs • Erectile dysfunction = PDE5 inhibitors
• Structural lesions - craniopharyngioma • Sweat dysfunction = moisturisers, temp regulation
, BELL’S PALSY BRAIN ABSCESS
↳ is risk factor
immunosuppression a
Acute, unilateral, idiopathic, facial nerve paralysis, which Causes
peaks in 20-40 years • Extension of sepsis, trauma or surgery
Features Features
• LMN facial nerve palsy -> FOREHEAD AFFECTED • Headache - dull, persistent
• Post-auricular pain • Raised ICP - nausea, papilloedema, seizures
↳ • Fever - may be absent
• Altered taste If forehead spared umN
= usion
• Dry eyes
(e g Stroke
.
.
• Focal neurology - CN III/VI palsy
• Hyperacusis
Investigations
Management • CT contrast
-
• PO prednisolone - within 72hrs of onset
• Antivirals - severe facial palsy Management
• No improvement after 3 weeks - urgent ENT referral • Surgery - craniotomy - Leftriaxone
• Full recovery within 3-4 months • IV antibiotics - cephalosporin + metronidazole
• ICP - dexamethasone
, AUTONOMIC NEUROPATHY
Dysfunction of sympathetic & parasympathetic nervous systems so impaired cardiovascular, genitourinary, gastrointestinal regulation
Features (multisystem) Investigations
• Cardiovascular - postural hypotension, reduced or absent HR • Cardiovascular autonomic test - HR variability, lying/
• Erectile dysfunction standing BP
• Impaired sweating or anhidrosis • Pupillary pharmacological testing
• Gastroparesis -> early satiety, nausea, bloating • Blood tests - HbA1c, B12, autoimmune screen, HIV, syphilis
• Pupillary denervation hypersensitivity -> dilates with adrenaline • Sweat testing, MRI brain/spine, nerve conduction studies
Causes Management
• Diabetes - most common cause • Treat underlying cause
• Gulliain-Barré syndrome, Parkinson’s disease • Postural hypotension
• Multiple system atrophy/Shy-Drager syndrome - Conservative = fluids, salt, TEDS
• Infections = HIV, Chagus’ disease, neurosyphilis - Medications = fludrocortisone or midodrine
• Drugs = antihypertensives, TCAs • Erectile dysfunction = PDE5 inhibitors
• Structural lesions - craniopharyngioma • Sweat dysfunction = moisturisers, temp regulation
, BELL’S PALSY BRAIN ABSCESS
↳ is risk factor
immunosuppression a
Acute, unilateral, idiopathic, facial nerve paralysis, which Causes
peaks in 20-40 years • Extension of sepsis, trauma or surgery
Features Features
• LMN facial nerve palsy -> FOREHEAD AFFECTED • Headache - dull, persistent
• Post-auricular pain • Raised ICP - nausea, papilloedema, seizures
↳ • Fever - may be absent
• Altered taste If forehead spared umN
= usion
• Dry eyes
(e g Stroke
.
.
• Focal neurology - CN III/VI palsy
• Hyperacusis
Investigations
Management • CT contrast
-
• PO prednisolone - within 72hrs of onset
• Antivirals - severe facial palsy Management
• No improvement after 3 weeks - urgent ENT referral • Surgery - craniotomy - Leftriaxone
• Full recovery within 3-4 months • IV antibiotics - cephalosporin + metronidazole
• ICP - dexamethasone
