aMMS

• 1+2: Age | DoB
• 3+4: Year | Time
• 5: Place
• 6+7: Monarch | WWI
• 8: 20->1 or WORLD<-
• 9: Recogn 2
• 10: 42 West St

Six Item Cognitive Impairment Test (6CIT)

• http://www.dorset-pct.nhs.uk/documents/the_organisation/archive/south_west_dorset/policies/clinical/dementiaGuidelines200406.pdf;
• http://www.kingshill-research.org;
  
• What year is it? T=0, F=4
• What month is it? T=0, F=3
• Remember the following address: John / Brown / 42 / West St / Bedford
• What time is it? T=0, F=3
• Count backwards from 20 to 1: T=0, 1error=2, ≥2 errors=4
• Months of the year backwards: T=0, 1error=2, ≥2 errors=4
• Repeat memory phrase: T=0, 1err=2, 2err=4, 3err=6, 4err=8, 5err=10

Stroke Classification (OCSP)

• {1|2|3}=unilat weakness and/or sensory deficit affecting {face | arm/hand | leg/foot}
• 4=dysphasia
• 5=visuospatial disorder (eg. sensory inattention)
• 6=homonymous hemianopia
• 7=brainstem/cerebellar signs
• 8=other deficits
• Total Anterior Circulation Stroke=TACS=1+2+3+{4|5}+6
• LACunar Stroke=LacS=1+2+3 or 1+2 or 2+3
• POsterior Cirulation Stroke=PoCS=6 or 7 or 6+7
• Partial Anterior Circulation Stroke=PACS=other combinations exc. 7+8
• TACS, LacS: 1:leg/foot--2:arm/hand--3:face
• TACS             4:dysphasia--5:inattention
• PoCS             6:hemianopia--7:brainstem/cerebell
• PACS             8:other

Oculomotor nerve palsy = 3rd nerve palsy

• eg Src: StudBMJ
• Sy: horizontal and vertical binocular diplopia; ptosis
• eye 'down-and-out', unable to move upwards/downwards/inwards
• ptosis
• large unreactive pupil='surgical palsy': possible post communic artery aneurysm
• if pupillary sparing='medical palsy': usu microvascular ischaemia (eg DM, Htn)

Periodic Paralysis

• periodic paralysis triggered by cold, heat, hi CHO meals, fasting, stress, etc
• 'channelopathy'; AD with variable penetrance
• eg {hypo-|hyper-}kalaemic periodic paralysis (=distribution problem, but overall K stores usu normal)
• DD: hyperthyroidism

Guillian-Barre-syndrome=GBS

• =acute inflammatory demyelinating neuropathy=AIDP: autoimmune disease affecting PNS, usu triggered by acute infectious process
• ascending paralysis, areflexic, +/- dysaesthesias, loss of proprioception, pain
• maybe lower CN involvment (weakness, oropharyngeal dysphagia)
• sometimes respiratory weakness, 30% GBS require ventilation
• Miller-Fisher variant: oculomotor weakness
• Diagn: CSF: albumino-cytological dissociation; EMG/NCS
• Diagnostic criteria
• Required
• Progressive, relatively symmetrical weakness of 2 or more limbs due to neuropathy
• Areflexia
• Disease course < 4 weeks [else: CIDP]
• Exclusion of other causes (see below)
• Supportive
• relatively symmetric weakness accompanied by numbness and/or tingling
• mild sensory involvement
• facial nerve or other cranial nerve involvement
• absence of fever
• typical CSF findings obtained from lumbar puncture
• electrophysiologic evidence of demyelination from electromyogram
• Differential diagnosis
• acute myelopathies with chronic back pain and sphincter dysfunction
• botulism with early loss of pupillary reactivity
• diphtheria with early oropharyngeal dysfunction
• Lyme disease polyradiculitis and other tick-borne paralyses
• porphyria with abdominal pain, seizures, psychosis
• vasculitis neuropathy
• poliomyelitis with fever and meningeal signs
• CMV polyradiculitis in immunocompromised patients
• critical illness neuropathy
• myasthenia gravis
• poisonings with organophosphate, poison hemlock, thallium, or arsenic
• paresis caused by West Nile Virus
• spinal astrocytoma
• Motor Neurone Disease
• Treatment
• ventilation: early intubation if
• VC<20mL/kg
• Negative Inspiratory Force (NIF)< -25cmH20
• 30% dcr in VC or NIF within 24h
• rapid disease progression
• autonomic instability
• hi dose IV Ig or plasmapheresis ASAP (must be <2wk since onset of motor symptoms)
• [Glucocorticoids: NOT effective]