21 November Flashcards
What is the acute management of migraine?
Triptan with either NSAID or paracetamol
People aged 12-17 consider nasal triptan first
What is prophylactic management of migraine?
If impacting on life and daily function with frequent occurrence
Propranolol
Topiramate- teratogenic
Amitriptyline
What is the management of Parkinsons disease?
First line levodopa if motor symptoms
If ongoing symptoms or dyskniesia development then add either dopamine agonist e.g. pramipexole, ropinirole, MOA-B inhibitors e.g. rasagiline or COMT inhibitors e.g. entacaponeW
What are features of abducens nerve lesion?
Lesion will be same side as affected nerve
Double vision when abducting eye- horizontal double vision
Weak/inability to abduct eye- double vision worsened on abduction
Convergent squint aka in rested position, eye faces towards nose
What are signs of a complete oculomotor nerve lesion?
Lesion will be same side as affected nerve
Down and out position of eye
Ptosis
Mydriasis (dilated pupil)
Non reacting to light
What are the features of trochlear nerve lesion?
Commonly caused by head trauma
Vertical torsional double vision (images on top of each other)
Double vision worse on downward gaze e.g. walking downstairs and gaze away from affected side
e.g. if left side affected double vision worse on looking to the right and vice versa
What are features of Wernicke’s encephalopathy?
Oculomotor dysfunction- nystagmus, lateral rectus palsy
Gait ataxia
Confusion
Disorientation
Inattentiveness
Peripheral sensory neuropathy
What are features of a middle cerebral artery stroke?
Contralateral hemiparesis and sensory loss upper extremity >lower
Contralateral homonymous hemianopia
Aphasia
What are features of Anterior cerebral artery stroke?
Contralateral hemiparesis and sensory loss
Lower extremeity>upper
What are features of posterior cerebral artery stroke?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia (can see cat in room but can’t tell you cat by looking at it)
What are features of basilar artery stroke?
Locked in syndrome
What are features of retinal/ophthalmic artery stroke?
Amaurosis fugax
What are features of anterior inferior cerebellar artery stroke?
Ipsilateral facial paralysis and deafness
Features of Wallenbergs syndrome
What are features of posterior inferior cerebellar artery stroke?
Wallenberg syndrome- ataxia, nystagmus
Ipsilateral facial pain and temp loss
Contralateral limb/troso pain and temp loss
What are features of Weber syndrome (stroke in posterior cerebral artery that supply midbrain)_
Ipsilateral CNIII nerve palsy
Contralateral weakness of upper and lower extremities
What should sodium valproate be switched to in women wanting to conceive?
Lamotrigine or keppra
When can anti-epileptic medication be stopped?
If someone is seizure free for more than 2 years
What are side effects of sodium valproate?
Teratogenic
Increased appetite and weight gain
Alopecia
Tremor
Nausea
Hepatotoxicity
Pancreatitis
Hyponatraemia
What are symptoms of acoustic neuroma?
Unilateral or asymmetrical hearing loss or tinnitus
Impaired facial sensation
Unexplained balance problems
Other symptoms are based on where the mass compresses
What are features of myasthenia gravis?
Fatiguable symptoms- slurring of speech/drooping eyelids in the evening
What are features of guillain-Barre Syndrome?
Post viral polyneuropathy
Initial malaise, weakness/tingling in the legs
Followed by rapid progressive ascending paralysis
Can involve resp muscles in severe questions
What are features of MS?
Optic neuritis- common prodromal
Followed by relapses of sensory/motor or cerebellar symptoms
What are sensory features of MS?
Pins/needles
numbness
Trigeminal neuralgia
What are motor features of MS?
Spastic weakness- commonly in the legs
