clinical 3 Flashcards
2 main categories of seizures
generalised and partial
general seizures include (4)
grand mal (tonic-clonic)
petit mal (absence seizures)
myoclonic: brief, rapid muscle jerks
partial seizures progressing to generalised seizures
types of partial seizure
simple (no disturbance of consciousness or awareness)
complex (consciousness is disturbed)
temporal lobe → aura, déjà vu, jamais vu; motor → Jacksonian
type of tremor improved by alcohol
essential tremor
which tremor has a strong family history
essential tremor (autosomal dominant)
in what position is essential tremor worse
outstretched arms
which features would suggest a tremor is caused by thyrotoxicosis
hyperthyroid signs: Weight loss, tachycardia, feeling hot
3 common signs of cerebellar disease
intention tremur
past pointing
nystagmus
in what gender is parkinsons more common
males 2:1
what is pathophysiology of parkinsons
degeneration of dopaminergic neurons in the substantia nigra
classic triad of features in parkinsons
tremor, bradykinesia, rigidity
type of rigidity in parkinsons
leap pipe
cog wheel: due to superimposed tremor
what are triptans
specific 5-HT1 agonists used in the acute treatment of migraine
contraindications of triptans
history of/risk of: ischaemic heart disease or cerebrovascular disease
what drug do you give in a prolonged seizure
rectal benzodiazapine (diazepam) usually 10mg in >12yrs, can give up to 30mg
site of stroke: Contralateral hemiparesis and sensory loss, lower extremity > upper
Anterior cerebral artery
site of stroke: Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Middle cerebral artery
site of stroke: Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Posterior cerebral artery
site of stroke: Ipsilateral CN III palsy
Contralateral weakness
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
site of stroke: Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
site of stroke: Symptoms are similar to Wallenberg’s, but:
Ipsilateral: facial paralysis and deafness
Anterior inferior cerebellar artery (lateral pontine syndrome)
site of stroke: Amaurosis fugax
retinal artery
site of stroke: ‘Locked-in’ syndrome
Basilar artery
in ABCD2 score which 2 factors give highest risk of having a stroke
- unilateral weakness
- TIA >60 mins ** 2 points each **
what is cataplexy
describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)
cataplexy is strongly associated with which other condition
narcolepsy
high stepping gait suggests what
foot drop from neuropathy
if high stepping gait (indicting foot drop) is unilateral, where is the most likely site of lesion
a common peroneal nerve
if foot drop is bilateral this indicates what type of neuropathy
peripheral
in regards to facial palsy, how do UMN and LMN features differ
upper motor neurone lesion spares upper face (forehead) where lower affects all of face
what 4 conditions can cause bilateral facial palsy
sarcoidosis
Guillain-Barre syndrome
polio
Lyme disease
way to remember what the facial nerve innervates
face (expression), ear (tapedius), taste (anterior 2/3), tear
first line treatment for generalised seizures
sodium valproate
how does sodium valproate work
by increasing GABA activity
which anti epileptic drug causes weight gain
sodium valproate
type of 5-HT drug used in:
acute:
prophylaxis:
acute: 5-HT receptor agonist
prophylaxis: 5-HT receptor antagonist
who should get migraine prophylaxis
if 2+ migraines a month
low CSF glucose indicates what
TB meningitis or bacterial
CSF glucose in viral meningitis is usually
60-80% plasma glucose
which 2 anti epileptic drugs should not be given together due to skin reactions
sodium valproate and lamotrigine
at what point should anti seizure medication be started
after 2nd seizure - unless meets other criteria that suggest to start after 1st seizure
criteria for starting anti seizure medication after 1st seizure
- the patient has a neurological deficit
- brain imaging shows a structural abnormality
- the EEG shows unequivocal epileptic activity
- the patient or their family or carers consider the risk of having a further seizure unacceptable
first line treatment for partial seizures
carbamazepine
first line treatment for generalised seizures
Sodium valproate
which drug may actually exacerbate absence seizure
carbamazepine
propanolol is a prophylaxis for migrane, but who shouldn’t get this
those with asthma
migraine prophylaxis for those with asthma
topiramate
preferred drug deliver method for triptans in:
12-17yrs
> 17yrs
12-17 yrs = nasal
> 17 yrs = oral
if first line acute treatment of migraine doesn’t work, what is then used
non-oral preparation of metoclopramide or prochlorperazine and consider adding a non-oral NSAID or triptan
woman of child baring age should receive which migraine prophylaxis
propanolol (topiramate may be teratogenic and it can reduce the effectiveness of hormonal contraceptives)
if first line migraine prophylaxis fails what is recommended
10 sessions of acupuncture over 5-8 weeks’ or gabapentin
