common neurological conditions lecture Flashcards
4 most common
migraine
parkinsons
epilepsy
MS
common migraine
no aura
fx of migraine
aura
sx of 20m to 60m - nil else gives a set of symtoms for this duration
movement exacerbates
photophobia
phonophobia
hyperosmia
nausea - relief versus anti-emetics
allodynia - pain due to stimulus that does not normally provoke pain
types of aura
zigzag strcutre
negative scotoma
positive scotoma
loss vision one sided
hemiplegic migraine
aura - hem sensory loss or weakness - start in face
headache often mild and ipsilateral to sx
may be familial
tx of acute migraine attack
aspirin 600-900mg
anti emetic
NSAID - ibruprofne and nurofen
triptans
triptans
agonist 5
prophylactic
proranolol - non slective if cardioselective horrifc
tricyclics
valporate
verapamil
candesartan
pizotifen
GONI - greater occipital nerve injections
topomax - topiramate - 2nd line in formula - can cause anorexia and contraindicated in glaucoma - not in child bearing age women
Bonta - botoz
anti- CGRP antagonists - end pathway of migraine blockade - can get constipated
botox in what nerve as tx for migraine
greater and lesser occipital nerve
parkinson disease
substantia nigral dopaminergic neuronal loss
non motor sx of parkinsons
depressions , constipation, sleep disturbances and olfactory dysfunction
bradykinesia
lose the amplitude of the action - movement becomes slower and and smaller.
expyramidial rigidity
cogwheel rigidity
tx parkinsons
physcial activity
l dopa side effects
psychiatric sx linked to depression
N&V
prolonged use can cause wearing off effect
2nd most common cause parkinsons
vascular induced
lower limb predominant
bilateral
epilepsy
at least 2 unprovoked seizures cocuring more than 24hr apart
seizures
little spike in neutrophils but no sign of fever or CRP - stress response
other one is subarachnoid haemorrhage
drug causes of seziure
tramadol
ciprofloxacin
neurleptics
ix epilepsy
haemo
biochem
uande ca
CXR
eeg
neuroimaging
ECG
only drug that treats epilspsy
tacrolimus
all other drugs are anti-seizure meds - ASMs such as
lamotrigine
levetriacetem
topiraamte
perampanel
side effect of kepra
mood changes such as bad tempered and then old increased OCD features
rescue therpay
buccal midazzolam
MS relapse remiting
younger people
primary progressive - older pts - bladder and bowel disturbance - all below the waste not normally involving optic nerve
what condition needs to be ruled out with a headache that elicits meningism signs
posterior communicting artery aneruysm
used to treat cerebral oedema in patients with brain tumours
dexamethasone
CT head showing temporal lobe changes - think
herpes simplex encephalitis
This patient’s decreased GCS and abnormal posturing (with fixed flexion of both arms, called the ‘mummy baby’ pose), on the background of a subdural haemorrhage, is highly concerning for brain herniation. what would you see in eyes
Downward and temporally-displaced gaze
CJD charcterised by
rapid onset dementia and myoclonus(jerks)
if a patient with Parkinson’s disease cannot take levodopa orally, they can be given a
dopamine agonist patch as rescue medication to prevent acute dystonia
Stokes-Adams attack
A Stokes-Adams attack is a fainting spell that occurs when the heart has an abnormal rhythm, resulting in a loss of blood flow to the brain.
Laughter → fall/collapse ?
Cataplexy describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened). Around two-thirds of patients with narcolepsy have cataplexy.
Features range from buckling knees to collapse.
status elipitucs managment
First-line drugs are benzodiazepines
in the prehospital setting PR diazepam or buccal midazolam may be given
in hospital IV lorazepam is generally used. This may be repeated once after 5-10minutes
If ongoing (or ‘established’) status it is appropriate to start a second-line agent such as levetiracetam, phenytoin or sodium valproate
NICE state ‘Take into account that levetiracetam may be quicker to administer and have fewer adverse effects than the alternative options.’
If no response (‘refractory status’) within 45 minutes from onset, then the best way to achieve rapid control of seizure activity is induction of general anaesthesia or phenobarbital
difference between incidence and prevelance
Incidence is a measure of the number of new cases - prevalence is a snapshot of existing cases
