Functional / Radiology / Drugs / DVLA Flashcards
What are functioning neurological symptoms
Change in function of brain rather than structure causing Sx
Blackout
Paralysis
Abnormal movement
How do you investigate
EEG
MRI
All normal
What are positive functional signs
Hoover +ve
Inverted pyramidal weakness
Functional sensory disturbance down midline
Tremor disappears if distracted
What is Hoover
Hip extension weak if tested directly
Normal when opposite hip is flexed
What is inverted pyramidal weakness
Normally extensor weaker in arm if lesion
But flexor weaker
How do you Rx
Refer psych
Rehab
CBT
Support
When are MRI useful for Dx
Epilepsy MS Neuro Sx from back Degeneration of spine Malignancy Paeds neuro
When can you not perform MRI
Electronic / metal implants Programmable shunts Insulin pumps Claustrophobia Pregnancy
When are CT’s indicated
Stroke Head trauma Headache Malignancy Post surgery of hydrocephalus and haemorrhage
When should you not perform
Minor head trauma
Seizure - do MRI
What is SPECT
Useful in Alzheimer’s
When is DAT useful
Parkinson’s
Don’t take up as much tracer
What is carbamazepine useful for
1st line partial seizure
1st line trigeminal neuralgia
Neuropathic pain
Bipolar disorder
What are AE
P450 inhibitor Ataxia Dizzy Headache Diplopia SJS Leucopenia Agranulocytosis Hyponatraemia due to 2 ADH
SE of lamotrigdine (Na blocker)
SJS
Similar to SV
What does phenytoin do
Binds to Na channel
Increases refractory
p450 inducer
What are acute SE
Dizzy Diplopia Slurred speech Nystagmus Ataxia Confusion Seizures
What are chronic SE
Gingival hyperplasia Hirsutism Coarse facial features Drowsy Metagloblastic anaemia due to folate Peripheral neuropathy LN Dyskinesia Drug induced lupus
Other SE
Rash Fever Hepatitis Dupytrens Anaemia Lupus
Teratogenic causing
Cleft
Congenital heart disease
How do you monitor
Trough levels before each dose
What is sodium valproate used for
1st line generalised seizures
How does it work
Increased GABA
P450 inhibitor
What are the SE
How do you monitor
Increased appetite and weight gain Nausea Alopecia Ataxia Tremor Hepatotoxicity Pancreatitis Thrombocytopenia Hyponatraemia Teratogenic
FBC + LFT prior
LFT throughout Rx
If stroke / TIA
1 month of driving
No need to inform DVLA
If multiple TIA’s over a short period of time
3 months of driving
Inform DVLA
Craniotomy
1 year of driving
Narcoplexy / cataplexy
Cease driving
Can start when satisfactory control of symptoms
Chronic neuro disorders e.g. MS / motor neuron
Inform DVLA
Complete PK1
Seizure
6 months if isolated
1 year epilepsy free if known epilepsy
Narcolepsy
Dx = Sleep EEG Rx = modafinil in day or Na oxybute at night
