General Neuro

Question 1

Idiopathic Intracranial HTN

Answer 1

• Raised ICP (same as brain tumour)
• Weight gain, medications

Clin Pres
• Chronic - frontal headache, can have vomiting
• Visual field loss, papilloedema –> then visual acuity
• Diplopia ( CNVI dysfunction/palsy)
Ix
• Orbital USS, visual field defects, MRI B
Mx
• Weight loss, stop meds, LP
• Acetazolamide (Diamox)
Surgery - VP shunt (rare)

Question 2

Migraine - acute and prophylaxis Mx and medications used

Answer 2

Management
Acute
• Supportive
• NSADI
• Triptan
• Chlorpromazine
Prophylaxis
• Freq >1 per week or disabling - goal to reduce to < 2/month

Flunarizine
• Calcium channel blocker
• Effective in trials

Beta blockers- Propanolol
• Contraindicated- asthma, allergy, depression
• Monitor BP HR in sporty children

Cyproheptadine
• Anti-histamine/serotonin antagnonist
• SE - weight gain, appetite stim, somnolence

Amitriptyline
• Weight gain

AED - Sodium valproate and topiramate
• Weight gain

Pizotifen
Serotonin antagonist

Question 3

Which medications are risk factors for IIH?

Answer 3

Stronger evidence
□ Growth hormone
□ Tetracyclines – e.g. doxycycline
□ Retinoids – e.g. isotretinoin
Weaker evidence
□ Thyroxine
□ Corticosteroid withdrawal
□ Lithium
□ Nalidixic acid
□ Nitrofurantoin

Question 4

5 m.o presents with altered conscious state. What are major and minor criteria for diagnosing encephalitis?
Mx?

Answer 4

• Phys - inflammation of brain parenchyma
• Causes - HSV, entero, EBV, CMV, HHV6, VZV
• Clinical - altered conscious state
• Major criteria - altered conscious state
• Minor - fever, seizures, new onset neuro Sx, CSF WCC >5
Mx - aciclovir

Question 5

Which is most common early visual finding in IIH?

Answer 5

• Visual field loss - enlarged blind spot, peripheral first then central

• Papilloedema
• Visual acuity - occurs AFTER vision field loss
- CNVI palsy

Question 6

Cerebellitis/Acute Cerebellar - what is it?

Answer 6

Ataxia
· 1-3 years
· Rapid onset Sx
· History prodromal illness
· Autoimmune affecting cerebellum
· Cerebellar signs - ataxia, seech, nystagus
· Ix - CSF normal mild pleocytosis,
· Nat Hx - ataxia improves few weeks up to 3 months
Mx - supportive, steroid and IVIG

Question 7

Brain abscess

Answer 7

· Any age 4-8 years most common
· Causes - embolisation - CHD R to L shunts (TOF), endocarditis
· Direct spread 50% - single abscess
· Haematogenous spread 50%
· Strep
· Clinical - low grade fever, headache, lethargy, vomiting, headache, seizures, papilloedema
· Ix - LP often CI, MRI - ring enhancing lesion
Mx - Cef, Met, mortality 5-10%

Question 8

Ischaemic Arterial Stroke - common causes? Ix Mx

Answer 8

· Focal infarct from occlusion of arteries
Causes
· Arteriopathy (>50% leading cause) - transient, post viral, vasculitis (Takayasu), moyamoya, fibromuscular dysplasia
· Cardiac (25%) - congenital heart disease - PFO paradoxical venous thromboembolism, cardiac cath/surg
· Haematological - sickle cell, prothrombotic states
· Clin pres - hemiparesis, acute neuro
· Ix - CT, MRI is choice, MRA
Mx - antithrombotic strategies, neuroprotective

Question 9

Vestibular neuritis/ Labrynthitis?

Answer 9

· Acute viral or post viral inflammation vestibular region
· Bacterial or viral infection eg otits media
· Hearing loss, vomiting, vertigo, nausea, gait disturbance
· Horizontal nystagmus
· Pos head impulse test
Gait instability

Question 10

BPPV?

Answer 10

· Calcium debris in semicircular canals
· Recurrent episodes, lasting 1 min or less, provoked by specific head movements
· Does not cause prolonged/sustained vertigo, hearing loss, tinnitus, neuro defects
· Dix Hallpike
Mx - Epley manouvre