GM: Neurology Flashcards
How do you differentiate between extradural, subdural and subarachnoid haemorrhage based on…
Presentation
Associations
Vessels involved
ED // SD // SA
lucid intervals between LOC // week-month Hx of neuro deficits // thunderclap headache
Fixed, dilated pupil // chronically old, alcoholic // Meningism, yellow CSF 12hrs
Middle meningeal // cortical veins // circle of willis
What bleed is this?
Subdural
Crescent shape inside skull
Can be low density due to time before presentation
What bleed is this?
Extradural
Lens shape
Bleed on other side also seen (Contracoup)
What bleed is this?
Scalp haematoma
Outside the skull
What bleed is this?
Subarachnoid haemorrhage
Bleed in the basal cisterns
What is the treatment of
Extradural
Subdural
Subarachnoid
Craniotomy + evacuation
High pressure: decompressive craniotomy, burr hole if low
Subarachnoid: Coil/clipping of bleed, 21 days nimodipine
How can you differ between migraine and tension headache clinically?
Migraine: Unilateral +/-aura, N+V. Worse on light
Tension: Bilateral across back of head, no assoicated symptoms
What is the diagnostic criteria for migraines?
5 bouts with 2 symptoms
How do you manage migraines
Acutely
Preventatively
Acute: PAINT
Prevent sickness (metoclopramide)
Aspirin
Ibuprofen
Naproxen
Triptans
Prophylaxis: PAT
Propanolol, Amitripyline/topiramate
Headache at start and end of day causing morning sickness and blurred vision but with normal MRI indicates what?
How do you treat?
Idiopathic intracranial hypertension
Acetazolamide (surgical shunting)
What is the treatment for trigeminal neuralgia? What are red flags prompting neuro review?
Carbamazepine
Sensory change, deafness, eye pain, <40yrs
How do you differentiate cluster headache from paroxysmal hemicrania or SUNCT?
Cluster: Young men, 45-90mins, alcohol
PH: Elderly women, 10-30mins
SUNCT: Nasal stuffiness and eyelid swelling
How do you treat cluster headache?
Acute: Oxygen and sumitriptain
Prophylactic: Verapamil + steroids
What seizure features point away from epilepsy?
Females with FHx
Gradual onset
Pelvic thrusting
Crying post-event
No tongue biting or incontience
Name the following seizure presentations…
Spasm in flexion/etension
body jerking
LOC, arched back
Clonic
Myoclonic
Tonic
What is a tonic clonic seizure?
Combination of tonic (LOC, arched back) and clonic (spasm in flexion, extension) in a sequence
What is the referral and investigations for seizures
Urgent referral following first seizure
MRI within 6 weeks for structural cause
EEG to confirm subtype
What blood test can help raise suspicion of epilepsy
Raised serum prolactin 10-20 mins post-event
When is drug therapy initiated in epilepsy? What is the mantra for epilepsy drug prescribing?
>=2 seizures and specialist assessment
One doctor, one drug, increase over 2-3 months
What drugs are first line in
Focal
Abscence
Generalised
Carbamazepine/lamotrigene
Sodium valproate, ethosuximide
Sodium valproate, lamotrigene
What are the DVLA rules for cars/motorcycles and seizures?
Seizure when…
Awake + LOC: After 6m (first), 12m (epilepsy)
Awake: if 12m ago
Asleep: If no awake attack for 3yrs
What are the DVLA rules about buses and lorries for seizures
One off: Stop for 5 years
>1/epilepsy: Seizure and medication free for 10 years
What are the following seizure syndromes
infant repeatedly drawing arms and legs in, developmental delay
<5yrs with absences, jerking and history of spasms
Paraesthesia on walking
Teen female with morning seizure and daytime absences
Infantile spasm
Lennox-Gaustaut
Benign rolandic
Juvenile myoclonic
What anti-epileptics are safe in pregnancy and breastfeeding?
Pregnancy: Lamotrigene, carbamazepine
Breastfeeding: All safe
What antiepileptic is associated with
neural tube defects
cleft palate
Weight gain
Weight loss
Steven-Johnson syndrome
Valproate
phenytoin
valproate
topiramate
Lamotrigene
What is the following aphasia and is its associated anatomy?
Fluent speech, comprehension intact (aware)
Fluent speech, comprehension impaired
Speech non-fluent, Comprehension intact
Speech non-fluent, comprehension impaired
Question heard in ear, travels to wernicke’s (superior temporal gyrus) for comprehension. Then travels along arcuate fasciculus to broca’s ( inferior frontal gyrus) to generate speech
Conductive (comprehension and speech broken due to arcuate fasciculus)
Wernicke’s (Comprehension impaired but forming response isnt)
Broca’s (understand but cannot generate speech)
Global (all areas affected)
How does diagnosis differ if a bitemporal hemianopia is
upper > lower
lower >upper
Pituitary (inferior chiasmal compression)
Craniopharyngioma (superior chiasmal)
What investigation is performed if a headache is worse on valsalva?
NON-CONTRAST CT
Raised ICP until proven otherwise
Impaired adduction of one eye, horizontal nystagmus in abducting eye suggests what?
INO
Seen in MS and stroke
For status epiliepticus what is…
The definition
The management
1 seizure >5 mins OR >=2 seizures in 5 mins without normality between
ABCDE
1st: PR diazepam/buccal midazolam if 1ary care, IV lorazepam with further dose at 10-20 mins ONCE in 2ary
Ongoing/established: Phenytoin/phenobarbital
Unresponsive: Induce <45 mins in
