Green - 1 Flashcards
bells palsy: UMN or LMN
LMN
bels palsy nerve
CN7
what is ramsay-hunt syndrome
varicella voster facial palsy
UMN lesion & facial palsy
forehead spared = TIA/stroke/MS
bels palsy & forehead
forehead spared (LMN)
symptoms of brown-squad syndrome
- ipsilateral spastic paraparesis
- contralateral pain/temp loss and no platter reflex
Ramsay hunt treatment
prenisolone
drug that often leads to delirium
anticholinergics
Delirium treatment
treat cause, dark quiet side room, haloperidol/lorazapam/antipsychitics if required
MMSE score for dementia
<24/30
alzheimers treatment (non severe)
donepezil
severe alzheimers treatment
memantine
fluctuating confusion, parkinsonism and hallucinations
lewy body dementia
drugs to avoid in lewy body
anti-psychotics and anti parkinsonian
treatment for lewy body
ACE - rivastigmine
generalised seizure treatment
sodium valproate
what typeof seizure must you Not give carbamazepine
absence
focal seizure treatment
carbamazepine
driving and seizures: first seizure
6 months off
driving and seizures: epilepsy
1 year off that must be seizure free
folic acid and sodium valproate
5mg folic acid when trying to conceive
problem when starting anti epileptic drugs
increased risk of suicidal thoughts
risk that needs to be explained to those with epilepsy
sudden unexplained death in epilepsy
essential tremor treatment
propanolol
what condition might you SIADH in
Guillain-Barre
hyponatremia: not due to low sodium but due to it being diluted in high plasma volume
Guillain-Barre treatment
IV immunoglobulin/plasma exchange/methylprednisolone
complication of Guillain-Barre
respiratory failure
Guillain-Barre investigations might show what
nerve conduction studies show demyelination
- SIADH
- high CSF protein
- ECG (blocks)
- spirometry changes
severe pulsatile unilateral headache
migraine
who don’t you give sumatriptan to
if cardiovascular risk
Migraine risk
ischaemic stroke
acute migraine treatment
aspirin and sumatriptan
migraine prophylaxis
atenolol
acute cluster headache treatment
oxygen, sumatriptan
cluster headache prophylaxis
verapamil
fat bitches get this
benign intracranial hypertension
triad for horners
ptosis
miosis
anhidrosis
what is ptosis
droopy eye lid
what is miosis
constricted pupil
Horners: total upper anhidrosis suggests what pathology
central lesion: stroke, MS, CNS tumour, encephalitis
Horners: facial anhidrosis suggests what pathology
pre-ganglionic: pan coast tumour (gastric cancer)
Horners: no anhidrosis suggests what pathology
post-ganglionic - carotid aneurism/disection , cluster headache
hunting tons genetics
autosomal dominant
CAG repeats > 40
MRI brain: large front horns of lateral ventricles
Horners
what is hydrocephalus
excess CSF production: can be communicating (venous blockage/high CSF production) or non-communicating (obstructive)
shuffling gait, urinary incontinence, dementia
normal pressure hydrocephalus
layers of dura from most outer inwards
dure => arachnoid => pia
what bleeds in extra dural
middle meningeal artery
extra dural shape on CT
convex (egg shaped)
extra dural/subdural treatment
conservative or burr hole/surgery is large
what bleeds in subdural
communicating veins
who gets subdural
old/alchy - brain atrophy
acceleration/deceleration injury
subdural on CT
concave (slim, flat)
sub dural deterioration pattern
slow
extradural deterioration
traume > LOC > lucid period > deterioration
thunderclap headache
subarachnoid
subarachnoid haemorrhage management
CCB: nimodipine to reduces vasospasm/ischaemia. surgery required
mixed UMN/LMN signs
motor neurone disease
fasciculations think what diagnosis
Motor neurone disease
MRI: lesions disseminated in place and time
MS
what type of immune cell drives MS
T cells
normal first presentation of MS
optic neuritis or horners
what is optic neuritis
deyelinaton of optic nerve: sudden loss of vision (partial or complete), sudden blurred or “foggy” vision, and pain on movement
acute MS treatment
methylprednisolone, interferon beta
what is myasthenia gravis
anti-ACh-receptor antibodies that causes muscle fatiguability
Myasthenia gravis treatment
pyridostigmine or prenisolone of severe
what is myasthenia gravis associated with
thymoma
myasthenia gravis symptoms
diplopia/ptosis, proximal muscle weakness, dysphagia, fatigue that worsens with activity and improves with rest
myasthenia gravis investigations
anti-AChR antibodies or anti-SM Ab
what is radiculopathy
damage to sets of nerves at nerve root
parkinsons triad
resting tremor, rigidity, bradkinesia
part of brain is affected in parkinson
substantia nigra
rule for parkinson treatment
avoid giving L-dopa as long as possible
what is dyskinesia
involuntary muscle movements
L-dopa side effects
dyskinesia and postural hypotension
location of stroke: hemiplegia, sensory loss, homonymous hemianopia, dysphagia
Cerebral hemisphere
location of stroke: quadriplegia, visual disturbance, locked-in syndrome
brainstem
location of stroke: isolated deficiency, intact consciousness
lacunar infarct
stroke investigations
CT, ECG/eco looking for AF, carotid doppler, lipid screen
stroke management
300mg aspirin if CT confirms ischaemic (continued for 2 weeks) and life long clopidogrel and statin
ABCD2
age > 60, BP > 140/90, clinical feature, duration >1hr, diabetes
time frame for thrombolysis on ishchaemic stroke
4.5 hours of onset
types of thrombolysis given on stroke
alteplase or tPA
follow up treatment if carotid found to have disease during investigations after stroke/TIA
carotid endarterectomy (clearing out of shit) - stand if occlusion > 70%
what causes stroke in young people
carotid artery dissection
