Headache Flashcards
Stroke: BP <185/110 BP high BP 150-220 \_\_\_\_\_\_\_\_\_
-Thrombectomy < #hrs
-Thrombolysis < #hrs
@#
-@AIS + #Circ @ #imaging
+ CT#/MR# = # ->
do what
@when?
<24hrs/wake up stroke: @AIS + Prox?Circ -?vessel -?vessel @?imaging \+ ? /? = ? \_\_\_\_\_\_\_
Thrombolysis < ?hrs:
- ?/? exclude = CThead @BIGHAM
- BP < ?/110 –>
?drug ?mg -?w-> -? -? -? @AF \_\_\_\_\_\_\_\_
Exclude ? ? outside ? inside Homeostasis: -BM ?-? -BP high + AIS + PANIC* = ? Tx (?PANIC) -->
CT-head exclude bleed=BIGHAM
->
SCAN types
Stroke
Thrombectomy <6hrs
Thrombolysis <4.5hrs
@pre-stroke \
func status <3\NIHSS>5
@AIS + ProxAntCirc @CT/MR angio \+ CTperf/MRd-w = ?save brain tissue -> Thrombectomy @6-24hrs/wake up stroke
<24hrs/wake up stroke: @AIS + ProxPostCirc -basilar -PCA @CT/MR Angio \+ CTperf/MR d-w = ?save brain tissue \_\_\_\_\_\_\_
Thrombolysis < 4.5hrs
- Hypo/Bleed exclude = CThead @BIGHAM
- BP <185/110 –>
Asp 300mg -2w-> -Clopidog -Dyp+Asp -AC @AF \_\_\_\_\_\_\_\_
Exclude hypo/bleed FAST outside Rosier inside Homeostasis: -BM 4-11 -BP high + AIS + PANIC* = BP tx -->
CT-head exclude bleed @: Bleed tendency ICP high GCS <13 HA AC Meningism -> CT/MR angio CT Angio / MR d-w = ?save brain tissue
*Pre-Eclampsia ADiss Nephro/Encephalopathy ICH <6hr/BP150-220 -> -BP lowering tx* = Aim 130-140 <1hr 7d CCF/MI
*Fucked struct GCS <6 Hematoma -major = poor prog -neurosurg evac
ICH (types?)
-?refer to who
-?dx process warrants surg->
SURG: MCA infarct - ? -MCA >50% -NIHSS >15 -GCS dropping \_\_\_\_\_\_\_\_\_
PTC @?
ICH
?* = Aim BP range <1hr 7d
iF HAVE ICH + VTE?
ICH (subdural/extradural)
-neurosurg/stroke docs
-HYDROCEPHALUS->
SURG: MCA infarct - Decomp HemiCraniotomy -MCA >50% territory -NIHSS >15 -GCS dropping \_\_\_\_\_\_\_
PTC @emergency Warfarin reveal <1hr = Stop Warf PTC + Vit K FFP @unavail \_\_\_\_\_\_\_
ICH <6hrs/BP 150-220 ->
BP Tx* = Aim BP 130-140 <1hr 7d
*Fucked struct GCS <6 Hematoma -major = poor prog -neurosurg evac \_\_\_\_\_\_\_\_\_
IF HAVE ICH + VTE?
-AC / IVC filter
- If suspect TIA, initial mx?
- What do they do at the latter of above answer?
- What to do is MR d-w confirms?
- What does the latter answer of q2 entail?
Indication for Carotid Endarterectomy?…
_____________
Venous Sinus Thrombosis = ???
-MR Venogram gold standard Ix
Art Diss = ???
Prosthetic valve –>
stroke AND ICH risk –> ???
HR bleed (surg) + HR stroke (AF/prev stroke) --> ???
Stable CVD + AF –> ???
Isch stroke –> AF = ???
For stroke prev:
- AC = ?
- no AC = ?
iF HAVE ICH + VTE?
- If suspect TIA, initial mx?
- 300mg + REFER <24hr TIA clinic - What do they do at the latter of above answer?
- MR diff-weighted + carotid imaging/doppler - What to do is MR d-w confirms?
- Statin @48hr
- Clopi > MR Dyp + Asp - What does the latter answer of q2 entail?
@Carotid Doppler Imaging
-Stable Neuro + Stenosis >50% NASCET =
Carotid Endarterectomy
- Stenosis <50% / <70% ESCT = 2ndary Prev
_______________
Venous Sinus Thrombosis =
LMWH -5d-> Warf 2-3
Art Diss = AP/AC
Prosthetic valve –>
stroke AND ICH risk –>
Stop AC, Start AP
HR bleed (surg) + HR stroke (AF/prev stroke) --> Stop AC, Start LMWH
Stable CVD + AF –> Stop AP, Start AC
Isch stroke –> AF =
Asp 300 mg 2w –> AC
For stroke prev:
-AC: DOAC/DabigaTHROMBINi/Warf
-no AC = LA Appendage Occlusion
____
iF HAVE ICH + VTE?
-AC / IVC filter
Codeine to PO morphine
PO morphine = to…
SC moprhine /?
OXYCOD PO /?
SC diamorphine /?
IV moprhine /?
OXYCOD SC /?
- SP—SI–S
- MO-DM-O
- 22—33–4
Alcohol units?
-AST > ALT (ratio usually> 2:1)
-toAST
________
Monoplegia -?
Hemiplegia -?
Quadriplegic -?
-Paraplegia -?
ACA–MCA–PCA*
*PCA - midbrain Weber
________________
Amaurosis fugax - which vessel?
Locked in syndrome - which vessel?
__________
- Absent < – > horizontal eye-move
- Miosis
- Paralysis=Quadriplegia
- Same FACE: PD/PT (paralysis/deaf // pain/temp)
- Opp limb
- Nystagmus
- Ataxia
- Same FACE: PD/PT (pain/temp)
- Opp limb
- Nystagmus
- Ataxia
__________
- Unilat sensory/motor FAL
- Cog dx - VisuoSpatial/Dysphasia
- HomoHNopia
1 of: -Sensory -AtaxicHemiParesis -Motor PURELY + HTN
CN dx + CONTRALAR motor/sensory dx
Conjugate EYE dx
CEREbellar dx - ataxia/nystag/vertigo
HomoHNopia
4-6-4 H:
CN4 present?
CN3 present?
CN6 present?
________
Nystagmus: central v peripheral?
______
Brainstem death
_________
Delirium > Dementia
_______
woman short-lasting UNILAT side of face = behind eye. UNILAT-sided tearing + nasal congestion -no photophobia -Several times/day Tx: indomethacin -> attacks stopped Dx? Tx? \_\_\_\_\_\_\_\_\_
?vessel lesions (dominant side - i.e. most ppl are ?-handed so ?-sided MCA fucked):
Lesion -> SPEECH = FLUENT sentences that make Sense -Repetition = FUCKED -AWARE of Errors making Comprehension is NORM
Lesion -> SPEECH = FLUENT sentences that make NO Sense -word substitution / neologisms #word-salad Comprehension FUCKED Repetition NORM
Lesion -> SPEECH = NON-FLUENT sentences that make Sense -Laboured + Halting -Repetition = FUCKED Comprehension NORM \_\_\_\_\_\_\_\_
? @Oed from tumour
? @Raised ICP
? @SAH to reduce vasospasm
__________
Gait ataxia = ?
? = finger-nose ataxia
? - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)
? - sensory symptoms, dyLEXia, dysGRAPHia
? - motor symptoms, expressive aphasia, disinhibition
Codeine to PO morphine /10
PO morphine = to…
SC moprhine /2
OXYCOD PO /2
SC diamorphine/3
IV moprhine /3
OXYCOD SC /4
Alcohol units = %.mls / 1000
-make a toAST with alcohol > ALT. 2>1
_________
Monoplegia - 1 limb
Hemiplegia - Unilat 2 limbs
Quadriplegic - 4 limbs
-Paraplegia - Bilat LOWER limbs
ACA MCA PCA*
L>UL ; UL>L
< – HemiParesis
……..Aphasia – > Agnosia
……..Sensory
….HomoHAnopia – > Mac-Sparing
*PCA - Weber Midbrain
-Same CN3, opp HemiParesis
-Agnosia
-Macular sparing HomoHNopia
________________
Amaurosis fugax - Retinal/Ophthalmic Artery
Locked in syndrome - Basilar Artery
____________
Pontine bleed: PAMP
- Absent < – > horizontal eye-move
- Miosis
- Paralysis=Quadriplegia
AICA: Lat Pont
- Same FACE: PD/PT
- ——(paralysis/deaf // pain/temp)
- Opp limb
- Nystagmus
- Ataxia
PICA: Lat Med Wallenburg
- Same FACE: PD/PT (pain/temp)
- Opp limb
- Nystagmus
- Ataxia
______________
Anterior Circulation Stroke:
3=TotalACS
2=PartialACS
-UCH
- Unilat sensory/motor FAL
- Cog dx - VisuoSpatial/Dysphasia
- HomoHNopia
LacACS = L-SAMP 1 of: -Sensory -AtaxicHemiParesis -Motor PURELY + HTN
POstCS
_________
4-6-4 H:
CN4 vertical nystagmus
CN3 Ptosis, Dilated, Vertical nystagmus
CN6 horizontal nystagmus
Nystagmus: Central v Periph:
central is:
- B/L
- Assoc sens/motor dx
- Direction = multi / purely uni or rotatory
Brainstem Death: Coma unknown Ax Reversible ax excluded Sedation X Electrolytes fine
Bronchial stim -> no cough Response to sound/Supra-Orb Pressure Occ-Vestib Reflex absent Corneal Reflex absent Disconnect ventilator 5-mins -> no resp support \_\_\_\_\_\_\_
-Emotions = fear, agitation
-Fluct Syx = worse @night, normal periods
-GCS impaired
-Hallucinations/Illusions/Delusions #perception
_________
Paroxysmal HemiCrania
-Indomethacin
__________
MCA lesions (dominant side - i.e. most ppl are right-handed so left-sided MCA fucked):
Conduction aphasia
- Arcuate Fasciculus
- Fluent + Sense + Comp NORM
- Repetition fucked
Wernicke Receptive
- SUP Temp gyrus
- Fluent + NO Sense + Comp FUCKED
- Repetition NORM
Broca Expressive -INF Frontal gyrus -NON-Fluent + Sense + Comp NORM -Repetition fucked \_\_\_\_\_\_
Dexa @Oed from tumour
Mannitol @Raised ICP
Nimodipine @SAH to reduce vasospasm
______
Gait ataxia = cerebellar vermis lesions
Cerebellar hemisphere = finger-nose ataxia
Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)
Parietal lobe - sensory symptoms, dyslexia, dysgraphia
Frontal lobe - motor symptoms, expressive aphasia, disinhibition
Headache
men > women
severe, throbbing/EXPLOSIVE
@moment of orgasm LOL
Dx? Tx?
____________
Headache: 30 min - 7 days
Bilat, tight pressing
Noooooooo N+V ; NON-Pulsating
?????PHONO/PHOTO-phobia
Physical ADL NOT worsen HA –> not avoid ADL
i.e. OPP TO MIG w/out AURA
Tx??
____________
Headache -
15days / month +++ pre-existing HA dx
overuse of ergotamines, triptans, simple analgesics or opioids.
MORE THAN ? months
Tx??
Coital cephalagia
- post-coital HA
- NSAID
____________
Tension
Paracetamol, Asp, Acupunt, NSAID \_\_\_\_\_\_\_\_\_\_\_
MOH
-MORE THAN 3 months
Month 1: stop meds
Month 2: HA return –> restart meds
Headache: 15 mins – 3hrs !!
5 attacks of severe
UNILAT
Orbital/Supraorbital/Temporal pain
ALCO WORSEN!!!!!!!!
Ipsilateral: Eye: -conjunctival injection/lacrimation; -swollen EYELIDS -mioooooosis
Nose: congestion/rhinorrhoea;
Face: Sweating/flushing
Ear: Aural fullness
RESTLESS / agitation.
??? is a contraindication to triptan use
Tx??
________________
woman short-lasting UNILAT side of face = behind eye. UNILAT-sided tearing + nasal congestion -no photophobia -Several times/day Tx: indomethacin -> attacks stopped Dx? Tx?
A 22-year-old man consults you as he and his housemate have been feeling generally unwell for the past few weeks. Has HEADACHE.
Questions may hint at badly maintained housing e.g. STUDENT HOUSES
Tx?
__________
Uinilat: Tn.M.C
Bilat: Th.Mo
Cluster headache
RATS Vera
Refer
Acute = Triptan, SBOT
Prev: Verapamil
Cardiovascular disease is a contraindication to triptan use
_____________
Paroxysmal hemicrania
-Indomethacin
____________
CO poisoning
oxygen saturation of haemoglobin decreases leading to an early plateau in the oxygen dissociation curve
O2 HF
Hyperbaric chamber
_________
Unilat: TNeur, Migr, Cluster
B/L: TensionHA, MOH
Vasc compromise or Trigem Nerve –? demyelination
Wash, Eat, Brush Shave –> Unilat elec shock
Tx?? Ix?
_____________
Headache = 4hr - 3 days!!!!!!!!
PHONO/PHOTO-phobia
Unilat, PULSATING
Mod/Severe Pain
Physical ADL –> worsen –> AVOID ADL
N+V
??? is a contraindication to triptan use
Tx??
___________________
Headache = 4hr - 3 days!!!!!!!!!!!
Zigzag lines and/or SCOTOMA/scintillations !!!!!!!!!!!!!!
Vertigooooooooooo
Aura –> headache within 60 mins!!!
Sensory: pins and needles.
Speech: Aphasia
Motor: weakness
Aura spreads gradually over AT LEAST 5 mins
2 or more symptoms occur in succession.
Each aura = 5-60 minutes.
At least one aura symptom is UNILAT.
??? is a contraindication to triptan use
Tx??
Trigem Neuralgia
Carbemazapine
MRI Head
_________
Migraine w/out aura
PANT TARA
ACUTE 1 +2a/b Paracetamol 2b AEmetics NSAID 2a Triptan 1
PREV Topirimate < Propranolol Acupunc RiB2flavin Amitriptyline
Cardiovascular disease is a contraindication to triptan use
__________________
Migraine with aura
PANT TARA
ACUTE 1 +2a/b Paracetamol 2b AEmetics NSAID 2a Triptan 1
Topirimate < Propranolol
Acupunc
RiB2flavin
Amitriptyline
Cardiovascular disease is a contraindication to triptan use
HA + BLURRY vision
CN6 palsy
- eye move in MEDIALLY
- ?horizontal nystagmus
Papilloedema, Large BLIND SPOT
Young
-FAT, Female, Fucked (preg)
Happens to have used TETRACYCLINES
Tx: WALTS
Tx??
BIIC-HTN - Benign Idiopathic IntraCranial HTN
WL, Acetazolamide, LP Topirimate (helpWL) Shunt/Optic nerve sheath decomp/fenest
RIGHT EYE–LEFT EYE
? ?
?—–?
?-? ?-?
4- ?CN
3- ?CN
6- ?CN
____________
Diplopia Double Vision Direction #H ^ ^ | < - - - - > | v v
?* ?* ?*
CranioPharyngioma = ?
Pituitary tumour = ?
____________
CN formula..?
NTR:
- RON ?
- chiasm-> (right chiasm = ?) - ROT ?
- LGN-> - SIñOR Pi-Ts:
- RsOR @which lobe -> ?
- RiOR @which lobe -> ?
- Rs+iOR = PiTs = ?
SIñOR Pi-Ts: S OR @?-qa I OR @?-qa Post Cerebal Art Occluded = ? \_\_\_\_\_\_\_
Med #?dx
INO - InterNuclear Ophthalmoplegia
Long
Fasciculus:
So.. normally when you trying to look left for example…
what muscle ABDucts @left eye
+
what muscle ADDucts @right eye
but in INO.. what muscle ABDucts @left eye \+ what muscle ADDucts=? @right eye -->
contra LR6 works ? to stim ? –>
? nystagmus
RIGHT EYE\_\_LEFT EYE
4 4
6-------6
3-dilated 3-dilated
ptosis ptosis
4-Trochlear
3-Occulumotor
6-Abducens
____________
Diplopia Double Vision DIRECTION: #H ^ ^ | < - - - - > | v v
4 6 4
- 4 vertical
- 6 horizontal
- 4 vertical
CranioPharyngioma =
-Inf Bitemp HAnopia
Pituitary tumour =
-Sup Bitemp HAnopia
____________
LR6 SO4 R3 =
-Lr - SO - 3R
6 4
Nerve Tract Radiation:
- RON - right MonoOccularVisionLoss
- chiasm-> (right chiasm = right NasalHAnopia) - ROT #LeftHomoHAnopia
- LGN-> - SIñOR Pi-Ts:
- RsOR @Pi = LiQA
- RiOR @Ts #Meyer = LsQA
- Rs+iOR = PiTs = #LeftHomoHAnopia
SIñOR Pi-Ts: S OR @PI-qa - Parietal-InfQA I OR @TS-qa - Temp-SupQA Post Cerebal Art Occluded = Macular SPARING \_\_\_\_\_\_\_
Med #MS #Stroke
INO - InterNuclear Ophthalmoplegia
Long
Fasciculus:
So.. normally when you trying to look LEFT for example…
contralat LR6 ABDucts @left eye
+
ipsilat MR ADDucts @right eye
but in INO.. contralat LR6 ABDucts @left eye \+ ipsilat MR3 ADDucts=FAILS @right eye -->
contra LR6 works overtime to stim ipsi MR3 –>
contra LR6 nystagmus
Diff between: Parkinson’s+Dementia VS Lewy-body?
-Parkinson’s + Dementia = ?
-Lewy-body = ?
__________
Parkinson symptoms
Tremor = WORSE as pt gets closer to target eg. Nose
- indicative of ?dx
Undershooting / Overshooting
Essential tremor VS Parkinson’s disease -
NICE recommend what to differentiate?
Parkinson Tx?
Parkinon’s TRAPS =
-Asymmetric/Symmetric?, pill-rolling @?,
-? with voluntary movement
(Rememer Back 2 the Future guy ice skating?!)
Tremor = WORSENS as reaches out to examiner’s finger
-? tremor = ? dx
?-pointing - pointing BEYOND the finger @finger-nose test = ? dx # ?
Tremor = worsens @OUTstetched arms = ? Dx
-bi/unilateral? + worsens/improve? with action
__________
Classical histories of :
1. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa -------impaired BALANCE #Falls -------O/E vertical-GAZE Palsy #Symm onset
2. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa --IMPOTENT --urinary RETENTION --OLD \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
Global deficit Relentlessly PROGRESSIVE decline -? - fine AND gross motor -? - impulsive -? - speech fucked
Apo-Lipo-Protein
Beta-amyloid plaques
Neurofibrillary tangles
Down’s Trisomy 21 therefore HRisk
—-Dx? Tx?
When to avoid galantamine?
When to avoid donepezil?
____________
2 causes of fluctuating GCS?
Fluuuuuuuuuuctuating GCS
Hallucinations
REM sleep dx
Parkinsonism
@Parkinson = Avoid which meds?
Similar to ?? hematoma - fluctuating GCS!!
__________
YOUNG < 65
RAPID AF ONSET!!!!!!
Personality/Speech dx:
3 types:
- PERSONALITY change and social-conduct dx - PERSONALITY ??’s dx
- APHASIA SPEEEEECH ChrProgAphasia
- Semantic
Memory + VisuoSpatial skills FINE
Neurofibrillary tangles
_________
_________
________
Acoustic neuroma = ? SVT
Menieres = ? of SVT + aural fullness
Diff between Parkinson’s + Dementia V Lewy-body?
-Parkinson’s + Dementia =
TRAPS –1/+yr–> Cog dx
-Lewy-body =
TRAPS + Cog dx
<1yr of each other
__________
Tremor - Pill-rolling RESTING
Rigidity - cogwheel LEADpipie
Akinesia brady
Post Instability
Tremor = WORSE as pt gets closer to target
–Intention tremor @ cerebellar dx #DANISH
dysdiadocho, ataxia, nystagmus, INTENTION TREMOR, staCCCato slurring , hypoTonia
Dysmetria - Under/Overshooting - ALS/MS
ET v Parkinsons =
NICE recommend 123I‑FP‑CIT SPECT
Levo/carbi
- Motor improve/cx increase
- ADLs improve
- Adverse rxns decrease (hallucinations/impulse/sleep)
- Time inc = effectiveness decrease
AMANTADINE/DBS
Selegeline MAOi - Tyramine foods, Off-time
Entacapone - COMTi - off-time reduce
Ropinirole/CabergolineCardiacFibrosis - hallucinations/impulse/sleep
DBS
Parkinon’s TRAPS =
-Asymmetric, pill-rolling @rest,
-IMPROVE with voluntary MOVEMENT
(Rememer Back 2 the Future guy ice skating?!)
Tremor = WORSENS as reaches out to examiner’s finger
-Intention tremor = cerebellar dx #DANISH
past-pointing - pointing BEYOND the finger @finger-nose test = cerebellar dx #Dysmetria
Tremor = worsens @OUTstetched arms = essential tremor
-BIlateral + WORSEN with action
-Propranolol -> Primidone
__________
Progressive Supranuclear Palsy #PSP
Multi-system atrophy
________
__________
- dysPRAXIA - fine AND gross motor
- dysINHIBITION - impulsive
- dysPHASIA - speech fucked
Alzheimer’s = ALAN GaRD MAdcl
AAAAlzheimer/LLLewy (not antipsychs/galantamine) = AAAChi –> NNNMDAblocker
AChi:
- GGGalantamaine(avoid @Parkinson w/ APsychotics)
- RRRivastigmine/
- DDDonepezil(avoid @AVBlock, BRADYcard NTSEuthyroid)
NmdaBlocker:
- Memantine @:
- -aDDDd-on @mild/mod,
- -aCCChi CI,
- -aLLLone @ severe
Avoid Galantamine + APsych @Parkinson’s
Avoid Donepezil @Brady/ AVN block/ NTSEuthyroid
____________
2 causes of fluctuating GCS?
- subdural hematoma
- LewyBodyDementia
Lewy body dementia
haLewycinations
Parkinsonism: Tremor pill-rolling/resting Rigidity - cogwheel/lead-pipe Akinesia/Bradykinesia Post Instability Shuffling gait
@Parkinson = Avoid @
- Antipsychotics - parkinonism TRAP
- Galantamine
@Donepezil = Avoid @
-AVNblock, BRADYcard, NTSEuthryoid
Similar to Subdural hematoma - fluctuating GCS!!
_____________
Fronto Temporal-Serial killer type
Personality PICK’S disease
_________
_________
________
Acoustic neuroma = PROGressive SVT
Menieres = Intermittent attacks of SVT + aural fullness
2 causes of fluctuating GCS?
Fluuuuuuuuuuctuating GCS
Hallucinations
REM sleep dx
Parkinsonism?
Avoid which meds???
Similar to ?? hematoma - fluctuating GCS!!
YOUNG < 65
RAPID AF ONSET!!!!!!
Personality/Speech dx:
Diff between Parkinson’s + Dementia V Lewy-body?
- Parkinson’s + Dementia = ?
- Lewy-body = ?
2 causes of fluctuating GCS?
- subdural hematoma
- LewyBodyDementia
Lewy body dementia
-haLewycinations
Tremor - Pill-rolling RESTING Rigidity - cogwheel LEADpipie Akinesia brady Post Instability Shuffling gait
Avoid:
- Antipsychotics - parkinonism TRAP
- Galantamine
Similar to Subdural hematoma - fluctuating GCS!!
Young=Fronto-Temporal
- Similar to serial killers!!!
-Personality PICK’S dx
__________
Diff between Parkinson’s + Dementia V Lewy-body?
- Parkinson’s + Dementia = TRAPS –1/+yr–> Cog dx
- Lewy-body = TRAPS + Cog dx <1yr of each other
YOUNG < 65
RAPID AF ONSET!!!!!!
Personality/Speech dx:
3 types:
- PERSONALITY change and social-conduct dx (Pick’s) PERSONALITY ??’s dx
- ? APHASIA
- ChrProg? - ?
- Memory fine
- VisuoSpatial skills FINE
- Neurofibrillary tangles
Fronto-Temporal
- Similar to serial killers!!!
Personality PICK’S dx
PERSONALITY change and social-conduct dx (Pick’s) PERSONALITY ??’s dx
- SPEEEEECH APHASIA
- ChrProgAphasia - Semantic
Dancing eyes, dancing feet
Ovarian teratoma –>
Psych dx, memory dx, encephalitis, seizures, dyskinesias, autonomic dx, language dx = Anti-??
Sudden onset of multiple seborrheic keratoses
___________________
Small cell lung cancer (anti-??),
Gynae/breast cancers (anti-??), and
Hodgkin lymphoma (anti-??)
Migratory superficial thrombophlebitis
___________________
SmLCC –> weakness ? with movement
-WADDLING gait
Thymoma -
Low Ig=?
Anemia + low retic=?
Weakness ? with movement
Myelodysplasia - tender purple plaques
Opso-myo clonus - Ataxia Syndrome
@ Neuroblastoma/SmLCC
Ovarian teratoma -
Anti-NMDA encephalitis
Sign of Leser-Trelat @ GI / Visceral cancer
___________________
SmLCC lung cancer (anti-Hu),
Gynae/breast cancers (anti-Yo)
Hodgkin lymphoma (anti-Tr)
Pancreatis cancer - Trousseau
___________________
Lambert-Eaton Syndrome
- Antibodies against presynaptic Ca2+ channels at NMJ
- Weakness IMPROVE with movement
Thymoma - Good Syndrome low Ig, Red cell aplasia, MyGravis - PostSynap Ach ABs -Weakness get WORSE with movement
Sweet Syndrome
Motor:Asc weakness (prox muscles before distal ones)
Reflexes: Reduced / absent
Sensory: ?distal paraesthesia
Autonomic involvement: e.g. urinary retention, diarrhoea
Hx of gastroenteritis - Campy
Resp muscle weakness
Dx? Tx?
___________
Thymoma - CT thorax
- Ptosis, Peak Sign/Snarl
- WEAK Reflexes+Power - WORSEN w/ use
- Diplopia
- Resp muscle involvement –> SOB
- bulbar muscle dx –>
difficulty chewing+swallowing
#dysphagia #mastication
Dx? Ix? Tx?
_____________
SmLCC Prox muscle weakness, IMPROOOOOOVE with muscle use Autonomic (dry mouth, impotence) --WADDLING gait = girdle weakness
Dx? Pathphys?
Guillain Bare
PlasmaPharesis/Exchange
IVIG
Neuropathy - DAG
DVT proph
PI-ND
________________
PI-PPT
Myaesthenia Gravis
- ElectroMyoGraphy
- Post-synaptic AChR AB
PlasmaPharesis/Exchange IVIG PyridoStigmine = LA Ach-i Pred Thymectomy
________________
Lambert Eaton
Pre-Synaptic Ca channel AB —> reduce Ach –>
So if move more –>
more presynap Ca release –> more ACh release
*PRAD: Pyrexia, Rigidity, Autonomic syx, Delirium
SSRI/MAOi/Ecstasy –>
RAPID onset PRAD*
HYPOOOreflexia NOOORMAL pupils
-ALL low - onset time, reflexes, pupils
- Dx? Tx?
APsych/ Parkinson-meds STOP –>
SLOW onset PRAD*
HYPERreflexia, DILATED pupils
-ALL HIGH - onset time, reflexes, pupils
- Dx? Tx?
__________________
Paraesthesia UNSTEADiness Restless + SLEEP dx, SWEATing -Mood change
? = HIGHER incidence of
DISCONTINUATION syx
than other SSRI
___________
? = indicated for patients with schizophrenia
who have not responded adequately
to at least 2 TWOOOOOOOOO antipsychotics.
AntiPsychotic HORQ - in old ppl issue?
APsych; SEs and receptors of typicals
Parkinson syx??
Treat EPSE w/ ?
- Intention tremor Ax?
- Dysmetria @ ??
Alpha HE MEN??
- SeRAPIDtotonin Serotonin Syndrome
- CyproPhetadine/Chlorpromazine
2. NMS: Anti-pSLOOOOOOOOWcotic Stop APsych/ Start Parkinson-meds, IVF, -Dantrolene/?DopAgonists - bromocriptine \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SSRI Discontinuation Syx
Paroxetine = HIGHER incidence of
DISCONTINUATION syx
than other SSRI
______________________
CLOZAPINE = indicated for patients with schizophrenia
who have not responded adequately
to at least 2 TWOOOOOOOOO antipsychotics.
AntiPsychotic HORQ - in old ppl = VTE/stroke
TRAP+Alpha.HE.MEN
Tard dyskinesia
-choreoathetoid chewing/pouting RETARDEDLY
Restless akathisia
Acute dystonia - torticollis, oculogyric
Parkinsonism EPSE - TRAP
-Tx EPSE w/ procyclidine/benzotropine
Tremor - Pill-rolling RESTING Rigidity - cogwheel LEADpipie Akinesia brady Post Instability Shuffling gait
Intention tremor @ CEREBELLAR dx Dysmetria - over/undershooting - ALSSS/MSSS -id-cam \_\_\_\_\_\_\_\_\_\_\_\_ Alpha receptors - post hypotn Histamine - sleep/?Weight EPSE Muscarinic blocker - opposite of SLUDS Endo - prolactin NMaligS -slow onset PRAD -high: onset time, reflexes-Hyper, pupils-dilate
Cremaster L??, Anal Wink S??
Reflex: Ankle S??, Knee L?? Bicep C?? BRadialis C?? Tricep C?? \_\_\_\_\_\_\_\_\_\_\_
Thumb C?
Middle Finger C?
Little finger C?
________________
Nipple ?
BellyButton - ?
Coeliac ?
_______________________
Inguinal?
SMA ?
MID-Thigh?
IMA ?
________________________
Kneecap ?
Big Toe ?
Lat foot small toe ?
_______________________
Cremaster L1/2, Anal Wink S3/4
Reflex: Ankle S1/2, Knee L3/4 Bicep C5/6 BRadialis C5/6 Tricep C7/8 \_\_\_\_\_\_\_\_\_\_
Thumb C6, Middle Finger C7, Little finger C8
_______________________
Nipple T4
BellyButton - T10
Coeliac T12
_______________________
1nguinal L1
SupMA L1
MidThigh L3
InfMA L3
_______________________
Kneecap L4 all 4’s…
Big Toe L5 ;
Lat foot small toe S1
________________________
For headaches:
Acute @migraine/cluster
Prev @migraine/BIIC-HTN/cluster
For headaches:
Acute:
Triptan @migraine/cluster
Subcut/INasal
Prev:
Topirimate @migraine + BIIC-HTN
Verap @cluster
Pain
Loss of motor/sensory/autonomic function
Hoffman
Ix?
Tx?
DCM
MRI c-spine Spinal surg (neuro/ortho) ASAP
- Laughter → fall/collapse
- postural tremor:
worse @ ? –>
improved @ ?
Titubation ?
Inheritance?
Tx: ?? –> ??
1 ?cataplexy - ppl can have narcolepsy too
- ADET: Auto Dom Essential Tremor
- worse @OUTSTRETCHED arms
- improved @ ALCO / Rest
- Titubation = head tremor
Tx: Propranolol –> Primidone
Delusion that a friend or partner has been replaced by an IDENTICAL-looking IMPOSTER
Delusional idea that a person whom they consider to be of higher SOCIAL/PROFESSIONAL standing is in LOVE with her
Delusional idea that the various people that the patient meets are in fact the SAME person
________________
Belief that infected with PARASITES / ‘BUGS’ under their skin
Irrational belief that one’s partner is having an AFFAIR with no objective evidence
Delusional idea that one is DEAD/rotting
Capgras - IMPOSTER
De Clerambault - SOCIAL/PROF higher STATUS in LOVE
Fregoli - SAME
________________
EkBom PARASITosis syndrome
Othello - AFFAIR
Cotard - DEAD (nihilistic is rotting etc)
MR: (Valsalva -> Syst @mitral-area)
SAM AsH #LVH=deep Q @V1-3ish
OFTEN ASYMPTOMATIC
-SOBOE, angina
Ex -> Syncope #sudden-death
O/E: Jerky/Bisfriens pusle
ECG: deep Q @V1-3ish + ST depr + T-invert
-HOCM assoc w/ which arrythmic dx?
\_\_\_\_\_\_\_\_\_ B12 def -> tracts: -? dx - ataxia -? dx - fine movement of ipsilateral limbs -? dx - prop/vib + fine touch
Subacute Degen SC
- HIGH-STEP-GAIT
- Eye dx
- Reflex: kneeLMN ankleLMN plantarUMN
Neuro syx YES = ?
Neuro syx NO = ? -> -DietRelated= ? -DietUnRelated= ? \_\_\_\_\_\_
Brown Sequard:
_________________
If damaged above T1, may present with?
______________
Classic ** pt accidentally BURN their hands WITHOUT Realising **.
- WASTE of SMALL muscles @HAND
- ‘cape-like’ (neck arms trunk)
- SENSORY loss of pain + temperature
-Preservation of what sensory modality #?Tract
crossing ? TRACTS
@ ? ? of Spinal Cord
#FIRST tracts to be affected
Ix? Assoc w/ ?Malformation
___________
P Painless retention E Eversion of foot weak N No ankle/knee jerk I Impotence S Saddle anaesthesia -Anatomy of compression?
Ix? Tx? Anatomy?
________
__________
- prob/vibr dx
|—–> Ataxia + Romberg POS + DTRs absent - fine touch dx -> Charcot
- Accom Reflex Present - Pupil Reflex Absent
_______
BOTH UMN+LMN dx: 1)-UMN: Pseudobulbar palsy #BSC \+ 2)-LMN: ?cell involvement #WATFR \+ 3)-NO SENSORY/BOWEL-BLADDER dx... this shit is NORMAL
Dx? Tx = survival?
_________
EXCRUCIATING pain @leg-muscles ---bum/ hip/ thigh ABSENT REFLEXES ----HbA1c 120 \_\_\_\_\_\_\_\_\_\_\_\_
Fever + WATFR = ?cell involvement
- -CSF = high WCC + normal CSF BM + norm/high Prot #LYMPHocytes
- -Replicate in GI tract -> kill ?cell
Floppy HYPOtonic baby Flaccid paralysis Fasciculations @tongue #WATFR LMN: Symm Weakness. \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
-BSC syx!!! STIFF spastic tongue DONALD Duck Speech BRISK Jaw Jerk i.e. HYPERREFLEXIA \_\_\_\_\_\_\_\_
WATFR Palsy of the -?CN = swallow/ taste post 1/3 -?CN swallow/ speech -?CN = ?Traps -?CN = Hypoglssal = Tongue WATFR movement Brainstem Motor Nuclei ?CNs #LoF -Prognosis? \_\_\_\_\_\_\_\_\_\_
Towards VS Away
Hypoglossal - Tongue ? Accessory - ? + cant turn to? V3 jaw ? Vagus - uvula ? \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
Classical histories of :
1. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa -------impaired BALANCE #Falls -------O/E vertical-GAZE Palsy #Symm onset
2. Recent 'diagnosis' of Parkinson's... -POOR response to levodopa --IMPOTENT --urinary RETENTION --OLD \_\_\_\_\_\_\_\_
- Motor: Foot-DROP = WEAK LOWER-Extremity
- Sensory dx –> Foot DEFORMITY
- —-pes Cavus=HIGH Arch
- —-Hammer-toe
Mitral Regurg #systolic
Syst Ant Motion of Ant Mitral leaflet
Asym Hypertrophy #LVH=deep Q @V1-3ish
-HOCM assoc w/ Wolff-Parkinson White
\_\_\_\_\_\_\_\_\_ SCD: Subacute Combo Degen of SC B12 def -> tracts: -Spinocerebellar dx - ataxia -CorticoSpinal dx - fine movement of ipsilateral limbs -DC-ML dx - prop/vib + fine touch
B12 def tx:
Neuro syx YES =
Admit + ?IM-HCB
Neuro syx NO = IM-HCB x3/w/2w --> -DietRelated=OralCyanoCobalamin -DietUnRelated=IM-HCB/3m \_\_\_\_\_\_\_\_\_
Same:
@level =
- ALL SENSATION
- LMN
@below level:
- Prop/Vib + FINE-touch #DC-ML
- UMN #CSTract
Opp:
-Pain/Temp + CRUDE-touch: below level - #SPTract
__________________
T1 dx ->
OculoSymp Dx
#IPSILAT Horners
____________
Syringomyelia
-Preservation of Prop/Vibr + FINE-touch #DC-ML
Dx = ST-AC
crossing SSSPINOTHALAMIC TTTRACTS
@AAANTERIOR CCCOMMISSURE of Spinal Cord
#FIRST tracts to be affected
Ix: MRI
Assoc w/ Arnold Chiari Malformation
_______
Cauda Equina -MRI -> Neurosurg+Steds -spinal roots L2 and below \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Tabes Doraslis-DORSAL-COLUMN-ML -Accommodation Reflex Present (ARP) -Pupillary Reflex Absent (PRA) #House-Case \_\_\_\_\_\_\_\_
ALS-Lou Gehrig
- ALS dismutase dx
- Riluzole confers survival
1)-UMN: Pseudobulbar palsy #BSC
2)-LMN: ANT HORN cell involvement #WATFR
3)-NO SENSORY/BOWEL-BLADDER dx… this shit is NORMAL
_______
DM Amyotrophy = ABSENT REFLEXES
__________
Fever + LMN signs (WAFER = ?cell involvement)
-CSF = high WCC + normal CSF BM + norm/high Prot
-Replicate in GI tract -> kill ANTERIOR HORN cell
——PolioMyelitis
____________
____________
UMN PSEUDOBulbar Palsy BSC
Stiff Spastic Tongue, Donald Duck, HyperReflexic Jaw-Jerk
_______
LMN PROGRESSIVE Bulbar palsy WATFR -9CN = swallow/ taste post 1/3 -10CN swallow/ speech -11CN = ?Traps -12CN = Hypoglssal = Tongue WATFR movement Brainstem Motor Nuclei ?CNs #LoF -WORST Prognosis \_\_\_\_\_\_\_\_\_\_
Hypoglossal - Tongue TOWARDS
Accessory - ipsi shoulder droop + cant turn to opp side
V3 jaw TOWARDS
Vagus - uvula AWAY!!!!!
Floppy Flaccid Fascic baby = Spinal Musc Atrophy
-Werdnig Hoffman
_________
_________
- Progressive supranuclear palsy #PSP
- Multi-system atrophy
_________
Charcot Marie Tooth aka HSMN Hereditary Motor Sensory Neuropathy
Common peroneal (fib) nerve = Deep + Superficial
? peroneal nerve-failed:
- dorsiflexion + toe extension
- fooooot EEEEEEVersion
- sensory loss in ??
? peroneal nerve-failed:
- Ankle EEEEEVersion
- sensory loss of ? + ? (except ?)
L5 nerve root –> sciatic –> CPeron = S/D
- hip abduction (gluteal muscles - superior gluteal nerve) - pain and sensory loss @lat side of the thigh, lower leg, foot-dorsum and toes 1-3
- Common peroneal fucked too (as above)
https://www.bmj.com/content/350/bmj.h1736.full
Common peroneal (fib) nerve = Deep + Superficial
Deep peroneal nerve-failed:
- dorsiflexion (tibialis anterior),
- toe extension (extensor digitorum/hallucis longus)
- fooooot EEEEEEVersion (peroneus longus/brevis), and
- sensory loss in first web space
Superficial peroneal nerve-failed: -Ankle EEEEEVersion (peroneus longus/brevis) and - sensory loss of the ANT-LAT lower leg + foot-DORSUM (except the first web space).
L5 nerve root –> sciatic –> CPeron = S/D
- hip abduction (gluteal muscles - superior gluteal nerve) - pain and sensory loss @lat side of the thigh, lower leg, foot-dorsum and toes 1-3
- Common peroneal fucked too (as above)
Hamartomas @?
A?
M?
____________________
A? HYPOPIG spots - fluoresce UV
R?
T?
____________________
O?
M?
A?
____________________
S?
S? over LUMBAR spine
Tuberous Sclerosis - ADom
_________
Hamartomas @CNS/SKIN/white RETINA
AngioFIBromas sebacum adenoma - RED rash
MRegurg
____________________
Ash-leaf HYPOPIG spots - fluoresce UV
Rhabdomyoma heart/LUNG
-LymphAngio-LeioMyoMatosis cysts
Tuberous sclerosis - Cafe au lait
____________________
Other: Butterfly nose, Nail Subung fibromata
Mental retard cog dx
AngioMyoLipoma - renal/PKD
____________________
Seizure
Shagreen rough patches over LUMBAR spine
Factors favouring pseudoseizures
Factors favouring true epileptic seizures
__________
Delirium > Dementia
__________
ALS and polio are UMN or LMN conditions??
Stiff spastic tongue
Donald Duck Speech
Brisk Jaw Jerk
________
Palsy of the -Tongue -Chewing muscles -Swallowing and -Facial muscles due to loss of function of Brainstem Motor Nuclei
Pseudoseizures FACTOrs:
- FHx epilepsy/Females
- ALONE = don’t occur
- CRYING after seizure
- Thrusting pelvic
- Onset = GRADUAL
Favour true epilep seizures:
- Tongue biting
- PROLACTIN
__________
-Emotions = fear, agitation
-Fluct Syx = worse @night, normal periods
-GCS impaired
-Hallucinations/Illusions/Delusions #perception
__________
ALS = BOTH polio = LLLLLLLMN conditions
PseudoBulbar Palsy
_______
Progressive bulbar palsy
-WORST Prognosis
