Key Neuro Presentations

Question 1

Difference between primary vs secondary headache

Answer 1

Primary has no known cause
Secondary has cause that we should be worried about

Question 2

Red flags in headaches-

Answer 2

Any signs of raised ICP- worse when lying down,waking up from sleep, reduced vision, pappilloedema,CUSHINGS,vomiting

Sudden onset thunderclap

Any signs of infection- fever, seizures,neck stiffness, altered conciousness or behaviour

Question 3

Diagnostic criteria of a migraine

Answer 3

At least 5 bouts of

Headache lasting 4-72 hours

Is two of:
Unilateral
Pulsatile
Moderate or severe pain
Aggravated by physical activity

And is accompanied by nausea, vomiting, phot or phonophobia

Question 4

What is and how common is an aura

Answer 4

1/3 have them
Visual disturbance

Question 5

What is premonitory phase of migraine

Answer 5

First phase before aura, yawning mood change and cravings

Question 6

Acute managment of migraines

Answer 6

100mg sumatriptan with high dose aspirin at time of aura beginning

Question 7

Prophylaxis of chronic migraine

Answer 7

Topiramate 50-100mg, propranolol 80-160, amitryptiline and candersartan

Question 8

Side effects of Topiramate

Answer 8

Teratogenic
GI disturbance
Weight gain

Question 9

Cluster headaches, paroxysmal hemicrania and SUNCT/A are all types of what

Answer 9

Trigeminal autonomic cephalagia

Question 10

What amount of usage is seen in medication over use headaches.

Answer 10

> 2-3 doses a week

Question 11

When does a headache become chronic

Answer 11

More than 15 days a month

Question 12

Common features of Trigeminal autonomic cephalagia

Answer 12

Unilateral
Restless and agitated
Centres on eye- watering,ptosis or miosis

Question 13

Cluster headache hx

Answer 13

Unilateral severe pain
Autonomic symptoms - streaming of eye, conjunctival congestion, runny nose
Night time attacks
Severe restlessness

Male and lasts 15min to two hours (less than migraines)

Question 14

Managment of cluster headaches

Answer 14

Treat as emergency (admit)

Acute- sumatriptan nasal spray or subcut and high flow oxygen 15l via a non rebreather mask

Question 15

Managment of Trigeminal neuralgia

Answer 15

Carbamazepine

Question 16

Hx of tension headache

Answer 16

Bilateral tight band around head
Less intense than migraine
Associated with stress or concentrated visual effort

NSAIDs or paracetamol first line

Question 17

Pathophys of parkinsons

Answer 17

A synuclein deposits called levy body cause neuronal death in substansia nigra = less dopamine

Question 18

What kind of tremor is seen in Parkinson

Answer 18

Resting tremor
4-6hz
Pill rolling tremor

Question 19

Triad and overall picture of Parkinson’s

Answer 19

Bradykinisia
Resting pill rolling tremor
Cog wheel rigidity

It is a unilateral/asymmetrical onset

Question 20

Management of Parkinson’s

Answer 20

Levodopa

Dopamine ago sit in younger oatient

Question 21

Side effects of levodopa

Answer 21

Motor fluctuations and dyskinesia

Question 22

What must levodopa be give with

Answer 22

Peripheral dopa decarboxylase inhibitors = carbidopa

Question 23

Example of dopamine agonist

Answer 23

Pergolide, ropinirole

Question 24

When is an MOA used and Sid effects

Answer 24

Used in very modest Parkinson’s

Causes postural hypotension and AF

Caution with tryclic anti depressants

Question 25

Pathophys of MS

Answer 25

Auto immune attack of oligodendrocytes causes demyelination of CNS

Question 26

Dawsons fingers seen where

Answer 26

MS

Question 27

Periventricular,juxtacortical and infratentorial demyelination seen on MRI in what

Answer 27

MS

Question 28

RF for MS

Answer 28

Genetic Vit D deficiency EBV

Question 29

Most common disease course of MS

Answer 29

Relapsing remitting (most will become progressive)

Question 30

Most common presentation of MS and what’s happens

Answer 30

Optic neuritis - unilateral reduced vision over hours and days Pain on eye movement with enlarged blind spot Impaired colour vision Relative afferent pupillary defect

Question 31

Eye movement abnormalities in MS

Answer 31

Conjugate lateral gaze disorder- lateral eye cannot abduct Caused by inter nuclear opthalmoplegis

Question 32

What is Lhermitte’s sign and where is it seen

Answer 32

Electric shock sensation when flexing the neck Seen in MS

Question 33

Treatment of acute MS attack

Answer 33

METHYLPREDNISOLONE 500mg PO for 5 days

Question 34

Initial managment of status (less than 5 mins)

Answer 34

Protect patient and airway Administer oxygen Gain IV access Obtain BM

Question 35

Treatment of status after. 5 mins

Answer 35

IV lorazepam 4 mg can be repeated after 5 mins 10mg buccal midazolam (or IM) can be repeated fate 5 mins

Question 36

2nd line treatment of status

Answer 36

IV levetricatem/phenytoin/valproate Phenytoin needs cardiac monitoring

Question 37

Things to check in status epilepticus

Answer 37

Is the patient is epileptic- have they taken their drugs. Check serum levels If not, think structural (bleed or tumour) or infective encephalopathy. Urine fox screen and CT and MRI

Question 38

Difference between GC status and PNEAD

Answer 38

Patients are cyanosed in GSCE, and pink in PNEAD

Question 39

Large amplitude semi purposeful waxing and waning movement seen in what

Answer 39

PNEAD

Question 40

Who gets PNEAD

Answer 40

Young women with past history of mental illness, abuse, trauma

Question 41

What is the triad seen in normal pressure hydrocephalus

Answer 41

Dementia, falls and urinary incontinence