Management of neuro conditions

Question 1

How do you manage a TIA?

Answer 1

Aspirin 300mg daily, start immediately
Refer for specialist assessment within 24 hours

(Diffusion-weighted MRI scan is imaging of choice)

Question 2

How do you manage an Ischaemic stroke?

Answer 2

NCCT head to exclude haemorrhagic stroke
IV Alteplase (thrombolysis, plasminogen activator)
Aspirin 300mg for 2 weeks (NSAID, antiplatelet)
Lifelong Clopidogrel 75mg (antiplatelet)

Question 3

How do you manage an Ischaemic stroke due to atrial fibrillation?

Answer 3

IV Alteplase
Aspirin 300mg for 2 weeks
Lifelong Clopidogrel 75 mg

+ DOAC like Apixaban (anticoagulant)

Question 4

What prophylaxis is given for both ischaemic and haemorrhagic strokes?

Answer 4

Atorvastatin (statin, lowers LDL)
Ramipril (ACE-inhibitor, antihypertensive)

Question 5

How do you manage a haemorrhagic stroke?

Answer 5

NCCT head to exclude ischaemic stroke
IV mannitol (for increased ICP)
Refer to neurosurgery

Question 6

How do you investigate a suspected subarachnoid haemorrhage?

Answer 6

CT head scan followed by CT angiogram (if CT positive) or lumbar puncture (if CT negative and still suspect haemorrhage)

Neurosurgery
Give nimodipine (CCB to decrease vasospasm and bp)

Question 7

How do you treat a subdural haemorrhage after confirming via NC CT head scan?

Answer 7

Surgery: burr hole and craniotomy (removing part of skull)

IV mannitol to lower ICP

Address cause is suspected child abuse

Question 8

How do you treat an extradural haemorrhage?

Answer 8

Urgent surgery

IV mannitol to lower ICP

Question 9

How do you treat a migraine?

Answer 9

Oral Triptan
or Aspirin 900mg

NSAIDs
Paracetamol

Question 10

What can be given for Parkinson’s disease?

Answer 10

Beneldopa (combo of Levodopa, synthetic dopamine, and benserazide, prevents metabolism before reaching brain)

Effects wear off so given at more severe stage.

Question 11

How do you treat a primary brain tumour?

Answer 11

Surgery with chemotherapy (before, during and after)

Consider steroids eg. Dexamethasone

Question 12

What medication is given for Alzheimer’s?

Answer 12

Donepezil or rivastigmine

(ACh-ase inhibitor)

Question 13

How do you treat an acute cluster headache?

Answer 13

Triptans (SC or intranasal sumatriptan)
High flow 100% oxygen

Question 14

What medication is used to prevent cluster headaches?

Answer 14

Verapamil (CCB)

Question 15

How do you treat epilepsy?

Answer 15

Sodium valproate
unless female 15-45 y/o as teratogenic. Then give lamotrigine

Question 16

How do you treat status epilepticus?

Answer 16

IV Lorazepam 4mg

If not worked, give 2nd dose.

If still not working, give Phenytoin

Question 17

How do you treat a tension headache?

Answer 17

Simple analgesia
Ibuprofen or paracetamol

For chronic or frequent headaches: amitriptyline

Question 18

How do you treat trigeminal neuralgia?

Answer 18

Carbamazepine

Possible surgery if symptoms persist

Question 19

How is Giant Cell Arteritis treated?

Answer 19

Prednisolone (immediately given before diagnosis confirmed to reduce risk of vision loss)

if vision changes, give IV methylprednisolone

Question 20

What is given for vascular dementia?

Answer 20

Antihypertensive eg ramipril (ACE-i)
Statins eg. atorvastatin
Antiplatelets eg. clopidogrel
Anticoagulant eg. warfarin
ACh-ase inhibitors eg. Donepezil or Rivastigmine

Question 21

What medications can be given for Huntington’s?

Answer 21

Tetrabenazine for chorea symptoms
Antidepressants

Question 22

How is MND managed?

Answer 22

Riluzole (anti-glutaminergic)
Supportive physio and breathing support

Question 23

How is bacterial meningitis treated?

Answer 23

Ceftriaxone or Cefotaxime with Dexamethasone

Question 24

How do you treat encephalitis?

Answer 24

Aciclovir (give when suspected before confirmed, antiviral for HSV and VZV)

If known cause is CMV, give Ganciclovir

Question 25

How do you treat myelopathy from a spinal cord compression?

Answer 25

Neurosurgery following an immediate MRI of spinal cord
Laminectomy or microdiscectomy

Chest XR if malignancy suspected

Question 26

How do you manage Cauda Equina Syndrome?

Answer 26

MRI of spinal cord, testing nerve roots and reflexes
Neurosurgery ASAP eg microdiscectomy, spinal fixation

Question 27

How do you manage carpal tunnel syndrome?

Answer 27

Wrist splint for night
Steroid injection
Surgical decompression

Question 28

How do you manage radial palsy?

Answer 28

Splint and simple analgesia

Question 29

How do you manage ulnar palsy?

Answer 29

Splint and simple analgesia

Question 30

How do you manage sciatica?

Answer 30

Analgesia and physio
Neurosurgery