Management of neuro conditions Flashcards
How do you manage a TIA?
Aspirin 300mg daily, start immediately
Refer for specialist assessment within 24 hours
(Diffusion-weighted MRI scan is imaging of choice)
How do you manage an Ischaemic stroke?
NCCT head to exclude haemorrhagic stroke
IV Alteplase (thrombolysis, plasminogen activator)
Aspirin 300mg for 2 weeks (NSAID, antiplatelet)
Lifelong Clopidogrel 75mg (antiplatelet)
How do you manage an Ischaemic stroke due to atrial fibrillation?
IV Alteplase
Aspirin 300mg for 2 weeks
Lifelong Clopidogrel 75 mg
+ DOAC like Apixaban (anticoagulant)
What prophylaxis is given for both ischaemic and haemorrhagic strokes?
Atorvastatin (statin, lowers LDL)
Ramipril (ACE-inhibitor, antihypertensive)
How do you manage a haemorrhagic stroke?
NCCT head to exclude ischaemic stroke
IV mannitol (for increased ICP)
Refer to neurosurgery
How do you investigate a suspected subarachnoid haemorrhage?
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)
How do you treat a subdural haemorrhage after confirming via NC CT head scan?
Surgery: burr hole and craniotomy (removing part of skull)
IV mannitol to lower ICP
Address cause is suspected child abuse
How do you treat an extradural haemorrhage?
Urgent surgery
IV mannitol to lower ICP
How do you treat a migraine?
Oral Triptan
or Aspirin 900mg
NSAIDs
Paracetamol
What can be given for Parkinson’s disease?
Beneldopa (combo of Levodopa, synthetic dopamine, and benserazide, prevents metabolism before reaching brain)
Effects wear off so given at more severe stage.
How do you treat a primary brain tumour?
Surgery with chemotherapy (before, during and after)
Consider steroids eg. Dexamethasone
What medication is given for Alzheimer’s?
Donepezil or rivastigmine
(ACh-ase inhibitor)
How do you treat an acute cluster headache?
Triptans (SC or intranasal sumatriptan)
High flow 100% oxygen
What medication is used to prevent cluster headaches?
Verapamil (CCB)
How do you treat epilepsy?
Sodium valproate
unless female 15-45 y/o as teratogenic. Then give lamotrigine
How do you treat status epilepticus?
IV Lorazepam 4mg
If not worked, give 2nd dose.
If still not working, give Phenytoin
How do you treat a tension headache?
Simple analgesia
Ibuprofen or paracetamol
For chronic or frequent headaches: amitriptyline
How do you treat trigeminal neuralgia?
Carbamazepine
Possible surgery if symptoms persist
How is Giant Cell Arteritis treated?
Prednisolone (immediately given before diagnosis confirmed to reduce risk of vision loss)
if vision changes, give IV methylprednisolone
What is given for vascular dementia?
Antihypertensive eg ramipril (ACE-i)
Statins eg. atorvastatin
Antiplatelets eg. clopidogrel
Anticoagulant eg. warfarin
ACh-ase inhibitors eg. Donepezil or Rivastigmine
What medications can be given for Huntington’s?
Tetrabenazine for chorea symptoms
Antidepressants
How is MND managed?
Riluzole (anti-glutaminergic)
Supportive physio and breathing support
How is bacterial meningitis treated?
Ceftriaxone or Cefotaxime with Dexamethasone
How do you treat encephalitis?
Aciclovir (give when suspected before confirmed, antiviral for HSV and VZV)
If known cause is CMV, give Ganciclovir
How do you treat myelopathy from a spinal cord compression?
Neurosurgery following an immediate MRI of spinal cord
Laminectomy or microdiscectomy
Chest XR if malignancy suspected
How do you manage Cauda Equina Syndrome?
MRI of spinal cord, testing nerve roots and reflexes
Neurosurgery ASAP eg microdiscectomy, spinal fixation
How do you manage carpal tunnel syndrome?
Wrist splint for night
Steroid injection
Surgical decompression
How do you manage radial palsy?
Splint and simple analgesia
How do you manage ulnar palsy?
Splint and simple analgesia
How do you manage sciatica?
Analgesia and physio
Neurosurgery
