neuro Flashcards
indications for carbamazepine
epilepsy, particularly partial seizures (no role in absence seizures)
trigeminal neuralgia
bipolar disorder
imaging for acoustic neuroma
MRI of cerebellopontine angle
which vitamin deficiency can lead to Wernicke’s encephalopathy
thiamine B1
it is found in Pabrinex
mx of Bell’s palsy
prednisolone if seen within 72h of onset
ix for ? Guillain-Barre syndrome
lumbar puncture (rise in protein with normal WCC) nerve conduction studies
secondary prevention after stroke
clopidogrel lifelong
aspirin + dipyridamole lifelong if clopidogrel CI/not tolerated
conduction dysphasia
speech fluent, repetition poor
comprehension intact
Broca’s (expressive) dysphasia
non-fluent laboured and halting speech
repetition impaired
comprehension intact
Wernike’s (receptive) dysphasia
speech is fluent but sentences make no sense, word substitution and neologisms - ‘word salad’
comprehension impaired
driving rules after first unprovoked seizure, normal brain imaging and EEG
cannot drive for 6 months
driving rules after first unprovoked seizure, abnormal brain imaging and EEG
cannot drive for 12 months
what FBC abnormality can phenytoin cause
megaloblastic anaemia
which medication in parkinson’s disease mx can cause impulse control disorders
dopamine receptor agonists, e.g. Bromocriptine, Cabergoline
first line mx for spasticity in MS
Baclofen and Gabapentin
most appropriate anti-emetic in Parkinson’s
Domperidone
features of Cushing’s triad
raised ICP causing: 1. bradycardia 2. irregular breathing 3. widening pulse pressure (also have hypertension)
sodium valproate effect on P450 system
inhibition
increases INR if taking warfarin
first-line options for neuropathic pain
amitriptyline
duloxetine
gabapentin
pregabalin
features of anterior cerebral artery stroke
contralateral hemiparesis and sensory loss
LL>UL
features of middle cerebral artery stroke
contralateral hemiparesis and sensory loss UL>LL
contralateral homonymous hemianopia
aphasia - dominant hemisphere strokes
when is carotid endarterectomy considered
in a patient who has had a TIA w carotid artery stenosis >70%
when would you consider multiple system atrophy over parkinson’s?
autonomic disturbance, e.g. atonic bladder, postural hypotension
cluster headache prophylaxis
Verapamil
cluster headache acute mx
SC Sumatriptan and high flow oxygen
features of Bell’s palsy
LMN facial nerve palsy therefore forehead is affected
inability to raise eyebrow and drooping of mouth on affected side
hyperacusis
post-auricular pain
acute mx of seizures
check airway and give oxygen if appropriate
place patient in recovery position
benzodiazepines are indicated in prolonged seizures - rectal Diazepam 10-20mg in adults
for thrombectomy in acute ischaemic stroke, when would an extended target time of 6-24h be considered?
if there is the potential to salvage brain tissue as shown by advanced brain imaging, e.g. CT perfusion
features of Wernicke’s encephalopathy
CAN OPEN Confusion Ataxia Nystagmus Ophthalmoplegia PEripheral Neuropathy
what is ‘saturday night palsy’
radial nerve palsy caused by compression of the radial nerve against humeral shaft
how may cataplexy present
laughter followed by fall or collapse
features of median nerve palsy
damage at wrist = carpal tunnel syndrome - paralysis and wasting of thenar eminences - weak opposition and abduction of thumb - sensory loss to palmar aspect of lateral 2 ½ fingers - commonly damaged in Colle's fracture damage at elbow = above plus - unable to pronate - weak wrist flexion - ulnar deviation of wrist
features of ulnar nerve palsy
hypothenar wasting
weak thumb adduction
mx of myasthenic crisis
IV immunoglobulins
plasma electrophoresis
ix for MS
MRI with contrast
bilateral facial nerve palsy and bilateral parotid gland enlargement
sarcoidosis
cause of vertical nystagmus vs horizontal nystagmus
vertical - suggests central cause (e.g. cerebellar stroke)
horizontal - suggests peripheral cause (e.g. viral labyrinthitis)
what happens when controlled hyperventilation is used for raised ICP?
hyperventilation -> reduced CO2 -> vasoconstriction of cerebral arteries -> reduced ICP
indications for urgent CT head in headache
vomiting >1 with no other cause new neurological deficit reduction in GCS valsalva or positional headaches progressive headache with fever
most common primary brain tumours in adults
- glioblastoma - poor prognosis
2. meningioma - arise from dura mater
most common primary brain tumour in children
pilocytic astrocytoma
acute mx of stroke
- Aspirin 300mg
- thrombolysis with Alteplase if within 4.5 h of onset and haemorrhage is excluded
- thrombectomy with thrombolysis if within 6 h of onset for occlusion of proximal anterior circulation
- thrombectomy within 6-24h for occlusion of proximal anterior circulation and potentially salvageable brain tissue
what monitoring is needed when giving phenytoin infusion
cardiac monitoring due to its pro-arrhythmogenic effects
features of extradural haemorrhage
lucid interval
biconvex haemorrhage on imaging
ix for myasthenia gravis
antibody screen
myasthenia gravis vs Lambert-Eaton + which antibodies to check for each
weakness in myasthenia gravis worsens after exercise (check ACh receptor antibodies)
weakness in Lambert-Eaton improves (check voltage-gated Ca-channel antibodies)
causes of upper vs lower quadrant bitemporal hemianopia
upper = inferior chiasmal compression, commonly pituitary tumour lower = superior compression, commonly craniopharyngioma
ix for venous sinus thrombosis
MR venogram
features of venous sinus thrombosis
headache, nausea and vomiting
may use COCP and have FHx of VTE
which anti-epileptic may cause weight gain
sodium valproate
“sodium val-pro-weight”
mx of idiopathic intracranial hypertension
acetazolamide
describe the tremor seen in Parkinson’s
unilateral tremor that improves with voluntary movement
features of Weber’s syndrome
ipsilateral CNIII palsy
contralateral weakness
weBer’s = Brainstem stroke
features of normal pressure hydrocephalus
urinary incontinence
gait abnormality
dementia
enlarged fourth ventricle on imaging
what can provoke absence seizures
hyperventilation or stress
when may stopping anti-epileptic drugs be considered
>2 years seizure free
AEDs stopped over 2-3 months
common biochemical complication of SAH
hyponatraemia
which CCB is used to prevent vasospasm in aneurysmal SAH
Nimodipine
head injury with signs of meningeal irritation
SAH
when should ICP monitoring be used
those with GCS 3-8 and abnormal CT scan
it is also appropriate if CT scan is normal
Todd’s paresis
post-ictal weakness seen in frontal lobe epilepsy
driving rules post-TIA
can start driving if symptom free after 1 month - no need to inform DVLA
features of pontine haemorrhage
Pinpoint Pupils (Point to Pons and oPiates)
Quadriplegia
Life threatening stroke associated with HTN
long-term prophylaxis of cluster headaches
Verapamil
ECG findings in SAH
Torsades de pointes - polymorphic VT
features of Horner’s
miosis (pupillary constriction)
ptosis
enophthalmos
anhidrosis
mx of brain abscess
IV ceftriaxone (3rd gen cephalosporin) + metronidazole
features of CN III palsy
if due to intracranial bleed, the palsy will be on the same side
fixed, dilated pupil, unresponsive to light
down and out pupil
ptosis
which anti-emetic (used for migraine attacks) can cause extrapyramidal side-effects in children and young adults
metoclopramide
isolated rise in protein on CSF indicates
Guillain-Barre syndrome
when does autonomic dysreflexia occur
in spinal cord injury at or above T6
Jacksonian march
type of focal aware frontal lobe seizure
characteristically affects peripheral body part then spreads
CI to triptan use for migraines
history of ischaemic heart disease
Nelson’s syndrome
rapid enlargement of pituitary adenoma that occurs after bilateral adrenalectomy
which dementia is associated with MND
frontotemporal
what pathology is proptosis/exophthalmus and down and out pupil seen in
cavernous sinus syndrome
features of brain abscess
headache
fever
focal neurology
recent acute sinusitis (source of infection)
prophylactic mx of migraines
propranolol and topiramate
avoid topiramate in women of child-bearing age as it can cause congenital abnormalities if they fall pregnant
avoid propranolol in asthma
imaging for stroke
NON-contrast CT head
cause of bitemporal hemianopia
compression of optic chiasm, e.g. due to pituitary adenoma
mx of temporal arteritis
high-dose prednisolone as soon as dx is suspected BEFORE temporal artery biopsy
drug causes of intracranial hypertension
COCP steroids tetracyclines vitamin A lithium
features of temporal lobe seizure
HEAD Hallucinations aura (Epigastric rising/emotional) Automatisms (**lip smaking/grabbing/plucking**) Deja vu/dysphasia (post ictal)
imaging for neck fracture
CT scan
features of encephalopathy
fever, headache
psychiatric symptoms
seizures
vomiting
most common cause of encephalopathy
herpes simplex virus
mx of status epilepticus
ABC, airway adjunct and oxygen as needed
check blood glucose
pre-hospital - rectal diazepam; hospital - IV lorazepam (can be repeated after 10-20 mins)
for established status - second-line agent such as phenytoin
no response within 45 min - general anaesthesia
features of epidural haematoma
combination of neurological deficit and severe back pain
epidurals are CI in coagulopathies due to this reason
most appropriate med for acute confusional state in Parkinson’s patients
lorazepam AVOID antipsychotics (i.e. Haloperidol)
