Neuro Flashcards
Medical management of meningitis
IM benzylpenicillin in community
Cefotaxime
amoxicillin/ampicillin for listeria cover if elderly/neonate
Dexamethasone (not for <3m or paediatric meningococcal)
Management of chronic cvryptococcus meningitis
ambisome +/- flucytosine
treatment of encephalitis
IV aciclovir 10mg/kg + IV ceftriaxone
IV amoxicillin if immunocompromised/>50y
acute management of meningitis other than antibiotics
blood cultures
check for raised ICP
airway support/fluid support/vasopressors
if no raised ICP, LP <1h
dexamethasone 10mg
if raised ICP, IV antibiotics, A-E, dexamethasone
Status management
Oxygen 100%, bloods, toxicology screen +/- fluids
buccal midazolam OR pr diazepam OR IV lorazepam
10 mins: IV lorazepam
30 mins: IV phenytoin/phenobarbitone
60 mins: rapid induction anaesthesia e.g. propofol
consider thiamine at 30m if alcohol/malnourished
glucose treatment
treat acidosis if severe
consider dex if cerebral tumour/vasculitis after senior consultation
Trauma guidelines for CT head immediately
GCS<13 or <15 2h-post skull fracture seizure focal neurology vomiting >1
Trauma guidelines for CT head within 8h
Warfarin
LOC AND either Age >65 bleeding/clotting problem 30m retrograde amnesia dangerous mechanism of injury
Trauma guidelines for CT spine immediately
GCS <13 pt intubated ?surgery Clinical suspicion AND: age 65/high impact injury/focal neurology/paraesthesia
Management for ischaemic stroke
antiplatelet immediately once confirmed for 2w
alteplase <4.5h
thromboectomy if alteplase not indicated <6h
statin after 48h
no AF: Clopidogrel long-term
AF: Apixaban long-term
Slowly lower any HTN
catheterise
hold anti-coagulation for AF for 14d
find cause e.g. AF, carotid artery stenosis
Management for haemorrhagic stroke
Rapid blood pressure lowering if SBP >150 and no CI
reverse anticoagulation
refer to neurosurgeons e..g decompressive hemicraniectomy
Stroke rehab
Management for SAH
CT
LP if CT inconclusive after 12h
nimodipine ASAP after confirmation for vasospasm
can use normal saline as well
monitor GCS for rebleed and Na for SIADH
coiling with IR or surgical clipping
Management for raised ICP
sit up to 30 degrees if intubated hyperventilate them mannitol OR hypertonic saline used with caution steroids (if oedema surrounding tumours) fluid restriction
refractory disease = pentobarbital coma, hypothermia and decompressive hemicraniectomy
management of cauda equina
PO dex if metastatic
decompressive laminectomy/discectomy if <48h
Management of spinal compression
PO dex +/- external beam radiotherapy OR surgery
think if unfit for surgery
Management of TIA
aspirin 300mg for 2w
no af: clopidogrel + statin long-term
af: apixaban + statin
Management of subdural haematoma
reverse clotting abnormalities
ICP management
neurosurgery for evacuation if large
Management of extradural haematoma
urgent neurosurgical intervention (clot evacuation and ligation)
Management of Parkinson’s
MDT approach
Home environment review
OT/PT
memory clinic
levodopa + carbidopa
antiemetic e.g. domperidone
consider rasagiline (MAO-B),
Management of Alzheimer’s
MDT approach
community organisation e.g. Alzheimer’s Association
Home environment review
OT/PT
anticholinersterase:
donepezil, galantamine, rivastigmine
memantine if severe (NMDAr antagonist)
management for MS
acutely: steroids
chronically: beta-interferon, natalizumab for MS
Life optimisation: anti-spasmodics pain (gabapentin, pregabalin) laxatives catheter/oxybutinin
Management for Myaesthenia Gravis
long-acting AChE inhibitors (pyridostigmine, neostigmine)
immunosuppression (pred, azathioprine)
check for thymoma
Management for myasthenic crisis
plasmapharesis/IVIG
intubation
Management for Lambert Eaton Syndrome
treat cancer
immunosuppression (pred +/- azathioprine)
management for MND
MDT (PT/OT, dietician, specialist nurse)
riluzole extends life by 3m
supportive management e.g. PEG feeding, analgesia, antispasmodics, NIV
Management for BPPV
Epley
Semont manoeuvre
consider: lorazepam
consider surgery
Management of Meniere’s
salt restrict
less: caffeine alcohol, smoking, stress
meclozine or promethazine
consider oral steroids or intratympanic injection
if sudden hearing loss: oral pred
tinnitus maskers
consider hearing aid, endolymph sac surgery
GBS management
spiro (FVC measurements 6hly)
IVIG OR plasma exchange
DVT prophylaxis ?mechanical management neuropathic pain management fluids antihypertensives
migraine management
prophylaxis: propanolol, CCB, antiepileptics, amitriptylline
consider menstrual cycle control
ongoing: NSAIDs, antiemetic
2nd line paracetamol monotherapy + antiemetic
3rd: triptan + antiemetic
avoid triggers: chocolate, wine, alcohol, smoking, stress, sleep deprivation
causes of peripheral neuropathy
Alcohol B12 Thiamine Diabetic Amyloidosis CMT Infections: Botulinum, diphtheria, lyme disease
difference between polymyositis and polymyalgia rheumatica
polymyositis = tenderness/weakness
polymyalgia = pain and stiffness without weakness
polymyalgia management
pred
polymyalgia investigation
CK
Biopsy
antibodies
malignancy screen
contraindications to thrombolysis
LP in last week, GI haemorrhage 3w, stroke last 3m HTN >200 Ongoing bleeding Pregnant ICH Seizure at onset Brain cancer Varices
what is false localising sign
6th nerve palsy doesn’t actually tell you where the lesion is as it takes a really long route
paediatric guidelines for CT head within 1h
NAI
Post-traumatic seizure but no history of epilepsy
GCS <14
GCS <15 after 2h
base of skull fracture
Focal neurology
<1yo, bruise/swelling/laceration >5cm on head
CT SAH sensitivity
> 95% if done within 6h
if negative but high clinical suspicion, do LP after 12h of onset
MCA stroke symptoms
Motor: upper body, facial droop
Visual: Eyes deviate towards lesion (looking at it), contralateral homonymous hemianopia
Other: verbal deficits -Broca’s aphasia or Wernicke’s
ACA stroke symptoms
Motor: lower body, pelvis
Other Urinary incontinence, personality change, aphasia
PCA stroke symptoms
Visual: contralateral homonymous hemianopia, visual hallucinations, visual agnosia
Other: Dysphagia, dysarthria, cerebellar signs
lacunar stroke symptoms
pure contralateral motor (branches of ACA and MCA)
absence seizure drugs
ethosuxamide, lamotrigine, valproate
partial seizure drugs
carbamazepine, valproate, lamotrigine, levetiracetam
tonic clonic seizure drugs
valproate, lamotrigine, carbamazepine
tonic/atonic seizures drugs
valproate
myoclonic seizure drugs
valproate, topiramate, levetiracetam
Bamford TACS
triad of
1) homonymous hemianopia
2) hemiplegia +/- sensory deficit
3) higher cerebral dysfunction (speech)
Bamford PACS
2 of
1) homonymous hemianopia
2) hemiplegia +/- sensory deficit
3) higher cerebral dysfunction (speech)
Bamford POCS
Any of
1) Cranial nerve dysfunction
2) Bilateral motor/sensory dysfunction
3) Conjugate eye movement disorder
4) Isolated hemianopia
5) Cerebellar signs
Bamford Lacunar
No loss of higher cerebral function + 1 of: Pure sensory Pure motor Sensorimotor Ataxic hemiparesis
carotid endarterectomy indications
stenosis >50% + stroke/TIA
Carried out within 2w
stenosis >70%
stroke scoring systems on admission
NIHSS
ROSIER
CT-ASPECT
Dermatomes Back of head Shoulder 3rd finger Nipple Umbilicus Hip Big Toe Little Toe
Back of head C2 Shoulder C4 3rd finger C7 Nipple T4 Umbilicus T10 Hip L2 Big Toe L5 Little Toe S1
Management of cluster headaches
acute: SC sumitriptan and 100% high flow oxygen
prevent recurrence: verapamil
lesions to optic radiations in temporal and parietal lobes lead to what type of visual defect
quadrantanopia
PITS = Parietal inferior, Temporal Superior
