neuro Flashcards
Px presents with unilateral facial pain limited to the mandibular region, brought on by brushing their teeth , given the likely diagnosis what would be the first line treatment?
Would disease would you consider investigating for?
Dx: trigeminal neuralgia
Tx: carbamazepine
Associated disease: MS
35 year old women presents to A+E with a sudden onset headache, PMH of smoking.
What is the most likely underlying pathology?
What is the first line Ix, and what would you see?
How would you Tx?
Pathology: SAH, rupture of berry aneurysms
Ix: CT head, ‘white star’ - blood in cisterns
Tx: intracranial aneurysm - coiling
IV fluids
nimodipine - prevent vasospasm (for 21 days)
38 year old male smoker presents with intense left sided pain around 1 eye, he gets the pain for 1 hour every day for the last 2 weeks, on examination his left eye is red and watery.
What is the most likely Dx?
How would you manage the headache?
Would would you give to prevent the headache?
Dx: Cluster headache
Mx: 100% high flow oxygen for 15 mins + SC 6mg sumatriptan
Px: verapamil (CCB) or prednisolone to break the cycle
A 60 year old male presents to A+E with a headache, neck stiffness and a 38.1 C fever, given the suspected Dx..
What special tests could you do?
WHat is the most likely causative organism?
What Ix would you like to carry out?
The LP is cloudy and has a low glucose and high protein - what Mx would you offer?
What prophylaxis is any should be given to contacts?
special tests: Kernig’s and Brudzinki’s
organism: Neisseria meningitidis (or Strep. pneumoniae)
Ix: LP (+PCR) + blood culture + bloods
CSF:
Bacterial - cloudy, low glucose, high protein, high polymorphs
Viral - clear/cloudy, normal ish glucose (60-80%), normal/riased protein
TB: Slightly cloudy/’fibrin web’, low glucose, high protein
Fungal: cloudy, low glucose, high protein
Bacterial more common than fungal so suspect that first, can be differentiated with WCC - B: 10-5000 polymorphs, F: 20-200 lymphocytes
Mx: IV cefotaxime
Contact prophylaxis: Ciprofloxacin
A 2 year old presents to GP with fever, drowsiness, her parents tell you she does not want to eat which is unusual for her and she won’t stop crying.
What is a DDx?
How would you Ix?
What is the most likely causative organism?
How would you Tx?
DDx: meningitis, encephalitis
Ix: LP - encephalitis would show increased lymphocytes
organism: HSV 1 (or 2)
Mx: IV acyclovir
A 51 year old man presents to his GP with a single seizure and a constant headache, he reports its worst on walking especially hills, constantly there, severity 7/10, not relieved by paracetamol. What DDx do you want to rule out? How would you Ix? What is the most common type? how would you Mx?
Dx: Space occupying lesion / brain tumour
Ix: MRI head
type: 1. brain metastases, 2. glioma , oligodendroglioma, pituitary tumour, acoustic neuroma
Mx: surgical resection + chemo + radio (or palliative)
32 year old pregnant women presents to the GP with 1 day Hx of right sided facial droop, dry eyes and right sided ear pain and reports being extremely sensitive to sound.
What is the most likely Dx?
What Tx would you offer?
Dx: Bell’s palsy
Mx: 10 days prednisolone within 72 hours of onset and eye lubrication
A 24 year old female present to GP with a 2 day Hx of weakness in her legs up to her knee and she says this morning she began to lose sensation in her fingers on both sides. She tells you 2 weeks ago she had D+V. On examination you cannot elicit an ankle reflex. What is the most likely Dx? What criteria could you use to Dx? Would Ix could help you Dx? how would you manage her? What is the prognosis?
Dx: Guillian-Barre (following gastroenteritis)
Criteria: Brighton criteria
Ix: nerve conduction studies would be abnormal, LP would show CSF with high protein
Mx: IV immunoglobulins + plasma exchange
Give VTE prophylaxis
Px: 80% fully recover
21 year old male presents to GP with 3 day Hx of R-sided ear pain and a rash around the ear, he also thinks his speech sounds slurred today. O/E you note he has R-sided facial weakness.
What is you most likely Dx?
What Mx do you offer?
What is the cause of this condition?
Dx: Ramsey-Hunt syndrome
Mx: oral acyclovir
Cx: reactivation of VZV
29 year old female comes to GP with a 2 days Hx of a rash on her arm that looks like a bulls eye, she also reports her joints feel stiffer than usual as she struggled with her morning yoga today. She regularly walks in the local woods.
What Dx are you thinking of? What other signs could be present?
how would you manage ?
What reaction could occur following Tx?
Dx: Lyme disease
could have fever
Cardiac: heart block, myocarditis
Neuro: facial palsy, meningitis
Mx: ABx
early: doxycycline
late: ceftriaxone
Reaction: Jarisch-Herxheimer reaction (more common when Tx syphilis)
fever, rash, tachycardia after first ABx
A 6 year old boy is brought to the GP as he is complaining of blurred vision and he has started to squint. On examination he has >8 coffe-coloured 5mm patches on his skin over his body and freckles in his groin region.
What Dx are you considering?
What Mx do you offer?
Dx: Neurofibromatosis type 1 (chromosome 17 AD) Mutation in neurofibromin other CF: Café-au-lait spots (>= 6, 15 mm in diameter) Axillary/groin freckles Peripheral neurofibromas Iris hamatomas (Lisch nodules) in > 90% Scoliosis Pheochromocytomas
Mx:
Monitoring to prevent complications
Chemo to shrink the optic nerve neuroma
A 17 year old boy presents to GP with gradual hearing loss and ringing in both ears and reports he’s more unsteady on his feet than normal. For the past week he thinks his face looks strange.
O/E you note weakness of the facial muscles bilaterally. You are unable to elicit the corneal reflex.
What Dx are you thinking?
how would you investigate?
how would you manage?
Dx: type 2 neurofibromatosis (C22, AD) affects schwann cells
Ix: MRI at cerebellopontine angle - bilateral vestibular schwannomas / acoustic neuromas
Mx: can be surgically removed if symptomatic
Joanna is a 24-year-old female who presents to the emergency department with an abrupt 2-hour onset of a painful and red skin rash extending across her trunk, face, and limbs. She has never had this skin rash before and has not recently used any new skin products. Her past medical history includes epilepsy, and a viral upper respiratory infection a couple of weeks ago. Her medications include lamotrigine which was started 3 weeks ago.
On examination, Joanna’s blood pressure is 120/80mmHg, pulse 90/min, respiratory rate 18/min, and she is afebrile. There is diffuse skin erythema, macules, and flaccid blisters across the majority of her body (except the palms and soles of the feet). There are also notable ulcers on her lips and genitalia.
What is the most likely Dx?
What is the most important immediate step in management?
Stevens-Johnson syndrome (SJS), rare SE of lamotrigine.
SJS usually develops up to two months after starting an anti-convulsant. Usually there is a prodromal illness which resembles a viral upper respiratory tract infection or ‘flu-like illness’. After this, there is a rapid onset of a painful red skin rash which starts on the trunks and extends abruptly onto the face and limbs. Interestingly, this rash rarely affects the scalp, palms or soles.
cease all meds and give IV fluids
What malformation is syringomyelia associated with?
Arnold-Chiari malformation (lower part of the brain pushes down into the spinal cord)
Syringomyelia:
In Syringomyelia a fluid filled cyst forms in spinal cord and expands over time. This causes slowly progressive neurological symptoms as seen in this patient.
- ‘cape’ like loss of sensation (don’t realise they burn themselves)
- weakness of lower limbs
What is vitamin deficiency results in wernicke’s ?
What is the triad most commonly seen in wernicke’s encephalopathy?
thiamine / B1
- ophthalmoplegia / nystagmus
- ataxia
- confusion
