Neuro Flashcards
Transient ischaemic attack investigations/management
- 1st line - DIFFUSION WEIGHTED MRI/CT
- 2nd line- carotid imaging ultrasound
- Loading dose - 300mg ASPIRIN
- No driving for month
- Antiplatelet therapy - 75mg aspirin, and clopidogrel daily
- Warfarin (anticoagulation) for those with AF
- Carotid endartectomy - remove plaques in CA
Ischaemic stroke presentation
ACA - contralateral weakness and sensory loss of LOWER LIMB
MCA - contralateral weakness and sensory loss along with SPEECH ISSUES
PCA - Perception, HOMONYMOUS HEMIANOPIA
Ischaemic stroke management
Immediate - CT/MRI to exclude haemorrhage and loading dose 300mg aspirin
Further - Aspirin 300mg daily for 2 weeks then clopidogrel daily long term
- Warfarin for AF
- Thrombolysis - IV alteplase given within first 4/5 hours
Extradural haematoma pres/management
- LEMON SHAPED LESION ON CT
- Skull fracture - temporal or parietal bone
- NO ASPIRIN
- Ventilation for oxygen support
- Craniectomy - clot evacuation and ligation
Subarachnoid haemorrhage/haematoma pres/management
- THUNDERCLAP HEADACHE
- Star-shaped lesion on CT (where ventricles are)
- Berry aneurysm rupture
- NIMODIPINE (CCB) for 3 weeks to prevent vasospasm
- Endovascular coiling
- Clamp berry aneurysm rupture
Subdural haematoma/haemorrhage pres/management
- BANANA SHAPED LESION on CT
- Clot turns from white (hypodense) to grey (hyperdense) over time
- Small trauma long time ago
- 1st line - irrigation via burr-hole craniostomy
- 2nd line - craniotomy
Epilepsy diagnosis/treatment
- Electroencephalogram (EEG) - supports diagnosis
- MRI/CT head - exclusion of space occupying lesions
- SODIUM VALPROATE
- If female of child bearing potential LAMOTRIGINE
- Myoclonic - levetiracetam/topiramate
- Absence - ethosuximide
- Partial seizure - lamotrigine
Status epilepticus info
- Continuous seizure lasting over 5 minutes or repeated seizures with no recovery in between
- IV LORAZEPAM
Parkinson’s disease pres/investigation/management
- Tremor at rest
- Parkinsonian gait
- B-amyloid plaques
- DaTscan
Young onset and biologically fit
- 1st line - Da agonist e.g. ROPINIROLE
- 2nd line - MOA-B inhibitor
- 3rd line - L-DOPA (Levodopa)
Biologically frail and comorbidities
- 1st line - L-DOPA
- 2nd line - MOA-B inhibitor
Huntington’s def/pres
- Progressive neurodegenerative disorder with 100% penetrance
- Loss of main inhibitory neurotransmitter GABA
- Chorea
- Incoordination
- Cognitive, behavioural difficulties
- Irritability, agitation, anxiety
Huntington’s investigation/treatment
- MRI/CT - LOSS OF STRIATAL VOLUME
- Genetic testing
- BENZODIAZEPINES/VALPROIC ACID for chorea
- SSRI - depression
Alzheimer’s and Lewy body dementia medication
Cholinesterase inhibitors
Migraine management
- Conservative - avoid triggers
- Mild - NSAIDs - ibuprofen
- Severe - Oral TRIPTANS e.g. sumatriptan
- Prophylaxis - beta blockers (propanolol), TCA’s
Multiple sclerosis presentation
- TEAM - tingling, eye (optic neuritis), ataxia, motor (paraparesis)
- Decreased vibration sense
- Dysphagia/constipation
- Visual impairment
- FALLS
Multiple sclerosis investigations/treatment
- MRI - GD-enhancing plaques
- Lumbar puncture
- MDT approach
- Acute - methyl prednisolone
- Relapse - DMARDs or biologicals
Types of MND
ALS (80%)
- UMN + LMN SIGNS
- Asymmetric
- Babinski response
Progressive bulbar palsy
- UMN + LMN
- Jaw jerk
- Hoarse speech
Progressive muscular atrophy
- LMN only
Primary lateral sclerosis
- UMN only
Myasthenia gravis def/pres
Autoimmune disease where antibodies destroy connection between nerves and muscles leading to INCREASING MUSCULAR FATIGUE
- Eyelid droop
- Face drop
- Normal reflexes
- Weakness
Myasthenia gravis investigation/management
- Positive tensilon test
- Symptom control
- Immunosuppression
Bacterial meningitis causes
- Neonates - group B strep (S. Agalactiae)
- Children <2 - strep. pneumoniae
- Up to 50 yrs - Neisseria meningitidis + strep pneumoniae
- > 50 - strep pneumoniae + listeria meningitis
Meningitis presentation
- TRIAD OF FEVER, HEADACHE AND NECK STIFFNESS
- Purpuric rash (sign of sepsis)
- Photophobia and phonophobia
- Papilloedema (swelling of optic disc on fundoscopy)
- Kernig’s and Brudzinskis sign positive
- Glass test - blancing or non blanching rash
Meningitis diagnosis/treatment
- 1st line - blood cultures
- Gold standard - lumber puncture + CSF analysis
- ABCDE + support
- Empirical therapy - IV BENZYLPENICILLIN
- Assess GCS
- 1st line - Ceftriaxone/cefotaxime, add IV benzylpenicillin for rash
- Prophylaxis - rifampicin and ciprofloxacin
Guillain-Barre syndrome def
- Neuropathy often after infection
- SUDDEN GROWING WEAKNESS AFTER INFECTION
ABCD2
- Scoring tool measuring risk of stroke after TIA
Age: >60 yrs +1
Blood pressure: >140/90mmHg +1
Clinical features: Unilateral weakness +2
Speech impairment without
weakness +1
Duration of symptoms: >60 minutes +2
<60 minutes +1
Diabetes: on medication/insulin +1
