Neuro Flashcards
Tension headache signs and symptoms
Bilateral dull pressure-like headache
Pericardial/neck muscle tenderness
Tension headache management
NSAIDs(ibuprofen, naproxen, diclofenac)
Paracetamol
Cluster headache signs and symptoms
Male
Heavy smoking/drinking
Severe unilateral pain at night
Headache comes in clusters
Sweating
Miosis ± ptosis
Conjunctival redness ± lacrimation
Nasal congestion ± rhinorrhoea
Eyelid oedema
Cluster headache management
Subcutaneous/nasal sumatriptan
Inhaled O2
Verapamil(CCB)
Migraine signs and symptoms
Unilateral throbbing headache
Nausea
Photophobia
Female
Triggers e.g. stress
Migraine management
Acute:
1. NSAIDs/paracetamol
2. Sumatriptans
Prophylaxis:
1. Propranolol
2. Topiramate
3. Amitriptyline
Trigeminal neuralgia signs and symptoms
Electric shock like pain
Unilateral
Trigeminal neuralgia management
Carbamazepine
Posterior fossa decompression
Raised ICP signs and symptoms
Cushing’s triad: high systolic BP, irregular breathing, bradycardia
Bilateral throbbing headache
Worse when lying down
Early morning N+V
Raised ICP investigations
Urgent CT head
NEVER do lumbar puncture
Ophthalmoscope: papilloedema
Meningitis signs and symptoms
Headache
Malaise
Fever
Stiff neck
Photophobia
Confusion
Non blanching rash
Meningitis investigations
Lumbar puncture: cloudy if bacterial
VBG
CT head
Meningitis management
Primary care: Benzylpenicillin IM
Hib: ceftriaxone IV 10/7
Strep: ceftriaxone IV 2/52
Meningococcal: ceftriaxone IV 1/52
Consider dexamethasone
Meningitis complications
Hearing loss
Sepsis
Impaired mental status
Pre-chiasmal visual field defect causes
Optic neuritis
Amaurosis fugax
Optic atrophy
Retrobulbar optic neuropathy
Trauma
Bell’s palsy signs and symptoms
Unilateral face drooping
Non forehead sparing
Dry eye
Sound hypersensitivity
Bell’s phenomenon
Idiopathic, 60% preceded by ARI
Ramsay-hunt syndrome signs and symptoms
Unilateral LMN facial palsy due to varicella zoster reactivation
Painful blisters in ear/hard palate/tongue
Horner’s syndrome signs and symptoms
Triad: miosis, ptosis, anhydrosis
Enophthalmos
Horner’s syndrome investigations
CXR: pancoast tumour
CT head: stroke/tumour
MRI angiography: carotid artery dissection
Type 1 Neurofibromatosis signs and symptoms
More common
Painful skin lesions
Cafe au lait macules
Lisch nodules(eyes)
Armpit freckling
Type 2 neurofibromatosis signs and symptoms
Hearing loss
Tinnitus
Vertigo
Neurofibromatosis investigations
Full body examination
Ophthalmological assessment
Hearing test
CT/MRI
MS signs and symptoms
Optic neuritis
Sensory loss
Muscle weakness
Fatigue
ataxia
Lhermitte’s(barber chair) sign
MS investigations
Absence of alternative diagnosis
Dissemination in time
Dissemination in space
Clinical history/examination
MRI: focal white matter lesions
CSF: inflammation
Electrophysiology
Myasthenia gravis signs and symptoms
Muscle fatigue with use
Ptosis
Diplopia
Dysarthria
Dysphagia
±SOB
Fatiguable muscles
NORMAL reflexes
Myasthenia gravis investigations
Bloods: anti-AChR & anti-MuSK antibodies(could be -ve, thymic hyperplasia)
EMG
CT upper thorax: thymic hyperplasia
Tensilon(Ch-ase inhibitor)/pyridostigmine(long acting Ch-ase inhibitor)->improve symptoms
TFT
Lambert Eaton myasthenia syndrome signs and symptoms
Associated with SCLC
Muscle weakness improving with use
Hyporeflexia
Motor neuron disease signs and symptoms
Progressive muscle weakness
Dysphagia
SOB
Sparing oculomotor, autonomic function
Thenar & hypoglossus wasting
Parkinson’s signs and symptoms
S - shuffling gait
M - hypomimic face
A - akinesia (+bradykinesia)
R - rigidity
T - tremor (asymmetrical)
Huntington’s signs and symptoms
Choreic movements(rapid jerky involuntary)
Speech impairment
Unsteady gait
Cognitive decline, dementia
Alzheimer’s signs and symptoms
Amnesia
Anomia
Apraxia
Agnosia
Aphasia
Alzheimer’s investigations
CSF: high tau, low beta amyloid
Mini mental state exam(MMSE)
Montreal cognitive assessment(MOCA)
Frontotemporal dementia signs and symptoms
Personality change
Emotion, behaviour affected
Vascular dementia signs and symptoms
Similar to Alzheimer’s but step wise progression
Wernicke’s encephalopathy signs and symptoms
Alcohol abuse
Triad:
Confusion
Ataxia
Ophthalmoplegia
Wernicke’s encephalopathy investigations
Bloods: albumin, vit B1, LFT
ECG
CT scan
Neuropsychology
Myasthenia gravis management
Initial:
Corticosteroids
Long term:
1. ACh-ase inhibitor(pyridostigmine)
2. Azathioprine
3. Thymectomy
Crisis:
IV immunoglobulin
Plasmapheresis
Parkinson’s management
Levodopa
Dopamine agonist
MAO-B inhibitor
MS management
Bolus methylprednisolone shortens relapses
Baclofen treats spasticity
Beta interferon reduces frequency of relapses
Guillain-Barre syndrome signs and symptoms
Acute LMN weakness
starts with hands & feet, ascending
Numbness/tingling in limbs(polyneuropathy)
Preceding infection
Bell’s palsy management
Prednisolone 40mg OD 7/7
Acyclovir 200mg 5x 5/7
Eyedrops, eye shield
Guillain-Barre syndrome investigations
Lumbar puncture: high protein
Spirometry: type 2 resp failure
Monitor vital capacity
Nerve conduction studies
Parkinson’s investigations
DaTscan
Bloods: rule out hyperthyroidism, anaemia
Varicella zoster signs and symptoms
Painful facial rash that stops at midline
Varicella zoster management
Acyclovir 800mg oral 5x a day 1/52
Topical lidocaine
Brain abscess signs and symptoms
Triad:
Fever
Headache
Neurological symptoms
Brain abscess investigations
CT brain contrast: Ring enhancing lesion
Brain abscess management
Hyperbaric oxygen therapy
Antibiotics
Surgical drainage or aspiration
Radiculopathy signs and symptoms
Pinched nerve root:
Pain
Paraesthesia
Numbness
Weakness
Radiculopathy investigations
MRI at spinal level
Nerve conduction studies
Radiculopathy management
Medical:
Pregabalin
Amitriptyline
Duloxetine
Gabapentin
Tramadol
Capsaicin cream if localised/oral not tolerated
Physical therapy e.g. Weight loss
Surgery e.g. discectomy
Epilepsy signs and symptoms
Absence seizure:
LOC for 10 seconds
Focal seizure:
Auras precede
Lip smacking
Generalised tonic-clonic:
Limb flexion followed by extension
Tongue biting
Myoclonic seizure:
Brief muscle spasm -> fall
Atonic seizure:
Bilateral loss of muscle activity >1s
Epilepsy management
tonic clonic:
male - sodium valproate
female - lamotrigine/levetiracetam
focal:
1st - lamotrigine/levetiracetam
2nd - carbamazepine
absence:
1st - ethosuximide
2nd - valproate(M) or lamotrigine/levetiracetam(F)
myoclonic:
male - sodium valproate
female - levetiracetam
tonic or atonic:
male - sodium valproate
female - lamotrigine
Extradural haemorrhage signs and symptoms
Lucid period
Headache
3rd nerve palsy
LOC
Head trauma
Extradural haemorrhage investigations
CT head: convex shape
Extradural haemorrhage management
Burr hole/craniotomy
Post surgery: anti-epileptics, hyperosmotics
Spinal cord compression signs and symptoms
Back pain at spinal level
Paraesthesia/anaesthesia of dermatome
Weakness below spinal level
Urinary/stool incontinence/retention
Hyperreflexia
Spinal cord compression investigations
X ray spine
MRI spine (gold standard)
Spinal cord compression management
Dexamethasone 16mg/day
NSAIDs/opiates
Bisphosphonate (myeloma/prostate/breast cancer)
Surgical decompression
Radiotherapy
SAH signs and symptoms
Sudden onset thunderclap headache
Meningism
SAH investigations
Non-contrast CT head (within 6h)
+ve: CT angiography
-ve: lumbar puncture 12h after
MR angiography
SAH management
Intubation + mechanical ventilation
NG tube
Codeine + anti-emetics
Initial:
Nimodipine (CCB)
Bed rest at 45 degrees
Surgery:
Coiling (preferred over clipping)
Subdural haemorrhage sign and symptoms
Head trauma
Confusion
Gradually increasing headache
Subdural haemorrhage investigations
CT head: crescent shape
Subdural haemorrhage management
Small:
Reabsorb naturally
Small catheter to suck out haematoma
Large:
Craniotomy -> suction and irrigation
Chronic:
Atorvastatin
Stroke/TIA signs and symptoms
FAST:
Face, arm, speech test
ACA: hemiplegia -> legs
MCA: aphasia, hemiplegia -> arms/face
PCA: homonymous hemianopia
TIA resolves within 24h
Stroke/TIA investigations
TIA:
MRI brain
Stroke:
Non-enhanced CT head
Stroke/TIA management
Initial: 300mg aspirin
Haemorrhage excluded:
Alteplase within 4.5h of symptom onset
Or
Thrombectomy within 6h of symptom onset with IV thrombolysis after confirmation by CT/MR angiogram
clopidogrel + statin
Oxygen if needed, maintain glucose