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