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Neuro Flashcards

1
Q

Tension headache signs and symptoms

A

Bilateral dull pressure-like headache
Pericardial/neck muscle tenderness

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2
Q

Tension headache management

A

NSAIDs(ibuprofen, naproxen, diclofenac)
Paracetamol

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3
Q

Cluster headache signs and symptoms

A

Male
Heavy smoking/drinking
Severe unilateral pain at night
Headache comes in clusters
Sweating
Miosis ± ptosis
Conjunctival redness ± lacrimation
Nasal congestion ± rhinorrhoea
Eyelid oedema

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4
Q

Cluster headache management

A

Subcutaneous/nasal sumatriptan
Inhaled O2

Verapamil(CCB)

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5
Q

Migraine signs and symptoms

A

Unilateral throbbing headache
Nausea
Photophobia
Female
Triggers e.g. stress

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6
Q

Migraine management

A

Acute:
1. NSAIDs/paracetamol
2. Sumatriptans

Prophylaxis:
1. Propranolol
2. Topiramate
3. Amitriptyline

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7
Q

Trigeminal neuralgia signs and symptoms

A

Electric shock like pain
Unilateral

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8
Q

Trigeminal neuralgia management

A

Carbamazepine
Posterior fossa decompression

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9
Q

Raised ICP signs and symptoms

A

Cushing’s triad: high systolic BP, irregular breathing, bradycardia
Bilateral throbbing headache
Worse when lying down
Early morning N+V

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10
Q

Raised ICP investigations

A

Urgent CT head
NEVER do lumbar puncture
Ophthalmoscope: papilloedema

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11
Q

Meningitis signs and symptoms

A

Headache
Malaise
Fever
Stiff neck
Photophobia
Confusion

Non blanching rash

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12
Q

Meningitis investigations

A

Lumbar puncture: cloudy if bacterial
VBG
CT head

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13
Q

Meningitis management

A

Primary care: Benzylpenicillin IM
Hib: ceftriaxone IV 10/7
Strep: ceftriaxone IV 2/52
Meningococcal: ceftriaxone IV 1/52
Consider dexamethasone

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14
Q

Meningitis complications

A

Hearing loss
Sepsis
Impaired mental status

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15
Q

Pre-chiasmal visual field defect causes

A

Optic neuritis
Amaurosis fugax
Optic atrophy
Retrobulbar optic neuropathy
Trauma

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16
Q

Bell’s palsy signs and symptoms

A

Unilateral face drooping
Non forehead sparing
Dry eye
Sound hypersensitivity
Bell’s phenomenon
Idiopathic, 60% preceded by ARI

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17
Q

Ramsay-hunt syndrome signs and symptoms

A

Unilateral LMN facial palsy due to varicella zoster reactivation
Painful blisters in ear/hard palate/tongue

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18
Q

Horner’s syndrome signs and symptoms

A

Triad: miosis, ptosis, anhydrosis
Enophthalmos

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19
Q

Horner’s syndrome investigations

A

CXR: pancoast tumour
CT head: stroke/tumour
MRI angiography: carotid artery dissection

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20
Q

Type 1 Neurofibromatosis signs and symptoms

A

More common
Painful skin lesions
Cafe au lait macules
Lisch nodules(eyes)
Armpit freckling

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21
Q

Type 2 neurofibromatosis signs and symptoms

A

Hearing loss
Tinnitus
Vertigo

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22
Q

Neurofibromatosis investigations

A

Full body examination
Ophthalmological assessment
Hearing test
CT/MRI

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23
Q

MS signs and symptoms

A

Optic neuritis
Sensory loss
Muscle weakness
Fatigue
ataxia
Lhermitte’s(barber chair) sign

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24
Q

MS investigations

A

Absence of alternative diagnosis
Dissemination in time
Dissemination in space

Clinical history/examination
MRI: focal white matter lesions
CSF: inflammation
Electrophysiology

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25
Myasthenia gravis signs and symptoms
Muscle fatigue with use Ptosis Diplopia Dysarthria Dysphagia ±SOB Fatiguable muscles NORMAL reflexes
26
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
27
Lambert Eaton myasthenia syndrome signs and symptoms
Associated with SCLC Muscle weakness improving with use Hyporeflexia
28
Motor neuron disease signs and symptoms
Progressive muscle weakness Dysphagia SOB Sparing oculomotor, autonomic function Thenar & hypoglossus wasting
29
Parkinson’s signs and symptoms
S - shuffling gait M - hypomimic face A - akinesia (+bradykinesia) R - rigidity T - tremor (asymmetrical)
30
Huntington’s signs and symptoms
Choreic movements(rapid jerky involuntary) Speech impairment Unsteady gait Cognitive decline, dementia
31
Alzheimer’s signs and symptoms
Amnesia Anomia Apraxia Agnosia Aphasia
32
Alzheimer’s investigations
CSF: high tau, low beta amyloid Mini mental state exam(MMSE) Montreal cognitive assessment(MOCA)
33
Frontotemporal dementia signs and symptoms
Personality change Emotion, behaviour affected
34
Vascular dementia signs and symptoms
Similar to Alzheimer’s but step wise progression
35
Wernicke’s encephalopathy signs and symptoms
Alcohol abuse Triad: Confusion Ataxia Ophthalmoplegia
36
Wernicke’s encephalopathy investigations
Bloods: albumin, vit B1, LFT ECG CT scan Neuropsychology
37
Myasthenia gravis management
Initial: Corticosteroids Long term: 1. ACh-ase inhibitor(pyridostigmine) 2. Azathioprine 3. Thymectomy Crisis: IV immunoglobulin Plasmapheresis
38
Parkinson’s management
Levodopa Dopamine agonist MAO-B inhibitor
39
MS management
Bolus methylprednisolone shortens relapses Baclofen treats spasticity Beta interferon reduces frequency of relapses
40
Guillain-Barre syndrome signs and symptoms
Acute LMN weakness starts with hands & feet, ascending Numbness/tingling in limbs(polyneuropathy) Preceding infection
41
Bell’s palsy management
Prednisolone 40mg OD 7/7 Acyclovir 200mg 5x 5/7 Eyedrops, eye shield
42
Guillain-Barre syndrome investigations
Lumbar puncture: high protein Spirometry: type 2 resp failure Monitor vital capacity Nerve conduction studies
43
Parkinson’s investigations
DaTscan Bloods: rule out hyperthyroidism, anaemia
44
Varicella zoster signs and symptoms
Painful facial rash that stops at midline
45
Varicella zoster management
Acyclovir 800mg oral 5x a day 1/52 Topical lidocaine
46
Brain abscess signs and symptoms
Triad: Fever Headache Neurological symptoms
47
Brain abscess investigations
CT brain contrast: Ring enhancing lesion
48
Brain abscess management
Hyperbaric oxygen therapy Antibiotics Surgical drainage or aspiration
49
Radiculopathy signs and symptoms
Pinched nerve root: Pain Paraesthesia Numbness Weakness
50
Radiculopathy investigations
MRI at spinal level Nerve conduction studies
51
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
52
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
53
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
54
Extradural haemorrhage signs and symptoms
Lucid period Headache 3rd nerve palsy LOC Head trauma
55
Extradural haemorrhage investigations
CT head: convex shape
56
Extradural haemorrhage management
Burr hole/craniotomy Post surgery: anti-epileptics, hyperosmotics
57
Spinal cord compression signs and symptoms
Back pain at spinal level Paraesthesia/anaesthesia of dermatome Weakness below spinal level Urinary/stool incontinence/retention Hyperreflexia
58
Spinal cord compression investigations
X ray spine MRI spine (gold standard)
59
Spinal cord compression management
Dexamethasone 16mg/day NSAIDs/opiates Bisphosphonate (myeloma/prostate/breast cancer) Surgical decompression Radiotherapy
60
SAH signs and symptoms
Sudden onset thunderclap headache Meningism
61
SAH investigations
Non-contrast CT head (within 6h) +ve: CT angiography -ve: lumbar puncture 12h after MR angiography
62
SAH management
Intubation + mechanical ventilation NG tube Codeine + anti-emetics Initial: Nimodipine (CCB) Bed rest at 45 degrees Surgery: Coiling (preferred over clipping)
63
Subdural haemorrhage sign and symptoms
Head trauma Confusion Gradually increasing headache
64
Subdural haemorrhage investigations
CT head: crescent shape
65
Subdural haemorrhage management
Small: Reabsorb naturally Small catheter to suck out haematoma Large: Craniotomy -> suction and irrigation Chronic: Atorvastatin
66
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
67
Stroke/TIA investigations
TIA: MRI brain Stroke: Non-enhanced CT head
68
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

Y3 (9 decks)

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