neuro Flashcards
low levels of which ion can cause seizures?
phosphate
how long does it take for delirium to resolve and its significance?
takes 4-6 weeks, sometimes up to 2-3 months. (means patient can’t be diagnosed w dementia unless symptoms longer than this)
when are headaches associated with raised ICP the worst?
in the mornings
what is a big risk after an SAH?
cerebral vasospasm
which prophylaxis do you give for cerebral vasospasm?
nimodipine -type of calcium blocker that decreases risk of vasospasm
what is roseola infantum caused by?
HHV-6
what is the presentation of roseola infantum?
viral illness-3-4 days of fever, 24 hours of maculopapular rash, self resolving
what is progressive supranuclear palsy?
degenerative condition of unknown aetiology that produces an akinetic-rigid form of parkinsonism characterised by early falls and abnormalities of extraocular movements
what are the typical signs of progressive supranuclear palsy?
backwards falls
hypometria
dysarthria
dysphagia
bradykinesia
what is hypometria?
when the eyes undershoot when trying to focus on an object
what visual field defect would a stroke affecting the optic radiation cause?
contralateral HH
what visual field defect would a stroke affecting the occipital lobe cause?
HH usually with macular sparing
what is brown-sequard syndrome?
result of hemisection of spinal cord-ipsilateral loss of fine touch, vibration, and proprioception, contralateral loss of pain and temp
what is the preferred imaging modality for TIA?
MRI brain with diffusion weighted imaging-to determine area of ischaemia
what is functional MRI used for?
assess regional blood flow in brain whilst patient performs tasks, may be used to study the effect of TIA once confirmed.
what drug is used as first line treatment of MS?
methylprednisolone
what is the recommended empirical therapy for adults >50 with suspected bacterial meningitis?
IV cefotaxime/ceftriaxone + amoxicillin/ampicillin
what is tardive dyskinesia?
disorder that result in involuntary repetitive body movements eg grimacing, sticking out tongue, smacking lips. most common=chewing, pouting jaw.
what medication is usually prescribed to relieve headache due to raised ICP?
dexamethasone
what is mannitol used for and why?
cerebral oedema, raised intra-ocular pressure, CF as add-on therapy (helps with pulmonary oedema)
is an osmotic diuretic
what is the nice treatment for neuropathic pain?
amitriptyline, duloxetine, gabapentin, or pregabalin
if one doesn’t work try one of the others-switch don’t add
tramadol can be used as ‘rescue therapy’
topical capsaicin can be used for localised neuropathic pain, eg post herpetic neuralgia
carbamazapine-1st line for trigeminal neuralgia
what is the 1st line treatment for early status epilepticus?
IV lorazepam
what do you do if it’s an ischaemic stroke but it’s been more than 4.5 hours?
give aspirin
what are the rules on epilepsy and driving?
1st ever seizure with LOC: license gone for 6 months, then have to reapply if no seizures for 6 months
have had more than one seizure with LOC: license gone for a tear, can reapply
if seizure because of medication change: can reapply after 6 months if back on previous medication and no more seizures in that time
what are the rules on stroke and driving?
driving may resume after 1 month if satisfactory clinical recovery-dvla doesn’t need to be notified unless residual neurological deficits
name 3 risk factors for MS
female gender
age 20-40
vit D deficiency
what is the investigation of choice for optic neuritis MS?
MRI with contrast-allows visualization of the demyelinating lesions
what is the drug management of status epilepticus?
1st line: IV benzos like lorazepam, diazepam (generally IV lorazepam)
PR diazepam or buccal midazolam can be given too
2nd line: phenytoin or phenobarbital infusion
if no response within 45 minutes, induce general anaesthesia.
when do you do thrombolysis AND thrombectomy to treat stroke?
confirmed occlusion of the proximal anterior circulation on imaging
what artery is occluded if you have amaurosis fugax stroke?
retinal/opthalmic artery
on the side you’re experiencing symptoms
what visual field defect would you get if you have an MCA stroke?
contralateral homonymous quandrontanopia/hemianopia
what visual field defect would you get if you have an MCA stroke?
contralateral homonymous quandrontanopia/hemianopia
what is hoover’s sign and its significance?
diagnostic test from neurological as opposed to psychological hemiplegia
positive hoover’s sign suggests it is psychogenic and not truly neurological
what is conversion disorder?
symptom, usually neuro, presenting after period of stress.
what is factitious disorder?
feigning of symptoms in order to receive compassion from healthcare professionals
what is titubation?
(involuntary) nodding movement of head or body usually caused by neuro disorder
what’s the firstline imaging for stroke?
NON CONTRAST CT head
what is the correct first line imaging for SAH?
non contrast CT head
when should you do a LP when suspecting SAH?
if the CT head had been performed after 6 hours from the onset of symptoms and came back normal. The timing of the LP should be 12h after the onset of symptoms to allow for the development of xanthochromia-not recommended to do any earlier.
what is essential to rule out in someone presenting with vertigo?
posterior stroke
what is a broad based ataxic gait associated with?
midline cerebellar pathology, eg a lesion in MS or degeneration of the cerebellar vermis due to chronic alcohol excess
in unilateral cerebellar disease what does their gait look like?
ataxic (staggering, slow, unsteady) and patient veers towards side of lesion.
what blood gas abnormality does meningitis show?
metabolic acidosis
what are some examples of third gen cephalosporins?
ceftriaxone, cefotaxime
what is the most common electrolyte abnormality complication of SAH?
hyponatraemia -usually due to SiADH
which GCSs indicate when to do a CT head?
<13 at first presentation: CT head within an hour
<15 2h post injury: CT head within 8 hours
what is the classic symptoms of normal pressure hydrocpehalus?
wet, wacky, and wobbly: urinary incontinence, gait ataxia, dementia
what are the features of viral labyrinthitis?
recent viral infection
sudden onset
vertigo, N+V, can affect hearing
what are the features of vestibular neuronitis?
recent viral URTI
recurrent vertigo attacks lasting hours/days
no hearing loss
what are the features of vertebrobasilar ischaemia?
vertigo
dizziness on extension of neck
happens in older people
what are the features of accoustic neuroma?
hearing loss, vertigo, tinnitus
absent corneal reflex
associated with neurofibromatosis type 2
what can acute severe hyponatraemia cause?
cerebral oedema
