Neuro Flashcards
Management of cluster headaches
Acute: 100% O2, sc triptan
prophylaxis: verapamil
Thrombolysis with alteplase for acute ischemic stroke
Administered within 4.5 hours of onset of stroke symptoms
Haemorrhage has been definitively excluded
Lambert-Eaton syndrome or myasthenia gravis?
Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise
Acute relapse of MS tx
High-dose steroids (e.g. oral or IV methylprednisolone) for 5 days
Classification system for strokes
The Oxford Stroke Classification (also known as the Bamford Classification)
Oxford Stroke Classification
The following criteria should be assessed:
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Migraine acute attack tx vs prophylaxis
- acute: triptan + NSAID or triptan + paracetamol
- prophylaxis: topiramate or propranolol
What scoring system measures disability or dependence in activities of daily living in stroke patients
The Barthel index
Anterior cerebral artery
Contralateral hemiparesis and sensory loss
lower extremity > upper
Middle cerebral artery
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Posterior cerebral artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Anterior inferior cerebellar artery (lateral pontine syndrome)
Symptoms are similar to Wallenberg’s (see above), but: Ipsilateral: facial paralysis and deafness
Retinal/ophthalmic artery
Amaurosis fugax
Basilar artery
‘Locked-in’ syndrome
Lacunar strokes
- present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
- strong association with hypertension
- common sites include the basal ganglia, thalamus and internal capsule
Most common cancers which metastise to the brain
lung, breast, kidney, melanoma and colorectal
Glasgow Coma Scale
How to to differentiate between a true seizure and a pseudoseizure
Raised serum prolactin = true epileptic seizure
Normal pressure hydrocephalus triad
- urinary incontinence
- dementia and bradyphrenia
- gait abnormality (may be similar to Parkinson’s disease)
MRC power score
0 No contraction
1 Flicker or trace of contraction
2 Active movement, with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity and resistance
5 Normal power
‘What?’ as the patient doesn’t understand a command
Wernicke’s aphasia
speech fluent, comprehension abnormal, repetition impaired
(lesion in superior temporal gyrus)
Broca sounds like ‘broken’ as the patient’s word-flow is broken
Broca’s aphasia
Broca’s is an expressive aphasia
Comprehension normal but speech is non-fluent, repetition is impaired
(lesion in left inferior frontal gyrus)
Brown-Sequard syndrome
Cushing reflex
Widening pulse pressure, bradycardia and irregular breathing
late sign indicating impending brain herniation
Investigation for Vestibular schwannomas
- MRI of the cerebellopontine angle
- Audiometry
Optic neuritis features
- Central scotoma (enlarged blind spot)
- Pain on eye movement
- Impaired colour vision
- RAPD
First-line for spasticity in multiple sclerosis
Baclofen and gabapentin
Medication for oscillopsia in MS
gabapentin
Dopamine receptor agonists
common adverse effects of levodopa
- dry mouth
- anorexia
- palpitations
- postural hypotension
- psychosis
Levodopa - end-of-dose wearing off
symptoms often worsen towards the end of dosage interval. This results in a decline of motor activity
Levodopa ‘on-off’ phenomenon’
large variations in motor performance, with normal function during the ‘on’ period, and weakness and restricted mobility during the ‘off’ period
Levodopa - dyskinesias at peak dose
dystonia, chorea and athetosis (involuntary writhing movements)
Levodopa in patient admitted to hospital or vomiting
Do NOT stop if admitted to hospital
If cannot take orally: give dopamine agonist patch as rescue medication to prevent acute dystonia
Assessment tools for dementia in the non-specialist setting
- 10-point cognitive screener (10-CS)
- 6-Item cognitive impairment test (6CIT)
Stevens-Johnson syndrome
Maculopapular, erythematous, diffuse rash with mucosal involvement and skin sloughing and blistering when rubbing the skin (Nikolsy’s sign)
Which area of the brain affects Alzheimer’s
Widespread cerebral atrophy mainly involving the cortex and hippocampus
Investigating a suspected SAH
Non-contrast CT head
- Positive CT → confirmed SAH
- If CT head is done >6hrs after onset and normal → do LP
- If done within 6 hours of onset and normal → consider alt dx (do NOT do LP)
Within what time frame should a LP be done in suspected SAH and why
At least 12 hours AFTER onset of symptoms
To allow development of xanthochromia
Role of Xanthochromia in SAH diagnosis
Xanthochromia helps to distinguish true SAH from a ‘traumatic tap’ (blood introduced by LP procedure)
Investigating cause of pathology once SAH confirmed
- CT intracranial angiogram (to identify a vascular lesion e.g. aneurysm or AVM)
- +/- digital subtraction angiogram (catheter angiogram)
