Neuro Flashcards
Migraine management acute and prophylactic
Acute: paracetamol/aspirin + triptan (sumatriptan) + NSAID
Prophylactic: propranolol/topiramate/amitriptyline
Trigeminal neuralgia management
Carbamazepine, gabapentin 2nd line
Unresponsive to medical therapy:
Classical - micro vascular decompression
Idiopathic - ablative surgery
Secondary - treat secondary cause
Focal seizure management
Lamotrigene/levetiracetam
Generalised seizure management
Sodium valproate/valproic acid
Status epilepticus management
Benzodiazepine - lorazepam/diazepam
Second line - IV phenytoin
How does a focal seizure present (different areas of brain)
Frontal: Jacksonian March (muscle spasm), post-ictal flaccid weakness, disinhibition
Temporal: Automatisms, epigastric discomfort, hallucinations
Parietal: Sensory disturbances e.g. tingling, pain, numbness
Occipital: visual phenomena
What investigation is done for a brain abscess and what do you expect to see
CT head/MRI for ring enhancing lesion
Brain abscess management
Vancomycin + metronidazole/clindamycin + ceftriaxone (3rd gen ceph)
Anticonvulsants: phenytoin/carbamazepine/valproic acid/levetiracetam
Dexemethasone in acutely decompensating patient
Surgical decompression
Management for essential tremor
Propranolol
Primidone (barbiturate) sometimes
Management for Bell’s palsy
Oral prednisolone
Eye protection e.g. artificial tears
Severe palsy/complete paralysis:
Consider antiviral therapy (valaciclovir)
No improvement after 3 weeks —> refer to ENT urgently
Management for encephalitis?
IV acyclovir initially if viral cause suspected (most common)
Investigations for encephalitis and results
Diagnostic MRI shows hyper intense lesions
CT brain in all patients with altered mental status
CSF analysis if 2/4 symptoms present: fever, headache, altered mental status, meningismus
EEG
Management for meningitis
GP: benzylpenicillin IM/IV + hospital admission
Hospital: IV ceftriaxone/cefotaxime + IV dexamethasone within 1 hour
If viral cause confirmed: supportive care e.g. paracetamol/ibuprofen
Investigations for meningitis
Lumber puncture for CSF analysis
CT head before LP if any symptoms of raised ICP or reduced consciousness
2 blood cultures before ABs (don’t delay however)
Blood glucose
FBC
Management for meniere’s
Nausea/vomiting: prochlorperazine
Vertigo: vestibular suppressant (meclizine)/anti-emetic/corticosteroid
Tinnitus: tinnitus maskers
Sudden hearing loss: corticosteroid
Prophylaxis: betahistine trial
If therapies fail do surgery
What is diagnostic of BPPV
Did-hallpike manoeuvre
Management for subarachnoid haemorrhage
Nimodipine (prevent vasospasm/delayed cerebral ischaemia)
Endovascular coiling/clipping
Imaging for TIA
MRI - determine territory of ischaemia
CT if patient has bleeding disorder or is on anticoagulant to rule out haemorrhage
TIA management
Aspirin
Clopidogrel - long term secondary prevention
High intensity statin
Management for cluster headaches?
Acute:
- 100% O2
- subcut triptan
Prophylaxis:
- verapamil
Investigation for cluster headache
MRI with gadolinium contrast
How does tension type headache present
Headband pain distribution (bilateral, non-throbbing, constricting)
Pain/tenderness can also be:
- pericranial
- sternocleidomastoid
- trapezius
- temporalis
- lateral pterygoid
- masseter
Normal neurological exam
Management for tension headache
Acute - aspirin, paracetamol, NSAIDs
Chronic - antidepressants e.g. amitriptyline
How to tell if meningitis is bacterial or viral with glucose?
Bacterial: CSF glucose < 1/2 of serum glucose
Viral vice versa
Prophylaxis for meningitis in close contacts
Ciprofloxacin/rifampicin
What’s the difference in appearance of subdural/extradural haemorrhage on CT
Subdural: crescent shaped
Extradural: oval shaped
Myasthenia gravis management
Pyridostigmine
Prednisolone
Thymectomy
Myasthenic crisis:
- Intubation and mechanical vent
- Plasmapharesis
- IVIG
Multiple sclerosis management
Acute relapse: oral methylprednisolone
RRMS: immunomodulators e.g. natalizumab/alemtuzumab/dimethyl fumarate
SPMS: Siponimod/methylprednisolone
PPMS: Ocrelizumab
Further drugs/management for specific symptoms
Investigations for subarachnoid haemorrhage
Non contrast CT
If -ve and after 6 hrs of onset: LP within 12 hrs
If +ve do CT angiogram (MR if preg/contrast allergy)
Management for Alzheimer’s
Mild: donepezil/rivastigmine/galantamine (cholinesterase inhibitors)
Moderate/severe: switch to or add memantine
Describe the tremor seen in Parkinson’s
Unilateral improving with voluntary movement
Management of MND
Riluzole + supportive care
Resp symptoms - NIPPV/IMV
Mucus - carbocisteine (mucolytic)
Dysphasia/weight loss - PEG/diet mod
Drooling - hyoscyamine/amitriptyline/atropine
Muscle weakness - PT/OT
Spasticity - baclofen
Management for subdural haematoma
Anti-epileptic prophylaxis for all patients e.g. phenytoin
< 10mm and midline shift < 5mm and stable/GCS 9-15:
- observation, monitoring, CT follow up
> 10mm or midline shift > 5mm or unstable/GCS < 9:
- Burr-hole/trauma craniotomy
Extradural haematoma management
Burr-hole/craniotomy immediately
What does a headache worse on lying down mean and vice Verda
Worse on lying down: increase ICP
Worse on standing: low ICP
