Neuro Flashcards
3 of the main epilepsy subtypes
(a) Focal (partial) seizures - one side of brain
- focal aware (simple partial)
- focal impaired awareness (complex partial)
- motor - Jacksonian march
- non-motor - deja vu, aura
(b) Generalised seizures - both sides of brain
- all of these have LOC
- motor - tonic clonic
- non-motor - absence
(c) Focal to bilateral seizures - on one side of brain and spreads to both lobes
Treatment for typical (petit mal) absence seizures
Onset 4-8years
1st line: ethosuximide
2nd line: sodium valproate (or lamotrigine/ levetiracetam if child bearing age)
Treatment for generalised tonic-clonic seizures, myoclonic, tonic/atonic seizures
Sodium valproate
Child bearing women are likely to have: lamotrigine or levetiracetam
Treatment for focal seizures
1st line: lamotrigine or levetiracetam
2nd line: carbamazepine, oxcarbazepine or zonisamide
What anti-epileptic medication can exacerbate absence seizures
Carbamazepine
n.b. carbamazepine is used to treat partial seizures, trigeminal neuralgia and bipolar disorder
Anti-epileptic that is associated with:
(a) neural tube defects
(b) cleft palate
(a) sodium valproate
(b) phenytoin
For women with epilepsy, if a COCP is chosen, it should contain a minimum of how much ethinylestradiol
30 µg
For women taking phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine, which contraceptives are UKMEC 1-3?
UKMEC 3: COCP, POP
UKMEC 2: implant
UKMEC 1: Depo-provera, IUD, IUS
For lamotrigine, which contraceptives are UKMEC 3 and UKMEC 1?
UKMEC 3: COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
Medications that worsen seizure control are alcohol, drugs, theo/aminophylline, bupropion, methlpenidate, mefanamic acid.
What 2 antibiotics can worsen seizure control in patients with epilepsy?
ciprofloxacin
levofloxacin
Infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents in the first 4-8 months of life in M>F.
Prognosis is poor but what is the management?
1st line = vigabatrin and high dose prednisolone
Donepezil (ACh-esterase inhibitor) side effects
Sleep disorders - insomnia
Bradycardia
What are the most important anti-epileptic drugs to prescribe by brand
Phenytoin
Carbamazepine
Hoover’s sign
pressure is felt under paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
Lhermitte’s sign
sudden electric shock sensation that occurs when bending the head forward towards the chest in patients with multiple sclerosis
Uhthoff’s sign
multiple sclerosis where the patient’s symptoms can be worsened with heat
Treatment of cluster headaches (acute and prophylactic)
Acute:
1. 100% oxygen
2. Subcutaenous triptans
Prophylaxis:
1. Verapamil
4 main features of PTSD symptoms
- Hypervigiliance
- Flashbacks
- Avoidance
- Emotional numbing
If taking warfarin / heparin, what SSRIs should be considered
NICE guidelines recommend avoiding SSRIs and considering mirtazapine
Reed-Sternberg cells are associated with what cancer
Hodgkin’s lymphoma
What type of lyphoma has alcohol induced lymph node pain
Hodgkin’s lymphoma
What haem cancer is likely to cause:
Painless, non-tender, asymmetrical lymph nodes in the neck (cervical/supraclavicular) > axillary > inguinal
Pel-Ebstein fever
Hodgkin’s lymphoma
Depression (variable appetite, poor sleep) with excess alcohol use may benefit from which antidepressant
Mirtazapine
Difference between viral labyrinthitis vs vestibular neuronitis
viral labyrinthitis = hearing loss and tinnitus are more likely to be present in
vestibular neuronitis = only vestibular nerve is involved so hearing is fine
what medications are used as prophylaxis for contacts of patients with meningococcal meningitis
Oral ciprofloxacin or rifampicin
what is the treatment for meningitis
Initial empirical therapy aged < 3 months or >50 years
IV cefotaxime + amoxicillin (or ampicillin)
what is the treatment for meningitis
Initial empirical therapy aged 3 months - 50 years
IV cefotaxime (or ceftriaxone)
what is the treatment for meningitis
Meningococcal meningitis
IV benzylpenicillin or cefotaxime (or ceftriaxone)
what is the treatment for meningitis
Meningitis caused by Haemophilus influenzae or Pneumococcal meningitis
Intravenous cefotaxime (or ceftriaxone)
what is the treatment for meningitis caused by Listeria
IV amoxicillin or ampicillin
Conditions that cause both UMN and LMN signs
e.g. hyporeflexia (LMN) and positive Babinski sign - extensor plantars (UMN)
Motor neuron disease
Subacute combined degeneration of the cord
Friedreich’s ataxia
Syringomyelia
Taboparesis (syphilis)
Conus medullaris lesion
When are triptans taken during headache
At the onset of HEADACHE (not aura)
What is the only antiemetic that should be used in parkinson’s disease
Domperidone
For parkinsons disease patients, if postural hypotension occurs then what medication can be given
midodrine
selegiline for parkinsons disease is what type of drug
MAO-B (Monoamine Oxidase-B) inhibitor
- these inhibit breakdown of DA
What is this sign called and what neuro condition is it seen in?
Gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
Hoffman’s sign
Seen in degenerative cervical myelopathy
And other UMN diseases e.g. MS
What is the gold standard investigation for degenerative cervical myelopathy
MRI of cervical spine
Rx: neurosurgery/ ortho spinal surgery to perform decompressive surgery
Two investigations done for Guillain barre syndrome
- Lumbar puncture - high protein, normal WCC (albuminocytologic dissociation)
- Nerve conduction studies - decreased motor nerve conduction velocity, increased F wave and distal motor latency
Sodium valproate effects on P450 system
INHIBITOR of the P450 system
Suspected TIA in the past 7 days requires an urgent assessment by stroke doctor within how long
urgent assessment (within 24 hours) by a specialist stroke physician
(if longer than a week, then to be referred to be seen within 7 days)
According to the NICE guidelines for neuropathic pain management (2013), first-line treatment options include what 4 drugs
amitriptyline
duloxetine
gabapentin
pregabalin
these are used as monotherapy. if one is not working, switch to another.
+ tramadol for rescue therapy
+ topical capsaicin
treatment for trigeminal neuralgia
carbamazepine
Topiramate (antiepileptic with risk of foetal malformation) reduces the efficacy of which contraceptives
COCP
POP
Implant - ukmec 2
The injection and IUS are not affected
Common peroneal nerve lesion
what features
Weakness of foot dorsiflexion and eversion
Sensory loss over foot dorsum + lower lateral part of leg
Wasting of anterior tibial and peroneal muscles
Foot drop unilaterally
Bilateral foot drop / high stepping gait causes with:
Motor loss
Sensory loss
Motor loss
- GBS, Charcot Marie Tooth, porphyria
Sensory loss
- Diabetes, uraemia, vit B12 def, alcoholism, amyloidosis, leprosy
Treatment for myasthenia gravis (antibodies against ACh receptors)
Pyridostigmine
(ACh-esterase inhibitor)
(+ Prednisolone
+ Azathioprine/ cyclosporin, mycophenolate + thymectomy)
Management of myasthenic gravis crisis
(maintainence Rx is Pyridostigmine)
Plasmaphresis
IV Ig
What two meds are used for migraine prophylaxis
Propranolol
Topiramate - bad for foetus
Drugs that can worsen myasthenia gravis
Penicillamine
Beta blockers
Lithum
Phenytoin
Quinidine, procainamide
Antibiotics (gent, macrolites, tetreacyclines)
What 2 medications are recommended for menstrual migraine prophylaxis
frovatriptan (2.5 mg twice a day)
zolmitriptan (2.5 mg twice or three times a day)
Acutely: mefanamic acid, aspirin, paracetamol, caffeine, triptans
What happens to gastric emptying with migraine
DELAYED gastric emptying with acute migraine attacks
Two meds that are first-line for spasticity in multiple sclerosis
Baclofen
Gabapentin (also useful for oscillopsia)
Treatment for acute relapse of multiple sclerosis
oral or IV methylprednisolone
5 drug options for multiple sclerosis maintenance
- Natalizumab
- Ocrelizumab
- Fingolimod
- B-interferon
- Glatiramer acetate
Meniere’s disease triad
vertigo
tinnitus (episodic)
sensorineural hearing loss
What cranial nerves and effects occur with acoustic neuroma (vestibular schwannoma)
CN 8: vertigo, unilateral SNHL, unilateral tinnitus
CN 10: absent corneal reflex
CN 12: facial palsy
Investigation for acoustic neuroma
MRI of the cerebellopontine angle
Complex regional pain management
- Physio
- Neuropathic analgesia (amitryptilline, pregabalin, gabapentin, duloxetine)
- Pain team
Which scoring system is most appropriate to use to evaluate whether a patient has had a stroke?
ROSIER score
DVLA rules for:
1. Seizure
2. 2nd seizure
3. TIA
4. Multiple TIAs
5. Craniotomy
6. Narcoplexy/cataplexy
- 1st seizure = 6 months
- 2nd seizure =12 months
- T1A = 1 month
- Multiple TIAs = multiple months = 3 months
- CraniotomYEAR = 1 year
- NOrcoplexy / CEAtaplexy = No/cease driving (until controlled)
autonomic dysreflexia most common triggers
faecal impaction
urinary retention
occurs with Hx of traumatic spinal cord (above T6) injury, bedbound
hypertension
flushing
sweating
above the level of the cord lesion
this is called…?
autonomic dysreflexia
What is the dose of rectal diazepam for seizures in:
Simplified to:
Neonate
<12yo
>12yo
Neonate = 1.25-2.5mg
<12yo = 5mg
>12yo = 10mg-20mg
What is the dose of midazolam oromucosal solution for seizures in:
1 year
1-4 years
5-9 years
>10 years
1 year = 2.5mg
1-4 years = 5mg
5-9 years = 7.5mg
>10 years = 10mg
Tremor difference in parkinson’s versus essential
Parkinson’s disease - resting tremor, goes away on movement
Essential - no resting tremor, occurs on movement/outstretch. Can affect voice.
Essential tremor is an autosomal dominant condition which affects both upper limbs:
1. postural tremor - worse if outstretched
2. improved by alcohol and rest
3. can affect the head
Treatment of essential tremor is…?
Propanolol
Primidone
Eye deviates down and out
Ptosis
Pupil may be dilated
What palsy
CN3 palsy
(same side CN lesion as the eye down and out)
Absence seizures - good prognosis: what percentage become seizure free in adolescence
90-95%
absence seizures are also called
petit mal
Rx sodium valproate and ethosuximide
Does a lower motor neurone facial nerve palsy (Bell’s palsy) affect the forehead or spare the forehead
LMN lesion AFFECTS the forehead (as facial nerve innervating both forehead and face sits more peripherally)
UMN lesion spares the upper face
Bell’s palsy - when to refer urgently to ENT if no improvement after what timeframe
If no improvement in paralysis AFTER 3 WEEKS
(plastic surgery referral after a 6-9 months)
Migraine and hormone replacement therapy (HRT) - what is recommendations
safe to prescribe HRT for patients with a history of migraine but it may make migraines worse
A 72-year-old man develops visual problems. He is noted to have a left homonymous hemianopia with some macula sparing.
Where is the lesion
Occipital cortex
Macula sparing lesions are in the occipital cortex!
Bitemporal hemianopia
(a) upper quadrant defect cause
(b) lower quadrant defect cause
(a) upper quadrant defect - pituitary tumour (inferior compression)
(b) lower quadrant defect - craniopharyngioma (superior compression)
Adenoma sebaceum (angiofibromas) butterfly distribution over nose is seen in which autosomal domninant neuro disease
Neurofibromatosis
Patient who has had an extensive stroke with right-sided hemiplegia, what side is the homonymous hemianopia
RIGHT SIDE
Remember: the homonymous hemianopia is always on the same side as the paresis.
what antibiotic can cause peripheral neuropathy
nitrofurantoin
Peripheral neuropathy is a known adverse effect of which antiepileptic
phenytoin
left homonymous hemianopia means visual field defect to the left has a lesion where?
LESION OF RIGHT OPTIC TRACT
Inferior homonymous quadrantanopia has a lesion in which lobe
Parietal lobe
Superior homonymous quadrantanopia has a lesion in which lobe
Temporal lobe
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, when should they be admitted /seen by stroke
IMMEDIATELY to exclude a haemorrhage
Without warfarin/DOAC, suspected TIA should be seen in 24 hours
What antiepileptic can cause megaloblastic anaemia
Phenytoin
as it alters folate metabolism
Acute treatment for tension headaches (3 drugs)
Aspirin
Paracetamol
Or NSAIDs
Prophylaxis for tension headaches if medications fail
Acupuncture - up to 10 sessions over 5-8 weeks
Paroxysmal hemicrania - headaches like cluster but more frequent episodes throughout the day. <30 mins episode.
What is the treatment
indomethacin
What % of patients with migraine have aura
25%
Restless legs syndrome - what is the most important blood test
Ferritin
Can be low
Restless leg syndrome treatment
- DA agonists e.g. pramipexole, ropinirole
- Gabapentin or pregabalin
- If sleep issues - use z-drugs or benzos short course
- Treat IDA, walk, stretch
Medication overuse headache - when to stop:
1. Simple analgesia + triptans
2. Opioid analgesia
- Simple analgesia + triptans - stop immediately
- Opioid analgesia - stop gradually
Eye palsy cranial nerves
LR6 SO4 R3
lateral rectus CN6 - inwards
Superior oblique CN4 - up and out
Rest CN3 - down and out
When can you stop anti-epileptics and how long should they be stopped over
Consider stopping if seizure free for >2 years, and stop the anti-epileptics over 2-3 months
A 14-year-old-girl attends along with her parents. They report that for the last month they have noticed occasional ‘twitches’ of her arms. These are more common early in the morning.
She should be referred to paediatric neurology urgently to investigate for
Juvenile myoclonic epilepsy
can present with absences and/or myoclonus (in upper limbs) before progressing to generalised seizures
Obese, young female with headaches / blurred vision
idiopathic intracranial hypertension
(papilloedema, CN6 palsy, headache)
Treatment for idiopathic intracranial hypertension (3 drugs)
Acetazolamide
Topiramate
Semaglitide
+ repeated lumbar puncture /surgery
5 medications that increase risk of idiopathic intracranial hypertension
- COCP
- Steroids
- Tetracyclines
- Retinoids
- Lithium
GCS scoring - score ranges
Motor
Verbal
Eye
Motor 1-6
Verbal 1-5
Eyes 1-4
A 75-year-old female presents with sensory loss to the little finger and wasting of the hypothenar eminence. What nerve has the likely lesion?
Ulnar nerve
Claw hand can occur with damage at wrist. Damage at elbow may not show claw.
Ulnar nerve is motor to
- Medial two lumbricals
- aDductor pollicis
interossei - hypothenar muscles
- flexor carpi ulnaris
Treatment for maintenance after stroke/TIA occurs
Clopidogrel 75mg OD + statin (after aspirin 300mg)
If not tolerated, give aspirin 75mg OD + dipyridamole MR 200mg BD (or separately if unable to tolerate one)
Laughter with fall/collapse is called
Cataplexy
typically triggered by strong emotions such as laughter, anger or surprise. usually a/w narcolepsy
Post-herpetic neuralgia treatment
- Amitriptyline
OR chronic neuropathic pain meds:
Duloxetine/ gabapentin / pregabalin
A rare but recognised adverse effect of lamotrigine therapy is
Stevens Johnsons syndrome
Reflex roots for
Ankle
Knee
Biceps
Triceps
Ankle - S1-S2
Knee - L3-L4
Biceps - C5-C6
Triceps - C7-C8
What do NICE recommend for migraine prevention if both topiramate and propranolol have been ineffective after 2 months or are unsuitable
Offer 10-sessions of acupuncture over 5-8 weeks
Riboflavin 400mg OD
Consider what medication to manage drooling of saliva in people with Parkinsons
glycopyrronium bromide
What medication is useful for managing tremor in drug-induced parkinsonism
Procyclidine
What parkinsons drugs are associated with pulmonary fibrosis
Dopamine agonists (first generation)
e.g. cabergoline, bromocriptine
For multiple sclerosis, does the typical (female, young age, relapsing remitting) or atypical patient (male, old, short interval between relapses) carry the worse prognosis
Atypical patient
(male etc)
carries the worse prognosis
What muscles are often spared in motor neurone disease
Extraocular eye muscles
No cerebellar or sensory signs in motor neuron disease!
What vitamin do NICE advocate as being useful in the prophylaxis against migraine?
Riboflavin
Vitamin B2
400mg OD
Frozen shoulder has what limited movement of the shoulder
external rotation
Which is the only cholinesterase inhibitors (out of rivastigmine, donepezil and galantamine) that is licensed for use for Parkinson’s disease and can help cognitive impairment
Rivastigmine
rare but important adverse effect of topiramate
acute myopia and secondary angle-closure glaucoma
Carbamazepine is generally ineffective in which type of seizures
Absence seizures
Cardiovascular disease is a contraindication to which headache medication
Triptans
normal pressure hydrocephalus triad
urinary incontinence
gait abnormality
dementia
Muscle wasting of the hands
Numbness and tingling
Painful neck
Headache
What is the likely cause
Thoracic outlet syndrome
Median nerve (carpal tunnel) injury affects what motor hand muscles (LOAF)
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Sensory = over thumb and 2nd, 3rd finger
multiple sclerosis tingling in hands when neck flexes
What is this an example of?
Lhermitte’s sign
also seen in cervical stenosis, subacute degen of cord
Saturday night palsy is caused by compression of what nerve
Radial nerve against humeral shaft
Hard to extend wrist
The dementia specialist commences an elderly lady with a diagnosis of severe Alzheimers dementia on a medication to treat her cognitive impairment. Which drug does NICE recommend for severe Alzheimers disease?
memantine
mild to moderate Alzheimer’s disease management medication options
Acetylcholinesterase (AChE) inhibitors:
donepezil
galantamine
rivastigmine
Donepezil is a medication to treat Alzheimers disease. One of the possible side effects of the acetylcholinesterase inhibitors (donepezil, rivastigmine and galantamine) is…
bradycardia
what are the 4 rotator cuff mucles
SItS
Supraspinatus
Infraspinatus
teres minor
Subscapularis
What are actions of supraspinatus
ABDUCTs arm
most commonly injured
What are actions of infraspinatus
rotates arm laterally
What are actions of teres minor
ADDUCTS arm
Rotates arm laterally
What are actions of subscapularis
ADDUCTs arm
Rotates arm medially
what score is used to assess severity of OA of the hip
Oxford hip score
what investigation is first line for hip osteoarthritis
plain x-rays
4 peri-operative and 3 post-operative complications of total hip replacement
PERI-OPERATIVE:
1. VTE
2. Fracture
3. Nerve injury
4. Infection
POST-OPERATIVE:
1. Leg length discrepancy
2. Posterior dislocation - presents with pain and ‘clunk’, internal rotation + shortening
3. Aseptic loosening with infection
What is the most common reason for revision of a hip replacement
Aseptic loosening
+/- prosthetic joint infection
which patient should receive migraine prophylaxis
if migraines are having significant impact on QoL and daily function, or occur frequently (more than once a week) or are prolonged + severe despite optimal acute treatment
Sudden-onset intense unilateral pain
Red/watering eyes
Blocked or runny nose
Extreme agitation
Everyday, lasting 4-12 weeks
what type of headache
cluster headache
Rx = sumitriptan or inhaled oxygen
Lennox-Gastaut syndrome may be an extension of infantile spasms. What dietary treatment can help?
Ketogenic diet
Juvenile myoclonic epilepsy (Janz syndrome) in teen girls usually has daytime absences, sudden shocks, then seizures.
What is the treatment?
Sodium valproate
First line tretament for parkinson’s disease if the motor symptoms are affecting patient’s quality of life
Levodopa
First line tretament for parkinson’s disease if the motor symptoms are NOT affecting patient’s quality of life
DA agonist (non-ergot derived); or
Levodopa; or
Monoamine oxidase B (MAO-B) inhibitor
What are the 2 risks if parkinson’s medication is not taken or not absorbed e.g. gastroenteritis
Acute akinesia
Neuroleptic malignant syndrome
Levodopa is nearly always combined with what
Decarboxylase inhibitor
e.g. carbidopa or benserazide
prevents peripheral metabolism of levodopa to DA
‘on-off’ phenomenon with levodopa
Normal motor in ‘on’ period
Restricted poor mobility in ‘off’ period
dyskinesias with levodopa
occur at peak dose
dystonia, chorea and athetosis - involuntary writhing movements
examples of dopamine receptor agonists used in Parkinson’s disease
Bromocriptine
Ropinirole
Cabergoline
Dopamine receptor agonists used for parkinson’s disease e.g. bromocriptine, cabergoline have been associated with what adverse effects
Pulmonary and cardiac fibrosis
Dopamine receptor agonists used for parkinson’s disease e.g. bromocriptine, cabergoline are associated with pulmonary and cardiac fibrosis.
What monitoring needs to be done for these treatment?
Echocardiogram
ESR
Creatinine
CXR
Before treatment, then monitor closely
What are the options for Parkinson’s treatment medications
- Levodopa + carbidopa
- DA receptor agonist e.g. bromocriptine, cabergoline
- MAO-B inhibitor e.g. selegiline
- COMT inhibitor
- anti-muscarinics
what is the longest duration of aura before migraine that is considered normal by NICE and British Association for the Study of Headache (BASH)?
5 mins to 1 hour
Typical migraine auras include what usually
transient hemianopic disturbance or a spreading scintillating scotoma (‘jagged crescent’)
NICE states which 5 aura symptoms are atypical and prompt further investigation or referral
- motor weakness
- double vision
- visual symptoms affecting only 1 eye
- poor balance
- decreased consciousness
Bell’s palsy symptoms
This is a LMN lesion which affects the forehead.
LMN facial nerve palsy
Post-auricular pain
Altered taste
Dry eyes
Hyperacusis
Management of Bell’s palsy
- Prednisolone
- Eye care - eyedrops + lubricants
- If no improvement after 3 weeks - refer to ENT
What does median nerve innervate in the hand for sensory function?
Over thumb and lateral 2.5 fingers
Palm
Good prognosis features of multiple sclerosis
Female sex
Age - young onset
Relapsing-remitting disease
Sensory symptoms ONLY
Long interval between first two relapses
Complete recovery between relapses
What analgesia is contraindicated in children
Aspirin
- due to risk of Reye’s syndrome (encephalopathy with liver, kidney, pancreases infiltration)
What is the most common psychiatric problem with Parkinson’s disease?
Depression
Parkinson’s disease is due to degeneration of dopaminergic neurons in what region
substantia nigra
Drug-induced parkinsonism has slightly different features to Parkinson’s disease such as:
- Motor symptoms are rapid onset and bilateral
- Rigidity and rest tremor are uncommon
If there is difficulty differentiating between essential tremor and Parkinson’s disease, NICE recommend considering what investigation
SPECT (123 I-FP-CIT single PET CT scan)
3rd nerve palsy
What are the 3 main features
Eye is down and out
Ptosis
Pupil may be dilated (surgical)
Causes of 3rd nerve palsy (down and out, ptosis, dilated if surgical)
Diabetes
Vasculitis e.g. GCA, SLE
Aneurysm
Weber’s syndrome
Patients with ischaemic stroke are given 300mg aspirin (then maintenance 75mg clopidogrel).
Some patients however are eligible for thrombolysis with alteplase instead - what are the 2 criteria for this?
- Administered within 4.5 hours of stroke symptoms onset
- Haemorrhage excluded with imaging
Management of acute stroke
Imaging to ensure not haemorrhagic, then:
1. 300mg aspirin PO/PR; 2. Thrombolysis with IV alteplase - within 4.5hours
3. Mechanical thrombectomy - within 6-24 hours (+ thrombolysis with alteplase)
then 75mg clopidogrel + statin thereafter when discharged +/- carotid atery endarterectomy
NICE recommend that all decisions about thrombectomy of ishcaemic stroke should take into account a patient’s overall clinical status. What scores and thresholds does it recommend?
Pre-stroke functional status of less than 3 on modified Rankin scale
and
Score of more than 5 on National Institutes of Health Stroke Scale (NIHSS)
When should thrombectomy be offered for patients with stroke?
- Proximal anterior circ stroke - within 6 hours
- Proximal anterior circ stroke with potential to salvage brain tissue - between 6-24 hours
- Proximal posterior circ stroke - within 4.5hours
Carotid artery endarterectomy is recomended to patients if they have suffered stroke/TIA in carotid territory and are not severely disabled. It should be considered if stenosis is above what?
> 70% ECST criteria
50% NASCET criteria
degenerative cervical myelopathy gold standard test
MRI of cervical spine
Guillain-Barre syndrome is an immune-mediated demyelination of peripheral nervous system often triggered by what infection
Campylobacter jejuni
Weakness in Guillain-Barre syndrome usually has what pattern
Ascending
Progressive
Symmetrical
What do patients on sodium valproate need to do every year for the valproate pregnancy prevention programme
See epilepsy specialist once a year for an Annual Acknowledgement of Risk form
What is the strongest risk factor for developing Bell’s palsy
Pregnancy
What cancer is myasthenia gravis linked to
Thymomas
What investigations can be done for myasthenia gravis?
- EMG
- CT chest - to rule out thymomas
- Bloods - antibodies to ACh receptors, normal CK
- Tensilon test
Neuroleptic malignant syndrome is usually seen in patients who have just started treatment or who have been taking it for a while?
Just started treatment!
Occurs within hours to days (slower onset)
Neuroleptic malignant syndrome treatment
Stop antipsychotic
IV fluids
Dantrolene
Bromocriptine (DA agonist)
Ulnar nerve is sensory to which part of the hand
Medial 1.5 fingers
Palmar and dorsal aspects
Triptans adverse effects - what are triptan sensations
Tingling
Tighteness of throat and chest
Heaviness + pressure
In a patient with a Bell’s palsy, severe pain might indicate what..?
Ramsay Hunt syndrome
What type of Parkinson’s disease medications has been most linked with impulse control disorders?
Dopamine receptor agonists
4th nerve palsy features
Eye is upwards and out
Head tilt
Torsional diplopia
CN4 supplies SO - this depresses eye and moves inwards usually
CN4 supplies what eye muscle
superior oblique
Foot drop
Frequently sprained ankles
High arched feet (pes cavus)
Distal muscle atrophy and weakness
Hyporeflexia
Stork leg deformity
what is the diagnosis
Charcot-Marie-Tooth disease
4 indications of cannabis based medicinal products
- chemotherapy nausea
- chronic pain
- spasticity in MS
- severe treatment resistant epilepsy
