NEURO Flashcards
Management of Cluster Headache
acute
100% oxygen (80% response rate within 15 minutes)
subcutaneous triptan (75% response rate within 15 minutes)
prophylaxis
verapamil is the drug of choice
there is also some evidence to support a tapering dose of prednisolone
features of cluster headache
intense sharp, stabbing pain around one eye
pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
the patient is restless and agitated during an attack due to the severity
clusters typically last 4-12 weeks
accompanied by redness, lacrimation, lid swelling
nasal stuffiness
miosis and ptosis in a minority
In ischaemic stroke, when is thrombectomy indicated?
proximal anterior circulation stroke
- within6 hours of symptom onset, togetherwith intravenous thrombolysis (if within 4.5 hours) for
- last known to be well between6 hours and 24 hours previously and potential to salvage brain tissue
immediate medical management of ischemic stroke
aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded
Thrombolysis within 4. 5 hrs
treatment of trigerm inal neuralgia
carbamazepine is first-line
failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology
Ankle reflex roots?
S1-S2
knee reflex roots
.L3-L4
Ankle knee Biceps triceps reflex herve root?
AnkleS1-S2KneeL3-L4BicepsC5-C6TricepsC7-C8
Dopamine receptor agonists
e.g.bromocriptine,ropinirole,cabergoline,apomorphine
sE?
pulmonary, retroperitoneal and cardiac fibrosis
Levodopa common side effects
dry mouth
anorexia
palpitations
postural hypotension
psychosis
features of essential tremor
postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)
Management
propranolol is first-line
management of motor neurone discare
Riluzole
prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months
Respiratory care
non-invasive ventilation (usually BIPAP) is used at night
studies have shown a survival benefit of around 7 months
Nutrition
percutaneous gastrostomy tube (PEG) is the preferred way to support nutrition and has been associated with prolonged survival
Prognosis
poor: 50% of patients die within 3 years
Hoffmans sign
positive result is exaggerated flexion of the terminal phalanyx of the thumb.
DCM
Stroke secondary prevention
- clopidogrel in people who have had an ischaemic stroke
- aspirin plus MR dipyridamole if clopidogrel is contraindicated
- MR dipyridamole alone is recommended after an ischaemic stroke only if aspirin or clopidogrel are contraindicated or not tolerated, again with no limit on duration of treatment
Alzheimers mx
Mild to moderate : Ach inhibitors (donepezil,galantamineandrivastigmine)
Second line memantine (NMDA receptor antagonist)
Common personal nerve lesion features
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial muscles
Features of sciatic nerve lesion
sciatic nerve is supplied by L4-5, S1-3
divides into tibial and common peroneal nerves
motor: paralysis of knee flexion and all movements below knee
sensory: loss below knee
reflexes: ankle + plantar lost, knee jerk intact
Homes adieu pupils features
unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light
Holmes-Adie syndrome
association of Holmes-Adie pupil with absent ankle/knee reflexes
Try geminal neurology management
carbamazepine is first-line
failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology
Ramsay hunt mx
oral aciclovir and corticosteroids are usually given
Ramsay hunt features
Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
Features
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
Bell’s palsy features
lower motor neuron facial nerve palsy → forehead affected
in contrast, an upper motor neuron lesion ‘spares’ the upper face
patients may also notice
post-auricular pain (may precede paralysis)
altered taste
dry eyes
hyperacusis
Bell’s
palsy management
eye care
oral prednisolone
most people with Bell’s palsy make a full recovery within 3-4 months
How is Huntingtons disease inherited
defect in the huntingtin gene on chromosome 4
Autosomal dominant
TACI
ALL Of
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
PACI
2/3 of
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
LACI
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
POCI
involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
What features suggest stroke > TIA
The definition of a TIA is now tissue-based, not time-based: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
Differentiate between ramsay hunt and shingles
shingles rash has vesicles - so you see shingles on the face and shingles in the ear. Ramsey hunt is just shingles in CN VII
MS Ix
MRI
high signal T2 lesions
periventricular plaques
Dawson fingers: often seen on FLAIR images - hyperintense lesions penpendicular to the corpus callosum
CSF
oligoclonal bands (and not in serum)
increased intrathecal synthesis of IgG
