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)