NEURO Flashcards

1
Q

Management of Cluster Headache

A

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

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2
Q

features of cluster headache

A

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

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3
Q

In ischaemic stroke, when is thrombectomy indicated?

A

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

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4
Q

immediate medical management of ischemic stroke

A

aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded
Thrombolysis within 4. 5 hrs

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5
Q

treatment of trigerm inal neuralgia

A

carbamazepine is first-line

failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology

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6
Q

Ankle reflex roots?

A

S1-S2

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7
Q

knee reflex roots

A

.L3-L4

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8
Q

Ankle knee Biceps triceps reflex herve root?

A

AnkleS1-S2KneeL3-L4BicepsC5-C6TricepsC7-C8

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9
Q

Dopamine receptor agonists

e.g.bromocriptine,ropinirole,cabergoline,apomorphine

sE?

A

pulmonary, retroperitoneal and cardiac fibrosis

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10
Q

Levodopa common side effects

A

dry mouth

anorexia

palpitations

postural hypotension

psychosis

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11
Q

features of essential tremor

A

postural tremor: worse if arms outstretched

improved by alcohol and rest

most common cause of titubation (head tremor)

Management

propranolol is first-line

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12
Q

management of motor neurone discare

A

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

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13
Q

Hoffmans sign

A

positive result is exaggerated flexion of the terminal phalanyx of the thumb.
DCM

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14
Q

Stroke secondary prevention

A
  1. clopidogrel in people who have had an ischaemic stroke
  2. aspirin plus MR dipyridamole if clopidogrel is contraindicated
  3. 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
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15
Q

Alzheimers mx

A

Mild to moderate : Ach inhibitors (donepezil,galantamineandrivastigmine)
Second line memantine (NMDA receptor antagonist)

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16
Q

Common personal nerve lesion features

A

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

17
Q

Features of sciatic nerve lesion

A

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

18
Q

Homes adieu pupils features

A

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

19
Q

Try geminal neurology management

A

carbamazepine is first-line
failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology

20
Q

Ramsay hunt mx

A

oral aciclovir and corticosteroids are usually given

21
Q

Ramsay hunt features

A

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

22
Q

Bell’s palsy features

A

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

23
Q

Bell’s
palsy management

A

eye care
oral prednisolone
most people with Bell’s palsy make a full recovery within 3-4 months

24
Q

How is Huntingtons disease inherited

A

defect in the huntingtin gene on chromosome 4
Autosomal dominant

25
Q

TACI

A

ALL Of
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

26
Q

PACI

A

2/3 of
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg

  1. homonymous hemianopia
  2. higher cognitive dysfunction e.g. dysphasia
27
Q

LACI

A

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

28
Q

POCI

A

involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

29
Q

What features suggest stroke > TIA

A

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

30
Q

Differentiate between ramsay hunt and shingles

A

shingles rash has vesicles - so you see shingles on the face and shingles in the ear. Ramsey hunt is just shingles in CN VII

31
Q

MS Ix

A

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