Neuro Flashcards
difference between ischaemia and infraction
ischaemia= reduced tissue supply
infarction= death of tissue due to reduced blood supply
what tool is use to identify stroke in an acute medical setting
ROSIER
how are TIAs mx
start 300mg aspirin daily
refer to a specialist TIA clinic within 24 hrs (within 7 days if it was more than 7 days ago)
diffusion weighted MRI scan to image
how are TIAs imaged
diffusion weighted MRI scans
how is aspirin given in suspected stroke
300 mg daily for 2 weeks
start after haemorrhage excluded by CT
how is blood pressure managed in a stroke
blood pressure is not lowered in ischaemic stroke
blood pressure is agressively lowered in haemorrhagic stroke
alteplase moa
tissue plasminogen activator
in what time frame of presentation is thrombectomy done for stroke
within 4.5 hrs
when is thrombectomy indicated in stroke
complete block of the posterior or anterior circulation
what 2 conditions are screened for when someone has a IA or stroke
carotid artery stenosis
AF
secondary prevention of stroke
ABCD
atorvastatin 20-80mg
blood pressure control
clopidogrel 75mg daily
diabetes control
what dose of statin is given in secondary prevention of stroke and when
20-80mg atorvastatin
not immediately delay by 48 hrs
what is given for secondary preventation of stroke/TIA when clopidogrel cant be given
aspirin plus dipyrimadole
blood vessel implicated in extradural haemorrhage
middle meningeal artery
blood vessels implicated in subdural haemorrhage
bridging veins
when is CT reliable for imaging in an SAH
first 6 hrs
after this its less reliable
how many hrs after CT head should lumbar puncture be done in SAH
after 12 hrs (to allow for build up of bilirubin)
what medication is given after SAH to prevent vasospasm
nimodipine
what part of the nervous system does multiple sclerosis affect
central
specifically oligodendrocytes
symptoms of optic neuritis
unilateral loss of vision
enlarged blind spot (central scotoma)
opthalmoplegia
red desaturation (impaired colour vision)
relative afferent pupillary defect
what is RAPD
when the pupillary light reflex is reduced when shining a light into the affected eye, but the consensual reflex in the affected when shining a light into the normal eye is normal
causes of optic neuritis
MS
sarcoidosis
SLE
measles/mumps
lyme disease
syphilis
optic neuritis mx
high dose steroids
what is intranuclear opthalmoplegia
a lesion in the medial longitudinal fasciculus (connects the cranial nerve nuclei that control eye movements)
there is impaired adduction in the affected eye and nystagmus in the contralateral eye
what eye movement abnormality is seen in intranuclear opthalmoplegia
inability to adduct the affected eye and nystagmus on abduction in the other eye
lhermittes sign
electric shock like pain down the spine when flexing the neck- occurs due to demyelination in the spine in MS
2 types of ataxia
sensory
cerebellar
what sign is positive in sensory ataxia
rombergs
a lesion in what spinal column causes sensory ataxia
dorsal column
lumbar puncture results in MS
may find oligoclonal bands
what is progressive bulbar palsy
a type of motor neurone disease that primarily affects the muscles of talking and swallowing
what medication can be given in MS to slow progression
riluzole
what is affected in MND
upper and lower motor neurones
triad of parkinsons disease
resting tremor
bradykinesia
rigidity
tremor in parkinsons disease
unilateral
pill rolling
worse when distracted/nit using the hand
what is rigidity
resistance to the passive movement of a joint
how does alcohol affect a benign essential tremor
improves with alcohol
what are the 4 parkinsons plus syndromes
multiple system atrophy
progressive supranuclear palsy
dementia with lewy bodies
corticobasal degeneration
main side effect of levodopa
dyskinesia
this could be dystonia, athetosis or chorea
what can be given with levodopa to reduce dyskinesia sx
amantadine
what are COMT inhibitors
they reduce the metabolisation of levodopa
used in parkinsons
prolonged use of dopamine agonists can cause
pulmonary fibrosis
monoamine oxidase b inhibitors moa
reduce the breakdown of dopamine, serotonin adrenaline
used in parkinsons
dopamine agonist examples
bromocriptine
cabergoline
COMT inhibitors example
entacapone
monoamine oxidase b inhibitors
selegiline
rasagiline
medications for benign essential tremor
propanolol
describe a benign essential tremor
a bilateral symmetrical tremor
worse on intentional movement
better with alcohol
worse with caffeine, stress, tired
not present when asleep
differentials for tremor
benign essential tremor
parkinsons
MS
hyperthyroidism
huntingtons chorea
antipsychotics
are patients awake and aware in focal seizures
awake yes
aware if simple, not aware if complex
describe a tonic clonic seizure
period of muscle tensing followed by a period of muscle jerking
describe a myoclonic seizure
sudden brief muscle contractions, patients are awake
describe a tonic seizure
sudden onset increased muscle tone, may result in a fall
describe an atonic seizure
sudden loss in muscle tone, often results in a fall
what are infantile spasms also known as
west syndrome
what is found on EEG in infantile spasm
hypsarrhythmia
seizure medications for men/ non child bearing women
sodium valproate first line apart from
lamotrigine/ levitiracetam for focal seizure
ethosuximide for absence seizure
seizure medications for women
lamotrigine first line apart from
levitiracetam for myoclonic seizure
ethosuximide for absence seizure
sodium valproate moa
increases GABA
benzo options and dosing for status
rectal diazepam (10mg)
buccal midazolam (10mg)
IV lorazepam (4mg)
status mx
2 x benzo
1 x IV infusion (phenytoin/kepra/sodium valp)
GA or phenobarbitol
definition of status
seizure lasting over 5 mins
multiple seizures without regaining consciousness
examples of weak opioids
codeine
tramadol
examples of strong opioids
morphine
oxycodone
fentanyl
buprenorphrine
what can be given for chronic primary pain
antidepressants
avoid the use of paracetamol, NSAIDs, opiates, anti epileptics
treatments for neuropathic pain and how they are given
amitriptyline
gabapentin
duloxetine
pregabalin
only use them as monotherapy
how do vessels over the optic disc look in papilloedema
they will be curved as they are travelling over a raised surface- usually they are flat as they are travelling over a flat surface
bilateral acoustic neuromas are associated with
neurofibromatosis type 2
