NEURO Flashcards
A patient has a suspected TIA that has fully resolved. When should these patients be admitted immediately for imaging and what is the imaging aiming to exclude?
DOAC / warfarin / bleeding disorder
Exclude haemorrhage
MOA of ondansetron:
5-HT3 antagonist
Tramadol has a dual MOA:
Weak opioid agonist
SNRI
Best opioid option for managing neuropathic pain when standard treatment options have failed.
Neuropathic pain 1st line drugs:
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
SWITCH don’t add, monotherapy is best
Topical capsaicin can be used for localised neuropathic pain
Who does autonomic dysreflexia develop in?
Patients who have had spinal cord injury at or above level of T6
Features of autonomic dysreflexia, and one complication:
Extreme hypertension
Flushing and sweating above level of cord lesion
Agitation
Consequence of HTN = haemorrhagic stroke
Pathophysiology of autonomic dysreflexia:
Afferent signals, usually triggered by fecal impacting or urinary retention, cause sympathetic spinal reflex via thoracolumbar outflow.
The usual centrally mediated parasympathetic response is prevented by the cord lesion.
Imaging in TIA:
MRI is preferred
Do NOT do CT unless haemorrhage is a concern for a patient on anticoagulants
Carotid imaging in people who are NOT severely disabled - duplex US / CT angio / MR angio
Most common cause of encephalitis in adults, and which lobes are typically affected, and investigations?
HSV-1
Temporal and inferior frontal
CSF; lymphocytosis, protein elevated, PCR for HSV, VZV and enteroviruses
Gold standard test for suspected cervical myelopathy:
MRI C-spine
NO ROLE FOR XR
Degenerative cervical myelopathy presenting symptoms:
Pain in neck, upper or lower limbs
Loss of digital dexterity
Loss of sensory function causing numbness
Loss of autonomic function e.g. urinary / bowel incontinence / impotence
Hoffman’s sign
Causes / associations of mononeuritis multiplex:
RA
SLE
Polyarteritis nodosa
Diabetes
Sarcoidosis
Leprosy
Amyloidosis
GPA
Migraine prophylaxis:
Propanolol
Topiramate NOT if child bearing age though
Amitriptyline
Acute treatment of migraine first line:
Triptan + NSAID or paracetamol
12-17 = nasal triptan
+ ?non-oral metoclopramide / prochlor / NSAID or triptan
Ineffective migraine treatment may be considered for injectable measures, very last line. Which targets do these drugs go for?
Botox
CGRP receptor e.g. erenumab
There are specific localising features of focal seizures which can be useful to remember. Give localising symptoms / signs of a temporal lobe focal seizure:
Aura - rising epigastric sensation, deja vu, more rarely hallucinations (not visual)
Automatisms during seizure e.g. lip smacking, plucking, grabbing.
May occur with or without impairment of consciousness.
A patient is known to have had a focal seizure. Their only complaint was paraesthesia - what location of the brain was most likely affected?
Parietal lobe
A patient presents with a focal seizure of head/leg movements, posturing, post-ictal weakness and a Jacksonian march. Where was the likely lesion?
Frontal lobe
