neuro 2 Flashcards
MG treatment
(3)
temporary symptom relief
- long acting acetylcholinesterase inhibitor= Pyridostigmine (1st line)
myasthenic crisis (resp muscles)
- Plasmapheresis and IV immunoglobulin
immune suppression to prevent relapses
- prednisolone
cluster headache
- prophylaxis
- acute rescue
Verapamil
sumitriptan + oxygen
migraine
- prophylaxis
- acute rescue
propanolol / topirimate / riboflavin / triptan / acupuncture
triptan and NSAID/ paracetemol
stroke in Anterior cerebral artery ACA
Contralateral hemiparesis and sensory loss, lower extremity > upper
Stroke in middle cerebral artery MCA
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
aphasia
Stroke in posterior cerebral artery PCA
Contralateral homonymous hemianopia with macular sparing (central vision ok)
Visual agnosia (can’t recognise objects, faces fine)
+/- Webers syndrome (branch off PCA to midbrain)
- Ipsilateral CN III palsy
- Contralateral weakness of upper and lower extremity
basilar artery stroke
locked in syndrome
stroke in Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
stroke in Anterior inferior cerebellar artery (lateral pontine syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Ipsilateral: facial paralysis and deafness
how to distinguish idiopathic vs iatrogenic PD
idiopathic - asymmetrical
iatrogenic - symmetrical
suspected TIA
- what next
aspirin 300mg asap
(unless already on asprin low dose, just continue, if patient has a bleeding disorder/ is taking an anticoagulant)
if patient has bleeding disorder/ is taking an anticoagulant –> urgent CT to exclude haemorrhage
referal to TIA clinic
(because TIA is imaging based, not time based, all need scan/ follow up)
- within 24h if suspected TIA in last week
- within 7d if suspected TIA over a week ago
if crescendo TIA (more than 1) –> urgent admission and specialist review
possible carotid doppler/ ECG later on
long term - clopidogrel 1st line. (aspirin + dipyridamole if not)
carotid endartectomy if 70% carotid stenosis and not severly disabled
lacunar infarct
1 of the following:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke.
- ataxic hemiparesis
total anterior circulation infarct
partical anterior circulation infarct
anterior and middle cerebral arteries
(Total) - 3 of
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
2 of them (partial)
posterior circulation infarct
vertebrobasilar arteries
1 of
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
alcohol withdrawal timeframe
- symtpoms
- seizures
- delerium tremens
- symtpoms 6-12h
- seizures 36h
- delerium tremens 72h
A painful 3rd nerve palsy is what until proven otherwise
posterior communicating artery aneurysm
would also give meningism
pontine stroke
reduced GCS,
paralysis- often all limbs
bilateral pin point pupils (miosis)
absent horizontal eye mvmts
normal pressure hydrocephalus
- triad
- imaging
urinary incontinence
gait issue/ ataxia
declining cognition
wobbly, whacky, wet
ventricles englarged, without or not proportionate to sulcal enlargement
ramsay hunt syndrome
- cause
- features
- tx
VZV in CN7
like bells palsy but also ear pain/ hearing symptoms (vertigo, tinnitus)/ ear rash
tx: steroids and aciclovir
what type of stroke is fluctuating conciousness/ confusion typical of
subdural
korsakoff triad
wernickes triad
korsakoff
1. confabulation
2. anterograde amnesia
3. retrogreade amnesia
wernickes
1. encephalopathy (confusion)
2. ataxia
3. opthalmoplegia ( nystagmus, eye palsy)
prolactinoma triad
headaches
amenorrhea
visual defects
labyrinthitis vs vestibular neuronitis
both
- vertigo
- n/v
- recent infection
labyrinthitis
- hearing loss
- tinnitus
vestibular neuronitis
- nystagmus
