Neuro

Question 1

Lumbar puncture can lead to what if increased ICP?

Answer 1

Cerebral herniation (caused eg by a space occupying lesion)

Question 2

Signs of meningism

Answer 2

Neck stiffness
Photophobia
Kernig’s sign (stiff knees to extension)
Brudzinski’s sign (flexion of hips when patient flexes neck)

Question 3

Migraine management

Answer 3

Conservative: Headache diary, avoid precipitating factors

Acute medical treatment: 
Sumatriptan (5HT agonist)
NSAID (naproxen)
Codeine
Antiemetics 

Prophylactic medical treatment
1st line: Propanolol or topiramate (anticonvulsant)
2nd line: Amitriptyline

(Beware of medication overuse)

Question 4

Signs of raised ICP

Answer 4

Vomiting 
Drowsiness
Irritability 
Seizures
Papilloedema
Focal neurology

Question 5

Causes of raised ICP

Answer 5

SOL (tumour, abscess, haemorrhage)
Hydrocephalus
Trauma

Question 6

SAH presentation

Answer 6

Sudden, thunderclap, usually occipital
Signs of meningism
Signs or raised ICP
Very severe and continuous

Question 7

SAH causes

Answer 7

Berry aneurysm at junction of circle of Willis
(Risk increased with Hx of FH of polycystic kidney disease)
Other risk factors: alcohol, smoking, HTN

Question 8

Subdural haemorrhage presentation

Answer 8

Gradual onset
Sleepiness, personality change
Continuous

Question 9

Subdural haemorrhage risk factors

Answer 9

Trauma

Advanced age

Question 10

Subdural or epidural haemorrhage investigation to order

Answer 10

Urgent non-contrast CT scan

Question 11

Epidural haemorrhage presentation

Answer 11

Acute onset following lucid interval

Deterioration of GCS (history of direct trauma to the head)

Question 12

Epidural haemorrhage vs subdural haemorrhage

Answer 12

Epidural: Collection of blood between the dura and periosteum. This build up is acute and the blood is arterial.

Subdural haemorrhage: Collection of blood between the dura and arachnoid coverings of the brain. This build up is usually gradual and the blood is usually venous.

Question 13

SAH investigations

Answer 13

Urgent CT scan within 12 hours

LP within 12 hours

Question 14

Encephalitis commonest causative organisms

Answer 14

No1 HSV
Others: ,CMV, EBV, HIV, VZV

Non-viral: any bacterial meningitis, TB

Question 15

Encephalitis presentation

Answer 15

Altered behaviour
Decreased GCS/coma
Fever
Focal signs
Seizures

If CT shows cerebral oedema –> Medical emergency

Question 16

Meningitis causative organisms

Answer 16

Neisseria meningitidis (meningococcus)
Strep pneumoniae

Question 17

What is Status Epilepticus

Answer 17

Emergency
Continuous seizure or serial discrete seizures between which there is incomplete recovery of consciousness of at least 30 minutes duration

Question 18

Status Epilepticus Management

Answer 18

ABC approach (maintain airway)
Oxygen 100%
Stop seizures- slow IV Bolus Lorazepam 2-4mg again if no response in 10 minutes

Continuing seizures-> IV infusion Phenytoin/Diazepam

Correct hypoglycaemia or hyponatraemia if present

Question 19

Down’s syndrome is associated with which form of dementia?

Answer 19

Alzheimer’s dementia

Question 20

Alzheimer’s dementia 5 As

Answer 20

Amnesia
Anomia
Apraxia
Aphasia
Agnosia

Question 21

Type of seizure associated with impaired consciousness and feelings of unreality, deja vu, or depersonalisation

Answer 21

Complex partial seizure (these are features of temporal lobe seizure that is often complex but can also be simple)