Neuro Flashcards
Parkinsons Management
Levodopa + decarboxylase inhibitor (co-beneldopa)
MAO-B selegiline
oral dopamine agnoists - ropinirole
PT, OT, SALT
Huntingtons disease patho
repeat of CAG on chromosome 4
autosomal dominant
Huntingtons presentation and investigations
middle age
mildly psychotic -> chorea -> personality changes (aggressive) -> dementia -> seizures -> death (15 years after diagnosis)
clinical diagnosis
CT shows caudate nucleus atrophy in later disease
Huntingtons management
symptomatic
chorea - benzos, valproic acid, tetrabenazine
?anti-psychotics
genetic counselling
MS investigations
MRI
LP - oligoclonal bands
Electrophysiological tests - prolonged evoked potential
MND types and symptoms
1) amyotrophic lateral sclerosis
- UMN and LMN
- fronto-temporal dementia
2) Progressive bular palsy
- UMN and LMN
- dysarthria, dysphagia, tongue fasciculations
3) progressive muscular atrophy
- LMN
- wasting and fasculations of hand small muscles
4) Primary lateral sclerosis
- UMN
- tetraparesis
MND ix and Mx
Ix: clinical diagnosis, EMG(electromyography) /nerve conduction
Mx: riluzole, baclofen
ALS diagnostic criteria
- Signs of LMN degen
- Signs of UMN degen
- Progressive spread of signs
- All without other cause
Which CN are affected in progressive bulbar palsy MND?
CN 9-12
Bacterial, viral, neonatal, preg, causative organisms for meningitis
bacterial - neisseria meningitides, strep pneumonia, mycobacterium TB
viral - enterovirus, poliomyelitis
Neonates- E.coil, GpB haemolytic strep
Preg/older - listeria monocytogenes
Chronic and viral meningitis presentations
viral = self limiting 4-10 days
chronic = long Hx headache, anorexia, vomiting, weary
CSF findings meningitis
bacterial: neurophils, raised protein, low glucose
Viral: lymphocytes, normal protein and glucose
TB: lymphocytes, raised protein, low/normal glucose
Meningitis management
IV cefotaxime, benpen if in community
+ampicillin to cover listeria if older patient
?meningococcal sept ASAP benpen or cefotaxime IV and blood culture to confirm
Prophylaxis: rifampicin or ciprofloxacin
Encephalitis causes
viral
herpes simplex, EBV, mumps
Encephalitis presentation
viral infection (fever, headache, nausea, drowsy)
-> decreased conc, focal neuro signs
seizures, coma, death
Encephalitis investigations
LP and CSF
Lymphocytes, raised protein, normal/low glucose
EEG- slow wave activity
Encephalitis management
ASAP acyclovir IV 2 /52
benpen ? meningitis
Migraine management
triptan (sumatriptan) + NSAID/para ±anti emetic
-BB or topiramate
Cluster headache management
acute: 100% 15L 02 10-20 mins
sumatriptan or zolmitriptan
prevention: verapamil, prednisolone
Myasthenia Gravis management
pyridostigmine
prednisolone
methotrexate
GCA patho
inflam granulomatous vasculitis of large cerebral arteries
GCA presentation
temporal pulsating headache
scalp tenderness
jaw claudication
superficial temporal artery (tender, firm, pulseless)
systemic (fever, fatigue, breathlessness)
GCA investigations
FBC (normochromic normocytic anaemia)
raised ESR, biopsy
GCA management
prednisolone ASAP to prevent ischaemic optic neuropathy
PPI+bisphosphonate
IV methylpred if visual sx
