Neuro Flashcards
list the types of MS
relapsing-remitting, primary progressive, secondary progressive
which areas are most commonly affected by MS
optic nerve, cervical cord, periventricular areas
2 signs in MS
Lhermitte’s - neck flexion = paresthesia
uthoff’s - worse in heat
investigations in MS
MRI - demyelinating plaques
LP - oligoclonal bands
evoked potentials
diagnosis of anterior stroke (ie symptoms) and arteries affected
need 3/3 for total and 2/3 for partial
unilateral hemiparesis, hemianopia, dysphasia
middle cerebral (arm), anterior cerebral (leg)
diagnosis of poterior stroke (ie symptoms) and arteries affected
one of; homonymous hemianopia loss of consciousness cerebellar syndrome vertebrobasilar arteries
diagnosis of lacunar stroke (ie symptoms) and arteries affected
1 of; unilateral weakness ataxic hemiparesis sensory change perforating arteries
long term management of stroke
aspirin for 2/52 then clopidogrel
management of TIA
do ABCDE2
warfarin if AF or clopidogrel if no AF
explain CHADS2Vasc
risk of stroke in AF
give warfarin
describe the presentation and CT findings of an extradural and vessel affected
lucid period then reduced LOC following temporal bone fracture
fixed dilated pupil due to CN III compression
biconvex lesion with midline shift
middle meningeal
describe the presentation and CT findings of a sub dural
fluctuating consciousness. can be chronic.
crescent shaped not limited by suture lines (bright/hyperdense in acute, dark/hypodense in chronic)
bridging veins
describe the presentation and CT findings of subarachnoid
sudden onset thunder clap headache, meningism, N&V
star sign, follows suture lines
circle of willis
investigations and management in subarachnoid
CT
Lp 12 hrs after onset - xanthochromia
nimodipine
presentation of parkinsons
rigidity, bradykinesia (slow intention, shuffling gait), tremor (resting, pill rolling, unilateral)
name the parkinson’s plus syndromes
multiple system atrophy - autonomic dysfunction
progressive supranuclear palsy - vertical gaze palsy, postural instability
lewey body dementia - visual hallucinations
vascular - risk factors
corticobasal degeneration - alien limb, sensory loss
trial of levodopa doesn’t help
what drugs are used in parkinsons
MAOi's (selegiline) dopamine agonists (ropinirole) - domperidone as antiemetic is nausea and vomiting l-dopa and madopar (decarboxylase inhibitor)
acute and chronic treatment of tension headache
short term analgesia/ amitriptyline
10 sessions acupuncture over 5-8 weeks
acute and chronic treatment of cluster headache
100% oxygen and SC/sublingual triptan
verapimil
acute and chronic treatment of migraine
oral triptan and analgesia
if get >2 attacks a month give topiramate (can give propranolol)
investigations in seizures
EEG, CT, glucose , U&E’s
management of epilepsy
sodium valproate (generalised) carbamazepine (focal)
driving advice in seizures
cant drive for 6 months after seizure and cant drive for 1 year seizure free in epilepsy
driving advice in TIA
at least 1 month off driving
management of status epilepticus
buccal midaz , repeat benzo, phenytoin, phenobarbital
signs in spinal cord compression
UMN signs BELOW level
LMN signs at level of lesion
contralateral loss of pain and temperature sensation
sphincter disturbance
neuro deficits in brown sequard
ipsilateral loss of vibration, proprioception, and fine touch (dorsal columns) and motor function at the level of lesion
contralateral loss of pain and temperature 1-2 levels below the lesion
management of MS
alemtuzumab
beta interferon
methylpred in flare up
criteria for MND
El escorial criteria
UMN and LMN signs
no sensory signs
progressive course
investigations and management of MND
EMG
creatinine kinase high
riluzole and baclofen for spacisity
presentation of myasthenia gravis
diplopia/ptosis speech change peek sign snarl swallowing and breathing difficulties
investigations in myasthenia gravis
Ab’s: anti Ach, anti-musk
CT thorax for thymus hyperplasia
EMG
management of myasthenia gravis (chronic and acute)
pyridostigmine, immunosuppression, thymectomy
acute: plasma exchange and IVIg
triad in normal pressure hydrocephalus
gait abnormality
dementia
urinary incontinence
signs in a c5/6 radiculopathy
loss of biceps reflex (6 letters)
altered thumb sensation
signs in C7 radiculopathy
loss of triceps reflex (7 letters)
middle finger sensation
signs in L5 radiculopathy
cant stand on heels (dorsiflexion)
big toe sensation
signs in s1 radiculopathy
cant stand on toes
absent ankle reflex
what does a negative rinne’s test mean
bone conduction = better than air conduction
conductive deafness
weber’s test lateralized to left ear means?
conductive problem in left ear (if rinnes negative)
or sensorineural deafness in right ear (if rinnes positive .- ie. normal rinne’s)
describe grading of muscle weakness (MRC)
0: no contraction
1: flicker
2: some active movement
3: active movement against gravity
4: active movement against some resistance
5: normal power
investigations in memory loss
AMT (out of 10)
MMSE (out of 30. <24 = demantia)
bloods: B12/folate, FBC, ESR, U&E, calcium, syphilis
CT
management in dementia
psychosocial
anticholinesterase i’s : donepezil, rivastigmine, memantine
causes of facial nerve palsy
bells (diagnosis of exclusion) ramsay hunt infection stroke tumour diabetes GBS parotid tumour
what is bells palsy
one half of face paralysed (LMN)
CN VII palsy
give prednisilone
what mononeuropathy gives you foot drop?
common peroneal
causes of polyneuropathy
diabetes Gbs b12/folate deficiency RA polyarteritis nodosa GPA polycythaemia HIV syphilis lymes disease charcot marie tooth drugs (alcohol, isoniazid, phenytoin, metronidazole, nitrofurantoin)
