Neuro

Question 1

Arteries and supply of brain

Answer 1

Anterior CA - feet, legs 
Middle CA - hands, arms, face, speech 
Posterior - Visual cortex
Basilar/vertebral - syncope
Cerebellum - coordination

(think posterior vision, then middle works its way down)

Question 2

Investigations for Stroke

Answer 2

1. Non-contrast CT
2. Tpa or not
3. Echo, ecg, carotid US
4. (longer term)- cvs risk factors - DM, cholesterol, BP, smoking, ect.

Question 3

Treatment acute and longer term

Answer 3

Acute
tpa, aspirin, BP (permisive HTN)

Chronic
lmwh to bridge for afib/aflut, aspirin or NOAC, DM, Ace, diuretic

Question 4

Treatment acute and longer term

Answer 4

Acute
tpa, aspirin, BP (permissive HTN)

Chronic
lmwh to bridge for afib/aflut, aspirin or NOAC, DM, HTN - Ace, diuretic

Question 5

Carotid artery stenosis management

Answer 5

> 80% then stent (only for patients who cannot tollerate surgery) or edarectomy

Question 6

Red flags for Headache and what it could be and what to do for each

Answer 6

New onset headache >50 - CT

Sudden crescendo headache - SAH –> CT, neuro surgery, control BP

Fever + headache - meningitis –> LP, culture, Abx (ceftriaxone)

Focal neuro deficit + F + H - abcess –> CT scan (drain), ABx

Progressive N & V, worse in morn - cancer –> CT, biopsy, chemo, radio, surg

Question 7

Primary headaches + IIH

Answer 7

Primary - tension, cluster, migrane, analgesic rebound

Cluster - unilateral eye pain, Horners syndrome, and clusters
Treat - Oxygen, triptans, calcium channel blockers

Migraines
-POUND (pulsatile, one day in duration, unilateral, N/V, disabling) 3 is diagnostic
-triggers, unilateral pounding, photophobia,
Mild - NSAIDs
Severe - triptan
-beta blocker phrophylaxixs, or calcium channel blocker

Tension - over counter

Medication overuse - withdrawal

Idiopathic intracranial hypertension

• Increase ICP with no tumour. (women, obese, childbearing age)
• LP, tap relieve headaches. acetazolamide

Trigeminal neuralgia - cold foods, pain across jaw, carbamazepine is treatment.

Question 8

Horners

3rd nerve palsy

Answer 8

Horners - Miosis, anhydrosis, pitosis (damage to sympathetic nerves of face)

3rd nerve - pitosis, diploplia, dilated pupil (mydriasis)

Question 9

Side effects of levodopa

Answer 9

• excessive sleepiness, hallucinations and impulse control disorders

unwanted effects: dyskinesia (involuntary writhing movements), ‘on-off’ effect, dry mouth, anorexia, palpitations, postural hypotension, psychosis, drowsiness

Question 10

Indications if have headache and need CT

Answer 10

Vomiting more than once with no other cause.
New neurological deficit (motor or sensory).
Reduction in conscious level (as measured by the Glasgow coma score).
Valsalva (associated with coughing or sneezing) or positional headaches.
Progressive headache with a fever.

Question 11

What drugs not to give with lewy body dementia?

Answer 11

Antipsychotics should be avoided in patients with dementia due to adverse reactions and increased mortality in the elderly. In Lewy body dementia, severe antipsychotic sensitivity reactions have been reported in 50% of patients- these include rigidity, immobility, postural falls, and confusion. They may lead to irreversible parkinsonism, particularly risperidone and typical antipsychotics such as Haloperidol.

Question 12

contraindications of thrombolysis

Answer 12

• Previous intracranial haemorrhage
• Seizure at onset of stroke
• Intracranial neoplasm
• Suspected subarachnoid haemorrhage
• Stroke or traumatic brain injury in preceding 3 months
• Lumbar puncture in preceding 7 days
• Gastrointestinal haemorrhage in preceding 3 weeks
• Active bleeding
• Pregnancy
• Oesophageal varices
• Uncontrolled hypertension >200/120mmHg

Question 13

cluster headaches

Answer 13

• unilateral, runny nose
• oxygen first line
• verapamil -

Question 14

metoclopramide side effects

Answer 14

extrapyrimidal side effects

dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.

Question 15

common reflexes

Answer 15

Ankle S1-S2
Knee L3-L4
Biceps C5-C6
Triceps C7-C8

Question 16

facial nerve palsy

Answer 16

Supply - ‘face, ear, taste, tear’

face: muscles of facial expression
ear: nerve to stapedius
taste: supplies anterior two-thirds of tongue
tear: parasympathetic fibres to lacrimal glands, also salivary glands

Causes of bilateral facial nerve palsy
sarcoidosis
Guillain-Barre syndrome
Lyme disease
bilateral acoustic neuromas (as in neurofibromatosis type 2)
as Bell’s palsy is relatively common it accounts for up to 25% of cases f bilateral palsy, but this represents only 1% of total Bell’s palsy cases

Question 17

Types of aphasia

Answer 17

wernickes aphasia - make no sense but can talk, comprehension impaired

brocas - speech is non-fluent , comprehension normal

conduciton aphasia - arcuate fasiculus - cannot comprehend well but can talk normally

global - receptive and expressive aphasia

Question 18

Ataxic gait pneumonic

Answer 18

P - Posterior fossa tumour
A - Alcohol
S - Multiple sclerosis
T - Trauma
R - Rare causes
I - Inherited (e.g. Friedreich's ataxia)
E - Epilepsy treatments
S - Stroke

Ataxic gaits typically occur following cerebellar injury, the causes of which can be remembered by the mnemonic ‘pastries’