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Neuro Flashcards

1
Q

What are lateralising signs?

A

Reflect a problem with 1 hemisphere versus the other

  • Inattention
  • Gaze paresis
  • Upper limb drift with arms outstretched and eyes closed
  • Slower localising/flexion response 1 side
  • Asymmetric motor response
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2
Q

Causes of Coma

A

AEIOUTIPS

  • Acidosis/Alcohol
  • Epilepsy
  • Infection- HSE/Meningitis
  • Overdose
  • Uraemia
  • Trauma to head- SAH
  • Insulin- hyper/hypo/DKA
  • Psychogenic
  • Stroke
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3
Q

Who can diagnose brainstem death?

A

2 medical practitioners who have been registered for at least 2 years, at least one consultant

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4
Q

What conditions need to be met in order to diagnose brainstem death?

A

Body temp > 34
MAP > 60 with no hypoxia
Acidaemia or alkalaemia

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5
Q

What are the criteria for brainstem death?

A

Pupils fixed & dilated & unresponsive
No corneal reflex
Oculovestibular reflexes absent- no eye mvmts on injection of ice cold water into ear
No motor responses by adequate stimulation
No cough reflex to bronchial stimulation
No evidence of spontaneous respiration or respiratory effort

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6
Q

Causes of brainstem death

A

Tumour, MS, metabolic (central pontine myelonecrosis), trauma, spontaneous haemorrhage, infarction, infection

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7
Q

Causes of cerebellar syndrome

A

MS, stroke, tumour, drugs (eg phenytoin), thiamine deficiency, paraneoplastic, hypothyroidism, infections

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8
Q

Signs of cerebellar syndrome

A 
DANISH
- Dysdiadokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- Hypotonia
(reduced reflexes)
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9
Q

What type of gait is seen in cerebellar syndrome?

A

Broad-based gait

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10
Q

Define epilepsy

A

Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures

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11
Q

Causes of epilepsy

A

Idiopathic

SOL, stroke, vascular malformation, tuberous sclerosis, SLE

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12
Q

Localising features of epilepsy

A

Temporal- automatisms, deja vu, emotional disturbance, taste/smell, auditory hallucinations
Frontal- motor features, motor arrest, speech arrest, post-ictal Todd’s palsy
Parietal- sensory disturbance, motor symptoms
Occipital- visual phenomena

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13
Q

A person has epilepsy with the following features: automatisms, deja vu, emotional disturbance, taste/smell, auditory hallucinations.
What lobe is the epilepsy affecting?

A

Temporal

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14
Q

A person has epilepsy with the following features: motor features, motor arrest, speech arrest, post-ictal Todd’s palsy.
What lobe is the epilepsy affecting?

A

Frontal

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15
Q

A person has epilepsy with the following features: visual phenomena.
What lobe is the epilepsy affecting?

A

Occipital

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16
Q

A person has epilepsy with the following features: sensory disturbane and motor symptoms.
What lobe is the epilepsy most likely affecting?

A

Parietal

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17
Q

What are myoclonic seizures?

A

Seizures involving sudden jerk of a limb, face or trunk

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18
Q

What are atonic seizures?

A

Seizures where there is sudden loss of muscle tone

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19
Q

Management of generalised tonic-clonic seizures?

A

Sodium Valproate
Lamotrigine
Carbamazepine

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20
Q

Management of absence seizures

A

Sodium Valproate/Lamotrigine

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21
Q

Which drug should be avoided in management of tonic/aclonic/myoclonic seizures?

A

Carbamazepine

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22
Q

Management of partial seizures

A

Carbamazepine

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23
Q

How long should somebody not drive after a seizure?

A

Avoid driving until 1 year seizure-free

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24
Q

Side effects of Carbamazepine

A

Leukopenia, diplopia, blurred vision, impaired balance, rash

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25
Q

Side effects of Lamotrigine

A

Diplopia, blurred vision, photosensitivity, tremor, agitation

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26
Q

Side effects of Sodium Valproate

A

VALPROATE:

  • Appetite lost
  • Liver failure
  • Pancreatitis
  • Reversible hair loss
  • Oedema
  • Ataxia
  • Teratogenic/Tremor/Thrombocytopenia
  • Encephalopathy
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27
Q

Which anti-epileptic should be used in pregnancy?

A

Lamotrigine

Supplement with folic acid

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28
Q

What is status epilepticus?

A

Non-self-limiting manifestation of epileptic seizure

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29
Q

What is the most common cause of status epilepticus in in people without epilepsy?

A

Alcohol

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30
Q

Stages of status epilepticus

A

T0: seizure starts
T1: point at which seizure is not self-limiting
T2: point at which there will be some physiological damage

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31
Q

Management of status epilepticus

A 
IV Benzodiazepine - Diazepam
Oxygen
Bloods for hypoglycaemia/hypercalcaemia
Cultures
Sodium valproate to prevent further seizures
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32
Q

What are psychogenic non-epileptic seizures?

A

Episodes of movement, sensation or experience that resemble epileptic seizures but without ictal cerebral dischaarges

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33
Q

Typical features of psychogenic non-epileptic seizures

A 
Eyes closed
Partially responsive
Very prolonged
Gradual onset
Can be emotional
Violent thrashing
Usually tired post-seizure
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34
Q

Gold standard for diagnosis of psychogenic non-epileptic seizures

A

Video electroencephalogram

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35
Q

Management of psychogenic non-epileptic seizures

A

CBT, Hypnotherapy, anti-anxiety/depressants

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36
Q

What is primary vs secondary head injury?

A

PRIMARY: damage at time of impact
SECONDARY: injury as a result of changes following primary insult eg oedema, haematoma

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37
Q

What are the criteria for C-spine immobilisation?

A
  • GCS < 15 at any point
  • Neck pain/tenderness
  • Focal neurological deficit
  • Paraesthesia in extremities
  • Any other clinical suspicion of C-spine injuries
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38
Q

Criteria for CT head within 1 hour

A
  • GCS < 13 initially or < 15 after 2hrs
  • Suspected open/depressed skull #
  • Signs of basal skull #
  • Post-traumatic seizure
  • > 1 episode vomiting
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39
Q

Signs of basal skull fracture

A 
Echymosis behind ear (battle sign)
Epistaxis
Subconjunctival haemorrhage
Periorbital haemorrhage (raccoon eyes)
Loss of sensation to face
Haemotympanum
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40
Q

Define stroke

A

Sudden onset of focal neurological signs of presumed vascular origin lasting > 24hrs

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41
Q

Risk factors for stroke

A

Hypertension, hypercholesterolaemia, smoking, diabetes, obesity, alcohol, carotid artery disease, recreational drugs eg cocaine, age, male, FH

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42
Q

What is the most common site of ischaemic stroke?

A

Middle cerebral artery

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43
Q

What are the different classifications in Bamford Stroke classification?

A

Total Anterior Circulation Stroke
Partial Anterior Circulation Stroke
Posterior Circulation Stroke
Lacunar Stroke

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44
Q

What is a Total Anterior Circulation Stroke as defined by Bamford Stroke classification?

A

ALL of…

  1. Unilateral weakness +/- sensory deficit
  2. Homonymous Hemianopia
  3. Higher cerebral dysfunction- dysphasia, visuospatial disorder
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45
Q

What is a Partial Anterior Circulation Stroke as defined by Bamford Stroke classification?

A

2 of…

  1. Unilateral weakness +/- sensory deficit
  2. Homonymous Hemianopia
  3. Higher cerebral dysfunction- dysphasia, visuospatial disorder
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46
Q

What is a Posterior Circulation Stroke as defined by Bamford Stroke classification?

A

1 of…

  1. Cerebellar or brainstem syndromes
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
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47
Q

What is a Lacunar Stroke as defined by Bamford Stroke Classification?

A

No evidence of higher cerebral dysfunction and 1 of…

  1. Unilateral weakness +/- sensory deficit
  2. Pure sensory stroke
  3. Ataxis hemiparesis
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48
Q

Investigations of Stroke

A

CT head scan within 24hrs of onset
MRI head if unsure/possible haemorrhagic
Carotid Dopplers if anterior circulation

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49
Q

Management of Stroke (ischaemic)

A

Aspirin
Thrombolysis- Alteplase <4.5hrs
Thrombectomy if NIHSS score > 10
Anticoagulation from 2wks after event

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50
Q

Management of Stroke (haemorrhagic) in a person on Warfarin

A

Reverse Warfarin:

  • Vitamin K takes 6-8hrs
  • Prothrombinex-VF if immediate
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51
Q

Features of Tension Headache

A 
Generalised headache- bilateral pressure + tightness around head
Non-pulsating
No nausea
Spreads into or arises from neck
Mild-moderate
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52
Q

Most common trigger of tension headaches

A

Stress

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53
Q

How long do tension headaches typically last?

A

30 mins - 7 days

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54
Q

Management of tension headaches

A
  1. Simple analgesia + reassurance
  2. Alternative to NSAID eg Naproxen
  3. Alternative therapies eg Acupuncture
  4. Amitriptylline
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55
Q

Which is the only headache more common in men?

A

Cluster headache

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56
Q

Risk factors for cluster headache

A

Alcohol, smoking, brain injury, FH, histamine, GTN

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57
Q

Features of cluster headache

A

Severe unilateral orbital, supraorbital, temporal pain
Lasting 15 mins - 3hrs
Abrupt onset and cessation
Associated with lacrimation, nasal congestion, rhinorrhoea, miosis, ptosis, eyelid oedema
Can’t sit still

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58
Q

Management of cluster headache (acute)

A

Subcut Sumatriptan
100% O2
Topical lidocaine IN

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59
Q

Prevention of cluster headache

A

During cluster: Prednisolone, Ergotamine

Prevention of cluster: Verapamil, Lithium

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60
Q

What is Hydrocephalus?

A

Accumulation of CSF within the brain –> raised ICP

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61
Q

What is the aetiology of Hydrocephalus?

A

Accumulation of CSF within the brain –> raised ICP
Due to obstruction of ventricular drainage
Pus- bacterial meningitis
Blood- SAH or intraventricular haemorrhage
Posterior fossa tumours
Spina Bifida

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62
Q

Investigations of Hydrocephalus

A

CT/MRI

LP CONTRAINDICATED

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63
Q

Management of Hydrocephalus

A

CSF diversion- external ventricular drain, CSF shunt etc

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64
Q

Causes of raised Intracranial pressure

A

Mass- haematoma, tumour, abscess
Oedema
Increased CSF
Increased cerebral blood volume- vasodilatation, venous obstruction

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65
Q

Presentation of raised intracranial pressure

A

Headache, vomiting, diplopia, blurred vision, drowsiness, papilloedema, limitation of upward gaze, fixed dilated pupil

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66
Q

Management of raised intracranial pressure (immediate)

A

Mannitol- osmotic diuresis

Burr hole/craniotomy

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67
Q

What is cushing’s triad?

A

Signs of raised intracranial pressure

  1. Hypoventilation
  2. Bradycardia
  3. Hypertension
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68
Q

What is the equation for cerebral perfusion pressure?

A

Cerebral perfusion pressure = MAP - intracranial pressure

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69
Q

What is Syncope?

A

Transient global cerebral hypoperfusion

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70
Q

Types of syncope (3)

A
  • Reflex- vasovagal, situational, carotid sinus hypersensitivty
  • Cardiogenic- arrhythmias, cardiac ischaemia, structural heart disease
  • Orthostatic hypotension
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71
Q

Investigations of syncope

A

ECG, CT/MRI, EEG

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72
Q

GCS Scoring

A 
Eye opening /4
1. None
2. To pain
3. To voice
4. Spontaneously 
Verbal response /5
1. None
2. Groans
3. Inappropriate words
4. Confused speech
5. Orientated
Motor response /6
1. None
2. Extension to pain
3. Flexion to pain
4. Withdraws from pain
5. Localises to pain
6. Obeys commands
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73
Q

Describe MRC Power grading

A 
0 = no muscular contraction
1 = visible muscular contraction but no mvmt
2 = mvmt at joint but not against gravity
3 = mvmt against gravity but not resistance
4 = mvmt against some resistance but not full strength
5 = full strength
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74
Q

Describe reflex grading

A 
0 = Absent
1 = Hypoactive 
2 = Normal
3 = Brisk/Hyperactive
4 = Markedly hyperactive with clonus
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75
Q

Causes of UMN signs

A

Tumour, masses, inflammation, MS, stroke, myelopathy

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76
Q

UMN signs

A

Spastic gait
Hypertonia
Hyperreflexia
Babinski- upgoing plantars
Ankle clonus
Hoffman’s sign (flicking middle finger makes index finger twitch)
Pyramidal weakness- flexors > extensors in arms, opposite in legs

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77
Q

Causes of LMN signs

A

GBS, peripheral neuropathy, myasthenia gravis, meningitis

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78
Q

LMN signs

A 
Flaccid weakness
Hyporeflexia
Hypotonia
Fasciculations
Wasting
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79
Q 
Nerve root for the following reflexes:
Biceps 
Triceps
Knee jerk
Ankle jerk
A

Biceps- C5/6
Triceps- C6/7
Knee jerk- L3/4
Ankle jerk- S1

80
Q

What is the dorsal column medial lemniscal pathway responsible for?

A

Fine touch
Vibration
Proprioception

81
Q

What is the anterior spinothalamic pathway responsible for?

A

Crude touch

Pressure

82
Q

What is the lateral spinothalamic pathway responsible for?

A

Pain

Temperature

83
Q

What is the spinocerebellar pathway responsible for?

A

Proprioception

84
Q

What is the pyramidal tract responsible for?

A

Voluntary muscle control of body and face

85
Q

What are the extra-pyramidal tracts responsible for?

A

Involuntary and automatic control of muscle

86
Q

What is the vestibulo-spinal tract responsible for?

A

Balance + posture

87
Q

What are the extra-pyramidal tracts?

A
  1. Vestibulospinal
  2. Reticulospinal
  3. Rubrospinal
  4. Tectospinal
88
Q

What is the reticulospinal tract responsible for?

A

Voluntary movements and muscle tone

89
Q

What is the rubrospinal tract responsible for?

A

Fine control of hand movements

90
Q

What is the tectospinal tract responsible for?

A

Movements of head in response to visual stimuli

91
Q

What are the 12 Cranial nerves?

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
92
Q

What is the function of the Olfactory nerve?

93
Q

What is the function of the Optic nerve?

A

Visual acuity, colour vision, visual fields, visual inattention

94
Q

What is the function of the Oculomotor nerve?

A

Eye movements

Pupil constriction

95
Q

What is the function of the Trochlear nerve?

A

Superior oblique- depresses and internally rotates the eye

96
Q

What are the components of the Trigeminal nerve?

A

Opthalmic, maxillary and mandibular branches

97
Q

What is the function of the Abducens nerve?

A

Lateral rectus- abducts

98
Q

What is the function of the Facial nerve?

A

Motor to face, taste to anterior 2/3 tongue

99
Q

What is the function of the Vestibulocochlear nerve?

100
Q

What is the function of the Vagus nerve?

A

Motor to palate

101
Q

What is the function of the Accessory nerve?

A

Sternocleidomastoid + trapezius

102
Q

What is the function of the Hypoglossal nerve?

A

Tongue motor

103
Q

Red Flags of Headache

A
  • Thunderclap
  • Jaw claudication
  • Atypical dural- >1hr or motor weakness
  • Associated with postural change/coughing
  • New onset headache with Hx of cancer
  • Unilateral red eye
  • Rapid progression of neuro deficit/cognitive impairment/personality change
  • Hx of HIV/immunosuppression
  • New onset headache age > 50
  • Waking from sleep
  • Worsening over weeks or longer
104
Q

Features of migraine

A 
\+/- aura
Unilateral, pulsating, moderate pain
N&amp;V
Photophobia/Phonophobia
Lasts 4-72hrs untreated
105
Q

Triggers for migraine

A 
CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese
OCP
Lie-ins
Alcohol
Tumult (loud noise)
Exercise
(Menstruation + stress)
106
Q

Management of migraines

A
  1. Simple analgesia + Sumatriptan
  2. Propranolol +/- Amitriptylline
  3. Topiramate
107
Q

Management of nausea and vomiting in migraine

A

Metoclopramide

108
Q

Organism causing Meningococcal disease

A

Neisseria meningitidis

109
Q

Risk Factors for meningitis

A

Young, immunosuppression, smoking, spinal procedures, diabetes, crowding

110
Q

Most common cause of meningitis

A

Viral infection

111
Q

Presentation of Meningitis

A 
Non-blanching petechial/purpuric rash
Cold extremities, skin mottling
Fever
Neck stiffness
Bulging fontanelle
Photophobia
Kernig's sign
Brudzinski's sign
112
Q

What is Kernig’s sign?

A

Seen in Meningitis

Pain and resistance on passive knee extension with hips fully flexed

113
Q

What is Brudzinski’s sign?

A

Seen in Meningitis

Hips flex on bending head forward

114
Q

What is tested on Lumbar puncture in Meningitis?

A

WCC, Gram stain, Glucose, protein, lactate, culture, Meningococcal + Pneumococcal PCR

115
Q

What does lumbar puncture show in bacterial meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Cloudy/turbid
Opening pressure elevated
WBC elevated > 100- primarily lymphocytes
Glucose low
Protein elevated
116
Q

What does lumbar puncture show in viral meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Clear
Opening pressure normal (or elevated)
WBC elevated- primarily lymphocytes
Glucose normal
Protein elevated
117
Q

hat does lumbar puncture show in fungal meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Clear or cloudy
Opening pressure elevated
WBC elevated
Glucose low
Protein elevated
118
Q

hat does lumbar puncture show in TB meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Opaque, if left settles to form a fibrin web
Opening pressure elevated
WBC elevated
Glucose low
Protein elevated
119
Q

Management of meningitis

A

Immediate: IM Benzylpenicillin
Viral: Aciclovir for herpes/encephalitis, Ganciclovir for CMV
Bacterial: Ceftriaxone IV 7 days
Dexamethasone

120
Q

Management of close contacts in meningitis

A

Ciprofloxacin/Rifampicin

121
Q

Risk factors for a brain tumour

A

Ionising radiation, immunosuppression, Neurofibromatosis, Tuberous sclerosis, Li-Fraumeni syndrome

122
Q

What are the most common primary sites of brain mets?

A 
Brain Mets Can Kill Lots
Breast
Melanoma
Colon
Kidney
Lung
123
Q

Clinical features of brain tumour

A 
Headaches worse in the morning
N&amp;V
Seizures
Focal neurological deficits
Behavioural change
Papilloedema
Raised ICP
124
Q

Investigation of suspect brain tumour

A

Urgent MRI within 2 weeks

125
Q

Management of brain tumour

A

Surgical resection
External beam radiotherapy- 1st line for mets
Chemo
Corticosteroids for raised ICP

126
Q

What is the first line treatment for brain mets?

A

External beam radiotherapy

127
Q

Differentials of a ring-enhancing lesion on CT brain

A

DR MAGICAL
D: demyelinating disease (classically incomplete rim of enhancement)
R: radiation necrosis or resolving haematoma
M: metastasis
A: abscess
G: glioblastoma
I: infarct (subacute phase), inflammatory - neurocysticercosis (NCC), tuberculoma
C: contusion
A: AIDS
L: lymphoma (this appearance more common in immunocompromised)

128
Q

Define vertigo

A

An illusion of movement, of the patient or surrondng, always worsened by movement

129
Q

Causes of vertigo

A

Central: MS, migraine, alcohol, acoustic neuroma, cerebellar infarct
Peripheral: Labyrinthitis, Vestibular neuritis, BPPV, Meniere’s, Ototoxicity

130
Q

General Management of vertigo

A

Prochlorperazine, Cyclizine, Promethazine

131
Q

What is the most common cause of vertigo?

A

Benign Paroxysmal Positional Vertigo

132
Q

What is the peak age for Benign Paroxysmal Positional Vertigo?

133
Q

What is the aetiology behind Benign Paroxysmal Positional Vertigo?

A

Otoliths detach and stimulate hair cells

134
Q

Causes of Benign Paroxysmal Positional Vertigo

A

Idiopathic

Head injury, post-viral, surgery

135
Q

Presentation of Benign Paroxysmal Positional Vertigo

A

Episodes of vertigo provoked by head movement
Worse to one side
Attacks sudden onset and last 20-30 seconds
Resolve once head is kept still
Worse in mornings
Nausea

136
Q

Diagnosis of Benign Paroxysmal Positional Vertigo

A

Dix-Hallpike maneouvre

137
Q

Management of Benign Paroxysmal Positional Vertigo

A

Epley maneouvre

Self-limiting in weeks

138
Q

Can people drive with Benign Paroxysmal Positional Vertigo?

A

Only once symptoms controlled

139
Q

Causes of encephalitis

A

HIV, Herpes simplex, CMV, TB, Lyme disease, parasite

140
Q

Presentation of encephalitis

A

Classic triad:

  1. Fever
  2. Headache
  3. Altered mental status
141
Q

Management of encephalitis

A

Urgent hospital admission

Aciclovir IV

142
Q

What risk score is used for risk of stroke after TIA?

A 
ABCD2 score
Age > 60
BP > 140/90
Clinical features:
- Unilateral weakness (2)
- Speech disturbance (1)
Duration:
- > 60 mins (2)
- 10-60 mins (1)
- < 10 mins (0)
Diabetes (1)
143
Q

What is ABCD2 score?

A 
Risk of stroke after TIA:
Age > 60
BP > 140/90
Clinical features:
- Unilateral weakness (2)
- Speech disturbance (1)
Duration:
- > 60 mins (2)
- 10-60 mins (1)
- < 10 mins (0)
Diabetes (1)
144
Q

What is a TIA?

A

Sudden onset of focal neurological signs of vascular origin lasting < 24hrs

145
Q

Investigations after TIA

A

MRI
Carotid dopplers
24hr ECG

146
Q

Management of TIA

A

Aspirin
Clopidogrel if high-risk
Carotid endarterectomy + stenting for 70-99% stenosis

147
Q

What is the most common aetiology of a subarachnoid haemorrhage?

A

Rupture of a saccular/berry aneurysm in the circle of willis

148
Q

Risk factors for subarachnoid haemorrhage

A

Hypertension, smoking, cocaine, alcohol, PKD, Ehler-Danlos, coarctation of the aorta

149
Q

Presentation of subarachnoid haemorrhage

A 
Thunderclap headache
Sudden death/reduced GCS
Meningism
Seizures
Can have 3rd nerve palsy and extensor plantar response
150
Q

Investigations of subarachnoid haemorrhage

A

CT then angiography

LP- xanthochromia

151
Q

Lumbar puncture findings in SAH

A

Xanthochromia

152
Q

Management of Subarachnoid haemorrhage

A

Nimodipine for vasospasm
Surgical clipping, endovascular coiling
Ventricular drainage

153
Q

Causes of Extradural haemorrhage

A

Traumatic: fractured temporal/parietal bone after trauma to temple- damage to middle meningeal artery/vein
Non-traumatic: coagulopathy, thrombolysis, vascular malformation

154
Q

What is the aetiology of traumatic extradural haemorrhage?

A

Fractured temporal/parietal bone after trauma to temple –> damage to middle meningeal artery/vein

155
Q

Presentation of extradural haemorrhage

A

Trauma to head –> LOC –> lucid interval after which patient deteriorates
Headache, N&V, seizures, raised ICP, Cushing’s triad, Unequal pupils, CSF otorrhoea/rhinorrhoea with tear of dura

156
Q

Investigations of extradural haemorrhage

A

X-ray skull- shows fracture

CT- haematoma/air- biconvex/lentiform

157
Q

Management extradural haemorrhage

A

ABC, fluids
Mannitol for raised ICP
Burrholes

158
Q

What is the most common aetiology of subdural haemorrhage?

A

Traumatic- tearing of bridging veins- mainly rapid deceleration of head (RTA)

159
Q

Causes of subdural haemorrhage

A

Rapid deceleration of head in RTA
Shaken baby
Non-traumatic- vascular malformations, meningitis

160
Q

Risk factors for subdural haemorrhage

A 
Cerebral atrophy (elderly)
Alcoholism
161
Q

Presentation of subdural haemorrhage

A

Acute LOC then lucid interval then LOC when haematoma forms

Chronic progressive symptoms 2-3wks later

162
Q

Investigations of subdural haemorrhage

A

CT for acute, with contrast if subacute - crescent shaped haematoma

163
Q

Management of subdural haemorrhage

A

ABC
Emergency craniotomy + clot evacuation
Burr holes

164
Q

Which disease is associated with temporal arteritis?

A

Polymyalgia rheumatica

165
Q

Presentation of temporal arteritis

A 
Pain with eating/brushing hair
Temporal headache
Scalp tenderness, facial pain
Jaw claudication
Fever, Malaise
166
Q

Features of temporal arteritis on examination

A

On palpation of the temporal artery- absent, beaded pulse, tender and enlarged

167
Q

Investigations for temporal arteritis

A

Raised ESR

Temporal artery biopsy: predominance of mononuclear cells or granulomatous inflammation, multinucleated giant cells

168
Q

What is found on temporal artery biopsy in temporal arteritis?

A

Predominance of mononuclear cells or granulomatous inflammation, multinucleated giant cells

169
Q

Management of temporal arteritis

A

40mg Prednisolone daily
60mg if claudication or visual Sx
Low dose aspirin + PPI

170
Q

3 Key features of Parkinsonism

A
  1. Resting tremor
  2. Rigidity
  3. Bradykinesia
171
Q

What is the aetiology of Parkinson’s in the brain?

A

Lewy bodies + neuronal cell death in the pars compacta of substantia nigra causing slowing of the basal ganglia

172
Q

What is the average age of onset of Parkinson’s?

173
Q

What 2 things reduce the risk of Parkinson’s?

A
  1. Smoking

2. Caffeine

174
Q

Causes of peripheral neuropathy

A

DAVID:

  • Diabetes Mellitus
  • Alcohol
  • Vitamin deficiency (B12/B1) / Vasculitis
  • Immune- Guillain-Barre / Inherited- Charcot-Marie-Tooth
  • Drugs- Isoniazid, Vincristine
175
Q

Patient has hyperacute limb and facial weakness, pronator drift and upgoing plantars, what is the pathology?

A

Vascular
UMN
In the brain
–> Stroke

176
Q

Patient has insidious onset weakness in both legs, with a sensory level, upgoing plantars and brisk reflexes, what is the pathology?

A

Compression/degeneration
UMN
In the spine
–> Spinal tumour

177
Q

Patient has insidious onset sensory change in the hand (lateral 3 fingers), wasting, what is the pathology?

A

Compression/degeneration
LMN
Peripheral nerve
–> Carpal tunnel syndrome

178
Q

Patient has subacute onset weakness in both shoulders and thighs and a raised CK, what is the pathology?

A

Inflammatory
Muscle problem
–> Polymyositis

179
Q

Causes of seizure

A 
Hypoglycaemia
Alcohol withdrawal
Metabolic disturbance
Infection (meningitis/encephalitis)
Stroke
Neoplasm
Drug overdose/toxicity
Inadequate anticonvulsant levels
180
Q

Investigations of seizure

A 
FBC, U&amp;E, LFT, Ca2+, MG2+, glucose, clotting
ECG
Toxicology?
ABG?
CT head?
181
Q

Management of a seizure- <5mins

A

Time, monitor, oxygen, supportive care

182
Q

Management of a seizure- >5mins

A 
Benzodiazepines:
- IV Lorazepam 4mg
- Buccal/IM Midazolam
- PR Diazepam
If unresponsive- load on anticonvulsant- Levetiracetam
183
Q

Neurological examination findings in Parkinson’s

A
  1. Inspection: mask-like facies, tremor (asymmetrical coarse pill-rolling resting tremor)
  2. Tone: increased, cogwheel rigidity
  3. Gait: shuffling, loss of arm swing, difficulty turning
  4. Voice: slow, faint, monotonous speech
  5. Bradykinesia
    Power, coordination, sensation and reflexes all normal
184
Q

Options for a NBM Parkinson’s patient

A

Timing of Parkinson’s meds is critical

  1. NG tube insertion for meds
  2. Rotigotine patch
185
Q

Which anti-emetics are safe to use in Parkinson’s?

A

Domperidone and Ondansetron are safe
Prochlorperazine and Metochlopramide contraindicated
Cyclizine can worsen symptoms

186
Q

What drugs are contraindicated in myasthenia gravis?

A

MANY
Beta blockers
Many antibiotics
Psych drugs

187
Q

Management of Vestibular neuritis

A

Vestibular sedatives- Betahistine

Will resolve in a few days

188
Q

What is the time frame of onset of Vestibular neuritis?

A

Subacute onset over a few hours

189
Q

Presentation of Meniere’s disease

A

Vertigo
N&V
Associated with hearing loss, tinnitus and sense of fullness in ear

190
Q

What does audiogram show in Meniere’s disease?

A

Low-frequency hearing loss

191
Q

Management of Meniere’s disease

A

Decrease sodium intake

Thiazides

192
Q

Contraindications to thrombolysis in stroke

A 
Haemorrhage
High BP
Major surgery
Anticoagulants
Recent stroke
Seizure at onset
Head injury
193
Q

What investigation needs to be done after thrombolysis?

A

CT 24hrs after thrombolysis to exclude haemorrhage before starting aspirin

194
Q

What type of stroke must somebody have to be considered for thrombectomy?

A

Anterior circulation large vessel occlusion

195
Q

How long after a stroke can somebody not drive for?

A

1 month then may need further assessment

Finals Revision (13 decks)

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