neuro Flashcards
associated features with migraine
photophobia
phonophobia
worse on exercise
nausea
vomitting
bed side tests to rule out meningitis + SOL
look for papilloedema
cranial nerve examination
kernig’s + brudzinki’s
migraine Mx
prophylaxis
- topiramate
- propanolol (use women of child bearing age, topiramate is tetra)
Acute Mx:
- triptan + NSAID/paracematol
- triptans (sumatriptans) - 5HT1 agonist
constricts the cranial arteries
clinical features of parkinson’s
tremor
bradykisea
rigidity
- micrographia
- mask-like expression on face
- shuffling gait
- stooped posture
- postural HTN (automomic dysfunction)
- increased tone (cogwheel)
Parkinson’s mx
medically:
- dopamine agonists (L-Dopa) - metabolised before BBB
- peripheral dopa decarboxylase inhibitor (carbidopa)
(slows down metabolising of L-dopa - long term effect)
physio:
- prevent falls
- speech therapys
- SALTs
SSRIs
- depression
neurosurgery
- only for young + selective
- deep brain stimulation
education
- parkinson’s disease society
what is the oxford stroke classification?
assessed on:
- unilateral hemiparesis / hemisensory loss
- homonymous hemianopia
- higher congitive dysfunction (dysphasia)
Ix after ischaemic stroke diagnosed
carotid doppler
echo
ecg - AF / MI
FBC - polycythemia
stroke Mx
CT determines if ischaemic / haem
ischaemic
- aspirin 300mg
- statin (>3.5)
- SALT assessment
- oxygen <94%
- avoid hypoglycaemia (brain injury)
<4.5hrs symptoms onset
- alteplase
- VTE propylaxis heparin
> 4.5hrs symptoms
- VTE propylaxis heparin
- supportive
stroke secondary prevention
stop smoking good glycaemia control / diabetic bp control statin wafarin in AF
stroke complications
seizures thromboemblism - VTE / PE speech impairment swallowing impairment infection (hospital admission, aspiration pneumonia) reduced mobility pressure sores
pathophysiology of MS
autoimmune disease which attacks the myelin of the nerves
neurological dysfunction - separated in time + space
Mx attempts to reduce the potential for triggering the bursts of inflammatory activity of relapses
pathophysiology of MS
autoimmune disease demyelinating of the nerves in white matter
neurological dysfunction - separated in time + space
Mx attempts to reduce the potential for triggering the bursts of inflammatory activity of relapses
Ix for MS
MRI brain - looking for areas of demyelination
visual evoked potential
- delayed conduction on central white matter
causes for epliepsy
alcohol withdrawal / intoxification
head trauma
infection (meningitis, encephalitis, abcess)
psychogenic
metabolic disturbance - sodium / calcium / magnesium
intracranial tumours
carbemazipine uses
anti-epileptic
neuropathic pain
bipolar
things to inform patient with newly diagnosed epilepsy
- have to be one year epilepsy free on medication before driving
- ## can’t operate heavy goods vehicles
causes of SAH
80% berry aneurysms
congential AV malformations
trauma
infective aneurysms
complications fo SAh
rebleeding
hyponatriaemia (siadh)
hydrocephalous
death
Ix for SAH
CSF - xathochromnia
CT head - hyperdense in basal cisterns, sulci
mX for SAH
clipping for acute
RF for subdura
elderly
alcoholics
anti-coagulations
DM
mx for subdura
surgical evacuation through burr holes
- due to cause of raised ICP
risk of coning
- rise to brain ischaemia in the basal ganglia leading to respiratory depression + death
pathophysiology of epidural
low impact trauma
- commonly middle meningeal artery
lucid interval - expanding haematoma and brain herniation
fixed, dilated pupil due to compression of the parasymtpathetic fibers of 3rd CN
causes of peripheral neuropathy
predominantly motor loss:
- guillian-barre
- charcot-marie-tooth
- chronic inflammatory demyelinating polyneuropathy (CIDP)
predominantly sensory loss: - diabetes - alcohol - B12 deficiency (subacute combined degeneration of the spinal cord) - uraemia - leprosy - amyloidosis
how to Mx peripheral neuropathy of diabetic patient
goog glycaemic control
diabetic shoes
diabetic foot specialist referral
neuropathic analgesias (TCA, gabapentin, pregabalin, duletoxine )
meningitis comp
epilepsy
brain abscess
hydrocephalus
focal neurological deficeit (sensorineural loss)
what is myopathic facies
facial appearance due to muscular facial weakness
indicative of:
MG
myotonic dystrophy
pathophysiology of MG
autoimmune disorder of the post-synaptic membrane at the NMJ
antibodies against the acetylcholine receptor
features of muscle weakness, repetative, improves on rest
signs on examination for patient with MG
Ix
ptosis
diplopia
ophthalamopegia
- serum antibodies acetylcholinesterase antibodies in 90% of MG patients
- tensilon test - give short anti-cholinesterase (positive = rapid improvement in weakness)
- nerve stimulation - decreased evoked potential
- mediastinal imaging (CT/MRI) - thymoma
Mx of MG
pyridostigmine / neostigmine - cholinesterase inhibitor
corticosteroids
immunosuppression
plasmaphoresis - removal of antibodies through machine
describe history of cluster headache
intense period of headaches over a week (4 - 12 weeks)
more common in men
alcohol can trigger attack
cluster headache Mx
acute
- 100% oxygen
- SC triptan
prophylaxis:
- verapamil
tension headache
tight band round head
symptoms bilateral
migraine - unilateral
tension head mx
acute
- aspirin / naproxen / ibuprofen
chronic
1. antidepressants / amitriptyline
- muscle relaxants
