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Phase 3A Quiz > Neuro > Flashcards

Neuro Flashcards

1
Q

Key Points - Subdural Haematoma?

A

Cause: Rupture of bridging following a blunt trauma or fall

Shape: Crescent shape

Presentation: Initially asymptomatic, as haematoma grown, px develops a slow progressive headache with altered mental status

Mainly affects elderly patients

SUBway under the BRIDGE

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2
Q

Why are elderly patients are most increased risk of Subdural haematoma

A

Atrophy of the brain is more common.
More space for bridging veins to rupture.

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3
Q

Key Points - Epidural Haematoma?

A

Cause: Fracture of temporal bone, leads to rupture of the middle meningeal artery.

Shape: Convex Lens (Elipse)

Blood does not cross the suture line

Px experience Lucid Intervals & CN 3 Palsy

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4
Q

Key features of CN3 Palsy

A

Ptsois
Dilation
Down and Out movement of the eyes

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5
Q

Intraparenchymal Haemorrhage

A

Unilateral flailing of extremities
2nd most common cause of stroke after ischemia
Basal ganglia, internal capsule, thalamus, pons & cerebellum
HTN most common cause
Microaneurysms of perforating arteries ( Charcot-Bouchard)

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6
Q

Breakdown Stroke Classification Types

A
  1. Ischaemic
    a -Thrombotic
    b- embolic
    c - Hypotensive
    d - Hypertensive
  2. TIA
  3. Haemorrhagic
    -Subarachnoid
    -Intraparenchymal
  4. Haematoma
    -Extradural(Epidural)
    -Subdural
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7
Q

Subarachnoid Haemorrhage

A

Cause: Rupture of berry aneurysm
Signs: Worst headache of life / Thunderclap
Neck stiffness similar to meningitis

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8
Q

What would you expect from LP of someone who had a Subarachnoid Haemorrage

A

Bloody/Xanthocromic CSF

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9
Q

Key Points - TIA?

(Transient Ischaemic Attack)

A

Transient neurologic dysfunction due to a vascular cause, typically lasting less than an hour.

Caused by ischaemia (focal brain, spinal cord or retina) WITHOUT acute infarction

Symptoms usually lasts for minutes.

3 Types
1. Atherosclerotic (>70% Occlusion - Increased risk (Symptoms lasts for minutes)
2. Embolic (symptoms lasts for hours)
3. Lacunar

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10
Q

What RFs are most at risk for berry aneurysms

A

SHAME

Smoking
HTN
Acute polycystic kidney disease
Marfans syndrome
Ehlers-Danlos syndrome

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11
Q

Ddx for stroke

A

Post-ictal state (Todd’s paralysis)
Migraine headache aura
Vertigo/Meniere’s disease
MS
Brain tumour
Cerebral infection
Conversion disorder/Malingering

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12
Q

Whats the gold standard diagnostic investigation for a stroke

A

Non-contrast CT of head
(Provided the px is stable)

Differentiate between ischaemic or haemorrhagic stroke

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13
Q

Most accurate imaging for a stroke ?

A

Diffusion-weighted MRI (Takes too long in emergency)

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14
Q

Most common occluded artery causing stroke

A

MCA

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15
Q

Ddx of collapse?

A

Neurological -Generalised seizure epilepsy , TIA/stroke, vasovagal syncope, Parkinsons, Situational syncope (Cough, micturition), Raised ICP, Intracranial Haemorrhages, Neuropathy (MS)

Cardiovascular - Aortic stenosis, Postural HTN, Arrythmias, carotid sinus hypersensitivity, Subclavian steal syndrome, vertebrobasillar insufficiency, structural (cardiomyopathy)

Other causes - Diabetes/Hypoglycaemia, Drug OD/Toxicity, Alcohol, Falls Injury, Ruptured AAA, ectopic pregnancy, delirium, Sepsis

Groupings - Epilepsy, Syncope & Non-epileptic attacks

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16
Q

Define Syncope

A

Abrupt and transient LOC
Leads loss of postural tone
As result of fall in cerebral perfusion

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17
Q

What important areas should you consider when FOLLOWING a COLLAPSE?

[Big 6]

A

Eye witness account
Triggers
Prodrome
Description of collapse
Recovery
PMH/Personal Hx

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18
Q

What Neurological Disorders do you need to consider stopping driving/Informing the DVLA

A

Epilepsy/Seizures
Chronic neuro disoders - MS, MND, Narcolepsy
Brain tumour/pituitary tumour
(Complete PK1 form with DVLA)

It is the patient’s responsibility to notify the DVLA in the case of any seizure.

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19
Q

Driving guidelines for epilepsy/seizures?

A

First unprovoked/isolated seizure: 6M off if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. 12M off if otherwise

Patients with established epilepsy or those with multiple unprovoked seizures:

May qualify for a driving licence if they have been free from any seizure for 12 months

No seizures for 5 years (with medication if necessary) a ’til 70 licence is usually restored

Withdrawal of epilepsy medication: should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose

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20
Q

Explain Driving guidelines for syncope?

A

Simple faint: no restriction
Single episode, explained and treated: 4 weeks off
Single episode, unexplained: 6 months off
Two or more episodes: 12 months off

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21
Q

Define Parkinsons Disease?

A

Chronic progressive neurodegenerative disorder characterised by motor symptoms of:

RESTING TREMOR
RIGIDITY
BRADYKINESIA
POSTURAL INSTABILITY

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22
Q

Onset of Parkinson’s?

A

Gradual

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23
Q

Characteristics of Migraine?

A

Recurrent, severe headache which is usually unilateral and throbbing in nature

May be be associated with aura, nausea and photosensitivity

Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe ‘going to bed’.

In women may be associated with menstruation

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24
Q

Characteristics of Tension Headache?

A

Recurrent, non-disabling, bilateral headache, often described as a ‘tight-band’

Not aggravated by routine activities of daily living

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25
Q

Characteristics of Cluster Headache?

A

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks

Intense pain around one eye (recurrent attacks ‘always’ affect same side)

Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers

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26
Q

Characteristics of Temporal arteritis?

A

Typically patient > 60 years old
Usually rapid onset (e.g. < 1 month) of unilateral headache
Jaw claudication (65%)
Tender, palpable temporal artery
Raised ESR

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27
Q

Causes of Acute single episode of headache?

A

Meningitis
encephalitis
subarachnoid haemorrhage
head injury
sinusitis
glaucoma (acute closed-angle)
tropical illness e.g. Malaria

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28
Q

Contraindication of Sumitriptan

A

Patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

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29
Q

Characteristics of Huntington’s disease

A

Chorea - Abnormal involuntary movement (Abrupt Dance like)
Personality changes (irritability, apathy, depression)
Dystonia
Saccadic eye movements

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30
Q

What inheritance pattern is Huntington’s Disease?

A

Autosomal dominant
Trinucleotide CAG repeat
Defective Huntington gene - Chromosome 4

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31
Q

Aetiology of Huntington’s?

A

Degeneration of cholinergic and GABAergic neurons in the striatum of the basal ganglia

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32
Q

Basilar artery Stroke Effects?

A

‘Locked-in’ syndrome

A condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking.

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33
Q

AICA stroke effects?

A

Ipsilateral: facial paralysis and deafness

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34
Q

PICA stroke effects?

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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35
Q

Retinal/ophthalmic artery stroke effects?

A

Amaurosis fugax

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36
Q

PCA stroke effects?

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

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37
Q

MCA stroke effects?

A

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

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38
Q

ACA stroke effects?

A

Contralateral hemiparesis and sensory loss, lower extremity > upper

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39
Q

Lacunar stroke effects?

A

Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule

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40
Q

What is Normal Pressure Hydrocephalus (NPH) ?

A

NPH is an accumulation of CSF that causes the ventricles in the brain to become enlarged.

“normal pressure” because despite the excess fluid, CSF pressure as measured during a spinal tap is often normal. Little/no increase in ICP in most cases.

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41
Q

Classic Triad of symptoms for NPH?

A

urinary incontinence
dementia and bradyphrenia (slower thinking and processing of information)
gait abnormality (may be similar to Parkinson’s disease)

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42
Q

Treatment for NPH?

A

Ventriculoperitoneal shunting

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43
Q

Aetiology of NPH?

A

2* to reduced CSF absorption at arachnoid villi
due to:

Head injury, SAH, Meningitis

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44
Q

Most commonly first-line medication for terminating acute seizures?

A

Benzodiazepines

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45
Q

What area of the Brain does Herpes simplex (HSV) encephalitis affect?

A

Temporal lobes predominately

Also can affect inferior frontal lobes

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46
Q

What are signs/symptoms of HSV Encephalitis?

A

Fever, headache, psychiatric symptoms, seizures, vomiting

focal features e.g. aphasia

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47
Q

What Characteristic signs on imaging do you see for HSV Encephalitis?

A

Petechial haemorrhages

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48
Q

Tx for HSV Encephalitis?

A

IV Aciclovir

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49
Q

Drugs causing peripheral neuropathy?

A

Amiodarone
Isoniazid
Vincristine
Nitrofurantoin
Metronidazole

50
Q

Pharmalogical Tx for Alzheimer’s Disease (AD)

A

AcH-Inhibitors - 1st Line
Rivastagmine, Donepezil

NMDA antagonist - 2nd Line
Memantine

51
Q

Aetiology of AD

A

cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein.

Causes widespread cerebral atrophy (particularly cortex & hippocampus)

Reduced acetylcholine from damage to ascending forebrain projection

52
Q

Common causes of dementia

A

Alzheimer’s
Lewy body dementia ~ Approx 10-20%
Cerebrovascular disease (Multi-infarct dementia) ~Approx 10-20%

53
Q

Key Differentials of dementia [8 Marks]

A

hypothyroidism, Addison’s
B12/folate/thiamine deficiency
syphilis
brain tumour
normal pressure hydrocephalus
subdural haematoma
depression
chronic drug use e.g. Alcohol, barbiturates

54
Q

Lamotrigine Indications?

A

2nd Line Tx for generalised and partial seizures.

55
Q

Carbamazepine indications?

A

Partial seizures
Trigeminal neuralgia
Bipolar disorder

56
Q

Wernicke’s Encephalopathy Triad ?

A

Nystagmus/Opthalmoplegia
Ataxia
Confusion, Altered GCS
Peripheral sensory neuropathy

57
Q

Causation of Wernicke’s Encephalopathy? (WE)

A

Thiamine deficiency. Petechial haemorrhages occur in brain structures (ventricle walls, mamillary bodies)

Commonly seen in alcoholics

58
Q

Investigations for WE?

A

Investigations
Serum Thiamine level
Therapeutic trial of Parenteral thiamine
Blood Glucose
UE
FBC
LFTs
MRI

59
Q

WE Differentials?

A

Alcohol intoxication- (elevated blood alcohol >100mg/dl)
Alcohol withdrawal
Viral encephalitis

60
Q

Management for WE?

A

Thiamine (IV)
Magnesium sulphate
Multivitamin

61
Q

Wernicke’s encephalopathy association with Korsakoff syndrome?

A

Wernicke-Korsakoff syndrome

Development of additional symptoms alongside WE.
IF WE ISN’T TREATED. [Long-term Thiamine deficiency]

Amnesia (Retrograde and anterograde)

Confabulation (Memory error in which gaps in a person’s memory are unconsciously filled with fabricated, misinterpreted, or distorted information)

62
Q

What Drugs are used for migraine prophylaxis?

A

Toprimate (Teratogenic) or Propanolol (B-blocker)

Patients experiencing 2 or more attacks per month.

63
Q

Management for acute migraine?

A

Triptan + NSAID (Sumitriptan/almotriptan +
Aspirin/Ibuprofen)

Triptan + Paracetamol

Anti-emetic - Metoclopramide (if above doesn’t work)

64
Q

A wide-based gait with loss of heel to toe walking

WHICH GAIT IS THIS?

A

Ataxic gait.

Cerebellar hemisphere lesions cause peripheral ataxia. (‘finger-nose ataxia’)

Cerebellar vermis lesions cause gait ataxia.

65
Q

Difference between syncope & seizures?

A

Syncope - Rapid recovery and short post-octal

Seizure - Greater post-ictal period

is due to a transient loss of cerebral blood flow (Cardiogenic)

Seizure - neurogenic or intracranial in origin - although it can be a result of cerebral hypoxia if blood flow is impaired.

66
Q

How could you differentiate between meningitis and encephalitis?

A

Meningitis - Cerebral function remains normal
Encephalitis - Abnormalities in brain functioning (Altered mental status)

67
Q

If encephalitis is suspected.

IMMEDIATE MANAGEMENT?

A

Prompt IV ACICLOVIR to cover HSV-1 infection.

68
Q

Clinical features of Encephalitis?

A

Fever
Headache
Seizures
Vomiting
Focal features (Aphasia)

69
Q

Which areas of the brain are commonly affected by encephalitis?

A

Temporal
Inferior frontal lobes

70
Q

Investigations for encephalitis?

A

LP- CSF: Elevated protein, lymphocytosis
PCR - For HSV
CT/MRI - Medial temporal + inferior frontal changes / - Presence of petechial haemorrhages
EEG - 2hz spike

71
Q

Most common pattern in bloods for someone with suspected neuroleptic malignant syndrome (NMS)?

A

Raised creatine kinase and leukocytosis (raised wbc).

72
Q

Mnemonic for NMS Clinical findings?

A

FEVER

F-Fever
E-Encephalopathy
V- Vitals (Symp NS activity increased). HTN,Tachy,++RR
E- Elevated CK
R- Rigidity (‘lead pipe’)

73
Q

Who is NMS most likely to be seen in?

A

Individuals taking antipsychotic medication (Atypicals)

Also occur in people with cessation of dopaminergic drugs (L-dopa) e.g. Parkinson.

Dopamine blockage -> Massive glutamate release -> Neurotoxity and muscle damage.

74
Q

Management for NMS?

A

Stop antipsychotics
IV Fluids to prevent Renal Failure
Dopamin agonist - Bromocriptine
Muscle relaxant - Dantrolene

75
Q

Mnemonic for Phenytoin SE?

A

PHENYTOIN

P- P450 interactions (Inducer)
H- Hirsutism
E- Enlarged gums (Bleeding/Gingival hyperplasia)
N- Nystagmus
Y- Yellow (Jaundice)
T- Teratogenic
O- Osteomalacia
I- Interference w/ B12 metabolism
N- Neuropathies

76
Q

Immediate management of TIA?

A

A patient who presents within 7 days of a clinically suspected TIA should have 300mg aspirin immediately (and be referred for specialist review within 24h)

Unless C/I - Bleeding disorder / Existing Anticoagulant therapy - Urgent CT Scan Needed to R/O Haemorrhage

77
Q

What Antiplatlet therapy is given long term following stroke

A

Clopigrel 75mg / [Aspirin + dipyridamole (c/I patients)]
Atorvastain

78
Q

Indications and Criteria for Carotid Artery endarterectomy?

A

> 70% carotid stenosis
Patient has suffered stroke/TIA in carotid territory and not severely disabled.

79
Q

Sodium Valproate SE

HINT: WHAT THAT PIG E?

A

W- Weight gain
H- Hepatitis
A- Ataxia
T- Thrombocytopenia

T- Teratogenic
H- Hyponatraemia
A- Alopecia
T- Tremor

P- Pancreatitis
I- Inhibits P450
G- GI: Nausea

80
Q

Reflexes
1. Ankle
2. Knee
3. Biceps
4. Triceps

A
  1. S1-S2 - Button my shoe
  2. L3-L4 Kick the door
  3. C5-C6 Pick up the sticks
  4. C7-C8 Close the gate
81
Q

What is the most common worldwide cause of epilepsy?

A

Neurocysticercosis
-Parasitic infection of the central nervous system
-Tapeworm(Taenia solium)
-Humans affected by eating undercooked food (Pork)

82
Q

Define Epilepsy

A

Syndrome of recurrent, unprovoked seizures

83
Q

Define Seizure?

A

Acute, Transient (<5min) neurological event caused by abnormal electrical discharges within the brain.

84
Q

Define Status Epilepticus?

A

Seizure activity that fails to terminate within the anticipated time period (5-30 minutes)

OR

SERIES OF CONSECUTIVE SEIZURES w/o recovery in between them

85
Q

Causes of Epilepsy?

A

Stroke
Brain tumour
Brain injury
CNS Infection

86
Q

Define Brain Death (Cerebral death) ?

3 Characteristic findings?

A

Irreversible loss of all function of the brain including the brainstem.

Coma
Absence of brainstem reflexes
Apnoea

87
Q

Define Brain Death (Cerebral death) ?

3 Characteristic findings?

A

Irreversible loss of all function of the brain including the brainstem.

Coma
Absence of brainstem reflexes
Apnoea

88
Q

Criteria for brainstem death testing?

Method of brain death testing?

A

Deep coma of known aetiology + failure to respond to external stimuli
Reversible causes excluded
No sedation
Normal electrolytes

Person’s heartbeat and breathing can only be maintained using a ventilator

Clear evidence that serious brain damage has occurred and it cannot be cured

TESTS
-No corneal reflex
-No fixed pupil response to any light intensity stimulation.
-Absent oculo-vestibular reflects (No eye movements following injection of ice-cold water (50ml) into each ear [CALORIC TEST]
-No response to supraorbital pressure
-No cough/gag reflex - Pharyngeal/bronchial stimulation
-No observed respiratory effect off ventilation (5 minutes)

2 DOCTORS, TEST ON SEPARATE OCCASIONS

89
Q

Define Raised Intracranial pressure?

Normal Values for ICP
-Adults
-Children
-Neonates

A

Sustained elevation in pressure exerted on the brain tissue by external forces (CSF and blood) above 20mmhg.

> 20+ (Intracranial HTN)

Normal Values
Adults (10-15mmhg)
Children (3-7mmhg)
Neonates (<2mmhg)

Increase in any of components leads to rICP [Brain/ Blood /CSF]

90
Q

Differentials for ICP?

A

Hydrocephalus
CNS Infectiosn - Meningitis/Encephalitis/Abcess
Trauma - Intracranial Haematoma
Cerebrovascular - SAH, Intracerebral/ventricular haemorrage
Status epileptics
Idopathic intracranial HTN

91
Q

Define Coma?

A

A person is in a coma if they are unconscious and unaware of what is going on around them and they do not open their eyes even in response to pain.

92
Q

High -altitude cerebral oedema.

What the most important management step?
What is considered high altitude?

A

DESCENT [FIRST LINE]
+ O2, Analgesia/ Dexamethasone

> 1500m altitude

93
Q

What Index is used to assess Disability following a stroke?

A

Barthel Index

Assess the functional status of a patient post-stroke and level dependancy to do tasks.

10 Tasks
-Feeding, moving from wheelchair to bed, personal toileting, getting on/off toilet, bathing, walking on level surface, ascending/descending stairs, dressing, controlling bowels and controlling bladder

0-100 (Completely dependent - Completely independent)

94
Q

What assessments should be done on stroke patients that are hospitalised.

A

Feeding assessment - Screening for safe swallowing needs to occur. (Reduce aspiration risk + complications)

Disability Scales- Barthel Index

Fluid management - Fluid status assessment (Maintain Normovolaemia

BP Management - Only be used in HYPERTENSIVE emergencies as (Don’t want to compromise collateral blood flow to affected regions by lowering bp)

Glycaemic control - diabetes (IV Insulin & glucose infusions / nil by mouth px (swallowing concerns)

95
Q

Stroke Fluid Assessments Considerations

A

Oral hydration is preferable - Patients who are able to safely swallow

IV Hydration- In those who have difficulties swallowing
Isotonic saline (No dextrose)

Monitor - Electrolytes

Monitor fluid status to prevent OVERHYDRATION (cerebral oedema, cardiac failure and hyponatraemia) / HYPOVOLAEMIA ( infection, deep vein thrombosis, constipation and delirium)

96
Q

For Individuals eligible for thrombotic therapy what is the IDEAL BP Range

PRE & POST TREATMENT

A

<185/110 (Pre- treatment)
<180/105 (Post treatement)

97
Q

Stroke Feeding Assessments Considerations

A

NIL By Mouth Until assessment
Assessment of any oral intake of food, fluids, and/or medication

Swallowing specialist assent within 24-72 hours if any concerns.

Recommendations for patients deemed unsafe for oral intake:
Patients should receive nasogastric tube feeding, ideally within 24 hours of admission, unless they have had thrombolytic therapy

If nasogastric tube feeding is not tolerated, patients should be considered for a nasal bridle tube/gastrostomy instead

Medications need to be assessed to determine if formulations are available for NG feeding/ conversion to subcut or IV.

Nutritional support need to reduce malnutrition risk post-stroke (due to dysphagia, poor oral health/ reduced self-feeding ability from weakness/paralysis)

98
Q

STROKE MANAGEMENT

A

A-E Assessment
Maintain - BG, O2 Sats, Temp, Hydration
BP Monitoring - LOWER ONLY IF HTN EMERGENCY/complication

CT SCAN - RULE OUT HAEMORRAGIC Stroek
Yes - Aspirin 300mg PO/PR

Thrombolysis
<4.5 hrs + Haemorrhage has been excluded

(+Thrombectomy if criteria is met)

2nd Prevention
Clopigogrel
Aspirin/Dipyridamole (C/I of clopidogrel)
Statin

99
Q

Contraindications to Thrombolysis

A

Suspected SAH
Previous ICH
Active Bleeding
Seizure at onset of stroke
Uncontrolled HTN > 200/120 (Above 185/110)
Prev stroke/ traumatic brain injury past 3M
Pregnancy
LP in last 7 days
GI Haemorrhage past 3 weeks
Oesphageal varices

Things to be aware of
INR levels (>1.7)
Major Surgery Prev 2 weeks
Bleeding diathesis (Cogulation defects - VWB, Hamophillia..)

100
Q

Criteria for Thrombectomy?

A

Acute Ischamic stroke Within 6hrs of symptom onset

Confirmed occlusion of - Proximal Anterior Circulation (CTAngiography/MRAngiography)

Proximal posterior circulation (Basillar/PCA) - confirmed by CTA/MRA

Potential to salvage brain tissue imaging -CT perfusion /DW MRI

+IV thrombolysis (Within 4.5 hrs)

101
Q

What scale can be used to test pre-stroke functional status (ADLs) ?

A

Modified Rankin Score

102
Q

What Pre-screening tools can be used to identify stroke

A

FAST (Face, Arms, Speech, Time to call 999)

ROSIER (ED stroke recognition)
LOC/Syncope (-1/0)
Seizure activity (-1/0)

Asymmetric facial weakness
Asymmetric arm weakness
Asymmteric leg weakness
Speech disturbance
VF defect
[1/0 mark for each]

Stroke is unlikely if <0 /= 0

NIHSS - Objectively QUANTITY THE IMPAIRMENT SEVERITY OF A STROKE

103
Q

Rankin Score

A

[ADD]

104
Q

What organism is responsible for neurosyphilis?
What disease process can neuosyphillis symptoms mimic?

A

Treponema Pallidum
Meningitis

105
Q

What are signs of rICP (Raised Intracranial Pressure)?

A

Papilloedema
Focal Neurological signs
Continuous/uncontrolled seizures
Reduced GCS (<12)

106
Q

When would you not do a LP?

A

Infection is present at LP site

107
Q

What are focal neurological signs/deficits

A

Set of symptoms or signs in which causation can be localised to an anatomic site in the central nervous system (Brain/SC/Nerve)

e.g. Paresis, Plegia

108
Q

What blood test can differentiate between a pseudoseizure and true seizure?

A

Serum Prolactin

  • Raised following true seizures (Spread of electrical activity to ventromedial hypothalamus -> leads to release of prolactin)
109
Q

Clinical signs indicating pseudo seizure?

A

Pelvic thrusting
Crying after seizure

110
Q

Essential Tremor (Benign essential Tremor)

Clinical features
Mangagement

A

Autosomal dominant, affects both upper limbs

Clinical features
- Postural tremor -> Worse when hands are outstretched
-Improved with alcohol and rest
-Can cause head tremor

Management
-Propranolol

111
Q

What is important pre-step before doing an LP with a Space Occupying lesion?

A

CT Head

-Check that there is no shift/asymmetry in the brain as this increases risk of herniation (pressure coming from one side is at risk)

112
Q

RF for Idiopathic Intracranial Hypertension (IIH)?

A

Obese Female
Pregnancy

113
Q

Clinical features of IIH?

A

Headache
Blurred vision
Papillodeama
6th nerve palsy
enlarged blind spot

114
Q

Management of IIH?

A

Weight loss
Diuretics - Acetazolamide (IIH + Glaucoma)
Repeated LPs
Surgery - Optic nerve sheath decompression

115
Q

Red flag criteria that indicates further imaging?

A

Vomiting more than once with no other cause.
Progressive headache with a fever.
New neurological deficit (motor or sensory).
Reduction in conscious level (GCS)
Valsalva (associated with coughing or sneezing) or positional headaches.

SCANIT
S - Sudden-onset headache (reaching max. intensity within 5 minutes)
C - Characteristics (Orthostatic, Valsalva, Change in chronic headache)
A - Age (>50), Arteritis, Acute Narrow-angle glaucoma
N - Nausea (2+ Vomiting episodes w/o cause), Neurological deficit
I - Impaired consciousness, Immunocompromised
T - Tumour (History of malignancy), Temperature (Systemic fever), Thinners (Anticoagulated)

116
Q

What might help you to differentiate between

A

Unilateral symptoms
More severe/early onset autonomic dysfunction (postural hypotension/erectile dysfunction).

117
Q

What is used to treat cerebral oedema in patients with a brain tumour?

A

Dexamethasone

118
Q

What is the most common long-term complication following meningitis?

A

Sensorineural loss.

119
Q

DVLA RULES

Epileptic patient changes medication and has a seizure. Is put back on original medication and is seizure free for 6M

Are they able to drive?

A

Apply to DVLA to reinstate licence.

6M seizure free period after changing medication. License can be reinstated.

120
Q

What is the main treatment for ALS (MND)?

A

Riluzole

Phase 3A Quiz (7 decks)

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