Neuro Conditions

Question 1

Stroke

Answer 1

Ix: clinical, Bms for hypoglycemia Imaging: CT head to exclude primary intracerebral haemorrhage
Mx: admit to specialist stroke centre, STAT 300mg Aspirin after CT for 2 wks, thrombolysis/ thrombectomy within 4.5 or 6.5 hours. Diffusion weighted MRI to establish vascular territory , carotid USS for carotid stenosis. Secondary prevention: Clopidogrel 75mg OD, Atorvastatin, Carotid endarterectomy if stenosis, treat diabetes/HTN. Rehabilitation: MDT of nurses, SALT, physios, OT, social services etc

Question 2

MS

Answer 2

Ix: Clinical diagnosis ‘lesions disseminated in time and space’, MRI demonstrates typical lesions, LP ‘oligoclonal bands’ in CSF, Opthal for optic neuritis
Mx: Education + MDT approach; neurologists, nurses, physios, OH, symptomatic treatment - amitriptyline for neuropathic pain, SSRIs for depression, Oxybutynin for urge incontinence, baclofen for spasticity. Relapses treated with methylprednisolone, DMARDs/biologics to induce long term remission

Question 3

MND

Answer 3

Ix: clinical Dx
Mx: No treatments for halting/reversing disease progression. Involve MDT, Advanced directives to document the patient’s wishes as the disease progresses/End of life care planning. Riluzole/Edaravone to slow down disease progression, NIV used at home to support breathing

Question 4

Parkinsons

Answer 4

Ix: Clinical Dx
Mx: Levodopa (synth dopamine) + carbidopa/benserazide (peripheral decarboxylase inhibitors) + COMT inhibitor i.e. entacapone, cabergoline/bromocriptine/ MAOBI i.e. Selegiline/Rasagiline if need to delay levodopa

Question 5

Epilepsy

Answer 5

Ix: rule out other causes of collapse i.e. FBC, BMs, Imaging: EEG, MRI brain, ECG to exclude heart pathology
Mx: Tonic-clonic, Absence, Atonic, Myoclonic: Valproate 1st, lamotrigine/CBZ 2nd, Focal: reverse of TC

Question 6

MG/LEMS

Answer 6

Ix: ACh-R/MuSK/LRP4antibodies, FVC, edrophonium testCT/MRI of thymus for thymoma
Mx: Reversible acetylcholinesterase inhibitors (pyridostigmine/neostigmine) Immunosuppression (e.g. prednisolone or azathioprine) to suppress antibodies, Thymectomy, Monoclonal antibodies e.g. Rituximab. Myasthenic crisis: NIV/intubate, IVIG + plasma exchange

Question 7

Guillian Barre

Answer 7

Ix: clinical, nerve conduction studies, LP for CSF (raised protein)
Mx: IVIG, plasma exchange, VTE prophylaxis, intubate/ventilate

Question 8

Cluster headaches

Answer 8

Mx: Sumatriptan + high flow 100% O2, verapamil prophylaxis