Neuro misc Flashcards
treatment for Non-epileptic attacks?
rectal benzo/ buccal
midazolam to try and abort the attack.
Ambulance: another dose of
lorazepam?
A-E
If so can give one further dose of lorazepam IV
when reach hospital.
Then move onto IV phenobarbital or phenytoin,
Anaesthetic agents.
Treatment for tonic clonic siezure?
Sodium valproate and lamotrigine.
How do you treat focal siexures?
Carbamazepine and lamotrigine.
how do you treat an abscent seizure?
NOT CARBAMAZEPINE, valproate,
ethosuximide.
Treatment for GCA
Prednisolone (45mg) and Aspirin (75mg) with a PPI
Characteristic feature of GCA?
Scalp tenderness and palpabale tender and reducded pulsation temporal arteries. temporal loss of vision - maybe in one eye. temporaal artery educed pulsations
Investigations for GCA
Raise ESR and CRP
ANCA negative
Raise aLP (alkaline phosphotase)
reduced Hb
Who isGCA most common in?
over 50 females. if under 50, suspect takayshu
what is a seizure?
A paroxysmal event in which changes in behaviour, sensation or cognition are affected by excessive hypersynchronous neuronal discharges in the brain.
What is epilepsy?
A recurrent tendency to seizures:
2 unprovoked seizures
1 seizure and EEG evidence of a tendency towards seizures.
Investigations for seizures?
Focal or considering neurosurgery do MRI.
CT if secondary to an injury
EEG to support diagnosis.
ECG
Exclude other causes- glucose, U&E, calcium, LFT.
Alzheimer’s treatments?
anticholinesterases (donepazil)
memantine (anti glutamate
control RF
MDT
Signs of meningitis?
Neck stiffness Headache Non blanching rash Photophobia Vomiting Reduction in level of consciousness/ seizures Signs of shock Signs of raised ICP. Fever If evidence of focal neurological deficit, think encephalitis instead.
CSF of viral meningitis
decrease WBC and protein
normal glucose
clear
CSF of bacterial meningitis?
Increase neutraphils and protein
decrease glucose
cloudy
treat a subarachnoid haemorrhage?
Nimodipine CCB to prevent ceberal artery bursting. fluids and rest
Treat GCA?
High dose oral prednisolone (40mg) + low dose aspirin (75mg)
+
PPI (both medications associated with gastrointestinal toxicity)
what is a focal seizure with consciousness?
jerk,y, seld aware, memory retained
Focal seizure with dysphagia and motor impairment?
proble with the frontal lobe
Focal seziure with numbeness, pain, tingling? (sensation impairent)
problem in parietal lobe
Wich siezure do u not treat with carbamazepine?
Absence - treat with Na Valporate and ethosuximide
Name the dementias?
Alzheimers
Vascular
Frontotemporal
Lewy body
What plaques would u find in alzheimers?
B amyloid. links to APP gene.
how do you test memory and alzheimers? (cognitive imparirment)
6CIT questions
ask about year, time, counting, address, current time etc, month, year and repetition. assess on confidence
Treat Alzheimer’s?
MDT, control vascular risk factors, anticholinesterases (donepazil) and memantine (anti glutamate).
What is Kernig’s sign?
supine hip flexed. knee cant be fully extended
What is Brudzinski’s sign?
neck rigidity. Flextion of nech causes flection of legs and thighs
What are the two signs of meningitis?
Kernig’s and Brudzinski’s
LP for TB?
clear, raised lymphoctyes, very raised protein, very low glucose
Encephalitis CSF?
clear, normal/raised protein and lymphocytes. normal or low gloucose
which meningisitse has cloudy CSF?
bacterial
Treat meningitis?
IV 3rd generation cephalosporin e.g. ceftriaxone
IM ben pen if community
Name a cephalosporin?
ceftriaxone
Features of cauda equina?
Urinary retention
Loss of ankle and knee reflexes
Severe radicular pain esp. down backs of legs,
Saddle anaesthesia, perianal numbness
Sexual dysfunction
Areflexic flaccid weakness with fasciculations.
Loss of anal tone- very late.
Treat cauda equina?
decompression surgery and high dose dex.
Cerebellar haemorrhage common features?
nystagmus gait disorder headache vomit dysarthia intention tremour - when guided to an object staccato speech
what disease presents with a resting tremour?
parkinsons
What is the most common cause of cerebellar haemorrhage?
Hypertension Use of anticoagulants Coagulopathies Arteriovenous malformation Metastatic tumour Cavernoma Trauma
name a prothrombin complex concentrate?
Beriplex
How do you treat cerebellar haemorrhage?
CT, rever warfarin Beriplex (prothrombin complex concentrate) fresh frozen plasma, vit K surgery BP control - BB
what makes up 80 percent of strokes?
ischaemic. the others are haemorrhagic
Signs of SAH?
Kernig’s sign
Brudzinski’s sign
sudden onset thunderclap headache
(no nausea or associated symptoms)
Most common cause of non-traumatic SAH?
Berry aneurysms
AVM rupture
Treating SAH?
Lifestyle – stop smoking, HTN
Medical – Nimodipine
(reduces vasospasm – lowers risk of cerebral ischaemia)
Surgical – Endovascular coiling/clipping
Complications of SAH
Hydrocephalus
Cerebral ischaemia
Seizures
Causes of sub-dural haemorrhage?
Trauma
Dementia / Alcoholism
Anticoagulation
DM
rupture to a bridging vein
Sub-duralheamorrage signs/
Loss of consciousness
Seizure
Nausea, vomiting
Evolving neurological deficit
Treatment of EDH?
Burr hol craniotomy (drainage to decompress)
Cause of EDH?
Trauma to temporal bone and haemorrhage of middle meningeal artery. treated with craniotomy
What is GBS
Guillain-Barre Syndrome (GBS) . condition where there is a damamged meylin and exposes nerve fibres
Symptoms of GBS?
Symmetrical, Rapid onset, progressive muscle weakness and Paraesthesia starting at hands and feet and moving upwards.
Autonomic Dysfunction – BP, HR, Sweating
pain common in back, shoulders
Complication of GBS?
respiratory failure, moniter FVC every 4 hrs
CSF of GBS?
raised protein (igG ganglioside antibodies) Normal WCC
What investigations would u find in GBS
Nerve conduction studies – slow conduction velocity (demyelination)
Anti-ganglioside antibodies
LP and CSF analysis – raised proteins (IgG anti-ganglioside antibodies), normal WCC
What antibodies would u find in GBS?
anti-ganglioside antibodies
Treating GBS?
IVIG -
Plasma exchange
Mechanical Ventilation if respiratory failure
What does GBS usually precede?
GI or Resp infection like diarrhoea symptoms or sore throat
What causes GBS?
Campylobacter, CMV, VZV, HIV, EBV
causes an autoimmune respone 1-3 weeks infection
Pathophysiology of GBS?
Anti-ganglioside IgG due to molecular mimicry, binds to gangliosides in peripheral nerves = destruction of myelin sheath by T cells and macrophages
What can sensory loss indicate?
MS, myelopathy
What can disturbances in eye movements indicate?
MG or MS
What can disturbances in sphincter indicate?
MS not MND
What signs arent seen in MND
No sensory loss (MS, Myelopathy)
No disturbances in eye movements (MG, MS)
No sphincter disturbances (MS)
Mx for MND?
RILUZOLE (Anti glutaminergic
TReatment for drooling in MND
– Amitriptyline
Treatment for spasticity in MND
Baclofen (GABA agonist) or Dantrolene (Inhibits Ca2+ skeletal muscle contraction
treatment for joint pain
analgesiac ladder
Treatment for meningitis?
cefotaxime
Treatment for meng. caused by listeria mono.
add amoxacillin to cefotaxime
4 types of MS?
PRMS
SPMS
RRMS
PPMS
Would you see nystagmus in MS?
yes
Demyelination for MS symptoms?
Diplopia Eye movement painful (Optic Neuritis) Motor weakness nYstagmus Elevated temperature (Uhthoff phenomenon) Lhermitte’s sign Intention tremor Neuropathic pain Ataxia Talking slurred Impotence Overactive bladder Numbness
Where would u see an intention tremou?
MS and Wilson’s disease
What would u se in CSF electrophoresis of MS
oligoclonal bands igG. this is CNS infammation
What investifations would u do for MS?
MRI WITH CONTRAST – active lesions (able to receive appropriate treatment
Treatment for neuropathic pain in MS
Gabapentin
What would u give to treat sexual dysfunction?
Sildenafil
