Neuro Prep Flashcards
What are the 7 red flags for headaches?
- thunderclap = max intensity within 5 mins of onset (SAH)
- malignancy = weight loss, neurological signs, waking at night
- fever with worsening headache, neck stiffness, rashes and change in mental status - meningism
- scalp tenderness, jaw claudication, visual changes (GCA)
- new onset focal neurological deficit, personality change, or cognitive dysfunction (intracranial haemorrhage/stoke/SoL)
- Headache that’s posture dependent (increased ICP)
- Headache with severe eye pain/blurred vision/N+V/red eye (acute angle closure glaucoma)
What imaging is recommended for (i) concerning headaches and for (ii) emergency evaluation of acute headaches (eg intracranial haemorrhage)?
(i) MRI with contrast
(ii) CT without contrast
What are the investigations for suspected meningitis?
U+Es, LFTs, glucose, coagulation screen
Blood culture, throat swabs for bacteria for bacteria and virology
Lumbar puncture - measure opening pressure (increased = meningitis)
Appearance + contents of CSF: bacterial = turbid, increased WBC, low glucose, high protein.
viral = clear, increased lymphocytes, increased protein
CXR for signs of TB
What is the treatment for meningitis? (bacterial and viral)
Give benzylpenicillin pre-hospital IV/IM
If under 55 = cefotaxime IV
If over 55 = cefotaxime + ampicillin IV
Aciclovir if viral encephalitis is suspected
Prophylaxis - discuss with public health. Give rifampicin 600mg/12h PO
What is the most common location of an extradural haemorrhage?
middle meningeal artery
What are the (i) investigations (ii) management in a patient with suspected subarachnoid haemorrhage?
(i) CT detects over 90% SAH w/in first 48h
Lumbar puncture if CT neg + no contraindication
CSF uniformly bloody early on + becomes xanthochromic after several hrs due to Hb breakdown
(ii) Refer all proven SAH to neurosurgery immediately
- maintain cerebral perfusion
- nimodipine (CCB) to reduce vasospasm
- endovascular coiling
What are the (i) investigations and (ii) treatment in a patient with suspected giant cell arteritis?
(i) raised CRP +ESR
obtain temporal artery biopsy within 7 days of starting steroids (skip lesions do occur)
(ii) Prednisolone 6mg/day - there is a high risk of vision loss so treat asap
Send urgent rheumatology referral
What is the treatment, and prophylaxis/prevention, of migraines?
Treat with NSAIDs and dispersible aspirin plus triptan (sumitriptan)
- note triptans contraindicated in IHD, uncontrolled HTN, coronary spasm, recent lithium, SSRIs, use b-blocker instead.
Prevent by removing triggers, ensure analgesic rebounding headache isn’t complicating matters
- use prophylaxis meds if experiencing more than 2 migraines/month.
- 1st line = propranolol, amitriptyline, CCBs
- 2nd line = valproate, gabapentin, pregabalin
What is the treatment for a cluster headache? What is the prophylaxis?
100% O2 for 15 mins via a non rebreather mask
- sumitriptan SC, or zolmitriptan nasal spray
Prophylaxis = verapimil or prednisolone
What is the treatment for tension headaches?
Responds to simple analgesia
What immediate investigations should be performed in a suspected 1st seizure?
EEG
CT/MRI
What are the types of partial seizures? How are partial seizures treated?
Simple partial Complex partial Partial seizure with 2ndary generalisation TREATMENT: 1st line = carbamazepine 2nd line = sodium valproate, lamotrigine
Describe a simple partial seizure.
awareness is unimpaired with focal motor/sensory/autonomic/psychic symptoms
NO post ictal symptoms
Describe a complex partial seizure
Awareness is impaired
May have simple partial onset (aura) or impaired awareness at onset
Post ictal confusion = common with temporal lobe seizures. Recovery is rapid with frontal lobe seizures
Describe partial seizure with secondary generalisation
Occurs in 2/3 of patients who experience partial seizures
Electrical disturbance starts focally and spreads widely causing a secondary generalised seizure thats generally convulsive
