Neuro problems Flashcards by Easy MRCOG

What is Idiopathic intracranial hypertension (IIH)

excessive formation of CSF
obstrutive drainage of CSF

causes headache and papilledema

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Idiopathic intracranial hypertension (IIH) predominantly affects which target group

Obese women of child bearing age

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What is the common presenting symptom of IIH

Headache and transient visual obscuration.
The headache can occur daily and is typically a throbbing, retrobulbar headache that can worsen with eye movements & coughing
straining Diplopia in 38% +/- loss of vision (31%) with diplopia

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IIH ratio in males to females

IIH has a female to male ratio of 8:1.

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Other symptoms of IIH

nausea
vomiting
photophobia
visual blurring
visual loss
double vision
tinnitus
vertigo
rarely, spontaneous CSF otorrhoea or rhinorrhoea.

This condition may aggravate pre-existent migraine

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What is the Lumbar pressure to diagnose IIH

Greater than 250 mmh2o

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What mode of delivery is allowed in IIH

Vaginal delivery can be allowed (50%)

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Which anasthesia is safest in IIH

Spinal

Avoid general and epidural

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Why can’t we give epidural anasthesia to patients with IIH

it carries a potential risk of increasing ICP because of large volume of drugs in the epidural space .

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IIH

Those patient who already have lumboperitoneal shunt ..What measures we can take for them

Particular attention to be given to women with lumboperitoneal shunt who need regional anesthesia.
*There is potential risk of shunt damage
Prior imaging is recommended because there is a risk of shunt enlargement

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Why we don’t prefer general anesthesia in IIH

Raises ICP when we use rapid sequence induction

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How we manage patients of IIH medically

Analgesics:
- paracetamol is safe
- Opioid can be use but can cause physical dependence in neonate
- NSAID should be avoided in late pregnancy

Diuretics:
* Acetazolamide
* Loop diuretics (only for short time)
* Steroids only in acute condition

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IIH

What is the mechanism of action of acetazolamide

Carbonic anhydrase inhibitor

Inhibits carbonic anhydrase enzyme in the CNS which delays abnormal and excessive discharge of CSF from choroid plexus .

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Why thiazide diuretics are contraindicated in IIH

Fetal Growth Restriction

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IIH

For breast feeding women what treatment you will prescribe?

Acetazolamide can be continued during breastfeeding
Paracetamol and short-term use of NSAIDs are safe to use.
Ibuprofen is the drug of choice if long-term use is contemplated.

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Define epilepsy

Recurrent unprovoked seizures resulting from excessive neuronal discharge

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What is the prevalence of epilepsy in.child bearing age?

0.5-1%

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WHAT is the most common cause of SUDEP?

Generalized tonic colonic seizures
Or Grand mal seizures

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How much is the risk of death increases in pregnant women with epilepsy

10 folds

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Who we consider as low risk women in pregnancy

10 years no seizure attack or 5 years is well controlled without AEDS

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What is the risk of congenital anomaly in WWE not taking AED

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What are the risk of epileptic fits on fetus?

Increase risk of IUGR
Increase risk of hypoxia
Developing childhood epilepsy

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What are the medication you will prescribe pre conceptual and in early pregnancy for WWE

Folic acid supplementation
taking AED at lowest dose, usually monotherapy, avoid sodium valproate

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What are thesuggested AED in pregnancy

Levoteracetam
Lamotrigine
Carbamazepine

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Sodium valproate is associated with which congenital anomalies

Facial cleft NTD poor cognition & neurodevelopment hypospadias

Phenobarbital and phenytoin are associated with what anomalies

Cardiac defects Fascial cleft

Risk of malformation with sodium valproate

6-10%

Risk of malformation with lamotrigine 300 mg

2-5%

Risk of malformation with carbamazepine 400 mg

2-5%

Risk of malformation with levetiracetam

0.07

If 1 child has congenital anomalies what is the risk of recurrence in next child

0.168

Is there any risk of autism.with AED?

Yes

When to avoid or postpone pregnancy

Uncontrolled epilepsy drug resistant epilepsy Non compliance Polytherapy High dose AED

How we care this patient antenatally?

- 5mg folic acid pre conception and 12 weeks - Manage as low risk and high risk In high risk MDT - Individualize the frequency of visits and at each visit ensure involving other specialities - avoid triggers - ensure AED compliance - asses seizure frequency -consider AED level - Serial growth scan from 28 weeks

What is preffered analgesia during labour?

TENS, Entonox, regional analgesia

Which analgesia is contraindicated

Pethidine *increase seizures potential*

Intrapartum care of WWE

Avoid stress, hyper ventilation or sleep deprivation. **AED should be continue in labour** If high risk of seizure manage with benzodizapine CEFM

What is the percentage of tonic clonic seizure in labour

3-5%

Define status epilepticus

Seizure lasting for more than 5 mins or having more than 1 seizure without any break in 5 mins

What is management of status epilepticus

- Left lateral - Oxygen - IVlorazepam 0.1mg/kg - Diazepam 5-10 mg I/ v as alternative *If no IVaccess then p/r 10-20 mg diazepam* *If seizure not control then phenytoin 10-15 mg/kg IV* *if no IV access then give diazepam 10-20 mg rectally repeat after 15 minutes if needed.* - Prevention tongue bite protection

What period is most vulnerable for seizures

Postpartum

If AED dose increases in pregnancy what time duration in which we have to taper it off postpartum

10 days

Which aed excreted in breast milk

1. Lamotrigen 2. Levetiracetam 3. Topiramate *transfer to larger extent through breast milk*

What will be the contraception advice for WWE

1. Cu IUD 2. LNG- IUS 3. DMPA (BEST)

Emergency contraception for WWE

Cu-IUD

Which antiepileptic has the least risk of malformations in the fetus?

Lamotrigine

If there is no **history of epilepsy** and a fit of seizures presented in **2nd trimester** treat it as:

Eclampsia

The effect of pregnancy on epilepsy

* Seizure free: 64% * Increased seizure frequency: 17% * Decreased seizure frequency: 16% * Intrapartum seizures: 3.5% * Status epilepticus: <2%

At which weeks to perform fetal anomaly scan?

18 - 20+6 weeks

Do we encourage wwe who are taking aeds to breastfeed?

Yes

Do we use levonorgestrel or ulipristal acetate as emergency contraceptives in wwe taking enzyme inducing aed?

No they are affected by them

Women taking lamotrigine monotherapy and estrogen containing contraception should be informed that

Potential increase in seizures due to fall in levels of lamotrigine

Babies born to wwe should be given

1 mg of IM VIT K

Do lamotrigine crosses in breast milk

Yes, so women must be encouraged to breastfeed before taking the medication

What is most common type of headache

Tension Migrian

Incidence of accidental dural puncture during epidural anesthesia

0.5-2.5%

Success rate of an epidural blood patch in ttt post dural puncture headache

60-90%

Name of the visual disturbance in migrain aura appears like zigzag pattetn

Fortification spectrum

Medication is both safe in pregnancy and reserved for ttt-resistant migraine

Sumatriptan

What is the name of the diagnostic criteria used for idiopathic intracranial hypertension

Modified dandy criteria

Which headache is diagnosed using angiography to detect vascular narrowing?

Reversible vasoconstriction syndrome

Most common site for cerebral venous thrombosis

Saggital sinus

# RECALL Best imaging modality for diagnosing CVT and what is the ttt | cerebral venous thrombosis

MRV venography LMWH for 6 months

# **RECALL** Antiepileptic drugs that cause SGA

1. Topramate 2. Phenobarbitol 3. Zinosamide | PIZZA

Which prophylactic antiepileptic medication is to be administered during labor?

Colbazam | long acting benzodiazipine

Name two medications usea to terminate seizures in a patient with IV access.

Lorazepam Diazepam

Name two medications used to terminate seizures in a patient without IV access.

Diazepam rectal Midazolam buccal

If initial seizure treatment fails, which two medications should be administered next

Phenytoin Phosphophenytoin

What are the three most suitable contraceptive options for women on hepatic enzyme-inducing (HEI) antiepileptic drugs?

- DMPA (best) - IUD - IUS

Which contraception is contraindicated with Lamotrigine?

COC

Prophylaxis of recurrent migrain

amytriptalins

Diagnosis of posterior reversible encephalopathy syndrome | brain loses function to regulate amount of blood coming to it

MRI

worst headache ever is caused by

subarchanoid hmge

Diagnosis of Cluster headache

headache in area of brain +- ottorhea +- rhinorrhea

Neuro problems Flashcards

(74 cards)