Neuro Summary Q's Flashcards
Cranial nerve exam, forehead raised but everything else weak. What does this mean and why?
Must be a lower motor neuron as all branches of facial nerve are blocked.
STORM BABy
Strength Tone Other (clonus, etc) Reflexs Musc mass Babinski In LOWER, all go down // UPPER all up except for strength
what mustnt be given to MG patient?
gent / B blocker / Mg2+
post seizure what investigations?
ECG and CT/MRI // then 24hr bloods, LP, EEG +/- CT Brain and advise no driving, swimming, heights
what nerve is damaged if winged scapula?
long thoracic nerve
what nerve innervates Radial, Median and Ulnar, and what might be seen in nerve palsy of these:
Radial - C5 Ulnar - C6 Median - C7 Radial - sat night palsy / tennis backhand movements Ulnar - claw hand / Median - pincer grip / LOAF muscs
causes of unconsciousness
Neuro - epilepsy, CVA, encephalitis, meningitis, head trauma Non-neuro - hypoxia, hypogly, drug OD,
management of status epilepticus
Serum CA / U+E’s / BM then give IV lorazepam +/- phenytoin + ECG
??SAH investigation plan
if red flags, CT within 48 hours + LP
treatment of MS (relapses)
Methylpred / IFN-1 / monoclonal ABs
drug causes of parkinsonian
metaclop + haloperidol
MG main CF and Investigation
Voice fades, extra ocular muscs, ptosis, limbs, swallowing problems, droopy face I - anti - acetylcholineserase AB’s + nerve conduction be aware of myasthenic crisis
RED FLAGs for headache
SNOOC Systemic (weight loss or fever) Neuro defecit Onset sudden Older person Ca hx
treating a SAH
coiling/clipping or nimodipine (prevents vasospasm)
MS key facts
??
stroke in young people causes
??tumor
causes of delerium
infections, dehydration, metabolic disturbance, psychiatric, drugs, withdrawls
managing a stroke in acute setting
Airway maintainance do ECG, BP, HR (clues to whether embolus) BM (aim for 4-11) Urgent CT/MRi to exclude haemo cause if ischaemic confirmed, thrombolyse if <4.5 hours
DDx of stroke
Migraine, sub-dural haem, head injury, hypoglyc, drug OD
CI to thrombolysing
haem, past CNS bleed, seizures at presentation, INR >1.7, BP >220/130
examples of axonal and demyelinating periph neurop
Axonal - HIV, DM, Nutritional, alcohol = more sensory defecit glove and stocking Demyelinating - Guillan Barre, CMV/EBV = ascending motor weakness over days
Basilar Stroke
??
CI to lumbar puncture (4)
GCS decrease/focal defecit wound infection over site cardio-resp decrease coag disorder
define GCS
what is common sign of extra dural haematoma?
CN3 - pupil changes
agitation
gcs decrease
N+V
papiloedoma
what are common causes of GCS deterirotation in alcohol/assault cases etc
hypoglycaemia
encephalopathy
substance abuse (alcohol)
DT’s
benzo’s toxicitiy (if given)
CI to giving entonox
decreased GCS / head injury
pneumothorax
abdo injury
what indicators of raised intra cranial pressure
cushings triad:
bradycardia
widening BP (rising systolic, declining diastolic)
irregular respiration
what treatment of meningitis is used?
ben pen (if menigococ suspected)
dexamethasone
IV ceftriaxone
what might these symptoms in the acute setting point towards?
dizziness, difficulty breathing, difficulty or inability to swallow, loss of coordination, double vision and nausea.
brainstem stroke
