Neuro treatments Flashcards
Ischaemic stroke
Investigations and treatments
Investigations
NCCT mainly to exclude haemorrhagic stroke
Treatment
Within 4.5 hours –> Alteplase
4.5 hours - 6 hours –> Thrombectomy
+ 300mg aspirin for 2 weeks
Clopidogrel for life
Haemorrhagic stroke (all 3)
Investigations and treatments
NCCT
Subarachnoid - Star shaped sign
+ Coronary angiogram - see where bleed is coming from
- Lumbar puncture after 12 hours of symptom onset –> xanthochromia
Tx - Endovascular coiling and neurosurgical clipping (Nimodipine - CCB)
Subdural - Crescent shaped haematoma
Tx - Craniotomy and burr hole
Epidural - Lens shaped limited by cranial sutures
Tx - Urgent surgery
Meningitis
Investigations and treatments
Investigations
Lumbar puncture and CSF analysis - See if viral or bacterial cause
Stool PCR for enterovirus (viral load higher)
Blood culture + PCR
Treatment
1st line in primary care –> IM benzylpenicillin
INFORM PHE
Viral - Acyclovir
Bacterial - Ceftriaxone and IV dexmethasone
(Listeria - Amoxicillin)
Encephalitis
Investigations and treatments
Investigations
Lumbar puncture - Viremia and increased lymphocytes
Treatment
Acyclovir (HSV,VZV)
Gancyclovir (CMV)
Alzheimer’s
Investigations and treatments
Investigations
Mini mental state examination (<25 = dementia)
GS - Cortical atrophy
Treatment
Supportive treatment (specialist dementia nurse, social worker)
+
Donepezil (acetylcholinesterase inhibitor)
(lasting power of attorney for advanced disease)
Lewy body dementia
Investigations and treatments
Investigations
Mini mental state examination (<25 = dementia)
GS - Cortical atrophy
Treatment
Supportive treatment (specialist dementia nurse, social worker)
+
Donepezil (acetylcholinesterase inhibitor)
(lasting power of attorney for advanced disease)
Frontotemporal dementia
Investigations and treatments
Investigations
Mini mental state examination (<25 = dementia)
GS - Focal atrophy of frontal and/or temporal lobes
Treatment
Supportive (specialist dementia nurse, social worker)
(Lorazepam if patient gets aggressive/impulsive/agitated)
Vascular dementia
Investigations and treatments
Mini mental state examination (<25 = dementia)
GS - Cortical atrophy, cerebrovascular lesions
Treatment
Supportive (specialist dementia nurse, social worker)
+
Ace inhibitors
Headaches (All 3)
Investigations and treatments
Investigations - Clinical
Migraine
Tx - Sumatriptan or NSAIDS
(prophylaxis - propanolol, metaclopramide for nausea and vomiting)
Tension headache
Tx - Simple analgesic - Paracetamol, aspirin
Cluster headache
Tx - Sumatriptan or oxygen therapy (100% oxygen)
Prophylaxis - Verapamil (CCB)
Trigeminal neuralgia
Investigations and treatments
Investigations
Clinical – 3 or more attacks of pain (on mechanical stimulation of mouth/face)
Treatment
Carbamazepine - anti convulsant
Epilepsy
Investigations and treatments
Investigations
First line - ECG
Brain MRI and CT - examine hippocampus + check for tumours
FBC - to rule out other metabolic causes
Electroencephalogram - 3Hz wave is indicative of ABSENCE seizure
Treatment
For generalised - Sodium valproate
For focal and women of child bearing age - Lamotrigine
For absence seizure alone - Ethosuximide
Status epilepticus
Investigations and treatments
Investigation - Nil - just a seizure happening more than 5 mins —– a neurological emergency
Treatment
1st line - ABCDE - remove objects, clear area, put them in a recovery position
BUCCAL Midazolam/ IV Lorazepam (benzodiazepine)
(After 2 doses of lorazepam, IV phenytoin)
Motor neuron disease
Investigations and treatments
Investigation
Mainly clinical
Electromyograph - check muscle’s respond when associated nerve is stimulated
Treatment
MDT approach supportive care + Riluzole (antiglutaminergic)
Supportive - physiotherapy
Multiple sclerosis - prophylaxis
Investigations and treatments
Investigations
FL + GS Brain and spinal cord MRI -
Mcdonald criteria — 2 or more relapses in space and time
Lumbar puncture may detect oligoclonal IgG bands
Treatment
Acute - IV methylprednisolone
Prophylaxis - interferon beta 1
Guillain barre syndrome
Investigations and treatments
Investigations
Nerve conduction studies
Lung function test for prognosis (Forced vital capacity)
Treatments
1st line - IV immunoglobulin (CI in IgA immunodeficiency)
If CI, then PLASMA EXCHANGE
Intubation for respiratory distress
Huntington’s disease/chorea
Investigations and treatments
Investigations
Genetic testing - CAG repeat test
>35 is positive, >60 is severe
Treatment
1st line - Genetic counselling for patient and family
For chorea - Tetrabenazine
Myasthenia gravis
Investigations and treatments
Investigations
Serology
- Anti acetylcholine receptor antibodies (anti - Ach-r )
- Anti muscle specific tyrosine kinase antibodies (anti - MuSK)
GS- Edrophonium test
Treatment
1st line - Pyridostigmine (Acetylcholinesterase inhibitor)
2nd line - Azathioprine
(Thymectomy - surgical)
Myasthenic crisis
Investigations and treatments
Investigations - Nil –> just acute worsening of symptoms with respiratory failure (due to diaphragm weakness)
Treatment
- Plasma exchange or IV immunoglobulins
Intubation and ventilation if required
Lambert-eaton syndrome
Investigations and treatments
Investigations
Serology - Anti voltage gated calcium channels
Treatment
Amifampridine (blocks potassium channels and increased acetylcholine in the synaptic cleft)
Prednisolone
IV immunoglobulins
Parkinson’s
Investigations and treatments
Investigations
Clinical
Has bradykinesia + 1 other major symptom (Rigidity, rest tremor, postural instability)
Treatment
Levodopa - body can become resistant to it
Can give Carbidopa alongside to (prevents conversion of levadopa to dopamine outside the brain barrier).
Cauda equina syndrome
Investigations and treatments
Investigations
MRI of the spinal cord - see where lesion and compression is
Treatment
Immediate neurosurgery - decompression surgery
Myelopathy (spinal cord compression)
Investigations and treatments
Investigations - MRI of the spinal cord to see where compression is
Treatment - Surgery (dexamethasone while waiting)
Sciatica
Investigations and treatments
Investigations
1st line - Sciatic stretch test
GS - MRI
Treatment
1st line - NSAIDS (ibuprofen)
+ physiotherapy
If severe - Surgery (spinal decompression)
Peripheral neuropathy
Investigations and treatments
Investigations
1st line - FBC/HbA1C –> Check for diabetes and Vitamin B12 deficiency
GS - Electromyography
Treatment
Analgesia - Ibuprofen + treat underlying cause
