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Phase 2a > Neuro treatments > Flashcards

Neuro treatments Flashcards

1
Q

Ischaemic stroke

Investigations and treatments

A

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

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2
Q

Haemorrhagic stroke (all 3)

Investigations and treatments

A

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

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3
Q

Meningitis

Investigations and treatments

A

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)

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4
Q

Encephalitis

Investigations and treatments

A

Investigations
Lumbar puncture - Viremia and increased lymphocytes

Treatment
Acyclovir (HSV,VZV)
Gancyclovir (CMV)

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5
Q

Alzheimer’s

Investigations and treatments

A

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)

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6
Q

Lewy body dementia

Investigations and treatments

A

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)

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7
Q

Frontotemporal dementia

Investigations and treatments

A

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)

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8
Q

Vascular dementia

Investigations and treatments

A

Mini mental state examination (<25 = dementia)

GS - Cortical atrophy, cerebrovascular lesions

Treatment
Supportive (specialist dementia nurse, social worker)
+
Ace inhibitors

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9
Q

Headaches (All 3)

Investigations and treatments

A

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)

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10
Q

Trigeminal neuralgia

Investigations and treatments

A

Investigations
Clinical – 3 or more attacks of pain (on mechanical stimulation of mouth/face)

Treatment
Carbamazepine - anti convulsant

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11
Q

Epilepsy

Investigations and treatments

A

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

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12
Q

Status epilepticus

Investigations and treatments

A

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)

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13
Q

Motor neuron disease

Investigations and treatments

A

Investigation
Mainly clinical

Electromyograph - check muscle’s respond when associated nerve is stimulated

Treatment
MDT approach supportive care + Riluzole (antiglutaminergic)

Supportive - physiotherapy

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14
Q

Multiple sclerosis - prophylaxis

Investigations and treatments

A

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

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15
Q

Guillain barre syndrome

Investigations and treatments

A

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

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16
Q

Huntington’s disease/chorea

Investigations and treatments

A

Investigations
Genetic testing - CAG repeat test
>35 is positive, >60 is severe

Treatment
1st line - Genetic counselling for patient and family

For chorea - Tetrabenazine

17
Q

Myasthenia gravis

Investigations and treatments

A

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)

18
Q

Myasthenic crisis

Investigations and treatments

A

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

19
Q

Lambert-eaton syndrome

Investigations and treatments

A

Investigations
Serology - Anti voltage gated calcium channels

Treatment
Amifampridine (blocks potassium channels and increased acetylcholine in the synaptic cleft)

Prednisolone
IV immunoglobulins

20
Q

Parkinson’s

Investigations and treatments

A

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).

21
Q

Cauda equina syndrome

Investigations and treatments

A

Investigations
MRI of the spinal cord - see where lesion and compression is

Treatment
Immediate neurosurgery - decompression surgery

22
Q

Myelopathy (spinal cord compression)

Investigations and treatments

A

Investigations - MRI of the spinal cord to see where compression is

Treatment - Surgery (dexamethasone while waiting)

23
Q

Sciatica

Investigations and treatments

A

Investigations
1st line - Sciatic stretch test
GS - MRI

Treatment
1st line - NSAIDS (ibuprofen)
+ physiotherapy

If severe - Surgery (spinal decompression)

24
Q

Peripheral neuropathy

Investigations and treatments

A

Investigations
1st line - FBC/HbA1C –> Check for diabetes and Vitamin B12 deficiency

GS - Electromyography

Treatment
Analgesia - Ibuprofen + treat underlying cause

25
Q

Charcot marie tooth disease

Investigations and treatments

A

Investigations
- Nerve conduction studies
- Genetic testing - gene mutation associated with a CMT subtype

Treatment - Supportive - physiotherapy, occupational therapy

26
Q

Carpal tunnel syndrome

Investigations and treatments

A

Investigations
- Phalen’s test
- Tinel’s test

GS if above tests are unclear - Electromyography/nerve conduction studies

Treatment
1st line - wrist splint worn at night time

If severe pain - steroid injection
Last resort - surgical decompression

27
Q

Radial nerve palsy

Investigations and treatments

A

Investigation - Clinical looking at a wrist drop

Treatment
Simple analgesia (paracetamol) and a splint

28
Q

Ulnar nerve palsy

Investigations and treatments

A

Investigation - Clincal, looking at a claw hand of the 4th and 5th digits

Treatment
Simple analgesia (paracetamol) and a splint

29
Q

Brain tumours in general
e.g.
Gliomas
- Astrocytoma - glioblasta (grade 4)

Vestibular Schwannoma

Investigations and treatments

A

Investigation
First line - MRI of head
Then do a biopsy - to determine grade

Treatment
- Surgical resection of tumour + chemotherapy

30
Q

Duchenne muscular dystrophy

Investigations and treatments

A

Investigation
First line - Serum creatinine
GS - genetic testing for mutation of dystrophin gene

Treatment
No cure
Supportive + prednisolone (to slow down muscle weakness)

31
Q

Tetanus

Investigations and treatments

A

Investigation
Clinical diagnosis –> exposure to dirty soil, involuntary muscle spasms

Treatment - Tetanus vaccination

32
Q

Herpes Zoster

Investigations and treatments

A

Investigation
- Clinical –> Painful/itchy rash confined to a dermatome

GS - PCR for varicella zoster

Treatment
- Acyclovir - antiviral

33
Q

Bell’s palsy

A

Oral prednisolone (and artificial eye drops - as they are unable to close their eyes, they are at risk of drying out)

Phase 2a (29 decks)

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