Neurology Flashcards
Name some of the treatable causes/mimics of dementia
- Vitamin deficiency
- Thyroid disease
- Infective: HIV, syphilis etc.
- Hydrocephalus
- Tumour
- Depression
Name some of the key features of Alzheimer’s disease
- Early memory disturbance
- Language and visuospatial problems
- Preserved personality
Name some of the key features of frontotemporal dementia
- Early changes in personality/behaviour
- Changes in eating habits
- Early dysphasia
- Preserved memory and visouspatial
How can the symptoms of dementia be managed?
- Non pharmalogical (OT, social work etc.)
- Insomnia treatment
- Behaviour treatment
- Depression treatment
Name the specific treatments for Alzheimers and Lewy body dementia
- Cholinesterase inhibitors (Donepezil, rivastigmine, galantamine)
- NMDA antagonist (memantine)
How does parkinsonism present?
- Bradykinesia
- Rigidity
- Tremor
- Postural instability
How can Parkinson’s disease be treated?
- Levodopa
- COMT inhibitors
- Dopamine agonists (e.g. ropinirole)
- MAO-B inhibitors (selegiline etc.)
- Deep brain stimulation
Name the cognitive features of dementia
- Memory
- Dysphasia
- Dyspraxia
- Dysgnosia (not recognising objects)
- Dysexecutive functioning
How does a tension headache present?
- Mild
- Bilateral headache
- Pressing or tightening
- No associated features
- Not aggravated by routine physical activity
How can a tension headache be managed?
- Abortive: paracetamol, NSAIDs or aspirin
- Preventative: TCAs
How can a migraine be treated?
- Abortive: aspirin, NSAIDs and triptans
- Prophylactic: propranolol, candersartan, anti-epiletics, TCAs and venlafaxine
Which type of headache has an absolute response to indometacin?
Paroxysmal hemicrania
How can cluster headaches be managed?
- Abortive: SC sumatriptan, nasal zolmatriptan, oxygen and occipital depomedrone injection or oral prednisolone
- Preventative: verapamil, lithium, methysergide and topiramate
How can SUNCT/SUNA be managed?
Prophylaxis: lamotrigine, topiramate, gabapentin, carbamazepine/ oxcarbazepine
How can trigeminal neuralgia be managed?
Prophylaxis: carbamazepine and oxcarbazepine
Surgical: glycerol ganglion injection, steriotactic radiosurgery and decompressive surgery
How can paroxysmal hemicrania be managed?
Prophylaxis: indometacin, COX-II inhibitors and topiramate
What are the “sinister” features of headaches?
- Associated head trauma
- First or worst
- Thunderclap
- New daily headache
- Change in headache pattern
- Returning patient
- Focal neurological symptoms
- Abnormal examination
- Neck stiffness
- Headache worse on lying down/ waking up/exertion
- Jaw claudication or visual disturbance
Name the three categories of syncope
- Reflex: medical situations, cough etc.
- Orthostatic: dehydration,anti-hypertensives, endocrine etc.
- Cardiogenic: arrhythmias, aortic stenosis etc.
Which investigations would you do for someone presenting with epilepsy?
- EEG
- MRI for <50yrs
- CT for >50 yrs
- Video-telemetry
Name the first line treatments for primary generalised epilepsies
- Sodium Valproate
- Lamotrigine
- Levetiracetam
Name the first line treatments for focal and secondary generalised seizures
- Lamotrigine
- Carbamazepine
- Levetiracetam
Name the first line treatment for absence seizures
Ethosuximide
Name the treatment options for status epilepticus
- First line: midazolam/ lorazepam/ diazepam
- Second line: phenytoin and valproate
- Third line: propofol or thiopentone
How can an ischaemic stroke be managed acutely?
- Thrombolysis
- Thrombectomy (anterior only)
- Aspirin 300mg
How can a haemorrhagic stroke be managed acutely?
- Manage hydrocephalus
- Blood pressure control
- Reverse anticoagulation
How can a TIA be managed acutely?
Aspirin 300mg
What medications should be used for stroke prevention after a TIA?
- Aspirin
- Dipyridamole
Name the types of skull fractures
- Linear
- Depressed
- Comminuted
- Ring fracture
- Contre-coup (orbital plates)
How does raised ICP present?
- Headaches (worse in the morning and coughing/straining)
- Papilloedema
- Visual disturbance
- Loss of upgaze
- Impaired consciousness
How can hydrocephalus be managed?
- Acetazolamide
- External ventricular drain (in emergencies)
- 3rd ventriculostomy
- Shunt insertion
How does normal pressure hydrocephalus present?
- Dementia
- Gait disturbance
- Urinary incontinence
How can raised ICP be managed?
- Avoid pyrexia
- Manage seizures
- CSF drainage
- Elevated head of bed
- Analgesia and sedation
- Mannitol
- Hypertonic saline
- Hyperventilation
- Hypothermia
- Decompressive craniectomy
How does Bell’s Palsy present?
- Facial sag
- Asymmetrical smiling
- Voluntary eye closure not possible
- No forehead sparing
What is Ramsay Hunt Syndrome?
LMN facial nerve palsy due to Herpes Zoster
How can Bell’s Palsy be managed?
- Eye care (lubricating eye drops)
- Steroids
- Surgery if no response to medical treatment
How can Ramsay Hunt Syndrome be managed?
- Aciclovir
- Steroids
How does an essential tremor present?
- Distal symmetrical tremor of the upper limbs
- Can sometimes effect the neck muscles
How can an essential tremor be managed?
- Propranolol or primidone
- Deep brain stimulation
How does Guillian-Barre syndrome present?
- Progressive ascending symmetrical weaknesss starting in the lower extremities
- Facial weakness, dysphasia or dysarthria
- Neuropathic pain
- Reduced or absent reflexes
- Parasthesiae or sensory loss
- Autonomic symptoms
How can Guillian-Barre be investigated?
- Electrolytes
- Lumbar puncture
- Antibody screen
- Spirometry
- Nerve conduction studes
- ECG
How can Guillian-Barre be managed?
- Plasma exchange
- IV immunoglobulin
- Steroids
- DVT prophylaxis
- Pain relief
- Admission to ITU may be required
How does MS present?
- Optic neuritis
- Sensory symptoms
- Limb weakness
- Diplopia/vertigo/ataxia
- Bladder symptoms
- Brainstem involvement
Name the 1st line disease modifying treatments for MS
- Beta-interferons
- Glatiramer acetate
- Teriflunomide
- Dimethyl fumarate
How does peripheral neuropathy present?
- Parasthesiae
- Neuropathic pain
- Loss of vibration sense and position sense
- Muscle wasting
- Autonomic: Incontinence and orthostatic hypotension
Name the causes of peripheral neuropathy
- Guillian Barre, Charcot-Marie-Tooth
- Alcohol
- Diabetes
- Vitamin
- Thiamine or B12 deficiency
- Carcinoma
How can peripheral neuropathy be managed?
- Foot care, weight reduction and sensible footwear
- Glucose and blood pressure control
- Steroids
- IV immunoglobulins
- Amitriptyline, pregabalin or gabapentin
What causes a radiculopathy?
- Intervertebral disc prolapse
- Degenerative diseases of the spine
- Fracture
- Malignancy
- Infection
How does a radiculopathy present?
- Paraesthesia
- Numbness
- Weakness
How can a radiculopathy be managed?
- Analgesia
- Amitriptyline
- BZDs
- Baclofen
- Physiotherapy
- Surgery
How does Wernicke’s Encephalopathy present?
- Visual changes
- Loss of co-ordination
- Profound memory loss
- Hallucinations
- Polyneuropathy
- Muscle atrophy
- Confabulation
How can Wernicke’s encephalopathy be managed?
- Thiamine
- Rehydration and diet
- OT assessment
- Assess capacity and insight
How can brain metastases be managed?
- Steroids
- Surgery
- Radiosurgery
- Chemotherapies
Name the types of brain tumours
- High grade: gliomas, glioblastoma multiforme , primary cerebral lymphomas and medulloblastomas
- Low grade: meningiomas, acoustic neuromas, neurofibromas, pituitary tumours, pineal tumours and craniopharyngiomas
- Metastases
How can brain tumours be managed?
- Resection
- Radiotherapy
- Chemotherapy (particularly in CNS lymphoma)
- Analgesics, anticonvulsants, anticoagulants and steroids
How do lumbosacral disc prolapses present?
- Unilateral leg pain
- Numbness, parasthesia and weakness in one nerve root distribution
- A positive straight leg test
- Pain relieved by lying down
How can disc prolapses be managed?
- Analgesia
- Keeping active
- Heat and massage
- Physiotherapy
- Discectomy
