Neurology Flashcards
Thrombolysis absolute CI
previous haemorrhagic stroke ischaemic stroke in last 3m CNS damage/neoplasm major surgery/HI/major trauma in last 3wks, active internal bleeding GI bleed in last 1 month aortic dissection known bleeding disorder proliferative diabetic retinopathy
Nausea
Vertigo
Nystagmus
MOA: otolith detachment into the semicircular canals of the inner ear
BPPV
subacute or acute onset of pain in the eye /headache pain with eye movements loss of vision central scotoma
optic neuritis
80M
difficulty moving and memory problems
tremor + bradykinetic
Unable to look down falls
not orthostatic
Progressive supranuclear palsy
(parkinson’s plus)
- UNABLE TO LOOK DOWN
diarhoeal illness, then
drowsiness
double vision
ataxia
BRISK reflexes
Bickerstaff’s encephalitis
NB in GBS DON’T get drowsiness + have absent reflexes
postural hypotension and urinary retention
parkinsonism
Dx?
multi-system atrophy
autonomic dysfunction
12 months cognitive impairment, parkinsonism, confusion, generalised myoclonus
started on L dopa
then visual hallucinations
Dx?
diffuse lewy body disease
- early cognitive impairment
(no hallucinations in PSP or MSA)
diffuse disease of small arteries
recurrent ischaemic events
may present with migraine
severe mood disorders, dementia
leukoencephalopathy on MRI
CADASIL
(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
dysphagia absent gag reflex nasal voice/dysarthria difficulty chewing tongue wasting/fasciculations
Bulbar palsy
LMN affects CN 9 - 12
Cause = brainstem stroke, GBS
hot potato voice
inc jaw jerk/gag reflex
UMN signs in UL
uncontrollable laughter
psudobulbar palsy
UMN
can you get CN III palsy in migraine?
Yes
ophthalmoplegic migraine
orogenital ulceration
iritis
pathergy (xs skin injury post minor trauma)
Behcets
weakness of dorsiflexion of the left foot
sensory loss Dorsum of foot
L5 radiculopathy
ataxia
encephalopathy
ophthalmoplegia
Wernicke’s encephalopathy
homonomous hemianopia
(often upper quadrantic)
Cortical blindness
Hemivisual neglect
Visual hallucinations
verbal dyslexiaposterior cerebral artery stroke
supplies occipital lobe
Coarse tremor
drug cause
cyclosporin
dose dependent manner
R wRist drop
sensory loss dorsum of hand
nerve affected
Radial nerve
supplies serratus anterior
winging of the scapula
nerve affected
long thoracic nerve
cannot abduct and oppose the thumb weakness in forearm pronation + finger flexion
sensory loss plantar thumb + 1st two fingers
nerve affected
median nerve
elbow injury
numbness in the 5th finger/ lateral aspect hand
+/- claw hand
ulnar nerve
70M
L sided weakness resolves in 2 hours
Next step?
next day TIA clinic
CT/MRI head and carotid duplex within 1 wk.
If carotid endarterectomy indicated - within 2 weeks necessary
phenytoin toxicity gait
broad based gait
cerebelalr syndrome
suspected TIA
which scoring system?
ABCD score
suspected TIA
ABCD >/= 4 9high risk stroke)
Mx?
aspirin 300 mg OD
next day TIA clinic
which anti HTN
dry mouth and dizziness on standing
doxazosin
alpha blocker
horizontal gaze palsy
impaired adduction ipsilateral to the lesion
abduction nystagmus contralateral to lesion
INO
Internuclear ophthalmoplegia
lesion at the medial longitudinal fasciculus
Causes Internuclear ophthalmoplegia
MS
brainstem infarction
syphilis and Lyme disease
drooling, tongue and lip swelling and tachypnoea
which drug can cause?
ACEi
ARB
does not necessarily occur as soon as the medication is started
cortisol level in hypoglycaemia
cortisol should increase
sodium valproate risk to foetus
neural tube defects
sodium valproate
carbamazepine
p450 effect
sodium valproate - INHIBITOR
carbamazepine - INDUCER
proximal lower limb weakness
areflexia (reflexes normalise with repetitive muscle contraction)
no wasting or fasciculations
sensory examination is normal
which Abs test for
VG Ca channel Abs
lambert-eaton syndrome
Pt started on carbamazepine
2 weeks later have to increase dose to maintain therapeutic range
whuch?
auto induction carbamazepine
carbamazepine p450 inducer therefore metabolism increases so need more for same therapeutic effect
Vertigo
Vomiting
Pressure within the ear
Deafness
Ménière’s disease
URTI
then acute disabling vertigo
Labyrinthitis
Nausea
Vertigo
Nystagmus
BPPV
Sudden onset of painless monocular visual loss in patients aged 50 or more is commonly due to ischaemic optic neuropathy
Nonarteritic ischaemic optic neuropathy
arteritic ION = GCA
carotid endarterectomy in dense stroke?
no
dengue fever initial Mx
normal saline
right sided weakness
Leg >arms
anterior cerebral artery stroke
MCA = UL > LL weakness
foot drop
nerve affected
common peroneal nerve palsy
