Neurology Flashcards
27-year-old woman Worsening headaches and blurred vision. noticed a blind spot in her eye Neurological examination shows reduced left eye abduction. Dx?
(all above are symptoms of IIH and also papilloedema)
Idiopathic Intracranial HTN
Idiopathic Intracranial HTN has which nerve palsy?
6th nerve
Tx of IIH?
Acetazolamide, a carbonic anhydrase inhibitor that reduces CSF production thereby reducing intracranial pressure.
Risk factors for IIH?
obesity female sex pregnancy drugs*; combined oral contraceptive pill steroids tetracyclines vitamin A lithium
Management of IIH
- weight loss
- diuretics e.g. acetazolamide
- Topiramate (has the added benefit of causing weight loss in most patients)
- repeated lumbar puncture
- surgeries: optic nerve sheath decompression and fenestration may be needed to prevent damage to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure
what is Bell's palsy? which nerve paralysis? related to which virus? age? most common in which people?
acute, unilateral, idiopathic, facial nerve paralysis. The aetiology is unknown although the role of the herpes simplex virus.
The peak incidence is 20-40 years and the condition is more common in pregnant women.
Features of bells palsy?
lower motor neuron facial nerve palsy - forehead affected
in contrast, an upper motor neuron lesion ‘spares’ the upper face
patients may also notice post-auricular pain, altered taste, dry eyes
(it is like a triangle; eyes, mouth and ears)
AND HYPERACUSIS(When everyday sounds seem much louder than they should.)
Tx of bells palsy?
prednisolone only and a combination of antivirals and prednisolone(there is consensus that all patients should receive oral prednisolone within 72 hours of onset of Bell’s palsy)
prescription of artificial tears and eye lubricants should be considered
Follow up of bells palsy?
if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT
prognosis of bells palsy?
most people with Bell’s palsy make a full recovery within 3-4 months
in Parkinsons disease which is the most common psych problem that happens?
Depression
NOT DEMENTIA
COMMON FEATURES OF parkinons dis
Bradykinesia; difficulty in initiating movement
rigidity; most marked at rest, worse when stressed or tired, improves with voluntary movement
typically ‘pill-rolling’ tremors/resting tremors
lead pipe and cogwheel rigidity d/t superimposed tremor
other associated features
mask-like facies flexed posture micrographia drooling of saliva postural hypotension
when should prophylaxis for migrainous headaches be confirmed?
if patients experience 2 or more attacks per month.
tx regime formula for migraine?
acute: triptan + NSAID or triptan + paracetamol
(for young people aged 12-17 years consider a nasal triptan in preference to an oral triptan)
if the above measures are not effective or not tolerated offer a non-oral preparation of metoclopramide* or prochlorperazine and consider adding a non-oral NSAID or triptan
prophylaxis:
1. topiramate or propranolol
(we don’t give topiramate in pregnant pts as it is teratogenic)
- Amitriptyline
- if these measures fail NICE recommend ‘a course of up to 10 sessions of acupuncture over 5-8 weeks’
or - riboflavin (400 mg once a day) may be effective in reducing migraine frequency and intensity for some people’
menstrual migraine propylaxis?
frovatriptan and zolmitriptan - may be used daily as a type of prophylaxis.
trigger of trigeminal neuralgia?
features of trigemnial neuralgia?
by light touch, shaving, eating etc.
Unilateral Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose) Optic neuritis A family history of multiple sclerosis Age of onset before 40 years
tx oftrigeminal neuralgia?
Carbamazepine 100mg BD starting dose
A guy had intermittent weakness;
weakness in his left arm and leg that lasted for 1 hour this morning. This has now been completely resolved. He has no facial drooping, no residual weakness and no slurring of his voice.He has a past medical history of a PE three months ago for which he takes apixaban.
What is the first-line management in this patient?
urgent admission;
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be admitted immediately for imaging to exclude a haemorrhage.
OR has
crescendo TIAs (two TIAs in a 7 day period). This warrants urgent assessment and urgent imaging.
OR
Any patient with an ABCD2 score greater than 4 or crescendo TIA should be admitted.
referral with 24 hrs;
1. TIA clinic within 24 hours , If he was not on an anticoagulant then this would be the correct answer.
- If the patient has had a suspected TIA in the last 7 days:
arrange urgent assessment (within 24 hours) by a specialist stroke physician
referral with in 7 days;
If the patient has had a suspected TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days
immediate tx for tia?
Immediate antithrombotic therapy:
ASPIRIN(ye to har ksi ko dain gey urgently js mein tia ya stroke ki suspicion ho)
give aspirin 300 mg immediately, unless
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team
ASPIRIN 300MG SHOULD BE GIVEN FOR 2 WEEKS
further tx for tia?LONG TERM
clopidogrel is recommended first-line
aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel
giving high-risk TIA patients aspirin + clopidogrel for the first 90 days compared to aspirin alone.
WHEN WILL WE THINK OF CAROTID ENDARTERECTOMY IN TIA?
if patient has suffered stroke or TIA in the carotid territory and are not severely disabled
should only be considered if carotid stenosis > 70% or >50%
60 year-old male presents with clumsy hands. He has been dropping cups around the house. His wife complains he doesnt answer his mobile as he struggles to use it. His symptoms have been gradually deteriorating over the preceding months.
DX?
RISK FACTORS?
Degenerative cervical myelopathy (DCM)
risk factor; 1. smoking due to its effects on the intervertebral discs, genetics
and
2. occupation; high axial loading
symptoms of DCM?
Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
TEST FOR DCM?
MRI of the cervical spine is the gold standard test
if MRI is contraindicated;
CT Myelogram
Action for DCM?
refer;Should be urgently referred to neurosurgery or orthopaedic spinal surgery
surgery;Decompressive surgery;Early treatment (within 6 months of diagnosis) offers the best chance of a full recovery.
obs;Close observation is an option for mild stable disease, but anything progressive or more severe requires surgery to prevent further deterioration.
(patients with cervical myelopathy require ongoing follow-up as pathology can ‘recur’ at adjacent spinal levels, which were not treated by the initial decompressive surgery. This is called adjacent segment disease)
physio;Physiotherapy should only be initiated by specialist services, as manipulation can cause more spinal cord damage.
female presents with stiffness and pain in her left shoulder, which started around a month ago. She had a similar episode that resolved by itself. Examination reveals limited external rotation.
dx?
Adhesive Capsulitis
MS affects at what age?
MS predominantly affects woman (3-4 times common) and usually presents before the age of 45.
GCS SCORE
how is it divided?
MOVE
M 6
V 5
E 4
gcs whole division?
M; 6 obeys=o 5 localizes=l 4 withdraws=w 3 abn flexion(decorticate posture)=af 2 extending to pain 1 none
V;
5 oriented (like 11.1 was in the morning)
4 confused (like he was in the afternoon)
3 words
2 sounds
1 none
E; 4 spont 3 verbal 2 pain 1 none
imp types of MS?
Primary progressive(progressive deterioration from onset more common in older people)
Secondary progressive disease
describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
relapsing-remitting disease go on to develop secondary progressive disease within 15 years of diagnosis
gait and bladder disorders are generally seen
Relapsing-remitting disease acute attacks (e.g. last 1-2 months)
tx of MS?
Acute?
High dose steroids (e.g. oral or IV methylprednisolone) may be given for 5 days to shorten the length of an acute relapse.
when do we use DMARDS(INTERFERON) for MS?
- relapsing-remitting disease + 2 relapses in past 2 years + able to walk 100m unaided
- secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)
Which drug do we use for muscle spacity in MS?
1ST ; Baclofen and gabapentin
2nd; dantrolene(also used in clonus with muscle rigidity) and tizanidine(also used with hyperreflxia with muscle rigidity)
3rd; diazepam
physio
when bladder dysfunction occurs in MS(secondary progressive type)
what to do?
may take the form of urgency, incontinence, overflow etc
guidelines stress the importance of getting an ultrasound first to assess bladder emptying - anticholinergics may worsen symptoms in some patients
if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics may improve urinary frequency
tx for Oscillopsia (visual fields apper to oscillate) in MS?
gabapentin
tx of fatigue in MS?
CBT and mindfulness training.
a female with multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck.
WHICH SIGN IS THIS?
Lhermitte’s sign
which indicates disease near the dorsal column nuclei of the cervical cord. It is also seen in subacute combined degeneration of the cord and in cervical stenosis
when do we start tx for epilepsy?
after the first seizure if any of the following are present:
the patient has a neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable
which anti epileptic drug is not to be taken in preg?
Na valproate(associated with a significant risk of neurodevelopmental delay in children)
anti epileptics for Generalised tonic-clonic seizures?
2st line; sodium valproate
second line: lamotrigine, carbamazepine
Absence seizures* (Petit mal)
sodium valproate or ethosuximide
Myoclonic seizures*
MSCL
MYOCLONIC
S; sodium valproate
second line: C; clonazepam, L; lamotrigine
Focal seizures
TX FOR FOCAL SEIZURE IS OPPOSITE TO GEN SEIZURES
1ST LINE; carbamazepine or lamotrigine
second line: levetiracetam, oxcarbazepine or sodium valproate
tx of generalised plus tonic clonic seizures
sodium valproate
which anti epileptic drug exacerbates absence and myoclonic seizures?
carbamazepine
which drug should be avoided in asthmatics who have migraine and asthma?
propranolol
topiramate will be used in this person
Symptoms of migraine in children?
nausea, vomiting and abdominal pain
cluster headaches are more common in?
Learn by SAM had a CLUSTER
M men
S smokers
A alcohol
features of cluster headache
it has to be differentiated from migraine because this is also unilateral
pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
clusters typically last 4-12 weeks
intense sharp, stabbing pain around one eye (recurrent attacks ‘always’ affect same side)
patient is restless and agitated during an attack
accompanied by redness, lacrimation, lid swelling
nasal stuffiness
miosis and ptosis in a minority
band type headache occurs in?
tension headache
GBS is associated with infection from which organism?
Compylobactor jejune
what is GBS
immune mediated demyelination of peripheral nerves
what is GBS
immune mediated demyelination of peripheral nerves
IS MEIN HYPOREFLEXIA HOTA HAI
reduced tone in both lower limbs with
altered sensations
B/L
antibodies related to gas and miller fisher syndrome
anti GM1 antibodies
anti GQ1b antibodies
shuffling gait is popular in?
Parkinsons dis
Duchene Muscular dystrophy
- progressive proximal muscle weakness from 5 years
- calf pseudohypertrophy
- Gower’s sign: child uses arms to stand up from a squatted position
- 30% of patients have intellectual impairment
- valley sign; there is infraspinatus and deltoid muscle enlargement with wasting of the muscles between deltoid and infraspinatus muscles causing a valley appearance.
bekers musclar dystrophy
- develops after the age of 10 years
2. intellectual impairment much less common
Examples of neuropathic pain are?
diabetic neuropathy
post-herpetic neuralgia
trigeminal neuralgia
prolapsed intervertebral disc
Tx of neuropathic pain?
1st amitriptyline
2nd duloxetine
3rd gabapentin or
4th pregabalin
Tx of neuropathic pain?
1st amitriptyline
2nd duloxetine
(like the pt in 1.2 was already having and then started on gabapentin)
3rd gabapentin or
4th pregabalin
5th tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
pain management clinics
How to differentiate between GBS and Mysthenia Gravis
muscle fatigue particularly after exercise
+
ocular manifestations - droop of the upper eyelids is typical with weakness of external ocular muscles producing diplopia.
In contrast to Guillain-Barre syndrome, tone, reflexes and sensation is normal in MG
Polymyositis affects which group of muscles?
diffuse weakness in the proximal muscles develops.
Acute transverse myelitis is associated with?
back or leg pain
Acute Transverse Myelitis is also b/l like GBS but the difference is?
acute episode of weakness or paralysis of both legs, with sensory loss and loss of control of bowels and bladder.
features of GBS?
history of gastroenteritis
respiratory muscle weakness
cranial nerve involvement
diplopia
bilateral facial nerve palsy
oropharyngeal weakness is common
autonomic involvement
urinary retention
diarrhoea
Less common findings
papilloedema: thought to be secondary to reduced CSF resorption
INVESTIGATIONS TO CONFIRM GBS?
- lumbar puncture
rise in protein with a normal white blood cell count - nerve condution studies may be performed
decreased motor nerve conduction velocity (due to demyelination)
TX of GBS?
Plasmapharesis and
IV immunoglobulin
Essential tremor (previously called benign essential tremor) is genetically which condition?
AD
Autosomal Dominant
Features of essential tremors?
postural tremor: worse if arms outstretched
improved by alcohol and rest
Tx of Essential Tremors?
- propranolol is first-line
2. primidone is sometimes used
common SE of Phenytoin?
peripheral neuropathy
MOA of Phenytoin?
binds to sodium channels increasing their refractory period
SE’ s of Phenytoin;
Since having his medication change he has experienced a ‘numbness’ of his hands and feet.
reduced sensation in a glove-and-stocking distribution
reduced ankle reflex. lymphadenopathy in the cervical and inguinal region
bleeding around the gums.
Acute
initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures
Chronic
- gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF)
- hirsutism
- coarsening of facial features
- peripheral neuropathy
- enhanced vitamin D metabolism causing osteomalacia
- lymphadenopathy
- aplastic or megaloblastic anaemia.
Teratogenic
associated with cleft palate and congenital heart diseas
Monitoring of Phenytoin is done at what time?
Before the dose.
why is phenytoin monitoring required?
adjustment of phenytoin dose
suspected toxicity
detection of non-adherence to the prescribed medication
CI’s to Triptans use
ischaemic heart disease or cerebrovascular disease
when should triptan be taken in case of migraine?
as soon as possible after the onset of headache, rather than at onset of aura
most common symptom of posterior circulation stroke?
Dizziness
Drugs for neuropathic pain are typically used as monotherapy?
yes
if not working then drugs should be switched, not added
management of breakthrough pain in neuropathic pain sufferers?
‘rescue therapy’ for exacerbations of neuropathic pain?
Tramadol
which drug to use in Parkinson’s for nausea?
Domperidone
first line radiological investigation for suspected stroke?Non-contrast or contrast CT head?
Non-contrast CT head
The only situation in which plain CT imaging of the central nervous system is appropriate is in acute trauma.
Which scan is used to view demyelinating lesions(eg MS)
(presenting with numbness and tingling in her left arm. She also reports an episode approximately seven months ago of visual blurring and pain in her left eye.)
MRI with contrast should be used to view demyelinating lesions
MRI without contrast would be the second-best option but cannot tell us if lesions found are acute or chronic.
? READ
A total anterior circulation infarct would present with a unilateral weakness of the face, arm and leg; as well as a homonymous hemianopia and a symptom of higher cerebral dysfunction.
A posterior circulation infarct would present with a cerebellar or brainstem syndrome, or loss of consciousness, or an isolated homonymous hemianopia.
A partial anterior circulation infarct would present with two of: unilateral weakness, homonymous hemianopia and higher cerebral dysfunction.
The CT confirms that there is no haemorrhage, so the answer cannot be option 5.
This is most likely a lacunar infarct, due to the presence of only a purely sensory deficit.
Parkinson’s Disease is a neurodegenerative disorder involving death of neurones in?
Substantia nigra
and btw Parkinson’s dis is associated with movement disorders
What will you see on ct and mri in Alzheimers dementia?
atrophy of the medial temporal lobe and temporoparietal cortex
not associated with movement disorders
ct and mri findings in huntingtons dis?
loss of striatal volume
movement disorder seen is chorea - jerky, uncontrollable limb movements.
ct and mri findings in Multi sys atrophy?
degeneration of the basal ganglia (as well as the cerebellum)
status epilepticus is categorised according to time?
when a seizure is going on for more than 5 mins
OR
>= 2 seizures within a 5-minute period without the person returning to normal between them
initial management of status epileptics?
ABC;AIRWAY,OXYGEN,BLOOD GLUCOSE
in hosp;IV lorazepam
out of hosp;rectal diazepam 10mg
followed by a repeat dose 10-20 minutes after the first if the seizure recurs or fails to respond.
If ongoing status ; phenytoin or phenobarbital infusion
If no response even in 45 minutes ; induction of general anaesthesia.
for monitoring of phenytoin levels when do we check the levels?
just before the dose.
headache unilateral, throbbing in nature.
Aggravated by routine activities Patients often describe ‘going to bed’.
it is?
migraine
headache related with mensuration?
migraine
tight band
headache not aggravated by daily activities
tension headache
Pain typical occurs once or twice a day,
each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
cluster headache
cluster headache is more common in?
common in men and smokers
> 60 years old rapid onset (e.g. < 1 month) of unilateral headache Jaw claudication (65%) Tender, palpable temporal artery Raised ESR DX? HEADACHE IS CAUSED BY?
temporal arteritis
medication overuse headache is most commonly caused by which meds?
opioids and triptans
pain around rt eye
feels nauseous and vomited
O/E her eye is red
Acute Glaucoma
carotid artery endarterectomy should be considered in cases of stroke when the stenosis is going to be how much %?
carotid stenosis >70%
weakness of right foot dorsiflexion and eversion.
which nerve is involved?
common peroneal nerve palsy/common fibular nerve leading to foot drop
how to differentiate between sciatic nerve problem and common perineal prob?
In peroneal nerve;
Sensory loss is over the dorsum of the right foot and lower lateral part of the right leg.
As sciatic nerve innervates tibial nerve that will cause sensory loss over the sole and weakness of plantar flexion
UMNL’S conditions?
spasticity, hyperreflexia, clonus and the Babinski reflex.
MSC;
MS
Cerebral venous thrombosis
Stroke
LMNL’S conditions?
hypotonia and hyporeflexia and would not cause the Babinski reflex.
Amyotrophic lateral sclerosis
poliomyelitis
both upper motor neuron (extensor plantars) and lower motor neuron (absent ankle jerk) sign
subacute combined degeneration of the cord motor neuron disease Friedreich's ataxia syringomyelia (syphilis)
types of focal seizures?
focal aware/simple partial
focal impaired awareness/complex partial
can be classified as being motor (e.g. Jacksonian march), non-motor (e.g. déjà vu, jamais vu; )
types of generalised seizures
motor (e.g. tonic-clonic)
non-motor (e.g. absence)
secondary prevention for ischemic stroke?
aspirin for 2 weeks
+ clopi life long
if intolerant to clopi;
Aspirin + dipyridamole
if aspirin and clopi both intolerable/CI; Only Dipyridamole
if the cholesterol is > 3.5 mmol/l patients should be commenced on a statin.
when should Migraine prophylaxis should be offered
if people are experiencing more than 2 migraine attacks a month
which drug should be used as migraine prophylaxis in women of child bearing age?
Topiramate(is associated with risk of cleft lip/cleft palate in infants if used in the first trimester of pregnancy)
a girl
numbness and tingling in her left arm.
an episode approximately seven months ago of visual blurring and pain in her left eye.
symptoms suggestive of?
MS
INVESTIGATION REQUIRED IN MS?
MRI with contrast
first line therapy for generalised seizures?
sodium valproate
investigation of choice for suspected stroke?
Non contrast CT Head
capgras synd?
person holds a delusion that a friend or partner has been replaced by an identical-looking impostor.
Othello syndrome
irrational belief that one’s partner is having an affair with no objective evidence.
De clerambault syndrome
delusional idea that a person whom they consider to be of higher social and/or professional standing is in love with her.
Cotard syndrome
delusional idea that one is dead.
Fregoli syndrome
various people that the patient meets are in fact the same person.
subdural hematoma
Subdural haematomas can present several weeks after the initial head injury
Chronic subdural haematomas most likely present 4-7 weeks following the insult
Diffuse axonal injury
unconsciousness is involved
there would not usually be as long a latent period before symptoms begin.
Extradural haematoma
symptoms of sudden onset soon after the injury, following a brief lucid interval.
A headache would be characteristic,
and compression of the third cranial nerve may lead to a fixed and dilated pupil.
Intraventricular haemorrhage
present soon after the trauma, with nausea, vomiting, headache and confusion.
ct findings for acute subdural hematoma
will show a crescentic collection, not limited by suture lines. They will appear hyperdense (bright) in comparison to the brain. Large acute subdural haematomas will push on the brain (‘mass effect’) and cause midline shift or herniation.
subdural hematomas are common in?
Elderly and alcoholic patients
since they have brain atrophy and therefore fragile or taut bridging veins
ct findings for ch subdural hematoma
Same cresentric shape
In contrast to acute subdurals, chronic subdurals are hypodense (dark) compared to the substance of the brain.
Management of chronic subdural hepatoma
If the chronic subdural is an incidental finding or if it is small in size with no associated neurological deficit then it can be managed conservatively with the hope that it will dissolve with time.
If the patient is confused, has an associated neurological deficit or has severe imaging findings then surgical decompression with burr holes is required.
weakness of the right leg. On examination, there is a weakness of right knee flexion but intact knee extension. There is a weakness of dorsal and plantar flexion of the right ankle, as well as the weakness of the right flexor hallucis longus. Right ankle jerk is lost but knee-jerk intact. The plantar response is downgoing.
which nerve lesion?
intact knee jerk but weak ankle jerk. This is consistent with damage to the sciatic nerve.
motor: paralysis of knee flexion and all movements below knee
sensory: loss below knee
reflexes: ankle + plantar lost, knee jerk intact
causes of sciatic nerve lesion
Causes
fracture neck of femur
posterior hip dislocation
trauma
NS OF iliohypogastric nerve.
T12-L1
genitofemoral nerve.
L1-2
femoral nerve.
L2-4
sciatic nerve
L4-5, S1-3
pudendal nerve
S2-4
educed absorption of B vitamins
sensory symptoms typically present prior to motor symptoms
which neuropathy?
Alcoholic neuropathy
examples of Predominately motor loss in neuropathy
GBS
examples of Predominately sensory loss in neuropathy
D Iabets
A alcoholism
V vitamin B12 deficiency
A amyloidosis
For thrombectomy in acute ischaemic stroke
time period?
extended target time of 6-24 hours may be considered if there is the potential to salvage brain tissue,
we do bring the bp down before thrombectomy in ischemic stroke
but with?
BP>200/12OMMhG (Is an absolute contraindication to thrombectomy)
labetalol
chromosome disorder in Huntington’s dis
ch 4
huntingtons dis is more in men or women
equal
features of Huntington’s
CPS-D chorea personality changes (e.g. irritability, apathy, depression) and intellectual impairment saccadic eye movements dystonia
FOR THROMBOLYSIS AND THROMBECTOMY
If the features started 4.5 hrs ago
only then it is indicated
carotid artery endarterectomy indications?
1) patient has suffered stroke or TIA in the carotid territory and are not severely disabled
2) should only be considered if carotid stenosis > 70%
71 years old female
since mid-morning her left arm has felt weak and a degree of facial asymmetry is noted when she smiles.
What will you do?
YOU ANSWERED U WILL CALL AMBULANCE FOR ADMISSION AND THAT YOU WILL GIVE ASPIRIN 300MG STAT
WHICH OBVIOUSLY AND CLEARLY WE SHOULD NOT DO
BECAUSE WE HAVE TO R/O THE HAEMORRHAGIC STROKE FIRST BY ADMITTING
Tx for cluster headache?
100% oxygen S/C triptans verapamil for prophylaxis tapering dose Of pred referral to neurology
