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.
