Neurology Flashcards
Treatment for trigeminal neuralgia?
Carbamazapine 100mg BD starting dose
When do you start antiepileptics?
After second epileptic seizure, OR:
- 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
Choice of antiepileptic for generalised tonic-clonic seizures?
sodium valproate
second line: lamotrigine, carbamazepine
Choice of drug for absence seizures (petit mal)?
sodium valproate or ethosuximide
sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy
Choice of treatment for myoclonic seizures?
sodium valproate
second line: clonazepam, lamotrigine
Focal seizures medication choice?
carbamazepine or lamotrigine
second line: levetiracetam, oxcarbazepine or sodium valproate
Most common psychiatric diagnosis in PD pts?
Depression (40%)
GCS scale?
Motor response
- Obeys commands
- Localises to pain
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
Verbal response
- Orientated
- Confused
- Words
- Sounds
- None
Eye opening
- Spontaneous
- To speech
- To pain
- None
Driving rules with seizures/epilepsy?
If one unprovoked seizure: 6 months off
If diagnosis of epilepsy have to be 12 months seizure free before driving.
Driving rules for stroke/TIA?
1 month off
If multiple strokes/TIAs then 3 months (and inform DVLA)
Craniotomy driving rules?
1 year, unless pituitary trans-sphenoid then 6 months.
Syncope driving rules?
simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off
Adverse effects of phenytoin?
Acute:
initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures
Chronic:
common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness
megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy
enhanced vitamin D metabolism causing osteomalacia
lymphadenopathy
dyskinesia
Idiosyncratic:
fever rashes, including severe reactions such as toxic epidermal necrolysis hepatitis Dupuytren's contracture* aplastic anaemia drug-induced lupus
Stroke thrombolysis window?
4.5hrs
Thrombectomy consideration guidelines?
If ischaemic and PACS:
- Thrombectomy within 6 hrs AND thrombolysis
- If ‘potential to salvage’ seen on imaging then can be within 6-24hrs
If ischaemic and posterior circulation
- 6-24hrs and ‘potential to salvage’
Features of common peroneal nerve injury?
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles
What nerve is the common fibular nerve a part of?
Common peroneal
It is prone to damage
How to remember brain lobes for quadrantinopia?
PITS (Parietal-Inferior, Temporal-Superior)
If there is a homonymous hemianopia is it the same side or opposite side tract that is damaged?
Opposite
If it is incongruous it would be the optic tract
Diagnostic criteria for migraine without aura?
A At least 5 attacks fulfilling criteria B-D
B Headache attacks lasting 4-72 hours* (untreated or unsuccessfully treated)
C Headache has at least two of the following characteristics:
- unilateral location*
- pulsating quality (i.e., varying with the heartbeat)
- moderate or severe pain intensity
- aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
D During headache at least one of the following:
- nausea and/or vomiting*
- photophobia and phonophobia
E Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder)
DCM symptoms?
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.
Temporal ateritis presentation?
Typically patient > 60 years old Usually rapid onset (e.g. < 1 month) of unilateral headache Jaw claudication (65%) Tender, palpable temporal artery Raised ESR
Do you need contrast in your MRI if looking for demyelination?
Yep
Management of PD?
For first-line treatment:
- if the motor symptoms are affecting the patient’s quality of life: levodopa
- if the motor symptoms are not affecting the patient’s quality of life: dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor
If a patient continues to have symptoms despite optimal levodopa treatment or has developed dyskinesia then NICE recommend the addition of a dopamine agonist, MAO‑B inhibitor or catechol‑O‑methyl transferase (COMT) inhibitor as an adjunct.
Dopamine receptor agonists SEs? (e.g. cabergoline)
Have been associated with pulmonary, retroperitoneal and cardiac fibrosis.
What is Amaurosis fugax?
Amaurosis fugax is a form of stroke that affects the retinal/ophthalmic artery
Primary open angle glaucoma visual field defect?
Peripheral field loss
Bitemporal hemianopia causes and upper or lower?
lesion of optic chiasm:
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
Most common presenting Symptom of posterior circulation stroke?
Dizziness
Bilateral acoustic neuromas are associated with….?
NF2