Neurology Flashcards
What is shingles also known as?
Herpes Zoster Infection
What causes shingles?
reactivation of varicella zoster virus
Key risk factors for shingles
increasing age, immunosuppressive conditions, HIV
typical presentation of shingles
acute, unilateral, painful blistering rash
Which dermatomes are commonly affected in shingles
T1- L2
Features of shingles
prodromal period
- 2-3day hx of burning pain over the dermatomes affected
- may have fever, headache, lethargy
Rash
- erythematous, macular rash which becomes vesicular
- demarcated by dermatome and doesnt cross the midline
How is shingles diagnosed?
clinical diagnosis
What is the medical management of shingles?
Analgesia
- paracetemol and NSAIDs
- amitriptyline if first line insufficient
- oral corticosteroids if not responding to the above
Antivirals within 72hrs unless <50yo and mild rash/pain with no risk factors
Advice given to patient with shingles
remind them they are infectious until vesicles have crusted over usually 5-7 days following onset (avoid pregnant and immunosuppressed people)
What are the complications of shingles
- post- herpetic neuralgia
- herpes zoster ophthalmicus
- herpes zoster oticus (Ramsay Hunt syndrome):
What is syncope?
transient loss of consciousness with spontaneous complete recovery
What are the main causes of syncope?
- Reflex mediated (neurally mediated)
- Cardiac (arrhythmias and structural causes)
- Orthostatic (iatrogenic, dementia, volume depletion)
Which investigations should be carried out in syncope?
- ECG (?prolonged QT)
- lying standing BP / tilt table test
- Glucose
- Electrolytes
- FBC
- Underlying illness (CXR, CT, LP, ECHO etc)
Causes of cardiac syncope
arrhythmias - bradycardia / tachycardia structural - valvular - MI - HOCM
Treatment of cardiac syncope
treat the problem
- medicine (beta blockers, atropine)
- electrical cardioversion
- catheter ablation
- pacemaker
- implantable cardioverter defibrillator (ICD)
What is vasovagal syncope?
triggered by emotion, pain or stress. Often referred to as ‘fainting’
What is subarachnoid haemorrhage?
presence of blood in the subarachnoid space
What are the causes of SAH?
head injury (traumatic SAH) is the most common cause
spontaneous SAH (non-traumatic)
Causes of spontaneous SAH
- Intracranial aneurysm( ruptured ‘berry’ aneurysms)
- Arterial dissection
Which conditions are associated with berry aneurysms?
- Adult Polycystic Kidney Disease
- coarctation of the aorta
Classical presentation of SAH
- Thunderclap headache
- N&V
- Meningism (photophobia, stiff neck)
How can a SAH be confirmed?
CT head
LP if CT Head if negative
Neuro referral
Which findings on an LP are indicative of SAH
xanthochromia (result of RBC breakdown) and normal or raised opening pressure
After SAH is confirmed, which investigations can be carried out to identify a causative pathology?
CT inter-cranial angiogram (vascular lesion e.g aneurysm)