Neurology Flashcards
Epilepsy
TBC
Focal (partial) seizures
TBC
Chronic headache
TBC
Generalised Seizures
TBC
Grand mal Seizures
TBC
Lumbar disectomy
TBC
Petit Mal Seizures
TBC
Hyperalgesia
TBC
Cerebral oedema
TBC
Cervical radiculopathy
TBC
Multiple Sclerosis
TBC
Orthostatic hypotension
TBC
Hemiparesis
TBC
Postural orthostatic tachycardia syndrome
TBC
Allodynia
TBC
Brachial Neuritis
TBC
Tactile Hallucinations
TBC
What is diaphoresis?
The term used to describe excessive/abnormal sweating.
Generalised Tonic-Clonic Seizures
TBC
Vertical gaze palsy
TBC
Amyotrophic Lateral Sclerosis/Motor Neurone Disease
TBC
Anti-IgLON5 disease
TBC
Nerve Damage
TBC
Syncope
TBC
Pronator Drift
TBC
What is charcot foot?
Charcot foot is caused by the weakening of the bones resulting from significant (typically diabetic) neuropathy
What is dystonia?
A movement disorder in which muscles contract involuntarily, causing repetitive or twisting movements.
What is akathisia?
A feeling of muscle quivering, restlessness and inability to sit still, often as a side effect to an antipsychotic or antidepressant.
What is tardive dyskinesia?
Repetitive, involuntary twitching (such grimacing and blinking), often caused by long-term use of antipsychotics.
What characterises Benign paroxysmal positional vertigo (BPPV)?
Benign paroxysmal positional vertigo (BPPV) causes sudden, intense, brief episodes of dizziness or vertigo when you move your head.
What is a common off-label use for quinine?
Quinine is often prescribed (inappropriately) for restless legs syndrome. This is common in older doctors.
What are grand mal seizures?
A type of seizure that involves a loss of consciousness and violent muscle contractions.
What is spastic paraplegia?
A general term for a group of rare inherited disorders that cause weakness and stiffness in the leg muscles
What is Myoclonus?
Sudden, involuntary muscle jerks, shakes or spasms.
What is vascular dementia?
A common form of dementia caused by an impaired supply of blood to the brain, such as may be caused by a series of strokes.
What should you always consider regarding VTE prophylaxis in neurology patients?
If they are planned to have a lumbar puncture, they should not be given VTE prophylaxis until after the lumbar puncture.
What is brachial neuritis?
A form of peripheral neuropathy that affects the chest, shoulder, arm and hand
What is cervical radiculopathy?
A pinched or irritated nerve in the neck causing pain, numbness, or weakness radiating to the chest or arm.
What is hyperalgesia?
An increased sensitivity to feeling pain and an extreme response to pain.
What is allodynia?
Pain in response to a stimulus that does not normally provoke pain.
What is a petit mal seizure?
A type of seizure that involves brief, sudden lapses in concentration.
What is cerebral oedema?
Swelling in the brain
What is Guillain-Barré syndrome (GBS)?
A rare disorder where the body’s immune system damages nerve.
Describe the role of pharmacological therapy for cognitive impairment in patients with dementia.
Pharmacological therapy for cognitive impairment is only one aspect of caring for people with dementia
Describe the pharmacotherapy available to treat dementia in Australia.
Acetylcholinesterase inhibitors (ie donepezil, galantamine and rivastigmine) and memantine (an antagonist of N-methyl-D-aspartate [NMDA]) can modestly improve or stabilise symptoms of some types of dementia, but are not curative and do not delay disease progression. These drugs are only approved by the Australian Therapeutic Goods Administration (TGA) for Alzheimer dementia.
What are the 3 types of dementia which can be treated with pharmacotherapy?
- Alzheimer dementia
- Dementia with Lewy bodies
- Dementia in Parkinson’s Disease
Describe the overall effects of drug treatments for Alzheimer dementia
Drug treatments for Alzheimer dementia are not curative and do not modify disease progression.
What class of drugs are the drug class of choice for Alzheimer dementia?
Acetylcholinesterase inhibitors
What are 6 medications starting with A that may increase the risk of seizures?
- Alimemazine
- Amantadine
- Amisulpride
- amiTRIPTYLine
- ARIPiprazole
- Asenapine
What are 3 medications starting with B that may increase the risk of seizures?
- Baclofen
- Blinatumomab
- Bupropion
What are 8 medications starting with C that may increase the risk of seizures?
- Chlorambucil
- Chloroquine
- cHLORPROMAZine
- Cinacalcet
- ciPROFLOXAcin
- cLOMIPRAMine
- clozapine
- cyclosERINE
What are 4 medications starting with D that may increase the risk of seizures?
- Donepezil
- doSULepin (dothiepin)
- doXepin
- droperidol
What are 2 medications starting with E that may increase the risk of seizures?
- Enzalutamide
2. Ertapenem
What are 3 medications starting with F that may increase the risk of seizures?
- Fampridine
- Foscarnet
- Flupentixol
What are 2 medications starting with G that may increase the risk of seizures?
- Galantamine
2. Ganciclovir
What is a medication starting with H that may increase the risk of seizures?
- Haloperidol
What are 4 medications starting with I that may increase the risk of seizures?
- Imipenem
- Imipramine
- Interferons
- Isoniazid
What are 4 medications starting with M that may increase the risk of seizures?
- Mefloquine
- Memantine
- Mianserin
- MOXifloxacin
What are 3 medications starting with N that may increase the risk of seizures?
- Neostigmine
- NORfloxacin
- Nortriptyline
What is a medication starting with O that may increase the risk of seizures?
Olanzapine
What are 7 medications starting with P that may increase the risk of seizures?
- Paliperidone
- Periciazine
- Phenelzine
- Pizotifen
- proMETHazine
- pyridostigmine
- pyrimethamine
What is a medication starting with Q that may increase the risk of seizures?
QUETIAPine
What are 2 medications starting with R that may increase the risk of seizures?
- riSPERIDONe
2. rivastigmine
What are 3 medications starting with T that may increase the risk of seizures?
- Theophylline
- Tranylcypromine
- Trifluoperazine
What is a medication starting with V that may increase the risk of seizures?
valGANciclovir
What are 2 medications starting with Z that may increase the risk of seizures?
- Ziprasidone
2. Zuclopenthixol
Describe the management of a first-time seizure.
Patients are not always given ongoing treatment for a first-time seizure. They may be loaded with an antiepileptic for abortive treatment, but then not continued on it.
What is L5/S1 Central Canal Stenosis also called?
Lumbar spinal stenosis
What is lumbar spinal stenosis (L5/S1 Central Canal Stenosis)?
A narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs.
What should be done before starting pharmacological therapy for cognitive impairment in Alzheimer dementia?
Discuss potential benefits and harms with the patient or their substitute decision maker—consider their goals of care and create a plan for when to stop therapy.
How should dementia with Lewy bodies always be managed?
Manage dementia with Lewy bodies in consultation with a specialist.
Describe the effectiveness of drug treatments for dementia with Lewy bodies.
Drug treatments for dementia with Lewy bodies are not curative and do not modify disease progression.
Describe the considerations required when reviewing therapy for dementia?
Assess whether the patient has a clinically meaningful response to therapy—assess cognition, function and behaviour and monitor for adverse effects
What is the major risk associated with stopping drug treatment for dementia?
Stopping these drugs can cause an irreversible or more rapid decline in function and cognition, and precipitate severe behavioural or psychological symptoms. However, this does not preclude stopping treatment at the request of the patient or their substitute decision-maker.
What are the 3 main points to discuss when discontinuing drug therapy for dementia?
- The process of stopping the drug (described below)—highlight this process is a trial and therapy can be resumed if required
- The potential benefits and harms of continuing the drug versus stopping it
- Any fears and concerns of the patient or their substitute decision-maker about stopping the drug.
What are 3 purposes behind avoiding abrupt cessation of therapy for dementia?
- Reduce the risk of severe withdrawal reactions (eg agitation, aggression, hallucinations, impaired consciousness)
- Reduce the impact of cognitive, functional and behavioural or psychological symptoms if they reoccur (these changes can be irreversible)
- Determine the minimum effective dosage if the drug cannot be stopped.
How should drug therapy for dementia be ceased?
Halve the dosage every 4 weeks until the lowest dose possible is used for 4 weeks, then stop. If available formulations do not allow the dose to be halved, step down through available formulations. Adjust the speed of dosage reduction depending on the reason for stopping the drug (eg stop therapy immediately if the drug has caused a severe adverse effect) and patient response.
What monitoring is required during dosage reduction in drug therapy for dementia?
Assess cognition, function, and behavioural and psychological symptoms at a minimum of every 4 weeks—more frequent monitoring may be required depending on the situation.
What monitoring should be done by the patient and/or their carer(s) during dose reduction in drug therapy for dementia?
Between assessments, the patient and/or their significant other(s) and/or carer(s) should watch for signs of deterioration and seek medical advice if symptoms worsen.
What should be done if a patient withdrawing from dementia therapy deteriorates during dosage reduction or after the drug has been stopped?
Before attributing their symptoms to drug withdrawal, consider alternative causes (such as delirium).
What should be done if a severe withdrawal reaction occurs within a week of dosage reduction or stopping therapy for dementia?
Straight away resume therapy at the previous minimum effective dosage.
What are 4 signs of a severe withdrawal reaction in dementia treatment?
- Worsening agitation
- Aggression
- Hallucinations
- Reduced consciousness
What should be suspected if cognition, function, or behavioural and psychological symptoms worsen after more than a week, but less than 6 weeks after dosage reduction or stopping therapy in drug treatment for dementia?
It is likely symptoms that were previously treated by the drug are re-emerging.
What may be done if cognition, function, or behavioural and psychological symptoms worsen after more than a week, but less than 6 weeks after dosage reduction or stopping therapy in drug treatment for dementia?
Consider resuming therapy at the previous minimum effective dose.
What is the likely cause if cognition, function, or behavioural and psychological symptoms worsen after more than 6 weeks, but less than 3 months after dosage reduction or stopping therapy for dementia?
This may due to be symptom re-emergence or natural dementia progression.
What is the likely cause if cognition, function, or behavioural and psychological symptoms worsen after more than 3 months after dosage reduction or stopping therapy for dementia?
Beyond 3 months, symptom worsening is usually due to dementia progression.
What does “inappropriate speech” refer to when measuring a Glasgow Coma Scale?
Random or exclamatory articulated speech, but no conversational exchange
What is syncope?
Loss of consciousness
What is presyncope?
Lightheadedness
