Neurology Flashcards
What are your DDX for headache?
Eye - Acute angle glaucoma
Tension, Migraine, Cluster
Vascular - Giant cell arteritis
Infection: Encephalitis, meningitis
Increased ICP / Trauma - ICH, SDH, SAD, SOL
MSK - Cervical osteoarthritis
Referred: Sinusitis, OAM,
What are some headache red flags?
SNOOP
Systemic: Fever, weight loss, fatigue (B symptoms)
Neurologic: FND
Onset: Thunderclap
Old: >50
Positional & Papiloedema
What medical condition is giant cell arteritis associated with?
Polymylgia Rheumatica
What are the features of giant cell arteritis?
JAW CLAUDICATION (pathognomic)
Throbbing headache, vision loss
DX and Mx of Giant Cell arteritis?
Dx - High ESR, temporal artery biopsy
Mx - High dose steroids to prevent vision loss, aspirin to prevent ischaemic events
What is the mx of a tension headache?
Lifestyle: SNAP, avoid triggers, supplements, hydration
Meds: NSAIDS, Paracetamol, low dose aspirin
What are some features of a cluster headache?
Vascular in nature, has episodic attacks
Unilateral eye pain
Autonomic sx: Lacrimation, rhinorrhoea
What is the Mx of a cluster headache?
Acute: Triptan + high flow O2
Chronic: Calcium channel blocker (verapamil). Can bridge with prednisolone until effective
Symptoms of a migraine?
POUND & Trigger +/- Photo/phono phobia +/- Aura
Pulsatile/ throbbing
One day average duration (4-72 hrs)
Unilateral (can also be bilateral)
Nausea and Vomiting
Debilitating
What is the Mx of migraines?
Lifestyle: Avoid triggers, SNAP, Sleep when feeling coming on & regular sleep cycle, Hydration
Vit B12 supplements, massages
Meds: Triptans, NSAIDS, antiemetics
What are the signs of basal skull fracture?
Raccoon Eyes
CSF Rhinorrhea
CSF Otorrhea
Battle sign
Haemotympanum
What is the management of head trauma (i.e. Neuroprotective strategies)?
CHISSEL
C – C-spine collar off
H – Hypotension and Hypoxia AVOID
I – Intubate & hyperventilate
SSS – Seizure prevention, Saline 3%, Sedation
E – Elevate head 30 degrees
L – Last resort use a chisel = neurosurgery
What are the types of brain herniations and their sx?
SubCUT
Subfalcine - ACA compression = headache, contralateral leg weakness
Central - Follows brain oedema. Drowsiness / decreased concentration
Uncal - CN3 compression = Ipsilateral pupil dilation, ptosis and down and out
Tonsillar - cerebellum herniation = Cushings triad, decerebrate posture
What are signs brain herniation has occured?
GCS drop of 2
Vomiting
Cushing’s triad
Dystonic posturing
Haemiparesis
What brain tumors are seen in children and where are they located?
Below tentorium cerebellum:
Pilocytic astrocytoma
Medullablastoma
What brain tumours seen in adults and where?
Above tentorium cerebellum:
Astrocytoma & GBM
Meningoma
Sx and mutation of pilocytic astrocytoma?
Abnormal gait
BRAF mutation
What is the path of GBM?
EGFR -> CDK2NA -> TP53 RB mutation -> unregulated growth
Where are the common locations for metastatic brain tumours to come from?
Breast, lung, renal, prostate
ACA Stroke -> What part of brain is supplied and signs?
Medial frontal and parietal lobes
FU GPs
Foot and leg weakness
Urinary Incontinence
Gait problems
Personality -> flat affect, lack of spontaneity
Short term memory loss
MCA Stroke -> What part of brain is supplied and signs?
Lateral Frontal and parietal lobes
Arm and face weakness
Visual changes contralateral fields
R: Contralateral neglect
L: Broca’s and wernicke’s aphasia
Lacunar Stroke -> What part of brain is supplied and signs?
Basal ganglia via MCA
Either Pure upper motor or pure sensory hemiparesis
PCA Stroke -> What part of brain is supplied and signs?
Occipital lobe, medial and temporal lobe
HAM
Hononymous hemianopia
Alexia
Memory Deficits
PCA Deep branches Stroke -> What part of brain is supplied and signs?
Thalamus, caudate brainstem
Contralateral sensory loss
CN3 palsy
Nystagmus, diplopia, vertigo
Contralateral homonymous hemianopia
Dyslexia
