Neurology

Question 1

What are your DDX for headache?

Answer 1

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,

Question 2

What are some headache red flags?

Answer 2

SNOOP

Systemic: Fever, weight loss, fatigue (B symptoms)
Neurologic: FND
Onset: Thunderclap
Old: >50
Positional & Papiloedema

Question 3

What medical condition is giant cell arteritis associated with?

Answer 3

Polymylgia Rheumatica

Question 4

What are the features of giant cell arteritis?

Answer 4

JAW CLAUDICATION (pathognomic)
Throbbing headache, vision loss

Question 5

DX and Mx of Giant Cell arteritis?

Answer 5

Dx - High ESR, temporal artery biopsy
Mx - High dose steroids to prevent vision loss, aspirin to prevent ischaemic events

Question 6

What is the mx of a tension headache?

Answer 6

Lifestyle: SNAP, avoid triggers, supplements, hydration
Meds: NSAIDS, Paracetamol, low dose aspirin

Question 7

What are some features of a cluster headache?

Answer 7

Vascular in nature, has episodic attacks
Unilateral eye pain
Autonomic sx: Lacrimation, rhinorrhoea

Question 8

What is the Mx of a cluster headache?

Answer 8

Acute: Triptan + high flow O2
Chronic: Calcium channel blocker (verapamil). Can bridge with prednisolone until effective

Question 9

Symptoms of a migraine?

Answer 9

POUND & Trigger +/- Photo/phono phobia +/- Aura

Pulsatile/ throbbing
One day average duration (4-72 hrs)
Unilateral (can also be bilateral)
Nausea and Vomiting
Debilitating

Question 10

What is the Mx of migraines?

Answer 10

Lifestyle: Avoid triggers, SNAP, Sleep when feeling coming on & regular sleep cycle, Hydration
Vit B12 supplements, massages
Meds: Triptans, NSAIDS, antiemetics

Question 11

What are the signs of basal skull fracture?

Answer 11

Raccoon Eyes
CSF Rhinorrhea
CSF Otorrhea
Battle sign
Haemotympanum

Question 12

What is the management of head trauma (i.e. Neuroprotective strategies)?

Answer 12

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

Question 13

What are the types of brain herniations and their sx?

Answer 13

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

Question 14

What are signs brain herniation has occured?

Answer 14

GCS drop of 2
Vomiting
Cushing’s triad
Dystonic posturing
Haemiparesis

Question 15

What brain tumors are seen in children and where are they located?

Answer 15

Below tentorium cerebellum:

Pilocytic astrocytoma
Medullablastoma

Question 16

What brain tumours seen in adults and where?

Answer 16

Above tentorium cerebellum:

Astrocytoma & GBM
Meningoma

Question 17

Sx and mutation of pilocytic astrocytoma?

Answer 17

Abnormal gait
BRAF mutation

Question 18

What is the path of GBM?

Answer 18

EGFR -> CDK2NA -> TP53 RB mutation -> unregulated growth

Question 19

Where are the common locations for metastatic brain tumours to come from?

Answer 19

Breast, lung, renal, prostate

Question 20

ACA Stroke -> What part of brain is supplied and signs?

Answer 20

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

Question 21

MCA Stroke -> What part of brain is supplied and signs?

Answer 21

Lateral Frontal and parietal lobes

Arm and face weakness
Visual changes contralateral fields
R: Contralateral neglect
L: Broca’s and wernicke’s aphasia

Question 22

Lacunar Stroke -> What part of brain is supplied and signs?

Answer 22

Basal ganglia via MCA

Either Pure upper motor or pure sensory hemiparesis

Question 23

PCA Stroke -> What part of brain is supplied and signs?

Answer 23

Occipital lobe, medial and temporal lobe

HAM
Hononymous hemianopia
Alexia
Memory Deficits

Question 24

PCA Deep branches Stroke -> What part of brain is supplied and signs?

Answer 24

Thalamus, caudate brainstem

Contralateral sensory loss
CN3 palsy
Nystagmus, diplopia, vertigo
Contralateral homonymous hemianopia
Dyslexia