Neurology Flashcards
What investigations would you request in suspected TIA?
BP
ECG
Carotid US
Bloods - clotting, lipid profile, cholesterol, glucose
what scoring systems are used for strokes?
ABCD2 - risk of stroke after TIA
CHADSVASc - risk of stroke in pts with AF
HAS BLED - risk of bleeding in pts with AF
ROSIER - likelihood of stroke given symptoms
NIHSS - severity of stroke
Bamford - severity of stroke sx
What is the treatment of a TIA?
300mg aspirin
not given if contraindicated, or is long term aspirin or anitcoag/ bleeding condition or symptoms lasting more than 7 days
+ clopidogrel and statin long term
What are some symptoms of the following strokes?
Anterior cerebral
Middle cerebral
Posterior cerebral
Posterior inferior
Anterior inferior
Anterior cerebral
contralateral weakness ad sensory deficit LOWER>UPPER, homonymous heminopia
Middle cerebral
contralateral weakness ad sensory deficit UPPER>LOWER, homonymous heminopia
Posterior cerebral
homonymous heminopia MACULAR SPARING, cerebellar syndrome (ataxia, imbalance)
Posterior inferior
ipsilateral facial pain and paralysis and loss of temperature detection, deafness
Anterior inferior
ipsilateral facial pain and paralysis and loss of temperature detection, deafness
NB - strokes are all forehead sparing as there is dual UMN innervation
what is the management of a haemorhagic stroke?
CT head!
- if negative do LP in 12 hours to check for bilirubin in Cf xanthochromia
nimodipine
IR coiling
surgical clipping
what is the management of an ischaemic stroke?
CT head to rule out bleed
1. Aspirin 300mg oral or PR for 2 weeks
ALSO
2. oral fluids, can give IV
3. check glucose, if diabetic VRII and glucose
4. check BP - IV labetelol
5. unsafe swallow? NG tube
if <4.5 hrs thrombolysis (alteplase)
if <4.5 hrs AND occulded ANTERIOR circulation thrombolysis and thrombectomy
if <6hrs = thrombectomy
Longterm - clopidogrel +statin
what investigations are done for suspected parkinsons?
CT head to rue out vascular issues
DaT scan - dopamine transporter scan
outline the management of parkinsons
- levodopa
- MAO B inhibitors selegiline
- Dopamine agonists
AVOID DOPAMINE ANTAGONISTS
- metoclopramide
- haloperidol
what are some side effects of levodopa?
Dyskinesia
On and off
Psychosis
Arterial BP low
Mouth dry
Insomnia
N+V
ED
when can anti epileptic drugs be stopped?
if 2 years seizure free, they can be stopped over a period of 2-3 months
in which direction do head and eyes turn in epileptic seizure?
opposite to lesion
what investigations would you perform in a pt with seizure?
A-E (including glucose)
Prolactin - to differentiate from dissociative seizures
ECG
MRI
how do you treat a seizure?
buccal midazolam or PR diazepam
if IV access lorazepam
IV lorazepam
IV pheytoin
call anaesthetics
what is first line treatment for:
tonic clonic
absent
myoclonic
focal
sodium valporate for all except focal = lamotrigine
in which seizures is carbemazepine CI?
myoclonic and absent
- cannot complete the MAZE
what are some side effects of:
carbemazepine
lamotrigine
levetiracetam
phenytoin
valporate
carbemazepine
- hyponatraemia, rash
lamotrigine
- SJS, dizziness
levetiracetam
- mood changes
phenytoin
- inducer, interactions, gum hypertropy
V + N
Anorexia
Liver toxicity
Pancreatitis
Oedema
Retain weight
Alopecia
Tetarogenic
Enzyme inhibitor
what are the 4 As of alzheimers?
Amnesia
Aphasia - speaking
Agnosia - recognising
Apraxia - dexterity
what is used prophylactically for migraine and cluster headaches?
migraines - propranolol
cluster - verapamil
what are some signs and symptoms of multiple sclerosis?
charots triad
- dysarthria - speech unclear
- intention tremor
- nystagmus
T ingling
E ye - optic neuritis
A taxia
M otor - spastic paraparesis/paralysis
Lhermites sign - flexion of neck = electric shock in trunk/limbs
Uhthoff’s sign - symptoms get worse with increase temperature
what investigations need to be done for suspected MS?
Blood antibodies
- anti- MBP
- neuromyelitis optica IgG
contrast MRI
LP - IgG oligoclonal antibodies
how do you manage MS?
Acute - methylprednisolone 1g IV
Chronic - IFN beta
which drugs make myasthenia gravis worse?
penicilamine
lithium
beta blockers
abx - tetracycline, gentamycin
pheytoin
how does a myasthenia gravis crisis present and how is it treated?
FCV <1L, need for ventilation, low RR
get an ABG and do spirometry
treat with plasmapheresis, IVIG, intubation
What investigations would you do for suspected myasthenia gravis
single fibre EMG
repetitive nerve stimulation
serial pulmonary function test - tiring
anti acetylcholine receptor antibodies
anti muscle specific receptor TK antibodies
how do you manage myasthenia gravis long term?
long acting acetyl cholinesterase inhibitors - neostigmine
prednisolone or azathioprine
surgical thymectomy
what is the difference between parkinsomism and parkinsons disease
parkinsons disease is the degeneration of doperminergic neurons in the basal ganglia
parkinsonism constillation of symptoms that have pther causes e.g. antipyschotics
parkinsonism - symmetrical, rapid onset, poor response to levodopa
parkinsons disease - asymmetrical, insidious onset, good response to levodopa
what is the management for alzheimers disease?
MDT
1. donepizile or rivastigmine Ach inhib
2. memantine NMDA partial agonist
carers, social support
what is the pathophysiology of myasthenia gravis
type 2 hypersensitivity reaction agaisnt the nicotinic Ach receptors
what is multiple sclerosis?
demyelination of CNS characterised by multiple plaques in separate space and time
type 4 hypersensitivity
how is lambort eaton different to myasthenia gravis?
LE antibodies against pre synaptic VGCC
- increase power with muscle use
MG antibodies against nicotinic Ach receptor
- fatiguability with use
what is LE associated with?
SCLC
breast and ovarian cancers too
therefore first line treatment is to treat the cancers, and give steroids
what is motor neurone disease?
loss of motor neurones in the cortex, brainstem, spinal cord, anterior horn
what is ALS?
amyotrophic lateral sclerosis - a subtype of MND
- UMN and LMN signs
- generalised weakness
- spastic paralysis and hyperreflexia in lower limbs
- flaccid paralysis and hypreflexia in upper limbs
- tongue twitching
- slurred speech, difficulty swallowing
SENSATION NORMAL
what is progressive bulbar palsy?
affects LMN only
- difficulty chewing, swallowing and speaking
has the worst prognosis
what investigations need to be done for MND?
MRI
EEG
LP
how do you manage MND?
riluzole
MDT symptomatic
- drooling - amitriptyline
- pain
- physio
- spasticity - baclofen
