Neurology Flashcards
Parkinsonian tremor speed
Essential tremor speed
-Slow - 4-6Hz
-faster - 6-12 Hz
Parkinson’s motor symptoms (5)
-Bradykinesia (esp. limbs)
-Mask-liked facies
-Hypophonia
-Micrographia
-Shuffling gait
Parkinsons non-motor sympotms (9)
-REM sleep behaviour disorder (dream enactment, vocalisation)
-Constipation
-Mood disorders
-Dementia (40%)
-Restless legs
-Sexual dysfunction
-Daytime fatigue/somnolence
-Dysphagia
-Autonomic features - postural hypotension
Parkinsons disease 1st line management
(?what to be wary about with dopamine agonists)
- Levodopa(+ carbidopa/benserazide) 300-600mg day in 3-5 doses
- MAO-B inhibitors also 1st line for mild symptoms - e.g rasagiline 1mg daily
Dopamine agonists - pramipexole/rotigotine patch - C/I if impulse control disorder e.g gambling/alcohol/hyperseual behaviour)
Migraine non-pharmacological Rx (4)
-Cold pack over forehead/back of skull
-Hot pack over neck/shoulders
-Neck stretches & self-mobilisation
-Rest in a quiet dark room
Migraine acute pharm Rx (non-opioid)
(3)
1) Aspirin 900mg, rpt dose 4-6 hours
OR ibuprofen 400-600mg
Add metoclopramide 10mg if nauseous
2) Triptans
e.g Sumatriptan 50-100mg oral, rpt dose 2 hours (max does 300mg)
OR naratriptan 2.5mg oral
[Triptans contraindicated in CVS disease]
Carotid artery stenosis clinical features
Acute neurological ischaemia (sensory/motor impairment, dysphasia)
Amaurosis fugax (monocular vision loss)
Distribution of symptoms - usually anterior circulation (MCA/ACA) or retinal artery, not usually post. circulation (e.g vertigo/cerebellar signs)
Carotid artery 1st line Ix
USS
(CT Angio 2nd line - for surigcal planning)
Carotid artery stenosis Rx
Symptomatic - CEA
Asymptomatic - antiplatelet + statin
Refer vasc non-urgent if >80% stenosis
Annual monitoring w/ carotid USS
Pharmacological Rx of Alzheimer’s disease - 2 medication (types)
Contraindications for each
Acetylcholinesteriase inhibitors (Donepezil, rivastigmine, galantamine)
-C/I in GI obstruction, active peptic ulcer. Precaution in seizures, heart block/arrhythmia, asthma/COPD
Memantine (NMDA receptor antagonist)
-C/I - seizures
ACEi first –> change to memantine if advanced
Antipsyhotic medication choices for BPSD (2)
Other medicaiton choice
as per eTG
- Risperidone
- Olanzapine
SSRIs (?citalopram)
Increased risk stroke/death/cognitive decline
Antipsyhotic medication choices for BPSD (2)
Other medicaiton choice
as per eTG
- Risperidone
- Olanzapine
SSRIs (?citalopram)
Increased risk stroke/death/cognitive decline
Idiopathic Intracranial Hypertension hx. questions
○ Is headache worse on getting up or w/ postural change?
○ Associated tinnitus? (?pulsatile)
○ Associated nausea/vomiting?
○ Is there blurring of vision?
○ Is there horizontal diplopia?
Idiopathic Intracranial Hypertension Rx features (5)
○ Reduce CSF pressure
○ Acetazolamide
○ Weight loss
○ Ceasing OCP
- Regular opthal r/v
Sight-threatening condition!
Brain-tumour headache clin. features
○ Starts early morning before pt gets up
○ Disappears soon after getting up
○ Focal neuro sx
– Hemiparesis, speech/cognitive deficits, visual disturbances, ataxia, seizures
not fit for unconditional licence!
Multiple Sclerosis risk factors
-FHx
Multiple Sclerosis risk factors (5)
-FHx
-EBV infection
-Low Vit D/sun exposure
-Obesity
-Smoking
Causes of facial weakness (6 broad categories)
Neurological - stroke, GBS, Multiple sclerosis
Idiopathic - Bell’s palsy
Ear - acute/chronic OM, cholesteatoma, scwannoma
Infection - Herpes zoster, mumps, rubella, EBV
Malignancy - cerebral tumour, cutaneous facial cancer, parotid tumour, lymphoma
Trauma - Temporal bone #, facial nerve damage from surgery
Diagnosis?
Asymmetrical onset
Progressive motor weakness
No sensory symptoms
Presence of both UMN and LMN lesions in same region (e.g brisk reflex in wasted area)
Fsaciculations
Motor Neurone Disease
ALS most common subtype, both UMN and LMN signs
Dx usually clinical (neurologist), MRI B - degeneration or normal
Rx - no cure, early resp support, advanced care planning
UMN signs (5)
LMN signs (4)
UMN
-slowed movement/stiffness
-Clonus
-Spasms
-Spasticity
-Hyperreflexia
LMN
-Weakness
-Wasting
-Fasciculations
-Hyporeflexia
Seizures DDx (10)
○ Cardiac syncope 2ndary to arrythmias, AS, cardiomyopathy
○ Non-cardiac syncope (e.g vasovagal syncope, postural hypotension)
○ Migraine
○ Narcolepsy-cataplexy
○ Tremors/tics
○ Pseudoseizures
○ Hypoglycaemia/hypoxia
○ Head injury
○ CNS infections - meningitis/encephalitis
-Stroke
First seizure - referral urgency?
Driving advice?
Avoidance advice?
- Any patient with first seizure –> semi urgent neurology referral 4-6 weeks
-Not to drive until adequately assessed - must see neurologist
-Avoid operating heavy machinery, swimming alone, heights, contact sports/recreation, drugs
Diabetic foot peripheral neuropathy examination (4)
Pinrick sensation
10g monofilament sensation plantar aspect of 1st toes/MT joints
Vibration sensation 128Hz tuning fork at dorsum, great toe
Ankle reflexes
Dementia medication options (3)
-Oral donepezil
-Oral galantmine
-Rivastigmine (patch > oral)
