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Medicine year 3 TCD > Neurology > Flashcards

Neurology Flashcards

1
Q

Most common bacterial causes of community acquired meningitis in 6-60 year olds?

A

Neisseria meningitidis
Streptococcus pneumoniae

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2
Q

Returning travellers at risk of which meningitis pathogen?

A

Penicillin resistant streptococcus pneumoniae

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3
Q

Presenting symptoms of meningitis

A

Fever
Neck stiffness
Change in mental status (GCS <14)
Vomiting
Photophobia (discomfort in bright light)
Usually of sudden onset

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4
Q

What extra symptom can bacterial meningitis present with

A

Non blanching rash due to septicaemia. Small red/purple spots that do not blanch. this type of rash is petechial rash and is caused by bleeding under the skin.

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5
Q

What tests can be done to check for meningitis?

A
  1. Kernig’s Test- patient lies on back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees.
    Creates a slight stretch in meningies- in meningitis will produce spinal pain or resistance to this movement.
  2. Brudzinski’s test- patient lies on back, use your hands to lift their head and neck off the bed and flex their chin to their chest. Positive test is when patient involuntarily flexes their hips and knees.
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6
Q

Gold standard for diagnosing meningitis

A

Lumbar puncture- CSF culture

LP- needle inserted into the L3-L4 intervertebral space.

LP should be done within the hour of hospital arrival before abx.

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7
Q

Contraindications for lumbar puncture

A

raised intracranial pressure, shock, extensive or spreading purpura, convulsions, sig bleeding risk, severe respiratory/cardiac compromise.

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8
Q

CSF analysis findings for bacteria and viruses

A

Bacteria in CSF will release proteins and use up the glucose. So bacterial findings are: cloudy appearance, low glucose, high proteins, raised neutrophils.

Viruses don’t use glucose but may release a bit of protein. Viral findings are: clear/cloudy appearance, normal glucose, normal/high proteins, raised lymphocytes

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9
Q

Meningitis- IV antibiotics for <3 month olds

A

Cefotaxime + Amoxicillin

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10
Q

Meningitis IV abx for > 3 months

A

Cefotaxime

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11
Q

Meningitis IV abx >50 years

A

Cefotaxime + amoxicillin

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12
Q

What medication is given to reduce frequency and severity of hearing loss and neuro dmg in meningitis>

A

Dexamethasone is given 4x daily for 4 days to kids over 4 months if the LP is suggestive of bacterial meningitis

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13
Q

Post-exposure prophylaxis of someone exposed to a patient w/ meningococcal infections

A

single dose of ciprofloxacin given ASAP ideally within 24 hrs of the initial diagnosis

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14
Q

Viral meningitis- most common causes

A

Herpes simplex virus
Enterovirus
Varicella zoster virus

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15
Q

viral meningitis treatment

A

Aciclovir can be used to treat suspected or confirmed HSV meningitis

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16
Q

What type of headache is a mild ache across the forehead and in a band like pattern around the head?

A

Tension headaches

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17
Q

Tension headache treatment

A

Basic analgesia: acutely- aspirin, paracetamol or an NSAID are first line
Prophylaxis- NICE recommend up to 10 sessions of acupuncture over 5-8 weeks

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18
Q

What type of pain is sinusitis

A

facial pain behind the nose, forehead and eyes

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19
Q

sinusitis predisposing factors

A

nasal obstruction, recent local infection, swimming/diving, smoking

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20
Q

sinusitis management

A

analgesia
Nasal irrigation w/ saline
inhaled corticosteroids may be considered if teh symptoms have been present for over 10 days
Oral abx are occasionally required for severe presentationss

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21
Q

cervical spondylosis presents with what?

A

neck pain, usually worsened by movement
headache

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22
Q

Trigeminal neuralgia presentation

A

90% of cases are unilateral. Presents w/ intense facial pain that comes on spontaneously and last anywhere bwt a few seconds to hours. Electricity- like shooting pain.

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23
Q

Trigeminal neuralgia treatment

A

Carbamazepine is first line.
Surgery to decompress or intentionally dmg the trigeminal nerve is an option

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24
Q

What is migraine?

A

Migraine is a wave of electrical activity thru the brain that can cause a variety of symptoms

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25
Migraine types
W/ aura W/o aura silent migraine (w/ aura but w/o a headache) Hemiplegic migraine
26
Migraine heaadache symptoms
Headaches last bwt 4 and 72 hrs Pounding or throbbing nature Usually unilateral Discomfort w/ lights (photophobia) Discomfort w/ loud noises (phonophonia) W/ or w/o aura Nausea and vomiting
27
What is aura? Types of aura?
Visual changes associated w/ migraines Multiple types of aura: Sparks in vision Blurring vision Lines across vision Loss of different visual fields
28
What is hemiplegic migraine
Can mimic stroke Symptoms include: Typical migraine symptoms Sudden or gradual onset Hemiplegia (unilateral weakness of the limbs) Ataxia (poor muscle control that causes clumsy voluntary movements) Changes in consciousness
29
What is typical migraine aura
aura is progressive, may occur hours prior to the headache, includes a transient hemianopic (loss of half of visual field for less than 24 hours) disturbance or a spreading scintillating scotoma (jagged crescent)
30
Acute management of migraines
First line- offer combo therapy of oral triptain (serotonin receptor agonist eg sumatriptan 50mg) and an NSAID, or an oral triptan and paracetamol If not effective, offer a non-oral preparation of metoclopramide and consider adding a non oral NSAID or triptan
31
When and what migraine prophylaxis is offered
Should be given if patients are experiencing 2 or more attacks monthly. Give either topiramate (teratogenic) or propranolol (in women) Can also give amitriptyline Can recommend a course of up 10 sessions of acupuncture over 5-8 weeks supplementation w/ vitamin B2 (riboflacin) may reduce frequency and severity if triggered by menstruation, prophylaxis w/ NSAIDs or triptans can be used as a preventative measure.
32
Intracranial bleed risk factors
head injury hypertension aneurysms brain tumours anticoagulants eg warfarin
33
intracranial bleed presentation
sudden onset headache seizures weakness vomiting reduced consciousness other sudden onset neuro symptoms
34
Principles of management of intracranial bleed
immediate CT head admit to specialist stroke unit discuss w/ specialist neurosurgical centre to consider surgical treatment consider intubation, ventilation and ICU care if reduced consciousness correct severe hypertension but avoid hypotension
35
Subdural haemorrage- what is it caused by and where does it occur
caused by rupture of the bridging veins- bleeding into the outermost meningeal layer. Occur bwt the dura mater and arachnoid mater
36
Subdural haemorrhage presentation
sudden onset headache seizures weakness vomiting reduced consciousness other sudden onset neuro symptoms
37
subdural haemorrhage- risk factors
elderly or alcoholics, these patients have more atrophy in their brains making vessels more likely to rupture
38
how does subdural haemorrhage look on CT
crescent shape and can cross over the sutures
39
how are subdural haemorrhages classified, and how do they differ on CTs
Acute- fresh blood caused by high impact trauma. CT shows hyperdense (bright) crescent shape. management= conservative if small/incidental, surgical options are monitoring of intracranial pressure and decompressive craniectomy. Chronic- present for weeks to months. Rupture of the small bridging veins within the subdural space rupture and cause slow bleeding. CT- hypodense (dark) crescents. Managements- if small/incidental then conservatie. Surgical decompression w/ burr holes if patient's confused, has an associated neurological deficit or has severe imaging findings.
40
What is extradural haemorrhage
blood bwt the skull and the dura
41
what usually causes extradural haemorrhage
Trauma- caused by rupture of middle meningeal artery in the temporo-parietal region, can be associated w/ a fracture of the temporal bone.
42
Typical extradural haemorrhage presentation
young patient w/ traumatic head injury w/ ongoing headache. Have a period of improved neuro symptoms and consciousness followed by a rapid decline over hours as the haematoma gets large enough to compress the intracranial contents. the brief regain in consciousness is called the LUCID INTERVAL.
43
How does extradural haemorrhage look on CT
biconvex (or lentiform), hyperdense shape around the surface of the brain. They're limited by the cranial suture lines of the skull (can't cross over the sutures)
44
Management of extradural haemorrhage
No neurological deficit- cautious clinical and radiological observation is appropriate. Definitive treatment is craniotomy and evacuation of the haematoma
45
Management of extradural haemorrhage
No neurological deficit- cautious clinical and radiological observation is appropriate. Definitive treatment is craniotomy and evacuation of the haematoma
46
Subarachnoid haemorrhage what is it
bleeding into the subarachnoid space, where the CSF is, bwt the pia mater and the arachnoid membrane. Usually the result of a ruptured cerebral aneurysm eg Berry aneurysm
47
Subarachnoid haemorrhage typical history
Sudden onset occipital headache that occurs during strenuous activity- sudden, severe, thunderclap headache. Other features: neck stiffness photophobia vision changes neuro symptoms eg speech changes,
48
Subarachnoid haemorrhage investigations
CT head is first line. Blood will cause hyperattenuation in the subarachnoid space. Lumbar puncture is used to collect a CSF sample if the CT head is negative. Red cell count will be raised. Xanthochromina- yellow contour of CSF caused by bilirubin Angiography (CT or MRI) can be used once a subarachnoid haemorrhage is confirmed to locate the source of bleeding
49
Subarachnoid haemorrhage management
Specialist neurosurgical unit Pts w/ reduced consciousness may require intubation and ventilation. Supportive care as part of MDT Surgical intervention may be used to treat aneurysms. Aim is to repair the vessel and prevent rebleeding. Coiling- inserting a catheter into the arterial system, placing platinum coils into the aneurysm and sealing it off from the artery. Nimodipine is a CCB used to prevent vasospasm- this is when a brain blood vessel narrows, blocking blood flow. Antiepileptic meds can be used to treat seizures.
50
what is an intracerebral haemorrhage?
collection of blood within the substance of the brain
51
causes of intracerebral haemorrhage
hypertension vascular lesion trauma brain tumour or infarct
52
how do intracerebral haemorrhages present?
Present similarly to an ischaemic stroke (sudden numbness/weakness of the face/arm/leg, especially on one side of the body), or w/ a decrease in consciousness
53
How do intracerebral haemorrhages look on CT
Hyperdensity (bright lesion) within the substance of the brain
54
Epilepsy symptoms and signs
As well as seizure activity, patients may also bite their tongue, or experience incontinence of urine. Following a seizure pts typically have a postictal phase where they feel drowsy and tired for around 15 mins
55
Epilepsy investigations/diagnosis
diagnosis is made by a specialist based on characteristics of the seizure episodes. EEG can show typical patterns in diff forms of epilepsy and supp the diagnosis. MRI, ECG.
56
Generalised Tonic Clonic Seizures are what?
loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes. May be associated tongue biting, incontinence, groaning and irregular breathing. prolonged post-ictal period where person is confused/drowsy after
57
Generalised Tonic Clonic Seizures management
Men- sodium valproate Women- lamotrigine
58
Focal seizures are what?
start in temporal lobes- can present in many ways eg hallucinations, memory flashbacks, deja vu, doing strange things on autopilot.
59
focal seizures management
first line- lamotrigine second line- carbamazepine
60
absence seizures what are they
patient becomes blank, stares into space and abruptly returns to normal, typically happen in kids
61
absence seizures management
Ethosuximide
62
atonic seizures what are they
brief lapses in muscle tone. may be indicative of Lennox- Gastaut syndrome
63
atonic seizures management
males: sodium valproate females: lamotrigine
64
myoclonic seizures what are they
present as sudden brief muscle contractions, pt usually remains awake
65
myoclonic seizures management
males: sodium valproate females: levetiracetam
66
epilepsy driving?
can't drive for 6 months following a seizures.
67
epilepsy pregnancy
breastfeeding is safe except barbiturates. take advice from neurologist prior to becoming pregnant
68
sodium valproate side effects
Teratogenic, liver dmg and hepatitis, hair loss, tremor
69
ethosuximide side effects
night terrors, rash
70
lamotrigine side effects
Steven Johnson syndrome or DRESS syndrome- life threatening skin rashes. Leukopenia
71
what is status epilepticus
medical emergency. seizures lasting > 5 mins or over 3 seizures in an hour
72
status epilepticus management
secure airway, high conc oxygen check blood glucose IV lorazepam 4mg, repeated after 10 mins if seizure continues If seizures persist: IV phenoarbital or phenytoin. Community options- Buccal midazolam Rectal diazepam or intranasally/under the tongue
73
raised intracranial pressure symptoms
papilloedema new onset headache- worse on coughing, straining, bending down. Vomiting. transient visual obscuration. Cushing's triad: widening pulse pressure, bradycardia, irregular breathing
74
raised intracranial pressure treatment
head elevation to 30 degrees controlled hyperventilation- aim to reduce pCO2 -> vasoconstriction of cerebral arteries -> reduced ICP. Drain from intraventricular monitor. repeated lumbar puncture.
75
Syncope causes
Primary syncope (simple fainting): dehydration, missed meals, extending standing in warm environment Secondary causes: hypoglycaemia
76
Syncope investigations
ECG- assess for arrhythmia and QT interval for long QT syndrome, WPW, LVH, heart block
77
syncope management
trigger avoidance, reassurance
78
brain tumour presentation
asymptomatic when small focal neuro symptoms depending on location often present w/ symptoms and signs of raised ICP Frontal lobe- unusualy changes in personality/behaviour/ decision making. Parietal lobe- sensory symptoms, dressing apraxia, visual field defects Temporal lobe- Dysphasia (can't put right words in a sentence), visual field defects Occipital lobe- visual fields posteiror fossa (dysmteria- can't control distance, speed and range of motion to perform coordinated movements)
79
what type of tumour is pituitary tumours and what can it cause
beningn can press on the optic chiasm causing a specific visual field defects- bitemporal heminanopia (loss of outer half of visual fields in both eyes) can cause hormone defficienes or release excess hormones leading to acromegaly, cushings, thyrotoxicosis
80
what's the 2ww suspected cancer referral for brain tumours
headache w/ features of raised ICP - actively wakes patient from sleep but not migraine or cluster, precipitated by Valsalva manouevres, Papilloedema Chronic episodic course- other symptoms of raised ICP headache, vomtiing w/o other obvious cause
81
brain tumour management
surgery dpeends on grade and behaviour
82
GCA symptoms
severe unilateral headache typically around temple and forehead scalp tenderness eg when brushing hair jaw claudication blurred/double vision irreversible painless complete sight loss- rapid
83
GCA management
40-60 mg prednisolone daily aspirin PPI refer to vascular surgeon, rheumatology, urgent ophthalmology review as emergency same day

Medicine year 3 TCD (10 decks)

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